Webchickadee

Nothing wrong with your question dear. Nor with the answer moregoodtimes gave...........moving right along......
Grehlin is a peptide hormone, as you mentioned. So it circulates throughout the body (just like insulin - also a hormone). So Grehlin itself cannot be removed.
There is however an area of the stomach in the Greater Curvature (the fundus) where the P/D1 cells produce Grehlin. As this part of the stomach is removed in the vertical sleeve gastrectomy (VSG) procedure, there is a significant reduction in Grehlin production in the body (though it is still also produced in the epsilon cells of the pancreas). The less Grehlin in your system, the less hunger you feel.
The pharmacological mechanism is complex and I won't go into detail. However, it is important to note that Grehlin works in partnership with another hormone (Leptin) that induces satiation (a feeling of fullness and hunger satisfaction). Before you eat, increased Grehlin levels make you hungry and after you eat, increased Leptin levels let you know you're full (in addition to stomach stretch receptors).
In this equation, if you reduce the amount of Grehlin, but leave the amount of Leptin constant, your body will feel full faster (biochemically), in addition to the mechanical signal of fullness from the smaller stomach.
There is however no longer a stretch receptor area in the stomach (also removed in VSG procedure), and it takes time for the brain to register signals from stomach to tell it to stop eating. That is why VSG patients (especially in the beginning of solid food phase) can easily overeat. 1-2 additional bites past capacity happen frequently unless the patient is weighing their portions. The brain can't keep up with the mouth!
It is also important to note that Grehlin has other much more important and useful functions for the body! The ability to learn and adapt to change are influenced by Grehlin availability. It also has a role in glucose metabolism and cell transcription/migration. Some other studies point to Grehlin's role in protecting against stress-induced depression and sleep duration and quality.
So you don't want Grehlin removed completely!
Of course no amount of physical change to this complex interwoven system can fight the evils of head-hunger! That is a learned response that we must each battle through in the beginning and good routines, will-power and in many cases supportive psychotherapy are key to ongoing success!

Go slow when you start on meat, especially beef. It is quite difficult to digest and is very dense. It will fill you up fast and in the beginning, we're terrible judges of how much food we can eat.
I still weigh everything to make sure I don't eat too much and end up in pain.
Since the "stretchy" portion of our stomach is removed, the stretch receptors in our stomach that usually tells our brain we're full is now gone. Before surgery, if we ate few bites after the "signal" made it to our brain, it wasn't a problem, as we had stretch areas left to handle the "overflow".
Now we have no extra capacity and even ONE bit more than our full mark can make us nauseous, throw up and in alot of pain.
I started by weighing out a total of 2-3 oz of food and going very slowly. I am now about 3 1/2 months post-op and I can eat about 5-6 oz at a time, but I still occasionally overeat and suffer!

Try to not panic! First thing to remember is that your starting BMI is quite low in relation to many people this forum. So for those of us who have higher BMIs, we've been eating many more calories a day to maintain that weight (prior to surgery). Suddenly, following surgery, we are eating 400-600 calories (and sometimes less) per day, whereas before, we might have been eating 3000+. Of course we're losing weight like crazy in the beginning!
As your weight (and therefore your Basal Metabolic Rate) is lower, you may have been only eating 2000 calories (or even less) to maintain your preo-op weight. Now, following surgery, you're probably in the 400-600 calorie range (and possibly higher if you're doing well with the protein).
So you're calorie difference pre and post surgery is only about 1400 calories a day (maybe a bit less). That means it will take you approx. 2-3 days to lose a pound (without exercise)! Whereas for me, my calories difference is probably at least twice that, and I'm losing a pound every 1-2 days (or better, since I'm also exercising!).
This is also the reason people weight loss slows down as they get closer to their goal. Their intake/output difference shrinks down to very little and it makes it much much harder to lose the weight without ramping up your exercise (since there's not much room to reduce calories any more at that point!).
I know, your response to that will be....."yes, but that means in 3 weeks, I should have already lost at least 8+ pounds". Maybe, maybe not! Have you been drinking all your fluids? You may be retaining Water. Have you had good bowel movements? That's very difficult to do in the beginning and you may be carrying a few pounds in your intestines! Also, as we eat less suddenly, a survival mechanism in our metabolism kicks in, trying to hold on to calories by slowing the metabolism down (because it thinks we are starving). Sometimes you have to actually increase your calorie intake a bit to fool back into the proper metabolism rate!
Try to take the long view and be patient (DAMN DAMN hard, I know!). You will get there. Try to keep the things I've mentioned in your mind and work on getting your Protein, fluids and exercise (even if it's just walking!) in.
I know this will work for you. Don't give up!

