All posts by Dee Anne Agonis

IS THERE A CURE FOR TYPE 2 DIABETES?

KC Bariatric CURE FOR TYPE 2 DIABETES Phyllis Cronbaugh blog

Is There a Cure for Type 2 Diabetes?

I was amazed when I heard the word cure used in the same sentence with Type 2 Diabetes (T2D) by a friend of mine. She’d been in the hospital three times in the last few months with out-of-control blood sugar issues. Always a model patient, insulin and the explicitly followed strict diabetes protocol was no longer working for her. The same surgery I’d had a year ago for the wildly fluctuating weight challenges I’d endured over the past twenty years couldn’t possibly be her cure too.

My friend was searching on the web when she found a June 2016 article, Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes 1. The article stated that countries like Japan and Brazil had been routinely using surgery in the treatment of T2D for some time. It went on to say that with minimally invasive metabolic surgery it might be possible to eliminate all medications and injections, instead of suffering through life with a Band-Aid on her disease.  

The first bariatric surgery was done in 1954 and became more widely used for obesity when laparoscopy or minimally invasive surgery became routine in the 1980s. Metabolic surgery became a more appropriate name for bariatric surgery about ten years ago when medical studies showed the myriad of conditions, diseases, and comorbidities that were helped, reversed, or cured with the simple procedure. The most common include:

  • T2D (even Type 1 Diabetes to a degree),
  • high cholesterol,
  • high blood pressure,
  • depression,
  • cardiovascular disease,
  • migraines,
  • venous stasis (blood clots),
  • stroke,
  • gastric reflux disease,
  • polycystic ovarian syndrome,
  • pregnancy and fertility problems,
  • asthma,
  • sleep apnea, and
  • stress urinary incontinence.
Dr Rober Aragon The Bariatric Center of Kansas City - Cure for Type 2 Diabetes - Phyllis Cronbaugh
Robert Aragon M.D, The Bariatric Center of Kansas City

Dr. Robert Aragon, one of four highly trained surgeons with The Bariatric Center of Kansas City in Lenexa, Kansas2 says that most patients with T2D can see a marked reduction in the need for insulin within a few days after surgery and may be able to quit their doses completely within a few weeks or months. If the individual suffers from T2D and obesity, this occurs even before the patient has lost significant weight. Of course, one solution is not optimal for every patient.

Why surgery works so fast on T2D symptoms

“Most people considering bariatric/metabolic surgery, for whatever reason, initially have a very simplistic view of the process,” says Dr. Aragon. “They believe the surgery, which will either reduce the size of their stomach or bypass it completely depending on the procedure3, will ultimately cause them to eat less and the result will be to lose weight. The reality is that the smaller stomach is the least of the factors that cause the weight loss. The surgery causes a massive metabolic and hormonal change. It’s no different from when a woman has her ovaries removed. Without ovaries, she is likely to have hot flashes, night sweats, mood swings, sleeplessness, fatigue, anxiety, and even loss of sex drive. Our stomachs and intestines are not just reservoirs for food. Like ovaries, they secrete substances that influence our appetite, sense of fullness, the way our bodies manage sugar, store fat, and more. The surgery removes or bypasses the source of these hormones. That is why we see almost immediate results for diabetics, whether weight has been part of the equation or not; their blood sugar comes under control without insulin. … An overweight patient does lose weight, but what’s interesting is that patients who are not obese do not seem to lose weight. They maintain their current weight and just enjoy the metabolic results of the surgery.”

Dr. Aragon also indicated that individuals with Type 1 Diabetes that opt for surgery have much better control of blood sugars. They can reduce the amount of injected insulin, but not eliminate it.

From someone who has had bariatric surgery for weight loss, having the simple procedure done so that I did not have to stick myself with a needle several times a day and have to live with a very restrictive diet seems elementary.

Insurance companies are willing to pay

In 2015, the 2nd Diabetes Surgery Summit (DSS-II)1 stated as part of their conclusions, “Health care regulators should introduce appropriate reimbursement policies [for individuals suffering from metabolic imbalances].”

Currently, most insurance carriers are more than willing to pay for surgeries for obese patients that meet certain criteria3. “From a financial point of view, bariatric surgery makes overwhelming sense,” says Dr. Aragon. “The money that is saved years down the line by an insurance company is astronomical. We tell patients that on a yearly basis they can save $10,000-$12,000 in prescription drug costs, doctor’s visits, diet programs, and food costs. So for an insurance company to not have to pay for twenty years of diabetic care or other commodities of obesity, it just makes sense. The government is well aware of this, so for individuals that qualify, Medicare doesn’t set up a lot of roadblocks either.”

Dr. Aragon says that if an insurance policy does not cover the surgery, it isn’t the insurance company that is the problem, but the employer that did not negotiate the surgery into their program because rates would be higher. “We’ve had patients band together and change corporate policy,” he says.

So, why hadn’t my friend heard about the surgery before?

 Insulin syringe with 29G. needle on white background.In the 60s, 70s and even 80s before minimally invasive surgery was common there were stories of patients who had bariatric surgery and required weeks in the hospital, had postsurgical problems, did not reach desired outcomes, or developed nutritional deficiencies. This caused most of the stigma and bias that we still see today,” said Dr. Aragon. “Now, with laparoscopic, the surgery takes less than two hours (KC Bariatric does most in less than 45 minutes), there’s minimal downtime, patients lose weight, get off medications, off insulin, become more mobile, and complications are rare.

