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Old 04-19-06, 12:18 PM   #1
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Cycling After Bariatric Bypass Surgery

Hi all,

I need some input, please. I am seriously considering having this surgery done in hopes it will eliminate some other serious weight related health issues. Now, I realize there will be some that feel this is an unjustified surgery. So be it, but what I am looking for is some *real* (first-hand or I know someone directly) advice/experience as to what to expect for eventual return to cycling.

Here are the stats:

Current cycling level is about 17 mph average with most rides being anywhere from 20-50 miles and some longer 65+ mile rides (doing my first century April 30th). I have been cycling for about 2.5 years. The usual weekly riding distance is between 120 and 160 miles per week. I think I do pretty well for a Clydesdale. Current Weight 240lbs - Height is 5'5" - age is 42 - female

Concerns are -
1. Will I be able to ride, after recovery, at the same level I do now?
2. What about hydration during riding after surgery?
3. What about the energy level/bonking on rides?

Thanks for all of your help and experience!

LS
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Old 04-19-06, 07:15 PM   #2
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I would discuss this with your prospective surgeon. My understanding is that bariatric surgery imposes severe dietary restrictions forever after. At a minimum, I would expect you will have to drink more often to avoid dangerous dehydration. You may also need to use easily digested foods like energy gels, but that's a guess on my part. Your questions are good and you definitely should get answers from the doctor before you decide to do this.

I expect that very, very few patients of bariatric surgery are cyclists. I can't recall anyone here claiming to have had the surgery. I'm surprised that someone who can ride 65 miles would consider it, but that's your business.
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Old 04-19-06, 09:41 PM   #3
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Supcom, thanks for the feedback

I agree with you that it is surprising for anyone to *want* to have this surgery. Unfortunately, I suffer from Type II Diabetes, high blood pressure and high cholesterol, all of which are brought on by the excessive weight. I am starting to see some very negative health ramifications from the medical issues. Also both parents died from the complications of the same health issues at a VERY young age...I plan on being around for a long time, or at least I hope too

I love cycling and I enjoy the fitness level that it brings and do not want to loose the ability to ride. This is why I am looking here in BF for some cyclists that may have similar experiences.

Again, thanks for your ideas and feedback! I am making a list of questions for the Doctor!

Best always!
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Old 04-20-06, 05:28 AM   #4
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Quote:
Originally Posted by HILL SLUG
Hi all,

I need some input, please. I am seriously considering having this surgery done in hopes it will eliminate some other serious weight related health issues. Now, I realize there will be some that feel this is an unjustified surgery. So be it, but what I am looking for is some *real* (first-hand or I know someone directly) advice/experience as to what to expect for eventual return to cycling.

Here are the stats:

Current cycling level is about 17 mph average with most rides being anywhere from 20-50 miles and some longer 65+ mile rides (doing my first century April 30th). I have been cycling for about 2.5 years. The usual weekly riding distance is between 120 and 160 miles per week. I think I do pretty well for a Clydesdale. Current Weight 240lbs - Height is 5'5" - age is 42 - female

Concerns are -
1. Will I be able to ride, after recovery, at the same level I do now?
2. What about hydration during riding after surgery?
3. What about the energy level/bonking on rides?

Thanks for all of your help and experience!

LS
I am post bariatric, and at 240 pounds, I'm not really sure you are a candidate for it. It's something you need to think about very carefully. I have to take supplements such as B1, B12, and Calcium for the rest of my life, due to surgically related malabsorption issues that go with the surgery. There's another effect, being female, that you should know about. A massive spike in fertility! If you can lose the weight without the surgery, that's always best. I'm not saying it's a bad surgery, but it is NOT an easy route to weight loss. It's a lifelong commitment. Initially, you will be eating 1 oz of food at a meal, and sipping fluid constantly, in one oz portions. That is the first 6 weeks. You will be taking liquid protein supplements as well so your hair doesn't fall out. I started out at 581 pounds and had my surgery March 11, 2005. I am now down to 241 pounds, so my surgery was truly successful. Yes, I would do it again as well. I just have to take extreme care of my diet and I have difficulty absorbing a LOT of foods, with resultant nausea or peristaltic waves (Dumping Syndrome). If you want more info on the early post bariatric period, go to the Archives at my old blogspot blog, http://theamazingshrinkingman.blogspot.com and there's a lot of info there. If you want to PM me that's fine as well. I'll answer any question you have honestly, concerning bariatric surgery. There are good points and bad. Risk of hernias, risk of mortality due to post-op infection, one in 200 mrtality rate just due to the procedure, as well. If you do it, go into it with eyes wide open and be VERY careful in your surgeon selection. Look into their record, there are bariatric surgeons and bariatric surgeons, if you know what I mean!
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Old 04-20-06, 07:54 AM   #5
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I have also heard that prolific and malodorous flatulence is a common side effect of this surgery. So group rides could be an issue
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Old 04-20-06, 09:06 AM   #6
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Maybe consider a lap-band, which is reversible? Instead of cutting and reconfiguring your innards
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Old 04-20-06, 10:52 AM   #7
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I would imagine that it will severely affect your ability to do long distance riding, due to limitations on how much you'll be able to drink and eat. Please, give the cycling time to make a difference and try other controls. Try to ride on the diet that you'll be forced to live on and see how that effects your energy levels. It seems SO drastic, and permanent, and counter to an active lifestyle.

