Does hunger mean your bariatric surgery is broken?

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell. This week we are talking about the topic of hunger after bariatric surgery. And the title is, does hunger mean Your Bariatric Surgery is broken? Now first off, I want you to understand that hunger is very normal and nope, your bariatric surgery is not broken. You see hunger is just really physiological and it occurs because of biological changes throughout your body and these signal your desire or need to eat so that you can maintain energy levels.

Dawn (01:00):

So our bodies require fuel and calories to sustain just normal body processes that our body doesn’t even have to think about doing things like breathing, your heart beating, digesting your food and the list goes on and on. So you can see that hunger is a necessary cue that your body should experience having bariatric surgery has created this thought that hunger is bad and hunger is not bad.

Dawn (01:27):

Hunger is a normal process that you should feel and experience, but guess what? Not everyone experiences hunger the same. So although it’s normal and you should experience it, all of us have different hunger cues that drive the need to eat. And some of them really are driven at a genetic level. So before bariatric surgery, some experience hunger that is never satisfied. And then others have kind of the normal hunger cues allowing them to eat the standard three meals a day and then a small group rarely even notice hunger until maybe the evening hours.

Dawn (02:10):

But they’re still seeking bariatric surgery because one, their health is compromised usually because or in combination of the obesity that they’re experiencing. So I’m sure you’ve witnessed several examples of this from obese to normal weight individuals you may know normal weight individuals who have high hunger levels but they manage it in different ways so that they don’t have obesity.

Dawn (02:59):

Having one doesn’t mean you will get the other. If you are experiencing hunger after bariatric surgery, that is not a red flag that oh no, I’m going to start gaining weight again. That’s where you have to separate those and know that really it’s at a deeper level and it really could be just your genetics or it could be kind of some of the other things that I’ll talk about on a different podcast like your appetite or cravings those types of things which are similar but different. The purpose of this talk is really about hunger and really helping you understand that hunger is normal and hunger is necessary. So don’t get confused in thinking that because hunger returns means that weight is going to return because that is just not true. So use those hunger cues as a signal to investigate what have I been eating?

Four simple reasons you may experience more hunger

Dawn (04:09):

Am I meeting my body’s needs? Or what has maybe changed? And that’s why I wanna dig in I to, I’m going to discuss some of the genetics, but I’m also going to cover just some simple reasons why you may experience more hunger. And number one is you’ve recently changed your workouts. Number two, you are consuming more protein shakes instead of solid, solid dense protein. And number three, your fiber and fat intake are too low.

Dawn (04:49):

And number four is a medication has a side effect of hunger. So let’s start with the exercise and hunger and increasing or changing your workout routine can affect your hunger. And if you exercise more frequently or more intensely, you may experience more hunger to kind of compensate for the excess calories and nutrients that your body has burned. So your body might naturally say, I need some more fuel. Now some of you may be thinking, okay, well aren’t you supposed to restrict those hungers to maximize weight loss?

Dawn (05:25):

And I would say the answer is it depends because this is where you have to work with your bariatric dietician because you need a professional to evaluate your true needs. There’s not one magic formula or protein goal or calorie number that can be utilized for all bariatric patients. You have to personalize this and having hunger after working out more, you might need to increase what you are consuming.

Dawn (05:49):

So that’s where working with a practitioner like myself or someone from your bariatric team that is a registered dietician, they can completely give you adequate guidelines and kind of just a real approach that can work just for you. So the goal is when you’re exercising is you don’t want to lose muscle mass. You want to help maintain it or build it, whatever your’re working towards whatever your health goals are or whatever your body needs are.

Exercise and hunger

Dawn (06:38):

So if you don’t sometimes actually tune into that hunger and actually start eating more food you might miss out on that opportunity because you’re not meeting your protein goals that you’re not going to be able to build muscle because you’re not going to be fueling your body adequately. So again, hunger is not a bad thing and that’s where first identifying these simple things and ruling those out is so important. The next one is we’re going to roll right into protein and hunger.

Dawn (07:09):

So we’ve talked about working out but now protein and hunger and protein shakes are kind of a necessary evil right after bariatric surgery. Without them, your meeting your protein needs will likely be impossible especially right after surgery. But as you transition into more solid dense foods that’s where those protein shakes should get less and can even get to zero. There’s no need to maintain protein shakes for the rest of your life in some scenarios.

Dawn (08:01):

Now don’t get me wrong, I’m not against them. I think they have a time and a place and I utilize certain protein powders with my patients. So don’t, don’t get misinformed with what I’m saying. You need protein. And for some individuals they get, I guess misdirected or confused or just scared out of fear a responsive fear of weight gain. They utilize liquid protein shakes for many meals, sometimes too many meals sometimes.

