Can Gastric Bypass Surgery Survive the Assault of Cheese Crackers?

Recently I have seen a good number of patients who had successful gastric bypass surgery several years ago and now are gaining weight back. Erin, for example, has lost 90 pounds after her bypass surgery and has managed to maintain the weight loss. For nine years, Erin has enjoyed her new life; free of medications for hypertension and diabetes, she traveled all over the world, hiked the Appalachian trail, enjoy her daily swimming and many other activities she was not able to do before her weight loss surgery.

Suddenly, Erin started gaining weight (20 pounds over the past 8 months). She still has excellent restriction and appetite control. Erin, however, admits to “munching on peanut butter and cheese crackers throughout the day”. She reports that she has recently developed this new habit and started buying boxes of cheese crackers to stock her pantry!

I have always been intrigued by this behavior. Why do bariatric patients revert to old habits? Habits they have overcome longtime ago and as a result they have enjoyed years of healthy happy living.

The answer is STRESS. The majority of patients that I have encountered in my practice, who regain weight many years after gastric bypass surgery report new onset anxiety and stress.

Chronic stress is one of the main reasons for weight gain in the 21st century. Whether you had bariatric surgery or not, chronic stress increases body cortisol level, which in turn leads to increased insulin resistance. High insulin resistance prevents the movement of sugar from the blood stream into muscles to be metabolized. Instead, excess sugar moves into fat stores favoring weight gain.

Furthermore, in addition to disrupting the metabolic machinery that burns excess calories and fat, chronic stress prevents an individual from exercising. Most people these days respond to stress by stewing in frustration and anger. Instead of moving, eating becomes the activity of choice to relieve stress. They stock their homes with an endless array of junk food items (crackers, pretzels, chips, ice cream, candy bars…) for munching on day and night. Grazing on junk food is the worst thing you can do to your gastric bypass. In addition to the hundreds of calories added per day, the efficacy of gastric bypass in dealing with processed food is very limited. Our intestines are not made to handle junk food. The end result of junk food consumption is invariably weight gain, diabetes, depression, hypertension, and sleep apnea…

In my next blog, I will go over techniques and solutions for coping with stress. Until then, try to relax, exercise and eat healthy.

A New Science On The Horizon: Your Gut Bacteria

I read with great interest the many articles being published on gut bacteria and their effect on health. Hardly any day passes by without coming across a new research study about this fascinating new science. Trillions of bacteria live in the large intestine (colon) and they seem to have a major effect on many aspects of our health. New research is revealing that these bacteria also called gut flora secrete a variety of substances that affect the brain, immune system, metabolism and diabetes, as well as your heart. Largely ignored in the past, we are only beginning to understand their role. Gut bacteria play an important role in maintaining the integrity of the intestinal wall and preventing the so called “leaky gut syndrome” which is believed to be responsible for many inflammatory diseases including coronary artery disease. Gut bacteria secrete a number of substances that are absorbed into the blood stream and affect distant organs like the brain. Serotonin is a well-known neurotransmitter in the brain but 90 % of body serotonin is secreted in the gut. Studies have shown that germ free mice (mice with no bacteria living in their intestines) produce 60% less serotonin than those with regular gut bacteria. Low serotonin level in the brain is associated with anxiety and depression. Indeed, studies in a timid strain of mice, treated with antibiotics to change their gut bacteria composition, show a dramatic change in their behavior. In another experiment, transferring bacteria from timid strain mice into the gut of normally active mice changes the latter into more passive animals. Many other experiments mainly in mice prove that bacteria living in the colon affect brain function including behavior and mood. Interestingly, gut bacteria alter more than just your mood; they have a role in weight control. Bacteria from an obese mouse injected in the colon of a regular mouse lead to weight gain. Gut bacteria from obese individuals compared to lean ones show less diversity and predominance of one variety called Firmicutes. Gastric bypass in mice and humans lead to changes in gut bacteria that are associated with weight loss. The mechanisms behind these observations are still unclear. One thing for sure, however, maintaining a healthy gut flora seems to prevent a plethora of diseases and mental disorders.

How to Protect Healthy Intestinal Bacteria?

