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DIET AFTER A SLEEVE GASTRECTOMY–PART ONE

ramana — Fri, 18 Sep 2009 14:47:51 +0000

The sleeve gastrectomy operation converts the stomach into a long tube with a capacity of around 120 ml (or whereabouts). Obviously, you cannot exceed the newly reduced capacity, and your meals are going to be small, though much bigger than after a gastric bypass.

To make matters better (and more interesting) you do not feel too hungry anyways, and there are usually no cravings for food that go unfulfilled. It is not as if the operation will leave you salivating for a huge meal, and you are cursed with a tiny portion of it all your life. You will be happy with what (and how much) you can eat.

For three to four weeks after surgery, you will consume liquids only.

Week One: Thin liquids only

Sample Full Liquid Meal Plan (1 week post-op)

7:00 am — 4 ounces of milk

8:00 am — 2 Tablespoons plain yogurt

10:00 am — 1 ounce whey protein isolate drink (e.g. Isopure Zero Carb) with 4 ounces

of skim or 1% milk

11:00 am — cup of dal

1:00 pm — 2 Tablespoons low fat cottage cheese (plain)

3:00 pm — 4 ounces whey protein isolate drink

6:00 pm — tea

8:00 pm — 4 ounces whey protein isolate drink made with skim or 1% milk

9:00 pm — 4 ounces of vegetable/chicken soup

Week Two to Week Four: Pureed/blenderized diet

Use natural, whole foods (like vegetables, meats, fish, dal and milk) and blenderize them till you obtain the consistency of a thick sauce. Strain out the larger particles/seeds/skin and use the rest.

How to measure your portions: use a measuring spoon or shot glass or an ice tray (each cube in the tray measures 1 ounce.

Useful link for pureed diet recipes: click here. But remember to follow the rules!

Rules for the liquid/pureed diet after operation:

(pic source: here)

1. No colas, sodas, or alcohol.

2. No sugar, commercial ‘low-fat’ drink, honey, agave nectar, corn syrup or HFCS, chocolate syrup, ice cream, etc. Your protein shake (as in the pic) may be chocolate-flavored.

3. Very limited ghee, butter, or olive oil.

4. Avoid coffee, especially if you have heart problems or diabetes.

5. Avoid restaurant food (they generally tend to be unhealthy).

6. Avoid hard meats and nuts till well into your second month after surgery.

7. If you feel like having something sweet (like milk or tea or a smoothie), add a sugar substitute, avoiding overuse.

8. No processed foods like chips, cakes, cookies, breads, pizzas, burgers, whatever!

9. Total fluid consumption in a day should be at least 1.5 to 2 litres (including water)

10. Take time in having your meals- your stomach is not what it used to be!

11. Have only less than 4 ounces of feeds at a time.

12. Eat 60 to 100 grams of proteins daily.

13. Use an online food journal like Fitday to calculate your protein intake or contact us.

14. Drink water at a different time from your meal.

15. Avoid fruit juices– they have a high glycemic index and could raise your blood glucose.

(pic source: here)

In regard to the above, weight training is as important, but that is another article!

PREPARING FOR YOUR BARIATRIC OPERATION

ramana — Mon, 14 Sep 2009 05:06:11 +0000

(pic credit goes to this site)

If you have decided to go for a bariatric operation, you need to do some preliminary preparation for it.

1. We tell our patients to go on a liquid diet for 15 days before the day of surgery. This does not mean you can drink ghee, condensed milk, juices and colas. You can drink soups, milk, dal, meat stocks, etc. You could also take ultra-low calorie liquid supplements like Optifast. The caloric deficit created by this would lead to around 15-20 lbs of fat loss or even more.

2. Significant fat loss immediately preceding bariatric surgery is good in terms of improving post-operative results and also in making the surgeon’s job easier. Much of the effects of the pre-operative low calorie diet is to shrink the size of the liver. This causes better visualisation during surgery.

3. A last binge before surgery is NOT a good idea! This is understandable from the patient’s point of view, but really does not do much good to him/her. Often, the last binge gives rise to one more, and then one final one, and so on. Rather than losing weight, the patient puts on some more!

4. Stop smoking and drinking alcohol! This is simply non-negotiable. Bariatric surgery is not a painless, cosmetic solution to some excess blubber your body may have. It is a serious undertaking on your (and our) part, in order to restore health to your body. There can be no healthy life if you drink and smoke. One is not referring to the occasional social drink or cigar, but you know what we are talking about! Smoking increases post-operative respiratory complications like pneumonia, as well as heart attacks and deep vein thrombosis. All these complications are terrible and potentially fatal, so be careful! Nothing is worth losing your life and health to, so quit NOW!

