Alcohol and Gastric Bypass

The information below is a repost from two outstanding resources in the WLS world. The words below are from Beth - Melting Mama - as she wrote on her blog a couple weeks ago and again on Obesity Help the other day. I actually missed the original discussion thread but found the reposting on Rob's blog - Former Fat Dudes - when he published it here.

Drinking alcohol after gastric bypass surgery is very serious and being educated about the biological, medical and emotional risks is essential. I love that this heavy topic with very deep scientific information is still so "Melting Mama" in the way she presents it. Having met Beth in person, I can tell you that she speaks the same way she writes ... with passion!

This post is very long with many outbound links to medical reviews, articles and research. But please read it all.

Melting Mama Wrote:

A few month gastric bypass post op writes 

“Can I have a glass or two of wine? I used to have a few glasses when I had a drink, would it be okay to just have one, or two now?”

No. 

(Bold for impact here. You DO NOT NEED ALCOHOL AT TWO MONTHS POST GASTRIC BYPASS.)

I won’t pussy foot around and say, “You’re going to do what you want, but always listen to your surgeon! How about a sugar free cocktail?”

Can I drink alcohol after weight loss surgery? – Dr. Garth Davis

We recommend waiting one year after surgery before consuming alcohol. Then, with your surgeon’s approval, you can enjoy a glass of wine or a small cocktail. Remember to be careful because even the smallest amounts of alcohol will affect you differently after obesity surgery.

That is obviously not working for us.

*Disclaimer - “But, MM! You’ve been photographed with The Drink! How dare you preach about the drink! I’m going to drink it anyway! Nanananana!” Yes. I have. There are lots of photos, mostly Facebook-style, one time taking one sip and having a seizure! The others? Totally product placement. I did not drink. Do as you please, but here is my truth. I am nearly seven years post gastric bypass, and I choose to have a sip or three on social occasions. This includes: weddings, uh, once a year, and perhaps a drink at an event. I typically regret imbibing even a sip or three quite immediately. But, just like food: I have selective memory. I get the “just a taste won’t make me sick” idea and it fails me, my gut, my brain. Are we clear? And, to be clear as mud, the more I learn, the more I know, and opinions change. Also, I will sip. I am SEVEN YEARS post gastric bypass. 

Absurdity, n.: A statement or belief manifestly inconsistent with one’s own opinion. (Ambrose Bierce)

“Why can’t I have a drink, MM?”

Because I said so.

Imagine if curing addiction were that easy? I’d like to see it done this way -

Early post op, you absolutely, positively do not need alcohol coursing through your new, altered guts. There is NO excuse for it. Zero. None. Zip. NADA. (I left out Zilch, ’cause that’s a product for mixing sugar-free alcoholic drinks.)

This should be common sense.

You just had your intestines surgically re-arranged. You have a fresh stomach pouch that needs to heal. Do you really want to send alcohol through your raw piping? You wouldn’t send certain foods through there, why would you consider something so caustic as alcohol?

Seriously, “OMG! I totally swallowed a piece of gum, will I die?” But, “Tequila is low carb!”

The months pass, and you’re no longer a newbie, and make you feel like you can handle a little drinkie-poo.

“I am an adult! I deserve it! Damn it I am going to drink if I want to, I had this surgery to be normal!”

You might start researching drinks, you might hit up the Google for “sugar-free alcoholic drinks” wondering what’s good.

You may ask your pouched peers when they had their first drink, and what it was, and did they “get sick?” You might consider, “What if it makes me dump? What should I drink so I won’t dump? How much should I have?” completely ignoring the actual nutrition of most alcoholic beverages.

You decide it’s time.

Because, it’s “Christmas! And, I just saw this great recipe/idea on a WLS website so it must be okay for Bariatric patients.”

This is where MM has the DUH realization (again) that people do take advice from the internet. BLINDLY. EVEN. “So and so said it’s good for me, so I will do it!” It doesn’t even MATTER if the information sucks.

Please do not take advice or suggestions from non-professionals on the internet. We are typically only patients, peers, bloggers or sales people with zero medical expertise. You are a big girl, you can make your own decisions. People on the internet with big mouths can only offer suggestions, but you must make solid, rational decisions based on what is GOOD FOR YOU. What is good for you must include input from your doctors, nutritionists, and your COMMON SENSE.

You’re feeling a bit powerful, ’cause you have a TOOL. And since you had WLS, you HAVE POWERTOOLSMM! This means you are magically cured from any and all prior addictive personality traits! You may feel that you “never had a problem with food anyway,” so you will maintain FULL control of yourself when tempted. You might tell folks you were never an addict, and you were just an over-indulgent eater. Super.

Your pouch and you head to a holiday party and you are at least, partially successful in avoiding the 12 foot buffet table filled with pastries, and then you see the libations.

You are socializing and talking, and fill your little cup up with some wine, maybe even half of what you might have drank pre-op, you sip. The first sip hits you like a bomb, it burns all the way down into your pouch. You feel like you swallowed a Brillo Pad, if even for a second.

