Answer to why vegetables are not part of TLBC's pre-op diet plan

[Cat 1]

Hi All,

I was made aware that SWLC (Dr. Coubourn/Mumford) allows its pre-op diet to include (aside from Optifast) various green vegetables. I contacted TLBC to ask why vegetables are not made a part of our per-op diet.

According to Maral from TLBC, vegetables, while good to serve as part of our regular diet, is not included in the pre-op diet because they add carbohydrate to our body. The diet of cottage cheese, yoghurt, milk, and for some of us, also chicken breast, is a high Calcium, high Protein diet. It minimizes the production of extra, unused fat (which is typically stored in our body) and drives our liver and body into a state of ketosis - which then activates the burning of already stored body fat as body energy fuel.

Here is what I gathered from websites on what ketosis means and does:

The primary source of energy for our body is fat in the form of ketones. Ketones are created in the liver from the fatty acids that result from the breakdown of body fat. These only appear when there is an absence of glucose and sugar. Our high calcium, high protein diet reduces the amount of glucose and sugar that is in the bloodstream. As a result, our body produces ketones for fuel. When our body is creating ketones it is called ketosis.

The main benefit being that it increases the body's ability to utilize fats for fuel, which gets very lazy on a high carbohydrate diet. When on high carbohydrate diets, the body can usually expect an energy source to keep entering the body. But in the state of ketosis the body has to become efficient at mobilizing fats as energy.

If our diet is changed from a highly glycemic diet to a diet that does not substantially contribute to blood glucose, the body goes through a set of stages to enter ketosis. During the initial stages of this process the adult brain does not burn ketones, however the newborn brain makes immediate use of this important substrate for lipid synthesis in the brain. After about 48 hours of this process, the adult brain starts burning ketones in order to more directly utilize the energy from the fat stores that are being depended upon, and to reserve the glucose only for its absolute needs, thus avoiding the depletion of the body's protein store in the muscles.

Here is what I gathered from websites on the negative aspect of ketones:

When insulin levels drop and your cells can't get the glucose needed for fuel, they resort to burning fat for energy. Sounds like a swell slimming strategy, but relying on this fallback energy source for too long can be bad news for the body. Burning fat makes ketones, which spill into the blood and urine. When ketone levels rise too high, you can become sick and possibly slip into a coma.

Here is what I gathered from websites on concerns with Diabetic Ketoacidosis (DKA).

When the body doesn't have enough insulin, glucose stays in the blood and can't get into the body's cells to be used for energy. This can happen, for example, when a person skips doses of insulin, or when the need for insulin suddenly increases (like when a person is sick with the flu) and the doses are not adjusted. When the body can't use glucose for fuel, it starts to use fat. When this happens, chemicals called ketones are released into the blood. Some of these ketones, like extra glucose, pass out of the body through the urine.

High levels of ketones in the blood can be a problem because they cause the blood to become acidic. Too much acid in the blood throws off the body's chemical balance and causes the symptoms listed below. In people with diabetes, this problem is called diabetic ketoacidosis (pronounced: kee-toh-ah-sih-doh-sis), or DKA. DKA is a very serious condition that can lead to coma or death if it's not treated. The good news, though, is that it's preventable and can be treated so very few teens actually die from it.

DKA occurs more often in people with type 1 diabetes, but can sometimes also happen to people with type 2 diabetes.

The symptoms of DKA usually don't develop all at once - they usually come on slowly over several hours. People who have DKA may:

· feel really tired

· feel really thirsty or pee way more than usual

· have a dry mouth and signs of dehydration

The symptoms above are caused by the high blood sugar levels that usually occur before a person develops DKA. If the person doesn't get treatment, the following symptoms of DKA can occur:

· abdominal pain

· nausea and/or vomiting

· fruity breath odor

· rapid, deep breathing

· confusion

· unconsciousness ("diabetic coma")

So that's good and bad of ketones in a nutshell.

PLEASE READ THE ABOVE FOR GENERAL KNOWLEDGE ONLY. ACCURACY OF CONTENT IS NOT GUARANTEED.

For more detailed and accurate information, contact your doctor or do your own research.

For me, having a general understanding the reasons and effects of the food we must/can eat does increase my coping motivation and I hope that it increases the motivation of others on the TLBC pre-op diet as well.

[Gaffer 1]

The Optifast diet is also a ketosis diet. Keep in mind that TSWLC patients are given guidelines as to which veggies to eat and which to avoid.

TSWLC patients are allowed to eat veggies like lettuce, cucumbers, spinach, celery which are all high in fibre, low in carbs, and low GI (glycemic index). They are not allowed to eat high carb veggies like carrots, corn, potatoes etc.

We were also limited to a small amount of them, they were not unlimited during the pre-op.

Andrew