In the beginning of your weight loss there are a few simple rules.
Eat small amounts. Just after surgery, your stomach holds only a couple of ounces of food. Though your stomach stretches over time to hold more food, by the end of three months, you may be able to eat 1 to 1 1/2 cups of food with each meal. Eating too much food not only adds more calories than you need but also may cause pain, nausea and vomiting. Make sure you eat only the recommended amounts and stop eating before you feel full. You need to learn to stop eating one bite BEFORE you are full. There is a time lag between actually being full and feeling full and exceeding the amount you can tolerate can be painful.
Eat and drink slowly. Eating or drinking too quickly may cause you to fill the stomach too quickly and then not sense the fullness. It can also result in dumping syndrome — when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, diarrhea, dizziness and sweating. To prevent dumping syndrome, choose foods and liquids low in fat and sugar, eat and drink slowly, and wait 30 minutes before or after each meal to drink liquids. Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink liquid very slowly. Limit your consumption of carbonated drinks. The gas they release in the stomach can be painful. Avoid foods high in fat and sugar, such as regular soda, candy and candy bars, and ice cream.
Chew food thoroughly. The new opening that leads from your stomach into your intestine is very small, and larger pieces of food can block the opening. Blockages prevent food from leaving your stomach and could cause vomiting, nausea and abdominal pain. Take small bites of food and chew them to a pureed consistency before swallowing. If you can't chew the food thoroughly, don't swallow it.
Drink liquids between meals. Drinking liquids with your meals can cause pain, nausea and vomiting as well as dumping syndrome. Also, drinking too much liquid at or around mealtime can leave you feeling overly full and prevent you from eating enough nutrient-rich foods. Expect to drink at least 6 to 8 cups (48 to 64 ounces) of fluids a day to prevent dehydration.
Try new foods one at a time. After surgery, certain foods may cause nausea, pain, vomiting or may block the opening of the stomach. The ability to tolerate foods varies from person to person.
Try one new food at a time and chew thoroughly before swallowing. If a food causes discomfort, don't eat it. As time passes, you may be able to try this food again. Foods and liquids that commonly cause discomfort include meat, bread, pasta, rice, raw vegetables, milk and carbonated beverages. Food textures not tolerated well include dry, sticky or stringy foods. I have some difficulties with pasta sauce made with tomatoes and red wine. In discussions with my surgeon, he told me this might go away at some point or not. I do take acid-reducing tablets to reduce the potential for pain.
Take recommended vitamin and mineral supplements. After surgery, your body will have difficulty absorbing certain nutrients because of the major alterations in your digestive system. To prevent a vitamin or mineral deficiency, take vitamin and mineral supplements regularly. These generally include a multivitamin with adequate levels of calcium, iron, vitamin D and of significance, vitamin B-12. The vitamin B-12 is not readily assimilated in pill form and you may need to take higher levels of the oral form even if that means taking a second vitamin tablet to ensure you are getting an adequate absorbable amount daily. Talk to your health care provider about recommended vitamin and mineral supplements following gastric bypass surgery.
Wednesday, September 9, 2009
Bariatric Surgery
More than 60 percent of the U.S. population is overweight and about 30 percent are classified as being obese. In recent years, however, society has shown an increased awareness of the need for the treatment and prevention of obesity. People all over the world are turning to trendy exercise routines, fad diets, pills or supplements and even hypnotism to battle the problems of weight control. Admittedly all of these efforts have made an impact; however, there are still a large number of people who've had little or no success losing weight and keeping it off.
Advances in technology and modern medicine may have given those people a chance to have a longer and healthier life. Morbid obesity is a disease of excess energy stores in the form of fat. This biologically-based disease goes beyond a simple disorder of willpower. People who suffer from morbid obesity endure physical and emotional trauma on a daily basis. Aside from poor self-image and self-esteem, a person who is severely obese is also more likely to suffer other chronic health problems such as: cardiac dysfunction, pulmonary problems, digestive diseases, and endocrine disorders as well as, obstetric, orthopedic, and dermatological complications.
In today's health conscious society, people suffering from this illness are constantly reminded of their problem and ultimately their inability to overcome this disease. Lack of respect and compassion for the morbidly obese is also an issue of concern. Widespread attitudes that severely obese individuals are weak-willed, ugly, awkward, self- indulgent and somehow immoral contributes often to low self-esteem in morbidly obese individual.
It is now widely accepted among those in the medical field that morbid obesity is a medical condition that requires treatment. In fact, it was recently announced that Medicare would remove barriers to covering anti-obesity treatments. This disease represents a management challenge for physicians and a psychological and biological challenge for those suffering from this disease.
