The Pound of Cure Weight Loss Podcast
Hosted by obesity specialist Matthew Weiner, MD and dietitian Zoe Schroeder, RD, The Pound of Cure Weight Loss Podcast provides a comprehensive approach to weight loss. We cover nutrition, the new GLP-1 medications, and Bariatric Surgery in depth and answer tons of questions from our audience every week. Check out our website for video versions of the podcast: www.poundofcureweightloss.com/podcast
The Pound of Cure Weight Loss Podcast
Thirst Trap: Why It's Okay to Drink After You Eat
In this Q&A-packed episode of the Pound of Cure Weight Loss podcast, Dr. Weiner and Zoe answer listener questions about navigating post-surgery challenges like dumping syndrome, food noise, and pregnancy after weight loss surgery. Here are the highlights:
How to Lower Your Set Point Without Food Noise Sabotaging You
Listener Rain asked about dealing with chocolate cravings after losing just five pounds. The team shared practical tips:
- Balanced Meals: Avoid skipping meals and eat nutrient-dense foods like vegetables, lean proteins, and fiber.
- Curb Sugar Cravings: Plan indulgences and make healthy swaps, such as Greek yogurt with cocoa powder and banana.
- When to Consider Medications: GLP-1 medications like Wegovy or Zepbound may help reduce food noise for sustained weight loss.
Considering Gastric Bypass Revision Surgery
Priscilla asked about revising her sleeve gastrectomy to address severe reflux and weight regain. Dr. Weiner outlined key points:
- Improved Safety: Advances in surgical techniques make bypass surgery much safer today.
- Risks: Be mindful of dumping syndrome, ulcers, and iron deficiency, which require diligent management.
- Benefits: Revision can alleviate reflux and improve long-term health outcomes. Mindful eating is essential for post-revision success.
What is Dumping Syndrome?
Dr. Weiner explained that dumping syndrome, common after bypass surgery, occurs when sugary or fatty foods enter the small intestine too quickly. To manage it:
- Prioritize lean proteins and vegetables.
- Avoid large meals and overly processed foods.
- Practice mindful eating to control portions and prevent discomfort.
Should You Avoid Drinking After Eating?
A listener wondered whether post-op patients must separate eating and drinking. Dr. Weiner dispelled the myth:
- No Universal Rule: The stomach pouch empties quickly, and drinking doesn’t affect fullness.
- Listen to Your Body: Some may feel bloated when drinking with meals, so adjust based on personal comfort.
Pregnancy After Weight Loss Surgery
Amanda sought advice on preparing for pregnancy post-surgery. Key recommendations included:
- Vitamin Adjustments: Switch to prenatal vitamins to ensure proper iron and folate levels while avoiding vitamin A toxicity.
- Mindful Nutrition: Focus on protein-rich, well-balanced meals while avoiding excessive weight gain.
- Manage Risks: Pregnancy slightly increases the chance of bowel obstruction, but with a proactive care team, this can be managed effectively.
Key Takeaways
This episode provides actionable advice for navigating challenges like dumping syndrome, food noise, and post-op pregnancy:
- Manage food noise with balanced meals, planned indulgences, or GLP-1 medications if necessary.
- Gastric bypass revision surgery can resolve reflux but requires careful post-op management.
- Dumping syndrome is manageable with mindful dietary adjustments.
- Pregnancy after surgery is safe and healthier with proper preparation and care.
Join the Conversation
Submit your questions for future episodes and let Dr. Weiner and Zoe guide you with science-backed strategies for success after weight loss surgery.
I'm not eating and drinking at the same time. It's a very common advice, especially if you're in different Facebook groups and you ask Google and whatever else. But it's not a hard and fast rule, especially not in our practice. And what's more important than that is actually being really good at recognizing and honoring when your body is telling you to stop. Welcome back to the Pound of Cure Weight Loss Podcast. Here we are with a Q&A episode Thirst Trap why it's Okay to Drink After you Eat. That's a clever title.
