Liquid Diet vs Surgery

[tn_junk]

Dr. wants me to have gastric bypass surgery. Says that I've got to lose weight NOW. The 3-4 pounds a month I am losing ain't fast enough. (This guy is a diabetic/internal medicine specialist). Says that my life depends on it.
Anybody out there doing a Liquid Diet? Anybody had the surgery?

thanks

galump

[susieM]

I recently read that people with this b-pass who also suffer from diabetes, have been found to have the diabetes symptoms back off, with some even being able to get off the meds. This was on GoogleNews and camefrom Australia.

It seems that it is maybe not so much the diet, altough losing weight is a big factor, but also the fact that with these by-pass things people tend to eat tiny meals often instead of big ones that seems to do the trick.

So forget the liquids and go for the by-pass.

[mammabooh]

Why not just start eating like you would after you had the surgery? I'd think that would have a dramatic effect. Sorry...that sounded sort of mean and simplistic. I know it's not as easy as that.

[tn_junk]

Originally Posted by mammabooh

Why not just start eating like you would after you had the surgery? I'd think that would have a dramatic effect. Sorry...that sounded sort of mean and simplistic. I know it's not as easy as that.

I know that you are not trying to be mean. But I am fifty years old and have been yo-yo dieting for 40 of those years. I weighed 160 pounds when I was 10 years old. I weighed 185 pounds three years ago. Have weighed as much as 425 before. Now am at about 300.
If you look at the world around you, there are a whole bunch of us that just can't seem to "get it". Can't seem to eat right and maintain a healthy weight.
I have already lost my mother and two uncles to obesity related issues, all under 60 years old. And I can't blame my problems on the way I was raised, because they didn't raise me. I was raised by my fathers family, and they are all slim skinny people.
Not making excuses, just stating fact. If I could just eat a little, lose weight and keep it off, I would have done so 40 years ago.

galump

[MaineFarmMom]

I have a friend who asked her doctor about gastric bypass and Lap-Band. Her doctor had two questions for her. First, is your stomach broken? No. Second, then why do you want to alter it? The problem isn't her stomach. Until she deals with the problems that cause her to overeat she'd be miserable not being able to eat. Her doctor said people who don't fix the head before tampering with the stomach too often are not successful with the surgery. They either find a way to continue eating, start eating again soon after and regain the weight, or replace food with another crutch.

It makes a lot of sense to me. I've been paying attention to what her doctor is having her do and some of it's applicable to me. I've lost four pounds since she started paying attention to what she eats. =) The only thing I'm doing is writing down every single thing I eat along with the emotions and goings on at the time. I realized last week that I'm an emotional eater. I'd have said I like comfort food now and then but I don't typically drown my sorrows in chocolate. I've realized I do in fact eat when I'm stressed and sometimes do it mindlessly. I was stressed over a phone call, hung up, immediately went to the kitchen, ate an apple muffin, and 20 minutes later realized what I'd done.

I think before I'd considering damaging a perfectly good stomach I'd have to get some professional help to figure out why I eat the way I do. So far so good with my friend. It's been only a few weeks but she's figured out some important patterns. I don't know if there's anything you want from this but it's something to think seriously about. People do die on the table from this surgery.

[RockyGlen]

Because diabetics don't heal as well, I would try the liquid diet first. I have an aunt who was 100 pounds overweight and diabetic. Here is how she lost the 100 pounds in just under a year:

all the water, black coffee, and celery she wanted, plus

breakfast: slim fast shake

mid-morning snack - a 100 calorie pack (whatever she felt like, as long as it was a premeasured 100 calories)

lunch - lean cuisine meal and diet coke

mid afternoon snack - a 100 calorie pack

dinner - slim fast shake

bedtime snack - a 100 calorie pack

I tried doing this diet, and lost weight....but still cooking huge meals for my family I was not able to stay on it long.

[seedspreader]

Just listen to your doctor and get the surgery.

My mom, dad, and sister have had the surgery and all came through it wonderfully.

It's hard, but it's worthwhile.

Myself... I am in good health so I am going at it the hard way. I've lost around 40 lbs so far... But I've changed my eating habits totally too.

