PollyEster

Required fuel (yes, I'm referring to the bariatric "c" word: carbs! 😂) for distance cycling and running: raw vegan superfood squares, loosely inspired by these two recipes.

Kindness and warm-hearted encouragement toward strangers is a rare and special gift. Thank you for your thoughtful words, and for sharing these beautiful images with me, Sophie; the honour is truly mine. It's always a joy to see a new post from you, and I very much appreciate the support and generosity you extend toward everyone here 😊 I also hear you on the ways covid-19 is truly wreaking havoc in society and in our lives, and on the difficulties it presents in terms of quality, structure, and function. There's only more uncertainty on the horizon, and in some ways, the longer it goes on, the more it feels like a pandemic of widespread social pain and discomfort... The current news out of Florida is extremely alarming, and I hope you and your family are staying safe in lockdown at home. From all of the activities you're planning and engaging in, you clearly have the adaptability and flexibility to remain creative and vibrant in every situation! I, too, have been using this time to develop new skills and build on existing ones, and am grateful for the opportunity to spend more time with my kids, exercise more, read and write more, paint more... and become more comfortable with being uncomfortable 😉 Please take great care. x

This excellent annual conference is available for free online for everyone this year because of the pandemic. Great opportunity to learn from experts in obesity and bariatric surgery, thanks to the Obesity Action Coalition. Online registration details are here. Event Details The Obesity Action Coalition (OAC) is excited to announce that our 2020 Your Weight Matters Convention & EXPO has been transformed to YWM2020 – VIRTUAL! Once again, YWM will be bringing together the most sought-after health and weight industry experts to present science-based information in an easy-to-understand format, designed to help attendees navigate the complex topic of weight management…. all easily at your fingertips in a VIRTUAL PLATFORM! YWM2020 – VIRTUAL is offered as a FREE virtual event series that is crafted with a one-of-a-kind program designed to help individuals seeking answers about their weight and health. This year’s virtual program will allow you to dive into the science behind weight, while learning key strategies and gaining access to valuable tools. If you’ve simply wanted the answers as to why weight can be such a struggle, then YWM2020 – VIRTUAL is an event you won’t want to miss! Events Program Agenda and Schedule Click here to view the full schedule. Event Dates Event 1: Saturday, July 11 1:00 pm – 3:00 pm EST/10:00 am – 12:00 pm PST Event 2: Saturday, July 18 1:00 pm – 3:00 pm EST/10:00 am – 12:00 pm PST Event 3: Saturday, July 25 and Sunday, July 26 1:00 pm – 4:00 pm EST/10:00 am – 1:00 pm PST

All of this ☝☝☝☝. It is SO helpful to hear about all of the experiences shared here, and be able to nod my head at every one of them. Thank you. I went to a bricks and mortar clothing shop this past weekend and discovered that size 4 pants are too big for me in the waist and hips (yet tight in the thighs). I'm finally clueing in that I'm actually going to end up in a size 2 or 0, which blows my mind on every level and is clearly going to take a loooooong time to sink in. Before I got fat (went from average weight to MO during a 2 year period), I wore a size 6 and thought I was practically obese 😂😂😭😭 Thinking back on that time, I remember seeing a photo of myself and asking, in all sincerity, "Who's that?" because I didn't perceive myself that way. It the same again now, but in reverse: I do not recognize my body as my own.

I appreciate and understand your concerns and frustration; thanks for sharing them. Across every area of medicine, there are many expert organizations and associations that develop clinical practice guidelines at the local, provincial, national and international level, and make them available to health care providers. Their primary purpose is to improve quality of care, increase quality of life, address clinical care gaps that exist (i.e. discrepancies between evidence-based knowledge and day-to-day clinical practice), reduce inappropriate variation in practice, promote efficient use of healthcare resources, identify gaps in knowledge, prioritize research activities, inform public policy, and support quality control activities including practice audits. They represent a summary of material and don't provide in-depth background clinical knowledge, which is covered comprehensively in medical textbooks and review articles. Guidelines are updated regularly and are not meant to provide a "single best" or "recipe driven" approach to patient care, where the clinician has no discretion. Every clinician understands this. Guidelines are meant to aid in decision making by providing recommendations that are informed by the best available evidence, but therapeutic decisions are made at the level of the relationship between the health care provider and the patient. That relationship, along with the importance of clinical judgement, can never be replaced by guideline recommendations. Evidence-based guidelines attempt to weigh the benefit and harm of various treatments, but patient preferences are not always included in clinical research and as a result, patient values and preferences must be incorporated into clinical decision making. For some clinical decisions, strong evidence is available to inform these decisions, and these are reflected in the recommendations within these guidelines. However, there are many clinical situations where strong evidence is not currently available, or may never become available due to feasibility issues. In those situations, the consensus of expert opinions, informed by whatever evidence is available, is provided to help guide clinical decisions that need to be made at the level of the individual. Final thoughts: I offer my sincere apologies to you, JRT Mom, for inadvertently hijacking this important topic. Self-perception and body image after WLS is such a critical area to explore and discuss. I wish I could move this to a separate thread. Again, I am sorry.