Dr. Weiner:That's we're trying to keep it clean here. All right, we have some good questions. We're actually been getting a lot of questions lately.
Zoe:Keep them coming people.
Dr. Weiner:Please keep them coming, and I think for me it's the questions sometimes that tell me, hey, we're getting somewhere, because we're really getting a lot of very thoughtful questions. I'm also seeing in the office a ton of people who've really they've done their research before coming in to see me, and that is also so much fun because it takes it from the hi. Let me talk to you about bariatric surgery. This is a gastric bypass. This is a sleeve to getting into the nuance and the real complexity about their individual life, their wishes and their wants and what they're hoping to get for. We can dig in at that very first visit and really make a lot of headway and formulate a great plan for these patients.
Zoe:Great individual life.
Dr. Weiner:Yeah, so I love that that's happening as well. It's something I think you know. That's what I hoped would happen with a podcast, and it's definitely out there, so keep the good questions coming. We really love answering them and hearing from you guys.
Zoe:Yeah, feel free to send us a message on Instagram, tiktok, facebook. We have a special spot on our website that you can see it, or YouTube, of course. Anywhere you want to put a question, we'll be sure to see it.
Dr. Weiner:Yes, so we're going to have Sierra Sierra's our office manager and she really runs the show in our office and I think anybody who's ever called our office we answer the phones, which is fairly unique amongst medical offices, and we really have a great office culture and everybody gets along and I think we all really enjoy caring for our patients and that's largely due to Sierra. So, sierra, why don't you start with our first question, please?
Sierra:First question comes from episode 36. It pays to be thin from rain. How do I change my set point without food noise ruining my efforts? Even when my diet and exercise is on point at the end of the day, my craving for chocolate is so incredibly intense. This usually starts happening once I lose five pounds and I can't figure out how to stop that uptick in cravings.
Zoe:Okay. So there's a lot to unpack here and there are a lot of different directions that I would want to know more about.
Zoe:The first thing that comes, I mean the first thing, but there's like so many things that I would want to know is okay if you are not eating very much throughout the day, or enough, or maybe skipping breakfast or skipping meals, trying to quote, be good or eat as little as possible that maybe that old dieting mindset has given you restrictive. What I find oftentimes, if it is that way during the day cravings specifically sugar cravings at night is that way for your body to play catch up and it's like give me the nutrition that I need in the form of cravings. So that's one thing I would say is like let's make sure you're eating consistently, eating enough of those nutrient dense, nutritious foods. You mentioned that maybe you could be eating a little bit more vegetables. Making sure you're getting enough protein, enough nutrient-dense vegetables, fiber, making sure your body is given what it needs, will make those cravings less likely. Something else to think about is if it is related to that weight loss. And so when you lose weight and your metabolic thermostat isn't actually going down with it, but you're just losing those five pounds, your body is trying to stay safe. It's trying to get you back to that, that higher weight, that higher set point, that you're set point. And so the way that it can do that is by triggering cravings to make you want to eat them, to make you get back to that set point. So focusing on those nutrient dense you know, maybe doing the metabolic reset diet, focusing on that volume, those unprocessed foods, to bring your set point down along with that weight loss.
Zoe:And then the other thing to think about is I mean, what is a life if you're never going to have chocolate again? It's, you know, not one that I would want to live. But, with that being said, completely depriving yourself all the time is a surefire way to stay hyper, fixated on it and to keep having those intense cravings. So I would recommend a couple of different strategies, one being a planned indulgence, a surefire way to stay hyper, fixated on it and to keep having those intense cravings. So I would recommend a couple different strategies, one being a planned indulgence.
Zoe:So maybe it's, you know, every couple of weeks or whatever works for you having a specific occasion where you know you're going to go out and maybe you share a you know chocolate cake with your partner after date night or whatever it is. So it's something to look forward to, it's planned, you don't feel guilty about it, it keeps you on track. The other thing is like, how can we do these little swaps on a daily basis that I do all the time, because I also have a sweet tooth and I love chocolate, but I want to make sure that what I'm having is still aligned with maintaining my health, maintaining my weight. So maybe it's you do a Greek yogurt, unsweetened cocoa powder, mashed banana situation, so you get that chocolatey flavor, but you're having something that has protein and fiber along with it. So there's a lot of directions to kind of go with.
