Weight Loss

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Friday, September 25, 2009

Contest update, and fill update

Click contest:
I have heard from 2 of the contest winners. I am still waiting to hear from KernieC, and if SparklyJules wants to be a winner, I have stuff for you too. The other two should receive their Click stuff sometime next week.

My update:
I saw my surgeon yesterday, Dr P. I haven't seen him in over a year, since I've been seeing the PA. But the PA changed his office hours, so he's not there anymore on the only day of the week I can definitely make appointments, Thursdays. I saw Dr. P, and was shocked that he remembered me, that my band was done elsewhere, and that I was an anesthesia grad student. He still reminds me of the actor Philip C. Hoffman. We talked for a while about what's going on with my band, I updated him on the empty band-refill situation, and let him know that my weight has been stable for the most part since then. He asked if I wanted a fill, and I was honest about where I am. The fill level I have provides good restriction most of the time. It could possibly help me more if I had a little more fill, but I thought the majority of the problem was mental. This made him laugh; he said he's never heard a patient tell him that, usually it's him telling the patient. But it doesn't really help me not to look at my situation honestly. I've had 30-plus years to develop my eating habits and mental craziness around food. I know that I eat when I am no longer hungry, even now. That is by far the hardest thing to overcome.

But still, I have never been overfilled, have had extremely rare heartburn, no vomiting or "PB's", ever. We decided to go ahead with a small fill. He accessed the band, found I actually had 3.1 instead of 3.0 cc, and gave me another 0.5cc (which is actually a pretty big fill at this point) to a total of 3.6cc in a 4cc band. He told me to come back in a month to 6 weeks for follow-up.

This time, instead of following my old "liquids-only" instructions after a fill, I ate a small dinner. My husband made a curried mahi-mahi risotto and I had about 3/4 c. of that and was full. What are other surgeons saying about diet after fills these days? It seems like the old recommendation to have only liquids for 24 hours has gone away now, but I don't really know. Neither my surgeon nor the PA have ever given specific instructions for eating after a fill. In Portland, they started out saying liquids for 24 hours after a fill, then went to "take it easy", whatever that means. I'm wondering: is this no longer the general recommendation? Either way, it wasn't a problem. The fill seems pretty good. I just have to stop eating way earlier than I usually want to.

There's no getting around it. I like to eat. It's not easy to stop after a small amount when the food tastes good and I feel like eating it, even if I am "satisfied" or even "full." I used to be able to do it, when I was an early post-op and jazzed about the whole weight-loss thing (and still getting the positive reinforcement of constant weight loss). Now it's been close to 3 years, and that motivation has waned, and I don't see much weight loss anymore. I do hope to see some weight loss now, but it's going to be much more dependent on my mindset than on my restriction.

Tuesday, September 15, 2009

That's Why I Can't Eat Ice Cream....

Whoa. What we always suspected...

Ice cream really can control your brain
Certain fat molecules suppress appetite-control signals, study finds
(source:Reuters, via MSNBC.com)

Before you flip open that tub of Ben and Jerry's, be aware that ice cream really can control your brain and say "eat me."

A U.S. study by UT Southwestern Medical Center at Dallas has found that fat from certain foods such ice cream and burgers heads to the brain.

Once there, the fat molecules trigger the brain to send messages to the body's cells, warning them to ignore the appetite-suppressing signals from leptin and insulin, hormones involved in weight regulation — for up to three days.

"Normally, our body is primed to say when we've had enough, but that doesn't always happen when we're eating something good," said researcher Deborah Clegg in a statement.

"What we've shown in this study is that someone's entire brain chemistry can change in a very short period of time. Our findings suggest that when you eat something high in fat, your brain gets "hit" with the fatty acids, and you become resistant to insulin and leptin.

"Since you're not being told by the brain to stop eating, you overeat."

The researchers also found that one particular type of fat — palmitic acid which is found in beef, butter, cheese and milk, is particularly effective at instigating this mechanism.

The study was performed on rats and mice but the scientists say their results, published in The Journal of Clinical Investigation, reinforced common dietary recommendations to limit saturated fat intake as "it causes you to eat more."

The study was conducted by exposing rats and mice to fat in different ways — by injecting various types of fat directly into the brain, infusing fat through the carotid artery or feeding the animals through a stomach tube three times a day.

The animals received the same amount of calories and fat and only the type of fat differed. The types included palmitic acid, monounsaturated fatty acid and unsaturated oleic acid which is found in olive and grapeseed oils.

"The action was very specific to palmitic acid, which is very high in foods that are rich in saturated-fat," said Clegg.

Monday, September 14, 2009

The Real Cause of Obesity (Newsweek)

Newsweek is running a web-exclusive series called The Fat Wars: America's Weight Rage. There are lots of great articles in it. I thought this one was particularly relevent: The Real Cause of Obesity.

