'nother

Actually, I would say that, because ultimately it is true. I will say that it's a bit of an unfair comparison because bike racing is a group activity, and you can actually put out less effort through drafting, etc. for a large part of a race, conserving energy to take the win at the end. Whereas consuming calories is strictly an individual sport; you don't have the luxury of relying on teammates to burn what you've consumed. Neither of these concepts are terribly complicated, though.

So do you care to actually refute what I've said? You haven't really clarified anything by saying, "it's more complicated than that." What makes it more complicated, beyond you saying that it is more complicated?

'nother

Please don't accuse me of saying things I have not said. I have stated only facts, which no one seems to want to discuss.

You say hunger; OK, fine, I don't dispute that it can occur and have never stated anything to the contrary. However, it doesn't change the equation or the facts. The surgery reduces the hunger impulse and, as I have said and repeated, forces the equation of consuming fewer calories than you burn. It really isn't complicated.

Cave

Wow, hot topic!

Surgery can be of 2 types:

Restrictive (eg. lap band; older procedures such as vertical banded gastroplasty)
These restrict the number of calories that can be eaten (as solid food) at a meal, ie. fewer calories in = less weight. This can be overcome with energy-dense liquids, with small frequent meals or with overdistension of the gastric pouch causing disruption of the operation or stretching of the pouch.
Initial weight loss in most studies is 45% - 55% of excess weight (not total weight; you can still be overweight or obese following surgery!).
Longevity of weight loss varies; generally good with most operations for >5 years; lap band may be better as it is adjustable.
Lap band is also reported by many to improve satiety - the restrictive effect makes you feel full with smaller meals.
Lap band is considerably safer in terms of operation, complications and metabolic side effects than bypass operations (or indeed stapled reduction surgery).
The prosthesis adds to the operative cost, but I have no idea of the relative (or absolute!) costs of these operations in the USA.

Malapsorptive eg. bypass or duodenal switch.
These bypass part of the gastrointestinal tract to reduce the ability of the body to digest or absorb food. They may also include a procedure to reduce gastric size.
The amount of weight loss is generally around 65% of excess, and the weght loss tends to be more long-lived than with restrictive procedures. However, malnutrition and malabsorption can go along with these procedures, and the operation is considerably more difficult than a lap band. In addition the chance of major complications or death is higher.
Outside of the USA few surgeons consider these operations suitable as a first procedure for the "average" patient. My impression is that the popularity of bypass operations in the USA is due to the relatively recent licencing of adjustable gastric bands, with the uptake of lap banding as the procedure of choice in Europe and Australia being much more rapid.

You still need to exercise and restrict caloric (and fat) intake following surgery, however surgery is the intervention most likely to result in satisfactory long-term weight loss in the greatest number of people. In Australia I would not consider surgery for someone with a body mass index of less than 35 (Caucasian patients, BMIs tend to be higher in Asians); I make your weight 108.9 kg and your height 1.65m, giving a BMI of 40, so surgery is certainly an option to consider.

I agree wholeheartedly with Dr K's advice - see a nutrition clinic or a bariatric surgeon to discuss your situation and the implications of surgery. Be aware that surgeons like to operate (!) and we make our living from operating (!!) and that, in the end, you can lose just as much weight with dietary manipulation and exercise - it is with maintaining that weight loss that surgery has an edge.

Maintaining a healthy weight is difficult in our nutrient-rich and activity-poor society. Even 160 miles a week is less than 2 hours of activity a day, compared to the 8-14 hours of activity that we evolved to perform. If you can change your lifestyle to maintain a healthy weight, you don't need surgery; if the harsh reality is that you can't, then an operation may be better than the alternative.

Best of luck.

Tom Stormcrowe

Well, hello Richard! I see you are still out there! Outstanding, and I appreciate your comments here, Amigo! (Quick thread hijack here......) You thinking about Lotoja in 2007? I'll be there and we can actually meet FTF! (Thread hijack over....)

Metaluna

Wouldn't someone like this be a good candidate for a low-carb ketogenic diet (e.g. Atkins and its ilk)? I realize they are pretty unpopular around here and, from experience, certainly aren't ideal for optimal sports nutrition (where you really do need significant carb intake), but they do seem to avoid this kind of problem in people who have become insulin resistant.

