PlumpKitty

Send Message

Block

Add Friend

 

You just got into a knockdown-dragout fight with your spouse. Or your kid. Or your mom. Or the guy behind you in the checkout line. Your reaction is to head for the kitchen to soothe yourself with something smooth, fattening, creamy, sugary, salty, or crunchy — pick your poison.

Sound familiar? If so, you're an emotional eater. But you've probably figured that out already. You've probably also figured out that unhealthy overeating leads not only to weight gain but to a destructive pattern of anxiety and self-loathing that's tough to break on your own. Want to break the cycle? I'm here to help.

You've got to start by facing the fact that there will never be a totally stress-free time in your life. There. That's as bad as it gets. Now on to the good news: You can stop emotional eating. The key is to identify the things that make you feel pressured, sad, angry, or anxious. Once you understand your triggers, you can break the cycle and start regaining control of when, why, and how you eat.

The best way to identify your emotional triggers is through self-examination. Face your issues. Bring them out of your subconscious and into your conscious reality. This is the most empowering thing you can do for yourself.

To change the present, you have to let go of your past. Forget about the times when you binged because you were upset, hurt, angry, or depressed. The past does not define you; the present does. Having a crystal clear vision of the future affects your behavior now. Let your daily actions be governed by your game plan for a new you. Keep that game plan in the forefront of your mind by writing about it and letting it become real. There's no deadline. Just commit to the process and take it day by day.   ~taken from today's daily email from www.jillianmichaels .com

http://www.billingsgazette.com/newdex.php?display=rednews/2005/08/31/build/health/60-naturo-meds.inc

Sugar operates like addictive drug in body

Rachel Roberts Oppitz
NATUROPATHIC MEDICINE

What's all the hype about sugar? Why is it so bad for people?

S.S., Shepherd, Mont.

 

Let's begin with a little sugar trivia:

A 20-ounce bottle of Coke contains 17 teaspoons of sugar.

In colonial times, the average amount of sugar consumed was four pounds per year. Cardiovascular disease and cancer were uncommon.

Currently, the average person eats 155 pounds of sugar a year, which is equivalent to more than half a cup per day. The average teen boy eats twice as much sugar than any other age or gender group. That puts him at over a cup of sugar a day.

Most children get on average 20 percent of their daily calories from sugar - that means 29 teaspoons of refined sugar daily.

Only one child in five consumes the recommended minimum of five fruits and vegetables a day, while the top 10 sources of carbohydrates in children's diets include soft drinks, cakes, cookies, jam, fruit drinks and fruit snacks.

Children who eat lots of sugar consume significantly lower amounts of protein, vitamin E, B vitamins, iron and zinc.

Most people are addicted to sugar, and along with grain addiction, the overconsumption of added sugars is one of the major health problems facing our nation today.

Although many people do not consider food a drug, sugar, white flour and refined carbohydrates are akin to drugs in that they are addictive substances with effects on brain neurotransmitters similar to those from alcohol. The taste for sweets leads to a craving for more sugar, just the way other drugs create cravings. Trying to go "cold turkey" from a diet with a heavy emphasis on these foods can result in withdrawal symptoms including strong cravings, fatigue, mood swings, irritability, depression, headaches and dizziness.

Sugar and refined carbohydrates are also intoxicating, causing the brain to increase its production of the chemicals dopamine, serotonin, and norepinephrine. This process leads to a high, similar to that from alcohol and other drugs.

Sugar depletes the body of calcium, phosphorus, chromium, vitamin E, magnesium, B vitamins and potassium. Vitamins B1, B2, and B6 are needed to detoxify and metabolize sugar; our bodies particularly need vitamin B1 to metabolize sugar. Sugar also increases the magnesium and calcium excretion in our urine and decreases the overall absorption from our food (which predisposes to osteoporosis). Just two teaspoons of sugar causes the calcium level to rise in the bloodstream while the phosphorus level drops, forcing all the other minerals in the body to go out of balance as well. Sugar increases the loss of potassium because it causes the urine to become alkaline.

