RickM

My wife stayed home on FMLA for my surgery and post-op time; she milked it for more than I needed the help (in part from her memory of having a harder time with her WLS a few years ago), but it was therapeutic for her to be away from work for a while longer!

You shouldn't be letting other people decide what your tastes are - Protein shakes vary all over the map in taste and texture; what's yummy to you may be ghastly to someone else. The important thing is to get in the protein that you need. To me, variety is a key, and I was lucky to be able to tolerate a variety of protein rich foods early on so that I wasn't overly dependent upon any one tiring source. Greek yogurts are a good protein source at around 10g per 4oz serving while standard yogurts are about half that - I would get awful tired of yogurt if it were my primary protein source, not to mention that I don't get along well with plain yogurt. I have used protein shakes for years and have evolved blends that work for me in providing a good level of protein and a pleasing taste; likewise with yogurts I have evolved blends that work for me - I find that the commercially available no fat yogurts are also sugar free and have a lot of artificial sweetener taste to them, and I don't care for the level of sweetness added to most products. So, I have developed my own blend of plain and sweetened vanilla greek yogurts (about a 3 to 1 ratio now) that works for me, particularly with some added fruit and nuts. Likewise with the protein shakes, they can be blended with fruit or other flavors to enhance them - I often add a little unsweetened cocoa powder to enhance the chocolate flavor and cut the sweetness of the protein powders. I also blend the Protein Powder and greek yogurt into sugar free pudding mix to make a protein rich snack. I haven't needed protein shakes to meet my protein goals since fairly early on but still use them at times for specific uses (usually strength training recovery, as they are a good source of rapidly absorbed protein) and because I like them (or at least my blends) and are part of the variety that I maintain. Do some experimenting and see what works for you!

Some docs do a low carb diet as part of their program while others do not. Likewise, some patients choose to do a low carb diet in addition to their doc's program. It's up to you what diet you want to follow as long as it meets your doc's program requirements - some people find that the ketosis state that's induced by the ultra low carb diet helps to boost the weight loss, or rate of loss, that they are getting from their WLS while others don't find much if any difference, and some find it detrimental to their loss. I never bothered trying to keep low carb, other than minimizing the simple carbs/sugars, preferring the better nutrition offered by as balanced a diet as I could have within the volume restrictions and Protein requirements that we have and never suffered any significant stalls - I've only had one week that was not a losing week over the six months plus since surgery and am less than ten pounds from goal. Indeed, that past couple of months I have been shifting some calories strategically to complex carbs to better fuel my workouts which helps burn more calories. So, both lower carb and higher carb can work to enhance the loss performance of your sleeve - it's a matter of what works best for you. Stalls are a normal thing, particularly around the three week mark (give or take some depending upon whether or not one was on any significant pre-op diet) and are usually broken, if not by time, then by changing something - intake levels up or down (not a lot of options there when so early out), or composition of intake or similar changes on the exertion front (also fairly limited when early in the process) or just by sticking it out. Your body is adapting to its new environment and it takes longer in some than others, but with the caloric deficits that we are running, it can't last forever.

I concentrate on overall nutrition, Protein first of course, but can't wrap my brain around cutting out that much good nutrition to do the low carb thing - it may help some who need an extra push beyond the VSG to reach goal or those who have diabetic issues, but for me to get to goal in six months rather than seven (assuming that it works as advertised) isn't worth the added health issues. Simple carbs have been limited, and I don't have as much fruit as I normally would in order to keep the calorie count in line (1000-1200 for me) but I do work to keep as much variety in my diet as I can. And yes, that includes potatoes sometimes (a good source of potassium, which is hard to supplement without prescription, and is a more efficient source calorically than most low carb alternatives,) and whole grain breads. I'm six and a half months out and within 7 lb of goal - so low carb is by no means essential to our weight loss. As LilMissDiva notes, caloric deficit is the key to our weight loss. If adding low carb on top of the VSG works for you, great, but if it doesn't, don't agonize over it- do what does work for you.

