Muscle Weighs More than Fat

Stop me if you've heard this one before. You're dieting and you watch the scale and see that you lose nothing despite your efforts, or worse, you're gaining weight. You complain to a friend about it and she says, "Well, muscle weighs more than fat."

Yes, there was a recent comment that said this, but that's not what prompted this blog post. I was thinking about this because while at Barnes and Noble the other day I found a book in the new releases discussing diet myths and this was one of them.

I didn't get a chance to read it or find out the "truth", but I saw the myth.

When I do get the book...it's cheaper online...I'll probably post something about it.

I did a quick check online for information on fat and muscle. The obvious answer I found was that they weigh the same. One pound of fat is the same as one pound of muscle, just like a pound of feathers weigh the same as a one-pound pile of sand.

I found some information at sites like MSN Health and Healthscience. A quick Google for "does muscle weigh more than fat" yields plenty of hits...just a word of advice: if you're looking this up because you heard this through the grapevine and want to find information on it, avoid hits that take you to forums where any yahoo is posting the same rumor over and over. It's often counterproductive.

Anyway the sites I read about the topic seemed to agree on a couple key points:

One, fluid levels vary your weight more than fat or muscle gain and loss.

Two, if you were gaining muscle without using the stuff that comes in bottles or syringes, you were taking in more calories than you needed to maintain your body weight. It is implied that if you're dieting and taking in fewer calories than necessary to maintain your body weight then you aren't gaining muscle mass since you need more raw material from which to actually build the proteins comprising muscle tissue.

Articles I found also implied that muscle is denser than fat, so it is possible to have a similar weight while losing inches. The only problem is that it takes time to gain significant muscle mass. So if you're gaining three or four pounds in a week, it's either water weight (or some kind of fluid weight) or you're just plain eating more than you think.

The healthscience site even said that "The amount of muscle someone may gain in a year on a truly healthy diet without supplements/medication and/or excessive protein, is actually quite small and for a women (sic) may be 8-10 lbs in a year and for a man a little more. Divide that by 52 and that is about what you may be gaining in a week, on average."

Like I said, I'll probably revisit this topic a bit if/when I get that book on myths for dieting. But I thought this would be a little food for thought. I know I've been thinking about it ever since I read that blurb on the book jacket.

Stupid Body

Every workday I get up and shuffle out to the living room and take my medications.

I pack up two 1-cup size ziplock containers, one for breakfast, one for lunch. I try to put a calcium and protein source into each; often this includes cheese and ham or some chicken. But these fit into 1-cup containers. If the foods were pureed they would end up taking up less than a cup.

At night I have approximately a cup or less of food. Sometimes a mini-sandwich, or some kind of a soup. Leftovers. Again, meat and cheese often fill the meal. With birthdays and such coming up we've been eating out and I've had a small portion of the food before packing the rest into a box to take home. Recently my wife and I were at Olive Garden for lunch and we had an entrée split between us, and we each ended up eating half of our meals and taking the rest home, so we had about a quarter of a lunch entrée as meals.

I drink water, I drink water with Kellogg's black-tea flavored protein powder mixed in, some milk during the day, no soda, no alcohol, no juices.

And yet for the past several days I gained a pound and a half and at this point have lost a pound of it. I have been taking my weight once every other day and since maybe the 7th or so I gained a pound and a half and slowly lost a pound of it. Maybe if I repeat it enough it'll make sense.

I'm eating a cup of food three times a day, no snacks, and I've gained weight. Huh?

How does that work?

How can I possibly have enough calories in me to sustain a 340-something pound body weight?

Is there food just slowly percolating through the intestines, thus adding weight?

Is there sodium causing me to retain fluids?

Is there some really screwing form of plateau going on, or the body adjusting to foods, solid foods, in the diet?

Am I really that screwed up?

I'm hoping this is something kind of "normal" in adjustment. I need to find a support group at my next doctor's appointment which happens to be coming up in two days. Am I supposed to just "stay the course" and hope the body finishes adjusting and continues losing weight? I can't see how, possibly, I can maintain my current body weight with my food intake.

If anyone else out there has had the surgery and knows what I'm talking about or has had this happen to them, please let me know. I'm a little over a month from surgery; a month and a week, almost, so why would I be plateauing now??

It's Just A Tool

I don't know if I mentioned this before, but there seems to be many people who think that Weight Loss Surgery is a magic bullet solution to obesity.

It's not.

When I was pre-bariatric, I never felt full. Well, rarely did I feel full. I think I could eat an entire pizza and not feel sick. A footlong hoagie an bag of Doritos was hardly a challenge. It just didn't stop.

But I could feel hungry.

