PollyEster

Tacos with roasted onions and butternut squash, smoky black beans, cinnamon-cayenne spiced walnuts, fresh-cut salsa, red cabbage, cilantro, lime cashew cream, and handmade corn tortillas. One for me, and the rest of a huge batch for others.

Great that you’re thinking about riding again! I’m a long-time cyclist. I distance cycled before I was MO, casually cycled while I was MO, and went back to distance cycling again after WLS. You can definitely cycle when you’re overweight – loads of overweight people do – but something to be aware of is that knee pain is the most common lower body injury in cyclists, even in those who aren’t overweight. Excess weight (any excess weight, but particularly excess weight around the abdomen) causes you to apply significant force when pedaling, which considerably increases stress on the knees. I had knee problems when I was MO, but still managed to casually cycle without causing too much extra knee pain or permanent damage. I enjoyed it more, and therefore spent more time riding, by being aware of a few important things: Buy a bike from a professional bike shop, since they will be able to assess and measure your anatomy and match that up with a bike that’s exactly right for your body (bicycle fit is *everything*, and is crucial to minimizing riding injuries). Cycling position: Keeping the hip angle open by sitting upright, with the handlebars positioned closer to you on a shorter stem, is the best way to alleviate pressure on your belly, spine, and knees while riding. Flexibility and limberness: before and after every ride, warm up/cool down and stretch to help reduce risk of injury and make your rides more comfortable. Good example of warm up at https://www.bobs-bikes.com/articles/stretching-before-you-ride-pg910.htm. Good example of cool down at https://www.trekchicago.com/articles/stretching-after-you-ride-pg331.htm Distance: keep your rides on the shorter side, and try to avoid hills as much as possible until you’re better conditioned to riding. Intensity: keep the intensity low, staying on flat terrain as much as possible. Cycling on windy days will increase the intensity at which you ride. Saddle: it’s already challenging enough to ride when overweight, so don’t add to this with saddle sores. Even a brief ride with the wrong seat can cause long-lasting pain deep under the skin. Buy a good saddle, and use an anti-chafing product if needed. Clothes: 100% cotton workout clothes fill with sweat and become heavy, don’t effectively cool, and cause chafing. Buy a good pair of cycling pants or shorts and a top, and wash them with soap and hot water after every ride. There’s an informative article on knee issues and cycling here http://www.cptips.com/knee2.htm (reprinted for free; the original is from The Physician and Sports Medicine Journal and can be found at https://www.tandfonline.com/doi/abs/10.3810/psm.2004.04.201). Make whatever modifications you need to make your bike fit your style and personality, and the ride as comfortable as possible. You’ll thank yourself every time you’re on it, and ride more often by doing so. You might even come to crave riding 😃 I hope you enjoy your time on the bike!

