Dances with DS

So your labs came back. And maybe they are less than perfect. Many people will get a deficiency despite strict compliancy. You may wonder how the heck it could happen if you are so good with your supplements. I ask myself this same question. On 3000mgs of calcium and slowly upping the dose, and abundant high dose Vit D daily, plus magnesium, I continue to lose bone according to my dexa & my last labs were a little low on calcium for the first time ever, though both PTH and Vit D are normal! (Go figure!). So I know how this feels! I’m not there yet but I may be a short hop away from osteoporosis. So I ponder this a lot and in no way am I embarking on preaching to anyone.

Juggling precise amounts of doses in an imprecise body is an art form all of it’s own. The body is not a thing we can freeze in time & space and put the same formula of vits/mins into hoping it will remain solid. It might - but then again it might not.It’s one I still don’t have a handle on.Reasons for deficiency may be many, among them:

• One is simply not taking enough of a certain vitamin/mineral.

• There will be times that immune function might be lower and it uses more nutrient supply. Simply not being well, or after a surgery may cause the body to use up supplemental resources rapidly.

• Perhaps there is conflict with the minerals at the absorption sites.

• A synergistic vitamin is missing out of the whole picture or it might be in a ‘low productive’ form eg calcium carbonate.

• There may be a low grade unsymptomatic bacterial overgrowth

• Malabsorption has increased for some unknown reason. (More common is that malabsorption decreases with time, but not always!).

• One may be using medications that are affecting absorption rates or metabolism.
• One may have a strong genetic disadvantage such as myself, regarding calcium metabolism.(And to think I’m probably going to get the good old menopause too in this decade! I could weep! )

The thing is it’s sometimes a silent process. We might start by getting just a whisper of tiredness or feel perfectly fine for quite a while until it suddenly becomes symptomatic.

Then there is the Vitamin quality itself. Do we absorb oil solubles? Sometimes, but only in megamega dose. I do, my labs prove it. However I believe dry forms are the most optimal and I compromise by current supplementation of dry form Vit D. On the other hand it suits me well to consider that the V4L I take contains many many other elements and vitamins in it that a traditional dry based formula would not give me. I once tried to get the conendrum worked out & the truth is if I want to do dry plus everything V4L provides me with I would take way more than 12 vitamins daily. Many of them would need various points of sourcing giving me a nightmare scenario of juggling supplies and additional shipping costs. So it’s a compromise and as I always said not ideal. In my ideal world I would want to see a formula based on dry form ADEK with strong doses of Multi B’s, Vit C, Zinc, Selenium, Vit K2, Boron, Copper, Iron, Zinc, Manganese, Chromium,molybdenum, potassium, lutein, biotin, folic acid. Plus a bone one with Vit K2 (natto based)Quality magnesium, Top form Calcium, Vit D. I get in all the vits/mins I just listed, but it could be better, in my ideal world some kind of formula that allows maximum individual tweaking would be nice. And just in case a nice kindly manufacturer happens apon this - please get plenty of Vit K2 in the supplement, it might just turn around the bone thing, for the next generation of DS patients.

Questions I currently ask myself while pondering the complexities:

What does the average GP know about vitamins? Not very much and then put it in the context of even less understood malabsorption and it’s too daunting for some of them to even try to help us. I felt sorry for my GP last time I visited as she said ‘we must do something about your bones’…then sighed and said it was best dealt with by my surgeon. For years I and many of my DS & RNY brothers and sisters have poured over any tidbit of vitaminology we can lay our minds on. Has it prevented me getting deficiencies. No. It hasn’t. It has however helped me quickly resolve some of them in the past and as a result I feel strangely optimistic about the future.

I say ’strangely optimistic’ , because it is peeving and sometimes it puts one in a head funk to be trying to find solutions for deficiencies. I hedge my bets that the DSer who escapes minor (but irritating) deficiencies longerterm is the exception rather than the rule. This is part of the landscape for many of us. The trick is to try to keep the deficiency in the minor league & that is not always easy. But chins up my friends - I think we will yet win the day & make distal surgeries finally completely safe by learning more and staying on top of new data. Imagine that!

Questions I currently ask myself while pondering the complexities:

Is the vitamin cut out for the job? This is a nice sticky area. Calcium carbonate is an example of that sticky area. As is magnesium oxide. I consider these low grade quality in a DS context. But others may disagree. I have said why enough in the past so I’ll leave it at that. Other things I have thought on - can a so called carbonate turn into magic citrate? ( We have many WLS patients on this NHS version). The jury is out, but personally I’m not convinced. Time will tell.

Ready for more?

Okay, what about synergy. Each vitamin has a synergistic mineral. It’s not always logical to assume because we are low in iron we are low in Vit C or Vit A…but sometimes it is worth giving the partners a little boost while trying to put right the primary offender, specially if the labs are ‘normal but lowish’.

Then there is the question of elemental intakes. 1000mgs of calcium does not mean 1000mgs of calcium. Ditto with magnesium & now it seems this might be the case with strontium too. There is an elemental amount of calcium/magnesium/strontium in each supplement that needs to be figured out otherwise one can be hugely deluded.

We are probably going to discover new vitamins we may malabsorb. I had this unpleasant little experience myself reading up on just how complex Vit K is for example and realising there is not a hope that I absorb Vit K2 - yup it is also fat soluble. Lutien was another wake up call I had in the haze of blunted eyesight which is mercifully much better for taking it now. The problem here is that aside from clotting factor labs for Vit K1, there are no labs for Vit K2. No labs for lutein either.

Sometimes one has a genetic ground to face. In my case it’s a strong family strain of osteoporosis. My bones have consistently been losing density over the past few years according to my dexa. Yet, for close on 5 years my PTH , Vit D and calcium levels looked fine on the labs. I won’t go into it here because I mouth off about the importance of dexa’s way too much as is! But get a dexa!!!(couldn’t resist that it just snuck in, sorry, lol!).

Might sound odd but I am actually doing pretty well on the bone front - by now I would have expected full blown osteoporosis & I am not there yet. Still I feel an urgency to turn this around so I am heeding my intuition.

I have had on-off zinc deficiencies and am dealing with one as I speak. I have had short bursts of iron deficiency that I have resolved, once even unknowingly. When I went to the local hospital to seek help with my bowel obstruction they did labs. The young doctor came back and asked me a strange question: ‘Did you have an iron transfusion?’ WOT!!!? I was puzzled until she explained that my GP should have done one as my iron levels had been extremely low. It’s amazing what went through my mind - I instantly felt dogtired and faint until she re-assured me that amazingly enough my iron had corrected itself. Phew! So there we go. I had not been informed. Then I remembered feeling tired and how for a month I had taken additional iron daily. But only for a month and this was a good 4 months later & the iron was fine. Maybe I was just lucky. My last labs a few months back look fine iron wise.

I learned something through my iron and zinc deficiencies. I learned that there will be some deficiencies I will be more prone to on my DS journey. It’s highly likely they will come and go. Provided I jump them as fast as possible I will probably not need everlasting supplementation (except for the bones stuff, but that’s another story!) - just on and off tweaking. Take my first zinc deficiency. I had it in the early days of my DS and I worked with it for many months until it looked stable and some time beyond the stability point too. Then I stopped the solvazinc but still took daily zinc in the V4L formula. I had around 3 years where my zinc labs looked fine.

Don’t despair if you have a deficiency. I was dead depressed when I got my first one, but the years have passed and I’m mellower about it emotionally now. I’m not malfunctioning. My life is still 96-98% quality. (And the 96% is momentary will divulge that later!)

No deficiency is going to keep me down, so join me if you have them, in beating it the best you can. You are not alone.Tackle it from every angle possible. We have so much to live for.

More bloggings to follow on the subject…just getting my head together about it all! I’m dragging my feet in the vitaminology department because:

I want to blog about (well nearly)fun stuff and the world out there quite aside from my small life.
I want to tell you about TODAY, how we walked the dog-persons along the beautiful canal, about how the light was dappled and we are on summertime hours even though I can’t for the life of me feel any summer yet, about how I am sick of the global warming theory as a DIRECT result of low Vit D.

Seriously though read this 1st link below…at last at last some common sense about Global warming. I love this planet as much as anyone else but the global warming religion is scary stuff - blogged about it before. Armegeddon has found a new place to reside in the global warming hysteria that people like Gore perpetuate. I find it all way more terrifying than the b/s they spout in their drive to CONTROL! The issue is not global warming - it’s control freak nature. I trust nature to find it’s own way. It’s too big for us puny stoopid little humans. Support nature by all means - I’m all for that. Quit dumping rubbish, plant flowers and trees in your garden, celebrate it’s beauty and diversity, but this fear mongering is crazy stuff.

I ask myself WHY is why is this link below not mainstream news globally???

http://www.heartland.org/Article.cfm?artId=22866

http://www.climatescienceinternational.org/index.php?option=com_content&task=view&id=41&Itemid=1

I digress though. I forget to add that I was moving it down the canal path, I can move it so well now I still can’t get over my own DS gratitude. I don’t want to dwell too long in the challenges of falling off the camels back, deficiencies, farty stuff but part of me feels it’s gotta be said & then I can move on.  I will get there on the vitamin thing - I promise. It shall be written and hopefully it won’t come back to bite me on the rear. But forgive me the odd wildly random diversion - life is sweeter that way.

Now….off to go count out tomorrows dose. I think they should zoot up these vitamins tbh, like put little faces on them or something. I fancy mine posing as little pink pigs with wings on them, don’t ask me why. Think it might put the fun back into it if I had some good visual material instead of facing a VitK2 capsule that looks not unlike a baby rabbits (or small guinea pigs) dropping. Maybe they could have an educational quiz on them like ‘guess the miniscule amount of elemental magnesium in this whopping big capsule’ Or what about pertinent reminders: ‘ Did you remember your 2 liters of water today?, ‘One more helping of carb will give you gas all night!’ or just plain old ingratiating encouragement: ‘well done for being so compliant!’ Ah, the joys!

I had an interesting chat with a cardiologist yesterday after writing about Vit K2. He is using K2 for his heart patients and I was able to ask him about the interaction of Vit E and Vit K2. He said that for Vit E to cause blood thinning it takes a very high dose and that the dose I take daily (460iu’s) would have no detrimental effects in conjunction with Vit K2.

So today I continue with the K2, onwards we go.

After 10 000 thoughts on the subject, I’m in need of a decent weekend! I need to not think and so I shall get on with restoring a few of the antiques that are yelling out for TLC. I walked through my garden this morning and was aware of it needing work. All the tulip bulbs I planted are out and they have buds! The maples are full of soft spring leaf, they are so beautiful that for a while I went into gazing mode. I have avoided the garden as I get sooooo cold out there, but today I’m going to put my thermals on and start to do some work. This year I want to remove the plants in one of the over grown beds and replace them with a mini wood of silver birch trees. I love all plants, but trees remain the true love of my life. My garden is like a strange wood as it is!

I hope I can do some work on it before I leave for South Africa. I feel that my muscles have slightly diminished recently, I feel frailer and a bit weaker than I was this time last year on the muscle front, so it will only do me good. It’s felt like a long winter to me!   Speaking of South Africa, although my mum is in good nick I am scared when I think about this next leg of the journey. Last time I was strong and I held things together. I was brave, I never cried infront of my mum once about her condition. (Just by myself on the loo in the hospital!) But this year I don’t feel strong anymore. It worries me. I just tell myself to lay off the fears. There are so many in my life sometimes, perhaps this is true for many of us. I’m afraid if I break, it will not be reversible. Comes a point I hand it over to a greater plan. But I have to remind myself to do this!

Last week Pete bought me an early birthday present. He spoils me rotten this man & I am a lucky person. I found a very unique and rare Japanese Butsudan for sale. I have been a keeper of Antique Buddha figures since my late teens and I have never had the joy of finding a Butsudan in the flesh, although I have had the priviledge of standing in front of many wonderful historical Temple Altars in my past. I was pathetically excited. I felt the way a butterfly enthusiast must feel standing in a rain forest watching clouds of rare butterflies flying up into the canopies. I feel like that every time I put flowers in our Butsudan. My oldest boy, Lukey and I went to collect it last week. In the car!!! It only just fitted in but we managed - me wodged into a gap on the back seat. I was grateful for once that I have a very skinny butt!

http://en.wikipedia.org/wiki/Butsudan

Now it stands in our living room and gives me a sense of joy each time I see it. It’s incredibly intricate - must have taken an age to carve all the bits and pieces and to gild them. It has presence. I think it was well used and loved in the past.

I am not Buddhist. I might as well add that, as people often ask me this question. I have studied almost all the major religions and have a deep love and respect of all ways of wisdom. But I can’t affiliate with only one religion. I just find that too narrow and too fraught with identification & labels. I hasten to add that I am absolutely not against one way being the best way for others. It is just not for me. My way is my own way! Sometimes I connect with Sufism, other times Buddhism, sometimes I connect with original forms of Christianity, other times it is Taosim, Zen or Hinduism for me. I don’t rest in one place.

Years ago when I used to visit a great and highly respected Sanussi (Medicine man) in Africa, he threw the bones for me one day as a special gift. He started to laugh when he was looking at the patterns they had formed. Among many other things, he told me that I was a bobbing cork on the great wide ocean and that this was the way it would always be for me.

A bobbing cork. ( Thrills the ego that one - LOL ) Mmmmmm….

….but he was absolutely right!

Well, onto more personal issues!

I haven’t stopped obsessing about this osteoporosis stuff. I’ve tried to research it the best I can. I don’t have osteoporosis YET. However as much as I try to keep the wolves at bay, I know I am sliding and I have a little time in which I can hopefully stall progress to the full blown mcoy & I want to go there yesterday!

It’s not that nothing is being done about my situation. I’m just impatient as usual. I am being well monitored currently with frequent labs and yearly dexa’s. My lab situation is as follows regarding calcium : Vit D is normal, PTH is normal, calcium was a little low, for the first time in all the time I have been a DSer. I’m supplementing appropriately & in traditional DS ways daily, calcium citrate and magnesium & Vit D plus plus!. But due to a genetic propensity for osteoporosis in my family, I have a more complex bone story than most DSers. In the next three months or so I may be seeing a bone specialist with whom I will discuss the in’s and out’s of what I discuss below.

I stress that what I write is speculative and highly layperson, that’s the nature of many blogs. My bloggings are largely intended to (hopefully) sort my own stuff out and reflect how I do this via constant enquiry. I don’t believe enquiry and questing for more new knowledge ever hurt anyone. I believe we all need to do this when we have a major surgery, imo - it comes with the territory. That said, bone metabolism is serious stuff. Think about it, do even more research using various sources, do your own enquiry. Then discuss it with your specialist. This way we can all gather more useful info and try to find out what is hype and what is not.