Head hunger, physical hunger, wanting more...but not full. Like The Hacker's Diet postulates, it's as if the "full" side of the body's thermostat is broken. Maybe my stomach was stretched from years of abuse, or maybe it was a natural tendency to keep shoveling it in, I don't know. But I know that when your thermostat doesn't work right it makes dieting a lot more difficult than it is for the normals to lose a few pounds.

Weight loss surgery is a tool to help you learn new habits, a new lifestyle, by "resetting" your thermostat. It won't cure your mental issues. It won't be bulletproof. And because of individual differences, the effectiveness and side effects are all individual as well, so just because one patient may throw up from eating too much another patient may not feel any discomfort.

I have far less physical hunger. I have not had dumping. I haven't had a huge amount of extra gas which was a warned effect. I am still relearning what "full" feels like, and having to concentrate on chewing thoroughly and concentrate on portion size.

All the surgery did was give a timeframe...it's supposed to be about 12 to 18 months...in which to relearn how to eat properly without focusing your life on your hunger, your appetite. You're given a chance to change your lifestyle, which is really the only way to actually lose weight. Diets don't work because they're short term or unnatural. You need to change your lifestyle. If you can change your lifestyle in that timeframe, you should be on a road to success.

There are some people who, after all the recovery pains and issues, regain the weight. They think the surgery is a magic bullet and treated it as such...if your body tolerates it, you can still slurp ice creams and cakes, or graze on snacks, gradually building up calories over the day until you're still overeating. You will gain weight again doing that.

There are people who start losing weight and regain it because they use food as a crutch or emotional comfort and refuse to change such behaviors. They don't solve the issues, just relying on surgery to...again...be some magic bullet to solve the problem. Doesn't work like that.

If you're considering or facing surgery, MAKE SURE YOU UNDERSTAND...it's just a tool.

Deep Fried Madness

It's no secret that for many Americans foods can be improved simply by slapping a coating of breading on it and then dipping the food item in the deep fryer. If breading it isn't an option, creating a batter akin to a pancake batter and pre-dipping the food in that before the hot oil bath will usually do.

I thought it was interesting when I was at the local carnivals and would see just plain batter fried (doughnuts, funnel cakes). Then I was exposed to the next level of yummy with Deep Fried Oreos (three for five bucks! What a deal!). We even figured out how to make them at home.

I found sites on the Internet that listed different fried food items...and apparently if it can be forced into a fryer, it can be improved. I was shocked. Check these out, for example...I mean, Coke? It seems that if you can imagine frying it, it can be fried.

For some reason my wife thinks fried foods are unhealthy. I haven't asked the nutritionist about fried foods and bariatric surgery. I'm thinking maybe deep friend ham isn't really all that bad for you, is it?

Now I thought that usually something as plain and "unhealthy" as fried Oreos is reserved for people with simple tastes...carnival tastes. Y'know, the crowd that is happy with shopping at the mall or eating at McDonalds.

My wife and I went to Olive Garden yesterday while out in town picking up a web-submitted job to FedEx Kinkos (or whatever they're named now). Read this description of one of their new limited time food items: "Parmesan-breaded lasagna pieces, fried and served over alfredo sauce, topped with parmesan cheese and marinara sauce." It's called "Lasagna Fritta."

While looking at the menu together, my wife said, "It's deep fried lasagna."

"You mean like deep fried Oreos?"

"Yup."

Um...okay. Olive Garden isn't exactly like the restaurants where you spend seventy dollars for an entree, but it's definitely a step or two above McDonald's (or Panera Bread, for that matter, in price for a meal).

This Lasagna Fritta is a limited time appetizer offer. Fortunately, Olive Garden is one of the major chains that prints their nutrition info on their website, including for limited time offers (Applebee's SUCKS in this regard, but that's a rant for another day.)

Brace yourself. The appetizer has 1030 calories, 63 grams fat (24 grams saturated), 1780 mg of sodium, 77 grams carbohydrates but 9 grams fiber.

That's the appetizer. So I guess it's not so bad if you split it among a family of five. I think there's six bite-sized chunks of lasagna there.

I think it's a sign when foods that are considered standard fare for the unwashed masses become mainstream enough that they can be dressed up with such flowery language in a restaurant that charges ten bucks or more for an appetizer dish. Before the surgery I would tell myself that if other people were eating something, it must not be too bad...normals are eating it. How bad can it be?

That sign is saying that unhealthy is mainstream. We can't rely on mainstream menus and restaurant chains to be giving us guidance as much as they're giving us what they think we want to buy...and we want the bad stuff. So now it's socially acceptable to offer the things that make us pigs. Buffets may as well be offering troughs instead of bars to fill our plates.

Scary.

The Cost of a Tinier Stomach

Some may wonder how much surgery like this costs. My employer happens to carry insurance for me that took care of a huge amount of the surgery bills, but I did have a significant copay.

