Dieting may be the traditional method for losing weight. Yet more and more obese individuals are giving up counting calories and measuring their food and instead are turning to surgery. Advances in bariatric surgery over the past 10 or so years has made possible a relatively short, simple operation to turn the pouch-like stomach into a skinny sleeve that holds no more than 2 to 7 ounces of food. The operation, called the gastric sleeve, is done laparoscopically, which means recovery is quicker than conventional surgery. According to the American Society for Metabolic and Bariatric Surgery, almost 42 percent of all bariatric surgeriesperformed in the United States in 2013 were sleeve gastrectomies,i.e., it’s currently the most popular weight loss surgery.
The operation is non-reversible; the major part of the stomach, which looks like a mildly curved banana pouched at one end (as if the banana swallowed a golf ball), is cut away. The original stomach cannot be reconstructed any more than a pair of jeans can be reconstructed after the legs have been cut off to make short shorts. The stomach still functions, but eating has to be miniaturized. Eventually, the stomach may stretch somewhat so food does not have to be measured with an eyedropper. Still, people who have had this operation will be unlikely to be able to eat a large pizza or a 12-ounce steak unless they spread the eating over several days.
Fortunately, one of the biggest advantages to this type of weight loss surgery is that when the fundus, that bulge at the bottom of the stomach, is removed, so too is ghrelin (rhythms with melon). Ghrelin is an appetite-stimulating hormone produced in the fundus. Normally, when the stomach is empty or (and this is bad news for a traditional dieter) when low calorie diets and/or chronic exercise regimens are followed, more ghrelin is produced. Hunger does not make dieting easy. Ghrelin goes up before meals and, not surprisingly, decreases after food is eaten. But the gastric sleeve surgery significantly decreases this hunger hormone.
The resulting lack of hunger is so striking that for months after the surgery, patients must remind themselves to eat. Consequently, during the post-operative year, weight is lost easily and many of the medical complications of obesity-like diabetes are lost as well. But as with other types of bariatric surgery, getting to a goal weight is not always attainable. It is possible to gradually restretch the stomach enough to hold more food and more calorically dense food.
But for most, the hunger may be gone, but the need to eat remains. As a woman wrote on an Internet site devoted to bariatric surgery, the operation does not ‘mend the mind.’ She was describing her need to eat sweets when she was tired or stressed. Others chimed in with their stories of being unable to control their eating when they experienced the mood and appetite changes of PMS. A man wrote in about drinking alcohol again as a substitute for eating candy to which, he said, he was addicted.
Will power, the surgically imposed inability of a now skinny stomach to hold much food at a time, and motivation to reach a healthy weight, keeps many from giving in to these cravings. But for some, not capitulating is like not taking a pain reliever during a bad headache or backache. These individuals use food as a sort of self-medication; they eat when they are depressed or anxious, or in an irritable mood and by doing so, feel better. The improvement in mood is not wishful thinking or a placebo effect.
Nature gave us a way of eating our way out of stress. We can do so by consuming carbohydrates that, in turn, results in the production of the brain neurotransmitter, serotonin. Serotonin is made when the amino acid tryptophan enters the brain. It does so only after starchy or sweet carbohydrates are eaten. (Eating fruit does not have this effect.) Eating small amounts of carbohydrate increases serotonin levels within about a half an hour.
Serotonin levels may fluctuate during the day, leading some people to feel a serotonin low in the afternoon. Serotonin is also lower during PMS and the dark days of winter.
However, nature never intended for the carbohydrates to be consumed in the form of cookies, chocolate, ice cream, pie, doughnuts, muffins, cinnamon rolls or strudel. The effect on producing serotonin is just the same if steamed rice, plain pasta, unadorned bread, unsweetened cereal, and boiled potatoes are eaten, rather than the fat and sugar-filled pastries or salt and fat-filled crunchy snacks. Again, it is unnecessary to eat large amounts of carbohydrate; about 25-30 grams, the amount in a small bag of fat-free pretzels, is sufficient. Presumably someone could consume this amount with a sleeve-like stomach once enough months passed since the operation, and real food is once again being eaten.
Of course it would be better not to eat out of emotional need. It would be wonderful if those of us who think ‘I have to eat something’ when confronted with a distressing situation or experiencing PMS, stopped feeling this way and managed to get through the stress or PMS without giving in to ourselves. But our brains are not all alike in this regard, and there will always be some of us who really need to eat some carbohydrate when we are upset. Only a brain transplant will stop us from doing so!
Post-operative gastric sleeve patients are given detailed instructions on how to eat to recover, regain their strength and not alter the size of their tiny stomachs. Would it not be helpful for these instructions to include how to eat to minimize stress without risking weight gain? Shouldn’t women be helped to get through their premenstrual days without imploding by showing them that tiny amounts of carbohydrate can have a enormously positive impact on their mood? The same remedy applies to people suffering from the winter blues, as well. Information about post-op refeeding should include the fact that the absence of carbohydrate will decrease serotonin, and perhaps lead to depressed or anxious moods.
Patients who eat out of emotional need can be taught to consume controlled, small portions of non-fat, non-sugary carbohydrates. By doing so, they will find that their emotional well-being will match their improved physical well-being.