I don't know if there is a "better" overall, but there may be a better for you at this time. If you aren't satisfied with your loss rate, or if you are stalling a lot, then try a change and see if that shocks your system into action. Initially, I needed six small meals a day but as I have progressed and could eat more different things, and more of them in a sitting in some cases, I have dropped one or two of those smaller meals to keep my daily calorie count in line. Smaller meals have classically been used to smooth out the insulin spikes during the day and to keep from getting too hungry and over-eating. Changes in intake or exertion are often used to break stalls; some find that upping their calories for a short term breaks a stall, fooling the body into thinking that it's no longer starving; trying the very low carb diet for a while, if you haven't already been doing so may do it - the shift into ketosis mode may tell your body that you're serious about this. Or try the other way around if you have been doing low carb and try adding carbs (preferrably complex carbs rather than twinkies!) - I have found that adding complex carbs in my meal (like some whole grain toast along with some meat and cheese) before a workout allows me to workout longer and with greater intensity than when I have a lower carb salad and meat. Another thing to look at is your workouts and exertion level. Simply changing a routine can often help, or varying the intensity of exertion. I found at around this three month time that my condition had improved enough that my exertion levels weren't taxing me as much as they used to - walking as fast as I could without breaking into a jog previously would get me into that 80% max heartrate zone (around 130+ at my age) that's often recommended for optimum cardiac and calorie burning effect but by the third to fourth month that same pace could barely get me to break 100 - it didn't feel all that much easier, but my body could sure tell the difference. Lots of things to try, good luck in ramping it up!

I am close at 53 and had my VSG in early May. I'm down about 95lb and within 10 to goal and overall have had an easy recovery and post-op period. I had a few days the second week where my lower GI couldn't decide of I should have diarrhea from the soft/liquid diet or be constipated from the residual pain meds and that kept me close to home and didn't get in as much walking as I should have that week, but before that I was starting to outpace my wife on the walking trails. I had very little restriction for liquids which helped in the early days which meant that in the early days I could have enough Protein drinks to be able to experiment with small amounts of other foods and still get in the requisite protein - enough that the doc was telling me to add veg to the diet by day 10. My system hasn't rejected anything that I have tried, so I have been able to keep a reasonably well balanced diet through all of this despite the volume restrictions (and yes, there sure is a restriction when it comes to solid proteins) and have been able to have a good variety of foods, both at home and when eating out. My wife had a DS (a VSG plus intestinal rerouting) when she was 55 and she, likewise, had a boringly average recovery while losing over 200lb. She wound up being lactose intolerant afterward, and still is to some extent, and had more tolerance issues than I did during the recovery and loss phase, and strangely had more liquid restriction than I ever had despite her nominally larger stomach - her Protein shakes had to be so concentrated to get in enough protein that they were ghastly to her. Just one of the variations between us all. Good luck down your chosen path,

I still have the sleep apnea six months out and almost 100lb down (almost to goal) though it's not nearly as bad as it was. I slept without the machine three nights this week and am getting reasonable rest, though my wife says that it's still there sometimes. So, I'll use it a while longer and try again. On the diabetes front, which my wife had for about twenty years before her DS a few years ago, just short of needing insulin, it resolved in her over a few months, sometime between 6 and 12. Our doc said that in his experience, typically the longer that you have had the diabetes, the longer it will take to resolve post-op. So some will drop their meds in the hospital and never need to pick them up again while others will take a few months for it to resolve, though the meds can usually be decreased during that time.

As my doc's program instructs, try new things one at a time, testing for tolerance, and if it doesn't sit well, try again in a couple of weeks (or later, as you feel like it.) Good luck,

As Thomas noted, carbs (preferably complex carbs) before and Protein after a workout is the common nutritional advice. I've never been into the low carb game (was never mentioned by doc or his program) but continued working on high density nutrition along with the requisite protein intake. I have started experimenting with more complex carb (rather than my typical lunch salad) before workouts and do find that it helps with my endurance and intensity in the pool, though haven't seen much difference in the weight room, even though it is typically a 75-90 minute workout. I do still use the Protein shakes after the strength workouts, but a more typical greek yogurt/fruit/nuts after the pool. At the level that most of us are working strengthwise, I suspect that we won't see much benefit from overloading either carbs or protein in our Quest for lean mass preservation, as opposed to serious body building, but a more normal carb/protein/fat profile is probably better than the trendy ultra low carb/ketosis diets for those into fairly serious exercise. At this point, as others have noted, just getting started at a measured pace to get used to things without overdoing it is probably best; once you get comfortable in a routine and building intensity after a couple of months you may find the need to start tweaking the diet to better fuel things.

Like Thomas, I was starting to play with salads somewhere around the four week mark - mostly chopped spinach instead of lettuce, and other chopped veg - avo (ok, a fruit...) tomato (a maybe fruit...) green onion, pepper, carrot along with a couple ounces of leftover meat.

