JudyAnn

Straws forbidden by my surgeon. Anyone still use them?

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Can show me 7000 reports saying it does - and they are still wrong.  It doesn't.  Straws are fine.

 

They aren't wrong.  The fact is that the air does not bother you, not that it doesn't exist.

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Ahh..., many of you know by now that I enjoy tackling these types of "discussions." As a scientist, I am always looking for legitimate data to support these "guidelines" or "myths" that float around. But, I also really believe in the importance of paying attention to anecdotal evidence, too (from people's experiences but not from scientific or controlled studies.)

 

This straw thing (and some of the other "it will stretch your pouch" warnings) has never interested me enough to do any digging. But, this conversation put a fire under my butt and I put a little effort into it. And this is what I found:

 

First of all, a search on the internet certainly comes up with THOUSANDS of warnings for bariatric patients to avoid straws for fear of stretching their pouch or introducing air into the new pouch. BUT, anyone can write that or include it in their literature and it will come up in a search. This does not mean that it is a study or evidence of the TRUTH of the phenomenon. A search for jackalope, the Loch Ness Monster, Bigfoot, or even Alien abductions would yield similar results and even "proof" but would not get us any closer to legitimate truth.

 

So, I did a search for straws and bariatric surgery among the scholarly and peer reviewed scientific literature. What I got were references to a condition called aerophagy (med speak for eating air) and just a few mentions that surgeons generally warn against using straws due to a "hypothetical" risk of introducing air into the stomach.

 

So... I thought, there IS something that makes them connect straws and air.

 

Digging a little deeper, I found that some folks have a propensity to swallow air and get lots of gas and distended/painful bellies. This seems to occur most often in babies (duh! bottles, crying, colic) and in children and adults with spine, breathing, gastrointestinal, and developmental issues. Yes, there is evidence showing an increase in aerophagy associated with drinking carbonated beverages, using straws, gum chewing, CPAP machines, and having loose dentures. BUT the key to it all is that these are things that exacerbate the already present condition. And, while I did not search for hours, I am quite adept at finding things pretty quickly and I did not find any studies that link bariatric surgery with aerophagy nor that link straw use or gum chewing with aerophagy in normal, healthy folks.

 

So, where would this continual warning keep coming from?

 

It is clear that many bariatric patients experience excess gas and gas pains, we also clearly have compromised GI systems, so it's not a far leap to recommend against other things that may contribute to more uncomfortable gas. I think these are reasonable warnings surgeons decided were worth presenting to patients to minimize discomfort (and increase compliance, thus increasing weight loss success-- no carbonated beverages means no soda means fewer liquid calories). I imagine the reasoning was-- Better safe than sorry, right? And I also imagine that over the years what started as a better safe than sorry warning sort of snowballed into a blanket rule. And once that rule was the norm but no one really knew where it came from, no one was really willing to leave themselves vulnerable by getting rid of it... just in case;) Except those few surgeons (like mine) who really LISTEN to their patients and have figured out that, on the issue of straws, it's an individual thing, but not a crisis either way.

 

Based on my new scientific knowledge and my few years of anecdotal experience, THAT is my take on the subject. What do you think?

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They aren't wrong.  The fact is that the air does not bother you, not that it doesn't exist.

 

They are wrong because it doesn't increase air inhalation.  Therefore it is a myth and straws are fine.

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They are wrong because it doesn't increase air inhalation.  Therefore it is a myth and straws are fine.

Gosh, I need to inform the Mayo clinic, Medline Plus, the University of Michgan, Healthline, Ohio State University, Dr. Andrew Weil, Dartmouth, University of Rochester, Minnesota Gastroenterology, Sonoran Heart Cardiovasuclar Specialists and ABC science!  Then I can start on page two of the list...

 

If it works then do it- I do.... but just because you feel okie dokie doesn't mean that it's not going on.

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Yes, they should informed so these misconceptions can be corrected in such documentation.