“In 2005 there were around 140,000 bariatric surgeries in the US. That [number] has grown but at a marginal rate. An impressive or actually unimpressive statistic from the American Society for Bariatric Surgery who sets the standard is that of the patients that would qualify for the surgery based on weight and medical problems, only 2%-3% actually have the surgery. There’s a huge discrepancy between those who need it and those who get it. Even with that today I would say there are over 200,000 surgeries every year in the US. Here at The Bariatric Center of Kansas City, we’ve done about 8000 since we opened in 2002, and around 1600 in 2016 alone.”

Why do I care?

Twenty-one years ago my husband was diagnosed with a rare form of leukemia. A seemingly perfectly healthy man was given three months to live if he did not undergo chemotherapy; with the chemo, he was told he should go into remission and live at least another four or five years. Doctors wouldn’t predict after that. Like my friend with T2D, he was a model patient and followed their the protocol, but somehow was overdosed on the chemo and lived three months eight days. It wasn’t until his death that I researched alternatives to his treatment. I believe that one of those alternatives would have given us a totally different outcome.

If you have a medical condition and aren’t completely satisfied with the treatment suggested, or the treatment you are undergoing isn’t working, do your research. We are led to believe that we have the finest health care in the world, but numerous countries treat medical conditions successfully in different ways than what is common here in the US. Take charge of your health. My friend is determined to have the metabolic surgery and is working to convince her physician and insurance company that in her case, it is the best solution.

 

Sources:

  1. Diabetes Care Volume 39, June 2016 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.
  2. The Bariatric Center of Kansas City (http://kcbariatric.com).
  3. Surgical Procedures – Wikipedia – The two most common procedures today are the gastric sleeve, in which the stomach is reduced to about 15% of its original size by surgically removing a large portion and leaving a tube, sleeve, or banana shape. Gastric bypass surgery is where the stomach is divided into a small upper pouch and a much larger lower “remnant” pouch, and then the small intestine is rearranged to connect to both.

This article was originally posted by  on Mar 7, 2017 on Executive Life Magazine. It is with the author’s permission that we post this article in its entirety.  

 

May 2, 2017 – Clinical Pearls to Prevent Weight Regain

Facilitator:  Chris Bovos, RN, CBN

Taken from The Bariatric Times, November 2016

 

There is a lifelong threat of weight regain after surgery.  A small amount of weight regain (3 – 5%) is expected after a patient reaches their lowest weight; but maintaining that weight loss is a challenge for most patients.

Some of the areas we looked at include:

Behavioral Health

Risk factors for weight regain include:

  • Preoperative binge eating, which can become loss of control eating after surgery;
  • Depression – many of the drugs used can increase weight Need to get depression under control prior to surgery and monitor after surgery;
  • Night eating or grazing – early, brief intervention can improve this.

Obesity Medicine

People frequently have trigger foods that trigger the dopamine or reward response.

  • Need to identify what your triggers are and avoid them;
  • Keep a food journal. Most people begin to have more liberal meals once they have lost their weight, and need to become aware when they are eating high glycemic, high-fat and carbohydrate-rich foods by journaling every day;
  • To “reset” things, cut to 1000 – 1200 calories a day for women; 1200 – 1600 for men;
  • Follow the physician orders and nutritional guidelines:
    1. Meet daily fluid goals of 64 ounces a day at least;
    2. Wear CPAP – poor sleep can increase cortisol and slow your weight loss;
    3. Eat 3 meals a day – skipping meals slows your metabolism.
    4. Get at least 1200 mg Calcium with Vitamin D each day to improve body’s ability to burn fat;
    5. May need to take a metabolic boosting medication.

Nutrition

Meal composition and portion control are critical:

  • 50% of your plate should be lean protein;
  • 30% of your plate should be vegetables (non-starchy);
  • 20% or less should be complex carbohydrates – not processed foods;
  • Eat slowly and take 2 bites of protein to 1 bite of something else – helps keep protein a priority, and wait 5 seconds between bites.

Physical Activity

Focus on making your muscles healthy in addition to losing weight

  • Muscle has a higher metabolism and increasing lean body mass increases metabolism;
  • Begin with 150 minutes/week and work up to 200 – 300 minutes a week;
  • Once you lose weight, your body is so much more efficient at using energy that you have to work harder than you did in the beginning;
  • Any kind of activity can be modified – don’t say “I can’t”.

Ongoing Monitoring

The most vulnerable time for people to start regaining is at 2 years’ post op.  Usually will see one of the following start:

  • Going from 3 meals a day to grazing;
  • Intake has switched from protein, fruits and vegetables to carbohydrates, sugars and fats;
  • Decreased physical activity;
  • Loss of Control eating.

In Summary

  • Eat real foods, not packaged foods (eat food that will rot over time);
  • Make protein a priority and omit all processed food, sugar and simple carbs;
  • No snacking or grazing. Be aware of mindless eating (eating from boredom);
  • 8 glasses of water daily, and don’t drink with meals or 30 minutes after meals;
  • Walk as alternative to driving. Take the stairs;
  • Follow up with physician and support groups;
  • You can regain control!

 

April 20, 2017 – Meal Planning

Facilitator: Stephanie Wagner, MS, RDN

Stephanie Wagner is a dietitian who has spent the last 8 years working with bariatric surgery patients, and has developed a support website and recipe book specific for patients who have had weight loss surgery.

