FrankParsonshadbeendietingforwhatseemedtobehisentireadultlife.Allthistimehehadbeentellinghimself,"I'vegottogetridofthisfat,"andinhismindhehadbeenimaginingthefatmeltingawayasheatelettuceleavesandricecakes.Thatis,hethoughtthatwayuntilhisspecialist,Dr.Jacob,gavehimadoseofreality:Frankisstuckwiththesamefatcellshewasbornwith,(1)andallthecomforteatinghedidinhisteensactuallycausedhisfatcellstoexpandsomuchthattheysplittoproducemorenewfatcells.Evenworse,fatcellscannotberemovedbyanydietcurrentlyavailable.Forsomeluckypeople,however,appropriatedietingwillcausethefatcellstoshrink.
Frankisnotoneofthoseluckypeople.Allthedietingintheworldhasnotmademuchdifferenceinthesizeofhis62-inchwaist,soheagreedtoconsideragastricbypassoperation.
Dr.Jacobexplainedthatthereareseveraltypesofbariatricsurgery.Eachapproachreducestheamountofspaceavailableinthestomachandintestines.ThegoodnewsisthatFrankwillnotbeabletoeatasmuchashedidinthepast.ThechallengeisthatFrank'sbodywilllosesomeofitsabilitytoabsorbthenutrientsthatitneedsonadailybasis.
ButtheoperationisnottheendofthestoryforFrank,orforanyoneelseseekingthissolutiontoexcessweight.Weightlosssurgerypatientscannotexpectthefatcellstoshrinkwithoutsomeverysignificantlifestylechanges.Theselifestylechangeswillallowthemtolivelongandhealthylives.
Inadditiontoeatingless,whichtheoperationaddresses,patientslikeFrankwillneedtobecomemorephysicallyactive.Thiswillrequiresomededication,especiallyforthosewhohavenotengagedinsignificantphysicalactivityforyears.Theywillalsoneedtopayparticularattentiontowiseeating.(2)Ifpatientsfailtocarefullymonitortheirproteinandvitaminintake,theycaneasilyslideintoastateofmalnutrition,whichmayshowitselfinmanyways.Excessivesweatingandhairlossaremildsideeffectsofmalnutritioncomparedwiththemoreseriousconditionsthatmayresult,includinganemia,calciumdeficiency,nausea,vomiting,anddiarrhea.(3)
Surgeryisnotaquickfixtoachievethebodythemediaportraysasdesirable.Instead,itrequiressignificantbehavioralchanges.Therewillbeanincreasedriskofsignificantandlife-threateningsideeffects,suchaswoundinfection,hernia,ulcers,bloodclotsinthelungs,andevendeath,foranypatientfailingtofollowthestrictdietaryandexerciseregimendemandedbybariatricprofessionals.
Peoplewhohavecarriedexcessweightformanyyearsareatadisadvantagewhenitcomestimeforrecovery.Theirheartshavebeenunderahighdegreeofstressforyears,workinghardtosupplyoxygenatedbloodtobodytissues.Lungcapacitymayalsobeimpaired;lessoxygenisgettingintotheblood,andlessbloodisbeingsuppliedtothewoundscausedbytheoperation.Themechanismofwoundhealingrequiresahealthysupplyofoxygenatedblood.However,woundhealingalsodemandsadequatesuppliesofproteins,carbohydrates,vitamins.andminerals(4)-theverysubstancesthatgastricbypasslimitsinthebody.Ifapatient'sfoodchoicesremainunchanged,thefoodheorsheeatsmaynotberichenoughintheconstituentsthatthehealingbodyrequires,especiallysincefoodquantitywillbelimitedbythereducedstomachcapacity.
Forthefirsttwelveweeksaftertheoperation,patientshavenooption.Thefirstfewdays,whenthestomachisnobiggerthananeggandholdsonlyanounceortwooffood,willbededicatedtointakeofliquidsonly;(5)patientsthenprogresstopureedfoods,abitlikebabyfoodwithnochunkssotheycausenodigestiveproblemsforinflamedandhealingstomachsandintestines.Afterthreeweeks,patientsmaybeabletomanagesoftfoodslikegroundmeats,cookedvegetables,andfreshfruit.Aftereightweeksofsoft-food,inconsultationwiththeirsurgeons,patientscanstartintroducingregularfoodsintotheirdiets.
