Some Crim Pictures

The Crim folks had some photographers at the race taking pictures of the racers and festivities. Thought I'd share a few with you all. Photos: copyright by BrightRoom

My Daily Protein Routine

MeChelle asked me about protein ice cream and was looking for ideas for getting in more protein. So figured I'd share it with everyone what my typical daily protein routine looks like. My personal goal for protein is 80-100g per day. I can easily hit the 100g mark as long as I have a meal plan and I'm conscious about tracking how much protein I've eaten throughout the day and adjusting to hit the goal by bedtime. My Nutritionist recommends 60-80g protein per day, but I find that I feel better and function better when I'm getting 100g/day. Protein Ice Cream Oh. My. Stars. This stuff is amazing! I have been eating homemade protein ice cream for breakfast everyday for the past month. It feels sinful and naughty, but it's actually very healthy, very nutritious and packed with protein. Protein ice cream is really nothing earth shattering or magical. In essence it's a protein shake that you put in an ice cream freezer and make into ice cream. Michelle / Eggface has been experimenting with different recipes for protein ice cream for a couple months now and she's converted everyone over on OH to the ice cream dark side. She has a post that she's been keeping updated with her most recent creations. Check it out to get the basic instructions for making protein ice cream and some delicious recipes. I personally do a few things different than Eggface does. Here's what: * I make big batches - essentially doubling the recipes she has posted. * I scoop the ice cream into individual serving sized bowls before freezing. That way I can just pull one dish out at a time and take it with me on my commute to work. * I add UpCalD (calcium) and Fiber Sure powder to my mix. I normally add these things to my protein shakes, so figured I should add them here too. Other Protein Ideas I eat 5 to 6 small meals/snacks per day. Every single meal must have protein as it's main character. I also try to balance my protein intake throughout the day. So divide 100g by 5 meals and I try to get 20g protein at each feeding. If I'm short on protein for the day, I'll add that 6th snack and make it a protein shake (or ice cream). Breakfast My pouch does not like solid, dense protein/food first thing in the morning. I have to start my day with a protein shake and somewhat soft food for breakfast. On workdays, I leave my house at 7:00 am and have a protein shake or ice cream on the 90 minute drive to work. Then around 10am, I have some breakfast at my desk. Here are some sample foods I might have for breakfast: Carb Master Yogurt (Kroger brand) 1/2c grapes and cheesestick Quaker Weight Control Oatmal Protein hot cocoa Lunch I normally cook a casserole or big pot of something on Sunday afternoons, then package that up into individual bowls and bring it for lunch everyday that week. Most of Eggface's casseroles work great for this. Here are some of my favorite lunch options ar: Chicken / Zucchini / Spinach Casserole Concoction South Beach Frozen Meal McDonald's Salad (eat most/all of grilled chicken and 1/3 of salad) Homemade salad with veggies, fruit, canned chicken/tuna Wendy's chili Dinner Because I eat so many of my meals and snacks away from home (at work) I try really hard to always cook dinner at home. I used to just grab fast food before surgery, but now that I'm more focused on eating right, I have made this commitment to myself. Dinner is usually very simple and quick because I get home so late. Casserole options that I had for lunch Homemade salad as noted above Tortilla pizza (have this about 5 days a week) If I'm in a rush I'll do some of the options above (i.e.: south beach, mcdonalds, wendy's) Snacks Technically my nutritionist's plan says no snacks and if I'm going to "eat" between meals it must be a protein shake. But I can't do that. I know myself and if I'm deprived of a daily snack I'll end up binging on junk food or things I should have. So I've planned 1 food snack into my day around 4:30 each afternoon. If I'm short on protein at the end of the day I'll either have another protein shake or one of these high-protein food snacks. South Beach protein bars Pure Protein protein bars Dry roasted edamame Cheesesticks (Sargento please) Grapes (usually goes with cheese) Apple slices w/ peanut butter Soy Chips The following are not a great protein choices, but deal with cravings w/ few calories Quaker Rice Cakes Sugar-free popsicles Sugar-free fudgesicles That's all I can think of at the moment. I'm sure I'm missing a bunch of really great stuff, but you get the general idea. ~Pam

My jeans are falling off

Remember these jeans? I'm wearing them today and they are falling off me! Every couple steps I need to hike them back into place. Guess it's time for a new pair, huh? ~Pam

Improving my cholesterol numbers

I just received this comment from Brian ... figured I'd answer it in a new post.