Dr. Weiner:So I have a question for you and this you know, to me chocolate is a little bit, it's almost a little bit different than other foods because it almost feels to some degree like chocolate is like uniquely addictive. There are certainly some people you think it's just the caffeine.
Zoe:Maybe not just the caffeine, but there's caffeine in it.
Dr. Weiner:Yeah, no, there is for sure. So it always has felt like you know, is a chocolate craving an addiction or is it just kind of a preference or a soothing thing? Because let's just say, and let's just say, we're talking about alcohol and someone's an alcoholic. The advice that most people are going to give is not going to be like, you know, if you had a drink once or twice a week instead of all the time. We all understand that alcohol is an addiction, and I'm not saying chocolate is either, but what element of that is is this is chocolate craving? Is that an addiction or is that a preference? And is it, is it going to be possible for everybody to modulate their chocolate intake, or are there going to be people out there who just they just can't have chocolate because they're just so hooked on it?
Zoe:Well, I think that goes for sugar, maybe chocolate specifically. But I know we have several patients who knows that addiction to sugar is truly an addiction and they just have to just not do it at all. And for those people having a planned indulgence is not the answer. So it is very individualized, for sure.
Dr. Weiner:It really is. I think most people probably can figure it out and do that plan indulgence like you talk about, but there are definitely people who are so and I hate this word but triggered by chocolate or sweets or other things like that, and that they have to completely avoid it altogether. What I think is also interesting about this person is that it's losing five pounds. That brings on that craving, and that's, I think, what you said about the importance of providing yourself all the nutrition and trying to look at a set point lowering diet, like the metabolic reset diet. That, to me, is kind of a really important strategy that you have to replace food. You have to give yourself tons of phytonutrients and a lot of times cravings are from nutritional deficits.
Zoe:Yeah.
Dr. Weiner:And so that also is. Maybe there's a deficit of another food, something you know chocolate has a lot of phytonutrients in it, and so maybe there's a similar food that has a lot of phyton, of similar phytonutrients, in it. Cocoa powder is a great, great one, because it's good. It is chocolate, um, and the cocoa powder itself isn't, isn't harmful, it's probably a pretty healthy thing to eat. Actually, it's all the sugar, the milk and the fat that we add to it.
Dr. Weiner:But anyway. So I think that's a really important thing. I think another piece of this is medications.
Dr. Weiner:Now we talk about first-generation and then second-generation meds. And the first generation are like Phentermine and kind of the old-school drugs which generally don't work too well for weight loss. But Contrave is one. It's a combination of bupropion and naltrexone, so it's an antidepressant and then naltrexone is an opioid blocker and I've used sometimes just naltrexone alone and it's dirt cheap and sometimes something like that could be helpful for someone in this situation. I think if we start getting the heavy hitters, the GLP-1 meds, the Wegovi, the Zepound, they're probably going to help with this. A ton a ton. And so again, if this person's only trying to lose 10 pounds and at five pounds is getting stuck, I don't know that a GLP-1 is appropriate. But if they're looking to lose 30, 40, 50 pounds, then I think a GLP-1 might be a really good answer, in addition to all the nutritional stuff if that's something that person would be interested in Like a long-term overdose could be a good issue.
Dr. Weiner:All right, Sierra, what's our next question?
Sierra:Next question comes from Priscilla on Instagram. What are the common complications of the Roux-en-Y gastric bypass revision surgeries? I'm considering but really scared. How are the complications corrected? I'm considering this because I have severe acid reflux from my sleeve eight years ago and have weight regain.
