Arts137

Nah, it's surgeon's choice. I had a 40... and still the 40 leaves a stomach about as big around as a Sharpie Pen. Worry not! Here's a Pix (visual representation) of Bougie sizes: http://imageshack.us/photo/my-images/40/bougiesize.jpg/ Hope (the pix) it works!!!

Oh Comfy, you are thinking and planning and you WILL do well! Do your best. Try as hard as you can and don't beat yourself up over any slips. Shoot for perfect, and accept success "anyway". :-) It's a tough 3 or 4 days, but it WILL get better...

Here is an excellent summary of the research. I believe that Buffle is closest to the mark... coffee restrictions, in the absence of a specific medical problem is a "better safe than sorry" approach. Full disclosure, I am very strict about following my program BUT I do drink coffee. (sigh) I usually post links, but it did not work, so the entire article is below I shall also post this in research _____ Dear Ontherighttrack, You’ve asked a great question. What is the effect of caffeine on sleeve gastrectomy? To answer your question, I did a search of the medical literature on PubMed, the index for the National Medical Library. I couldn’t find any articles that address your question directly. Incidentally, there were no articles that addressed the effect of caffeine on gastric bypass either. Next I searched for both sleeve gastrectomy and gastric bypass and coffee. Again the medical library search engine did not return any articles. Thus, so far there have been no studies performed on sleeve gastrectomy patients or gastric bypass patients that would permit or discourage caffeine or coffee use. Most surgeons recommend that gastric bypass and sleeve gastrectomy patients avoid caffeine or coffee. These recommendations stem from research work that has been done on non-weight loss surgery patients. Before looking into this further let’s distinguish between caffeine and coffee. Caffeine is an alkaloid chemical that has stimulant effects on the central nervous system as well as other parts of the body. Caffeine is a moderate stimulant of gastric acid production. In some studies it has been shown to decrease lower esophageal sphincter pressure and thus potentially promote reflux. In other studies, the effect on sphincter pressure is not so clear. Coffee is brewed from the coffea plant. Coffee contains numerous biologically active chemicals including caffeine. The degree to which these compounds are present in a given cup of coffee depends on the specific species of coffee plant as well as the roasting and processing methods used to bring the coffee to market (see article by Van Deventer below). Even the type of filter used in a coffee maker will change the types of plant oils that remain in the brew. Gastroesophageal reflux (GERD or GORD) is reflux of stomach juices into the esophagus. GERD can cause heartburn. There are several full medical articles attached at the bottom of this reply. Please download these for further information. Coffee/caffeine and gastric acid stimulation There is general agreement that caffeine and coffee are two factors that stimulate stomach acid production. According to Cohen and Booth (1975) “Decaffeinated coffee gave a maximal acid response of 16.5 per hour (mean)which was similar to that of regular coffee, 20.9 mEq per hour, both values being higher than that of caffeine, 8.4, on a cup-equivalent basis.” Thus there are chemicals in coffee aside from caffeine that have potent acid stimulatory effects. In this study, decaffeination did not reduce acid stimulation. Further information about decaffeinated coffee was put forth by Feldmen et. Al (1981): “At equal concentrations, decaffeinated coffee was a more potent stimulant of acid secretion and of gastrin [an acid stimulating gut hormone] release than peptone [a Protein meal acid stimulus]. The ingredient(s) of decaffeinated coffee that accounts for its high potency in stimulating acid secretion and gastrin release has not been identified.” Coffee, caffeine, and esophageal reflux There is considerable controversy in the medical literature as to the effects of coffee and caffeine on esophageal reflux. Here are the conclusions to three articles on the subject. The full article summaries are added below. Wendl (1994) writes, “Coffee, in contrast to tea, increases gastro-oesophageal reflux, an effect that is less pronounced after decaffeination. Caffeine does