Archives: June 2026

Are There Good Carbs and Bad Carbs?

Carbohydrates are an important source of energy, but they don’t all affect the body the same way. There are differences between simple and complex carbohydrates that are good to know about when endeavoring to lose weight.

Carbohydrates have gotten a bad reputation, especially with the popularity of low-carb and ketogenic diets. They’re more than just “good” or “bad.”

Carbohydrates are one of the body’s three main macronutrients, along with protein and fat, and they’re necessary for providing energy for your brain, muscles, and other organs. You can’t live without carbs.

Rather than using qualifying labels (e.g., good or bad), look at the quality of carbohydrates, how processed they are, and the nutrients they provide. Carbohydrates rich in fiber, vitamins, and minerals are supportive in a number of ways, and limiting refined carbohydrates may reduce the risk of certain chronic diseases.

Simple vs. Complex

Carbohydrates are in most foods, and your body breaks them down into glucose, which is used as a primary source of energy. They’re grouped into two categories:

• Complex carbohydrates are longer chains of sugar molecules and are mostly found in whole, minimally processed foods.
• Simple carbohydrates, which are made up of one or two sugar molecules that break down easily, are digested more quickly. Some simple carbohydrates occur naturally in foods like fruit and milk, and others are added during food processing in foods like candy, pastries, canned goods, sugar-sweetened beverages, and ultra-processed items.

The carbohydrates that people benefit most from are the complex ones found in whole grains and produce. They provide fiber, and that slows digestion, makes you feel fuller longer, helps regulate blood sugar levels, and are instrumental in a healthy digestive tract.

Highly refined carbs, on the other hand, don’t have as much fiber or nutrients because they’ve been removed during the refining process. That includes white bread, crackers, sugary cereals, cookies, and a lot of other snack items. They digest more quickly than complex carbs and cause larger spikes and drops in blood sugar.

“Bad” vs. “Good”

What we think of as “bad” carbs are the refined, or simple, carbohydrates – they’re considered “energy-dense” but “nutrient-poor.” Without fiber to slow digestion, refined carbohydrates are broken down into glucose quickly, causing blood sugar levels to spike. Your body responds by releasing insulin to move glucose into cells and moderate blood sugar levels. Not only can it leave you feeling hungry again sooner, but frequent blood sugar and insulin spikes create insulin resistance over time, which can lead to type 2 diabetes. Regularly consuming simple, refined carbs also increases the risk of obesity, heart disease, and other chronic health conditions.

The complex carbohydrates found in most whole foods are better for heart health, provide steady energy throughout the day, promote healthy digestion and cholesterol levels, and do more to help with weight management. On nutrition labels, look for a higher fiber-to-sugar ratio and pay attention to serving size.

Don’t Cut Too Much Out

You want to consume more complex carbs than simple ones, but eliminating them altogether probably isn’t a great idea unless your healthcare provider recommends it for a specific medical reason. Otherwise, they should be showing up as part of a balanced diet.

Instead of thinking in terms of “good” versus “bad,” discover more about your food:

• Is this food minimally processed?
• Does it contain fiber?
• Does it provide vitamins and/or minerals?
• Is it good for me, and does it meet my health goals?

Eating foods that are closer to their natural state is better for you – as in an actual strawberry as opposed to strawberry jelly, for example. Both have carbs, but the strawberry has more fiber and complex carbs than the strawberry jelly, which has had refined sugar added. You need carbs; you just need the complex ones more!

If you’re cleaning up your diet and it feels too restrictive to quit some favorite foods cold turkey, focus on making small changes over time – give yourself windows of opportunity. Diets that are too restrictive are not sustainable and can undo the good habits you’re aiming for. Swapping white bread for whole grain bread, choosing fresh vegetables instead of chips, eating fruit to satisfy a sweet tooth instead of candy, or replacing sugary beverages with herbal tea are small changes that will start to add up.

The healthiest eating pattern is one that is balanced, enjoyable, and sustainable.

Our team at SAMPA is dedicated to helping people safely manage weight loss and find strategies that meet their long-term health goals. Healthy eating is just one part of improving your overall health. If you’re struggling with obesity, weight-related medical conditions, or have questions about surgical treatment options, our board-certified clinicians are here with answers. Contact our office to schedule a consultation.