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LOL I would love to hear a conversation with you telling the Mayo Clinic that they are wrong.... "But it doesn't feeeeel like I'm swallowing air!!!"

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There are many many things in my 40 page eating book from the hospital that don't apply to me, I'm aware of them, but I don't worry about them.

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Ladies, ladies...

I realize my post was quite long winded, so I thought it may help bring a better understanding if I boil it down to a few points:

Based on a search of the current scientific literature, I have found :

1. Some doctors DO regularly warn against using a straw after bariatric surgery and often openly HYPOTHESIZE (that means guess) that it could introduce air into the system.

2. You can find that very warning in thousands of documents online, BUT that does not mean the warning is based on direct evidence that proves it is true. Anyone can say anything online and many surgeons (even good ones from Mayo and Johns Hopkins) offer "guidelines" that become "industry standards" based on hypothetical

conditions.

3. There appears to be NO DOCUMENTED SCIENTIFIC EVIDENCE that using a straw introduces air into the pouch/sleeve in a normal Bariatric patient-- or any NORMAL patient for that matter.

4. There is often a reason a "guideline" is set and becomes "industry standard." In this case, there appears to be a loose, indirect possibility that straws could maybe make drinking uncomfortable in SOME patients, particularly those already prone to swallowing air.

In summary, there is NO EVIDENCE that straws introduce air into bariatric systems, but many surgeons feel it may be a possiblility so they warn against it. If straws make you gassy and uncomfortable, don't use them. If you drink better with straws, use them... Guilt free.

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Sorry, I don't agree that your google search means that there is no scientific evidence...

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Sorry, I don't agree that your google search means that there is no scientific evidence...

You are welcome to believe what you want-- and I say that with all sincerity. I am simply giving the results of my academic knowledge and personal experience, as I explained in my initial too-long-to-read post. I have no stake in whether you choose to consider my response or information. But I will point out -again- that MY search was not composed of google hits since anyone can say anything on the web. I, instead, performed a search of the published academic peer reviewed literature.

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Thanks hon but I wasn't asking for permission.

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I've made my contribution to this topic and actually put some effort into getting a useful (edit: it was already "useful" i suppose in-depth is a better word) dialogue started. I certainly hope this thread can continue in a positive way. It has potential for some darn good discussion.

Thank you for all of your wonderful information! It is very helpful. If it will encourage getting more fluids down, I will definitely mention it to my doctor when I see him this week.

Judy, I'm sure I'm not alone when I say I'm very interested to hear you surgeon's point of view on the issue. Edited by BugdocMom

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I've made my contribution to this topic and actually put some effort into getting a useful (edit: it was already "useful" i suppose in-depth is a better word) dialogue started. I certainly hope this thread can continue in a positive way. It has potential for some darn good discussion.

Judy, I'm sure I'm not alone when I say I'm very interested to hear you surgeon's point of view on the issue.

On Friday, I will speak to him and post what he says. Thank you for all of your dilligence in supplying us with information to ponder on this subject!

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Can I just add a little anecdote?  I also got the warning from my surgeon.  As usual, I tested my boundaries and experimented.  If you suck a little water and that first bit of air up with the first suck from a straw, you can let it out your nose and then get no air while you finish with the straw.  Simple solution to air sucking.  

 

A lot of people slurp when they drink.  They swallow that air, too.  It seems like no matter how we drink, air has the potential to go down the gullet.

 

Bugdoc, thank you SO much for your amazing (as usual) contributions.  I read your first long post and it made so much sense.  They tell us that because they've always told us that because they don't want to take any chances.   

 

It's OUR bodies, and we have the right to test out theories on them.   If there is a surgeon that has had this surgery, then odds are they also use a straw.  It just makes sense and it's SO much easier to get our liquids down using one.  I wish we knew of a surgeon that went under the knife so we could ask.