The woman I know who had the surgery really struggles with the limited diet. She has lost weight, but realizes now that she could have done it with just diet. You have the added benefit of already exercising. How long have you been trying to diet?

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Old 04-20-06, 11:46 AM   #8
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Originally Posted by 'nother
I have also heard that prolific and malodorous flatulence is a common side effect of this surgery. So group rides could be an issue

Ot it could work to my advantage...like a tailwind

Edit: I have to keep a sense of humor about this
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Old 04-20-06, 11:52 AM   #9
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Quote:
Originally Posted by Pedal Wench
I would imagine that it will severely affect your ability to do long distance riding, due to limitations on how much you'll be able to drink and eat. Please, give the cycling time to make a difference and try other controls. Try to ride on the diet that you'll be forced to live on and see how that effects your energy levels. It seems SO drastic, and permanent, and counter to an active lifestyle.
Hi Pedal, you are correct, it is drastic, but so is kidney failure, blindness and amputation. I am already down to one functioning kidney and only 42 years old. Overweight my entire life with many failed attempts at weight loss.

Quote:
Originally Posted by Pedal Wench
The woman I know who had the surgery really struggles with the limited diet. She has lost weight, but realizes now that she could have done it with just diet. You have the added benefit of already exercising. How long have you been trying to diet?
I have been dieting on and off my entire life. I have been cycling for the past 2.5 years all of which I have put serious time and effort into exercising. In addition to riding I also lift weights, do ball work and of course the sit-ups etc...I am heavier today than I have been most of my adult life
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Old 04-20-06, 12:16 PM   #10
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And, your average speed kicks mine to the curb! I assume you've been to a doctor about the weight. With the amount of miles and the speed you're riding, I can't begin to fathom why the weight isn't falling off. Some of your recent weight gain might be muscle gain, because of the weightlifting and ab work -- muscle weighs quite a bit more than fat. Are you sure there isn't something metabolic going on? Again, this just seems to drastic, especially for someone so committed to fitness.

(Whenever I see a documentary on folks going through the surgery, they never seem to be doing anything to actively try to lose weight, by either exercise or diet. I yell at the TV, "Go ride a bike -- that's all you need to do!" So, it's hard to understand why you can be doing everything right and still not losing weight.)
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Old 04-20-06, 12:34 PM   #11
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I agree with pedal wench. With that kind of mileage, there's something else going on that's keeping the weight from coming off.

Could be nutrition, hormones, or a whole bunch of other things that I'm not competent to comment on. I do know, however, that some people in your situation aren't eating enough calories, so their body is hoarding the fast stores. Or something like that. I think that spending the money on a sports-oriented nutritionist who might have experience with your situation would be great, presuming you can find someone.

You say you've been cycling for 2.5 years. Have you lost weight in the past and just hit a plateau, or are you having trouble loosing any weight?
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Old 04-20-06, 01:28 PM   #12
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Originally Posted by Pedal Wench
And, your average speed kicks mine to the curb! I assume you've been to a doctor about the weight. With the amount of miles and the speed you're riding, I can't begin to fathom why the weight isn't falling off. Some of your recent weight gain might be muscle gain, because of the weightlifting and ab work -- muscle weighs quite a bit more than fat. Are you sure there isn't something metabolic going on? Again, this just seems to drastic, especially for someone so committed to fitness.