In another post you mention that you've worked on your hdl. What did you do to improve that? I've lost 20 pounds, stopped eating red meat and bad-fat foods and my cholesterol #'s have stayed the same! Ug. ~Brian

Yep, I've raised my GOOD cholesterol and lowered my BAD cholesterol. I actually haven't done anything specific to tweak my cholesterol numbers, per sa, but I think the stuff I've been doing with my diet and exercise is the result of better readings. Here's some background: Total Cholesterol Before surgery: 170 Last week: 129 Lowered by 41 points LDL Cholesterol (the bad stuff) Before surgery: 104 As of May: 61 Lowered by 43 points HDL Cholesterol (the good stuff) -- ideal is over 50 Before surgery: 47 As of April (before Crim): 37 Last week: 50 Notice that before my surgery my good cholesterol wasn't all that far off the target number of 50 or higher. But with the rapid weight loss and lack of exercise early after surgery it dropped down to 37 at my 6-month check up. But with added exercise with Crim training, my good numbers are now up to 50. Still working to get it up even higher though. What'd I do?

• I'm eating according to my post-op diet plan. This includes a balanced diet of protein (40%), carbs (40%) and good fats (20%). I eat a lot of fruits and veggies - at least 5 -7 servings per day. The protein I eat is very lean and healthy.
• I'm exercising my butt off!
• I'm losing weight.
• I'm cutting out bad fats and focusing on good fats (including taking an Omega 3 tablet twice a day)
• I avoid, like the plague, any food that has an ingredient listed: "partially hydrogenated anything." That's the trans fats we need to avoid.
• I'm getting in good quality fiber (25-30g/day)

For an article from the experts on how to raise your HDL levels, here's one that might help.

So really I'm not doing anything earth shattering to get my readings in good shape. My total cholesterol already wasn't all that bad before my surgery, so I didn't have too far to go. Plus, the basic plan of eating better and exercising more and getting rid of unhealthy habits seems to be what is recommended by the medical community to improve your cholesterol.

There's a great chart here on this website that explains the differences in the types of fats we eat (saturated, trans, monounsaturated, etc.) ... examples of the types of foods that contain those fats and what effect they have on our cholesterol. Very interesting.

I'm not sure that my answer was all that brilliant or magical, Brian. But I hope this points you in the right direction for getting your cholesterol numbers in line.

~Pam

Some things I've learned about food ...

Over the past 9 months my relationship with food has changed in many different ways. I thought I'd share some of my rambling thoughts here... First, let me preface with talking about food addiction. So many people who have WLS are battling food addictions or compulsive eating or an inability to control cravings or urges with certain types of food. I do not believe I am one of those people. Remember that for 2 years before I had RNY surgery I was on a pretty strict 1,200 calorie/day diet of healthy foods with very little junk food. Yes, I'd blow the diet once in a while and order a pizza or indulge in ice cream or cake/cookies... but I never felt that I was out of control with food. So no addiction here.

Since my surgery I am even MORE conscious about what goes in my mouth and how it will effect my body overall. I've learned a bit more about trigger foods (foods that trigger overeating or over-indulgence) and also what foods work with my pouch and what doesn't. So here's my list of what I've learned:

• I love vegetables and fruits. I'm still picky on some things (like melon and green peppers), but as I experiment with recipes and techniques, I find that more and more I realize how much I love these types of foods.
• My pouch likes steak! I went 8.5 months without steak but finally tried it for the first time when I was on vacation in Ludington a couple weeks ago. Yum! Since then I've had it another half dozen times.
• Salsa is now banned from my house! Salsa by itself is fine, it's healthy and very low in calories. But what goes with salsa? Chips! Chips are evil and too easy to overeat. So no more salsa for this girl. If I have a recipe that calls for it, I substitute a can of diced tomatoes, onions and spices to mimic the taste without actually having the evil stuff in the house.
• Kettle corn is also evil. Thankfully it's not that easy to come by and you can only find it at fairs and festivals. I just need to learn how to resist buying a bag whenever I walk by those booths.
• My pouch does NOT like solid food before noon. Like I learned at the Crim race this past weekend, a slice of turkey and a few grapes can too easily get stuck in a pouch that hasn't been awake for long enough. So I'll continue to so protein supplement and soft foods to start my day.
• Protein Ice Cream is a guilty pleasure with none of the guilt. Who would have ever thought that I could eat ice cream every morning for breakfast!?!
• Eggs are still not my friend. For some reason my pouch does not like eggs - fried, over easy, poached, hard boiled - they just don't work. The only way I can sometimes tolerate eggs is as egg salad. Go figure.
• Chicken is my friend now. It took about 7 months for chicken and I to come to terms and figure out how to get along .. but now we are the best of friends.
• I'm a Salad Snob. Iceberg lettuce is just not good enough for me. And if I go for romaine lettuce, I need it to be mixed with baby spinach for variety. My main preference is baby mixed greens. Organic please. Mix in some hearty matchstick carrots, a few baby portabella muchrooms, some fruit (blueberries, mandarin oranges or pineapple), sunflower seeds and a splash of Kraft Light Zesty Italian dressing and I am a happy camper.
• I never eat food I don't enjoy. I can eat such small portions of food now that when I encounter some food that doesn't taste top-notch, I don't bother eating it. It must be delicious and nutritious before it will pass my lips. It's all about quality now.
• Tracking my food intake on http://www.fitday.com/ helps keep me accountable and on my eating plan. If I'm off for a few days I find that I'm a bit more lax with getting in enough protein and water.
• Water is hard. I can go several days in a row (like right now) where I just can't drink all my water in a day. It's not that I'm physically unable (be right back, going to go get a glass of crystal light)......it's that I get busy and forget to have a glass of water at my desk at all times. Or I drink one glass down and don't get up to refill it. Bad, bad, bad.

I knew this post would turn into a long rambling-fest. It's interesting to make a list like this and realize how much I have grown to understand myself and what things are important to me now. I could probably add another dozen things to this list and I might update it from time to time. It's good to see it all here in writing though.

~ Pam

I Finished the Crim 10-Mile Race!

I finished!

The heat and humidty was brutal and I was sweating like a pig and drank a ton of water... but I finished and I'm proud of myself.

See that picture to the right? Yep... that's what the start line looked like. From the time the start gun went off to the time I actually crossed the start line it was about 6-7 minutes. I knew there were about 15,000 racers signed up, but you don't really understand what that number means until you're inside the crowd. Truly amazing to be part of something that huge.

I was a bit unsure about what to eat on race day. I loaded up on carbs the day before, which was fine. And I had some protein ice cream at around 5:30 am on the drive to Flint. I also brought along some sliced turkey, grapes and cheesesticks figuring I'd eat a little something before the race. Big mistake! Stupid Pam! I knew my pouch didn't like solid food in the morning, so why would I attempt meat and cheese? I should have done yogurt instead. I ate the turkey and grapes on my walk from the car to the spot I met my training group. Yep - you guessed it. Breakfast got stuck!

When I have food stuck, one of two things happens. 1) I get the dry heaves and things rearrange themselves enough to be comfortable or 2) things stay stuck for about 3 hours and I just have to suffer through it. Once I met up with my training group I stood around hoping the dry heaves would come (it's not something I can force or make happen on my own). It took about 25 minutes, but thankfully they came and my pouch rearranged itself and got the turkey unstuck. So about 15 minutes before the start of the race I was still a bit shakey and hoping all would be fine. Once the race started I was feeling normal again, but I was definitely worried I wouldn't be able to do the race at all. Stupid, stupid, stupid... no more solid food before a race!

One of the big highlights of this race is all the supports who came out to cheer us on. All along the 10 mile route residents were out on their lawns clapping and cheering as we went by. Regular old people had water stations set up in their front yards, so many people had their garden hoses out offering free showers to racers (which was wonderful!), a couple fraternities were out - one with a beer station and one handing out Krispy Kreme Donuts - lots of local bands playing along the way, marching bands from local schools too and even residents who set up personal karaoke machines in their front yards to sings for the racers. Who needs an iPod when you have that kind of entertainment to keep you motivated!

Around the 6.5 mile mark I came upon a friend from my training group. She was really struggling with cramps in her feet and soreness in her hips. She has always been one of the leading walkers in our group, so for her to be struggling was a big deal. I stayed with her for those last 3.5 miles and we walked together. It was slow going at the end, but we finished the race together. Just hitting the bricks in downtown Flint and crossing that finish line is an emotional experience.

We got our finish medals and wore them proudly around the festival grounds afterward. I'll have to snap a photo of it and post it here ... it's pretty cool!