It is no secret that dental diseases such as periodontal (gum) disease and cavities are related to refined sugars. If you consume three sugar snacks per day, dental destruction exceeds dental and skeletal formation for up to six hours per day.

Learning disabilities and behavior problems are also associated with sugar intake due to allergy, yeast overgrowth, or low blood sugar reactions.

The digestive tract is often referred to as the "Root of the Tree" because the entire body is impacted by the health of the intestines and liver. Excesses of refined sugars contribute to dysbiosis, an abnormal ecology, favoring unfriendly bacteria and fungal overgrowth. This imbalance is the source of an entire array of symptomatology, including fatigue, depression, dermatitis and fibromyalgia.

Elevated blood sugar levels cause increased liver cell division and may lead to liver enlargement and excess fat deposition there. The heart and cardiovascular system are also vulnerable to sugar - excess sugar in the bloodstream stimulates the generation of free radicals; in blood vessels, free radical damage causes an accumulation of plaque that can lead to blocked arteries and cardiovascular disease. Increased refined carbohydrate intake also elevates insulin levels, which lead to inflammation and atherosclerosis/arteriosclerosis.

Type II diabetes and obesity are caused and exacerbated by overconsumption of refined carbohydrates. As sugar is stored in the form of fat tissue, resistance to insulin is exaggerated, and as fat cells manufacture additional estrogen, greater insulin resistance develops. Overweight people commonly find they can eat less and less and still gain weight.

For more simple solutions on how to reduce or eliminate refined sugar consumption, please visit our Web site at www.yncnaturally.com.

 

Rachel Roberts Oppitz, ND, is a resident at Yellowstone Naturopathic Clinic. She completed pre-med at Gustavus Adolphus College in St. Peter, Minn. She received her doctorate of naturopathic medicine from the National College of Naturopathic Medicine in Portland.

Richard Horton, editor of the British medical journal The Lancet, has said that "The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability -- not the validity -- of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong."

Pouch Rules for Dummies

INTRODUCTION: 

A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren't really trying to lose weight. The truth is it may be because they haven't learned how to get the "satisfied" feeling of being full to last long enough.

HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1) Weight loss occurs by actually "slightly stretching" the pouch with food at each meal or;
2) Weight loss occurs by keeping the pouch tiny through never ever overstuffing or;
3) Weight loss occurs until the pouch gets worn out and regular eating begins or;
4) Weight loss occurs with education on the use of the pouch.

PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness.

What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing himself or herself, or does the pouch actually re-grow in a healing attempt to get back to normal? 

For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs.
We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.

OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon's "observations" as opposed to "blind" or "double blind" studies, but it IS based on 33 years of physician observation.
Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe turned into an advantage, as I was able to follow my patients closely. The following are what I found to effect how the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1 ½ cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch is important.
5. By lightly stretching the pouch with each meal, the pouch sends signals to the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched for a while.
7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight hours.
9. After 1 year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible ("water loading"), the patient will get a feeling of fullness that lasts 15-25 minutes.
11. By eating "soft foods" patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain.
12. The patients that follow "the rules of the pouch" lose their extra weight and keep it off.
13. The patients that lose too much weight can maintain their weight by doing the reverse of the "rules of the pouch."

HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the "rules of the pouch," it doesn't matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
OUTLET SIZE:
Regardless of the outlet size, liquidity foods empty faster than solid foods. High calorie liquids will create weight gain.
EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full.
After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time.
OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time.
IDEAL MEAL PROCESS (rules of the pouch):
1. The patient must time meals five hours apart or the patient will get too hungry in between.
2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal.
3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure.
4. No liquids for 1 ½ hours to 2 hours after each meal.
5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake.
6. 3 hours after last meal, begin drinking LOTS of water/fluids.
7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called "water loading," IF YOU HAVEN'T BEEN DRINKING OVER THE LAST FEW HOURS, THIS 'WATER LOADING' WILL NOT WORK.
8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient preoperatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective.

NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the "rules of the pouch" before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn't work. The real work of learning the "rules of the pouch" begins after healing has caused hunger to return.

PREVENTION OF VOMITING:
Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick.

It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient's mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.
In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting.

Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc., will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when "comfortably satisfied," until the patient learns the size of his/her pouch.

SIX WEEKS:
After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours
after meals.

REASSURANCE OF ADEQUATE NUTRITION:
By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on proteins and vegetables at each meal.

MEAL SKIPPING:
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal.

ARTIFICIAL SWEETENERS:
In our study, we noticed some patients had intense hunger cravings, which stopped when they eliminated artificial sweeteners from their diets.

AVOIDING ABSOLUTES:
Rules are made to be broken. No biggie if the patient drinks with one meal - as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party - that's OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up.

THREE MONTHS:
At three months, the patient needs to become aware of the calories per gram of different foods to be aware of "the cost" of each gram. (cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures.

THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY:
1. Fill pouch full quickly at each meal
2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
3. Protein, protein, protein. Three meals a day. No high calorie liquids.

FLUID LOADING:
Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz.

Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time.

POST PRANDIAL THIRST:
It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won't make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow.

URGENCY:
The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time.

SIX MONTHS:
Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat.

INTAKE INFORMATION SHEET AS A TEACHING TOOL:
I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them "back on track." Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to "get it", and a small percentage never quite understand these rules, even though they are quite intelligent people.

HONEYMOON SYNDROME:
The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don't need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the "honeymoon syndrome" and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient's weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track.

EXERCISE:
In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down.

THE IDEAL MEAL FOR WEIGHT LOSS:
The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health.

VOLUME VS. CALORIES:
The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don't worry about calories. This is the easiest way to "count your calories." For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings - it would stuff them way too much.

ISSUES FOR LONG TERM WEIGHT MAINTENANCE:
Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off.

COUNTER-INTUITIVENESS OF FLUID MANAGEMENT:
I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a "soup" in the stomach that is easily digested.

SUPPORT GROUPS:
It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others "get it" and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a "peer pressure" to stick to the rules that the staff at the physician's office simply can't create.

TEETER TOTTER EFFECT:
Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left. Now if you don't concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh.

TOO MUCH WEIGHT LOSS:
I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially "break the rules" of the pouch. Drink with meals so they can eat snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories. A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have
experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don't "get" that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger.

BARIATRIC MEDICINE:
A much more common problem is patients who after a year or two plateau at a level above their goal weight and don't lose as much weight as they want. Be careful that they are not given the "regular" advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets.
SUMMARY:
1. The patient needs to understand how the new pouch physically works.
2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes.
3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch. The goal is for the patient to become an expert on how to use the pouch.

EVALUATION FOR WEIGHT LOSS FAILURE:
The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up.
1) the staple line needs to be intact;
2) same with the outlet and;
3) the pouch is reasonably small.
1) Use thick barium to confirm the staple line is intact. If it isn't, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a re-operation must be done to actually separate the pouch and the stomach completely and seal each shut.
2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call "soft calorie syndrome." This causes frequent hunger and grazing, which leads to weight regain
3) To assess pouch volume, an upper GI doesn't work as it is a liquid. The cottage cheese test is useful - eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn't be able to hold more than 1 ½ cups in 5 - 15 minutes of quick eating.
If everything is intact then there are four problems that it may be:
1) The patient has never been taught the rules;
2) The patient is depressed;
3) The patient has a loss of peer support and eventual forgetting of rules,
or
4) The patient simply refuses to follow the rules.

1) LACK OF TEACHING:
An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery), which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test, which showed the pouch to be a small size and that there, was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago.

2) DEPRESSION:
Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for a while only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, which it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry.

3) EROSION OF THE USE OF PRINCIPLES:
Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their "new" life surrounded by those who have not had Bariatric surgery. Everything around them encourages them to live life "normal" like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician's office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer "refresher courses" for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again.

