To the weight loss surgery patient slider foods are the bane of good intentions and ignorance often causing dumping syndrome, weight loss plateaus, and eventually weight gain. Slider foods, to weight loss surgery patients, are soft simple processed carbohydrates of little or no nutritional value that slide right through the surgical stomach pouch without providing nutrition or satiation. The most innocent of slider foods are saltine crackers, often eaten with warm tea or other beverages, to soothe the stomach in illness or while recovering from surgery.
Understanding Slider Foods
The most commonly consumed slider foods include pretzels, crackers (saltines, graham, Ritz, etc.) filled cracker snacks such as Ritz Bits, popcorn, cheese snacks (Cheetos) or cheese crackers, tortilla chips with salsa, potato chips, sugar-free cookies, cakes, and candy. You will notice these slider foods are often salty and cause dry mouth so they must be ingested with liquid to be palatable. This is how they become slider foods. They are also, most often, void of nutritional value.
For weight loss surgery patients the process of digestion is different than those who have not undergone gastric surgery. When slider foods are consumed they go into the stomach pouch and exit directly into the jejunum where the simple carbohydrate slurry is quickly absorbed and stored by the body. There is little thermic effect in the digestion of simple carbohydrates like there is in the digestion of protein so little metabolic energy is expended. In most cases patients in the phase of weight loss who eat slider foods will experience a weight loss plateau and possibly the setback of weight gain. And sadly, they will begin to believe their surgical stomach pouch is not functioning properly because they never feel fullness or restriction like they experience when eating protein.
The very nature of the surgical gastric pouch is to cause feelings of tightness or restriction when one has eaten enough food. However, when soft simple carbohydrates are eaten this tightness or restriction does not result and one can continue to eat, unmeasured, copious amounts of non-nutritional food without ever feeling uncomfortable.
Many patients turn to slider foods for this very reason. They do not like the discomfort that results when the pouch is full from eating a measured portion of lean animal or dairy protein without liquids. Yet it is this very restriction that is the desired result of the surgery. The discomfort is intended to signal the cessation of eating. Remembering the "Protein First" rule is crucial to weight management with bariatric surgery.
Gastric bypass, gastric banding (lap-band) and gastric sleeve patients are instructed to follow a high protein diet to facilitate healing and promote weight loss. Bariatric centers advise what is commonly known among weight loss surgery patients as the "Four Rules" the most important of which is "Protein First." That means of all nutrients (protein, veggies, complex carbohydrates, then fat and alcohol) the patient is required to eat protein first.
Protein is not always the most comfortable food choice for weight loss surgery patients who feel restriction after eating a very small amount of food. However, for the surgical tool to work correctly a diet rich in protein and low in simple carbohydrate slider foods must be observed. The high protein diet must be followed even after healthy body weight has been achieved in order to maintain a healthy weight and avoid weight regain.
As some may know, I have been trying for WLS since August of 2005. Finally my time came and I was sleeved. I was a very active member on ObesityHelp until I found this site. Enjoy the info and videos...
The word bougie means "candle" in French. "F or FR/Fr" following a bougie size=French
Its just a guide that the surgeon uses to butt the stapler up against, when forming your VSG. The closer s/he gets to the guide the 'tighter' /truer to guide the sleeve is. During surgery the bougie is inserted into your mouth down your throat, towards the end of yer stomach where it meets the pylorus via an esophageal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, possibly why some VSGrs complain of a sore throat post op.
Some surgeons will use an endoscope or other "guide" to size ones new stomach. I read an OH post of a VSGr who's surgeon explained an endoscope is the same size as a 32F bougie...Im not sure.
Bougie size determination is between YOU and YOUR surgeon. Discuss size, rationale for size chosen, type bougie and technique used when sizing your new stomach........ PRE-OP!!
Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve.
In order for an "oversewn" staple line to affect stomach size it MUST be running or continuous oversewn suture line across majority of staple line not intermittent oversewn nor merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn" techniques (to prevent leaks) are done today. Make sure your surgeon explains what his/her "oversewn" technique is. Do not assume because a surgeon "oversews" you have a tighter than bougie sized sleeve.
A bougie is 1/3 mm PER french. i.e to calculate ~ inches 40F bougie 1/3 x 40 = 13.33mm convert to inches = ~.52 inches or ~1/2 inch in diameter.
Below are diameters of bougie/ "guides" in inches
32F = .40"
34F = .425"
36F = .45"
38F = .476"
40F = .5"
46F = .576"
60F = .75"
Video 1
This VSG surgery video shows a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc
.http://www.orlive.co...eight-loss-surg ery-gastric-sleeve
Red bougies are older mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury).
