My conversation with Dr.K about Low BMI revision and Very LCHF diets (Crap Cycle)

[Munchkin]

@Munchkin, there's a lot of pretty decent info out there on IF.. however, most I read suggest an "eating window" of 6-8hrs.. I think even normies struggle with the "Warrior Diet" deal of a 3 hr or less 1 mega-meal/day- if for nothing else than, damn.. that would be uncomfortable! I don't personally find IF uncomfortable or a "diet" of the fad type- I naturally seem to fall into the routine of eating after about 12-14hrs of not eating.. no hunger until then, provided I've been eating enough fat, and not overdoing the carbs. It comes down to, imo, if you are hungry- eat, if not, don't- I don't intentionally IF, but some days if you count that I don't eat until after noon- I am by default IFing.

I never knew DSers did fat-bombs, I thought that was strictly normies who were following a LCHF or keto way of eating to get in needed calories for weight maintenance..- big calorie load in a small package. Just as some suggest they have a significant metabolic derangement, needing the surgical reset of the DS, some (like me, through trial and much error) have discovered that my tolerance of carbs is not that great, and I feel and function best/don't gain/can easily lose if I adjust carbs down and fats up.. If I exceed a certain level of carbs in my diet.. I have consequences, so the macro I play with the most is fats. When I want to lose- I reduce carbs and fats a bit as needed (usually the gain is from too much carb), when I want to maintain- I up the fat. I have not personally had any need or want to do "fat bombs" or drink oil! I'm happy enough adding butter, eating chicken skin, and the crispy bits from untrimmed ribeye!

From what I can gather, most DSers by default have lowered carbs post-op.. just due to protein and fat forward diets? Please correct me if I'm wrong- I just am assuming, from what I've read- since most say- focus on protein, don't worry about fat.. and stay away from carbs from things like sugars and grains until the weight is off, then slowly test the waters from there..

If I don't count coffee, I have been IFing all my life. Like today. It's 7 pm and all I've had is coffee. Getting ready to eat dinner soon because I am starving. I always thought my bizarre skipping meals and eating once a day was one thing that made me even fatter...

 

[Jo777]

Nope, not at least from all the stuff I've read/researched over the years.. Todd generally eats 1-2x big meals a day, always has.. just doesn't eat when he's not hungry (weirdo ). The eating 6x a day "to keep metabolism humming" is a myth. I generally do 3, sometimes 4 if you count a late night snack.. today was 3, I was busy, ate first at 1, then 7:30, and made a prot shake dessert thing an hour ago since I really didn't have enough protein today w.o. it. I was genuinely hungry this eve, not really thatmuch this am.. and the shake was just because I wanted something creamy cold and banana flavored.

For me, what made/makes me fat was continual eating- really big meals interspersed with little ones, overloaded with carbs. You shouldn't be hungry 6x a day, unless you are eating 2oz meals at each sitting (or eating nothing but carbs/low fat ****)! If left to my own devices, I would live on pasta and pizza, and when I have.. I'm ALWAYS hungry or compulsively eating and thinking about food. If I focus on fatty meat, veggies w. lots of butter, etc- that goes away. It's weird, but I've done this dance with myself so many times, I can feel when I'm slipping and eating too much in the danger zone (physical and mood), plus eventually I gain if I keep it up.

*edited to add, I do not malabsorb, so I don't know if a DSer gets hungry more often or not.. I don't have that first hand experience so can not/should not generalize on that one.

 

[Jo777]

I see no reason to eat LEAN meat - I'd probably choke on it. Chicken THIGHS, not breast; marbled beef; butter on everything else, but only as much as sticks to the food - I don't drink it.

IF is dieting and uncomfortable - I see no need, not even with 30 extra pounds on me - I did the DS to live normally, and my health parameters are all pretty good. She can keep her size 2s - I'll eat 6 times a day, when I'm hungry, thankyouverymuch.

Legitimate curiosity question: have you ever tried intermittent fasting to know that it's uncomfortable (for all?), and are you actually physically hungry 6x a day?

I agree about the chicken btw, I have not bought breast meat in years.. skin on, bone in thighs salted under & on skin, roasted at 475 till done, TYVM.

 

[DianaCox]

No, I've never tried intermittent fasting - I am hungry every few hours - gnawing my own arm hungry - and I get low blood sugar symptoms, as well as liquid diarrhea if I don't eat for 12 hours (blood draw days are murder, trying to empty my guts at home before driving to the lab without having loose poops). I LIKE eating frequent small meals - I'm on a permanent tapas diet.

 

[Jo777]

Fair enough, was it like that pre-DS too?

We all got here in our own ways.. I get the same issues you mention when I eat a carb heavy intake, except for the runs.. If I kept up eating the way I had for most of my life- I would eventually be just like much of my family- diabetic. My aunt went from T2D w. daily insulin to no meds with strict carb restriction several years ago.. most just say **** it, take the meds and keep eating crappy (really crappy.) I'm slowly learning I need to be in group A.