There are two vitamins that currently interest me regarding malabsorptive patients. We all know the general fat solubles that we don’t fully absorb, Vitamins A, D, E, K. However as usual it’s not that simple.

Vit K for example has various forms. Like most of us I knew about bog standard Vit K1, the one we get from dark leafy greens and plant oils. What I never gave much thought to was Vit K2. I knew it is synthesized from Vit K1 to a degree , but that was about it. I stumbled on Vit K2 while I was driven to research how best to stabilize my bones and it has set me thinking.

A decent vitamin supplement should provide some K1 and K1 can synthesise to K2 in our intestines, but is it enough? Does it synthesize adequately to K2?

I’m not convinced. I am concerned about Vit K2 and whether we can produce enough of it. If ordinary people have deficiencies (see the first link below) then this is a real concern for WLS patients, surely? Vit K2 appears to play a vital role in our bone metabolism (more directly and more potently than Vit K1, it seems).

As usual I tried to find out more about the cons of Vit K2. And there are big cons (in both meanings of the word!)out there in the vitamin world, coral based calcium comes to mind .

In any event, I could not find any medical papers that stated it had not worked during a trial. I could not find anything about potential side effects of overdose. If the link below stating that it is going to be added to milk in the USA is true, I presume it is indeed safe.( Idid I might add, have a temporary side effect but more about that below in my little tale of starting Vit K supplementation.)

Note: It should not be taken with anti-coagulant meds such as warfarin without consulting a GP first.

Also - I know Vit E can affect clotting of the blood but I have not yet researched how Vit K & Vit E interact.

Aside from benefits for the old bones, I would hope that the anti inflammatory role Vit K2 plays may also help DSers & RNYers who have gut/bowel problems. It may help UTI’s as well? Could lack of it play a part in Chrohns disease? Who knows. But it is all worth thinking about.

I also worry that the ‘clotting test’ commonly performed to check out Vit K levels is enough to know if we have a deficiency. It might not be (again based on the info in my first link below.)

There is a tendency among DSers to write off Vit E & Vit K as ‘lesser’ than Vit A & D…I fess up I was willing to see these as less important too - until I started researching it. I think we all need to know about Vitamin K2 as we may have several factors against us for it’s natural absorption and we might be highly deficient on account of our malabsorption:

• Firstly stomach removal might affect it’s absorption, in a cancer trial where stomachs had been partly or fully removed, the patients developed osteoporosis due to lack of Vit D…..if it is possible with Vit D is it also possible with K2?? ( I better quantify that this was full removal of the stomach - and we only get part removal. The study below was done on rats and is food for thought.

http://sciencelinks.jp/j-east/article/200403/000020040304A0026938.php

• Secondly our shortened intestines coupled with any bacterial overgrowth (even low grade) might very well inhibit our natural production of it. It is an intestinal bacteria.
• Thirdly, many of us have fat malabsorption to greater or lesser degrees. Like Vit K, Vit K2 is also fat soluble unfortunately.
• What about use of flagyl? Does it affect K2 levels? Should we supplement during or after flagyl use, even if we are not dealing with a bone challenge?
• Last, but not least I doubt (particularly as we malabsorb Vit K 1) that we can eat enough veg containing K1 to allow enough conversion of K2 in our intestines.

Studies show it has effect on both bone health and heart health & there is further speculation about it regarding liver cancer and other diseases. Obviously more research has to be done and hopefully it will be. It will be interesting to see if the osteoporosis drug companies don’t start releasing some ‘anti’ papers !

Vitamin K is found in foods such as fermented cheese products, beef liver, chicken, butter and a fermented soya bean Japanese dish called natto - which I think I will skip as I hear it is slimy and smells of ammonia! Not for me!!! Cheese is going to be a better option for me - it seems cheese that undergoes fermentation is highest in Vit K2 - bring on the gouda! Cottage cheese also has it apparently. It might be a great option for RNYers and people who like it . I have found various foods listed that have it and yet these differ from source to source, so it’s difficult to be conclusive about it. As far as I know cottage cheese does not ferment, but even so, it’s good food for all surgery types. Try to verify VitK2 sources for yourself. While I will supplement with a natto based supplement as I have the bone thing going on and need to take a huge dose, I also will make a point of eating daily fermented cheese snacks to get it via food. Maybe liver & chicken will be more regular choices in my diet. As WLS patients we can’t go wrong doing this - we’ll get extra protein at the very least.

Q. How do you know if a cheese has been fermented?

A. Apparently any cheese that has holes in it has undergone fermentation.

My DS friends in the USA might be really pleased to see this: (Oh how I wish the UK would move faster on such issues!!! (Doing small frustrated muttering number!)

http://www.nutraingredients-usa.com/news/ng.asp?n=83042&m=1NIU205&c=[emailcode]

My little tale of starting on Vit K2:

I went to Boots and bought the Vit K2 a month ago. At night I lie wake fretting about the bone scans.. I actually don’t know how to do more calcium as the constipation already is gruelling.

A few DS surgeons are saying we must go for 4000mgs plus a day. But I wanna know (as usual), if we take this amount, and it is not being properly assimilated by the bones - where does it go? Is aIl the excess excreted via stool? What evidence is there that excessive calcium does not cause the body harm? I know it can circulate in the blood stream and make the labwork look a-okay when the reality might be that the bones are losing density. This is true of me. Apart from my last lab, all my other bone labs have come back looking good…but my bones…sigh.

Anyway I might try hedging the calcium figures up a little more despite my questions. I’m not looking forward to further constipation effects.

MenaQ7 (a brand of Vit K2) is not cheap - it’s another expense to consider. I had a lump in my throat not caused by over eating when I realised how much it would cost. I was so grateful for the 3 for two offer I nearly hugged the teller. I’m almost worried in a weird way, that it will work for my bones. How ironic is that. If it does - I’m worried that people won’t be able to afford it. It’s going to bite my budget hard, but I honestly feel it would be a waste not to take advantage of my dexa scans as fully as I can. And they will tell the tale for me about whether or not Vit K2 is as viable for malabsorptive patients as it seems to be for ‘normies’.

When I started K2 supplementation it felt like eating gold. But only for a short while. Firstly the pill is a hard little nut of a thing. I decided for best effect I would have to bite the casing. The taste is somewhat vile, but I can’t risk the pill does not dissolve. Next, I bloated up considerably and as nothing else had changed, I chalked it up to going into supplementation guns blazing. I researched but could find nothing about VitK2 related overdose. In fact nothing about overdose at all as it seems there are no side effects. 4 days into it and looking like a rotund Russian doll, I thought about chucking it in. Then I remembered my own good advice of the past : Start off slowly when introducing anything new! So I backed down on 150mgs and did 50mgs for several days, then 100mg and I am up to 150gms with no side effects currently.

A strange thing which I am freaking a little about is that I now have brown poo that looks nearly like a normies number two. It still is stinky but it has a normie under current whiff which is also scary. At first I panicked as I thought I might be giving my malabsorption away. (And despite the extra vits, I treasure my malabsorption I truly do, as you all know.) But it still floats & smells mainly DSey, so I think it’s okay.

I’m thinking therefore that my luck might be in and that I am absorbing some K2. I truly hope so. Time will tell.

http://www.springboard4health.com/notebook/v_k2.html

http://www.americanwellnessnetwork.com/index.php/Something-Exciting-Vitamin-K2.html

http://blogs.webmd.com/integrative-medicine-wellness/2007/11/vitamin-k-keeping-calcium-in-your-bones.html

http://www.webmd.com/food-recipes/features/featured-nutrient-vitamin-k

Amounts of Vit K1 in foods:

http://www.dietitian.com/vitamink.html

A little about Vit K & Cancer:

http://www.encyclopedia.com/doc/1G1-107835437.html

DEXA stuff:

I always believed in pref pre op Dexa scans for Bypass patients both RNY & DS. My own experience continues to convince me. For a long time my calcium blood labs tested as normal (not a surprise to me I might add as previous research I did shows this is common.) Only my most recent one shows a slightly low amount in my bloodstream. The last one 6mnths ago was normal. Meantime the dexa is confirming continuing bone loss.

What does surprise me is that my Vit D & PTH still look normal range despite the drop in blood level calcium, or maybe it is causing the drop, perhaps the calcium is actually being utilised! (Ever the optimist!). But hey - I am not complaining, Vit D & PTH normal is good news! Obviously despite my feelings about adding more undirected calcium into my diet and my constipation, I will do just that. But I don’t want the stuff circling around my blood stream being underutilized by my body.

With a history of genetic osteoporosis, I doubly feel a dexa must be done before a DS surgery as in my own experience, it may complicate the whole matter.

Add to this the fact that many WLS patients get WLS in their late 30’s and 40’s - and we are heading for menopause in our fifties, when bone loss often naturally accelerates. I don’t think we can underestimate a Dexa Scans role in giving us the best indication of bone health that technology affords us at this point in time, but just my opinion. Some medical people argue it as a requirement and point out some drawbacks, but what else is there? Blood labs can be even more uncertain and if I had only had blood labs, I’d not have known that my bones are losing density. (Sometimes I do think that ignorance is bliss, though probably not longerterm!)
Some patients do tell me that getting a dexa can be very difficult & some are outright refused the privledge. I don’t know if it might be of use but perhaps a visit to the dentist might help. (What!?, I hear you cry! ). I knew my bones were possibly losing mass before I had my first dexa.How? My dental x-rays showed minor bone loss in my jaws at the time. It’s not accurate and this is speculation on my part. Remember you can lose bone in isolation on your body, but it might be the only way to convince your GP that if you have bone loss in your mouth, you might have it elsewhere too. Besides you need to know the state of your teeth as these are sometimes affected by WLS too.

(BTW - another good reason to think on Vit K2 might be dental health. Think it was mentioned in one of the links below, or I read it somewhere. It might play a role in reducing gum disease. One thing in Africa that always struck me as amazing was the prevalence in rural areas of lovely straight strong white teeth, despite lack of dentists and technology. Now, by comparison just gander over the WLS forums where probs with teeth are sometimes discussed… Argh!!! I think too much!).

STRONTIUM:

During the course of my wading through piles and piles of potential misinformation and some more valuable info, I come across the fact that strontium is available in the UK on the NHS.

I found out that it does have side effects among them quite strong allergic reactions. Also that it needs to be considered with caution. Some feel that there is still a lot that needs to be learned about it. (See links below for various plus/minus opinions. ) But for now, I am still interested and think that although I am not yet confident about trying it (don’t want to feel like a lab rat yet ;-)  erm, I forgot I already am one albeit a willing rat by proxy of my DS ), it’s worth keeping an eye on. The thing is we are not just talking about potentially stopping bone loss, it appears that strontium will also lay down new bone.

Only thing about the NHS source of strontium is it’s peppered with aspartamine. And wot’s the ranelate then?   Mmmm. Reading the veritable side effects - it read a bit like the list of aspartamine toxicity to me.  Reminds me of when deflatine decided to include sorbitol instead of sugar in it’s new formula. If you don’t know - sorbitol is sometimes associated with gastric distress!!! Where are their heads??? It’s probably all down to how cheaply they can manufacture something. Anyway if I decide to supplement with NHS strontium, I would have to accept the dayum aspartamine. I can’t afford not too unfortunately.

On the surface Vit K therapy looks less prone to side effects than strontium at this point in time. I think I will lay off strontium supplementation until I have had a consult with a bone specialist, but not by a long chalk am I closing the door on it. I have written about strontium here in the hope that others might know more about it, if so please e-mail me. (My e-mail contact is in the right hand sidebar.) Meanwhile I might just start munching more brazil nuts daily as they are apparently a natural source of it.

Stontium is also found in sea water but I think I will give this source a miss. (Yuck!)

Hopefully if K2 works & becomes more mainstream, it will be cheaper in years to come, or at least added to diary products world wide. Hopefully strontium will be as viable as I hope, but the jury is out on that one. For now I am organising my daily intakes of Calcium, magnesium, Vit D, zinc, VitK2 plus more, the best I can. Deep joy!

Here are a few more links about Vit K2 & strontium for those of you that are interested:

http://www.bmj.com/cgi/content/full/330/7505/1400

http://jcem.endojournals.org/cgi/content/abstract/87/5/2060

http://www.annalsnyas.org/cgi/content/abstract/1092/1/403

http://www.clinicalanswers.nhs.uk/index.cfm?question=7082

http://www.expertopin.com/doi/abs/10.1517/13543784.13.7.857?cookieSet=1&journalCode=eid

http://jcem.endojournals.org/cgi/content/abstract/90/5/2816

http://jcem.endojournals.org/cgi/content/abstract/jc.2004-1774v1

This is a debate about how excess calcium may affect our vascular systems. I’m open minded about it - but on reflecting the paper concerned I must say it didn’t wash well with me for several reasons, some of which the debate includes. I popped it here as I thought the one on Vit K2 and the snippet on magnesium were thought provoking.

http://www.bmj.com/cgi/eletters/bmj.39440.525752.BEv1#188835

SO WHAT ELSE MIGHT WE NEED FOR BONE HEALTH?

It was my DS friend Mellie who first pointed out to me, several years ago, the possible importance of adequate magnesium in bone metabolism disorders. She went on to develop a CalMagD supplement for us, which I take in conjuction with the calcium I get in V4L. ( The link is on the right side of this blog, first in the box.) As an aside, I have always questioned V4L’s formula of both iron & calcium in the same supplement. It might be neccesary for DS patients on V4L to bear in mind that down the line they may need additional calcium supplementation. (Keep watching your labs, get dexa’s if possible). If you are not taking magnesium ( check your vitamins -it’s sometimes included) discuss this with your specialist to work out beneficial ratio’s for your individual needs. Please read all the contra-indications in the below links too.

I’m learning magnesium also absorbs differently according to the type it is, not only that but it also has an elemental doasage. Currently I am on mag oxide (in the V4L)  & mag citrate (in the CalMagD). I recently read the oxide is not great at doing it’s job. Citrate is a good middle road choice it seems. It’s actually supposed to have  laxative properties, so maybe upping my dose might actually help my constipation. MMMmmm. I can but hope!  Magnesium citrate might be a good choice for constipated WLSers then.

http://dietary-supplements.info.nih.gov/factsheets/magnesium.asp 

 http://lpi.oregonstate.edu/infocenter/minerals/magnesium/index.html

http://www.ncbi.nlm.nih.gov/pubmed/18048993

http://jcem.endojournals.org/cgi/content/abstract/91/12/4866

http://www.spineuniverse.com/displayarticle.php/article1080.html

INULIN & OLIGOFRUCTOSE(FOS):

Interesting one this. I have always felt intuitively that trying to supplement on a gut that is not in fundamentally good health may hinder nutrient absorption. Note that initially inulin supplements might cause temporary bloating.