5. Continue to take your diabetes and hypertension medicines, unless told otherwise.

6. If you have respiratory problems like asthma, please see a respiratory physician or therapist who would treat your lungs with nebulisers, antibiotics (when indicated), and chest physiotherapy. In some patients, vaccines against respiratory pathogens (like Pneumococcus and Hemophilus influenzae) are also prescribed. Patients suffering from sleep apnea may need a CPAP machine that helps to oxygenate the lungs during sleep.

7. Walking every day or doing some mobility exercises is good for you– this is also important for you. We encourage patients to be ambulant immediately after surgery, and this helps.

8. Prepare a food journal– this should become a habit after your operation, so start anyways.

9. Ask other patients about how they have adapted to life after bariatric surgery. Remember that they may have a different procedure and their adaptations and restrictions may not apply to you!

10. Do you need further counselling? Are you nervous or unsure about anything? Don’t hesitate. Ask your bariatric surgeon!

LOW CARB DIET BETTER FOR DIABETES!

ramana — Tue, 01 Sep 2009 00:30:21 +0000

According to a study published in the Annals of Internal Medicine (September 1 edition), a Mediterranean diet low in carbs scored far better in diabetics than a low fat diet as recommended by the American Heart Association.

Article source here.

A summary in Medpage Today says that “Among diabetics who followed a Mediterranean-style diet, only 44% required antihyperglycemic drug therapy, compared with 70% of patients who followed a standard low-fat diet (95% CI -31.1% to -20.1%, P<0.001)”.

“Compared with a low-fat diet, a low-carbohydrate, a Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes,” Dario Giugliano, MD, PhD, of the Second University of Naples, and colleagues wrote.

Full Medpage Today article may be read here.

ORLISTAT- A CANDIDATE FOR WITHDRAWAL?

ramana — Tue, 25 Aug 2009 23:08:58 +0000

Many patients and physicians are averse to bariatric surgery for the management of morbid obesity and its attendant evils of diabetes, hypertension, sleep apnea, etc. Fair enough, I say, but then how do you achieve fat loss when you are unlikely to be in the 5% who will achieve it with lifestyle changes? Clearly, people who get morbidly obese are extremely hard pressed to get back into shape and health, even with medical supervision.

In this scenario, they often resort to taking drugs to help with weight loss. One such drug, now popular all over the world, is Orlistat, sold over the counter in the US as Alli.

The drug works by inhibiting the digestion and absorption of ingested fat in the alimentary tract. Net result- the ingested fat is passed off in the stool. So, the patient can eat fats and not put it on– after all, it is not getting absorbed into the body. Cool, ain’t it?

Not really. The drug, as we have seen with rimonabant before, is not without its inherent problems. The stools become oily and loose, not to say foul-smelling. As a result of this, much time is spent in the toilet. If that is not bad enough, the oil trickles in through the anus and soils your clothes!

Orlistat (sold in India in the names of Reeshape or Obelit, among others) also causes malabsorption of fat-soluble vitamins and could be harmful if consumed for longer periods of time. Remember that fat is an important macronutrient for the body, even in fat people!

According to this report (and some others), Orlistat has been found to cause severe liver toxicity, including liver failure in several patients, leading the FDA to launch a product review on the drug.

FDA said it “is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed, and those using over-the-counter Alli should continue to use the product as directed.”

But the FDA advised orlistat users to “consult their healthcare professional if they are experiencing symptoms possibly associated with the use of orlistat and development of liver injury, particularly weakness or fatigue, fever, jaundice, or brown urine. Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.”

However, if history is any indicator, it is our prediction that this will go the way of rimonabant and Ephedra and die a natural death in some time in the future.

HOW MUCH TIME DO YOU HAVE FOR FAT LOSS?

ramana — Mon, 10 Aug 2009 01:26:47 +0000

A well known person in Kolkata called me up for helping her to lose around 20 lbs of fat. “But I don’t have the time to exercise like you!”, she said.

(pic source: flickr.com/photos/ geekandpoke/2231731282/)

Now, she had no real way of knowing anything about my exercise regime or durations. I took it as a compliment that my physique looked to her as if I spent a lot of time in the gym (I don’t).

I had to answer her. I had to tell her that fat loss was not just a phone call away. One doesn’t get fat loss tips on the phone, and get lean. Fat loss comes when you commit to it. It is a full time commitment — not a half hour workout on a treadmill watching the news.

Another important thing she needed to hear was that the most important component of a fat loss program is not exercise, but diet (and the main component of a diet should be motivation, but we digress). It is what you eat that makes you fat. It is what you eat (and don’t eat) that will make you slimmer. Exercise is merely the icing on the cake (if you can excuse the bad pun). So, how much time do you need to eat right?

