December 26, 2024 • 36 mins
In this Q&A-packed episode of the Pound of Cure Weight Loss podcast, Dr. Weiner and Zoe answer listener questions about navigating post-surgery challenges like dumping syndrome, food noise, and pregnancy after weight loss surgery. Here are the highlights:
How to Lower Your Set Point Without Food Noise Sabotaging You
Listener Rain asked about dealing with chocolate cravings after losing just five pounds. The team shared practical tips:
- Balanced Meals: Avoid skipping meals and eat nutrient-dense foods like vegetables, lean proteins, and fiber.
- Curb Sugar Cravings: Plan indulgences and make healthy swaps, such as Greek yogurt with cocoa powder and banana.
- When to Consider Medications: GLP-1 medications like Wegovy or Zepbound may help reduce food noise for sustained weight loss.
Considering Gastric Bypass Revision Surgery
Priscilla asked about revising her sleeve gastrectomy to address severe reflux and weight regain. Dr. Weiner outlined key points:
- Improved Safety: Advances in surgical techniques make bypass surgery much safer today.
- Risks: Be mindful of dumping syndrome, ulcers, and iron deficiency, which require diligent management.
- Benefits: Revision can alleviate reflux and improve long-term health outcomes. Mindful eating is essential for post-revision success.
What is Dumping Syndrome?
Dr. Weiner explained that dumping syndrome, common after bypass surgery, occurs when sugary or fatty foods enter the small intestine too quickly. To manage it:
- Prioritize lean proteins and vegetables.
- Avoid large meals and overly processed foods.
- Practice mindful eating to control portions and prevent discomfort.
Should You Avoid Drinking After Eating?
A listener wondered whether post-op patients must separate eating and drinking. Dr. Weiner dispelled the myth:
- No Universal Rule: The stomach pouch empties quickly, and drinking doesn’t affect fullness.
- Listen to Your Body: Some may feel bloated when drinking with meals, so adjust based on personal comfort.
Pregnancy After Weight Loss Surgery
Amanda sought advice on preparing for pregnancy post-surgery. Key recommendations included:
- Vitamin Adjustments: Switch to prenatal vitamins to ensure proper iron and folate levels while avoiding vitamin A toxicity.
- Mindful Nutrition: Focus on protein-rich, well-balanced meals while avoiding excessive weight gain.
- Manage Risks: Pregnancy slightly increases the chance of bowel obstruction, but with a proactive care team, this can be managed effectively.
Key Takeaways
This episode provides actionable advice for navigating challenges like dumping syndrome, food noise, and post-op pregnancy:
- Manage food noise with balanced meals, planned indulgences, or GLP-1 medications if necessary.
- Gastric bypass revision surgery can resolve reflux but requires careful post-op management.
- Dumping syndrome is manageable with mindful dietary adjustments.
- Pregnancy after surgery is safe and healthier with proper preparation and care.
Join the Conversation
Submit your questions for future episodes and let Dr. Weiner and Zoe guide you with science-backed strategies for success after weight loss surgery.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Zoe (00:00):
I'm not eating and drinking at the same time.
It's a very common advice,especially if you're in
different Facebook groups andyou ask Google and whatever else
.
But it's not a hard and fastrule, especially not in our
practice.
And what's more important thanthat is actually being really
good at recognizing and honoringwhen your body is telling you
to stop.
(00:20):
Welcome back to the Pound ofCure Weight Loss Podcast.
Here we are with a Q&A episodeThirst Trap why it's Okay to
Drink After you Eat.
That's a clever title.
Dr. Weiner (00:35):
That's we're trying to keep it clean here.
All right, we have some goodquestions.
We're actually been getting alot of questions lately.
Zoe (00:47):
Keep them coming people.
Dr. Weiner (00:48):
Please keep them coming, and I think for me it's
the questions sometimes thattell me, hey, we're getting
somewhere, because we're reallygetting a lot of very thoughtful
questions.
I'm also seeing in the office aton of people who've really
they've done their researchbefore coming in to see me, and
that is also so much fun becauseit takes it from the hi.
(01:11):
Let me talk to you aboutbariatric surgery.
This is a gastric bypass.
This is a sleeve to gettinginto the nuance and the real
complexity about theirindividual life, their wishes
and their wants and what they'rehoping to get for.
We can dig in at that veryfirst visit and really make a
lot of headway and formulate agreat plan for these patients.
Zoe (01:32):
Great individual life.
Dr. Weiner (01:33):
Yeah, so I love that that's happening as well.
It's something I think you know.
That's what I hoped wouldhappen with a podcast, and it's
definitely out there, so keepthe good questions coming.
We really love answering themand hearing from you guys.
Zoe (01:46):
Yeah, feel free to send us a message on Instagram, tiktok,
facebook.
We have a special spot on ourwebsite that you can see it, or
YouTube, of course.
Anywhere you want to put aquestion, we'll be sure to see
it.
Dr. Weiner (01:59):
Yes, so we're going to have Sierra Sierra's our
office manager and she reallyruns the show in our office and
I think anybody who's evercalled our office we answer the
phones, which is fairly uniqueamongst medical offices, and we
really have a great officeculture and everybody gets along
(02:20):
and I think we all really enjoycaring for our patients and
that's largely due to Sierra.
So, sierra, why don't you startwith our first question, please
?
Sierra (02:28):
First question comes from episode 36.
It pays to be thin from rain.
How do I change my set pointwithout food noise ruining my
efforts?
Even when my diet and exerciseis on point at the end of the
day, my craving for chocolate isso incredibly intense.
This usually starts happeningonce I lose five pounds and I
(02:50):
can't figure out how to stopthat uptick in cravings.
Zoe (02:54):
Okay.
So there's a lot to unpack hereand there are a lot of
different directions that Iwould want to know more about.
The first thing that comes, Imean the first thing, but
there's like so many things thatI would want to know is okay if
you are not eating very muchthroughout the day, or enough,
or maybe skipping breakfast orskipping meals, trying to quote,
(03:15):
be good or eat as little aspossible that maybe that old
dieting mindset has given yourestrictive.
What I find oftentimes, if itis that way during the day
cravings specifically sugarcravings at night is that way
for your body to play catch upand it's like give me the
nutrition that I need in theform of cravings.
So that's one thing I would sayis like let's make sure you're
(03:39):
eating consistently, eatingenough of those nutrient dense,
nutritious foods.
You mentioned that maybe youcould be eating a little bit
more vegetables.
Making sure you're gettingenough protein, enough
nutrient-dense vegetables, fiber, making sure your body is given
what it needs, will make thosecravings less likely.
Something else to think aboutis if it is related to that
(04:04):
weight loss.
And so when you lose weight andyour metabolic thermostat isn't
actually going down with it,but you're just losing those
five pounds, your body is tryingto stay safe.
It's trying to get you back tothat, that higher weight, that
higher set point, that you'reset point.
And so the way that it can dothat is by triggering cravings
(04:27):
to make you want to eat them, tomake you get back to that set
point.
So focusing on those nutrientdense you know, maybe doing the
metabolic reset diet, focusingon that volume, those
unprocessed foods, to bring yourset point down along with that
weight loss.
And then the other thing tothink about is I mean, what is a
life if you're never going tohave chocolate again?
(04:48):
It's, you know, not one that Iwould want to live.
But, with that being said,completely depriving yourself
all the time is a surefire wayto stay hyper, fixated on it and
to keep having those intensecravings.
So I would recommend a coupleof different strategies, one
being a planned indulgence, asurefire way to stay hyper,
(05:09):
fixated on it and to keep havingthose intense cravings.
So I would recommend a coupledifferent strategies, one being
a planned indulgence.
So maybe it's, you know, everycouple of weeks or whatever
works for you having a specificoccasion where you know you're
going to go out and maybe youshare a you know chocolate cake
with your partner after datenight or whatever it is.
So it's something to lookforward to, it's planned, you
don't feel guilty about it, itkeeps you on track.
The other thing is like, howcan we do these little swaps on
(05:33):
a daily basis that I do all thetime, because I also have a
sweet tooth and I love chocolate, but I want to make sure that
what I'm having is still alignedwith maintaining my health,
maintaining my weight.
So maybe it's you do a Greekyogurt, unsweetened cocoa powder
, mashed banana situation, soyou get that chocolatey flavor,
(05:54):
but you're having something thathas protein and fiber along
with it.
