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Suggest Ways To Loose Weight When Diagnosed With Diastasis Recti

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Posted on Thu, 11 Feb 2016
Question: I am looking for a solution or at least to know my options.
I am under treatment for diabetes type 1, high blood pressure and asthma and I am trying to improve my health and lose weight, but I am very aware of the bulge in my stomach that I thought was a hernia, but I was told by a doctor that is diastasis recti.
I would like to know what are my options to reconstruct my abdominal wall.

Is there any way to save myself from a surgery?
doctor
Answered by Kathy Shattler (13 hours later)
Brief Answer:
Hello, and Welcome to HCM

Detailed Answer:
I have reviewed a rather lengthy and complicated health history on you. You have many things going on with your health requiring a highly tailored nutritional and treatment approach.

I was ready to assist you with your diet and noticed that you just want to know your options for dealing with this diastasis recti. I will comment on what other patients have discussed with me, but HCM should have referred you to a surgeon and I suggest you bring this up to them.

An alternative to surgery would be a technique I neither recommend or am experienced to discuss with you. Ask your doctor about the tupler technique: https://www.diastasisrehab.com/what-is-tupler-technique

I would, however, love to discuss your diet with you. If interested, write me back. I will alert HCM about the referral mix-up. You may continue with me with regards to your diet, however, and I will be here to help. Regard, XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Kathy Shattler (11 hours later)
Thank you Ms. Shattler,

I really appreciate the information. and I am gladly XXXXXXX to see that there is a dietitian and nutritionist in your network.

I would really appreciate if you can give me some information that can help me with a my diet.
I admit that I am looking for a long term nutrition plan (not another quick diet). I am tired of the diets and I would like a plan that I can follow long term to lose all this weight that is making me so sick.

I've tried pretty much every diet out there, and I am looking for a plan that can help me to stick to the plan and lose the weight.

My doctor wants me to get bariatric surgery, but I am not ready to give up on my options, just like that. I am 4'10" and I weight 173 pounds. My weight yo-yo in a devastating ways, and many times I don't make much changes to my meals.

I did the XXXXXXX diet, south beach diet, weight watchers and most of the diets shown on the woman's world and first magazines.
I lose some weight and then I gained it right back, but when I gain the weight back I notice I get less muscle mass. I am having problems with water retention, bloating, gas and I was told I have gastritis (but I guess that I have IBS too, but I don't know what to think of the constant pain I feel from my chest to my lower belly. The pain is almost constant, sometimes is milder than other times, but it is always there. It's a burning pain that won't go away day or night; in 2011 my doctor suggested to remove my "slow" gallbladder thinking that was the reason of the pain starting right under the sternum, but the pain continued.

I have issues to work on, especially because I work at night and I usually don't eat breakfast, start with my first meal around noon or afternoon, I go to sleep very late and get 4-6 hours of sleep per day. I am under a lot of stress and I think the hormone cortisol may have a lot to do with the amount of fat on my stomach and mid section.
In my quest for better health and to relieve the eternal pain from my breastbone to my lower belly I've tried gluten free meals, lactose free and now I am trying to reduce the sugar and salt intake as much as possible. I noticed that when I stop eating each of those group of foods, I do feel better, the bloating is reduce and the pain is reduced too, but when I try to create meals with not milk, gluten and using Stevia as sweetener, the pain is not reduced. I only feel the difference when I eliminate one group at the time.

I would really appreciate if you can point me in the right direction. My doctor says that if I lose 50 pounds all my medical problems would go away. I do want to lose that weight as soon as possible, I just need a plan that allow me to cook my own meals and give me a little flexibility at least once in a while.
This is what I do on a daily basis:
I drink a lot of water, I don't drink sodas or juices, in the worst case scenario if I go to dinner I try to stay with a bottle of water or a lemonade and light meal.
I am not eating much meat, I may eat 2oz to 4oz of meat 2-3 times per week. I eat fresh fruits early in the day. When possible I like to cook my own meals.
I grew up in the Caribbean, therefore I like to add a lot of spices to my meals.
The spices I use are: Oregano, garlic, onion, cayenne pepper, paprika, thyme, turmeric, sage, cilantro, cloves, cinnamon, all spice, nutmeg.