Like any living organism, bacteria need a suitable environment to thrive. Besides avoiding unnecessary antibiotics that decimate your bacterial flora, consuming a high fiber, plant based diet promote a healthy and diverse gut microbiome. According to Michael Pollan “With our diet of swiftly absorbed sugars and fats, we’re eating for one [kind of microbe] and depriving the trillion of the food they like best: complex carbohydrates and fermentable plant fibers. If you want to feed your gut bacteria, you need to eat a wide variety of fruits, vegetables, nuts and whole grains. Intestinal bacteria need fiber to thrive and Houstonians are not eating enough fiber in their diet. Take control of your life and minimize the consumption of processed food rich in salt and sugar and completely devoid of fiber. Let food be your medicine and rid yourself of obesity, heart disease and diabetes.

Are you drinking enough water this summer in Houston?

Your body is composed of 60% water. Staying hydrated keep your body functioning properly. Water facilitates the transfer of electrolytes across cell membranes, promotes nutrient and oxygen circulation, and helps your kidney and liver flush out waste and toxins. You are constantly loosing water especially in the hot summer temperature of Houston. When water intake does not match water losses you become dehydrated. Dehydration results in a sluggish metabolism that may put you at risk for weight gain.

Indeed, a study published in 2003, in the journal of clinical endocrinology and metabolism, showed that drinking 2 liters of water per day increased the energy expenditure by approximately 100 calories. That doesn’t sound a lot, but over one month this is equivalent to 3000 calories or almost one pound of fat. So over a year you may lose up to 10 pounds. Not all research studies agree on the ultimate effect of increased water intake on weight loss among dieters. However, many people go throughout their day a little or a lot dehydrated without realizing it. Daily total water intake recommendations depend on your age, gender, size, and physical activity… If you are cycling in Houston these days you probably need more water than a sedentary person living in North Dakota. The best way to know that you are well hydrated is by checking the color of your urine. If it is clear or light yellow then you are doing well. If it is darker in color you need to drink more water.

Many individuals feel hungry when in fact they are thirsty. It is difficult for the body to differentiate between hunger and thirst. Quenching your thirst with water before grabbing a snack may save you a few extra calories you would have consumed when not needed. Have a glass of water 20 minutes before each meal. Several studies have shown that you will end up consuming fewer calories. Drink water instead of soda, sweet tea, juice or coffee. For years, I developed the habit of drinking coffee every time I felt thirsty. Coffee is a diuretic. This means that coffee promotes water loss in urine leading to dehydration. Coffee is obviously not a hydration beverage. Worse is drinking sweetened beverages throughout the day ending up with hundreds of extra calories in the form of simple sugars. The best beverage to drink is simply water. To stay hydrated, I keep a glass of water on my desk at work, and I sip on water throughout the day. When I workout I always carry with me at least 2 large insulated sports bottles of water. Before I go for a workout, I drink a cup of water and when I wake up in the morning a drink a cup of water before breakfast. You can add a fruit like a banana or an apple to replenish your electrolytes during intense workout but remember the best hydrating fluid is water.

Lap Band Revision Surgery Houston

Is Sleeve surgery a good option for patients with heartburn?

The incidence of heartburn in our overweight patient population is very high. Heartburn results when acid backs up into the esophagus. Normally, a competent lower esophageal sphincter, LES, acts as a barrier against acid reflux into the esophagus. With weight gain, fat accumulates inside the abdomen increasing the pressure on the stomach and leading to acid reflux. Furthermore, a higher intra-abdominal pressure increases the incidence of a hiatal hernia. A hiatal hernia occurs when part of the stomach herniates into the chest thereby leading to a weak LES. To make things worse, overweight individuals tend to overeat especially at dinnertime. Overeating stretches and weakens the LES, further aggravating the reflux of acid. Delayed gastric emptying and a dilated gastric fundus (upper part of the stomach) promote the development of a permanent “acid bubble” in close proximity to the LES which in turn may contribute to the increased incidence of acid reflux in this patient population.