Published scientific reports show that non-operative methods have not been effective in achieving significant long-term weight loss in severely obese individuals. Dietary weight loss plans often cause depression, anxiety, irritability, weakness and preoccupation with food. For those individuals who have tried and failed to lose weight using non-surgical methods, there is hope for a longer, healthier life.
Bariatric surgery or surgery which is intended to assist a person to lose weight has been around since the mid 1970’s. The goal of gastric weight loss surgery is to promote significant and lasting weight loss in those severely overweight individuals who have been unable to achieve or maintain a healthy weight through diet and exercise. However, gastric or bariatric surgery is not a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. The success of this surgery depends in large part on understanding your weight issues and on your commitment to follow a healthy diet and a regular exercise program after the surgery.
In the 1990’s bariatric surgery was not considered an effective way to promote weight loss due to the historic problems and the still prevailing opinion of many doctors that all it takes to lose weight was will-power, an active exercise regimen and a low calorie diet. Overweight people are often prejudiced against by doctors as well as much of society. Self-image and self-doubt made the effective loss of weight difficult or even impossible for many of these people. As the “epidemic” of obesity became a major health issue in our society, surgical intervention was considered a “last resort” technique for morbidly obese people.
Two bariatric surgical procedures (the Roux en Y Gastric bypass surgery and the Duodenal Switch surgery) have been used in a large number of cases. These procedures were developed in the 1990s and were modified versions of the earlier digestive system bypass. These two surgical options do present some potential problems with the digestive processes in the intestine. They both alter the physiological digestive processes as well as restricting the input of food. While these methods have worked on many patients, there are also often a fair amount of digestive systems upsets. The two newest procedures include the Lap Band, which is an inelastic band placed around the stomach to reduce food intake and the Vertical Gastrectomy where approximately 90% of the stomach is removed, both effectively reduce food intake.
For more information on bariatric surgery, go online on the Internet and search for “bariatric surgery”. You will find hundreds of papers and articles describing the physical and emotional aspects of the various surgical options.
My experiences in eating in the months following my surgery were checkered. It was a learning period. Dietary items I had considered normal before the surgery, created some distress in the stomach and I had to be very careful what types of foods I consumed. I found that soft foods, such as poached fish or shrimp were tolerated better than a grilled hamburger patty. The textural quality of the food, especially in this early post-surgical phase, is important. It is important not to stress the surgical sites or put pressure on the staples until the healing is complete in 3-4 weeks.
I would try foods that I had experience with as well as new foods to see how my system reacted. I found that spicy foods did not create any particular issues, but harder textured foods did. I developed many of the recipes I will be posting as I experimented with the dietary restrictions and limitations that my body was placing on me. The process continues.
Advances in technology and modern medicine may have given those people a chance to have a longer and healthier life. Morbid obesity is a disease of excess energy stores in the form of fat. This biologically-based disease goes beyond a simple disorder of willpower. People who suffer from morbid obesity endure physical and emotional trauma on a daily basis. Aside from poor self-image and self-esteem, a person who is severely obese is also more likely to suffer other chronic health problems such as: cardiac dysfunction, pulmonary problems, digestive diseases, and endocrine disorders as well as, obstetric, orthopedic, and dermatological complications.
In today's health conscious society, people suffering from this illness are constantly reminded of their problem and ultimately their inability to overcome this disease. Lack of respect and compassion for the morbidly obese is also an issue of concern. Widespread attitudes that severely obese individuals are weak-willed, ugly, awkward, self- indulgent and somehow immoral contributes often to low self-esteem in morbidly obese individual.
It is now widely accepted among those in the medical field that morbid obesity is a medical condition that requires treatment. In fact, it was recently announced that Medicare would remove barriers to covering anti-obesity treatments. This disease represents a management challenge for physicians and a psychological and biological challenge for those suffering from this disease.
Published scientific reports show that non-operative methods have not been effective in achieving significant long-term weight loss in severely obese individuals. Dietary weight loss plans often cause depression, anxiety, irritability, weakness and preoccupation with food. For those individuals who have tried and failed to lose weight using non-surgical methods, there is hope for a longer, healthier life.
Bariatric surgery or surgery which is intended to assist a person to lose weight has been around since the mid 1970’s. The goal of gastric weight loss surgery is to promote significant and lasting weight loss in those severely overweight individuals who have been unable to achieve or maintain a healthy weight through diet and exercise. However, gastric or bariatric surgery is not a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. The success of this surgery depends in large part on understanding your weight issues and on your commitment to follow a healthy diet and a regular exercise program after the surgery.