After the race I made my way to the Festival Lot where they had pizza and beer for all the racers (I chose water and could only eat about 1/2 of a slice of pizza). The sheer number of people milling around afterward was awesome. There were food vendors and a beer tent and kid's bouncy things and a DJ then later live music -- a celebration party for all 15,000 participants.

There was suppose to be a kiosk set up where we could have our timer tag scanned to find out our official race time. It wasn't working, so I never did find out my official time. I had my stop watch on, but forgot to stop it when I crossed the finish line. But I think I was right around 3:05. The race times will be posted on the Crim website soon, so I'll update when I know more.

So that's about it. Good race. Definitely proud of myself and looking forward to starting the next round of training for the half-marathon. I can't believe that in 6 weeks I'll be doing this again!

Thank you all for you support and well wishes! You all mean so much to me!

~Pam

Why I Choose Chewable Vitamins

To chew or not to chew? Are chewable vitamins better for us than pills, tablets or capsules? Personally I feel more comfortable staying with the chewable vitamins and calcium because I know 100% sure that the pill is broken up and mixed with saliva (digestive enzymes) before it even hits the pouch. If you swallow a whole pill it first has to dissolve in the pouch -- or if you take it with water, it's probably washed straight through to the intestines. How long does it take that pill to dissolve? Even if it's less than 30 minutes, how far down the digestive tract has that pill traveled and will it stay in my body long enough to release all it's nutrients before it hits the large intestine where very little absorption takes place? I don't know any of those things for sure and haven't been able to find any scientific evidence of one being better than another for WLS folks. But my logical brain tells me that chewables are best for me and my peace of mind.

What the Crim Training has Done for my Health

As you know - because I blabber about it so much - I am just finishing up the 15-week training program through Crim Fitness Foundation. The race is just 2 days away and I'm going to go pick up my rack packet this afternoon. As part of the training program they offer Health Screenings. You go in before training begins then again after it's done - in this case, I went last night. They check your weight, blood pressure, cholesterol and body fat percentage. Seems like I've done pretty amazing! Check out my numbers: (top number is pre-training, bottom number is post-training) Weight 220.4 lbs 198.4 lbs Body Fat % 45.7% 38.4% Total Cholesterol 136 129 HDL (Good Cholesterol) 37 50 Cholesterol Ratio 3.7 2.6 Blood Pressure 118/60 110/70 Some thoughts:

• I love Hurley Health and Fitness's scale! That 198.4 weight was taken at 7:00 in the evening after a full day of eating and I was fully clothed and it's still 1 pound less than my scale at home. I'm not using that number officially, of course... but it was fun to see.
• I have been working hard to get my HDL cholesterol number up. That's the good cholesterol and the ideal level is anything above 50. You increase it with healthy eating and exercise. So it seems I've done a good job in this area and just need to boost it up a bit more.
• The body fat percentage is looking pretty good. My goal is to be at about 20-22% which is a healthy athletic range. 38% is still in the obese category, but at least I can see that it's going down steadily.

Look for a couple more posts about my Crim experience in the next day or two. I can't believe the big day is already here! And before I know it, I'll be starting my next round of training for The Brooksie Way!

~Pam

100 Pounds Gone!

Imagine my surprise when I stepped on the scale this morning and saw 199.4. I had a full 3 pounds to lose this week to reach that goal and I hadn't lost 3 pounds in a week since my first month after surgery. Wow! I finally hit the 100-pounds-lost mark!

A month ago I'd set the goal to be down 100 pounds before the Crim. The Crim Race is just 4 days away and I've hit the goal in the nick of time!

9 Months Today

Today, August 13th, marks the 9-month mark since surgery. Time is flying! It seems only a few weeks ago that I was fighting the insurance company guidelines of that 12 month diet documentation. And it seems like it was only last week when I was coming home from the hospital barely able to sip 2oz of watered down cream soup for dinner. Sitting here realizing that my life has changed so much in the past nine months still boggles my mind.

What has changed for me in the past nine months?