At Houston Weight Loss Surgery Center, we offer the sleeve gastrectomy for most patients with a body mass index (BMI) higher than 35 and suffering from heartburn. Sleeve surgery allows for long-term effective weight loss leading to alleviation of most acid reflux symptoms. Sleeve gastrectomy is currently the most commonly performed weight loss procedure around the world. During sleeve surgery 85% of the stomach is resected ending up with a banana shaped stomach. As you loose weight following sleeve surgery, heartburn tends to resolve. A recent study published in the Annals of Surgery by Dr. Morino showed that heartburn resolves after sleeve gastrectomy in the majority of patients who suffered from gastro-esophageal reflux disease (GERD) prior to surgery. The study also showed that new onset acid reflux after sleeve gastrectomy is rare. Interestingly, the study demonstrated that sleeve surgery increases the pressure of the lower esophageal sphincter, LES, hence strengthening the acid reflux barrier. This is an additional anti-reflux property for the sleeve that is independent of weight loss.

At Houston Weight Loss Surgery Center, the only contraindication for sleeve surgery in GERD (gastro-esophageal reflux disease) patients is the presence of Barrett’s esophagus. Barrett’s esophagus results from long standing severe acid reflux and possible bile reflux into the lower esophagus. In this case, gastric bypass surgery is a better option for weight loss. Gastric bypass diverts acid and bile from the lower esophagus therefore preventing and halting the progression of Barrett’s into cancer. Gastric bypass also preserves the rest of the stomach in case it is needed in the future for reconstructive surgery if esophageal surgery is ever needed.

If you have persistent heartburn and interested in weight loss, Dr. Darido offers state of the art effective solutions for both heartburn and excess weight. Please give us a call at 281.205.3205 for a free private consultation at Houston weight loss surgery center.

Houston, we have a weight loss problem?

Houston, we have a weight loss problem?

JAMA, the journal of the American medical association describes our time as “The age of obesity and inactivity” and we all know it:

  • 2/3 of adults and 1/3 of children and adolescents are now classified as obese or overweight.
  • The cost of treatment of obesity related conditions has reached 10 % of the total US medical expenditure.
  • Obesity is reversing all the gains made in the past 100 years by lowering cholesterol, hypertension and smoking rates.

What We Should Do?

The answer is simple: Eat Less and exercise more. 25% of American men and 43% of women attempt to lose weight each year. Of those who succeed 5 % manage to keep it off for the long haul. 45 million Americans belong nowadays to a health club as opposed to 23 million in 1993. $19 billion per year are spent on gym memberships. A Houston heart survey showed a 10% increase in regular exercise from 1980 till 2000. Yet, obesity figures in Houston more than doubled in that same time frame.

Why is our body fighting against our own good health?

In an article published in 2011 in the New England Journal of Medicine, Dr. Proietto, from the University of Melbourne, showed that multiple compensatory mechanisms encouraging weight gain, persist for at least 1 year after weight loss. He followed 50 overweight individuals for approximately one year after putting them on a very low calorie diet for several weeks. Hunger and satiety hormones were monitored. Dr. Proietto showed that following diet induced weight loss, hunger hormones go up and satiety hormones go down. In other words, every time you lose some weight following any kind of diet you feel hungrier than before. The more you lose weight the harder it is to maintain a low calorie diet. Furthermore, your metabolism goes down as you lose weight. Your body goes into an energy conservation mode making it harder to shed additional pounds. In this fight between you and your own body, guess who wins? 95% of all those who attempt to lose weight by diet and exercise end up gaining it back. The reality is that very few of us can overcome our basic biology to maintain the weight loss.

At Houston weight loss surgery center, we clearly differentiate between preventing weight gain and treating excess weight. We strongly recommend eating less and exercising more to stay fit, and healthy. If however you are already overweight, weight loss surgery is the only effective treatment for durable weight loss. Bariatric surgery prevents the compensatory changes that accompany weight loss. You are no longer fighting your own body. The struggle against obesity becomes a journey. A journey, we are privileged to be part of. If you are overweight and you are trying to lose weight please give us a call at 281.205.3205

Is your lack of sleep causing weight gain?

Being overweight is the result of hormonal imbalances that disrupt the metabolic system. A disrupted metabolic system leads to poor dietary choices, fatigue, increased appetite and low fat burning capacity. Sleep plays a pivotal role in regulating metabolism.

