Mystery of Appetite Suppression

by Christine on September 16th, 2011

filed under Gastric Banding Surgery

As I was reading up on the whole process behind appetite, hunger levels, and appetite suppression, I kept coming across information about a hormone called Ghrelin. This is my own take on the information that I’m reading.

Ghrelin is a hormone produced by cells in the stomach and pancreas that stimulates hunger. Before you eat a meal, ghrelin levels rize, consequently signaling to your brain “Hey man! I’m hungry!”  To turn off the ghrelin, people typically eat food; if you eat enough food, ghrelin decreases and you’re less hungry.

Ghrelin is regulated by the hypothalamus, which we have no mental control over. No amount of “willpower” can change how the hypothalamus works.  However, the gastric band can actually work to control your hypothalamus!  When normal people eat, the foo consumed stretches the upper stomach as it works its way en route to the lower stomach. When this streching happens, the hypothalamus sends out a hormone (pro-opiomelanocortin), which suppresses ghrelin. If you don’t eat, the upper stomach isn’t stretched, so you’re hungry.

With gastric band patients, when you eat, your food remains in the upper stomach for a longer than normal period, keeping the upper stomach stretched out. Consequently gastric band patients feel full after just a few bites of food.  Smart patients will quit eating soon after that, or at least moderate the amount of food that they eat. (It is very easy to get used to the “full” feeling and start to ignore it.)

This is one reason why your doctor tells you not to drink when you’re eating food. Liquids will help wash that food out of your upper stomach, into your lower stomach, thereby reducing the amount of “stretch time” you’re getting. Consequently you’re more apt to feel hungry sooner after your meal.  I would think that foods that are more fiberous, that stay in the upper stomach (take a little more time to break down), may also help you feel fuller for longer.

Interestingly, there have been a lot of studies that show that mere surgery alone can have an effect on ghrelin levels. Gastric bypass patients have been known to show an actual drop in ghrelin levels following surgery, where as gastric banding patients experience a drop in hunger but not in actual ghrelin. With sleeve gastrectomy, the area of the stomach that produces ghrelin is removed.

Researchers apparently are working on some miracle anti-obesity vaccine right now that would prevent ghrelin from reaching the central nervous system, thereby helping to suppress the appetite and preventing weight gain. Preliminary studies are being done on rodents and pigs.

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Why stress makes the gastric band tighter

by Christine on September 15th, 2011

filed under Gastric Banding Surgery

My blog reader Kris was able to link me to an article explaining why our gastric bands feel tighter when we are stressed (or PMSing).  How very interesting! The article can be found here. The answer is that the gastric band is a semi-permeable membrane that actually can absorb fluids in the body!

Often times patients will come in because their Lap-band feels too tight. They find more difficulty with some foods, and are uncomfortable. They ask me “does stress cause the band to tighten?” The answer is, yes, it does.

The biology of stress is this: when you have stress, be it physical stress (like an illness) or mental stress (like your mother-in-law coming by for a short two week visit)…the body reacts by retaining fluid. You may notice that wedding rings are tighter, and there is more swelling in the legs at night.

The balloon of the adjustable Lap-band is a semi-permeable membrane, meaning it is osmotically active. In plain English: the more water you retain,  some is transmitted to the band, so it swells.

If a patient has 5.5 cc in their band (we measure it) and they come in and it feels tighter, we find they have 6 cc in the band. Where did the ½ cc come from? That is from the extra water the body is carrying. Since the balloon on the band is semi-permeable it will retain more water also.

This is the same reason that most people find the Lap-band to be tighter in the morning. In the evening you may notice you have some swelling of your ankles – by gravity your body water has gone down to the legs.  In the morning that swelling is gone, and the water has gone back to the central compartment of the body where the band is. If we measure the band in the morning it can have 0.25 to 0.5 cc more in it (which can make a difference).

This is also why we don’t like bands being too tight. People need room for stress – of all kinds. Leaving room in the band to allow for this, means that patients will have fewer difficulties.

 

Upon further web searching, I see that there are several scientific studies that have been performed that have verified this claim, such as this one here.

This knowledge makes me realize two things: (1) When your band is too tight or too loose, don’t go running to your doctor to get it fixed right away. Give it a little time to see if the saline levels balance themselves back out. Also, (2) If you experience a “looser” band, it doesn’t necessarily mean that your band is leaking or is broken. First try increasing your fluid consumption and see if that fixes the problem. If there is a noticeable decrease in “restrictive feeling,” then go see your doctor.