[Shazza]

I think the surgery is too drastic a step to take...thinking of afterwards...you will still weigh the same but only able to eat a cup of food at a time. The weight will drop off you not because you have changed your lifestyle but because you are starving. My good friend who lives in the top end of Aus had this surgery done. She only weighed 100 kgs but has Diabetics in her family....she must have done some sweet talking for him to do the op. She now of course only weighs 60kgs 7 mths later. I fear she will fade away and become unhealthy on the other end of the scales.
Remember that when they downsize your stomach they take away the "chemical indicator" to your brain that tells you you are hungry.
I agree with mammhboo, practice eating tiny tiny bits of food, reward hunger pains with a glass of water.
But it all comes down to what you want to do...good luck.

[Jaclynne]

Everyone keeps saying just eat as if you had the surgery.

Well, how is that?

No more than 1 cup of food at a time. How often?

Does it matter what it is? Is it liquid, bland, no fat, sensible diet, or just anything you want?

I've heard people with prior gastric problems are not candidates for the surgery or lapband. What is considered gastric problems? Gerd, I know but what else?

Are lapband or surgery patients required to take some medications?

Halo

Have you tried weight watchers? What about therapy? Seriously, the first place you need to work on is your head. I'm 120 pounds overweight and I'm just now getting it. I've lost 20 pounds so far, but I need to be serious and quit looking for ways to "cheat".

[Shazza]

I said one cup cos that is all you can fit in after the op...anymore than that and you will have EXTREME gut ache cos you will be over full...stuffed...so one would make sure that that one cup is low GI food...something very healthy. Or one of the SUPER veges...carrots, corn, broccoli, peas, beans....they have the most mins/vits and anti-oxidants.

[ArmyDoc]

Disclamer: The following is only general information. It is not to be construed as medical advice. You should talk to your doctor about all medical decisions. I am not your doctor.

That said, I am a bariatric surgeon, and I would be happy to provide you with general answers about bariatric surgery. I’ll give an overview here, and answer more specifically if you ask. But seriously, if you decide to pursue this, you need to find your own surgeon and talk to him/her about your specific situation.

First off, who is eligible for weight-loss surgery? Answer: Patients who are morbidly obese. The term implies patients whose obesity is causing them medical problems, or who can be relatively certain that it will eventually cause them medical problems. The standard is a BMI over 40 or a BMI over 35 with some obesity related condition. BMI is calculated by taking your weight in kilograms and dividing it by your height in meters squared. (it’s easier to use one of the on-line BMI calculators)

The problem is, that it is actually more complicated than that. There are plenty of patients who are morbidly obese who are poor candidates. They maybe too sick for surgery (this is major surgery – don’t let anyone tell you otherwise.) They may not be mentally ready for the major lifestyle changes that this surgery will entail. They may not be willing to stick to the diet post-operatively, to name a few.

Concerning Bariatric surgery, there are currently 2 main surgeries being performed in the US right now. The Gastric Bypass and the laparoband. There are a few other variations, but I won't go into those right now.

The most common, and most successful is generally the Gastric Bypass. It does two things: 1) it decreases the amount you can eat and 2) it decreases the efficiency of your bodies absorption. It can be done open (through and incision) or laparoscopically. Most patients lose about 65% of your excess body weight. (for example, if your ideal weight is 145#, but you actually weigh 295#, then you are 150# over weight. The average patient would lose about 65% of the excess weight, or 100#)

The laparoband is a laparoscopic surgery that effectively makes your stomach smaller by putting a band around the upper part. This decreases the amount you can eat at one time. In most studies, it doesn't reslult in as much weight loss as gastric bypass - averaging 40 to 50% of excess weight. Also, it can have a revision rate of up to 40 percent, and in some studies does it does not provide as good results over the long term (several years). That said it can be beneficial for some patients.

As for diet vs surgery, that is a hard decision. Though I do the surgery, I am not a fan of surgery. It is not a quick fix, it is a court of last resourt. Anyone who views it as a quick fix is likely to regain a significant amount of weight inspite of having surgery.

