Dr. Cirangle's Support Group meeting.. Lots of INFO from his meeting

Yesterday at Dr. Cirangle's support group several of us asked him various questions and there was a lot of information, a great deal of which was quite interesting.  I took notes and wanted to share with you all.  In fact I agreed with just about everything Dr. C said last night.

Please keep in mind that this is my understanding/interpretation of what he said, so please take what I write with a grain of salt and not gospel.. I offer this as food for thought only.

1) First and most importantly, we asked Dr. C about carbs.  He is a big advocate of staying as low carb as you can, even in maintenance.  He said that he "absolutely *knows* for sure" that even those who may have lost and/or maintained on higher carb, will have their behaviors catch up to them.

He said that the VSG procedure itself improves insulin resistance but that effect doesn't last for much more than a few years, and even regular exercise will eventually not quite keep things in-line with regards to insulin.  He said we absolutely have to keep our diet in line with regards to carbs. He sees people that are as far as 10 years out so I'm sure he has probably seen what happens further out.

2) He says that people want to focus on converting to protein metabolism, which won't happen if your carbs are too high.  He wants to see people around 20 and not much above or below, especially during weight loss. He said that even if you eat plenty of protein, having too many carbs in your diet effects the way the protein is metabolized.

He does not consider veggies like broccoli to be part of the typical "carb" category, but he DOES consider fruit like bananas to fit into the category of things to avoid (I would agree with him there).  That's because broccoli is mostly fiber with very little digestible carbs, while bananas are much less fiber and more carbs.  From my understanding anything but veggies belongs in the category he considers carbs.

3) He spoke a bit about the quality of proteins, and said (in my understanding) that different kinds of proteins such as collagen proteins and whey proteins are all helpful.  He also said that the brain runs best using protein as fuel.

4) Dr. C said that it is very important to follow a pre-op diet because you can 1/2 the size of your liver in 2 weeks with a good diet that cuts fats/carbs.

5) Dr. C recommends a protein shake before working out.. he says that you will keep your energy levels even with protein rather than carbs for workout fuel.  He recommends resistance and interval training for the best fat loss results.

6) We asked him at what point the stomach staple line is healed, and is it weaker at that point where it is always at risk for coming apart.  He said at one month out the staple line should be completely healed and that the staple line is then stronger than the actual native stomach line, so no risk of it coming apart with a blow to the stomach or anything like that.

7) He said if someone has a leak past one month, then they already had that leak from earlier on, because the staple line should be healed by one month.

8) He said watch out for the 1-800 Think Thin people that are coming to the San Fran bay area and other locations.. they have already killed 4 people, have done many unsafe/unethical things, etc.

9) Dr. C explained that when you make a sleeve properly, it is in the shape of a hockey stick.  Where the curve is in the stomach is where food can get stuck if it is not chewed well and can't go around the curve.

When it gets stuck it is stuck at the point before it hits stomach acid, and spit and phlegm that you swallow gets backed up because the food is blocking the way to the stomach. This is what causes the foamies.  Chewing thoroughly, eating smaller amounts and eating slowly is what helps with this problem.

10) Dr. C says that when done correctly the incidence of reflux is a lot less with the sleeve at one year out then pre-op.. he thinks it is practically a cure for reflux.

11) There was someone present who was diabetic so they asked about protein in the urine.  He said that this is a sign of leaky capillaries and diabetes that is getting out of control.. the key is to cut carbs.

12) Dr. C talked about the four surgeries he does and what he thinks of them.  He said that he thinks the DS is too risky long term except for perhaps a very small percentage of people.  He said that risk of complications is 20% even when done by the best surgeon.. complications meaning bone disease, severe vitamin/mineral deficiencies, etc.

He also thinks DS people use the surgery as a justification for making bad food choices.  He thinks RNY is not a good surgery at this point and will go away in favor of the VSG.  He says bands are good for people who have low BMIs or to help failed RNYs have restriction again.  So essentially he likes VSG the best and band in some cases.. and DS in rare/extreme cases.

13) Dr. C explained that it's very important to do a tight sleeve, because even with a few millimeters difference in sleeve size the increase in volume is 16 fold due to the nature of cyllinder size (I hope I'm explaining this correctly.. I don't really understand this).

14) Finally Dr. C was appalled that some doctors are recommending normal food right after surgery.. he says digestion is not going to stop just because someone is on a liquid diet and over the first month putting so much pressure on a healing staple line is creating more risk for a leak.  He says this is an example of all people who have medical degrees are not always right/ethical, etc.

15) Dr. C said that when you eat mixed consistency foods like soups, they won't stay in the stomach as long as if you ate protein plain.

Hope you find this information helpful.. I was soaking it in last night!

Wow, thank you soooooo much for all of this valuable information!! Thank you for taking the time to write the notes and then transposing them here for all of us.  You are a sweetheart!  Hugs...

Really great info, I hang on his every word.  Hie is really something else, I am so impressed with his skill, after care, pre-op info, professionalism and hair ;)

Thanks again honey, it is really appreciated,

Cindy

p.s. -   I asked my surgeon for the smallest safest size he could do, I have the equivalent of a 28 French Bougie.
-  However, my surgeon is one that allowed me to advanced VERY quickly in my food stages, thank goodness I had no trouble with my staple line.
-  I have no acid reflux
-  I am high on my carbs compared to what he suggestes...
-  I think the Sleeve is still the best option for a low BMI, was a Lightweight at 30.8 BMI when I started and I LOVE my Sleeve and would never want the band...

You're welcome... part of the reason I take notes is to avoid jumping in on the conversation.. between that and Elina kicking my leg occasionally under the table, I can manage not to **** off Dr. C.  Strategy!

Thank you so much for taking such thourough notes! This is great information. I go to a support group meeting monthly, but the doctors rarely attend. It's headed up by our nutritionist. It's a good meeting, but even a year out I still soak up everything I can find on the VSG!

I do have to give Dr. Sunshine credit for his commitment to his post-ops and support, even if I have to grind my teeth at times and develop TMJ. :)

sorry if this should be obvious, but what is it that makes you grind your teeth? 

Well...well.....aren't we the little "doctor's pet"  Takin' notes and all!  Tryin' to knock Frisco off the #1 spot?   Thanks for the info.

They'll both have to fight to move up past me.

 to "move past you" would not be easy....i don't think any of us could run....bike....or swim past you!    i could prolly beat ya thumb-rasslin!

 
I could move past her........on my motorcycle!.......but my motorcycle doesn't do well in water......


frisco