Samantha123

Intermittent fasting

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Hi, anyone here tried intermittent fasting? 

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I have been heavily researching it recently as it applies to bariatric surgery patients. From what I've determined by research it is a totally unacceptable approach for the first 6 months post-op when malnutrition is already a huge post operative issue. Okay after 12 months have passed provided the person looking to do it has achieved good dietary habits and is getting all their recommended protien needs in reliably.....highly questionable from 6-12 months....really dependent upon the individual and their nutritional compliance and state of mind. 6-12 months is seen by many to be the most negative "head game" period after surgery. Weightloss has slowed, maintenance may be looming, and often riskier weightloss strategies are being considered rather than the reliance on lifestyle changes. It is considered to be the time period after surgery when our "fears" are at their highest...well that's the conclusion the bariatric surgeons I've researched have come up with. Looking back at that time period for me, I do recall that is when the people who had surgery about the same time as me, were all quite seriously discussing concerns about maintenance,  regain etc....so that did have a resounding ring of truth in my reality. I realise you're well past these timeframe, but included them for those who might be reading this thread out of interest even though their surgeries are more recent.

Having just turned my dietary lifestyle on its it's head about three weeks ago, I'm taking my time to work up to this. The conclusion I've come to is that we should all be doing a 12:12 IF as part of a healthy eating plan anyway. Fat burning supposedly starts at 8 hours, give or take. That's what my focus is right now, and to be honest I've pretty much been doing that since surgery anyway. Once that's comfortably in hand it's easy to drop a breakfast, but my research suggests that should only happen 2-3 times weekly. This should give you an 8:16 protocol 2 or 3 days a week. For those who've had bariatric surgeries, a 24 hour fast is only recommended once per month, with none of the longer fasts at all. We have quite specific nutritional needs and a significantly smaller stomach space in which to get those needs in, so reducing the timeframe for achieving those goals makes for a very delicate juggling act.

I probably should have added here....for the benefit of my TTF friends that might be concerned that I'm becoming overly obsessive about diet....that I came into this research from the point of view of finding a way to control my insulin response to food. That of course took me straight into the  quite strict, and often very poorly researched but aggressively touted world of ketogenic diets, which quickly warps into some very aggressive approaches to intermittent fasting. You need to have some good research skills when it comes to some of the folk pushing these techniques in cyberspace.  None of them though are discussing bariatric patients, so read or watch the videos they produce with a very high level of scepticism. We had surgery to get off the yoyo dieting hamster wheel, and it's neither healthy or sustainable to go back on it and bugger up our metabolisms again. The real way forward, in my case at least, appears to be a "real food diet" with a low carb level that would still be much higher than would ever be acceptable to any keto fanatic, along with a moderate protien macro to ensure those needs are adequately met, thereby reducing the incredibly high fat macro traditionally espoused by the ketogenic dieting community. In other words healthy fats, real hormone free meats (not processed and preferably not grain fed), dairy, and lots of "above ground grown" vegetables and fruit. I'll be remaining grain free for sometime yet, maybe forever if my insulin sensitivity doesn't improve dramatically. 

Hope this helps you somewhat.

Edited by Aussie Bear

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@Rob_VSG has talked about fasting, sure he can chime in on this topic.  

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I am happy to share on this subject.  Let me qualify first that I am just sharing my experiences and how it has been working for me and this may or may not be right for other individuals.  Also, I'm an engineer and not a doctor.  Since VSG, generally, does not cause nutrient malabsorption I wasn't too concerned about proper nutrition as my post-op recovery was pretty easy as far as the amounts of food I was able to consume was fairly substantial and I keep up with my vitamin supplements.  I did focus on protein and drinking lots of water  like the doctor told me.

