Ghrelin is a hormone produced, in part, by the fundus in upper part of the pre-bariatric surgery stomach. It is of particular interest because it is known to regulate hunger. Theoretically, if you remove the production of the hunger hormone, a patient will be less hungry and lose weight as a result. In practice, not all patients get that benefit, but many do. There is some research to suggest that ghrelin may also affect sleep patterns and depression, both of which in turn can affect weight. While this seems like a relatively simple solution to obesity, it still requires other considerations – making it a bit more complex.

Firstly, not all of the ghrelin is eliminated from the body when the fundus is removed. There are other areas of the body that procedure this hormone including the brain, pancreas and small intestine. That said, the majority of the hormone’s production is stopped after certain bariatric surgeries.

Secondly, in order to eliminate the fundus, some sort of restrictive bariatric surgery must be performed. This is where the gastric sleeve helps. During the gastric sleeve procedure, 80% of the stomach is cut away and removed from the abdomen. With this removal comes the reduction of stomach size, the elimination of the stomach’s fundus and with it, much of the body’s production of ghrelin. The sleeve is the only major procedure that actually removes the fundus from the body.

Thirdly, not all patients who may be overweight or obese are suitable candidates for major abdominal surgery. This is especially true for patients whose excess weight may not be causing them significant medical issues beyond any aesthetics. Further, those with significant scar tissue and those who are not able to safely undergo surgery due to health concerns may not qualify.

Data and clinical testing on the effect of ghrelin on weight loss is still in its infancy but a suppression of hunger is a point to be explored. It is also part of the reason behind the gastric sleeve’s ever-increasing popularity in the United States. But is everyone suited to the gastric sleeve? The short answer is no. Some patients, especially those with significant or uncontrolled gastroesophageal reflux disease or GERD and those with significant or poorly controlled type 2 diabetes may benefit from a gastric bypass. The best way to find out is by calling our office and scheduling a consultation with Dr. Duncan.

Related Topics:

• Hunger after Bariatric Surgery
• Head Hunger – Are You Really Hungry?
• Hunger after Bariatric Surgery
• What is Mindful Eating?
• Understanding Obesity

Having weight loss surgery is only the beginning. Anyone who has visited us for a preoperative consultation will be reminded of this more than once. Not because we are trying to convince you that bariatric surgery is not the right option, but rather we want you to understand that it is not a magic bullet. There are several responsibilities that a patient must take on after weight loss surgery, not least of which is controlling diet. The post-op diet will be significantly restricted for the first 6 to 8 weeks after surgery and will be different from prior to surgery for all patients.

There are many strategies for eating less. We will go over them in more detail in our blog and elsewhere on our website, but the most important consideration is portion size.

As a society, we have been led to believe that portion size is an important part of the dining experience – whether at home or eating out. However, portion size only takes into account one factor – value for money. It is not a measure of the quality of the food we eat, nor should modern portion sizes be used as a gauge for how much we should eat at every meal. In fact, portion sizes from fast food to fine dining have increased dramatically over the past several decades and this has certainly contributed to the obesity epidemic.

So, If Portion Sizes Are So Bad, How Do We Go about Eating after Bariatric Surgery?

A normal portion of protein is about 3 ounces, or the size of a deck of cards. When you think about that, it’s likely that you have eaten far more at each meal. And while protein is very good for you – the building block for long-term weight maintenance – too much of a good thing is still bad. It still contains calories and as such you can still gain weight.

How Do I Ensure Proper Portion Sizes?

This is one of the most difficult parts of the postoperative lifestyle. It is truly difficult to make sure that you are eating the proper portion size. But there are a few tips and tricks to help.

First, in the early stages of your post-operative recovery, you will likely be limited in how much you can eat by virtue of the size of your stomach. Whether it’s a gastric bypass or gastric sleeve, the stomach ends up between 15 and 20% of its original size. As a result, you simply won’t be able to overeat. However, your stomach is an adaptable organ, and it can and will stretch over time, especially if you overeat on a regular basis.

At home, at least in the early stages of recovery, we suggest that you measure out your portions using a scale and/or measuring cups. Yes, it is tedious, and no, we do not expect you to do this forever, unless you really want to. The idea is to train your brain to see proper portion sizes. You can only truly understand what you see, and measuring is a great way to do so.

What about going out? Take out or otherwise. You don’t have the luxury of preparing your own food and you certainly can’t whip out the scale and measuring cups to make sure you’re eating right. The best option? Take your food and immediately split it into two portions. One half can be placed in a separate to-go container to be put in your refrigerator. What’s left over is closer to a normal portion – though with some proteins, especially steak, you may need to cut it in thirds.