There are *many* evidence-based clinical bariatric surgical and nutrition guidelines available to health care professionals. They are updated regularly based on the quantity and quality of the best available scientific studies. I’m attaching just one example here: it’s the most recent (2019) guideline provided by the American Association of Clinical Endocrinologists, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologist (and endorsed by the American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, International Federation for the Surgery of Obesity and Metabolic Disorders, International Society for the Perioperative Care of the Obese Patient, and Obesity Action Coalition). In my experience at the intersection of biology and medicine, I've observed that eminence-based medicine tends to be the rule, not the exception. Medicine functions in the gulf between ideas/beliefs and science. Science is based on doubt. Medicine is a road built upon a foundation of good ideas and beliefs put into practice, but it is also a road literally paved with the cadavers of every good idea and belief that didn’t pan out. Even when they do pan out, they still need to be meticulously studied and regularly verified and updated to determine precisely how, why, and which patients benefit the most and the least. The results are not straightforward because bodies are not straightforward: there are incalculable external/environmental variables that are constantly in flux colliding with incalculable internal/genetic variables that are constantly in flux. I don't know any good scientist or clinician that wouldn't trade everything they know for everything they didn't know in a heartbeat. All researchers and practitioners, including bariatric clinicians, should ideally continually examine and assess their own results, making changes where and when necessary, to ensure they are delivering the best outcomes for their patients. Even though this inevitably leads to variations in form -- but not function -- it's just good medical practice. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures 2019 Update.pdf

Mmmmmm, pfeffernüsse 😋😋🤤🤤 Dinge, die ich an Deutschland vermisse... (Things I miss about Germany...).

You're welcome! My clinic -- and it's not alone in this -- also advises patients to be cautious about where and how time is spent on online bariatric forums. The main reason is that they are rife with false and inaccurate information, and BariatricPal is no exception. It's not as unbridled as Facebook, but it's still social media: brimming with opinions and beliefs and thoughts, not evidence-based science and medicine. Given the vulnerabilities many bariatric patients face in the immediate pre-op period -- but especially the hormonal, emotional, and interpersonal vulnerabilities that can arise during the post-op period -- and the numerous studies correlating the link between social media use and stress, anxiety, and depression, perhaps it would be wise to limit time on bariatric forums in order to mitigate the potential stress-cortisol-nutrition-weight connection.

I checked out the Alphafoods website and see that there's a spekulatius/lebkuchen flavour, omg 😋🤤 Hadn't thought of those spices as a protein powder flavouring before, but it's all I'm thinking about now! 😂 My favourites are pea protein isolate and brown rice from Canadian Pea Protein, the fermented vegan+ blend from Genuine Health, hemp protein from Prairie Naturals, and Amazing Grass products. I bought the unflavoured unsweetened protein powders so I could flavour and sweeten them to my liking, and also use them in baking, soups, etc. Maybe you could order Vega from their UK site? Very limited selection, though.

This looks absolutely wonderful! I can almost taste it 🤤. Slow-cooked beef carnitas was one of my favourite meals when I ate meat. I'm going to make a vegan variation this weekend. Thanks for the inspiration!

Thank you both so much, I really appreciate the compliment! Confession: I do sell photos (just not for a living) and also had a food blog for many years, so have taken a food pic or two before 😉. I haven't updated it for a number of years now, but let's just say that I never used tricks such as hairspray or glue to enhance anything: I cooked the food, styled it naturally, then ate it afterwards... now here I am on a bariatric forum, so we'll leave it at that 😂😂😂😂. I kept a few of the food styling props like dishes and bowls, and have a good camera, lenses, lights, reflectors, etc. Since I haven't been able to do photography outside of my home during the pandemic, I set a goal of taking a photo a day during this time just to keep up -- and hopefully improve -- my skills. Sometimes it's food, but usually it's not 😊.