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Too much restriction!

by Christine on September 14th, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

I really think this is the first time in 2.5 years that I’ve had TOO much restriction with my gastric band! And I’m not sure why.  What correlation does stress have on the band? Unless it’s getting an injection, the band is a relatively static piece of plastic. So why am I suddenly so tight I can’t keep any food down? Does stress somehow cause irritation of the stomach lining or something? That doesn’t seem like a reasonable physical response to me.

Yesterday I went to Paneras for lunch and ordered the creamy tomato soup (my favorite). And hour later I had only had 5 spoonfuls, and I had to barf the last of that up. NOT NORMAL!

I have an appointment scheduled for next week with my surgeon’s office. I had originally intended on getting a fill because I was feeling like I could eat too much and I was hungry all the time. Now, I’m wondering if I should cancel my appointment or even get a little Un-Fill?  I wonder if this will pass.

In better news…my medicine is finally kicking in, and today I feel more human than I have felt in a week. Much less depressed and much better focused.

Also–my weight is creeping back down. 130.0 today and going down by the day.

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New Tool Decides When to Authorize Weight Loss Surgery

by Christine on August 16th, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

There’s a new tool out there hitting the medical community that will help doctors determine when a person should get weight loss surgery. It’s call the Edmonton Obesity Staging System (EOSS) and you can read about it in this WebMD article here.

A selection from the article:

“When you have a waiting list, you try to think about how you prioritize people on that waiting list,” says study researcher Arya M. Sharma, MD, PhD, professor and chairman of obesity research and management at the University of Alberta, in Edmonton, Canada, “Who do you see first?”

“So we thought, maybe take the heaviest patients first because they might be the people who are sickest,” Sharma tells WebMD. “But when we looked at that closely, we found that that isn’t always true.”

Doctors call this the obesity paradox.

 

And this little tidbit:

And when researchers cross-referenced their work against death records, they found that BMI wasn’t a reliable predictor of a person’s death risk, but their EOSS score was.

 

Interesting stuff. Even more interesting is that they list a BMI of 25 or higher as the start of their criteria for the surgery. When I got the surgery, I had to have a BMI of 40 or higher!  Hells bells, I only have a BMI of 24 right now, which just barely puts me in the “Normal Weight” category; I’m only 1 point away from being obese.  In a mere six pounds more than I weigh now, I could qualify for weight loss surgery again. Man, that’s….weird.

What do you think of this new EOSS tool?  What do you think of the BMI requirement for surgery?

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Dentist Appointment & The Band

by Christine on June 21st, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

I haven’t had a dentist appointment in two years since I had my gastric banding surgery. I’m not a big fan of the dentist, and I wasn’t happy with the work my last dentist did to me, so I just haven’t gone in a while.  Yesterday I made an appointment with a new dentist and went in for a checkup with X-rays.

One of the things I really wanted to make sure I told him was about The Band and potential side-effects with barfing episodes. You see, bulimics are pretty notorious for having bad teeth. The stomach acid erodes the protective covering of the teeth. Some bulimics have chipped or broken teeth; others have teeth that start to rot away.  Google “Bulimia” and “teeth” sometime and check out some pictures. I’d post them here, but the pictures are really…ugh…super gross.

Anyway, I was concerned that perhaps during any gastric-banding-“stuck”-episodes that the same thing would occur–the acid would start to erode the lining on my teeth.  I am glad that I spoke up and mentioned it to my dentist (although, admittedly, he gave me a really funny look when I mentioned barfing and seemed dubious that it had anything to do with the gastric band). He said the first casualty is usually the front teeth, so he inspected those really closely.

Good news! No erosion going on! Hooray! He made a note in my file and will check up on that at future visits. If you are a gastric bander, consider having the same conversation with your dentist the next time you go.

But my appointment definitely wasn’t all good. I have some kind of bone loss going on underneath an old baby tooth, which is going to have to involve getting the tooth ripped out, bone installed, and an implant put in….for a price tag of just under $4,000. Yikes!  I don’t have that kind of money so that surgery is going to have to wait and be budgeted for.  When I came home and told hubby the news, he told me that he needs to have the same thing done on his mouth, too, so we actually have $8,000 worth of dental work that needs to be done between the two of us. Holy moses.

You just never get to catch a break, you know?

I actually rather like my smile. I’ve got decent teeth. My parents were kind enough to put me in braces when I was a kid (boy, if you could see pics of me as a teenager, you’d realize that I really needed braces!) so the result isn’t too bad. I’d like to be able to protect that investment and keep my teeth healthy and strong so I won’t have to deal with lost teeth when I’m an old lady!

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