In the Caribbean we eat a lot of rice, beans. legumes, vegetables (green and ripe plantains, sweet potatoes, Yucca roots, chayote, eggplant, okra, mushrooms, tomatoes, cucumber, celery, green and ripe bananas, lettuce, cabbage, etc.), grains (unrolled oats, bulk wheat, brown rice, long grain white rice once a month). I don't eat pork and try to stick to lean meats, fish, ground turkey meat.

I can bake, and I admit that's my downfall sometimes. I may bake coconut cookies for my kids and eat a couple, I love fresh bread (but I am trying to stay away from it). I love flan, porridge, but I am staying away from it.

I drink a cup of green tea in the morning with a half teaspoon of apple cider vinegar.
This week I bought some Special K cereal, so far I have eat two bowls of Special K with 2% milk.

I would like to know if you think I could use those favorite ingredients to create my own menus. I've tried buying Lean cuisine and smart ones meals under 260 calories.
I have problems with my feet getting swollen, but I still try to walk a quarter mile on my treadmill and ride 3 miles on my reverse bicycle and I am trying some upper body workouts on my total gym. I have a lot of workout equipment, but I have to make the best of the little time off I have. I have all the overweight on the upper body.

Sorry for all the information. Take your time, but I would appreciate if you can help me to succeed in my fight against obesity.

Once again thanks for any information you can give me.

Regards,

Ada
doctor
Answered by Kathy Shattler (6 minutes later)
Brief Answer:
My dear, I have printed out your history and I need some time

Detailed Answer:
I need some time to completely review this. There is much here. In the meantime, can you clarify - you mentioned you had Type I Diabetes yet I do not see Insulin on your medication regime. I see Metformin which is generally A Type II drug.

Please clarify.

If you can write down a sample diet of how you generally eat, foods you dislike and foods you like.

It is 3 am here and I am no good to you at this point until I review all your information and I will do my best to provide guidance.

You have 3 followups with your query and if I cannot finish we will work something out.

Please give me 24 hours to review your information and I will start on it when I wake up in 4 hours.

I am more than happy to try to help. I completely understand how frustrated you may be.

Thank you for giving me time to review all the information.

In the meantime, I have a pinterest educational board you can start looking over for nutrition, weight loss information at https://www.pinterest.com/kathyshattler/

I look forward to our next conversation. Regards, XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Kathy Shattler (5 hours later)
Good morning Ms. Shattler,

I am sorry for the typographical error, indeed my doctor diagnosed me with type II diabetes. We have a long argument with that because until recently I was hypoglycemic. In fact I am not taking the prescribed doses of Metformin because with two 500mg pills per day my blood glucose drops too much, specially if I am not eating much bread, rice or pasta on a daily basis. Right now I am taking one pill of 500mg in the morning and I am monitoring my blood glucose and blood pressure twice daily.

I live with my husband and two teenage children in rural NC.
Unless it is a very special occasion we eat at home or if I am very busy I may buy Chinese food or pizza for dinner. Since I don't have family in NC, I didn't party much or cooked big meals.

During the last 3 weeks this is a sample of my daily meals:
9:30am Once cup of green tea with a teaspoon of Bragg's apple cider vinegar and a few drops o lime juice.
Some mornings I may have one of the following for breakfast (late breakfast that is):
1 1/2 cup of fresh papaya, or 1 cup of Special K cereal, or two slices of whole wheat bread with one slice of natural swiss or cheddar cheese, once a month on the weekend I have a three eggs omelette with a little cheddar cheese, plenty vegetables (onions, peppers, tomatoes, mushrooms) a tiny amount of iodized salt and 1/4 teaspoon cayenne pepper.

