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I was told 80 grams of mozzarella a day was OK that's why I split it over 2 meals and I was having home made air fryed chips instead of the seafood sticks but I suffer from reactive hypoglycemia so I tent to avoid potato as much as I can and switched to seafood sticks and the advice I was given from the hospital also was a boiled egg is a perfect snack between meals

1. Iv been eating like this for about 6 months now. 2. 5 foot 11inch (180cm) male. 3. The only thing I do suffer from is reactive hypoglycemia which means when I eat cars my body produces to much insulin and my sugar levels drop very low that's why I try to avoid cars. When I spoke to the hospital last I was talking to them about portion sice and calories ect and there reply was as long as I stick to the bariactric place then calories and portion size will never be an issue

Aww, thanks! I'm glad it helped! It is amazing at how sensitive and reactive our tummies are post-op. They definitely have opinions! How are you feeling now with another week having passed? Early out things can change so quickly looking back on it but in the moment feel like they take forever. I blame it on the "drinking water like it is your only job" thing, the day seems to stretch on sooo long when you have 64oz worth of baby sips to take! 🤣

I have reactive hypoglycemia also. It is true that each surgeon/office will have their own ways of doing things. You're comment: "portion sice and calories ect and there reply was as long as I stick to the bariactric place then calories and portion size will never be an issue" - I submit there will be an issue. You can pile that plate and still are getting too many ounces of food. I can say right now, we have veggies only rather than fruit (carbs) and veggies and salad. Carbs, we don't have that, we have fruit. There's one issue I can see. The only carbs we get are in the fruit and we are to go for low calorie fruit (meaning not bananas or grapes). Berries are what they discuss.

Following up with a GP is good for general health, but following up with your bariatric surgeon is crucial if you are still having complications from bypass. There are a number of things that can be causing your symptoms, some that can be easily corrected by procedures during an endoscopy. As far as the blood spike, do you mean your blood sugar? Some people that have bypass can develop reactive hypoglycemia which can definitely make your blood sugar levels bounce around and cause fatigue and such. I'm sorry you are feeling bad!

Have they tested you to see if you are having issues with reactive hypoglycemia? This usually kicks in 1-4 hours after a meal, but since you've had a bypass it is possible it could kick in faster for you if your food is transitioning faster. I've seen FB groups for bariatric patients that have this issue. I've noticed it often happens years out from surgery... I used to have issues with this before bariatric surgery, even on a low carb diet. Eating small meals often with fat and protein paired with your carbs is usually what they advise to treat it, along with other dietary adjustments. Personally if I don't eat every 2-3 hours, I aggressively crash energy wise. It is very pronounced. I have to carry snacks with me everywhere to prevent me going past that 3 hour mark or I look like the Energizer Bunny without his battery! LOL

Check your blood sugar when this happens. This sounds like what happens to me and it is reactive hypoglycemia and happens if I eat too many fast digesting carbs. My glucose will go into the 50’s and I need to eat 5- 10g or so fast acting carbs to raise it back again. (But not too many or it will keep swinging) This is something I have developed since having sleeve surgery over 10 years ago and the only way to control it is with diet and not eating high sugary volume of stuff.

Gold and silver are softer and therefore more porous on a microscopic level, and can "pit", meaning bacteria or other irritants can cling to them. They can also flake off into the open wound, and are more reactive with body fluids. They're generally fine for a healed piercing (which can take a few weeks to several months depending on what kind of piercing it is), but because they're not as hard and non-reactive as something like surgical steel or titanium. I worked, unfortunately, at a Claire's in a mall for several years when I was in college, and I know that stores like that push gold as being "safer" when really it is "more profitable". I had nothing but problems with piercings done in gold with a piercing gun. I have since gotten SEVERAL more piercings done with a single-use hollow needle at a piercing parlor, and have had none of the same issues. The right establishment should almost feel like a medical office.