Dr. Weiner:There's been this. I think there's over the years. There's been this whole thing where a sleeve is this and a gastric bypass is so much more drastic and so much different than a sleeve and I've done plenty of both surgeries and I've been doing this for a long time. I look at them really as kind of points on a spectrum, as opposed to this like drastically different surgeries. I think in the old days when we weren't as good at doing gastric bypasses and there were like sepsis and ICU and all this kind of leaks and perforations and all these kind of terrible things, we saw those with a gastric bypass and, as I've talked about before on the show.
Dr. Weiner:A sleeve is easy, like it is not a hard surgery to do. There's a few little tricks to make it come out nicely, but it's not something where it's like touch and go. A gastric bypass is much more challenging to do. You're connected. You're doing two connections. Things have to reach and stretch and sit nicely and the tissue integrity plays a role. We've gotten very, very, very good at doing the surgery and so we've eliminated a lot of these kind of terrible, awful gastric bypass stories which in general are surgical complications, and so if you do the gastric bypass correctly, then the long-term consequences of a gastric bypass to me are fairly similar in scope and severity to the long-term consequences of a sleeve gastrectomy, and so I think that's the first thing that you know.
Dr. Weiner:You can't look back at 10 or 15 years of gastric bypass history and say, well, that's what's happening now too. It's a very different surgery now, and if you go to someone who does the surgery regularly, you know I sleep great at night. Nobody wakes me up in the middle of the night. Nobody's crashing and burning. I'm not going into visiting my patients in the ICU or taking people back to the OR. I do the surgery, I go home, I go to sleep. I just rounded this morning. Oh how you doing Great, ready to go home, yeah, let's go.
Zoe:So many people are like did he even do the surgery? I feel no pain, I get that so much.
Dr. Weiner:I mean. That means, I'm doing my job right.
Dr. Weiner:It's not a terribly painful surgery. With some strategy, get can get on the new other diet and eating is the hardest part, and that's where you come in helping them. And again, a quick reminder anybody out there, if you've just had surgery and you want some nutritional help for sign up for our nutrition program. You can meet with zoe almost every day to get you back on your post-op eating book, eating plan. Um, so anyways, but there are differences between the two surgeries and there are some things that you need to consider before going from a sleeve to a gastric bypass.
Dr. Weiner:I think the first and most obvious one is dumping syndrome. We really don't see a dumping syndrome with a sleeve. There's a little bit of it, but it's not the same as what we see with a bypass, which means that fatty, greasy, sugary foods cause GI distress, and so your body's going to comment a little more on that. Alcohol use and again, we do see a little bit of an increased risk of alcoholism with a sleeve, but not like we see it with a bypass. You absorb alcohol differently, you get drunk faster, it wears off faster and it's more addictive after surgery, and so I think you have to be much more careful with alcohol use after the surgery. Smoking is just a hard no after a gastric bypass.
Dr. Weiner:And then there's really three complications, three long-term complications that we see after a gastric bypass. The first is ulcers, and they're quite uncommon, thankfully. I'd say probably 1% or less of people have major issues with ulcers, but they can bleed, they can perforate and they can be a real problem. They're particularly challenging when you've gone from a sleeve to a bypass, because your bailout move if someone has just a terrible, awful ulcer that we're really struggling to be able to treat, your bailout move is to actually reverse the gastric bypass. Oh geez, use the old stomach.
Dr. Weiner:I've done that, I think, five times in my career. So it's not something I've done with any regularity, but it is like your bailout safety move. If you've had a sleeve, you don't have that because the portion of the stomach's been removed that would allow you to reverse it. So that, to me, is kind of the one thing. That, to me, is kind of the one thing, that being said, I've had out of. You know, I see probably 10 to 15 new patients a week, and so you put that at 500 a year, let's say over almost 20 years of practice. Maybe not quite that volume, but I've seen a lot of patients over the years. I think I've seen this really come to a head two or three times at most.
Zoe:So out of maybe 10,000 patients.