not seem to be responsible for gastro-oesophageal reflux which must be attributed to other components of coffee.” Boekema (1999) and associates came to an opposite conclusion: “Coffee has no important effect on gastro-oesophageal acid reflux in GORD [GERD] patients, and no effect at all in healthy subjects.” Zheng (2007) conludes, “In conclusion, this large monozygotic co-twin study provides evidence that BMI, tobacco smoking and physical activity at work facilitate the development of GER, while physical activity at leisure time appears to be a protective factor. The association between BMI and frequent GER symptoms among men may be attenuated by genetic factors. In addition, heavy coffee intake may be a protective factor of GER in men and lower education may be a potential risk factor in women.” CONCLUSIONS Caffeine, and more so, coffee and decaf coffee stimulate gastric acid production. Caffeine and coffee may promote gastroesophageal reflux. Caffeine and coffee are just two of many factors that promote gastric acid production and gastroesophageal reflux. Clinical Implications: For sleeve patients who suffer from gastroesophageal reflux, it is best to avoid caffeine and coffee. For sleeve patients who do not have reflux, I do not see any reason not to enjoy coffee or use caffeine products in moderation. For gastric bypass patients, most surgeons recommend against caffeine and coffee because the acid stimulation that occurs may contribute to the development of anastomotic ulcers. Since there are many other factors involved in the development of these ulcers (alcohol, cigarette smoking and nicotine, and NSAID drugs), it is impossible to know how important the role of coffee and caffeine is. Most surgeons are thus saying avoid coffee and be “better safe than sorry.” REFERENCES Good summary of caffeine and it's effects from Johns Hopkins. About caffeine from Wikipedia About gastroesophageal reflux from Wikipedia SUMMARIES OF MEDICAL JOURNAL ARTICLES Gasrtoenterology. 2007 Jan;132(1):87-95. Epub 2006 Nov 17. Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins. Zheng Z, Nordenstedt H, Pedersen NL, Lagergren J, Ye W. Source Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE 171-77 Stockholm, Sweden. Abstract BACKGROUND & AIMS: Lifestyle and genetic factors dominate the etiology of gastroesophageal reflux disease. We investigated associations between lifestyle factors and gastroesophageal reflux (GER) symptoms, with and without controlling for genetic predisposition. METHODS: In 1967 and 1973, questionnaires including lifestyle exposures were mailed to twins in the Swedish Twin Registry, and data on GER symptoms were collected by telephone interview during 1998-2002. Two analytic methods were used: external control analysis (4083 twins with GER symptoms and 21,383 controls) and monozygotic co-twin control analysis (869 monozygotic twin pairs discordant for GER symptoms). RESULTS: In the external control analysis, leanness (body mass index [bMI] <20), upper normal weight (BMI 22.5-24.9), overweight (BMI 25-29.9), and obese (BMI > or =30) conferred -19%, 25%, 46%, and 59% increased risk of frequent GER symptoms compared with normal weight (BMI 20-22.4), respectively, among women, whereas no such associations were evident among men. When adjusted for genetic and nongenetic familial factors, these estimates were -28%, 44%, 187%, and 277%, respectively, among men. Frequent smoking rendered a 37% increased risk of frequent GER symptoms among women and 53% among men compared with nonsmokers. Physical activity at work was dose dependently associated with increased risk of frequent GER symptoms, and recreational physical activity decreased this risk. CONCLUSIONS: BMI, tobacco smoking, and physical activity at work appear to be risk factors for frequent GER symptoms, whereas recreational physical activity appears to be beneficial. Association between BMI and frequent GER symptoms among men seems to be attenuated by genetic factors. ________________________________________________________________________________________ J Appl Physiol. 