Recent Posts
Topic: RE: ..starvation mode..
Please see my reply to earlier questions posed by Ms. Court & others.
Although I would respect a personal trainer's opinion on exercise physiology, muscle-building, ROM etc, unless he/she has a great deal of experience with WLS anatomy & nutritional science, I would be careful in evaluating this advice.
After all - you were in "starvation mode" a full year after your RNY, and yet managed to lose weight, did you not? The whole point of RNY or Lap-Band surgery is to trick the mind into thinking it's NOT in starvation mode - yes, you truly ARE, yet you're not constantly HUNGRY because your pouch nerve endings signal your hypothalamus in your brain that you're SATISFIED, and these signals override the hunger signals of starvation mode. [also, with RNY there are other hormonal triggers that suppress hunger like leptin & protein-YY, but those are theoretical and beyond complicating the issue].
Also, the only REAL way of dianosing starvation mode is to measure your urine for ketones [easy to do; teststrips from pharmacy; frequently done with Atkins diet]. I wouldn't be surprise if you were, but that doesn't mean you can't lose weight. Loss of weight is still a simple equation: calories in< calories out. You may be adding muscle mass, but that's not a bad thing. However, 2-3 extra protein drinks a day may be adding a lot of calories you really don't need.
The bottom line is that if you are eating & drinking right (see my other post) and STILL hungry between meals, it means you might have an issue with your pouch or your stoma. I would encourage you to see your surgeon to a) review with him the very habits you described in your post, including a journal of 2 weeks of calorie intake, and b) if your habits are spot-on, have him consider an Upper GI to assess your pouch & stoma.
Good luck!
Although I would respect a personal trainer's opinion on exercise physiology, muscle-building, ROM etc, unless he/she has a great deal of experience with WLS anatomy & nutritional science, I would be careful in evaluating this advice.
After all - you were in "starvation mode" a full year after your RNY, and yet managed to lose weight, did you not? The whole point of RNY or Lap-Band surgery is to trick the mind into thinking it's NOT in starvation mode - yes, you truly ARE, yet you're not constantly HUNGRY because your pouch nerve endings signal your hypothalamus in your brain that you're SATISFIED, and these signals override the hunger signals of starvation mode. [also, with RNY there are other hormonal triggers that suppress hunger like leptin & protein-YY, but those are theoretical and beyond complicating the issue].
Also, the only REAL way of dianosing starvation mode is to measure your urine for ketones [easy to do; teststrips from pharmacy; frequently done with Atkins diet]. I wouldn't be surprise if you were, but that doesn't mean you can't lose weight. Loss of weight is still a simple equation: calories in< calories out. You may be adding muscle mass, but that's not a bad thing. However, 2-3 extra protein drinks a day may be adding a lot of calories you really don't need.
The bottom line is that if you are eating & drinking right (see my other post) and STILL hungry between meals, it means you might have an issue with your pouch or your stoma. I would encourage you to see your surgeon to a) review with him the very habits you described in your post, including a journal of 2 weeks of calorie intake, and b) if your habits are spot-on, have him consider an Upper GI to assess your pouch & stoma.
Good luck!
David C. Elliott, MD, FACS, FASMBS
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Topic: RE: LOOKING FOR SURGEON.... IM A MILITARY SPOUSE!
i absolutely LOVE Dr Halmi. He was my lifesaver!
Topic: RE: LOOKING FOR SURGEON.... IM A MILITARY SPOUSE!
See my reply to your earlier email: I'm pretty sure Walter Reed still has a good bariatric program. Don't know of any other military programs or military surgeons in northern VA area. There are 3 of us ex-military types here in Richmond, although it's a bit of a hike (90 minutes IF there are no backups on I-95!)
David C. Elliott, MD, FACS, FASMBS
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Topic: RE: Dr. Elliot - we have some questions
Oh yeah PS to my "healthy habits" above: that's for MAINTAINING weight in RNY steady state. If you want to LOSE more:
a) increase exercise to 5-6 days per week
b) no snacks at all
If a RNY patient finds they're losing TOO MUCH weight (which occasionally happens), I'd rather them add 1-2 healthy snacks/day (deli meat, fruit; not Snickers or Nabs) than increase meal size or give up on exercise
a) increase exercise to 5-6 days per week
b) no snacks at all
If a RNY patient finds they're losing TOO MUCH weight (which occasionally happens), I'd rather them add 1-2 healthy snacks/day (deli meat, fruit; not Snickers or Nabs) than increase meal size or give up on exercise
David C. Elliott, MD, FACS, FASMBS
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Topic: RE: Dr. Elliot - we have some questions
Oh, forgot: vitamins.
I usually recommend Flinstones Complete or Centrum Chewable, initially 2 daily in AM for 1st 6 months (when meal size is < 1/2 cup) and 1 daily thereafter, forever.
Only other supplement needed is Calcium/Vitamin D (you can't take calcium with iron, as they interfer with each other's absorption); calcium is best absorbed in afternoon, so I recommend a Viactive Chew after lunch & 1 after dinner - almost like a desert!
I usually recommend Flinstones Complete or Centrum Chewable, initially 2 daily in AM for 1st 6 months (when meal size is < 1/2 cup) and 1 daily thereafter, forever.