An Unexpected Plot Twist: Female Fertility, Bariatric Surgery, and Oral Contraceptives

Did you know your oral contraceptive may not be working as well? Obesity makes getting pregnant difficult because of the disruption it causes to hormones and ovulation. However, bariatric surgery often reverses those changes, restoring fertility much sooner than some people expect and making contraception an important topic of conversation before and after surgery.

Obesity can make getting pregnant a challenge for many couples. That’s because excess weight can interfere with hormone regulation, disrupt ovulation, and make conception more difficult for women.

That can change after bariatric surgery. As the weight comes off, hormone levels and ovulation start to normalize, and fertility might be restored within weeks or months. It can be one of the most exciting and unexpected health benefits of weight loss surgery. But it also creates a new challenge that isn’t discussed enough – the same surgery that restores fertility can also make oral contraceptives less reliable by changing how medications are absorbed.

Obesity and Fertility

​Fat (adipose) tissue is not a passive substance that just increases your waistline. It is hormonally active and produces hormones and chemical messengers involved in metabolism, menstruation, ovulation, and reproduction. When excess adipose tissue is present, those signals become disrupted, altering the delicate hormonal balance required for normal fertility.¹

One of the most common metabolic consequences of obesity is insulin resistance, a condition in which the body’s cells become less responsive to insulin. This causes blood sugar to build up and puts the pancreas into overdrive. To compensate, the pancreas produces more insulin, resulting in chronically elevated insulin levels (hyperinsulinemia). In women, excess insulin stimulates the ovaries to produce more androgens (male hormones), which can interfere with normal egg development and ovulation.²

PCOS, or polycystic ovary syndrome, also has a high occurrence in obese women and is one of the leading causes of infertility. Although not everyone with obesity has PCOS, excess weight can worsen the condition by increasing insulin resistance and hormonal imbalance. The result is often irregular menstrual cycles or a complete absence of ovulation, making conception much more difficult.²

At the same time, chronic low-grade inflammation, another health concern associated with obesity, exacerbates metabolic disruption. Excess adipose tissue releases inflammatory molecules called cytokines that can intensify insulin resistance and hormone dysregulation.²

Bariatric Surgery and Fertility

​This is part of the plot twist – bariatric surgery often improves reproductive function.

Does bariatric surgery significantly reduce body weight? Yes, that’s what it’s known for. But it’s also known for putting type 2 diabetes in remission, reducing cardiovascular disease risk, and improving fertility in both women and men.

As weight decreases after surgery, insulin sensitivity tends to improve, reducing the hormonal disruptions caused by insulin resistance, restoring more predictable ovulation, and making menstrual cycles more regular. For obese women dealing with irregular periods, PCOS-related infertility, or difficulty conceiving, this can be life-changing.

Not only are these changes welcome, but they happen fast – ovulation can return before a person realizes it. That presents its own challenge of becoming pregnant before you’re ready. Increased fertility is great news, unless you’re not planning for a family yet.

Oral Contraceptives After Bariatric Surgery

​This is the other half of the plot twist – the same surgery that induces these wonderful benefits can also render your oral contraceptive ineffective, and you don’t want to become pregnant too soon after the procedure.

Restrictive procedures, such as sleeve gastrectomy, primarily reduce stomach size and don’t have as great an effect on medication absorption as a malabsorptive procedure like gastric bypass. The latter surgery reroutes portions of the small intestine, which is where many medications are absorbed.

After gastric bypass, changes in stomach acid, intestinal surface area, digestive enzymes, and transit time can affect how much of an oral medication enters the bloodstream and is therefore effective. Because oral contraceptives depend on consistent absorption to maintain reliable hormone levels, their effectiveness may be reduced after malabsorptive procedures.³ This isn’t unique to birth control pills, and other medications might require changes in dosage, formulation, or route of administration. However, contraceptives require special attention because even a temporary reduction in effectiveness can result in an unintended pregnancy during a time when pregnancy is usually not recommended.