4) TRUE NONCOMPLIANCE:
The most difficult problem is a patient who is truly noncompliant. This patient usually leaves your care, complains that there is no 'connection' between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the noncompliance that causes this attitude. A truly noncompliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven't figured out how to do that yet. Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.
This rewrite was done exclusively for the people of this spotlight obesity support group. It should not be sold for any reason. "Dummies" version rewritten by Sally Perez
Original article written by:
Mason. EE, Personal Communication, 1980. Barber. W, Diet al, Brain Stem
Response To Phasic Gastric Distention.
Am J. Physical 1983: 245(2): G242-8 Flanagan, L. Measurement of Functional

Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). It is thought to represent a consequence of excessive insulin release triggered by the carbohydrate meal but continuing past the digestion and disposal of the glucose derived from the meal.

The prevalence of this condition is difficult to ascertain and controversial, because a number of stricter or looser definitions have been used, and because many healthy, asymptomatic people can have glucose tolerance test patterns said to be characteristic of reactive hypoglycemia. It has been proposed that the term reactive hypoglycemia be reserved for the pattern of postprandial hypoglycemia which meets the Whipple criteria (symptoms correspond to measurably low glucose and are relieved by raising the glucose), and that the term idiopathic postprandial syndrome be used for similar patterns of symptoms where abnormally low glucose levels at the time of symptoms cannot be documented.
Common symptoms

Although symptoms vary according to individuals' sensitivity to the elevation and decline of glucose levels, some of the more common symptoms are:

• fatigue
• dizziness
• light-headedness
• sweating
• headaches
• palpitations
• depression
• nervousness
• irritability
• tremors
• flushing
• craving sweets
• increased appetite
• rhinitis
• epileptic-type response to rapidly flashing bright lights

[edit] Causes

There are different kinds of reactive hypoglycemia: [1]

1) Alimentary Hypoglycemia (consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery)

2) Pre-diabetes

3) Hormonal Hypoglycemia (due to lack of some hormones; i.e., hypothyroidism)

4) Helicobacter pylori-induced gastritis (some reports suggest this bacteria may contribute to the occurrence of reactive hypoglycemia)^[1]

5) Congenital enzyme deficiencies (hereditary fructose intolerance, galactosemia, and leucine sensitivity of childhood)^[2]

6) Idiopathic reactive hypoglycemia

7) Late Hypoglycemia (Occult Diabetes; characterized by a delay in early insulin release from pancreatic B cells, resulting in initial exaggeration of hyperglycemia during a glucose tolerance test)^[3]

To check if there is real hypoglycemia when symptoms occur, you can have an OGTT, or even more accurate for this kind of diagnosis, a "breakfast test". [2] Then, additional tests may be applied to see if there is another disease (i.e. hypothyroidism) causing the reactive hypoglycemia.

[edit] Treatment

To relieve reactive hypoglycemia, some health professionals recommend taking the following steps:

• Eat small meals and snacks about every 3 hours.
• Exercise regularly.
• Eat a variety of foods, including meat, poultry, fish, or non-meat sources of protein, foods such as whole-grain bread, fruits, vegetables, and dairy products.
• Choose high-fiber foods and food with a moderate-to-low glycemic index.
• Avoid or limit foods high in sugar, especially on an empty stomach.
• Avoid alcohol, caffeine, and highly starchy foods such as white rice, potatoes, corn, and popcorn (all very high on the glycemic index).
• Adding soluble fibers (e.g., 5 to 10 grams of hemicellulose, pectin, or guar gum) to a meal may help to relieve symptoms, especially in dumping syndrome. [3]

Your doctor can refer you to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet for reactive hypoglycemia. If the diet does not provide a relief in symptoms, there are some medications which can be useful in reactive hypoglycemia, and that should be administrated only by a physician.

Pre ops and newbie post ops PLEASE PLEASE PLEASE heed the following :)

Weight loss over TIME is basic mathematics. Weight loss in the short term is not predicatable for anyone. You may be normal, abnormal or a mixture of the two. Rest assured you arent the only one scared when the scale stops moving.