I cannot IF if I'm eating SAD, I can if I'm eating fat/protein forward.. but I don't intentionally IF, just find it funny that there's a name for it. I eat when I'm hungry (sometimes for the heck of it, or for convenience sake/timing) and don't otherwise.. unless I'm doing the carb tango.. then I just eat all the damn time.

I cannot moderate carbs- they **** up my moods badly, bring on intrusive food thoughts and crazy hunger. To me, it's like telling an alcoholic or celiac to just moderate alcohol or wheat.. there's no gray in the way my body deals with them, that's me. I can tolerate a little, but mostly from veggies, berries, a little potato, I mean little.. give me a quick-sugar load like white bread/sugar.. bad news. I've done it over and over with the same results. We are NOT all the same, and need to knock off the sweeping generalizations of how we all eat or what works/doesn't work for all. (that was not aimed specifically at you, just the general you of everyone..)

Good conversation..

 

[DianaCox]

No - pre-DS I always WANTED something, but I wouldn't say I had gnawing hunger - i had inner hunger that nothing would satisfy. When I eat now, I get to a point and I'm done (most of the time).

I just don't think IF is a healthy thing. It doesn't make sense to me. And aside from biology, emotionally it sounds obsessive and a form of anorexia, where the focus is on deprivation as proof of control, at least if not eating is going against what your hunger is telling you.

 

[Jo777]

I know you have access to medical lit, have you actually searched out information/read up on it past what people post in message boards? You have your opinion that it doesn't sound healthy, and sounds (insert various negative adjectives).. but is there anything that you've found that backs that up? You have been really big on stating facts over opinions. I have an opinion that someone who gets ravenously hungry six times a day possibly has a blood sugar aberration that could be caused my numerous issues, some possibly within their control.. as I have the opinion that humans should not have to eat every 2-3 hours.

As far as deprivation, I can't speak to that as I don't personally IF, I just fall into the pattern from time to time -esp if I'm eating low-carb/HF, I just no longer get hungry often. I know from experience it's not healthy for me to eat all the time if I'm not hungry! IF would not be something comfortable for me to do when I'm in the middle of a carb binge.. I didn't seek out any info on it in particular until I started reading more on other health topics and kept coming across it.. watched a PBS program that was entertaining and interesting, then dug around a bit deeper to see if it was legit. It appears to me it is, and has some interesting biological perks.

Comparing IF to anorexia, the mental illness, however to me is a stretch IMO.. a really big one.

 

[DSRIGGS]

Hello Jo,

I am on my phone and can't see your profile. What batiatric surgery did you have? Diet for a DS patient is much different than RnY or sleeve..... So I am curious

Thanks

 

[DianaCox]

Well, first of all, I'm assuming hat there is a huge variety in people's metabolisms, so one size will not fit all. For my own situation, I can't eat that much at one sitting, so eating 6 times a day suits my physiological arrangements and seems appropriate - it takes about 3-4 hours for my stomach to empty and and then I get very hungry again. I may still tend to (prediabetic?) hypoglycemia, which I had before surgery - an "overreaction" of insulin to meals - so I get VERY hungry when my stomach empties (hmm, just occurred to me that it has been MANY years since my last GTT, at least 15-20, and not since my DS - I wonder if I should have one?). Since I am getting older, I'm still technically obese (BMI 32) and diabetes runs in my family, I should probably take a look at that. But since I don't crave carbs when I'm hungry - I crave protein - I don't

I looked at the scientific literature about IF, several months ago. I didn't see any long term studies. I base my opinion about the negative psychological aspects of IF simply by being an armchair psychologist, reading the posts by IFers - while not an unbiased source of information, the IFers who post where I have seen appear to me to be people who are seeking control over their lives and unduly focus on their eating.

But yes, it is just my o.pinion. As is your view. And my opinion about MY physiology is necessarily different from yours. Your statements "I cannot moderate carbs- they **** up my moods badly, bring on intrusive food thoughts and crazy hunger. To me, it's like telling an alcoholic or celiac to just moderate alcohol or wheat.. there's no gray in the way my body deals with them, that's me." do not resonate with me at all - I have never had that kind of relationship with food.

As for using the term anorexia, perhaps I should have said a form of orthorexia - obsession with eating "correctly." I have seen suggestions that IF is a "gateway" to binge-eating disorder, and that it induces hormonal dysregulation as the starvation signals are repeatedly triggered. Again, what I haven't seen is long term studies - perhaps because, like any extreme form of dieting, the vast majority of people cannot stick to IF in the long run - with the exception of those who become obsessed with it. And that is not a "normal" population in the first place.