TL/DR: Worried about losing weight by not eating enough. | Looking for tips to reach protein/calorie goals when not hungry. | Looking for others' experiences with lack of hunger this far out in WL Journey. ------------------------- I meet with my nutritionist for check-ins about every 3 months. For this last one, my 9-month, she told me not to be upset if I hadn't lost, as a stall was expected. Yet, I had lost just as much as I had been. We went over what I had been eating & she wasn't concerned about content but suggested increasing variety. [I'm a meal repeater 🤷‍♀️] Though, she again warned me that it is now especially likely that I would stall since I hadn't yet. Since that appointment, I've still been losing weight. I know it might appear strange to worry about meeting the goals we are here to meet, but my nutritionist is big on trying to relearn the natural cues of the body. So, as they are absent, you can notice pressure in your stomach, sighing, or a runny nose as indications of fullness. As indications of hunger return, you can utilize them to increase portions within the parameters of slow eating and not exceeding controlled sizes. The thing is, I don't know that the initial increase after, you know, the literal wounds healed, I have really expanded much more. I don't really get hungry until 'early-bird dinner' time. So eating during the day is purely done out of obligation. [& if I'm being truthful, there are times when I forget entirely until after work.] So obviously, that leads me to try to have all of my calories in one 'meal' in the day, which I have to eat over a couple hours [even if it is small] if I don't want to get nauseous or actually regurgitate. [The regurgitation has improved slightly over the last couple of months. I had a very reactive stomach that required me to prolong my dependence on protein shakes. Pre-surgery, I don't think I came even close to needing to vomit since pre-school 🙁.] To be fully upfront, I have not counted a single macro or calorie or weighed a single food item during my entire journey. I've tried tracking before in my weight-loss journey, and it was not healthy mentally for me. I realize that I may be under goals rather than over them, but straightforward counting of calories is just not something that would be part of a successful journey for me. So, all of this is a longwinded way to say: - Is anyone else struggling to eat enough this far out? - What helps you to reach your protein/calorie goals when you don't really want to eat? - Any other tips/tricks/specific brand or meal suggestions?

Nothing as severe as yours but I get horrible hypoglycaemia when I eat carbs/sugar. But it’s addictive and the world is full of it so October succumb - sometimes accidentally but often just through weariness! Anyhoo - for me low carb works. If I’m eating Keto I’m fine apart from cramps and palpitations. banana’s definitely spike my sugar and set off cravings - I try to stick to berries and yogurt. hope you get some help with this - hypo can be terrifying and feeling ill all the time is what we wanted to leave behind!!!

There is a good reason to avoid the RNY revision if you can - the reactive hypoglycemia and marginal ulcer (and all of the medical care limitations that stem from it) issues, but it's not the end of the world, either if that's what you need. It's a common procedure that's been done in one form or another for 140 years, so its quirks and features are well known (but I would rather avoid its quirks if I can). I would certainly get a second, and even third, opinion on it, as while the sleeve is a fairly straightforward procedure most to do these days, repairing one that isn't working correctly is not necessarily so. Most bariatric surgeons started out with the bypass, so that is their comfort zone and they often prefer to go back to the familiar when things get a bit complicated, while there are some who have gone deeper into the sleeve and specialized in it and related procedures, such as the DS, and they are more comfortable doing things that others wouldn't do. We sometimes hear on these forums that "you can't do a Nissen (fundoplication) on a sleeve as there isn't any fundus left (well, not much) yet there are some who routinely perform them. Between that and meshing, there are options, and an RNY doesn't necessarily fix the potential recurring problem, as it, too, yield a small stomach pouch that is subject to herniating. If possible, for a second opinion, I would seek out a surgeon who does the DS (duodenal switch) as that is a good proxy for one who is well experienced with dealing with sleeves, and is more comfortable with more complex procedures as well. If they recommend an RNY revision, too, then that's a pretty solid confirmation of what's appropriate for your specific case.