So there's a lot of directionsto kind of go with.
Dr. Weiner (06:02):
So I have a question for you and this you know, to
me chocolate is a little bit,it's almost a little bit
different than other foodsbecause it almost feels to some
degree like chocolate is likeuniquely addictive.
There are certainly some peopleyou think it's just the
caffeine.
Zoe (06:16):
Maybe not just the caffeine , but there's caffeine in it.
Dr. Weiner (06:18):
Yeah, no, there is for sure.
So it always has felt like youknow, is a chocolate craving an
addiction or is it just kind ofa preference or a soothing thing
?
Because let's just say, andlet's just say, we're talking
about alcohol and someone's analcoholic.
The advice that most people aregoing to give is not going to
be like, you know, if you had adrink once or twice a week
(06:40):
instead of all the time.
We all understand that alcoholis an addiction, and I'm not
saying chocolate is either, butwhat element of that is is this
is chocolate craving?
Is that an addiction or is thata preference?
And is it, is it going to bepossible for everybody to
modulate their chocolate intake,or are there going to be people
(07:00):
out there who just they justcan't have chocolate because
they're just so hooked on it?
Zoe (07:04):
Well, I think that goes for sugar, maybe chocolate
specifically.
But I know we have severalpatients who knows that
addiction to sugar is truly anaddiction and they just have to
just not do it at all.
And for those people having aplanned indulgence is not the
answer.
So it is very individualized,for sure.
Dr. Weiner (07:26):
It really is.
I think most people probablycan figure it out and do that
plan indulgence like you talkabout, but there are definitely
people who are so and I hatethis word but triggered by
chocolate or sweets or otherthings like that, and that they
have to completely avoid italtogether.
What I think is alsointeresting about this person is
(07:46):
that it's losing five pounds.
That brings on that craving,and that's, I think, what you
said about the importance ofproviding yourself all the
nutrition and trying to look ata set point lowering diet, like
the metabolic reset diet.
(08:07):
That, to me, is kind of areally important strategy that
you have to replace food.
You have to give yourself tonsof phytonutrients and a lot of
times cravings are fromnutritional deficits.
Zoe (08:19):
Yeah.
Dr. Weiner (08:21):
And so that also is.
Maybe there's a deficit ofanother food, something you know
chocolate has a lot ofphytonutrients in it, and so
maybe there's a similar foodthat has a lot of phyton, of
similar phytonutrients, in it.
Cocoa powder is a great, greatone, because it's good.
It is chocolate, um, and thecocoa powder itself isn't, isn't
harmful, it's probably a prettyhealthy thing to eat.
Actually, it's all the sugar,the milk and the fat that we add
(08:43):
to it.
But anyway.
So I think that's a reallyimportant thing.
I think another piece of thisis medications.
Now we talk aboutfirst-generation and then
second-generation meds.
And the first generation arelike Phentermine and kind of the
old-school drugs whichgenerally don't work too well
for weight loss.
But Contrave is one.
(09:05):
It's a combination of bupropionand naltrexone, so it's an
antidepressant and thennaltrexone is an opioid blocker
and I've used sometimes justnaltrexone alone and it's dirt
cheap and sometimes somethinglike that could be helpful for
someone in this situation.
I think if we start getting theheavy hitters, the GLP-1 meds,
the Wegovi, the Zepound, they'reprobably going to help with
(09:35):
this.
A ton a ton.
And so again, if this person'sonly trying to lose 10 pounds
and at five pounds is gettingstuck, I don't know that a GLP-1
is appropriate.
But if they're looking to lose30, 40, 50 pounds, then I think
a GLP-1 might be a really goodanswer, in addition to all the
nutritional stuff if that'ssomething that person would be
interested in Like a long-termoverdose could be a good issue.
All right, Sierra, what's ournext question?
Sierra (09:56):
Next question comes from Priscilla on Instagram.
What are the commoncomplications of the Roux-en-Y
gastric bypass revisionsurgeries?
I'm considering but reallyscared.
How are the complicationscorrected?
I'm considering this because Ihave severe acid reflux from my
sleeve eight years ago and haveweight regain.
Dr. Weiner (10:17):
There's been this.
I think there's over the years.
There's been this whole thingwhere a sleeve is this and a
gastric bypass is so much moredrastic and so much different
than a sleeve and I've doneplenty of both surgeries and
I've been doing this for a longtime.
I look at them really as kindof points on a spectrum, as
(10:40):
opposed to this like drasticallydifferent surgeries.
I think in the old days when weweren't as good at doing
gastric bypasses and there werelike sepsis and ICU and all this
kind of leaks and perforationsand all these kind of terrible
things, we saw those with agastric bypass and, as I've
(11:00):
talked about before on the show.
A sleeve is easy, like it is nota hard surgery to do.
There's a few little tricks tomake it come out nicely, but
it's not something where it'slike touch and go.
A gastric bypass is much morechallenging to do.
You're connected.
You're doing two connections.
(11:21):
Things have to reach andstretch and sit nicely and the
tissue integrity plays a role.
We've gotten very, very, verygood at doing the surgery and so
we've eliminated a lot of thesekind of terrible, awful gastric
bypass stories which in generalare surgical complications, and
(11:41):
so if you do the gastric bypasscorrectly, then the long-term
consequences of a gastric bypassto me are fairly similar in
scope and severity to thelong-term consequences of a
sleeve gastrectomy, and so Ithink that's the first thing
that you know.
You can't look back at 10 or 15years of gastric bypass history
(12:02):
and say, well, that's what'shappening now too.
It's a very different surgerynow, and if you go to someone
who does the surgery regularly,you know I sleep great at night.
Nobody wakes me up in themiddle of the night.
Nobody's crashing and burning.
I'm not going into visiting mypatients in the ICU or taking
people back to the OR.
I do the surgery, I go home, Igo to sleep.
(12:25):
I just rounded this morning.
Oh how you doing Great, readyto go home, yeah, let's go.
Zoe (12:29):
So many people are like did he even do the surgery?
I feel no pain, I get that somuch.
Dr. Weiner (12:36):
I mean.
That means, I'm doing my jobright.
It's not a terribly painfulsurgery.
With some strategy, get can geton the new other diet and
eating is the hardest part, andthat's where you come in helping
them.
And again, a quick reminderanybody out there, if you've
just had surgery and you wantsome nutritional help for sign
up for our nutrition program.
You can meet with zoe almostevery day to get you back on
(12:58):
your post-op eating book, eatingplan.
Um, so anyways, but there aredifferences between the two
surgeries and there are somethings that you need to consider
before going from a sleeve to agastric bypass.
I think the first and mostobvious one is dumping syndrome.
We really don't see a dumpingsyndrome with a sleeve.
There's a little bit of it, butit's not the same as what we
(13:21):
see with a bypass, which meansthat fatty, greasy, sugary foods
cause GI distress, and so yourbody's going to comment a little
more on that.
Alcohol use and again, we dosee a little bit of an increased
risk of alcoholism with asleeve, but not like we see it
with a bypass.
(13:41):
You absorb alcohol differently,you get drunk faster, it wears
off faster and it's moreaddictive after surgery, and so
I think you have to be much morecareful with alcohol use after
the surgery.
Smoking is just a hard no aftera gastric bypass.
And then there's really threecomplications, three long-term
complications that we see aftera gastric bypass.
(14:04):
The first is ulcers, andthey're quite uncommon,
thankfully.
I'd say probably 1% or less ofpeople have major issues with
ulcers, but they can bleed, theycan perforate and they can be a
real problem.
They're particularlychallenging when you've gone
from a sleeve to a bypass,because your bailout move if
(14:28):
someone has just a terrible,awful ulcer that we're really
struggling to be able to treat,your bailout move is to actually
reverse the gastric bypass.
Oh geez, use the old stomach.
I've done that, I think, fivetimes in my career.
So it's not something I've donewith any regularity, but it is
like your bailout safety move.
(14:48):
If you've had a sleeve, youdon't have that because the
portion of the stomach's beenremoved that would allow you to
reverse it.
So that, to me, is kind of theone thing.
That, to me, is kind of the onething, that being said, I've
had out of.
You know, I see probably 10 to15 new patients a week, and so
you put that at 500 a year,let's say over almost 20 years
(15:12):
of practice.
