Jennifer Reichow - Transcript


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Originally published at: https://ketowomanpodcast.com/jennifer-reichow-transcript/

This transcript is brought to you thanks to the hard work of Trish Roberts.

Welcome Jennifer to the Keto Woman podcast. How are you doing today?

I'm doing really great, Daisy. I'm so happy to be here talking to you today.

Oh, it's nice to be talking to you too. Why don't you tell us a bit about yourself and your journey?

I think I had a fairly regular childhood. I kind of like to start with that. I was a fairly...I'm using quotation marks, although you can't see that...normal weight up until I was about six years old. I have a picture from when I was in kindergarten and I looked like I was at a...again, quotation marks...normal weight. And then after that I started getting a little bit chunkier. I like to say I was a chubby child, an overweight teenager that grew into an obese adult. And just as I went from high school, I was overweight. I wasn't terribly overweight, but I was probably about 15 or 20 pounds overweight. And when you're a teenager you really... it could be a hundred pounds. It feels the same even though it really isn't. Since I got older and I had the full-time job and started having the children and you're just kind of gradually gaining weight over time.

I ended up being about 300 pounds and that was just before the birth of my last child. I was 300 pounds. And even after I had my baby, I still only lost about 30 pounds. So I was about 270 pounds. I'm only five foot two. So, I felt that I looked pretty awful and I wasn't feeling very healthy and I had looked into weight loss surgery because I felt like I had tried everything and just really gotten nowhere. At the time, here where I live in Ontario, Canada, they did not offer any kind of weight loss surgery, that wasn't paid for by the government and otherwise you had to pay for it out of pocket. And it probably runs like $10,000 or $15,000. If you qualified, you could go and have it done in the United States and they would pay for it. But again, it was a huge process and I was a bit worried about going to another country to have surgery. So after a couple of years they did end up offering surgery here. They really made a very big program into it and quite a process because they recognized that short term it was less expensive for the government to pay for a surgery, than for me to develop diabetes and heart disease and have to have acute care somewhere along the road.

Where were you with all that? Did you have, you know, any health issues, apart from the obesity obviously, but usually there are other things that go with it or was it actually just like I had... really, I actually was fairly healthy from a metabolic and blood work point of view, but it was the practicalities of it that I found very difficult. And I wanted to ask you just going back a little bit, how you found both your pregnancy and then the stresses and strains of dealing with a young child when you were that size. Because, snap, as far as the weight was concerned, that was the weight I was. I'm a little bit taller than you and I know how limiting it was for me and how hard work it made, everything. So I can only imagine how it must have been for you with a baby.

When I was at 300 pounds towards the end of my pregnancy, it was quite awful. I was swollen everywhere. I could barely stand. I could barely walk. I had to leave work about two months early just because there's no way I could cope. And then after I had the baby, I was still fairly limited in what I could do because I had no strength. But I bounced back pretty quickly, because up until then I'd been a fairly healthy person. I hadn't had any major health issues other than being overweight. And I think that's where a lot of people are, that they don't have a lot of issues and people are almost fatter younger because of the obesity epidemic. I think when I was in my twenties and thirties there really wasn't that many obese people and now...or at least it didn't seem like it anyways...and now it's much more common to see people in their twenties and thirties that are morbidly obese.

And so I think that having a lot of healthy, overweight people - and that it's a good idea from a government perspective to try and get a handle on costs - to look at trying to help these people that are otherwise healthy before they start developing other issues. And I think I was very lucky that way, that I hadn't developed any blood pressure or diabetes or heart disease or anything like that. I think I was quite lucky that way. But otherwise, I'd always been fairly healthy. I was strong. I went to the gym quite a lot. I had a physically demanding job, so that way it was, it worked out well for me that, going into the surgery, that was my only issue, was being obese.

So as far as the process went, because it sounds a bit like a similar process to here in France and I know in the UK...I'm not so familiar with the States, but again, I should imagine somewhat similar. It's a process in differing lengths that you have to go through and you have to tick certain boxes to be eligible for that surgery. Unless of course you're paying out of pocket and then you can do what you like. But if you're reliant on some assistance from the government, there's this process that you have to go through. Did you have any issues with ticking all the boxes or did it just purely come down to you're a certain weight and so that automatically puts you through? Which was pretty well the case for me actually…I went in and he had his sort of dial that he worked out my BMI and he said, right, this is the surgery for you. And it was literally just because you're overweight.

That was pretty much the situation for me as well. Here in Ontario, they have what they call a bariatric registry. So you go to your family doctor, you tell them you're interested in having this surgery, they refer you to this bariatric registry, which then refers you to whatever the closest hospital is in your area that does the surgery, their clinic contacts you, and then you start a series of appointments. You see a social worker. You see a nurse. You see a nutritionist. You see a resident. You meet the surgeon. And this is usually over the course of several months. You have to have an ECG. You have a gastroscopy. You have an abdominal ultrasound so you go through all of this preparation work. Oh, you may or may not have a sleep study to see if you have undiagnosed sleep apnea. You answer a lot of questionnaires. You do blood work.

So it's quite a process because they want to make sure that you're relatively healthy going into it. Yes, you do have to have a certain amount of weight on you. From my experience and from what I've heard from other people, they go by the BMI, which isn't the greatest indicator, but that's generally what their guidelines are and have other co-morbidities. So I mean there's always the potential to develop diabetes and obviously high blood pressure, heart issues when you're carrying excess weight. So you've pretty much got those co-morbidities down to begin with if you're morbidly obese. So the process can take anywhere from about nine months to a year to get through all of this.

It's a lengthy barrage of tests isn't it? I had the same here put together a dossier of various appointments.

Yes, that's right. Yeah. I do wish though that in hindsight, I wish that they had done a little bit more emphasis on the social work, mental, emotional aspect of it because I think that that would have been a really big indicator going forward, how I would have managed after the surgery. I don't know that I ever would've been able to manage losing weight without the surgery, but I think that I could have maximized my abilities afterwards if I knew a little bit more about myself as a person and why I had gained the weight to begin with. Because I don't think people just gain weight in a void. Most people gain weight for a reason. And if I'd been able to understand that going in, I think I would have done much better after. As it was, I struggled for several years with losing weight.

I lost probably about 70 lbs right off the bat, which was great. It put me under 200 pounds, but then I kind of yo-yoed with about 20 pounds here and there, kind of getting down to about 175 at one point. And then I was up to about 220, so I kind of yo-yoed back and forth. And then I had sort of settled around 200 and I just wasn't able to lose any more. And then I had actually gone back to the bariatric clinic to ask for a revision. I had the vertical sleeve gastrectomy, which is a surgery where they basically leave your digestive system intact. They just cut away the bottom part of your stomach, which is the biggest part. Your stomach is shaped like a banana - essentially how they leave it. And I had gone and asked if I could have a revision to a surgery called a bypass - they do a lot of moving things around and making your stomach into teeny tiny pouch about the size of a golf ball or a tennis ball. And it's so that you cannot absorb a lot of your nutrients that you're taking in and that's how you lose weight.