Dawn (09:09):

Now I’m not opposed to grabbing a protein shake or a protein smoothie for a meal when you are on the go and you’re otherwise going to skip it or you just don’t have time to consume a meal that is real life, use a protein shake, make a protein smoothie and I prefer protein smoothies because you can kind of meat more of your nutrient goals by adding in some frozen fruit and some flax seed or some hemp seeds or a good protein powder or some healthy fats and then some type of vegetable.

Protein and hunger

Dawn (09:29):

Those are great ways to meet your nutrient needs protein wise, but as well as fiber and healthy fats and polyphenols and antioxidants and all those properties and compounds that you will likely not get from just a straight protein shake that you grab and go at the convenience store. So that’s why I’m a pusher or a believer in protein smoothies because to me it’s more about the nutrients that you aren’t getting when you do just those grab and go.

Dawn (10:09):

Again, protein, you need solid dense protein. Not just liquid protein shakes. So if you are noticing, hey, I am hungry and I’m several months or maybe even several years out of bariatric surgery, you just have to ask yourself, how many ounces of solid dense meat do I consume in a day? Cuz maybe you’re having some tolerance issues with protein and you just don’t tolerate meats very well, so you just don’t eat it very often.

Dawn (10:38):

This can quickly cause hunger. So if you are not even eating a solid dense meat once a day, you may find that your hunger is increased. So that’s why it is important again to work with a bariatric dietician. Find a registered dietician that you can connect with like myself, who can help you dial in the right amount of protein for your body based on your lifestyle and your health goals and your medical conditions and you’re aging.

Dawn (11:09):

Because as we age, we start losing muscle mass. So we have to support that so that we don’t lose our muscle so that we know is important. The next one is fiber, fat and hunger. And I know that we as dieticians really push the protein piece, but I will tell you that fiber and healthy fats are just as important and you have to find ways to get these in as well.

Fiber, fat & hunger

Dawn (11:51):

So and fat are two kind of food properties that really do play a role in how much hunger you may feel. And consuming more non fiber filled carbohydrates can lead to increased hunger. So more of those refined star cheer foods. If that’s what you’re consuming more of, then you may find that you do feel more hunger.

Dawn (12:29):

So that’s where again, it’s evaluating what am I doing working with a registered dietician and really just honing in on what you are currently taking in and evaluating, what else could I do to fix this? Do I need more fiber or do I need more healthy fats? And additionally, I want to discuss this that many of you may have a fear of adding fats to your diet and if you’re still under the belief that fats are bad for you or fats or eating fat will make you fat.

Dawn (12:58):

I want you to know that that is no longer a belief or a thought process. We know with many research studies that this was misguided by the heart association and they’ve kind of recanted their stance and their belief has shifted and they do feel like that more of the heart disease is driven by the refined carbohydrates and not the fats in cholesterol. So if you’re still under that belief that these fats are bad.

Dawn (13:39):

I want to encourage you to maybe go to the heart association’s website or just really start digging into why your body does need healthy fats. And healthy fats are what make all of our hormones. So if you don’t consume adequate fats you’re going to influence your hormones. But additionally, there are certain fats that can really influence your gut microbiome and your gut bacteria in a positive way. So it’s, it’s something that I challenge you to learn more about and ask more questions.

Saturated fats

Dawn (14:23):

I’d be happy to answer any questions on fats and why you do need them. I prefer you have a little bit of each meal but definitely every day you need to be incorporating in healthy fats. So these are things like olive oil, avocado oil, avocados, nuts, seeds, olives, fatty fish. These are all great healthy fats that you can incorporate into your daily diet and it can help maintain normal hunger cues.

Dawn (14:59):

So making sure that you have adequate fiber and adequate fats is a great way to address hunger. So if you are like, okay, I really don’t consume any fat I really try to stay low fat, I buy non-fat cheese or non-fat dairy I would challenge you and encourage you to up that and start incorporating in more of those fats. Now those dairy fats are saturated, so I would strongly encourage you to do more of the Mediterranean type of oils like olive and avocado oils instead of the saturated.

Dawn (15:38):

I’m not against you having dairy foods but keep in mind they are saturated fats. So you wanna get more unsaturated fats than saturated and that will provide you with a better approach, especially if you don’t know your genetics cuz certain genes can handle a little more saturated fats than others. So that’s where it’s good to take kind of the middle road and do more Mediterranean oils so that you stay safe in your choices.

Dawn (16:19):

The next one is medication and hunger. And keep this in mind. If you are experiencing more hunger, you need to evaluate, have my medications recently changed or been started? And maybe some of those are driving your increased hunger. So check with your pharmacist, check with the prescribing provider and ask, Hey, is this medication capable of making me feel more hunger? And they can help you determine if there’s a better medication available that won’t influence your hunger not just obesity but hunger.