Tom Stormcrowe

Metaluna, that would be all well and good, but when you reach morbid obesity, your metabolism slows down so much, that it literally cannot burn the fat. In addition, when you do the bariatric route, in effect, you remove a signifigant portion of the nutrient receptors from the equation. As was said before in the thread, Bariatric Surgery is a tool that is quite successful for those who have been on the diet wagon and failing miserably. Yes, there is cognitive-behavioral therapy before, and after bariatric surgery as well as continual followups with a dietician. Having gone through bariatric surgery myself, I should point out that if you are capable of losing the weight without surgical intervention, that's great. That's actually the optimal solution. If not though, the person getting ready for the surgery has generally researched it for over a year by the time they get approval. The decision and approval process is long and onerous, so don't think it's a lark, or easier, because it's not. For example, it took me two years of constant effort, including Dietician and Doctor supervised diets, as well as Psych evaluation, as well as the diagnosis of Empty Sella Syndrome, which in the form I have it is considered a lethal metabolic disease. I had to take dangerous steroids as well as insulin to regulate my metabolism, and over the long haul, surgery was the safer option.

I had gotten so debilitated by the weight gain that I was no longer capable of physical exercise, as well. I was basically in a box I couldn't get out of. All the willpower in the world would not have helped in the circumstance I was in. To those of you reading this thread, understand that those of us who elected to have this surgery are NOT under any circumstances taking an easy road or a shortcut, but trying to stay alive. It's as simple and honest as that. One individual on this thread, I will not single him or her out, has been rather truculant and that's their right......fine! Understand though, that at least in my case, it was the most difficult decision I've ever had to face in my life. I'm looking at it from the other side now, and can definately see I made the right decision, regardless of what others think. I am willing to talk about my experience as well. This requires a level of exposure many would find very uncomfortable, and the surgery involves a risk 99% of you will never have to take. If you need to use the tool, use it! That's why God gave us the brains he gave us, to develop methods and tools for dealing with life's problems. Don't limit yourself to conventional thought. Look outside of your personal viewpoint for just a minute and try to place yourself in the trap I was in and maybe, just maybe, you will get a little more understanding of the victory I've achieved over a situation I had little control over. In essence, my body betrayed me, and I beat it.

Pedal Wench

Thank you, Tom. I'm beginning to get a grasp of the metabolic changes that make it impossible to lose the weight any other way. I guess I'm hung up because the original poster is such a strong athlete. All of these opinions are really changing my point of view. Like I said earlier, whenever a person is featured in a documentary, they never show the struggles with diet. They just said that they tried and failed. Well, tried for how long? Did they try exercise? Did they ride a bike, because that is so much fun that if they just tried it, the weight would fall off. I wish they would show these cases from earlier on, before the decision is already made.

Tom Stormcrowe

Not a problem, PW! I'm always pleased to meet an open minded person not too hung up in their own opinion to see another viewpoint! That's a big compliment, by the way!

matagi

I agree it would make it easier to understand what is happening if you could follow someone's struggle with weight issues, etc from early on ...... Except most people don't embark on a diet and/or exercise program with the expectation of failure and most people in this case don't anticipate years of failed dieting and health problems in their future, so finding someone to follow in this situation is difficult.

CheeseLouise

Hi PW, Tom is right, it is nice to have people like you that have an open mind!

Below is our ride we did this evening (pay no attention to the broken cadence function) If you look at all the stats, we rode pretty hard. When I started the ride my Blood Sugar was 85...Yes!!!! I might feel good on this ride. So half way through the energy just starts to fade. I think oh, must be low blood sugar. Nope, when I got home and checked it was 234. My body did not know what to do with all that energy so it just dumped it into my blood stream...so much for the entire process of burning fat through exercise. I think I gain a few pounds from all that sugar dumping I was doing

My point is that if this continues, soon the pancreas will just shut down becasue it will be tired, I already experience vision problems riding. Things get blurry; yet another sign of WAY to high of blood sugars. It is sort of like waking up in the movie "groung Hog Day" It is just the same viscious cycle over and over again. So sure I can cycle now, I can even hammer and get some good speeds, Even with the extra 110lbs. I carry. But as time passes so will all of my ability to do any of these things as my size continues to yo-yo and all the symptoms get worse, my vision was blury after the ride today, No fuzzy is more like it the wood railings in our house looked like they had fuzz all over them. My skin will start to develop sores that won;t heal, this leads to amputation. My kidney fails (I only have one). So now in a few short years I am blind, I am on Dialysis and I have lost one or both of my lower legs. Or since dieting has failed for me time and time again plus add the level of exercise I do and still no success I am to the point where I choose, risk the surgery and fight to use a tool that could elimate all these horible disease or die of all the horrible diseases. I think I am really leaning towrds useing a tool to live a longer, better, health life style.