Things to keep in mind:

Many of us are weight loss resistant. In simple terms our bodies are fat hoarders. We are efficient little eating machines waiting for the apocolypse. Your body wants to be able to say "seee told ya so" when you get stuck under rubble for 3 weeks after an earthquake and live through it. Sadly you are more likely to stroke or heart attack first, apparently our bodies arent as smart as they could be :P

Most of us will lose a nice chunk of weigh post op, 10 - 50 pounds in a week or two. Then the brakes are ON and the weight loss seizes up. This doesnt mean you are doing something wrong AND it doesnt mean you are doing something right. It means your body is ticked and slipping into hybernation syndrome. It will try to shut down and wait out the food shortage. You will likely feel ravenous, tired and depressed through this. This is normal. This is also why we failed at diets long term, our bodies rebell. Its not a matter of will power it a matter of your body overriding your brain. Thanks to surgery you cannot feed this need. 

After a week or 10 your body will finally start burning fat at a reasonable rate to subsidize your limited diet. At this point you should start feeling somewhat energetic and less depressed. 

For many people this will only happen once. For me it happened every couple of months. Starvation mode sets in, my depression bottoms out, my energy shrivels up and dies and all I want to do is sleep. I learned to up my cals by 200 a day everytime I hit this phase and that was all it took to coast on through. 

Currently Im in a calorie deficit. Im not sure if its because my body does not want to burn more stores or because Im running out of stores to use. The problem is Im at my mental and physical calorie limit right now. I am trying to bump up to 2000 cals a day everyday and it just isnt happening. I burn out on 1500. Waaa BUT enough about my problems :)

Why is all of this info so important? In the first 6 months after surgery you HAVE to relearn how to eat. Now you can relearn to eat exactly like you ate pre op which leads to regain in a couple years or you can relearn how to eat like a "healthy" person and create habits that will help you maintain weight loss for life. Either way you WILL lose a LOT of weight but the long term is what is important. Who cares if you weighed 150 last year if youre back up to 250 this year.

So when the big stalls hit, our natural response is *fluck it!* Im gonna eat what I want since this doesnt work anyway. Over time this decision will either make weight loss as hard as it always was or sabatogue you into gaining weight later.

Learn the post op life. Learn what successful long term post ops do (no I dont mean me, at 16 months Im still in the "honeymoon") and especially learn what unsuccessful long term post op do. You get the habits all down pat and the weight loss will take care of itself.

I admit I have been a daily weigher. I love weighing. It thrills me to see the number. I dont care if its 2 or 8 pounds more than it was yesterday, I care that its not what I started out as. I dont think weighing is bad, I think some people take the scale waaaay too seriously. 

Anywho.. thats my preaching for today :)

A lot of people here talk about eating normally as their goal. We never define "normal" though. There is normal for a SMO person, normal for chubby people, normal for healthy people and normal post wls people to consider. The word normal is so ambiguitous that I almost cringe when I see it now.

The "normal" person in our society is overweight, eating too many processed/refined foods, suffering from food related illnesses and likely to die of a lifestyle related illness (heart disease, stroke, cancer: all food/lifestyle related and they are the bigguns)

So I would like to as unshamefully as I can compare my pre op "normal" to my post op "normal". I am a terrible creature of habit so my old volume is not something I will forget easily.

"Healthy" Foods:

I have always LOVED yogurt and cottage cheese. I prefer 2% cottage cheese and fat free, sugar free yogurt. Pre op I would grab the tub of yogurt or cottage cheese and eat it. Post op I measure out 1 cup of yogurt or 1/2 cup of cottage cheese. Yogurt is 70 cals per cup and 300 cals per tub. Cottage cheese is 110 cals per 1/2 cup and 440 cals per tub. 

Fruit!! I have always loved fruit. Its been a staple of mine forever. Generally fruit is a "snack" for me now because a whole piece fills my pouch. If I eat with a meal I eat 1/2 of a medium sized fruit. I have eaten at one setting, 12 mandrin oranges, a whole honeydew melon, 1/4 watermelon, a large can of fruit cocktail and a few bananas. This wasnt the "meal" or the "snack" this was the beginer or ender of a meal or snack.