Then, maybe your ears get hot, maybe your face flushes. In the average non-WLS person, alcohol takes ONE MINUTE to hit the brain. You have a straight shot from MOUTH > SMALL INTESTINE, guess how fast it hits your brain?

INSTANEOUSLY.

Whee. “I think I already feel it. Holy shit, two sips and the room feels a little, whoa….”

“When consumed by the gastric bypass patient, alcohol readily passes through the stomach pouch largely unimpeded and into the jejunum where, due to its large surface area, it is rapidly absorbed. Research has shown that gastric bypass patients—even those that are three or more years postoperative—have a more rapid absorption of alcohol and a peak in blood alcohol content that is considerably higher than that of someone with normal gastrointestinal anatomy. (Bariatric Times)

You might “like” this. This might be tipsy, tipsy might be good. It might feel really good.

For some people it doesn’t feel good at all, and they are quite turned off by alcohol post WLS. (Ironically, this feeling now bothers me, because it feels like an oncoming seizure.)

Perhaps you enjoy it and soon, you’ve finished that glass and “Maybe just a little more?”

The buzz you had a short time ago, feels like it’s gone, even if the alcohol is still coursing through your blood. You are still drunk. You might drink more to reach tipsy again.

Patients should be warned about drinking alcohol too quickly because even relatively small amounts of alcohol, such as two small glasses of wine (0.3 g kg−1) might produce unexpectedly high BAC shortly after the end of drinking. Also when other surgical procedures are performed on the gut such as gastric resection and gastrectomy, a more rapid absorption of ethanol can be expected. The present experiment with alcohol as a model substance might have implications for the absorption and pharmacological effects of other drugs or when prescription drugs are taken together with alcohol. (Wiley Online Library)

This effect of alcohol on our post bypass systems is dangerous. We may not have ANY IDEA how DRUNK WE ARE, until we are passed out, in a coma, or driving home and crashing.

“You’re too dramatic, Beth, that won’t happen to me.”

Sure it won’t.

We aren’t talking about binge drinking here (although it happens), this can occur with relatively SMALL amounts of alcohol. I am pointing to the casual drink or two that hits too hard. I could potentally kill myself with one martini. There is NO WAY that I can drink hard liquor in one sitting. MM + Martini = Fun Down The Escalator! BOOM!

...Gastric bypass surgery may enhance alcohol sensitivity by altering the rate that alcohol is absorbed or metabolized. Such changes in alcohol sensitivity and clearance significantly increase the risk for alcohol toxicity and its deleterious consequences (i.e., liver disease, cardiomyopathy, loss of muscle mass and strength, neuromuscular and cognitive defects, gastritis, pancreatitis, acid reflux, and specific vitamin deficiencies) (Bariatric Times)

You’ve stopped drinking, either because you’re toasted, or you are AWARE you have had enough and made a choice to stop. Make sure to give a warm welcome to hypoglycemia!

Alcohol use may also adversely affect the health of the bariatric patient by increasing the risk for hypoglycemia and its potentially negative influence on cognitive function and neuromuscular control. (Bariatric Times)

Recognizing and treating hypoglycemia with a gastric bypass is hard enough, and it is a known side effect of the surgery. However, recognizing a low blood sugar and treating it effectively while you aren’t AWARE of it? That is “fun.”

Drinking, especially binge drinking, can cause hypoglycemia because your body’s breakdown of alcohol interferes with your liver’s efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be very serious and even fatal. (Islets of Hope)

Those of us with diagnosed reactive hypoglycemia post roux-en-y gastric bypass probably shouldn’t drink at all. The risk of dropping our glucose levels so low, and not being aware enough to fix it? Sure a couple glucose tabs and crackers will help you, but again, NOT IF YOU AREN’T AWAKE, dear.

Another problem with hypoglycemia due to the excessive consumption of alcohol? HYPOGLYCEMIA LOOKS LIKE DRUNK. I live with this, I know this.

Generally, symptoms of hypoglycemia include:

Mild Hypoglycemia

• Increased or sudden hunger
• Feeling shaky, dizzy or nervous
• Pounding heartbeat
• Drowsiness, feeling tired
• Sweating (cold and clammy)
• Numbness or tingling around the mouth
• Headache or stomachache

Moderate Hypoglycemia

• Any of the above mild symptoms, plus:
• Headache
• Personality change
• Irritability
• Confusion and/or difficulty concentrating
• Headache or stomachache
• Slurred or slow speech
• Poor coordination

Severe Hypoglycemia

• Any of the above mild or moderate symptoms, plus:
• Loss of consciousness
• Seizures and/or convulsions
• Death

You make it through the holiday season, and navigated your way through a few drinks, and you seem to be okay with handling yourself and alcohol. But, maybe you find a new craving for that “glass of wine with dinner,” and it becomes a pattern. Two or three nights a week, you’re having a glass of wine (other libation…) and soon you’re having it nightly.