The following is a list of abbreviations commonly used on this board. ACL = Anterior cruciate ligament AGB = Adjustable gastric banding AMRAP = As Many Rounds As Possible (crossfit) AT = Aspiration Therapy BB = belly button bc = because BCBS = Blue Cross/Blue Shield BDD = Body Dysmorphic Disorder BED = Binge Eating Disorder bf = best friend BM = bowel movement BMI = Body Mass Index bp = blood pressure BPD = Borderline Personality Disorder or Biliary Pancreatic Diversion bs = blood sugar btw = by the way C25K = Couch Potato to Running 5K CBT = cognitive-behavioral therapy CC = common channel c diff = clostridium difficile cos or cuz = because CPAP = continuous positive airway pressure CRNP = certified registered nurse practitioners CT = Computed Tomography (commonly called CAT Scan) cw = current weight CXR = Chest X-Ray DDD = degenerative disc disease Dr. = doctor DS = Dumping Syndrome or Duodenal Switch EBT = Endoscopic Bariatric Therapies EGD = Esophagogastroduodenoscopy EKG = Electrocardiography ER = emergency room ESG = Endoscopic Sleeve Gastroplasty ff = fat free f/u = follow up GB = gastric bypass GERD = gastroesophageal reflux disease GI = gastrointestinal GIF = Gastric Intrinsic Factor GNC = General Nutrition Corporation store GP = general practitioner or family doctor HBP = high blood pressure hr = heart rate hw = highest weight ICU = Intensive Care Unit Idk = I don’t know IGB = intragastric balloons IF = Intrinsic Factor IMHO = in my humble (honest) opinion IMO = in my opinion IUI = Intrauterine insemination LAP Band = Laparoscopic Adjustable Gastric Band LES = lower esophageal sphincter lol = laughing out loud LSG = Laparoscopic Sleeve Gastrectomy med = medicine MFP = my fitness pal MGB = Mini Gastric Bypass msg = message NAFLD = nonalcoholic fatty liver disease NASH = Nonalcoholic steatohepatitis nf = non fat NG = Nasogastric NP = nurse practitioner NSAIDS = Non-steroidal anti-inflammatory drug NSV = non-Scale victory (“scale” means “weight scale”) NUT = nutritionist OA = Overeaters Anonymous omw = on my way Onederland = a magical place or destination for those trying to lose weight. It might correspond to attaining a weight in the hundreds or losing a hundred pounds. op = operation OSA = Obstructive Sleep Apnea OTC = Over the counter Oz = Australia PB = Productive Burps PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PICC= Peripherally Inserted Central Catheter PM = private message (email) PMS = premenstrual syndrome POSE = Primary Obesity Surgery Endolumenal postop or post–op = post-operation or post-surgery PPI = Proton Pump Inhibitors ppl = people preop or pre-op = pre-operation or pre-surgery PTSD = Post-Traumatic Stress Disorder PVC = Premature ventricular contractions RA = Rheumatoid arthritis RH = reactive hypoglycemia RN = registered nurse RNY = Roux-en-Y RTD = ready to drink Rx = Prescription medicine RYGB = Roux-en-Y gastric bypass SADI-S = single anastomosis duodeno–ileal bypass with sleeve gastrectomy s/f or sf = sugar free SG = Sleeve gastrectomy SIPS = stomach intestinal pylorus-sparing surgery smh = shaking my head, scratching my head SO = significant other SOB = shortness of breath st = stones (a unit of weight measurement) sw = weight at surgery tmi = too much information TPN = total parenteral nutrition TT = tummy tuck TTC = trying to conceive Ty = Thank you. [but according to the urban dictionary “Ty” is also an abbreviation for “a total stud with a massive carrot”.] u = You UGI = Upper Gastrointestinal VSG = Vertical Sleeve Gastrectomy Vit = vitamin wks = weeks WLS = Weight Loss Surgery WOD = Workout of the Day w/o = without wt = weight

We had Chinese about a month ago, or so. I had Hunan Chicken with steamed rice and Chicken Lo Mein. I did not eat the fortune cookies. I didn't dump. But, I took very small amounts and, like you, I definitely stopped before I was full. I don't dump, but I do get reactive hypoglycemia. So, if I'm going to eat something high in carbs, I know that I'm going to have to eat something low carb and high protein within 2 hours, or my blood sugar will crash.

