Is keto right for me?

ketosteakSo many bariatric patients are asking if the keto diet is the proper diet for them. Note that I am not a nutritionist or a doctor. I am not an expert. For me, the keto diet does not work. I honestly feel that it’s a fad and, as bariatric patients, we should concentrate on eating the healthiest, best food possible since we’re so limited. Having said that, there are many good things about keto that you can apply to a bariatric life. If you want to do keto, I’m not here to judge or stop you. I want you to educate yourself further and be informed. I would also suggest that you don’t follow the normal keto diet, but one that has been adapted specifically for bariatric patients.

So, what is a keto diet? 

A keto, or ketogenic diet, is basically a low-carb, moderate protein and high fat diet that is supposed to put your body into ketosis.

What is ketosis? 

Ketosis occurs when you’re body is using fat as energy (ketones) and not carbs. Your liver will create ketones instead. Acetoacetate is the most common ketone. It’s created from the breakdown of fatty acids. Acetoacetate is then broken down into BHB or Acetone. The Acetone can account for the bad breath and smelly waste during your beginning phase of the keto diet.

 What can you eat on a keto diet? 

You are encouraged to eat low-carb foods like:

  • Meat
  • Fish
  • Eggs
  • Greens like kale, arugula, swiss chard, etc.
  • and Broccoli.

You can also eat high-fat foods like:

  • Avocado
  • Sour  Cream
  • Olive Oil,
  • and  Marrow.

What about water?

You should drink plenty of water (between 40 – 68 oz a day at least) especially when you are in the early stages of ketosis. Alcohol and soda, including diet, is not encouraged, which should be fine for most bariatric patients. We’re not supposed to have carbonation. It can stretch the stomach. Some coffees and teas are okay, but sweeteners are not.

Now, bariatric keto plans are even more restrictive. You generally have to limit your calories to around 1,000 per day. You should get your 60 – 75g of protein and avoid really high-fat foods so you don’t dump. If you do decide to follow the keto plan, please get some assistance from a bariatric keto professional or support group.

Don’t attempt to go it alone.

 

 

 

 

Why Do I Need to Follow a Post-Surgery Progression Diet?

I was just going to tag this part into the bottom of my Post-Surgery Progression Diet page, but I decided to give it its own post. Why? Well, I determined that it’s necessary for you to understand why you need to do the diet.

Some people are so ready to eat food before their stomach is ready. The post-surgery progression diet is in place to give your stomach the time it needs to heal. Sometimes it can take up to six months for your stomach to heal properly.

Remember, sleeve surgery removes about 70% of your stomach. It’s a major surgery, folks. It’s not a little thing that just happens. You are re-creating your anatomy and you need to give your body time to heal.

The stomach needs a break from food. That’s why the liquid phase is so important. I know I hear many people in bariatric support groups complain about being really hungry during this time, but it’s mind hunger. You can fight it. You can overcome it and you should really consider doing so.

Your body is no joke. Your stomach is healing from major trauma. Be gentle with it. The plan is not in place to test or upset you. The plan is there to help you heal and be ready for real food. It’s only a few short weeks that you’re on the post-surgery progression diet so, be patient.

Good things do come to those who wait.

I even advise people to stay on liquid as long as they can, but I’m not your doctor or a medical professional. I found liquid to be very helpful in my own healing process. So long as you get in your protein with protein shakes and protein water (available from Protein20 on Amazon.com. Try the grape and mixed berry.) and your water, you will be fine.

Good luck and happy healing.

Post-Surgery Progession Diet

Now, every surgeon’s office is different. Your surgeon’s office may give you different instructions than I was given. Remember, I am not a medical professional. I am a life coach who is trying to provide you with information. Take the information as provided. It is meant to educate you on the processes surrounding the sleeve surgery.

Now, most surgeons will provide you with a progression diet. This is to help your stomach heal. There are several phases to the post-surgery progression diet. They are:

  • Liquids
  • Pureed
  • Soft
  • Regular

How long you stay on a given level of the progression is up to your doctor. Mine was a five-week plan with two weeks set aside for liquids. We were told that after ten days, if you wanted to go on pureed foods to contact the practice’s nutritionist to get approval from him directly. I personally waited until my two-week checkup with my surgeon to ask if I could go liquid.