Just to clarify, I think the reason WifeyMaterial worded her question this way is because VSG patients don't have a "pouch". That is terminology that is used for Gastric Bypass patients, primarily.
A pouch is when a smaller portion of stomach is formed from the existing stomach and the existing stomach is left in the body. A "pouch" or smaller pocket-sized stomach is created, but no stomach organ is surgically removed from the body.
VSG patients actually have approx. 80% (+/- 5%) of their stomach surgically removed. There is no "pouch". The stomach is reshaped into a long narrow shape (like a banana) and then stapled and resewn.
While you CAN damage your stomach (especially in the early post-op days), it would take considerable force and generally speaking, that force would usually come from INSIDE the stomach, by overeating which strains the staples and/or sutures. A leak is life-threatening and any symptoms such unexplained consistent fever greater than 100.5 degrees farenheight, pain: left upper torso shoulder/back, left ribcage, tachycardia (fast heart rate) also increased abdominal pain, shortness of breath, sweating, chills, general malaise could be indications of leak. Make sure you are investigated immediately if you have any of these symptoms (especially if you have more than 1 concurrently).
In terms of lifting objects, bending, etc. It is important that you give your abdominal wall time to heal and not strain your abdominal muscles. Even though you most likely had a laparoscopic procedure (you don't specify), you still had incisions (as many as 8 or 9!) through the muscle layers of your abdominal wall that are now trying to heal. There are absorbable sutures in there keeping things together, but excess bending, straining and lifting will tax those sutures and they could burst, causing problems.
So take it easy! Don't lift anything (your surgeon will have given you guidelines for weight and how long you have to be careful). Coughing should be fine (especially if stabilized by a pillow), unless you have very serious prolonged coughing. Most precautions you've been given are more aimed at preventing pain and increasing the speed of your healing time. If you follow your instructions, there is VERY little chance you can damage your new stomach or abdominal wall!
Just keep moving (walk as much as you can) and sipping (in small sips, but throughout the day). You'll feel a bit better every day and in a couple of weeks you'll be in great shape!

140 g of Protein per day? That seems quite high! I am currently in the 250 lb range and I'm getting between 60-80 g a day and even that is challenging without drinking shakes or eating Protein Bars every day. Naturally sourced protein for me seems to work better and I enjoy it more. But as it stands, I'm eating mostly protein every day and still not really getting more than 80 g.
I also wanted to point out that you should double check with your surgeon that those high protein numbers are what he is advising. High levels of protein put extra strain on the kidneys. That is not a problem in the short term if your kidney function is healthy, but can become problematic in the long term.
Also, high levels of protein require greater hydration (at least 1/2 gallon of fluids for every 100 g of protein), and you must be sure to make room in your calorie food intake for other vital nutrients. Protein is great but not at the expense of everything else your body requires! Carbs are "the devil", but your body needs "good carbs". These include fruits, vegetables, Beans, and whole grains. They deliver essential Vitamins and minerals, Fiber, and a host of important phytonutrients. I try to keep my carbs below 40 per day (occasionally higher or lower). Especially once you begin more strenuous exercise, the carbs are a vital part of your energy stores during exercise, as well as your post-exercise recovery.
Common symptoms of excess protein in your diet include:
- Weight gain (probably not an issue for VSG patients, but may be contributing to stalls)
- Intestinal irritation
- Dehydration
- Seizures (a rare and extreme symptom!)
- Increase in liver enzymes
- Nutritional deficiencies
- Risk of heart disease (with long-term excess protein intake)
- Kidney problems
Again, I want to reiterate, if your medical team is advising you to have 120-140 g of protein per day, you should follow their direction. I simply wanted to put "the word" out that this is quite a bit higher than what I have seen others discussing here on VST and is approx. 2x the amount my medical team has advised me to consume.

140 g of Protein per day? That seems quite high! I am currently in the 250 lb range and I'm getting between 60-80 g a day and even that is challenging without drinking shakes or eating Protein Bars every day. Naturally sourced protein for me seems to work better and I enjoy it more. But as it stands, I'm eating mostly protein every day and still not really getting more than 80 g.
I also wanted to point out that you should double check with your surgeon that those high protein numbers are what he is advising. High levels of protein put extra strain on the kidneys. That is not a problem in the short term if your kidney function is healthy, but can become problematic in the long term.
Also, high levels of protein require greater hydration (at least 1/2 gallon of fluids for every 100 g of protein), and you must be sure to make room in your calorie food intake for other vital nutrients. Protein is great but not at the expense of everything else your body requires! Carbs are "the devil", but your body needs "good carbs". These include fruits, vegetables, Beans, and whole grains. They deliver essential Vitamins and minerals, Fiber, and a host of important phytonutrients. I try to keep my carbs below 40 per day (occasionally higher or lower). Especially once you begin more strenuous exercise, the carbs are a vital part of your energy stores during exercise, as well as your post-exercise recovery.
Common symptoms of excess protein in your diet include:
- Weight gain (probably not an issue for VSG patients, but may be contributing to stalls)
- Intestinal irritation
- Dehydration
- Seizures (a rare and extreme symptom!)
- Increase in liver enzymes
- Nutritional deficiencies
- Risk of heart disease (with long-term excess protein intake)
- Kidney problems
Again, I want to reiterate, if your medical team is advising you to have 120-140 g of protein per day, you should follow their direction. I simply wanted to put "the word" out that this is quite a bit higher than what I have seen others discussing here on VST and is approx. 2x the amount my medical team has advised me to consume.