Aussie Bear is spot on!  I too did much research, even before my surgery date, however in my case I didn't manage to come across the concerns about trying IF in the first 6 months post-op but have since found similar information that Aussie Bear discussed.  I just saw a Dr. V video on youtube about why its best to focus on nutrition and getting your head straight during the honeymoon period post-op.  In my case, my thought was trying IF while in the honeymoon period was a good idea because it would give me the confidence I would need to be able to implement it when my weight loss slows in the future.  In my case, this worked out fine, but then I'm 58 years old, live alone and don't have many psychological challenges around food other than I really like to eat tasty food!.  I even tried 3 24hr fasts in the first 6 months and when I went in for my 6 month surgery follow up, my nutritionist was aghast when I told her and she admonished me and warned that would slow my metabolism.  After that the doctor measured my Resting Metabolic Rate and it was HIGHER than pre-op!  Also my blood work looked great.

After 8 months post-op, my weight loss did slow considerably so I slowly started extending my over night fast into the morning by skipping breakfast and found 12 hours eating and 12 hours fasting really easy to do.  At 11 months post-op now my target is 8 hours eating and 16 hours fasting.  Some days I hit that target some days I only get 12-14 hours fasting and others I can go as long as 18 hours fasted.  This gives me plenty of flexibility to attend work lunches if needed.

I should add, I too am following close to what would be considered "ketogenic diet" macros however I'm not super strict so I would call it keto-ish or keto-esque, and like Aussie Bear, approached my diet from the "low glycemic" point of view.  So if I eat fruit, it is low on the glycemic index like organic wild blueberries or cherries.  If I eat red meat it's usually grass fed beef, or poultry will be free range chicken, fish will be wild caught salmon and vegetables typically organically grown.  Refined carbs or sugars are close to zero.  

Using Keto+IF has seriously reduced my head hunger and I feel very in control and satisfied.  The reduced eating time window means less time planning and preparing healthy meals as well as less time thinking about food.  My plan is to reach my goal of being a "normal" BMI then just fine tune my eating vs. fasting times to switch to maintenance. During this honeymoon period I have worked hard to find healthy alternatives to satisfy my every craving and over time my tastes and cravings have actually changed towards those healthy alternatives so I rarely feel like I am denying myself food that I want.  Denial is rarely a long term strategy for success.

I feel much better using IF and I don't believe the human body is well suited for long periods of eating and short periods of fasting.  See Dr. Jason Fung's videos on Insulin and fasting, they are very informative.  Being diagnosed years back as pre-type 2 diabetic, which means becoming insulin resistant, I am very focused on controlling insulin.

Editing this post with an additional addendum:

My weight loss post op has been done almost entirely on just diet and NO intense exercising.  I can usually get in a 20 or 30 minute walk 3 or 4 times a week but other than that my lifestyle is rather sedentary.  I am doing it that way because of my personality and I know if I force myself to exercise as part of losing weight that most likely at some point in the future I will likely lose interest in that activity so my full focus is on proper nutrition and eating strategy and turning that into my "new normal".  Some folks on these forums are different though and have physical activities they truly enjoy and are able to enjoy even more after losing weight and that is really awesome.  I still expect that at some point in the future I will find a physical activity I enjoy that keeps me motivated, but until then, I'm on track with my current approach.

Edited by Rob_VSG

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@Rob_VSG Thanks for the response hopefully Samantha will see it.  I also lost my weight without the exercise and used good nutrition. Although I am more active then I use to be.   Congrats on hitting goal.  (passed goal)  Nice to have a buffer

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Thanks @Rob_VSG. It sounds like our diet routines are fairly similar...and with similar reasoning. Almost embarrassingly I have to admit our lack of enjoyment of exercise is well matched also! I'd be interested to hear from you about any A1C results you might have had recently. While mine were always in the high 4s, so not pre-diabetic by that matrix, within three weeks of cutting all grains out mine was last measured at 4.2. While I haven't had the opportunity to discus that with any doctors yet, I'm tending to think that is indicative of still having too high an insulin response at play. Unfortunately in Australia it is rare that doctors ever order insulin level testing, so I've no idea what my levels were like before, and given I won't be carb-loading to have accurate testing done in future that will have to remain a mystery. For now I seem to have managed to stop my blood sugar levels spiking and then dropping into hypoglycemic numbers, and that's a great relief in itself, but my body isn't well adapted yet to running on quite consistently low blood sugar levels either. It's certainly a tenuous balancing act, and that also plays heavily into making exercise even more unenjoyable than ever.....for me any excuse will do to avoid more than just walking a few times a week.