I'm so tired of the moralizing about obesity, the blaming, the shaming. We should take responsibility for the things that are within our control, and that means doing what we can to control our weight. But we should also acknowledge that there are things about our weight that are not so much in our control. There is a genetic predisposition to obesity in many people, and eating the modern American diet (in the modern American way: big portions, big calories) will unveil this tendency towards obesity in most of us. Also, when we lose weight (a lot of weight), our metabolisms adjust to help us hold onto whatever calories we ingest. Same goes for exercise: studies have repeatedly shown that our bodies respond to increased activity by increasing intake. Usually our exercise only burns a few hundred calories at a time, and it's very easy to ingest a few hundred more calories without noticing. This is why just exercise doesn't cause weight loss in most people.

The fat wars are becoming more public as talk of health care reform intensifies. The press and the public are identifying the biggest health care costs and arguing over how to address them in a system where potentially the taxpayers will be (overtly) bearing more of the direct costs, and obesity is one of those areas. There is a lot of finger-pointing going on. But WE know that obesity is not a moral failing. It isn't a sign of laziness or stupidity. The solution ISN'T "take the fork out of your mouth." Wouldn't it be great if, as a society, we could actually address the real causes and conditions of obesity as a society, in a holistic way, rather than pointing fingers and shaming? What if we could devote more research to things other than the magic weight-loss pill (that will make some company billions of dollars, even if it causes other health problems, a la Fen-Phen), and identify real ways to prevent and treat obesity long-term? What if we actually stopped publically supporting the corporations that profit from our food addictions and susceptibility to marketing and subtle ways of getting consumers to eat more high-calorie junk? What if we altered the way we work and live to make room for a healthier lifestyle as a society?

But no, instead we spend our energy complaining that the new surgeon general, Regina Benjamin, recipient of the MacArthur Genius award and champion of rural primary health care, is not qualified for the position because she is obese. Never mind that she is a real representation of the real problem that most Americans face: healthy lifestyle, extremely busy professional and personal life, trying to get a handle on weight. By all accounts she is active and healthy, but obese. Hey, that sounds familiar! Perhaps she could actually be an example for Americans? Is that possible?

Anyway, I found the article to be interesting and refreshing. Enjoy.

Contest Winners

The contest ended on Saturday, but I was out of town, rafting the Tieton River with friends. It was lots of fun, and renewed my jones for getting outdoors more and doing more stuff--hiking, camping. I want to learn how to river kayak, and living in eastern Washington, there are lots of rivers around here great for rafting and kayaking. So...stuff to look forward to next summer.

There are 4 contest winners: KernieC, Jo, and HillHilly, plus Sparkly_Jules, who asked not to be entered in the contest but officially has another chance here. You don't have to have had WLS (or be in the process) to be in the contest, so if you want to try this stuff out, I'm happy to send it to wherever you are.

So, contest winners, send me either your email address OR your mailing address in a comment on this post. I will not publish the comment or your personal information (I moderate the comments here), just use it to send you your goodies.

Thanks for your entries. It was really fun to read your stories on here, and fun to check out the blogs that were linked to some of the profiles. (SparklyJules, it's been a long time since I read yours...love it!)

I know some others have sent me links to your blogs in the past...some I have checked out, some I forgot to check but wanted to. Anyone have a blog you want people to know about? I think it's time to update my blogroll, so if you want yours linked here, send me the url in a comment and I'll publish it (AND read it, promise) here.

Saturday, September 5, 2009

Sharing The Love

CLICK came through and sent me a box of goodies yesterday. Lots of goodies! So it's only right to share them with my readers. I got a bunch of single-serving packets that are easy to send to you guys. I've been thinking about how to do this, and here's how I think it will go: I will send 5 people 3 packets of Click. (I could send more people fewer, but I'm still a poor graduate student, and shipping isn't cheap.)
So, let's call it a contest. It's a simple one. I want to know a little bit about my readers. What led you to WLS? It doesn't matter if you have already had surgery, lap band or another surgery, or if you are just researching it. Just a little something about what brought you here. Leave me a comment with your story (not too long, I don't even know what the word limit is for comments on Blogger). I will choose 5 of them and post here on the blog who they are. The winners will need to comment back with your email address or mailing address--I moderate the comments here, so I promise not to publish your personal information on the blog, I will only use it to mail you your prize, and will then delete it. Promise!

I'll leave this contest open for one week. Deadline is September 12, 2009. Have fun with this! And thank you to CLICK for making this contest possible. I think you are gonna love this stuff. It's yummy and has protein and vitamins and gives you energy, what's not to love?

Wednesday, September 2, 2009

Beginners: Are there foods I can't have?

@aminorharmony asked a few weeks back about foods you can't have after lap band surgery. She is having surgery soon (congrats!) and I was planning on addressing that a while back but didn't get around to it. So, here goes.