I try to drink at least one 3 (69.9oz) bottles of Niagara water.
Lunch (depending on office schedule can be between 12:00pm and 3:00pm) I may get 1 lean cuisine meal under 260 calories or 1 -2 cups of boiled chayote or small salad, if I am stock at the office I make a sandwich with two slices of wheat bread or 1 sub bread (6 inches long) with Swiss or Holland style cheese, if my blood sugar is low I may go to the bakery close to the office where I work and buy a flan (Hispanic dessert made with eggs, milk, vanilla and sugar) or if I have blurred vision I may buy a pastry (not more than twice a month) like an apple turnover or pineapple stuffed pastry in the worst case scenario). If I am working from home (sometimes I am allowed to do that) I bake a sweet potato or two ripe plantains and eat them with mozzarella or Holland style cheese.
Most of the time I forget to eat for many hours and that is one of the issues I have with my glucose.
If I can't get my lunch I may eat a snack like a cup of yogurt, or another cup of green tea.

Dinner: I may eat more papaya if I have some available or most days I eat a small amount of chicken breast, 1 cup of rice with beans, or boiled green plantains (2) with scramble eggs with tomatoes, bell pepper and onion.
During the last three weeks I have been at home to cook dinner, but starting next week with the coming tax season (I work with a bookkeeping company) I may be so busy that I may have to buy take out meals for my family or order them pizza while I work later hours at the office.
If I buy fast food I mostly order Chinese food since there is a restaurant close to my house. I buy either hibachi 3 meat (shrimp, beef and chicken) with steam brown rice or pepper steak and onion for me, or I may buy two small chili beans at Wendy's or a chicken sandwich in the worst case scenario.
I don't feel like eating much meat lately. I am sick and tired of cooking chicken almost every day, I avoid beef and prefer ground turkey meat than ground beef.
I get tired of eating the same things all the time, and with the amount of acid in my stomach sometimes I don't know what to eat. I love fruits like pineapple, red apples, bananas, cantaloupe, berries, globe grapes, lime, oranges, grapefruits (even though I am avoiding citrus fruits) and vegetables Yucca root (small amounts), green and ripe plantains, sweet potatoes, zucchini, and green leaf legumes.
doctor
Answered by Kathy Shattler (50 minutes later)
Brief Answer:
Good morning, my, you should be a writer!

Detailed Answer:
I truly thank you for the additional information. Every little bit helps me form the puzzle to all of your complicated pieces. Luckily, I am experienced enough to XXXXXXX through the details.

I must admit I have not had time to review all of the several pages of information. What I would like to do is calculate your caloric needs and break your diet down into carbs, protein and fat. Then I would like to counsel you on the TYPES of each of the food groups best for your health and the healing of your organs.

I would like to discuss the multitude of drug-nutrient interactions which will require that I enter a great deal of information into my computer program to generate a report on how to make food work with your medications and how they are affecting your weight.

It is difficult to recommend supplements with so many medications but I will tell you one thing. According to the plethora of recent literature, anyone on Metformin, diagnosed as diabetic or hyperlipidemic can benefit from B12 supplementation in addition to a B complex vitamin and that is something you can consider today. Look for hypoallergenic products always and I suggest Pure Encapsulations since I know of their quality control. I can give you a code for a discount off their site if you are interested. I will look for the code today.

Omeprazole also depletes B-12 and decreases calcium absorption by 61%. You most likely need calcium citrate supplementation with vitamin D as well. Generally the calcium/D mixtures come as a calcium carbonate, which mean you will have to take with food. Calcium citrate can be taken on an empty stomach. Take omeprazole 1/2 hour before meals. You will feel less fatigued once your nutritional needs are met. Keep in mind that a B12 deficiency may not show up in regular lab work and special homocysteine or methylmalonic tests need to be ordered and even then if its subclinical it won't show up. This is all recent 2015 literature although apparently we have known about this for years prior but no one bothered with it.

Logistics: you have used two of your three follow-ups. Let me work on the rest of your material. Contact me Friday morning and I will have a tentative meal plan worked out for you. In the meantime, consider what I have discussed above, it is less to discuss next time.

Make certain you use my pinterest board for free education. You will see my clinic/education hub link at the top.

I see you mention bariatric surgery. It may be a viable option but research it well. for example, the gastric sleeve down the road fails with glycemic control in individuals with diabetes and weight is frequently gained back. You can read an article about it on my blog page at https://kathyshattler.wordpress.com/ As my article says a verticle sleeve would be a better choice if considering a gastric sleeve approach. A Roux-n-Y can cause significant malabsorption which is something you can't afford right now. So, looking into all the options is critical.

