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Tag Archives: bariatric surgery

What You Need to Know About the Gastric Sleeve

Posted on November 20, 2019 by

The gastric sleeve, or sleeve gastrectomy, is the new kid on the block so to speak. It’s not a new operation. We used to do the surgeries for other reasons not including weight loss. About 15 years ago a hormone was discovered called ghrelin. It’s a hormone made by part of the stomach that makes you feel hungry. We thought if we took that part of the stomach out, we’ve actually done two things. First we’ve made you a smaller stomach so you can’t eat very much. Secondly, when you take that part of the stomach out, ghrelin levels go way down. Since ghrelin makes you feel hungry, hunger levels go way down in its absence. If you think about it, one of the potential downfalls of every single weight loss plan in the world is hunger. If we can control hunger it’s a lot easier to lose weight and keep the weight off. Sleeve gastrectomy is the fastest growing option out there. It is the most common operation for weight loss right now. Last year about 2/3 of all operations done for weight loss were sleeve gastrectomy in the US. It’s close to 95% of what I do these days because it works so well and we see a quick recovery with very low risk. It keeps your anatomy normal.

In the sleeve gastrectomy, we remove the greater curve of the stomach (stretchy part). If you eat a large meal the stomach fills and stretches way out as you eat. That’s how it can hold so much. When we remove the stretchy part it leaves you with a tubular part (or sleeve). Sometimes when people hear the term sleeve gastrectomy they mistakenly think we’re placing something around the stomach. We’re not placing anything around the stomach. It’s referred to as a sleeve gastrectomy because we’re changing the shape. Like the sleeve on a shirt, it’s tubular shaped. We’re making it into a tubular shape. Nothing is bypassed so there is no malabsorption.  Your anatomy remains normal. Food is going to enter the stomach and empty into the small intestine the same way it did before. The size of the stomach is about the size and shape of a medium banana. The part of the stomach that’s removed is the part that makes the hormone ghrelin. Ghrelin is decreased so hunger decreases. This doesn’t mean that you won’t get hungry. There are still good reasons to get hungry. Your hunger is just much easier to control. This surgery is increasingly popular and the fastest growing option out there. It’s literally close to 95% of what I do nowadays.

The surgery doesn’t take that long. It generally lasts about 45 minutes. 95% of the surgeries we do are outpatient. It’s pretty rare that someone needs to spend the night. Full recovery isn’t as fast as the adjustable bands but it’s a lot faster than gastric bypass. Most people are comfortable driving about 3-4 days after surgery. Generally in 2 weeks people can do most things. In a month you can do anything you want. Recovery tends to be really quick.

What are the risks?  The first 30 days is the same as the other surgeries. It’s just slightly different numbers. In theory the death rate and leak rate should be the same as gastric bypass. But we’re not seeing that. What we’re seeing is about 1:1000 for deaths and less than half a percent for leaks. Wound infections, DVT’s, PE’s and dehydration have fewer risks than gastric bypass because the surgery doesn’t last as long. But it’s not impossible for any of those things. One of the things I really like about this operation is that we’ve gotten rid a lot of the long term risks. You’ve got normal anatomy so once you’re healed, you’re healed. The thing we have to keep in mind is stenosis.   Stenosis means narrowing. Anywhere along the tubular stomach could get scarring and become too narrow. If that happened you would go see a gastroenterologist. They can look in there and take care of it. It would be very rare to need another surgery after the sleeve. In theory stenosis should be about 1%. I’ve done over 1600 of these surgeries. I’ve only seen 1 case of stenosis.

We basically see the same weight loss as we did with the gastric bypass. Average weight loss is 70% of what you were overweight. If you are 100 pounds overweight, your average weight loss will be 70 pounds. If you are 200 pounds overweight, your average weight loss will be 140 pounds. That’s average. Some will lose more and some will lose less. That is very good weight loss. Long-term we see about 10-20% regain most of their weight. With any of these operations you can gain your weight back. Your stomach is a little bigger than with the gastric bypass. So why do we see a similar result?  It’s because ghrelin levels go down. In the other operations, that part of the stomach is still there. We can control the hunger somewhat with appetite suppressants. But they’re not necessarily ideal. With the sleeve gastrectomy ghrelin levels go down and hunger is easier to control.

Overall, for most people considering weight loss surgery, the sleeve gastrectomy is the better option. One of the reasons is we keep the anatomy normal. There’s a lower risk with the procedure, a fairly quick recovery and very good weight loss. We also get rid of any concerns about having anatomic abnormalities or nutritional abnormalities (malabsorption). There’s no mechanical device. Finally, you haven’t burned a bridge. That means if you don’t get out of it what you wanted out of it your anatomy is at least still normal. If your anatomy is still normal you could still have any of the other surgeries done. You could have a band placed on it or converted to a bypass. This is much more difficult after any other the other weight loss surgeries. We haven’t revised these things. We’ve seen really good results with them.

How does CFWLS compare to the national average? Obviously we’re doing this for weight loss to improve medical problems and improve your life.  We’re doing the same thing as everyone else in the world but we’re seeing better weight loss. We have a 15.8% better average weight loss at 2 years. We have good education and weight loss.  We give you a full year afterward. And with that better weight loss we also see better reduction in medical problems:  Diabetes 78.6% vs 62.3%, HTN 62.5% vs 46.9%, lipids 70.7% vs 45.3%, sleep apnea 69.4% vs 56.6%, and GERD 74.3% vs 16.6%.  Some people think weight loss surgery shouldn’t be done on patients with GERD. But we’ve seen it get much better, not worse. Again, it’s not the operation. It’s what you do with the operation. If you do the right things it can fix these medical problems.

Why is the education and support so important? We have Weight Management University for Weight Loss Surgery™.  It’s a 12-month post-op program. It includes all kinds of thing including the following:  pre-op and post-op text books, monthly support group, 12 Weight Management University courses, access to Members Only portal, fitness classes, personal training and more.

View the online surgical webinar and then schedule a call with Cat Williamson to go over any further questions you may have.  You’ll get a copy of my best-selling book, Less Weight…More Life!