Ghrelin and leptin are two hormones that control appetite and energy metabolism. Sleep deprivation can cause a 19% decrease in the level of leptin and 28% increase in the level of ghrelin. The net result is increased appetite and decreased metabolic rate. Lack of sleep can also increase emotional eating for comfort rather than caloric need.

Insulin is another hormone that affects metabolism. In a study published in the Annals of internal medicine, researchers showed that after four nights of sleep restriction, insulin sensitivity was decreased by 30 percent. Decreased insulin sensitivity also called Insulin resistance leads to type-two diabetes and obesity. Indeed a study that followed about 70.000 women for 16 years, showed a significant increase in body weight in those who slept 5 hours or less compared to those who slept 7–8 hours.

Today we sleep on average 6.5 hours compared to 8.5 hours in the 1950s. As sleep time decreased over time there has been an increase in the prevalence of obesity. At Houston Weight Loss Surgery Center, we recommend you to improve our sleep hygiene to prevent weight gain. Here are a few tips:

  1. Keep a consistent sleep schedule. Get up at the same time every day even on weekends and vacations. Go to bed early enough to have at least seven hours of sleep.
  2. Avoid any caffeine in the afternoon. Caffeine will keep you in the lighter stages of sleep, which are associated with poor sleep.
  3. Make your bedroom quiet and relaxing. Keep the room at a comfortable temperature and limit light exposure in the evenings.
  4. Exercise regularly to improve sleep quality.
  5. Watch what you eat before bedtime. Rich heavy meals before bedtime decrease the quality of your sleep. Avoid consuming alcohol before bedtime for the same reason.
  6. Last but not least, if you snore at night, wake up with a headache or feel sleepy throughout the day, you may be suffering from sleep apnea. Sleep apnea is the sudden cessation of breathing during sleep. Obstructive sleep apnea results from sudden obstruction of the airway. Obstructive Sleep apnea is very common in overweight individuals. It can lead to serious health conditions if left untreated. There are different treatment solutions for obstructive sleep apnea. The most effective treatment for obstructive sleep apnea in overweight people is weight loss. At Houston Weight Loss Surgery Center, we offer outpatient testing for sleep apnea. Our patients have major improvement in sleep apnea following weight loss surgery.

In conclusion, good healthy sleep reduces your risk of weight gain. Adopting healthy sleeping habits is an integral part of a healthy lifestyle. If you are overweight you may want to adopt an effective weight loss strategy to improve your health and sleep. Houston Weight Loss Surgery Center offers effective and durable weight loss solutions. Please give us a call at 281.205.3205 for a free consultation.




Diets and lifestyle changes that speed up your metabolism

Your metabolic rate is how fast you burn energy. It is the corner stone for any successful weight loss solution. Men burn more calories than women. Younger individuals have higher metabolic rates than older ones. This is why we tend to gain weight as we age. The higher the metabolic rate the more likely you can stay lean. While you cannot control your age, gender or genetic background, here are some suggestions that may help you improve your metabolism.

1. Build and maintain your muscle mass

Strength training activates your muscles and boosts your metabolism. Muscle burns more calories than fat tissue. Muscles that are not used tend to be replaced by fat leading to a lower metabolic rate and weight gain.

2. Adopt a daily aerobic exercise routine

Aerobic exercise especially high-intensity workouts raise your metabolic rate. Try short bursts of jogging while walking. Join a cycling class at the gym. I personally had great success with racquetball.

3. Stay hydrated

Houston is very hot in the summer months. If you are mildly dehydrated your metabolism goes down. All energy burning processes in the human body require water. Drink a glass of water before every meal or snack. Keep a bottle of water with you at all times especially when working outside.

4. Choose good sources of protein

Lean protein like turkey, fish, egg white, beans and low-fat dairy products can rev up your metabolism. Adopt a balanced healthy light and fresh diet free of processed food items, sugar and saturated fat.

5. Have 3 meals a day and snack smartly

Do not skip meals especially breakfast. A good breakfast in the morning gives the needed energy to start your day. Skipping breakfast lowers your metabolic rate throughout the day. Choose healthy snacks to maintain your energy. Avoid sweets and white flour. Use fresh fruits and vegetables instead.