When I was pre-op, my doctor and nutritionist went over what foods I should eat, and what foods I shouldn't eat. There wasn't a "can't" in there. They told me that a lot of bandsters can't tolerate certain foods--breads are a common one, foods that are rubbery like eggs are a problem for some, foods that are fibrous like asparagus, celary, or pineapple are another. Basically they told me that it will be trial and error, and you'll know if it's something you shouldn't eat again. Bread is probably the most common problem food, and some people can eat one kind of bread product and not another, others can't have any bread-type food at all, not even tortillas or flatbread. Which is fine, because bread isn't the most nutritious thing you could be eating anyway. Grains are important, but you can get your whole grains in other ways and skip all the carbs in bread.

Personally, I have never found a food that my band wouldn't let me eat. I've never been super tightly filled, either--I think the most I have had is 3.5cc in my 4cc band, and I've never once had reflux or had any food come back up. The tighter the band is adjusted, the more problems you are likely to have with foods that form a gummy ball or aren't chewed well enough. Some people use this to their advantage. The band helps them modify their behavior by not letting them eat certain foods, like bread. But I would offer a caveat to this--the band will never prevent you from eating the real "junk" like ice cream, candy, or most other sweets. Unless you are overfilled, if you can get water down, you can get sweets down. This is one reason that people can be overfilled and still gain weight. They like having their band so tight that it prevents overeating, but they subconsciously alter their diet to include only "soft" foods that go down easily, and just trickle through the banded stomach. This is known as "eating around the band". So, if your band is so tight that you can't eat a good band meal--4-6 oz. solid protein, then a small amount of veggies--but you compensate by eating ice cream and processed junk foods all day, you can take in a lot of calories and get no nutrition. If the tight band causes you to vomit every time you try to eat solid food, or have a lot of acid reflux, you can risk a band slip, as well.

I hope that your nutritionist went over how you should be eating once you are banded, and I hope you've started eating that way before surgery so you know what to do, and can start changing your habits now. A good band meal consists of SOLID food. You should be eating about 1/2 to 1 cup total per meal, and it should consist of solid protein (chicken or meat, fish, etc.) followed by veggies, and if you aren't full/satisfied yet you can have a little starchy food like potatoes. You should not drink while eating, because this can wash food through the banded stomach and cause you to eat more. Your meal should keep you satisfied for 3-4 hours. All of this is once you are past the post-op diet and have had a few fills so that you are starting to experience what bandsters call "restriction".

Refill update

Well, here it is, September already. I miss you, August. Please come back soon.

Yesterday I returned to my band people to check out the status of my refill 2 weeks ago. It seems that my (new) band surgeon has turned over all things band-related to his PA, Brian. Which is fine with me. Brian is the band guy at NW Surgical Bariatrics. That's cool. I get that surgeons like doing surgery, not long-term management afterward. I know, I know, but really. There's a reason that bariatric surgeons often recommend gastric bypass when the band would work just fine--they didn't go to med school and do a surgical residency and a bariatric surgery fellowship just to manage fills and help patients figure out that drinking a McDonald's milkshake every meal will not help their weight loss. Surgeons like doing surgery. So my surgeon turned over band management to the PA, which is not unusual and works out fine for everyone.

Anyway, there was good news when he accessed my port: all 2.5cc were still there. It felt like there was nothing there again, but it was there. He said this isn't uncommon, and I know many people have talked about their fills "settling in" after a day or so. He added 0.5cc to put me at 3cc total, and told me to come back to check on it again in 2 weeks.

We also talked about how losing this last bit of weight is going to be all in the details. In the beginning, you can go along doing the "right" things 80% of the time and lose weight. But he used a good analogy for the last few (several?) pounds of major weight loss. He said if you want to get an A in a class, you have to get about 95% right, and that's what I'll have to do now to get an A in my weight loss. Eat the right things 95%, exercise right 95%. That makes good sense to me. He also reiterated what I have said on this blog for a long time: I am more efficient at storing calories than many people are, or in other words, I have to eat fewer calories to lose weight than most people do. There are people who are even more efficient than I am, and they have to work even harder, but a few calories makes a big difference for me. The same is true for most people who have WLS. If simple dieting would have worked for us, we wouldn't have had surgery.

I'm happy not to have surgery looming on me now. I still wonder what happened to 2.5cc over the course of 15 months (since my previous fill). The saline fairies must have taken it. I guess I will just be more vigilent about keeping a good fill level and going back to the office if things don't seem right.

In the future, if I do find the band is leaking, I'll do what I have to do then. For now, I hope I can get back to a place where I am losing weight again and keeping it off. I do acknowledge that gaining only 15 pounds with an empty band for 6 months is itself something of an accomplishment. I don't want to think too much about that, though, because complacency will not get me to goal.