140 g of Protein per day? That seems quite high! I am currently in the 250 lb range and I'm getting between 60-80 g a day and even that is challenging without drinking shakes or eating Protein Bars every day. Naturally sourced protein for me seems to work better and I enjoy it more. But as it stands, I'm eating mostly protein every day and still not really getting more than 80 g.
I also wanted to point out that you should double check with your surgeon that those high protein numbers are what he is advising. High levels of protein put extra strain on the kidneys. That is not a problem in the short term if your kidney function is healthy, but can become problematic in the long term.
Also, high levels of protein require greater hydration (at least 1/2 gallon of fluids for every 100 g of protein), and you must be sure to make room in your calorie food intake for other vital nutrients. Protein is great but not at the expense of everything else your body requires! Carbs are "the devil", but your body needs "good carbs". These include fruits, vegetables, Beans, and whole grains. They deliver essential Vitamins and minerals, Fiber, and a host of important phytonutrients. I try to keep my carbs below 40 per day (occasionally higher or lower). Especially once you begin more strenuous exercise, the carbs are a vital part of your energy stores during exercise, as well as your post-exercise recovery.
Common symptoms of excess protein in your diet include:
- Weight gain (probably not an issue for VSG patients, but may be contributing to stalls)
- Intestinal irritation
- Dehydration
- Seizures (a rare and extreme symptom!)
- Increase in liver enzymes
- Nutritional deficiencies
- Risk of heart disease (with long-term excess protein intake)
- Kidney problems
Again, I want to reiterate, if your medical team is advising you to have 120-140 g of protein per day, you should follow their direction. I simply wanted to put "the word" out that this is quite a bit higher than what I have seen others discussing here on VST and is approx. 2x the amount my medical team has advised me to consume.

Go slow when you start on meat, especially beef. It is quite difficult to digest and is very dense. It will fill you up fast and in the beginning, we're terrible judges of how much food we can eat.
I still weigh everything to make sure I don't eat too much and end up in pain.
Since the "stretchy" portion of our stomach is removed, the stretch receptors in our stomach that usually tells our brain we're full is now gone. Before surgery, if we ate few bites after the "signal" made it to our brain, it wasn't a problem, as we had stretch areas left to handle the "overflow".
Now we have no extra capacity and even ONE bit more than our full mark can make us nauseous, throw up and in alot of pain.
I started by weighing out a total of 2-3 oz of food and going very slowly. I am now about 3 1/2 months post-op and I can eat about 5-6 oz at a time, but I still occasionally overeat and suffer!

Generally speaking, a 15g "serving" (about 9 small pieces) of pork rinds are about 90-100 calories, with 5-6 g of fat, 300 mg of sodium, 20 mg of cholesterol and 6-7 g of Protein (with only 1 g of carbs).
That sounds pretty good. But let's dig a little deeper.
If you were to eat 100 calories worth of grilled chicken breast (approx. 2 oz), you would have approx 1 g of fat, 10 mg of sodium, 10 mg of cholesterol and 6 g of protein (with 0 g of carbs).
So for about the same amount of calories and protein, you're saving 4-5 g of fat, 290 mg of sodium and 10 mg of cholesterol by eating grilled chicken breast rather than pork rinds.
Yes, pork rinds are fun, crunchy and yummy! But let's remember they are NOT an alternative to better, cleaner more healthy protein such as chicken, fish, etc. Keeping that in mind, if you want to have a small pork rind treat once in a while, go for it!
Just be well informed in your choices!

Generally speaking, a 15g "serving" (about 9 small pieces) of pork rinds are about 90-100 calories, with 5-6 g of fat, 300 mg of sodium, 20 mg of cholesterol and 6-7 g of Protein (with only 1 g of carbs).
That sounds pretty good. But let's dig a little deeper.
If you were to eat 100 calories worth of grilled chicken breast (approx. 2 oz), you would have approx 1 g of fat, 10 mg of sodium, 10 mg of cholesterol and 6 g of protein (with 0 g of carbs).
So for about the same amount of calories and protein, you're saving 4-5 g of fat, 290 mg of sodium and 10 mg of cholesterol by eating grilled chicken breast rather than pork rinds.
Yes, pork rinds are fun, crunchy and yummy! But let's remember they are NOT an alternative to better, cleaner more healthy protein such as chicken, fish, etc. Keeping that in mind, if you want to have a small pork rind treat once in a while, go for it!
Just be well informed in your choices!