Steph began by discussing how we frequently manage many areas of our lives well, but don’t do a good job managing our “food life” well.  She gave us some tips on grocery shopping, such as Wednesdays being the best shopping day.  There are more deals, double coupons, and stores will be out of less food, since grocery stores do their restocking on Tuesday nights. She told us that she does her shopping for large bulk items once a month at Sam’s or Costco. Then once a week, she uses Walmart’s Pick up Service, where she can order the week’s food online and pick it up Wednesday morning. As a busy mom, this saves her time trying to shop with children.  It doesn’t make any difference what your system for shopping is – she just recommends you find one that works for you and stick to it. 

She spoke about making small portions for after surgery and cooking for one. 

  • She uses a silicone muffin pan to make individual mini meatloaves, egg & ham breakfast muffins. Even chili is something she puts into the muffin pan and freezes them. Once they are frozen, she can easily remove them and put them in a gallon freezer bag and they are good for 6 months. 
  • She uses a cookie scoop to make small meatballs
  • She uses kitchen shears to cut up meat into bit size pieces – it cooks faster and is ready for small portions
  • She uses ¾ cup size food storage containers made by Elacra to prepare food for the day,
  • And she uses a covered baker to make crock pot meals only much more quickly in the microwave. 
  • She uses rotisserie chicken to make a lot of meals using chicken

Some suggestions for converting old family recipes into healthier versions: 

  • Use fat free Parmesan cheese in place of breadcrumbs when making meatloaf or meatballs – 1 cup of grated cheese equals 1 cup of breadcrumbs
  • Use fat free yogurt in place of sour cream
  • There are many ways to convert recipes you love without tasting the difference

Stephanie also has written a cookbook that is available on her website or on Amazon called “Best Fork Forward.”

Her website, which includes a blog, recipes,  meal planning and coaching is www.foodcoach.me.  You can try the website free for 2 weeks, or join for $10 a month.  With the membership, there is a series of educational courses, including a Back on Track course with videos to assist you getting back on track if you are struggling with any weight regain.  Some of the other courses available are:

  • Reading nutritional labels
  • Gastric Sleeve 101
  • Gastric Bypass 101
  • Lap Band 101
  • Pantry clean out challenge
  • Top 10 reasons for weight regain
  • The Dos and Don’ts of Protein
  • Surviving Holidays
  • Food Addiction
  • Stress Eating
  • 6 ways to overcome feeling hungry

Stephanie will be coming back for our August 1 meeting at 5:30 pm, so if you missed her this time around, mark it on your calendar and don’t miss this one!

 

 

Enough is Enough: Mastering Your Body Signals

Enough Is Enough - Hunger

It is well known that hunger is a common complaint after weight loss surgery. Bariatric surgery induces changes in various metabolic hormones such as Gherlin, Leptin, Gastrin, and Insulin. These hormonal changes have a long-term effect on energy expenditure and the sense of hunger and satiety. Still, as human beings, life and survival depend on the ability to find food for immediate metabolic needs and to store excess energy in the form of fat to meet metabolic demands during fasting. Hunger and satiety continues to be a fundamental body mechanism after surgery and is critically guided by the brain reward system. 

Leptin & Ghrelin Affect Hunger & Satiety
Leptin & Ghrelin Affect Hunger & Satiety

Yes! There is still a gut-brain interplay controlling your eating behavior. Stomach hunger, or physical hunger, involves a complex interaction between the digestive system, endocrine system and the brain. The brain detects alterations in energy stores and triggers metabolic and behavioral responses designed to maintain energy balance.

After bariatric surgery, is important to understand your body, the foods you like, the ones that you have control over, and your triggers. It is also important to understand your physical feelings of hunger and satiety. Listen to your body and respond to it. Remember that the pleasure and rewarding feelings from eating affect the ultimate deciding factor of what kind of foods and how frequently you eat.

Hunger Explained

Hunger Can Make Your Stomach Ache
Hunger Can Make Your Stomach Ache

The stomach starts to ache and rumble in early signs of hunger. You start feeling tired and weak, while finding it harder to concentrate and work. When you begin eating in response, you really enjoy the food and start feeling better, because a bodily need is being met.

If you don’t feed your body when it needs food, the physical symptoms intensify. The stomach starts to really hurt. You find it more difficult to concentrate and may experience lightheadedness. You may also get irritable and short-tempered. In addition, some people get shaky and nervous, while others get a headache. Because you are so ravenous at this point, once you do start to eat, you’re very vulnerable to uncontrolled eating.

While eating, learn to stop when the stomach feels comfortable, and satisfied–not stuffed. You soon begin to feel calmer, more alert and energized. It takes approximately 20 minutes for fullness signals to transmit from the stomach back to the brain. You may experience a runny nose, watery eyes, hick-ups, sneeze, or a deep sigh.

Overeating Doesn’t Feel Good
Overeating Doesn’t Feel Good

If overeating occurs, you are mechanically taking bites and swallowing, but you aren’t really enjoying the food anymore. You are feeling pressure and discomfort in your stomach. If filled further, it starts to hurt. You may even feel queasy and after a while you start to feel sluggish. You may also experience heartburn, nausea, or vomiting. Avoid overeating.