Foods high in inulin: dandelion, chicory, onions, artichokes, bananas, asparagus, garlic, leeks.

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=686772

http://www.ajcn.org/cgi/content/full/82/2/471

http://www.nutraingredients-usa.com/news/ng.asp?n=70789-orafti-prebiotics-inulin-bone-health

http://www.drugs.com/npp/chicory.html

BORON & SILICON

http://www.spineuniverse.com/displayarticle.php/article1083.html

ZINC & COPPER:

http://www.spineuniverse.com/displayarticle.php/article1084.html

LUTIEN:

This is not connected to Bone metabolism, but thought I would mention it here anyway as I think it’s an important one.The other nutrient (that possibly no one told you about) is Lutien. This plays a role in vision & eye health.

Yup, I supplement this too. Have done for quite a while. I will blog more about it in my following blog which will start with Vitamin A.

I thought I would compile a list of important Vitamins and try to top up my own knowledge again. Got to do it as part of updating my website anyway, knowledge about them moves on. So, if you are interested, keep ploughing through my ever voluminous blogs!

As usual, please note that you should consider consulting with your surgeon when introducing higher or lower doses of vitamins, or if introducing new vitamins as you may be on other meds that could be affected by supplementation or have different health issues than me.

So what’s a portion?

• A small ‘cupped’ handful of food equals an american cup. ( This is for estimating: veggies/whole grains/fruit. ) Personally as a WLS patient I move towards more veg than fruit and as my weight is on the lower BMI I eat veg abundantly - probably double their guidelines (including a portion or two of whole grain complex cereals most days - remember I am trying to gain some weight - go for one portion if you are not!). WLS patients needing to lose weight could consider not lowering portions imo- rather focus on what type of veg they are eating perhaps? For example, replacing starchy veg with more dark green veggie servings & a couple of orange/red veggies instead.)
• A palm equals a portion of meat, fish or poultry.

A palm sized portion of meat, or a cassette size or deck of cards size is iro 3 ounces of meat which = iro 21gms of protein. I go by this measurement generally applied to all meat/fish I eat. It’s a rough estimate. You need to visualise the meat without the bone too! But I am an ‘oldie’ who can effortlessly get in enough daily protein so it works well for me and keeps my protein intake on the ball. I eat daily around 3 -4 card deck sized portions of meat or fish. Iro 60-80gms. A further 20gms at least is made up by my milk drinks, beans, cheese, eggs, nuts or various combo’s of these foods.

If you are a newbie WLSer and need to count every gram of protein use fitday or read package grams to ensure you are getting in enough. If you just managed a piece of protein & feel stuffed! don’t feel you’ll never get to a point that you can eat as above. It’s very progressive thing with the DS.

Said this before but it is important: As soon as you notice you can overshoot your protein requirement - that is the time to add veggies and some whole grains to your diet. Don’t start adding junky carbs, get in the habit of good eating as soon as you have the space.

I don’t count my portions of complex carbs but generally a bowl of cereal = 2 handfuls for me. I stay with less grain based complex carbs than veg based complex carbs. A half cup of veggies is the standard size according to the USDA of 1 serving of complex carbs. Recommended intake for ordinary people is around 5 servings a day minimum, but I try to exceed that most days.

For the rest of it regarding complex carbs, I try to eat as many brightly coloured ones as I like, orange & red are nutrient rich. I usually have chopped onion daily (cooked) as it provides me with inulin & sulphur. I always eat at least two portions of leafy dark greens a day and include broccolli, spinach, kale into that equation! I eat a potato if it’s on the menu, but prefer sweet potato. I really don’t sweat this stuff. The main thing imo is to get a broad variety going over a time period of a week or two. It balances itself out.

I eat a half to 1 portion of fruit a day. On days I have a wobbly gut I eat a banana - which I swear by to calm down an irritable bowel and an irritable me!

A slide show about portions & servings:

http://www.mayoclinic.com/health/portion-control/NU00267/RETURNTOOBJID=CEC0DBA2-8C25-4390-B56802619D846C6F&RETURNTOLINK=1&slide=7

Note: This is representive of a ‘normies’ diet and though the measurements are useful, my plate of food looks very different than their end result! I think all that spagetti & bread too - can’t be a good thing, not for me anyway! I would eat a bigger portion of the spag bol meat and no pasta or a tablespoon or 2 at most. I’d have cheese on top of it. The broccolli is fair enough but I would eat half that, and the other half would boast a different veg - something colourful. The bread, I would omit, or if I was very hungry I would have a slice of Burgens Bread. ( Burgens is a Soya & Linseed Loaf, for my friends that don’t have it in their supermarkets overseas.)

A few more GL links:

http://www.gifoundation.com/glycemic_load_concept.htm

http://en.wikipedia.org/wiki/Glycemic_load

More on visually measuring your food servings:

http://www.gerberlife.com/gl/view/newsletter/apr07/article2.jsp

Supplements:

When it comes to supplements I believe there is a place & time for everything. If you cannot eat enough protein then supplement with a protein drink. While I would always veer towards a natural food over a man made one - such as fortified milk over a bought protein drink, if milk is out for you by all means use whatever suits you.

I supplement my diet with a good multivitamin base. I take 8 -12 V4L a day. I know they don’t suit everyone but they keep my bloodwork in reasonable basic nick overall. I like the fact that they include rarer nutrients such as chromium in them & no fillers. I take extra calcium, extra Vit D, Lutien and currently extra zinc. I do get deficiencies but more about this later!
Dieting:

I know it can be tempting but my advice - think about this seriously, even if you have gained weight. There are other ways. Any diet worth it’s salt is merely going to direct you back towards eating more healthfully but many diets won’t. Instead you may go down the road that led you to WLS in the first place with caloric restriction playing a part and the subsequent possible effects of feeling deprived, not getting enough nutrients, and potential metabolic damage etc.

Some people join clubs - these might be a possibility and I believe they are a lot better than taking drugs or not doing anything to address weight regains. But why not instead of dieting start to apply low GL principles to your life? - it’s not dieting - it’s common sense! I never ever regard myself as being on a diet. Eating as above is not a diet - it might feel like that at first, but as one grows to enjoy the food more it just is the way one eats. It’s simply how the human body works best and always has, way back into history before the advent of sugars, transfats, food additives and white flours.

Eating like this does take some thought and planning. Without a doubt it is easier to grab a sandwich on the run. And sometimes that too is okay. However there just is no getting out of this effort if our surgeries are to work optimally for us.

My feeling is that if a plate of food contains protein & complex carbs, it’s highly possible a little starch won’t send insulin into overdrive. Food works synergistally, so there will be some buffering effect going on. The thing is to avoid those carby or sugary snacks that we usually eat in isolation to our meals. If you must have these - eat some protein first & preferably one that contains fibre - such as skin -on nuts.

In the USA some DSers swear by peppermint tea to boost weight loss. Might be worth a try.

Exercise is vital for RNYers & bandsters particularly, but we can all benefit. You may see weight gains - it doesn’t matter. Your shape will change but you won’t look fat! Muscle is compact unlike fat. Muscle helps burn fat, so think of it this way. Banish the scales and trust it to work.

Last note for friends who struggle greatly with nutrition due to factors like vomiting & heavy restriction.

Firstly - take steps to get meds for vomiting if you have a DS or RNY. Speak to your GP - to fight against your body will merely exhaust you & you need ammunition. It’s enough to just make the effort to eat. And this is where your energy needs to go. I am aware you face a big daily challenge. It’s probably very hard but don’t let it get you down. If you wonder how I could possibly know, I had mega restriction in the first months of my DS but even more, I struggled hugely after my bowel obstruction op. I flashed on those of you who have difficulty in that struggle and I learned a lot. I had to live with it for several months. I know it was only several months, but it was wearing. Keep giving it your best. There’ll be terrible days but the better ones all add up.

In times of just trying to cope & perhaps also dealing with more pressing health issues - with labs targeting those issues, it may be easy to think you don’t need labs relating to WLS. Especially if you have no malabsorption. However this is far from the truth. Get labs done by your doc. Get protein, VitA, iron, zinc, magnesium and calcium, Vit D & PTH checked out at the very least. Discuss your surgical needs in relation to other needs even ig there is not a connection. If on statins discuss taking CoenzymeQ10 with your GP as statins may rob your stores of this and ironically your heart needs it.

• Eat mini meals every few hours and kick off with breakfast.
• Hit the soup. Try to find protein rich varieties. Look for soups based on fresh ingredients and watch out for soups that contain too much starch. Fish soup & chicken soup can be high in protein, blitz till smooth. Cullenskink is quite strong tasting but high protein, baxters makes it. Add fromage frais to make it milder. I lived off it post surgery. I know soup can be boring as hell so add spices and herbs to your soups. Make a ginger chicken thai soup. Make a basil & tomato & cheese med soup. Do an indian curry soup with a big spoon of yogurt in it. Keep your taste buds alive else you will lose interest. Think about including hummous, lentils and barley in your soups. Sprinkle sesame seeds on some of your soups. Try to get inventive & don’t give up. It will nourish you. If it is all you can digest, work with it. And please write us a soup book when you have mastered it!
• Mashed food can be approached in the same way.
• Always try for a ‘double-whammy’ approach. You could eat plain mashed potato. But you could also eat mashed potato made with fortified marvel ‘cream’ (just a very concentrated amount of marvel in milk) and add grated low fat cheese to give it protein power. You could have plain milk, but if you add some mashed banana and marvel, you get more for less! Always think like this and remember even small healthful additions add up a lot over a week.
• Take a powerful multivitamin every day. I don’t mean a crappy one either. Go for pre-natal at the very least. It should include zinc and magnesium for your heart. Or buy a bariatric one such as V4L and take one or two a day (if you have no malabsorption). You deserve to buy the best quality available. Don’t think it won’t make a difference. My mum was very weak & malnourished after a major traumatic surgery & I cooked her very nourishing sloppy foods, but her energy was refusing to return. I was worried by her lethargy that seemed to also make her depressed. In desperation I gave her one of my V4L a day experimentally for 10 days. She really could not believe the difference she felt. It was a turning point for her.
• Use my powerhouse mix recipe if you like and sprinkle it on soup & on sloppy food.
• Take cod liver capsules.
• Try for plenty of milk. Failing that - try for soya milk or if milk bloats you try lactose free milk.
• Cottage cheese is a good food. So is yogurt.
• Marinate any meat you are going to try with buttermilk or pineapple. Eat it saucy.
• Crackers are good for complex carbs. Ryvita is nourishing. Try seed based crackers.
• Oats porridge or Spelt made into sloppies might stay down.
• While fibre might be a pain & prompt vomiting, if you whizz it up till you can hardly see it, it will help digestion.
• Eat a small banana a day. You need may need pottasium if you are vomiting. Sprinkle cinnamon on it to avoid insulin rises.
• Make up a veggie based sauce of all the veg you tolerate. Freeze in mini portions and add it to your food.
• Sweet potato, mashed is a gorgeous food. Squash is excellent too. In South Africa we rear our babies on butternut squash.
• Don’t despair. I am sure it can be hellish & tempting to give up - but if you are nourished you WILL feel better and it will make up for all of your effort. I believe it is entirely possible to be healthy on a sloppy diet. You will need to be creative to keep your interest going though.
• If oil is too rich for you - try virgin coconut oil. You only need a tiny amount each day or eat a little butter - it is rich in Vit A. Don’t make oil your enemy. It is way better for you than simple carbs.
• Pate’s are often rich, but if you mix them with fromage frais they might sit better. Bottled meat spreads are less rich.
• A cheese spread can be made by using low fat cheese grated into philadelphia low fat.
• Low fat cheese sauce: Low fat cheese, arrowroot dissolved in skim milk to thicken it, skim milk . Use a whisk to make it smooth. A little powdered chicken/veg stock, mustard,or paprika (try smoked paprika for a lovely flavour) lifts it from plain to gourmet!
• Nut butter can be used in yogurt (hazelnut is really nice as are roasted almonds). A little peanut butter is also fine - not sure I would have it in yogurt , but it could go in Thai soups, or into your mashed banana to add extra nutrition and protein.
• A simple recipe I posted years ago: Sugar free jelly, a small tub of low fat philadelphia (full fat if you are DS), milk. Dissolve the jelly with a little boiling water, use milk instead of water (around half the amount the packet recommends)Whisk the philadelphia into it. Allow to set. Tastes quite cheesecakey & delicious.
• Because you are limited in food choices - buy QUALITY. Pay the extra, it is often well worth it. Organic Tomato sauce for example has almost double the lycopene (a powerful antioxident)of standard tomato sauce.
• If you have somehow gained weight it may amaze you that despite heavy restriction/vomiting you are dealing with this as well. Simple carbs are probably the culprit along with perhaps water swelling from too little nutrient/protein intake. Chuck them all out. It’s hard as you may feel they are your only way to survive & I’m not saying you may not be right. They might well be all that work for you - if so - NO GUILT okay. But if you suspect you could approach it from a different angle , give the above a try. You might still not lose weight but you will be very much healthier.

Finally - quite aside from diet , seek support. Be that from your peers or your surgeons team. Support is vital. Don’t feel ashamed, we all fall off the wagon from time to time. The people that win the day most often are those that actively seek support during such times.

If you are gaining weight despite everything - go over the side effects of any drugs you are on. Anti depressants are notorious for gut related/weight gain related probs. Don’t get a shock if the list seems long & scary - bear in mind side effects are not hugely common else the drugs probably would not sell! But be realistic, and if you think it is the cause consult your medical team and try to find alternatives. Never go off a drug by yourself.

Sadly - what I have written about is as plain and simple as can be. Probably there is little that is new that you read here. There are no magic ways to lose weight & why try to do it at cost to one’s health? The effort that goes into dieting is way more than the effort that goes into a little forethought and planning around our food.

I do not know of a person who honestly eats like this who does not either lose or maintain their weight after WLS. The only trick is to not allow too many sugars or processed food into the way we eat, but we all know this! It’s doing it that counts. Even complex grains should not be over indulged in…a serving or two daily is probably enough for us. The more weight we have to lose, the less of these we should eat.