I believe that it is one of the facets of whether or not a surgeon requires it - some require them for all, some only for their heavier patients, and some not at all. My doc doesn't require it and I don't know of any of his patients who were required to go through it, even the SMO 60+BMI ones like my wife was. But then, he also does biliopancreatic transplants aside from his bariatrics practice, so it seems as if crappy liver condition doesn't particularly bother him, or that there is enough change from the diet to make it worthwhile for him to require it (though he is rather anal about liver care post-op) and it is likely that he has skills and experience in that area that exceed the norms for most bariatric surgeons. My general point, however, is that while some docs seem to be comfortable with things as they are without pre-op diets and others feel that they do better with them, that you should follow your doc's instructions - he's the guy with his hands (directly or remotely) inside you reworking your insides and you want him to be as comfortable as possible while he is doing so. If your doc doesn't require it (and he is an experienced at bariatrics) while others do, don't agonize over it; just as one shouldn't agonize over their doc not requiring a trendy low carb post op diet while others do - if his experience with his patients indicate that it's not necessary, there's little need to argue about it, but if it makes you feel better, then have at it.

No need to worry about it - if your doc needed you to do it, he would ask you to do it. Some docs have the skills and experience to work around any such problems while others need all the help their patients can give them. If you doc gives you such instructions, follow them as you want him to be as comfortable as possible while he's messing around with your insides; if he doesn't, then be thankful for his skills and experience.

It mostly depends upon how soon you are able to get enough Protein from "real" food, and that's a variable depending upon different doc's programs and individual patient tolerances. i was usually able to get enough in after about three weeks that I didn't routinely need the Protein shakes, though I still do sometimes use them now, at six months, for workout recovery as they do have rapidly available protein which is useful after strength training. As to other supplements, those are also dependent upon how well you can get them from food, though some supplements will probably be needed long term/permanently due to our reduced food volume. B12 is likely to be a permanent supplement as our small stomachs don't produce enough of the intrinsic factor that's needed to properly break down and absorb what we eat. Calcium will depend upon what your long term post-op diet looks like - I used to get enough in pre-op but long term post-op it is unlikely that I will have as much dairy or other calcium rich foods as I used to. Likewise, postassium - which is difficult to supplement without prescription - I used to get in the typical RDA of 4700mg through my normal diet, but am only at 40% that level these days (and low carb diets would make that worse); so far blood levels are fine, but it is something that we are watching.

It seems like you may have developed a lactose intolerance, which happens with some after WLS, and is usually (but not always) temporary. Whey protein is often considered to be the most absorbable form, and the most desirable form of that is isolated whey protein which is lactose free. It is also the most expensive form, so it is often blended with cheaper non-isolated whey protein. If you can find a protein mix that is 100% whey protein isolate, and they do exist but you may need to go to a GNC, Vitamin Shoppe or other such store, that should work for you. As noted by others, you can try soy based protein supplements, and while they may not be considered as good as whey based products, if that's what works for you, you go with it.

I guess it depends upon how meaty the "meaty soup bones" are, but it sounds plausible - better and more palatable than the commercial broths, and a lot less sodium (which is probably what would make me gag if I had to have that much of it.) I think that if you depended upon it as your primary Protein source that you would tire of it quickly (I sure did, and only used Soups for a week or two post op.) I don't find the powders to be all that objectionable, though I have been playing with them for several years, finding blends that suit me. The unflavored powders can be put into Jello for some variety (though that is another thing I tired of and haven't revisited since) and the chocolate or unflavored varieties can be made into instant SF puddings for a hi-pro snack (which I still use.) The bigger challenge will be finding enough variety to keep you sane, particularly if your doc is one who goes into extensive liquid post-op diets. Thankfully, between my tolerant stomach and surgeon, I was able to progress to more real foods fairly quickly and maintained my sanity through it all. Good luck to you,

It took me about eight years, though there were distractions of my wife going thru this during that time. We decided that we needed to do something about our mutual problem. The RNY was not a solution that we could live with but when she found the DS in her research, that sounded like it did what we needed and allowed a reasonably normal postop life, so we started going to the support group/seminar meetings for the brothers Rabkin in SF (one of the few practices that did both the DS and RNY at the time, so we felt we could get a less biased view on things from them). It took a couple of years to get her on the table after the insurance denials and going into self-pay, but it was worth it for her (six years out and still maintaining 200+ down.) In the meantime, with the normal insurance 6 month roadblock diet/exercise program I found that I actually liked going to the gym (was nice getting back into swimming after years away from it) and lost around 50 lb of my problem and some more before settling back at the down 50 level. After losing that and maintaining it with a continually evolving sanity diet and moderate gymwork, I was uncertain about needing something as strong as the DS, and the RNY was not going to happen - i'd keep the weight I had rather than subject myself to that (nor were the silly bands under consideration,) and the VSG was too new as a stand alone procedure to have enough history or insurance backing. So, I let it go for a while, maintaining what I had lost but not making any more progress (didn't want to get into any of those unsustainable diet programs that have, maybe, a 5% success rate.) When our insurer started covering the VSG last year, it was time to look at it again with the confidence that I had regain issues under control so that I didn't need to do the DS with its better regain resistance. We had continued going to the support group meetings fairly regularly so it was pretty seemless in starting the process again, mainly more formally documenting the diet and exercise efforts for the obligatory insurance 6 month deal (surgeon doesn't have any special pre-op program) until all the paper could be put together for submission. So, eight years is the long answer, but after deciding finally to go for it, it took around ten months to get all the insurance nonsense together and take the walk into the OR (yeah, they walked us in there...) Six months later, I'm down 90lb with another 10-ish to go, depending upon how the body composition ends up.