Women are encouraged to wait 12-18 months after bariatric surgery to become pregnant. That’s because it takes the body at least that long to adjust. During the first year is when the most weight loss happens, and both the mother’s and the baby’s weight should stabilize, and nutritional status improve.

During the rapid weight loss phase, nutritional deficiencies in iron, folate, vitamin B12, calcium, and vitamin D can develop, and these nutrients are especially imperative for healthy fetal development. Becoming pregnant with a nutritional deficit can increase the risk of complications such as fetal growth restriction, low birth weight, and preterm birth.

Because oral contraceptives can be less reliable after surgery, it’s best to discuss contraception and non-oral options before surgery. For bariatric patients who wish to become pregnant, family planning works best as a coordinated effort between the patient, bariatric surgeon, OB/GYN, and other members of the care team. Pregnancy after bariatric surgery is usually very successful when appropriately timed.

We believe these conversations are an important part of comprehensive bariatric care and not an afterthought. If you are considering surgery, have questions about contraception, or are planning a future pregnancy, the SAMPA team can help you understand what to expect before, during, and after surgery.

References:

1. Pavli, P., Triantafyllidou, O., Kapantais, E., Vlahos, N. F., & Valsamakis, G. (2024). Infertility Improvement after Medical Weight Loss in Women and Men: A Review of the Literature. International Journal of Molecular Sciences, 25(3), 1909–1909. https://doi.org/10.3390/ijms25031909.
2. Houston, E. J., & Templeman, N. M. (2025). Reappraising the relationship between hyperinsulinemia and insulin resistance in PCOS. The Journal of endocrinology, 265(2), e240269. https://doi.org/10.1530/JOE-24-0269.
3. Schlatter, J. (2017). Oral Contraceptives after Bariatric Surgery. Obesity Facts, 10(2), 118–126. https://doi.org/10.1159/000449508.

Your Gut on Chronic Stress

Stress affects more than your mood – it can influence your entire digestive system. Chronic stress changes the gut–brain connection, and bariatric patients may experience the effects differently. Read to the end for some outside-the-box tips on recalibrating when life hits you hard.

You’d be hard-pressed to find an adult who hasn’t experienced stress. It’s a normal part of life, but it creates a chain reaction throughout the body, including digestion.

Stress has a measurable effect on the digestive tract because the gastrointestinal (GI) system is tightly connected to the brain through the gut–brain axis. Stress does not just “feel” like a stomach problem; it can change gut movement, hormone release, immune activity, and the gut microbiome.

For someone who has had bariatric surgery, these effects can be different because the anatomy, nutrient absorption, eating patterns, and hormonal signals of digestion have already been altered.

What Happens

When a person experiences stress, the body activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (“fight-or-flight” response). This releases stress hormones such as cortisol and adrenaline, and that affects the gut in several ways.

1. Gut Motility

This refers to movement through the intestines, and stress can either speed it up or slow it down. Some people experience diarrhea, urgency, or cramping, while others might experience constipation, bloating, or slowed digestion. Stress is also known to affect disorders like irritable bowel syndrome (IBS).

2. Gut Sensitivity

Stress can make the nerves of the digestive tract more reactive. A normal amount of gas or intestinal stretching can feel more painful or uncomfortable than it normally would. This is called visceral hypersensitivity. It’s not just a psychological overreaction; it’s a real biological issue.

3. Stomach Function

Higher up in the digestive tract, stress can change how our stomachs react to food. Stress can reduce stomach emptying in some people, cause nausea, worsen acid reflux symptoms, and alter acid secretion and the ability to digest food.

4. Gut Microbiome

Deep in the intestines is an ecosystem of beneficial bacterial colonies called the gut microbiome. These “gut bugs” help with a myriad of processes other than digestive, and they cross-talk with other body systems, including the immune and nervous systems. Chronic stress can change the balance of bacteria living in the intestine, which can affect anything from intestinal permeability (“leaky gut”) to mood.

5. Eating Behavior Changes

Stress changes how we eat as well as what we eat. Some people shy away from food, some people eat more, and others reach for specific cravings. This is an indirect way in which stress affects our digestion: skipping meals, increasing high-fat or high-sugar foods, and emotional eating.