Yeah, because they bypass part of the digestive tract…part of the intestine is bypassed. That's literally how it gets its name, isn't it?

That's right. Yeah.

You're not absorbing everything. Just to go back a little bit, two questions. By the sounds of it, they offer different operations. So presumably when you went in, were you given any kind of choice with the operation you had, or were you told the operation that they thought was appropriate for you? What was that initial choice of operation process? If there was any.

What they do here is they generally do the bypass as kind of the gold standard, because that's the surgery that they really have the most studies on, and long-term data to understand that it's the one that's the most successful for most people. The other surgery, the vertical sleeve gastrectomy, is being done a little bit less. It's a little less invasive and takes a little less time and there are a little less complications with it. And that was the surgery that I was interested in, but understanding that they would probably want to do the bypass, I actually wrote a letter to my surgeon asking him about getting the sleeve. Because I have migraines and I have to be able to take Ibuprofen, and when you have the bypass they discourage you from taking Ibuprofen because long-term use of Ibuprofen, you have the potential to develop ulcers.

And when you've got a bypass, getting an ulcer is a bad thing. Especially if you get it in the portion of the stomach that's been, effectively, sutured off or stitched off. So if I got an ulcer in that spot, they would never be able to see it on an endoscopy if they were checking to see what was going on. Why was I having all of this pain? So that's why they discourage using Ibuprofen. But with my migraines, that's the only thing that I could take that was effective for me. I tried with other medications. I couldn't find anything really that worked as well as Ibuprofen. So I asked him if I could have the sleeve just so I could be able to manage my migraines and he was agreeable to that. And that's why I got the sleeve. I think they're doing the sleeve a little bit more now than what they used to.

Maybe because they find that people are having good results with it, or that there's less complications. I'm not really sure, but it seems to be about half and half - the people that I am in contact with that have had surgery. Some of the people are getting bypass and some are getting sleeve. So it seems to depend on the surgeon when they get in there. Sometimes if the person's had other surgeries before, they have a lot of adhesions and scarring and things like that, so they prefer to do the sleeve as opposed to doing the bypass, which is a little bit more intensive.

And what advice were you given? Well globally, but for what you should be eating post-op?

The nutritionist at the bariatric clinic that I go to, they advocate a moderate diet in all food groups. Now Canada has this wonderful Canada's food guide and they advocate a certain number of servings of this and a certain number of servings of that. And that's kind of what they have to go by because they are a government funded clinic. So they kind of have to follow whatever the government guidelines are, which at this time advocate eating from all the food groups. So they want you to have a certain number of calories. They know right after surgery, you're not going to be able to eat much. So they advocate getting your protein in, but as the weeks go on, you're supposed to increase your diet and have a certain amount of carbohydrates, a certain number of fats, a certain amount of protein, protein first always, but they're still advocating that you should be able to eat moderately from all food groups. And that was difficult for me. So, I just did not get on well after the surgery. I lost a bit. I mean, you're going to, because for the first few weeks you really just can't eat, so you're going to lose weight. So I lost about 70 pounds fairly quickly. But after that, I really struggled because I just could not maintain that moderate diet that the clinic was advocating.

So from a macros point of view, you would see if you were to look at a graph, say, that the protein percentage would be probably the highest macro to start with because of the quantity you can eat. So because of the “protein first” mantra, you're having to take up most of the available space - most of what you physically can eat in a day. If you're going to eat your protein first, you're going to quite often find that there's not much else you can eat after that. And is this something they were really strict about enforcing because I know it's something that I came across a lot that they hammered home that all things in moderation - actually from the get go I was given in hospital...bearing in mind, I was in hospital for quite a long time. They had me in for eight days in total.

I nearly went rather bland. Most of that was post-op. I was actually only on liquids. I think they had me fasted properly for the first day post-op and then I was on liquid for a day. But then straight after that, I was actually on pureed or minced up foods. They actually had me ahead of the schedule that I've seen in other places. You know, other places are on liquids say, for two weeks afterwards. But the point I'm making here about the macros is that I was given the balanced macros, if you like, so I would have this minced up spoonful of meat, and minced up spoonful of vegetables, and minced up spoonful of mashed potato, or pasta, or whatever it was. They would insist on me eating regular meals. So I was having something like six small meals a day and as those alternate meals between what you think of as the standard meals, were like something like a yogurt or something. It was usually a dairy based sugar - of course, it had in it - snacks in between. It felt like they were feeding me constantly. I just didn't want the food. But, my point is I certainly didn't have that protein first. The whole “protein first” mantra I got actually, was from information online in forums and in Facebook groups and things. But were they quite forceful with you about doing that? Was that the message you were getting from your nutrition team?

Yes, absolutely. It was protein first. They were very, very hard and fast that you had to have your protein first.

So even if you could eat nothing else, if all you could eat was your minimum requirement of protein, then that was all you ate in a day.

Yeah, because right after you have the surgery, they give you what our group calls the Bible. So it's a handbook of what you're supposed to do, what you're not supposed to do, and guidelines for each week and suggestions for food. So week one you would be having your protein shakes kind of thing. Now they've changed a bit since I had the surgery, they are pushing people along faster. I guess they've found that people are recovering from the surgery faster and so can start eating more. I think it's actually better the way that I did it because I think I did like two weeks of shakes. Then I did like two weeks of full fluids, and then a week of soft foods or puree. And then moving onwards. But yes, protein was absolutely first, but then they would have your carbohydrates. So they would have cream of whatever, soups, cream of mushroom soup. They would want you to have protein, so like your shake. And then if you needed to have chicken or something you would like blend it in a blender and add broth to it, or whatever.

But then they still wanted you to have your other foods, your other carbohydrates, and cream of chicken soups, and oatmeal, cream of wheat, soft cereals like that. And then moving on, when you're getting to real food - things like Melba toast was okay, and chili. Going to one of the fast food places here that serves a good chili seems to be on everybody's, the first thing I'm going to do when I get to that week, I'm going to go to this fast food place and get their chili, seems to be quite the thing. And as long as you don't get the bun, I guess its okay. Not that I think that it's okay, but I think that they really need to sort of look at those guidelines again to weed out some of these things like Melba toast, which for me was a major trigger food. I can't just eat one Melba toast but I guess some people can and that's good for them, if you can eat in moderation. But if I think if I had known a bit more that I couldn't stop at one Melba toast and looked at it from a different perspective, I think I would have done much better.

I would actually argue that the majority of people who end up having weight loss surgery and actually probably the majority of people who end up morbidly obese have an issue with moderation.

Absolutely.

Because otherwise where would be the problem? And well, more so a problem with moderation with certain foods because we all know when we eat the right way for us having to moderate becomes less of an issue. It's certain foods that we have trouble with when it comes to control and moderation, and I think it's going back to what you were saying about going through that process of tests and interviews and appointments with the lead up to surgery; there should be much more emphasis on finding out how and why the person in question that's on the receiving end of having to have all these tests, got that way in the first place.

That's right.

And then if you decide that surgery is the right course of action, then tailoring the program afterwards. The two things really that are going to have the most influence as far as that goes, is tailoring their diet to address that, but then also tailoring if it is part of it, the emotional issues that go with it, and the habits that have been formed over years, and why those habits are there.