I don't get along with the ketosis concept, but as the OPs doc suggested, it may accelerate the weight loss. For me, it's not worth the downsides to get to goal in six months rather than seven, assuming that it works as advertised. We are malnourished enough as it is with the limited volume and high protein requirements without adding the ultra low carb restriction to it as well. If I were starting out heavier and needed every trick in the book to get to goal, then it might be worthwhile. At this point, I seem to work better with a reasonable amount of complex carb in my diet, burning more calories with longer and more intense workouts, than when keeping lower carb. But we are all different in how we respond to these things - try the low carb/ketosis diet and see how it works, but don't be afraid to go to a more balanced diet if it doesn't do much for you.

My doc is one of those who does mushies from the hospital on out, as patient tolerance permits. Of course, liquids are still permitted and encouraged (still have to get in your 64+ oz of water, etc) but they have found that patients do better the more real foods that they can tolerate. They've been doing sleeves for about twenty years, so I trust that they know better than most what the sleeve can handle (as opposed to the primarily RNY guys who are just getting thier feet wet with the sleeve.) They told me to start adding veg at the ten day mark as I was getting in more than the requisite protein at that time; fruits and other simple carbs in general were to be minimized, though things like mashed potatoes, oatmeal, rice and beans, etc were acceptable early mushies before meats were tolerated.

My doc didn't do any pre-op diet either, other than the clear liquids the day before, and they've been doing sleeves and DSs for around twenty years; I'm not going to argue with him!

When my wife and I were first looking into WLS about eight years ago, the official NIH mortality figures for obese people having surgery (any surgery, not just WLS) was about 1 in 200 simply from anesthesia. It seems like those figures have improved some since then, but it did illustrate that surgery is not risk free, and that such elevated risks would continue to be with us as we aged and needed other surgeries to live. That also put some urgency into getting the WLS sooner rather than later, and with a surgical team, particularly the anesthesiologists, who were experienced with dealing with obese patients.

It does serve as a good reminder that there are other sources of Protein than meat, though for them to consider a fast food cheeseburger like that a "meat dish" may be stretching things a bit, particularly amongst our crowd. Much of calories in there are from the far from lean meat used and the bun - a 4oz patty of 85% ground beef pan fried with cheese is around 240 cal and 27g protein. And, while some of the veg mentioned, like broccoli and cauliflower, may have a decent amount of protein per calorie, it doesn't help us much with the volume restrictions that we have. Nevertheless, it is still a good lesson that we can mix things up some and still get in our protein.

I set my goals based upon body composition rather than BMI, looking to get into the 15% bodyfat range (which is on the lean side of "normal", "recommended" or mid-"fitness" range on most charts, women would be around 28-29% on the same charts) which would still put me "overweight" on a BMI basis (26-27) because I am still maintaining much of the muscle mass that I had built up over my pre-op fitness efforts. I'm lower now than any number I can remember from college, though in better shape now than I was then, and still have another 10-15lb to go. BMI really only applies to populations rather than individuals, but is a good starting point until one figures out how their body comp works out - one can be an "overweight" BMI but still lean as I will be when I get into goal range in another month or so, and one can be a "normal" or even "low" BMI but still be overly fat if there isn't enough lean muscle mass left, though most in the normal BMI range will still have a fairly normal body composition. Both factors really need to be looked at to determine a healthy goal range - body comp is the most important factor, but most of us shouldn't be too far off of the normal BMI range either - some of the serious body builders qualify as "obese" on a BMI basis, some being in the upper 30's while still incredibly lean, but that's a real high maintenance place to be, to say the least.