Dr. Weiner:I've seen two or three times, I've seen this become an issue. So I don't want anybody out there to think, oh, don't have this surgery because you'll get an ulcer and then you'll be screwed. It's a really, really uncommon thing.
Zoe:Well, and smoking can cause the ulcer. Most ulcers are preventable, which is why it's right, exactly why we want to listen to the recommendations.
Dr. Weiner:Smoking alcohol, nsaids.
Zoe:Right.
Dr. Weiner:That's probably responsible for 85% of the ulcers that we see Bowel obstruction the intestines can twist on themselves. After surgery. You develop severe abdominal pain. That can be catastrophic I've seen it twice in my career be catastrophic but for the majority of patients it's like appendicitis. And so the key really and in those two situations when it was catastrophic it was a delay in diagnosis.
Dr. Weiner:And so as long as you seek help and treatment for your abdominal pain after bariatric surgery, after gastric bypass, from a bariatric surgeon, that's not going to get missed and it really is a very treatable problem. And I think the frequency is decreasing. I used to feel like I did like one of these a month and now I feel like I've done one this year so far. So it's much more uncommon. I think that the nutritional deficiency we see is iron deficiency, without question, and we can see a little bit after a sleeve, but it's much more profound after a bypass. You check your iron, you take your iron regularly. It's a manageable problem.
Dr. Weiner:I think the other piece of this is that severe acid reflux is not benign. It's not benign first of all because it's miserable. It's a miserable way to live and second of all because chronic acid exposure to the esophagus increases the risk of esophageal cancer, and so we recommend endoscopy every three years for anybody who's had a sleeve and has heartburn symptoms, to screen for Barrett's esophagus, which is a premalignant condition. So kind of living the rest of your life with acid reflux in my mind may be your riskiest option of all the things we've talked about. So you know, what I would advise to Priscilla is please find someone who does this surgery regularly and have them do it and move forward with this, because it might help with your weight loss, and it's definitely going to help with your acid reflux.
Dr. Weiner:So what do you see in your practice in terms of the differences between eating after a bypass versus eating after a sleep? Is there much difference? You know what are patients experiencing. What do you see?
Zoe:Yeah, you know, I mean obviously the iron being the number one nutritional deficiency, but in terms of, like, the progression of the steps after you know, introducing the foods back in same steps, maybe you know what I see with the revision is that you can sometimes go through those steps a little bit more quickly, kind of like your body knows what to do. But you know, in general the recommendations are going to be the same. You know, um big emphasis on mindful eating. Sleeve patients can oftentimes eat a little bit more than the bypass patients, maybe over time and that kind of thing. But ultimately we give the same recommendations and that that vitamin deficiency, with the iron is, is the main thing with the vitamins. That's going to be different.
Dr. Weiner:Yeah, there's also, I think, some differences in terms of with the sleeve, it's the amount that you can eat that really determines what your symptoms are. But the it's the amount that you can eat that really determines what your symptoms are. With a bypass, it's the amount. That's also what you need.
Zoe:Right, like going past that point of fullness. That's where the mindful eating comes in. We really want to get good, no matter which surgery you've gotten really good at recognizing when your body is telling you to stop. Because, just like you were saying, yes, going too much, you know volume. On either end, whether it's the sleeve or the bypass, it's going to be uncomfortable, maybe cause nausea, vomiting, that sort of thing. But, like you were saying, with the bypass you could get that dumping syndrome with those sugary or fatty foods versus maybe not experiencing that so much with the sleeve.
Dr. Weiner:Yeah, so I'll give you my theory on why and I and I totally agree with you when you go from a sleeve to a bypass, I think you could progress your diet much faster.
Dr. Weiner:So I think there's two factors that cause you to have difficulty eating in the immediate phase after surgery. One is kind of anatomic swelling and just a new anatomy, but the other is the set point. Your set point is so lowered and your body is working so hard to drive that weight loss that it just causes this kind of nausea and food aversion and it's the opposite of, the opposite of hunger is not full, it's nauseous. And I think that the surgery is working so well for a small group of people that they have some nausea and that it's that opposite of hunger effect. Now, when you go from a sleeve to a bypass, you don't get that big set point lowering because you've already gotten it from the sleeve and so you're just getting the difference between the two. So you really just have the anatomic effects, which tend to be much more modest compared to some of the set point lowering effects in terms of impacting your ability to eat.
