From Referral to Surgery

I wanted to stay on the same theme from yesterday’s post and talk a little about the process of getting approved for surgery (in Ontario) from your first referral to the date of surgery. For me – it was a 1.5 year long process but there were definitely delays due to COIVD-19 outbreaks.

Orientation Class

I was initially referred to the bariatric surgery program the fall of 2018. In less than 3 weeks I was called and asked to come to a mandatory group orientation class. I attended and received my future appointments. The only problem, I wasn’t ready. I didn’t think I could take the time off for surgery, I didn’t like the idea of daily vitamins for the rest of my life, I just wasn’t ready. With that – I let my referral expire and I didn’t attend any further appointments.

Then in the summer of 2019 I decided I was ready – it was a mixture of of a few things. I knew the hunger hormone changes Saxenda gave me was very helpful – and that surgery was the permanent solution. I also had friends who had surgery and were doing so well. I asked my family doctor for a 2nd referral and again within a month I was given my orientation class appointment.

In the orientation class you receive a patient information package including questionnaires and health information forms that need to be filled out and brought to future appointments. You will also be asked about participating in research. There are videos with patient experiences and you hear about the full process from start to finish.

Appointments after that are generally in no particular order and usually scheduled 1 every month or so.

Social Worker

This is a one-on-one appointment. There are questionnaires that need to be filled out and brought to the appointment. This appointment will be very individual for each person so there is not much to say about the details of the conversation. The aim of all pre-surgical appointments is to determine if the patient is a good candidate for surgery.

Psychologist

Similar to the appointment above – very individual to the patient. Again, questionnaires maybe needed.

Nurse Practitioner Appointment

In the orientation package you will receive a blood work requisition. This blood work needs to be completed and sent to the clinic BEFORE your NP visit. At this visit the NP will review your health history extensively and your blood work.

Nutrition Essentials Class

This is another mandatory group class. Lead by the dietician team this class outlines the pre and post diet guidelines, the vitamin and mineral regimens and answers any questions. They will also talk about what needs to change from your current life before you can be approved for surgery. This may included getting more protein, eating 3 meals and 2 snacks per day, eating less fast food, drinking less sugary drinks etc. There is a 2 week intake record that needs to be completed before your one on one appointment with a dietician.

Dietican Appointment

At the appointment you will review the 2 week intake records and discuss any areas for improvement. You can also talk about any questions or concerns you have about what your diet will look like after surgery.

Like I said earlier there is no order to these appointments (except for the nutrition class should come before the dietician appointment). Once the appointments are completed the team will meet and decide if you are ready for surgery. After that, you will have an appointment with the Surgeon and *maybe* get a surgery date:)

If you have any questions please let me know!

TTYL,

Em

Sourdough Bread: A series of fortunate events

Here in Ontario, Canada we are well into our third lockdown and unfortunately the worst wave of the COVID-19 pandemic. Most people ventured into homemade bread making during the first lockdown over a year ago. Me, I’m a little late to this game. This weekend I had my first attempt at making sourdough bread and it was such a journey I just HAD to tell it here, for you all to enjoy.

It all started 2 weekends ago when my partner asked me if I wanted to try making sourdough bread. I agreed, saying I would love to but I think making a starter can be very intimidating. He reassured me that he could handle that, but if I’m being completely honest I had my doubts. Having my doubts or being skeptical of this process is a bit of a running theme in the process.

Last weekend we did a grocery run and it was decided we would make margherita pizza. I bought some pre-made fresh dough from the deli section and away we went. Pictured below is our finished product- yum!

Using a piece of this dough ( about the size of a loonie) my partner began the process of making the sourdough starter. In a glass mason jar, which he kept in the fridge, he fed the starter daily with equal parts regular flour and water. On Friday night he texted me from work saying “Take that starter out of the fridge and let’s try to make bread tomorrow”. I removed the mason jar from the fridge, almost full to the top with what looked like the ideal paper mache paste. You guessed it – I wasn’t too sure this was going to work.

The next day after a sunny bike ride in the city my partner was making lunch. He noticed the top of the mason jar was bent and there was bubbly white matter all around the jar. With a hiss I opened the jar over the sink and saw the gorgeous starter bubble up. I looked at my boyfriend and yelled “she’s alive!!”.

Using the following recipe I took my first crack at a dough:

  • 250 g water
  • 150 g starter
  • 25g olive oil
  • Whisk with a fork then add:
  • 500 g AP flour
  • 10 g fine sea salt

First of all, I didn’t quite hit all the weights exactly. I did use a digital kitchen scale but I was a tiny bit over on almost every ingredient. The next step was to mix with your hands – the dough should feel “soft, dry and shaggy”. I was then supposed to cover in plastic wrap and let the bread “autolyse” for 30 minutes – to develop the gluten I’m told.

I didn’t get any pictures of the next few parts to this story – because honestly I thought all hope was lost.

After the first 30 minute period I was to knead the dough in the bowl (no specific amount of time was given) and then let it bulk rise for 3-24 hours. After this first hands on dough experience I was worried that there were hard chunks of what I’m assuming was unincorporated flour and oil. To explain the texture it was like bits of dried play-dough throughout an otherwise smooth and soft dough. I had hoped that with time maybe these hard bits would soften and absorb? Wishful thinking really.

We went to the dog park with our girls to enjoy the nice weather and left the dough to do it’s thang in our 72F apartment, because room temp matters people.

When we returned the dough had expanded very little and nothing improved with the hard lumps. Now – this is where we went off script, got experimental, threw caution to the wind – the dough was already not right how much worse could I make it?

I threw the dough into my kitchenaid stand mixer with the dough hook attachment (this is how I should have started really). I then willy nilly added in some flour, oil and water. This is the first miracle of this bread – I will never be able to re-create this exact recipe. I kneaded the dough with the mixer for, well I’m not sure how long, but until everything was combined and soft.

The dough then sat to autolyse and at the 45 minute mark I tried the pull and stretch method. We settled on the couch to watch Mortal Kombat, hoping the dough would rise.

Now, if the whole cowboying ingredients part was the only “off script” moment I wouldn’t have been that surprised that the bread turned out. But it’s what happened later that night that really sent things into a downward spiral. My loving, wonderful, smart, partner stood up to get a drink in the kitchen. He said “I’m going to flip this dough” I called back, ” No, it’s fine just leave it”. Then I heard it – the SLOSH. Yes you heard that right – SLOSH. That wet pasty sound of water being added to the dough. I cried out in a desperate tone ” Did you just add water to that dough?!” – he replied “my hands were a little wet thats all”. Busted – when I stood up to inspect he had a small bowl of water that he added to the dry, soft dough. I was devastated. I was sure there was no returning from this blunder. He was whole heartedly convinced the bread would still turn out. See in the picture below the pasty remnants of the added water.

The next morning the dough had doubled in size but still had a sticky, sour smelling ring of water around the edges. I used a little bit of flour on my hands to form the dough into a ball and to take away the stickiness.

I lined an oven safe pot with parchment and placed the dough ball into the pot, covered for a final rise. I pre-heated the oven to 450 degrees towards the end of the final rise.

Once the oven was preheated I reduced the temp to 400 degrees and scored a cross in the top of the bread.

I placed the pot cover and baked at 400 for 20 minutes.

After the 20 minutes I removed the cover and returned the pot to the oven for another 40 minutes.

Finally, when the 40 minute timer went off I removed the bread from the oven and placed on a wire rack to cool. I read that it is very important to let the bread rest. So I let it hangout on the counter for a little over an hour.

Wow, there are no words for how well this bread turned out. Its tangy and sour, delicious with a bit of butter. Soft on the inside with just the right amount of crack in the crust.

Will I be able to recreate this – who knows.

Will I try again – Heck YES!

Have you ventured into bread making? Let me know if you have any tips, unexpected successes or funny fails!

P.S. After writing this post I’ve been watching youtube videos about sourdough. A lot of the videos I’ve seen keep the dough really moist and sticky as they let it rise. So maybe my partner new what we was doing – but don’t tell him I said that..shh..

I definitely have some things I want to change, like pre heating the pot and maybe getting a real dutch oven so the seal is tighter. Also allowing the crust to go a little darker, and letting it rest a little longer after baking!

To all the Diets I’ve Tried Before

As I adjust to my new lifestyle post bariatric surgery I find myself also settling into a new way of looking at the food I eat. As mentioned in a previous post, dieting and tracking calories, protein, sugar etc. all used to have a very negative connotation for me.