What You Need to Know About a Gastric Bypass

Posted on November 11, 2019 by

gastric bypassLet’s start with a few facts about the gastric bypass. It’s been around the longest period of time. If you know anyone who’s had gastric bypass, they lose weight fairly quickly. People are often very concerned about the speed of the weight loss. Speed of weight loss doesn’t matter. It’s all tied to  body composition.. If you’re losing weight quickly and it’s all fatty tissue, than the faster the better. On the other hand, if you’re losing weight quickly but it’s lean body mass, that’s not so great. You’re going to get more and more tired and weaker and weaker. You’re slowing your metabolism down which will make it much harder to lose weight and easier to gain weight. No matter what, if you have gastric bypass, you’re going to lose weight fast. We refer to gastric bypass as being restrictive and malabsorptive. Restrictive means we’re making your stomach smaller. If we make you a smaller stomach, you can’t eat very much. You’re going to lose weight. The concept is simple. We make your stomach about the size of an egg. People often wonder if their stomach is going to stretch out. The answer is yes. We know it’s going to stretch out and we want it too. We don’t want your stomach the size of an egg. What we’re shooting for long term with all these operations is meal size, that being a small plate. That’s where we want to go. But, we’re working with stretchy material just like your skin is stretchy. If we make your stomach meal size small plate it would stretch way out. A normal size stomach can hold about 2-3 liters. We have to make your stomach tiny to begin with knowing that it’s going to stretch out.

The second part is the malabsorptive part. That’s where the bypass comes in. We’re going to bypass the part of the stomach called the excluded portion.  We go to the very beginning of the small intestine and divide it and pull it up and hook it into that tiny stomach so that we bypass the rest of the stomach. Whenever we bypass any portion of the intestinal tract, you’re not going to absorb things perfectly. You don’t absorb all the calories that you eat. But, you also don’t absorb some of the vitamins, minerals, and micronutrients quite as well either, which can be problematic. The surgery itself doesn’t take that long. It’s about 1 hour and 40 minutes. It can be done laparoscopically now. What we do is use long instruments and cameras and make little incisions on you. Recovery is pretty quick. Hospital stay is pretty quick. Recovery can take a while because this is a big operation. Whenever we start rearranging your anatomy, that’s a big operation. Recovery can take a good 4-6 weeks. Sometimes it can take up to 8 weeks to feel back to normal.

There are risks with every operation in the world. This is a bigger operation so the risks are bigger. When I talk about risk, I divide it into two time-frames. This is not something I made up. This is a medical standard which is basically right around surgery (peri-operative). By medical definition this means the first 30 days. The second time-frame is long-term which, by medical definition, means longer than 30 days. What’s the worst thing that could happen in that first 30 days? Could you die?  The answer is yes it could happen. The risk of death is real when we start dividing your intestinal tract. It wouldn’t matter if I was talking about taking your appendix out or taking your colon out. When you look at national statistics, the risk is about 1: 200.  What we see is about 1:500.  Bottom line is that it may be rare, but not impossible. The things we worry about the most are infections. Some things are easy to treat such as urinary tract infections. Other infections aren’t so easy to treat such as pneumonia. They occur about 2% of the time after any surgery where you have to go to sleep for. You have to go to sleep for all these surgeries. It’s somewhat related to how long did the surgery take? The biggest fear as far as infections go is a leak on the inside. What if the pieces we took apart during surgery and put back together leaked?  There are literally trillions of bacteria that live in the intestinal tract. When we start dividing the intestinal tract some of those bacteria could potentially get out. If they set up a rip-roaring infection, potentially you’d have to have another surgery to fix that. Wound infection means on the skin. They’re more of a nuisance than dangerous. They have to be treated with antibiotics. DVT is a deep venous thrombosis. PE is a pulmonary embolism. These are blood clots. You can get a blood clot without having surgery. You can get it from being dehydrated. One of the most common ways to get a blood clot is traveling on a long plane ride. You can also get it from having a general anesthetic. Again, it’s somewhat related to how long the surgery takes. The longer the surgery takes, the higher the risk is. We do all kinds of things to prevent that during surgery. The blood clot risk is 1-2%. If you got a blood clot you have to be on a blood thinner to dissolve that blood clot. The first thing that happens to that tiny stomach is the tissue swells up. Just like if you sprained your ankle. Your ankle would swell up. Stuff just trickles through the stomach initially. If you’re not able to stay hydrated you have to come back to the hospital to get IV fluids. You have to rest for a few days.

Long-term means 30 days until forever. The most common long term physical problem is peptic ulcer. You can get an ulcer without having gastric bypass. But when you have the anatomy of gastric bypass, the risk of getting an ulcer goes up. The people who tend to get ulcers are smokers and people who take anti-inflammatory meds. Ulcers just need to be treated. Something that could require another surgery is a bowel obstruction. Adhesion means scar tissue. If you’ve had any surgery on your abdomen you’re going to have scar tissue, not only on the outside, but also on the inside. That scar tissue can potentially kink the intestine. Just like a kind in a hose, nothing is going through there. You then have to go back to the operating room. Hernias are another risk. You can get them without having surgery. Any place we make an incision there is potentially a weaker spot. Stenosis means narrowing. What we’re talking about is right where we take the stomach and hook the small intestine to it. A scar could potentially form and cause a narrowing. If this happened, stuff wouldn’t go through very well. We would send you to a gastroenterologist. They would take a look down there and can stretch it out. Typically it doesn’t need any surgery but it does need to be evaluated and treated. Vitamin and nutrient malnutrition is relatively common. You won’t be able to absorb things perfectly. You’re going to have to take some things long term in addition to taking a battery of tests every 6-12 months to make sure those things are staying where they should. That’s a forever thing. That doesn’t go away.

We see great results with gastric bypass. You’ll lose about 70% of what you were overweight.  If you were 100 pounds overweight you’ll lose 70 pounds. If you’re 200 pounds overweight, you’ll lose about 140 pounds. That’s the average. Some people lose more, some people lose less. About 40% of people with gastric bypass regain most of their weight back. Overall the long term anatomical and nutritional problems, with relatively poor weight maintenance, make it difficult for me to recommend gastric bypass for most people.