Coping with Stress During COVID-19: What Bariatric Patients Need to Know May 1, 2020 by Harold Bays, MD, FOMA, and Lydia C. Alexander, MD, FOMA Dr. Bays is Medical Director and President of the Louisville Metabolic and Atherosclerosis Research Center in Louisville, Kentucky. Dr. Alexander practices obesity medicine at Kaiser Permanente Medical Weight Management Group in San Francisco, California. Funding: No funding was provided. Disclosures: Harold Bays, MD, FOMA is Trustee, Chief Science Officer, and Lydia C. Alexander, MD, FOMA, is Secretary/Treasurer for the Obesity Medicine Association. During this most unique of times, as frontline healthcare workers and hospital staff, we frequently face difficulties when treating patients threatened by a rapidly increasing pandemic. This is made even more difficult with the stress of limited essential medical supplies. Among all the turmoil and disruption, the emergence of COVID-19 has created special challenges for patients with obesity. Many patients with obesity have impaired immunity, impaired lung function, sleep apnea, and hypoxia, making a virulent upper respiratory tract infection especially perilous. Added to this are obesity-related debilitation, immobility, orthopedic changes, polypharmacy, more limited access to medical/preventive care, and adiposopathic complications of diabetes mellitus, and cardiovascular disease.1 Collectively, patients with obesity are more susceptible to COVID-19 disease and have worse outcomes once infection occurs. For many bariatric patients, the rise of the novel coronavirus has created additional challenges, such as the effect of mental stress on their lives. Increased mental stress can worsen complications from obesity, such as hyperglycemia, high blood pressure, dyslipidemia, and might also worsen obesity itself. The good news is that if clinicians are attuned to the physical impacts of mental stress, then proactive measures can be taken to mitigate the potential adverse consequences of mental stress. Acute Stress, Chronic Stress and COVID-19 Acute, or short-term, stress is a function of the natural “fight or flight” response. One of the systems activated by the stress response is the sympathetic nervous system, which increases production of hormones epinephrine and norepinephrine. The acute stress response can be beneficial—it can increase visual acuity, decrease pain, increase blood flow, and boost the immune system. This complex sequence of hormonal changes and physiological responses helps people when they need to fight or flee to safety. Conversely, chronic, or long-term “submit and stay” stress has the potential to worsen health outcomes. Chronic stress can increase cortisol production, which might promote visceral fat accumulation.2,3 Symptomatically, chronic stress can cause decreased cognitive ability, diminished healthful decision-making, and more pronounced pain. Physiologically, chronic stress can impair immune function, impair sleep patterns and increase blood sugar, high blood pressure, and body weight.4 The Toll of Chronic Stress on Patients with Obesity During COVID-19 Stress and anxiety are understandable during the COVID-19 situation. We are living in a time of an unprecedented global pandemic crisis. Doom and gloom are everywhere. Good news is rarely reported. Stress is to be expected. However, clinicians can assist patients with proactive stress management techniques, especially for people living with obesity. Many patients are staying home to keep themselves and others safe and limit the spread of the novel coronavirus. Other patients are staying home because of governmental mandates. But while “distancing” from others could have potential benefits in preventing viral spread, staying home might result in less healthful nutrition and reduced physical activity. As we navigate the unparalleled COVID-19 crisis, it is critical that clinicians, including bariatric surgeons, counsel patients to recognize the signs of mental stress, as well as its potential negative impact to health. This would include increased blood sugar, high blood pressure, increased body weight, and challenges fighting viral respiratory infections. Bariatric patients should receive specific and actionable guidance on safely optimizing nutrition and physical activity during periods of shelter-in-place orders.5 Coping with Stress During COVID-19 As we await a cure or vaccine for the novel coronavirus, one of the most important measures clinicians can take in the interim is to address potential mental stress head-on, as one of the first topics of discussion during patient encounters (e.g., via telemedicine or otherwise). When appropriate, clinicians can then recommend patient-centered stress management techniques that might prove helpful. Here are some ways to get started: Feel your feelings. While it might seem intuitively obvious, many patients might not truly recognize the degree by which mental stress is altering their behavior, lives, and overall health or might be avoiding addressing feelings of sadness or loss of previous routines and lifestyle. This should be a prime topic to discuss during any patient encounter. Patients should be educated to become in touch with their feelings and recognize how those feelings might be affecting their behavior. Negative or unproductive feelings and the potential adverse effect on behavior cannot be resolved until it is first acknowledged. Take it one moment at a time. At this time, no one knows how or when the COVID-19 crisis will end. It is likely nothing will ever go back to “normal.” This might be a daunting notion to patients with obesity, who might already have a sense of hopelessness. Thus, instead of focusing on the seemingly unending days of isolation ahead, patients should be encouraged to focus on manageable, demonstrable, and accountable healthful measures that can be accomplished today. Behavior changes that are doable, accountable, and sustainable represent the mainstays of a behavior modification plan. Perform a food inventory. It is common that patients with increased mental stress resort to “comfort food,” which is often energy dense and highly processed. Temptation to consume these foods is increased if these nutrition-deficient foods are in the location where people live. Thus, patients might best be advised to perform an inventory on the nutritional quality of food where they live. When ordering food or grocery delivery, patients should virtually shop when they are not hungry or exceptionally stressed. Having friends or family review the list might also be helpful for some to ensure healthy foods are chosen. Stay physically active. When shelter-in-place regulations prevent leaving the house, patients can be advised to look for novel ways to keep moving. Pacing while on the phone, putting the laundry away one item at a time, listening to music and dancing, and taking a lap around the house or backyard are all ways to remain physically active while sheltering in place. Passive stress relievers, such as surfing the internet, watching television, and playing video games might seem like an ideal way to pass the time. But these do not contribute much to energy expenditure and might worsen anxiety. Too much time spent with passive screen activities can have a negative impact on health. It is a good idea for clinicians to specifically talk to their patients with obesity about limiting screen time. Stick to routines and care plans. Now is not the time for patients to fall out of previous healthful routines and self-care that was either promoting health, or helping with health maintenance. Patients should be encouraged to think beyond COVID-19. They should avoid having these few months negate years of potential progress that were so hard to achieve. Patients should especially be advised to monitor their sleep patterns. Poor sleep can contribute to worsening metabolic disease, cardiovascular disease, and obesity. Closer clinician contact with bariatric patients at this time is critical to identifying early maladaptive behaviors and routines and ensure continued long-term success Practice active stress reduction. Patients should be encouraged to explore activities, such as walks (where permissible), puzzles, books, yoga, meditation, and other hobbies. Maintaining social connection via phone and video calls while physically distancing can be an important method of stress reduction. These pastimes can have a soothing effect during this stressful time. Look for the helpers. Fred Rogers said it best, “Look for the helpers. You will always find people who are helping.” During times of crisis, finding a way to join the helpers can be gratifying not just for the one being helped, but also the one doing the helping. Participating in community efforts to improve the lives of those affected by the COVID-19 crisis can have a relieving impact for everyone. Maintain social connectivity. While the recommended jargon of “social distancing” is prevalent, perhaps the implication of this approach is not what was intended. Perhaps a better term is “physical distancing.” Remaining socially distant is not always the best plan, especially for patients with obesity who are already stressed and who might already feel isolated. For many patients, it might be best to recommend to seek and maintain social connection via a simple phone call, or FaceTime, Zoom, Google Hangouts, or any of the myriad digital communication solutions available. As clinicians continue to look for ways to help their patients during these stressful and uncertain times, bariatric surgeons can empower patients via implementing simple techniques, such as the ones described here. The Obesity Medicine Association (OMA) offers a trove of resources for clinicians and health care professionals, including continuing medical education, American Board of Obesity Medicine (ABOM) exam preparation, Obesity Treatment Proficiency Badges™, and The Obesity Algorithm®, which offers comprehensive clinical guidance on the latest obesity management trends and evidence-based medical approaches to treatment.6–8 To become an OMA member, visit: https://obesitymedicine.org/join/. For more obesity medicine resources, visit: www.obesitymedicine.org. References Scott KA, Melhorn SJ, Sakai RR. Effects of chronic social stress on obesity. Curr Obes Rep. 2012;1(1):16–25. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression and type-2 diabetes mellitus. Ann N Y Acad Sci. 2017;1391(1):20–34. Kyrou I, Tsigos C. Chronic stress, obesity and gonadal function. Hormones (Athens). 2008;7(4):287–293. Yaribeygi H, Panahi Y, Sahraei H, et al. The impact of stress on body function: a review. EXCLI J. 2017;16:1057–1072. Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of metabolic syndrome: a systematic review of cohort studies. Endocr Connect. 2014;3(2):R55–80 Obesity Medicine Association. https://obesitymedicine.org/badges/. Accessed March 24, 2020. Obesity Medicine Association. https://obesitymedicine.org/. Accessed March 24, 2020. Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm/. Accessed March 24, 2020