A good pace and distance is whatever you are comfortable doing, and is working your heart some. I don't walk a lot since the immediate post op period, preferring gym and pool work to our boring SoCal neighborhood, but I do walk more when I'm up in Monterey (like next week) since there's more interesting places to walk. They occasionally have nice 5k walk/runs that are fun to do - I just did one about three weeks ago in Pebble Beach. You're working at a good pace and as much time as you can spare for it is great. A suggestion on finding a healthy pace is to get a heart monitor - the cheaper ones (maybe $50) are just built into a watch and you put your fingers across the face when you take a short break. The general guideline is that you should try to work your heartrate to around the 80% of maximum rate for good cardio workout and calorie burning. A rule of thumb max heartrate is 220 - your age. One of the things that sneaks up on you as your weight drops is that the walking becomes easier and it's a bigger challenge to get your heartrate up into that zone by simple walking - it doesn't feel like it's any easier, but your body can sure tell the difference. During the first couple of months post-op I would have no problem getting my heartrate up into the low 130's, which is that good working zone for me, but a couple of months later I could barely break 100 when walking as fast as I could without breaking into a jog (which the knees still don't like) This is one of the reasons that the weightloss slows down as we progress - our daily activities and purposeful exercise burns less calories unless we make a significant effort to ramp it up as the weight comes off. Some people on these forums have reported that their docs don't even consider walking to be exercise after a few months because of this effect. Good luck and keep it up - you're off to a good start.

I get pretty much the same feedback from my surgeon's staff and an unaffiated RD that I see. Keep the simple carbs/sugars in check but otherwise keep it balanced within the confines of the Protein requirements and calorie limitations consistent with the required weight loss. I just can't see doing the low carb diet and leaving all that nutrition on the table - we are already unbalanced enough with the limited volume we can consume during this time without compounding the problem. As we often see with the packaged goods that advertise low carb but boost the fat to keep the flavor, (or low fat that boost the sugar for the same reason) so goes the real food world - potassium is one of the nutrients I track since it isn't conveniently supplemented and many of the best sources come attached to carbs. Some suggest low carb alternate sources such as avocado, which i do use in my salads, but avo is twice the calories per unit of potassium as a baked potato, and about 50% higher than a banana - is low carb really saving anything if one is interested in nutrition? There are specific therapeutic uses for low carb, just as there are for most any kind of dietary restriction, but it certainly isn't a one-size-fits-all complement to the sleeve, or WLS in general I will admit, however, that the low carb fad does provide some amusement, particularly over on OH where we have the carb nannies that come in waggin their fingers at anyone having a banana! (BTW, did anyone headslap you for last weekend? lol) I don't measure by volume like that, preferring the scale, but roughly those proportions but maybe still biased a bit toward the meat. 3 real meals and 2-3 snacks of Protein Drink, yogurt/fruit/nuts, or protein loaded pudding; have normally dropped the morning snack from earlier practice. 11-1200 cal/day. Classic fitness nutrition of heavier complex carb (typically low-med fat, med protein, med-high complex carb - like meat and cheese on whole grain) before and readily absorbable protein after. I have found that the whole grain toast for lunch before the afternoon pool workout does let me work longer and with greater intensity, though I haven't noted a significant difference on my strength training days between the sandwich lunch and my more typical salad with meat. I do weigh daily and frequently twice daily but not for obsessive'compulsive reasons; rather the impedance scales give a more accurate reading of body composition in the late afternoon when one is usually fully hydrated, but a first in the morning is a more repeatable weight measurment (ok, so maybe not ob/com but latent engineer....) As Rootman noted, this seems odd due to the conflict between iron and calcium absorption. I'm not overly worried about iron since we don't have the mineral absorption issues of the RNY or DS, and I'm typically getting in double or more of the RDA of iron thru my normal Multivitamin and food; calcium is my greater concern and I do space that out from the morning iron containing multi and split it up so that no more than 5-600mg are taken at a time. (Eight years of going to DS oriented support group meetings tend to hammer these things into one's brain....) I lost a net of 50lb a few years ago with the classic balanced/sane dietary/exercise adjustments when my wife was going thru her WLS, and maintained the loss but couldn't make much more progress on any sustainable basis, so that's why I went with the sleeve - I have high confidence that the maintenance issues have already been resolved, rather than depending/hoping on making the necessary lifestyle changes after the fact. Good luck to all,

It sure does. I'm right about 29 BMI now, but 21-23 %BF which is just at or above normal for men on the charts I've seen (they list "normal" as being 11-21 or 22) but there's more variation in how BF is classed by different groups than BMI. I'm targeting 15%BF, which will still put me at an overweight 26-27BMI. BMI only really has value on a population basis and as this chart shows, has little value to the individual. One can have a "normal" BMI and still be over-fat. I'll take a lean "overweight" anytime.