Just be mindful of your postoperative packet, making sure that you are following directions closely. A couple bonus tips that will serve you well during your longer-term weight loss surgery recovery include:

1. Eat your food slowly. Not only will you enjoy the food more, but you will allow your brain to catch up with your stomach and give you appropriate sensations of fullness/satiety.
2. Do not drink liquid with your meal. Only drink liquids 45 minutes before or after.
3. Don’t beat yourself up for bad days. We all have them. If we cannot bounce back from bad days, we set ourselves up for long-term diet failure and
4. Don’t rush the diet plan. Stick to the postoperative plan that you received from our office – it is optimized that balances safety with effectiveness and long-term ability to maintain a healthy weight.

Of course, if you have any questions about your diet after bariatric surgery, please give us a call so we can help you work through this exciting, but challenging part of your postoperative recovery.

Related Topics:

• A Vegan Diet – Is It OK after Weight Loss Surgery?
• Hunger after Bariatric Surgery
• Diet after Surgery
• Head Hunger – Are You Really Hungry?
• Eating Out After Bariatric Surgery

Prebiotics and probiotics have been around forever. The foods we eat – yogurts, fermented foods and much, much more all contain varying amounts of beneficial bacteria and foods that support them. Over the past several decades, as we have improved our understanding of the human gut and how it affects overall health and metabolism, probiotics (bacteria containing foods and drinks) and prebiotics (matter that promote these bacteria to flourish) have been touted as the solution to a number of ailments from excess weight to intestinal disease and more.

But Do They Work and Are They Worth It?

Pre-and probiotic products are marketed heavily and as such carry a similarly hefty price tag. A small bottle of probiotics can cost upwards of $10, $20 or even $30 with the promise that it will improve a host of issues. Following, we will try to separate the truth from myth and offer some guidance on improving gut health.

The Case for Probiotics

It stands to reason that if:

1. our guts are made of millions of strains of healthy bacteria and
2. when we eat poorly and take antibiotics when unnecessary we can disrupt our bacterial ecosystem known as the micro biome

Then refilling it with healthy bacteria (probiotics) should get us back to normal. After all, we need those good bacteria and ingesting them should be beneficial.

Further, there are dozens of extremely healthy foods, especially those that are fermented, that are low in calories and relatively nutrient dense. These foods, if substituted for processed foods may not only rebalance our gut health but help us lose weight as well. Many of these foods are delicious to eat.

The Case Against Commercial Probiotics

Unfortunately, while the concept of a probiotic makes sense in theory, the practice is not as simple. We don’t know, with any accuracy, the composition of our gut’s microbiome. We just know that bacteria exist and work harmoniously to keep our metabolism humming. We also know that these bacteria can be neutralized and sterilized if we eat continue to eat the highly processed foods that, unfortunately, we have become accustomed to in the modern diet. Ultimately, while probiotics in many of the healthy foods we eat don’t hurt us, the idea that there is a commercial probiotic supplement that can mimic the gut’s my microbiome is simply unproven.

Further, the cost of pre-and probiotics is staggering. Anyone who routinely takes the supplements can pay tens or even hundreds of dollars per month, ultimately with no guarantee behind its efficacy. While it is unlikely that these pre-and probiotics are dangerous, their efficacy can certainly be called into question. As a reminder, supplements are not regulated by the FDA and some rely on questionable data for their marketing claims.

Lastly, but certainly not least, is that many probiotic-containing food and drinks are less healthy than you may think. There is no question that we have a sweet tooth, and some probiotics have plenty of sugar added. As a result, whatever benefit you may be receiving from the probiotics themselves may be more than offset by the higher calorie and sugar content of the product.

The Bottom Line and What to Do Next

Colon health is directly related to our overall health. Those of us suffering from excess weight or obesity are also less likely to have a normal gut microbiome, making weight maintenance and weight loss that much more difficult. However, probiotics in and of themselves are not the answer. If there is a probiotics food or drink that you enjoy and can afford, while being healthy for you, we don’t see a reason to avoid it. However, bear in mind that it may not have a significant beneficial effect on your health or weight. Rather, focus on improving your diet and exercise, increasing water intake and getting the appropriate amount of protein and fiber every day. Making small changes such as eliminating sodas and other high sugar foods and drinks, replacing processed foods with home cooked meals and eating fresh fruits and vegetables are all proven to contribute positively to your gut and overall health.

Related Topics:

• Probiotics
• 5 Reasons Most Diets Fail (and Succeed)
• Surprising Finding: Gut Microbes Make Dark Chocolate Healthy
• Vitamins
• Vitamin Supplementation after Gastric Bypass Surgery

More on this topic from NPR: A Dire Sign Of The Obesity Epidemic: Teen Diabetes Soaring, Study Finds : Shots – Health Blog : NPR

Our take: Childhood obesity is nothing new and while children’s bodies are better able to withstand many of the ailments that accompany obesity, there is a limit. As children become more and more obese they will begin to develop the very same comorbidities as obese adults. Each of these comorbidities can cause serious damage to the body, if left unchecked. The result, as we are seeing, will be ever younger diabetes patients and shortened lifespans with a poor quality of life. Childhood obesity in the United States is an epidemic the likes of which we have never seen before.