What should you do? You need to decide what’s best for your unique situation. There is no right or wrong here.  What I encourage you to do is give us a call and set up a 1:1 consultation to discuss the options.  Let’s you and I sit down and go over your situation. Everybody’s situation is different.  Give us a call at (757) 873-1880 or email us at success@cfwls.com.

I have some final thoughts for you. Weight loss is the most important step you can make to improve your health!! There are so many medical problems that are directly related to weight loss. If we can control weight, we can control medical problems. If we can control all these medical problems it gives you the best chance of living a long, healthy life.

Watch the online seminar and give us a call (757-873-1880) and set up your 1:1 appointment. If weight is contributing to your health problems let us help you.  I hope to see you very shortly here in the office.

What Are the Options for Weight Loss Surgery?

Posted on November 04, 2019 by

What are the options for weight loss surgery?  The most common options done worldwide are: gastric bypass, Laparoscopic Adjustable Gastric Banding (LAGB), and sleeve gastrectomy. I’m going to give you the basics on all of these. You can also watch our complete online webinar on Weight Loss Surgery Options.

Gastric bypass has been around for a long period of time. The first gastric bypass was done in 1955. It’s been around for over 60 years. It’s a well-studied operation. We know what happens to people who have gastric bypass. We know the problems that arise and what to do about the problems. It’s a very well-studied operation.

 

Adjustable gastric bands have been around in the US since 2001. Worldwide they’ve been around since the early 1990’s. Why do you care how long an operation has been around? We talk about long-term problems and long term results. By medical definition, long-term means 10 years long. That wouldn’t matter if I was talking about brain surgery, heart surgery, or knee surgery. It doesn’t matter. With weight loss we’re going to be talking about things that literally can last 20, 30 or 40 years. If you’re fairly young it could be 50 or 60 years. Looking at the long-term issues is very important and how it impacts your health for your lifetime.

The sleeve gastrectomy is the new kid on the block. It’s not a new operation. We used to do the surgeries for other reasons not including weight loss. About 15 years ago a hormone was discovered called ghrelin. It’s a hormone made by part of the stomach that makes you feel hungry. We thought if we took that part of the stomach out, we’ve actually done two things. First we’ve made you a smaller stomach so you can’t eat very much. Secondly, when you take that part of the stomach out, ghrelin levels go way down. Since ghrelin makes you feel hungry, hunger levels go way down in its absence. If you think about it, one of the potential downfalls of every single weight loss plan in the world is hunger. If we can control hunger it’s a lot easier to lose weight and keep the weight off. Sleeve gastrectomy is the fastest growing option out there. It is the most common operation for weight loss right now. Last year about 2/3 of all operations done for weight loss were the sleeve gastrectomy in the US. It’s over 95% of what I do these days because it works so well and we see a quick recovery with very low risk. It keeps your anatomy normal.

How does CFWLS compare to the national average? Obviously we’re doing this for weight loss to improve medical problems and improve your life.  We’re doing the same thing as everyone else in the world but we’re seeing better weight loss. We have a 15.8% better average weight loss at 2 years. We have good education and weight loss.  We give you a full year afterward. And with that better weight loss we also see better reduction in medical problems:  Diabetes 78.6% vs 62.3%, HTN 62.5% vs 46.9%, lipids 70.7% vs 45.3%, sleep apnea 69.4% vs 56.6%, and GERD 74.3% vs 16.6%.  Some people think weight loss surgery shouldn’t be done on patients with GERD. But we’ve seen it get much better, not worse. Again, it’s not the operation. It’s what you do with the operation. If you do the right things it can fix these medical problems.

Why is the education and support so important? We have Weight Management University for Weight Loss Surgery™.  It’s a 12-month post-op program. It includes all kinds of thing including the following:  preop and postop text books, monthly support group, 12 WMU4WLS courses, access to a private membership site via CFWLS.com, “Losing Weight USA” (weekly live webinars with access to Dr. Clark), and a private Facebook support group.

What should you do? You need to decide what’s best for your unique situation. There is no right or wrong here.  What I encourage you to do is give us a call and set up a 1:1 consultation to discuss the options.  Let’s you and I sit down and go over your situation. Everybody’s situation is different.  Give us a call at (757) 873-1880 or email us at success@cfwls.com.

I have some final thoughts for you. Weight loss is the most important step you can make to improve your health!! There are so many medical problems that are directly related to weight loss. If we can control weight, we can control medical problems. If we can control all these medical problems it gives you the best chance of living a long, healthy life.

Watch the online seminar and give us a call (757-873-1880) and set up your 1:1 appointment. If weight is contributing to your health problems let us help you.  I hope to see you very shortly here in the office.

Weight Loss Surgery Options

Posted on October 15, 2019 by

Let’s talk about the problem of obesity and what you can do about it. I will preview the operative procedures and the risks of having surgery, as well as the results. I’ll give you my opinion. For most people I think the sleeve gastrectomy is the better option! I see all the nutritional problems that arise and abnormal anatomy problems with the bypass. And I see the device problems with the adjustable bands. There’s relatively poor weight loss with the bands. The sleeve gastrectomy is a fairly low risk procedure.  It’s a quick recovery and we see really good weight loss with it. And, you keep your anatomy normal. I’ve become convinced over the years that keeping the anatomy normal is probably a good thing.

Weight loss is hard. Surgery is an extension of an overall medical weight loss plan. Weight doesn’t magically fall off just because you have surgery. It’s still diet, exercise, and behavior modification. Surgery is a “tool” to assist you with weight loss. That’s all it is. A tool can either be used correctly, or it can be used incorrectly. If used correctly it can be very powerful. If used incorrectly it doesn’t work well and you can get into some real problems. Long term weight control is still very hard. Some people think they’ve had the surgery and lost the weight so they don’t have to worry about it anymore. YES YOU DO! You can regain your weight. It doesn’t matter what operation we’re talking about. You need to do the right thing. You have to know what the right things to do are. Then, how do you implement those things? Sometimes the concepts are really straight forward but you have to know what they are. Implementing the concepts is the hard thing. We have the expertise and support here. We can help you with how you do this in your life. Sometimes life tends to get in the way. Surgery combined with a Medical Weight Loss program gives you the best chance for long term success. It’s not that we’re doing better or different operations but we see better weight loss than other places. We see better weight loss because it’s the education and support side of this whole thing that really gets people optimizing weight loss and then keeping that weight off long term. That’s absolutely key.