6. Do not starve yourself

Avoid starving yourself in the hope of loosing few pounds. Many Houstonians attempt to loose weight by consuming less than 1300 calories a day. This is a recipe for failure. Your metabolic rate goes down with starvation. You end up burning fewer calories than before the diet. In addition, your hunger increases and you end up eating more than you used to eat before.

7. Consider bariatric and metabolic surgery

Last but not least, if you are more than 75 pounds overweight and interested in weight loss, metabolic surgery is currently the most effective approach to increase your metabolism. Gastric bypass and sleeve gastrectomy are currently the most reliable and effective techniques to boost your metabolic rate, curb your appetite, and loose weight.

For more details on effective weight loss solutions please contact our office at 281.205.3205 for a free private consultation with Dr. Darido.

What is Mindful Eating?

  • Allowing yourself to become aware of the positive and nurturing opportunities that are available through food preparation and consumption by respecting your own inner wisdom.
  • Choosing to eat food that is both pleasing to you and nourishing to your body by using all your senses to explore, savor, and taste.
  • Learning to be aware of physical hunger and satiety cues to guide your decision to begin eating and to stop eating.
  • Acknowledging responses to food (likes, neutral or dislikes) without judgment.

Thoughts That Flavor the Meal

By Megrette Fletcher, M.Ed., R.D., CDE

It is amazing to notice how much thoughts can influence whether a situation is viewed as “good” or “bad.” It is common for those scheduled for bariatric surgery (and even after surgery) to have worries about the unknown, hopes and expectations for the future, and questions related to the surgery itself. If these types of thoughts are present when eating, consider trying this suggestion. Before you take a bite, pause and fill your lungs with air. Then slowly let the breath out. Now, observe the food before you. Look at it, noticing any labels of “good” or “bad,” “allowed” or “forbidden.” If this is hard to do, take another breath and slowly exhale – relax. Allow yourself to be a witness to the experience of eating a meal: Its shape, color and texture. Now, take a bite. Let it rest in your mouth for a moment before chewing. With your next bite, notice how the food feels in your mouth. Is the bite size comfortable? Does it feel too big to chew easily or too small to really taste the flavor? If the size of the bite was not pleasant, adjust the amount you select so you can actually taste the bite, chewing it a little bit longer each time before you swallow. Experiment with sizes and how long you chew each bite.

Now that you have had a few bites, ask yourself: Did slowing down and chewing my food feel new, different, or maybe a bit uncomfortable? Eating in a mindful way allows you to “wake up” and notice new things. These things may include taste, texture, or even how much food is selected for each bite. Frequently the information received does not stop there. When a person eats mindfully, she may notice how some thoughts can trigger anxiety, anger and desperation, making these emotions part of the meal.

If uncomfortable feelings are present while eating, take a deep breath. Fill your lungs with air, and then slowly let this air out. Remind yourself that you are not “bad,” “stupid,” “a failure” or “wrong.” These are just the thoughts and feelings that are with you. They are not facts.

For many individuals, the thoughts that are present when eating contribute a large part to how the meal tastes. An important question to ask is: Are these thoughts helping me enjoy the food in my mouth? Practicing mindful eating is more than seeing what and how much you eat. It is learning to welcome the thoughts that are present when you eat. This process of opening up can profoundly change the taste of the bite. At times you may realize it is your thoughts that are actually flavoring the meal. Noticing each bite can help you season the meal with thoughts you enjoy.

Megrette Fletcher, M.Ed., R.D., CDE, is a cofounder of TCME. She is a diabetes educator and contributes to the blog site She can be reached at

What is hunger?

Hunger and the desire to eat are two different entities. Hunger is hormonal, but the desire to eat is emotional. We need to eat to replenish our energy stores and maintain our metabolism. Hunger drives us to seek food to survive. Hunger subsides after eating enough food or a regular size meal. The desire to eat, on the other hand, is emotional. We eat when we are sad or happy. We crave ice cream to compensate for certain events in life. We snack on food throughout the day to cope with stress or boredom. We seek “comfort food” rich in saturated fat, sugar and salt. Slowly we develop habits of unhealthy eating that become entrenched in our daily life. Habits become second nature and very soon we become victims of a highly processed diet rich in sugar, salt and fat.