Does it take longer to eat meat, eggs, salad and fruits compared to hamburgers, pizzas, sodas and chips? Maybe, maybe not. But, for sure, you are going to spend eating more times in a day if you pig out on junk food. Eating clean is, in more ways than one, timeless.

As far as exercise is concerned, how much time is good? Fitness pros know that the testosterone and growth hormone peaks that come with exercise disappear after 45 minutes or so. So, if you have time enough to train for 45 minutes three times a week, it should be good. If you are super busy, you could train for less. Like 10 to 15 minutes. In a sense, less is more in the fitness world, but you should know that those 10 or 15 minutes should take more out of you than an hour of running.

(pic source: http://www.funnies.com/notimeforbreaks.jpg)

So, I told this lady, “How much time do you have for fat loss? Less time than you spend in the bathroom? Do you have time to go to the bathroom every day? Then you have time for fat loss! Do you have time to live? If you do, you have time for fat loss. For you, that is what life should be centered around- your health.”

Is it any wonder that friends call me an extremist?

WHAT ORGANS CONTROL OUR BODY FAT?

ramana — Sun, 09 Aug 2009 16:20:48 +0000

Organs that control the activities of other distant parts of the body are part of our nervous system or a part of the endocrine (hormone-releasing) system.

While the brain clearly does a lot to spook our willpower and weaken our ‘eat not, want not’ resolve, it is not an organ we normally want to mess around with. The brain works by using chemicals called neurotransmitters to effect its commands. For example, hunger, mood, craving, etc. may all be induced by manipulating the level of these chemicals in specific parts of the brain. We are increasingly aware of this, but our knowledge is still a long way away from being able to encapsulate it in a pill to make us thinner and healthier.

Take, for example, the case of rimonabant. It was touted as the drug that would kill bariatric surgery. It acts on the cannabinoid receptors in the brain and kills hunger. Advocates said the drug would cause massive weight loss without the risks and costs of surgery.

What happened? The drug has become another footnote in history, after being withdrawn because of the high incidence of degenerative diseases like Parkinsonism and Huntington’s disease. You clearly don’t want to mess with the brain!

Apart from this, the brain has a part known as the hypothalamus, that houses both the hunger and the satiety centers. The hypothalamus also secretes and stimulates the secretion of a host of hormones that affect body metabolism and composition. Diseases that affect it may cause massive obesity in patients.

If we leave the brain aside, what are the other organs that affect fat loss or fat gain?

Clearly, the pancreas is top dog, with insulin and glucagon controlling all the major pathways of metabolism (like glycolysis and gluconeogenesis). Diseases that affect the pancreas may cause diabetes and weight loss. However, in the condition known as Type II Diabetes Mellitus, the pancreas either stops insulin production or its insulin does not work on the body (resistance). This condition is usually associated with obesity. Clearly, there ismore than one organ, then, affecting body fat levels.

Body fat itself is now given more attention by scientists. Previously thought of as an inert mass of blubber, it is now considered an endocrine organ! The fat that resides around the organs (like the kidneys, intestines, omentum, etc.) and in those love handles is supposed to be metabolically active. Fat produces hormones like leptin and ASP which are now known to be important hormones affecting fat deposition in many ways. Leptin acts to achieve a sense of satiety, and obese patients are often found to be resistant to it, much as they have resistance to its more famous brother, insulin.

The small intestine, consisting of the duodenum, jejunum and ileum, is an important engine of metabolism. There are nearly 200 hormones, called incretins, that affect metabolism in mysterious ways. The incretins act on the pancreatic islet cells to secrete insulin, thereby helping control diabetes. This effect is more marked following gastric bypass, leading to diabetes resolution. More about incretins in later posts!

The stomach, rather surprisingly, secretes a hormone critical in the phenomenon of hunger. The hormone ghrelin is secreted by the fundus of the stomach, and this helps explain why patients of the sleeve gastrectomy or the gastric bypass procedure have a marked loss of appetite, resulting in major weight loss (up to 75% of excess body weight).

In summary, there is more to the neural and endocrine control of body fat and metabolism than insulin. The topic of ASP (Acylation Stimulation Protein) is an extremely interesting one that serves to highlight how closely interconnected various disparate organs may be in the regulation of body fat.

This topic is fascinating in many ways, and underscores how oversimplified people’s perceptions of obesity are, when they identify single villains (insulin, for example) or heroes (antioxidants/beta-HCG/acai berries, etc,). The truth is far too complex!