That said, I am also not a fan of any type of diet that you can not stick to for the rest of your life. So I guess you could say I don’t believe in any type of “diet” because the common concept of a diet is a short term change in what you eat. The problem with diets is, when you stop your diet you go back to eating the way you did before you went on your diet. In other words, you eat the way that made you obese in the first place.

In order for any weight loss program to work, diet and exercise based or surgery based, you are going to have to make a permanent change in your lifestyle / eating habits. Surgery is very effective at causing the type of permanent changes that are necessary, and I believe in general for the morbidly obese patient is more effective than diet and exercise programs.

Even so, diet and exercise should be the first line of treatment. Concerning diets, studies have shown that in general, losing weight at 1-2 pounds a week is generally as much as is sustainable on a diet program. More than that, and you have an increased rate of rebound. Weight loss of more than 10% of your body weight is also associated with a high rate of rebound. Does this mean you can’t lose weight and keep it off without surgery? NO! It means it isn’t easy. But I think you already know that, right?

Your doctor’s urgency may be more related to your age, than your health – but again, never having met you, I can not say for certain this is true. Your doctor may be concerned that if you continue to yo-yo back and forth with your weight, you may be too old for surgery by the time you decide to have it. You see, many Bariatric surgeons will not operate on older patients. It’s not that the risk of surgery is any higher in the older patient. The complication rate is the same in older patients as it is in younger patients. But in older patients, the patient’s ability to tolerate a complication is decreased. I’m sure anyone who’s over 40 recognizes that we don’t bounce back as well as we did when we were 20. Our bodies reserves just aren’t what they used to be.

I hope this helps. A good resource is www.obesityhelp.com There are many other good sites, but this one should at least get you started.

[ArmyDoc]

Originally Posted by HaloHead

Everyone keeps saying just eat as if you had the surgery.

Well, how is that?

Halo

Excellent question. Because mammabooh's suggestion is actually a very good one. Bariatric surgery isn't magic. If you can stick to a post-bariatric diet you would definitely lose weight.

Immediately after surgery, you are on a liquid diet only. The connections made between the intestines and stomach need time to heal. After a few days patients are advanced to a purre (baby food consistency) diet. The time for this phase depends on the surgeon. I recommend 4 weeks. After this, firmer foods are added slowly.

The key is in portion sizes. Most surgeons create a pouch that is about 30cc or about 1 oz in size. You can't eat much at a time. This means frequent small meals consisting of 3-6 bites at a time. The type of food is also important. Because you can't eat much, you have to make it count. This means high protien, low fat and low carbohydrate meals. Also, after bypass surgery foods that are high in carbohydrates and fats are likely to make you nauseous or give you diarrhea. This is a side effect of the surgery.

Gastric bypass forces you to eat differently from the way most people eat. It forces (at least initially) you to eat in a pattern that is healthy. But if you can eat that way without surgery, and not just for a few months or years, but for the rest of your life, you may not need surgery at all. What is that healthy pattern?

Basically:

1) Don't eat when you aren't hungry
- most people don't eat when they are hungry. They eat when they are bored, want a certain taste, are cellebrating, are happy, are sad, or any number of other reasons that have little to do with being physically hungry. Also, the phyical feelings of thirst are almost identical to hunger, so many times people eat when they are really just thirsty. Try drinking a cup of water and waiting 10 minutes. A lot of the time you'll find you won't be hungre after wards.

2) Don't continue to eat after you no longer feel hungry
- notice I didn't say don't eat after you are full. I said don't continue to eat when you no longer feel hungry. If you feel full, you ate too much, and probably too fast. Eat slowly, a few bites then wait for 5 or 10 minutes to allow your body to recognize that it's not hungry any more. It should take you a half hour to eat 4 ounces of food.

3) Eat healthy. Avoid fats and carbohydrates, and increase protiene. You don't have to go to extreams, but recognize that fats give you twice as many calories per gram as protiens, and carbohydrates will be burned faster (resulting in your feeling hungry sooner) than protiens.

4) Drink lots of water through out the day, and BEFORE your meals. This will ensure you are not eating because you are thirsty.

Those 4 things are the foundation of a healthy eating lifestyle.