In today’s environment, we consume more than what we really need because the desire to eat has trumped the natural feeling of hunger. We no longer listen to our bodies to know when to eat, what to eat and how much to eat. At Houston weight loss surgery center, we spend lot of time educating our patients on “mindful” eating habits:

  1. Have 3 meals a day. Do not skip breakfast. In fact let breakfast be the most important meal of the day. Avoid grazing on small amounts of food throughout the day.  Avoid eating while driving or watching TV. Give yourself time to enjoy a meal and listen to your body, as you are getting full. Do not overeat. Instead stop eating shortly before you feel you are full.
  2. Avoid SUGAR. Sugar is the enemy of weight loss. Sugar increases your appetite and decreases your metabolism. Sugar will ruin any weight loss attempts and significantly contributes to weight regain after bariatric surgery.
  3. Snacks: The purpose of a snack is to simply hold you over to your next meal.  Do not consume calorie rich snacks like potato chips and candy bars. Rather choose fruits and vegetables for snacking. You may use nuts from time to time but remember nuts are rich in fat and calories. Do not consume more than 100 calories per snack.
  4. Craving certain food items can wreck havoc on your weight. We usually crave high fat high sugar food that adds hundreds of calories per day. Here are some healthy alternatives:

Craving Crunchy

Veggie sticks, such as celery, carrots, red bell peppers and fennel, are water rich and will help to suppress your appetite while satisfying your craving for crunchy.

Craving Comfort

Oatmeal can be a great high-fiber, snack any time of day— it’s not just for breakfast. Low fat, sugar free yogurt is another option.

Craving Protein

Working a little protein into your snacks is a great way to fuel your day and keep unhealthy cravings at bay. Keep a few hard-boiled eggs in the fridge at home or at work. When you pack your lunch, add a couple of pieces of sliced turkey rolled in lettuce for midday snacking. Low-fat cheese sticks and cottage cheese are also good.

Craving Sweet

Fresh berries, including blueberries, strawberries, blackberries and raspberries, all contain fiber and an abundance of natural sweetness.

Craving Fried Foods

Oven-baked fried chicken strips can be a surprisingly good alternative to greasy wings. Substitute baked sweet potato fries, a sweet and crunchy snack, for traditional french fries.

Craving Ice Cream

Create your own low-fat, creamy alternative to ice cream. Try frozen peaches blended with coconut milk and chilled in the freezer. Frozen strawberries blended with ice, low-fat yogurt and a banana makes a great smoothie.

Is your lap band causing you heartburn?

Adjustable gastric banding or lap band surgery is a weight loss procedure that is rarely performed nowadays. Few years ago, however, lap band surgery was quite common. The concept of adjustable gastric banding revolves around creating stomach restriction forcing the patient to eat less. The band is progressively tightened around the stomach by injecting fluid inside its lumen. Unfortunately, most patients were over-restricted in hopeless attempts to make them loose weight. Over-restriction resulted in near obstruction of the esophagus. Food passage into the stomach was hindered. Patients developed heartburn, food regurgitation, nocturnal cough, and vomiting.

If you have a lap band and suffer from heartburn, food regurgitation, nocturnal cough or vomiting you may be over-restricted. Band over-restriction if left unattended leads to irreversible damage to your esophagus. You may develop esophageal dilation and difficulty swallowing. The esophageal lining may herniate through its muscular wall creating a blind pouch we call diverticulum. Food accumulates in the diverticulum causing pain, regurgitation and nocturnal cough. Nocturnal cough results from food material backing up into your upper airway and lungs when you lay on your back. This is a dangerous condition as it puts at risk for aspiration pneumonia. Aspiration pneumonia is lung infection developing from stomach content entering your lungs.

If you have a lap band you need to follow up with your doctor on a regular basis for adjustments. If your band is causing you heartburn, and you are satisfied with your weight loss, Houston weight loss surgery center offers effective weight loss solutions. Dr. Darido will discuss with the best options to alleviate your symptoms and help you loose weight.