Go slow when you start on meat, especially beef. It is quite difficult to digest and is very dense. It will fill you up fast and in the beginning, we're terrible judges of how much food we can eat.
I still weigh everything to make sure I don't eat too much and end up in pain.
Since the "stretchy" portion of our stomach is removed, the stretch receptors in our stomach that usually tells our brain we're full is now gone. Before surgery, if we ate few bites after the "signal" made it to our brain, it wasn't a problem, as we had stretch areas left to handle the "overflow".
Now we have no extra capacity and even ONE bit more than our full mark can make us nauseous, throw up and in alot of pain.
I started by weighing out a total of 2-3 oz of food and going very slowly. I am now about 3 1/2 months post-op and I can eat about 5-6 oz at a time, but I still occasionally overeat and suffer!

Hi guys. I see a lot of you are struggling and worried pre-op about the pre-op diet. It is a HUGE challenge, but for me, it was an important one.
Exactly 1 year ago, I was in the middle of a 2 week liquid pre-op diet because my BMI was 55+ and I was self-pay in Mexico. Traveling from Canada meant that a reschedule would be A LOT of extra expense if my surgeon had to stop due to an enlarged liver mid-surgery. I had NO CHOICE but to follow the diet.
It also meant that cheating would increase the chance of complications and a longer recovery (or worse), all because I could not follow a 2 WEEK diet. Really? Here I was, about to take a seriously radical, life-changing step and get 85% of my stomach cut out permanently. But I can't follow a 2 week diet? That's crazy.
Post-op was going to be difficult for MONTHS, not days. So if I couldn't get my head in the game for the pre-op diet, then maybe I wasn't ready for what was going to follow post-op. I was terrified!
So I started the liquid diet. And I was STARVING. I was dreaming of all the foods I thought were leaving my life forever. Suddenly I didn't care that I had spent my life morbidly obese, I wanted my comfort back. I wanted to fill myself to bursting at every meal, like it was my last meal forever.
But I didn't break my diet.
Because for once, I wasn't going to cheat myself. It was time to grow up (I'm 43....) and take responsibility for my health, my future and my choices. A lifetime of justification, gluttony and excuses brought me to that operating room. Now it was time to face the music and get on with owning my future.
The first 3 days were HELL. That is when your body is detoxing from the carbs. You are using up the glycogen in your liver (to help "shrink" it) and it's screaming for replacement carbs to fill it back up. You can get through it. After 3 days it gets MUCH better. After a week you start to feel normal and more healthy than you have felt in years. You may be hungry, but you don't have the carb cravings anymore.
Most importantly, you feel IN CONTROL; and mentally and emotionally strong for battling your demons and winning. This is the first tangible proof in an unsure future that you CAN get through the post-op recovery and that you CAN succeed in losing the weight this time, FOR LIFE.
Whatever weight you lose during your pre-op diet is really inconsequential. What is important is what you gain:
- Confidence
- Emotional and physical self-control
- The desire to succeed and overcome "impossible" obstacles
- The knowledge that you are a WINNER as long as you do your best
Please don't look at the pre-op diet as a "condition" that your surgeon imposes on you (and some surgeons don't require it!). It is an OPPORTUNITY for you to test yourself, to help build your will, character and emotional toughness BEFORE you have the surgery.
It's like training for a marathon.....you put the blood sweat and tears in before the race to help you finish the race on game day. Without training and preparation, you will likely fail and you can get hurt really badly along the way!
Use your pre-op diet to work through your demons, build up your confidence and prove to yourself you can do it. If you "fall off the wagon" one day, the next day is a fresh start.
Aim for excellence. You owe it to yourself.

Hi guys. I see a lot of you are struggling and worried pre-op about the pre-op diet. It is a HUGE challenge, but for me, it was an important one.
Exactly 1 year ago, I was in the middle of a 2 week liquid pre-op diet because my BMI was 55+ and I was self-pay in Mexico. Traveling from Canada meant that a reschedule would be A LOT of extra expense if my surgeon had to stop due to an enlarged liver mid-surgery. I had NO CHOICE but to follow the diet.
It also meant that cheating would increase the chance of complications and a longer recovery (or worse), all because I could not follow a 2 WEEK diet. Really? Here I was, about to take a seriously radical, life-changing step and get 85% of my stomach cut out permanently. But I can't follow a 2 week diet? That's crazy.
Post-op was going to be difficult for MONTHS, not days. So if I couldn't get my head in the game for the pre-op diet, then maybe I wasn't ready for what was going to follow post-op. I was terrified!
So I started the liquid diet. And I was STARVING. I was dreaming of all the foods I thought were leaving my life forever. Suddenly I didn't care that I had spent my life morbidly obese, I wanted my comfort back. I wanted to fill myself to bursting at every meal, like it was my last meal forever.
But I didn't break my diet.
Because for once, I wasn't going to cheat myself. It was time to grow up (I'm 43....) and take responsibility for my health, my future and my choices. A lifetime of justification, gluttony and excuses brought me to that operating room. Now it was time to face the music and get on with owning my future.
The first 3 days were HELL. That is when your body is detoxing from the carbs. You are using up the glycogen in your liver (to help "shrink" it) and it's screaming for replacement carbs to fill it back up. You can get through it. After 3 days it gets MUCH better. After a week you start to feel normal and more healthy than you have felt in years. You may be hungry, but you don't have the carb cravings anymore.
Most importantly, you feel IN CONTROL; and mentally and emotionally strong for battling your demons and winning. This is the first tangible proof in an unsure future that you CAN get through the post-op recovery and that you CAN succeed in losing the weight this time, FOR LIFE.
Whatever weight you lose during your pre-op diet is really inconsequential. What is important is what you gain:
- Confidence
- Emotional and physical self-control
- The desire to succeed and overcome "impossible" obstacles
- The knowledge that you are a WINNER as long as you do your best
Please don't look at the pre-op diet as a "condition" that your surgeon imposes on you (and some surgeons don't require it!). It is an OPPORTUNITY for you to test yourself, to help build your will, character and emotional toughness BEFORE you have the surgery.
It's like training for a marathon.....you put the blood sweat and tears in before the race to help you finish the race on game day. Without training and preparation, you will likely fail and you can get hurt really badly along the way!
Use your pre-op diet to work through your demons, build up your confidence and prove to yourself you can do it. If you "fall off the wagon" one day, the next day is a fresh start.
Aim for excellence. You owe it to yourself.

