3 Solutions for regain after gastric sleeve

Regain after gastric sleeve is a fear for many.  Learn how following these 3 solutions can turn things around!

Check out this audio transcript

Dawn (00:00):

Hello and welcome to the gastric health show. My name is Dawn Boxell. We are going to discuss the three solutions for regaining after gastric sleeve. And this is going to dig into just some different strategies you maybe haven’t thought about at a level that impacts so many different areas of your metabolism and your body to efficiently work like it’s opposed to.

Dawn (01:00):

So let me dig into this and just really give you some different insights to strategies that you can think about and kind of how it all plays out. So here’s what we know. Everyone experiences regain for different reasons and no one is going to react the same way after gastric sleeve surgery. For example there’s many patients that don’t really follow any specific meal plan or program and flourish and lose weight and maintain it yet.

Introduction 

Dawn (01:23):

There’s others that follow everything to a T and they struggle and kind of plateau it six months and slowly watch the scale increase over the next months and years. And sometimes it doesn’t make sense. And I will tell you when you really dig into you as a person and understand that none of us are alike and we are all different when it comes to our genetics, our cellular health, our hormonal health, our bacterial level all of those influence our ability to lose and maintain weight.

Dawn (02:00):

So it’s going to impact your success with gastric sleeve surgery. And all of those, your genetics, your cellular health, your hormones, your gut bacteria are all gonna influence how well you lose weight and how easily you can regain weight. So here’s the good news though. There are solutions.

Dawn (02:40):

There are things you can do that can optimize your hormones, your cellular function, your gut bacteria, and your genes. So you don’t have to be captive to where you’re at. And there are strategies that will help you put the odds in your favor. There’s no one formula that’s going to work for every person after gastric sleeve surgery. But there are some, let’s call it just general things.

Why do some regain after gastric sleeve ?

Dawn (03:30):

Some, a big umbrella that if you really focus on these three areas you are likely to put yourself in a really good position to be able to lose any regain and set yourself up for further maintenance long term and of course, with the appropriate effort with your food and your movement and your water and your supplements this all…

Dawn (04:00):

There’s not one thing that’s going to fix it all. There’s no one pill, there’s no one diet and no one, anything that will help you lose, regain and maintain it off.  It is likely a combination of things, but we’re gonna discuss three that have a very big impact on your ability to maximize your results and influence how you change your outcomes. So if you are struggling with regaining after gastric sleeve surgery, or you never really felt like.

Dawn (04:45):

Hey, I didn’t even really lose all that. I felt like I should have lost or would have liked to have lost. Now there’s a huge difference there, but regardless I think if you look at it medically, there is still room for improvement if you still have comorbidities that need to be refined and improved, and you have other indicators that are outside of the scale. So outside of that number on the scale, because really to me, the scale is not your best indicator of where you are in your health journey.

3 core solutions for regain after gastric sleeve

Dawn (05:19):

It’s really just.. Should be just a confirmation of.. Yep. This is out of whack right now. So I would expect the scale to be higher. My hormones are off. So I would guess my.. The scale is going to be higher. So you, outside of the scale, what are some things that you can think about and work on that will put kind of the odds in your favor that you can lose the weight that you have regained, or maybe never really lost.

Dawn (06:05):

Take it from a different approach and a different view that can really help you get the results that you’re hoping for. So the three solutions for regain that we’re going to discuss are restoring gut imbalances. Improve blood sugar stabilization and decrease inflammation. And I’m gonna weave in all of those that I mentioned your genetics, your hormones, your gut bacteria, all of those and your cellular health is kind of mixed into all of them.

Dawn (06:34):

All of those are going to be interwoven in these three core areas. So gut imbalances, blood sugar stabilization, and inflammation. Those three things alone, if you can really hone in and just focus on that. You’re going to allow your body to work like it’s supposed to and optimize your results. So restore gut imbalances. So number one, correct dysbiosis. And if you followed me long enough, you have heard me talk about dysbiosis. And really dysbiosis is just an imbalance in your gut bacteria.

Firmicutes and bacteroidetes ratio 

Dawn (07:00):You have either too little good bacteria, too much bad bacteria, or you have too much bad.. Too much bacteria in the wrong location or a combination of all of those. So that’s dysbiosis just an imbalance and gut bacteria. Then also you would want to improve your Firmicutes to Bacteroidetes Ratio. And again, I’ve done videos on this as well, and this is important because they understand, even though these are beneficial, good bacteria, when they are out of balance they cause problems.