It’s really up to you and how ready you are. Some people get sick of liquids. I personally was not and was wanting to ensure my stomach was healing properly. It’s an individual choice and remember, your surgeon may tell you differently than I am. When in doubt, always follow your surgeon’s advice.

Okay, so here goes.

LIQUIDS

For the first two days after surgery, stick to clear liquids only. Basically, whatever you ‘ate’ the day or two before surgery is what you’ll stick with the day or two after. You will be tired and groggy and not really hungry, so it’s not usually a big issue. Clear liquids include:

  • Popsicles,
  • Jell-O,
  • Coffee,
  • Tea,
  • Juice,
  • Broth,
  • And Water.

On days, 3-7, you can add in full liquids with your clear liquids. These include your protein shakes with milk as well as:

  • Cream soups (make sure they’re blended),
  • Milk
  • And V-8.

You are shooting for between 40-64 oz. of liquids per day. At this point, all liquids count equally. As for supplements, we were encouraged to start our sublingual B-12 on Day 4 and nothing else at this point. How your surgeon handles supplementation is something you need to address with him or her.  Follow their guidelines. They are there for a reason.

PUREED

On the third week, we were allowed to go to pureed foods. It was a happy time for me. I was excited to eat pureed food and ready. These included:

  • Apple Sauce,
  • Mashed Potatoes,
  • Yogurt,
  • Sugar-free pudding,
  • Baby foods
  • And anything else that was blended to a pureed consistency.

I really enjoyed mashed potatoes in chicken broth at this point. I thought it was the best thing ever. I was also told to add in 1 multi-vitamin per day, preferably a chewable. I personally crushed the Bariatric Advantage multivitamin with my meds and had to use two because it was requested if I used that brand, to do two by my surgeon. I had to crush mine for all five of the post op weeks. Not sure if that’s common or because I’m bipolar and on so many different medications.  Again, check with your surgeon if you have questions.

You must remember at this point, that you cannot have liquids with meals. You need to wait at least half an hour after eating to have a liquid. I was told I could drink up to five minutes before a meal and I learned the hard way that I need to wait a full hour before I can drink after. It’s all a big learning process. Be curious as to how your body reacts to different triggers and events.

SOFT FOODS

Oh I could not wait for this point. I was in heaven eating refried beans and guacamole. Week 4 was soft foods and my mind if not my body was ready for them. I noticed some regurgitation at this point because I was so hungry I was eating too fast. Make sure you consistently chew 30 times per bite. I forgot to do that. You also want to make your meal last about half an hour. Stop between bites. Don’t sip anything.

Some of the foods I could eat at this point were:

  • Canned fruit,
  • Baked potato,
  • Fish,
  • Soft cheese,
  • Scrambled eggs,
  • Canned veggies,
  • And refried beans.

At this time, I was to add to my daily supplement list a Calcium chew. I use Bariatric Advantage Caramel Calcium Chews daily. Women will eventually need to add another calcium supplement to their day. I added a second one during the regular foods phase. I still use it to this day.

REGULAR

Regular food means good, healthy nutritional food. My surgeon likes to see us eat:

  • Fresh fruit,
  • Fresh vegetables
  • And meat.

We are also encouraged to eat certain complex carbohydrates like quinoa.  At this point, I was raring to go. I was ready for regular food and I eat like this to this day. Unfortunately, I have some weird side effects. I can’t eat animal protein so I supplement with protein water and shakes still even though my surgeon prefers ‘real food’. He and my nutritionist understand my challenges.

Now, I want you to remember that this is according to my bariatric surgeon, Dr. Steven Fass. He is located at Southwest Bariatrics in Austin, TX. Your surgeon may have a different plan in mind. That’s fine. Follow your surgeon’s office and ask a nutritionist if you need further tweaking or advice.

As a bariatric life coach, I can offer you support through the process, an ear to listen and a heart to hold your joys and sorrows. I am here for you. Feel free to call me at 512-484-7634. I work with people all over the country.

What do I focus on first – protein or hydration?

This question  stumps a lot of newbies. After surgery, you are given a post op progression diet in most cases. You basically go from liquid to pureed to soft then to regular foods. These “diets” differ among surgeons and some require you to be on the program longer than others.