Maybe then, you feel that a little “mommies’ sleeping pill” might help in addition to dinner, and you’re sipping wine to help you fall asleep. But, remember, you are still a gastric bypass patient, and maybe you feel normal, look normal.. but… this behavior may quickly NOT be normal. 

BIG RED FLASHING WARNING SIGNAL HERE.

Bariatric patients with pre-existing addictive behavior toward food could, with food restriction, transfer such addiction to alcohol. All of these observations point to the likelihood of alcohol use having a more negative influence on health status postoperatively than was previously recognized. (Bariatric Times)

Research is limited, but I implore you to ask around and find peers you can trust to discuss this issue with. Your friends are addicts. Old statistics, one via an old episode of Oprah stated 30% of us “find a new drug” post operatively, but I would bet my $15Kworkneededteeth that it is vastly understated.

Weighty Secrets -

I drink because it keeps me from eating. I look forward to eating and it has become the high point of my day. I know exactly how much to eat now before I get sick. I’m gaining weight and just keep telling myself that all I have to do is quit drinking to lose it. I'm lying to myself and I know it. Hate myself. Go figure. Life just sucks ass huh?

I would say that this issue, of alcoholism (and the whole myriad of addictions… drugs, shopping, gambling…etc.) in the post op community is not discussed, nor researched enough at this time.

“…lifetime rates of substance use disorders among candidates for bariatric surgery are substantial, but rates of current substance use disorders prior to surgery are low.” (American Journal of Psychiatry)

There isn’t much research to say, either, but what is seen in our communities is enough to warrant a larger scale look. For instance – studies show that WLS patients are less likely to die from the co-morbid diseases of obesity, BUT, have a higher rate of death from accidental deaths and suicide.

“Reports reveal that a substantial number of severely obese persons have unrecognized presurgical mood disorders or post-traumatic stress disorder or have been victims of childhood sexual abuse. Data on the association between presurgical psychological status and postsurgical outcome are limited. Some centers for bariatric surgery recommend that all patients undergo psychological evaluation and, if necessary, treatment before surgery and psychologically related surveillance postoperatively. Although research has shown an improved quality of life after gastric bypass surgery, certain unrecognized presurgical conditions may reappear after surgery. The results of our study suggest that further research is warranted to explore the optimal approach to evaluating candidates for surgery, including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery. (NEJM)

Transfer addictions are real after weight loss surgery, and can stem from the innocent (Hello internet!) to illegal drugs.

What Causes Addiction Transfer and Cross Addiction?

Psychologists originally developed the phrase “addiction transfer” because of a trend they observed: Drug addicts and alcoholics in treatment recovered from an addiction to one form of drug only to swap it for another type of drug or other compulsive behavior. Because these patients still feel a void or haven’t fully addressed the underlying reasons for their addiction, they find new ways to escape or numb their emotions. For those who thought life would be perfect if only they could overcome an addiction, the reality sets in that life is still at times difficult, boring and hard to manage. 

Addiction transfer also has a neurological basis. Research suggests that the same biochemical processes are at work in multiple types of impulse-control disorders, such as compulsive eating, alcoholism, smoking, compulsive gambling and drug addiction. Each of these behaviors triggers the same reward sites in the brain, resulting in cravings that are difficult to resist.

Addiction is a brain disease, and the brain is immensely complex. “The brain may be the most difficult puzzle in the universe,” says Graham. “The brain is hard to study, and it gives up its secrets slowly. This is the main reason that neurology and psychiatry have not necessarily kept pace with the progress of other areas of medicine.” (Drug Addiction Center.com)

Everyone has an opinion on how much is too much alcohol after weight loss surgery. But, only you know what you’re really doing. All the explaining in the world does not discount the fact that alcohol is dangerous for you with your new anatomy. Trying to validate WHY you have to have it doesn’t change anything.

Ask yourself why you have to have alcohol. Do you really require a cocktail at dinner every single night — or to bed — and on the weekends — and? Are you prepared to pay the consequences of your actions? Are you aware that the consequences might involve you, blacked out, on the floor with no help? Yeah. That’s sexy. You did this for your health, right?

RESOURCES:

• Weighty Secrets - Addictions, Alcoholism
• Weighty Secrets - Video Posts from 20/20 Moms and Alcoholism
• Intervention - Amber, Eating Disorder and Alcoholism
• Is Alcoholics Anonymous for You? 12 Questions Only You Can Answer:Alcoholics Anonymous asks drinkers to honestly answer 12 questions about their drinking habits. If you answer “yes” to four or more questions, alcoholics recommend seeking help. 
• Rethinking Drinking is an outpost of the NIAAA where drinkers can assess their drinking habits and learn to spot warning signs.
• What’s Your Drinking Pattern? Find out how your drinking habits compare to those of other adults in the United States at the institute’s website.
• NIAAA’s Cocktail Content Calculator can help you keep track of how much alcohol is in your drink. How strong is your mixed drink or cocktail?