I experienced food aversion for the first 3 months after surgery. Physical hunger was completely absent until the 5 1/2 to 6 month mark. At nearly 7 months out, the beginnings of a physical hunger-like sensation are occasionally present but so far it's unlike the sensation experienced prior to WLS (less tenacious, not persistent, dull or muted as opposed to pressing). I don’t really experience much emotional hunger because I spent thousands of hours working on addressing and managing that well in advance of being sleeved. Feeling physical hungry is healthy and desirable, and it will return—and so it should. The good news is that there's no correlation between physical hunger and habit development: you can create new neural pathways and develop new habits whether or not you’re feeling hungry. There's not enough information in your post to know exactly why you’re asking this question, but if you're asking because you're an emotional eater, the best thing you could ever do for your future post-surgery self is to begin examining that and altering your behaviours as far in advance of surgery as possible. And I'm not talking about during the 7 or 14 day pre-op diet. Start embracing making completely different foods choices by cutting out processed foods and fast food, instead focusing on high quality vegetables, fruits, beans, pulses and legumes, healthy fats such as nuts and seeds, tofu, tempeh, and sustainably caught wild seafood/clean antibiotic and hormone-free meats and eggs in moderation. During the first 6-7 months after surgery, you are not driving the loss and will lose the same amount of weight no matter what you do. There are many who don’t appear to comprehend this and resume eating the way they used to once they're able to tolerate more food at roughly the 6 month mark. All you need to do is look around this or any other WLS forum to see that this never ends well. It's extremely common for post-ops to not reach their goal weight, or regain some or all of the weight back. Even those who work at maintenance can gain weight back, just like anyone who's never needed WLS gains weight if they don’t follow a healthful eating plan and don’t exercise. It's not hunger that drives this, it's a failure to make the correct nutritional choices every day for the rest of their lives. So if you already know you're typically hungry for love, calmness, stability, reassurance, attention, or some sense that no matter what, everything will be alright, address it prior to surgery. Invest in a therapist if you need one and start working with them now. To be successful with WLS long-term, you will need to learn how to give these things to yourself without food.

Being in quarantine with so many other people doesn't just sound tough, it sounds difficult to the power of 12! I hope that with so many other things to deal with right now, you’ll lend yourself some compassion and not deplete yourself psychologically over a bit of up and down with weight. Most people generally adapt well over time to life-changing and stressful situations, and you will, too. You already have the fortitude to want to deal with this head-on, are finding creative ways to carve out alone time, are getting in a lot of steps each day, and probably a bunch of other things you haven’t even mentioned here. Earlier today I posted an article from the latest issue of Bariatric Times magazine; hopefully there'll be something in there that might prove useful for you? One thing that is helping me is developing some realistic goals and doing something regularly — even if it seems like a small accomplishment — that enables me to move toward the things I want to accomplish, such as continuing to lose weight. Instead of focusing on tasks that seem unachievable, each morning I ask myself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?" For example, I've set up an eating schedule for myself and I only eat at the designated times (breakfast, lunch, snack, dinner). If it's not time to eat, I don’t eat, end of story, so I never have to wonder about whether I'm eating out of stress, boredom, craving, or hunger — all I have to do is look at the clock, and if it's time to eat, then I eat. The lockdown is demanding and challenging, but it is temporary and absolutely does not have to determine the outcome of our WLS for this year. The outcome is entirely up to us.

Ditto on both counts for me as well, even though I am about to run out of TP and still can't find any in my city. Since you work in the healthcare profession, I expect that either directly or indirectly, you've been deeply affected by covid-19. I'm a biologist with a secure job and career, but also a long-time volunteer in the field of end of life care. The nature of my volunteer work hasn't changed lately, but the volume of patients we’re seeing and the environment in which we’re caring for them has been meaningfully altered. The pandemic does not allow the luxury of time with my patients and their relatives. News is broken quickly, visitors and families are largely absent, faces are obscured by masks and visors, and more people are dying alone. The atmosphere in hospitals and hospices is taking an emotional toll on us all. Perhaps you’re experiencing something similar at work, as well. I'm grateful that my WLS surgery is in the rear-view mirror (or I’d be worrying about access to enough fresh foods, since pre-op I ate 3lbs of raw veg and fruit daily), but still not too far away, as I remain relatively uninterested in food (cooking and food science used to take up a lot of my free time and without a doubt I'd be doing way too much cooking and eating right now if I hadn't had surgery). I still have to work hard to adhere to a strict eating and exercise schedule, but I'm at ease with that and view this is a beneficial intensive training period that will serve me well over the long-term. Like you, I embrace this as an opportunity to learn more about myself and others. One of the few consolations of the coronavirus is the possibility that it could (eventually) lead to some progressive economic and political changes. I find it (somewhat) helpful to frequently remind myself that none of what we are experiencing right now is permanent. Please take care, and stay as safe as you possibly can.

That's just marketing, for the most part. You're very welcome, and I'm genuinely thrilled for you, AZhiker. To my way of thinking, it doesn’t matter a whit what people look like after WLS; the only issues of consequence are physical and mental health, lowered risk of disease and premature death, weight maintenance, vitality, energy, and overall well-being. Following a WFPB diet for several years prior to WLS, I was able to lose over 50lbs on several occasions, and almost 100lbs once, but of course was unable to maintain those losses. For a morbidly obese person, a WFPB diet, like any dieting in an of itself, leads to weight gain, stress + increased cortisol levels, slowed metabolism + having to eat ever less food in order to lose weight, bouts of overeating (the common mammalian response to starvation), and eventual regression back to your set point. Until scientists find the elusive reset button for body weight (if there even is one), WLS is the best bet for obese/MO people. As an aside, I have several overweight (but decidedly not obese or MO) friends and family members who were inspired by the dramatic changes I experienced after going WFPB, and decided to give it a try themselves. Every one of them lost the weight, and those who remained WFPB (all but two) have maintained their losses to this day.