In her essay, Gay described the decision to have bariatric surgery as "the last straw", clearly a pragmatic choice shaped by a lifetime of cultural and personal indignities and abuses. Her exquisite honesty is balm for a crude world, and a lesson in humanity. Attitudes and decisions about weight, body image, and health are profoundly personal, but burdened and fraught. Many people make the arrogant assumption that they have a vote in what obese strangers – particularly women – decide to do (or not do) with their bodies, something Gay herself doesn’t subscribe to. She's never condemned the choices of other women, advocates for (and fully embodies) having painfully honest conversations, and makes it abundantly clear that she has "nothing but empathy for anyone who decides on weight loss surgery... or not." Weight management, including bariatric surgery, is a complex, multifactorial decision, just as obesity is a complex, multifactorial disease. It should begin and end with respect for the individual, with the goal of improving health – nothing more, nothing less. It was the right decision for me at the right time in my life, but I fully identify with the ambivalence, the resentment, the resistance to surrendering, and the replacement of one set of anxieties with another – and this is without the unimaginable, colossal pressure of worrying about publicly betraying fat positivity.

Stomach Intestinal Pylorus-Sparing (SIPS) surgery has been around for about 8 years. It's a simplified DS procedure, and lots of bariatric surgeons perform it. Long term SIPS outcomes are similar to any other bariatric surgery.

You have difficult decisions to make and it’s completely understandable that you’re obsessing about all of it – how could you not? I, too, am a strong advocate of the “think a million times, cut once” philosophy. With regard to being a pioneer patient, from extensive research conducted prior to my own bariatric surgery, and as a medical scientist, please allow me to offer an assessment: no surgeon would select a ultra-low or even low-volume surgeon for him-/herself or his/her relatives for any surgery. The correlation between high volume and quality of surgical outcomes is empirically well documented, meaning that the outcome of every surgical procedure is directly dependent on the number of operations performed at a given hospital as well as by the designated surgeon. In other words, the higher the number of operations of a specific type a surgeon performs, the more likely optimum treatment results and low complication rates are achieved. This fact is supported by a large volume* of studies and meta-analyses that have been conducted, peer-reviewed, and published between 1979 and 2019. Because of comorbidities and lower cardiopulmonary reserve thresholds, bariatric patients are often high risk patients. In complex procedures like bariatric surgery – and particularly with riskier procedures such as RYGB, BPD/DS, and SIPS – it is worth paying extra attention to the correlation of procedure-specific skills of the surgeon and the complication rate. Since you’re several months away from surgery, I’d encourage you to keep researching extensively, and talk with as many people as possible who have recently had DS and VSG, and particularly those who are at least 5 years out from both surgeries. I hope that by the time you reach a final decision, you’re able to do so with clarity and a sense of ease. Wishing you all the very best! ****** *A small sampling of available data includes: 1. Zevin B, Aggarwal R, Grantcharov TP: Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 2012;256:60-67. 2. Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE: The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004;240:586-593; discussion 593-594. 3. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD; Michigan Bariatric Surgery Collaborative: Hospital complication rates with bariatric surgery in Michigan. JAMA 2010;304:435-442. 4. Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ; Michigan Bariatric Surgery Collaborative: Surgical skill and complication rates after bariatric surgery. N Engl J Med 2013;369:1434-1442. 5. Chowdhury MM, Dagash H, Pierro A: A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007;94:145-161. 6. Luft HS, Bunker JP, Enthoven AC: Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364-1369. 7. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FE, Batista I, Welch HG, Wennberg DE: Hospital volume and sugical mortality in the United States. N Engl J 2002;346:1128-1137. 8. Amato L, Colais P, Davoli M, Ferroni E, Fusco D, Minocci S, Moirano F, Sciatella P, Vecchi S, Ventura M, Perucci CA: Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data (Article in Italian). Epidemiol Prev 2013;37(suppl 2):1-100. 9. Pieper D, Mathes T, Neugebauer EAM, Eikermann M: State of evidence on the relationship between high-volume hospitals and outcomes in surgery: a systematic review of systematic reviews. J Am Coll Surg 2013;216:1015-1025. 10. Al-Sahaf M, Lim E: The association between surgical volume, survival and quality of care. J Thorac Dis 2015;7(suppl 2):152-155. 11. Maruthappu M, Duclos A, Lipsitz RS, Orgill D, Carty MJ: Surgical learning curves and operative efficiency: a cross-specialty observational study. BMJ Open 2015;5:e006679. 12. Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, Begg CB: Hospital and surgeon procedure volume as predictors of outcome following GI resection. Ann Surg 2002;236:583-592.