RESOURCES - GETTING HELP:
More than 1 million people submit to detox and rehab programs for alcohol addiction every year in this country.

• National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), where you can find information on treatment options and facilities.
• For local information on treatment available in your city and state, check out the Substance Abuse Treatment Facility Locator through SAMSA.gov.

WLS Support Groups Work!

Did you know that if you attend an in-person WLS support group that you have a better chance to lose more weight and keep it off more successfully for the long term?  Yep, it's true!

I attend 3 different meetings each month - one of them I lead. If you don't have a local group, then start your own and gather other WLS patients in your area to meet on a monthly basis.


For more information about the groups I attend... as well as support group meeting topics... see the special page for Support Groups above.

I found a couple studies on the topic.

• Zirui Song, et al published an article in the ASMBS publication Surgery for Obesity and Related Diseases (SOARD) in 2006 entitled: "Association between support group attendance and weight loss after Roux-en-Y gastric bypass."
  
  Results: Patients who attended more than 5 support meetings within the first year lost 55.5% of their excess weight. Patients who attended less than 5 meetings lost 47.1%. So by attending meetings, they lost an additional 8.4% of their excess weight.
  
  In real world numbers that would mean:300-pound pre-op weight, with 135-pound ideal weight = 165-pound excess weight
  >>  47.1% EBWL = 77lbs lost
  >> 55.5% EBWL = 92lbs lost

• Whitney S. Orth, et al presented their findings at the International Federation of the Surgery of Obesity annual meeting in 2006 in a report called: "Support Group Meeting Attendance is Associated with Better Weight Loss."
  
  Results: Patients who attended support meetings saw a reduction in BMI by 42% whereas patients who did not attend, only realized a 32% reduction in BMI.
  
  In real world numbers that would mean:300-pound pre-op weight at 5'6" (me!) = 48 BMI>> 32% reduction = ending at 33 BMI (still obese)
  >> 42% reduction = ending at 28 BMI (just overweight)
  

So what does that mean to you?  It means, find a support group in your area and attend the meetings!  In fact, find more than one support group and attend as many meetings as possible. 

~Pam

Living in a Non-Op World

Just because you had WLS, doesn't mean everyone else did too. How can you make good choices about living a healthy life when all those around you don't follow the same rules? Cookies in the breakroom at work --- dinner with friends who choose a buffet restaurant --- a family tradition of a lazy Sunday afternoon gathered around the TV. How can you remain a part of their lives, not grow resentful or angry, but still make good choices for your weight loss surgery lifestyle?

Here's a list of ideas the support group members came up with in response to various situations we'll find ourselves in after WLS. The goal is to still participate in things going on around you in life, but to do it in a way that you don't expect others to change their own behavior for your lifestyle choices.

My family only serves unhealthy food at gatherings so it's impossible to eat right around them!

• I don't have to eat the food they make.
• I can bring a healthy dish to pass to add to the meal.
• I can choose to eat smaller portions.
• Suggest a new recipe for the meal - a healthier option that's delicious too.
• Talk to family members about boundaries or guilt-trips about not eating all their prepared dishes.
• Suggest other types of family gatherings that don't focus on food.

During the holiday my Grandma slaves over the stove to bake cookies and other delicious treats. It'd be rude not to have one!

• Thank Grandma for her hard work, but explain that eating sugary treats makes you sick and you can't indulge.
• Ask if you can take some treats home for other family members instead.
• Have one bite or taste only. (There's no need to eat the whole cookie!)
• Share new healthier recipe options with Grandma and ask if you can make the treats together.

My spouse doesn't like to walk and I don't like to walk alone, so I don't get a lot of exercise.

• Walk with a neighbor.
• Get a dog.
• Go to the mall and walk with the other mall walkers - and window shop!
• Use a treadmill, stationary bike or video aerobics instead.
• Park in the far corner of the parking lot to get extra walking in while doing errands.
• Join a walking club or races.
• The hard suggestion --- learn that walking by yourself is OK and can be a great way to meditate, clear your mind and get a great workout. Don't rely on someone else to get the exercise you need.

I have to buy chips and treats! My kids need them for their lunches. But I can't keep my hands out of them! (This applies to spouse's treats too)

• Childhood obesity is approaching epic proportions. Kids don't need chips or sugary treats for lunch! Buy healthier options that you can eat too. Apples, soy crisps, veggie sticks, etc.
• Set limits with children or spouses about which foods are allowed in the house. Your home is your safe domain and you have the rights to set the rules.
• Keep treats for other family members in inconvenient places - outside the normal food storage spots. For instance, Lori's husband can have his potato chips, but they must be stored in his work truck, not in the house.
• If there is no way around having unhealthy food in the house - then employ the techniques you've learned here: Managing Emotional Eating

There are always bagels, muffins and cake in the break room at work and bowls of candy on co-workers desks. I have no control over these daily temptations!

• Stay away from the break room.
• Keep healthy meals/snacks in your desk drawer that are "legal" for you.
• Keep a dish of sugar free candies at your desk.
• Be sure to eat breakfast and snacks according to your schedule so hunger does not become an added temptation.