2000 Sep;89(3):1079-85. Gastrointestinal function during exercise: comparison of Water, sports drink, and sports drink with caffeine. Van Nieuwenhoven MA, Brummer RM, Brouns F. Source Department of Gastroenterology, University Hospital, Maastricht, 6202 AZ Maastricht, The Netherlands. m.vannieuwenhoven@hb.unimaas.nl Abstract Caffeine is suspected to affect gastrointestinal function. We therefore investigated whether supplementation of a carbohydrate-electrolyte solution (CES) sports drink with 150 mg/l caffeine leads to alterations in gastrointestinal variables compared with a normal CES and water using a standardized rest-exercise-rest protocol. Ten well-trained subjects underwent a rest-cycling-rest protocol three times. Esophageal motility, gastroesophageal reflux, and intragastric pH were measured by use of a transnasal catheter. Orocecal transit time was measured using breath-H(2) measurements. A sugar absorption test was applied to determine intestinal permeability and glucose absorption. Gastric emptying was measured via the (13)C-acetate breath test. In the postexercise episode, midesophageal pressure was significantly lower in the CES + caffeine trial compared with the water trial (P = 0.017). There were no significant differences between the three drinks for gastric pH and reflux during the preexercise, the cycling, and the postexercise episode, respectively. Gastric emptying, orocecal transit time, and intestinal permeability showed no significant differences between the three trials. However, glucose absorption was significantly increased in the CES + caffeine trial compared with the CES trial (P = 0.017). No significant differences in gastroesophageal reflux, gastric pH, or gastrointestinal transit could be observed between the CES, the CES + caffeine, and the water trials. However, intestinal glucose uptake was increased in the CES + caffeine trial. ___________________________________________________________________ Scand J Gastroenterol Suppl. 1999;230:35-9. Coffee and gastrointestinal function: facts and fiction. A review. Boekema PJ, Samsom M, van Berge Henegouwen GP, Smout AJ. Source Dept. of Gastroenterology, University Hospital Utrecht, The Netherlands. Abstract BACKGROUND: Effects of coffee on the gastrointestinal system have been suggested by patients and the lay press, while doctors tend to discourage its consumption in some diseases. METHODS: The literature on the effects of coffee and caffeine on the gastrointestinal system is reviewed with emphasis on gastrointestinal function. RESULTS: Although often mentioned as a cause of dyspeptic symptoms, no association between coffee and dyspepsia is found. Heartburn is the most frequently reported symptom after coffee drinking. It is demonstrated that coffee promotes gastro-oesophageal reflux. Coffee stimulates gastrin release and gastric acid secretion, but studies on the effect on lower oesophageal sphincter pressure yield conflicting results. Coffee also prolongs the adaptive relaxation of the proximal stomach, suggesting that it might slow gastric emptying. However, other studies indicate that coffee does not affect gastric emptying or small bowel transit. Coffee induces cholecystokinin release and gallbladder contraction, which may explain why patients with symptomatic gallstones often avoid drinking coffee. Coffee increases rectosigmoid motor activity within 4 min after ingestion in some people. Its effects on the colon are found to be comparable to those of a 1000 kCal meal. Since coffee contains no calories, and its effects on the gastrointestinal tract cannot be ascribed to its volume load, acidity or osmolality, it must have pharmacological effects. Caffeine cannot solely account for these gastrointestinal effects. CONCLUSIONS: Coffee promotes gastro-oesophageal reflux, but is not associated with dyspepsia. Coffee stimulates gallbladder contraction and colonic motor activity. ________________________________________________________________________________________________ Eur J Gastroenterol Hepatol. 1999 Nov;11(11):1271-6. Effect of coffee on gastro-oesophageal reflux in patients with reflux disease and healthy controls. Boekema PJ, Samsom M, Smout AJ. Source Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands. pboekema@worldonline.nl Abstract BACKGROUND: Many patients with gastro-oesophageal reflux disease (GORD) report that coffee aggravates their symptoms and doctors tend to discourage its use in GORD. OBJECTIVE: To assess the effect of coffee ingestion on gastro-oesophageal acid reflux. DESIGN: A randomized, controlled, crossover study. PARTICIPANTS: Seven GORD patients and eight healthy subjects. METHODS: After 1 day of coffee abstinence, participants