Dr. Weiner:Just, my theory I got zero science to support that. All right, sarah. What's our next question?
Sierra:This question came in by email. Is it necessary for bariatric patients to not drink for 30 minutes after they eat if they are a couple years out from surgery?
Zoe:Okay, so this is where our title comes from.
Zoe:You know, not eating and drinking at the same time.
Zoe:It's a very common advice, especially if you're in different Facebook groups and you ask Google and whatever else, and you know that it's kind of a guideline to start, but it's not a hard and fast rule, especially not in our practice. And what's more important than that is actually the mindful eating piece again, so that you again, like I said just not too long ago, being really good at recognizing and honoring when your body is telling you to stop, and you're learning new anatomy, you're learning your new body, you're learning your new satiety signals, and so it's that's the most important is relearning how to eat. And you might find that I was just talking to somebody before this um in one of our support groups who was saying you know she doesn't necessarily wait to stop drinking up until when she eats, but she knows if she starts drinking right away afterwards she feels really full. So I think not just the mindful eating pieces is knowing that everybody's different and knowing that you are going to have to learn what works for you.
Dr. Weiner:Yeah, I think that's that's really the essence of getting through the surgery comfortably is some people. There are people out there who when they drink it and eat at the same time, causes some pain and discomfort. I think it's a minor, it's a relatively small group and I think even if it happens to you at first, it doesn't mean that's how you got to live the rest of your life, because this is changing over time, right, and what you experience at one week after surgery and what you experience of one year completely different, completely different. So I think that's again where mindful eating comes in is it allows you to to kind of adjust your behaviors and your strategies as your anatomy and your stomach and everything heals and changes. This is, without question, a very, very common myth that still is out there.
Zoe:Yeah, yeah, yeah. Um but and this is something that, you know, we kind of warn, I warn patients about in the pre-op session um, just like being on the lookout but knowing that this isn't something that you have to do forever and that everybody is kind of different.
Dr. Weiner:There's, there's, I think there's two places where there's two reasons why people excite, and I feel like it's almost 50-50. The first reason is that if you eat and then you drink, it's going to wash the food through your pouch and so you're not going to feel full, and I think that reason holds absolutely zero water, no pun intended. Holds absolutely zero water, no pun intended. So the reason is is because, first of all and I've sat there and I've watched these studies If you have someone drink after a gastric bypass or we even do sometimes some food studies where we take barium and kind of put it on top of the food and watch people eat the food, if you watch someone eats the food, it goes through their esophagus, it sits in their stomach pouch. How long watch someone eats the food? It goes through their esophagus, it sits in their stomach pouch. How long do you think it is until it's in the small intestine? A minute.
Zoe:It's washing through quickly regardless.
Dr. Weiner:It's going through quickly, regardless, right? And when you drink water it's through immediately. So the surgery isn't working by filling your pouch up. And when your pouch is full, well, then you're full too, and that's where that whole quarter cup of food, or how much does my pouch hold? Your pouch doesn't hold anything.
Zoe:It all goes right through it, which is why we don't assign specific portion sizes.
Dr. Weiner:Exactly so. I think understanding the mechanics of pouch emptying kind of shows you that that just doesn't make any sense at all. The food doesn't sit there for an hour or two and you feel full when the pouch is empty. It's a much, much more complicated issue. The more common thing and I think the idea that does hold water is that drinking and eating can be uncomfortable. And you eat and then you drink on top of it and you, like, fall off too much and everything starts to stretch and that can be very uncomfortable and really the risk in that situation is your own pain and suffering and vomiting, and so you're not going to perforate or cause less weight loss or have any kind of negative long-term consequence. You just get uncomfortable. Negative long-term consequence, you just get uncomfortable.