Dawn (08:04):

But what they’ve learned is that this, these two bacteria. They’re really phyla, which is bacteria, but these two Bacteroidetes & Firmicutes. When they are elevated and their ratio gets off. One is elevated or they’re both elevated. Then guess what that means? That you are going to have issues with your health and with your weight. So we..so this is a known thing. And bariatric surgery in general, we know that it flips or shifts that Firmicutes to Bacteroidetes ratio. And we know that it lowers that Firmicutes to a more normal number. Which is good. So the Firmicutes is the

Dawn (08:55):

One, whenever it’s elevated this. Whenever you have a high Firmicutes. Then that means that your body is extracting more calories from the foods you are eating. So it really makes it hard to lose weight because you are actually, you know, absorbing more from the foods you’re eating. And it also increases fat storage. So that alone really does not help you get the results that you’re hoping for when it comes to weight loss or maintenance, even. So there’s many things.. I do.

Regain, blood sugar & genetics

Dawn (09:02):

I have some videos on Firmicutes to Bacteroidetes and beneficial gut bacteria and talk about “Are you lacking this after bariatric surgery?” I think is one of the podcasts that I talk about or a video on YouTube that I talk about. So that might be a good, good place to learn more about Firmicutes to Bacteroidetes ratio.

Dawn (09:30):

This is a testable bacteria. So you can do a stool test and determine if your Firmicutes to Bacteroidetes ratio is off. And that will sometimes give you enough information to know where to go. Which direction what’s driving. My weight loss resistance, what is driving my weight gain. So if that is elevated then you will know that we just really need to work on that. And there’s a couple of strategies that are.. Evidence based that are definitely known to improve that Firmicutes to Bacteroidetes ratio.

Dawn (10:45):

So it’s just changing and shifting things that you’re doing, okay we’ve got to restore gut imbalance, correct dysbiosis and then improved Firmicutes to Bacteroidetes ratio. And then also you want to improve your gut bacteria diversity. And the diversity just means that you have lots of different bacteria represented.

How firmicutes/bacteroidets ratio impact regain

Dawn (11:14):

So there are trillions and there are multiple different species that you can have in your gut. And the more, the better. And we actually have good and bad that kind of live harmoniously in our gut and they live happily. So it’s not like you’re gonna have zero bad bacteria. That’s not necessary. That’s part of the balance of having good and bad. So that’s where kind of understanding these basics. So how do you, how do you do diversity? How do you improve gut bacteria diversity? And that really comes down to fiber. Plants, plants, and more plants.

Dawn (12:00):

So you need lots of fiber fiber fiber to accomplish diversity and variety, lots of variety of different plants will improve that. Also your nutrient levels. So, you know, making sure you don’t have deficiencies in your nutrition. Will also factor in on that piece of it as well.

Dawn (12:32):

So that’s kind of that cellular health and making sure that your, your cells are getting the vitamins and minerals. For example, so if you have a serum B12, so weight loss surgery, patients, this is a known test that we evaluate annually to make sure that you are getting adequate amounts of B12, in your supplements and in your diet and all of that.

Diversity in your gut & regain

Dawn (13:00):

So there’s a serum level and that tells us what’s circulating in your blood, but there’s a better indicator that’s telling us, what’s getting inside the cell. And that’s methylmalonic acid, MMA. And that is a better indicator. I, I need both because I need to see what’s available with your intake. Is it adequate enough? But then I also got a see, do you have the ability to get it into your cells? So that’s kind of the cellular piece that matters and that happens in your gut as well and at a cellular level.

Dawn (13:39):

So.. here we go Gut bacteria, diversity fiber plants, you need lots of that. You also need resistant starch, and I’ve done videos on this as well. If you just kind a search for resistant starch. I talk mostly, or one that I enjoy talking about on resistant starch is potatoes. So potatoes get a bad rap. But in essence, if you choose the right type of potatoes, they actually help you.

Dawn (04:07):

They actually grow the diversity in your gut and you have more variety of bacteria. And so that is where you cook a potato. You chill it and that chilling kind of balls up that starch molecule, and it will be resistant to digestion. So that makes it act more like a prebiotic and helps grow the short chain fatty acids that help our health. So increase the resistant starch.

