RVwriter

I posted this question on the 50-plus section of the forum and was advised to come here. Didn't know about this section and thought it was about something involving horses. lol

I joined the forum a couple of weeks ago, asked some questions about nutrition, after-ride recovery ideas and a few other related areas, only to learn that none of the answers would work for me.

Sometimes I'm a little slow on the uptake (senior moments, don't you know), but it's now quite clear that riders who went through gastric bypass surgery often have several health issues that other riders don't -- especially if pre-surgery life included serious Type II diabetes, high blood pressure, high cholesterol, neuropathy and other related foibles.

So I'm asking if there are other riders here who had bariatric surgery and, like me, are learning how to cope with balancing exercise, nutrition, fitness, weight loss, hypoglycemia, pulse rates, blood pressure and the various other left-over side-effects.
In case there's a discussion to be generated here, I'll start it off.

I'm 73 and had RNY surgery in early 2009, at which point I weighed 284 pounds (at just under 5'8"). I was rapidly approaching an appointment with the grim reaper and knew it. My diabetes was getting worse, and I was injecting 93 units of insulin daily. In addition to high blood pressure/cholesterol/neuropathy, I used a ventilator at night for sleep apnea and had a troublesome, enlarged prostate. I was spending $800 a month on medication.

I couldn't bear the thought of leaving my lovely wife alone (who was she going to boss around if I were gone?), and I wanted to watch my six grandchildren grow up.
After trying various diets for 30 years, I realized gastric bypass was my last and best option, and I went into it fully knowing there could be complications and that I'd spend the rest of my life coping with a new digestive system.

Unfortunately, the surgery was botched, and in the middle of the night 10 days later, I found myself in an ambulance headed to the hospital emergency room. A hole about the size of a dime was found in my new egg-size pouch, and my interior was flooded with bile and nastiness that had to be vacuumed out.

A constant stream of nurses flowed into and out of my room after the surgery, and I couldn't figure out why until one of them told me they were there to see the results of the heroic operation that a handsome young doctor had performed. I was, she said, literally minutes away from death.

Now, those of you who have gone through gastric bypasses know that you're almost nagged to death to get out of bed and walk, walk, walk following surgery. There was none of that after my second surgery. In fact, I needed help to make it to the toilet.

I was weak, had a series of vitamin, mineral and electrolyte deficiencies, my blood pressure was out of control, and I had acquired four rather severe staph infections. Finally, after nearly a week in the hospital bed, my wife took me home because she was certain the hospital was going to kill me.

At home, I forced myself out of bed each day and walked around the block (one-third of a mile) with the help of a cane. A month later, I was walking a mile. Then two miles and finally by the end of the year, four miles. Meanwhile, my weight dropped to under 200 pounds, and I reduced my daily insulin from 93 units to 25.

During the spring of 2010, I climbed aboard my 1980 Huffy six-speed bike and rode around and around as long and as fast as I could until by year's end, I was riding up to 10 miles daily and was sick of my neighborhood. But by that time, I was down to 164 pounds; my blood pressure and cholesterol were normal; my sleep apnea was gone, and so was my diabetes. Neighbors talked to each other about "the crazy old fat guy with the cane" who was now riding a bicycle!

Along the way, however, I learned I had a few unpleasant side-effects from my surgeries. First, it took nearly five months to get rid of the staph infections. Then the scar tissue from my second surgery evolved into a permanent stomach ulcer which then resulted in a series of four different esophageal strictures that had to be treated by balloon inflations down my throat. Much of my new weight loss was due to the liquid diets I was on before and after each inflation.

In addition, a long-term potassium deficiency worsened. Swollen legs and an inclination to infections were left-over side-effects from the diabetes. Each minor cut or scrape must be treated carefully with first-aid and usually antibiotics.

I regained 20 pounds that winter and was determined to lose it by bike riding. As soon as the weather permitted, I hauled my Huffy to the nearby bike trails and began an earnest fly-by-the-seat-of-my-pants training program. I also had a LBS re-gear the bike for 12 speeds. It worked. By fall, my weight was 170 pounds and I was riding 20 miles nearly every day. During the winter, I kept fit and maintained my weight by brisk walking inside a shopping mall up to 3.6 miles daily.

In March 2012, I gave myself a new 21-speed Giant Cypress for my 73rd birthday and set out to regain the 20-mile distances I had ridden the previous fall. After gradually increasing my time and distances, I'm now riding 14-18 miles and averaging 12 mph.
However, each day I face a struggle with health-related issues.

Like many other post-bariatrics people, I have to eat six or eight small meals every day. I can't ingest acidic foods such as oranges because of the ulcer. No chocolate or caffeine or carbonated beverages for the same reason. Can't digest anything that won't chew up to a mushy consistence. That means no dense meat such as steak or pork chops. No spicy food; no garlic. No stringy veggies such as broccoli, no fruit with skins such as grapes. Greasy foods are often a problem. I can't handle sodium-rich food or drinks such as Gatorade due to the neuropathy.

Unlike non-bariatric riders, I have to eat a nutritious breakfast before beginning my early morning ride because I have no energy reserves left from my evening meals. But since my egg-size stomach won't handle much food, I can't eat much more than some oatmeal with milk, a very small protein shake and a slice of rye toast slathered with peanut butter. And halfway through my ride, I have to stop and eat either a power bar or a couple of peanut butter crackers. If I don't do that, by the time I'm finished riding, I have seriously low blood sugar -- hypoglycemia -- that puts me out of action for the rest of the day with shaking hands, weak arms and legs, slurred speech, blurred vision and almost uncontrollable sleepiness.

