Thursday, December 1, 2016

All My Sleeve Wants For Christmas Is...

The activity on the bariatric surgery forums and message boards has been ramping up lately, which is great. I love to see new people joining the ranks, asking questions, and getting plugged into the community. However, any time you get a large number of new folks joining an online "community", there are going to be questions. And, recently, I am seeing the same questions posted over and over and over again: all varying versions of "when can I have/why can't I have (insert forbidden item here?)"

I get it - really, I do. Not every bariatric patient got to participate in the awesome nutritional counseling that Lor and I did with Albuquerque Health Partners. Some folks are forced to self-pay and end up getting their surgeries out of the country, meaning they might receive little to no nutritional info at all. So, in the interests of public service, I thought I would share a little information (and personal experience) about the forbidden foods most commonly asked about.

1. Bread/Pasta/Cereal: By far the most asked about food types on the boards, everyone wants to know why they can't have their favorite go-to-in-a-hurry foods any longer. There are a couple of reasons. First, grain-based products tend to have a very poor protein to volume ratio - 2 ounces (2 standard slices) of bread, for example, contain around 20 - 30 grams of carbohydrates and only 4 or 5 grams of protein. Our lives post bariatric surgery are going to forever be focused on increasing protein intake and minimizing carbohydrate intake, to avoid malnutrition. So, sadly, grain-based products tend to be a non-starter for us.

Secondly, once ingested, bread can expand in the stomach for many of us post surgery (myself included.) This can lead to major discomfort, illness and leads to the inability to ingest anything other than a couple of bites, leading to even bigger nutritional deficiencies. Prepare yourself for life without sourdough bread, lasagna, and Rice Krispies.

2. Bananas: Apparently a very popular subject, bananas hold an odd place within the post-surgery diet. They are a fruit (which the great majority of diets want you to be eating), but they make many bariatric patients ill. What gives?

Bananas, as it turns out, are a natural repository of huge amounts of sugar: one medium banana is worth about 25 grams of carbs, over 15 grams of which is sugar. Strawberries, by comparison, only contain about 7 grams of sugar per serving. Though every patient is different, the higher the amount of "pure" sugar one takes in, the greater the risk of "dumping syndrome": the rapid movement of food from your stomach to your small intestine. One can only find out where the tipping point is by experimentation, but I can tell you from experience that once you go over, you will wish you hadn't. Any high-sugar food, even bananas, needs to be approached cautiously.

3. Soft Drinks: Not a day goes by that I don't read on some forum or another "When can I start drinking cokes again?" Soft drinks may be the most evil and pernicious addiction the world has ever known. So, congratulate yourself, bariatric patients: you have kicked the habit. Because there ain't no goin' back.

Soft drinks, aside from being highly concentrated sugar delivery devices, are also repositories of carbonation, which can seriously compromise your reduced stomach size. How? Open a bottle of your favorite soft drink. Attach a balloon to the neck. Shake vigorously. See how that balloon inflates? That is what happens to your reduced stomach pouch any time you ingest carbonation. It inflates, just as it is designed to do, to accommodate larger-than-normal meals for our berry-gathering ancestors. Will one soft drink ruin your post-surgical condition? Probably not. But, I can tell you from personal experience, ingesting any form of carbonation will hurt like hell. You have been warned.

Now, pour your experimental soft drink down the drain. Don't expose yourself to temptation.

4. Beer: My greatest bariatric surgery regret is that I will never drink Guinness again. It hurts me, deep in the secret places of my heart. But it is a sacrifice I was willing to make, and one that comes up frequently in our discussions with other bariatric patients. So, why no beer?

Firstly, see "no carbonation" just above. Beer is delivered in a carbonated liquid, with all the same drawbacks as soft drinks. (Though better taste, in my opinion.) As much as I love the stuff, I am not willing to inflate my new sleeve repeatedly until I can eat half a cow at one sitting again.

Secondly, beer contains alcohol. (Duh.) And bariatric surgery leaves us very susceptible to the effects of intoxicants - in short, we become cheap dates. I used to be able to put away a 12-pack of beer in the course of an evening. A twelve pack will now most likely put me in the hospital. A single drink of alcohol will have an almost immediate effect, and will then wear off pretty quickly as well. I have yet to start experimenting with this myself but have been able to watch it in others. Be wary of any alcoholic beverage, and avoid any delivered in bubbles.

5. NSAIDS: Post-surgery, pain is a big issue. And many patients are dismayed to find out that their favorite pain relievers are no longer allowed thanks to the changes to their digestive system. Those that have previously taken things like Asprin, Advil, Aleve, Motrin, and other Non-Steroidal Anti-Inflammatory Drugs are informed that these are entirely off the menu and that they need to switch to acetaminophin-based products. Those of us that can't take acetaminophin (like myself) are basically just out of luck.

But, why?

The reduced size of the stomach pouch has many interesting side effects. The one that affects pain relievers is this: a smaller stomach pouch has a reduced size, meaning a smaller amount of stomach acid (for breaking down things like drugs) and a reduced amount of mucus (for protecting the stomach lining against the tissue-damaging effects of things like drugs.) This means that the corrosive side effects of NSAIDS can burn right through the reduced protective layer in your stomach and start directly affecting the walls of the stomach pouch, resulting in things like ulcers. In a large stomach pouch, the side effects are mitigated by the sheer amount of real estate. In our surgically reduced stomachs? Not so much. Switch to Tylenol if you can. If you can't, due to medication interactions like mine, you will have to learn to grin and bear it.

Hopefully, this gives everyone a little clearer idea as to why so many of our favorite things have been seemingly randomly removed from our lives. Just remember - there are a host of healthy food items out there that you have likely not even tried yet. Instead of pining over the comfort foods you have lost, go out and discover some new, healthier ones. I, for one, was happy to trade chocolate chip cookies for the ability to walk  several miles without being in pain. What are you willing to trade your favorite foods for?

Waiting To Trade Whiskey For Beer Next Year,

- Hawkwind

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