(Whenever I see a documentary on folks going through the surgery, they never seem to be doing anything to actively try to lose weight, by either exercise or diet. I yell at the TV, "Go ride a bike -- that's all you need to do!" So, it's hard to understand why you can be doing everything right and still not losing weight.)

Thanks for the compliment on the avg. speed

Yep, been to the docotor multiple times and in paticular have been focusing on weight loss. I have been to the same Doc for years and he is very familiar with me. He is as stumped as I am. We have tried everything, from pills to execise etc... The hubby and I Have been doing the exact same workout for 2.5 years and he has lost 80 lbs and it is staying off. I lost around 30-40 at first, but then the pounds started coming back and the diabetes started getting worse and the same ole roller coaster as before. I have nearly gained all the wieght I lost back. My doctor can find no reason for it, We have tested hormones and all...we can find no other cause. I even have witnesses to my activity level when it comes to exercise. The doctor says both the 'hubby and I are his start patients when it comes to getting exercise. He said some peoeple are just geniticaly programed to not process food and food calories properly, then our our bodies store too much fat. It seems that is where I am at
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Old 04-20-06, 01:32 PM   #13
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Whow, stop right there. If you have been doing all that the doctor recommends, including watching your diet, then I can't imagine the surgery really changing anything either. There really must be something else going on.
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Old 04-20-06, 01:54 PM   #14
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Originally Posted by HILL SLUG
He said some peoeple are just geniticaly programed to not process food and food calories properly, then our our bodies store too much fat. It seems that is where I am at
I am extremely skeptical of this claim. The basic formula for weight loss (gain) is calories in versus calories expended, and as far as I know it is not now nor has it ever been in dispute (scientifically and medically, at least).

The hard facts are: if you are gaining/not losing weight, then you have to either increase the amount/intensity of exercise while maintaining the same caloric intake, or reduce caloric intake while maintaining exercise. It's a simple formula, but it's not easy (though the surgery tends to make it easier for some to comply with reducing caloric intake).
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Old 04-20-06, 02:16 PM   #15
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I'm reading some misconceptions here!

Quote:
Originally Posted by Pedal Wench
Whow, stop right there. If you have been doing all that the doctor recommends, including watching your diet, then I can't imagine the surgery really changing anything either. There really must be something else going on.
Pedal Wench, let me clear up some misconceptions here. I had bariatric surgery just over a year ago. I have lost 340 pounds in the last 13 months. I have a pituitary disorder called Empty Sella Syndrome, which caused me to gain this tremendous weight over a 10 year period. You WILL lose weight after bariatric surgery, when you can't in any other way. Over a 6 month period you build up from 1 oz food at a meal to 6 oz. This gives you a caloric intake initially of about 100 calories a day from normal food. In liquid form by way of protein shakes, another 500 or so. You WILL drop weight. It requires a commitment to a total lifestyle change though. By the way, the flatulence does exist, but it's not as bad as y'all seem to think! I've never gassed anyone behind me to the point they wrecked the bike! As to long distance cycling? I'm currently training for the Hilly Hundred in Southern Indiana, and current personal best is 76 miles in 6 hrs on a mountainbike converted as a fat tire touring commuter. I also have as of now a weekent 106 mile loaded tour under my belt. I am also am training for the Lotoja in September 2007.

My surgeon was actually hesitant about doing my surgery, I was in such bad shape. I was insulin dependant diabetic, on heart medicine, 10 liters O2, and in a wheelchair if I had to walk more than 50 feet. In essence, I was nearly DEAD! The surgery is not without risk, with a mortality rate of 1 in 200 due to complications or post op infection. You face malabsorption issues the rest of your life as well. In exchange, I cycle long distance now, I'm no longer diabetic, I'm off the heart meds, and I expect to live a long time yet! This was in doubt last year. Would I do it again? In a New York Minute!