Basic Protein Grams list:

http://http://lowcarbdiets.about.com/od/whattoeat/a/highproteinfood.htm

Quick food vs Fast food:

The above doesn’t mean we have to cook everything! I love to cook but it’s not for everyone and although I work from home, somedays I’m too busy to do much more than quick food. I think nothing of eating a super market ready prepared meal if I’m too busy to cook. But I am selective. I go for simple meals - I’m very partial to Tesco’s Prawn & Thai mix right now. My idea of a take out is a bag of prepared salad, perhaps some veggies that can be heated fast and a Tesco Ready Roasted chicken. Followed later by fruit & yogurt perhaps. Other quick foods I eat are things like stir fries using the ready mixed fresh beansprout chinese mixes at tesco’s and thinly sliced beef for example. My lunch options are burgeons sarmies stuffed with ham, cheese , pates and sliced tomato. Or tinned beans (luv the mexican mix! or those yummy greek giant haricots) with melted cheese in it. If I feel posh I add chopped bacon to the lot or I top the beans with tuna. When I make burgers I usually make enough for the freezer too. I buy roast meats - although expensive if you add up the price of two punnets of lamb chops it makes better sense to do a roast leg of lamb. The next day I eat the meat cold. Roast beef is another fav - I recycle leftovers into beef onion & mushroom & gravy quick hotpots the next day. My family get happy with the yorkshire puds! It really need not be long & laborious to cook.

Because I am highly disorganised it helps me to make up my cereal mixes etc once a week. At the same time I put my nuts and dried fruits into jars for quick snacks and toppings. Every few days I boil up a few eggs - peel them and pop them in the fridge ready for a fast snack on the go. I have a big cheese tupperware in my fridge and I often grate up some cheese as well for the week ahead. I enlist my lads to do the grating! I buy my yogurt weekly and my meat or fish to last me three days ahead. If I feel seriously industrious - I knock up lamb koftka or beef meatballs which I freeze to heat in the microwave. Life is short & I am no domestic goddess! I probably prove that even a numpty can eat well with a tiny bit of thought and planning and I am all for healthy short cuts.

Getting back on track can initially call for effort, but sometimes we do need to take the leap. We also need time for the taste buds to kick back into life. Estimating portion sizes and applying them to our surgeries requirements is important. Overeating will stress the best of surgeries. There is no need to go hungry or feel deprived, it just takes a new approach sometimes to see this. Nor will there be the need to overeat if we stop eating the sorts of foods that trash our insulin production. Consistent daily eating of the above foods will modify your diet for you. You just have to prepare the food and enjoy it. I know I have blogged on eternally about it - but once you start to eat like this you will find it is actually pretty simple!

Getting inspiration to go the golden mile regarding eating nutritiously:

I’m a slow learner and before my surgery, food was just food. It tasted good or it did not. Simple.

However after my duodenal switch this all changed for me. I developed a bit of an obsession with my malabsorptive qualities! I was fearful of deficiencies. I’m still afraid of them, but in a way more mellowed out way. I’ve lived through them & have experienced first hand that they haven’t exactly killed me! My bigger fear is for those of us that don’t move fast when there is a dip. Or who don’t comply. A dip left alone will turn into a physical and mental trough …our bodies cannot regain balance without our intervention and without proper supplementation (preferably in a synergistic way for faster results).

When I began to work on my diet & nutrition I realised that food is not just food! Even a humble apple is a powerhouse of chemistry & biology. Then I learned how vitamins and minerals interact with each other and I have not stopped learning.

I started to see my food very differently. Not just a delicious thing to eat - but also a way for me to maximise all the joy and energy my new found weight loss was giving me. I really wanted to support that. I also felt I had this precious second chance & if I was to continue to benefit from it it wouldn’t hurt me to try to feel out my metabolism more & to rewrite the old and disastrous habits of days gone past.

It wasn’t always easy, especially at first. Sometimes I craved junk like anything. I would have weeks of destructive ‘experimentation’ and I certainly tested my poor old DS sometimes.:-? But I ultimately I would sum it up nutritionally and see and feel the damage of my evil ways.

I used to crave carbs pre menstrually to some degree, but I especially missed it if I was on one of my ‘phases’. My phases consisted of eating one food to death until I was heartily sick of it! Now there is a lot of protein in the world…but even so there are times one feels if one sees another piece of chicken one will cry! My cooking skills were not great either at the time.It seems obvious that eating the same limited food sources will lead to boredom, but for an age I never ‘got’ that! When the pennies dropped , I began to evolve ways to address this. It didn’t always mean changing the source of food either - on months the cash flow was slim we had to live off eggs & mince! I changed the way I cooked these foods, fried eggs became omellettes, various scrambled ( some with bacon, some with ham & onions for example), boiled and poached!. I got creative with seasonings.

I had an ephinany one day . I realised that I was just not interested in the old diet books & telly shows anymore and that I no longer needed them. I bought a couple of real foodie books, simple recipes but tasty stuff, watched some good foodie programs on the telly and in a month my family never enjoyed such a diversity of flavours. I learned shortcuts and what flavourings and spices worked best with what and suddenly protein became utterly delicious and tasty to eat. I had fun experimenting and the doggie grew a bit fat on my disasters but it was all part of my curve. So if you are floundering, buy books, read recipe websites and chat food with your WLS mates, experiment in your kitchen. Get cooking instead of relying on too many take out meals. It does help.

If you want to explore ultra nutritious foods browse some of the websites around, one I like to use is: (check out just how amazing food is by looking at the nutrient contents of the foods.) Sometimes I go on here and I pick some foods I will eat during the week when my idea bank is running low.

http://www.whfoods.com/foodstoc.php

It’s a joy to eat nutritious food, it’s so tasty. I like healthy too - but tasty is what we need to aspire too, so that we delevop and expand our diets. In fact this is one of my points - we need to bring back joy in eating. There is nothing wrong with eating good natural foods - it’s pleasurable and it is meant to be pleasurable , otherwise the gods would have made us breatherians!

My DS has taught me so much. Among things I have learned from it are that with it - I don’t need to comfort eat…comfort eating for me was never a pleasant thing. It was fraught with stress, fear of weight regain & guilt. Is that comforting??? I don’t think so.

It should be called ‘Discomfort eating!’

Eating and enjoying is a whole different thing from ‘comfort eating’. If I enjoy what I eat, the need to comfort eat largely falls away. More over I’ve realised I don’t need either vast quantities or crappola to enjoy my meal. What I need is a plate of tasty, food full of colour and vitality. I have learned that this is the way to go the long haul with my surgery.

Boring is a choice we make.

No food needs to be boring (wish I had known this when I was in year one chomping away on my protein feeling like weeping with boredom!)

Small additions go far and improve both the look and taste of food. Plus it makes one more creative! Sauces add digestability and nutrition to food when we are restricted.

Concoct your own spice & herb mixes. I have recently experimented with Indian curries and nothing is like a homemade one!

Making up a Thai condiment using lemon grass, ginger, coconut milk etc helps tired tastebuds.

The world is our oyster. Even the least culinary if us can add flavour to foods - think Thai, Med, Japanese, Chinese, Indian, Morrocan, South african (always dear to my lil African heart!) …the list of flavours out there for you to try is amazing.

The great meat debate:

So is meat an unhealthy Food? Meat and saturated fat are pretty inseperable, even though over the years the fat content of many meats has dropped. I read somewhere pork is as lean as chicken, if only the lean part is eaten. True or not I don’t know, but I thought that was interesting. I researched just how healthy/unhealthy meat is (as a DSer I was concerned!) - and I was suprised by what I found.

It made me flash back on my childhood and remember a way of life I had forgotten in my city driven life. My grandmother lived in a small rural village in South Africa. As children when we visited her we ate simply but delicious food. Although we ate meat at lunch sometimes too, the main meal of our dinner was meat , always 3 vegetables on the side (must be magic in the number 3!) and sometimes a little rice. This was what was freely available. We were taught this was a healthy way to eat and I believe it is.

Seems we might have been sold such a pack of misinformation regarding our diets that the mind boggles. The very foods (including meat) that may have saved many a life from heart failure, were instead replaced with a low fat idea to the point that it is quite scary. It seems that meat fat is highly unlikely to harm us - a great deal of it is mono unsaturated…(yup the same stuff that makes ‘med’ diets so healthy). Fat is required in our diets, it makes Vit’s ADEK accessable to us metabolically (even to a degree in impaired guts like my own)and may even have some other functions we are not aware of. I’m not saying let’s go crazy and eat fat extensively - no one would want to (would they? )!

Anyway,  the issue of saturated fats in meat is still an evolving subject .

Meat has every amino acid we could need. It’s also got Zinc, Riboflavin, Various Vits, Iron, copper & many other nutrients. Properly prepared and cooked, it’s great food. I seldom add more than a smattering of olive oil to cook my meat as it contains it’s own cooking fats. Broiling, grilling and roasting are better cooking methods than frying. Slow cookers are good news for cooking meats to perfection. I never add oils if it is minced meat. I eat meat at least once a day and aside from bacon and ham from time to time - I seldom eat processed meat.

Other sources of protein that I include in my daily diet are:

Legumes, Nuts, diary, plenty of milk, cheese and eggs.

Fat:

I’ve always said fat is my friend , but that doesn’t mean it is yours! Fat can create loose stools for DSers and cause stomach cramps. However I like my fat. Without it my stools get too solid. We need fats for ADEK absorption among many other functions & even though it’s probably more marginal for DSers due to malabsorption- it’s still there. I eat plenty of meat fat inherent in my meat- not the stuff on the edges ( I just don’t like it really).I often have no need to add more fat to my cooking as a good piece of meat cooks in it’s own fat. When I select a steak for example, I go for one with lot’s of ‘marbling’. A well marbled piece of meat is usually tender and succulent.

New research is pointing towards it not be as harmful to our hearts as we once all were brainwashed into believing. More and more professional medical people are starting to release to us information that supports certain fat intakes - among them meat fat. We may have been so brainwashed into believing meat fat is bad for us and ‘low fat’ is healthy for us (or our hearts specifically) that we might well have lost the plot.

If meat & the saturated fat it contains, is such a disaster for our hearts then why are the Massai tribe in Africa - a tribe that eats a diet of meat based mainly on beef, and milk, so incredibly healthy? Not just them, but also many other remote people that live a life around meat and who value fats. Heart disease is almost non existent among them. However, I should add something here that I often wonder about and that I might cover more in a later blog - many (but not all) of these people also include a lot of fermented milk based products in their diets, and perhaps this plays a role in their health too?

There are counter arguments of course! The Mexican Pima people live on a very high carb diet and also exhibit excellent health with little diabetes. However their more Westernized relations, the Arizona Pima have a problem with obesity, diabetes etc. Seems much of this has been chalked up to lack of exercise. It’s probably even more complex than that though.

I’ll leave it at that. Others, more qualified than myself, are talking about it & questioning it strongly. If you are interested in your nutrition, Gary Taubes wrote a highly thought provoking book ‘The diet delusion’ that exposes the tangled roots of misinformation and is worth a read.

On the other end of the scale some researchers believe that it is not faulty sugar metabolism that causes diabetes. It is they say, faulty fat metabolism. How this interplay happens is beyond my mental ability really. All I have is questions. If it is true that high fat diets might cause diabetes, is this due first to sugar metabolism? Or do they act in a much less linear, more interactive way perhaps? High fat experiments on animals such as rats and hamsters don’t wash much with me - these animals are not designed to eat fats other than those found naturally in seeds and plant matter. It brings to mind what happened when our cows here were fed a meat based mush, poor creatures. I don’t know of any Atkins dieters who developed type 2 diabetes, on the contrary it seems according to what I have read, that Atkins has the opposite effect, but I may be missing something. However, I think before we all rush into fervently believing either side of the fence, we should bide our time and wait for further information to develop.

In the meantime, I still instinctively feel that higher fat intake is better than higher carb intake, but I am keeping an open attitude. I’m not convinced that the few abstracts I superficially glanced at sufficiently justify their claims for high fat causing diabetes, but then I’m just a lay girl. I’m more of the persuasion that it is good ol transfats creating the havoc, or perhaps just very unbalanced diets. This is just my gut feel, I don’t have a lab or for that matter huge knowledge on the deeper biological interactions that may be taking place. My way forward is to eat plenty of fats from unprocessed sources knowing that my malabsorption tempers my excesses,hopefully bringing a good balance to my body. If had a normie body I would probably hedge my bets on a moderate intake and eat less than I currently do. The other side of this coin as I pointed out in my last blog is a diet that also has a good intake of complex carbohydrates as soon as it is feasibly possible to work on this aspect.

I might add that RNyers are generally advised to medically follow a low fat diet. I’m not going to go against that, though I do speculate if, for those with more malabsorption, this is such a wise approach. Still, fat contains high calories and we still don’t know the exact way our body metabolises them. Hopefully if you eat enough protein some fat contained in it will continue to aid your bodily processes in a positive way. I might add that I don’t believe we need vast amounts of fat to accomplish this either, just some quality natural, unprocessed fat each day from both animal & plant sources.

I try to avoid processed & transfats like the plague, but unfortunately I still have the odd moment when I overlook it by accident. When I do I pay for it bigtime. It causes me to have violent explosive diahorrea and sometimes it creates a xenical like leakage. Awful stuff!

Seems all of us can benefit from healthy omega type fats. Coconut oil though regarded as saturated is a topic on it’s own. It might be very beneficial for us who have bypasses as the lauric acid it contains is antibacterial & antiviral. I use virgin coconut oil in a lot of my cooking. I also know of an endocrinologist who uses it extensively with severely malababsorbing patients to good effect. Anything that stops bowel overgrowth is imo a possible option, but again - research it and you decide!. Mary Enig has written some very interesting papers on fats. If you want to read her work google her name. Below is one link to an article she wrote called ‘The skinny on fats’.

Nut oils can turn veggie dishes into top gourmet stuff. Recently I have used sesame oil on my butternut and beans - tastes wonderful!

I currently take a good dose of fish oil capsules (on & off admittedly) to balance my omega intake. It probably would not hurt most of us WLSers to do this.

Fat & Plateau’s for the DS folk!

I have used fat before to knock my body out of plateaus that lasted longer than 3 weeks. (I feel a plateau is a neccessary thing awful as it is on our heads) and we should always give it reasonable time to get over itself! Our bodies don’t go latent and inert on temporary plateaus, it just feels that way because the scales are inert. But I can assure you that this is our body going into ‘thinking’ mode. You need time to think - well so does your body! It is consolidating and rebalancing itself. It’s intelligent - remember. Sometimes it may be undergoing a bit of villi growth or performing other metabolic functions we are unaware of in our terror! LOL. It is very hard to trust this process, but your body will not generally act in your worst interests provided you are supplying it with it’s basic needs.

Here is some info about fat/meat that you may find interesting:

Changing concepts in lipid nutrition in health and disease

Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity.

The International Network of Cholesterol Skeptics

The Skinny on Fats

I am writing up a blog about portions at the mo. Hopefully will post it up in the next day or two.

Continuing on from yesterdays blog - here’s more food for thought!

Before we go on - let me just say that as you read the following that protein is on your highest list of priorities. Until your body can adequately take in more complex carbs - don’t worry about it. Generally somewhere in year two is the time to really start to consciously include complex carbs in your diet, if you can. Before that just do your best when you can.