A lot of weight loss has to do with mental programing. To be successful, you have to reprogram yourself, break old habits and form new ones. With that in mind, here are two other things to remember:

1) Hunger is your body's way of telling you: "unless you feed me, I'm going to start losing weight."
-If your goal is to lose weight, when you feel hungry don't be upset, rejoice! You are accomplishing your goal. Have a drink of water. Then wait for a half hour or so before you eat. You might be surprised - your hunger pains might go away. Don't push it longer than this though - or you won't stop eating after those first few bites. You need to stop after 3-4 bites to give your stomach a chance to change signals from hungy to not hungry.

2) The sensation of being full is your bodies way of telling you: "You ate too much, and now I'm going to have to convert this to fat."
- Feeling full is a bad thing. It means you over did it.

[Jaclynne]

Thank you ArmyDoc. Good information.

Halo

[tn_junk]

Thank ArmyDoc, good info.

Even at 325 pounds I have low cholesterol (165), good blood pressure (118/72) and decent triglycerides (205). Only health problem is an extended q-t interval, and arthritis. Dr. is concerned that I will get type II diabetes, and wants me thin NOW. Have tried OA, WeightWatchers, individual therapy, you name it. Have not had long term (over 5 years) success.
Will talk to a surgeon next week.

Thanks

galump

[ArmyDoc]

Originally Posted by galump

Thank ArmyDoc, good info.

Even at 325 pounds I have low cholesterol (165), good blood pressure (118/72) and decent triglycerides (205). Only health problem is an extended q-t interval, and arthritis. Dr. is concerned that I will get type II diabetes, and wants me thin NOW. Have tried OA, WeightWatchers, individual therapy, you name it. Have not had long term (over 5 years) success.
Will talk to a surgeon next week.

Thanks

galump

I wish you every success. I'm sure you will do well. The key will be to remember that the surgery won't do the work for you. But if you work with the surgery, it will help you to lose the weight. After you lose the weight, it will remind you when you are eating to much - it's still up to you to listen to that reminder. Use the first two years after surgery to learn new eating habbits. Once you've learned those new habbits, stick to them!

Good luck and god bless.

[Jaclynne]

I am recently diagnosed with type 2 diabetes, but have no problems with bloodpressure (120/70), cholesteral (149), etc. I do have a real problem with water retention, though heart/circulation tests show no reason for it. My doc says its the extra weight.
The diabetes is controlled with diet - small, frequent meals. So I think trying the eating style for a GB surgery patient is the way to go for me.

Halo

[suburbanite]

That seems to me to be a bit low threshold for getting the surgery. I thought the guideline was two co-morbidities, not an isolated co-morbidity (diabetes in this case). ArmyDoc may have some enlightening comment on that?

Ask your doc what the post-op diet would be and then try that for awhile. You'll be ravenously hungry but it will give you a trial run of post-surgical life.

I disagree with ArmyDoc in that I think for the purpose of losing weight, a 'diet' is a useful tool. But understand, the point of the weight-loss diet is to get you down to a weight where you can safely increase your physical activity level. You will not be able to maintain the restrictive diet forever, and it is the exercise that can re-set your metabolism and allow you to shift over to a more sustainable long-term diet plan.

From the story of your family it sounds to me like you have a genetic/hormonal predisposition to be fat. However, since there aren't really any good tools for treating such a condition, even though it makes your weight 'not your fault', you are still left with having to use the old 'diet and exercise' routine to address it.

There are a few emerging elements which might be helpful to experiment with. First, corn syrup is getting to look more and more disadvantageous to losing weight, having to do with what sugar metabolism pathways are activated to deal with the fructose. Second, the sodium benzoate used as a preservative in most diet soft drinks is now found to be toxic to mitochondria, independent of its potential to become carcinogenic benzine if improperly stored.

Mitochondria are what convert sugar in your cells into ATP, the energy currency of the cell, and so although no studies are yet out to explore what role this toxicity might have in obesity, it seems a reasonable leap of logic that a mitochondrial toxin could have a role in the development or maintenance of a weight problem. Until there's data to see whether this has any effect, and given that there's already some question about the benzene, it seems reasonable to me to cut out anything containing sodium benzoate and see if that helps or not.