When my friends go out to eat, they always choose a buffet restaurant. So I just sit at home and don't socialize with them anymore. ...Or... there's never anything healthy on restaurant menus, so I just order whatever I want and try not to feel guilt about eating bad food.

• Prepare yourself before arriving at a restaurant. Most businesses have their menu published on their website along with nutrition information. Otherwise, use Diet Facts website to look up nutrition labels for menu items. Know what you'll order before you arrive.
• Buffets are not evil. Have a plan of action before you decide what to eat. Browse the entire buffet first, then decide which foods meet your eating plan criteria. Use a small salad plate instead of a dinner plate. There are always several high-protein, lean meat choices - choose these first, then go for the veggies and healthy salad options. Load up your plate with the same amount of food as you'd serve yourself at home for a normal meal. Stop thinking of a buffet as "all you can eat" and start thinking of it as "eat what is right for me."
• There's ALWAYS something you can order at a restaurant. It might take a bit of work and creativitiy to find those healthy options, but it's entirely possible. Don't be afraid of the restaurant menu!
• Ask your server for help in choosing the healthiest options.
• When ordering from a menu - anything is fair game. Ask for substitutions or order ala carte.
• Understand cooking terms so you can order the healthiest prepared options.  Here's an online Food Dictionary that can help.
• Request fat-free or low-sugar dressings for salads. Order dressing on the side and dip your fork in for each bite, rather than drowning your salad with too much dressing.
• Replace unhealthy carbs (potatoes / rice) with healthy veggie option.
• Request no oil or butter.
• Avoid the bread basket - ask your server to take it away when other diners are done with their serving.
• When your meal arrives, immediately ask your server for a to-go box. Divide your meal and decide what your allowed portion is, then box up the rest to take home. This will discourage over-eating.
• If all else fails, order a mug of hot tea and just socialize with your friends/family. You can eat later when you get home. (This is NOT recommended though, the whole point of this exercise is to be part of the non-op world.)

Our Favorite Protein Shakes

This is the third installment of the summary of this evening's support group meeting.  The other two parts of the discussion summary can be found here:

Meal & Snack Planning Tips
Our Favorite Protein Bars

We went around the room and asked everyone for their favorite protein shake recipe. Some were super simple, some more complex... and some not even a shake at all.


Keith
vanilla protein powder
almond milk
banana
strawberries
carbmaster yogurt
ground flaxseed
-- whirl in blender


Karen
Muscle Milk Light ready-to-drink protein shake


Lori
Nectar Fuzzy Navel protein powder
Apricot/Mango Yogurt (Yoplait or store brand)
water
ice
-- whirl in blender


Tammie
Body Fortress chocolate protein powder
water
-- shake in blender bottle


Kathy
Chocolate protein powder
Coffee



Cheryl
unflavored protein powder
coffee
sugar free flavored syrup (English Toffee -- Black Cherry -- Hazelnut)

Ruthann
Body Fortress Vanilla protein powder
Coffee
Vanilla Caramel Coffeemate Creamer


Jean
GNC 100% Whey - chocolate or cookies-n-cream
water
-- shake in blender bottle


Michael
Ultimate Nutrition (GNC) Chocolate Creme
Milk
Raspberry Torani Sugar Free Syrup
-- shake in blender bottle


Holly
Isopure Chocolate protein powder
Coffee or Milk
-- shake in blender bottle

Pat
Body Fortress chocolate
milk or water
ice
--- whirl in blender


Alice
Skip the shake... go straight for the oatmeal. Mix the following in large bowl making several servings and cook until done. Then each morning take our your small portion for breakfast.
-Steel Cut Oats
-Flaxseed
-Protein Powder
-Cinnamon
-Slivered Almonds


Mark
Body Fortress Strawberry protein powder
Milk
Ice
-- whirl in blender


Pam (that's me)
Iced Protein Coffee
Protein Chai Tea - served over ice in the summer, hot in the cooler months


Which one sounds the best to you?  I'm intrigued by Lori's Apricot Mango Fuzzy Navel concoction and I love the idea of doing a healthy oatmeal for breakfast. I can see experimentation coming on...

Share your favorite protein shake recipe in the comments section!

Our Favorite Protein Bars

Continuing to compile the recommendations of my support group members. This is a summary of the discussion about protein bars. For the rest of the discussion, see: 

Meal Planning & Snacks 

Our Favorite Protein Shake Recipes

I personally have a set of strict rules when choosing a protein bar. I'll spend an hour in the protein bar aisle at the grocery store reading labels before choosing a new brand. Here are the rules:

• Less than 200 calories
• Must have more protein grams than carb grams
• No more than 9g sugar
• Be careful with sugar alcohols, some people have problems with these
• Fiber is good

The taste of protein bars is so subjective, that you'll have a dozen (or more) opinions about which brand is the best. Here are the ones mentioned at the meeting.