I think that's absolutely right, but I think the issue from the bariatric clinic or even the health care system in general, is that it's going to cost a lot more money than doing the surgery and turning people loose. Because if you want to be completely honest, and people always say I'm an emotional eater and what they really mean to say, but they don't want to say it out loud is, is I'm a food addict. I'm a carbohydrate addict. Because saying that you're an addict is a negative thing that people don't want to admit to. Saying I'm an emotional eater sounds much better, but it's the same thing. If you're an addict, it's because you have this compulsion to do something that you know is going to have a negative outcome. So if I go and I'm upset, I've had a fight with my husband and I go to the refrigerator and I get a quart of Haagen-Dazs and I know I'm going to feel like crap afterwards, but I eat it anyways.

That's an addiction. It's no different than as if I took a beer or I smoked some crack or whatever. It's exactly the same, but it's harder I think to admit to because somebody that doesn't think that - oh, I would never do anything like that. I'm not an alcoholic. I'm not a meth addict - are going to have to cop to, I'm an addict. And it's a lot easier to say, oh, I'm an emotional eater, than I'm an addict. But sometimes you have to get a little bit hard with it. You have to look at the truth. And the truth is, is that you cannot control your eating. And even after you've had the surgery, you cannot control your eating because they're not doing surgery on your brain. They're doing surgery on your stomach. And at some point, even if I've had the surgery, my brain is still going to say to me, ooh, I want carbohydrates and therefore I'm going to eat carbohydrates.

It doesn't make a difference whether I've had surgery or not. I think some people need to have surgery. I needed to have surgery. Even if I had done keto I don't know that I still wouldn't have been able to stop eating carbohydrates. I don't know. I don't know for sure, but I think that definitely there's a place for surgery, but at the same time people regain weight all the time with these surgeries. All the time because they don't get that chance to overcome that carbohydrate addiction because they are being told that you should be able to eat moderately.

Yes, I absolutely agree with that and I think it's the biggest failing of the system and I think just like with any other trap that people fall into, it's the same almost as something like Weight Watchers or any kind of plan that somebody adheres to and has some success with weight loss, and then something goes wrong and they regain. What they're told is it's not the program's fault. There's no problem with the program. The problem is with you. You've messed up. You failed. You failed to adhere to it. That's where the problem lies. But that is the biggest flaw that I see of weight loss surgery because basically the message that I see coming across is, we are going to impose on you an enforced restrictive eating plan - that's basically what it is - we're going to make you, because we're going to adjust your body so that it is physically impossible for you to eat more than a certain amount.

So it's like you going on your calorie controlled diet, going to Weight Watchers, going to whatever. It's a bit unfair that I always mention Weight Watchers, but I forget the names of all the others. Use Weight Watchers as a global term for all these diet programs. But the problem is, if you could stick to that kind of program, if they were sustainable, then there wouldn't be a problem and the exact same thing happens with weight loss surgery. This is the problem I see coming from people who've had it, who all of a sudden think this is amazing. I can suddenly eat in moderation. Problem solved. I can do exactly what people have been telling me to do all these years. I can do exactly what my surgery team are telling me what to do.

It's fine. It's easy. This is going to work. This is going to be me for the rest of my life. I can still eat cake. I can still eat ice cream when I want it. Everything's wonderful. Except it's not, is it? That wears off. It might take longer than one of these programs that you've gone to that involves you using just your willpower and sticking to it. You know, think of this as someone's enforcing that willpower on you, but it does not last. Apart from an absolute tiny, tiny minority, it doesn't last. And so if you don't address those problems, if you don't address and change your way of eating, you're going quote unquote, fail. But it's not you who's failing. Again, just like with so many people who've been on this podcast who've had that lightning bolt moment when they've read someone like Gary Taubes who says, it's not your fault.

Well it's the same, except these people are going back. These people are working on another level because they're going back just like you did, and we'll come back to that, with me going off on this tangent, but you going back - and they ended up going back - and having revision surgery. So they have a second surgery. And I'm one of those people. The problem with my first one was it was the band, which is just a nightmare surgery that fortunately is happening less and less now. But a lot of people have the sleeve and then go on to have a bypass, or DS - a Duodenal Switch. Of course, that's how it started the sleeve, wasn't it? It was the first stage process for the DS surgery. And sadly I think a lot of surgeons still actually do have that attitude. And I have heard people whose surgeons have said to them, we're going to give you the sleeve, but the chances are you're going to be back in a couple of years for revision surgery either to the DS or bypass. That I think is criminal.

That's right, yes. When I first got onto the idea about addiction, which was I think a couple of years ago, I thought everybody that had had ever had to have weight loss surgery was a food addict. And then after sort of seeing some more people in my Facebook group, or with my weight loss surgery Facebook group, and there are a lot of people that, they have their surgery and they are able to eat moderately, and they are able to lose weight, and God love them, I wish I was one of them. And after thinking about what my perspective was on food addiction, and then when I got into keto as well, I came to the conclusion that there's a lot of people that they're using food to smother their feelings, they're emotional eaters. At some point or another they worked through whatever it was.

Maybe they had problems with their husband or their wife, or whatever. They worked through it, but they're stuck in that addictive carb cycle, and they can't break free of that carb cycle. They have the surgery which breaks them free of the carb cycle, and then they're able to eat moderately. They go on their merry way, they lose weight with the surgery and they're good to go. And then the rest of us, I think either we're still dealing with the emotional issues - we've just kind of never worked through them completely or we're just too stuck in that carb cycle. Because they do say that carbohydrates are as addictive as any kind of opioid and maybe we are just kind of stuck in that's the way that we're going to be forever. Whether we've got still got some underlying emotional issues or not. And yes, people will regain and then they try and go back or a second surgery, which I did.

I went to see if I could get another surgery because I was stuck. I wasn't losing weight. I went back to the bariatric clinic. I asked them about getting a revision. At that time though - they go by the BMI - they said, no, your BMI is too low, we won't do another surgery. I was pretty upset by that afterwards. In hindsight, I'm glad that I didn't, and I'm glad that I'm addressing the other issues because maybe I wouldn't have got to that place where I needed to see that there's other things going on. This is why I can't lose weight. So I'm glad in hindsight that I didn't get the other surgery. But I think from the get go they sort of need to look a little bit deeper into why people are needing the surgery to begin with.

And doing a second surgery - when somebody comes back to them - that's when they really need to say, okay, you had one surgery, you're not making it work, what's going on? Don't just automatically sign them up for another surgery. Maybe some people will need it. People that are 500 pounds - here anyways in Ontario - they will do the sleeve as the first step. It's planned to do the DS when they've lost like about a hundred pounds. When it's a little bit safer for them to be under the anesthetic for the longer period of time that it would take to do that surgery. So sometimes it's a plan to step surgery, but other times people are getting it because their weight loss is stalled. And I think that that's when they need to do a little bit more intensive digging into why aren't you losing weight?