Throughouthislife,Frankhasstruggledtoachievetheself-disciplinetoeatsmart.Now,thatself-disciplineispreciselywhatisnecessaryforhimtorecoverfromtheoperationandtolivewithhisnewstomach.Forfastandeffectivehealing,Frank,likeallotherbypasspatients,musteateasily-digestibleprotein-richfoodslikecottagecheese,eggsubstitute,cheese,chickenandotherpoultry.Whilethishigh-proteindietmaybelimiting,itdoesnotneedtobeunvaried.Patientsmayconsumefish,shellfish,tofu,milk,soymilk,texturizedvegetableprotein,andawholerangeofsugar-andfat-freecommercialproteinsupplements.(5)
Theonlyproblemwithmostoftheproteinsourcesmentionedisthattheproteinsarriveinapatient'stenderpost-operativestomachasverylargemoleculesthatarenormallybrokendownbytheacidsandenzymesinthestomachinaprocesscalledhydrolysis.However,thepost-operativestomachwillnolongerbeabletobreakdownfoodsthewayitdidbeforesurgery,soitmakessensetoeatfoodsthatarealreadyhydrolyzedtosomedegree.Someproteinsupplements(6)aremadefromablendofhydrolyzedproteinsthathavebeenreducedtoaminoacidsorpeptideswithoutchangingtheirnatural,biologically-activestructure.Thesepeptidesareverysmallinsizeandcanbeabsorbedintothebodyveryrapidly.
Otherchallengespatientswillfacewhenselectingaproteinsupplementareservingsizeandtaste.Someproteinsupplementsaretoolargeforapostoperativepatient'ssmalldigestivesystem.Itmaytakehourstoconsumea16-or20-ounceproteinbeverage.Too-largeproteinbarsanddrinksmayalsoover-extendthereducedstomach.Thatcan,byitself,causeserioussideeffects.Tasteisperhapsthemostimportantfactorofall,especiallyifproteinsupplementationbecomespartofapatient'sdailyroutine.Ifapatientmusttrickle-feedatwoouncemealoveraperiodaslongassixtyminutes,thatmealshouldatleasttastegood.
Keepinghighproteinintakethroughthiscriticalphasewillnotonlyassistinthehealingprocess,itwillalsopreventmusclewastage,provideenergy,andfuelthemetabolicchangesnecessarytopromoteweightloss.
Ifapatientneglectsproteinasamainconstituentoftherecoveryregimen,heorshewillalmostcertainlyexperiencetheplateaueffect,whentheweightlossinitiallyachievedasaresultoftheoperationcomestoamysterioushalt.Thiscanhappenevenifthepatientiseatingsmallerportionslessfrequentlyandisavoidingsweetandfattyfoods.(4)
Foodshighinsugarandfat-likesoda,candy,cookies,honey,potatochips,icecream,hotdogs,anddoughnuts-canalsocauseaparticularstomachdiscomfortcalleddumpingsyndrome.(4)Thisoccurswhenfoodinthestomachmovestooquicklyintotheintestineandcausesarangeofside-effects,includingdiarrheaanddehydration,leadingtomusclecramps,sweating,dizziness,headaches,andgeneralweakness.
WorkingtogetherwithDr.Jacobs,Frankaimstogetintoaroutineofthreehealthymealseachday,alongwithsmallsnacks,andtostopthegrazingbehaviorthatisasurerecipeforweightgainwithorwithoutgastricbypasssurgery.Thegastricbypassoperationisonlythefirststepontheroadtoahealthier,happierlifestyle.ThejourneytofullhealthandconsistentweightlossdependsalmostentirelyonfollowingallofthestepsspelledoutbyconcernedandcompetentsurgeonslikeDr.Jacobs.AsforFrank,hewillhavetolearntoavoidallofthefoodandself-disciplinedemonsthatgothimandthosepeskyfatcellsintotroubleinthefirstplace.
References1"IstheNumberofFatCellsyouHavePredetermined?".iVillage./diet/experts/wlcoach/qas/0,,222000_36838,00.html?arrivalSA=1&cobrandRef=0&arrival_freqCap=1&pba=adid=13185251
2"WhatYouNeedtoKnowAbout:GastricBypass".About.com./cs/gastricbypass/l/blgastby1.htm
3"GastricBypass".MedlinePlus./medlineplus/ency/article/007199.htm
4"NutritionalGuidelinesafterGastricBypassSurgery".JohnHopkinsBayviewMedicalCenter/NUTRI/gastricsurg.html
5"Gastricbypassdiet:Nutritionalneedsafterweight-losssurgery".MayoClinic.com/health/gastric-bypass-diet/WT00007
6"WhattypeofproteinisthemostvaluabletothehumanbodyandwhatmakesProfect'sproteinformulationsospecial?"Protica.comcom/faq_products.htm
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