It’s a symptom of ‘mild dumping’ you have experienced I think. I experienced this a lot in the first few weeks and especially as you begin to learn what foods your new tummy likes and what it dislikes rather loudly too. I’d say it’s due to the advocado most likely. Swap to say a very soft poached egg instead. Try adding advocado in a few days to see if it settles better next time. Just because it didn’t quite settle today means your tantrum provoking baby tummy wasn’t quite liking what you fed it but that’s not to say it will not like it in a few days or in a week or a month for example. new tummy means many foods may cause this slight ‘hypo’ feeling even though you may have eaten these foods prior to surgery with no problems. your tummy is new. Brand new like a babies tummy - yet to try food for the first time. Like some babies will vomit, nappy soils a plenty, be colicky or dislike the food - your tummy should be considered like the babies. this feeling you have described is exactly what we all experience. Dumping is like a blood sugar hypo - in bed sweating / cold / shivering / sometimes with loo trips and vomiting and tummy pain but sometimes not. it can last for mere minutes to 5 hours and nearly always zonks you so groggily that you need to sleep. Energy drain and lethargy is instant. This doesn’t mean you’ll have extra sensitivity to dumping either - it’s literally your new tummy telling you it didn’t quite like what you ate. I hope this info and my experience helps you feel reassured. ❤️🥰

Don't think of losing weight as if it were a given symmetrical line going down for each day you burn more than you consume. Your body is a reactive machine and will retain fluids if it's TOM, or you consume processed flour/sugar, or too much sodium or simple carbs. Fluids can create plateaus that last months. If you're exercising, you will retain some fluids due to your body rebuilding torn muscles. If you exercise, you can lose fat but gain weight. Weight vs. fat are two different animals. Burning fat cells and replacing them with muscle cells will make many weight scales stop moving or even increase. This is a long long journey and one or two weeks or even months here or there are inconsequential in the long run. tmf

Thanks. I went to my GP to discuss my sugar problems. He's going to do another GTT. When I have my 5 hour test 19 years ago, they took me to the hospital in an ambulance. I'm really dreading the test next Fri. Ever since I started exercising, I'm having trouble again with my hypo. Doc said I need to eat more carbs. I'm not so sure about that.

No offense, but your doctor is on crack. The last thing a hypo needs for stabilization is carbs. That is such an old school of thought and exactly what has made diabetics fat for so long. Protein, protein, protein! Carbs will certainly give you the immediate rise, but then you crash again. Your foods intake and your body mass and composition are still changing - you haven't "settled" yet. Keep up the protein - if you want to have something before you work out, half a Protein shake is a grand idea.

I feel like shit I barley eat anything , I feel very weak and now I'm having trouble with very low sugars I don't no if I should of had this surgery I'm having dibetic hypos on a daily basis I'm just lost for words really no support out here where I live I feel all alone I'm off to the hospital for a suspected blood clot to can things get any worse ???????? Sent from my SM-N910F using the BariatricPal App

I have hypothyroidism too. I can tell when doses are off. I am thinking its off now. Heart racing lately. I know the signs and symptoms of both hypo and hyper. Maybe this surgery jacks up hormones and changes occur. How long ago did you get banded?

Im not a diabetic however sine being banded 8months ago i have been dealing with low sugars. Its called RHG reactive hypoglycemia for me its when i would eat carbs an not include a protein. So for me i am sticking to a low glycemic index diet an it helps

Welcome! My weight gain came on with hypo-thyroidism also. Welcome to the group! My surgery is April 8th.

I'm concerned about my hypothyroid too, although my doctor thinks my hypo may go away when I lose some weight. Fingers crossed!