As far as your argument about type II and hypoglycemia. I was a Certified Diabetic Educator and worked for ten years with mostly Type II diabetes and Type IIs on insulin and I have seen that it is not unusual for beta cells as they start to get unhealthy and insulin response is unstable, low blood sugar is a precursor of full blown diabetes. So, not unusual to have low blood sugar before you are diagnosed diabetic.

You will be happy to know that Metformin helps with weight loss and is a good choice to be on except for the B-12.

Our meal plan should help you with the roller coaster rides with your blood sugar. I will see what I can put together.

You mentioned you don't know what to eat - my dear you are on two acid inhibitors - once weight is lost we can get rid of at least one inhibitor in all probability, but until then, stay away from ACIDIC foods like citrus, hot chilis, pizza, high fat foods as these will increase gastric acid reflux. You say you are avoiding the acidic foods but you aren't as you don't know what all of them are if you are still eating pizza, vinegar, lime juice-heavens girl!

Just avoid the bothersome foods and don't eat too much at a time, the fuller your stomach the greater the chance it will push through your esophagus and cause acid reflux. Tiny amounts 6 times per day. Don't eat 3 hours before bedtime except for a small snack (planned) and no food for 12 hours between supper and breakfast. Buy a 4-6 inch elevated incline pillow and sleep on it - propping pillows won't work.

I keep reading down your last entry and am almost overwhelmed. Are you ready for a lifestyle overhaul??? I need you to go to the pinterest board called weight loss/motivation 2015 and pack your mind with motivation because we have a lot to do.

Avoid all sugar substitutes except stevia. There are new products out by TrueLeaf I think the company is called that puts out chocolate, caramel, coconut flavorings so you can still have taste without the sugar. They also make flavoring drops for water if you get bored with drinking your fluids.

You mentioned you eat legumes. They are a good source of fiber, protein and the type of fiber they contain should help regulate blood sugar. If they give you gas, just soak overnight then dump the water and fill with fresh or bring to a rolling boil and discard water and put fresh in. That will help with any gas you may experience when you eat them.

Lean Cuisine in an emergency is ok, but please don't rely on them and get low sodium choices if you can. Sodium intake should stick in the range of 2,300 mg day or about 1 teaspoon of salt (sodium chloride) per day. You are on a very high sodium diet and that does not go well with your high blood pressure or your Clonidine which requires a low sodium diet.

Now, I am being timed with these queries. I have given you a great deal of information, but no diet yet. I need time to work on this. Please read what I wrote carefully and summarize it on a piece of paper in a notebook. Follow through with the pinterest board, then visit my website so you will always know how to contact me. Work on the suggestions I have already given you. Google the DASH diet to help you with the sodium issue. Your next reply to me will be your last follow-up on this query I believe and I will do my best to give you an idea of a diet. Until, then, keep your chin up. I am out of time. I will be ready Friday with ideas for a nutrition/lifestyle plan. Smiles, hugs XXXXXXX Shattler, MS,RDN


Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Kathy Shattler (28 hours later)
Ms. Shattler,

Thank you for answering my question.
I just intended to let you know that I found the webpages you suggest that I read.

I really appreciate your efforts and I promise to review any information you send me.

Thank you for your patience and cooperation in this matter.

Regards,

Ada XXXXXXX
doctor
Answered by Kathy Shattler (4 minutes later)
Brief Answer:
Ada, I have started a Plan for you