More surgeons will use SINGLE USE disposable sized bougies
Video 2
In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique
~9-2012
In another Forum, this member's bougie pix is from hospital she works at 1st: 36F, 2nd: 38F on left, 32F on right
General/ crude comparison chart created by another Forum member
Standard sized bougies in the US and Mexico are 32F. 32F is the smallest guide a bariatric surgeon in the US may safely use in forming your sleeve. Your surgeon may prefer any size bougie from 32-50F, based on YOU, your height, weight, or perhaps the need for a malabsorptive procedure in the future, inc. 1st step of 2 part DS. Discuss what to expect, rationale for size chosen with your surgeon if this is a concern.
LapSF/Dr. Criangle on their routine use of 32F bougies in VSG "Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .
Some surgeons will welcome discussion and your input on bougie sizes. After reading a published journal on the higher incidence of VSG surgically induced GERD (acid reflux/heartburn) in use of 28-32F bougies, it may be wise to request a higher bougie size. However, like all surgeries, we will need years of data to support whether or not this claim is actually true.
The History of using Bougies
In 2000 the use of 50-60F bougies were standard for VSG when it became a stand alone WLS, as they were the standard sizes of DS bougies, which VSG was modeled after. As the years went by, bariatric surgeons thought..smaller bougie, better restriction, less regain. So in ~2005 an adopted 32F bougie became the VSG standard. Rarely, if ever are 28-30F or 50F and over bougies used in the US for VSG as stand alone anymore. Many many VSGrs do EXTREMELY well with 40F-48F bougies as the guide to sizing their new stomach, losing all the weight they need to.
In 2008 study (small poll 135 pts) on Bougie Sizes in VSG seems to indicate at 6 mos and 12 mos post VSG .... 40F and 60F bougies with no significant difference in EWL (eventual weight loss) 2008 Bougie Size Comparison
In 2009 study (a large poll) on Bougie Sizes in VSG seems to indicate at 5 years post VSG ... 32F and 44F bougies show exactly the same EWL (eventual weight loss) 2009 Bougie Size Comparison
In 2012/13 study (a very large poll) on Bougie Sizes in VSG seems to indicate at 3 years post VSG, a LESS than 40F bougie and GREATER than 40F bougie show no difference whatsoever in EWL (excess weight loss) 2012/13 Bougie Size Comparisons
VOLUME/GASTRIC CAPACITY in VSG:
PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal
POST VSG (~6-8 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal
(depending on weight/density of foods you eat! can be much less or much more)
The length of an adult stomach is 10-12 inches. DNA affects the length of our stomachs, as well as variations in shape. Tall people, for instance are known to have longer stomachs..so makes sense they have a bit more capacity, short people have shorter stomachs therefore less capacity.... so volume/capacity can be influenced by the length and physical anatomical variations of an individual's stomach.
Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates
to volume.
This limited 2009 study is interesting in looking at gastric capacity in VSG,
just 3 days post op (120 ml=~1/2 cup) compared to 2 years post VSG (250 ml=~1 cup)
http://www.ncbi.nlm.nih.gov/pubmed/19533260
At the end (8:28 mark) of this LapSF VSG surgical video shows 1 DAY old (pod) sleeve Xray and a sleeve Xray at 4 years out. It is not clear to me if same pt. or solely to impress the new "normal" sleeve size. Note the "new normal" 32F tightly formed sleeve has dilated/stretched naturally to perhaps triple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks)
This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is 5 minutes or less due to space creating a reservoir for large volumes of fluids. In VSG stomachs: fluid empty rate looks MUCH faster than that... youdecide!
The COTTAGE CHEESE TEST /CCT (link following) may be helpful to VSGrs that are curious about their new stomachs capacity. It was developed for RNY but an effective tool in VSG as well! I'd suggest waiting until you are on a regular diet before checking. When doing this test PLEASE eat to sensation of satiety - no longer hungry, and absolutely not full.
A simpler method, following the basic guidelines and time frame in the link provided... is to place 1 level cup (8oz) of small curd cottage cheese in a bowl and eat from that. Using a measured tablespoon to eat any remaining cottage cheese from the original container. Add or subtract any cottage cheese eaten or not finished using the measured tablespoon. 2 TBS=1oz. Total...the amount consumed = your sleeve's capacity.
http://www.bsciresourcecenter.com/proddetail.php?prod=A4
STRETCHING in VSG:
YOU CANNOT STRETCH/DILATE out your sleeve to anything remotely close to its original size.
From LapSF/Dr. Criangle: The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food.
The fundus (inc. majority of stomachs 'body' up to pyloric canal) of the stomach is ALL but removed with VSG.
The fundus is the upper most part of the stomach's greater curvature. The fundus is:
1) the stomach's stretchy/expandable tissue, capable of expanding 2-3xs its resting 'unfilled' size
2) the pre-op 'mass quantities' of food, waiting to be digested, storage section
3) where 70% of the body's grehlin a "hunger hormone" is produced.