There are quite a few recipes to check out here; have tried a few and they were good, but of course they all involve protein powder since it's a protein powder company website. I overbought in preparation for surgery and still have quite a bit of pea, rice, soy, and hemp powders to use up, though. Currently am making this recipe using either unsweetened Ripple pea milk or a homemade nut mylk, stevia or monkfruit, and peanut or tiger nut flour instead of nut butter. Usually I toss in 15-30 gr of ground flaxseed as well. Sometimes I use toasted cocoa nibs in place of cocoa powder, or toss in some coconut manna. It is quite similar to the peanut butter chocolate No Cow bar, actually. If you wanted to dupe that, you could try adding a bit of glycerine to replicate the mouthfeel aspect. Please share the links or recipes of bars that you make and enjoy.

I began the WLS process 16 months ago at 292lbs. I lost 50 lbs during the 6 month wait for surgery by following a 1100 kcal/day whole-foods plant based lifestyle (which I'd already been following for over 6 years), and exercising at least 150 minutes per week (beginning with daily yoga and simply walking as far as I could each day, slowly working up to 10,000 steps/day and adding weight training, cycling, hill hiking, and indoor rowing). After surgery, I reached my goal weight in 7 months, and am continuing to lose rapidly without the slow-down that is commonly experienced at the 6 month mark. Currently, I have lost not only 100% of my EBW, but 58% of my entire body weight. I now expect to reach the weight I was in high school, 112-114 lbs, and to maintain long-term in the 115-120lb range. The rapid loss window after surgery is finite: only about 6 months. How much weight one loses in those 6 months is primarily determined by genes, but all gene expression is dependent upon environmental variables, so I did everything I possibly could to maximize loss during that time. For me that meant: protein first veggies second; eating only nutrient-dense whole, clean, plant-based foods (meaning no processed or packaged foods, no animal products, no nutrient-poor foods); staying hydrated; waiting 30 mins before and 45 mins after drinking to eat; consuming no more than 600-800 kcal/day; practicing portion control; being mindful while eating and chewing food extremely well before swallowing; no snacking or grazing or emotional eating; weighing and tracking all food; taking all of the required vitamin and mineral supplements; weighing myself daily; using a fitness tracker and logging all exercise; exercising upwards of 15 hours per week (because I really enjoy it; I never had to force myself); meditation; taking good care of my emotional and mental health, and sleeping 8 hours minimum per night. I still do every single one of these things, except now I eat more (not too much, but enough to healthfully support my activity levels) and exercise more (upwards of 25 hours per week training for eventual distance cycling and triathlon events, as well as many other sports including weight training and squash especially). Though it's all just my regular, everyday, normal life now, I'm still only 8.5 months out from surgery, so it’s all relatively effortless. I'm fully committed to doing all of these things for the rest of my life, however. I will *never* forget how disabled I was -- how limited I was, and how limited my life was -- because of morbid obesity. Edited to add: According to several bariatric experts that I've spoken with, the "honeymoon stage" basically ends when people resume some or all of their old habits: making poor food choices, eating too much, not exercising, and not following evidence-based best practices for long-term weight loss and maintenance (based on observing 5 and 10 year outcomes for hundreds of thousands of bariatric patients). Obesity is a disease and WLS is a treatment, not a cure. If you have heart disease and undergo a triple bypass but start eating burgers and fries again 6 months after surgery, you’re still going to die of heart disease because you’re not addressing the underlying cause of disease unless you change your diet and lifestyle. 50%-60% average weight loss after VSG is just that, an average. So if you don't want to end up with average results over either the short or long term, then definitely do not do what the average person does. Use the first year after surgery to entrench yourself in an entirely new way of eating and moving your body (including weight bearing exercises to build muscle), regularly examining what's working and what isn't, and adjusting or pivoting as needed over time to continue seeing the desired results.

Roxane Gay had VSG two and a half years ago, in January 2018. You can read about her decision (it is not one she arrived at easily) and her process here and here.

The amount, and speed, of weight loss in the first six months after bariatric surgery is mainly determined by genes, so one person's results are in no way predictive of anyone else's. There are gender-specific differences in weight loss that you'll also likely benefit from. Genetic expression, however, is dependent upon environment, so we can all help our DNA along after surgery -- and for the rest of our lives -- by following key evidence-based bariatric rules such as no liquids 30 mins before or after meals, staying hydrated, practicing portion control, mindful eating, protein first veggies second, chewing food extremely well before swallowing, not slipping back into old eating behaviours and food habits, reading labels if you eat packaged foodstuffs, getting in at least 150 minutes of moderate intensity aerobic physical activity per week, getting enough sleep, and taking all of the required vitamin and mineral supplements. Wishing you well with your surgery!