We will discuss a sample post op progression diet in a later post.

Basically, people wonder if they should try to get in their protein or their liquid first. Personally, I was told that it’s the hydration you need to worry about first. It’s the most immediate need and most helpful for your body to recover.

Remember, when you were put under, you were inflated with air and you will have gas as a result of the surgery healing process. Gas is not pleasant and the water seems to help it get moving and your bowels too.

So, if you are having trouble navigating whether to get your 60 – 75 grams of protein in a day or your 40 – 64 fluid ounces of liquid, do the liquid first. Don’t try to manage everything it once. It wil come in time.

So, hydration first, then protein. The best way to get your priorities in order is to know what they are. If you have questions or your surgeon’s office deals with this issue differently, please check with them. This is what I know to be true from my own expereience and that of my friends in the bariatric community.

 

How Much Weight Will I Lose?

People are always making the mistake of comparing their weight loss journey to other people’s. I can tell you that every journey, like every person, is different. Some people naturally lose weight faster than others. It’s true.

How much weight can I expect to lose after bariatric surgery?

Weight loss varies per person. About 10 lbs. a month is reasonable to assume. Probably more at the beginning, especially during the post-op progression diet, which takes about four weeks. You go from liquids to solids progressively and it’s an interesting time for your body and your life. Your stomach is healing and so is your mind.

Give it time and don’t give up. Work the program and try to exercise as soon as you’re cleared by your surgeon to do activity.

Why am I losing less weight than so and so? 

First of all, stop comparing yourself to so and so. If you must know, there are a variety of factors why weight loss is different for different people. This person may be eating less or exercising more. They may crave different foods than you do. You don’t know their journey and they don’t know yours. As long as you are moving in a downward direction, don’t worry, okay? Personally, I have lost 135 lbs in about 11 months. Some people have lost more weight; some have lost less.

I am happy  with my results. I like how I look and better yet, how I feel. I no longer need knee surgery and am so much more mobile than before.

Look at your non-scale victories. 

Some questions to ask when you’re getting discouraged include:

  • Have I gained muscle?
  • Do my clothes fit better?
  • Can I do things I wasn’t able to do when I was bigger?
  • What is my pant, shoe, shirt, etc. size? How is it different than before?

Remember that pounds lost is just one indicator of success and it’s not always the most accurate. I lost 1.5 shoe sizes so far. I didn’t even think feet lost weight. Now, that’s cool.

Will I Be Hungry After Surgery?

I personally did not experience any physical hunger for the first week after surgery. At points in time, I can go a week or even two without feeling physically hungry. However, you need to learn to distinguish the difference between physical and emotional hunger.

What is physical hunger? 

Physical hunger is when you are actually hungry. You feel stomach pains and you want food like now. There’s a definite difference between physical and emotional hunger. Everyone’s different and experiences physical hunger differently. A good thing to try before surgery is to go about 3-4 hours between meals. You should start to feel, real physical hunger pains at about hour 3. If you wait too long, you can get too hungry and then you may binge.

What happens if I wait too long to eat?

You want to eat until just before satisfied to avoid overeating or bingeing. With a bariatric stomach, bingeing could be very painful and potentially destructive. Of course, this will take practice. If you feel overstuffed and uncomfortable after eating, you ate too much and were listening to your mind, not your body. Your mind plays terrible tricks on you regarding hunger. However, if you do this, don’t beat yourself up about it. Get back on plan immediately. Don’t wait until tomorrow or Monday. Let it go and do what you’ve got to do.

What is mind hunger?

Mind hunger can mimic physical hunger, but it is very different. You should think about how you’re feeling when you are mind hungry. Are you lonely? Angry? Bored? Tired? Some people eat when they are stressed or depressed. They may even eat when they are happy. Our society literally mind fucks us when it comes to hunger. “Big food” makes money when we are hungry and they always want us to be hungry.

How to know the difference between mind hunger and physical hunger? 

Well, I’ve already discussed it a little bit. The difference is physical symptoms like stomach pains and a mild headache. That’s real hunger. That’s also a sign that you got too hungry. You want to try and shoot for eating every 2-3 hours. Have a small snack, less then 3 oz. of  food. Some bariatric surgeons and nutritionists will disagree with me, but I find snacking more to help me keep both types of hunger at bay.