Now – in the post op bariatric life I rely on reading nutrition labels and tracking my protein intake and portion sizes to ensure my body functions well and doesn’t revolt against me (ie. too much sugar and dumping syndrome). I now see tracking macros, ensuring I get enough water in the day, and taking my vitamins as self care, because, unlike the diets I’ve tried before, there are real and serious consequences to not taking care of myself.

To explain that last concept a little further – before surgery I knew certain types of food, in large portions, not taking vitamins or drinking water would be detrimental to my overall health. But the results of that detriment would take years to show. In a post op lifestyle the results of not taking care of myself can have an almost immediate affect if not an affect within weeks not years. This is one more reason why I see weight-loss surgery as a tool for lasting weight loss management.

I read a statistic yesterday from a bariatric surgeon in the US that said, if your BMI is over 35 you have a 1% chance of loosing weight without surgery and sustaining weight loss. I don’t love this statistic because I know there are has to be more than 1% that loose weight through diet and exercise and can maintain the weight loss- but I definitely feel like I had reached the end of my dieting rope when I decided to have surgery.

The following is look back at all of the diets I’ve tried and how I felt about each.

Simply for Life

One of the first questions asked in the preparation for weight loss surgery is “what diet changes have you tried in the past, and where any successful”. Simply for life (SFL) was my first real structured diet with the accountability of going into an office once a week, presenting food diaries and being weighed in. This was before the advent of apps on smart phones to track intake, and everything was hand written onto a calendar style sheet of paper. I’ve mentioned before that there is a right way and a wrong way to follow any diet. For instance weight watchers (funny enough the only diet program I hadn’t tried) is a points based system. There were adults in my life who would say they are doing weight watchers but then eat chips, cookies and pop – but make sure everyone knew they were counting points. I thought even at a young age, “I’m not sure that’s how it’s supposed to work”.

The idea behind SFL was to teach you about nutrition and portion sizes. That you are eating “simply to live”. I remember the phrase “eat to live don’t live to eat” being thrown around a lot. For me the restrictive no sugar, low carb, low fat diet translated into – deprive your self of salt, sugar and flavour in general and then binge the night after weigh in. Whether I’m remembering the actual rules SFL set out for eating, or only remembering my distorted interpretation of those rules, the diet was not sustainable. Well, not sustainable if I also wanted to preserve my mental health. Most of what I thought about nutrition and dieting would be built on the foundation of my experience with SFL, which looking back was as sturdy as a pile of sticks.

I was active during this time – I participated in rec sports and was a member at a curves gym that also offered Zumba!

Isagenix

Isagenix was the next real program I remember trying for longer than a few months. The gist was 2 meal replacement shakes per day and only 1 well balanced meal. Then once a month* (I’m pretty sure it was per month but also could’ve been weekly) I would need to do a fasting day. This meant no food or drinks besides water, and this extremely unpalatable cleansing juice provided by the company. At the time I was working shift work and the early morning shake, substantial lunch and evening shake were honestly not all that bad. I would reserve the fast day for a day I didn’t have to work and could just grumble around the house hangry. Those fasting days were psychologically very taxing. During this time I was also involved with a fee for service fitness group at my local goodlife. It was honestly the best shape I had been in in my 20’s.

After deciding to stop the Isagenix program because it was expensive and the results were not sustainable physically or emotionally I did continue to use Protein shakes for occasional meal replacement.

Gluten free

At the age of 25 I developed migraines for the first time in my life. While in the midst of trying to find the trigger of migraine headaches one theory that popped up was the possibility of having developed a gluten intolerance. At the time it was the only thing that I could note as a trigger in my day to day life. I always knew that if I ate too many bread products in a day I would have IBS like symptoms but somehow headaches were also linked. In the end it was determined that it was my oral contraception and that yes, gluten can increase systemic inflammation, but it wasn’t the sole cause.

None the less I had almost a full year of a gluten free diet. Again, there is a right way and a wrong way to follow any diet. Finding a gluten free bakery and having a box of sweet treats in one sitting wasn’t going to affect my weight and overall health. When I would avoid all carbs I felt great! This was probably lending to the fact that gluten free bread products tend to have a higher glycemic index, meaning the food is turned to sugar faster in your body than regular bread products. At the end of the day consuming a lot was consuming a lot of fast sugar that my body didn’t necessarily need.

Orlistat

Ugh, I almost forgot my short 3 month foray into this weight loss drug. I think it was deliberately pushed out of my brain. Orlistat is an oral medication that is taken with meals and works by blocking the enzyme that breaks down fat in your diet. The undigested fat then passes through your stool. It does not have an affect on calories consumed from sugar and other non-fat foods. This medication was unpleasant to say the very least and had the smallest affect on my weight when compared to anything else on this list. If I ate any more that 13 g of fat per meal the after affects were so, so very, unpleasant.

Keto

Knowing at this point in my mid 20’s that higher levels of fast sugars in my diet made me feel pretty rotten I did a lot of research on the keto diet. Eating so few carbohydrates that your body goes into a state of ketosis and burns fat for energy. Every single human on the face of this earth responds differently to different diets. The jury is still out as to why but modern medicine is researching a mixture of factors such as genetics, ancestry and environmental factors.

I did try the keto diet for a little under a year. I do not think I followed it to the T but I drastically changed what I was eating. My meals were smaller, high fat and high protein. I was not exercising as much as I should have and may have been burning muscle more than fat. In the beginning I felt great but eventually started to feel really run down. One day I decided I needed to find a way to incorporate all food groups, but still somehow loose weight.

Noom

I have only good things to say about Noom. Did it necessarily work for me? not really- BUT- do I think someone starting out on a lifestyle change journey would benefit from the Noom program – ABSOLUTELY. Noom is a mixture of lifestyle, psychological and diet related advice in a neat interactive app format. Similar to my “know it all” approach to the weight loss clinic later in life I had a “this is information I already know” approach to Noom. Not proud of that poor attitude but it was enough to make the program not effective for me and therefore I decided not to continue spending money on it. I really was my own worse enemy.

Circling back to my first thought though – if you are someone who is making steps to change your lifestyle for the first time I think Noom is an amazing option. It is knowledgable about changing food habits while also being psychologically safe.

Calorie Counting & Personal Trainer

In my late 20’s I tried the road not previously travelled. I spent *too much* money on a personal training program and I downloaded the first rendition of MyFitness Pal.

My only regret about personal training was the amount of money spent. In all fairness I started that journey with unrealistic expectations and was disappointed that I didn’t have the before and after pictures I was expecting. My trainer did an amazing job, and to anyone wanting to increase strength and learn how to work out I would totally recommend working with them. I didn’t keep up the other end of the bargain. I didn’t work out on off days and I was in a terrible relationship that involved a lot of enabling with food, and no emphasis on physical activity. I think if I had the disposable income again in the future I would revisit working with a trainer again one on one.

Intake counting was/is a lot easier with apps that can scan the products bar code and automatically be in your food diary. MyFitnessPal has come lightyears in terms of development from 2017 to 2021. In the past when I would decide to hunker down and ‘count calories’ or track my food it would always start out great, but then would break down slowly over time. It would be either a meal too complex to record properly, or something I felt guilty about eating and didn’t want on record. One missed day would turn into 2 or 3 and then the tracking would stop altogether. There were times when that same restrictive, negative feelings from the SFL days would creep back in and discourage me from continuing on with tracking. As discussed above I currently use MyFitnessPal post op to track protein intake and my thoughts process has dramatically changed.

Vegan

Veganism can definitely be a whole blog post on it’s own. So I will skim the surface of my history. In the summer of 2017 I had a sudden change in how my body handled dairy and high animal fat foods. I was working as a camp nurse and one evening watched the What the Health documentary on Netflix. Now I know that a well done documentary can convince most people to believe anything, but this set off a spark in me to investigate the benefits of a plant based diet further. I watched Forks Over Knives and decided to do a Plant Based Nutrition Certificate from Cornell University. I was determined to go into this lifestyle change with as much information as possible. My little brother was also considering a change to veganism and we decided to do it together.

I made this choice for a few reasons. I was hoping a whole food plant based diet would be beneficial for my overall health and help with a lot of the inflammation I was having and I disagree with the toll mass farming has on animal’s lives and the environment. At first the change was easy, and I felt better than I had in many years. So much so, that I wasn’t even tempted to break back into animal based foods because the change was so significant I didn’t want to revert back.

Slowly after about 8 months of strict veganism I started to have bites of meat or dairy when travelling or out for dinner with friends (you know sharing food pre COVID). I continued to only eat plant based when buying groceries or cooking for my self but I wasn’t 100% strict at all times. As I broke away I would still listen to my body. If I had a certain dairy product and my body rejected it I would avoid. If I had a week of eating animal based foods and I was feeling run down I would reset to plant based for a few weeks.