How to know if inflammation is causing regain

Dawn (14:54):

So potato salad over potato chips, fries, mashed potatoes, baked potatoes, all of those. Potato salad is the best choice. So that’s a side note. The next one is increasing short chain fatty acids. And I just mentioned this, but these actually are produced. They are kind of the byproduct of what happens when we eat undigestible fibers. So those are the FODMAPs. So the fermentable oligosaccharides, disaccharides monosaccharides and polyols.

Dawn (15:30):

So all of those are different types of fibers that will actually increase the short chain fatty acids that our gut bacteria produce. And guess what? That lowers inflammation in your gut, and it improves your gut wall integrity. So it helps those tight junctions with making it so that you can protect yourself from viruses and diseases and autoimmune diseases and food allergies and sensitivities and histamine reactions and all kinds of things that cause our, our gut wall to break down and cause disease.

Dawn (16:27):

So think of it, like we call it test increased intestinal permeability but you’re probably more familiar with hearing it as a leaky gut. So that again, increasing those short chain fatty acids, because you’re increasing diversity. With your different types of fibers and plants with the variety. Then you are setting yourself up for a healthy gut long term. I mean, it’s really going to make a difference. The next one is to help improve diversity is add polyphenols. So polyphenols are those foods that are dark in color, dark purple, blue and red.

Great sources of polyphenols

Dawn (17:04):

So cherries, blueberries, raspberries all of those deep rich colors are, are great sources of polyphenols. And guess what polyphenols boost Akkermansia Muciniphilia and Akkermansia is associated with a healthier metabolism and butter and better blood sugar balance. So this is kind of a newer bacteria that they are discovering that they realize that this is a game changer for weight.

Dawn (17:30):

So we know that Akkermansia plays a role in your metabolism. We don’t yet know at how this all works, but they are really finding some, some interesting evidence about this bacteria. That really does benefit you when it comes to weight loss and blood sugar balance. They have realized that they have an affinity for these polyphenol foods. The things that are really rich in polyphenols, it makes them grow and that will help improve your diversity.

Dawn (18:25):

So more Akkermansia or higher levers of, of Akkermansia is going to benefit your metabolism. And as a side note, I will say that what they do know about after bariatric surgery, they know that and this is a piece for gastric sleeve is we know that after a Roux-en-Y gastric bypass, the Akkermansia actually increases. But it does not change after a gastric sleeve. So again, we don’t understand all of this yet.

Regain & inflammation

Dawn (19:13):

We just know that this occurs. So that will be fun to understand as that grows in research.  okay, add polyphenols. We’re improving the gut bacteria with fiber resistant starch increasing the short chain, fatty acids and adding polyphenols. All of those are going to help improve diversity in your gut and which translates into improving metabolism and improving your overall gut health and weight loss and losing and weight loss resistance and, and losing weight, all of that.

Dawn (20:03):

The next thing that is influenced in your gut or another area that needs to be evaluated or potentially restored because this isn’t a common thing that can happen with females. So Beta Glucaronidase is a stool marker of estrogen metabolism, and this is associated with.. So when you have elevated levels of Beta Glucaronidase in your stool test. This is going to tell you that you have dysbiosis and maybe potentially SIBO.

Dawn (20:37):

So you would probably need to do like a breath test when they are elevated. And then it’s also an indicator that you are having issues with phase two detoxification in your liver. There’s some liver connection with this indicator, again, that all plays a role with inflammation and your gut. knowing, so we know that your hormones are rooted in your gut, if you feel like your hormones are off.

Stress hormones & regain

Dawn (21:13):

So think of estrogen, testosterone, progesterone even you have to weave in the stress hormones like cortisol and DHEA. All of those are important to understand, and they’re all going to be influenced by what’s happening in the gut. So if your gut is if you have dysbiosis, you are likely going to have hormone regulation issues. So the first and foremost, if you feel like, Hey, my hormones are off, I’m a little tearful. I’m a little crabby. I’m emotional. I don’t manage my cycle very well.

Dawn (21:55):

Guess what you would want to start with cleaning up your gut and fixing that. So if you feel like, Hey yeah, I’m having some hormone issues. That would be a good thing to evaluate. To find out if, Hey, maybe I might need to tweak and support myself a little differently. Okay. So we’ve made it through the restore, your gut imbalances.