Soluble & insoluble fibre remains one of my biggest concerns relating to WLS patients and indeed, myself. I believe that low fibre diets might to see us really hit hard health wise in years to come. We must think in advance. What are diets based on protein with the odd smidgen of complex carb going to do to our bodies?

If we have even a basic understanding of the synergistic way that both vitamin/mineral supplementation (for example) and food plays in our systems, it just makes sense to move towards a diet that is synergistic - a balance of complex veg carbs and protein. If our eating habits are unbalanced it’s not rocket science to see that we may become ill. On lopsided diets, I predict in true soothsaying tradition that we will be at high risk of intestinal & bowel cancers at worst, at best we may be a community struggling with diverticulitis, IBS etc. Having seeing my mum battle diverticulitis which I once thought was a low ranking discomfort factor - I have changed my tune big time! Study the % of over 60’s battling it and what it can do if you like, it’s a real wake up call. I just feel too little is written about the importance of fibre (in complex carbs)for WLS patients.

That said, although this blog is weighted towards the fibre in complex carbs, equally important are the array of nutrients eating them gives us.

Daily recommended Fibre intakes: http://www.medic8.com/healthguide/articles/fibre.html

As you can see this is a high fibre intake and even more so for us with limited space. I eat a lot of veggies etc, I probably hit half of what they recommend. And I am almost 6 years out! However, my point is not so much about amounts here. I just feel the more we can take in the better, because whatever intake we do manage our bodies will respond. I also think about it as getting another edge on beating hunger. I’m personally fine living with half of that recommendation. For a good few years I did not even come close to this. I just kept plugging way at it, much as I did with my protein intake. Don’t worry if you can only do a little daily - a little is fine and if you feel it is not, supplements are a possibility.

The Types of Fibre:

Insoluble fibre: this is the skin of a peach, for example.

Soluble Fibre: is the inside contents of a peach.

Resistant Fibre: A type of starch added to foods sometimes. It resists digestion to it’s component glucose in the small intestine and passes to the large intestine unaltered.

Although I can’t find much info on it my feeling is that for WLS patients, it makes sense to look at fibre also in the context of it’s source, as much as is possible within our limitations. There are vegetable and fruit based fibres and there are grain based fibres. For our bodies it’s probably best to put a higher emphasis on vegetable fibres than on fruit (which can be high in sugar if too many are consumed daily). Grain based fibres, may also can cause probs with bloating and wind, and may boast more calorie content than vegetables.

How to introduce more complex carb fibre into your diet:

Facing complex carbs for the first time can be a bit worrying. I know a couple of DSers that started to eat veggies, bloated and have been put off by this. It’s painful and feels awful to be bloated so I do empathise. However our DS usually needs time to adapt to veggie intakes being increased. It takes persistence. Don’t go rushing in guns blazing and eat the really high fibre ones to kick off with! Start with gentler veggies: butternut squash, sweet potato, carrots etc. Progress slowly.

If complex carbs make you windy, Beano can help with veggie based bloating.

http://www.beanogas.com/UsingBeano.aspx

Sadly it is only avail in the USA as far as I know. My poor hubby lugs some back for me whenever he goes to the US on business. I find these do work for me. They taste of very little and dissolve in one’s mouth easily. I don’t use them often (no need really), although when I first started upping my complex carb intake I used them a fair bit. Nowadays they are more for when my tum has been wobbly. I use them preventatively.

Be particulary careful of wheat based fibre rich foods - these can trigger gastric problems. Always introduce only one grain into the diet at a time, ( and have a stash of wind-eeze or similar on hand during your experiments!). This way if you get uncomfy reactions you know what has caused it. If a mineral deficiency is chronic - it might be best to omit high fibre foods until the situation is stable. If gas/wind is a huge problem, give it more time. Try to condition your gut by eating only a little to see if you have a threshhold point.

I can tolerate vegetables well and eat them abundantly now although at first I did bloat a little. My body has adapted to them. With fruit I can eat around 2 a day with no ill effects depending on the type of fruit. Grains - even complex ones affect me the most and I omit wheat grains to a large extent. I can eat 1-2 servings of grain with no problems, but if I exceed that amount I have discomfort. We are all different so try to work out at which point you get discomfort. Also bear in mind that the further out from surgery we are, the more we adapt and the better we tolerate these foods.

Fibre has drawbacks - in that it has phytates which might bind some of our minerals, but the benefits are worth an extra mineral pill (especially calcium & zinc)daily to counteract this effect imo.

For more restrictive surgery types than the DS & all WLS newbies:

Some veggies can be really difficult to eat, especially those high in fibre. Concentrate your veggies by making lot’s of healthy sauces with them. Almost any veg can be boiled down to make a thickish vegetable sauce. Boiling them down means they lose a lot of bulk and you can get more of them in for less pouch space Soups and Mashed veg may sit better for you, as you already know! Try to eat at least 1 small bowl of vegetable based soup a day. Add protein sources to your soup to get even more nutrition. Cheese and pate can be stirred into soup as can potted meat pastes. Soup can get profoundly boring, so try to make it more interesting by adding very finely chopped soft leafy herbs, parsely & basil spring to mind. Try other things like coconut milk in a spicy soup. A squeeze of lemon can lively up tomato based soups. Try out a new veggie in your soup - celeriac for example. Try avocado soup. Don’t think because you can take in only very little, it’s not worth the effort. It adds up & little is way better than none at all.

The benefits of fibre:

Shields high insulin responses in the body that lead to fat storage.

Helps stabilise blood sugars.

Fibre keeps the gut flora healthy and may promote good peristaltis.

Cleans the bowel, strengthens the mucosa.

May provide food for your good gut bacteria.

Increases satiety and may help fight hunger.

It complements protein based diets perfectly.

Fiber is not only fiber - the veggies & grains that contain it also contain useful nutrients. Different fibres act differently on the body. I focus on veggies and fruit that are rich in inulin when I have a bowel that is niggly. Inulin is a soluble fibre that provides a source of energy that enables the good gut bugs to reproduce. It’s useful after taking flagyl for example and eating it in conjunction with acidophilus capsules may be beneficial for us. Some sources of inulin are banana’s, leeks and onions. I suspect eventually fibre may be pinned down as one of the cornerstones of why GI & particularly GL diets work for weightloss. Be interesting to see if I am on the mark.

I find more than a slice or two of any bread, wholewheat or white, makes me bloaty. If you love bread, try replacing it with Burgens or Vogels linseed & soya. Or try Rye bread.

Rye based crackers such as Ryvita are nice and ‘Dr Karg’ make a great seed cracker.

HOT TIP:

Burgens Crackers:

To use up Burgens bread before it goes stale, remove crusts, flatten it a little with a rolling pin, cut into 3/4 slices per slice, leave in a low oven for a few hours until lovely and crispy.

What about ‘bought’ fibre supplements?

Well, I think using them has it’s place. I don’t know for a fact but I think they are generally ‘resistant fiber’. However while beneficial, they do have ‘ relatively empty nutrition’ . A helping of green beans, spinach, broccolli etc is just bursting with phytonutrients and other nutrition factors. Grains that are high fibre such as rye/oats/spelt/bran or veggies with skin on where ever possible, will do us well. They give wonderful mineral and vitamin content. HOWEVER, the benefiber brands etc do have a place for us in year one if required (give your surgery plenty of time to settle first though), and longer for those who don’t have the capacity to eat around half the recommended grams through food, and feel they need more. For DS patients they can help diahorrea by firming the stool, for Bandsters and RNYers they may soften the stool.

Frankly I always thought of fibre as an inert carboardy, gloppy all-brany brown mass. Highly unappetising and off putting! It is generally wheat based foods that bloat us - but the world of fiber goes beyond weetabix! As I stated above, rye, spelt flakes, oats,may not do so and in my case they don’t. I still don’t eat much in the way of complex ‘grain carbs’, my focus is more on vegetables. However, when I do it’s either in the form of oats porridge, or the breakfast below, or soya linseed bread. I find a serving or two of complex grains daily is enough and I’d caution anyone sensitive to carbs (ie - they make you feel hungry) to limit these. The same goes for people who are trying to lose the last few stone later on in WLS.

Breakfast recipe for complex grains:

Note: Rye & Spelt do contain some gluten so if you are gluten intolerant you may experience side effects. However many people who are wheat gluten intolerant say that they tolerate these grains much better than wheat. I am one of those people. Again, if introducing a new grain to your diet, try a little first to see if you have a reaction or not.

Mix Rye flakes with Spelt Flakes and Spelt Puffs. (Tescos sells it in the ‘health section’ as an ‘own brand. It also sells Rude Health products in the same isle.) Or Rude Health sells these via mail order: http://www.rudehealthfoods.co.uk/ and some good steel cut quality oats (none of those instant oats!). I use less oats than the other grains else it gets a bit stodgy. This will give you a base cereal to which you can add all manner of healthy things. It’s not cheap, but I get a lot of mileage from my cereal!
I eat it with:

Berries

Fruit such as banana & papaya

Raisons, mixed dried fruits, apricots

Nut & fruit mixes

I always use my ‘powerhouse mix’ (see below for recipe)over it too.

For RNY & bandies, by adding hot milk you can make a very nourishing healthy sloppy food from these grains. My friends tell me that sometimes it is hard to eat more whole foods, but you’ll know the ropes! This is a good alternative to the white carbs that slip down so easily - cautiously give it a try!

To make the cereal protein rich is a simple matter of adding heavily fortified milk and nuts to the cereal. Adding ground linseed and nuts boost fibre further as well as add a richer nutritional profile. Add to this tasty melange some Goji berries, or strawberries, blueberries - any berries and I swear it - breakfast rocks!!!

Jane’s Powerhouse Digestion Support Sprinkle:

Pumpkin seeds

Poppy Seeds

Sesame seeds

Flax or Linseeds

Almonds

Brazil nuts

Rye

Capsules of acidophilus, opened (You may or may not taste these in the mix, if you taste it - lower the amount you put in!)

Using a multimix type of blender grind up seeds finely. You can use different proportions according to your own taste. Flaxseeds can be quite gritty so I use less of those (but still a fair amount!)& I use less rye too. I go heavy on the almonds, sesame, brazils and pumpkin seeds because they give it a lovely nutty taste. For a cup of this mixture I use 4 good quality acidophilis capsules, opened and contents sprinkled into the mix. I don’t use much of them - reckon this amount is fine to help maintain a healthy bowel. After antibiotic use, I use more capsules in addition to taking them neat.

Keep it in the fridge. Eat within 10 days or so. Enjoy!

If you are on a low oxalate diet because of kidney stones or problems this mix is not a good idea. Also oxalates & phytates might inhibit calcium/iron/zinc absorption - but so far it looks to be by a very slight amount. Some calcium is naturally contained in the mix anyway. On balance, except rarely, it is still much more beneficial to ingest these foods. My likelyhood of being depleted of some of the minerals they contain way outweighs the minor effect they may have on my calcium absorption. As I have calcium & sometimes zinc issues, I take extra calcium and zinc. Generally it covers any phytate/oxalate losses. However if I have very low labs I go much easier on fibre.  So - just some thoughts but weight it up in your own context.

Aside from fibre this mix also provides good mineral content.

Nutrients include:selenium, pottasium, zinc,magnesium,manganese,copper, B3, even a little protein and more!

I eat this on some veggies ( I like it on carrots and with pumpkin, butternut, green beans and sweet potato), in yogurt and love it with mashed banana (with a little cinnamon added). It goes into my curries. I mix it into peanut butter . Added to balsamic vinegar and olive oil it makes a fab salad dressing. I eat a few tablespoons daily.

Here is a well written article about the benefits of rye & fiber: http://www.whfoods.com/genpage.php?tname=foodspice&dbid=65#nutritionalprofile

More about Fibre in general:

http://www.nutrition.org.uk/upload/Fibre-PDF.pdf

As an aside, bear in mind that a high protein - highish fibre diet will require plenty of fluids for optimal health. You won’t be hungry for reasons other than just the ‘filling’ capacity of protein & fibre. You are highly unlikely to be hungry because your gut will work optimally & you will get plenty of nutrition.

Most of us know the drill. But for the record here it is:

Protein first

Then Veggies

Minimal Carbs

Plenty of Water & fluids

Blood labs once a year - more if a newbie or if there is a deficiency.

Supplements:

All of us, both RNY & DS should take calcium. DSers need A&D especially but imo E & K should not be ignored. Surgeons differ on their approaches to E&K - so if in doubt go with what your surgeon says . RNYers need B12 and Vit D and the oil solubles should not be unaccounted for either. A good bariatric or potent multivitamin serves bandsters & RNYers well. DSers need iro of 2-3 multivits daily. Possible extra’s are iron, B12 & zinc. Also a balanced omega oil may be useful and/or fish oil.

Food vs supplements?

A lot of Dsers believe supplements will help them go the golden mile. In a way they are absolutely right. There is no way a Dser should ever imagine they can forgo vitamins/minerals just because they eat a lot & feel healthy. This is dangerous thinking, but it is easy to fall into. Don’t go there!

However I don’t believe in only protein and supplements LONGERTERM. Infact if it is possible (one has enough capacity) I believe in the benefits of nutrition also, derived from food as early as possibly. Why? Because simply put we don’t yet fully understand the synergy and role of food derived micronutrients in our bodies. There are very likely vitamins or vitamin-like substances in food we are not aware of yet. The bioavalibilty of food derived nutrients is generally higher than synthetic substitutes. They may even facilitate absorption of our pill form vitamins and minerals. As malabsorbers we can argue we might not derive benefit from them, but I think that’s shortsighted. We will always absorb something and even a little might be protective for us longerterm. It adds up.

There is a place for man made supplements Protein bars & powders) and times a person has no choice but to use them. That’s fine. In the event this is not the case, my ethos is to stick with natural sources of protein for example fortified milk for protein drinks and as much natural unprocessed food as is possible AND continue with daily vitamin & mineral supplementation appriopriate for your surgery type.

Let’s say you do all the above but still, your weight is stuck - what then?

Consider the following:

How are you eating?

Eating protein first, then veggies, then other carbs can help a lot. I repeat it often because it is so logical. If you eat this way you will fill up quicker on the most nutrient dense foods and have less space for junk.

Are you a longertermer that has not quit snacking habits? Go to 3 meals a day plus at most, 2 protein snacks.

Are you taking a long time to finish your food? While eating slowly is a good thing, if a meal goes past 30 mins consider chucking whatever is left on your plate.

Are you getting enough protein & water daily?

Too little may cause water retention. Enough water is essential with a high protein diet as protein is a highly concentrated food. Enough water prevents strain on the kidneys & liver, so it’s well worth glugging (or sipping ) it down daily. (Said somewhat mournfully, so no telling what my issues are then!)