Tom, You sir are a god send! You are strong and brave far beyond what people will ever know! I have done it! I sent in my informational packet along with my family doctors approval. The completed information packet was mailed today to the clinic. Now I wait for a call as to when I can go in for my first consultation. I am so scared and excited at the same time. Wow! Wonder what it would be like to fit in a ride at the Local Amussment Park, Or fit in a bathroom stahl and not always use the handicaped stahl

Take care all!

Tom Stormcrowe

I'm glad you made your decision. That was the hardest part! Bona Fortuna, and I hope you still have my email, go ahead and email me if you need any questions answered, or info searched. I'll be glad to help in any way I'm able to. Meantime, keep pedaling!

Pedal Wench

HS, I can relate to some of your issues. My brother has juvenile diabetes, diagnosed when he was 8 (I was 5), so I've been around it all my life (we're well into our 40's now). The vision and circulatory and sore issues are very, very real. And, obviously, this needs to be addressed and reversed if possible. If my brother could have an operation that might reverse his condition, I would sign him up in a heartbeat - and pay for it myself!

I applaude your courage, and honesty, and willingness to share your problems in a very public, at times uncompassionate forum. Good luck, and please, please, please keep us posted with your progress. Seriously, with your cardio and leg strength, your recovery should be swift, and you will be a force to contend with!

rodfrank

After all is said and done, it seems to me that the surgery is simply " reduction of calories available to the body".

Tom Stormcrowe

Respectfully, I disagree. There are a whole host of mechanisms involved, and if I go through all of them, I promise that your eyes will glaze and roll up into the back of your head. Agreed, caloric reduction is a component. In addition:
1) The number of receptors for nutrients as well as the type of receptors in modified
2) The duration of food in the digestive tract is altered
3) The bodies endocrine balance is altered due to removal of interaction from those said receptor sites
4) In modifying the endocrine balance, you are able to jump start the metabolism and initiate weight loss where it wasn't possible to do so before
5) Back to the nutrient receptors: In removal from the equation of a signifigant portion of the receptor sites, your body is forced to utilize excess stores of adipose tissue( Fat) and triglycerides from the blood stream. The net effect is to desaturate and re-enable the remaining receptor sites to start functioning properly.
6) Diabetes is alleviated due to those same receptor sites returning to normal function (Type II Diabetes, that is)
7) There is definately a genetic component to morbid obesity as well. Marker genes unique to individuals with obesity problems have most definately been identified. We aren't production models you know, each individual human is a "one off" custom production and transcription errors occur in the process. Obesity could actually be a survival mechanism for someone living in conditions like the hunter/gathering humans in prehistoric times situation may have been, with chronic famine and variances in availability of food. A slower metabolism under those circumstances is a definate plus, whereas with plentiful food now, with the difference in processing capability, the human "greyhound" is at a survival advantage. Food is processed differently in everybody's body, but in those with morbid obesity, the mechanism isn't working properly. I'm going to put this in small words and simple terms: Imagine if your car is getting bad gas mileage, do you just put less gas in the tank and hope for the best, or do you go to the mechanic and repair what's wrong? Your body is a machine, just like your car! It runs on Glucose, and ATP and oxygen, instead of gasoline and oxygen is all.

Saying in the end it's just the reduction of calories is simplifying the situation too much. There are valid anatomical and genetic reasons for the problem, and self discipline isn't one of them. I've said several times in this thread that if you are physically capable of losing the weight and keeping it off, then that is the optimal solution! If not, then this surgery is a tool to help. If you want to feel superior because you ain't fat, then so be it! At least know what we're up against is all I ask!

Tom Stormcrowe

Not to put to sharp a barb on, you realize that there are also people who still believe the Earth is flat, as well! Not trying to be nasty, just reminding you that sometimes people have trouble accepting simple facts that are outside of their experience base, and guess what, that makes you HUMAN!