Like let's look outside of the box. Let's look at what you're eating. But then it kind of goes back to - a lot of people have talked about this - the current healthcare systems don't want to admit that they were wrong about the carbohydrates. That it's not an essential part of your meal plan - there's no such thing as essential carbohydrates - but they don't want to admit that because that goes against everything that they've been saying for the last what, 50 years or so. And that's not what our government supports, so we're kind of stuck.

Sometimes it is the case obviously, that people do need to go back for the second phase of the operation. That happens, especially for people who started off at a much higher weight. But yes, that's exactly why they started doing the sleeve because they found that a lot of people were having so much success with it. It's that first stage of a two stage operation, and they weren't needing to go onto the second stage when they started using it a lot more. But, yes I think you're right. I think at that point when someone goes back for a revision, or goes back to say that they're regaining weight, and why they're regaining weight, there shouldn't be that assumption that they've done something wrong and the way to fix it is another operation. Just to go back to the whole moderation thing.

I think there are echoes with this. It's not just with people who've had weight loss surgery that these principles apply. I think there are lots of people who start doing keto who it's almost like that magic switch that is switched by having the weight loss surgery. Suddenly you can do everything in moderation. Suddenly your hunger and satiety signals start working perfectly. And you hear lots of people saying this. Richard Morris is a really good example. When you hear him talking about how back in the carbie days, he could eat vast quantities, but now he is doing keto, once he's full, that's it. He stops eating. He doesn't have cravings. All is hunky dory. But there are some of us, if we still have these addiction issues that they're not completely fixed by keto. Just like they're not completely fixed with weight loss surgery, and although those signals they tune back up much better, we still have to combat those other issues that are going on.

Oh, I absolutely agree with you on that. They really need to start looking a little bit more at what's going on in your mental and emotional state rather than just, what are you eating and why aren't you eating hundred grams of carbohydrates, and thinking that that's the answer. Because it's not. But I mean counseling is intensive. Not everybody wants to do it. They don't want to dive into those kinds of issues, but they would rather go and have another surgery and think that's going to fix them. I do have a lot of people say; I'm so hungry all the time. And I'll say, if you stop eating carbohydrates, I promise you, you will stop being hungry.

And then I tell them the story - Dr Fung likes to use this, and I've heard Megan Ramos say it on podcasts before - they use this wood analogy where carbohydrates are your fast burning wood and fats are your hardwood that takes longer to burn. So if you're going to go out, and you've got your fireplace and you want something to burn in it, and you've got all this lovely hardwood that you've been stocking, and instead you throw in an old dining room chair that's made out of softwood that burns in 15 seconds. And in 15 seconds you need more wood for the fire. Well, that's kind of your body. Your carbohydrates burn off instantly and you need more carbohydrates. So that's why you're always hungry. Your body is just screaming out for carbs.

But if you give it fat - you give it that nice hardwood that takes longer to burn - then you don't feel hungry. So that's the kind of the analogy that I use - and that's Megan's analogy, not mine, I never take credit for that - because I think it's something that people will understand - that if you give your body something that's going to take longer to burn, and if you listen to your body...that's key too, is you have to listen and understand why am I hungry? Well I'm hungry because maybe I haven't eaten in 18 hours, or maybe it's because what I had an hour ago, like I had a bowl of pasta, has already burned off. So if you just kind of eat nice fats and protein, and not have any carbohydrates, you're not going to be hungry. At least your body's not going to be hungry, and maybe your head's still going to be hungry, and that's a whole other story that we're talking about as well.

Well that's the problem, isn't it? It's this interference that goes on between your body and your brain. It's the interference that goes on between that's the problem. You mentioned before about how it often comes down to potentially a cost, but I would have thought that the extra cost of tailoring the program a bit more, tailoring it nutritionally and adding on counseling, is a lot cheaper than revision surgery. I think maybe part of the problem is having to admit that the nutrition advice they're giving is not correct, and having to change that; and they can't go back on that.

That's right. Especially with us being government funded, they can't go and say, oh no, we don't want you to eat carbohydrates when our Canada's food guide - the latest one that just came out - is almost entirely plant based. And I mean it's nothing but carbohydrates. So they can't now suddenly turn around and say, no you can't eat carbohydrates. And not only that, but the numbers of people that are going through this program are just unbelievable. The number of people that they're trying to get through and have the surgery... it's taking months and months, not just because it's so time intensive with the appointments, but because there's so many people that they're trying to get through the system. The clinic is running at full speed all the time and the wait lists are phenomenal. It takes months just to get that first phone call, to start with the orientation and learning more about the program, and then getting in through the appointments.

If you try and even call the clinic if you've got a question, it takes a long time for them to get back to you. And after the surgery you're supposed to go in for one week check-up. Well, sometimes you don't get in for two weeks. Or your one month check-up will be two months later. Or your six months check-up might be a year and a half later just because they're overwhelmed with the number of people that want to have the surgery. So unfortunately stuff like that just falls by the wayside for sheer numbers.

Absolutely. And it's definitely a sign of the times to see how long the waiting lists are. So you went back to ask for the revision surgery and they denied that. So how did it come about then that you started looking at changing the way you were eating. How did you find out about keto? What led you down that path?

I was actually at my local public library and I happened to see Dr Fung's book, "The Complete Guide to Fasting", which I picked up and I started reading. I was fascinated and it was one of those lightning bolt moments where I realized, wow, it's not my fault. I am not able to lose weight because of this whole carbohydrate insulin cycle. And what really impressed me about the book in particular was that it didn't seem like your common diet book. Every chapter had references to studies and medical journals. And I felt, well, this is somebody I can trust that knows what they're talking about. So after I read that, his co-author on that book was Jimmy Moore. And so I went on the internet and I was looking at Jimmy Moore, and I happened to see that he had all of these podcasts, and he had these books.

So I started listening to Jimmy Moore. And then I think from Jimmy Moore, then I found the 2 Keto Dudes. So I listened to them. And then from the 2 Keto Dudes, they had the episode that you were on, and Liz, I think, talking about weight loss surgery.

Louise and Donna, yeah.

So then that's how I got listening to you as well. So it was sort of a chain reaction that I started with Dr Fung's book, and I started listening to all of these podcasts, and I heard about Nina Teicholz and Gary Taubes, and I got their books and I read them. So I think at this point I've probably listened to hundreds, if not thousands, of hours of podcasts, and watched all of these videos and read all of these books. Immediately though, after I read The Complete Guide To Fasting, I started to go low carb.

Of course, I did this completely backwards. I don't even think I had been doing it for a couple of weeks and I thought, oh, I'm going to do a fast. Let me do a fast. So I actually did a six day fast, which probably not even fat adapted at that point. I actually managed and I wasn't hungry. And things that I noticed - of course I did lose weight right off the bat because you're losing all of that water weight, not eating carbohydrates -was not being hungry was fantastic. It was just unbelievable to me that I could go so many hours without eating. Whereas before, and with the bariatric clinic, and what is kind of common, nutrition guidelines, you're supposed to eat every three to four hours, which I probably was doing. But I wasn't hungry and that I didn't need sugar. Like if I was going to go and have coffee before, I had to have all of this cream and sugar in it.