At the end of my ride, I am always famished and generally refuel with a soft-poached egg mixed with a small, shopped up microwaved potato and some sour cream. Lately, I've also been adding half a high-protein shake.

Warning: Do NOT pay attention to bike riders who tell you that you cannot digest and absorb food effectively if you eat it within two hours before your ride. That advice might apply to non-bariatric people, but not to riders whose digestive systems have been altered the ways ours have.

Similarly, IGNORE the advice of those who say if there has been adequate nutrition the day before a ride, the muscles with have a full complement of glycogen in the morning and that an overnight fast does not deplete your body's supply of energy. That just doesn't work for us.

Enough about me. If there's anyone out there like me, let's hear it.

Don

psalm

Well I did not have the same surgery you had, but a few years ago my colon ruptured and I too had to have a life saving surgery. The doctor advised my wife she might want to start funeral preparations just in case. Needless to say I survived, but without 10 inches of my colon. Since then I have found a lot of different foods I can no longer eat. Food goes through me a lot faster then before. A few of my favorite foods I can't eat anymore like eggs and mayo. I used to love both of those, but now I'm running to the restroom literally minutes after I eat them, so I don't eat them.

Before a ride I'll have peanut butter and jelly sandwich on wheat toast. I'll take a cliff bar with me in case I get hungry. Post ride is a peanut butter banana sandwich or a flour tortilla with peanut butter.

Just keep at it, you'll find your rhythm and find what works for you.

vesteroid

I won't pretend to understand what you are going through, but will at least say that it's difficult to believe the surgery changed all metabolic processes in your body. (such as gylcogen storage and utilization)

Be that as it may, I do have an idea.

Drinking whey protein prior to exercise is a no no. However I would suggest you give hammer perpepteum a try. It's a non sugar carb protein powder that miss with water and is designed to sustain exercise.

You can get single serving packets at rei and many local bike shops so you can at least try it out prior to purchasing an entire bulk bag.

I would also at least question how many grams of carbs (non sugar) you are eating in a day. If you have adopted a low or no carb diet and are crashing as you describe, I think you should try slowly adding carbs back to your diet over a few days and see if that helps.

RichardGlover

Cyclists, sports nutritionists, and other non-post surgery people are going to give you advice that works for them, but not for you.

Post-surgery nutritional specialists are going to give you advice that works for most post-surgery patients, but not for you.

Your needs are not the same needs as other cyclists; likewise they are not the same as other post-surgery patients.

While riding, all bets are off. You're doing something your doctors haven't considered. And you're doing it with health issues other cyclists haven't considered.

You need to eat, while on the bike, in ways that you won't eat other times. If you're ever going to ride more than about 2 hours at a time, you have to learn how to consume 300 calories an hour while riding, and then you have to have the discipline not to use those same techniques while you're NOT riding.



I had RNY surgery about two years and 170 lbs ago.

I ride my bike every day to work (~7 miles each way), and do a 200k ride about once a month (last few months have been off due to illnesses).

I had to agonize through much of the same nutritional hurdles you did. I didn't have any of the complications you had, but you might try some of what I've learned.

The advice your doctors/nutritionists about not taking in all of your calories by liquid? Ignore it.

The advice about not eating and drinking within 30 minutes of each other? Ignore it.

The advice about only eating every 3 or 4 hours? Ignore it.

You need to ingest electrolytes to replace what you sweat out. And liquid. And calories. Just like any other cyclist.

You have to avoid high-fat foods. That's not a problem - nobody wants fatty foods while exercising.

You probably have to be careful around high-carb food and drink. They give me grief. This is your biggest problem. You can't just suck down a sports drink and get the calories you need.

What works for me is to fill one bottle with pure water. Just water. A second bottle with either a low-calorie sports drink (all of the electrolytes, fewer calories). And I bring snacks that work for me. Typically, I find I can handle anything that has at least 25% of it's calories from protein instead of carbs. Payday bars work for me.

Or replace the sports drink with something like Perpetuum. Brings some (but not all) of the calories I need, along with the electrolytes.

It's important to have that 2nd bottle of pure water. It can help moderate your calorie intake, your electrolyte intake, etc... If you start feeling gassy (an early warning that I ate too many carbs), you can drink some water to help settle your stomach.

And I find that I need to CONSTANTLY eat. On long rides, I set a timer and eat something every 15 minutes, and take sips from my bottles in between. Keep an eye on the clock and make sure I go through one bottle (total) of liquid per hour.

And I've got to listen to my body. Some days are better than others. Some _meals_ are better than others. Sometimes, if I don't chew something up properly, it sets me off eating for hours - and even drinking for an hour or more. If that happens on a ride? I have to slow waaay down - or stop altogether - until I can start drinking again.

But the synopsis is this: Experiment. Find food and drink that works for you, and take small amounts often. Half a snack sized (fun size?) payday bar every 15 minutes... or 2 fig bars every 20 (have to get protein somewhere else). I've used those, too... but have a lot of fiber and on long rides that's a bad thing.

If you ever join a 'supported' ride, you have to assume they won't have what you need. I bring sugar-free electrolyte drink packets and mix them with water at the stops, and bring enough food to last the whole ride.