Exactly this ☝☝☝☝ In the modern food environment, simply not getting fat requires some degree of knowledge, effort, and awareness on the part of most people. Studies indicate that a relatively small percentage of the population* who are getting adequate nutrition are genetically inclined toward being underweight (defined as having a BMI below 18.5). And even when the genetic dice are loaded in their favour, many of them have to work to combat the social and environmental factors that contribute to overweight and obesity, such as the prevalence of highly processed but calorie-dense and nutritionally void foodstuffs, fast food, socioeconomic status, etc. * Roughly 4.8% of men and 6.7% of women worldwide, based on a study conducted from 1975 to 2014 with data from 186 countries, representing over 99 percent of the world's population.

Morbid obesity is a life sentence without surgical intervention. Despite endless debate about the relative value of different approaches — in every scientific head-to-head comparison, diet plans that provide the same exercise and calories through different types of food lead to similar weight loss and regain within similar timeframes. The science could not be clearer: there is no diet that overrides the basic complex biological reality of obesity. Bariatric surgery is currently the only way to permanently alter your genetics, reset your defended weight or set point, lower your metabolism, and alter the pathways and production of brain and gut hormones such as PPY, GLP-1, CRF, CCK, NPY, leptin, ghrelin, dopamine, cortisol, etc. *Edited to add that I regret squandering several years of optimal health and well-being by attempting overcome biology and evolution with a WFPB diet, instead of just having WLS. Good on you for not doing that! WLS got you to where you are now, and WFPB will keep you there for life.

I started my preop diet on 5 May 2019 and tend to think of this date as my anniversary, rather than my actual surgery date of 15 Oct 2019. Since May 2019 I've lost about 140lbs; 90lbs of this was after being sleeved. I lead a very busy, very active life and my goal weight is within sight, but it's more important to me to be fit, strong, and healthy, which I now am. Before becoming MO, I was a competitive athlete, and am again able to participate in sports and fitness the way I used to. There have been dozens of NSV's, and I'm grateful for every one of them. My focus continues to be on the psychological adjustments and actions required to permanently change my habits and behaviors. Since the coronavirus lockdown, I've continued to strictly follow an eating and exercise schedule so that I remain on track. With so much uncertainty at this time, what I put in my mouth and do with my body are one of the few things within my control right now. Congrats and well done to all my fellow Oct sleevers.

The strategy that works for me is following an eating schedule (breakfast 8am, lunch 12pm, snack 3pm, dinner 6pm). With an eating schedule in place, any time I think about eating (is this boredom? is this a craving? is this hunger?) there's no need to make a decision about whether or not to eat. Having to ask these questions throughout the day is tedious and leaves too much room for error. When I follow an eating schedule, every time I think about eating, I just look at the clock. If it’s time to eat, I eat. If it’s not time to eat, I don’t eat. Period. I never have to worry about figuring out whether it’s hunger, or a craving, or boredom. It simply doesn’t matter why I might want to eat. Following the schedule places restrictions on when I can eat, which is incredibly liberating because it frees me from ever having to make any food decisions. If I ever feel like eating at an unscheduled time, I just remind myself that my next meal or snack isn’t far away, and I find something else to do until that time.

So far I seem able to tolerate all types - red, yellow, brown, green, Puy, black/beluga, and macachiados. Are you able to tolerate other types besides red? Overcooking can sometimes help with the digestibility of the brown/green lentils, so while they might not work for you in, say, a salad, dal might be just fine. One thing I've learned through trial and error is not to salt beans during cooking: it makes them cook faster, but it also makes them tougher in texture so they may not have the same digestibility that slow soaking and cooking afford. Another thing I've noticed that using the freshest beans/legumes possible makes a difference. Older ones take longer to cook or don’t completely soften up, and often shed their skins during cooking. Sprouted beans/legumes are also easier for some to digest (plus, it's kind of fun), so you could also give that a try. I try to sprout most nuts, seeds, beans, legumes, and grains before eating. https://draxe.com/nutrition/sprout/

I know this is a horrific time for so many people, and I grieve for them. But in most every other way, I'm personally enjoying this time tremendously, actually. I appreciate not being immersed in the turmoil of daily life, and finally having time to pursue many of the intellectual pursuits and interests that are meaningful to me but that I never could find the time to engage in. This is the sabbatical I’ve longed to have. I'm healthy and fit. I have an extremely active life of the mind, am skilled with being in relative solitude, am emotionally pretty experienced with managing change and disruption, and deeply fortunate about not having to be fearful about my career. Each day I learn more about myself, the needs of others, and do what I can from home, as well as delivering groceries each week for several family friends who are seniors. When I'm part of the world again, there will be additional opportunities to be a better friend and citizen. Prior to the lockdown I was training for a sprint triathlon and have continued to even though it was obviously cancelled, so am doing 10-12km per day of walk/run intervals, cycling 40km per week, and swimming 2km daily. I still do twice weekly weight training and 20km per week of indoor rowing or solo outdoor hill hiking, and am trying to do yoga a few times a week. Occasionally I throw in stretching, core exercises, or an online or dvd exercise class just to mix it up a bit. In terms of diet, I'm still not particularly interested in food per se, though I really enjoy preparing food and looking at it/eating it. My rate of weight loss hasn’t slowed, so the average loss of 12-14lbs per month seems to be continuing and likely will as long as I stay the course with current diet and exercise levels. For those who have lost a loved one, or their job or income, it's impossible to relax and enjoy the free time. A sustaining hope for me is that a more equitable and humane society might emerge from this struggle. A guaranteed national income here at home so that everyone has food and shelter, additional wealth taxes, a greener economy, and stronger national public service (and for Americans, universal health care for every citizen). All of these are things that many have long dismissed as panacea, and I hope they now seem more like pragmatic necessities. It gives me a sense of optimism to imagine society getting through this together, and to people working together to be an active part of an emerging, improved new reality.