Maybe not quite that volume,but I've seen a lot of patients
over the years.
I think I've seen this reallycome to a head two or three
times at most.
Zoe (15:22):
So out of maybe 10,000 patients.
Dr. Weiner (15:23):
I've seen two or three times, I've seen this
become an issue.
So I don't want anybody outthere to think, oh, don't have
this surgery because you'll getan ulcer and then you'll be
screwed.
It's a really, really uncommonthing.
Zoe (15:35):
Well, and smoking can cause the ulcer.
Most ulcers are preventable,which is why it's right, exactly
why we want to listen to therecommendations.
Dr. Weiner (15:44):
Smoking alcohol, nsaids.
Zoe (15:46):
Right.
Dr. Weiner (15:47):
That's probably responsible for 85% of the
ulcers that we see Bowelobstruction the intestines can
twist on themselves.
After surgery.
You develop severe abdominalpain.
That can be catastrophic I'veseen it twice in my career be
catastrophic but for themajority of patients it's like
appendicitis.
And so the key really and inthose two situations when it was
(16:10):
catastrophic it was a delay indiagnosis.
And so as long as you seek helpand treatment for your abdominal
pain after bariatric surgery,after gastric bypass, from a
bariatric surgeon, that's notgoing to get missed and it
really is a very treatableproblem.
(16:30):
And I think the frequency isdecreasing.
I used to feel like I did likeone of these a month and now I
feel like I've done one thisyear so far.
So it's much more uncommon.
I think that the nutritionaldeficiency we see is iron
deficiency, without question,and we can see a little bit
after a sleeve, but it's muchmore profound after a bypass.
You check your iron, you takeyour iron regularly.
(16:53):
It's a manageable problem.
I think the other piece of thisis that severe acid reflux is
not benign.
It's not benign first of allbecause it's miserable.
It's a miserable way to liveand second of all because
chronic acid exposure to theesophagus increases the risk of
esophageal cancer, and so werecommend endoscopy every three
(17:14):
years for anybody who's had asleeve and has heartburn
symptoms, to screen forBarrett's esophagus, which is a
premalignant condition.
So kind of living the rest ofyour life with acid reflux in my
mind may be your riskiestoption of all the things we've
talked about.
So you know, what I wouldadvise to Priscilla is please
(17:40):
find someone who does thissurgery regularly and have them
do it and move forward with this, because it might help with
your weight loss, and it'sdefinitely going to help with
your acid reflux.
So what do you see in yourpractice in terms of the
differences between eating aftera bypass versus eating after a
sleep?
(18:00):
Is there much difference?
You know what are patientsexperiencing.
What do you see?
Zoe (18:05):
Yeah, you know, I mean obviously the iron being the
number one nutritionaldeficiency, but in terms of,
like, the progression of thesteps after you know,
introducing the foods back insame steps, maybe you know what
I see with the revision is thatyou can sometimes go through
those steps a little bit morequickly, kind of like your body
(18:26):
knows what to do.
But you know, in general therecommendations are going to be
the same.
You know, um big emphasis onmindful eating.
Sleeve patients can oftentimeseat a little bit more than the
bypass patients, maybe over timeand that kind of thing.
But ultimately we give the samerecommendations and that that
(18:47):
vitamin deficiency, with theiron is, is the main thing with
the vitamins.
That's going to be different.
Dr. Weiner (18:53):
Yeah, there's also, I think, some differences in
terms of with the sleeve, it'sthe amount that you can eat that
really determines what yoursymptoms are.
But the it's the amount thatyou can eat that really
determines what your symptomsare.
With a bypass, it's the amount.
That's also what you need.
Zoe (19:05):
Right, like going past that point of fullness.
That's where the mindful eatingcomes in.
We really want to get good, nomatter which surgery you've
gotten really good atrecognizing when your body is
telling you to stop.
Because, just like you weresaying, yes, going too much, you
know volume.
On either end, whether it's thesleeve or the bypass, it's
(19:27):
going to be uncomfortable, maybecause nausea, vomiting, that
sort of thing.
But, like you were saying, withthe bypass you could get that
dumping syndrome with thosesugary or fatty foods versus
maybe not experiencing that somuch with the sleeve.
Dr. Weiner (19:40):
Yeah, so I'll give you my theory on why and I and I
totally agree with you when yougo from a sleeve to a bypass, I
think you could progress yourdiet much faster.
So I think there's two factorsthat cause you to have
difficulty eating in theimmediate phase after surgery.
One is kind of anatomicswelling and just a new anatomy,
(20:01):
but the other is the set point.
Your set point is so loweredand your body is working so hard
to drive that weight loss thatit just causes this kind of
nausea and food aversion andit's the opposite of, the
opposite of hunger is not full,it's nauseous.
And I think that the surgery isworking so well for a small
(20:23):
group of people that they havesome nausea and that it's that
opposite of hunger effect.
Now, when you go from a sleeveto a bypass, you don't get that
big set point lowering becauseyou've already gotten it from
the sleeve and so you're justgetting the difference between
the two.
So you really just have theanatomic effects, which tend to
be much more modest compared tosome of the set point lowering
(20:45):
effects in terms of impactingyour ability to eat.
Just, my theory I got zeroscience to support that.
All right, sarah.
What's our next question?
Sierra (20:53):
This question came in by email.
Is it necessary for bariatricpatients to not drink for 30
minutes after they eat if theyare a couple years out from
surgery?
Zoe (21:03):
Okay, so this is where our title comes from.
You know, not eating anddrinking at the same time.
It's a very common advice,especially if you're in
different Facebook groups andyou ask Google and whatever else
, and you know that it's kind ofa guideline to start, but it's
not a hard and fast rule,especially not in our practice.
And what's more important thanthat is actually the mindful
(21:27):
eating piece again, so that youagain, like I said just not too
long ago, being really good atrecognizing and honoring when
your body is telling you to stop, and you're learning new
anatomy, you're learning yournew body, you're learning your
new satiety signals, and so it'sthat's the most important is
relearning how to eat.
(21:47):
And you might find that I wasjust talking to somebody before
this um in one of our supportgroups who was saying you know
she doesn't necessarily wait tostop drinking up until when she
eats, but she knows if shestarts drinking right away
afterwards she feels really full.
So I think not just the mindfuleating pieces is knowing that
(22:07):
everybody's different andknowing that you are going to
have to learn what works for you.
Dr. Weiner (22:13):
Yeah, I think that's that's really the essence of
getting through the surgerycomfortably is some people.
There are people out there whowhen they drink it and eat at
the same time, causes some painand discomfort.
I think it's a minor, it's arelatively small group and I
think even if it happens to youat first, it doesn't mean that's
how you got to live the rest ofyour life, because this is
(22:35):
changing over time, right, andwhat you experience at one week
after surgery and what youexperience of one year
completely different, completelydifferent.
So I think that's again wheremindful eating comes in is it
allows you to to kind of adjustyour behaviors and your
strategies as your anatomy andyour stomach and everything
heals and changes.
This is, without question, avery, very common myth that
(22:58):
still is out there.
Zoe (23:00):
Yeah, yeah, yeah.
Um but and this is somethingthat, you know, we kind of warn,
I warn patients about in thepre-op session um, just like
being on the lookout but knowingthat this isn't something that
you have to do forever and thateverybody is kind of different.
Dr. Weiner (23:16):
There's, there's, I think there's two places where
there's two reasons why peopleexcite, and I feel like it's
almost 50-50.
The first reason is that if youeat and then you drink, it's
going to wash the food throughyour pouch and so you're not
going to feel full, and I thinkthat reason holds absolutely
(23:38):
zero water, no pun intended.
Holds absolutely zero water, nopun intended.
So the reason is is because,first of all and I've sat there
and I've watched these studiesIf you have someone drink after
a gastric bypass or we even dosometimes some food studies
where we take barium and kind ofput it on top of the food and
watch people eat the food, ifyou watch someone eats the food,
(23:59):
it goes through their esophagus, it sits in their stomach pouch
.
How long watch someone eats thefood?
It goes through their esophagus, it sits in their stomach pouch
.
How long do you think it isuntil it's in the small
intestine?
A minute.
Zoe (24:09):
It's washing through quickly regardless.
Dr. Weiner (24:10):
It's going through quickly, regardless, right?
And when you drink water it'sthrough immediately.