At the end of the day I do feel a plant based whole food diet is what is absolutely the best for humans and for the environment. In a post op world I’ve opened up to poultry, eggs and some dairy as protein sources but still eat a mostly plant based diet. My partner is a vegetarian and my brother is still following a vegan lifestyle so I’m the odd one out.

Saxenda

Saxenda in an injectable medication that is self administered sub cutaneously. It comes in a pen format very similar to that used for insulin in diabetes. It is a GLP-1 like medication that affects your appetite and insulin in the body. I remember when it was first prescribed I was resistant (surprise, surprise) but I was told “this drug will give you the same effect temporarily that having surgery gives you permanently”.

After trying and finding short term success with Saxenda is honestly a huge factor in my acceptance of weight loss surgery. I realized how different my life was without a constant feeling of hunger pain and how easy it was to control portion sizes. Eventually, I realized that Saxenda is not a long term solution because; I didn’t want to take a needle everyday of my life, it was cost prohibitive, and I was having side effects.

I am grateful for my experience because it opened my eyes to how surgery could help me in the long term.

At the end of the day its about your personal relationship with food. I’m not saying that any of these diets, apps or drugs are WRONG. I’m simply sharing my experience and how, for me, my relationship with food and eating sabotaged all pre surgical weight loss attempts. I will continue to say, I’m only at the very beginning of my journey with bypass surgery as a weight loss tool, and I know I have many hurtles ahead of me. I hope this sort of reflection on my past will be helpful in knowing how to deal with challenges in the future.

TTYL,

Em

First Month Post Op Struggles

I’ve been struggling this weekend to find the creativity and motivation to write about some vulnerable topics like family support and stigma around surgery. I really want to do these topics justice and my head is not in the game. Instead this weekend I’ve been feeling a lot of the frustrations and post op struggles boiling to the surface.

So I thought – hey- this is a perfect time to write about the non insta worthy side of recovering from bariatric surgery. I’m hoping this post will serve 2 purposes – 1. To show the ups and downs of the recovery process and 2. To allow me to vent and capture this phase in writing.

Typical Em

I have a habit – good or bad is a glass half full question – of not giving recognition to the hard parts of life where due. I tend to push through or bottle up whatever the situation is. Usually a happy or sad video will cause the dam of tears to break, I have an emotional release and then I look back and analyze what has been weighing on me.

This phenomena caught up to me this weekend. I needed to force myself to chill out and relax, not to push myself, but also not feel guilty about doing so. My body has also told me to take a step back and not rush the healing process.

Physical Cues

I have to say, I am overall very happy with my post operative course. I hate being nauseated and that was a real fear I had going into surgery. Sure there was some immediate post operative nausea but I have been very lucky to not experience ongoing nausea, nor any vomiting. I’m getting used to my full cues and to listening to my body on whether it will tolerate a new food or texture.

I thought that my laparoscopic incision sites were healing well as they were all dry and scabbed but last night as I was cleaning I learned that in-fact the wounds are quite deep and possibly infected for 2 of the 5 sites. Being a nurse and a patient is a tricky thing. Knowing what you need but not being able to get the dressing supplies or other treatments is stressful. Even before COVID I was not interested in going to ERs and now that feeling is even stronger. I am hoping I can see my bariatric team or family doctor tomorrow, and will take care in the meantime. This definitely feels like a set back. I had plans to clean and do laundry today but that has all gone out the window. I realize that I need to slow down and take care, but I wish my body chose a different way of sharing that message.

Eating

Anyone who has ever sat down to a meal with me AND my family pre op knows how fast we eat. I am fully aware that eating fast is not the greatest but it was a habit I had for a long time. It takes the body up to 20 minutes to feel full, so when you eat to quick you can feel overstuffed in that short period of time – and will definitely consume more than you intend to. Part of working on intuitive eating before surgery was learning to slow down meals, chew throughly, put down the utensil in between bites, and stop eating at the first cues of fullness. I mean I still ate quickly but I do think there was an improvement.

Post op 1 month, I still need the stopwatch on my phone to make sure I’m not eating too fast. I am chewing throughly and putting the spoon down between bites but without watching the time I go for that next bite too fast. I have had a few meals that I know I ate too fast and the discomfort afterwards was just not worth it. I am concerned about going back to work and feeling rushed to eat with my busy schedule. This is a goal for April for sure. And with COVID its difficult to eat or drink in areas with other people, so I will get my steps in walking to the break room or office to make sure I’m eating and drinking – hold me accountable blog!

Drinking

When I lived in Newfoundland I held a record for being able to chug a can of carbonated alcohol made with yeast and barley – 51.9 sec to finish the can. Not something I would put on my resume, but an example of how easily I can quickly drink a beverage. There is (or should I say was) nothing more satisfying than downing a full water bottle after a hard work out, or drinking with a meal.

Sadly these are all activities I can no longer participate in. While in the grand scheme of things I know drinking large amounts quickly will be a small sacrifice in the end – it’s still a struggle to get used to in this first month. I do hope to be able to get to a point where I can have a sip or two of something with a meal but for now I set the 30 minute timer after my last bite and stare down the clock until I can drink.

Loosing Weight

I think for myself I had followed many people on social media who are 1 + years into their weight loss surgery journey and I subconsciously thought I’d be a size 16 going back to work in one month (I was a Size 20-22 pre op). Somewhere deep down I was convinced I’d need a whole new wardrobe before I could return to work.

Obviously this is extremely unrealistic, and I’ve come to terms with the fact that no, your old bra still fits, it’s not too big yet. I will say that work clothes which fit very snug pre op are now fitting well and are more comfortably, so that is a non scale victory. And as for new clothes- I think I’m going to wait until I absolutely need them, not just because. As stores are open now and all have amazing deals after being closed since November I did consider buying pants a few sizes smaller – but I decided no – let’s wait until I think I need that size and try them on. That will be a great feeling.

Body image and body dysmorphia is extremely common in obese individuals, especially those who have had weight loss surgery and loose a lot of weight quickly. I haven’t had that experience yet but I’ve also not reached a point that I haven’t bounced around from in the last few years. Another thing I consider is how I viewed my body before having surgery. I remember telling my therapist that when I look in the mirror I see someone who is curvy, but sexy and not that big at all – but when I see a picture of myself I feel like I look 2x bigger than the person in the mirror. My therapist told me that this feeling is common in people who are overweight but still very athletic. This is all to say that if anything I feel like the body I now see in pictures is meeting up with the body I see in the mirror.

And for the record even before surgery I felt strong, sexy and confident in my skin – I was hoping to portray in that last paragraph that my insecurity came out when looking at pictures rather than the mirror.

Weight stalls are common as well post op. Every single person is different and the body is still healing. I was expecting a 2-3 lb loss every week – so when I almost didn’t loose anything at week 4, I felt discouraged. I wondered if it was something I was eating or if I wasn’t moving my body enough? I checked in with the dietician from my bariatric program and she was so supportive. She normalized stalls at all stages and encouraged me to stay on track – not to compare myself to others.

I worry seeing social media posts from others on the same post op journey who challenge each other to set unrealistic weight loss goals and revert back to full liquid diets one month on to reach those goals. I know there is nothing I can do but I worry about the people who look up to those for advice and support.

Overall I’m Happy with My Progress

At the end of the day I am very happy with how far I have come. I couldn’t have asked for a better support system in my family and friends! I’m so excited for the future and I know all of these struggles are small bumps on the road. Your perspective of how bad the bumps are depend on where you sit on the struggle bus. Sit up front you’ll barely feel them, sit in the back and you’ll go flying. I’m learning to sit at the front of the bus, to recognize my struggles and allow them to live in the light so they don’t overwhelm me in the future.

I hope you all have a wonderful weekend and thank you for 1000 blog views!

TTYL,

Em

Favourite Foods from the Pureed Diet Phase

As I prepared for surgery I did a lot of research on different foods I can eat during the liquid, pureed and soft diet phases of the post bariatric surgery recovery. Pinterest had a few ideas that were helpful and this cook book is extremely informative: The Complete Bariatric Cookbook and Meal Plan.

If you are new to cooking for yourself and struggle with meal planning and knowing what to cook, I would recommend the Complete Bariatric Cookbook. I’ve definitely drawn on the recipes in this book for inspiration but have also created a few delicious recipes myself that I would like to share!

To start off it’s important to know that everyone tolerates foods and textures differently after surgery. For these recipes you can leave them more whole for the soft diet phase or puree more to tolerate in the early weeks post op. As always make sure you eat slowly (over 30-40 minutes) and avoid drinking 30 minutes before or 30 minutes after. Again, these drinking guidelines are those shared with my by my bariatric dietician – so that’s what I follow- but everyone has a different tolerance.