Lots of different medical problems go along with weight. Every single one I’ve listed on the slide is directly related to weight. When weight goes up, they get worse. As weight comes down, they get better. Some of them completely go away with weight loss. If they don’t go away, at least they get under control. Some of them are very significant: diabetes, high blood pressure, heart disease, and more. These things can potentially be life threatening. Weight loss treats them all. If I could boil it down to the biggest problem it’s the risk of dying. It goes way up. For someone who is 75-100 pounds overweight, on average, you’re going to die about 10-15 years before someone who’s not overweight. That’s the issue. We want you to live a long, healthy life and die of old age. Last thing you want is that premature death. By treating the weight, we can treat all those other problems.

To learn more about your weight loss surgery options, check out our informative webinar: Weight Loss Surgery Webinar

Get your free digital copy of my best-selling book too!  (Details here)

The Top 10 Dieting Mistakes

Posted on October 07, 2019 by

We all make mistakes, especially when we’re trying new things like weight loss. With weight loss people have typically tried many things. These are going to be some of the more common mistakes. You need to see it as an opportunity to change, and hopefully for the better.

Mistake #1 is “kinda” working on weight loss. Kinda working on weight loss does not work! We often want that quick fix. We have to learn the skills over a period of time. If you’re just going to “kinda” work on it, it isn’t going to work. Skills have to be learned. Then, they have to be ingrained and become habit.  They have to be practiced over and over and over again so they can become lifelong habits. Think about a serious athlete trying to make the Olympics. They can’t just “kinda” work on it.  Commitment is absolutely essential. You can’t expect perfection. We’re going to make mistakes.

Mistake #2 is making weight loss too complicated. Yes, weight loss is hard, but you really need to stick to the basics.  The basics are: dietary changes, behavior/habit modification, and increased activity and fitness. Those are the basic concepts. It sounds easy, but obviously it’s not so easy. I put together a webinar about a month ago that went over some really important concepts about controlling weight. It really boiled down to controlling insulin levels. It was about all the things you need to do to control insulin levels. Diet has to be the cornerstone of all that. Slowly work on all the basics and you will continue to make progress. With any type of change you need to ask yourself two questions: Can I do it? Is it worth it? If you can’t answer yes to those two questions you’re going to struggle and not make that long term change.

Mistake #3 is not exercising!  Exercise does not make you lose weight faster. So many people come in and say they’d be losing weight faster if they were exercising. It’s probably not true, but it’s still very important. It’s absolutely essential to preserve lean body mass. The natural part of aging is losing lean body mass at a rate of 1% a year.  LBM is what drives your overall metabolism. Simplistically speaking, a pound of muscle burns a lot more calories than a pound of fat. It’s actually a pound of well-trained muscle (think of the Olympic athlete) burns calories like crazy versus a pound of fat. You want to have a fuel-burning machine.  Muscle does that. Our overall metabolism is dependent on how much lean body mass we have. The better trained the lean body mass, the higher the metabolism will be. You can increase your metabolism with better trained muscle. It burns a lot more calories than untrained muscle. So exercise is extremely important. It doesn’t make you lose weight faster. It makes you lose weight longer and makes it so much easier to keep that weight off.

Mistake #4 is avoiding the scale. I’ve said many times that the scale is the best monitor we have. Patients often say they don’t weight themselves routinely.  They only weigh when they come into the office. Why would you think that’s a good idea??! I’ve said many times that you need to stand on the scale every day. The best time to weigh yourself is early in the morning. It’s the most accurate. If you forget to weigh yourself in the morning, just wait until the next day. Your weight will go up during the day. Make that part of your morning routine. The reason is to reflect on the previous 24 hours. What was different about that previous 24 hours? You’ll figure out the little things that matter. It may be as simple as you had to much salt or you didn’t have a bowel movement. Those little things that we typically eat really matter and will show up on the scale.  Once a week doesn’t work.  How many of us can look back on a week and figure out what we did differently during that week versus the previous week? Literally two days I can’t remember what I did differently. Looking back on 24 hours is relatively simple. What worked? What didn’t work? You’ll figure those little things out that affect day to day weight.

Mistake #5 is believing that genetics is responsible for your weight. Genetics does influence our weight. But if we are using genetics as a reason for our weight that’s just an excuse. When you really look closely at that thought process, weight is more likely contagious than it is inherited.  We tend to do the things we surround ourselves with. If everyone in your family is overweight it is slightly genetics but it’s very likely what they’re eating and doing. It tends to be contagious. We do the things that the people we hang around do. That’s true in our family and social life. It’s going to be a very rare situation where genetics is truly the reason. Weight is more likely contagious rather than inherited.

Mistake #6 is giving in to saboteurs. Friends, family, and acquaintances will all try and sabotage you. They will say the following:  “You deserve this.” “A little won’t hurt.”  “It’s the holidays!” There will be saboteurs. Be prepared to say, “No thank you” in multiple different ways. Deflect the comments by changing the subject. Explain to them the importance of this and that you want to recruit them to help. Tell them you value their support. You want them to help you rather than hinder you. Sometimes they don’t realize they’re sabotaging your progress.

Mistake #7 is being inconsistent. It’s that mentality of, “I’ve been good all week. I’m going to take the weekend off.” “I deserve this vacation because I’ve been so good.” Consistency goes along with commitment. Ask yourself those questions: “Can I do it?” “Is it worth it?” A bad weekend can undo 2 weeks of hard work. You tell yourself that you can slide just a little bit. You’ll find that you’ll slide a lot. It’s really easy to gain weight. It’s incredibly easy to gain weight. Write down your motivations for weight loss and review them often. “Why am I doing this?” “Where do I want to go with this?” Hopefully you’ll realize being consistent is worth it.