In my experience it depends on the kitchen tool and vessel used, not the sweetener, water, coffee, or proportions (to a certain extent as long as no more than a few tbsp water is used in total). I always got a super fluffy, aerated, dense-but-light foam using a high-powered blender (Vitamix) or high-powered stick blender (Kitchen Aid) in a tall narrow container. For sweetener, stevia, Truvia, honey, sucanat, and unsweetened Torani syrups all worked perfectly well, as would any other sweetener. I had equal success using just water and instant coffee, as well as with water at any temperature (or just Torani syrup instead of water). I made my own nut mylks, and if anyone's into doing that I recommend hazelnut mylk especially since it's so absolutely rich, creamy, and decadent. Once I'm in maintenance, I know I'll be enjoying this drink again...

Absolutely not monotonous! Just healthy, delicious, filling, substantial, beautiful, colourful gorgeousness. I've been eating like this everyday for years, and it never gets old. Just wanting to pass along a few favourite cookbook recommendations, in case you ever need inspiration or do get bored, though. Show Up for Salad: 100 More Recipes for Salads, Dressings, and All the Fixin's You Don't Have to Be Vegan to Love by Terry Hope Romero Salad Samurai: 100 Cutting-Edge, Ultra-Hearty, Easy-to-Make Salads You Don't Have to Be Vegan to Love by Terry Hope Romero The Modern Salad by Elizabeth Howes Food52 Mighty Salads: 60 New Ways to Turn Salad into Dinner by Food52 Williams-Sonoma Salad of the Day by Gorgeanne Brennan Saladish: A Crunchier, Grainier, Herbier, Heartier, Tastier Way with Vegetables by Ilene Rosen Ruffage: A Practical Guide to Vegetables by Abra Berens Salad for Dinner: Complete Meals for All Seasons by Jeanne Kelley Mandy's Gourmet Salads: Recipes for Lettuce and Life by Mandy Wolfe

Beans contain three types of oligosaccharides: stachyose, raffinose, and verbascose. These are natural food sugars that humans can’t digest because we don’t produce the enzyme (alpha-galactosidase) required to break them down. Once beans reach the colon, our resident bacterium begin fermenting these indigestible prebiotic sugars, fuelling the growth of beneficial microbes to amplify immunity and help prevent allergies, type 2 diabetes, inflammatory bowel disorders, certain cancers, heart disease, and obesity – all worse than having a bit of gas! There are a number things you can do to reduce gas or bloating, such as: Cook your own instead of buying canned. Soak dried beans in plain water for 12 -16 hours or overnight to reduce the amount of gas-producing sugars. Soaking twice (draining and refilling with fresh water) will further reduce the oligosaccharides. Even if you use an Instant Pot to cook beans, always soak them first. After soaking, always rinse beans well in a colander under running water, then use fresh water to cook the beans (water plants with the soaking/rinsing water so that it doesn’t go to waste). Quadruple-rinse canned beans in a colander under running water to remove oligosaccharides and sodium in the liquid. Add a large piece of kombu seaweed to the pot/Instant Pot of beans and water before bringing to a boil, discarding it after the beans are done. Regularly skimming off the foam during boiling also helps to reduce oligosaccharides. If you’re just starting out on a plant-based diet, begin with small servings (1/4 cup or less) to prevent your gut microbes going into fermentation overdrive. Eating beans daily builds up the population of gut bacteria that can digest oligosaccharides. As the community of bacteria in your gut adapts to oligosaccharides, you’ll produce less gas (several studies indicate that gas returns to normal after one to three weeks of eating beans four or more times per week; here’s one of them: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228670/) Chew extra thoroughly, like you had to in the first several months after surgery! Chewing food stimulates your salivary glands to release amylase, an enzyme which begins breaking down carbohydrates. Chewing food well helps limit gas production in the intestine, and eating slowly also prevents you from swallowing excess air. A bunch of gas-producing ingredients in one meal can cause excessive gas, so if you’re making a dish with beans, onions, and garlic, adjust the recipe as needed. Besides beans, brassicas, asparagus, celery, mushrooms, green peas, garlic, and onions all cause intestinal gas. Not all types of beans increase gas equally, so try different types of beans until you find the ones that work best for you (lentils and black-eyed peas are lowest in oligosaccharides, while chickpeas and navy beans are highest. Coronavirus lockdown is an ideal time to experiment with beans and discover which ones will work best once you’re back at work.