In the 1990’s bariatric surgery was not considered an effective way to promote weight loss due to the historic problems and the still prevailing opinion of many doctors that all it takes to lose weight was will-power, an active exercise regimen and a low calorie diet. Overweight people are often prejudiced against by doctors as well as much of society. Self-image and self-doubt made the effective loss of weight difficult or even impossible for many of these people. As the “epidemic” of obesity became a major health issue in our society, surgical intervention was considered a “last resort” technique for morbidly obese people.
Two bariatric surgical procedures (the Roux en Y Gastric bypass surgery and the Duodenal Switch surgery) have been used in a large number of cases. These procedures were developed in the 1990s and were modified versions of the earlier digestive system bypass. These two surgical options do present some potential problems with the digestive processes in the intestine. They both alter the physiological digestive processes as well as restricting the input of food. While these methods have worked on many patients, there are also often a fair amount of digestive systems upsets. The two newest procedures include the Lap Band, which is an inelastic band placed around the stomach to reduce food intake and the Vertical Gastrectomy where approximately 90% of the stomach is removed, both effectively reduce food intake.
For more information on bariatric surgery, go online on the Internet and search for “bariatric surgery”. You will find hundreds of papers and articles describing the physical and emotional aspects of the various surgical options.
My experiences in eating in the months following my surgery were checkered. It was a learning period. Dietary items I had considered normal before the surgery, created some distress in the stomach and I had to be very careful what types of foods I consumed. I found that soft foods, such as poached fish or shrimp were tolerated better than a grilled hamburger patty. The textural quality of the food, especially in this early post-surgical phase, is important. It is important not to stress the surgical sites or put pressure on the staples until the healing is complete in 3-4 weeks.
I would try foods that I had experience with as well as new foods to see how my system reacted. I found that spicy foods did not create any particular issues, but harder textured foods did. I developed many of the recipes I will be posting as I experimented with the dietary restrictions and limitations that my body was placing on me. The process continues.
In the Beginning
In 1981, my first wife went through an extensive process to have bariatric surgery in El Centro California. At the time she weighed 300 pounds and had tried many diets and diet plans. Because of back pain caused by several earlier surgeries, she felt that weight reduction surgery was her only alternative to provide a higher quality of life, fewer pain medications, and the ability to buy nice clothes again. She was not an over-eater, but as students living on a relatively low income; beans, starches and other high calorie foods were our normal choice for meals. We had both gained weight over time.
That summer she had a bariatric procedure that based upon today’s technology, would be quite primitive. A line of staples were placed through her stomach creating the pocket which limited the amount of food being consumed. A small inelastic band was then attached to ensure that the movement of food from the pouch to the rest of the stomach was very slow. Her surgery took approximately 5 hours and her hospital stay was 10 days. In those first few weeks and months she subsisted primarily on ice chips and water. She did begin to lose weight and within a year was down over 100 pounds. She looked great and had fun buying new clothes. She developed the self-confidence to go out into the job market and develop a new career and I had a new wife.
As you can tell, the role of bariatric surgery in weight loss and nutrition has been an essential element of my life. I had received my Ph.D. from the University of California at Davis in 1978 in ecology. My dissertation just happened to be on the digestive physiology of stomachless fishes and I was actually well-versed in the physiological aspects of digestion when no stomach is present. I was quite ready to understand the digestive processes in play after my wife’s surgeries. After 24 years in the post-surgery period, she developed pancreatic cancer and died on Valentine's Day in 2005.
However I was not interested at all in putting myself through what I perceived to be a problematical procedure just to lose weight. So I remained overweight, had high blood pressure, and developed Type 2 diabetes. I controlled the diabetes using several injections of short and long acting insulin daily. In the spring of 2008 my new wife and I watched a program on 60 Minutes on the bariatric surgery done by a doctor on the east coast of the U.S. All of the patients interviewed had lost in excess of 100 pounds and all of them eliminated their Type 2 diabetes . That information was very important. I was interested in the surgery if I could get rid of my diabetes.
My decision to have the surgery was based upon the thirty years I had weighed nearly 300 pounds and my many futile attempts to reduce the weight. I knew that I didn't want to be on insulin for the rest of my life. When I saw how bariatric surgery influenced diabetes and all of the associated health risks with that disease, I realized that this was my chance to do something positive. So even with the serious reservations I had from watching my first wife go through twenty-four years of her life with all the complication, I decided that the health benefits outweighed the risks.