Mistake #8 is not eating enough. The common thinking is less is better. The reality is starvation has never been a good weight loss plan. Starvation is cutting way back but history has shown that it isn’t successful for weight loss. Fifty to sixty years ago some semi-starvation experiments were done. Around WW II there were contentious objectors. These people refused to join the military so they were asked to help by being put on semi-starvation diets. They found that if you cut those calories in half of what someone normally would be eating, people didn’t actually lose weight. They lost weight for a while but their metabolism slowed way down to make up for the calorie deficit. Part of the problem with just decreasing calories, and to continue to decrease calories, is that it only tends to work for a short period of time. Your body adjusts fairly quickly and it will slow your metabolism way down. It can slow it down to almost 50%. That is your body’s survival mechanism which is good if there truly is a famine. However, most of us aren’t living in a famine. Part of the issue with the semi-starvation diets is they cut their protein way back. If you’re getting sufficient protein, typically your calories will be decent.  Weight loss will become more difficult. It will also become really easy to regain weight.

I had written that mistake #9 was skipping meals. It’s actually not such a bad thing because intermittent fasting works really well. Intermittent fasting is just skipping meals. I do encourage people to eat breakfast for a couple of reasons. There are also reasons to skip breakfast. There isn’t a right and a wrong here. I’ve become convinced about that. Some of it depends on what you’re eating for breakfast. If you tend to eat a high carbohydrate breakfast, studies show you’re going to be eating 300-400 calories a day extra because you tend to be hungrier. If you’re going to eat a high protein breakfast you tend to stay full longer and you eat about 200 calories less a day. Most people don’t wake up starving. For certain individuals, skipping meals can actually work nicely. Skipping meals can actually be a good thing.

The NEW Mistake #9 is thinking that meal “timing” doesn’t matter. It DOES matter. The same meal late in the evening has a greater insulin response.  If you eat that meal earlier it will have a different insulin response. This goes along with skipping meals. Some people do much better with eating 2 meals a day. We already talked about intermittent fasting. It works. There’s no doubt about it. Insulin is key to weight control. The longer time you can spend with lower insulin levels, the easier it is to lose weight. The concept of eating multiple small times throughout the day will never work well. If you’re sensitive to carbohydrates or somewhat insulin resistant, the small meals throughout the day will never work for you. The reason is that, no matter what, whatever we eat will raise insulin levels. Carbohydrate just does it the most. You want to spend as much time as possible with low insulin levels. Skipping meals will give you more time with lower insulin levels.  Eating the same amount of calories but spreading it out throughout the day is asking your body to stimulate insulin levels multiple times throughout the day. That concept doesn’t have a whole lot to do with how many calories you’re eating. It’s just a pattern of eating. Timing matters. It’s a really rare person that controls their weight well by eating a little bit multiple times throughout the day. That’s just not my patient population. That’s not who I see. There are some individuals who aren’t that sensitive to carbohydrates. Those people will be fine eating small meals throughout the day.

Mistake #10 is having that “All or None” mentality. It’s feeling that you’re either doing everything great, but if you make a mistake you’re all done and throwing in the towel. This is a learning process. We’re human and we won’t be perfect every day. Accept the mistakes and move on. You didn’t gain the weight overnight. It didn’t happen with just one meal or one bad day. When you have that bad day, chalk it up to a learning experience. Figure out what you’re going to do differently when you’re in that same situation next time. Figure out those tools you can utilize to prevent you from falling off the deep end and get back on track for the next meal. Don’t beat yourself up.

In summary, to err is human but it does not define your destiny. Don’t let mistakes derail your weight loss plan. Dust yourself off and keep going. At CFWLS this is what we do. We’re here to help you. If you need some help just give us a yell. If you have any questions give us a yell here at CFWLS. Call, send an email, or walk in the door.  You should be checking your body comp. Make sure you’re losing fat not lean body mass.

If you would like weekly weight loss tips and recipes and a chance to ask me questions, subscribe to Losing Weight USA!  Remember it’s your life! Make it a healthy one! Have a good evening everyone.  Take care!

Gluten Sensitivity – Part 1

Posted on September 23, 2019 by

I want to start out with some humor. It’s a cartoon. The doctor is talking to the patient and says, “The high carb diet I put you on 20 years ago gave you diabetes, high blood pressure and heart disease. Oops.” How true is that?!

I have a graph that shows what’s happened over the last 20 years or so. It’s the year versus the number of diabetics. The number of diabetics was fairly stable in the early 80’s into the 90’s.  As the population grew, it went up a little bit. It was stable at about 6-7 million. Then in 1992 the US Government endorsed a high-carb, low fat diet. The American Diabetic Association and the American Heart Association followed suit with similar recommendations in 1994.  Then in 1994 the graph started going up. From the early 90’s at 6 million diabetics to the 2000’s and now it’s over 20 million. That’s a huge increase in a short period of time. Coincidence??? I don’t think so.

Gluten has been around for a long period of time. It’s a Latin word that means glue. It’s a large water soluble protein found mainly in grains. Wheat is the biggest culprit. It gives elasticity to dough. It helps it rise and keep its shape. There are a lot of disorders that can be related to gluten. We call them gluten related disorders. It’s an umbrella term of any disease that is triggered by gluten.  This includes Celiac Disease (the one that you hear about most), gluten sensitivity, and wheat allergy. You sometimes hear the term gluten intolerance.  The real term is gluten sensitivity. Intolerance means you don’t tolerate it well. All of these are immune related disorders. Your immune system is responding to the exposure of gluten. For some people it can be a life threatening problem.  If they get even close to gluten they have all kinds of problems.

Celiac disease affects about 1-2% of the population. The prevalence of this is going up and up.  We’ll talk about why later. There’s something different now about the wheat than there was years ago. Unfortunately it’s never been tested to see if it’s a safe thing. Some of the symptoms are chronic diarrhea, abdominal pain, and malabsorption. It’s a true anti-inflammatory response in the intestinal tract.  The diagnosis is made by endoscopes. A biopsy is taken. The treatment is a gluten free diet.  There’s no other treatment.

Non Celiac Gluten Sensitivity means you don’t have the full blown disease. These people feel there are certain problems that arise when they eat gluten. You may or may not have any intestinal complaints. Multiple symptoms are improved when gluten is removed.  This is much more common (30-40% of the population).The percentage of the population continues to go up.