• Pure Protein Bars - Chocolate Peanut Butter -- Chocolate Deluxe -- S'Mores
• Chocolite Protein Bars - Triple Choc Fudge -- Cookies-n-Cream -- Peanut Butter - Chocolate Turtle
• South Beach Protein Bar - Peanut Butter -- Cinnamon Raisin -- Chocolate -- Maple Nut
• Power Crunch Bar - Triple Chocolate -- French Vanilla Creme - Peanut Butter Fudge
• Oh Yeah! -- Peanut Butter Cup -- Vanilla Creme -- Vanilla Toffee Fudge
• Atkins Endulge Bars - Caramel Nut Chew -- Chocolate Chip Granola - Chocolate Coconut

Meal & Snack Planning Tips

The goal of tonight's WLS Support Group meeting was to compile a list of tips and tricks for meal planning, healthy snacking and making healthy choices at restaurants. We also went around the room and shared our favorite protein shake recipes - I'll share that list in the next blog post. Below is the list we all brainstormed together.

Two more parts from this discussion

Our Favorite Protein Bars

Our Favorite Protein Shake Recipes

Meal Planning - making sure meals are the right size, contain the right balance of nutrients and are the healthiest choices we can make

• Always measure or weight food portions
• Write down meal plan ahead of time -- the night before or first thing in the morning
• Pack your breakfast and lunch the night before so it's ready as you run out the door in the morning
• Use small containers to pack individual portion sizes (like Ziploc extra-small bowls)
• Use Snack Size Ziploc baggies for small portions on the go
• Don't travel without food (see snack ideas below)
• Write everything down that you eat in a food log
• Use an electronic or online food journal to record food (if you're not a written food log type of person)
• Cook once - prepare one dish and portion into individual bowls for lunches all week
• Keep food choices simple to reduce calorie counts
• Choose fruit for dessert
• Use small plate and bowl instead of standard sizes
• When cooking for your family, eat the same thing but choose smaller portions and forgo starchy carbs and read for protein and veggies instead
• Planning ahead removes the temptation of too many choices or eating based on cravings or moods
• Recognize when you make mistakes and move on making the necessary changes
• It's easier to resist temptation in the grocery store than it is when the bad food is in your kitchen, so don't even bring it into the house. 

Restaurant Tips - how to make good choices when ordering off a menu

• Before you arrive, look at the restaurant's menu on their website and decide what you'll order when you get there
• Use the website Diet Facts to review nutritional information of menu items before you arrive
• Keep it simple -- if recipes are overly complicated, it generally means added calories. Order simple foods prepared in simple ways.
• When you need a quick meal - skip the drive through. Instead go to any convenience store or gas station and pick up a package of beef jerky and cheesesticks - most places have these options now.
• Dessert - there are several options:
• order fruit (berries have the lowest natural sugar content whereas pineapple has the highest)
• order one dessert for the entire table and everyone have one bite
• order the mini desserts (bite-size tasters usually served in "shot glass")
• Don't be afraid to order something not on the menu - such as cottage cheese or chicken broth, most kitchens have alternate foods not shown on the menu
• Don't be afraid to order anything off the menu, even if it's not specifically listed. For instance if you see that shrimp is used in Fettuccine Shrimp Alfredo - but don't want the pasta or Alfredo sauce, just order the shrimp as a main dish with a side of steamed veggies.

Health Snack Options - looking for protein-forward snacks

• Cheesestick or cubed cheese
• Raw almonds
• Jerky -- either beef or turkey
• Carbmaster Yogurt
• Wasa Flatbread as a base for tuna, egg or chicken salad (Mark loves the rosemary flavored ones!)
• Flax crackers, also as a base for a protein snack
• Dry Roasted Edamame
• Fresh veggies -- buy carrots, celery, green peppers, cucumbers and have them cut up and read for grabbing in the fridge

Measuring Success

How do you measure success?
Do you let the scale tell you if you're a success or not?
Do you let clothing sizes determine your level of success?

Too often we forget that this WLS journey is not about a series of numbers - whether it's our weight or clothing sizes or the number of inches we've lost.  There is a whole list of measurements that play into our overall good health.  By looking at each one of these different things in our life, we can see if we are truly doing what's best for our body, our mind and our soul.

Download the Measuring My Success Checklist here.

This checklist is designed to be used on a weekly basis.  Each week you sit down with this checklist and record how well you did during the previous days and determine which things you need to work on for the following week.

Activity Level

• Number of workouts this week
• Level of intensity of those workouts
• How active where you overall 

Nutrient & Caloric Intake

• Was your eating on track at least 90% of the time?
• Did you drink 64oz of water each day?
• Did you take all your vitamins and supplements?

Size and Shape

• Clothing - is it looser or tighter this week?
• Measurements - did your lose or gain inches?
• Weight - what'd the scale say?

Emotional and Spiritual Health

• Did I work on the mental stuff this week?
• Did I play this week?
• Did I pamper myself?

Wow's and Challenges

• What Wow Moments, triumphs or goals am I celebrating this week?
• What challenges did I face this week?