Pre operatively I did not tolerate dairy very well and I preferred a mostly vegetarian diet. With that I admittedly struggled with protein intake. Post operatively dairy is being tolerated A LOT better (fingers crossed that continues) and I have included chicken into my diet. I am still going to avoid pork and beef – so stay tuned for more vegetarian and poultry recipes.

Breakfast is the most important meal of the day. This recipe I’ve had for breakfast but it would totally work for any meal or snack throughout the day! My bariatric program recommends ONLY poached eggs during the puree phase. Now, I didn’t even like eggs until I was in my early 20’s and then I would really only eat boiled or scrambled. The only time I would eat poached was covered in hollandaise sauce for an Eggs Benedict. With that being said I needed to learn how to make – and like poached eggs.

I did some research on how to poach an egg and I tried 3 different methods:

  • Simmering water + vinegar + strained egg
  • Simmering water (swirled like a tornado) + vinegar + whole egg
  • Simmering water + strained egg (no vinegar)

My favourite method- with the least complications– was to cook the egg in simmering water + 1 tsp of white vinegar. I strained the egg to get rid of whispy whites and dump the strained egg into the simmering water. This creates a beautiful oval poached egg that is easy to remove from the pot without all the whisps. In the non vinegar pot the egg stuck to the bottom, and in the whole egg tornado the egg didn’t come together at all -instead it’s appearance was very dementor like in the pot.

The guac is a mash of avocado with lemon, garlic and salt. I’m avoiding spice at the moment for a couple of reasons. I’m worried how it will be tolerated, and I’m worried it will increase my risk of gastric ulcer (a common side effect post op). In the future I will for sure add some jalapeno or crushed red chili flakes. Don’t forget to put the pit in with leftovers to slow the browning process.

I called this recipe chicken sub on melba because it’s not fully a chicken salad. My favourite condiments on a chicken sub are mayo and regular yellow mustard, so I went with that! This was my first lunch of the puree phase and man oh man was it delicious! Especially after 3 weeks of a liquid diet.

You can get creative with this recipe. Add in your favourite condiments and spices. If you are tracking sugars pay attention to any sauces with more that 8 g of sugar per serving (or per the amount you will use).

This is truly a delicious dish, it tastes exactly like a chicken gyro – or greek chicken meal. I bought a small package of ground chicken and cooked off the whole package at once with garlic powder, onion powder and salt and pepper to taste. Once cooled I placed the ‘plain’ ground chicken in an air tight storage container and placed it in the fridge. This allows me to just remove the 1/4 – 1/3 c. of chicken I want per meal and reheat with spices to fit whatever dish I am making.

For this recipe I scooped out 1/3 c. of the ground chicken and reheated in a non-stick pan with a pinch of dried oregano and a pinch of dried parsley. Once heated thorough I added to a small bowl with the tzatziki and tabbouleh. Before eating I took a pretty picture then blended all together to bring down the texture. If you are on the soft diet phase you can just mix together and chew well.

This was another tasty meal that can be made with processed cooked rotisserie chicken OR you can use a scoop of the cooked ground chicken and reheat in a pan with taco seasoning.

I like to use plain yogurt in lieu of sour cream, and the fresh salsa from the deli section of the grocery store. Again, you can keep as is for soft diet or you can blend further to smooth out the texture for pureed.

For this dish I was heavily inspired by the Baked Ricotta dish in The Complete Bariatric Cookbook and Meal Plan. Ricotta is a very common ingredient in the layers of delicious lasagna. In my Mom’s lasanga recipe she uses cottage cheese, so I knew this would be a great substitute for ricotta.

Cottage cheese is high in protein and very versatile. It can be added to a dish to boost creaminess or as a side dish, or eaten on its own for a snack. I added cooked and crumbled beyond meat sausage then topped with a smooth tomato basil sauce, and shredded cheese. The end result- I was eating the lasagna of my childhood – no meatballs or noodles were missed!

Making this dish in a small single serving dish is super convenient when cooking for your self. There is very little prep time and you can have a fresh serving multiple days in a row if desired.

Beyond meat sausage tastes completely like a real pork sausage. The hot Italian flavouring is my personal favourite. When the casing is removed it fries up just like meat sausage and the results is a soft, easy to chew crumble.

Each cooked beyond meat sausage is 2 servings of 1/4 c. each. So with the left over sausage from my lasagna I made a quick supper of sausage, sweet potato and cottage cheese. No real theme or story behind this one, although mixing potatoes with cottage cheese is super nostalgic for me.

For those reading this who are on a weight loss surgery journey I hope you can find some inspiration for your own meal planning. I enjoy cooking and creating new recipes so I will definitely be sharing more meal ideas in the future! I would love to know some of your favourite recipes for the first few weeks post op!

TTYL,

Em

Mental Health, Food and Weight Loss Surgery

Surgery is on your stomach not your Brain – This is a phrase that you will hear often when preparing for Bariatric Surgery. There is a reason you need to see a full interdisciplinary team of health professionals before being approved to go ahead and have this life changing procedure. You need to have a plan for how you’re going to eat high protein, low refined sugar foods. You need to be aware that you cannot binge eat in one sitting, our you could find yourself in a medical emergency – at the very least a lot of pain. And as I’m sure everyone is aware- how much and what we eat is often a decision made in our brain not our stomach.

Researchers at Cornell University estimate that humans make more that 226 decisions about food alone PER DAY. Some may think that after surgery you need to think less about food than before. This is definitely not the case. After surgery – I can speak for the immediate post op period for sure- you make SO MANY decisions about food. You have to think about what you are eating, the speed of eating, the texture of food, the timing, the protein content and the sugar content. For a person who is starting off a weight loss surgery journey with a poor relationship to food, surgery, and the care needed after can be extremely overwhelming and mentally taxing.

In this blog post I would like to talk a little about my mental health history with food, how I worked on that relationship before surgery, and how I’m feeling one month post op.

History of Food Addiction and Disordered Eating

I’ve said it before and I’ll say it again. I love food. I will also love cooking and creating new recipes. Trying new foods and going back to the old comforts every now and then. For as long as I can remember I have found my mind occupied with food.

The earliest memory I have is around the time I transitioned from elementary to middle school. At the time I didn’t equate the food habits to my life (I was only 10-12 years old), but looking back it was a rocky time. In school I bounced around from friend group to friend group. Trying to climb that hierarchy of popularity so coveted at that age. I was changing who I was in almost every way and morphing my personality to fit with whatever clique I was trying to be friends with. I knew that I carried more weight than my peers but that never stopped me for garlic sticks with dipping sauce and pizza at lunch. I would feel upset about my weight but did not fathom changing how I nourished and moved my body.

I don’t want to focus too much on my garlic stick lunches – because at the end of the day thats what every single kid ate. In fact it was a mad rush to make sure you got one before they sold out everyday. What is more disturbing to me now looking back, is the behaviours around food at home. The sneaking and hiding, knowing what I was doing would be frowned upon and finding new and creative ways of hiding my bingeing.

We had an extra fridge in our basement, and the basement was also were all the children were relegated to when family visited. During the holidays there were a lot of children and a lot of food. So much so that my Mom would store deserts in the downstairs fridge when the kitchen fridge was overflowing. I have a clear memory of escaping to the small room that held that spare fridge and eating small scoops of the homemade whipped cream meant for our apple and pumpkin pies. I was aware I needed to – 1. not get caught in the act 2. not eat enough that it would be noticed and 3. make sure the swirls on top looked natural, not like a finger or spoon had been dipped in.

From that time, I don’t remember the feeling eating the secret deserts gave me. I do remember the guilt and the fear of being caught. Moving on to junior high and high school. My brother and I were mostly turn key kids. In that, most days when we would return home from school we would be there alone. There was a designated after school snack cupboard that we would each grab something from and then go on to do our homework. Although somedays – both after school times and any time I was left alone – I would want to eat more. A few “snacks” that stick out in my mind, in terms of things I felt guilty about were – cooking and eating 2 – 3 hotdogs out of the freezer, or 2 packs of mr.noodle, or melting butter with brown sugar to make “fudge”. The reason these stick out is the memory of how I covered up my crime. After indulging on a snack I shouldn’t have had, I would wash and put away every dish I used. I would take any garbage and bring it out the big dumpster, then bury it deep – as if my parents would riffle through the kitchen garbage after work to find evidence like in CSI- they didn’t have time for that!