Stress, Digestion, and Bariatrics

A person after bariatric surgery does not have the same digestive system as someone with typical anatomy. How stress affects the bariatric digestive tract can depend on the procedure the patient had, but several general differences matter.

1. Smaller Stomach, Bigger Consequences

Whether you had a sleeve gastrectomy or gastric bypass surgery, the stomach pouch is smaller and holds less food. Eating too quickly, grazing frequently, choosing calorie-dense foods, and not getting enough protein can cause nausea, vomiting, severe abdominal discomfort, and dumping syndrome (after gastric bypass). A bariatric patient has a greater chance of experiencing more intense effects from smaller deviations.

2. Dumping Syndrome Intensifies

Dumping syndrome already feels bad enough, and stress can make it worse. It happens when gastric bypass patients eat too much sugar or drink too much fluid with a meal and the stomach contents move too quickly into the small intestine. Stress itself can stimulate faster intestinal activity through the nervous system. In someone with altered anatomy, this may compound abdominal cramping, diarrhea, sweating, and other associated symptoms.

3. Stress Complicates Nutrient Deficiencies

Bariatric patients are at a higher risk of iron, vitamin B12, folate, vitamin D, and thiamine deficiency. Being chronically stressed and adopting unusual eating patterns can make getting proper nutrients more difficult and potentially make it harder to maintain supplementation. Both nutrient deficiency and stress can induce fatigue, brain fog, and mood changes on their own; together, they make those symptoms worse.

Stopgap Stress Eating

Stress management is not just about relaxing, and for bariatric patients, the most interesting strategies are often the ones that target the gut-brain connection. It can influence stomach emptying, bowel patterns, food choices, inflammation, and the behaviors that determine long-term surgical success.

Most people, not just bariatric patients, focus on what they eat but not the state their nervous system is in when they eat. Before a meal, try this: inhale through the nose for about 4 seconds, exhale slowly for 6-8 seconds, and repeat for 1-2 minutes. This activity, especially the longer exhale, activates the parasympathetic nervous system (“rest-and-digest”). It’ll help with slowing down eating, bringing awareness to fullness cues, and possibly alleviating any discomfort.

Movement also helps, and taking a short 5-15 minute stroll after eating can be surprisingly gratifying both mentally and physiologically. It can help the body better control blood glucose and reduce post-meal spikes, encourage gut motility, and actually calm stress hormones. Not only that, but movement is highly encouraged for weight loss, and this would count toward daily physical activity goals. Win-win.

It’s also useful to pay attention to how we’re eating. This sounds almost too simple, but chewing more than feels necessary is one of the most practical bariatric “hacks.” Chewing mechanically breaks food down before it reaches a smaller stomach; chewing even more slows down eating, gives satiety hormones time to respond, and helps the digestive tract process food more efficiently. Another useful trick is to put the fork down between bites.

When stress hits and you reach for comfort food, try stress substitutions if you feel like you’re having a momentary lapse in willpower. A lot of stress eating happens because food is filling a nervous system role. Instead of telling yourself, “Don’t eat,” ask yourself, “What am I feeling that food will make me feel better?” If you’re trying to find contentment, warm tea, a weighted blanket, and calming music might work. If you just need a break to catch your snap, a walk around the block and cucumber water can be a great reset. The point is to find substitutes that meet the emotional regulation your nervous system is seeking and teach your brain that it can be found in sources other than food.

A particularly interesting area of ongoing research is that bariatric surgery doesn’t just change the size of the stomach, it changes how the brain, gut hormones, and microbiome communicate. Stress management after surgery can be thought of as more than psychological support and as part of maintaining the biological changes that make surgery successful.

Life can come at us fast sometimes. When you’re trying to move into new and healthier habits, feeling stressed can be a double whammy. After bariatric surgery, learning how to care for your changing body while managing life’s demands takes patience, support, and the right guidance.

SAMPA is here to help you build healthy habits that last. Our team provides comprehensive care focused on long-term health, not just surgery. As leaders in laparoscopic, robotic, general, and weight loss surgery, SAMPA’s board-certified surgeons are all Fellows of the American College of Surgeons and provide patients with compassionate care throughout their weight loss experience.