My Success Score

• Devise your own scoring method and rate your success for this week

This is the presentation I gave at my surgeon's support group meeting in June.  It's a great exercise for other support group leaders because it takes the focus off the numbers on the scale and helps us to realize that all areas of our life contributes to our overall good health. 

~Pam

No Drinking Allowed

Almost two years ago I wrote an essay explaining Why We Don't Drink with Meals. It has now been updated (click the link to be taken to the original page with the updates). I've fixed some typos, added some additional information and organized the content a bit better.

Plus I've laid out the information in a two-page handout that can be printed and distributed at your local support group meetings. Download it here.

Enjoy!
~Pam

Winning the Battle Against Emotional Eating

Here's a quick summary of our support group meeting and discussion last night. Complete with homework!
Download the Handout

Some highlights:

• It's OK to have feel your emotions. You don't need to bury them or celebrate them or run away from them, which is what emotional eating does, you can simply sit quietly and acknowledge your emotions and feelings. If you're sad, just be sad. If you're happy, just be happy. You don't need to feed those emotions with comfort food, you can just feel them and move on with your day. 
• Know your emotional triggers. What feelings make you turn to food? Make a list of ALL your emotions and explore each of them one by one. 
• Know your food triggers. Which foods do you turn to when you're emotional? Different emotions might have different food triggers. Make a list. 
• Keep and emotional journal. At the end of each day take 5 minutes and write down a couple sentences about how you felt that day and explore how you used food to sooth or celebrate those emotions.
• Make the call. As you do the above 3 tasks you'll get to know yourself better and begin to recognize when you're experiencing the warning signs of emotional eating. Soon you'll be able to identify the emotion and why you want to turn to food. 
• Stock your toolbox. The lists above and your newfound knowledge are your first tools. Also make a list of the following:
• Alternate activities. Know what you'll DO instead of eating next time. If you're happy, turn the radio up and dance around the house. If you're sad, take the dog to the park and play frisbee. If you're angry, try kickboxing or scribbing toilets. Each different emotion might need it's own list of activities.
• Phone a friend. Lean on others when you're not strong enough to stand on your own. Make a list of all the friends and loved ones you can lean on when you're weak. Write down their phone number, email address, chat ID and facebook name... go find them when you need them. 
• Knowing is half the battle. We will still find ourselves in the midst of emotional eating no matter how hard we work at this technique. But you'll find that the more you become aware of how you react to emotion, you'll be able to recognize better when it's happening. That's a huge step from where we used to be when we didn't care what we stuffed in our mouthes. 
• Mistakes Happen. If you screw up, don't beat yourself up about it. Forgive yourself and move on. The very next meal needs to be the right choice. And if you screw up your day's calories with a candy bar, that doesn't give you permission to starve yourself the rest of the day. You still need to get your nutrition in, so eat your normally planned healthy meals for the rest of the day and just take the hit for that stupid candy bar. And make sure you're recording everything in your food journal - accountability is key.

At the end of the article I designed a worksheet to get you started on building your toolbox. This won't be enough room to do all the tasks above, but it'll get you started with answering some basic questions.

Next meeting is Saturday, June 26th --- we're doing the 5k race at the Bay City State Park in the morning and then heading to Ruthann's for a Pool Party and a lunch potluck afterward.

~Pam

WLS Support Groups

Each month I attend three support group meetings. Each is different, but each is essential to my overall success with WLS. I am the leader of one of the groups, the other is lead by fellow patient in a neighboring town and the third is the official meeting held at my surgeon's office.

It makes me sad when I hear of people who don't have access to any support groups - or have do not feel their surgeon's support group meets their needs (usually coming from long-time WLS'ers who find surgeon's groups cater only to pre-ops and newbies).  I am truly blessed to have such an extensive community of bariatric patients who come together often in support of one another. If your support group is lacking in some way, I hope that my descriptions here might help you understand what is possible and give you the motivation to suggestion changes to your leader.  If you don't have a WLS support group but want one, start your own!

My Surgeon's WLS Support Group Meetings

We are offered a few different options for group meetings. Here is Hurley's Support Group website. One specifically for band patients and one in a different town - but the main monthly meeting is held the first Monday of the month at the bariatric clinic and all are invited to attend (even patients who had their surgery elsewhere). There are about 30-50 people at this main meeting.  These meetings are medically supervised in compliance with Center of Excellence guidelines (they must have a certain percentage of meetings conducted by a medical professional and others can be peer-lead or open discussion). A different speaker is brought in each month - doctor, psychologist, surgeon, nurse, patient - and discusses a topic of their choice. Sometimes there's time for questions and answers after their presentation. I was asked to be a speaker at a meeting last fall and we discussed the science of protein and then did a protein shake taste testing after. I'll also be speaking at the June meeting.