Are you eating too much protein?

Balance is essential. I believe we can eat too much protein, particularly DSers might. Protein is not a calorie free food. If too much is eaten the body might start to store it as fat. Your body is highly creative! There are times that it is wise to concentrate on a little more protein for example before & after a surgery, after illness, or if you are a large person, but otherwise aim for the upper limit of around 100gms a day if you are a DSer. Around 60 gms a day for RNYers & around 45gms a day if you are a bandster or have other non malabsorptive surgeries. Remember that protein = nutrients too. Eat a variety of protein daily to benefit fully.

If you can exceed 90-120gms of protein daily - it’s a sign to start introducing veggies without a doubt!

Why eat vegetables?

Vegetables are not yuck. I used to think so but when I started to use them as my new ‘pasta’, I realised what wonderful tasty food they are. Vegetables are much more than just a source of nutrition. They provide soluble and insoluble fibre. They also condition the gut and keep it in good health. As WLS patients we need both these factors. If one has problems with veggies - they can be mashed or taken as concentrated sauces and soup in year one for Dsers - longerterm for bandsters and RNYers. At 2-3 years out in the ideal world a DS patient should be taking 5-6 servings or more a day. Unless restriction has just never become looser, DSers should be eating complex carbohydrates by year 3 and sooner if possible.

There may be wind particularly in year one which makes one loathe to try for veggies - but this subsides given time. Beano - from the USA can help considerably if you are a sufferer. And please don’t fret if you just cannot do it, it’s okay. In year one it is difficult & protein, vitamins and water are fine. Even in year two some people can’t eat much in the way of veg. That’s also fine. There are no hard and fast rules and it is very much about being guided by one’s own body. We are all different. I lived like this in year one and survived very well to tell my tale! Complex carbs can come later and it’s probably best that they are introduced into a gut that is far from newly rerouted. When you do introduce it -go easy. Just a couple of teaspoons at a time to see how your body reacts.

Fruit:

Nothing wrong with a little in moderation. Just beware of those smoothies please. They are not healthy. They are choc full of fruit sugar. Several times now I have pinpointed these as the reason someones weight is stalling. Eating a whole fruit is a much better option. Fruit can sometimes trigger carb - hunger for some people. Best for not doing this are the ones that are relatively low on the GL list.

Sugar & Carbs:

Again very moderately. Some of us can eat these others cannot. Threshholds differ. Eating these depends on where you are personally at weight wise and how they affect you. Some DS surgeons say no more than 40 -60 gms daily as a guide.

Fats:

Know your fats. Not all are bad for you. In fact for those of us with a lot of fat malabsorption eating fats might not be a bad plan. I will blog on the topic more later but for now here is a link about fats:

http://www.hsph.harvard.edu/nutritionsource/fats.html

Finally but very importantly:

A recent study of WLS patients showed many of us suffer from a kind of low key bowel overgrowth. It’s not always going to give us the usual symptoms of bloating and wind/gas, diahorrea, either. This is most likely going to affect our absorption of nutrients and we should try our best to heal the situation. (See my gut health recipe in the blogs to follow). Good nutrition practice will go a long way towards sorting this out.

Eating fermented foods is good for the gut so try for yogurt everyday. Also take acidophilus on and off to keep your gut sweet. After year one introducing a little fiber into your diet can help too. (More about the subject later.)

http://www.ingentaconnect.com/content/klu/os/2007/00000017/00000006/00009139

http://www.springerlink.com/content/9408j43670452286/

You knew it would snuck in and here it is: EXERCISE.

At first it can appear to increase weight, just ignore that. This is compact weight gain on your muscles, it won’t make you look fat! On the contrary it will improve your shape.

Exercise is basically just moving about more. If you want to get serious or need too - fitness clubs might be the ticket. As for me I dance wildly by myself -lol! I walk daily.

Find something you love to do. A walk through art galleries (walk the stairs!) or along a river is exercise. A morning shopping is good exercise! Or am I just making an excuse now!

THE WAY I EAT:

First off let me repeat my oft repeated disclaimer that I am just your ordinary Jane Doe. I don’t have a medical background nor a degree in nutrition. If in doubt check with your primary medical carer.

All I have is my rerouted guts and a growing sense of desperation about how little the nutrition requirements for WLS patients is investigated. Nothing in my opinion could be more important. I know I am biased, but our health depends on it. Our quality of life depends on it. Our families depend on it, because we matter to them. The longerterm public views regarding WLS depend on it. The next generation of morbidly obese WLS patients will depend on it. The future of WLS surgeons may depend on it as if we don’t do all we can to keep ourselves healthy, the media will have an open day bashing not only the surgery but our surgeons. The knock on effects on our WLS community are potentially much bigger than one individual bucking compliancy.

We need to realise it’s not just about our own life, we are part of a bigger community and our personal ripple might have far reaching effects. We need to remember this.It upsets me greatly every time I read of a patient on the cutting edge of malnutrition. I always think - that might have been avoided. If only. I often think that somehow we just might not be getting the message across regarding the swap of good nutrition for our obesity. I feel I have a responsibility to myself and my WLS peers to try to bring to our communal cooking pot - if nothing else, food for thought.

For over 4 years I have focussed on eating a GL (Glycemic Load) type of diet intuitively on demand from my DS that modified my behaviours. I don’t think I am exceptional, many WLS patients get modification - but that is one part of the pie only. If we don’t listen to our bodies it is possible to completely mess it up all over again.

Eating like this has served me well. I had to smile at the fact that now it is suddenly the new buzzword-diet, I thought it was just good old common sense tbh! In my days it never had a name! But on the other hand I am delighted to see it articulated in ways people can understand & use it. I think it’s brilliant that it is bringing to light firstly the damage caused by simple carbs and secondly the fact that meat is actually a very healthy food! ( see under meat for further explanation).

Whereas I always found most GI (Glycemic Index) based low carb diets quite harsh and difficult to sustain, the GL type is more versatile, more relaxed and for me, better geared to living it lifelong.b You may find other variants better for you.

At this stage (keeping an open mind) I’m not convinced I buy into these diets because of the weight loss factor alone, though I like it! Some people say a calorie is a calorie and these diets reduce calories.Others say not all calories are created equal and I tend to agree…I mean logically a sugar calorie is empty, while a calorie from protein has nutrition. And this is the nub of my diet - if it is high on nutrition I eat it over something lower ranking. After my protein, high nutrition foods that contain fibre are my foods of choice. My feeling is that in years to come FIBRE will come to light as the next buzzy-diet thing.It once made the headlines, and I reckon it will reappear in ‘modified’ form as most diets do! I’m not talking only about insoluble fibre such as bran, but also soluble fibers that are just as important.

I think low carb diets are good logic - don’t get me wrong. However I do feel many of them are based on singular factors and are often not well explained. I don’t believe in omitting any veggie - that includes the humble potato which has good Vit C levels present. However the way we eat it may be important. A bowl of mash - mmmm, I can see the damage in that if the consumption is large and frequent. But I feel if we eat it with the skin on, the fibre may buffer huge insulin responses. Also if it is eaten along with complex carb vegetables and protein, does it have the same effect on insulin as it would if eaten alone? I don’t know, but it may not? Plus - we need Vit C. Vit C may be low for some WLS patients, and it plays many roles in our bodies.

It’s really simple and no one needs a diet sheet to follow, just a little basic studying of these foods can provide invaluable direction.

Here is an article that explains the difference between a GI based diet & A GL based diet:

http://www.timesonline.co.uk/tol/life_and_style/health/healthy_eating/article521694.ece

Here is a good foodlist and lot’s of other well researched info:

http://mendosa.com/advice.htm

A nice GL chart (simple), and a man after my own heart who states that in limiting carbs we need to consider: ‘the quality of nutrients a particular carbohydrate contains. Where we will disagree is about his take on red meats…understandable in his context perhaps. Nonetheless - makes a good read with some diet plans that could inspire food ideas!
https://www.releasingfat.com/healthy_lifestyle_6.asp

A tad about GL limitations:

http://www.nutritiondata.com/help/estimated-glycemic-load

Interesting potentially useful alternative to LC diets - the Satiety Factor:

http://www.nutritiondata.com/topics/glycemic-index#lowcarb

HOW MANY SERVINGS OF LOW GL FOOD POINTS A DAY?

It sounds like a simple question but blow me over - I can’t find anything solid out there. Some say it must not exceed 100 points daily. Others say 300. Others increase that figure even. There are plenty of variables it seems. I simply can’t find a general daily recommended amount.

As for me I don’t count my GL load. I don’t need to lose weight - I eat for my health alone. I will however give this more time and energy and try to assess my daily GL loads over time in the future.

I presume as WLS patients those of us that malabsorb would need to modify any daily amounts that do surface.

Please if you find info relating to daily loads share with me & I’ll post it up. Thanks!

I have blogged on hugely about this issue and it’s way too much for one blog. I plan to post what I have written over this week, probably most days. Some further things I have written about include how I estimate my protein grams, how to ensure you are eating the right amount of food daily, fibre in our diets, my ole gut sprinkle recipe, other stuff, and rather weirdly about ailing over weight doggies.

Hope you are doing well and finding some use in my plethoric bloggings! Stay with it and best of luck…watch for my next blogs - they will be marked (B),(C),(D) etc….

Lastly - hope you are enjoying the weekend! I’m off now to go and do a spot of bargain hunting at a local Antiques fair. My head needs a rest - and I need some exercise…LOL.

HOW TO ACTIVATE MOTIVATION:

Mentally:

Plan ahead. Get organised. Write up your good food list and go shopping. Work out your snacks in advance. Cook some meals and freeze them for those crazy days when you won’t have time to cook. Buy your vitamins. Clear out your cupboards and fridge/freezer, throw out all the junk food. It’s no good getting up in the morning abuzz with the changes we want to make only to discover we have a choice of white bread or a chelsea bun for breakfast.

Action Summary:

• Doing it is easier than you think. Think ‘Today’ only. Don’t think about next week.

• If weight and or nutrition are your concerns, observe what you eat. Join ‘Fitday’ or a similar food monitoring program and key in HONESTLY what you eat daily for one week at least.

• LISTEN TO YOUR BODY. Your body has intelligence. It speaks to you by using symptoms and signals. Give it quality time. Sit with it. Feel it in your mind. How does it feel right now? When I was morbidly obese I hated my body so much. I could not even look at it, let alone listen to it. But really it is not the enemy. It is how we live - it’s a beautiful phenomena that allows us to be here on the planet with all our loved ones. It deserves respect. Never mind the overweight or the flab, these are truly not the main reasons we are in our bodies. If you come to your body with understanding you will find as I have that it is a gift, not a curse. No matter what is going on with it, it is a spiritual gift.
• Seek support. Some lapbandsters and RNYers join Weight loss clubs such as weight watchers. If it works for you do it, but do think about the fact that as a RNYer your needs are different to a ‘normies’ needs nutritionally.

• Your energy is your power to change and it supplies your daily motivation. It’s precious like gold. Don’t throw it to the dogs! Don’t waste it on negativity or negative people in your life. It’s not going to change them, only their energy can change them.

• Rome was not built in a day: You may not lose weight quickly, feel happier quickly, feel healthier quickly. Be patient.

• On the other hand, if you are a procrastinator, take stock now! Ask yourself why you are procrastinating? Observe how procrastinating affects yourself. I am a procrastinator by nature. I find all sorts of things to do other than what I should. It affects me badly because I start to get overwhelmed by my backlog. I lose energy. I am learning to be firm with myself. Why wait to take that calcium! I tell myself : DO IT NOW! When I do it’s remarkable how it clears my energy. One less thing to remember! I’m learning it is well worth my while to do something immediately I think about it. I’m not accumulating mental baggage. It frees me up considerably.

• Don’t sweat the small stuff! If you have a bad day or a bad hour don’t let it de-motivate you. You can redress any imbalance. You may have ate a really unhealthy lunch. Fine. Supper is coming so make it full of good stuff! It was a bad day - it happens. Tomorrow will be much better.

• Don’t aim for perfection. We practise living with a surgery until around year two or three. It’s a journey of learning how to adapt. For a while. Then the goal posts may shift or the surgery itself may undergo a change and we go back to the learning process again. The old adage we learn by our mistakes is true. Learn from any mistake you make and next time you may have the insight not to repeat it.

• Live by the 80-20 rule. If you do most things right 80% of the time, you will get where you need to go.

• Aim to create a habit. Consistently doing something can become a habit. I hated eating breakfast. It was a real effort for me to factor it into my day. But now it is a habit. I miss it when I don’t have it. The effort has gone.

• Make one or two small changes , when they become a habit add in another one or two.

• Don’t underestimate the power of a small change. Dropping one small choc daily meant that I lost close to a stone in the months to follow.Doing one thing one enjoys once a week can re-energise one for several days.

• Don’t allow deprivation regarding food, but do work out a compromise or a replacement for that food that is better for you.

• Don’t wait for ‘perfect conditions’ to start anew. In one’s mind there will always be a better day than ‘now’ to start.

• Take action as soon as problems arise. If one just goes along despite them, it reinforces them and they become ‘bad habits’. Break the pattern early on.

• Portion sizes do matter after a year or two. As a Dser I eat a flat plate of food 3 times a day. I leave around 20% of it uneaten. I have 2 protein snacks. Consider always leaving food on your plate. A small side plate might help you regulate portions better. EAT SLOWLY!

Ask ‘why?’

Why should I avoid carbs? Why should I not eat fat? It is stating the obvious but so often I hear a person say:’ My surgeon told me not to eat fat.’ Did he explain why? - if so, you understand the reasons. If not try to understand why he said that. Examine it from your own personal perspective, do you have a non malabsorptive surgery? Or do you have a DS? If you eat fat what effect does it specifically have on you? I I eat fats because I feel fine eating them, they don’t affect my body…but I walk the middle road. Most of my fats are from natural sauces. I avoid trans fats if I am aware a product has them, I have unsatured fats if I please. If you have time, do a little research to feel out a more global perspective about those ‘taboo foods’.

Should I have sweet things in moderation?

Depends! Can you? Or does it usually end up in a binge and guilt feelings? There are times in my life when I can be moderate. There are times in my life when I know I will not be moderate because of circumstances. Stressful or very busy times mean I won’t be moderate even with my best intentions. For some people they find it is the other away around, relaxed times mean they won’t be moderate!

Ask ‘how?’

How can I remind myself to take my vitamins daily? How can I change XYZ habits? How can I feel better about myself? etc!

….But sometimes, STOP thinking:

Thinking can be wonderful if it leads you to greater awareness and understanding. It can take you into yourself to discover just who you are and what your meaning and lessons in life are. But sometimes it can add to your fog, leave you tired, upset and confused. You feel even more stuck. At times like this living by the old saying ‘Keep it simple’ can help.

