When surgeons operate on patient’s stomach for weight loss surgery we have to then rebuild their diets. Could what we do help someone who has not had weight loss surgery? Give a listen as Dr Terry Simpson and Dr Garth Davis discuss the pathways and pitfalls of patients who have undergone weight loss surgery.
The interesting thing about infants is they know how much food to take in. Enrich formula of an infant and they will take in less. Water down the formula of an infant and they will take in more. Somehow this gets lost as people become adults.
Weight Loss Surgery is like having a new, infant’s stomach. And we surgeons get a chance to introduce foods in the right amount, and texture for optimal health. And, patients experience “satiety” and “feeling full” in a different way.
Dr. Simpson and Davis both agree on several principles:
(a) Real food for patients – not bars or shakes
(b) Base the diet around fruits, vegetables, and legumes
(c) The Mediterranean Diet (using the 9-point system) is an excellent way for patients to track their progress
(d) Too many patients get back to old diets that have never served them well
(e) We like to think in terms of food, not protein, carbohydrates, or fats
Metabolic surgery – or weight loss surgery – has a profound effect on a person’s health, and long-term success occurs with the closer adherence to a simple, real-food program that is easy to follow.
Surgeons are thought of as just a simple plumber with the guts – but Dr. Davis and Dr. Simpson take the postoperative diet rebuild quit seriously.
Here is the show transcript:
Terry Simpson: As some of you know, I am a weight loss surgeon and weight loss surgeons have a unique role in that we get to rebuild someone’s diet after we rearrange their guts. They’re like the newborn baby with a new stomach. The patient starts anew, but one of our hardest tasks is to get rid of the bad information people learn from years of trying one diet after another, what food is bad, what food is good, but food is healthy. Now I want you to imagine going out to dinner with a weight loss surgeon. Well let’s just say sometimes our wives get embarrassed by us.
Garth Davis: You know, I think there’s a real big problem when we start talking about macro nutrients. I mean that’s just not what suit is. You know? Like I hate it when I go, my wife especially hates it when we’d go out to eat and I order a salad. Then they say, would you like some protein with your salad? My wife’s like, “Oh my God. Here we go.” And I’m like, well, what do you mean by protein? And they’re like, well, do you want steak? I’m like, well steak is protein. And a lot of fat, so are you asking if I want fat with my salad?
Terry Simpson: That is my good friend and fellow bariatric surgeon …
Garth Davis: My name is Garth Davis. I’ve been doing bariatric surgery for almost 18 years now, but I’m also boarded in bariatric medicine. I’ve written two books, the Experts Guide to Weight Loss Surgery and Proteinaholic. I’ve got a pretty deep interest in nutrition and actually how can I put myself out of business by getting people healthy and no longer suffering from obesity.
Terry Simpson: On today’s show, Garth and I, two weight loss surgeons who love food, get together and talk about taking patients who have had weight loss surgery and rebuilding their diets. Maybe what we recommend for them will help you.
My name is Dr. Terry Simpson and this is culinary medicine, where we sort out the crazy from credible about food from its source to its effect on your body, busting myths and showing evidence where food can be medicine.
Terry Simpson: People who have chronically been on diets for weight loss get a lot of bad information stuck in their heads like what foods are healthy and what foods are not.
Garth Davis: It’s interesting when my patients come to see me, I guess most patients, you know, the nutritionist are looking at what’s your protein intake, what’s your carbohydrate? What’s your, I don’t want to hear a word about what your protein intake is, and what your fat intake is. I want to hear about what you are actually eating. Cause to me there’s healthy foods and unhealthy foods, but you can’t break it down in macronutrients.
Terry Simpson: Isn’t that how everyone talks these days? Order a salad and the waiter asked if you want to add protein to that. My pre-op patients tell me that they want to “avoid carbs”. But why do we hate chicken breasts? I mean my good friend Simon Majumdar and I, when we cook, we agree on this, we hate tasteless food and tasteless is how most people prepare it. And there’s this odd notion that people think that eating chicken breast is healthy, that it is “protein”.
Garth Davis: To give you an idea of how crazy it is. I had this lady come see me, very intelligent lady worked at NASA, rocket engineer. She was originally from Uganda, moved to America twelve years ago, and since that time had become morbidly obese, and so as I do with most of my patients, I asked her, what do you think the cause is, what’s the reason? And she said, well, it’s because of my carb intake. And I looked down at her diet log that I have everybody fill out and there’s no carbs in it. She’s eating eggs for breakfast and chicken for lunch and steak for dinner. And I’m like, but there’s no carbs. And she says, :”Well, you know, once in a while, a couple times a week I get together with my Ugandan friends and we eat a traditional Ugandan diet,” which obviously is high in grains and high in legumes and starches and I was like, that’s why you’re overweight?