Hi guys. I see a lot of you are struggling and worried pre-op about the pre-op diet. It is a HUGE challenge, but for me, it was an important one.
Exactly 1 year ago, I was in the middle of a 2 week liquid pre-op diet because my BMI was 55+ and I was self-pay in Mexico. Traveling from Canada meant that a reschedule would be A LOT of extra expense if my surgeon had to stop due to an enlarged liver mid-surgery. I had NO CHOICE but to follow the diet.
It also meant that cheating would increase the chance of complications and a longer recovery (or worse), all because I could not follow a 2 WEEK diet. Really? Here I was, about to take a seriously radical, life-changing step and get 85% of my stomach cut out permanently. But I can't follow a 2 week diet? That's crazy.
Post-op was going to be difficult for MONTHS, not days. So if I couldn't get my head in the game for the pre-op diet, then maybe I wasn't ready for what was going to follow post-op. I was terrified!
So I started the liquid diet. And I was STARVING. I was dreaming of all the foods I thought were leaving my life forever. Suddenly I didn't care that I had spent my life morbidly obese, I wanted my comfort back. I wanted to fill myself to bursting at every meal, like it was my last meal forever.
But I didn't break my diet.
Because for once, I wasn't going to cheat myself. It was time to grow up (I'm 43....) and take responsibility for my health, my future and my choices. A lifetime of justification, gluttony and excuses brought me to that operating room. Now it was time to face the music and get on with owning my future.
The first 3 days were HELL. That is when your body is detoxing from the carbs. You are using up the glycogen in your liver (to help "shrink" it) and it's screaming for replacement carbs to fill it back up. You can get through it. After 3 days it gets MUCH better. After a week you start to feel normal and more healthy than you have felt in years. You may be hungry, but you don't have the carb cravings anymore.
Most importantly, you feel IN CONTROL; and mentally and emotionally strong for battling your demons and winning. This is the first tangible proof in an unsure future that you CAN get through the post-op recovery and that you CAN succeed in losing the weight this time, FOR LIFE.
Whatever weight you lose during your pre-op diet is really inconsequential. What is important is what you gain:
- Confidence
- Emotional and physical self-control
- The desire to succeed and overcome "impossible" obstacles
- The knowledge that you are a WINNER as long as you do your best
Please don't look at the pre-op diet as a "condition" that your surgeon imposes on you (and some surgeons don't require it!). It is an OPPORTUNITY for you to test yourself, to help build your will, character and emotional toughness BEFORE you have the surgery.
It's like training for a marathon.....you put the blood sweat and tears in before the race to help you finish the race on game day. Without training and preparation, you will likely fail and you can get hurt really badly along the way!
Use your pre-op diet to work through your demons, build up your confidence and prove to yourself you can do it. If you "fall off the wagon" one day, the next day is a fresh start.
Aim for excellence. You owe it to yourself.