Food tastes different

Taste adjusts while you eat just like hunger and thirst. It takes only a few bites for your taste buds to adapt. If you take two, three, or four bites of food and pay attention, you’ll notice that it rapidly gets less tasty, less satisfying, and less crave-worthy. Your taste buds are usually the first part of your body to start sending the “had enough” signal.

Pay attention on how your stomach feels

The stomach isn’t by your belly button. It’s higher behind your ribcage. For most people, the feeling of fullness is more like a pressure or tight feeling and happens just behind the bottom of the sternum, behind the little indentation between your belly and your chest. In the first few weeks after surgery, you may feel the pressure up in your chest area.

Do Not Skip Meals

Eat-RegularlyEat 3 times/day within your waking hours. Long periods of fasting when skipping a meal can trigger hunger.

Follow Your Eating and Drinking Routine

Remember to stop drinking 30 minutes before your meal, do not drink while eating, and wait 30 minutes after you are done eating to drink fluids again.

Drinking fluids while eating or right after your meal will empty your stomach quickly. This means you will feel hungry sooner. This in turn will lead to snacking/grazing affecting your weight loss success.

Helpful Tool: Download the Baritastic App. It has reminders, a 30 min timer, and many other tools to help you succeed. The Bariatric Center of Kansas City has downloaded additional resources and helpful links on the app as well. Add code: 76319. Yes, it is free!

Focus on Eating Solid Foods

Solid foods will remain in your stomach longer. This will make you feel full and satisfied for a longer period of time. Avoid drinking your calories.

Other Body Signs Unrelated to Physical Hunger

Don’t Eat to Chew Frustrations Away
Don’t Eat to Chew Frustrations Away 

Teeth Hunger

Sometimes, especially if we’re feeling irritated or stressed, you want to chew frustrations away. Your body is not calling for food, but you eat in an attempt to relieve anxiety.

Mouth Hunger

You see or smell something that looks so delicious that your mouth starts to water. Sometimes just thinking about a food brings on a craving for it. You desire to taste the food, but really aren’t physically hungry.

 

Mind Hunger

You look at the clock and think you have to eat a certain amount of food because “it’s time”, even if you don’t feel like eating.

Thirst

 Sometimes You Just Need to Hydrate
Sometimes You Just Need to Hydrate

Sometimes the sluggishness of dehydration can be confused with actual hunger. The body is calling for fluids, not food.

Fatigue

When you sense low energy levels you automatically think that if you eat something you will feel better. However, if you’ve been working extra hard and/or haven’t been getting enough sleep, your body is calling for rest, not food.

Heart Hunger/Emotional Hunger

You feel an ache and emptiness in your hearts due to unmet emotional and/or spiritual needs. Rather than acknowledge your feelings and work through your issues, you try to fill the void with food. You may try to use food to “stuff” your feelings down. Although there can be physical discomfort in the gut when you’re upset, it is a distinctly different sensation from stomach hunger.

When you learn to be in synchrony with your body, understand your strengths and weaknesses, and make the most of them, you just might recognize that what you have eaten is simply enough.satisfied

Laura Hernandez, MBA RD LD

http://www.sciencedirect.com/science/article/pii/S0196978115002454

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761859

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710609

http://www.findingbalance.com/articles/understanding-hunger-and-fullness-cues

Additional credit to:

Experience Life, April 2017. The Art of Enough by Elizabeth Millard.

 

 

April 4, 2017 – Optimizing Weight Loss

Facilitator:  Dr. Saradih 

Dr. Saradih shared a fishbone diagram (see below) that shows different things that affect our weight after surgery, and addressed what we need to do with each area in order to maximize weight loss in the first 6 – 9 months following surgery. 

Dr. Saradih also pointed out that the first 3 things he addresses when someone stops losing weight is:

  1. Stop protein shakes – need to be eating protein using whole foods
  2. Make sure you are getting enough Calcium Citrate – it is essential for losing weight
  3. Make sure you are eating at least 800 calories a day, because your metabolism will slow if you eat less than that each day.

The other areas he discussed were:

  1. Barriers to weight loss – these need to be removed. 10% of excess weight can be attributed to medications that cause us to gain weight or prevent weight loss.  These include:
  • Insulin and sulfonylureas for type 2 diabetes
  • Beta blockers
  • Antidepressants
  • Antipsychotics
  • Mood stabilizers
  1. We need to treat disease states that contribute to weight gain, such as:
  • Hypothyroidism – and we need to recheck the thyroid after every 30 – 40 lb weight loss after surgery and readjust thyroid medication
  • Testosterone deficiency in men
  • Vitamin D3 and Calcium levels need to be optimized; a deficiency in calcium can negatively impact weight loss
  • We need to address depression
  • Bariatric surgery is the best option for resolving type 2 diabetes, obstructive sleep apnea, hypertension, and high cholesterol
  1. Dietary concerns include:
  • Eating 800 calories a day
  • Getting 60 – 80 grams of protein a day
  • Getting around 50 gm of carbohydrates a day
  • Eating 3 meals a day – don’t wait until you get hungry!
  • Use protein shakes only for the short term. Try to be off protein shakes within a couple of months, and then just use them occasionally! The number one reason people stop losing weight and plateau once they are more than 2 – 3 months out is they continue to have a daily protein shake, when they need to be eating their protein instead.
  • Eat real food – not processed food
  1. Sleep is very important:
  • We need 6 – 8 hours of good quality sleep
  • We all have a certain circadian rhythm when hormones have peaks and valleys, and these can affect how our body rests, our metabolism, and how we deal with stress. If you don’t get enough good quality sleep, it causes your stress hormones to rise and increase weight.
  • Sleep apnea can significantly affect the quality of sleep – wearing your CPAP can improve weight loss
  • Certain sleep aid medications can cause you to gain weight, such as Benadryl
  1. Activity should be used to keep muscles healthy. The healthier your muscles, the faster your metabolism, so think of activity as keeping your muscles healthy instead of exercising to lose weight.  150 minutes of activity a week will help maintain weight loss, but to optimize weight loss you need to increase to 300 minutes a week or increase the intensity of your activity, such as resistance or weight training.
  1. Hunger is something most patients don’t deal with after surgery. However, 30 – 40 % of patients have Binge Eating Disorder, and after surgery can show up as Loss of Control Eating.
  • Do not fast – when you fast, your metabolism slows down in order to conserve energy, and your body is very efficient at storing energy.
  • Grazing and night time eating out of boredom can prevent weight loss – you need to find another activity to satisfy you at those times
  • Frequently hunger is really dehydration – try drinking when you feel hunger, especially in the early months.
  • There is no way you can be physically hungry after surgery, but you may feel mental hunger. That needs to be addressed
  1. It takes an entire team to provide resources to assist patients for weight loss success. In addition to the surgeons our team includes:
  • Internal Medicine/Obesity Medicine Physician
  • Nurse Practitioners
  • Clinical Psychologists
  • Dietitians
  • Educators
  1. Follow up after surgery is critical, as the earlier we are able to intervene when someone isn’t losing weight as expecting, the sooner we can help them get back on track to reach their goal. We need to see patients at 1 week post op, 2 months, 6 months and then annually.  Our goal is that our patients reach their maximum weight loss within 18 months, regardless of which procedure they have done.

Relationships After Weight Loss Surgery: For Better or Worse

relationships-after-weight-loss-surgery-kc-bariatric

What To Do When Those Closest To You Are More Comfortable With “Worse”

We all know that change doesn’t happen in a vacuum; it’s dynamic. As you change, your relationships with those closest to you change too. Yet, most of us are caught by surprise when our dynamics with those closest to us begin to change in the aftermath of our weight loss surgery (WLS). Understanding why these changes occur, and how to address them, can make the difference between deepening the intimacy and connection we feel with those that matter most to us, or losing that intimate connection.

domestic-quarrelPrior to having WLS, most of us had at least one person in our lives (a partner, parent, child, friend, etc.) that expressed concern about our health and longevity and supported our decision to have the WLS. That person had a stake in wanting us alive, well, and in their life for the long haul. So, we are understandably hurt and confused if the same person that initially supported and encouraged us begins to change their tune as we become healthier, thinner, more mobile, and more social.

Obesity is often a family disease. The family is the core unit of all social relationships across cultures. Even if we are not connected to our original families anymore, we tend to recreate the family systems we grew up in with those closest to us. When one person in the family goes through major changes (like WLS), the rest of the system experiences “aftershocks,” like in an earthquake. In the Earth’s case, the “aftershock” is a natural way to release the remaining tension and pressure so equilibrium can be reestablished. In our loved ones’ case, I would argue that the same holds true.

elderly-friendsWhen we lose weight and become more available to work, run errands, and socialize with others, those closest to us may feel threatened and may (unconsciously) do or say things in an attempt to reestablish old roles, routines, and responses. They don’t do any of these things to consciously hurt us or make life harder for us. They are just trying to get back into equilibrium.

They just want life to feel “safe” again, on solid ground, like they did when we were overweight and our roles were clearly defined, predictable, and exclusive. It’s important to remember that our loved ones may be used to having us virtually all to themselves, so suddenly sharing us with a broader social network may be challenging and difficult for them to adjust to.

exercising-after-weight-lossOne of the biggest oversights in the WLS preparation process is the lack of education and communication about how our WLS will impact those around us. The focus of the preparation is generally on how the surgery will impact us, not on how our weight loss may affect those closest to us. This common (and often painful) oversight usually results in no one being adequately prepared to deal with the complicated range of feelings that arise (all around us) as a result of our WLS.

The bottom line is we all want to feel safe, loved, and know that we belong. Wanting safety, predictability, and reassurance during any transition is a normal, natural response. We aren’t the only ones that need support during our WLS transition. Those closest to us are going through their own tough transitions; it’s just not as obvious because there are no pounds and inches melting away before our very eyes.

lets-talkSo, if you’ve noticed that your loved ones are doing or saying things that feel like they are trying to sabotage your weight-loss progress, or blame you for not being as available, you are not alone. But, it may be helpful to understand that jealousy and sabotage (whether it’s self-sabotage or actions taken by another) can always be traced back to that deep desire to “protect” and preserve the equilibrium or status quo – even when that status quo made everyone miserable! Because, like it or not, even misery (that we are used to) is predictable, and change (even if it’s positive) is not.

It’s critical to understand that your family, close friends, and loved ones need their own source of support to adjust to “the new you” in order for the transition to work for everyone. If your partner or family members are willing to acknowledge that your WLS transition is difficult for them too, that’s half the battle. The other half is getting everyone the support they need to make the transition as productive, healthy, and sustainable as possible.