After bariatric surgery 👍👍👍👍: Before bariatric surgery 😂😂😂😂:

Yesterday was Canada Day. There were no public celebrations because of the pandemic, but we spent most of the day with friends who are part of our small social bubble. I brought a picnic-style lunch for everyone: vegan banh mi with oil-free cannellini bean miso mayo in coconut wraps, green salad with oil-free blueberry vinaigrette, and various flavours of smoothies. We ate grilled peaches with orange blossom water, pistachios, and tofu ricotta for dessert. Most of my friends are foodies, and a few are chefs. A vegan chef made dinner, so it was fairly spectacular: kale Caesar salad with roasted chickpea croutons, smashed roasted potatoes with garlic avocado aioli (I skipped this), and black bean, mushroom and walnut burgers with caramelized onions and roasted tomato chutney (sugarless) on raw dehydrated onion and mixed seed (pepitas, sunflower seeds, flax seed, psyllium husk) zero carb buns. Dinner was lovely, but I enjoyed not having to make it even more. We ended the day with homemade raw vegan coconut ice cream bars (sans caramel; I only had one bite). Whew! Even though I still can't -- and don't want to -- eat much, participating in a food-focused social gathering was exhausting. This formerly well-worn neural superhighway of mine has been "road closed / detour" since surgery, and will remain that way save for one or two days per year, at most.

Losing 202lbs is well and truly beyond phenomenal, so congratulations and well done on all of your hard work! That's a remarkable result! Refined bread, pasta, grains, and rice are simple carbs, not complex carbs (unless you are talking about less highly processed items such as Mestemacher bread, chickpea pasta, sprouted brown rice or wild rice, etc. which I doubt you’d be concerned about), and of course they are unhealthy foods that lack nutrition, cause rapid spikes in insulin levels and consequently fat storage, and have been proven in thousands of peer-reviewed scientific studies to cause both physical (neurochemical) and psychological cravings. These refined foods have been stripped of all fibre and nutrients and don't contain any phytonutrients. Only whole, unprocessed foods such as fruits and vegetables, legumes, nuts, tea, and some spices, contain phytonutrients. Ancient whole grains don't contain phytonutrients, but they do contain beneficial phytochemicals. If certain foods cause you to crave more simple carbs, why would you consider eating them again? Long ago you broke the cycle of carb addiction that keeps eaters of refined carbs and processed foods in the cycle of obesity, disease, feeling hungry soon after meals, and craving more refined carbs. Deciding not to eat something that that you know for a fact has never worked for you isn’t a sign of an unhealthy mindset, it's a sign of clear, insightful, empowered thinking and applied wise boundaries. You're right to be wary, since trying to control consumption of refined and highly palatable foods is generally about as successful over the long term as trying to control drug addiction without abstinence from drugs. WLS forums are full of people who have eventually regained all of most of their weight as a direct result of making poor food choices. Every single thing you put in your mouth is not only either making you more or less healthy, it is also influencing the next thing you put in your mouth by causing a cascade of complex responses along the gut/brain axis. There are plenty of ways to enjoy and embrace the health benefits of whole complex carbs such as vegetables, fruits, and ancient grains in your diet. By focusing on whole foods and complex, unrefined carbs, you'll naturally reduce your intake of sugar and processed carbs, keep your blood sugar stable, maintain a healthy weight, and still enjoy incredibly satisfying meals and treats. You’ll not only feel healthier and more energetic, you'll keep yourself out of the unrelenting refined carb addiction cycle so many post-surgery people struggle with. Trust your own self-knowledge, and embrace and cultivate your own insights into yourself. Brené Brown, among others, has some excellent thoughts in this regard.