Just to clarify, I think the reason WifeyMaterial worded her question this way is because VSG patients don't have a "pouch". That is terminology that is used for Gastric Bypass patients, primarily.
A pouch is when a smaller portion of stomach is formed from the existing stomach and the existing stomach is left in the body. A "pouch" or smaller pocket-sized stomach is created, but no stomach organ is surgically removed from the body.
VSG patients actually have approx. 80% (+/- 5%) of their stomach surgically removed. There is no "pouch". The stomach is reshaped into a long narrow shape (like a banana) and then stapled and resewn.
While you CAN damage your stomach (especially in the early post-op days), it would take considerable force and generally speaking, that force would usually come from INSIDE the stomach, by overeating which strains the staples and/or sutures. A leak is life-threatening and any symptoms such unexplained consistent fever greater than 100.5 degrees farenheight, pain: left upper torso shoulder/back, left ribcage, tachycardia (fast heart rate) also increased abdominal pain, shortness of breath, sweating, chills, general malaise could be indications of leak. Make sure you are investigated immediately if you have any of these symptoms (especially if you have more than 1 concurrently).
In terms of lifting objects, bending, etc. It is important that you give your abdominal wall time to heal and not strain your abdominal muscles. Even though you most likely had a laparoscopic procedure (you don't specify), you still had incisions (as many as 8 or 9!) through the muscle layers of your abdominal wall that are now trying to heal. There are absorbable sutures in there keeping things together, but excess bending, straining and lifting will tax those sutures and they could burst, causing problems.
So take it easy! Don't lift anything (your surgeon will have given you guidelines for weight and how long you have to be careful). Coughing should be fine (especially if stabilized by a pillow), unless you have very serious prolonged coughing. Most precautions you've been given are more aimed at preventing pain and increasing the speed of your healing time. If you follow your instructions, there is VERY little chance you can damage your new stomach or abdominal wall!
Just keep moving (walk as much as you can) and sipping (in small sips, but throughout the day). You'll feel a bit better every day and in a couple of weeks you'll be in great shape!

My personal choice for the sleeve rather than the bypass was due to my reluctance in having my digestive tract permanently modified. I did not like the idea of having to take large quantities of supplements for the remainder of my life due to the large majority of my food intake not being absorbed by my intestines!
With the sleeve I am able to eat the same types of food as I would with a normal-size stomach (no dumping). I retain all nutrients, Vitamins, etc. from that food and my pylorus valve is intact. The only difference (generally speaking) between pre-op and post-op is the quantity of food I can eat at one time.
This makes sure that I am still responsible for my own weight (I have to eat well and I can't just eat crap and rely on the bypass to "ignore" the bad nutrition I've eaten). I have more direct control of how my body deals with my meals (at least in my mind it seems that way).
That being said, many people have had tremendous success with the bypass and it is a VERY personal choice to select the type of surgery you want. I applaud everyone who considers WLS of any type to help take control of their situation.
I'm thrilled with my sleeve and I'm 55% of the way to my goal (in less 6 1/2 months). I've lost 100 lbs to date!
I know someone at work who had the bypass one month after me and she was off work for 3 months (I was off work for 2 weeks). She's done very well in terms of weight loss (I haven't talked to her about numbers, but I can see a dramatic change.) She does however struggle with fatigue, low Iron levels and quite a bit of food intolerance.
I have more energy than I know what to do with! And I'm able to eat nearly anything (spicy food seems to disagree with me now....). My last full physical in September, my doctor was amazed. Everything was perfect! Vitamin levels, BP, sugars, cholesterol.....you name it, it was great! Best shape I've ever been, and I still have 80+ lbs to lose!

Nothing wrong with your question dear. Nor with the answer moregoodtimes gave...........moving right along......
Grehlin is a peptide hormone, as you mentioned. So it circulates throughout the body (just like insulin - also a hormone). So Grehlin itself cannot be removed.
There is however an area of the stomach in the Greater Curvature (the fundus) where the P/D1 cells produce Grehlin. As this part of the stomach is removed in the vertical sleeve gastrectomy (VSG) procedure, there is a significant reduction in Grehlin production in the body (though it is still also produced in the epsilon cells of the pancreas). The less Grehlin in your system, the less hunger you feel.
The pharmacological mechanism is complex and I won't go into detail. However, it is important to note that Grehlin works in partnership with another hormone (Leptin) that induces satiation (a feeling of fullness and hunger satisfaction). Before you eat, increased Grehlin levels make you hungry and after you eat, increased Leptin levels let you know you're full (in addition to stomach stretch receptors).
In this equation, if you reduce the amount of Grehlin, but leave the amount of Leptin constant, your body will feel full faster (biochemically), in addition to the mechanical signal of fullness from the smaller stomach.
There is however no longer a stretch receptor area in the stomach (also removed in VSG procedure), and it takes time for the brain to register signals from stomach to tell it to stop eating. That is why VSG patients (especially in the beginning of solid food phase) can easily overeat. 1-2 additional bites past capacity happen frequently unless the patient is weighing their portions. The brain can't keep up with the mouth!
It is also important to note that Grehlin has other much more important and useful functions for the body! The ability to learn and adapt to change are influenced by Grehlin availability. It also has a role in glucose metabolism and cell transcription/migration. Some other studies point to Grehlin's role in protecting against stress-induced depression and sleep duration and quality.
So you don't want Grehlin removed completely!
Of course no amount of physical change to this complex interwoven system can fight the evils of head-hunger! That is a learned response that we must each battle through in the beginning and good routines, will-power and in many cases supportive psychotherapy are key to ongoing success!