Metaluna

Sorry I didn't mean to give the impression that I was a strict calories out > calories in advocate, any more than I would claim that a Formula 1 race car burns diesel fuel just as well as gasoline. I was actually seriously considering the surgery a few years ago but I was able to drop ~180 lbs through diet (Atkins) and exercise. I consider my case unusual though, and it's only been 3 years so it remains to be seen how well I can maintain the weight loss. I still have problems with binge eating spells that have thus far prevented me from reaching my goal weight, and have been considering some kind of behavior modification therapy. I certainly can relate to the feelings of hopelessness of the morbidly obese, which I suffered under for many many years. I would never discourage someone trying the surgery if they have exhausted all the less radical methods.

Tom Stormcrowe

I didn't take it that way, Meta, not at all! I was just trying to explain what I was saying clearly. I do get a bit........intense sometimes! No need to apologize either, as whether I agree with it or not, you definately have the right to state your opinion. Besides, you weren't stating "Calories in-calories out mantra anyway. You were offering under normal circu,stances a perfectly viable option!

CheeseLouise

Tom,

Just a quick note to say THANK YOU! I was able to connect with Shannin, and she, like yourself, has been a wealth of knowledge and support. I can clearly see that people like you and Shannin are priceless , wonderful and beautiful people.

I'll be in contact with both of you throughout this process, and afterward if that is okay I already feel like I have two good friends who understand!

From now on I am going to start my own blog and take this off this forum and contact you and Shannin via blog and email. You two are truly an inspiration!

Take care,

Linda

Pelon

Well said. With the exception of water gain, it simply is not possible to add weight while burning more calories than you consume. At least not if you are following the laws of physics. People get fat because they do the opposite: they consume more than they burn. For some, it is from inactivity and poor eating habits (I would put myself in this category). Their best solution is to change their lifestyle. For others, it is a genetic or environmental factor that makes it extremely hard for them to keep the equation in the negative. These individuals' only hope may be other methods (surgery, drugs, etc.). Regardless, we are all subject to the basic truth of that equation.

cohophysh

Check out https://www.diabetes-normalsugars.com/ I started this diet and blood sugars have been below 100 and weight is coming off.

wretchedheathen

totally jumping in here, I had the LAP RNY on Wednesday, May 31, 2006 and was on my bike by Friday June 2, 2006. I was very ginger and took just a tiny stroll down the lane, about 2/10ths of a mile to 'test' the waters as it were. at this point, I can not see any foreseable problems.

I can see where I will have to bascially start over at -0- on my distances. but that is true whenever you take a break. I walked for 2 hours today and over did it, so I plan to do 1 mile on my bike tomorrow to see how it goes.

my plan is increase my distance by 3 miles a month during the 6 month recovery, so that by 6 months when my stomach is full size (6 - 8 oz) I will be riding 18-20 miles a day. my husband rides and we were just talking today about gatorade and my tummy. I do no know if it will cause dumping yet, each person's physiology is different.

so to summarize:
1. Will I be able to ride, after recovery, at the same level I do now?
eventually, with training, you could go as hard or easy as you feel is appropriate.

2. What about hydration during riding after surgery?
you need to drink xx amount of ounces a day based on your body mass, your effort of exersize,
is the calculator that I use.
as for hydration, a camel pack and sip sip sip is the recommendation for the day anyways.

3. What about the energy level/bonking on rides?
if I am any indication, I do not see change, but I stick to under 20 mpd at 11 mph before the surgery. I anticipate that with decrease weight, I will have increased energy and thus increased stamina.

jennings780

I am sure you have tried diets and things and are obviously exercising. But, if you haven't read "Eat to Live" by Dr. Joel Fuhrman you should before you try something drastic like gastric bypass surgery.

Tom Stormcrowe

In the long run, you will be able to do anything that you could and more. My personal best day on the bike is now 126 miles in just over 8 hrs. Hydration initioally required constant sipping in 1 oz portions, to prevent taking in too big a sip and damaging the surgical site. As your healing process goes along, uou should be able to handle gels and clif bars fairly well. BEWARE if peanut butter though, it can make you quite sick! It forms a blockage in the outlet of the stomach pouch that is exquisitely painful and nauseating! You will be able to overrun your glycogen/glucose stores in the body quite quickly, but when in a high output riding mode, you should be able to stave off the bonk with Gels and liquid protein supps as well as some solids of moderate glycemic balance liker Clif or Power Bars. Moderate balance means a blend of Mono and Disaccharides. (Simple and complex sugars or for example Glucose, galactose or Maltose[Monosachs] vs Sucrose[Disach]). A blend also results in slower uptake of both types, leading to a sustained burn vs a spike and crash like a large amount of either type alone. If you get the sugar intake too high too quickly though, it will result in "dumping syndrome", not fatal, but certainly uncomfortable and possibly embarrassing.