So the surgery isn't working byfilling your pouch up.
And when your pouch is full,well, then you're full too, and
that's where that whole quartercup of food, or how much does my
pouch hold?
Your pouch doesn't holdanything.
Zoe (24:30):
It all goes right through it, which is why we don't assign
specific portion sizes.
Dr. Weiner (24:34):
Exactly so.
I think understanding themechanics of pouch emptying kind
of shows you that that justdoesn't make any sense at all.
The food doesn't sit there foran hour or two and you feel full
when the pouch is empty.
It's a much, much morecomplicated issue.
The more common thing and Ithink the idea that does hold
water is that drinking andeating can be uncomfortable.
(24:56):
And you eat and then you drinkon top of it and you, like, fall
off too much and everythingstarts to stretch and that can
be very uncomfortable and reallythe risk in that situation is
your own pain and suffering andvomiting, and so you're not
going to perforate or cause lessweight loss or have any kind of
(25:16):
negative long-term consequence.
You just get uncomfortable.
Negative long-term consequence,you just get uncomfortable.
And to me this is just, insteadof like making some rule for
every single patient who's everhad bariatric surgery, where it
only applies to maybe 5% of them, we teach mindful eating
strategies and teach people howto kind of monitor and determine
.
Hey, if every time I drink andeat it hurts, I'm going to learn
to not drink and eat at thesame time.
(25:37):
I'm going to separate it alittle bit If every time I drink
and eat.
I don't notice any difference.
Last question what do we have?
Sierra (25:48):
This question comes from YouTube from Amanda.
I'm about to have the gastricbypass surgery and plan on
trying to conceive about 18months to two years post-op.
I have two questions involvingbariatric surgery and pregnancy.
One outside of taking mybariatric vitamins and getting
my labs done regularly, what canI do from a nutritional
(26:09):
standpoint to prepare my bodyfor a healthy pregnancy?
And two, from an anatomicalstandpoint, is there a higher
risk of bowel obstruction duringpregnancy, since the womb would
be taking up so much space anddisplacing the bowel?
Thank you so much for all ofyour content.
I have enjoyed watching all ofyour videos and listening to
your podcasts over the lastseveral months.
Dr. Weiner (26:30):
Okay, so this question to me is exactly what I
was talking about.
I have enjoyed watching all ofyour videos and listening to
your podcasts over the lastseveral months.
Okay, so this question to me isexactly what I was talking about
earlier, when we were sayingabout how we get these great
questions and it shows us likehere's someone, they're making
major life decisions here andthey're making it with some
really accurate, helpfulthoughts about this thing.
(26:51):
So let's kind of break thisdown.
So, first of all, what do yourecommend vitamin-wise for
pregnancy, for pregnant patients?
Zoe (26:58):
So with a history of bariatric surgery, we would
recommend discontinuing thebariatric-specific vitamin and
doing two prenatal vitaminsinstead.
And doing two prenatal vitaminsinstead.
The reason why is because wewant to make sure you're getting
the proper amounts of iron andfolate for proper fetus
development.
But the vitamin A toxicity riskis greater with the bariatric
(27:24):
vitamins and vitamin A toxicityfor a developing fetus can
result in spina bifida or acleft palax.
It's in the that um the neuralneural tube neural yes we both
took embryology, but it's been along time, yeah, a long time,
for me for sure vitamin wise,that's what we would recommend
(27:46):
and, of course, like gettingyour labs checked regularly as
well, and then, from a generalnutrition perspective, making
sure you're getting enoughprotein, making sure you're
getting enough hydration andadequate nutrition as a whole
like really focusing on thatwell balanced diet.
Dr. Weiner (28:02):
Yeah.
So I think from a bowelobstruction perspective, there
is an increased risk duringpregnancy, and so we you know
I've done this surgery a handfulof times, thankfully not very
often.
But patients can develop aninternal hernia or small bowel
obstruction, typically in thethird trimester, when the uterus
(28:23):
kind of pushes everything up,and so so Amanda, as she's done
her homework, I mean, this isnot something that's like widely
out there in every pregnancyliterature.
I think the OBGYNs, I can tellyou, at Tucson Medical Center
where we work, the OBGYNs aretuned into this.
So the few times I've beeninvolved, the OBGYNs are the
ones who picked it.
They made the diagnosis.
They didn't call me and saythere's a patient who had
(28:44):
bariatric surgery, has abdominalpain, can you help?
They said there's a patient whohad a bariatric surgery.
I think she has an internalhernia.
I'm ordering her a CAT scan.
I wanted to give you a heads upbecause she is going to need
surgery ASAP if she has it.
And so I've been able to reducethe bowel obstruction, do it
laparoscopically, and none ofthese well, one of them actually
(29:05):
, they were, I think, 36 weeks,which was more than adequate for
development, and we did aC-section and I fixed her hernia
.
At the same time, there wasanother one who I was able to
release the bowel obstructionand she was able to finish out
her pregnancy.
Wow yeah.
So if you get the right teamand that team is your OB and the
(29:27):
bariatric surgeon this is asolvable problem.
Now, this is again notsomething that is happening all
the time, but it is.
There's that kind of smallfraction of a percent of women
who develop a bowel obstructionduring pregnancy, after a
gastric bypass, and it is scary,but it you know, it is not a
untreatable problem.
(29:48):
I think the bottom line also isif you're out there, you're
pregnant, you've had a gastricbypass and you have
unexplainable abdominal pain,it's probably worth a visit to
your bariatric surgeon and weactually will do CAT scans.
Even though the radiation, youknow, can be harmful to the
fetus, it's not nearly asharmful as missing this
diagnosis Right.
And so we will do CAT scans onthese patients, and I've looked
(30:11):
at these CAT scans and it'shonestly it's a pretty
impressive.
You're looking at a CAT scanand then in the middle there's a
baby.
Zoe (30:17):
I know.
Dr. Weiner (30:18):
I know it's kind of crazy, but yeah, this is a very
real risk.
But I think it's also importantto understand that having a
child and conceiving when you'resubstantially obese is also
quite risky, and I've talked tomany OBs about this and they all
(30:40):
have told me I would muchrather take care of a patient
after bariatric surgery and kindof manage this minor
nutritional issues and this very, very unlikely risk of bowel
obstruction, then manage a 280pound woman gaining 50 or 60
pounds during a pregnancy andthen delivering emergently.
That is very, very harrowing anddifficult and risky.
(31:04):
And so you know, likeeverything in life, there's risk
on either side of thesedecisions, and so I think it's
important to that I would never.
I think when you weigh riskbenefits on this risk benefits
to the mom, risk benefits to thebaby it's going to favor
surgery massively 18 months ormore after.
So that's our recommendation.
That's what the data out thereshows is that after 18 months
(31:27):
it's probably as safe, if notsafer, to have to be to conceive
after bariatric surgery.
And again, on GLP-1s GLP-1s arecontraindicated in pregnancy,
so if you are, I think theyrecommend trying to stopping
them two weeks before you try toconceive.
Zoe (31:45):
Or as soon as you find out you're pregnant, because that's
something we see a lot.
Dr. Weiner (31:49):
Yeah, that's not recommended, but that's that's
an unanswered question at thispoint.
So again, I think you talked alittle bit about the vitamins,
but what about nutrition?
What do you recommend from anutritional perspective for
someone who is pregnant?
Zoe (32:05):
Well, like I mentioned, having that overall
well-balanced diet, reallyprioritizing that protein.
But I think there's thismisconception that you need a
whole bunch of extra calories.
The reality is it's really onlylike a couple hundred max of
extra calories, so you're noteating for two, especially if
you do have a history of, youknow, the gastric bypass and you
(32:30):
want to make sure that you'remaybe minimizing excess weight
gain, really being in tune withthat mindful eating, maybe only
bumping up your, your proteinand your overall calories by a
couple hundred.
Dr. Weiner (32:41):
Yeah, I think you know you're, you're not eating
for two, you're eating for like1.1, but but I think also,
there's never a time in yourlife when it's more important
for you to eat well than whenyou're pregnant, and I think
that's the exact opposite thanwhat we've been.
You're eating for, true, go forit, right, yeah, and so I think
(33:02):
we, we we've been giving peoplepretty bad advice about eating
during pregnancy, and I think wehave to make sure that's that's
as a community.
Yeah, but we as a community, Isay we as healthcare providers.
