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Understanding DS Eating Requirements

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UNDERSTANDING EATING IN THE DS CONTEXT.

Many people look at the DS, see that eating is optimal and that we can enjoy our food and then are totally shocked to find that the DS has it's own brain when it all boils down to reality! Firstly, for months your eating is a minimal state of affairs. You might only eat a small array of foods, as some foods might make you feel nauseaus. Secondly, many DSers report complete lack of appetite.

This is something I want to focus on because it is the only time that I feel we must override what the body is saying. Not eating for a DSer is not clever. Your health is very important. Forcing food was not uncommon for me in the early months... but I did it because my body needed the protein grammage. Yup, it is not easy or pleasant and drinking a good portion of protein is the way to go along with a protein bar to boost the situation. I cannot stress this enough. Mentally there is also an inclination to just not eat because it is such a nice feeling in a way after years of uncontrollable hunger. So easy just to eat a few bites and push the plate away. But please don't do this. Dish up the portion of protein and stay with it until it is all eaten. Using flavoursome sauces on the food is a good way to get it a little more palatable.

This is extremely common for the DSer. The trick is to persist and to force sometimes. If your tum is extremely small and not giving you nice stretches eat 5-6 times a day. I had a teenier tum than most and I ate this amount of food most days in the first 6 -7 months. Again - drink a portion of protein. Make enriched milk with milk powder to boost protein. Cut a protein bar into tiny blocks so it doesn't feel daunting and try to eat these between meals. A variety of cheese cut into little blocks might help too. It's okay if you are eating all day long - just go until the protein is in.

I cannot emphasize enough that you must please EAT,EAT & EAT! Healthy DSers are the ones that eat the right foods in abundance. I am not talking about stuffing yourself at a single sitting - but about eating properly with nutrition in mind until your tum feels just at the comfortable 'warm glow' stage! The unhealthy guys are finnicky feeders still caught up in the dreaded dieters mentality. It alarms me to sit with a DSer for more than 3 hours and not see a protein food pass their lips in that time. Eating protein in smaller quantities might increase absorption too, making it more effective. Some experts in the field say that the body only absorbs around 30grams at a sitting.

I eat in this protein pattern to this day:

Be careful that you eat the right foods too. Eating abundant simple carbs and sugars and even fruits, is something we really should not do - it is not going to make you healthy and fills up space much better given to your protein. Once you have your protein in by all means have the odd carb or a yummy piece of fruit.

In time the greater majority of DSers will have the superior quality of life eatingwise that they read about during research. But it is 'in time'!

THE DSERS FOOD PYRAMID: in order of importance

We malabsorb proteins and fats. 25 -30% of fats are absorbed by us. We absorb a large percentage of carbohydrates and all sugars including alcohol sugars. Water is at the top in the first months as you must stay hydrated for saliva production among many other things. Water is also required when the diet is high protein as ours is.

Dry mouth is common- post surgically -drink more fluid. Try for at *least* 1,5 liters a day... much more if you are very big. To tell if you are hydrated your tongue should be nice and pink - if you get a whitish film on it it may mean you need to up your water. Tea and coffee are diuretics and for every cup you drink you probably won't gain much fluid. Try to stick with plain water.

Chew very well - digestion begins in your mouth with saliva enzymes. Go slowly... it takes time to adjust to food and some foods might give you a reaction. Treat your system as though you are feeding an infant - with care.

THE WORST DS FOODS YOU CAN EAT

Overdoing simple carbs and fats at the same time can lead to all sorts of mayhem in your body. Bloating is on the lesser scale, further up there is bacterial overgrowth, if it does not stop you may be at risk of what Scopinaro describes below:

The increased loss of endogenous nitrogen is of much greater importance in the first months following BPD, when the forced food limitation causes a negative balance both for energy and nitrogen, thus creating a condition of protein-energy malnutrition (PEM). In the latter, as it is known, two different subtypes can be identified: marasmic form (MF) and hypoalbuminemic form (HAF). In the MF PEM, which represents the effective metabolic adaptation to starvation, both energy and nitrogen deficits are present. The ensuing hypoinsulinemia allows lipolysis and proteolysis from skeletal muscles which supplies aminoacids for visceral pool preservation and hepatic synthesis of glucose, necessary for brain, heart and kidney metabolism and for the oxidation of fatty acids. This, in association with protein sparing due to energy negative balance, ensures both energy and protein homeostasis. The result is a loss of weight due to reduction of adipose tissue and muscle mass in complete well-being. On the contrary, in the HAF PEM the nitrogen deficit is associated with a normal or near-normal energy (carbohydrate) supply. This causes hyperinsulinemia, which inhibits both lipolysis and skeletal muscle proteolysis. Not being able to draw on its protein stores, and in absence of protein sparing, the organism reduces visceral protein synthesis, with consequent hypoalbuminemia, anemia, and immunodepression. The result is a severely ill person with body weight unchanged or increased, maintained adipose tissue size, and lean body composition pathologically altered for decrease of visceral cell mass and increase of extracellular water.