Dawn (23:08):

So it’s, again, it makes it easier for you to increase your fat storage when that insulin level is, is sta.. Having to show up to rescue all this excess sugar that is in your bloodstream. It.. It has to correct it. And when it can’t, then guess what you have high blood glucose numbers. So that’s when it becomes problematic and you have issues. So stabilizing, these blood sugars are super important but they also have a genetic component.

How to support a healthy metabolism for regain

Dawn (23:43):

So your genes can influence how you regulate blood sugar and how well you can stabilize your own blood sugar. So let me give you a few examples. We’re not gonna go too crazy, but the SLC2A2 this one is associated with impaired insulin metabolism and type two diabetes with increased insulin response to sugar and refined carbohydrates. So if you have this genetic snp and certain alleles, not both alleles. But so this snip in general is going to be think of it as you’re, it’s going to react more rapidly and dramatically.

Dawn (24:40):

So think of like a two year old tantrum. It’s going to react. When you have this genetic snp that you are going, your blood glucose is going to respond more dramatically with eating sugar and refined carbs. So that’s where you may find that I have to be super careful with how often I have real sugar and how often I have those carbohydrates that don’t have natural fibers in them. So the refined carbohydrates, we want complex carbohydrates.

Dawn (25:13):

Those are the fibers and the plants that help grow our gut bacteria diversity and help us with blood sugar regulation. So you want those but not the refined carbs. And those are like snack, crackers and chips, and you know, white bread and that just have a lot of added sugar and things in them. So those refined things are not helpful and your body is going to react more dramatically.

Blood sugar stabilization and regain

Dawn (25:48):

If you have that genetic snp, another one is PPAR, and it is a major regulator of glucose stabilization, lipid metabolism, and vascular inflammation. So again, this one does play a role in your body’s natural ability to stabilize blood sugar. And if you have this genetic snp, a certain allele. Then you will be more prone to having type two diabetes and just struggling with your blood sugar balance.

Dawn (26:33):

So it just helps you understand that, Hey, I might have to approach food differently to manage this disease state that I have. So one thing that I do wanna say is all the genetics that I discuss are not the high impact genetics. These are the, the low impact that are not going to, you know, it’s not like you have a genetic defect. The ones I discuss you can influence with diet, lifestyle, supplements, isolated nutrients you have the ability to change this.

Dawn (27:06):

So in the genetic world, we say that your genes load the gun and your diet, lifestyle and environment pulls the trigger. So if you have these genetic snps, that doesn’t mean that you’re doomed and you have nothing you can do about it. No, there’s a lot you can do about them. These are influenced. These genetic snps can be influenced. They can change and shift and turn off and turn on based on what we’re doing with our diet and lifestyle and nutrients.

Check that insulin

Dawn (27:43):

So correcting some things is maybe all you need. You just have to think about going upstream to the gene that is maybe having issues so that we can silence it so that it’s not being so noisy.. To put it simply. So, so those are blood sugar stabilization. I mean, it’s going to help you with your cravings. It’s going to improve that insulin level and prevent that need.

Dawn (28:16):

And, you know, if that would be a great indicator is checking that insulin level, having your doctor check that insulin level, not just your hemoglobin A1C or your, your fasting blood glucose. Check that insulin. And it should be definitely less than 10 and more ideally in the two to five range to have optimal health outcomes. And I think, again, that goes back to genetics and all the other factors that contribute to that.

Dawn (28:49):

But for most people, if you get it closer to that five, you’re probably gonna feel the best and be able to manage your disease states pretty easily. Okay, number three is decrease inflammation and this gets woven back into blood sugar stabilization and your gut bacteria. All, again, these are all interwoven with each other. So fixing one helps the other in a way.

Regain & inflammation

Dawn (29:26):

So decrease inflammation, I, and you can do this by restoring your gut balance. It will help prevent that low grade inflammation. So we know obesity in general is just a chronic low grade inflammation that occurs. By fixing the gut dysbiosis that will help improve your inflamatory markers. Plants are considered anti-inflammatory. So again, that goes back to your gut diversity. So the more plants you eat in a week the better.