Dr. Weiner:And to me this is just, instead of like making some rule for every single patient who's ever had bariatric surgery, where it only applies to maybe 5% of them, we teach mindful eating strategies and teach people how to kind of monitor and determine. Hey, if every time I drink and eat it hurts, I'm going to learn to not drink and eat at the same time. I'm going to separate it a little bit If every time I drink and eat. I don't notice any difference. Last question what do we have?
Sierra:This question comes from YouTube from Amanda. I'm about to have the gastric bypass surgery and plan on trying to conceive about 18 months to two years post-op. I have two questions involving bariatric surgery and pregnancy. One outside of taking my bariatric vitamins and getting my labs done regularly, what can I do from a nutritional standpoint to prepare my body for a healthy pregnancy? And two, from an anatomical standpoint, is there a higher risk of bowel obstruction during pregnancy, since the womb would be taking up so much space and displacing the bowel? Thank you so much for all of your content. I have enjoyed watching all of your videos and listening to your podcasts over the last several months.
Dr. Weiner:Okay, so this question to me is exactly what I was talking about. I have enjoyed watching all of your videos and listening to your podcasts over the last several months.
Dr. Weiner:Okay, so this question to me is exactly what I was talking about earlier, when we were saying about how we get these great questions and it shows us like here's someone, they're making major life decisions here and they're making it with some really accurate, helpful thoughts about this thing. So let's kind of break this down. So, first of all, what do you recommend vitamin-wise for pregnancy, for pregnant patients?
Zoe:So with a history of bariatric surgery, we would recommend discontinuing the bariatric-specific vitamin and doing two prenatal vitamins instead. And doing two prenatal vitamins instead. The reason why is because we want to make sure you're getting the proper amounts of iron and folate for proper fetus development. But the vitamin A toxicity risk is greater with the bariatric vitamins and vitamin A toxicity for a developing fetus can result in spina bifida or a cleft palax.
Zoe:It's in the that um the neural neural tube neural yes we both took embryology, but it's been a long time, yeah, a long time, for me for sure vitamin wise, that's what we would recommend and, of course, like getting your labs checked regularly as well, and then, from a general nutrition perspective, making sure you're getting enough protein, making sure you're getting enough hydration and adequate nutrition as a whole like really focusing on that well balanced diet.
Dr. Weiner:Yeah. So I think from a bowel obstruction perspective, there is an increased risk during pregnancy, and so we you know I've done this surgery a handful of times, thankfully not very often. But patients can develop an internal hernia or small bowel obstruction, typically in the third trimester, when the uterus kind of pushes everything up, and so so Amanda, as she's done her homework, I mean, this is not something that's like widely out there in every pregnancy literature. I think the OBGYNs, I can tell you, at Tucson Medical Center where we work, the OBGYNs are tuned into this. So the few times I've been involved, the OBGYNs are the ones who picked it. They made the diagnosis. They didn't call me and say there's a patient who had bariatric surgery, has abdominal pain, can you help? They said there's a patient who had a bariatric surgery. I think she has an internal hernia. I'm ordering her a CAT scan. I wanted to give you a heads up because she is going to need surgery ASAP if she has it. And so I've been able to reduce the bowel obstruction, do it laparoscopically, and none of these well, one of them actually, they were, I think, 36 weeks, which was more than adequate for development, and we did a C-section and I fixed her hernia. At the same time, there was another one who I was able to release the bowel obstruction and she was able to finish out her pregnancy.
Dr. Weiner:Wow yeah. So if you get the right team and that team is your OB and the bariatric surgeon this is a solvable problem. Now, this is again not something that is happening all the time, but it is. There's that kind of small fraction of a percent of women who develop a bowel obstruction during pregnancy, after a gastric bypass, and it is scary, but it you know, it is not a untreatable problem. I think the bottom line also is if you're out there, you're pregnant, you've had a gastric bypass and you have unexplainable abdominal pain, it's probably worth a visit to your bariatric surgeon and we actually will do CAT scans. Even though the radiation, you know, can be harmful to the fetus, it's not nearly as harmful as missing this diagnosis Right. And so we will do CAT scans on these patients, and I've looked at these CAT scans and it's honestly it's a pretty impressive. You're looking at a CAT scan and then in the middle there's a baby.