As to ride nutrition, I use Ghu, Clif Bars, Protein Bars and Electrolyte drinks just like the rest of you, I just have to be a little more careful is all. As far as the cycling, that's one of the reasons I've lost as much as I have, and have regained the health I have. I'm about 25-30% ahead of the curve as far as loss of weight goes. Basically though, the surgery has given me my life back. I don't know any way to put it plainer than that, other than I have risen from Hell on Earth to a virtual Paradise!
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Old 04-20-06, 02:32 PM   #16
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Sorry Thom, I'll be the first to admit I don't understand all the implications of the surgery. And, I've usually seen it referred to in people who really aren't trying to do anything about it any other way - in other words, people who aren't dieting or exercising. Hill Slug is exercising, which I always thought was all it would take. Obviously, I was wrong. I'm thrilled to hear about your success. Anyone who changes their life and gets on a bike is a winner in my book!
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Old 04-20-06, 02:36 PM   #17
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Quote:
Originally Posted by Tom Stormcrowe
I have a pituitary disorder called Empty Sella Syndrome, which caused me to gain this tremendous weight over a 10 year period. You WILL lose weight after bariatric surgery, when you can't in any other way. Over a 6 month period you build up from 1 oz food at a meal to 6 oz. This gives you a caloric intake initially of about 100 calories a day from normal food. In liquid form by way of protein shakes, another 500 or so. You WILL drop weight.
What you are saying is basically confirming that the weight loss is achieved by calorie reduction, no? Not through some kind of magic. You still have the pituitary disorder, right?


Quote:
It requires a commitment to a total lifestyle change though.
This is true of any weight loss program.


Quote:
By the way, the flatulence does exist, but it's not as bad as y'all seem to think!
Well, that was kind of a joke, but it is listed as a common side effect. Not everyone will have the same experience.
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Old 04-20-06, 02:55 PM   #18
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Hi, I've been lurking here for some time, but I've got to jump in here. My qualification is that I am a surgeon who performs bariatric surgery and cares for people who have had the surgery.

We need to clear up some MISCONCEPTIONS here:

1. No one has surgery if they haven't tried and failed conventional methods of weight loss, such as diet and exercise. Research shows that the typical bariatric patient comes to surgery after a lifetime of failed attempts, (typically > 12) and has considered and researched surgery for at least 2 years.

2. Forget the argument of how someone becomes morbidly obese (the point where weight effects your health and longetivity), once there people become trapped and so far surgery has been the only proven method for these patients.

3. Patients who are morbidly obese are probably genetically different than those who aren't. Examples are inability to convert excess calories to heat (as exemplified as feeling warm and sweating after a big meal or even impaired ability to develop heat during exercise), increased weight is cruelly associated with increased appetite (possibly linked to hormones such as ghrelin, which is not yet well understood), etc. Yes we live in a society with supersized foods, but some stay thin, some get heavy and some get morbidly obese. The best quote I have heard is "The genetics loads the gun and the environment pulls the trigger"

4. Surgery is not an easy way out. It is a tool, and probably most of it's effect is removing physiologic hunger. The patient still needs to do all of the other healthy stuff like diet and exercise and the original poster should be commended on her efforts and it seems to me she would be an excellent candidate. Perhaps Lapband would be a better alternative to avoid possible dumping that may be associated with the high caloric drinks we use during exercise and in recovery.

The original poster posed a good question, and wants input from other cyclists who have had bariatric surgery. I think this is a good question I would also like to learn the answer to. It is well established that weight loss after surgery is associated with increased exercise tolerance and many patients have participated in athletics to a high degree. But cyclilng is an "ultra" type of sport and I wonder if it is possible to get past the stage of glycogen depletion at 2 hours or so and if the abililty to hydrate would be a problem at that time range. I don't believe it would be a problem for 1 or even 2 hours.

Stop the simplistic responses about "trying harder" and "calories in < calories out" and let people with the answer to the question that was posed respond.

Thanks for listening to my rant. I'll go away now.
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Old 04-20-06, 03:43 PM   #19
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Originally Posted by Kadowaki
Hi, I've been lurking here for some time, but I've got to jump in here. My qualification is that I am a surgeon who performs bariatric surgery and cares for people who have had the surgery.

We need to clear up some MISCONCEPTIONS here:

1. No one has surgery if they haven't tried and failed conventional methods of weight loss, such as diet and exercise. Research shows that the typical bariatric patient comes to surgery after a lifetime of failed attempts, (typically > 12) and has considered and researched surgery for at least 2 years.

2. Forget the argument of how someone becomes morbidly obese (the point where weight effects your health and longetivity), once there people become trapped and so far surgery has been the only proven method for these patients.