Talking to our loved ones about getting the support they need is key, so we don’t resort back to old behaviors (like overeating) in an effort to make them (and us) more comfortable in the moment. So, the next time you find yourself getting confused, angry, or reaching for food you didn’t intend to eat after a loved one says or does something that triggers or hurts you, ask yourself if they may be feeling scared or threatened and just looking for any way possible to get back to “normal” again.

therapy-for-couplesIf the people that matter most to you are willing to work together to explore, understand, and consider one another’s experiences and needs with respect and compassion, then you have a chance to make your relationships more meaningful and intimate than ever. With this sort of foundation, you can work through your collective transitions with a new appreciation and understanding of all that is possible for each of you now. To do that, I recommend that you and your partner (or family) either participate in:

1. Structured coaching, designed to help each person identify and implement practical strategies to move through his/her individual transition with more ease, understanding and, support; or,

2. Couples or family counseling (with a professional in your area) to help you work through more complicated, longer-term relationship issues.

couples-therapyWhatever you choose, understand that your WLS can be framed either as an opportunity to increase the satisfaction and depth you experience in your closest relationships or as something that shines a light on the growing divide between you and those closest to you. How you frame it and the actions you take based on that belief is up to you.

Credits to:
Jill Temkin, founder, Living Thin Within
Written for ObesityHelp

March 23, 2017 – Post Op Exercise Options

POST-OPERATION BEGINNER EXERCISE OPTIONS AND MODIFICATIONS

Katherine Caddell (Element Fitness) – March 2017

Getting started exercising is the hardest part, but once you begin, your body will love you for it!

Equipment Needed:

  • Chair
  • Resistance Bands – Color matters (Check package to make sure they comply)
    Yellow 4-6 lbs      Green 8-10 lbs      Red 12-14 lbs      Blue 16-18 lbs
  • Ankle weights -Allows you to change the weight from 1-5 lbs based on ability level
  • Dumbbells -Light works well to begin with, and as strength builds, you can increase

*10 and 3 are beginners’ magic numbers – 10 repetitions of each exercise with 3 sets.

Exercises with chair – Sit on the edge of your seat with great posture to engage your core

For any questions or guidance, feel free to contact me at KCaddell@ElementFitnessKC.com or by calling Element Fitness at 913-268-3633.

March 7, 2017 – Changing Relationships after Surgery

Bariatric Support Group

Date:  March 7, 2017

Facilitator:  Dr. Ravi Sabapathy

Dr. Sabapathy came to talk to the group how bariatric surgery impacts relationships, both before and after surgery.  He discussed that there were 3 domains that are impacted:

  • Biological
  • Psychological
  • Social

Patients talked about the ways their lives had been impacted positively in each of those domains.

Biologically: 

  • Physically more comfortable
  • More energy
  • Greater mobility
  • Off medications – healthier

Psychologically:

  • Increase in self-confidence leading to being less concerned with what others think
  • Increase in self-esteem and able to focus on themselves
  • Feel that they have more choices and more options, since they are not limited by their weight
  • They are no longer noticed for “being fat” – but no longer “invisible”
  • Feel that they have their freedom back, and are more willing to try new activities
  • With absence of continuous urge to eat, have more time rather than planning on eating all the time

Socially:

  • Have enough energy to do things in the evenings rather than being too tired all the time
  • Go out and do things by self, meet new people, join social gatherings
  • Increased professional/career confidence
  • Find their family/friends are more conscious of what they eat and have begun making better food choices and losing weight also.
  • Don’t have to worry about going places like theatres that may not have large enough seats, restaurants that don’t have adequate seating, etc. Can go anywhere now

Dr. Sabapathy says these are the reasons he calls weight loss surgery “health improvement and function surgery!” He talked about the different relationships in our lives.  The first one we think of is the relationship with our spouse.  There is currently a 50% divorce rate just in the general population.  There are a few statistics showing that 2 years after bariatric surgery can be a time of challenge; but he finds that those who have a strong relationship find it gets stronger, and those with a weaker relationship find it gets weaker.   While it is easy to blame the surgery, there are usually other issues involved.  For example, if the patient who has had the surgery has more energy and wants to get out and do more, this can be challenging for the partner who doesn’t want to see that change.  Change is hard, and “change breeds more change.”

  • The first big change most people make is a job change. Once they have lost the weight, they feel they are freer to explore more career options.  Previously they frequently work long hours and have a lot of emotional exhaustion.  Once they lose weight and are focused on self-care, they often want to look at something that isn’t so draining, and they have the confidence to consider more options.
  • Another change can be with family and friends. Some patients mentioned that the control in a relationship can change, and some find themselves facing some rejection from the other person who doesn’t want to give up control.  Families may resist changes that involve the patient spending more time away from home as the patient becomes more social; and some have sensed jealousy from family and friends who may be jealous of the new, thinner person.  It may force them to look at themselves, and can bring out their own insecurities.
  • Some relationships in our lives are toxic, and those can sabotage patient outcomes.  You may need to leave those toxic relationships behind in order to be successful.  Communication is key, addressing how different you feel and addressing how that changes the way they feel. 
  • Your relationship with food is a big one that needs to change. You develop your habits beginning as a toddler, and you just eat what you’re given.  You now eat for nutrition, and not for other reasons.  Sugar is as addictive as heroin, so you need to avoid it, especially if you know you are prone to addiction.  Be very mindful about food.  Find something to replace the pleasure you got from eating – find another source of pleasure instead. 