underwent 24-h oesophageal pH and manometric monitoring. At well-defined times, they ingested either 280 ml of regular paper-filtered coffee or 280 ml of warm water. Coffee or water was drunk 1 h after Breakfast, during lunch, 1 h after dinner and after an overnight fast Reflux and oesophageal motility parameters were assessed for the first hour after each coffee or water intake. RESULTS: Coffee had no effect on postprandial acid reflux time or number of reflux episodes, either in GORD patients or in healthy subjects. Coffee increased the percentage acid reflux time only when ingested in the fasting period in the GORD patients (median 2.6, range 0-19.3 versus median 0, range 0-8.3; P = 0.028), but not in the healthy subjects. No effect of coffee on postprandial lower oesophageal sphincter pressure (LOSP), patterns of LOSP associated with reflux episodes or oesophageal contractions was found. CONCLUSION: Coffee has no important effect on gastro-oesophageal acid reflux in GORD patients, and no effect at all in healthy subjects. _______________________________________________________________________ Aliment Pharmacol Ther. 1994 Jun;8(3):283-7. Effect of decaffeination of coffee or tea on gastro-oesophageal reflux. Wendl B, Pfeiffer A, Pehl C, Schmidt T, Kaess H. 2nd Medical Department, München-Bogenhausen Hospital, Germany. Abstract BACKGROUND: Coffee and tea are believed to cause gastro-oesophageal reflux; however, the effects of these beverages and of their major component, caffeine, have not been quantified. The aim of this study was to evaluate gastro-oesophageal reflux induced by coffee and tea before and after a decaffeination process, and to compare it with water and water-containing caffeine. METHODS: Three-hour ambulatory pH-metry was performed on 16 healthy volunteers, who received 300 ml of (i) regular coffee, decaffeinated coffee or tap water (n = 16), (ii) normal tea, decaffeinated tea, tap water, or coffee adapted to normal tea in caffeine concentration (n = 6), and (iii) caffeine-free and caffeine-containing water (n = 8) together with a standardized breakfast. RESULTS: Regular coffee induced a significant (P < 0.05) gastro-oesophageal reflux compared with tap water and normal tea, which were not different from each other. Decaffeination of coffee significantly (P < 0.05) diminished gastro-oesophageal reflux, whereas decaffeination of tea or addition of caffeine to water had no effect. Coffee adapted to normal tea in caffeine concentration significantly (P < 0.05) increased gastro-oesophageal reflux. CONCLUSIONS: Coffee, in contrast to tea, increases gastro-oesophageal reflux, an effect that is less pronounced after decaffeination. Caffeine does not seem to be responsible for gastro-oesophageal reflux which must be attributed to other components of coffee. Dig Dis Sci. 1992 Apr;37(4):558-69. Lower esophageal sphincter pressure, acid secretion, and blood gastrin after coffee consumption. Van Deventer G, Kamemoto E, Kuznicki JT, Heckert DC, Schulte MC. Source Center for Ulcer Research and Education, Los Angeles, California. Abstract This study tested the hypothesis that differences in the processing of raw coffee Beans can account for some of the variability in gastric effects of coffee drinking. Coffees were selected to represent several ways that green coffee beans are treated, ie, processing variables. These included instant and ground coffee processing, decaffeination method (ethyl acetate or methylene chloride extraction), instant coffee processing temperature (112 degrees F or 300 degrees F), and steam treatment. Lower esophageal sphincter pressure, acid secretion, and blood gastrin was measured in eight human subjects after they consumed each of the different coffees. Consumption of coffee was followed by a sustained decrease in lower esophageal sphincter pressure (P less than 0.05) except for three of the four coffees treated with ethyl acetate regardless of whether or not they contained caffeine. Caffeinated ground coffee stimulated more acid secretion that did decaf ground coffees (P less than 0.05), but not more than a steam-treated caffeinated coffee. Instant coffees did not differ in acid-stimulating ability. Ground caffeinated coffee resulted in higher blood gastrin levels than other ground coffees (P less than 0.05). Freeze-dried instant coffee also tended toward higher gastrin stimulation. It is