Zoe (33:16):
Yeah.
Dr. Weiner (33:16):
Yeah, yeah.
So anyway, I think we have torecognize that, that there's
also this concept of epigenetics.
So your genetics are your genesthat you pass on to your
offspring.
But genes are not this staticthing where, once you pass it on
, well that's what's going tohappen to you.
There's something calledepigenetics and that's our
(33:38):
body's ability to turn on andoff certain genes.
It's so fast, it's so fast, andwhat it does is it allows us to
kind of evolve, not over 20generations, which is kind of
how DNA will change, but overone or two generations, because
it can turn on certain genes.
And so when you're eating abunch of garbage and you're
(34:00):
you're developing child isexposed to the same foods that
you're eating.
I mean, when you're eating,you're feeding your baby too,
and so you're exposing yourchild to processed foods, to
processed crap.
It's turning on those genesthat cause obesity, that cause
diabetes and that cause allthese health problems that
you're not going to want yourchild to have.
(34:21):
When you're eating reallyhealthy, you're turning on genes
that promote health andwellness and insulin response,
not insulin resistance andinsulin response, not insulin
resistance, and so it's soimportant to kind of push the
right foods into your baby sothat you're turning on the very
best genes that you can from ahealth perspective.
(34:41):
So great questions.
This segment I know really goodquestions Again.
Zoe (34:46):
keep those questions coming .
Let us know what we can helpyou with.
We are excited to potentiallyanswer it on the next show.
Dr. Weiner (34:53):
All right, we'll see you next time.
I'm not eating and drinking at the same time.
It's a very common advice,especially if you're in
different Facebook groups andyou ask Google and whatever else
.
But it's not a hard and fastrule, especially not in our
practice.
And what's more important thanthat is actually being really
good at recognizing and honoringwhen your body is telling you
to stop.
(00:20):
Welcome back to the Pound ofCure Weight Loss Podcast.
Here we are with a Q&A episodeThirst Trap why it's Okay to
Drink After you Eat.
That's a clever title.
Dr. Weiner (00:35):
That's we're trying to keep it clean here.
All right, we have some goodquestions.
We're actually been getting alot of questions lately.
Zoe (00:47):
Keep them coming people.
Dr. Weiner (00:48):
Please keep them coming, and I think for me it's
the questions sometimes thattell me, hey, we're getting
somewhere, because we're reallygetting a lot of very thoughtful
questions.
I'm also seeing in the office aton of people who've really
they've done their researchbefore coming in to see me, and
that is also so much fun becauseit takes it from the hi.
(01:11):
Let me talk to you aboutbariatric surgery.
This is a gastric bypass.
This is a sleeve to gettinginto the nuance and the real
complexity about theirindividual life, their wishes
and their wants and what they'rehoping to get for.
We can dig in at that veryfirst visit and really make a
lot of headway and formulate agreat plan for these patients.
Zoe (01:32):
Great individual life.
Dr. Weiner (01:33):
Yeah, so I love that that's happening as well.
It's something I think you know.
That's what I hoped wouldhappen with a podcast, and it's
definitely out there, so keepthe good questions coming.
We really love answering themand hearing from you guys.
Zoe (01:46):
Yeah, feel free to send us a message on Instagram, tiktok,
facebook.
We have a special spot on ourwebsite that you can see it, or
YouTube, of course.
Anywhere you want to put aquestion, we'll be sure to see
it.
Dr. Weiner (01:59):
Yes, so we're going to have Sierra Sierra's our
office manager and she reallyruns the show in our office and
I think anybody who's evercalled our office we answer the
phones, which is fairly uniqueamongst medical offices, and we
really have a great officeculture and everybody gets along
(02:20):
and I think we all really enjoycaring for our patients and
that's largely due to Sierra.
So, sierra, why don't you startwith our first question, please
?
Sierra (02:28):
First question comes from episode 36.
It pays to be thin from rain.
How do I change my set pointwithout food noise ruining my
efforts?
Even when my diet and exerciseis on point at the end of the
day, my craving for chocolate isso incredibly intense.
This usually starts happeningonce I lose five pounds and I
(02:50):
can't figure out how to stopthat uptick in cravings.
Zoe (02:54):
Okay.
So there's a lot to unpack hereand there are a lot of
different directions that Iwould want to know more about.
The first thing that comes, Imean the first thing, but
there's like so many things thatI would want to know is okay if
you are not eating very muchthroughout the day, or enough,
or maybe skipping breakfast orskipping meals, trying to quote,
(03:15):
be good or eat as little aspossible that maybe that old
dieting mindset has given yourestrictive.
What I find oftentimes, if itis that way during the day
cravings specifically sugarcravings at night is that way
for your body to play catch upand it's like give me the
nutrition that I need in theform of cravings.
So that's one thing I would sayis like let's make sure you're
(03:39):
eating consistently, eatingenough of those nutrient dense,
nutritious foods.
You mentioned that maybe youcould be eating a little bit
more vegetables.
Making sure you're gettingenough protein, enough
nutrient-dense vegetables, fiber, making sure your body is given
what it needs, will make thosecravings less likely.
Something else to think aboutis if it is related to that
(04:04):
weight loss.
And so when you lose weight andyour metabolic thermostat isn't
actually going down with it,but you're just losing those
five pounds, your body is tryingto stay safe.
It's trying to get you back tothat, that higher weight, that
higher set point, that you'reset point.
And so the way that it can dothat is by triggering cravings
(04:27):
to make you want to eat them, tomake you get back to that set
point.
So focusing on those nutrientdense you know, maybe doing the
metabolic reset diet, focusingon that volume, those
unprocessed foods, to bring yourset point down along with that
weight loss.
And then the other thing tothink about is I mean, what is a
life if you're never going tohave chocolate again?
(04:48):
It's, you know, not one that Iwould want to live.
But, with that being said,completely depriving yourself
all the time is a surefire wayto stay hyper, fixated on it and
to keep having those intensecravings.
So I would recommend a coupleof different strategies, one
being a planned indulgence, asurefire way to stay hyper,
(05:09):
fixated on it and to keep havingthose intense cravings.
So I would recommend a coupledifferent strategies, one being
a planned indulgence.
So maybe it's, you know, everycouple of weeks or whatever
works for you having a specificoccasion where you know you're
going to go out and maybe youshare a you know chocolate cake
with your partner after datenight or whatever it is.
So it's something to lookforward to, it's planned, you
don't feel guilty about it, itkeeps you on track.
The other thing is like, howcan we do these little swaps on
(05:33):
a daily basis that I do all thetime, because I also have a
sweet tooth and I love chocolate, but I want to make sure that
what I'm having is still alignedwith maintaining my health,
maintaining my weight.
So maybe it's you do a Greekyogurt, unsweetened cocoa powder
, mashed banana situation, soyou get that chocolatey flavor,
(05:54):
but you're having something thathas protein and fiber along
with it.
So there's a lot of directionsto kind of go with.
Dr. Weiner (06:02):
So I have a question for you and this you know, to
me chocolate is a little bit,it's almost a little bit
different than other foodsbecause it almost feels to some
degree like chocolate is likeuniquely addictive.
There are certainly some peopleyou think it's just the
caffeine.
Zoe (06:16):
Maybe not just the caffeine , but there's caffeine in it.
Dr. Weiner (06:18):
Yeah, no, there is for sure.
So it always has felt like youknow, is a chocolate craving an
addiction or is it just kind ofa preference or a soothing thing
?
Because let's just say, andlet's just say, we're talking
about alcohol and someone's analcoholic.
The advice that most people aregoing to give is not going to
be like, you know, if you had adrink once or twice a week
(06:40):
instead of all the time.
We all understand that alcoholis an addiction, and I'm not
saying chocolate is either, butwhat element of that is is this
is chocolate craving?
Is that an addiction or is thata preference?
And is it, is it going to bepossible for everybody to
modulate their chocolate intake,or are there going to be people
(07:00):
out there who just they justcan't have chocolate because
they're just so hooked on it?
Zoe (07:04):
Well, I think that goes for sugar, maybe chocolate
specifically.
But I know we have severalpatients who knows that
addiction to sugar is truly anaddiction and they just have to
just not do it at all.
And for those people having aplanned indulgence is not the
answer.
So it is very individualized,for sure.
Dr. Weiner (07:26):
It really is.