Veggies!! Oh how I love my salads, stirfrys, crunchy veggies n dip, and just plain cooked veggies!! I have been a rabbit food muncher my whole life. It almost makes me wonder why I relate to a kitty so much :P Today I eat 1 cup of veggies cooked and 2 cups raw either by itself or with 3oz of meat. I have no idea how much I ate then but my texas skillet which holds about 2 gallons was 1 meals stir fry for me and my giant of a hubby. A tray of pre cut veggies was 1 movies snack (not the whole snack, just that part of it was the whole tray, probably 8 cupsish then came the popcorn etc etc)

Meat??? Well meat was ok, on top of bread, pasta, crackers, chips, rice etc. 4 cups rice to 1/2 cup chicken would have been pretty normal. I have since learned that The rice, bread, pasta etc dulled my tastes. They didnt improve the meals flavour, they improved my distended tummy. So now 90% of the time I skip the breads all together and go straight for the flavour of meat and sauce. My favorites were spaghetti n meatballs, chicken fettuchini alfredo, veggie, rice and chicken stirfry. Any one of these meals at home was about 2000 calories, most of which coming from the pasta and sauce to drench it in. I actually eat the same amount of meat and veggies now the only thing cut back is the sauce and pasta.  

What about unhealty??? Well I have chosen to abstain from certain ingrediants and establishments (whites, McDs, etc) BUT I still eat the same foods as always.


Pizza delivery, sigh this was one of my worst things to do. I ate the following 1 - 3 times a week depending on how emotional I was. 1/2 square 12" pizza, 1/2 square 12" garlic cheese fingers with bacon, 1 4oz donair sauce, 2 regular donairs and then dessert. Dessert?? 1/2 super size bag o chips, 2 cups ice cream, a box of lil debbies, a few pieces of cake or whatever I was in the mood for. In the end about 6000 cals for this "meal". Today? 1 south beach diet pizza stuffs me FULL for 350 calories. Or I make a meat crust pizza for 200 cals. People wonder why I eat the meat crust pizza. Well a normal slice of homemade pizza is NOT going to give 20grams protein. Gotta keep in mind the small volume of our tummy requires a large volume of protein. If you eat regular pizza in very small quantites your calories will be great but your protein, not so much.

McDonalds/BK/KFC *shudders* Once a week I take mom out for errands. We called it picnic lunch because we ate in the truck. Keeping in mind I eat the MOST in the evening, regardless of what I ate in the day. McDs: Oreo mcflurry, lg diet coke, super sized fry, mcchicken and a big mac. This was 2400 cals, about 400 more than I should be eating in an entire day all for "lunch". If I made it in time I went to BK for the breakfast meal, large taters, 2 sausage croisants and a bacon croisant, with a diet coke! This was 1800 calories, practically dieting!! EEEP but then there was KFC which had 2 crunchy chickens and a small popcorn chicken along with 4 bbq sauces for 2000 calories and I admit this never filled me so I usually got a hotfudge sundae at DQ on the way home. I cant really compare this to what I eat now but to say I eat similar foods but nothing like these meals offer. I dont do deep fried anything now. I do eat homemade cheeseburgers on whole wheat with real cheese and sugar free ketchup. 1 burger does me 2 meals. 

Buffets??? Oh wow.. Ill sum it up quickly, I made enough trips and carried enough food to consider buffets work.

This was normal to me. 3 - 4 days a week I ate 3000 ish cals in "healthy" foods and 3 -4 days a week I ate 6000 in very very unhealthy foods. Common denominator in all of this? I simply ate TOO much for anyone. I didnt get surgery to eat normally. I got surgery to eat less, lose weight, and save my life. We all come from such different pasts but our presents have merged to be very similar. I gotta say I love my new normal and remembering how I used to eat really makes me appreciate everything surgery has done for me.

Anywho just some musings for the day :)