A true Wheat Allergy is like an anaphylaxis. It’s like someone allergic to peanuts eats one by mistake, they go into anaphylaxis. This is a very quick onset. The others have a slow onset. A wheat allergy is much rarer.

Gluten is made up of glutenin and gliadin. There’s also water which gives the dough its elasticity. It tends to be everywhere! That’s where the problems come in. Many grains and products have gluten in them. Where is it hidden? The obvious one is wheat. Anything that has wheat in it is going to have gluten. It’s also found in barley, bulgur, cous cous, matzo, rye, spelt, and more. There are grains that don’t have any gluten in them. Some of those grains are relatively rare. Some of them are common like potato, corn, rice and millet.  I’ve made a list of things you wouldn’t guess have gluten in them: baked beans, beer, blue cheese, bouillon, most cereals, chocolate milk, energy bars, egg substitutes, hot dogs, fruit fillings, ice cream, imitation crab meat, ketchup, vinegar, mayonnaise and meat balls, Gluten is added to a lot of things you wouldn’t really expect.   Oats may or may not have gluten. French fries are made out of potato. But before they’re frozen they are actually sprinkled with wheat flour so they don’t stick to each other.  A lot of cosmetics have gluten. Medications, play dough, some shampoos, some vitamin supplements have gluten.  There are a lot of things that are code words for gluten. Sometimes they’ll put it as the genus species of the actual plant. There will be hidden gluten. Keep in mind that gluten free does not mean low carb. It could actually mean high carb.

Gluten sensitivity can cause all kinds of symptoms. From a GI standpoint, they can be somewhat similar symptoms as true celiac disease but not quite as dramatic. The GI symptoms are: abdominal pain, bloating, diarrhea, constipation, nausea, GERD, gas, stomatitis, and mouth ulcers.  There are also symptoms of gluten sensitivity that have nothing to do with the GI system such as:  migraines, brain fog, fatigue, fibromyalgia, joint/muscle pain, numbness, eczema, skin rashes, depression, anxiety, anemia, folate deficiency, asthma, rhinitis, and eating disorders.  There are neurologic symptoms. Gluten can set off schizophrenia. It could be a factor in autism, peripheral neuropathy, ataxia, ADD, and ADHD. We see this diagnosed all the time nowadays. It actually could be a gluten problem.

There are some antibody tests to diagnose for gluten sensitivity. However, they’re going to miss a lot of people.  The only good way is a diagnosis of exclusion.  You remove gluten from your diet for at least a month and then try and reintroduce it. If your symptoms come back, it’s probably due to gluten. It’s not the most scientific thing in the world to do but it actually works pretty well. It’s like an elimination diet.  The treatment is a gluten free diet.  Those with gluten sensitivity often have the false impression that “cutting back” is helpful, but really need to avoid all gluten. I want everyone to keep in mind that if you eliminate gluten, no nutritional deficiency will occur.

It’s really amazing some of the symptoms that can be related to gluten sensitivity. I already mentioned a lot of them. Some other symptoms are: autoimmune disorders (rheumatoid arthritis, diabetes, Hashimoto’s), bone pain, cancer,   heart disease, infertility, dental problems, skin problems, and more.  Gluten sensitivity can have a lot of things to do with things you never expect. The only way to know is getting rid of the gluten. Obviously we think of gastrointestinal problems associated with gluten sensitivity.

Unfortunately there are no real standards for testing gluten intolerance.  The simple way to do it is to get rid of the gluten. We can measure anti-gliadin antibody (IgA) in the blood or stool. If you measured everyone’s blood, 12% have antibodies to anti-gliadin.  There are 30% in the stool. It can cause an immune reaction. If something causes an immune reaction there can be damage. The reaction is usually an inflammatory reaction. Cytokines develop and are released. The Gold Standard is gluten free for 1 month, then re-introduce. If symptoms pop up, then you are sensitive to gluten.

Gluten-free should not mean eating all the junk/processed food that is labeled as gluten free.  It doesn’t correlate with low carb. The “Core Diet” is just 3 things: hydration (water), good protein sources, and salad stuff. That’s what you should eat. Get rid of most everything else. Do I agree with trying to keep a gluten-free diet??? Absolutely!

I have more to say about gluten and I’ll post another article next week.  We’ll delve into this more and look at all the major body organs that can be affected by gluten sensitivity. I’ll go into a little more detail with that.

If you think of questions, don’t hesitate to call (757-873-1880), text or stop by. This is something that’s really common. I think this is something that’s going to become more and more important. Part of the problem is that the wheat that’s being grown now is not the same wheat that was grown 100 years ago. It was genetically modified (GMO’s). You hear about GMO’s all the time. The problem with GMO’s is whether they’ve been tested for safety.

Remember to stop by and get your body comp checked.

Remember, it’s your life. Make it a healthy one.

Breaking Through a Weight Loss Plateau After Bariatric Surgery

Posted on April 22, 2019 by

Today we’re going to talk about those dreaded weight loss plateaus. What do we do about them?  What should you look for? We all dread them. They are going to happen. It doesn’t matter what we’re taught. You’re going to go through plateaus. What do you look for? What can you do to break through the plateaus? At some point you need to think about whether it’s your weight maintenance. That’s a slightly different topic. We’re not going there today. I’m going to just assume that you’re not where you want to be and not where you can be. So subsequently you’re at a weight loss plateau.

What is a weight loss plateau? Sometimes we look at the scale and it hasn’t budged in three days and therefore it’s a plateau. That’s not really a plateau. A weight loss plateau is when you’re doing the right things and your weight is stuck for a few weeks.  So, for two or three weeks nothing is happening. Subsequently then, yes, you can be in a weight loss plateau. Shorter than that means there can be just a lull in the action, so-to-speak. Your body adjusts. As it adjusts, it’s going to try and turn off weight loss. It doesn’t want you to lose weight. With any weight loss plan, your body is going to assume you’re in a state of deprivation. So, it doesn’t actually want you to lose weight. It wants to hang on to that energy source if you truly were in a famine.

We’re in a weight loss plateau. What is going on? What I usually do is give people questions to ask themselves about certain things. I’m going to give you this list of questions and we’re going to talk about what some of the solutions are.