The most important relationship you want to address is the relationship you have with yourself.  Patients at support group agreed that self talk is important – especially when you go somewhere socially and you cannot have something that is available to eat.  You want to keep reminding yourself of what you are trying to accomplish and keep on track. 

The Harm of Fat Shaming and its Effects on Weight Loss & Health

Fat-Shaming-Scale_127604420

What is fat shaming and what does it mean for weight loss? Fat shaming is the process of insulting, bullying or stigmatizing a person for their weight. This is nothing new in American culture where rhetoric, the entertainment industry and media have all insisted fat people are inferior.

Even well intentioned instances of fat shaming are considered socially acceptable because they are framed in a way that seems to express concern for someone’s health. Examples include discouraging someone from eating dessert or telling them they need to be more active. But fat shaming has been proven to be counterproductive. The language we use to talk about weight and the assumptions we make based on a person’s size can actually contribute to more weight gain and less self-care, like seeking medical attention.

Think you’re helping that overweight family member or friend with fat shaming commentary?  Here’s what actually happens:

Fat shaming can spike stress hormones that can increase weight gain

  • Numerous studies show weight stigma and discrimination can lead to elevated levels of cortisol, a stress hormone that’s been linked to overeating, binge eating and weight gain;
  • Dieting alone is also considered inherently stressful and can lead to weight gain, not weight loss, because weight anxiety is linked to binge eating.

Fat Shaming stems from the insinuation that overweight people lack control, but losing weight isn’t as simple as having willpower  

  • Too many in our society hold the belief that weight loss is as simple as summoning willpower; that people who fail to lose weight just aren’t trying hard enough, that they are lazy;
  • Weight loss-focused shows like The Biggest Loser, suggest getting thin is about working hard and really wanting it, but they don’t tell the full story. Several former contestants of The Biggest Loser struggled to maintain their weight loss, according to the New York Times. Contestants that lost the most weight had to actually eat less and exercise more to maintain their weight loss than their peers who had lost less weight; clear evidence that losing weight and maintaining it involves much more than just self-discipline;
  • These forms of entertainment actually perpetuate the fat shaming myth: research has shown that people who are not trying to lose weight that watch weight loss reality TV are more likely to believe that weight can be controlled solely by self-discipline;
  • Weight gain and obesity stem from a whole host of factors including genetics and environment, a report from Harvard Medical School noted. Roughly 400 genes, childhood habits and many features of modern life (e.g. inflated portion sizes, sedentary jobs, lack of sleep) can increase the likelihood someone is overweight or obese.

Even doctors are prejudiced, which can be harmful to their overweight patients

  • Fat-Shaming-Doctor-Prejudice_49297156Many medical professionals hold weight biases which can prevent provision of the best possible care; they too can buy into the fat shaming stereotype about lack of willpower and self control;
  • Yoni Freedhoff, assistant professor at the University of Ottawa and founder of Ottawa’s Bariatric Medical Institute, has addressed professional biases toward the overweight population and how they can affect the type of treatment a provider recommends. Freedhoff also suggests patients who sense this bias from a health professional can be less likely to seek care if they have had a negative experience with a medical provider in the past;
  • Dr. Michelle May, a medical physician and member of the advocacy group, Health at Every Size, shared, “This is about people receiving inadequate health care, and preventative advice, and counseling and support and treatment – because the focus is on weight instead of managing risk factors.”;
  • While already facing health consequences, obese patients risk facing even more dangers if their doctors don’t support them or if they feel so discouraged that they stop seeking professional care;
  • Health care providers shouldn’t think of obesity any differently than other medical conditions that carry degrees of risk.

Fat-Shaming-Results_127604387In the end, it would be wise for all to understand that body size is not directly correlated with a person’s work ethic or worth. If there’s any laziness associated with fat shaming, it’s the laziness of failing to correct our own flawed beliefs about weight and health. Love, compassion and encouragement will do far more to help than the counter-productive effects of fat shaming.

Original Article – https://mic.com/articles/162629/fat-shaming-not-lack-of-willpower-is-why-so-many-americans-struggle-with-their-weight#.d4FXOOW2t

 

Empower Your Gut Microbiome Footprint to Heal and Protect Your Health

Gut Bacteria

Microorganisms are everywhere. From those that live in the ocean to those found in the soil that helps feed the world. Other microorganisms live in a host environment, and our body is no exception to this rule.  According to Merriam Webster’s Dictionary, a microbiome is “a community of microorganisms (such as bacteria, fungi and viruses) that inhabit a particular environment and especially the collection of microorganisms living in or on the human body”. There are about the same number of cells that make up the entire human body as the number of microbiomes in us. Microbiomes that reside inside the gastrointestinal tract are referred to as gut microbiomes and are found all throughout the GI tract. They participate in a wide variety of systems and they influence human health in important ways. 