Garth Davis: So I said to her, have you been to Uganda recently? And she was like, well, yeah. And I was like, were there any obese people? She was like, no, there weren’t. I was like, okay. And she was like, “You know, what was interesting, while I was there, I actually lost weight.” I was like right, because the food that you were eating back there is not what’s making you fat. What’s making you fat is this obsession with getting protein and stuffing yourself with calorie dense food that creates inflammation in your body.
Terry Simpson: Most weight loss surgery patients, and in my series of patients, about 95% have been on some form of a low carbohydrate diet. Atkins, South Beach, Keto, Paleo, pick one, and it is from this they get the idea that protein or meat should be the primary focus of what they should eat. It somehow didn’t work for them before. Now, if you’ve ever seen a group of Tibetan monks eat, they eat a lot of rice and they’re not fat. And consider this one fifth of the world relies upon rice, white rice as their primary source of calories and obesity is not an issue, but talk to someone who has been on a low carb diet about rice, no matter what their weight is, or potatoes and they will cringe.
Garth Davis: It is extremely hard for your body to turn carbohydrate into body fat. It’s extremely hard, it’s called de novo lipogenesis and they’ve done these massive overfeeding trials where they’d given people huge amounts of carbohydrates and they will only turn about 2% of it into fat. And in fact, if you get to that really, really high carb diet, you actually start increasing your thermogenesis, it takes energy to turn carbs to fat. So it’s very rare.
Garth Davis: And when you look at the blue zones in the world, the parts of the world that have the longest lifespan, they’re eating up predominantly carbohydrate based diet. The main food Okinawans eat is sweet potatoes and the next thing they eat is rice. And there’s not a you or me over there counseling people on obesity, although we’ll probably have to move there because you know, they’re starting to adopt western ways. But this carb fear we have is so unfounded and such a problem. And if you see there was a huge lancet article, huge, where they looked at 189 prospective studies and I think 57 randomized controlled trials looking at carbohydrate intake health. And they concluded that we absolutely have to be eating more carbohydrates. Of course, we’re talking about whole food carbohydrates that are full of fiber and that fiber may be the number one predictor of longevity and health.
Terry Simpson: Feeling full is a high priority with our patients and with us as weight loss surgeons, take breakfast. Many of my patients might need some eggs and they’ll tell me that they feel satisfied. Then I ask them to compare, eat two slices of whole grain toast and check how long it is before they feel hungry again. Guess which meal lasts longer? Yeah, the toast.
Garth Davis: They did a great trial, Dr. Halt at the Pennington Institute did this excellent trial where they had people eating different foods and they’re trying to satiety index, and at top of that satiety index, meaning the food that was most satiating that you could possibly eat, is a potato. And the interesting thing I see, is I see a lot of people switched to a plant based diet because they want to get healthy, they want to help the environment. So they decided they’re going to eat more vegetables, but what they end up doing is they just eat salad, you know, and that there’s still portion size and because we’re so used to in this country thinking, oh my God, I’ve gotta portion size and at the same time all there eating is salad as so they’re getting so little calories and nutrients and then they’re sitting there going, oh my God, I feel horrible, this diet’s terrible.
Garth Davis: The diet I advise for people is extremely high in starches and in legumes, and therefore is extremely satiating. And I tell my patients, I kind of have a red light, green light, yellow light type food breakdown, but the foods in the green category, I tell them you can eat as much as you want. I don’t care how much eat. And so for them, you know, the idea that they could eat whole grain pasta with lots of vegetables and tomato sauce and this isn’t a Vegan or even vegetarian diet. I don’t care if they eat a little bit of meat dairy, but the predominance of the plate should be plant based and that is extremely rewarding for them in extremely, there’s a lot of pressure off them. There’s no counting calories. There’s no counting of anything.
Garth Davis: If you look it up online, I followed Barbara Rolle’s work. She’s done a lot of work on what’s called volumetric eating and I’m telling you when people follow a volumetric brand and they don’t fear carbs and they basically don’t do Americans tell you to do what we generally think about from the media and the social media, they have unbelievable success.