I've read so many times in various threads about people eating super low calories, and it always worries me. And also high fat, high Protein, low carb diets... I wanted to post about the dangers of very low calorie diets and of high fat/protein low carb diets, so here is some info and the sources it comes from: "When you want to lose weight, a very low-calorie diet can seem attractive. After all, the sooner you lose weight the better, right? Well...no, that's not right. Eating fewer than 1000 calories a day can, at best be a short-lived attempt at dieting, at worst it could be a recipe for long term health problems. Your body is not designed to function well on a very low calorie diet. In fact, it goes into starvation or famine mode and tries to preserve essential functions at the expense of the less essential ones. So what happens to your body on fewer than 1000 calories a day? Your metabolism slows down to conserve energy. Your body uses blood sugar, made from carbohydrates, for fuel just as a car uses gas (petrol). Without blood sugar, the brain and central nervous system, as well as other bodily systems, will cease to work efficiently. To try to counteract the lack of blood sugar from carbohydrates in the diet, your body will break down fat, which is what you want, but it will also breakdown muscle and other lean body tissue. Losing lean body tissue can be very dangerous. Even organs can be broken down to use as fuel. Losing lean body tissue can also be counter-productive. Muscle tissue increases the resting metabolic rate. With reduced amounts of muscle, your metabolism will slow. When you come off the diet, increased fat cells will form because your metabolism is slow and so your body needs less blood sugar for fuel. It is also a survival mechanism in case of another 'famine'. With very low calorie diets, an imbalance in minerals and electrolytes can occur, which can be dangerous. These govern the balance of fluids in the body allowing nerves and muscles to function. Osteoporosis can be another danger, especially for women. Often dairy products like eggs, milk and cheese are cut out of a very low calorie diet so cutting out a major source of Calcium leading to loss of bone mass. Anaemia (a lack of Iron in the blood) can also be another risk. If taken to extremes, women can find that menstruation (periods) becomes irregular or stops altogether. A lack of serotonin in the brain can be another problem which leads to clinical depression. You might find that the lack of essential nutrients on a very low calorie diet leads to a deterioration in the condition of your hair and nails. One of the great dangers of this kind of dieting is that you can become acclimatised to it. As your body reduces some of its functions, including those of the brain and nerves, and as depression takes hold due to a lack of serotonin, you can slip into anorexia nervosa - a truly life threatening condition. As mentioned above, when you finally come off this diet, you will almost certainly regain all the weight you have lost plus more leading to yoyo dieting, now believed to be dangerous. Altogether, very low calorie diets are a danger to physical and mental health. They are counter-productive and can lead to long term problems as well as a lifetime of yoyo dieting. It is far better to lose weight safely and slowly on a sensible diet." (source reference: http://www.allinfoaboutdietsnutrition.com/index.php?page=21 ) "Low-carb/high-fat diets pose dangerous health risks and may increase the risk of contracting serious chronic diseases. Studies have linked extreme low-carb/high-fat diets to an increased risk of developing certain disease states, including: • Alzheimer disease • blindness and macular degeneration • some forms of cancer • cardiovascular and heart disease • c-reactive protein/inflammation • metabolic syndrome and insulin resistance • osteoporosis • kidney stones This is due to increased levels of saturated fat and dietary protein in the diet, with inadequate nutrition coming from plant-based phyto-chemicals. [/url]Low-carb diets may increase the risk of birth defects and childhood cancers. Bread, Pasta, Breakfast cereals and orange juice — foods that are “off-limits” in a low-carb diet — are fortified with folic acid, a micronutrient essential to the neurological development of fetuses. The U.S. food and Drug Administration currently requires that enriched grain products be fortified with the essential Vitamin folic acid (the synthetic form of naturally occurring folate, or vitamin B-9, found in many leafy green vegetables, fruits and legumes). Since the fortification of grain-based foods with higher levels of folic acid, beginning in 1999, there