I don’t know why I went to such great lengths to hide food. I think I knew my parents were trying their best to be supportive of healthy eating, and that I came home from school crying about bullies taunting my weight enough times that they wanted to support a healthy body image. I felt guilty that I had urges to eat foods that were not on the healthy spectrum – or would want to eat a high volume of foods.

Something I’ve always struggled with was feeling like people were watching me when I ate and judging me for what I was eating given my appearance. This stemmed from insecurities passed down from my mom and from comments made during lunch periods in high school – from well meaning friends.

In university, dining hall felt like being in a fish bowl of people watching and judging each meal. In some cases this feeling steered me towards healthier options while in dining hall but promoted binge eating in my dorm room.

After university and living alone I didn’t feel the pressures I’d had previously. This time was also my 10 year long journey with every diet and work out regimen under the sun. So there were waxes and wains of binging and restricting. Something that sticks out as evidence I still felt the need to hide what I was eating – when my mom would call and ask “what’s for supper” – I’d look down at my plate of homemade fully loaded nachos and say “salad”.

Accepting Addiction and Disordered Eating

Addiction is a touchy subject for me. Unfortunately, there is a strong history of addiction in my extended family and a lot of the behaviours I witnessed around addiction had a negative impact on me. Even without that prior experience it is extremely difficult for someone to admit they have an addiction. You are accepting defeat – accepting you need help, that you weren’t strong enough to stop this activity/substance from taking over your life.

Throughout my 20’s I would repeat this phrase over and over again – you can quit drugs and alcohol and still be alive – you can’t quit food and still live. I’m my opinion that is complete admission of a food addiction, but I wouldn’t be open to accepting that concept until I was in my early 30’s.

It was at the weight loss clinic where I was initially referred for surgery that I was confronted with my addiction. The same doctor who said “surgery is the only way you’re going to loose weight” also said “you should go to a support group for food addiction”. As I mentioned before, both of these suggestions made me furious at the time. In my mind I had complete control over food, I just had cravings sometimes, and I didn’t need surgery, my will power was strong enough to loose weight naturally.

I don’t know what prompted me to do a google search of books on food addiction but I did. That summer I was rebuilding after a rocky relationship. I went home to Nova Scotia to see my parents and brought with me a book called Food Junkies by Phil Werdell and Vera Tarman. This book changed my life and allowed me to final accept and say out loud – I am addicted to food and I need help.

Changing my mindset around what is an eating disorder was also really important. Even as a health care professional I had the mindset that binging, purging, restricting, was only medically significant if you were at a dangerously low weight. I think as a society we need to accept that NO MATTER what your outward appearances is, disordered eating is serious and can have long term affects on mental and physical health. Any disordered eating, no matter what your weight is an eating disorder.

Getting Help

Thankfully I was already engaged in therapy with a wonderful practitioner for 4 years. When that practitioner left the practice I was referred to a therapist who specialized in disordered eating and food addiction. Building this new therapy relationship was much easier once I accepted how disordered my history with food was and I made a commitment to changing it.

I read books and worked hard on getting out of the dieting headspace, some my say found the anti-diet lifestyle. I also worked on intuitive eating, listening to my body for hunger and full cues, paying attention to how some foods made me feel physically and how I felt when I avoided those foods. I changed how I viewed food. Instead of allowing food to be good, bad or affecting my self esteem – I changed to – is this food nutritious or not nutritious, what portion of this food will I choose.

I will say I was offered many times to participate in food addiction support groups. This is also something recommended in the pre-surgery assessment process. With my first attempt at a surgical referral the need to attend this groups was on the list of reasons I wasn’t ready for surgery. I have accepted that these groups maybe helpful, but have not reached out to attend any. I bring it up to be accountable for my own resistance but also to make sure you know there are resources out there.

Still a Struggle Everyday

It might sound like I’ve come a long distance from the kid sneaking whipped cream in the basement- and in some ways I have. It is still a constant daily struggle, with some days being better than others.

Before surgery, my binging and restriction patterns had greatly improved, but at times I still found myself occupied, even obsessed with foods until I could get some. I also stopped bringing foods into my home that I know I would have little control over eating or eating too much of. I continue to work with my therapist and I feel that recognizing behaviours and thoughts is extremely important to me.

Shouldn’t vs Can’t

Since having surgery I’ve been thinking a lot about these occupying thoughts of certain foods. For instance on the east coast we have a dish called garlic fingers with donair sauce. Calling it a dish makes it sound a lot fancier than it is. Essentially, garlic fingers are cheesy bread sticks dipped in donair sauce which is an extremely sweet garlic flavoured dipping sauce.

Before surgery when I would crave this meal I would think, I really shouldn’t – there is no nutritional value, it’s a dish I tend to eat too much of, and I almost always have a stomach ache after. In the end there were no really consequences to prevent me from eating it.

Now, post surgery when I think of eating garlic fingers and donair sauce again I think, I can’t eat this. There are a few reasons I will probably never eat garlic fingers again – 1. There is no nutritional value. I have so little that I can eat in a day that one or 2 sticks would be filling, and the nutritional value does not coincide with my goals for the day 2. Unless I want to be in extreme discomfort, the taste and satisfying a craving would not be worth the dumping syndrome and abdominal discomfort afterwards. 3. I don’t need to eat it, eating this meal will not change how I feel about myself.

Garlic fingers and donair sauce are just one example of how I’m working on my mindset around food post operatively. I think the list of foods I said shouldn’t before and can’t now will be low. For the most part I’ve been using my love of creativity with food to reimagine meals I enjoy in bariatric friendly ways. Like bunless burgers, or buffalo chicken salad instead of chicken wings. Deserts will be tricky going forward but I do feel I’ve “detoxed” from sugar since the pre-op diet phase. There are a lot of low sugar options out there to allow for deserts, whether or not I struggle with portions is yet to be determined. It is a bridge I must cross one at a time.

How I’m Feeling 1 Month Post Op

I do feel that the immense amount of work I put into my relationship with food and developing the tools to work with my addiction pre operatively has helped with my transition to a post op bariatric diet. I also think that I would’ve really struggled if I had had weight loss surgery any earlier in my life. Like I said above, the struggle is not over now that the surgery is completed, in some ways the struggle has taken on a new form.

Counting protein and sugar has a different meaning for me now. In previous attempts with marco counting for weight loss there was a lot of guilt around not meeting or going over targets set. Now, I need to focus on these two measurements to ensure I heal quickly and I feel well. Protein is essential to keeping muscle mass and not allowing the body to burn muscle instead of fat. This affects my energy levels and quite frankly my goals in having surgery. I want to run 10k races, play sports and climb walls. I need my muscle mass to do so. Paying attention to sugar is important because, like most, I’m terrified of dumping syndrome. So anything to avoid discomfort is worth it.

I still have an incredibly long road ahead of me, and I hope to share the hills and valleys of that journey on this blog. I will say that caring for your mental health after weight loss surgery is, in my opinion, as important if not more than counting macros and exercising.

Resources for Ongoing Support

Ongoing support is important. I have a wonderful support system in my friends and family but I still set a high level of importance on therapy was well.

I would recommend Food Junkies to anyone. Not just a person in the process of accepting an addiction to food, but also to the people who surround them in life.

I am grateful that the bariatric surgery program where I am a patient is extremely supportive and provides a lot of resources to help guide through every stage of surgery.

In addition to that support I’ve also found the Bariatric Surgery Nutrition program extremely helpful.

From social media there are is also a lot of support. One account in particular as meant a lot to me. The information is frank, is evidence based and really resonates with me. Please check out Healing is Freedom on Instagram!

I want to thank each and every person who takes the time to read this blog. It means a lot to me to have this platform and share my experience. I’m so looking forward to continuing on this journey!

TTYL,

Em

Dreaming of Mexico

The last calendar year has been a strange one to say the very least. Before the COVID-19 pandemic affected international travel I would get on a flight at least twice a year if not more. I still have a long to do list of places to visit – waiting for the day it is safe to do so again.

In the meantime I would love to share some memories of my favourite trips!

The first place I want to share is Mexico- specifically two cities on the Yucatan Peninsula – Mérida & Campeche.

My Last Trip Before the World Shut Down

Exactly one year ago on March 6th, I made a last minute decision to buy a plane ticket and fly to Campeche (by way of Mérida) to surprise my parents who were already down there.

March 2020 in Campeche trying out ‘influencer’ poses 😉

Mexico is – in my heart- my home away from home. To explain my love affair with this country I’ll need to do what I do best, and tell a long drawn out story.

The year was 2006 – just kidding I won’t be that cliche- but seriously its been 15 years since our family of 4 became unofficially a family of 5. My other brother (literally from another mother) first came to Canada as part of a junior high exchange program. Students from Campeche, Mexico came as a large group to Nova Scotia for a 2 week visit. Each student was paired with a Canadian student who would then go back to Mexico for their two week visit. My Mexican brother Alfonso was paired with my little brother Ralph.