Sometimes it’s easiest just to reconnect with our surgeries compliancy needs or rules. It’s easy to let these slip with the years. What do you need to come back into your life? Be specific. If you need to eat better food - what do you mean by that? What type of food? Healthier food? What is truly healthy food? Which of the healthy foods do you like? Which don’t you like? Defining food preferences are important, you’ve got to be able to live with it and eat it! No good knowing whole wheat bread is better for you if it just gets mould in the breadbox!

When motivation does not work:

…It’s sometimes because we actually don’t want it to. Sometimes we set ourselves up for an internal argument. While preferences are always a good thing to have on one’s side there might be times even this has to give way. We can’t always like everything. I don’t like eating when I don’t have an appetite, but the fact is I actually don’t have a choice. Why not? Because my health matters. It’s just as simple as that. I eat whether I like it or not! Sometimes we need ‘tough love.’ Occasionally a Dser won’t take their vitamins. Why? Is it due to stressful circumstances or bad memory? No. It’s simply because they don’t like them. My response: Tough. No one likes to take medicine, but this was the trade off for the obesity. Take them, or be willing to suffer the consequences.

Sometimes, we really do need to just give it over:

Sometimes there are times when life is out of our control and utterly overwhelming. Crises do occur in our lives. No amount of planning stops the daily avalanche of endless priorities. It seems that everyone else’s needs are more pressing than our own and sometimes they are. When my mum was ill I was buckling under big strain and even my workable boundaries fell apart between constant hospital visits and mega disruption. Don’t forget to take a little time out during the day, even half an hour alone can recharge the old batteries. Don’t try to do major getting back on track work. However, do the bare basics: Drink or eat enough protein, take vitamins/ minerals and any meds you are on. This will maintain your basic health. The rest can come later. Get as much help and support as you can. Draw on your faith. Ask good friends to visit you. Spoil yourself a little between every one else’s needs. Get out even if just for a head clearing walk. Remember, everything is temporary and what you are going through now will also pass. When it does, move to give as much of your energy as you can, to yourself, while you get back on track. It’s not selfish, it’s about surviving.

GOALS OR MILESTONES?

You decide. Personally I plump for milestones and here’s why. A goal is an attempt to fix something permanently. I used to live by goals. My goal was to get down to a normal weight and I did, but since then the goalposts have moved. A lot. I have regained a little at times putting me outside my goal. I have lost too much at times threatening my goal. I have realised that I can’t actually accomplish a goal permanently. Why? Because it’s attempting the impossible. Nothing in life is permanent. Moreover it makes me feel disappointed when I can’t freeze it in time. I get right back onto my ‘failure’ pedestal. The goal posts always move because life itself is a moving phenomena…it just doesn’t work on a fixed A to B kind of line. Not in my experience anyway. I used to have goals because I wanted to ‘be in control’.
Milestones however are flexible. I’m living with surgery lifelong so it suits me to be flexible. A milestone is not fixed to a frozen point in time. It’s just part of my unfolding journey. I plod along pondering things and doing my best. Suddenly I realise I have had another milestone! It’s so exciting! It’s happened enough for me to have faith, both in myself and my surgery. And as I am discovering this WLS journey actually has no end, not while I am alive anyway. So why do I need to make goals for myself? Why do I want to put myself under so much stress and pressure? Short answer: I don’t!

“When you’re finished changing, you’re finished” (Benjamin Franklin)

I hope the above helps you think about some things you can do to get back on track. I know some of it might seem simplistic, but sometimes even when the obvious is staring us in the face we don’t see it.

You may already understand a lot about yourself and your surgery. Great - next step might just be to plan a workable boundary for yourself and begin the action.

It’s never too late to give things a shot. Our surgeries do undergo a degree of adaptation. I have found myself several times during my own process needing to rethink things. I’m no saint, I write things such as the above and believe me I see my own shortcomings glaringly too - lol! It’s also my way to kick myself up the jacksie and get my own flow moving too. I seldom hit a 100% perfection rate…and right now my water consumption among other things is sad .

In my next blogs I want to share with you some of the easy ways that I deal with the foodie/vitamin aspects of my life. That’s the kind of stuff I really enjoy writing about the most - food! From what a portion of food actually is - to a neat way of eating that helps me never feel hungry. Right now I’m having difficulty just keeping up with everything that is demanding my time. I’ve been trying ‘badly’ to cook the usual dinners, but I need to get on top of my fast nutrition fixes again. I’ll cover some of my ‘quick fix’ meals later in this blog series as well. My motivation for the week ahead is to eat well but cook fast! Oh, and get onto my water intake again!

Hope you have a great and motivated week!

WILLPOWER VS MOTIVATION:

I love what Mae West once said: “ I used to be Snow White, but I drifted.”

We are always Snow white when we think our willpower is working well. But drifting can happen!

WLS patients sometimes find themselves off track regarding eating habits. The surgery still works, but it’s just not as optimal as it once was. We might have had a regain recently and fear it will spiral. We fear we have no willpower or self control and berate ourselves for this. In doing so we kill our spark of motivation. It’s not willpower that effects motivation. The very word ‘willpower’ is de-motivating’ for many of us. Some people swear by it and if it works for them fine. Personally I avoid the word. Inherent in it is a backlash for feeling like the worlds biggest failure.

‘Willpower and self control’ just smack of deprivation to me. Lifelong deprivation?! Who wants that? Certainly not me. I have had enough of that.

In my late first year I had a wobbly phase and I tried to apply willpower to eating better and failed dismally. It was very depressing. I decided that my old willpower, self control days were over!

So now what? No willpower and the sweets/carbs/crappola were yelling my name. Worse my tum had just had a further stretch.

Willpower is a self imposed law that inevitably comes out of a negative mindset. When I was trying to use it, I only knew sweet food was fattening and therefore bad for me. Some one else told me that, probably long ago when I was a kid. Every time I passed a piece of cake, or a bag of sweets I had to call upon my willpower again and again …and yet again. I lived my life being on the defensive all the time. Several times a day. I had to consciously remind myself not to eat the forbidden goods. It usually depended on an external trigger first for me (the sight of all that yummy food!) and involved efforts to avoid even looking at that temptation! Of course the more I tried to avoid it, the worse it became. I became food fixated in my very effort not to. Summoning up willpower day in and day out, is a very tiring business. No wonder I ‘failed.’

Motivation on the other hand does not come out of willpower. In fact it only comes out of understanding. It’s a wide open Why? Why are sweet foods fattening? Was it just calories that would do the damage? Or was it the way that my particular body reacted to simple carbs? I discovered that while calories could play a factor for me, with my insulin resistance, eating simple carbs was a red flag for the insulin to run amok in my body. It was the insulin responses I was having that caused my weight gains far more than the merely the calories involved. Did I want to try to tempt fate by eating it every other day after my surgery?

Knowing this I don’t eat many simple carbs because I understand the damage they could do me fully. I don’t need to think about it every time a simple carb is in my view. I’m seldom tempted and when I am, I usually just settle for a little bit or I find some other food that tastes just as good to me. With willpower I had to react in the moment. With motivation I am always armed with good reasons to make the choices I do. Motivation is much more an internal constant for me than the temporary fix my willpower once was. It has taken me into ‘the longerterm’ phase of my surgery because it is part of my daily life. The interesting thing has been to see how over the years what was once motivation (and effort) has become habit (with no or little effort.)

Recently my needs regarding carbs changed, as regular readers will know. I purposefully ate simple carbs as I need to gain a little weight. I admit I was hoping they would sit well with me. Unfortunately, I’m still not able to eat them as they still create acute insulin responses for me. Because I understand the responses of my body, I was able to understand even more fully the impact they have on me and stopping them was a relief, not an act of willpower.

ENERGY =ENERGY:

It’s a neutral force. We can choose how we percieve it and what emotions we will attach to it. We decide where and how we want to expend it.

I decided some years ago to de-baggage myself of this willpower stuff and all the (usually negative) emotions that go with it. I used to be extraordinarily good at self flagellation. Then I realised that it’s my choice not to keeping beating myself up about my life and how things were turning out. It once occurred to me that the same energy I was losing on my ‘lack of willpower’ fallouts and subsequent depression could rather go into making a daily effort.No matter what our circumstances are, everyone owns this choice. It’s Gods freebie.

However, expect adversity. It’s going to happen to most of us on our surgical journey, as much as we have high expectations to start off with. However it does not mean the end of our journey. Adversity brings us to the forks in the road where we decide which way we are going.

CREATE A WORKABLE BOUNDARIES PLAN:

I decided to expend my energy on getting myself to feel motivated about what I was going to eat. I researched what the best foods were nutritionally. Then I set myself workable boundaries instead of self control. I never had inherent idea’s about what portion control was, for example, and with the DS there comes a time when we need to assess that. If I was hungry I would just reach for any old food and keep eating it, sometimes quite automatically. I needed limits. A workable boundary is a way of drawing limits without feeling pressured to be on the constant alert. Self control is not needed because once these limits are defined, there’s no argument with oneself. No if’s and but’s…just ‘do it!’ It’s a simple, constant and clear cut structure, unlike self control which is a wobbly state of affairs at best and subject to all sorts of emotional and environmental fluctuations.

A good set of workable boundaries will automatically act as a ‘damage limitation’ structure. ‘Automatic’ is what we should be heading towards because if we feel we are continuing to make huge efforts longerterm , it indicates that we may not have given things enough thought.

Here is my workable set of boundaries which I still live by today:

• Always eat breakfast
• At any meal: eat my protein FIRST then my veggies, then if I still wanted a simple carb I’d have it.
• Make my protein as tasty as possible. I started using lot’s of different spices and herbs and sauces to give my protein extra zing factor.
• Find out what head hunger is vs real hunger. ( I starved myself for a day to find out what real hunger felt like and boy is it different from the head stuff!)Once you feel it, you will know the difference.
• No food is utterly taboo, but I can only have sweet simple carbs after 8pm in conjunction with a ‘buffering’ snack such as nuts or a bit of cheese. A buffering snack is a way to evade a direct sugar hit on my insulin. Recently I use cinnamon sometimes, as it has been shown to help slow down release of blood glucose.
• Try to figure out my cravings & start to use less harmful food replacements. Chocolate can be replaced with hot chocolate milk. Processed cereals can be replaced with a muesli made of :organic oats, spelt flakes, rye flakes, seeds and nuts. Bread can be replaced with rye bread, or soya-linseed loaves. Desserts can be replaced with hot fruit & creamy yogurt or low fat(for those who follow low fat) ideal milk concocotions that include sugar free jellies perhaps.
• Taking vitamins and minerals is NOT a choice. It’s a non negotiable daily fact for me. Point blank.

The result was I filled up throughout the day. I began to enjoy veggies again and my protein tasted so good even I was impressed by my efforts!. After eating a meal I enjoyed, simple carb didn’t much appeal to me because it tasted…well, tasteless really. I seldom had much space left for it anyway. I found after 8 pm a small chocolate was all I needed for satisfaction factor. (Later even this dropped away of it’s own accord!) I felt happier because I wasn’t ‘trying to control’ myself all the time. My weight loss continued. I felt inspired and motivated to carry on with the above.

Did I maintain this? Nooooo, there were days in the beginning and there are still times that I fall off the wagon. Holidays and Christmas are times I tend to lose my own plot. I just try to reinstate my workable boundaries as fast as possible. After around 6 months of consistently doing this I no longer thought about it. It just became natural for me.

I read a fellow DSers post the other day. She’s come a long way and now she feels okay about her weight. She wants to eat the odd carb treat but she has set herself a workable boundary: eat it slowly and really really taste and savour the biccy. No more than 3 a day. Sounds like a good workable boundary to me.

Maybe you could also figure out what workable boundaries would suit you? Feel free to adopt mine if they suit you. Think about it carefully. It’s important that you feel you can live with them longerterm and that means being able to implement them everyday. The simpler the better.

Then write them up. This is important because in sight = in mind! I have a blackboard in my kitchen & mine went there. Put the list where you will see it several times a day. It will sink in if it is visible and help you condition yourself to your new way of life.

WHAT DOES LONGERTERM WEIGHT MAINTENANCE MEAN?

It means it is never going to end, unless you have your surgery reversed.

There is no longerterm about it really…it means doing what you need to do everyday. Then hopefully the longer term will look after itself.

FLICKING THE MOTIVATION SWITCHES ON:

Defining motivation:

• Motivation and effort are flip sides of the same coin. Motivation inspires effort. Effort inspires motivation.
• Motivation is a deep inner process that moves you towards what you feel is important for you.
• The root of the word motivation comes from a combination of ‘emotion’ and ‘to move’. What emotions are you feeling currently? Are you going through stressful times with emotions that are bogging you down? What can you do to shift your perceptions? What is important to you right now in terms of your surgery? In terms of your values? In terms of your life? What do you need?

Ask yourself what gives you motivation?

Some people are motivated by extrinsic factors, such as financial reward or a certificate of achievement. Other people are motivated by intrinsic factors such as moral values they hold as important. Still others may be motivated by fear. Fear of what would happen if we did not act as soon as possible. Generally this is regarded as not such a great motivation factor as it can backlash and make people feel powerless. But for me it is viable. I fear what would happen to me if I do not take my calcium for example. Every time I take it I move away from that fear. I focus more on my health now than on the fear underlying my actions. Some people are motivated by all or combo’s of the factors above or may have other ways of getting motivation that I haven’t thought of.

Equally important, what does not motivate you?
If you constantly think fearful anxious thoughts you might find yourself stuck in a rut. Fear might not be a good thing for you. I manage my fear okay, but you might not. You may find that reading something inspirational each day motivates you much more. There may be many negative thoughts clouding your head right now. Jot them all down on paper. Ask yourself if they are serving you in any way? Be honest, even it pains you. Sometimes it does serve us to be negative. We may be protecting ourselves from failing in some way by sabotaging ourselves with negative thoughts before we even begin to do something. Sometimes we use our negativity to manipulate others around us unconsciously.

There was a time in my life when I was very negative. I whinged and complained about everything in a destructive fashion. I affected others around me. I felt suppressed anger because no one pulled their weight around the house. I also noted the harder I whinged the more they tried to sympathize and please me, probably to preserve their own sanity . One day I had a long thought about it all. Did I want cheap sympathy in exchange for real love and affection? Was I actually creating paralysis in everyone else as well as myself? What did I want and how could I best express my needs constructively? Instead of whinging could I give everyone set tasks to do at the beginning of each week? I put some more constructive plans into action. I spoke out about my feelings but not in an angry way. I cut the whinge. We all felt the better for the improvements we made regarding housework. I still lapse into my cycle from time to time, I’m far from perfect. But I know better now what to do about it, I try to catch it before we all start walking in the hall of misery.