Gatorade: Start out at 70% H2O/30% Gatorade and go from there. Drink it SLOWLY!

I had the Roux-N-Y March 2005 and if I can ever be of assistance, email me if you want or PM me. Either way you are comfortable with. Us Bariatrics have got to stick together!

CheeseLouise

Hi Tom!

Just wanted to say that you are one amazing person! I saw you post on bikenaked to, just have been really busy and have had no time to post. ARGH!

You are such an inspiration.

Now...I need to state that I really appreciate all the input from all of you wonderful cyclist out there. I have to start by saying that generally, I am in great health and yes, gastric bypass surgery or Roux-en-y is a serious operation. It has risks and it is a life long commitment. Lifelong is the key word that I would like to touch on.

First, lifelong also applies to diabetes, high blood pressure, renal failure, retinopathy (blindness) and high cholesterol. Just a few of the co morbidities I have or am in early stages of. I am 42 years young I have only 1 kidney, lost the other at the age of 15. I have type II diabetes and have since the age of 30. I have early stages of retinopathy (sp?). And, I have high blood pressure and high cholesterol. Wow, I sound like a walking medical dictionary. Ugh.

After a lifetime of fighting with the weight (I was actually born overweight, really, I was an 11+ lb baby) and 12+ years of fighting all the other health issues my dr suggested I seriously consider RNY.

A little family history...I know boaring!!!! But please keep in mind that my mother died in a nursing home after kidney failure, multiple heart attacks, leg amputation and many otehr complications of type II diabetes and at the age of 62. Since I am 42 that gives me about 20 years give or take a few *gasp* This is my reality! The choices I have 1) wait and see what happens; naw not my style I would much rather take control of my health issues. 2) or I can take control and take action. I choose control and action rather than wait and see if I can join the nursing home ranks.

The RNY procedure has amazing results in correcting and or eliminating type II diabetes and some pretty spectacular results for reducing cholesterol and high blood pressure to. Sure, lose weight and it will go away. Nope, been there done that, about 20 or so trips up and down the scale. Always ends up in the high digits on the scale. Hmmm, do you think I am fighting some genetics here. My entire family is obese. Brothers, Sister, Aunts, Uncles. I think it might run in the family (sarcasm).

I have always been active and into sports, despite my weight. Even now, I weigh 239 and am 5'5" tall. I can ride my trusty Specialized Ruby (recently upgraded to full dura-ace by my DH) at average speeds of 16-17 mph. I would have a really hard time doing the things that make life wonderful from a nursing home.

So yes, the surgery is a risk, in fact, it is drastic, but so is the other option. At least with the surgery I have a calculated risk and am having a strong say in my health.

I meet next Monday, June 12 with my surgeon and I will be scheduled for surgery at that point. I am really excited about the chance to have a healthy me. Yes, I will still have to exercise. YEAH! I like to, yes I will still have to eat the right foods, I try to for the most part, yes it will take work on my part. But the very nature of the surgery will greatly diminish or eliminate all my other health issues.

I will have to recover. I will have to work my way back into cycling. However, if I can do it now with all my health issues and at 239 lbs I can certainly do it at 140 lbs with the health issues gone!

Again, thanks for all your input and Tom, You are absolutely and inspiration. Cannot say it enough!

Take care my friend and keep in touch

Linda

wretchedheathen

this is extremely good to know. currently I am on a STRICT diet of .5 oz meat and .5 oz leafy green vegetables until I reach target weight. supplimenting with all the water I can drink, which is .5 oz sips at a time, so 64 oz a day TAKES FOREVER. the projection is that the target weight will be in 4 months, and then I can start adding in gatorade and protein supliments and travel food.

my husband is one of those beanpoles that can eat 4x the calories a day that I do, and he looses weight, so is very supportive, but for the most part has no idea what it is like.

126 miles is INSANE! my personal best at 242 lbs was 20 miles in a day with two toddlers, one in the cart behind me with his lunch sack and the other toddler on his own bike. took us 8 hours to complete.