I recently had the insurance statements come in. If I totalled everything correctly...and no doubt this is rounded a little and doesn't include the consults and psychiatric evals and appointments and whatnot...the surgery and recovery in the hospital came to about $15,000.

Ouch.

Again, not out of pocket entirely except for my copay, but it amazes me how much hospitals charge to insurance companies and what small fraction is actually paid.

Is this average? Anyone else know what theirs cost, approximately, and is willing to share?

EDIT: another bill statement came from the insurance company. Adding this anesthesiologist's bill, the total is closer to $17,500...so far...

Weight Loss Surgery Regrets

I saw in an online support group forum someone asking if people who had undergone Weight Loss Surgery had regrets about doing so.

I hadn't really thought about this too much. With Roux-en-Y, once it's done, there's no going back; it's not like banding. I didn't think about the subject after the surgery because what's done is done.

But seeing that question made me think that if I'm keeping this, in part, to help other people considering the surgery, I should probably address this (or express my thoughts on it).

I was scared as the time approached. I really really contemplated telling them, "Hey, guys, ya'know what? Hows about we just sort of think about this a little longer...maybe, schedule it later this week? Yeah?" I even thought about running away down the hall with my gown flapping in the wind behind me, scared of the complications, the hardships, what if I missed something, what if this is a mistake, what if what if what if...plus my dieting had been pretty successful from January to April! I could just do that, see how that goes...

But I also knew that do not do it would mean a lot of hassle to try again. My insurance company, the time invested in me by the doctors and nutritionist, our own time and money for things like the hotel and the copayment to the hospital. My previous attempts to lose weight, some marginally effective at first, all ended up failing miserably. Statistics don't lie; this surgery can fail, but it is still the most effective tool in weight loss.

I write those feelings off to cold feet. I went through with it, fear and all. I suppose that couldn't be called a regret.

After the surgery there was one moment I started down the path of thinking, "What in Hell have I done?!"

That was the first night after the surgery. I was up every hour, hour and a half or so laying in a pool of blood. By five in the morning I was very groggy and tired and still in a bit of pain as the pain drugs waxed and waned in effectiveness, as well as my own panic at constantly feeling blood trickling down my abdomen from under giant amounts of dressings taped to me.

Since that time...no regrets. I can honestly say it hasn't been easy. I've written here about a lot of the challenges I've encountered along the way. But things get better. A little bit at a time, things get better.

Now I can eat proper portions and not physically feel hungry. I still have head and emotional hungers but after the surgery I could feel the physical hunger divorced from my other senses when I see food or mealtimes rolled around. It's a feeling that really cannot be easily described as much as it must be experienced!

If you're wondering whether the surgery caused regrets, no, at this point it has not. Never never mistake this as an endorsement for a magic bullet solution like you get on TV from pills and herbs and whatever is in magazines these days; it's not magic, it's not simple. It's expensive. It's a hassle. It's a transition and a change in lifestyle. And it forces you to try confronting the reasons you're fat and that is never easy. But it isn't something to regret because by the time you really are in need of considering the surgery option, you are really past the stage where you should regret going through with it.

Update: May 7th, 2009

It's been a little while, so I thought I'd stick in a quick weight check.

Since starting my dieting efforts in the name of the surgery back in January I have lost 117 pounds.

My surgery was on the 7th of April (hey! A month ago!) and I've lost 35 pounds since that surgery.

My friend...from whom I haven't heard again since challenging me to lose 60 pounds before he can lose 30 with a gift card to Amazon at stake...his challenge date has me losing 22 pounds. Although I'm still curious if he's going to drop the challenge soon :-) His wife and I both told him I had an advantage here and I told him there's no shame in dropping out of this. I think most bariatric surgeons would tell him that he would have trouble with this kind of friendly wager.

So...thirty five pounds since surgery a month ago...good? Bad? Average? Any other bari' patients care to share their one-month milestones??

Does This Thing Work?

I sometimes ask my wife if she's sure the surgeon actually did anything to me other than cut my abdomen open.

Another patient at the nutrition class/appointment said that he can barely drink anything without extreme caution and he's already had incidents of certain foods (or amounts at one bite) causing extreme discomfort.

I had a half-liter of water with a protein mix (I believe it was black-tea flavored). I was finished with it by the end of the meeting. The person to whom I was referring said it would have taken him hours to drink what I had just downed.

It worries me sometimes that I'm not really feeling an all-out discomfort or nausea or any other "reinforcing" side effects while experimenting with foods and portions. I just don't know if I'm doing something wrong, or if my stomach is as iron-clad as it was before the surgery. Then I begin to worry about whether or not I could be accidentally stretching the pouch out!

I mean...if I overdo it, is there a guarantee that I'll throw it up or feel as sick as a dog?