Terry Simpson: Now Garth is a Vegan, but he realizes that this isn’t a diet most people will follow. I certainly won’t. But whole plants as it turns out are also the basis of the Mediterranean Diet. That’s a diet that we both endorse and teach the Mediterranean diet, following weight loss surgery or before weight loss surgery is considered the healthiest diet on the planet. In fact, we did an entire episode in season one just about the Mediterranean diet. Trust me, it’s not just feta cheese, salad, wine and olive oil. And while I am a meat eater, I love meat. Too much meat can have a downside. It’s kinda like this. I love aspirin to aspirin, will take care of my headache, but I’m not going to take the entire bottle.
Terry Simpson: Meat is dense in calories. Compare a half a cup of steak, that’s 650 calories to a half a cup of grapes, that’s 30 calories. And when you look at countries that have increased consumption of meat in their diets, they have increased their obesity. You can see this in China, Japan, Italy, but take China, the birthplace of my producer, Producer Girl. They have experienced an increase in obesity, especially in the cities. But it’s not because of an increase in their carbohydrates, it’s because they’re putting more meat into their diet.
Garth Davis: What’s fascinating is China has this huge increase in diabetes lately, which the Chinese Ministry of Health has said is because of the meat consumption, so people don’t realize this, but meat is strongly, strongly tied to diabetes and you kinda hit on it with the insulin. The carbs aren’t the problem. The problem is when we get insulin resistant, people think that because you have high sugar, when you have diabetes, that means it’s the sugar that’s a problem. But it’s not the sugar that’s the problem. It’s the fact that you’re not processing sugar, like I mean our bodies are made from the moment we take a bite there’s amylase in our saliva to start breaking down starch. Our whole insulin process, the way we store carbs in glycogen, the way we ourselves then go through cellular respiration by utilizing carbohydrates, to form ATP, it’s just a perfect system.
Garth Davis: The problem with the system comes when fat gets into the cells, specifically the muscle cells. So intro-musclar fat, muscle cell fat. When fat gets in the muscle cells, it breaks down the ability of the muscle cell to make insulin receptors and when it breaks down the ability to make insulin receptors, now you can’t process those carbs very well, so you’re exactly right. You take spaghetti and you make the meatballs with at the saturated fat in the meatballs is the exact kind of bad that gets into the muscle cells that creates the insulin resistance and now you’ve got really high insulin secretion which causes your body to store even more fat and then you get this vicious cycle which leads towards diabetes.
Terry Simpson: You know, it’s sort of a problem that there are a lot of diets out there, and anyone can lose weight on any diet and all weight loss is a good outcome. A better outcome is lasting weight loss. And by the way, if you want to hear a fun weight loss episode, listen in season one to our beer and sausage diet. But Dr. Davis and I are both focused on our weight loss surgery, patients learning how to eat properly after they’ve had weight loss surgery.
Garth Davis: You mentioned that anybody can lose weight on diets and that’s absolutely true. Ketosis does lose diet that they always came back, the a to z trial showed this. I mean there’s many, many, many studies. I can’t tell you how many studies that have looked at all the different diets and said that they all gain back weight. You can change the macronutrients however you want. It doesn’t make a difference. It’s a problem because I’m a member of the American Society of Bariatric surgeons now called OMA. That group is wedded to a high protein diet basically, because they sell products, so they put people basically on shakes to get them to lose weight and they do get success with that and it doesn’t last. But they’re so wedded to short term success and a lot of doctors aren’t because someone comes in and they want to lose weight. You want to give them something that actually well work in the short term. You don’t want to get into the real how to do it right. You want something quick and easy. And so that’s what they use.
Garth Davis: And the problem with this, with all this dieting is it leaves our patients feeling hopeless and helpless because I’m sure you’ve experienced this, but when you ask that patient, how long did it take you to regain that weight? And they say two months, when you start talking to them about how did the diet work, a lot of language I get from them is I failed the Diet, not the Diet failed me, but I failed the Diet. That’s kind of the you know, especially with obese patients that feel victimized all their life. That’s all they get in their mind is that they failed. And so they start losing hope that anything will work. And so my attempts with patients are first of all to get rid of all this diet lore, you know, no more talk about protein, no more talk about carbs and no more carb fear, no more shakes and fake products. We’re talking all about whole foods.
Terry Simpson: So let me be clear. I’m not opposed to meat. I love meat. But as with every food, you can overdo it. And let’s just talk about recipes, things that Garth and I love to give to our patients, our recipes. Simple things that they can learn to cook because many of them don’t cook. Well, let’s start with let’s say a baked potato, but, but not the butter.
