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How an AHA Statement on Diets Affects Bariatric Patients

assorted wines and other mediterranean diet foods on table with ocean view

Though it’s a different specialty, bariatric surgeons always take note of guidance from the American Heart Association or AHA. We do so because many metabolic disorders we treat are reflected in longer-term heart disease. When patients experience significant excess weight issues, especially obesity, the heart takes the brunt of the problem. For example, patients who are obese tend to have accelerated atherosclerosis or narrowing of the arteries due to plaque buildup along their walls. Type two diabetes is also a widespread consequence that can constrict arteries and cause cardiovascular issues and problems with virtually every organ in the body.

So, we listen when the AHA provides guidance on the diets they think are best for heart health. This is precisely what was published in Circulation recently. After reviewing comprehensive studies on diets, the AHA released its list of best diets, giving each a percentage score and grouping them into three distinct tiers.

Somewhat Predictable Results

If you are researching bariatric surgery or are in your early stages postoperatively, you’ll notice that most of our recommendations are not drastic. Yes, it’s essential to eliminate some of the worst offenders in our diets, like sodas and desserts, that only provide empty calories and do little to keep us full while spiking blood sugar. But for the most part, the postoperative bariatric diet is not draconian as much as it is somewhat restrictive. On the other hand, many of our patients’ diets before bariatric surgery, some of which are pushed hard on social media by “influencers,” aren’t as good as they seem.

The American Heart Association called out two diets for being particularly unhelpful to the heart: paleolithic and ketogenic. You’ll likely recognize that these diets are highly carb restrictive. The worst-scoring diet, keto, is arguably one of the most, if not the most, restrictive on carbohydrates. Unfortunately, there has been a misconception about the value of carbohydrates, and they have been vilified to the point where eliminating them seems like a good idea. However, carbs are essential. Our cells need sugar to function, and complex carbs, like whole grains, give us energy throughout the day, keep blood sugar spikes in check, and can keep us full. The true villains in the carbohydrate world are the refined grains and sugars that add calories but don’t do much to help with nutrition or fullness.

But Why Do I Feel Good When I Get off Carbs?

Most patients feel good after getting off refined and complex carbs because they’re eliminating harmful sugars, which is a good thing. However, by eliminating most carbs, we lose that motivation quickly as our mood and general physical ability deteriorate. With no carbs to burn, our bodies look for other sources of energy, and that is often muscular tissue. Eventually, this degrades our ability and creates a less toned body.

What Are the Best Diets?

According to the AHA and a great deal of empirical evidence, the best diets promote whole foods, including a mix of carbs, healthy fats, and proteins. As such, DASH (Dietary Approaches to Stop Hypertension), an antihypertensive diet created by the National Institutes of Health in the 1990s came out on top with a perfect score. The pescatarian, Mediterranean, and vegetarian diets are all great options for anyone looking to change their lifestyle.

The Problem With Dieting

There are two essential concerns with dieting. The first is right there in the name. Dieting suggests a temporary state of reduced caloric intake. But what most of us need is a permanent lifestyle change. If you think about a drastic versus moderate diet, losing 10 pounds in a month is great, but losing 20 pounds over the year is far better. Often, those 10 pounds come right back on after we quit the diet.

So, regarding sustainability, a very low-carb diet is difficult, if not impossible, to maintain over the long term. This is one of several reasons why diets of that kind were ranked so poorly. The second problem with diets, especially those that are very broad in scope, is that there is always a way to get around them. Let’s take the vegetarian diet, for example. Refined white grains and soda are very much in line with a vegetarian diet. Yet these kinds of carbs are decidedly bad when consumed in significant quantities. The same holds for many other diets that don’t specify what should and shouldn’t be eaten. So ultimately, whether you’re dieting or not, it comes down to understanding the nutritional and caloric value of everything you eat.

Ultimately, while this announcement may create an outcry amongst the groups that strongly believe in these diets, the moral of the story is moderation. Moderation offers the best of both worlds, allowing us to lose weight, maintain muscle mass, and feel good throughout our lifestyle changes. Of course, we always encourage you to speak to your surgeon about any new diets you are considering and whether they jive with your bariatric procedure. Ultimately, we want to help you change your life through a moderate, healthy, and frankly delicious diet.

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