Question #1—Have you actually cut your calories too low? Sometimes people do cut their calories down too low. If you cut them down too low, your body is going to go into starvation mode and you’re not going to lose weight very well. It’s hard to put an exact number on that. Potentially if you’re going lower than 1000 calories and you’re not in a medically supervised plan, that’s generally not the greatest thing. In the surgical plan right after surgery you’ll often be between 700-800 calories. Long-term that’s really not the right answer either. You want to make sure you haven’t cut calories too low.

Question #2—Are you getting enough water? This is probably one of the most common reasons I see initially in a weight loss plan and especially after surgery when things start slowing down. If you start to get a little behind in your water, the body will tend to hang on to everything-fat included. I encourage people to push the water.

Question #3-How many carbs are you really taking in? At The Center for Weight Loss Success we talk about restricting carbohydrates. Everyone is going to have a tipping point with carbohydrate. If you go above that tipping point you struggle with weight loss. Are you above your tipping point? If you don’t know what your tipping point is, it’s hard to know that answer. It is something we can figure out. It’s not necessarily easy to do.  You have to write it down! That goes along with one of our solutions-Journaling! Write these things down, especially carbohydrate. If you’re going to measure one thing, count your carbs. I don’t know how many times I’ve said that over the past couple of years.

Question #4-Are you getting enough protein? Carbohydrate influences insulin. You want to keep your insulin level as low as possible. Insulin is a hormone we can’t survive without. You’ve got to have some but you want to survive with the absolute smallest amount possible. Insulin can cause so many problems. Weight gain is just one of them. If you’re not getting in enough protein, your body will preferentially break down lean body mass, slowing your metabolism down. Protein manipulates other hormones too. Protein is more satisfying so you stay fuller for a longer period of time. It also increases growth hormone and glucagon. Glucagon is the opposite hormone of insulin. Insulin is telling your body to store fat. Glucagon is mobilizing the fat. As adults we don’t need that much growth hormone, but we make it because we can’t survive without it. If we can optimize what we do make, it’s going to help you preserve lean body mass, keeping your metabolism higher. So you want to make sure you’re getting in enough protein.

Question #5-Is your exercise too routine? Your body will get used to whatever exercise program you’re doing. When you’re body gets used to it, it doesn’t get the same out of it as it did originally. If your exercise gets too routine you don’t get as much out of it. The real trick with exercise is you want to preserve lean body mass to keep your metabolism as high as possible. Exercise alone typically doesn’t make you lose weight, but if you can preserve or build lean body mass you’re going to increase your metabolism and keep you on a weight loss track. The flip side to your exercise routine is whether you are exercising too hard? That can also slow down weight loss. Inherently that doesn’t make sense but it actually can do that because too much exercise can cause our stress hormone, cortisol, to go way up. When cortisol levels go up, it’s hard to lose weight. It makes us resistant to weight loss. This was a survival mechanism when we were stressed. Typically our biggest stress was not being able to find food. Stress typically makes us resistant to losing weight. It leads us into the next question.

Question # 6- Are you handling your stress alright? If you’re going through a stressful event, whether it be social, work, family, or medical, if you’re not handling stress well then it could turn on the plateau.

And, finally a couple things to look at as far as asking yourself about weight loss plateaus. What about caffeine and artificial sweeteners? Inherently both of those don’t make sense in a weight loss plan of turning off weight loss. But some people are sensitive to caffeine because it will increase your stress hormone because it’s a stimulant. Increasing stress hormones can make your resistant to losing weight. You want to be cutting back or getting rid of the caffeine. Caffeine can stimulate appetite which makes it harder to stick with the plan.

Artificial sweeteners can turn off weight loss for a couple of reasons. They can make us want sweet things. We get used to the sweet taste. They tend to be so much sweeter (even 1000 times) than sugar. Artificial sweeteners have no calories but it trains us to want something sweet. It makes it harder to stick to the diet plan. Also, they can often increase insulin levels. Inherently that doesn’t make sense. The sweetness you’re tasting from the artificial sweetener make the body think that you’re getting something that has a lot of calories. It’s expecting those carbohydrate calories so the body releases insulin. Hunger and cravings will increase. Insulin tells your body to store fat. Artificial sweeteners can turn your body into fat storing mode even though there are no calories in it.

What do we actually do about this? These are questions to ask yourself once you’ve hit a plateau. What are we going to do about these things? Some of these answers I hit a little bit on during the questions themselves.  What can you do?

  1. Write it down. Go back to journaling. It is a basic thing. If you don’t write it down, you’ll never really figure out where the problem area it. You have to write down everything. I’m referring to what you’re eating, drinking, and how much activity.
  2. You need to make sure you’re counting the carbohydrate, protein, and water. You want to watch all those things. If they’re all good, then we have to figure out how we work with that. Push the water. Hydration!!
  3. Go back to the beginning. Many people do the Jump Start diet. It’s using some of the protein meal replacement shakes. It gives you a good protein source, controlled carbohydrate, calories will be fairly low, and it gives you exact numbers so that you know exactly what happens when you have X amount of calories, carbs, and protein.
  4. Look at the exercise. Is it routine? Now it’s time to change gears. You really want to make sure you’re doing plenty of resistance training. You can do body weight exercises (push-ups, pull-ups, sit-ups, squats). You don’t necessarily need weights to do it. The best exercise for weight loss is high intensity interval training (HIIT). The best piece of exercise equipment you can have is a heart rate monitor. You’re pushing your heart rate up to near max, back and forth. Potentially you’re going into the anaerobic training where you go up to your heart rate max. You’re crossing over into anaerobic metabolism which gives you the best fitness gains. You can’t do that if you’re just starting in fitness. But if you are into fitness and you’re good at that, this is something that can really get you going and get you back on that weight loss plan.
  5. Something I mentioned is ratchetting down that carbohydrate and lifting up that protein. You can do it with food. Again, you have to count it.
  6. We can start looking at over-the-counter products. There are a lot of different things out there. Green tea is actually one of the things that can be helpful. It can boost your metabolism about 4%. In a 2000 calorie diet that’s about 80 calories. If you’re on a 1000 calorie diet, it’s about 40 calories. It’s not really that much but enough that can help to get you back on the weight loss curve. Cayenne peppers as a supplement or eating the food can boost your metabolism. There’s some evidence that probiotics can change your intestinal flora. Often it can help with weight loss.
  7. Make sure you’re doing the basics. Are you taking your vitamins? We often think of B-vitamins as our energy vitamins. You can either do B-vitamin injections to potentially jump start a weight loss plan or a high dose of B-6. I would encourage doing an activated form of B-6. It can bump up your metabolism some. We’re talking about 50 or 100mgs. If you’re buying B-6 by itself it’s usually 1 or 2 tablets.
  8. It’s kind of like an amino acid. It helps mobilize fat molecules into the mitochondria. The fat molecules are what you’re trying to get rid of. The mitochondria are your energy furnace. That’s what is actually being burned for energy and truly converted to energy. By itself it’s not energy until it’s converted to ATP. That happens in your mitochondria. Carnitine helps mobilize fatty molecules into the mitochondria. It’s like a steam engine. You’ve got to get the fuel into the furnace. Carnitine gives you a bigger shovel so it’s easier to move the fuel into the furnace. Typical you may need to take 1-2 grams of carnitine. You can find it in most health food stores.