has been a remarkable 19 percent drop in neural tube birth defects in the United States. Followers of a low-carb diet do not receive the benefits of folic acid fortification. Low-carb/high-fat diets are not more effective for weight loss. According to studies published in the New England Journal of Medicine and the Journal of the American Medical Association, there are no significant differences in weight loss between low-carbohydrate diets and conventional weight-loss plans. The study published in the Journal of the American Medical Association (April 9, 2003) reviewed studies of low-fat diets conducted between 1966 and 2003, and found that weight loss from low-carbohydrate diets was associated with length of diet, pre-diet weight, and the number of calories consumed, but not reduced carbohydrate content. The study published in the New England Journal of Medicine (May 22, 2003) found greater weight loss with a low-carbohydrate diet than a conventional diet during the first six months, but no significant differences in weight were observed after one year.1 Low-carb diets are perceived to be effective because of the rapid, initial weight loss. However, the weight loss is primarily due to the loss of muscle glycogen and Water — not body fat. Loss of muscle glycogen can result in lethargy and fatigue.1 Foods high in carbohydrates, such as fruits and vegetables, are generally more filling — more “bulky” — than foods high in fat, and less prone to overeating. Foods high in fat can increase energy intake (calories) because they are more energy dense, not as “bulky,” and taste good, leaving eaters desiring more and making it easy to over-consume them. A lifestyle that is high in high-fat foods and low in exercise can lead to weight gain. Carbohydrates, such as pasta, do not make you fat. Consistently overeating calories— whether they’re from carbohydrates, fat, or protein — will make you fat. The only genuine, time-tested principle of healthy, long-term weight loss is to take in fewer calories than your body burns. Low-carb diets may cause cognitive difficulties. Carbohydrates are the only source of fuel that the human brain — the most energy-demanding organ in the body — can use. Muscle cells can burn both fat and carbohydrates, but the brain does not have the “machinery” to burn fat. Depriving the brain of carbs means depriving it of energy — and the shortfall can affect intellectual performance, such as memory and cognitive processing.1 Once the body’s glycogen reserve is exhausted, the brain ends up using ketones, a by-product of the breakdown of fat. Ketones are not the optimal energy source for the brain, and their increase in the body has been shown to impair mental judgment.2 Low-carb diets can make people — especially women — short-tempered. A new study at the Massachusetts Institute of Technology found that the brain produces serotonin — which regulates moods and emotions — only after a person consumes sweet or starchy carbohydrates, in combination with very little or no protein. A shortage of serotonin can lead to mood swings and depression. Eating a healthy pasta meal encourages the brain to make serotonin; eating a steak actually stops it from being produced.3 A Healthier Choice According to the American Dietetic Association, the voice of nutrition in America, there are no good or bad foods — only good or bad diets. At “Healthy Pasta Meals,” a recent Barilla-sponsored conference in Rome, Italy, a team of 38 nutrition scientists from around the world concluded that the “Mediterranean diet” is an excellent choice for maintaining overall health. The Mediterranean diet includes abundant plant foods (such as vegetables and pasta); olive oil; dairy products; fewer than four eggs weekly; fish and poultry in low-to-moderate amounts; red meat in low amounts; and wine with meals, in low-to-moderate amounts. A 2003 study in the New England Journal of Medicine found that the Mediterranean diet reduces the risk of death from heart disease and cancer.4" Low-carb/high-fat diets pose dangerous health risks and may increase the risk of contracting serious chronic diseases. Studies have linked extreme low-carb/high-fat diets to an increased risk of developing certain disease states, including: • Alzheimer disease • blindness and macular degeneration • some forms of cancer • cardiovascular and heart disease • c-reactive protein/inflammation • metabolic syndrome and insulin resistance • osteoporosis • kidney stones This is due to increased levels of saturated fat and dietary protein in the diet, with inadequate nutrition coming from plant-based phyto-chemicals. Low-carb diets may increase the risk of birth defects and childhood cancers. Bread, pasta, breakfast