Here are some areas of potential influence when gut microbiomes heal and protect your health:

  • Act as a mediator. They are the first to be in contact to environmental changes, protecting you from illness;
  • Maintain human homeostasis. They can modulate your body’s metabolic status, vitamin production, nutrient absorption, and how you utilize carbohydrates and fat, whether you feel hungry or full;
  • Influence inflammatory process. They help maintain the integrity of the gut lining, regulate immunity, and control inflammation preventing a leaky gut;
  • Influence your brain health. They directly affect the function of the cells along the vagus nerve. Some of the gut’s nerve cells and microbes release neurotransmitters that speak to the brain in their own language. Many scientists are now calling them the “second brain”. They affect your mood, ability to concentrate, and libido. A dysfunctional microbiome could be the root of headaches, anxiety, and inability to concentrate;
  • Act as a physical and chemical mechanism to prevent gastrointestinal infection. They can detoxify chemicals such as environmental toxins in a way that when they are consumed, they can act on the primary source of exposure and protect you. This means they serve as natural antibiotics, antivirals, and antifungals. They can interact with oral medications and potentially reduce side effects.
Probiotics help you lose more weight
Probiotics help you lose more weight

You can change the state of your microbiome footprint and the fate of your health, opening the door for better health. A study published in the Journal of Gastrointestinal Surgery showed that patients who take probiotics after the gastric-bypass procedure tend to lose more weight than those who don’t take the supplements. Other researchers have found evidence linking bariatric surgery to long-term positive changes among the gut microbiomes.

Significant changes in the array of gut bacteria can take place in as little as six days after instituting a new dietary protocol. This plan can help you get started:

EAT FOODS RICH IN PROBIOTICS

Probiotics are live bacteria and yeast that support good digestive health. Long before probiotic supplements became available, the health benefits of fermented foods such as sauerkraut and yogurt were well recognized. The type of fermentation that makes most foods rich in beneficial bacteria is called lactic-acid fermentation. In this process, good bacteria convert sugar molecules in food into lactic acid, and, in doing so, the good bacteria multiply. This lactic acid, in turn, protects the fermented food from being invaded by pathogenic-bacteria because it creates an environment with a low pH. This kills off harmful bacteria, which has a higher pH. There’s no better way to consume bifidobacteria and lactobacilli than to get them from food sources as well as food based micronutrients. However, due to stomach restriction after bariatric surgery, it is recommended to include probiotics into your daily nutrient supplementation regimen.

These are some of the best food sources for probiotics:

  • Live-Culture Yogurt: Check the label to make sure your yogurt contains live cultures, and avoid products that are heavily sweetened. Coconut yogurt is an excellent alternative for people who are sensitive to dairy;
  • Kefir: A fermented-milk product that has a more liquid texture than yogurt;
  • Kombucha Tea: A tart, fermented black tea;
  • Kimchi
    Kimchi
    Kimchi: Spicy, fermented vegetables that are Korean in origin. Kimchi is one of the best probiotic foods you can add to your diet;
  • Sauerkraut: Real, fermented sauerkraut fuels healthy gut bacteria and contains choline, a chemical needed for proper transmission of nerve impulses from the brain through the nervous system. You can make your own real sauerkraut at home or find it in the refrigerated section of grocery stores;
  • Pickles: The most basic and beloved probiotic. As with sauerkraut, choose real, brined pickles that have been refrigerated.

 

LOWER YOUR CARBS AND CHOOSE HIGH QUALITY FATS

Healthy Fats From Nuts & Seeds
Healthy Fats From Nuts & Seeds

A diet that keeps your blood sugar balanced keeps your gut bacteria balanced. A diet high in rich sources of fiber from whole vegetables and fruits feeds good gut bacteria and produces the right balance of short-chain fatty acids to keep the intestinal lining in check. A diet that’s intrinsically anti-inflammatory is good for the brain also.

Diets high in sugar and low in fiber fuel unwanted bacteria and increase the chances of intestinal permeability, a compromised immune system, and widespread inflammation. It’s a vicious cycle; all of these further disrupt our protective microbial balance. Choose fats from those naturally found in the protein foods, from butter and olive oil used to prepare the dish, and from nuts, seeds, avocado, and coconut.

CONSUME FOODS RICH IN PREBIOTICS

Prebiotics are food-borne fuel for the beneficial bacteria that live in the gut, and they occur naturally in raw garlic, cooked and raw onions, leeks, chicory, artichokes, and jicama. Estimates suggest that for every 100 grams of prebiotic carbohydrates we consume, a full 30 grams of good gut bacteria are produced.

Prebiotics have many additional benefits, including the ability to reduce inflammation in inflammatory-bowel disorders, enhance mineral absorption, and promote a sense of satiety. Animals given prebiotics produce less ghrelin, the hormone that signals the brain that it’s time to eat.

DRINK FILTERED WATER

No Chlorine
No Chlorine

Consuming plenty of water is important to intestinal health, but it’s critical that the water doesn’t contain gut-busting chemicals like chlorine. Environmental toxins can disrupt your microbiome footprint.

Use a household water filter. There are a variety of home water-treatment technologies available, from simple filtration pitchers to under-sink units with a separate spigot. Make sure the filter you buy removes chlorine as well as other contaminants, and be sure to maintain and change it regularly. Finally, ditch plastic water bottles and choose reusable bottles made from stainless steel or glass instead.

References:

Experience Life Magazine September 2015. David Perlmutter, MD

ASMBS Obesity

Week Conference 2016 New Orleans, LA

https://www.sciencedaily.com/releases/2009/07/090713114512.htm

http://www.the-scientist.com/?articles.view/articleNo/43681/title/Gut-Microbiome-After-Weight-Loss-Surgery/