When you are mind hungry, you crave foods that are not as nutritionally sound. Processed, or junk, foods spring to mind. Mind hunger is harder to identify and beat, but it can be done. With the surgery as your tool, you can defeat mind hunger and learn to control it. You can keep it at bay. It takes practice, know-how and an understanding of hor your new stomach works.

So, will I ever be hungry again? 

Even though the removal of 70% of your stomach does impact hunger hormones and you will be hungry less often, yes, you will still feel hungry sometimes. It’s okay. Being hungry is not the end of the world. You can and will learn to control how you respond to it.

Be patient with yourself. Begin learning about the difference between mind hunger and physical hunger pre-surgery so that you can distinguish the two after much better. It will serve you well.

Question? Need support? I will be running support groups beginning in the Spring of 2019. Feel free to contact me for more information.

 

 

Can I Eat This?

pizzaI see this question asked in online bariatric support groups all the damn time. It kind of makes me mad. The truth is that there are certain food rules you may want to consider following as a bariatric patient. There are some foods that like us back better than others.

In general, you want to:

  • Eat small meals (3 oz. or less),
  • Steer clear of simple carbohydrates. Complex carbs like quinoa are encouraged and part of a healthy diet plan.
  • Stick to healthy, unprocessed foods whenever you can.
  • Get in your protein…between 60 – 75 grams of it each day.
  • Stay hydrated by drinking 64 oz of fluid or more daily.

I don’t believe that there are any ‘bad’ foods or even ‘good’ foods for that matter. Food is an inanimate object and well, we shouldn’t think of it in positive or negative terms. It just is fuel for our bodies. We should strive to fuel our bodies with the best possible fuel. That means that you should eat lean protein and fresh produce as much as you can.

Of course, you will probably need to add in protein water or a protein shake to make your protein goal every day. I use Vega Protein, it’s a plant-based protein powder. I have to drink mine with soy milk because other milks cause dumping for me. TMI,  I know.

Truthfully, if you want to eat pizza, or Oreo cookies or a candy bar, do it. There’s room in a healthy diet for it. You don’t have to ask permission of people in a support group who don’t know you and may judge you for it. You are a grown up and can eat whatever you like.

Act like it. Do it and deal with the consequences. You may not lose as much weight as other people do or as quickly, but you shouldn’t be comparing yourself to them anyway. You may also be happier in the long run. I, myself, follow an 80/20 approach as suggested by my nutritionist. I eat well 80% of the time and allow myself to slip up or eat something I’m craving that’s not as nutritionally sound about 20% of the time.

I have learned to listen to my body and give it what it wants. Personally, I’m a big advocate of eating whatever you want when you want it. The body knows what it needs. My cravings have changed too, as a result of the surgery. I honestly crave things like avocado, seeds and other protein sources. I don’t like sugary foods and gluten is not my friend.

You may find that pizza no longer appeals to you. Yup, it’s true. It’s very freeing but also a bit unusual. Good luck, eat what you want and stop worrying about what other people think. You do you. As a coach, I do not judge your food choices and encourage you not to either. If you do ‘slip up’, do NOT beat yourself up over it. It does not serve you.

Call me today at 512-484-7634 for more information on working with me. I can help you help yourself on this process.

5 Steps to Follow Pre-Surgery

Pre-surgery, you are probably pretty excited, and maybe a bit scared. Bariatric surgery is no joke. I have had two bariatric surgeries, a lap band in 2010 (removal 2013) and a sleeve in June of 2017. Each time, I struggled with nerves and anxiety throughout the process. I can honestly say that the second time was easier.

Why? I had some knowledge of the process and was more prepared mentally. However, the sleeve surgery was more permanent and more invasive. I found myself preparing for the worst but hoping for the best.

During the pre-surgery period, I used that time to begin to get acclimated to the bariatric life. I suggest you do the same.

What did I do?