Detailed Answer:
Hello Again,
Holy Cow! You can get that 50 pounds off, be patient, be committed and follow my directions. You have so many areas I can help you change in your life to achieve the health you search for! Are you ready to try? I am going to give you a lot of information at once which is the value of continuous follow-up with telenutrition.
Before I forget, the url to my blog on Gastric Bypass is https://kathyshattler.wordpress.com/2015/03/22/gastric-bypass-patients-regain-weight-due-to-abnormal-glucose-tolerance/ and the url for Pure Encapsulations is : http://www.pureencapsulations.com/ and your code, if interested, I will have to send you by communication through my website contact form as I cannot have it publicized, but it will give you 15% off provider only products at Pure Encapsulation.
Also, another item . . . you stated that you took your medication sporadically due to low blood sugar episodes. Please don’t do this. For optimal control, take your metformin as prescribed (it will help with weight loss as well) and get a blood glucose monitor. Take your blood sugars before meals, after meals and keep a log book. If you think you are low, take your sugar, document it and, if necessary, eat a little something to bring it back up, but don’t overdo it. Don’t treat yourself because you “think” you are low which is considered 60-70 mg/dl and the treatment is 10-15 Gms. Easily absorbable carbohydrate.
Another thing that happens that makes those who are developing full blown diabetes and makes them feel low is the rapid swing of blood sugars from one level to another with neither particularly “bad” it is just the rapid swing that makes one feel “low”, so until we get a blood sugar log and objective measurements, your glucose management will be more difficult.
With diet, please google low and high glycemic foods as space prohibits me from providing such lists. It is the low glycemic carbohydrates in your meal plan that I want you to eat more of avoiding the high glycemic as much as possible. A good resource is the XXXXXXX Diabetes Association, but here is a URL:
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html and another helpful link:
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html
I also ran a drug-nutrient interaction check on all your medications and with the exception of avoiding licorice and grapefruit we have discussed already my main concerns with the B vitamins, esp. B-12, Calcium and vitamin D. Zyprexa is known to alter the brain metabolism so the patient gains weight, but we know more about fighting that effect now.
Let’s start with Nutrition. I calculated your needs as follows:
1800 calories is your maintenance calorie intake at your current activity level
To lose one pound per week you will need to stick to a 1300 calorie diet, but I am calculating it at 1200, which Is the lowest I can go safely. This is your recommended nutrient breakdown: You will lose more if you follow my exercise plan I will describe later.
45% carbohydrate = 135 gm. Carbohydrate (no lower, you need 130 gms per day minimum)
22% protein = 66 gm
33% fat, omega-3s, good fats = 44 gms (extra virgin olive oil, nuts, canola oil, olives, limit Trans and saturated fat.
Divide into 5 meals (I said six earlier, change to 5)
Breakfast, mid-morning snack, lunch, mid-afternoon snack, supper checking blood sugar.
Breakfast: Continue with Green Tea

1,200-Calorie Sample Meal Plan          
Scramble egg without fat, boil, or grill with cooking spray. Or, you may use the margarine to cook the egg and eat the toast dry or with sugar-free jam or jelly.
Choose sugar-free, fat-free yogurt with less than 100 calories per serving.
At breakfast, you may substitute 2 slices low-calorie bread (40 calories/slice) for 1 slice regular.
Soft-tub margarines are lower in saturated and Trans fats than butter or stick margarine.
Eat nonstarchy vegetables without added fat as desired.
General Issues I picked up on that I need agreement from you that you will sit down and make a plan for correcting these lifestyle issues that are contributing to your weight problem. Ok? Ready?
1.     4-5 hours’ sleep is not enough. You need 7-8 minimum. Please create a plan to allow you the rest you need to function.
2.     Self-defeating things like not eating breakfast have to change. Breakfast gets the metabolism going in the morning and it is especially important to have a source of protein in the am as well for the same reason.
3.     Lemonade is a huge problem. Please stop drinking it completely. It is a prime aggravator of your gastritis and burning you feel.
4.     Stress Management. Please refer to my board on Pinterest. On your piece of paper start listing positive ways to cope with your stress that do not involve eating. Use these ways instead of using food. I cannot help you here at this level of consult.
5.     Your protein intake is low compared to other nutrients taken in, that is why you are losing muscle and muscle contains mitochondria the power houses of the cell that regulate our metabolic rate.
6.     Use stevia flavorings to get fulfill that sweet craving in part caused by Zyprexa. The company that makes stevia products has a cookbook. I recommend you obtain that and make substitutions not excuses for your sweet binges.
7.     Do not assume you are low sugar, as I suggested, let’s start tracking the blood sugar.
8.     Please implement a way to monitor your heart rate and I am going to modify your exercise program. This requires being able to monitor your heart rate while you are walking (that is your chosen exercise, correct?)
9.     Portion Control. Can you please start weighing and measuring things for a short period to get the eyeball back on portion sizes, please?