• My weight, of course, has changed. Right now I’m looking at a 98-pound loss and don’t even recognize myself in the mirror when I happen to catch a glance.
• My health is excellent. No more high blood pressure, no more asthma, no more joint pain, no more back pain, no more stress incontinence, no more sleepless nights and amazingly, my allergies seem to be almost completely gone.
• My physical energy is amazing. In just 10 days I’ll be walking in the Crim – a 10-mile race that I’ve been training for since the first of April. Then just 6 weeks later I’ll be walking a half-marathon. In less than a year I’ve gone from morbid obesity to a half-marathon… I can’t wrap my head around that!
• My emotional and mental health and my attitude are completely different. Before surgery I felt beaten down and defeated. I could succeed in all other areas of my life but I couldn’t lose the weight and get healthy. But now I feel like I’m finally seeing success and the emotional weight is lifted from my shoulders. I’m sure it helps that I’m actually working hard to be focused and deal with the mental stuff that goes along with all this change, too.
• My eating has become habit. I sometimes can’t remember the way I ate before surgery. Granted I was dieting pretty hard for 24 months before surgery, so maybe things haven’t changed all that dramatically. But when I think back to the days when used to order a whole medium pizza and eat almost all of it by myself… I can’t comprehend I’d ever done that. The way I eat now feels so normal and real.
• My free time is spent taking care of myself now. Since I shut down my business this past spring I don’t feel the pressure of running a business, marketing, client work and all that goes with it. Now my free time is spent taking care of my own physical and mental health. It makes me feel free.

I’m happy. I didn’t even realize that I wasn’t happy nine months ago. But now that I really am … I’m glad I’m at this place in my life that allows me to live the life I’ve always wanted. There are still changes and improvements and goals I want to see in my life, but knowing I’m on the right track makes me glad I’ve worked so hard to get here. Where I am right now is exactly the right place for me at exactly the right time. ~Pam

Back from a Mini-Vacation

I spent a long weekend in Ludington enjoying the Lake Michigan coast. I have some self-discoveries to share and some food stories to digest. As soon as I catch up on what's going on back here in real-life, I'll post some stuff. Pam

The Letter Q

If this post confuses you.. just move on. If you're laughing your butt off because of this post, you know it's for you. Origin of the Letter Q

The Roman letter 'Q' started its life as the Phoenician letter 'Qoph', the same Arabic letter 'Qaph', a word meaning the back of the head where it is connected to the neck, and represented by a simplified shape of a head and neck. Q ("kyoo") is the 17th letter and 13th consonant of the alphabet. Despite its position of honor on the QWERTY keyboard, Q is the one of the three least-used letters in the English language (explaining its value of 10 points in SCRABBLE). In the grammar of English and most Romance languages, the rule is that Q is immediately followed by a U, and is pronounced as /kw/. The letter Q is both historically and phonetically linked to the letter K. It had achieved its present graphical form by the mid-Latin period.

:: big grin :: ~Pam

Pig Gig 5K Race

I walked the PigGig 5K race in Bay City this morning. Did it in 52:09 minutes - which is about 40 seconds faster than my best race time so far.


I literally finished LAST place though. LOL! I stayed back from the crowd at the start line so I was at the back of the pack. There were 4 of us ladies who were at the end and we all crossed the finish line together. It was definitely a runners race and actually organized by the Bay City Runners Club (I think) so the walkers were pretty scarce to begin with. I'm proud of my time, so that's all that counts.

After the race we (my mom went with me) hung out at the Pig Gig -- rib festival. Not a lot of stuff to do unless you were a kid or someone who ate a lot. They had a tent with cooking demonstrations going on that we spent a lot of time at. After each demo, we got some samples. Some very good food going on there! And I got a great recipe for a grape salad that I want to try out.

Bad news is that I caved in at the offer of a cookie. They had a kid's hour cookie decorating time and there were some left over. So the cooking demo tent folks had the leftover cookies for sale at .50 each. These were huge cookies! Big fat sugar cookies probably 4" across with a pile of frosting and sprinkles. I ate about 1/3 of it. Surprised I finished that much. Kind of dumb to be eating that much sugar while I was out and about and nowhere near a bathroom -- but thankfully I didn't dump.

Overall... a good day. The pic here is one (of way too many) that my mom took of me at the race today.

~Pam

Why we don't drink with meals ...

UPDATED -- This post has been updated with a re-write on May 14, 2010.

After Weight Loss Surgery we are given many new and unusual rules that we must abide by for the rest of our lives. But the idea that we must change the way we think about a behavior forever can be daunting. Sometimes understanding why the rule exists helps us to be more compliant with these new rules.


The Rule
No drinking with meals or for 30 to 60 minutes after a meal (this includes snacks too). In this article we’ll explore the reasons why this rule is so important and what happens when we don’t follow the rule.