The above also made me realise that people who sap my energy don’t motivate me any more than I motivate others when I’m being a whinger!

Avoid naturally negative people. Avoid people who purport to support you but always deliver the sting anyway : ‘ of course you have done very well, it’s taking me slower to lose my weight, but then you did take the easier way out!’ Avoid people who love to say: ‘I told you so!’ If you cannot avoid them remember you have the right to tell them you have had enough and that if they can’t be constructive you’ll leave the room when it suits you.

IS YOUR SURGERY OFF TRACK OR IS YOUR LIFE OFF TRACK?

It’s darned difficult sometimes to find the thin boundaries between one’s life and one’s surgery. I fall into this trap often. It’s my surgery making me tired when really it is my hectic overburdened life. It’s my surgery making me ill, when really I ate a plate of chips for lunch followed by a chocolate bar! ‘My surgery is making me miserable’ , when maybe it is the way my LIFE is right now that is making me miserable. Is your surgery really causing you the problems you face? What is your overall quality of life right now? How can you sort out the things in it that bother you? A stressy life can make a surgery play up. A calm peaceful life can help us give our surgery more attention and make getting back on track a helluva lot easier.

It might help to think about what a quality of life means for one? Is it really about eating a plate of carbs or is what we long for perhaps more friends? Or just, more fun?

Sometimes we go into denial about what’s really going on. Jenny (not her real name)called me in a state because she’d put on a stone in a very short space of time and she’d developed diahorrea that was getting hard to manage. We chatted about it trying to figure it out. We went through her daily foods and analysed them on fitday. It looked fine.She was exercising weekly. I could not understand it until she mentioned casually that recently she had been having ‘a couple of drinks’ at night to relax herself. How long was ‘recently’ ? Around 4 months. Her gain correlated with exactly with that window of time. How many drinks ‘was a couple?’ Well it differed but mostly 2 or 3 at night.

We worked out a compromise plan between us because she did not want to give her drinks up. I called her quite regularly and there were no improvements regarding her weight. Was she compromising? No, because what damage could a couple of drinks do anyway? I pointed out that some damage had clearly already been done and that alcohol is a pure ’sugar’ hit that can affect our livers, our pancreas and cause bacterial overgrowth in the bowel which might explain her sudden development of diahorrea. She took it in and agreed to think about it. She phoned me a few weeks later and told me she realised she was in denial and needed help with her addiction. We talked about how sometimes WLS patients transfer addictions and how difficult it can be to see this process developing until it has already spiralled. She joined alcoholics anonymous and stopped drinking. She took a short course of antibiotics to stop the diahorrea (as alcohol was not to be taken with the flagyl it helped her in this way too). She started to lose weight easily again. She’s still doing well, maintaining her loss and has no bowel issues.

If your life is fine, but your surgery needs tweaking try to define exactly what needs to be done. Is it your weight bothering you? Or is it your health? Or both? Usually a focus on health brings the weight back into line. Or, what you are eating may not be as important as when you are eating. Sometimes teasing out the strands gives clarity to a fuzzy picture.

Quite often I observe WLS patients stating on forums that they suddenly ‘feel driven’ to eat for no good rhyme or reason. They believe they are comfort eating but I don’t believe them! I don’t think ‘comfort eating’ explains the ‘whys’ of the matter. Most sudden changes of behaviour have good reason behind them. Usually we start to look for any emotional reasons in ourselves (and yup this can happen) but sometimes it’s related directly to our bodies. A smart body ‘knows’ it’s needs, much as we may know our emotional needs. It’ll give you a signal, but it’s up to you to interpret the needs of the signal. Sometimes, we use food to self medicate ourselves. Except for definite food eating disorders (and possibly even then) , comfort eating is usually nothing more than a form of self medication.

Eating uncontrollably might well be our bodies way of trying to get certain nutrients. With with iron deficiency for example, a sudden need to chew ice can be a symptom. While I am clueless about the ‘ice’ connection in relation to iron - it’s an example of body over mind. Other examples are that wonderful ‘time of the month’ when hormonal flux is happening. Sometimes when the body is yelling out for more complex carbohydrate we misinterpret this impulse and succumb to the junk carbs instead of giving it what it needs properly, ie complex carbohydrates.

Simple carbs can set up an endless hunger based on endocrine function and low blood sugar crashes. We know the pattern - we reach for sugar for energy. A little later our glucose levels drop, we feel tired, we reach for a simple carb snack. Sugar and simple carbs also help release seratonin, the feel good chemical in our brains, so when depressed we often eat simple carbs and chocolate! Instead of doing this - have a good source of complex carb on hand. It will give the same benefits as simple carbs but without all the negatives. Crackers like Ryvita are tasty and healthful. A wholewheat slice of toast with cheese or nut butter on it, can do the job more effectively than a slice of white bread smeared with jam. A half apple grated into yogurt is another idea. Think in advance of the snacks you could eat instead of sugars and simple carbs. Eating these sorts of snacks every few hours can stabilise the body and prevent comfort eating. Simply not drinking enough water can affect blood pressure, making it low. It’s worth looking at one’s daily vitamin routine - are we taking enough minerals & vits? Getting labs done may reveal a deficiency that once addressed,may solve ‘driven’ eating.

It might be of some use to you to ask yourself the questions above and then to write down your own answers to gain insight into yourself & your surgery.

I started to write down the above and in my typical fashion, the blog kept growing and growing! So I decided to split what was one looooong blog into two and the next one which covers the ‘doing it aspects’ will be posted up tomorrow, so if you are interested, keep this space in mind.

The subject of what we might do if we are experiencing regains, that I’m going to blog about over the next few weeks may not apply to every individual.

Some may feel their surgery is not optimal for them no matter what they do. It may well have broken down mechanically.(There’s a body of evidence to prove it can and it does.) It may be a surgery type that makes it well nigh impossible to eat very much at all to sustain oneself. Carbs might be the only viable option short of starvation. There may be other extremely trying issues such as constant nausea and vomiting to cope with. Or more hidden ones such as subliminal bowel overgrowth that affects absorption of minerals and vitamins despite a persons compliancy. Having a surgery that is not optimal actually affects not only peoples emotions, but physically they are often really not well at all. Being not well, it becomes even harder - like when I am ill, I find it very difficult to just get through the day doing ordinary little things. We who witness posts on forums should bear the above in mind. One day, we could be walking the same path, there are no guarentees in life. These are uniquely very difficult situations to find oneself in. I know of people who try everything possible and make huge efforts despite these odds, including eating the best they can, and it still doesn’t work. No way would I ever see someone in this position as ‘a failure’. I know how hard it can be sometimes to just ensure my DS is acting out optimally, and it’s in good nick! So to try to control a surgery that works against one must be incredibly challenging and trying.

On the other hand, I think most of us know of people who do consistently eat the wrong stuff and they appear to be in a refusal to comply with their surgeries needs, despite what appears to be a working surgery. They post up about the awful side effects and about their continuation of repeat behaviours. They indicate that although they want support, they themselves are not actually willing to make the required changes. It can be very frustrating for those of us witnessing such posts and thankfully it is quite rare. We can only reiterate the compliancy factors of our surgeries strongly and hope they’ll see that our writing is not ever meant in judgement, but rather to aid them in changing things. Sometimes though the truth stares us head on we continue our denials to our own detriment. I’m no saint in this regard being quite the old ostrich myself at times, but I do think there is a time in our lives when we have to become responsible for our own actions. However I do feel we must make divisions between those who cannot do any more and those that can. And this is difficult because not experiencing things directly and as onlookers, the lines can appear blurred sometimes.

The way I see it is that we don’t know what the future holds. Practising good dietary habits will hopefully help those of us who are able live comfortably with our surgeries well into the future. However, in years to come, there will be great strides taken in the development of WLS. There may be ways I can negate the downsides of my surgery and I’m going to feel free to do just that if I want to.

Many of us understandably hold the notion of the idea that our WLS will be cut out in stone, a permanent fixture that will provide permanent weight loss. I did before I had my surgery.This is quite unrealistic, but we have high hopes sometimes.

Firstly the body is a dynamic field of change and constant movement, from our peristaltic movements, to it’s ability to fight back with compensation, right down into still unknown processes of cellular function. I have experienced this with my DS - I have at times needed to reassess the way I handle my wildly bucking DS-horse! Secondly, WLS is a changing field. It’s not static in any way. WLS history tells us this is not a new thing. When the JIB was developed, I’d vouch for it that many who had it could have realised at the time, that one day they would be revising their surgeries on doctors commands. The eRNY, stomaphyx and the new VERGITO (a surgery that involves a sleeve gastrectomy, splicing the ileum & locating it upstream in the intestine and removing the omentum :http://www.johnhustedmd.com/vergito.htm) are interesting possibilities that may expand our choices or bring further insights. We are all on a learning curve of some kind all the time with WLS.

So, what I write is never intended as advice for people who are in the challenging position of thinking about a revision, and is not meant to cause any upset. I’ve always felt the above, but I’m just not sure I always clarify that enough in the moment, because I just accept it as a ‘given’ fact. I also either seem to write with a very individual response and if anyone read what I wrote as a ‘one off post’ it would be easy to misunderstand where I come from. For example, for a person who is still in early phases of their surgery and it is highly likely there is no mechanical breakdown, no surgical incompatibility, no underlying reasons such as side effects, I’d probably write my head off about making correct food choices, breaking old habits and patterns,but my response may be variable. For some one later on in surgery if I suspect a mechanical breakdown, my post may be different. Just depends on how I percieve where that individual is at. It’s not easy and my perceptions could be completely wrong.

Giving out support based advice is a risky business and there are times one feels like chucking it in. It’s got it’s pitfalls. It may not be the best for a person (and here I trust they would just heartily disagree with me & chuck whatever I said!). Writing down my thoughts as I do, I also realise that this has many shortcomings as people don’t have the means to read my expressions and pick up my nuances & vice versa - so misunderstandings are inevitable. I do it anyway mostly because I hate the thought of someone struggling all alone, or of ignoring a plea for help. I really think most of us try to help each other with the best of good intentions, we are ‘there’ for each other. I hope my support is a little helpful and at best harmless, but I am sure sometimes I miss the boat. Which is why I always say that it is best for a patient who suspects mechanical failure, or who is struggling, to go to their surgeons who have the knowledge and means to dispel doubt. Your surgeon knows you best and his help will be invaluable.

Sometimes my writing is very generalized and it doesn’t always pertain to the individual, it’s just my perception of a global situation. People who read what I write may not know my background on how I perceive revisions for example.

I really should remember to always state this, but sometimes I forget.

So I am clarifying it for the record here, not just for those who read my looong bloggings, but also for myself.

Those are my feelings above. My thinking processes deepened even more when I read what my friend Nell had written in response to someone who asked what we could do to help those needing revisions. Tbh Nell’s post was so powerful, from the heart & well articulated, that I had to reread this several times. I thought no one could verbalise things better because it comes from experience . Her post made me look at my own limitations in understanding. It reminded me that we cannot possibly know how it is to stand in another’s shoes and what we see on forums is so often just a tiny nugget of the bigger picture of a persons life. I felt her post, though personal, was a strong voice for other people who are battling this. It stayed with me several days , so I asked her if I could quote it here and she kindly gave me permission.

QUOTE:

“While I understand your post was with the best intentions, I am replieing, in an honest and open manner as one who is both struggling and having regained some, and considering revision options, but unsuccessful? yes I have regained about 4 stone from my lowest weight, and yes I have beaten myself up about it and pulled apart my diet etc, but considering I am still 81/2 stone down from my highest weight any surgeon would still consider that a success. Its me that feels the failure because I was so sure such a drastic option as major surgery would be the last time I would have to worry about weight related issues, I had high expectations, but nothing in this world is a sure bet, and I withdrew from posting for a while and infact hid by stepping down from some of my commitments, I felt I had let people down. I was happy to give support, but it got to a point where I was concerned a select few would feel I had no right to give advice and support when I couldnt reach A “Normal” bmi, so stepped back before it got to the point where I would have to deal with that, as well as feeling a failure. As habitual dieters in the past, we have all had to deal with that feeling of “failed yet again” but this time it really knocked teh stuffing out of me, and I sank into a deep depression, I didnt want people just to say ” there there, and listen to my ” making excuses for my unsucessfulness”. Asking me what I am eating isnt going to help me either personally, as I could write a book about nutrition, from dieting and fasting and trying every eating plan under the sun, I know what I should be eating and I know what I should be doing, but for me personally I happened to have teh wrong op for me, which has restricted my nutritional choices to a point that I am physically unable to eat a full healthy diet without pain and discomfort. I dont want to go over old ground here, I am doing the best I can with what I know, and its not forever, but, if I could offer any advice about posting in this forum, please, dont be flippant when replying to a post here, in some cases it has taken an awful lot of courage to admit you are in trouble and drowning, we are the first ones to beat ourselves up, and probably harder on ourselves than anyone else could be, before any derogatory comments are posted. I know people mean well, and some feel they have to comment on everything, but unless you really do understand, sometimes its better to say “I feel for you, and am ready to listen if you need to talk”, because for many of us our families just dont get it, they love us fat or thin, and cant see what the problem is.

Try not to judge, there are many reasons why some have regains, its not always just about what is put in as fuel, head stuff, depression, physical illness, a combination of all of the above in my case, everyone is different so to assume its just about the diet is to assume the postee isnt intelligent enough to know the difference. try to really listen to what the person needs, ask outright if need be, never assume you have the answer with out clarifying the question, I know when I first found the courage to start posting again I wasnt sure what it was i needed, but I knew I needed to be listened to, by someone who had some experience of walking in my shoes, that wouldnt judge me or look on me as a “whiner, attention seeker, or a failure. for some people this is the only place they can get that, sometimes a kind word and a cyber hug is all that is needed for the member to take a deep breath realise someone else does care, and its enough to give them the strength and courage to look for the answers they need. I have come to realise its going to be a constant battle, one that at times I am going to have to step back and regain my strength from, but knowing that there are people who really care, that do understand what I am going through, gives me the strength to keep at the battle, even when I have felt so tired I didnt think I could go on anymore. ( you know who you are )”

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regards
Nell

In closing - I hope if you need a revision that you find a surgery that will help you to really soar to the heights of your dreams. Let me know directly if I can help in any way. Don’t stop looking in though, while the next few blogs don’t cover revisional needs, there might be something else there that you find useful. It’s not only applicable to surgery - some is applicable to life! Besides I like your company. So don’t be a stranger.

Right - let’s post up those other blogs now…watch for a few more over the next few days. After that I am going on a long non blogging holiday - lol!