Alfonso must’ve found something he liked in my funny little family because he came back as an international student the next school year in 2007. Since that time my parents have gone to Mexico for vacation to see Alfonso and his family every single year! I myself have had the wonderful opportunity of going all but one year since 2010. We have a community of friends and family in Mexico that I miss dearly when away and am so excited to get back to every spring. Part of this family is a cousin of Alfonso’s who also came to Canada as an international student – allowing my parents one more school year before becoming full time empty nesters- thanks Carolina:)

My Spanish is rough around the edges but I pick up a little more every year. One thing I have gotten the hang of is navigating around the cities of Mérida and Campeche.

Mérida

Mérida is the largest city in the Mexican state of Yucatan. There is a bustling population of around 890,000 people. In 2019, Mérida was considered one of the safest cities in the America’s, only second to Quebec City in Canada. Mérida is a 4 hour drive on a divided highway from Cancun, but no need to drive – unless COVID changes things- because there are direct flights from Toronto right into Merida.

The city is like most cities in the world, the downtown is historical and beautiful. With central and peripheral squares, each with a cathedral that’s size corresponds to the size and importance of the square.

A hotel on the corner of the main square
One of the beautiful cathedrals in the historical down town core

As you move to the periphery of the city new subdivisions boast modern homes and large shopping malls with chain restaurants and movie theatres serve the residents of that area.

Mayan World Museum of Mérida

There’s a Costco and Sam’s club, along with huge Walmarts with everything you will need for a vacation in a rental house. In most of the historical squares downtown you’ll find markets with extremely delicious and extremely cheap food /drinks.

Cochinita Pibil Tostada
Agua Fresca and Fresh Juices

Food!

Food in Mexico is beyond delicious! There are chain restaurants, high end dining and then the market kiosks busy every day with locals and tourists.

A few of my favourite foods that I look forward to each year are cochinita pibil, agua fresca sandia and horchata.

Cochinita pibil is essential a pulled pork dish. The pork is marinated in a sour orange juice mixed with achiote paste. Achiote paste has a rich, dark red color (that will satin when you cook with it) with a peppery, nutty taste but also sour from vinegar that’s included in the paste. The red color comes from seeds grown on the Annatto tree. There are spiky pods on the Annatto tree that contain seeds, these seeds are ground to give the signature taste and color!

Anyway back to the pork – traditionally the marinated pork is wrapped in banana leaves and slowly cooked in a pit within the ground. The result is a pulled pork, mixed in the juices and sauces from remaining marinade. The cochinita is served a few different ways. My Dad’s favourite is on a soft white bun with nothing else – just the pork – this is a cochinita torta. You can also eat the pork on a freshly made corn tortilla with pickled onions and hot sauce if you’d like. The third option I’ll mention is cochinita tostada. A tostada is a corn tortilla deep fried with smooth beans on top (or inside). You then top the tostada with the cochinita, pickled onions, lettuce and tomato. Can you tell how much I love cochinita pibil?

Agua fresca sandia and horchata are delicious beverages. These can be purchased at the same food stand or the one right next door in most places. Sandia is Spanish for watermelon – this drink is blended watermelon with added sugar and diluted with water. Horchatta is another sweet drink that is creamy from a base of rice and has a vanilla/cinnamon flavour – p.s. horchata goes great with a touch of dark rum (aka rumchatta).

Grabbing a bag of cochinita, a half a dozen fresh rolls and a litre of aqua fresca will cure any hangover 😉

Where to stay?

As I mentioned above Mérida is a very safe city. I personally feel very safe moving around the city with my siblings and even on my own when needed. Our family almost always rents a full house when we visit, but we have experienced hotels in the historic downtown core.

The back of MY favourite rental home in Mérida

I love renting a full house for a few reasons. My family and I have our own space to spread out but also be together. We have a private outdoor space including a pool, and don’t need to worry about a busy/expensive bar. I love to grocery shop and cook when I travel abroad. I love exploring grocery stores and eating some of Alfonso’s favourite foods that you can’t get in a restaurant. At the end of the day when I cook at the rental home, I feel that I consume less food and spend less money on food/drinks.

Obviously if you think – hey, I’m on vacation I don’t want to cook and then have to clean up afterwards- I get it. There are still lots of perks to renting a home without the pressure to cook.

There are also downsides of renting a home. You may not get the opportunity to meet new and interesting people from around the world at the hotel bar. Most homes for rent are in residential areas where the local neighbours are not always appreciative of rowdy Canadians on vacation. You really have to do your research to make sure the home is safe and up to whatever your standards may be. I would recommend talking to friends or family that you know have rented to get their opinions.

Hotel courtyard in Mérida

Hotels and hostels are also a great option for places to stay in Mérida. I’ve only experienced staying in hotels that are historical properties. With that, the rooms and bathrooms are usually on the smaller side when compared to a modern hotel. I for one love the beauty of the old buildings and didn’t really spend a lot of time in my room, so the size didn’t bother me. These hotels are extremely central to the downtown core and everything for the most part is within walking distance (ie. food, tourist areas, local markets).

Day Trips

There are a few great options for day trips in and around the city. As pictured above there is a beautiful Mayan World Museum that has an amazing modern architectural design. You can do a walking or bus tour of the historical properties down town, or visit the large zoo/animal sanctuary within the city. If you wanted to rent a car or hop on a tour bus you can leave Mérida and explore ancient Mayan ruins, beautiful cenotes or hang out at the beach in Progreso.

The main beach in Progreso
Chichen Itza

Campeche

At this point I’m worried this post is a little too long- but if you’re still reading please stick around because I want to talk about a wonderful city called Campeche.

Campeche is a 2 hour drive from the airport in Mérida. It is the capital city of Campeche State but has a significantly smaller population than Mérida (Around 220,000). The growth of Campeche in the last 10 years since I’ve started visiting in terms of tourism and small business has been outstanding!

The city is a seafarers dream – for that reason the Spanish built a defensive fort around the city to protect it from pirates and buccaneers (not always successfully). There are significant portions of the fortified walls that remain well preserved and statuesque around the city. The gates and walls from the late 16th century frame tourism areas that are protected as an UNESCO world heritage site.

Parts of the Fort you can explore

Much like Mérida there are larger and smaller squares throughout the historical downtown. Calle 59 is a street heading straight through the heart of downtown from the Peurte del Mar (the sea gate). The street is closed to cars/traffic and restaurants’ tables spill into the street. You can sit outside, enjoying the fresh sea air and sipping on a cold drink.

Calle 59 (looking away from Sea Gate)

If you walk straight towards the water from the sea gate you will see a shining statue with an angel on top. And from there a colourful Campeche sign that my family and I took full advantage of for a picture. The malecon is a beautiful 7 km seaside walkway that spans the entire sea front of the city, here you can see the most beautiful sunsets.

Vibrant Art work in the main square at night
Cathedral in main square

Where to stay? What to eat?

Campeche is very similar to Mérida in terms of options for accommodations and food. Being close to the sea there is a wider range of fresh seafood available at local markets and restaurants. Also, with it being a smaller city there are less options for hotels, home rentals and hostels. The options that are available are affordable, clean and comfortable.

There is the added option to rent a beach house if you are able to find one online. The warm gulf of Mexico waters are a huge draw for my family and I to spend at least a little time at the beach. You can stay in an accommodation on the beach or take day trips to local beaches.

Sunset from 1 year ago at a rented beach house in Campeche

If you ever have the opportunity to travel to either of these cities I can promise you, you will not regret it.

I feel like I can only graze the tip of the iceberg in a travel post, to avoid writing a small book. If you have any questions please let me know!

I am counting down the days to when I can return to my home away from home and my chosen family in Mexico.

TTYL,

Em

Is Food a Moral Compass?

Is food good or bad? Does what we eat provide us with a moral compass on how to view ourselves?

Is a french fry and a baked potato not the same thing at the end of the day – a potato?

Then why have I have had extreme feelings of guilt and worthlessness after eating the french fry versus feeling healthy, and successful after eating the baked potato. For me- I blame the diet industry. In Canada the diet industry made over $270 million a year from 2015-2020, and in the US $71 billion dollars in 2020 alone.