And tea. I could not drink tea without sugar. So when people were talking about bulletproof coffee or putting heavy whipping cream in coffee, and I started that and I didn't eat sugar. And that was like a revelation to me. It really was. That I did not need sugar in my coffee or my tea, which kind of sounds strange, but it just seemed so unreal that I did not need sugar and I did not need sweets. I did not need to eat dessert. I just lost all of those sugar cravings, which, you know; it was just such a relief not to have those sugar cravings. And I did lose weight. I lost about 20 pounds fairly quickly. So that was great. Unfortunately I did end up regressing and it was because I had not addressed some of those emotional things that were going on in my life, and I had a lot of stress.

I did end up gaining the 20 pounds back because I was really kind of stupid. And I thought to myself, and I remember this very clearly thinking, okay, you're going to have stress. You're going to want to eat. So why not go for it. Which in hindsight sounds really dumb. I should have really just tried to work through it a little bit better. But I did end up gaining the 20 pounds back, and at the beginning of the year I really recommitted back to being more strict with my keto, and I have lost almost half of that. I've lost 10 pounds. So that's been great. But more importantly, I feel so much better. When I was kind of letting myself go with the stress eating, I felt like crap all the time. And I knew that I felt like crap, but I was stuck already in that - it doesn't take long to get stuck back in that carb cycle where, even though you know you're going to feel horrible, you still keep eating it.

I think it really kind of took me hitting the bottom of that barrel. I just feel so awful. I'm waking up every morning with a headache. I have no energy. I need to get back to doing this. And instead, I think when I had been doing my keto before; I was really trying to still eat the 20 grams of carbs. And now I'm probably closer to zero. I'm really eating more meats and dairy and eggs and very little actual carbohydrates in the way of vegetables. And I find that that works so much better for me. I am hardly hungry. There are days where I really have to push myself to eat so that my metabolism doesn't bottom out.

Do you still employ some intermittent fasting? Because that always seems the sensible thing that, if you have days when you don't feel like eating, instead of not eating very much is to actually harness that opportunity, and say, okay well I'm going to have a day when I don't eat anything.

I do, I really do. Or I will have like one meal a day and trying to go along with, what is your limit of fasting? Because you'll see some people will say nothing at all, like just water or black coffee or with a splash of whipping cream if you want, but like no substantial calories. And some people will say, oh if you have less than 500 calories, that should still be okay. I don't know. I think the jury's kind of still out on all of that. And then you're kind of getting into when does autophagy kick in, and all of that.

I always go back to what Terri Lance says. I've seen her talk about it on quite a few posts when people ask that same question, you know, what counts as a fast, and is this a fast, and is that a fast? And the important question that she says you need to ask; is what are your goals? So if your goals are weight loss, then having a few of those things that have some calorific value aren't necessarily a problem. If your goal is more the autophagy side, then you need to potentially be a bit stricter about what you're having. And you know, it's only water or maybe some coffee and things like that. So it's really important just to figure out what your goals are, but also of what you're capable of, what you're happy with and, and what you feel good with. And there's often a difference between what you do when you start out.

Megan Ramos talks about training wheels, doesn't she? That there might be some things, like you might need a little splash of heavy whipping cream in your coffee, or some broth, or things like that. If they're going to get you through while you're getting used to fasting - because I think everyone agrees that its consistency is what is a good thing - is to get into that routine of fasting. Now if when you start doing that, you need a few of those things to get you through - to get you into that habit, to get that habit formed, and what you can probably find is that those things get dropped off as you get more used to doing it. It all comes down to the individual and what works for you and what your goals are, I think.

I think that's right and you have to definitely find what works for you, and if you just want a couple of eggs and a couple of slices of bacon, then that's good. I don't think you need to worry too much about it. With having the weight loss surgery, I can't eat like...I would like to have one meal a day where I ate 1200 or 1600 calories, but I physically can't without making myself sick. So I do tend to eat twice a day, like once in the morning and once in the evening. And it's hard though, when you're not hungry to make those calories count because you have to balance - again, eating enough so that you're keeping your metabolism going. Or not eating anything, so you're keeping your metabolism going. You don't want to consistently eat only 600 or 700 calories, and then your metabolism slows down to account for the fact that you're not eating enough. It's kind of a tricky spot just to find the right combination that works for you for whatever your goals are. It depends f your goal is weight loss, or if your goal is metabolic healing, or if your goal is autophagy.

Absolutely. Just going back to what you said right at the beginning, about your choice of surgery and part of what drove you to ask for the sleeve as opposed to bypass, was the fact that you suffer from migraines. Well, I've certainly seen a big improvement in my migraines, so I was wondering if you've seen a positive change in yours?

Oh absolutely. And there's been times where I've almost kicked myself because I think that weight loss was definitely a part of that. I think a lot of my migraines were hormonal in nature, so getting older sort of took care of that. But if it was even just from a pure weight loss standpoint, sometimes I've kicked myself, like I said, I could have had the other surgery, the bypass, and maybe been more successful with it, and still not had the migraines. So it's been kind of a catch 22 you know, like you can maybe have the surgery that you'll lose weight faster and you still won't have migraines, but you're kind of taking a chance. Maybe you'll still have the migraines and then you won't be able to take the medication that you need for the migraines. But yes, definitely I did see an improvement almost right away that I didn't need to take any medications for my migraines. So you don't know what you don't know, right?

That's interesting then that you found an improvement just with the surgery. Interestingly enough, I did see a period of about three months when I first had the sleeve where I didn't have problems with my migraines and I thought it was potentially just down to the operation. With hindsight actually I think it was probably because I was in ketosis without knowing it at the time. The combination of what I was eating and how much I was eating. Although I wasn't eating ketogenically, I think just by the fact of how little I was eating probably got me down, if not in ketosis, down closer to that state, and that is what was helping. Because it only lasted for those few months and then they came back again. And it was only a couple of years later...I did start doing low carb fairly soon after that...or a moderate carb I should say, because it wasn't low enough to impact significant change. But it was only when I dropped it down to a ketogenic level that I started seeing real success with my migraines. That's why I was interested in knowing the difference with you, whether they improved straight away or whether it wasn't until you switched to fasting and keto that you saw that improvement.

That's interesting because now that you're saying that, I'm just thinking back to the fall when I was stress eating and eating a lot more carbohydrates, and I did notice that I did have a couple of migraines where I don't think I've had like a really bad migraine in a couple of years. So that's interesting that you say that it's probably been a combination of the weight loss and being in ketosis that has really taken care of the migraines. For anybody that suffers from migraines, you know how horrible they are.

We have kind of addressed that question. I think it's something that we probably not only get asked by other people, but we ask ourselves. And that is, if you'd known about keto and fasting before you went for the surgery, would you still have done it?

I think if I'm really honest with myself, would I have lost weight without the surgery? If I'm really honest, I'm going to say no. because in the period leading up to the surgery, because it does take quite a while, I said to myself, I'm going to do my utmost best to lose weight and I could not shift a pound. Even if I had known about keto, would I have been able to stick to it. There's a certain element of willpower to any change. Not just changing what you're eating, but committing to any kind of change in your life. There's a certain amount of willpower because instinctively I think most people don't like change because it can be a lot of hard work and I don't think I could have stuck to it.