I think most people probablycan figure it out and do that
plan indulgence like you talkabout, but there are definitely
people who are so and I hatethis word but triggered by
chocolate or sweets or otherthings like that, and that they
have to completely avoid italtogether.
What I think is alsointeresting about this person is
(07:46):
that it's losing five pounds.
That brings on that craving,and that's, I think, what you
said about the importance ofproviding yourself all the
nutrition and trying to look ata set point lowering diet, like
the metabolic reset diet.
(08:07):
That, to me, is kind of areally important strategy that
you have to replace food.
You have to give yourself tonsof phytonutrients and a lot of
times cravings are fromnutritional deficits.
Zoe (08:19):
Yeah.
Dr. Weiner (08:21):
And so that also is.
Maybe there's a deficit ofanother food, something you know
chocolate has a lot ofphytonutrients in it, and so
maybe there's a similar foodthat has a lot of phyton, of
similar phytonutrients, in it.
Cocoa powder is a great, greatone, because it's good.
It is chocolate, um, and thecocoa powder itself isn't, isn't
harmful, it's probably a prettyhealthy thing to eat.
Actually, it's all the sugar,the milk and the fat that we add
(08:43):
to it.
But anyway.
So I think that's a reallyimportant thing.
I think another piece of thisis medications.
Now we talk aboutfirst-generation and then
second-generation meds.
And the first generation arelike Phentermine and kind of the
old-school drugs whichgenerally don't work too well
for weight loss.
But Contrave is one.
(09:05):
It's a combination of bupropionand naltrexone, so it's an
antidepressant and thennaltrexone is an opioid blocker
and I've used sometimes justnaltrexone alone and it's dirt
cheap and sometimes somethinglike that could be helpful for
someone in this situation.
I think if we start getting theheavy hitters, the GLP-1 meds,
the Wegovi, the Zepound, they'reprobably going to help with
(09:35):
this.
A ton a ton.
And so again, if this person'sonly trying to lose 10 pounds
and at five pounds is gettingstuck, I don't know that a GLP-1
is appropriate.
But if they're looking to lose30, 40, 50 pounds, then I think
a GLP-1 might be a really goodanswer, in addition to all the
nutritional stuff if that'ssomething that person would be
interested in Like a long-termoverdose could be a good issue.
All right, Sierra, what's ournext question?
Sierra (09:56):
Next question comes from Priscilla on Instagram.
What are the commoncomplications of the Roux-en-Y
gastric bypass revisionsurgeries?
I'm considering but reallyscared.
How are the complicationscorrected?
I'm considering this because Ihave severe acid reflux from my
sleeve eight years ago and haveweight regain.
Dr. Weiner (10:17):
There's been this.
I think there's over the years.
There's been this whole thingwhere a sleeve is this and a
gastric bypass is so much moredrastic and so much different
than a sleeve and I've doneplenty of both surgeries and
I've been doing this for a longtime.
I look at them really as kindof points on a spectrum, as
(10:40):
opposed to this like drasticallydifferent surgeries.
I think in the old days when weweren't as good at doing
gastric bypasses and there werelike sepsis and ICU and all this
kind of leaks and perforationsand all these kind of terrible
things, we saw those with agastric bypass and, as I've
(11:00):
talked about before on the show.
A sleeve is easy, like it is nota hard surgery to do.
There's a few little tricks tomake it come out nicely, but
it's not something where it'slike touch and go.
A gastric bypass is much morechallenging to do.
You're connected.
You're doing two connections.
(11:21):
Things have to reach andstretch and sit nicely and the
tissue integrity plays a role.
We've gotten very, very, verygood at doing the surgery and so
we've eliminated a lot of thesekind of terrible, awful gastric
bypass stories which in generalare surgical complications, and
(11:41):
so if you do the gastric bypasscorrectly, then the long-term
consequences of a gastric bypassto me are fairly similar in
scope and severity to thelong-term consequences of a
sleeve gastrectomy, and so Ithink that's the first thing
that you know.
You can't look back at 10 or 15years of gastric bypass history
(12:02):
and say, well, that's what'shappening now too.
It's a very different surgerynow, and if you go to someone
who does the surgery regularly,you know I sleep great at night.
Nobody wakes me up in themiddle of the night.
Nobody's crashing and burning.
I'm not going into visiting mypatients in the ICU or taking
people back to the OR.
I do the surgery, I go home, Igo to sleep.
(12:25):
I just rounded this morning.
Oh how you doing Great, readyto go home, yeah, let's go.
Zoe (12:29):
So many people are like did he even do the surgery?
I feel no pain, I get that somuch.
Dr. Weiner (12:36):
I mean.
That means, I'm doing my jobright.
It's not a terribly painfulsurgery.
With some strategy, get can geton the new other diet and
eating is the hardest part, andthat's where you come in helping
them.
And again, a quick reminderanybody out there, if you've
just had surgery and you wantsome nutritional help for sign
up for our nutrition program.
You can meet with zoe almostevery day to get you back on
(12:58):
your post-op eating book, eatingplan.
Um, so anyways, but there aredifferences between the two
surgeries and there are somethings that you need to consider
before going from a sleeve to agastric bypass.
I think the first and mostobvious one is dumping syndrome.
We really don't see a dumpingsyndrome with a sleeve.
There's a little bit of it, butit's not the same as what we
(13:21):
see with a bypass, which meansthat fatty, greasy, sugary foods
cause GI distress, and so yourbody's going to comment a little
more on that.
Alcohol use and again, we dosee a little bit of an increased
risk of alcoholism with asleeve, but not like we see it
with a bypass.
(13:41):
You absorb alcohol differently,you get drunk faster, it wears
off faster and it's moreaddictive after surgery, and so
I think you have to be much morecareful with alcohol use after
the surgery.
Smoking is just a hard no aftera gastric bypass.
And then there's really threecomplications, three long-term
complications that we see aftera gastric bypass.
(14:04):
The first is ulcers, andthey're quite uncommon,
thankfully.
I'd say probably 1% or less ofpeople have major issues with
ulcers, but they can bleed, theycan perforate and they can be a
real problem.
They're particularlychallenging when you've gone
from a sleeve to a bypass,because your bailout move if
(14:28):
someone has just a terrible,awful ulcer that we're really
struggling to be able to treat,your bailout move is to actually
reverse the gastric bypass.
Oh geez, use the old stomach.
I've done that, I think, fivetimes in my career.
So it's not something I've donewith any regularity, but it is
like your bailout safety move.
(14:48):
If you've had a sleeve, youdon't have that because the
portion of the stomach's beenremoved that would allow you to
reverse it.
So that, to me, is kind of theone thing.
That, to me, is kind of the onething, that being said, I've
had out of.
You know, I see probably 10 to15 new patients a week, and so
you put that at 500 a year,let's say over almost 20 years
(15:12):
of practice.
Maybe not quite that volume,but I've seen a lot of patients
over the years.
I think I've seen this reallycome to a head two or three
times at most.
Zoe (15:22):
So out of maybe 10,000 patients.
Dr. Weiner (15:23):
I've seen two or three times, I've seen this
become an issue.
So I don't want anybody outthere to think, oh, don't have
this surgery because you'll getan ulcer and then you'll be
screwed.
It's a really, really uncommonthing.
Zoe (15:35):
Well, and smoking can cause the ulcer.
Most ulcers are preventable,which is why it's right, exactly
why we want to listen to therecommendations.
Dr. Weiner (15:44):
Smoking alcohol, nsaids.
Zoe (15:46):
Right.
Dr. Weiner (15:47):
That's probably responsible for 85% of the
ulcers that we see Bowelobstruction the intestines can
twist on themselves.
After surgery.
You develop severe abdominalpain.
That can be catastrophic I'veseen it twice in my career be
catastrophic but for themajority of patients it's like
appendicitis.
And so the key really and inthose two situations when it was
(16:10):
catastrophic it was a delay indiagnosis.
And so as long as you seek helpand treatment for your abdominal
pain after bariatric surgery,after gastric bypass, from a
bariatric surgeon, that's notgoing to get missed and it
really is a very treatableproblem.
(16:30):
And I think the frequency isdecreasing.
I used to feel like I did likeone of these a month and now I
feel like I've done one thisyear so far.
So it's much more uncommon.