 

[Jo777]

@DSRIGGS - VSG, and my posts are kind-of, but not really a side-track convo within this thread based on the posts here and elsewhere (FB) on this same topic that I was elaborating on from my own knowledge and experience.. specifically the HFLC thoughts, and the side-track IF posts, regarding various interventions (getting diet in check first -not my words) not associated with revision.

Again, not every VSGer eats the same- nor every DSer. I personally eat a high fat diet, with moderate protein.. in proportion to my % total intake (not low-calorie) it works, for me. It leans towards very high % fat when I'm really active and maintaining, but still- no fat "bombs" for me. I can see their place (for normies/VSGers) needing additional calories for maintenance, sans carbs, however I had not heard DSers espousing the same, as the laxative effect would be too much for many- so that part was surprising to me that Dr. K had.

*A side-note, as a VSGer, I realize I am an outlier here. While I do not find much direct "support" (read as serious air quotes there please.. I really don't seek a lot of support from boards anymore being this far out.) I come here for the intelligent conversation and camaraderie. There are very few places online I have access to the level of thought as to the various metabolic issues/interest that the collective "we" have, aside from personal internet-friendships. If my intelligent input on conversations is discarded or devalued due to not living with a DS despite having a lot of knowledge of it- but no direct experience.. that would be a sad situation, both for myself- and what this board is (I believe) hoping to create. I do not try to ascribe something to the DS, I may ask curiosity questions, and I do typically quantify some of my posts that I do not malabsorb, however these were side-track conversations, but still on-point within the context. I also attempt to not generalize a population as much as possible..

 

[Jo777]

But yes, it is just my o.pinion. As is your view. And my opinion about MY physiology is necessarily different from yours. Your statements "I cannot moderate carbs- they **** up my moods badly, bring on intrusive food thoughts and crazy hunger. To me, it's like telling an alcoholic or celiac to just moderate alcohol or wheat.. there's no gray in the way my body deals with them, that's me." do not resonate with me at all - I have never had that kind of relationship with food.

As for using the term anorexia, perhaps I should have said a form of orthorexia - obsession with eating "correctly." I have seen suggestions that IF is a "gateway" to binge-eating disorder, and that it induces hormonal dysregulation as the starvation signals are repeatedly triggered. Again, what I haven't seen is long term studies - perhaps because, like any extreme form of dieting, the vast majority of people cannot stick to IF in the long run - with the exception of those who become obsessed with it. And that is not a "normal" population in the first place.

Ok, Yes- my biology, from personal testing over and over- sometimes intentional, sometimes not, makes me very aware when I am going overboard with carbohydrates- specifically fast-acting high GI ones. The mood correlation was slower to acknowledge as it took a few times of cycling through it to suss out which came first.. still not entirely clear, however it is clear is exacerbates it (still not good, period.)

Edited to add: & I can see if you still have decent restriction combined with malabsorption, the need or biological imperative to eat more frequently. I still have very good restriction, zero malab. and therefore can maintain on 3 meals a day, sometimes less/sometimes more depending how I tweak it.

& yes, I AGREE whole-heartedly with you re: Orthorexia vs Anorexia.

I have read conflicting studies re: hormonal disruption usually along the male/female line, females being more susceptible, and cortisol effects- which were not necessarily negative, however interesting.

 

[talitali]

Diana, thanks for sharing your conversation with Dr. K. I'm finding the side conversation on IF interesting as well.

I've spent the previous 3 months doing IF from 8pm-12pm and strangely it helped my blood sugar quite a bit but I also felt really good doing it. I've recently gone back to having a morning protein shake because my protein levels are in a range I'm not happy with. I wasn't able to eat enough protein during my 8 hour window of time as I was only eating two meals a day.

One major thing it did for me was bring my body out of it's holding pattern related to my weight. I have been hovering closer to the high end of my preferred weight and could not get it back down where I wanted until I started to IF and it dropped into the lower end of my range and has stayed--even after going back to 'normal' eating.

That all said, IF is very person dependent, particularly with females.

 

[DianaCox]

These are all interesting anecdotes - I think "shaking things up" can be helpful - but don't make for a long-term solution. The takeaway lessons of this conversation can be (1) "fat bombs" are counterproductive; (2) IF or any other extreme variations of eating are unlikely to be sustainable long-term; and (3) the goal of WLS is to be healthier, and more NORMAL - extreme diets and restrictive behaviors are unsustainable and can lead to eating disorders.

 

[talitali]

These are all interesting anecdotes - I think "shaking things up" can be helpful - but don't make for a long-term solution. The takeaway lessons of this conversation can be (1) "fat bombs" are counterproductive; (2) IF or any other extreme variations of eating are unlikely to be sustainable long-term; and (3) the goal of WLS is to be healthier, and more NORMAL - extreme diets and restrictive behaviors are unsustainable and can lead to eating disorders.

 

[terrik]

Diana, again thank you for posting. Love some Dr K conversations and your thoughtful questions and feedback are priceless.