I don't know if it would have been thinking well, surgery is on the horizon, I've got that to fall back on. Or I just didn't have the willpower. Or I was just too stuck into that carb addiction cycle. I don't know. But honestly, I've thought about it a lot since I kind of discovered keto and when those 20 pounds dropped off last year - fairly quickly - I was really like, I wish I'd known about this before I had my surgery. But then I really thought about it and no, I really don't think I could've done it. Now to kind of qualify that. If I'd had some coaching or some counseling along with the keto, then maybe. If I'd had a bit more insight into what was going on with me, maybe then. Maybe then I would have been able to do keto and lost the weight and not had the surgery.

But just by itself, it's a nice thought. It's a nice thought to think that you can do it. And I'm using air quotes - normally - because you'll hear people say that, oh, why don't you just lose weight the normal way without having surgery? I mean, it's nice to think that you wouldn't have to go to the lengths of having surgery to lose weight because losing weight seems like something...it sounds like it should be simple, but of course it's not. We know it's not. But I think it's probably the perception of a lot of people that don't have weight problems, that's what they think. Weight loss is simple. I can lose five pounds tomorrow if I wanted to. But of course it's not that easy. And if I could have done keto and lost the weight, that would have been fantastic. I really don't think I could have, if I'm honest.

It's a very interesting question, isn't it? I'm not sure either. I think part of the problem certainly for me was all that interference I spoke about before - those habits of food addiction, the depression. The habits I had of eating carbs to not only numb the pain of depression, but also that would get me into this eat, sleep cycle, so that basically I just didn't have to be awake more than I had to be because it was just not very pleasant to be awake. So I don't know if the benefits of keto would have been able to kick in quick enough and to be strong enough to get all that interference down to a low enough level for me to be able to do it long enough to really start affecting that change. I really don't know. And I think that's what weight loss surgery did for me is, it forced me into that position for a certain period of time.

And I do know that if I hadn't have found keto, I would probably be heading back towards where I was to start with. So I do know how important it has been for me, but I struggle with it. I struggle with that, and I struggle with...and I don't know how you feel about this, both coming from yourself, but potentially from what other people have either said directly to you or about people who have weight loss surgery in general; and that is you've cheated. You haven't done this the hard way like we have. You've taken the easy way out and you cheated. How do you feel about that? Because I bet you've come across that.

I haven't. To be honest, I haven't personally ever had anybody say that. I'm in a Facebook group for the people that have had surgery at the same hospital that I had, the same clinic, and a lot of people have said that they've had people that to them, and it's really one of those things that I just kind of have to take it with a grain of salt. I tell people that's how you should take it. Because you can't know what it's like to be a morbidly obese person unless you've walked a mile in their shoes any more than I could know what it's like to be a person of another race, or another sexuality. Until you've walked a mile in that person's shoes, you just can't judge. And they come from a position of not being informed, not having the understanding. And it's easy to say, oh, just let it go, because they don't know.

But ultimately, that's what you've got to do. Unless you want to try and educate the person and say, you know, this is what my life was like when I was morbidly obese and I could not for the life of me control my eating. But I don't think you need to get that personal with a random person unless you really want to. I think people just don't understand. You can't. You really can't understand. It would be like asking an alcoholic; why don't you just stop drinking or somebody that's addicted to any other substance. Why don't you just stop? Or people that smoke? Why don't you just stop smoking? I don't smoke. I've never smoked a day in my life. And even I wouldn't say that to a smoker. Why don't you just stop? Because I know it's not that easy. It's not easy when you're stuck into that behavior that's so addictive and so compelling and so compulsive, that you've got no control over it.

And it's all the same. It doesn't matter whether its food or tobacco or alcohol, it's just the same difficulty to stop. And I think actually food is harder, because I don't have to smoke a cigarette. I don't have to drink an alcoholic drink, but I do have to eat and there's not the same level of compassion I think, for people that are obese as there are for people that smoke or people that drink. People don't say to an alcoholic...they don't push people. If I've identified myself as an alcoholic, nobody's going to push me to have a drink or nobody's going to push me to have a cigarette. If I tell people I just stopped smoking, nobody's going to do that.

But people will push you to eat, you know, just have an ice cream. It's not going to hurt you. One's not going to hurt you. But it's funny, if I was a vegan; people aren't going to push me to have a burger. So I don't know why people that if I identify myself, oh, I don't eat carbohydrates or I'm a low carb...why would people push me to eat, or have a piece of bread, or, oh, you can have a bun with your burger. It's kind of an interesting comparison I think, that people don't have the same compassion for things around food and obesity. It's interesting.

It certainly is. And complicated. And like you say, it's not something you can ever really understand until you've been in that specific position yourself. And then even then you're going to have different thoughts about it and a different reaction. So you said that your day to day keto these days is looking pretty like carnivore by the sounds of it?

It's pretty close. Actually there are days where I am a full on carnivore. My son, he actually started doing keto not too long ago. He's 17 and he just kind of wanted to drop a few pounds. So he was interested in doing keto. When I'm making supper, he still has some vege, and the other day I just popped a piece of broccoli in my mouth and I thought, wow, when was the last time I actually ate a vegetable? And I couldn't really remember. Because I'll have bacon, I'll have eggs, I'll have whatever meat that we're having for dinner. I don't usually have the vege that I'm serving with it. I have dairy. I'm terrible with cheese. I love cheese. I'm kind of glad I'm not there in France with you because I would never lose weight. I'd be eating all the cheese. Every once in a while I'll go and buy like a really good piece of cheese and it's like gone in a day. I just love cheese.

I think that's the best way to do it actually. Well, it depends. And that's where the whole addiction thing comes in. If you can...and I can do this with cheese. If I was to do it with sugar type foods…if I indulged, it would be a slippery slope, and it would just turn into a full on binge. But then there are these foods that sort of start getting closer into that addiction circle, if you like, but they're close enough to the edge that they're the kind of things that I can indulge in every now and then. So like you, I will buy a couple of bits of cheese and have a cheese board or something, and then I would just accept the fact that I'm going to pick at them and I'm going to indulge them and they're going to be gone in a couple of days. But that's okay.

It's a great keto food. It's very low carb - sometimes even zero with some of the cheeses I choose - and so it's not going to do a huge amount of damage. I feel indulged. It's not going to start some slippery slope where I turn into a cheese monster for two weeks. So it's interesting isn't it? There are different categories for these foods that we do find addictive that they can't necessarily be of our daily lives, but they can be an every now and then food without causing too much damage.

I think you're right. It's just knowing yourself. Like am I going to be able to have a piece of cheese and maybe I eat it for a day or two and then I don't have any for another couple of weeks or whatever. Or, am I going to go back the next day and buy another block of cheese. So it's just knowing yourself. It's having that self-assessment, okay, I finished this block of cheese, am I going to go get another? Nah, I'm good. I'll be good for a couple of weeks and maybe I'll see another block of cheese...something different in the store a couple of weeks from now and then I'll do the same thing. So it's just kind of doing that self-assessment piece and self-analysis, if you want to call it that, and just knowing yourself and knowing what you're going to do with yourself.