cereals and orange juice — foods that are “off-limits” in a low-carb diet — are fortified with folic acid, a micronutrient essential to the neurological development of fetuses. The U.S. Food and Drug Administration currently requires that enriched grain products be fortified with the essential vitamin folic acid (the synthetic form of naturally occurring folate, or vitamin B-9, found in many leafy green vegetables, fruits and legumes). Since the fortification of grain-based foods with higher levels of folic acid, beginning in 1999, there has been a remarkable 19 percent drop in neural tube birth defects in the United States. Followers of a low-carb diet do not receive the benefits of folic acid fortification. Low-carb/high-fat diets are not more effective for weight loss. According to studies published in the New England Journal of Medicine and the Journal of the American Medical Association, there are no significant differences in weight loss between low-carbohydrate diets and conventional weight-loss plans. The study published in the Journal of the American Medical Association (April 9, 2003) reviewed studies of low-fat diets conducted between 1966 and 2003, and found that weight loss from low-carbohydrate diets was associated with length of diet, pre-diet weight, and the number of calories consumed, but not reduced carbohydrate content. The study published in the New England Journal of Medicine (May 22, 2003) found greater weight loss with a low-carbohydrate diet than a conventional diet during the first six months, but no significant differences in weight were observed after one year.1 Low-carb diets are perceived to be effective because of the rapid, initial weight loss. However, the weight loss is primarily due to the loss of muscle glycogen and water — not body fat. Loss of muscle glycogen can result in lethargy and fatigue.1 Foods high in carbohydrates, such as fruits and vegetables, are generally more filling — more “bulky” — than foods high in fat, and less prone to overeating. Foods high in fat can increase energy intake (calories) because they are more energy dense, not as “bulky,” and taste good, leaving eaters desiring more and making it easy to over-consume them. A lifestyle that is high in high-fat foods and low in exercise can lead to weight gain. Carbohydrates, such as pasta, do not make you fat. Consistently overeating calories— whether they’re from carbohydrates, fat, or protein — will make you fat. The only genuine, time-tested principle of healthy, long-term weight loss is to take in fewer calories than your body burns. Low-carb diets may cause cognitive difficulties. Carbohydrates are the only source of fuel that the human brain — the most energy-demanding organ in the body — can use. Muscle cells can burn both fat and carbohydrates, but the brain does not have the “machinery” to burn fat. Depriving the brain of carbs means depriving it of energy — and the shortfall can affect intellectual performance, such as memory and cognitive processing.1 Once the body’s glycogen reserve is exhausted, the brain ends up using ketones, a by-product of the breakdown of fat. Ketones are not the optimal energy source for the brain, and their increase in the body has been shown to impair mental judgment.2 Low-carb diets can make people — especially women — short-tempered. A new study at the Massachusetts Institute of Technology found that the brain produces serotonin — which regulates moods and emotions — only after a person consumes sweet or starchy carbohydrates, in combination with very little or no protein. A shortage of serotonin can lead to mood swings and depression. Eating a healthy pasta meal encourages the brain to make serotonin; eating a steak actually stops it from being produced.3 A Healthier Choice According to the American Dietetic Association, the voice of nutrition in America, there are no good or bad foods — only good or bad diets. At “Healthy Pasta Meals,” a recent Barilla-sponsored conference in Rome, Italy, a team of 38 nutrition scientists from around the world concluded that the “Mediterranean diet” is an excellent choice for maintaining overall health. The Mediterranean diet includes abundant plant foods (such as vegetables and pasta); olive oil; dairy products; fewer than four eggs weekly; fish and poultry in low-to-moderate amounts; red meat in low amounts; and wine with meals, in low-to-moderate amounts. A 2003 study in the New England Journal of Medicine found that the Mediterranean diet reduces the risk of death from heart disease and cancer.4" (source: http://www.barillaus.com/Dangers_of_LowCarb_Diets.aspx ) Take care of yourselves! and research the effects of your choices!!! XO Leila