Garth Davis: So instead of a baked potato with butter, sour cream, cheese and bacon bits, my patients are eating a baked potato and I have them mash it up and put avocado, salsa and black beans and some broccoli, and he has some salt and pepper. And you’ve got a great tasting little meal. It fills you up like you cannot believe, you’re getting just about every nutrient in the book. It’s very low and inflammatory causing suits that have endotoxin such as meat and dairy. And so the patients, they eat these meals that are extremely simple to make, or like one of my favorite things is I tell patients, okay, here’s the simple thing. You’re taking a can of beans, a can of tomatoes, a bag of frozen mixed vegetables, and you’re gonna mix it with different spices and put it on a starch. So for instance, you could have whole wheat pasta, you’re cooking that, it takes ten minutes.
Garth Davis: You’re going to get a pot and you’re going to put a can of white beans, a can of tomatoes and a bag of frozen mixed vegetables in Italian seasoning. Mix that up. You could put a little tomato paste to make it a little bit thicker and you’re going to pour that onto the whole wheat pasta. A great meal takes five minutes and cheap as hell, and the patients love it. Or You could take rice that you’re cooking and now the formula is a can of black beans, maybe a can of Pinto beans, a can of tomatoes, bag of frozen mixed vegetables, and now you’re putting Mexican seasoning on it, Mexican spices, and then you throw it over the rice. And so these simple kind of, we have a lot of simple meals like that that we try to go over with the patients, breakfast is almost always oatmeal and berries or we do toasts and jams and a lot of fruit, during the day there’s definitely fruit eating. I love soups, vegetable soups, lentil soups, these kinds of things. Especially, I really like to get my patients to eat legumes during lunch because it’s been shown that has a satiety effect, not just at lunch but also at dinner.
Garth Davis: They’re very good at controlling blood sugars during the day so you don’t have that two o’clock, I mean a two o’clock I’m not like wanting to sleep after my lunch and I have huge lunches because I’m not creating acidosis in my body, so my focus is, again on whole food plant based. I don’t really, if they’re going to eat meat or dairy, I ask them to do that as an accouterment, or it’s kind of like you talked about how China used to be where they would do a big bowl of rice and vegetables and maybe a little slice of pork on top of it instead of what we see now, which is pork with you know, a side of rice and vegetables.
Terry Simpson: Does this sound like the Mediterranean diet? Here’s the problem. If you check some websites about what the Mediterranean diet is, they talk a lot about olive oil and chicken. Well, I’m calling out the Mayo Clinic website because they clearly don’t understand what it is.
Garth Davis: And yet here you’ve got one of the big hospital systems in the world talking about what they think as a Mediterranean diet, which is not what a Mediterranean diet is, a Mediterranean diet is, what they were eating in Crete in 1950 or what they’re eating in the mountains of Sardinia.
Terry Simpson: We have a lot of good data about people who have undergone weight loss surgery and their long term success. As a surgeon, we get to rebuild their diet. So what do we tell our patients? We tell them to eat real foods, whole foods like fruits, vegetables, legumes, fish and some meat, but not too much. It’s a formula that works to maintain their weight loss after surgery. But one thing that doesn’t work are weird diets like fake food from shakes and bars. Have you ever noticed the most protein bars have as many calories as a Snickers bar? And let me ask you, which one would taste better? Which one would you rather eat? And if you think eating that protein bar is healthier than eating a Snickers bar or less calories or will do more good, I have a bridge to sell you.
Terry Simpson: There are a lot of odd diets out there, but weight loss primarily comes from our surgical patients because patients can’t eat as much and they’re satisfied with a lot less. But over time, successful weight loss surgery patients like all people, weight loss is sustained when people eat real foods. Special thanks to Dr. Garth Davis for lending his comments to today’s show and of course thanks to you for listening to this episode of culinary medicine with me, Dr. Terry Simpson. While I am a doctor, I’m not your doctor and you should always seek the advice of a trusted licensed medical professional with experience in your particular condition or concern before taking any actions. But if you are my patient, you better be on the Mediterranean diet.
Terry Simpson: Oh please. If you like this podcast, please do give us a kind review and rate us, apparently this counts for something. I think I get points and can go to heaven if I get enough. Culinary medicine is a part of the your doctor’s orders network, and you can find the post of this on yourdoctorsorders.com it’s produced and distributed by our friends at simpler media. My executive producer is the talented and charitable Producer Girl born in Kaolin, and you can follow me on Twitter where I’m @DrTerrySimpson. I’ll be back next time when we will have another conversation about food. as medicine for unveil another food con. Until next time, don’t drink the water. Drink the rose.
Garth Davis: Yeah, Evo. You know, since I had pneumonia, my taste is just not the same. Most red wines too bitter for me soon. I just have to have like a half a glass of rose and I’m good. I think that’s moderation.