concluded that some of the observed variability in gastric response to coffee consumption can be traced to differences in how green coffee beans are processed. __________________________________________________________________________________ JAMA. 1981 Jul 17;246(3):248-50. Gastric acid and gastrin response to decaffeinated coffee and a peptone meal. Feldman EJ, Isenberg JI, Grossman MI. Abstract We compared five graded doses of decaffeinated coffee and a widely used protein test meal (Bacto-peptone) as stimulants of acid secretion (intragastric titration) and gastrin release (radioimmunoassay) in eight healthy men. In each subject, for both acid and gastrin, the sums of the responses to all five doses were greater to decaffeinated coffee than to peptone. The mean +/- SE peak acid output in millimoles per hour was 18.5 +/- 2.9 to decaffeinated coffee and 14.7 +/- 2.7 to peptone, representing 70% and 55%, respectively, of the peak acid output to pentagastrin. The mean +/- SEM peak increment over basal rate in serum gastrin in picograms per milliliter was 84.8 +/- 4.4 to decaffeinated coffee and 44.8 +/- 2.1 to peptone. At equal concentrations, decaffeinated coffee was a more potent stimulant of acid secretion and of gastrin release than peptone. The ingredient(s) of decaffeinated coffee that accounts for its high potency in stimulating acid secretion and gastrin release has not been identified. ___________________________________________________________________________________ Dis Esophagus. 2006;19(3):183-8. Effect of caffeine on lower esophageal sphincter pressure in Thai healthy volunteers. Lohsiriwat S, Puengna N, Leelakusolvong S. Source Department of Physiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sislr@mahidol.ac.th Abstract Caffeine affects many aspects of body function including the gastrointestinal system. A single-blinded experimental study was performed to evaluate the effect of caffeine on lower esophageal sphincter (LES) and esophageal peristaltic contractions in healthy Thai adults. The volunteers were six men and six women aged 19-31 years. Subjects drank 100 mL of water. Five wet swallows were performed 30 min after the drink. The basal LES pressure was continuously measured using esophageal manometric technique. They then consumed another 100 mL of water containing caffeine at the dose of 3.5 mg/kg body weight. The swallows and basal LES pressure monitoring were repeated. The results showed no change in basal LES pressure after a water drink while caffeine consumption significantly lowered the pressure at 10, 15, 20 and 25 min. The mean amplitude of contractions and peristaltic velocity were decreased at the distal esophagus at 3 and 8 cm above LES. The mean duration of contraction was decreased at the distal part but increased at the more proximal esophagus. The heart rate, systolic and diastolic blood pressures were increased significantly at 10-20 min after caffeine ingestion. This study indicated that caffeine 3.5 mg/kg affected esophageal function, resulting in a decrease in basal LES pressure and distal esophageal contraction, which is known to promote the reflux of gastric contents up into the esophagus. N Engl J Med. 1975 Oct 30;293(18):897-9. Gastric acid secretion and lower-esophageal-sphincter pressure in response to coffee and caffeine. Cohen S, Booth GH Jr. Abstract Caffeine stimulates gastric acid secretion and reduces the competence of the lower esophageal sphincter in man. These effects of caffeine have been used as evidence that regular coffee should not be used by patients with peptic-ulcer disease or gastroesophageal reflux. We compared the dose-response relations of caffeine, regular coffee and decaffeinated coffee for gastric acid secretion and sphincter pressure in normal subjects. Decaffeinated coffee gave a maximal acid response of 16.5 +/- 2.6 mEq per hour (mean +/- S.E.M.), which was similar to that of regular coffee, 20.9 +/- 3.6 mEq per hour, both values being higher than that of caffeine, 8.4 +/- 1.3, on a cup-equivalent basis. Sphincter pressure showed minimal changes in response to caffeine, but was significantly increased by both regular and decaffeinated coffee (P less than 0.05). These data suggest that clinical recommendations based upon the known gastrointestinal effects of caffeine may bear little relation to the actual observed actions of coffee or decaffeinated coffee