[suburbanite]

Sometimes if you have a lot of body fat in your abdomen it can press on the vena cava (which returns blood to the heart) and cause water build up in the extremities. This is part of why some women get puffy ankles when pregnant (its not all just hormonal).

[suburbanite]

When I was in college I weighed 140 lbs and was doing sprint-length triathlons--1/2 mile swim, 12 miles bike, 3 miles run.

To train for this level of competition I swam 6 miles a week, ran 15 miles a week, and biked 40-60 miles per week. Since I was comparing myself to other triathletes, I considered this to NOT be much exercise.

Part of what you'll need to do is re-adjust your concept of what constitutes 'active'. Since your genetic cards seem loaded against you, my college level of activity is probably something like what you'll need to shoot for to keep weight off, eventually.

This probably seems to you like an impossible level of activity to maintain. I had to quit this level when I left college primarily because I could not find a suitable local swimming venue. I gained about 20 lbs (partly also due to a serious bout of pneumonia that left me with diminished reserve for about 6 months). Then after becoming disabled after an accident (RSD/CRPS) I gained weight and am now about 90 lbs overweight myself.

But back in the day it wasn't as hard as one might think. Swimming can be done daily, and the lower body intensive exercise was alternated with one day off in between. So I'd swim Monday through Saturday for an hour each morning, and then at the end of the day either run or bicycle for about 30 minutes, alternating days. Saturday and Sunday I'd go on a longer bike ride or run to hit my mileage target for the week, or I could take Sunday off entirely. Also on weekends I could substitute another physical activity, such as hiking or skiing or some other social sport.

My suggestion to you is the plan I keep wanting to implement--loose weight via dieting (in my case, Atkins is the only one I can stick with) until I get low enough to sit comfortably on my bike again (which is on a wind trainer so if my disability acts up I won't be stranded miles from home), or in your case perhaps to go on long walks. I figure this for me will be a loss of about 30 lbs, which is not that difficult with diet alone. Then I hope to increase my activity level on the stationary bike such that I can slowly liberalize my diet while still losing weight at a 2-3 lb/week rate.

Now, swimming will not cause a person to lose weight. But what it will do, is strengthen muscles around joints and increase your cardiac fitness. This in turn can reduce your risk of injury and increase your endurance for when you begin adopting other forms of exercise (such as bike riding or walking) which *do* help you lose weight.

So if you have access to a swimming pool--not a backyard puddle but a real pool of minimum 20 yards length--then you should start swimming laps. You can do this even at 300 lbs. If you have poor form swimming, take lessons--with summer coming up there should be a lot of classes offered. You need to become proficient enough that you feel comfortable swimming laps, not like you're just flailing in the water. Start off with about 500 yards three times a week, keep that up until it is not exhausting, then add days one per week until you're up to 6 days a week, then you can add 100 yards at a time, as rapidly as weekly. You'll want to work up to about 2000 yards a day, 6 days a week. The most common way to fit this into a schedule is to do it first thing in the morning. If you do it at the end of the day you're more likely to get tired and blow it off. You can do this now so that when you get your weight down to a level where walking doesn't whack your joints badly, you're heart will be up to the walk and your joints will have good muscle strength to protect them.

You want to be going slowly and consistently--what athletes call 'long slow distance'. Don't worry about speed or strength at this point. Since you're going for fitness not competition, those are secondary considerations and will come with time. (If you want to improve them after you've been exercising awhile, you can add weight training, but that is a whole other topic).

There used to be a book 20 years ago called the 'run easy method' or something like that. If you can find it then you can use that to guide your walking program (it works for walking or for running). It uses something called 'the target heart rate' to adjust your exercise intensity to match your current fitness level. The basic principal using the heart rate is very good to use across all the various cardiac exercises that you do.

Sports books for competitors will talk about sprint training and hills and such. Ignore all such tactics until you've been at a sport for over a year. Right now you just need to focus on the basics of getting your fitness level up.

The exercise will change the way your muscle cells handle sugar and this will help you lose weight faster. It will also increase your baseline metabolism so that you are burning energy faster when at rest. In this way you will eventually be able to go on a less restrictive diet, although your diet will probably never be able to be as free as that of someone without a history of weight problems.