I think that the nutritionaldeficiency we see is iron
deficiency, without question,and we can see a little bit
after a sleeve, but it's muchmore profound after a bypass.
You check your iron, you takeyour iron regularly.
(16:53):
It's a manageable problem.
I think the other piece of thisis that severe acid reflux is
not benign.
It's not benign first of allbecause it's miserable.
It's a miserable way to liveand second of all because
chronic acid exposure to theesophagus increases the risk of
esophageal cancer, and so werecommend endoscopy every three
(17:14):
years for anybody who's had asleeve and has heartburn
symptoms, to screen forBarrett's esophagus, which is a
premalignant condition.
So kind of living the rest ofyour life with acid reflux in my
mind may be your riskiestoption of all the things we've
talked about.
So you know, what I wouldadvise to Priscilla is please
(17:40):
find someone who does thissurgery regularly and have them
do it and move forward with this, because it might help with
your weight loss, and it'sdefinitely going to help with
your acid reflux.
So what do you see in yourpractice in terms of the
differences between eating aftera bypass versus eating after a
sleep?
(18:00):
Is there much difference?
You know what are patientsexperiencing.
What do you see?
Zoe (18:05):
Yeah, you know, I mean obviously the iron being the
number one nutritionaldeficiency, but in terms of,
like, the progression of thesteps after you know,
introducing the foods back insame steps, maybe you know what
I see with the revision is thatyou can sometimes go through
those steps a little bit morequickly, kind of like your body
(18:26):
knows what to do.
But you know, in general therecommendations are going to be
the same.
You know, um big emphasis onmindful eating.
Sleeve patients can oftentimeseat a little bit more than the
bypass patients, maybe over timeand that kind of thing.
But ultimately we give the samerecommendations and that that
(18:47):
vitamin deficiency, with theiron is, is the main thing with
the vitamins.
That's going to be different.
Dr. Weiner (18:53):
Yeah, there's also, I think, some differences in
terms of with the sleeve, it'sthe amount that you can eat that
really determines what yoursymptoms are.
But the it's the amount thatyou can eat that really
determines what your symptomsare.
With a bypass, it's the amount.
That's also what you need.
Zoe (19:05):
Right, like going past that point of fullness.
That's where the mindful eatingcomes in.
We really want to get good, nomatter which surgery you've
gotten really good atrecognizing when your body is
telling you to stop.
Because, just like you weresaying, yes, going too much, you
know volume.
On either end, whether it's thesleeve or the bypass, it's
(19:27):
going to be uncomfortable, maybecause nausea, vomiting, that
sort of thing.
But, like you were saying, withthe bypass you could get that
dumping syndrome with thosesugary or fatty foods versus
maybe not experiencing that somuch with the sleeve.
Dr. Weiner (19:40):
Yeah, so I'll give you my theory on why and I and I
totally agree with you when yougo from a sleeve to a bypass, I
think you could progress yourdiet much faster.
So I think there's two factorsthat cause you to have
difficulty eating in theimmediate phase after surgery.
One is kind of anatomicswelling and just a new anatomy,
(20:01):
but the other is the set point.
Your set point is so loweredand your body is working so hard
to drive that weight loss thatit just causes this kind of
nausea and food aversion andit's the opposite of, the
opposite of hunger is not full,it's nauseous.
And I think that the surgery isworking so well for a small
(20:23):
group of people that they havesome nausea and that it's that
opposite of hunger effect.
Now, when you go from a sleeveto a bypass, you don't get that
big set point lowering becauseyou've already gotten it from
the sleeve and so you're justgetting the difference between
the two.
So you really just have theanatomic effects, which tend to
be much more modest compared tosome of the set point lowering
(20:45):
effects in terms of impactingyour ability to eat.
Just, my theory I got zeroscience to support that.
All right, sarah.
What's our next question?
Sierra (20:53):
This question came in by email.
Is it necessary for bariatricpatients to not drink for 30
minutes after they eat if theyare a couple years out from
surgery?
Zoe (21:03):
Okay, so this is where our title comes from.
You know, not eating anddrinking at the same time.
It's a very common advice,especially if you're in
different Facebook groups andyou ask Google and whatever else
, and you know that it's kind ofa guideline to start, but it's
not a hard and fast rule,especially not in our practice.
And what's more important thanthat is actually the mindful
(21:27):
eating piece again, so that youagain, like I said just not too
long ago, being really good atrecognizing and honoring when
your body is telling you to stop, and you're learning new
anatomy, you're learning yournew body, you're learning your
new satiety signals, and so it'sthat's the most important is
relearning how to eat.
(21:47):
And you might find that I wasjust talking to somebody before
this um in one of our supportgroups who was saying you know
she doesn't necessarily wait tostop drinking up until when she
eats, but she knows if shestarts drinking right away
afterwards she feels really full.
So I think not just the mindfuleating pieces is knowing that
(22:07):
everybody's different andknowing that you are going to
have to learn what works for you.
Dr. Weiner (22:13):
Yeah, I think that's that's really the essence of
getting through the surgerycomfortably is some people.
There are people out there whowhen they drink it and eat at
the same time, causes some painand discomfort.
I think it's a minor, it's arelatively small group and I
think even if it happens to youat first, it doesn't mean that's
how you got to live the rest ofyour life, because this is
(22:35):
changing over time, right, andwhat you experience at one week
after surgery and what youexperience of one year
completely different, completelydifferent.
So I think that's again wheremindful eating comes in is it
allows you to to kind of adjustyour behaviors and your
strategies as your anatomy andyour stomach and everything
heals and changes.
This is, without question, avery, very common myth that
(22:58):
still is out there.
Zoe (23:00):
Yeah, yeah, yeah.
Um but and this is somethingthat, you know, we kind of warn,
I warn patients about in thepre-op session um, just like
being on the lookout but knowingthat this isn't something that
you have to do forever and thateverybody is kind of different.
Dr. Weiner (23:16):
There's, there's, I think there's two places where
there's two reasons why peopleexcite, and I feel like it's
almost 50-50.
The first reason is that if youeat and then you drink, it's
going to wash the food throughyour pouch and so you're not
going to feel full, and I thinkthat reason holds absolutely
(23:38):
zero water, no pun intended.
Holds absolutely zero water, nopun intended.
So the reason is is because,first of all and I've sat there
and I've watched these studiesIf you have someone drink after
a gastric bypass or we even dosometimes some food studies
where we take barium and kind ofput it on top of the food and
watch people eat the food, ifyou watch someone eats the food,
(23:59):
it goes through their esophagus, it sits in their stomach pouch
.
How long watch someone eats thefood?
It goes through their esophagus, it sits in their stomach pouch
.
How long do you think it isuntil it's in the small
intestine?
A minute.
Zoe (24:09):
It's washing through quickly regardless.
Dr. Weiner (24:10):
It's going through quickly, regardless, right?
And when you drink water it'sthrough immediately.
So the surgery isn't working byfilling your pouch up.
And when your pouch is full,well, then you're full too, and
that's where that whole quartercup of food, or how much does my
pouch hold?
Your pouch doesn't holdanything.
Zoe (24:30):
It all goes right through it, which is why we don't assign
specific portion sizes.
Dr. Weiner (24:34):
Exactly so.
I think understanding themechanics of pouch emptying kind
of shows you that that justdoesn't make any sense at all.
The food doesn't sit there foran hour or two and you feel full
when the pouch is empty.
It's a much, much morecomplicated issue.
The more common thing and Ithink the idea that does hold
water is that drinking andeating can be uncomfortable.
(24:56):
And you eat and then you drinkon top of it and you, like, fall
off too much and everythingstarts to stretch and that can
be very uncomfortable and reallythe risk in that situation is
your own pain and suffering andvomiting, and so you're not
going to perforate or cause lessweight loss or have any kind of
(25:16):
negative long-term consequence.
You just get uncomfortable.
Negative long-term consequence,you just get uncomfortable.
And to me this is just, insteadof like making some rule for
every single patient who's everhad bariatric surgery, where it
only applies to maybe 5% of them, we teach mindful eating
strategies and teach people howto kind of monitor and determine
.
Hey, if every time I drink andeat it hurts, I'm going to learn
to not drink and eat at thesame time.
(25:37):
I'm going to separate it alittle bit If every time I drink
and eat.
I don't notice any difference.
Last question what do we have?
Sierra (25:48):
This question comes from YouTube from Amanda.