Dawn (39:13):

Some feel and say, and find that hitting 30 to 40 different types of plants a week is going to give you the diversity that you need. So there’s a challenge for you. So, okay, so plants are anti-inflammatory and then also a thing to consider when it comes to decreasing inflammation is lowering your histamine levels. And because histamine, everyone has a histamine response and some of us can manage it better than others at a genetic level.

Dawn (30:49):

And I’ll cover that in a minute. But high levels of histamine impacts your inflammatory responses. And one thing that can really increase histamine, especially in bariatric patients, gastric sleeve included is SIBO, small intestinal bacterial overgrowth that we mentioned with the gut dysbiosis that is also an area that increases.

Histamine response

Dawn (31:13):

So if you have SIBO, you could easily, not everyone that has SIBO has high levels of histamine, but some of you will experience high histamine likely because of your genetics is contributing to that. But if you get you, you lower the burden of the bacteria in your small intestines, and you don’t have the overgrowth, you get that in a better place. It’s not an infection, it’s just an overgrowth then that allows you to lower that histamine level and that histamine response. Okay. The next one is blood sugar stabilization can lower inflammation.

Dawn (32:05):

So anytime that your blood sugar is chronically elevated, you’re going to have inflammation. It is accompanied with inflammation. Our body is not intended to have high levels of blood glucose. So that’s why it’s important to go back to that. Number two, blood sugar stabilization. So to decrease inflammation, it’s probably helpful to check a few levels. You can check your CRP, which is just a blood test, and this is kind of an, an acute in a chronic inflammatory marker.

Dawn (32:43):

So it can tell us, Hey, you’ve had some inflammation going on for a little while. So it, and, and you have inflammation right now. And that’s just a great way to discover if I have inflammation issues. There’s also a stool test that can identify microbial inflammation. So if we know that your calprotectin is elevated we know that there is some inflammation in your gut and you will likely have a lot of digestive problems. Then also genetics.

Regain inflammation & genetics

Dawn (33:18):

So there are certain SNPs that can tell, can tell you how your body manages the inflammatory responses. One is DAO diamine oxidase. And this one is just when you have a deficiency it’s linked to a histamine intolerance. So this is what kind of captures that excess histamine and keeps it in, in check. Keeps you where it’s not causing you havoc. Another one is HMNT plays a role in histamine degradation. And so this one, if you have this genetic snp a certain allele you will struggle to break that down. So if you have both of those histamine issues are going to be a, a big problem. Those are the people that get hives and have allergic reactions to things and flushing. They have exercise intolerance will be red. So, you know, it’s a genetic based thing.

Dawn (34:24):

And then also TNF alpha TNFA TNF alpha. Is tumor, necrosis factor alpha and it plays a role in regulating inflammatory pathways. if you have that, then this snp, then you have kind of the it, it’s going to tell you if you are good at managing your inflammation or do a poor job at managing your inflammation, again, you know, we’re all genetically different. So it’s hard to say unless, you know, those genetics.

Dawn (35:13):

So those three areas, restore gut and balances, improve blood sugar stabilization and decrease inflammation. Those three things will set a huge impactful foundation that will allow you to manage your regain and get it back under control and actually start losing weight again. It’s just, if you understand these three things, these three areas, and really put ’em into practice, you know, if you followed me, I’m not a believer in perfection, but you’re intentional.

How to restore gut balance to improve regain

Dawn (35:43):

You are trying, and you are working towards fixing, correcting and influencing these areas. You are going to see weight loss. It is going to help you even years after bariatric surgery. If we correct these areas, you are going to have weight loss. So if you feel like you are struggling with regain and you haven’t experienced any, you haven’t experienced success, like you would have liked to. With the strategies you’ve implemented.

Dawn (36:13):

I would strongly urge you to consider these three areas to evaluate, correct, and stabilize so that you can get the results that you’re hoping for. If you need help I’d encourage you to join our next free bariatric regain tuneup. We are going to help guide you through these three steps and help you figure out what do I need, what’s out of balance. And what can I tweak? What do I need to tweak? So that you actually can get the weight loss that you are desiring.

Dawn (36:59):

So I hope that has helped. I know this is a long one this time, but I really hope this has I’ve broken it down well enough that you can see the importance of just these three basics and why it matters to your overall success with weight loss after gastric sleeve. So hope to talk to all you guys soon, have a good day bye bye.
Your future health awaits…