Those are some things you can do as far as working through some weight loss plateaus. We went through a lot of information. Weight loss plateaus are very common. It happens to everybody until their finally in maintenance. So it’s literally going to happen to everybody. You want to work through it. The last thing you want to do is throw in the towel. You can go through those questions as well as the solutions that I talked about. You can also use appetite suppressants. They are carefully regulated by the FDA. But if you’re in a medical or surgical weight loss plan and are stuck or have cravings, appetite suppressants can be very helpful. They just have to be monitored very carefully. Some people are not candidates for them.  Another thing that helps with cravings is chromium. It’s a mineral just like sodium and potassium. We need minerals in tiny amounts. If we take them in higher doses it can help with cravings. You can buy it at health food stores, pharmacies, and here at CFWLS. You do need to take it three times a day. It will say take one a day on the bottle. That doesn’t work. You usually need to take it three times a day.

There are lots of little solutions. Hopefully something there will help you with your weight loss plateau. Work through it. If you have questions please let us know. We’re here to help. If you want more information go to our corporate website which is www.cfwls.com  If you want to join me each week in a webinar, we talk about all kinds of different topics about weight and overall health. You can go to losing weight USA and sign up there.  The website is: www.losingweightusa.com    Sign up and you’ll get access to me plus recipes and tips every week. Thank you all for listening. If you have questions just give us a yell here at Center for Weight Loss Success. I will talk to you on the next podcast. Remember-it’s your life. Make it a healthy one!

The Skinny on Ketosis and Low Carb Diets

Posted on April 15, 2019 by

Low Carbohydrate diets actually have a lot of misconceptions. So we’re going to go through a bunch of them. Let’s start out with the first two I hear most commonly.

The first misconception: Ketosis is dangerous.

The second misconception: Low carb diets make you lose bone mass and are bad for your kidneys.

Ketosis just means you have ketones in your bloodstream. We have ketones in our bloodstream all the time. It’s just the level of ketones.  Ketones are really just an energy source. They come from the breakdown of fat. Isn’t that what you want in a weight loss plan? You want to have some ketones in your bloodstream so you can use them as an energy source. Ketosis is often confused with diabetic ketoacidosis, and that’s a completely different thing. That occurs when the ketones get about 10 times the level of what would happen in a low carbohydrate diet. Ketosis by itself is not dangerous at all. It’s just an energy source.

Initially in low carb diets we saw that there was some extra calcium in the urine. But long-term we found that we actually absorb more calcium. So for a little bit of calcium that’s lost in the urine, there’s still a positive calcium there. We don’t actually lose bone mass. We can actually improve bone mass. Kidney failure doesn’t happen. There’s a difference between kidneys that can have low carb diets and kidneys that shouldn’t have low carb diets. What I mean is, with kidneys that are normal, there’s no problem with having a low carbohydrate diet. Kidneys that are abnormal should not be on a low carbohydrate diet. Typically, on a low carbohydrate diet, you’re going to have a little more protein, and it’s the protein that’s the problem.  It’s the extra nitrogen in protein that kidneys can’t handle if you’ve got bad kidneys. If you have normal kidneys, it could actually improve kidney function.

Remember-it’s your life. Make it a healthy one!

Low Carb Diets and the Truth About Water Weight

Posted on April 08, 2019 by

It’s often thought that low carbohydrate diets are only good for short term weight loss because they cause you to lose water.  Isn’t that bad??  Yes it is good for short term weight loss is because you lose water. The reason you lose water is because insulin levels will go down on low carbohydrate diets. Insulin is a hormone that tends to make you retain sodium. When you retain sodium, you’re going to retain water. So, when insulin levels go down on a low carb diet, you no longer will retain sodium. Subsequently you’re going to get rid a lot of that extra water that goes along with the sodium. One of the nice things about that is you can actually have a little bit of extra sodium because you won’t retain it. So, yet, you will lose weight fairly quickly on a low carb diet because you lose some water weight. But you’re also losing fat.

Remember-it’s your life. Make it a healthy one!

Do Fat Blockers Really Work?

Posted on April 01, 2019 by


Fat blockers are out there.  You’ll see them on the internet.  You can buy them over-the-counter.  Do they work? Can they be helpful a weight loss plan? The short answer is potentially they really can be helpful.

What are fat blockers? There are two different fat blockers out there. They’re the same generic medication called orlistat. Orlistat can be found over-the-counter as Alli.  It also can be sold in prescription strength as Xenical. They’re the same thing. But what they can do is block 25%- 1/3 of the fat that you eat. By doing that, it can decrease the amount of calories that are absorbed.  You have to be very careful because if you’re not absorbing that fat, it’s going to run through you.

Potentially, fat blockers can cause significant gastrointestinal problems. You might get bloated or have cramping. Eventually, it’s coming out the other end. If you eat too much fat it might be coming out the other end sooner than you thought.  So, you’ve got to be careful.  But it can be helpful. If you’re doing the right things like a good diet and exercise, cutting back on fat can decrease some of the calories you’re eating.

Remember, it’s your life!  Make it a healthy one!