I was WFPB for years before being sleeved, am still WFPB, and will remain WFPB for the rest of my life. For me, a WFPB diet has been as instrumental in improving my health and well-being as having WLS: before going plant-based, I had extremely high CRP, cholesterol, and triglyceride levels, was pre-diabetic, had severe IBS and allergies, was exhausted all the time and had zero energy, and was depressed. Within a few months of going plant-based every single one of these health issues reversed, I got off statins, I lost weight, my sleep improved, and I felt fantastic and had more energy than I had in years. Since being sleeved, my labs are perfect, I have enjoyed an astonishing rate of weight loss, have even *more* energy than before, and continue to enjoy even lower CRP, cholesterol, triglyceride, and glucose levels. It's highly unusual for WFPB eaters to experience GI issues after transitioning. Fibre is present in all unprocessed plant foods in high amounts. Fibre what makes up the structure of the plant, and the more of it you eat, the more you access all of its benefits. While you may have more gas than usual during the first few weeks if you don’t prepare your beans properly (by pre-soaking, rinsing well before cooking, and either pressure-cooking or boiling with added kombu until fully cooked to break down the sugars that cause flatulence), eating a plant-based diet improves the health of your gut so you are better able to absorb the nutrients from food that support your immune system and reduce inflammation. The increased fibre lowers cholesterol and stabilizes blood sugar, and it’s the best medicine for optimal bowel management. In fact, many people who had IBS prior to going plant-based find that they no longer have IBS, myself included. You could go cold turkey, or start out by eliminating meats while cutting back on dairy. There are no specific foods to either focus on or avoid, other than incorporating more of the flavours and textures you like most into your diet each day. In addition to plenty of fresh fruits and veggies each day, incorporate a wide variety of beans, lentils, legumes, pulses, seeds, and nuts, as well as seitan, tofu, tempeh, nutritional yeast, whole grains and sprouted whole grains (buckwheat, teff, amaranth, quinoa, farro, spelt, etc.), wild rice, hemp hearts, chia seeds, spirulina, nut butters and nut milks (homemade when possible), spices, herbs and other natural flavourings, minimal added oils, green smoothies, etc. Supplement with faux meats once in awhile for variety and pleasure, always checking the ingredient list and trying to consume the least highly processed varieties (i.e. soy curls). You do NOT have to worry that you won't get enough protein or enough of the "right" kinds of it: protein "combining" was never medically or scientifically legitimate and was discredited almost as soon as it first appeared over 50 years ago (for a very brief overview see https://en.wikipedia.org/wiki/Protein_combining). In my opinion, WFPB eating really is the anti-diet: you can eat a lot of delicious food, never feel hungry, never gain weight, and enjoy remarkable physical and mental health benefits. More important than opinion and personal experience, however, is evidence-based nutrition. A few good places to start learning include: The Physicians Committee for Responsible Medicine: https://www.pcrm.org/news/exam-room-podcast/vegan-after-weight-loss-surgery and 21 Day Vegan Kickstart https://kickstart.pcrm.org/en Dr. Garth Davis (bariatric surgeon): http://proteinaholic.com/lifestyle-first-and-always/ and http://proteinaholic.com/ Dr. Matthew Weiner(bariatric surgeon): https://www.youtube.com/user/DrMatthewWeiner and https://www.poundofcureweightloss.com/ Plant Trainers: https://www.planttrainers.com/eating-plant-based-after-weight-loss-surgery-ptp082/ And: If you’re neither a reader nor inclined toward research, it would definitely be worthwhile to invest in an online visit or three with a WFPB bariatric nutritionist to fine-tune your new diet to meet your individual health needs and taste preferences. Another option, though not inexpensive, is the online plant-based nutrition course from the T. Colin Campbell Center for Nutrition Studies at Cornell. It's a superb resource for anyone, especially those new to a WFPB lifestyle.

I didn’t have a liquid pre-op diet due to following an extremely healthful and nutritious plant-based whole foods diet (meaning fresh veg, fruit, nuts, seeds, beans, tofu, tempeh, and no processed foods or animal foods whatsoever) for a number of years prior to surgery. In the 6 months prior to surgery, I cut back to 900-1000 kcal/day (under the care of the clinic dietician) and lost 52lbs before surgery. If I hadn’t been eating this healthfully, I would have opted for the liquid diet since it offers a number of benefits: 1) decreased liver size, 2) weight loss, 3) improved blood sugar, 4) a clean stomach and intestinal tract decreases chances of surgical complications, 5) physical and psychological adaptation: if you are eating processed foods, unhealthy carbs, sweets, sodas, junk food, etc. then you are feeding an addiction, but your brain will stop craving these foodstuffs within several days of eliminating them from your diet so that you can focus entirely on meeting your post-surgical water and protein needs instead of on struggling with withdrawal 6) after surgery you will continue the liquid diet for 2-6 weeks (depending on your program), and being adjusted to the liquid diet before surgery will teach you how to eat after surgery, and 7) ca. 25%-30% of bariatric patients regain some or all of the weight, and getting the earliest possible start on self-control around food and eating is a strength in terms of the mental awareness required to make a commitment to a permanent lifestyle change and lifelong weight maintenance.

