There is no bariatric surgery that inhibits the absorption of carbohydrates and sugar. If you do not limit the total amount of carbs (and sugar) you will lose the effect of weight loss surgery. Carbohydrates are simply long chains of sugars, strung together, which your body will break down and absorb. Nutrition and the famous food pyramid are about as interesting as watching corn grow. It seems you should be able to simply eat and all the proteins, minerals, vitamins, and other stuff would take care of themselves. Who really has time to figure out if they are eating portions of fruit, dairy, or vegetables anyway?

Even when I was a kid and everything was interesting, the food pyramid seemed like a rip off—I mean, the real pyramids in Egypt, now they were interesting. Then I became a weight loss surgeon, and guess what—it is still boring! So, forget the food pyramid, they are reworking it anyway and no doubt will be different. In the traditional food pyramid, carbohydrates were the building block upon which all other food groups rested. If we were to build a pyramid for bariatric surgery patients, we would want protein to be at the base, or the foundation for all meals. That is why we have meal plans and menus at the end of this book.

There are no bad foods

—but there are bad quantities of them

Sometimes talking about certain foods to weight loss surgery patients who have reached their goal weight, is like talking to an alcoholic about vodka. Some weight loss patients who reached their goal all had a simple, single vision of where they wanted to go, identified those foods that got them in trouble, and avoided them zealously. Most who reached their goal avoided highly processed, high glycemic index carbs— potatoes, bread, rice, and pasta (although there clearly are some pastas that have a lower glycemic index, these pastas are not the ones typically found in restaurants). They also avoided fast food places, with specific exceptions. Once they were within sight of their goal they expanded their diet, but were wary of certain foods and watched the scale.

Those are the two simple approaches: complete avoidance of the high carbohydrate foods that commonly cause obesity, or a rational reintroduction of certain carbohydrates in your diet according to your BMI. If you find that you only eat those foods that cause obesity—that is, high glycemic carbs (sugars, candy, soda, potatoes, breads) or fats (red meat, butter, cream, hamburgers)— or common combinations of the two (donuts, ice cream, potatoes with butter and sour cream), then you must change your eating habits. Why change? Besides obesity, a diet that contains a lot of calories generally does not contain a lot of nutrition. So, while you may succeed in having plenty of calories, you will become progressively malnourished and fat. After any weight loss surgery, there is a limited amount you can eat. Because of that enforced limitation, if you do not eat properly you will not do well. Which means, sigh, you must learn what you need to eat. You probably need to learn some new recipes, and when you eat out make certain you are eating foods that have a high nutritional value.

High Glycemic Carbohydrates

—the carbs that don’t stick to your ribs, only to your thighs

Not all carbs are created equal. (See Appendix One.) Some carbs cause an immediate rise in blood sugar, peaking quickly then falling, leaving you hungry faster. These carbohydrates have a high glycemic index. Examples of these are breads, potatoes, sugar, and candy. Other carbs cause a much slower rise in blood sugar and give you the sensation of feeling full for hours after eating them. These carbs have a low glycemic index. Examples of these include apples, lentils, beans, and most vegetables.

I love the Atkins diet because I am a meat eater by nature, and never hesitate to have half a heifer for dinner. Having a breakfast of steak and eggs makes me feel rich and full. The Atkins diet has a low carbohydrate approach to life, and the simple counting of carbs makes the diet easy to follow and quite successful. But, all carbohydrates are not created equal.

This is where the glycemic index comes in. All carbs are not equal at all. Take my morning choice—when I go to the surgery lounge at the hospital, they have a wonderful selection of donuts and fruit. Now an apple contains about 25 grams of carbohydrate, and a donut contains the same—so which is better? OKAY, the apple is better, but why—if it is just carbohydrates, then 25 grams is 25 grams, isn’t it? The answer is no because the glycemic index is different. A donut has a glycemic index around 75, which is fairly high. This means you will eat the donut, and you will have a rapid rise in blood sugar, which will peak and then decrease rapidly, leaving you feeling hungry. An apple has a glycemic index of 34, which is fairly low. The apple will cause a slow rise in blood sugar, and you will maintain that low level for several hours. You won’t get the quick rise, or quick fall and you will feel full longer. But even more, the apple contains more vitamins, better nutrition, and more fiber than the donut. Okay, you probably knew that, and we just gave the scientific reason.

High glycemic foods tend to cause obesity, diabetes, heart disease, and even cancer. Does that mean you must never have that donut, the white bread, or the lasagna? Not at all, the good news is that if you combine a low glycemic food with a high one you average the load. Eat those vegetables! At one time if you were diagnosed with diabetes, you were told you could never have sugar again; now the thinking is that we should eat a combination of foods to decrease the glycemic index as much as possible.

How can you tell the high glycemic foods from the low ones? There is no simple answer. There is no test to tell us which is a high or low glycemic food, we simply must test the food by feeding a specified quantity to people and watching for the blood sugar response to all this. In the not so distant past we thought that “complex carbohydrate” was the same as a low glycemic food, but those notions have gone the way of the buggy whip. For a while we assumed that fiber in the carbs would slow digestion. Fiber does help a great deal in nutrition, but fiber isn’t the only answer. These are still notions you will see in the popular press, but for this year, glycemic index, determined through testing, is our best approximation of how your body will react to certain foods.