During the first 5 months, it was a full-time job - and a chore - meeting those protein and water goals for me, too. The first 4.5 months, it generally took 12 to 14 hours per day - and sometimes 16 - to get it all down with those extremely tiny sips. Things improved slightly between months 4 to 5 in terms of volume: at some point I turned a bit of a corner, and it didn't take quite as long to get it all in. Looking back at my notes, I fell short on protein only 4 days during the first 5 months, but most days were such a struggle. As long as you're getting in anywhere from 46-75 for the average female (though a min. of 60 is best during the first 3 months when you're not able to eat much whole food), or 0.8g per kg of your ideal body weight, you'll be just fine. I found it encouraging that in 23 years of WLS, my program has never had a single patient that was protein deficient, even the ones who had severe, ongoing complications. If you Google around, you'll find loads of recipes that incorporate protein powder: pancakes, puddings, soups, bars, balls, oatmeal, etc. Unflavoured powders such as Nectar Medical can be added to virtually any food. One resource that I found especially helpful was the book "Protein Ninja: Power Through Your Day with 100 Recipes that Pack a Protein Punch" by Terry Hope Romero. Most of the recipes in the book incorporate protein powder. You will get through this 😊, even if it doesn't always feel like you will!

Welcome and congratulations on making such a smart decision about taking control of your health and well-being by having bariatric surgery! What's helpful and what's not in terms of prep (and on an ongoing basis) will depend on your personality type and how you prefer to learn, but what I've found to be most useful and beneficial is staying away from social media for the most part, and instead engaging in a great deal of on- and offline research. I read A LOT of scientific papers and studies prior to surgery (and still do), and was careful to seek out evidence-based information and data on types of surgery, outcomes, complications, expectations, etc. from scientists, obesity specialists, bariatric surgeons, bariatric dieticians, and other medical professionals working in the field. What a lot of quality, realistic thoughts and suggestions you're receiving in reply to your question here! I would add that for me, taking maximum advantage of the first 6 months -- and particularly the first 3 -- after surgery has been *crucial* to my overall loss and success. If you're not hungry after surgery, take full advantage by keeping your calories very low, because the honeymoon phase is finite. Begin entrenching good food habits right now (if you haven't already) and work to sustain the changes over the long term by cutting out processed foods, highly palatable foods, and sugar and instead focusing on eating healthy, whole, nutrient-dense foods once you've passed the fluid stage(s). Start an regular exercise program if you haven't already. Look for ways to keep increasing your NEAT (non-exercise activity thermogenesis) and act on them daily as your ability increases over time. Contact your bariatric team immediately with any concerns that may arise around potentially significant physical or psychological issues because social media absolutely cannot help with those. Wishing you all the very best with a successful surgery and recovery, and much ease as you pass through all of the bariatric stages and into your new life 😊 Highly-Palatable-Foods-slides.pdf

Food and liquid timing, pyloric sphincter function, and how it pertains to VSG function and GERD: The pyloric sphincter (PS) is located at the bottom of your stomach/sleeve, and connects the sleeve and duodenum. When open, this valve is roughly the diameter of a dime. When closed, it’s roughly the diameter of the tip of a ballpoint pen. In terms of VSG function, dense proteins and foods that take longer to digest (i.e. fibrous foods) cause the PS to close and hold food in the stomach for pre-digestion, allowing acids begin to break down these foods. This is why we’re instructed to eat protein first: to close the PS so that food stays in the sleeve longer, providing a sense of satiety. It takes ca. 30-60 minutes for food to clear the PS. This is also why we’re instructed not to drink liquids for 30-60 minutes after eating. Incidentally, "slider" foods do not close the PS: instead, these foods "slide" directly through the open PS into the duodenum. In terms of GERD, after you consume a protein-dense meal, the PS closes, holding the contents of the meal in the sleeve for pre-digestion. If you drink liquids within 30-60 minutes after a meal, the liquid has nowhere to go but up, where it hits the lower esophageal sphincter (LES), and above that, a flapper valve. The function of both of these valves is to prevent food, bile, and acids in the stomach from backing up into the esophagus. This is an exceptionally high pressure system, and is the reason why it hurts when you eat to much or too fast, or drink too soon, after eating when the PS is still closed. Vomiting and/or foamies is the only available pressure release. Even in a full-size stomach, the addition of liquids to food speeds gastric emptying by roughly 15%-20%, and some studies indicate that the transit time is anywhere between 25%-35% after VSG. *It’s also interesting to note that after VSG, simple carbs passing through the PS are less liquified due to fewer digestive enzymes being available than with a complete stomach, which is also what causes dumping and reactive hypoglycemia. These unhealthy simple sugars pass directly through the pylorus, causing pancreatic enzymes to flood the bowels in order to be able to digest them. The pancreas then reacts by “dumping” large amounts of insulin into the common bile duct, causing a massive reduction in sugar absorption and feelings of weakness and other diabetic symptoms. It’s very similar to dumping syndrome in RNY patients.