Plant protein is just as ‘complete” as animal protein. The idea that plant proteins are “incomplete”, necessitating some sort of “protein combining”, was based on a 1971 fad diet called “Diet for a Small Planet” by Francis Lappe. “Protein combining” was debunked DECADES ago, yet for some people this myth remains pervasive despite 49 years of medical and scientific nutrition evidence to the contrary. All of the essential amino acids humans need are structurally identical regardless of the source, so in terms of getting enough protein, it doesn’t matter if amino acids come from animal or plant protein. But protein isn’t consumed in isolation, since all plant and animal foods contain essential nutrients in addition to protein. And the other nutrients that you’re consuming – or not, depending on whether you eat animal or plant protein – is where the serious health implications lie. Plant protein is packed with fibre, antioxidants, and thousands of protective phytonutrients. Animal protein has absolutely no fibre, antioxidants, or phytonutrients whatsoever. Plant proteins contain no saturated fat and cholesterol. All animal foods (including “lean” meats like chicken, salmon, turkey, etc.) contain saturated fat and cholesterol. We don’t need to consume any saturated fat and cholesterol, since our bodies naturally produce all the cholesterol required for physiologic functions. Eating saturated fat and cholesterol causes atherosclerosis (the accumulation of excess cholesterol in the lining of our vessels) and significantly increases the risk of heart disease, currently the number one cause of death in developed countries. People eating a plant-based diet devoid of animal products have significantly less risk of developing heart disease, and several studies have found that a plant-based diet can even reverse atherosclerosis. Plant protein causes no increase in insulin-like growth factor-1 (IGF-1). Animal proteins cause our bodies to produce higher levels of the hormone IGF-1, which stimulates cell division and growth in both healthy and cancer cells (higher circulating levels of IGF-1 result in increased cancer risk, proliferation, and malignancy.) Plant protein causes no increase in trimethylamine N-oxide (TMAO). Animal proteins increase circulating levels of TMAO, which injures the lining of blood vessels, creates inflammation, and enables the formation of cholesterol plaques in blood vessels. Plant protein causes no increase in phosphorus or fibroblast growth factor 23 (FGF23). Animal proteins contain high levels of phosphorus, and when we consume a lot of phosphorus, the body reacts by producing high levels of the hormone FGF23 to normalize phosphorus levels. FGF23 injures the lining of blood vessels, creates inflammation, and enables the formation of cholesterol plaques in blood vessels, and is directly associated with heart attacks, sudden death, and heart failure. Plant protein causes no increase in bone health problems. Animal proteins have higher concentrations of sulfur-containing amino acids, which can induce a subtle state of acidosis when metabolized, causing our bodies use to compensate by leaching calcium from our bones to help neutralize the increased acidity. Studies have demonstrated that populations with higher dairy consumption, or higher consumption of animal protein in general, have a higher incidence of bone fractures. You probably conducted a lot of research to determine which type of 1 or 2 hour bariatric surgery would allow you a healthier and longer life. Conduct even more research to determine if what you eat every day for the rest of your life after surgery is going to increase your health and longevity, or increase disease and shorten your life. Everything we put in our mouth either increases longevity by decreasing the development of disease and illness, or contributes to premature death by increasing the development of disease and illness. Dozens upon dozens of peer-reviewed studies confirm that people on plant-based whole food diets (meaning whole minimally processed plant-based foods, and no processed foods) are at significantly lower risk of many diseases including cancers, type 2 diabetes, hypertension, heart disease, and obesity. So get your protein from plants whenever possible to maintain your weight loss for life and become as healthy as possible. Eating vegetables, fruits, legumes, nuts, seeds, tofu, whole grains, and other plant-based sources of protein is a win for your health and the health of the planet.

Yes, I’ve hiked both the Great Divide Trail and the West Coast Trail in Canada, the Te Araroa Trail in New Zealand, and the Via Francigena in France and Italy. Of course, I had a full-size stomach on those journeys. Do you plan on carrying water bottles, or will you be using a hydration pack? Water isn’t light, so I’m still trying to determine how much I’ll need to carry between refills before buying a pack specifically for this hike. I am fairly athletic and have a pack that I currently use on long cycling trips, but at 2 litres it might be too heavy (4.4lbs) for me to carry on foot. I use a bariatric-specific multi-vitamin that is complete including iron, so will only need to carry 35 of those in addition to 70 calcium citrate mini-tabs purchased specifically for this trip (800 mg of calcium citrate plus 800 IU of vitamin D3 per tab, brand is “Rainbow Light”). I see a WLS nutritionist who is also an expert in bariathlete nutrition, and as I move closer to the departure date, I’ll be asking her for Camino-specific advice. I would be happy to post her suggestions here, though keep in mind they will be specific to plant-based whole foods eaters.

Hi Sammi-Katt, I rarely log in here, but just checked in today to see how you're doing and am so glad you're feeling a bit less alone and worried at the moment, and am especially pleased to learn that you're seeing a therapist. Journalling is such a great exercise for awareness and self-realization, too. I have read all of the books listed and found much that is useful and beneficial for both myself and others in them, and hope you do, too. I'm wishing you well in every way...

If you read over the hundreds of threads here on this very topic, you'll find thousands of different outflows of advice. Who knows if any of the feedback leads to anything other than second guessing or confusion. There are innumerable individual medical, health, lifestyle, psychological, emotional, and personality factors that guide the decision about which surgery to select. Ultimately all one can do is methodically research each option, and make a decision that is based on both logic (research and information) and feeling (self-knowledge and insight). As an aside, gastrectomy surgery has actually been around since 1881, and since the 1950's it has been -- and remains -- the most common surgery to treat stomach cancer, severe ulcers, and traumatic injury to the stomach. So there's a vast amount of medical studies and health outcomes research data (far more than Roux-en-Y data, which only goes back to 1996) thanks to millions of patients around the world living long lives after complete and partial gastrectomies.... just not specifically for weight loss purposes. Naturally these studies don't address long term weight loss maintenance, but ultimately how much we lose and whether or not we keep it off long-term is entirely within our control based on our food and exercise habits. When considering VSG for weight loss, I studied the long-term (20-35-50 years post-op) data on these patients. Research indicates that the only notable long-term issues are regarding vitamin and/or mineral deficiencies in some patients depending on the percentage of stomach that was removed; more specifically, vitamins D, B12, calcium, folate, and iron. In fact, the long-term data collected on stomach cancer gastrectomy patients is the basis for supplement recommendations for post-op VSG patients.