3. Patients who are morbidly obese are probably genetically different than those who aren't. Examples are inability to convert excess calories to heat (as exemplified as feeling warm and sweating after a big meal or even impaired ability to develop heat during exercise), increased weight is cruelly associated with increased appetite (possibly linked to hormones such as ghrelin, which is not yet well understood), etc. Yes we live in a society with supersized foods, but some stay thin, some get heavy and some get morbidly obese. The best quote I have heard is "The genetics loads the gun and the environment pulls the trigger"

4. Surgery is not an easy way out. It is a tool, and probably most of it's effect is removing physiologic hunger. The patient still needs to do all of the other healthy stuff like diet and exercise and the original poster should be commended on her efforts and it seems to me she would be an excellent candidate. Perhaps Lapband would be a better alternative to avoid possible dumping that may be associated with the high caloric drinks we use during exercise and in recovery.

The original poster posed a good question, and wants input from other cyclists who have had bariatric surgery. I think this is a good question I would also like to learn the answer to. It is well established that weight loss after surgery is associated with increased exercise tolerance and many patients have participated in athletics to a high degree. But cyclilng is an "ultra" type of sport and I wonder if it is possible to get past the stage of glycogen depletion at 2 hours or so and if the abililty to hydrate would be a problem at that time range. I don't believe it would be a problem for 1 or even 2 hours.

Stop the simplistic responses about "trying harder" and "calories in < calories out" and let people with the answer to the question that was posed respond.

Thanks for listening to my rant. I'll go away now.
Thank you Kadowski! By the way, in answer to my ability to get past the Glycogen depletion after about two hrs? Yes, I can. I have bonked and interestingly enough it was at the 2:15 point. I have learned how to manage my intake to avoid dumping syndrome AND get past the 2 hr depletion point now, though. I still operate at a caloric deficit, but don't we all! As long as I stay hydrated and consume about 300kcals/hr, either through liquid nutrition or Glycemically moderate bars like Clif, I'm fine.

Reference the answer to the commenter, yes, I did reduce calories, and I did diet for years and continued to gain weight. Your metabolism can get so depressed that it literally becomes impossible to lose weight short of drastic measures. I would most likely be dead now if not for the surgery. Then we run into the perception of obese people, those that seem to think we all eat at all you can eat buffets every meal, so to speak. I hate to break it to ya, but I didn't ever nor will I ever eat at a buffet. I am currently participating in a gene study, right no as well, to add data to the study of whether obesity has a genetic component. They HAVE identified a marker gene, by the way that appears to have a very strong connection to obesity.

So everyone knows, I didn't post on this string to subject myself to veiled ridicule or scorn, but to assist someone with the experience and data I had.
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Old 04-20-06, 03:57 PM   #20
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Thank you Kadowski! By the way, in answer to my ability to get past the Glycogen depletion after about two hrs? Yes, I can. I have bonked and interestingly enough it was at the 2:15 point. I have learned how to manage my intake to avoid dumping syndrome AND get past the 2 hr depletion point now, though. I still operate at a caloric deficit, but don't we all! As long as I stay hydrated and consume about 300kcals/hr, either through liquid nutrition or Glycemically moderate bars like Clif, I'm fine.

Reference the answer to the commenter, yes, I did reduce calories, and I did diet for years and continued to gain weight. Your metabolism can get so depressed that it literally becomes impossible to lose weight short of drastic measures. I would most likely be dead now if not for the surgery. Then we run into the perception of obese people, those that seem to think we all eat at all you can eat buffets every meal, so to speak. I hate to break it to ya, but I didn't ever nor will I ever eat at a buffet. I am currently participating in a gene study, right no as well, to add data to the study of whether obesity has a genetic component. They HAVE identified a marker gene, by the way that appears to have a very strong connection to obesity.

So everyone knows, I didn't post on this string to subject myself to veiled ridicule or scorn, but to assist someone with the experience and data I had.
NO!! Kadowski, Don't go away. Tell me more...please, this is such a permanent, crtitcal, vital, life changing decision.

Tom...thank you for your tough and candid honesty, this is not an easy quality to find in people these days. Pedal Wench, you too are one in a million. It is not many that have an open enough mind to even try and understand.

OMG!!! Reading all this brings me to tears. I have felt so very alone and have come to believe that *I* must be hopeless and that it must just be *me* not doing something right. Despite all my best efforts to elimante the weight I have failed again and again.

Please anyone else with experiences, good or bad, please share them. If you are not comfortable posting please send me a PM.

Thanks again for everyones input! This is such a crucial decision in my life. I need all the experience, information and honesty I can find.

Take care all!