Stretching, due to overeating is most common in RNY because more of the stretchy fundus part of the stomach is retained to make the 'pouch', and is usually NOT covered by insurance to correct. Re-sleeving or a need for a malabsorptive surgery post VSG may or may NOT be covered by your insurance plan.
Anecdotally, Ive read from select OH VSG members, or according to a/their particular surgeon..overeating will cause your sleeve to stretch out. Ive read/found no scientific data, published or otherwise, to date that says this is a TRUE statement.
Since food stays in our stomach less than ~ 3 hours after a meal..common sense tells me food doesn't stay in our stomachs long enough to create 'stretching'. Food once ingested, immediately begins to be churned into a liquidy sludge called chyme through peristalsis in the stomach. This liquidy sludge must be small enough to pass through our very small pyloric valve and into the small intestine for further digestion /breakdown and absorption of 'micronutritents' ...so there cannot be enough pressure for long sustained periods of time in our stomachs to cause it to stretch.
Post op VSG ... depending upon the amount of swelling/inflammation you have..even a little 'thick/er' dense liquids or pureed foods/mushies may or may not feel restrictive, as you pass through the progression of texture dietary phases ( to promote healing) and onto your regular diet ~2mos post op. ... swelling/inflammation has naturally reduced. Density of meals becomes a key player in restriction. By 1 year out you'll find you can eat more than you could at 2 days post op, at 2 weeks post op, 2 months post op, and 6 months post op. Your sleeve has naturally and fully matured.
Depending on the food..you can eat more or less than the 8-12 oz capacity of a fully matured sleeve.......at any particular meal.
Toleration of a food, does NOT make it a good choice!
"just because I CAN...doesn't mean I DO"
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The bougie size controversy/wars are ridiculous imo.. 'get a smaller one, you can stretch it out, you're not going to have any restriction, that bigger one is all wrong, you'll re-gain easily years out, my surgeon made mine smaller and I got to goal in 6 months'
...all nonsense DO NOT PAY EM NO MIND!! This is YOUR story! YOUR journey!
ALWAYS REMEMBER THIS TRUTH:
YOUR WEIGHT HAS NOTHING TO DO WITH THE SIZE OF YOUR STOMACH, altered or not!
Most important is the quantity and quality of the food choices you ingest post-op
Have you experienced a stall in your weight loss? Has it been 2 weeks or more since the scale has moved? If so read on.
Chances are really good that IF you are following the Dr's guidelines you are most likely having small body adjustments and have lost size. Start by measuring your thighs, upper arm, forearm, neck, waist, hips, chest. I encourage everyone to do this twice a month. It a true stall is when all of your numbers, including the scale doesn't move. That is something you can show the Dr and NUT and you can work on figuring out how to solve the issue.
The scale can give discouraging (and misleading) numbers, but cover up the numbers with a piece of masking tape and put your goal weight on the tape. Only find out your true weight from your Dr. at check ups because that is the weight that is going to matter when it is jotted down in your record.
It is stressful enough trying to readjust to life post op and enjoy foods one at a time, why add more by constantly worrying about stalls?
In addition to measuring yourself I found out in my San Diego support group that many have experienced stalls/plateaus. Almost all of them swore by eating avocado with every meal for a week to break the plateau. View the .pdf file that explains a bit more about this and the science behind how this works.
Need to to mix up your protein shakes and try something different?
There is a clear liquid protein broth from Unjury called Chicken soup and it REALLY good.. BTW you can eat this one warm, and it taste EXACTLY like how you would want homemade chicken soup to taste.
If you like chocolate, try Syntrax's Nectar in Chocolate Truffle. With water it tastes like a YooHoo, with milk it tastes like a Wendy's milkshake.
I also have The Nectar in Vanilla Bean torte (23gm protein) and I mix it up with 2 oz of blueberry kefir and 4 oz of milk (9gm protein). Kefir is 99% lactose free and has just as much protein as milk.
If you like fruit juices try Unjury's Strawberry Sorbet. Mix it with water, lemonade, or milk and yogurt (strawberry cheesecake). I have made this one so many ways even into ice pops!
Of course all of these items are 0 carb and 0 fat too. Samples of the Nectar can be purchases at Vitamin Shoppe and Unjury through Unjury.com
Looking for sleeve & bypass recipes from someone who actually had it AND tastes YUMMY?… go here… http://theworldaccor...e.blogspot.com/
Just put some masking tape over the number part of the scale. On the tape write down your goal weight. Now EVERY time you step on you will ONLY see your goal weight and are forced to either wait until you see the Dr. or bend over and remove the tape (which you KNOW will be wrong)