THE GOOD -- the best part of these meetings is the chit-chat time after the formal presentation. There are many long-timers who attend this meeting and use this opportunity to pay it forward to newbies and pre-ops.  New patients know we are there to answer questions and offer advice based on our own experiences. In my opinion, the real support of these meetings happens in the 30 minutes after the meeting is over.

THE BAD -- you can only hear so many topics before you've "heard it all."  So sometimes I feel like the presentation portion of these meetings is not helping me very much. Sometimes I get lucky and the topic is outstanding and I learn lots - but that's more rare the further out from surgery I get.

Peer-Based WLS Support Group Meetings - in neighboring town

See that link on the bottom navigation bar - Flint Area Bariatric Support (FABS) Group - that's the link to this group. The leader is a RNY patient who had surgery 4 or 5 years ago. We meet at a local health club in one of their classrooms on the 3rd Monday of the month at 5:30 p.m.  This gathering is very informal. Just a bunch of post-ops getting together to chat about whatever topic they need to talk about that day. We go around the room and each person has a chance to introduce themselves and/or share what's going on with them and ask for advice on something.  Or just share a Wow Moment or milestone. Because there are no medical folks at these meetings, people seem more free to ask questions about topics that might not be politically correct in the presence of professionals.  Yes, we talk about farts and poop right alongside conversations about vitamins and food and exercise.

THE GOOD -- people are free to talk about whatever they want. No holds barred.  If you have something you're struggling with you'll get 4 or 5 different ideas for how to handle it based on other people's experiences.

THE BAD -- because many of the same people attend both the surgeon's meeting and this informal meeting, we have all become friends (that's a good thing, of course) - but that also has the potential of seeming like a clicky group to newcomers, so it's something we need to be aware of. Also when you're in a room with 20 people you already know, the topics have usually all been covered and we all know what each other is struggling with or triumphing about - so that might discourage the vets from coming regularly.


Peer-Based WLS Support Group Meetings -- the one I lead in my hometown

First - let me direct your attention to the tab at the top of the page called "Support Group Topics." This is a new page I created as an index of topics from past meetings, upcoming topics and activities for groups to do outside the meeting.  I'll keep this page updated as I upload more handouts and information as well as in coming months as our group discusses more topics.

In an attempt to combine the style of my surgeon's support group meetings and the very informal Flint support group meetings - the group that I lead is a hybrid of the two. We meet at each other's homes - with members taking turns hosting the monthly meeting. We have grown to a regular meeting having 15-20 members attend. Each month I have a somewhat formal "lesson," usually with handouts and homework, and then after the discussion we have open chat and just hang out as a group of friends and talk about whatever we want to.

Because our meetings are held at dinnertime (6:30pm) and many of our members are coming straight from work, we eat together as a group. Lately we've been doing potluck style meals where the hostess prepares some main dish (usually soup or something similar) and we each bring a small dish to pass for sharing.  The meals are always WLS friendly and recipes are shared. We've also done "brown bag dinner" where we each bring our own meal and eat together at the meeting and for a while we were meeting at local restaurants for our meetings. Some have criticized us for this concept of eating at a weight loss surgery meeting. But, we have to eat right?  I would rather eat a healthy WLS-friendly potluck meal than stop at fast food on the way to the meeting for something far less healthy.  We all have to learn how to make good food choices no matter what the situation - so why not learn to make those good choices at a potluck filled with all good choices?

I also work hard to create a supportive environment outside our monthly gathering.  This year we are doing a series of 5k races together. The first one was a couple weeks ago and our last one is scheduled for November.  We've also done a couple Field Trips together to Goodwill and converted a couple summer meetings into pool parties at a member's house with a pool. If you live in the Bay City - Saginaw - Midland, Michigan area - send me an email for details about an upcoming meeting.

THE GOOD -- the friendships created in this group are so important to me and I've heard others say the same thing. By making this group about more than just the monthly meeting, I think we are truly a support system for each other all the time.

THE BAD -- we're growing. Ok, this is good. But the bad part is that we're out-growing our members' living rooms and we can't seem to find a free public meeting room that will accommodate us in the evenings. (Lots of daytime places, nothing in the evenings that I've been able to find.) The other downside of growing too large is that we lose the intimacy we've had for the past couple years. So it's something we'll need to work on and find a way to still connect on a person-to-person level to keep that small group feel while still supporting as many people as we can.


Start your own WLS Support Group

If you live in an area with no support groups - start your own!  It's easy. Find two or three other WLS patients who want to form a group, set a date and get together.  You can meet for coffee or at someone's house or at the local library or bookstore. Decide as a group which day of the month works best for regular meetings. Then just keep meeting.  Support each other throughout the month with phone calls or emails.  Invite other WLS patients to join the meetings.  You will need one person who is "in charge" - who will handle the logistics of making sure the monthly meetings are set up and everyone knows the details of the meeting time and place. But that same person doesn't need to be the "leader" of the group necessarily. If you want a topic or lesson each month, it can be the same person each month or it can rotate around to each member.  The design and mission is yours to decide. And as more people learn about your group, the more members you'll attract. And the more friends you'll make!