Linda
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Old 04-20-06, 06:05 PM   #21
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Stop the simplistic responses about "trying harder" and "calories in < calories out" and let people with the answer to the question that was posed respond.
Well no one is stopping anyone from responding as far as I can tell; the thread is still open to replies.

I have never mentioned anything about "trying harder", but I won't stop with the "simplistic" response of calories in < calories out, because this is a basic fact of human physiology, not a misconception (if you can show me some kind of reputable study, research, etc. that shows otherwise please do and I'll shut up).

Of course there are genetic factors that effect the body's ability to process foods normally, and I don't dispute that. However, there is no genetic factor that can cause a person to gain weight when they consume fewer calories than they burn. It is simply not possible.

What it boils down to is that the surgery basically forces this equation. It doesn't change your genetics. It *may* change your psychology (which is probably as important in obesity as any genetic factor), especially with the behavior modification therapy that is frequently prescribed as a follow up to the surgery. This is not a misconception either -- you *have* to re-learn how to eat; pre-surgery the consequence is weight gain, but post-surgery you can do much more serious internal damage.
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Old 04-20-06, 08:36 PM   #22
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Really, my comments were more a fear that the surgery might restrict the one activity that you love to do more than anything else. Especially since you are so much stronger and faster than I will probably ever be! I know what it takes to get my body through a century, and if I weren't able to properly fuel, it would be impossible. I just was raising questions, same as you, to ensure that you're doing something that will be a decision you can live with forever. Doc K., is there any downsides to doing the less-permanent lapband for someone who is commited to an active lifestyle?
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Old 04-20-06, 09:20 PM   #23
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Doc K., is there any downsides to doing the less-permanent lapband for someone who is commited to an active lifestyle?

Very good question! Also what about the positives and negatives of both procedures in regards to an active lifestyle, the -y and the band?
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Old 04-20-06, 10:09 PM   #24
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Clarification. Of course "calories in < calories out" is true. My point is that it is more complicated than that. If someone asks how to win bike races you answer wouldn't be "go faster than the other racers."

Regarding Lapband versus bypass (Y) the Lapband doesn't bypass any part of the GI tract, so perhaps it may be a better option for someone who wants to be able to drink high caloric fluids without concern of dumping. Lapband is still considered permanent. Although reversible, if removed the weight loss would be regained. There is concern that in this country that weight loss, on average, is not as great with Lapband as opposed to bypass. For a further answer I would recommend researching a surgeon in your area by going to www.ASBS.org which is the American Society of Bariatric Surgery and the most widely recognized society that bariatric surgeons belong to. Most surgeons will provide educational seminars that go into great detail regarding the surgical options, risks and expected outcomes. I would not recognize any differences regarding an active lifestyle after surgery in general terms beyond the above issues.

Another option is to attend a support group at your local bariatric surgery center. We have these every other week at our facility and always welcome "preop" patients who are interested in learning about life after surgery firsthand from people who have been through the procedures.

Tom: congrats on what you have accomplished so far, I'm sure you will continue in the future. Thanks for your insight too.

Hill Slug please don't feel hopeless. I have seen so many patients come into my office with a look of defeat that is beating them down. The great part of a successful surgery is that the cycle that has been working against you (increased weight -> decreased activity/increased appetite/decreased energy -> increased weight) begins to work for you (less weight -> increased activity/energy/decreased appetite -> more weight loss). People do things they never thought possible. In my experience people who have established good exercise habits before surgery do very well after surgery.
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Old 04-20-06, 10:24 PM   #25
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I have never mentioned anything about "trying harder", but I won't stop with the "simplistic" response of calories in < calories out, because this is a basic fact of human physiology....
Let's discuss human physiology and beginning endocrinology.

For the morbidly obese, the body is simply incapable of converting sugar into energy. You exercise; the body's normal response is to release sugar from the liver into the bloodstream to feed the cells. For the morbidly obese, the cells are not able to process the sugar. In spite of the sugar in the bloodstream, the cells are starving for food -- and you become incredibly hungry. No matter how much you eat, however, your hunger cannot be sated.

It's easy for somebody like me (5'9", 150#) and you to say "You just need more willpower." But the fact is the hunger drive is incredibly difficult to overcome, especially when that drive is coming straight from your starving, underfed cells.

Even if you have normal caloric intake for your activity level, because your cells are out of whack and aren't properly metabolizing the blood sugar, the sugar in your bloodstream just gets converted straight to fat.
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