Please...I'm tired of not knowing, but I'm a bit too cowardly to sit down and snarf a giant brownie sunday with sugar sprinkles to find out what happens. I need to know how easy...or hard...it is to "accidentally" overdo it after Roux-En-Y surgery. The Physician's Assistant I normally see in followups tells me that I'm worrying too much. I take solace in that, but still the thought haunts me.

Fun With Richard Simmons!!

If you're over twenty and overweight, how can you not know Richard Simmons?

He is well known for interacting with people personally. As a matter of fact, Wikipedia has this in an article about him:

"Simmons is known for interacting at a personal level with the people using his products. This began when he started personally answering fan mail he received while a cast member of General Hospital. As a self-described devout Catholic, Simmons still personally answers emails and letters, and makes hundreds of phone calls each week to those who seek his help.He also talks to people on the air during his radio show, and holds weekly live chats in the "clubhouse" area of his website. His appearances also include a "meet and greet" time, so that people can speak to him one on one."

He always seems so friendly and inspiring that while I was still at home recovering from the operation I figured I'd go to his website and see if I could find contact information for him and send a message.

There was a webform for submitting an "email" to him. So I filled it in. I said that I had never heard his stance on weight loss surgery and was interested in knowing what he thought of it; I think I also plugged my blog somewhere in there too...okay, I really think I plugged the website. I figured it wouldn't hurt anything. Dude probably gets huge volumes of messages and mine was just one more bit of white noise in the background. That was weeks ago, I didn't think any more of it.

Today I opened my inbox and saw an email from "Richard Simmons."

The message said,
************
I am not a big fan of surgery as a weight-loss tool. However, I do make an exception when a person is so morbidly obese that their very lives are at risk. A lot of people who are not in that situation make the mistake of seeing surgery as a weight-loss tool believe it is going to be like some "magic bullet" and all of their weight-loss troubles will be over once they have the surgery. But the bottom line is that, even with the surgery, successful weight-loss is all about making important lifestyle changes for the rest of your life. You still have to do the work it takes to lose the weight and that's the bottom line. I do hope that you are still working hard reaching for your own goals and that you never give up on YOU!

Your Friend,
Richard
**************

I have mixed feelings about this. I think it may be him; he has a reputation for personally interacting with people struggling with weight issues. My wife immediately asked what I already suspected; what if this isn't really " The Richard Simmons"?

If I am to believe his public persona, his reputation, the long time that elapsed between sending the initial message and getting this one back as well as the vocabulary choice in the reply, I'm apt to believe it really was him. I hesitate because everything is spelled properly and sounds like proper grammar, which is normally a red flag that something is a boilerplate response; call it wishful thinking, but I would rather think he either has staff check for mistakes or he's just a smart guy.

So this time around I'm going to take a chance and believe this was him. It makes me happy to think so, makes me feel a little more inspired for the day! If it really was him, I think it speaks volumes about his character that he would take time out of his schedule to speak to some insignificant lonely voice on the Internet asking him an innocent question. Sometimes taking five minutes from your own schedule can make a big difference in someone else's day and make them feel as if maybe, just maybe, they're not as insignificant as they think themselves to be.

Thank you Richard.

Doctors and Email

The nutritionist I had been seeing just before my surgery left abruptly.

I don't know the details, I just sort of heard about it when I was recovering in the hospital. Apparently she and her husband had an opportunity to move back south, something they always wanted to do, so they took it.

I met the new nutritionist last Monday. She seemed nice, maybe a little frazzled; we had been told before that she's hard at work filling the void left when the previous nutritionist vacated the position. They had a lot of backlog with new patients as well as taking care of the post-ops. So a little frazzled can be forgiven.

The thing that I was impressed with was that she gave us her email address!

I rarely encounter that. I don't know if doctors...medical staff in general...are technophobes or just think that such information would be abused (which wouldn't surprise me). I very much appreciated it, though.

Two days later my daughter tells me there was a call from "a " with a number local to a city an hour away. It was late when I got home, so I didn't return the call...the next day I emailed her to see if it was her. She replied, I gave more information and she replied right back. Two quick emails. Quick and convenient!

I don't want to abuse the access to mail but I did let her know that I really appreciated being able to get quick access for a minor question without having to interrupt her (or myself) with a phone call.

I remember having one medical staff member tell me that they don't do that sort of thing because it wouldn't be billable. My thought is that if you can answer the question in two minutes with an email, it would be a far better use of your time than having to inconvenience the patient by scheduling an appointment for a quick question or having to waste the medical professional's time with the paperwork and hullabaloo of an in-person assessment for a five-minute problem.

How about you? Have you any experiences with doctors giving out their email addresses for questions, or have you found my experiences to be the norm?