Medication & hunger

Dawn (16:58):

Cause if this makes you feel an more hungry at times, of course it’s going to lead to obesity because you’re going to need and have to eat more frequently or more food at a sitting. So again, working with your providers on optimizing the medications that you’re taking that can at least minimize the amount of hunger that you experience.

Dawn (17:29):

And then the next or last area is going into the genetics and hunger. And I will tell you that genetics is kind of where I began to look at hunger through a different lens. I truly saw that some individuals are just genetically designed to experience more hunger. And so it doesn’t mean that you don’t have willpower or you know are always going to fail at dieting or you have a broken bariatric surgery it is, or that even that you can’t do anything about a gene that drives more hunger.

Dawn (18:16):

Can our genes really just load the gun and our epigenetics, which means our diet and our lifestyle pull the trigger. So it doesn’t mean that you can’t turn it back off. If one of the hungry genes has been turned on working with a provider like myself can help you turn that back off and with very intentional approach and very guided instructions on how to do this so that you can get that hunger back under control.

Dawn (19:09):

So in reality, everyone experiences hunger differently and it’s very, hunger is very unique to you. So all of us have a genetic background that no one else owns. It’s only us. We are the only person in this entire world that has this genetic makeup. So I promise you, I will not be dismissive if you say that, Hey, I feel hunger, I have hunger more than I feel satisfied.

Genetics and hunger

Dawn (19:38):

I believe you because that is probably a cue for me to say, you may have one of these what we call hungry genes that really can drive you to a space of hunger that is difficult. Again, it doesn’t mean that it can’t be turn back off, but at some point you have to ask yourself, okay, I’m hungry. I have hunger more than I feel satisfied. What has happened? And that’s where you have to timeline it and go back through the last 3, 6, 12 months and evaluate what has happened in my life.

Dawn (20:09):

Could something have turned this gene back on? Because again, the epigenetics, the diet, the lifestyle, our environment our exposures, our experiences, a trauma a big life event, stressors, all of those things can turn genes on. So that’s where you have to say, okay, what has maybe contributed to this? I’ve ruled out all these simple things, the protein, the fibers, the fat, the medications, my exercise, I’ve addressed all of those, and genetics may be where it is.

Dawn (20:58):

So that’s where you have to say, okay, what has driven it and what can we do about it? So the good news is they can be turn back off and you can feel satisfaction with the foods that you consume it. It might require you to be a little more intentional and to be more guided in your choices for especially a period of time to get that gene back in line.

Dawn (21:29):

But there are solutions, and that’s what I want you to feel empowered with is just because you’re having hunger doesn’t mean that we can’t fix it and we can’t do something about it. And it definitely doesn’t mean that your bariatric surgery is broken, it just really means that you’re human and there are things happen in your life. And usually I try to get you to look through the lens of what in your life is out of balance.

What has happened that has created this imbalance?

Dawn (22:00):

And if you were in the bariatric Symposium, I presented on this, this was the whole topic of kind of cravings and hunger and appetite, and I kind of dove into this topic of what in your life is out of balance? That’s what you have to ask yourself. What has happened that has created this imbalance? So let’s dig into, it’s just the three genes that I am addressing for hunger. I’m truly only discussing the hungry genes.

Dawn (22:39):

I will be discussing about appetite and cravings and those genes as well and what drives that. But that will be in the next few weeks, I will get into those topics because all the. Although these are all similar, they are different and they do present in a different way and they do have some strategies that can be tweak because of the differences in this and approach may be a little bit different for a craving than a hunger for me. Same with appetite.

Dawn (23:19):

I’m going to address these differently for some people and some people might experience all of them, so I might have to weave in strategies to address all of these. So let’s dig into these genes. So the first gene is MC4R. And the carriers of the MC4R gene have weaker satiety signals and increased calorie intake.

Dawn (23:41):

Now, I want you to know that you should never treat an isolated gene. So just because you have this genetic snp it doesn’t necessarily mean that we have to do anything different. Now if hunger becomes the issue of course we’re going to look at MC4R gene. And evaluate what should we do differently than what you are doing currently. But just know that that genes don’t work independently, they’re influence by other pathways.

Dawn (24:09):

So we have to, for me, yeah, if I see that you have the mc for our gene. I’m not going to freak out. I’m going to start looking at other pathways to determine is this something that’s going to be a problem. Or is this the bigger problem? And if I can just switch this gene back off, then we should get these other pathways in line as well. So I hope that makes sense.

The genetic SNP doesn’t always mean you will experience hunger

Dawn (24:47):

But just having this genetic SNP doesn’t always mean you will experience hunger. And if you have it we might have to just approach food a little differently and. Include foods that digest more slowly like protein, fiber, and fats to help control hunger more optimally. The next gene is FTO. And this was actually the first obesity susceptibility gene identify. And the good news is it is very highly responsive to diet and lifestyle interventions.

