Medical Weblog

1. Partitioning procedures or gastroplasties

These produce a small stomach pouch of 15-30cc connected to the lower pan of the stomach by a narrow opening or ‘stoma’. The effect of these procedures is to limit the patient to a very small meal which empties only slowly through the narrow stoma producing a feeling of satiety lasting 3-4 hours. Total daily food intake is, therefore, vastly reduced.

In order to achieve a good weight reduction with these procedures, patients must be prepared to make sacrifices and to be disciplined in the way in which they eat. This is not an easy way out and the patient must be strongly motivated to lose weight otherwise they may not feel that the sacrifices are worth while. They must:

• Adhere to a diet of easily masticated foodstuffs such as cereals, vegetables and white meats. Red meat is difficult to eat and the diet can seem boring.

• Measure food volumes and eat no more than 5 dessertspoons of food per meal. To eat more may cause vomiting and may stretch the pouch.

• Chew each small mouthful of food to a pulp before swallowing otherwise the food pieces may block the stoma causing vomiting and pain.

• Avoid high calorie semi-liquid foods such as chocolate and ice cream as these liquefy and pass rapidly through the stoma, causing weight regain or preventing weight loss.

• Avoid solids when rushed or upset as vorniting is more likely in this situation.

• Take daily multivitamins and occasionally take iron if required.

With discipline, excellent weight reduction can be achieved with the average loss being 35kg and some patients losing much more. Two common methods used are ‘stapling’ and ‘banding’.

*212\186\4*

Some scientists have decided to use a 50 grams carbohydrate portion of white bread as the reference food because it is more physiological—typical of what we actually eat On this scale, where the G.I. factor of white bread is set as 100, some foods will have a G.I. value over 100 because their effect on blood sugar levels is higher than that of bread.

The use of two standards has caused some confusion but it is possible to convert from one to the other using the factor 1.4 (100/70—white bread has a G.I. value of 70 when glucose is the reference food).

To avoid confusion throughout this book, we refer to all foods according to a standard where glucose equals 100.

he higher the G.I. factor, the higher the blood sugar levels after consumption of the food. Foods with a high G.I. usually have both a higher peak and maintain a higher blood sugar level for longer.

Rice Bubbles (G.I. factor equals 89) and baked potatoes (G.I. factor equals 85) have very high G.I. factors, meaning their effect on blood sugar levels is almost as high as that of an equal amount of pure glucose (yes, you read it correctly).

*25\33\4*

This book dispels many myths about food and carbohydrate. We now know from our scientific research into the glycaemic index that the following popular beliefs about food and carbohydrate are not true.

Myth 1. Starchy foods like bread and potatoes are fattening. Not true, bread and potatoes are rich in carbohydrate— the easiest fuel for our bodies to burn—and therefore among the best foods you can eat to help you lose weight.

Myth 2. Sugar is the worst thing for people with diabetes. Not true. Sugar and sugary foods in normal serves have no greater effect on blood sugar levels than many starchy foods. Saturated fat is far worse for people with diabetes.

Myth 3. Sugar causes diabetes. Not true, sugar has no unique role in causing diabetes. Foods that produce high blood sugar levels may increase the risk of diabetes, but sugar has only a moderate effect.

Myth 4. All starches are slowly digested in the intestine. Not true. Some starch, like that in potatoes, is digested in a flash, causing a greater rise in blood sugar than many sugar-containing foods.

Myth 5. Hunger pangs are inevitable if you want to lose weight. Not true, high carbohydrate foods, especially those with a low g.i. factor (e.g. rolled oats and pasta), will sustain the feeling of fullness almost to the next meal.

Myth 6. Sugar is fattening. Not true, sugar has no special rattening properties. It is no more likely to be turned into fat than any other carbohydrate. Sugar, which is often present in foods high in energy. And fat, may sometimes seem to be ‘turned to fat, but it’s the total energy (calories) rather than the sugar in those energy dense foods that may contribute to new stores of body fat.

Myth 7. Starches are best for optimum sports performance.

Not true, in many instances starchy foods (e.g. potatoes) are too bulky to eat in the quantities needed for active sports people.

Myth 8. Foods high in fat are more filling. Not true, recent studies show that high fat foods are

Among the least filling. It is extremely easy to ‘passively overconsume’ foods like potato chips and crisps.

Myth 9. Diets high in sugar are less nutritious. Not true, studies have shown that diets high in sugar (from a range of sources including dairy food and fruit) often have higher levels of micronutrients such as calcium, riboflavin and vitamin c than low sugar diets.

Myth 10. Sugar goes hand in hand with dietary nit. Not true, the reality is that high sugar diets are usually low in fat and vice versa. Most sources of fat in the diet are not sweetened (e.g. potato chips) and most sources of sugar contain no fat (e.g. soft drinks). Yes, there are many foods high in both fat and sugar (chocolate, ice cream, cakes, biscuits) but these usually represent less than 10 per cent of energy intake.

*1\33\4*