I thought this was a really great FAQ that answers a few more questions beyond the usual what is a band/how is it adjusted type of question. Also, interestingly, the doctor talks about the causes and repair of erosion, slippage, and pouch dilation. This docter says erosion has to do with the way the band is stitched to your stomach. If that's true, it might explain why erosion is more likely to happen with some surgeons than with others. Just a thought. liquids. That said, average weight loss is 50% of excess weight at 5 years. But this includes all patients, including those who have lost little or no weight. How is the Band adjusted? The Band is tightened by accessing the port with a needle. This is most commonly done in the office. Some surgeons do it at the hospital under x-ray guidance, but this is generally not necessary, and makes the procedure much more expensive. For patients with very thick abdominal walls, it may be more difficult to find the port. In our office we have an ultrasound machine which makes it possible to access most ports without need for x-ray. Can I adjust my own Band? In theory, yes. But the answer is NO. NO. NO :confused: (you just know somebody has tried this at home) Why do I have to take Vitamins? The LapBand operation is purely restrictive, so technically you don't need to take vitamins if you are eating a healthy diet. On the other hand, by definition you are eating a hypo-caloric diet, one which will cause you to lose weight. Because of this, we worry that you won't get all the vitamins and minerals you need. This is the main reason we ask you to take vitamins after the surgery. What about the gallbladder? We don't remove the gallbladder unless you already have gallstones that are causing symptoms. Weight loss is slow and natural, so the risk of gallstones is not sufficiently elevated as to make gallbladder removal worth doing. Can the Band be rejected by my body? The Band is made of silicone rubber, and cannot be rejected. Of course it can become infected and require removal, but this is not the same as being rejected like a transplanted organ. What happens after I lose my weight? The Band causes you to lose weight by restricting your caloric intake to less than your caloric expenditure. As you lose weight, your calorie requirements diminish. Once intake matches expenditure, you stop losing weight. How long does the Band stay in? The Band stays in forever. If it is removed you will regain all the weight you lost. What is a slipped Band, and what causes it? There are two types of slippage; anterior and posterior. This refers to whether the front or back side of the stomach slips. There is something else called concentric pouch dilation, but this is not the same as slippage. Slippage or prolapse is when the stomach slides up through the Band, making the pouch bigger. If this happens the Band usually becomes too tight, and patients experience symptoms of reflux (heartburn) as well as nausea and vomiting. This is because the amount of stomach being “squeezed” by the Band is increased, thereby obstructing the Band. There are several causes. Posterior slippage was more common when the Band was placed by the “perigastric” technique. With this technique the back side of the stomach was free to slide up through the Band. These days most surgeons use the “pars flaccida” technique, which was developed to prevent posterior slippage, and has more or less eliminated the incidence of this problem. Anterior slippage is when the front of the stomach slips up through the Band. We try to prevent this by suturing the stomach below the Band to the stomach above the Band, “locking” the Band in place in the right spot. In spite of this, slippage still occurs. It can happen because we haven't placed enough stitches, or they haven't been placed in the right place. Slippage can also occur if patients eat too much and vomit frequently. How is a slipped Band diagnosed? Fortunately, this is very easy. Often the diagnosis is made based on the history alone. A patient who has been going along fine, with no problems, and then suddenly develops reflux symptoms or symptoms of a too-tight Band will most likely have a slipped Band. The diagnosis is easily confirmed with an x-ray and barium swallow examination. Endoscopy is rarely necessary. How is a slipped Band fixed? A slipped Band needs to be fixed with an operation. The Band has to be dissected out, all the sutures removed, and the position of the stomach made right. Some surgeons remove the Band and place it back through a new tunnel. Others just straighten things out and re-suture the stomach over the Band. What happens if the Band slips again? That's a tough one. One could certainly try to fix the slip again, but my personal view is that, for whatever reason, the Band is just not working for that particular patient, and ought to be removed. What is a Band erosion? This is when the Band actually erodes into the stomach. It is a more serious problem, and generally requires removal of the Band. Band erosion is thought to be related to placing too many sutures (or too tight sutures) at the time of Band implantation. Surprisingly, Band erosion is often unnoticed. Occasionally the port will become infected if bacteria track along the catheter out to the port. Other times patients will stop losing weight. Diagnosis often requires an endoscopy. What is concentric pouch dilation? This is technically not the same as slippage. In this case the pouch just seems to be enlarged. Sometimes partial emptying of the Band may help with this. What is esophageal dilation? This is when the esophagus enlarges over time, and is probably related to either too tight a Band, or possibly improper placement of the Band around the junction of the esophagus and stomach. This requires loosening or removal of the Band. What happens if my Band has to be removed because of complications or failure to lose weight? One option, of course, is to give up on weight loss surgery. Another option is to convert to another procedure such as Roux-en-Y gastric bypass. This can be done at the same time the Band is removed, and is generally done laparoscopically. If you have questions that have not been answered by this FAQ, please send them to me and I will try to answer them for you. Mark A Pleatman MD 43494 Woodward Ave. #202 Bloomfield Hills, Michigan 48302 Office Hours: 9:00 AM to 5:00 PM Phone: (248) 334-5444 Fax: (248) 334-5484 Email: pleatman@laparoscopy.com