You've identified a critical issue and reached out, but I'm sorry to say that unfortunately this is not a venue that can provide the knowledgeable, meaningful, consequential long-term advice and support that you may well need. If you read bariatric boards and blogs, you'll quickly realize that the keys to overcoming disordered eating and successfully losing and maintaining over the long term are committing to changing behaviours and developing new emotional coping strategies. I'm not talking about knitting and calligraphy. If you have an eating disorder, you won't be able to do this without professional help. Seeing a therapist regularly over the long term, reaching out to whatever mental health support programs you may have available, reading self-help and addiction books, actively engaging with self-help workbooks each day, and joining a professional online addiction food recovery program are all options that will likely need to be used in combination. If you put the time and effort into getting help to address your inner demons and learn how to make different choices, then you will have a successful outcome. If you are not able to do this, then you likely will not. Surgery only takes an hour, but for some it takes a lifetime of mental health support to achieve and maintain weight loss. Sometimes it may take hundreds of hours of introspection, therapy, and mental health support to be able to change the behaviours that lead to obesity. Surgery will help you lose weight, but it doesn't keep you from gaining it all back. A person could have 20 weight loss surgeries and still end up being obese. For many obese people, myself included, the real reasons behind becoming obese have absolutely nothing to do with how much - or how little - they can eat. Please reach out to your team and let them know that you're struggling. They're there to support you, and they have access to both internal and local community resources that can help you work through this. And please don't stop talking about how you're doing here - it may not be much help, but connection is better than isolation. In the meantime, here are a few books that address the mental health aspects of disordered eating to get started with: Weight Loss Surgery Does NOT Treat Food Addiction by Connie Stapleton The Emotional First Aid Kit: A Practical Guide to Life After Bariatric Surgery by Cynthia L. Alexander Bariatric Mindset Success: Live Your Best Life and Keep The Weight Off After Weight Loss Surgery by Kristin Lloyd The Cognitive Behavioral Workbook for Weight Management: A Step-by-Step Program by Michele Laliberte Overcoming Binge Eating, Second Edition: The Proven Program to Learn Why You Binge and How You Can Stop by Christopher G. Fairburn The Binge Eating and Compulsive Overeating Workbook: An Integrated Approach to Overcoming Disordered Eating by Carolyn Coker Ross

I was sleeved on Oct 15, 2019. I lost 50 lbs in the 6 months leading up to surgery, and weighed 242 on surgery day. This morning I weighed 176 lbs: 115 lbs lighter than I was at this time last year 🤩, and down 66lbs since surgery four months ago 😍. My BMI has gone from 55 to 32, and I'm physically able - and have enough energy - to do everything I want, including being active 7 days a week with hill hiking, race walking, distance cycling, squash, cardio, weights, sea kayaking, downhill skiing, etc. Currently I’m training for a triathlon (5km race walk, 400m swim, 20km cycle) in August, and will be walking the Camino de Santiago, a distance of 800km (500 miles) for 35 days in June. Though the surgeon set a goal for me based on the fact that I always weighed somewhere between 117lbs - 125lbs up until I was in my mid-30's, I don’t have any real expectations about how much I'll lose overall, nor do I have any specific timeframe in mind. I don't compare my loss to anyone else's since everyone's journey is different. Instead, what works best for me is to concentrate on being strong and fit and healthy, enjoying a whole foods plant-based diet, taking good care of my mind as well as my body, keeping a positive attitude, and looking for NSV's for validation and encouragement rather than at numbers on the scale. Happy sleevedom to all!

This June, I'm walking the Camino from St. Jean Pied de Port in France to Santiago de Compostela in Spain. I estimate the walk will take about 30 to 35 days, walking between 23 and 27 kilometers (14 to 16 miles) per day. At that time, I'll be ca. 9 months our from surgery, so have been planning meticulously to ensure proper food and hydration. There are plenty of places to stop and eat along the way, and if, like me, you're travelling with a group, you'll be able to eat off of their plates if they order the pilgrim's specials. Otherwise, small dishes (tapas) are available at virtually every establishment. You can get water and cheap food and snacks all along the way. I've spent a lot of time in Spain and chicken dishes feature heavily, so if you eat animal protein then you'll be fine. As you near the sea toward the end of the Camino, seafood is also available everywhere. If you’re staying in albergues (hostels), most of them serve breakfast, and many serve communal evening meals. Most albergues have kitchens for guest use, so pilgrims can buy groceries and do a lot of their own cooking along the way, if desired. Even as a whole foods plant-based eater, I'll be able to manage nicely on the journey with bean dishes, vegetables, nuts, fruits, etc.. I'll carry snacks such as nuts, seeds, and pea protein powder and bars with me. My main concern is hydration, so I'll be wearing a hydration pack and carrying electrolyte powder at all times. I'm not concerned about bag weight. I've opted for a 20 litre bag with a waterproof cover, and filled it'll be no more than 5% of my (estimated) body weight at that time. Be super strict with your pack weight - this is crucial on any hike, but especially on the Camino. I'll be wearing well-cushioned broken in trainers, not hiking boots. In the pack will be sunglasses, a small and an extra large microfibre sports towel, a lightweight thin waterproof jacket and trousers, a light poncho, a wide brim foldable hat, 2 t-shirts, 1 long sleeve tee, 2 pairs thin light shorts, 2 pairs thin light trousers, 1 pair light flip-flops, and 8 pairs super high quality double-layered walking socks, 6 pairs 100% cotton ankle socks, 1 bra, 4 pairs underwear. I'll wash each night - the type of fabrics the clothes are made of will dry in an hour, or two at most. 60 SPF sunscreen, toothpaste, travel toothbrush, earplugs, soap leaves for washing clothes each night plus 4 clothespins, Lush shampoo bar. Phone, charger, solar-powered portable charger kit, adaptor, earphones, a few Ziploc bags, 2-3 drybags in different sizes, vitamins, massage ball/roller. Not taking a sleeping bag as the weather will be warm enough in June for a silk sleeping bag liner only, even outside. You're going to need a small portable first aid kit. You will get blisters and you will need to carry a foot care kit: Compeeds, moleskin tape, band aids, talcum powder, small scissors, petroleum jelly (to rub on sore areas before putting on socks), needles and thread (pierce blisters all the way through with a needle and leave a length of the thread in it to prevent refilling). You are going to lose a lot of weight on the Camino! Have a wonderful trip, and if you go before me, please post tips afterwards!