More on this topic at Medical News Today: More Aggressive Papillary Thyroid Cancer Found In Obese Patients

Our take: Dr. Duncan is one of the foremost thyroid and parathyroid surgeons in the United States and has been at the leading edge of several surgical techniques including the no neck scar thyroid removal. This, combined with his extensive experience in bariatrics, has given him first-hand experience with how obesity and excess weight affects other parts of the body. Ultimately, the findings of this study are not terribly surprising. Obesity takes a toll on the entire body and developing a definitive link between obesity and certain forms of cancer is an important next step.

More on this topic from the USATODAY.com Editorial: The fatter the nation is, the more you pay

Our take: Weight loss surgery and medical weight loss programs are two of the most effective ways to lose weight, and keep it off, over the long term. The key however is prevention. While we will never fully stamp out obesity, we need to find out how to reduce its impact on our society. Whether it is through innovative government, corporate or school policies or alternately an incentive program, we are all looking forward to the answer that finally “clicks.”

Generally speaking, dumping syndrome is not a life-threatening emergency, but it is very uncomfortable. It occurs when the food consumed passes through the stomach too quickly, dumping into the small intestine with very little digestion having taken place. It is also called rapid gastric emptying.

Symptoms of dumping syndrome include dizziness, nausea, vomiting, sweatiness, fatigue and other undesirable side effects. These symptoms are usually accentuated in gastric bypass patients since the majority of the stomach has been cut away and the small intestine has been altered. Dumping can happen immediately or up to a few hours after a meal depending on the food consumed and the individual’s metabolism.

There is no sure way to avoid dumping syndrome except to eliminate the foods and actions that cause it. Following your dietitian’s nutritional plan and staying away from high fat and high sugar foods is a must. Patients should also avoid drinking any kind of liquid with a meal. Rather drink water and other liquids 45 minutes before or after a meal.

If you have any questions about dumping syndrome or how to avoid it, speak to your physician or our office. If you have any severe symptoms and believe you are having a medical emergency please call 911 immediately.

There is what looks a delicious meal or amazing sweet treat in just about every food advertisement – on TV, in a magazine or even in the grocery store itself. Advertising and marketing can certainly make you head hungry, even if you are physically full. Ultimately, the purpose of the commercial is to make you think about food and get you to buy the product. Dehydration is another cause of “mistaken hunger.” Sometimes we eat when we are actually thirsty.

So what to do?

• First, take a minute to think if you’re really hungry. Think about the last time you ate, wait ten minutes and then see if you still want those sweets.

• Second, work on your portion sizes. Food portions are always increasing. Many times they are two or three times the size of a recommended serving. Restaurant patrons want their money’s worth, but sometimes that comes at the expense of their waistline. You might want to get a box before you eat and put half the portion away – keep it for lunch the next day. You may not feel full, but then again, feeling full all the time isn’t a good thing.
• Eat 5-6 small meals a day versus 3 large ones. This will smooth out sugar spikes and drops and keep you from feeling ravenous at any time.

• Finally, make sure you are well hydrated. The average bariatric patient will need to consume at least 64 ounces of water each day to remain fully hydrated.

Emotions are also a big trigger of head hunger. Feelings such as boredom, loneliness or sadness are stressful and we comfort ourselves with food. Happy times often call for celebratory food too. Unfortunately, eating when your body isn’t hungry only adds extra calories to your diet and does little to relieve our problems. Even a few bites, several times a day, can cause a great deal of weight gain (or hinder your weight loss) over the long-term.

So always take a second and think about what you’re eating and why you are eating it. You’ll be much more successful after surgery as a result.

It is important that, before you commit to gastric bypass surgery, you understand that supplementation will be a necessary part of the rest of your life. The gastric band and gastric sleeve are two other bariatric operations that do not alter the small intestine and allow more vitamins and minerals to be absorbed without supplementation. It is worth noting however that both the gastric band and the gastric sleeve will also require the patient to take some sort of vitamin or protein supplement in perpetuity.

Remember, although it may seem to be a pain to have to take vitamin or mineral supplements, the effects of a deficiency can be devastating. You will be checked routinely for any nutritional deficiencies and if there is something of concern, it will be corrected either through additional supplementation or diet modification.

You can learn more about this and other topics of interest after a gastric bypass by attending one of our weight loss surgery seminars. These seminars are a great way to get the knowledge and understanding you need to make the best bariatric surgery decision for your particular circumstance.

Read more at Medical News Today: Waist Less Than Half Of Height Helps You Live Longer

Our take: This is a very interesting article and the study referenced is a new take on measuring risk. As a weight loss surgery practice, with a non-surgical component, we know that there is no single, perfect predictive tool. Obesity is a complicated disease that manifests itself differently in every person. By incorporating several diagnostic tests, we can get an even better picture  of overall patient risk.