There will be a time in the future where you will look back fondly at losing 1/2 lb a day and think "wow, those were the best days!". Sounds like you're doing well. Fluids need bumping up, and you'll get there I'm sure.
My numbers were/are very similar to yours, I'm just further along the road. You'll hit lots more stalls in the coming year, just like I have. Keep a close eye on what you're eating (track everything, I use MyFitnessPal), and start incorporating exercise when you feel your ready.
I'm averaging about 2.7 lbs per week now (that includes all the time from 1st day post-op to today) and that number is getting lower as I get closer to goal. But even with stalls (my last stall was for a month, and ended about a week ago), my numbers are still going down and I know I'm going to get to goal and stay there.
Keep up the great work!

Hi guys. I see a lot of you are struggling and worried pre-op about the pre-op diet. It is a HUGE challenge, but for me, it was an important one.
Exactly 1 year ago, I was in the middle of a 2 week liquid pre-op diet because my BMI was 55+ and I was self-pay in Mexico. Traveling from Canada meant that a reschedule would be A LOT of extra expense if my surgeon had to stop due to an enlarged liver mid-surgery. I had NO CHOICE but to follow the diet.
It also meant that cheating would increase the chance of complications and a longer recovery (or worse), all because I could not follow a 2 WEEK diet. Really? Here I was, about to take a seriously radical, life-changing step and get 85% of my stomach cut out permanently. But I can't follow a 2 week diet? That's crazy.
Post-op was going to be difficult for MONTHS, not days. So if I couldn't get my head in the game for the pre-op diet, then maybe I wasn't ready for what was going to follow post-op. I was terrified!
So I started the liquid diet. And I was STARVING. I was dreaming of all the foods I thought were leaving my life forever. Suddenly I didn't care that I had spent my life morbidly obese, I wanted my comfort back. I wanted to fill myself to bursting at every meal, like it was my last meal forever.
But I didn't break my diet.
Because for once, I wasn't going to cheat myself. It was time to grow up (I'm 43....) and take responsibility for my health, my future and my choices. A lifetime of justification, gluttony and excuses brought me to that operating room. Now it was time to face the music and get on with owning my future.
The first 3 days were HELL. That is when your body is detoxing from the carbs. You are using up the glycogen in your liver (to help "shrink" it) and it's screaming for replacement carbs to fill it back up. You can get through it. After 3 days it gets MUCH better. After a week you start to feel normal and more healthy than you have felt in years. You may be hungry, but you don't have the carb cravings anymore.
Most importantly, you feel IN CONTROL; and mentally and emotionally strong for battling your demons and winning. This is the first tangible proof in an unsure future that you CAN get through the post-op recovery and that you CAN succeed in losing the weight this time, FOR LIFE.
Whatever weight you lose during your pre-op diet is really inconsequential. What is important is what you gain:
- Confidence
- Emotional and physical self-control
- The desire to succeed and overcome "impossible" obstacles
- The knowledge that you are a WINNER as long as you do your best
Please don't look at the pre-op diet as a "condition" that your surgeon imposes on you (and some surgeons don't require it!). It is an OPPORTUNITY for you to test yourself, to help build your will, character and emotional toughness BEFORE you have the surgery.
It's like training for a marathon.....you put the blood sweat and tears in before the race to help you finish the race on game day. Without training and preparation, you will likely fail and you can get hurt really badly along the way!
Use your pre-op diet to work through your demons, build up your confidence and prove to yourself you can do it. If you "fall off the wagon" one day, the next day is a fresh start.
Aim for excellence. You owe it to yourself.

Hi guys. I see a lot of you are struggling and worried pre-op about the pre-op diet. It is a HUGE challenge, but for me, it was an important one.
Exactly 1 year ago, I was in the middle of a 2 week liquid pre-op diet because my BMI was 55+ and I was self-pay in Mexico. Traveling from Canada meant that a reschedule would be A LOT of extra expense if my surgeon had to stop due to an enlarged liver mid-surgery. I had NO CHOICE but to follow the diet.
It also meant that cheating would increase the chance of complications and a longer recovery (or worse), all because I could not follow a 2 WEEK diet. Really? Here I was, about to take a seriously radical, life-changing step and get 85% of my stomach cut out permanently. But I can't follow a 2 week diet? That's crazy.
Post-op was going to be difficult for MONTHS, not days. So if I couldn't get my head in the game for the pre-op diet, then maybe I wasn't ready for what was going to follow post-op. I was terrified!
So I started the liquid diet. And I was STARVING. I was dreaming of all the foods I thought were leaving my life forever. Suddenly I didn't care that I had spent my life morbidly obese, I wanted my comfort back. I wanted to fill myself to bursting at every meal, like it was my last meal forever.
But I didn't break my diet.
Because for once, I wasn't going to cheat myself. It was time to grow up (I'm 43....) and take responsibility for my health, my future and my choices. A lifetime of justification, gluttony and excuses brought me to that operating room. Now it was time to face the music and get on with owning my future.
The first 3 days were HELL. That is when your body is detoxing from the carbs. You are using up the glycogen in your liver (to help "shrink" it) and it's screaming for replacement carbs to fill it back up. You can get through it. After 3 days it gets MUCH better. After a week you start to feel normal and more healthy than you have felt in years. You may be hungry, but you don't have the carb cravings anymore.
Most importantly, you feel IN CONTROL; and mentally and emotionally strong for battling your demons and winning. This is the first tangible proof in an unsure future that you CAN get through the post-op recovery and that you CAN succeed in losing the weight this time, FOR LIFE.
Whatever weight you lose during your pre-op diet is really inconsequential. What is important is what you gain:
- Confidence
- Emotional and physical self-control
- The desire to succeed and overcome "impossible" obstacles
- The knowledge that you are a WINNER as long as you do your best
Please don't look at the pre-op diet as a "condition" that your surgeon imposes on you (and some surgeons don't require it!). It is an OPPORTUNITY for you to test yourself, to help build your will, character and emotional toughness BEFORE you have the surgery.
It's like training for a marathon.....you put the blood sweat and tears in before the race to help you finish the race on game day. Without training and preparation, you will likely fail and you can get hurt really badly along the way!
Use your pre-op diet to work through your demons, build up your confidence and prove to yourself you can do it. If you "fall off the wagon" one day, the next day is a fresh start.
Aim for excellence. You owe it to yourself.