I'm about to have the gastricbypass surgery and plan on
trying to conceive about 18months to two years post-op.
I have two questions involvingbariatric surgery and pregnancy.
One outside of taking mybariatric vitamins and getting
my labs done regularly, what canI do from a nutritional
(26:09):
standpoint to prepare my bodyfor a healthy pregnancy?
And two, from an anatomicalstandpoint, is there a higher
risk of bowel obstruction duringpregnancy, since the womb would
be taking up so much space anddisplacing the bowel?
Thank you so much for all ofyour content.
I have enjoyed watching all ofyour videos and listening to
your podcasts over the lastseveral months.
Dr. Weiner (26:30):
Okay, so this question to me is exactly what I
was talking about.
I have enjoyed watching all ofyour videos and listening to
your podcasts over the lastseveral months.
Okay, so this question to me isexactly what I was talking about
earlier, when we were sayingabout how we get these great
questions and it shows us likehere's someone, they're making
major life decisions here andthey're making it with some
really accurate, helpfulthoughts about this thing.
(26:51):
So let's kind of break thisdown.
So, first of all, what do yourecommend vitamin-wise for
pregnancy, for pregnant patients?
Zoe (26:58):
So with a history of bariatric surgery, we would
recommend discontinuing thebariatric-specific vitamin and
doing two prenatal vitaminsinstead.
And doing two prenatal vitaminsinstead.
The reason why is because wewant to make sure you're getting
the proper amounts of iron andfolate for proper fetus
development.
But the vitamin A toxicity riskis greater with the bariatric
(27:24):
vitamins and vitamin A toxicityfor a developing fetus can
result in spina bifida or acleft palax.
It's in the that um the neuralneural tube neural yes we both
took embryology, but it's been along time, yeah, a long time,
for me for sure vitamin wise,that's what we would recommend
(27:46):
and, of course, like gettingyour labs checked regularly as
well, and then, from a generalnutrition perspective, making
sure you're getting enoughprotein, making sure you're
getting enough hydration andadequate nutrition as a whole
like really focusing on thatwell balanced diet.
Dr. Weiner (28:02):
Yeah.
So I think from a bowelobstruction perspective, there
is an increased risk duringpregnancy, and so we you know
I've done this surgery a handfulof times, thankfully not very
often.
But patients can develop aninternal hernia or small bowel
obstruction, typically in thethird trimester, when the uterus
(28:23):
kind of pushes everything up,and so so Amanda, as she's done
her homework, I mean, this isnot something that's like widely
out there in every pregnancyliterature.
I think the OBGYNs, I can tellyou, at Tucson Medical Center
where we work, the OBGYNs aretuned into this.
So the few times I've beeninvolved, the OBGYNs are the
ones who picked it.
They made the diagnosis.
They didn't call me and saythere's a patient who had
(28:44):
bariatric surgery, has abdominalpain, can you help?
They said there's a patient whohad a bariatric surgery.
I think she has an internalhernia.
I'm ordering her a CAT scan.
I wanted to give you a heads upbecause she is going to need
surgery ASAP if she has it.
And so I've been able to reducethe bowel obstruction, do it
laparoscopically, and none ofthese well, one of them actually
(29:05):
, they were, I think, 36 weeks,which was more than adequate for
development, and we did aC-section and I fixed her hernia
.
At the same time, there wasanother one who I was able to
release the bowel obstructionand she was able to finish out
her pregnancy.
Wow yeah.
So if you get the right teamand that team is your OB and the
(29:27):
bariatric surgeon this is asolvable problem.
Now, this is again notsomething that is happening all
the time, but it is.
There's that kind of smallfraction of a percent of women
who develop a bowel obstructionduring pregnancy, after a
gastric bypass, and it is scary,but it you know, it is not a
untreatable problem.
(29:48):
I think the bottom line also isif you're out there, you're
pregnant, you've had a gastricbypass and you have
unexplainable abdominal pain,it's probably worth a visit to
your bariatric surgeon and weactually will do CAT scans.
Even though the radiation, youknow, can be harmful to the
fetus, it's not nearly asharmful as missing this
diagnosis Right.
And so we will do CAT scans onthese patients, and I've looked
(30:11):
at these CAT scans and it'shonestly it's a pretty
impressive.
You're looking at a CAT scanand then in the middle there's a
baby.
Zoe (30:17):
I know.
Dr. Weiner (30:18):
I know it's kind of crazy, but yeah, this is a very
real risk.
But I think it's also importantto understand that having a
child and conceiving when you'resubstantially obese is also
quite risky, and I've talked tomany OBs about this and they all
(30:40):
have told me I would muchrather take care of a patient
after bariatric surgery and kindof manage this minor
nutritional issues and this very, very unlikely risk of bowel
obstruction, then manage a 280pound woman gaining 50 or 60
pounds during a pregnancy andthen delivering emergently.
That is very, very harrowing anddifficult and risky.
(31:04):
And so you know, likeeverything in life, there's risk
on either side of thesedecisions, and so I think it's
important to that I would never.
I think when you weigh riskbenefits on this risk benefits
to the mom, risk benefits to thebaby it's going to favor
surgery massively 18 months ormore after.
So that's our recommendation.
That's what the data out thereshows is that after 18 months
(31:27):
it's probably as safe, if notsafer, to have to be to conceive
after bariatric surgery.
And again, on GLP-1s GLP-1s arecontraindicated in pregnancy,
so if you are, I think theyrecommend trying to stopping
them two weeks before you try toconceive.
Zoe (31:45):
Or as soon as you find out you're pregnant, because that's
something we see a lot.
Dr. Weiner (31:49):
Yeah, that's not recommended, but that's that's
an unanswered question at thispoint.
So again, I think you talked alittle bit about the vitamins,
but what about nutrition?
What do you recommend from anutritional perspective for
someone who is pregnant?
Zoe (32:05):
Well, like I mentioned, having that overall
well-balanced diet, reallyprioritizing that protein.
But I think there's thismisconception that you need a
whole bunch of extra calories.
The reality is it's really onlylike a couple hundred max of
extra calories, so you're noteating for two, especially if
you do have a history of, youknow, the gastric bypass and you
(32:30):
want to make sure that you'remaybe minimizing excess weight
gain, really being in tune withthat mindful eating, maybe only
bumping up your, your proteinand your overall calories by a
couple hundred.
Dr. Weiner (32:41):
Yeah, I think you know you're, you're not eating
for two, you're eating for like1.1, but but I think also,
there's never a time in yourlife when it's more important
for you to eat well than whenyou're pregnant, and I think
that's the exact opposite thanwhat we've been.
You're eating for, true, go forit, right, yeah, and so I think
(33:02):
we, we we've been giving peoplepretty bad advice about eating
during pregnancy, and I think wehave to make sure that's that's
as a community.
Yeah, but we as a community, Isay we as healthcare providers.
Zoe (33:16):
Yeah.
Dr. Weiner (33:16):
Yeah, yeah.
So anyway, I think we have torecognize that, that there's
also this concept of epigenetics.
So your genetics are your genesthat you pass on to your
offspring.
But genes are not this staticthing where, once you pass it on
, well that's what's going tohappen to you.
There's something calledepigenetics and that's our
(33:38):
body's ability to turn on andoff certain genes.
It's so fast, it's so fast, andwhat it does is it allows us to
kind of evolve, not over 20generations, which is kind of
how DNA will change, but overone or two generations, because
it can turn on certain genes.
And so when you're eating abunch of garbage and you're
(34:00):
you're developing child isexposed to the same foods that
you're eating.
I mean, when you're eating,you're feeding your baby too,
and so you're exposing yourchild to processed foods, to
processed crap.
It's turning on those genesthat cause obesity, that cause
diabetes and that cause allthese health problems that
you're not going to want yourchild to have.
(34:21):
When you're eating reallyhealthy, you're turning on genes
that promote health andwellness and insulin response,
not insulin resistance andinsulin response, not insulin
resistance, and so it's soimportant to kind of push the
right foods into your baby sothat you're turning on the very
best genes that you can from ahealth perspective.
(34:41):
So great questions.
This segment I know really goodquestions Again.
Zoe (34:46):
keep those questions coming .
Let us know what we can helpyou with.
We are excited to potentiallyanswer it on the next show.
Dr. Weiner (34:53):
All right, we'll see you next time.
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