In the early post-BPD period the preservation of protein homeostasis, already threatened by the negative energy-protein balance due to the food limitation, is made more difficult by the presence of the increased endogenous nitrogen loss which has to be counterbalanced. If the operated patient devotes its reduced eating capacity mainly to protein-rich food, he compensates the loss and, like the starving individual, develops a MF PEM, which is the goal of the procedure. If, on the contrary, he eats mainly carbohydrates, the nitrogen loss makes the HAF PEM even more severe than kwashiorkor. Paradoxically, a starving patient is in a better metabolic situation, since he can draw on his protein store to try both to satisfy the requirement and to compensate the loss. Though this is rarely achieved, the occurring HAF PEM is milder than that of the carbohydrate-eater. Between the two extremes, HAF PEM of different severity can take place in the patients with mixed intake, depending on how much on one hand protein intake is smaller than protein loss, and on the other hand the relatively excessive energy intake prevents skeletal muscle proteolysis and protein sparing.'

THE DS DIETARY TIMELINE

This is intended as a general rough guide only. You are an individual and what is true for some might differ for others. Do not be alarmed if your processes are different from mine. Especially during the first months overlaps can and do occur. Sometimes things appear to be regressing but when you work out what the problem is and address it, it resolves. Much of living with the DS is a rediscovery of your body - honouring it, listening to it and knowing that very few of the problems you have will be unresolvable.

PRE-SURGERY:

Some weeks before surgery it may be a good idea to eat a high protein diet of lean meats and fish with loads of veges and salads to give the liver a chance to shrink before surgery and to ensure you are in good shape. Many surgeons advocate this. Eat no fats and keep carbs down as much as possible. Drink plenty of fluids.

WEEK ONE TO WEEK SIX:

Depending on your surgeon you will be on a fluid only then pureed diet. Some surgeons will keep patients on fluid for longer. Still other surgeons say solids are fine from the get go. Listen to your surgeon, he/she knows your dynamics the best. You may have nausea. Bowel movements are likely to be erratic and often more than 6 times a day.

WEEK SIX TO WEEK 12:

We begin to test what foods are okay with us. Vitamin routine is to be started. Meat may be slowly introduced at this stage. Try not to launch into steak first. Start with soft fish, then chicken, then ground beef and if all sits well then try eating a little beef fillet. During this phase the stomach is likely to have it's first real stretch allowing more eating capacity and higher protein intake. Ironically you may have no appetite at all. You may need to force yourself to eat - it will pass. Add a bit of fibrous food to your day - oats is very good- effective but gentle. Add milk powder to give it a protein boost. The stomach begins to settle and bowel movements should become more regular and more solid.

WEEK 12 TO 6 MNTHS:

The odd salad or vege might be eaten but it is still a juggle to get in proteins. The proteins should be varied...don't just eat chicken day after day! Aim for a fair amount of fish in the weekly diet. The stomach continues to stretch very slowly. The bowel motions may during this time appear to be regressing! Occasionally this also happens for some people in week 6 to 12. If your tummy works too much during the day consider taking acidophilus capsules as your system may need tweaking from time to time. If you have excess wind, bloating and general bowel misery try a course of flagyl but be sure to take acidophilus daily for the duration of the flagyl course.

6 MNTHS ONWARDS:

Not everything is a progression. There will be days when you still wonder what you have done to yourself! There will be days you don't want to eat but have to. As long as you are going forwards more than backwards everything is normal. The full amount of protein is being consumed daily. Begin to add concentrated veggie soups and fruit smoothies to your diet to take your nutrient levels to the limit. Don't eat junk - but don't deprive yourself either! Junk for the DSer means SWEET things. Alcohol is also JUNK! Expect a few tummy upsets at first on the concentrated smoothies, in time the tum adjusts. At 8 months I first got the return of an appetite which still comes and goes. Hopefully now your bowels are well settled and you are losing beautifully! Remember to chew well!