Obesity & Diabetic Eye Disease Risk

Elevated blood sugar levels and type 2 diabetes are common comorbidities of being overweight or obese. They can also lead to vision complications like glaucoma.

Updated for 2026

Eyes are the windows to the soul, and keeping your body healthy helps to keep those windows operating smoothly. If you are obese, you may be more concerned about your heart health than your vision, but the risks for diabetic eye diseases, including glaucoma, are increased by obesity.

What is Glaucoma?

Glaucoma is a general term for a group of eye diseases that lead to irreversible damage of the optic nerve, which connects your eye to your brain, and can cause total blindness if left untreated. The damage is caused by intraocular pressure when the natural fluid in the eye (aqueous humor) cannot drain properly. Gradual vision loss is usually the only symptom, and since the condition can’t be cured, it’s important to be aware of your risk factors and see an ophthalmologist regularly. These risk factors can include:

• A family history of glaucoma (especially a first-degree relative such as a parent, sibling, or child)
• Type 2 diabetes
• Older age
• Severe nearsightedness
• Being of African or Hispanic descent¹

Primary open-angle glaucoma (POAG) is the most common type of glaucoma in the US, and it affects an estimated 2.7 million people over the age of 40.² POAG is generally symptom-less in the early stages, but we do know that high eye pressure plays a major part in the development of the disease. Likewise, lowering eye pressure is the only proven treatment to slow its progress.³ Obesity is related to type 2 diabetes and increased eye pressure, so individuals with type 2 diabetes are at a higher risk of developing POAG and should have a yearly dilated eye exam with their ophthalmologist to detect symptoms.

There are also two other forms of glaucoma that diabetic patients have a heightened risk of developing. Neovascular glaucoma is when new vessels grow abnormally, usually onto the iris and the eye’s drainage system, causing scar tissue to develop. Steroid-induced glaucoma is caused by steroid eye drops or injections,4 which can cause increased eye pressure and damage to blood vessels in the retina. Luckily, steroid-induced glaucoma is reversible without permanent damage if the steroids are stopped quickly enough.

Early Detection is Critical!

About 50% of individuals with glaucoma are totally unaware they even have it, so early detection is critical to the prevention of the disease.5 Just as keeping your blood pressure, blood sugar level, and cholesterol in check is necessary for your overall health and well-being, doing so is equally important for the health of your eyes. For overweight individuals, losing weight is likely to help with all of these conditions.

If you have diabetes, talk to your doctor about ways to control your blood sugar, and please, don’t put off your eye exams. Get your eyes checked regularly so that the complications of glaucoma in connection with diabetes can be caught and addressed quickly.

SAMPA is committed to helping patients improve their long-term health by addressing obesity and its related medical conditions. Our team of board-certified surgeons specializes in the prevention and treatment of obesity through comprehensive medical and surgical weight loss care, and is here to help you build healthier habits for the future.

References:

1. Ou, Y. (2021, August 27). Primary Open-Angle Glaucoma. National Glaucoma Research | BrightFocus Foundation Program. https://www.brightfocus.org/glaucoma/article/primary-open-angle-glaucoma.
2. Ou, Y. (2021a, August 24). Glaucoma and Diabetes. National Glaucoma Research | BrightFocus Foundation Program. https://www.brightfocus.org/resource/glaucoma-and-diabetes/.
3. Ou, Y. (2021, August 27). Primary Open-Angle Glaucoma. National Glaucoma Research | BrightFocus Foundation Program. https://www.brightfocus.org/glaucoma/article/primary-open-angle-glaucoma.
4. Ou, Y. (2021a, August 24). Glaucoma and Diabetes. National Glaucoma Research | BrightFocus Foundation Program. https://www.brightfocus.org/resource/glaucoma-and-diabetes/.
5. U.S. Centers for Disease Control and Prevention. (2016). Announcement: Glaucoma Awareness Month – January 2016. Morbidity and Mortality Weekly Report (MMWR), 65(1). https://www.cdc.gov/mmwr/volumes/65/wr/mm6501a4.htm?s_cid=mm6501a4_w.