My first memory of seeing a commercial on TV and wanting to change my body was when I was 12 years old. It was an ad for a product that when wrapped around your abdomen would stimulate your muscles to shed belly fat. They used extremely unrealistic before and after photos to demonstrate this little machine’s power. That year I asked Santa to bring me one – so I could loose my belly weight fast and fit in with low rise jeans and crop tops. That was the first year I didn’t get what I asked for, and the year I stopped truly believing in Santa. I did however get a letter from Santa’s workshop explaining that I am beautiful just the way I am, and that I didn’t need this magical (in my mind) weight loss machine. In retrospect, if my child asked for something like that at that age I’d write the exact same letter.

In my teen years, when I started making my own money baby sitting and working cash at a local grocery store, I would buy weight loss supplements (pills) from the supplements store and hide them in my sock drawer. I made sure to take them before every meal but I never noticed any difference in my weight – so I stopped. I was never, and still am not very good at lying to my parents.

Then, my first real structured diet, with rules, was a program called Simply for Life. Now, there is definitely a right way and a wrong way to do everything, and diet plans are no exception. It’s safe to say I did SFL the wrong way. I would restrict all week to weigh in on Friday and then binge all weekend. I was given a diet, but not any tools – and I definitely was not engaged with mental health support.

Unfortunately this restrict binge cycle was successful and I lost 40 lbs. When I would restrict and eat 800 calories a day of tasteless, non fat, sugar free food I felt like a success. I felt strong and skinny, like I was worthy of compliments and adoration. Then, all day Friday leading up to the weigh in I would fantasize about what I was going to eat that night (amounting to thousands of calories). After eating the “bad” foods I would feel terrible, both physically and mentally. I was worthless, I didn’t deserve to be loved because I was gross. Strong words I know, but it’s the reality of that post binge.

When I started university I had a lot of set backs in terms of friendships, hazing and bullying. Even though I was physically the smallest I had ever been, I had zero self confidence. I feel into poor eating habits (huge portions, eating late, binge drinking) and gained a freshman 50 lb. But every summer I would go home, and it would be back to that same restrict/binge cycle.

Although I was not formally a part of the SFL program anymore a lot the the rules and attitudes about food followed me through my 20’s and countless diets after that (more on my diet history later).

At 27, I was living in Toronto completing my MN-NP and I had made new friends. These friends were very supportive of me in seeking mental health care for the first time in my life. Although the diets continued until 30 years of age, my mindsets began to shift with therapy.

When I was first referred to the weight loss clinic that would eventually lead me to surgery I was told I may have an addiction to food. Addiction is a touchy subject for me and like all addicts I was in complete denial. That summer I had ended a serious relationship that was negatively affecting my body image and began to rebuild. Part of that rebuild was the acceptance of a food addiction and the realization that yes, I have a long torrid history of disordered eating. The amount of food is part of the disordered eating, but so the way I viewed food.

Good and bad, worthy and unworthy, should eat and shouldn’t eat – these were all descriptors of food I needed to remove from my vocabulary.

After this realization I explored the path of intuitive eating. Listening to my body in terms of hunger and fullness cues (and as we know from my last post my body betrayed me there a bit). Also listening to HOW I felt after eating certain foods. For example, how did I feel after eating a poutine versus a salad. I know that after the poutine I felt groggy, had stomach cramps and no energy. So maybe not a food I eat everyday BUT it’s ok in moderation.

While I will probably always have some lingering feelings of “I did good” or “I did bad” after a meal I know my focus has changed to – how do I change the script on how food is described, avoid giving food and good or bad label and recognize the food for what nutritional value it gives me (from a scientific point of view).

A potato deep fried (aka a french fry) is giving my body added saturated fat, which in small amounts is totally fine, in fact your body needs it – but in large amounts consistently, over time that added saturated fat can be dangerous. All this to say – a french fry is food that is cooked a certain way -it’s not evil and eating it does not make me a bad person.

At the end of the day how you feel about food is completely up to you. Don’t let anyone tell you what you’re eating changes your worth or makes you a good/bad person.

Let’s change the way we talk about food, especially around the kiddos and teens. They are learning from scratch and we have a golden opportunity to enforce that food is food right from the start. Please explain, no you can’t have chocolate cake every day because your body doesn’t need that much sugar to do it’s job – but that having cake for a birthday isn’t bad. Saying “Oh I really shouldn’t be eating this, its bad” in front of an impressionable youth reinforces your rhetoric of negativity towards food.

So remember – at the end of the day a cake is just sugar, flour and eggs – a french fry is just a potato.

TTYL,

Em

Hunger Hormones & Bariatric Surgery

How does bariatric or bypass surgery change your body to help you lose weight? Is it just a smaller stomach so you eat less? In short the answer is hunger hormones!

I’ve been looking forward to writing this post, and I am very excited to share some knowledge about the hormones in our bodies that affect our appetite.

Before I started my own journey with weight loss surgery, I like many others, thought surgery was successful because mechanically you have a smaller stomach and you eat less – therefore you lose weight. Something I feared about having surgery was the crushing hunger pain I had pre-op would continue after, and I wouldn’t be able to eat enough to satisfy the perceived need. After experiencing a drug called Saxenda and researching more about hunger hormones I realized that surgery itself, and the subsequent weight loss has a huge affect on appetite regulating hormones, thus taking away my fear of feeling forever hungry.

First a few definitions….

Roux-en-Y Gastric Bypass (RYGB) makes up 70-75% of bariatric surgical procedures. This is the procedure I had, and for the purposes of this post I will focus mainly on how hormones are affected in this procedure. This is how the RYGB procedure works….

GLP-1

Glucagon-like peptide – 1 (GLP-1) is secreted from the distal ileum and colon in response to food intake. This hormone regulates your appetite by reducing hunger and increasing satiety. Some of the functions GLP-1 is responsible for are :

  • Slowing gastric emptying of food into small bowel
  • Promoting insulin release
  • Inhibits glucagon secretion
  • Inhibits gastric acids secretion
  • and Works on the nervous system to induce satiety – therefore decreasing food intake (feeling full)

GLP-1 is like a brake mechanism that helps your body regulate the movement of food through the GI tract.

But how does GLP-1 change after RYGB surgery?

Studies show that levels of GLP-1 are much higher in patients after RYGB when compared to the same patient before surgery and other normal weight patients. The reasoning for this is thought to be related to the speed at which food enters the small bowel (GLP-1 is released) after surgery. With higher levels of GLP-1 your hunger cues will be lessened and you will feel full sooner.

Saxenda

This is a perfect time to talk about Saxenda. The generic name for this drug is Liraglutide. This drug mimics GLP-1 so by giving a daily dose, hunger will be decreased, as well, insulin availability and sensitivity which are both increased. Saxenda is injected subcutaneously and is approved in Canada for use in type II diabetes. I will definitely discuss my experience with Saxenda in a later post – I wanted to loop it in with the hormone it most mimics for future reference.

PYY

Peptide tyrosine-tyrosine (PYY) is also secreted from the distal ileum and colon but only AFTER a meal. Like GLP-1 this hormone promotes satiety, delays gastric emptying and inhibits gastric acid secretion.

But how does PYY change after RYGB surgery?

Again, like GLP-1, levels of PYY measured in persons after RYGB surgery are higher than those pre-surgical or in other types of bariatric procedures. Food will enter the lower GI tract faster post operatively, therefore the theory is PYY levels are increased.

Leptin

Leptin is secreted from fat cells and influences appetite by acting on the hypothalamus in the brain. Leptin signals the hypothalamus to decrease food intake and increase energy expenditure. The amount of Leptin circulating in the body is in proportion with the amount of fat cells one has.

So wait? Did I just say that the MORE fat cells you have the MORE leptin you should make? How does that make sense in obesity?

Progression of obesity is thought to be a product of leptin resistance rather than a deficiency of leptin. That explains how more fat cells = more leptin , but if the body is resistant to the leptin it will not reduce food intake.

Sleep is also really important for the regulation of leptin. The less sleep you get the less leptin you will produce – leading to more of an appetite and increased food intake.

But how does Leptin change after RYGB surgery?

Unfortunately the results of a scientific review were not consistent in regards to how leptin changes after RGYB surgery. The working theory is weight loss increases the body’s acceptance of leptin and decreases resistance, but this is a hard process to measure.

Ghrelin

Last, but certainly not least is Ghrelin. Ghrelin is a little different from the first 3 hormones discussed. While GLP-1, PYY and leptin induce satiety or fullness – ghrelin tells your body its hungry!

Ghrelin is released from both the pituitary gland in the brain and from the lower part of the stomach. It’s main job is to stimulate appetite, telling the body to take in food/energy when the body is in a negative energy balance (eg. in a fasting state or during a restrictive diet). As you can imagine this is an evolutionary protective measure to keep us from starving to death. However in obesity, studies show that eating food, or the intake of energy does not suppress the action of ghrelin.