  1. I cut out soda and all carbonated drinks. This was hard. I was addicted to soda for many years. I would try to get off it, only to return to the sweet stuff a few months later. I knew that a sleeved stomach couldn’t really handle soda so I quit. I did make the switch from regular soda to sugar free for a bit, but found I did not like the taste of sugar-free enough to stay with it for a while. I was also addicted to sparkling mineral water, particularly Topo Chico. I decided the best thing to do was switch to regular water and Diet Green Tea. I made the transition about six months pre-op and it was one of the better things I did for myself. This helped me significantly during the pre-surgery diet that my insurance plan wanted me to be on.
  2. I followed the pre-surgery diet. I just mentioned this briefly. My plan did not require me to lose weight, but it didn’t want me to gain. During the 3-month period where I worked with my personal nutritionist, I gained in the middle month. I was frightened that I would not be allowed to have the surgery. That final month, I buckled down. I ate smaller meals and exercised more. I only lost about 8 lbs. during that three month period but was so proud of that that I did a happy dance (or waddle) in the nutritionist’s office. Losing weight was damn near difficult for me, hence the main reason for my surgery.
  3. I kept my eyes on the prize. I went through every insurance hoop imaginable. They were pretty significant. I see some people complain about these ‘hoops’, but I realized that they were there to protect me and help make sure that the bariatric lifestyle was one that I wanted to and could follow. I went to all of my pre-op appointments. I saw a cardiologist and had a stress test to make sure my heart was healthy enough for surgery. I did a sleep study for my sleep apnea. I hate sleep studies, but I did it. I saw a psychologist to be mentally evaluated. As a bipolar woman with a history of bulimia, this caused me some stress, but I made it out okay. I also went faithfully to my nutritionist. I asked a lot of questions of all my professionals along the way to become better educated about the bariatric lifestyle and what it would mean to me.
  4. My friend bought me tiny plates and silverware. So that I could take smaller bites and eat less, my friend, Sarah, who had the surgery before I did, gave me some plates and silverware to use. It was baby silverware and very cute. I still use it to this day. I can’t imagine eating without it and when I go to a restaurant, I am shocked and in awe of how big the silverware and plates are. I feel like I’m Alice in Wonderland in a way. I am so grateful to have had a friend who went through the surgery before I did. She even recommended my sleeve surgeon to me.
  5. I didn’t give up. There were times when the process seemed ridiculous and unfair to me. I can honestly say it was. However, I did not give up and I did what was asked of me. I was a good patient and I followed instructions. I wanted this surgery and I prepared mentally, physically and emotionally for it with the help of my nutritionist, therapist and life coach. I knew the going would get tough, but I was tougher.

If I can do it, so can you. You can have a successful pre-surgery period. Take the time to get your mind right and you will be even more successful post-surgery. I was after the sleeve. It was much easier than life after the lap band for me. My attitude played a big role in my pre and post-surgery life. I find that the better your attitude and the more willing you are to do what needs to be done, the more likely you are to keep the weight off. Yes, many bariatric patients do regain at least some, if not all, of their weight. I am not concerned about that in my case. I know I’ve done the work and food is just food to me. I no longer have a relationship with it.

You can do it and I can help you get there just like my professionals got me there. Contact me today for a free consultation.

Is Bariatric Surgery Worth It?

questionmarkThis is not an easy question to answer. I can only answer it from a personal perspective. Please note that I am not a medical professional and this article does NOT serve as a substitute for medical advice. I am a life coach who specializes in working with bariatric patients at all levels of the spectrum. As a life coach, I do not give my opinions or advice. It’s not the way things work.

I believe you have the answers within you. I help you bring them out by listening intently and intuitively and by asking you specific questions that are designed to help you find clarity. If I were working with a patient who wanted to know if surgery was right for them, I would ask the following questions. I will answer them as myself, from my own experience.

What is causing you to feel the need for surgery?

I am sensing the need for surgery because I need to lose a lot of weight quickly. I have a bad knee and need to have knee replacement surgery. My orthopedist, nutritionist and primary care doctor think my best option going forward is to have the Sleeve. I can lose a lot of weight quickly, but I am concerned about malabsorption issues and the fact that I had such difficulty with the lap band. This is not reversible.

How do you think we can address those concerns?

Well, I honestly think that I need to weigh the pros and cons. I met with the surgeon and we discussed malabsorption. He said it was less of a problem with the sleeve than the RNY. So, I opted for the sleeve. It’s going to be a process and I will be going to my nutritional counselor. I have prepared mentally and do not feel the emotional attachment to food as I did when I had the lap band. I am in a different place and it’s a different surgery. I also need my knee. I can’t get down to a 40 BMI on my own. I’ve been trying for four years and I’ve only put on weight despite my best efforts. I weigh 387 and do not want to get to over 400 again.