Only other supplement needed is Calcium/Vitamin D (you can't take calcium with iron, as they interfer with each other's absorption); calcium is best absorbed in afternoon, so I recommend a Viactive Chew after lunch & 1 after dinner - almost like a desert!
David C. Elliott, MD, FACS, FASMBS
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Topic: RE: Dr. Elliot - we have some questions
Hi y'all,
Thanks for your questions. Sorry been out of the loop for a few days. As far as "steady-state" post-RNY calorie intake, there are no hard & fast rules or data. I try to get my patients, long-term, to get out of burden of having to count calories or grams of protein every day for the rest of their lives. Rather, I think healthy habits may help them keep weight stable as well as their sanity!
These habits include:
1) Three (not 2, not 6) solid meals (not soup, not yogurt) daily, each no bigger than one-1.25 cup in size (and, yes, you have to MEASURE that meal at least once a day because your eyes will LIE to you about how big your meal is!!), and each consisting, half of good protein (meat, egg, fish) & half green veggies; SCANT amounts (< 1 TBSP) starch like potatoes & even fruit. Watch the sauces, gravies, salad dressings (use "spritzer" instead of Ranch....)
2)Hydration: at least 48 ounces , preferably 60 ounces daily liquids a) non-carbonated! b) no calories!! (yes, there are calories in fruit juice, lattes, sweet tea, Gatorade, skim milk; cut out protein drinks between meals too - you don't need extra protein if you're eating meals right); c) between meals (don't drink with meals or 60-90 minutes afterward).
3) No other calories between meals: keep a journal to see if you're sneaking in calories - coffee creamer, handful of nuts or crackers at work, nighttime TV-watching deserts etc. Also watch for those liquid calories.
4) Exercise! At least 3 days a week.
With this, I would think most individuals should be getting 1200-1500 cal a day, balanced by similar expenditure with exercise.
If you're following these guidelines and a) 1.25 cup food doesn't fill you up, 2) you're getting STARVED 3 hours after meal and c) you know you're not drinking with or within 1 hour after meal, it could mean your pouch or stoma are stretched, & you might benefit from having your surgeon check it out.
Thanks for your questions. Sorry been out of the loop for a few days. As far as "steady-state" post-RNY calorie intake, there are no hard & fast rules or data. I try to get my patients, long-term, to get out of burden of having to count calories or grams of protein every day for the rest of their lives. Rather, I think healthy habits may help them keep weight stable as well as their sanity!
These habits include:
1) Three (not 2, not 6) solid meals (not soup, not yogurt) daily, each no bigger than one-1.25 cup in size (and, yes, you have to MEASURE that meal at least once a day because your eyes will LIE to you about how big your meal is!!), and each consisting, half of good protein (meat, egg, fish) & half green veggies; SCANT amounts (< 1 TBSP) starch like potatoes & even fruit. Watch the sauces, gravies, salad dressings (use "spritzer" instead of Ranch....)
2)Hydration: at least 48 ounces , preferably 60 ounces daily liquids a) non-carbonated! b) no calories!! (yes, there are calories in fruit juice, lattes, sweet tea, Gatorade, skim milk; cut out protein drinks between meals too - you don't need extra protein if you're eating meals right); c) between meals (don't drink with meals or 60-90 minutes afterward).
3) No other calories between meals: keep a journal to see if you're sneaking in calories - coffee creamer, handful of nuts or crackers at work, nighttime TV-watching deserts etc. Also watch for those liquid calories.
4) Exercise! At least 3 days a week.
With this, I would think most individuals should be getting 1200-1500 cal a day, balanced by similar expenditure with exercise.
If you're following these guidelines and a) 1.25 cup food doesn't fill you up, 2) you're getting STARVED 3 hours after meal and c) you know you're not drinking with or within 1 hour after meal, it could mean your pouch or stoma are stretched, & you might benefit from having your surgeon check it out.
David C. Elliott, MD, FACS, FASMBS
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Bariatric Surgeon & Bariatric Medical Director
Parham Doctors' Hospital
Richmond, VA
Topic: RE: missing for a couple of days
Sorry for your loss and just know that you and your family is in my prayers.
Topic: RE: Plastic Surgeon in Woodbridge, VA area
Insurance doesn't usually pay fpr plastics sadly.... every case is taken individually. I used Dr Mitchel Krieger of Fair Oaks - the man is a GOD! I am mega happy with everything he did for me and many others have used him here too and love him - he specializes in bariatric plastic surgery so you could not be in better hands - your first consult is free....
You need to have a stable weight first because you dont want to have plastics and then lose another 70 lbs.....
You should just go and have a talk to him - there is no pressure...
Jackie
You need to have a stable weight first because you dont want to have plastics and then lose another 70 lbs.....
You should just go and have a talk to him - there is no pressure...
Jackie
Topic: RE: LOOKING FOR SURGEON.... IM A MILITARY SPOUSE!
Hiya,
I had Dr Halmi and can't say enough good things about him and his practice! He is a wonderful surgeon!
Jackie
I had Dr Halmi and can't say enough good things about him and his practice! He is a wonderful surgeon!
Jackie
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