ONE YEAR ONWARDS:

It is easy at this point to think one feels so great there is no need to swallow the pills and calcium anymore. I can understand this, for to all intents and purposes one feels pretty much 'normal'. But normal we are not and it is best to just accept the pills will be lifelong. Yes, the system has adjusted and the intestines may even be compensating to a degree now, but even so do not take risks. At this stage the full protein grammage is being consumed pretty effortlessly. If you weigh a lot less you can probably safely drop the protein grams slightly. Currently I take in around 60 to 65 grams daily. (PLEASE DON'T DO THIS - I THOUGHT I COULD, IT WAS A NO GO - READ THE NEW SECTION BENEATH 'PROTEINS')

Other foods are easier to fit in and the diet has much more variety. At 14 months out I can eat a full plate of food in a restaurant more often than not. I now eat a lot more vegetables (after all protein has been consumed) and aim for those with the highest nutrition values. I have lost my taste for carbohydrate foods and five chips is more than enough! I don't like pasta at all anymore. Yucky tasteless stuff! I have totally regained my love of chocolate but it is not an issue - a few blocks fulfils my yearnings -lol!

I panicked at my last most recent tum stretch. It made me very scared. It arrived with a huge surge in appetite and I thought I was going to be in big trouble. It made me remember how life was for me when I was suffering obesity. I was eating all day long - just like the bad old days. I decided seeing as I was in the grip of something instead of fighting it to just go with it & to experiment and I think I also wanted to test my DS to it's limits. I purposefully (if very nervously) ate excessively. I took my calorie intake to close on 4000 cals per day by eating cans of condensed milk and an entire BIG chocolate bar. I did this for 5 days. I gained 1,5 kilo's. (Much less incidentally than if I had done this before my DS). For the next 3 days I ate well, I ate some sugar but not near as much as during the 5 day experiment. The 1, 5 kilo's came off effortlessly. I have great faith in the DS now :-)

It is about creating a balance through the surgery and staying within that balance afterwards. I am not advocating that you try this excessive eating as I did! Naturally if we eat high sugar foods we are going to gain weight and certainly my experience proved that. My excessive hunger surge has gone and currently I am having days I don't care much for food - interspersed with hungrier days. Back to normal.

*** TWO YEARS OUT:

I'm still very highly focused on nutrition. More so than ever. I drink a lot of milk sometimes 2 pints in a day! I stay with 2 liters of water everyday. I eat fish at least 3 times a week, veges everyday and eggs most days. Cheese I adore. Steak I still enjoy too. My choc days are over I eat it occasionally of late - think I realised food is never going to run out for me (A) and (B)if I want it I can have it, no big deal! I'm more inclined to have a piece of fruit recently, but I am still not purist about it. I am not grazing as much though some days I do.

I have restriction I certainly cannot have second helpings and I still wait an hour if I want a pud!

I am seldom hungry -really hungry - and there are days I would not eat if it were not that I know I must.

Food is food is food.

I really love this about my life - the normality of it is streets away from my obese life. I have foodie times when I just so enjoy a good meal and a lovely creamy dessert and then there are times I eat simply and to sustain my health. The one thing I have realised is how quickly and easily carbs can snuck into ones day - I am still not mad for them but they are easy food to eat and a few weeks ago I had a bit of overkill on them. I might add that they defo give me gas but I was ignoring that!

My weight is pretty stable I go between BMI25-27. I watch for regain but I have some leeway up my sleeve which I would play if I needed to. I honestly believe DSers who are too rigid with carbs and calories in the beginning might have more difficulty metabollically than a lax person like me when it comes to this stage of the game. ..but I hypothesize.

Right now no regain in my life so I am still relaxed and just have what I want within reason.

I still think my DS is the bees knees!

THINGS TO TOUCH AT YOUR OWN RISK!

Beware of sorbitol, mannitol any of the 'ol's' as they cause awful wind and bloating more often than not.

YOUR LAB REQUIREMENTS:

In year one labs are every 3 months. In year two every 6 months. Labs are important and must be done.

YOUR PROTEIN REQUIREMENT:

In the very first weeks post op it is okay to eat anything that you can tolerate. The main thing is that you are eating and making your body function. By week 6 most surgeons like you to shift your choices heavily towards protein.