Sleep is also an important factor for ghrelin regulation. I use this fact all the time when talking to teens about sleep hygiene, and the importance of a good nights sleep. The less sleep you get the MORE ghrelin you release – therefore sleepless nights can lead to a higher hunger drive and more food intake.

But how does Ghrelin change after RYGB surgery?

Ghrelin is significantly lower post operatively and sustained at a lower level for up to a year post op. It is most likely that ghrelin is suppressed because the area where it is released (the lower stomach) is bypassed in RYGB and no food comes into contact with that area. So overall your hunger drive is turned WAY down after RYGB surgery.

So, what has been my experience so far?

As of today I am 3 weeks out from my RYGB surgery and down 30.4 lb since my pre op diet began. To say I have’t felt hunger in 3 weeks would be absolutely true. I know as time goes on, my new stomach gets used to “real” food (not liquid or puree) that some of those hunger hormones will change further.

While my hunger cues have changed significantly, so have my full cues. Big porition sizes were truly my downfall pre operatively but that was alongside extreme hunger (headaches, stomach pain, nausea). I know that what I was eating and how much all played a big role in that hunger but the point I’m trying to make is – I remember the hunger more than the fullness. Feeling full was usually a huge over exageration on the other end of things – feeling STUFFED, over eating. Now, I eat very slowly (1 tsp of food every 5 minutes) and usually around the 40-45 minute mark I start feeling like I need to burp. This is what I am now calling my fullness cue. Again, I’m sure that will changes as my intake/diet changes but I will just continue to listen to my body!

Thank you for taking the time to read this post. All of the information was from a review written by Beckman et al. (2010). If you have any questions at all – or anything you would like to comment on – please leave a public comment or use the contact me page to reach out!

TTYL,

Em

Beckman et al. (2010). Changes in gastrointestinal hormones and leptin after roux-en-y gastric bypass procedure: A review. J. Am Diet Assoc. 110(4); 571-584

Choosing Bariatric Surgery

Just Getting Started is the Hardest Part

Wow, this first post was a struggle. In true Emily form I’ve been procrastinating from starting and trying to organize all of the thoughts in my head as to what I want to post about. I’ve put together about 10 different Instagram posts – all with an idea for a corresponding blog post- but I haven’t been able to get the writing started.

That leads us here. I figured I’d start at the very beginning. I wanted to chat about why I chose bariatric surgery and the first steps needed to start down this path. There are ideas and themes that I would like to write about in more detail (mental health, dieting, family support etc.) so I’ll just skim the surface as an introduction.

My best friend Dennise and I as toddlers.

For as long as I can remember I’ve loved food. The picture above elicits a lot of feelings for me. On one hand, I’m reminded of my oldest friend in the whole world, my soul mate – Dennise. Then on the other, this picture is like a time capsule of my singular focus on food (especially my love of chips and dip).

It was probably grade 4 when I first realized I looked much different than the rest of the girls my age. I was starting puberty a lot faster than most, I was tall and chubby. I remember doing everything in my power to fit in through middle school and junior high, inculding changing friend groups every semester. This sadly also meant leaving Dennise behind in my prusuit of acceptance.

In high school I was involved in everything! From student council, to rugby, to musical theatre I was always busy. In the last semester of grade 12 I broke my leg skiing and had to drop out of the things that kept me physically active (the school musical CATS and my senior year of rugby). It was during this time I was reunited with Dennise who was by my side everyday. Without her it would’ve been impossible to go to school with such a bad injury.

While recovering I watched a lot of the Food Network and fell in love with cooking. I also gained much more weight than I ever had before. I was inactive and continued to eat and cook rich foods with big portions. A later post will dive into the disordered eating patterns that started in high school.

My First Real Weight Loss Success

During this time my Mom and I were focused on getting fit and healthy. An obsession we shared then and continued to share my whole life. My first significant weight loss was that spring, from 233 lbs to 199 lbs. This was made possible by an extremely restrictive and disordered eating plan that affected my relationship with food and my body image for many years to come.

Since that time I’ve tried just about every diet and exercise regimen out there, hoping something would stick. What I realize now is – none of those programs were realistic to change long term outcomes.

The Stigma of Weight Loss Surgery

When I was 28 my family doctor told me I was morbidly obese and that my BMI was extremely unhealthy. He followed that up with – “but your vitals and blood work are all in the normal range so you’re lucky for now”. What a slap in the face! I’m a nurse practitioner, I know my weight is not healthy but the last comment was equivalent to “but you’re so pretty for a big girl”. When I asked what he could do for me he slid a copy of the Canada’s Food Guide across the table and I could swear there was steam coming out my ears!

When I was 30 years old, after hearing about it from my therapist, I was referred to a weight loss clinic here in Toronto. I know I had a poor attitude and was confrontational going in there. What were these people going to tell me that I didn’t already know? The doctor sat down and handed me a script for Saxenda, then told me “you need surgery, its the only thing that will help you”.

I was totally distraught. I was always of the thought that surgery was the lazy way out. That people who needed surgery didn’t have the will power to exercise and diet. Also, what is this medication he is trying to give me? It’s going to cost how much per month!? (It was 500$/month by the way).

It took 2 years and a 2nd referral to the bariatric clinic for me to accept that weight loss surgery is what I needed to life my best life. These 2 years came with trying Saxenda, and realizing that the way it changed my appetite hormones gave me a sense of control over my appetite and portion sizes. I also realized that like the other diets, Saxenda was not a feasible long term solution [More on Saxenda later]. I also need time to work with a therapist around disordered eating and food addiction. I needed time to have conversations with my family, because their support was so important to me. And let’s just say – the surgery stigma runs deep.

My Advice on Important First Steps

  1. Figure Out Your Why

Even at one of my highest weights (285 lbs) I was very active. I ran my first 10 km race in 2019, that year I also started rock climbing and I got back into playing recreational ultimate frisbee. I remember one time at the climbing gym while my brother was belaying me, I was struggling to hold up my weight. He was so encouraging and told me to not give up – but I had to. When I got to the bottom I looked at him and said “think of how fast I could get up at wall if I was 100 lbs lighter”.

Being active, reaching activity goals easier, less pain in my joints, a long health span, and someday being a healthy and active mom – These are my why’s.

Of course there are a magnitdue of other non-scale victories I’m looking forward to but these are my main drivers.

I realized – I was no longer afraid to die having the surgery – I was afraid to not be able to live my best life without it.

2. Accept Disordered Eating and/or Food Addiction

AND SEEK TREATMENT. Apologies for the caps but I can’t stress this reccomendation engouh. You will hear me, and many others in this community say over and over – Surgery is on your stomach not your brian.

If you don’t address your relationship with food- and some of the hang ups you may have – the restrictions and changes after surgery will be very emotionally and physically distressing.

3. Talk to Your Family and Friends About Your Decision to Have Surgery

This for me was extremely important. I had decided that surgery was the best thing for me and my future, and I would be doing it regardless- but my family supporting me was so so important.

I say this realizing that not everyone has the same relationship that I have with my family. So the point I really want to get across is – whoever your chosen family is – support is crucial.

4. Ask For a Referral

This step is specific to Ontario and the rest of the Canadian Proviences. While there are private practices to have bariatric procedures, it is more common to go through a publicly funded progrma. In Ontario if you meet criteria (I did with a BMI of 47 alone), OHIP completely covers the surgery- food and supplements will be extra.

The main point I wanted to get across was start the process of actually getting the surgery.

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Well – for having a hard time getting started this ended up being a really long post! If you stuck through to the end thank you!

Please stayed tune for more about bariatric surgery and my experiences with it!

TTYL,

Em

Welcome!

Hello! and welcome to the Bariatric Em blog site. My name is Emily and I am a 32 year old east coast woman currently living and working in Toronto, ON. I work in healthcare and I am so proud of my nursing career!

On February 10th, 2021 my life changed forever when I underwent a Roux-en-Y gastric bypass surgery. In preparing for my own surgery, I drew a lot of inspiration from others in the bariatric community through their social media accounts. While the community is AMAZING there is also not a HUGE amount of peer information out there for those going through this life changing process.

With lots of support from my family, (more on that later), I decided to start an instagram page to share my experience with bariatric surgery and to hopefully support/inspire others!

In just 2 short weeks I realized I wanted more space, more of a platform to write about my experiences – beyond the instagram posts and stories. This is how Bariatric Em blog was born!

I will continue to post on Instagram but I will also be expanding on ideas, recipes, my life in general and other things that inspire me in this blog.

So please, join me on this journey, share, comment and interact if there is something I can elaborate on or if you want to show support or need support.

Thank you and happy reading!!

Em