and I am not a female, but am not bothered by any info. Remember, we've all had people playing with our insides and removing a majority of our stomach. Please see your OB-GYN. Very likely homonal see for basics: http://www.paleoforwomen.com/the-physiology-of-womens-weight-loss-part-i-estrogen/ And yes, menstruation and anemia can certainly go hand in hand.

Donegon and Broncho are right. Just do it, even if so, so, so very hard. Celebrate your hard work, with things other than food!

Coach while we all are different, I lose cravings IF I can avoid processed or simple carbs for 3/4 days. If I give in, I've got ANOTHER 3/4 days of craving hell to go through....

I agree with ManBat (and I am also 64) I believe I have come to agree that silence and a smile, or a "Why do you ask?" response is generally appropriate. BUT REMEMBER, there is a reason why I believe this way. At the core of my being is the strongly held belief that "When I want your opinion, I'll beat it out of you". I do NOT give advice unless asked, and I do not ask for advice (generally preferring my own research) Made school fun. Teachers sure got tired of me.

I'd LOVE to see the quinona/bean salad and the Greek Yogurt cheese recepies!!!

YES, MD or ER... Dehydration is a bad thing

Lets work backward. I will "pass" on mashed potatos and dressing/stuffing. But I bet that I see brussel sprouts and cauliflower on the holiday menue. And HUMMUS is a great low Glycemic Index snack, but not on chips or crackers...

SLOOOOOW... not too much discomfort, and I enjoyed the good hospital drugs!

My program askes for a 6 month wait. I followed that even though I LOVE wine and have a fairly large "collection". Two reasons, alcohol can irritate the healing stomach and they worry about transerring our addiction from food to alcohol. I am now part 6 months and have had a few glasses of wine. My tastes seem to have changed some... liking the 'meatier' reds now. Had a sip of brandy, but could tell that my stomach was not happy so I stopped!

OH, and popcorn is a SUPER High High Glycemic Index Food!

At 423# my BMI was about 55. I went with the sleeve since it can proceed to bypass if needed, but this "bigger" procedure might not be needed... My options remain. I am 6 months out and have lost 100# from my highest weight at 46# since surgery.

You will feel better day by day. Get the Water in. Move/walk as much as you can. I used to sleep on my side, but now I sleep on my back. Go figure???!!!

All of life is choices. The sleeve is a BIG choice. A cookie is not a BIG choice. Who knows what you will choose then? Let's home that your choices will let you continue your journey!!! What you want then might differ from what you want now.

You sound like a Cool Bird, then and now!

Hang in there "This too shall pass"

hmmmm ASK, there IS a point to the pre-op very low calorie diet, it shrinks the liver and that helps the surgeon. BUT some surgeons do not ask the patient to do this...

Madame, you can still have the butter AND the salt... (but maybe not the bread) And I, having grown up in the 60s, admit that I HAVE reformed but I have NOT repented!!!

RJ's, and all: You said: "People are talking about me...People are waiting to see me...People are looking at me..People are making judgments about me. I just wanted to become invisible...No one would look at me because I was no longer morbidly obese..It does not seem to have happened.....I was scared! " One of the few GREAT things about being fat was invisability. All people would see is "oh, there's a FAT guy" and never look further. And I LIKED being invisable. But no more (though being an OLD guy is not bad for the same reason). Again, a GREAT and honest thread. In the end, what choice do I have? Really... The choice for me is life or death, and I still want a little more healthy years. The payment may feel steep, but all in all it's a fair trade. PS, I love you all... all my "newly visable" compatriots!

This is a terrible story. "RATE HIM" on the site!!!

This was me! I slept all night and took naps during the day whenever I could! For me it got better, but not till 4+ months out!!!

Some lose fast some slow. Some lose more of their excess weight, some less. But when watching these boards EVERYONE has stalls. My BIG one was the 5th month out...

AOK, then that's your plan.. Mine was a two week Optifast fast, but surgical practices differ!