THIS WAS TO BE IN THE NOTES SECTION OF YOUR 1200 CALORIE MEAL PLAN
I AM NOT SURE WHY IT DID NOT COPY ( update)

Use mustard (free food) instead of mayo at lunch and save the fat for dinner.

Notes
Avoid limes, grapefruit, oranges, cayenne pepper, chilies, paprika, cabbage, sorbitol, lactose (use lactaid,yogurt,cheese ok), switch from 2% to 1% milk, continue to eliminate all sugar, high fructose corn syrup *read labels, salt/sodium, lemonade (big problem for gastritis), no more treating "feelings of low blood sugar" with desserts, sugar, or other foods that are on your "avoid list" Rather, emphasize turmeric, cumin, garlic, onion as spices avoiding the ones that stimulate gastric reflux.

Do not eat for twelve hours between supper and breakfast and what we discussed about high glycemic carbohydrates and fiber still holds.

Exercise Program Recommendations per doctor’s clearance due to cardiac status:

Frequency: 150 minutes per week or 30 minutes 5 days per week. Begin with 5 minutes of warming up and finish with 5 minutes of cool down.

Intensity: Walk at 70% of your maximum heart rate to get your metabolism to burn optimally
220- age of 44 = 176 (maximum heart rate) x .7 = 123 beats per minute is target heart rate zone

Duration: See below
For five minutes gradually get your heart rate up to 123 and try to keep it there for 30 minutes then gradually over 5 minutes lower it. These are specific directions that I think will make a difference in your work out

I also suggest some strengthening exercises such as arm exercises – you may find pictures of these and other exercises on my fitness board on my pinterest site.
I am again out of time. I hope all of this gives you some direction, some references on where to learn more and motivation to realize you can achieve your goals.

We never discussed supplements, but if you are on those, it would be beneficial to have someone take a look at all of them, the timing, interactions -if any-to optimize your program.

Good luck with all the changes.

Okay, I see the sample diet I did for you did not copy and paste. I will find another way to try to get that to you.

I hope I have helped. If satisfied, please rate and close. Be Well. Regards, XXXXXXX Shattler, MS,RDN.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Kathy Shattler (1 hour later)
Brief Answer:
Thank you and please rate the question

Detailed Answer:
The company seems to enjoy seeing star ratings. If satisfied, please rate a 5 star and any comments can be entered under the rating. The public sees this.

I feel very satisfied when I can truly help someone. XXXXXXX
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Kathy Shattler (0 minute later)
Thank you Ms. Shattler for ALL your efforts, I must give it to you. You have gone above and beyond to give me your professional opinion and to provide me with the sample menu.

I AM VERY GRATEFUL AND SATISFIED WITH YOUR ANSWER.
I will follow your advises and won't stop until I get my health and weight on track one step at a time.

THANK YOU VERY MUCH FOR YOUR HELP.
I will continue checking my blood pressure and glucose twice daily as I do every day.

Best regards,

Ada
Answered by
Kathy
Kathy Shattler

Dietitian & Nutritionist

Practicing since :1985

Answered : 903 Questions

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Suggest Ways To Loose Weight When Diagnosed With Diastasis Recti

Brief Answer: Hello, and Welcome to HCM Detailed Answer: I have reviewed a rather lengthy and complicated health history on you. You have many things going on with your health requiring a highly tailored nutritional and treatment approach. I was ready to assist you with your diet and noticed that you just want to know your options for dealing with this diastasis recti. I will comment on what other patients have discussed with me, but HCM should have referred you to a surgeon and I suggest you bring this up to them. An alternative to surgery would be a technique I neither recommend or am experienced to discuss with you. Ask your doctor about the tupler technique: https://www.diastasisrehab.com/what-is-tupler-technique I would, however, love to discuss your diet with you. If interested, write me back. I will alert HCM about the referral mix-up. You may continue with me with regards to your diet, however, and I will be here to help. Regard, XXXXXXX Shattler, MS,RDN