Zoe:I know.
Dr. Weiner:I know it's kind of crazy, but yeah, this is a very real risk.
Dr. Weiner:But I think it's also important to understand that having a child and conceiving when you're substantially obese is also quite risky, and I've talked to many OBs about this and they all have told me I would much rather take care of a patient after bariatric surgery and kind of manage this minor nutritional issues and this very, very unlikely risk of bowel obstruction, then manage a 280 pound woman gaining 50 or 60 pounds during a pregnancy and then delivering emergently.
Dr. Weiner:That is very, very harrowing and difficult and risky. And so you know, like everything in life, there's risk on either side of these decisions, and so I think it's important to that I would never. I think when you weigh risk benefits on this risk benefits to the mom, risk benefits to the baby it's going to favor surgery massively 18 months or more after. So that's our recommendation. That's what the data out there shows is that after 18 months it's probably as safe, if not safer, to have to be to conceive after bariatric surgery. And again, on GLP-1s GLP-1s are contraindicated in pregnancy, so if you are, I think they recommend trying to stopping them two weeks before you try to conceive.
Zoe:Or as soon as you find out you're pregnant, because that's something we see a lot.
Dr. Weiner:Yeah, that's not recommended, but that's that's an unanswered question at this point. So again, I think you talked a little bit about the vitamins, but what about nutrition? What do you recommend from a nutritional perspective for someone who is pregnant?
Zoe:Well, like I mentioned, having that overall well-balanced diet, really prioritizing that protein. But I think there's this misconception that you need a whole bunch of extra calories. The reality is it's really only like a couple hundred max of extra calories, so you're not eating for two, especially if you do have a history of, you know, the gastric bypass and you want to make sure that you're maybe minimizing excess weight gain, really being in tune with that mindful eating, maybe only bumping up your, your protein and your overall calories by a couple hundred.
Dr. Weiner:Yeah, I think you know you're, you're not eating for two, you're eating for like 1.1, but but I think also, there's never a time in your life when it's more important for you to eat well than when you're pregnant, and I think that's the exact opposite than what we've been. You're eating for, true, go for it, right, yeah, and so I think we, we we've been giving people pretty bad advice about eating during pregnancy, and I think we have to make sure that's that's as a community. Yeah, but we as a community, I say we as healthcare providers.
Zoe:Yeah.
Dr. Weiner:Yeah, yeah. So anyway, I think we have to recognize that, that there's also this concept of epigenetics. So your genetics are your genes that you pass on to your offspring. But genes are not this static thing where, once you pass it on, well that's what's going to happen to you. There's something called epigenetics and that's our body's ability to turn on and off certain genes. It's so fast, it's so fast, and what it does is it allows us to kind of evolve, not over 20 generations, which is kind of how DNA will change, but over one or two generations, because it can turn on certain genes. And so when you're eating a bunch of garbage and you're you're developing child is exposed to the same foods that you're eating. I mean, when you're eating, you're feeding your baby too, and so you're exposing your child to processed foods, to processed crap. It's turning on those genes that cause obesity, that cause diabetes and that cause all these health problems that you're not going to want your child to have.
Dr. Weiner:When you're eating really healthy, you're turning on genes that promote health and wellness and insulin response, not insulin resistance and insulin response, not insulin resistance, and so it's so important to kind of push the right foods into your baby so that you're turning on the very best genes that you can from a health perspective. So great questions. This segment I know really good questions Again.
Zoe:keep those questions coming. Let us know what we can help you with. We are excited to potentially answer it on the next show.
Dr. Weiner:All right, we'll see you next time.