But generally I think I kind of am a little bit more carnivore than completely keto. Kind of coining the keto carnivore phrase that's going around where you're just making sure that your fat macros are still on the higher side than the protein. I don't really overly track, but I do try to eat the fattier cuts of meat. Or if I'm making something lean like a chicken breast, then I'm cooking it with some butter and maybe adding some cheese on it or something like that. I feel great.

I never cook chicken breasts, I just don't eat chicken. But I've never particularly like it. I have always been someone who likes the full fat versions of things. I've never bought low fat mayonnaise or anything like that. And it's the same with meat. I've always liked the fatty cuts. I've always liked the dark meat on a chicken. I've always loved the chicken skin. I've always loved the fatty bits of bacon, the fat on lamb. I've always loved that. So keto is just heaven. I don't have an issue with that at all. I know some people don't like that visible fat on meat, but I love it.

I do enjoy the dark meat on the chicken, or the turkey, or whatever. The issue is actually budgetary because I don't know where you are, but the dark meat...if I was going to go buy a chicken thigh it's actually more expensive than a chicken breast. And I don't know how that works exactly.

Oh, isn't that interesting? No, it's the opposite here. The cheapest chicken I can buy is a kilogram tub is what I tend to buy from Lidl of chicken thighs - that is the cheapest form. So I lucked out on that. Drumsticks are more expensive for some reason. But chicken breast is the more expensive. So I have it the right way round.

I tend to buy in bulk and then portion things out and put them into freezer bags. So if I go to a market that they do their own butchering and they'll have like big bags of giant chicken breasts, and I can buy a big bag of those when they're on sale, and those will do for like a couple of week’s worth of meals. And to buy like the chicken thighs, I wouldn't even get half as much.

Wow, interesting.

So when you're watching your budget you just have to go with what you've got. So I'll just try and make it a little bit more fatty by cooking it in butter or cooking it in bacon fat, because I've always got lots of bacon fat. Or putting some cheese on it and I find that that's fine for me.

I don't want anything else. I was cutting up some melon for my kids the other day...I popped a couple pieces of melon. Now before, I would have eaten like the whole thing, but I was quite happy just having one or two really nice cold juicy pieces of melon. I found that I was a little worried, because afterwards I was like, do I feel that sugar craving? And...I'm okay, I'm okay. But even that. There's a lot of sugar in melon, but it could have spiked that sugar craving, so I feel that its better just not to even go there. If I'm going to have vegetables like broccoli, they're not sweet, so you're not going to have that sugar craving.

So it's just better really not to go there in whatever way that you're eating. If you know you're going to be triggered by something, just don't even go there. Like with the weight loss surgery we were talking about earlier, in the second or third week, they said that you can eat Melba toast. Well you can. Do you want to? Should you if that's going to be a trigger food for you. If before surgery you could eat a sleeve of crackers...that used to be one of my things...I could eat a whole sleeve of crackers with cheese whiz or peanut butter. Then maybe crackers isn't a good idea for me. Even if you want me to eat moderately, sort of pairing up the idea of what caused you to gain weight in the first place, and now that you've had weight loss surgery, sort of incorporating what you know about yourself and making that model work for you for maximizing your weight loss. So if carbie foods are a trigger, then you'd better not eat them. Not until maybe you've lost a lot of weight and you feel comfortable that you could eat them without being triggered to overeat.

And that's the power of the Internet, I think. Because that's certainly what I was able to tap into. Interestingly enough one of the things that was also on my meal plans was to have these...I'm trying to think what they call it here...but it basically looks like slices of mini toasts as your Melba toast type thing; that I used to have with cream cheese on. And that was something that was recommended as a snack, and it was one of the things that sent up a red flag for me is: why can I eat more than they're saying I should have, and I'm still hungry, but then it's just inducing these cravings that I want to keep going back. I want to go back and have some more half an hour later, and more half an hour later. And I could just be, just like you, I could just be on and on and on at that all day.

And that was one of the first things that got me thinking, hold on, something's not right here. And that's when I started tapping into things online and hearing about the experiences of other people and starting to question the wisdom of what I was being told by the surgical team. So sometimes we do have to go against what we're being told to figure out what's going to work for us. And I know a lot of people don't necessarily want to do that, especially if it crosses paths with having to accept that they've got addictive type tendencies. It's possibly a lot easier to just say, well, my team knows better, I'm going to do what they say and then deal with the problems when they arise. It's been fascinating talking to you today and, and throwing around this topic of weight loss surgery. It's not something that I've talked about with somebody else on this podcast in more depth and I've been looking forward to discussing this topic with you. I know there are a lot of people out there who are about to go through it or who've gone through it and run into problems.

And it is something that is sometimes shunned a bit in the community and people feel like they need to keep it a bit secret. But I definitely feel that keto is something that works very well as a way of eating after you've had surgery. It certainly has for me.

I think I have to agree with you on that. And I think I have heard in the United States there's more bariatric clinics that are recommending the keto diet, which I find is fantastic. And I know amongst the people on my weight loss surgery Facebook group, there's so many people that are discussing regaining and they've come to me and asked me about keto, and I've pointed them in the right direction. And that's when I've heard people say, I'm so hungry all the time; even with the surgery, I am just hungry. And I've said, well, this has been my experience with keto, especially when I stopped the carbs; I know that I'm not hungry. And if that's your challenge, then this is going to work for you I think. And I really hope that it does work for them. I think that a few people have already seen some good results with it. And I hope they continue on that.

And I just put myself out there and I've had numerous discussions with people saying, you know, our clinic says that we shouldn't do fad diets. I try not to get into that whole argument about is it a fad diet? To me it's a way of eating. It's not a diet; it's a way of eating it. Just as being a vegan is not a diet, it's a way of eating. So is keto or low carb, or whatever, or being a carnivore, it's a way of eating. Often too, when talking about keto, people will say it's not sustainable. And it's absolutely sustainable.

And people will say, I will miss this, I will miss that. And I want to say, tell me whatever it is you think you'll miss and I will tell you a keto alternative. Because there's so many people out there, so many people doing blogs and websites. Everybody's developing all of these recipes that you can replace anything - crackers or breads or ice cream - there is a low carb version of it. So you're not missing out on anything. You want on a birthday cake? You can have a low carb birthday cake. I don't think you're going to eat it every day, but you can have it. It's there. You're probably just going to find you're not going to want to eat.