Dawn (25:19):

I have this gene I would assume I have not done the genetics of my siblings or. My parents or extended family. But I would assume this is definitely a gene that is in a lot of my family and. He cool thing is that it just because. You have this obesity gene it doesn’t necessarily mean that again has to be turn on. But if you have it and you are experiencing more hunger. Than this is where really dialing in with a practitioner like myself to help you maintain a blood sugar balance. And consuming more nourishing meals and then moving your body more can really help with normal hunger cues.

Dawn (26:26):

So again, it’s all about the approach and helping those signals. Not stand out or be so loud when it comes to hunger. The last genetic SNP is APOA2 and it is the second most abundant a lipoprotein in the HDL. So we’re all familiar with the good and bad cholesterol, LDL and HDL. And HDL is the good cholesterol. So I’m sure you’ve heard that before. But they additionally play a complex and really relatively. Undefined role in lipoprotein metabolism, satiety obesity, insulin resistance, and atherosclerosis susceptibility.

Dawn (27:09):

So not to mention that you may be likely to consume more fat containing meals when you have this gene. It’s like you’re going to be more drawn to fatty foods, especially saturated fats. So that’s where you have to think about those dairy foods. I remember a patient that came in, gosh, years ago and. She was literally having 12 servings of dairy a day and. She had hives and she was having food allergic symptoms as well as sensitivities.

Mediterranean oils and its uses

Dawn (28:02):

She had all kinds of congestion and ear infections and sinus problems. And it was almost like because of the queso morphines that are in it. For some people it can almost be trigger like an addictive response. And for her, that’s really what it was playing out to be more like an addictive response. Because she was just beside herself at the thought of even just cutting it in half and decreasing. What she was consuming because her body was obviously not tolerating it.

Dawn (28:39):

Well there she was not her body needed a break. So sometimes because of this gene. You may find that you’re drawn to more of those saturated  fats like in dairy. But it may also be other saturated fats. That are out on the market like butter or like a coconut oil or something. And it’s not that saturated fats are bad. But for some people your genetic makeup doesn’t allow you to process these well. In this case this is where the me Mediterranean oils would be super important. Because this is going to help you maintain good healthy fats. But yet not consume too many of the saturated fats.

Dawn (29:37):

And it can help satisfy that fatty desire, the fatty foods that you’re interest in. But in a more healthy version with an olive oil or an avocado oil or just olives or avocados. So it’s a great way to still get healthy fats that can help with hunger. But yet not compromise your fat metabolism or the lipoprotein metabolism. Regardless if you have this genetic snp, your body has to have healthy fats. So don’t avoid the healthy fats thinking that this is a good approach for hunger.

Dawn (30:09):

That’s kind of the opposite. Just keep your saturated fats low and consume more Mediterranean oils and fats and it will all work out. So let’s kind of wrap this up because hopefully we’ve maybe brought to light some reasons. Why you are experiencing hunger after bariatric surgery that in your mind you felt was bad or wrong. That you shouldn’t experience hunger and that you are doing something wrong.

Dawn (30:31):

But I want you to see that hunger is a normal biological function and. Everyone should experience hunger even after bariatric surgery. And really additionally, your hunger is going to be very unique to you. And that’s because of the genetics you were given. So even when hunger returns after bariatric surgery, although very normal. Your hunger may be different than another bariatric patient because of your genetics.

Dawn (31:39):

You may have these genetic SNPs that are driving it. And that’s where working, again with a practitioner like myself. Who can help guide you on how to switch off these genes. And really get your hunger back in control so that you feel satiated and feel just more satisfied with eating. One, you just remove that burden of thinking that you’ve done something wrong. When it’s a normal thing that should occur. So hopefully first, remove all the simple things first.

Conclusion of hunger mean your bariatric surgery

Dawn (32:21):

Compare, has my exercise or medications changed? Am I consuming more liquid protein shakes instead of solid, dense meats? Am I not getting enough fiber and healthy fats and fix those first or address those first? And then if you’re still having issues with hunger. Then that’s where working with a provider like myself checking out our gastric health membership. I would say this is probably your best option. It’s the best value because I can work with you at a. It’s a high value because you get access to me at unlimited visits that we can work through this.

Dawn (33:09):

We can come up with a strategy with or without a genetic test. I love the genetic test. But I know that not every person is going to want or desire to have a genetic test. And that’s okay by me. We may not be able to dial it in as personal without it. But we can at least get you going in the right direction so that you do feel good with. Here Your hunger level is regardless of your genes. And we’ll get you in a place that you feel fabulous after bariatric surgery.

Dawn (33:49):

So I really hope this has helped in giving you kind of a different perspective. When it comes to hunger and realize that your surgery isn’t broke and there’s absolutely nothing wrong with you. And don’t compare yourself to another bariatric patient because you. May likely carry one of these genetic SNPs that is driving it. So I hope that helps and you guys have a great week and we will see you next time. Bye-bye.
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