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2 hours ago, Aussie Bear said:

Thanks @Rob_VSG. It sounds like our diet routines are fairly similar...and with similar reasoning. Almost embarrassingly I have to admit our lack of enjoyment of exercise is well matched also! I'd be interested to hear from you about any A1C results you might have had recently. While mine were always in the high 4s, so not pre-diabetic by that matrix, within three weeks of cutting all grains out mine was last measured at 4.2. While I haven't had the opportunity to discus that with any doctors yet, I'm tending to think that is indicative of still having too high an insulin response at play. Unfortunately in Australia it is rare that doctors ever order insulin level testing, so I've no idea what my levels were like before, and given I won't be carb-loading to have accurate testing done in future that will have to remain a mystery. For now I seem to have managed to stop my blood sugar levels spiking and then dropping into hypoglycemic numbers, and that's a great relief in itself, but my body isn't well adapted yet to running on quite consistently low blood sugar levels either. It's certainly a tenuous balancing act, and that also plays heavily into making exercise even more unenjoyable than ever.....for me any excuse will do to avoid more than just walking a few times a week.

Pre-op my HbA1c was around 6.2 and I was told I was pre-diabetic.  Three months post OP my HbA1c was 5.5 and considered in the "normal" reference range.  My surgeon didn't check my HbA1c at my 6 month follow up.  My 12 month follow up is coming up in February, I'll make sure he checks it then.  Doctors here don't typically measure Insulin level either.  I have home meters to monitor Glucose and Ketone levels.  My fasting glucose seems to sit on the high end, typically 90-105 mg/dl (or 5-5.8 mmol/L) and my blood ketones usually range from 0.5-2 mmol/L.  I would suspect that if you have good ketone levels (a better energy source than glucose) then fairly low glucose levels wouldn't be too much of a worry, but, without checking insulin at the same time it feels like we only have half of the picture.  If you are concerned about hypoglycemia you might want to use a home meter if you are not are not currently doing so.  My understanding is that a FBG above 50 mg/dl or 2.78 mmol/L is adequate to keep you out of a hypoglycemic state.

Cheers!

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2 hours ago, Rob_VSG said:

without checking insulin at the same time it feels like we only have half of the picture.  If you are concerned about hypoglycemia you might want to use a home meter if you are not are not currently doing so.  My understanding is that a FBG above 50 mg/dl or 2.78 mmol/L is adequate to keep you out of a hypoglycemic state.

Cheers!

I do have a home BGM. Doctor insisted on it, but I already had one in order to get the readings I needed to prove I had issues in the first place. Because my A1C was never above 5 there was an assumption that glucose control was fine, and as blood sugar readings were always taken at the time iron studies were, they were always fasted results so never caught the high readings. I've been told to self-correct at 3.5 as that is considered the start of hypoglycemic range.  I often dropped to 2.3 which s a very impaired state for me. I do have a better handle on it at the moment, but it does concern me that an A1C of 4.2 equates to average levels of 4.1 and despite that this level is deemed "optimal glycaemic control" it simply isn't enough for my body to meet its energy needs at the moment. I don't have a ketone meter at the moment to know for sure what this level is. Maybe I just need to wait and see if my body adjusts to this new lower glucose state. I agree that not checking insulin levels only gives us half the story, and I suspect that the half we are missing is actually the more relevant half of the picture. I could probably talk my doctor into measuring glucose now given he has seen the peaks and troughs of my glucose readings, but no way am I prepared for the carbohydrate loading that would be required to get an accurate set of readings now that I'm finally on a more even keel, and not suffering the consequences of wild fluctuations in glucose levels.

Thanks for the information. 

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