Dser's need to try to get in 85 -100 grams of protein everyday.

Some manufacturers of protein drinks say the body will only absorb around 30grams of protein at a time (although this is debatable) however - it may be worth not eating 50grams at a sitting but trying to space out the protein more for max absorbability.

In the first months you will struggle to get in 85 -100 grams - it's normal to struggle so don't feel too down! Just keep going hour by hour - you are AIMING for 85-100 grams and eventually you will get there.

You may need to eat *ONLY PROTEIN* foods to get there, from week 6.

This is hard because we are programmed to believe healthy eating includes a salad, fruit, veges. Not so for the DSer in the early months.

Later you can add some of these things to your diet but don't waste precious space on them please. The benefits of a salad bowl are negligable for a DSer in the first 4 months. Your vitamins are your fruit and veg. Please remember you no longer take up as many nutrients from your food as before. Veges and fruits will merely be filling you up and giving you fibre and any nutrients from them will be in such minor quantity it hardly bears mentioning. It might look very odd just to have a thigh of chicken and slice of cheese on your plate but it is 100% fine.

Introduce meat at around 7 to 10 weeks unless you surgeon says otherwise. Eating meat can prove a battle for the first months. Persevere because meat is quality protein...and it has vital amino acids. If you are having problems with meat you can try marinading it overnight. Eating it in a sauce can help. Avoid white chicken and go for the thigh or brown meat. Eat soft fish such as lemon sole. If you can tolerate mackeral it is a very healthy source of omega oil. Omega oils are anti-inflammatory so this may have added benefit to someone recovering from major surgery. I eat 3 eggs a day and have done so for months as eggs are highly nutritious and we DSers need not worry about cholesterol.

Drinking some of your daily protein is a good plan. Milk is an excellent food for us -semi skimmed is my choice. Build up is good and the chocolate flavour is really nice. Take lactase tablets if milk upsets your tummy or you have bloating. It is worth persevering with the milk because this can be a godsend on a poor or ill day. One word about milk however - it does contain sugars. Therefore do not be excessive with it unless you are having an ill day and cannot eat for some reason. If you go on a plateau and you are drinking a lot of milk omit it to see if it is hindering weight loss.

For me it does not cause problems with losing but some Dsers say it stops loss for them.

Protein I take:
CARBS:

Eating useless carbs like white bread is silly. Try to have complex carbs where possible and when possible. Some Dsers don't eat carbs at all but I feel at 4-6 months or so it is good to have some carbs in a small ratio to the protein. There are times when eating carbs is highly appropriate - in the very early weeks post op up to week 6 when meat and protein are harsh on the system carbs can be good. The liver needs them. On days when depression is looming using carbs to help boost seritonin can be a better idea than sticking to protein.

Salads are fine when you can eat them, I had my first lettuce at around 3 months and a bit of raw carrot, but some people can tolerate salads sooner - just go slow.

Food that makes you feel like retching now - might sit very well for one just a few weeks later. ALWAYS LISTEN TO YOUR BODY.

SUGARS:

We absorb 100% of sugar. Some Dsers are very strict and never touch sugar but I couldn't be bothered to be that extreme. I believe in my newfound freedom & I like to celebrate ENJOYING eating. I have sugar - 2 or 3 spoons a day in my tea. I eat choccies, desserts, biscuits. I have no problem losing weight because of this, but if you, do stop the sugar. HOWEVER...I only ever indulge after my protein & vits are in...and I eat these things well within reason. For some people too much sugar upsets the balance of flora in the intestines causing problems.

AT SIX MONTHS:

Try now to add more complex carbohydrate to your food choices. Also add the occasional fruit or veg smoothie to your diet if you can tolerate it. Smoothies are a good way to get max fruit/veg into minimum spaces. Your tum might run for the first few times but eventually it gets the message and seems to stabilize. If fruit gets your stomach working overtime I suggest raw veggie smoothies or nutritious soups.

FOOD IS YOUR MEDICINE

There will be days the thought of eating is just tiring. There will be days were you may be tempted to just let the food go for the day and not eat at all . It's not a good idea as the system needs fuel to keep it going. Try to think of your food as medicine or as functional food. If you still cannot eat, carbs on these days can help tremendously, so have them. Just don't make a habit of it!

Try thinking of food in a new medicinal light - for example:

***Really top DS foods for excellent all round nutrients:

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