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If there is a surgeon that has had this surgery, then odds are they also use a straw.

If there is somebody like this out there, I'd expect to see a lot of the rules change.

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Although I definitely listen to medical professionals and do my best to be compliant with my guidelines, I realize that these people are also human.  I always do my own research and realize that medical studies are based on hundreds or thousands of people, and we aren't always going to have the same issues or reactions.  Medical professionals are often so scripted and regulated in the things they say because of legalities.  As an example (not saying this is true): If four or five people were bothered by straws, then just say that no one should use a straw...it will avoid any potential discomfort, complications, and eventually lawsuits.  If four people accidentally swallowed their gum and had to have an endoscopy to remove it (surgery? really??), then let's avoid the whole issue by telling the other couple million bariatric patients that gum is not allowed.  No one needs gum or straws anyway, so they'll live just fine without them and no one will sue in the end (hopefully).

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I use straws everyday and I've never had a problem. I've stayed away from gum and have a small lifesaver if I'm worried about my breath. I haven't tried bubbly drinks and I don't plan too. 

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Right after surgery my doctor said no straws.... At my 3 months check up I asked him if I could start using one. He said it was ok just to take small amounts in. He also told me they say no at first so that we don't take in to much at one time. I love my straws!!!!

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BDM - Thanks for taking the time to look through the peer reviewed research and give us your opinion after that review.  Clearly, we all have to make our own choices and determinations about what is right or wrong for us.  Honestly, other than the prohibition against use of ibuprofen that my surgeon gave me during my one session with him, there were very few specific absolutes given by my clinic.  Everything was really a guideline that was offered to give the best possible chance of success.  Obviously, we can all do what we want - we're adults who can make choices.  

 

FWIW - my clinic never said anything to me about not using a straw or not chewing gum... at least not that I remember. And yes, it is a Center of Excellence.   (honestly, I probably inhaled more air from my CPAP in the last few months I used it than anything else and they definitely weren't going to tell me not to use that). 

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I'm not knocking anyone who uses or doesn't use a darn straw LOL. Listen to your body and your doctor. Me? I use a CamelBak Eddy bottle. It has a straw inside and helps me guzzle my liquids with ease. No issues and i love it.  :P

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You guys rock! I KNEW it would be worth a look up even if I wasn't too particularly interested in the original topic. Got interesting quickly, though, huh? ;)

 

I remember reading about a female bariatric doc who had RNY or Sleeve herself. I'll see if I can find that article. I remember her talking about bringing a different perspective to her patients once she had the surgery herself. Certainly makes sense. BUT, like Florida Girl pointed out, the way it goes is to give a blanket warning to cover the masses... and the surgeons' a$$es. (I couldn't resist that one).

 

The interesting thing is that most of these "guidelines" are not based on studies that show 4 out of 5... They are just intuition or conjecture. It's a HUGE reminder that they still really DO NOT KNOW HOW OUR SURGERIES WORK. Especially malabsorptive procedures.

 

Heck, we don't really know how weight gain, metabolism, and our hormonal controls really work. All the rules we quote like "it takes 3500 calories to create a pound" "the honeymoon period lasts 12-18 months" "RNY patients re-grow their villi" and so many others are generalizations that are only sometimes based on direct or even indirect medical studies.

 

So, we need to remember there are very few hard and fast rules in this game so we must be very diligent in determining what works best for OURSELVES.

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Heck, we don't really know how weight gain, metabolism, and our hormonal controls really work. All the rules we quote like "it takes 3500 calories to create a pound" "the honeymoon period lasts 12-18 months" "RNY patients re-grow their villi" and so many others are generalizations that are only sometimes based on direct or even indirect medical studies.

 

So, we need to remember there are very few hard and fast rules in this game so we must be very diligent in determining what works best for OURSELVES.

 

 

VERY true.  The calories in, calories out rule is a complete crock for nearly everyone, bariatric or not, but it's still preached like religion.

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