The Old Anatomy
First, let’s understand how our old stomach used to work. Before Roux-en-Y Gastric Bypass Surgery you had a normal stomach with a pyloric valve at the bottom to keep food inside the stomach while it began the digestive process.

The stomach is a powerful muscle that contracts around the food in a churning motion. The stomach release gastric acid (made up mostly of hydrochloric acid) to further break down food as it’s churned. As food is broken down enough the pyloric valve (a trap door, really) opens to let some food particles out of the stomach and into the small intestine. This churning process continues and the pyloric valve will keep opening and closing as more food is prepared for release. This process can take 2 to 3 hours in a normal stomach. It’s much different after Roux-en-Y gastric bypass surgery.


The New Anatomy
After RNY the pyloric valve is no longer part of the newly formed pouch. It remains at the bottom of the stomach which is bypasses, so we will never use the pylorus again to control the flow of food from the stomach to the small intestine.

Our new stomach pouch is shaped like a funnel. Which is a larger bowl shape at the top with a small narrow opening at the bottom. The food we eat is held in place in the larger upper portion of the funnel and gravity allows food to slowly flow out the lower narrow opening at the bottom of the pouch. That narrow opening is called the anastomosis or “stoma” for short.
With our new pouch we have to mimic the action of the pyloric valve manually and the only way to keep food in our pouch is to eat dense foods and not mix it with liquid.


The Food
The more dense the food, the longer it can stay in the pouch. The softer and more liquid the food, the sooner it will empty from the pouch. Dense food can stay in your pouch for 1.5 to 2 hours if you don't drink water. But the moment you add water (or any liquid) to the pouch, you are creating a "soup" that will quickly empty out of your pouch.

Soft foods that slide straight through the stomach pouch are called “slider foods” and include things like yogurt, soup, pudding or ice cream. Although these are good foods to consume in the early stages after surgery, be careful not to get into the habit of using slider foods as your main food source.

Of course when your pouch is empty you’ll get hungry sooner. For new post-ops, this isn’t a major concern because the hunger hasn’t returned fully. But for those further out from surgery, the hunger can be ravenous for some and the primary way to stave off hunger is to keep food in the stomach pouch for as long as possible. This is why it’s recommended that the further out you are from surgery, the longer you wait to begin drinking after meals (60-90 minutes).



The New Digestive Process
About 40% of the digestive enzymes required to fully break down simple starch-based carbohydrates is contained in our saliva (known as ptyalin). To break down complex carbohydrates, protein and fat, our body requires the addition of gastric acid and other digestive enzymes normally produced in the stomach. But our new stomach pouch does not produce in any significant amount of gastric acid or enzymes. This is one of the main reasons why we need to chew, chew, chew really well.

Once food gets to the pouch, the digestive enzymes from our saliva and the limited amount produced by the stomach go to work on the food to begin breaking it down. Our pouch doesn't churn as much as our old stomach used to, but there is still some movement with that well-chewed food.

The longer food stays in the pouch, the more it is broken down and prepared for the intestines to do their work of grabbing micro and macro-nutrients from the food. If we wash the food out too quickly a few different things happen. First, if food is not properly prepared for optimal absorption (chewed well, mixed with enzymes) we risk having food move too quickly through our digestive track without the benefit of full nutrient absorption. Second, if food is not well chewed or broken down, we are also at greater risk for intestinal blockages or constipation.



The Other Big Risk
There's also the risk of stretching the stoma (the opening between the pouch and intestines). If you have dense food that has not yet begun to be digested in the pouch and you drink water you are forcing dense food through the stoma prematurely. The opening is only about the size of a lady’s index finger, but if you habitually push food through the opening before its ready to go, you'll eventually stretch the stoma. This is far more worrisome than stretching your pouch. Once the stoma is stretched it can become the same diameter as the pouch itself. This would essentially create one big long tube that food can be packed into at meals. Need a visual? Stretching your stoma would give you a 20-foot long stomach.

This caution from surgeons is not a scare tactic. This rule is about biology and medical science because now you have to manually do the work of the pyloric valve that has been bypassed. By following this rule for the rest of your life, you’ll properly prepare your food to give your body the best chance of absorbing the vital nutrients it needs for survival as well as achieve the level of satiety needed to reduce hunger between meals.

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This article can be downloaded as a PDF.

Check out this video from Former Fat Dudes - a visual lesson!