With assistance of my new wife, Elizabeth, I had a vertical gastrectomy (VG) at California Pacific Hospital in San Francisco, California on June 4, 2008. The surgery took slightly over an hour and 20 minutes. It was done using a minimally invasive laparoscopy technique through a 2” incision in my abdomen. I stayed in the hospital overnight and went home the next day at noon. I was on a high protein liquid diet for three weeks. That was a far cry from the surgical procedure my wife went through 27 years earlier. I had no significant pain and was able to do most daily activites relatively soon after surgery.
As I was recovering from the surgery and relearning what and how to eat again, I kept thinking of what I had had said to my wife immediately after her surgery. I had told her that if she could only have eight bites in a meal, I wanted them to be the very best eight bites I could make. I became a much better and more creative cook because of her nutritional limitations. This book is dedicated to her and all of those individuals who have made the difficult decision to have this surgery and to those who are considering it.
At the same time these recipes and culinary ideas are also tasty and can be incorporated into any dietary program. They are designed to be generally high in protein and low in carbohydrates, be aggressively spiced and flavored, and often use interesting ingredients. I want to provide those people who have had bariatric surgery some dietary options that taste and look wonderful and also allow them to enjoy eating without feeling that they are relegated to sitting quietly by while others enjoy their meals.
It is important to keep in mind, that we are what we make of ourselves. So if you can only eat eight bites, make them be eight great bites. Mangiamo!
That summer she had a bariatric procedure that based upon today’s technology, would be quite primitive. A line of staples were placed through her stomach creating the pocket which limited the amount of food being consumed. A small inelastic band was then attached to ensure that the movement of food from the pouch to the rest of the stomach was very slow. Her surgery took approximately 5 hours and her hospital stay was 10 days. In those first few weeks and months she subsisted primarily on ice chips and water. She did begin to lose weight and within a year was down over 100 pounds. She looked great and had fun buying new clothes. She developed the self-confidence to go out into the job market and develop a new career and I had a new wife.
As you can tell, the role of bariatric surgery in weight loss and nutrition has been an essential element of my life. I had received my Ph.D. from the University of California at Davis in 1978 in ecology. My dissertation just happened to be on the digestive physiology of stomachless fishes and I was actually well-versed in the physiological aspects of digestion when no stomach is present. I was quite ready to understand the digestive processes in play after my wife’s surgeries. After 24 years in the post-surgery period, she developed pancreatic cancer and died on Valentine's Day in 2005.
However I was not interested at all in putting myself through what I perceived to be a problematical procedure just to lose weight. So I remained overweight, had high blood pressure, and developed Type 2 diabetes. I controlled the diabetes using several injections of short and long acting insulin daily. In the spring of 2008 my new wife and I watched a program on 60 Minutes on the bariatric surgery done by a doctor on the east coast of the U.S. All of the patients interviewed had lost in excess of 100 pounds and all of them eliminated their Type 2 diabetes . That information was very important. I was interested in the surgery if I could get rid of my diabetes.
My decision to have the surgery was based upon the thirty years I had weighed nearly 300 pounds and my many futile attempts to reduce the weight. I knew that I didn't want to be on insulin for the rest of my life. When I saw how bariatric surgery influenced diabetes and all of the associated health risks with that disease, I realized that this was my chance to do something positive. So even with the serious reservations I had from watching my first wife go through twenty-four years of her life with all the complication, I decided that the health benefits outweighed the risks.
With assistance of my new wife, Elizabeth, I had a vertical gastrectomy (VG) at California Pacific Hospital in San Francisco, California on June 4, 2008. The surgery took slightly over an hour and 20 minutes. It was done using a minimally invasive laparoscopy technique through a 2” incision in my abdomen. I stayed in the hospital overnight and went home the next day at noon. I was on a high protein liquid diet for three weeks. That was a far cry from the surgical procedure my wife went through 27 years earlier. I had no significant pain and was able to do most daily activites relatively soon after surgery.
As I was recovering from the surgery and relearning what and how to eat again, I kept thinking of what I had had said to my wife immediately after her surgery. I had told her that if she could only have eight bites in a meal, I wanted them to be the very best eight bites I could make. I became a much better and more creative cook because of her nutritional limitations. This book is dedicated to her and all of those individuals who have made the difficult decision to have this surgery and to those who are considering it.
At the same time these recipes and culinary ideas are also tasty and can be incorporated into any dietary program. They are designed to be generally high in protein and low in carbohydrates, be aggressively spiced and flavored, and often use interesting ingredients. I want to provide those people who have had bariatric surgery some dietary options that taste and look wonderful and also allow them to enjoy eating without feeling that they are relegated to sitting quietly by while others enjoy their meals.
It is important to keep in mind, that we are what we make of ourselves. So if you can only eat eight bites, make them be eight great bites. Mangiamo!
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