Great! So you are already doing this on your own. Can you speak a little bit as to why you feel discomfort surrounding the surgery?

I’m concerned about money. Insurance only covers so much. We may need to pay thousands out of pocket. I know we can manage it, but it’s still quite the expense. I don’t know how I feel about making a permanent change to my anatomy. It seems so final and it can’t be undone so if I have complications then I will have to deal with them.

Yes, but you’ve dealt with more difficult things in the past and came out okay. Right?

Yes, I have, but this is just something I didn’t want to have to do. Now, I feel I need to do it.

Well, it sounds like you’ve come to a decision. Do you feel complete at this time about it?

Yes, I do. I feel much better and ready to handle this head on.

Conclusion

Now, the conversation we would have would go a bit differently because you would probably have different reasons and issues. I simplified this for you. Just know that any decisions made in a life coaching session are yours. They are not mine. I help you determine what’s right for you. I provide you support and encouragement. I hold the space for you.

I will have you know that my life coach and therapist helped me work through my concerns. I also spoke to the surgeon – I came armed with written-down questions. If I have one bit of advice, it’s to do your research but not be so broad in scope. The internet is full of horror stories that are just not going to serve you. Stick to the facts and embrace your fears. Almost a year out from surgery, I am down 130 lbs. and I don’t even need the knee surgery anymore.

Is bariatric surgery worth it? For me, it has been a lifesaver. For you, it may be something different. Contact me today and we can figure it out — together.

Bariatric Rules to Live By

Rules_fromss

The bariatric life is not easy. Some people think it’s a quick fix or an easy way out but I am here to tell you that it’s not. You put in the work. You do the effort. Don’t let anyone tell you anything else. I have lost almost 140 lbs. and counting. I am serious when I say to you that I did that. I know I did. It’s my accomplishment. No one can take it away from me. I won’t let them. If you work with me, I will teach you the same too. You can overcome emotional overeating. You can succeed as a bariatric patient. You can do anything you set your mind to. You can become a bariatric badass like I am.

It’s within your power, you just have to believe.

Bariatric Rules

Okay, I’m going to be honest. I struggled with these, but you don’t have to. I’d suggest if you are still in the pre-op stage, to begin practicing now. Now, I will begin by letting you know that not every doc is the same. Rules vary among surgeon groups so I’d suggest you check with your doctor, but these bariatric rules seem pretty standards, so here goes.

  1. Eat small meals. Your stomach is small. Remember that. You can’t overfill it or you will get sick. You should probably stick to about 2-3 oz. per meal.
  2. Go slow. Your meals should take about half an hour to consume. Try to use small utensils so you take small bites. Be sure to chew each bite about 30 times so that it’s a bit of paste or liquid-y as it goes down. This can be hard to learn and I learned the hard way. You can easily throw up if you don’t follow this bariatric rule.
  3. Drink at least 64 oz. of fluid every day. More if you can. This will keep you hydrated.
  4. Make sure you get between 60 – 75 grams of protein a day. This is important to prevent muscle loss. You should also include some weight-bearing exercises as well to tone and keep extra skin to a minimum. This can be a hard goal for me to reach personally because I cannot eat meat. My surgeon told me that about 20% of his patients have the same problem. I am the most reluctant vegetarian ever, but I gotta do what I gotta do. I have found some good veggie burgers and plant-based protein supplements. I also drink at least one full protein shake made with soymilk every day.
  5. Do not drink soda or anything carbonated. It will stretch the stomach and impede weight loss.
  6. Please try to avoid drinking from a straw. Why? It causes air to build up in your esophagus and stomach which can lead to painful gas and stomach stretching.

Conclusion

Bariatric rules, like all other rules are there for a reason. Again, your surgeon’s office may differ from mine. I have found that these work for me and I have worked hard to make it so. I really hope that you can work on following the bariatric rules too. They will give you the opportunity to live the best bariatric life you can.

For more information, please feel free to call me for a free consultation today. I can be reached at 512-484-7634. If you are motivated to change, I am happy to work with you.