Sometimes I think there's a fear around low carb as well. And I feel a little bit that the bariatric clinic - ours in particular - pushes that a little bit...that you still have to eat carbs; that low carb is bad. And so I don't know if that's the perception that anybody else has ever had with their weight loss surgery clinics? You know, being low carb is a bad thing. But I think that they still do get that. So I'll get some argument, oh we're not supposed to do low carb. Low carb is bad. And you try and challenge them. Why? Why is it bad? Tell me what's your evidence? Where's your science? And that's the thing I absolutely love about keto, is that everybody is super knowledgeable about it. You go on to any of these websites - Diet Doctor, the Ketogenic Forum, the 2 Keto Dudes, and yourself - you all have all of this information at your fingertips. And people that do fad diets, they don't know anything. They couldn't answer a why question if their life depended on it. But I could ask anybody that's serious about keto why something, and they'll know. And if they don't know, they'll go and find out why. And they'll tell you why and that's the way I am too.

If somebody asks me a question, why this, why that? I'm pretty sure I know the answer at this point and if I don't I can probably find out. And the second piece that I really like about keto is the self-assessment. Everybody's very much into doing these N=1 experiments to see what works for you and what doesn't work. Nobody is saying you have to eat this or you have to eat that. It's like, well try this and see how it works. It might not work. You might not feel better, or maybe you will, and if that doesn't work, then try something else. There's no cookie cutter, one size fits all diet, the way that the weight loss clinic surgeons and dietitians would have you believe. You have to find what works for you because we're all different. We all have different metabolisms, and all different body structures. We're all different. You need to look outside the box. You need to experiment. So that's what I really like about keto. Nobody is so stuck in the mud...it's all written in stone...you have to do it this way.

Yes, exactly. I think that's right. That's what I was saying before about the biggest flaw I see about it is, them trying to put us all in one box, and that's never going to work. It's been great talking to you today. Perhaps you could round us off with a top tip.

I was thinking about that and there's like so many things that I think would work so well, but kind of going off off...I saw one of your other interviewees was saying...they we're talking about making a plan, and having goals, and I think that's when you...how does the saying go? Failure to plan is a plan to fail. So if you can have a goal in mind. Somebody in the group had their action plan, and sleep was their goal. So if sleep is your goal, for example, make it measurable. So if sleep is your goal...I want to improve my sleep - that's kind of nebulous. So how am I going to determine if I have reached that goal? If you make something measurable, and you make yourself accountable to that, I think you'll do better. So first just using sleep for an example, I can improve my sleep when I have three hours of deep sleep according to my Fitbit or whatever. You know, or one of those nice Oura rings that people have been getting.

Then I would know my sleep will have improved. Make it measurable. Don't have these up in the air goals or objectives. I want to lose weight is a great goal, but it's kind of nebulous. Drill down a little bit. Like what is it that you're really after? And make it measurable and make it attainable, and really look at what steps...like for sleep, maybe painting your room a different color or putting room darkening blinds...like there's a lot of different things that you could do for your goals if you make it very specific. It's much easier to research and see how you can attain that goal.

And then with that, to make it time specific - time that you're going to work on reaching this goal. Like if you're going to work on it for a month, then the really important piece, I don't think people do...talking about self-awareness and self-assessment. Do that evaluation...okay, has this improved? Have I reached my goal? If I haven't reached my goal, then what do I need to do to reach that goal? How have I not reached it? Have I completely failed? I think that person with the action boards that she hadn't been looking at it for months probably because it wasn't specific enough. It was too vague. It was too, you know, like unattainable. There was no timeline. So if you set yourself up something you can succeed at, you need to sort of plan it. We have your plan, you have your objective, you have your action steps, you have your evaluation. But if you make things very specific, I think it makes it easier to succeed at it.

Yes, especially if they're nice little bite size steps that are attainable, and like you say, you can then re-evaluate when you've got to that point and change up that plan if you haven't managed to achieve the goal, you set out, re-evaluate, and work out why it was difficult in this instance to get to it, and change it, and reset it, and then work towards that next step and so on. I think that's a very good point, is taking it away from these sort of vague sweeping statements and drilling down into something really specific. It's more actionable, isn't it? When it's specific?

Yeah. I think when you make things very specific, they do become much more actionable and much more attainable. One other guest said about keeping it simple, silly. So if it's something simple, something actionable, something attainable; I think you'll be much more successful in the long run. And doing that self-assessment piece, the self-evaluation. And don't be afraid of it. People fail at things and you need just to learn from your mistakes. And don't swim around in it. If you've had a failure, that's okay. You can still pick yourself up and move on. Just don't get bogged down by failure. Everybody fails at something. You just got to learn from them and move on. Get back on that horse.

Absolutely. And then it's not a failure, is it, if you've learnt from it. I think you're right. I think getting specific about something forces you to really look at it and set those goals. Because it's very different, isn't it? Saying I want to lose weight, to saying I want to get into that pair of jeans that's the next size down. And being specific about your goal makes you actually figure out and work out what is a realistic target, and what is a realistic timeframe for that. So yes, I like it.

Well thank you very much for talking to me today. It's been a pleasure.

Thanks so much for having me on Daisy. I've really loved this. It's been fantastic.


(Monique) #2

WTG Trish Roberts, never ceases to amaze me the work she does to pull these transcripts together.

Very timely topic (for me) this week- I have one friend considering bariatric surgery and another who is seriously regretting her recent surgery. I have been totally at a loss at how to support either of them. Have now sent the transcript to both, because the advice and experience shared here is priceless!


#3

Trish is an absolute super star.

I’m sorry your friend regretted it/ Why? Have there been complications? Overall, it was the right thing for me (at least the sleeve was, we shall simply discount the nightmare that was the band!) but it comes with its own set of issues, although rarely impacts me anymore.

Being able to talk to other people in the same boat is the best advice I can give. That is what helped me the most, although actually only some of it! One person in particular gave me great advice and it was them who led me down the low carb path and then keto. There is a lot of guff out there so I guess the best advice I can give is to go keto. It really is the best suited way of eating post surgery, once your system has calmed down. That and don’t worry about the whole low calorie thing. It is far more important to get the right way of eating down as a natural habit than worry about calories. You simply won’t be able to consume that many, whatever you eat, but that wears off over time and you are left having to control cravings again unless you have sorted what you are eating out during the honeymoon period.


(Monique) #4

I am so glad you have had a positive experience! It’s encouraging to hear.

My friend is struggling with the small frequent meals, and the impact it has on her social life. Physically, she’s doing very well and the weight is melting off her. Psychologically though she tears up when the subject of food arises. She tears up at mealtimes. She hates the fact she can’t eat and drink at the same time. Definitely struggling with the reality of her changed way of eating.


#6

Is is quite recent? She should be able to move away from that gradually, although it depends a little which op she had. The bypass is more restrictive than the sleeve which is what I have. It is important to get good caloric intake in in each meal and protein first (fatty ideally). It might be possible to reduce the frequency somewhat if she does that but it really depends on how much she can eat and how soon after the op it is. Basically the first 6 months you have to be really gentle on it to allow for good healing and everything to settle down. It will settle down though and she will be able to progress to eating more normally as far as meal times etc go. If she is struggling to get enough in I would look at something like Keto Chow shakes as they are packed with vitamins etc. and go down a lot easier. Whole food is best but it might help to replace a meal or two a day if she is struggling. It’s all so variable and individual but there are some tweaks you can make at any given point to help. Does she have other bariatric patients to talk to?