That's great advice! I am going to call today to change my reservation. I can't wait to not have to ever worry about these things! Congrats on your success!

It depends on your size....for example, I am 5'4" and I was 320 lbs (minus pre-op diet loss of about 12 lbs) when I flew to San Diego. I could have fit in a regular coach seat, but it would have been VERY tight (and a long nearly 5 hr flight). Plus I would have absolutely needed a seat-belt extender.
I chose to upgrade to the equivalent of business class, which has wider seats, longer seat belts and more leg room. Even with short legs, the extra space in front is very helpful when bending down, etc.
It cost less to upgrade my seat (and I got much better service....) than it would have cost to buy an extra coach seat.
A possibility to consider.
FYI, we went for a vacation (back to Mexico) 8 months later (and 110 lbs lighter) and I fit comfortably in the coach seat (with LOTS of seat belt length unused).

I was concerned about this myself. I traveled to San Diego 2 days prior to my surgery date so that I could spend those 2 days walking around and making sure I didn't have any clots collected in my legs, etc.
I was given injected anticoagulents post-op in the hospital on the day of surgery and the next day. I did a ton of walking the next 4-5 days post-op as well (increasing each day as my stamina tolerated). Of course the walking also helped a lot with getting rid of gas!
I had no problems whatsoever with clotting. I arrived in San Diego on a Saturday (surgery in Tijuana), had my surgery on the Monday and left to return to Canada on the following Saturday (7 day stay overall).
I was careful to walk as much as possible at the airport prior to the flight (lots of wait time with security, preboarding, etc!) and also got up on the plane to walk the isles at least 1x per hour (nearly a 5 hr flight for me).

I am 20 months post-op and did GREAT during the first year. I lost about 135 lbs, logged all my food, was careful with carbs, started exercising regularly and was on-track.
Then when I hit the 1 year mark (May 2013), I started playing alot of softball and the extra exercise upped my appetite. Since I was exercising so much, I was able to maintain my weight, despite eating more (per meal, quanitity-wise and more often daily). However, I stopped logging my food, didn't pay attention to carb #'s (I was "cheating" a lot!) and I stalled bigtime.
I was training to complete my first-ever half-marathon walk on my 44th birthday (Oct. 2013) and did complete that in a great PB time, but injured my left great toe (runner's "black toe") and the exercise stopped.
Blammo!
Appetite still big, capacity seemed alot bigger (especially with sliders/carbs/junk). I put on 14 lbs from Oct 20, 2013 to Jan. 5, 2014!
I'm still 40+ lbs from my revised goal, so I'm back on the wagon now. Eating clean, tracking everything, keeping carbs reasonable and watching my portion sizes. Down 2.5 lbs this week, and hoping to keep a 1.5 lb loss per week for the rest of the winter/spring/summer.
As to capacity, today, for the first time in about 6 months, I had sashimi for lunch. In the past I could eat about 3 oz. of wakame salad (seaweed salad) and 3 oz of salmon sashimi, then I was FULL. Today, I at 5 oz. of salmon and 3 oz of wakame, and I could still eat (though I do feel the restriction kicking in).
This is where it gets hard! The sleeve is still there, but the capacity is much more "normal" that what were first used to post-op and during early recovery. Now some extra degree of willpower and self-control must be partnered with the sleeve to meet our goals.
sigh. I was hoping the VSG would help me avoid this, but alas, reallity kicks in.
The good news is I know I can do this. I just need to restablish my good habits (eating) and get my exercise sorted out (did my first cross-fit class this week!).

These are my 1 year anniversary photos. Down 137 lbs. Still have another 38 lbs to go.....