SteveT74

Nope.... weight loss is weight loss. A sleeve is just a great tool to help you along your journey--but it's just a tool. The science behind good nutritional habits applies to everyone regardless of where you are along your journey. As I said, I am not able to do intermittent fasting or even follow a true therapeutic keto diet because I am only 6 weeks post-op, but if I were 5 years post op and experienced modest weight regain like OP, I would be following a true therapeutic keto diet with intermittent fasting. At that point, if you can consume enough calories to experience weight regain, you can consume enough calories to do keto right and incorporate IF. The science behind keto is there--it's just a matter of whether it's something the OP can comfortably follow.

I would be careful with the patch. My surgeon is against them and I there's no real research out there to show how much of the vitamins you can actually absorb trans-dermally. I wouldn't take the chance with those personally.

Really? My doctor said the opposite. He told me I could ditch the bariatric chewables for regular pills, but go with high quality vitamins (not the Centrum crap). I personally like the Methyl Life brand for a multivitamin. It has the best forms of each vitamin and, since they are methylated, its much easier for your body to absorb. You have to go sublingual for your biotine and B12 (they don't absorb well in pill form). I am taking Iron, Vitamin C and potassium in a pill form now. I don't take calcium since I am prone to developing kidney stones.

It would be, but I am only 6 weeks post op. I am eating 3 meals a day, spaced out at least 5 hours apart. I have done it a couple of times since surgery, but it's not something I would do on a regular basis until I am much further out from surgery.

I use MyFitnessPal and love it. I also use a garmin fitness track which links to MyFitnessPal, so the food I log shows up on the garmin site. If you're a fitbit person, fitbit has its own proprietary tracker built in to its app. Other people like bariatric specific apps, but I haven't used them yet so I can't comment.

Thanks for the tip.

Snacking is really not good for us sleevers. It triggers bad habits and grazing. I understand we might only be able to eat 4 or 5 oz during any given meal--and that helps with weight loss. However, if we are going to snack between meals, you can basically eat around your sleeve. You're not exercising discipline and that's NOT good. We want to change our past bad behaviors while we have this great opportunity. Even if you're losing weight with the snacking, that doesn't meant the snacking isn't having a negative impact on your weight loss. You have to also think about how this is going to effect you long term when your sleeve has greater capacity. I say NO snacking between meals. That said, I sometimes cave and have a snack--it's a tough thing to resist. I do everything I can not to eat it though. I'll make myself a drink comprised of 2 tablespoons of apple cider vinegar and 8oz of water. That usually kicks the cravings to the curb. If am still hungry after that, i'll allow myself a very small snack and track on MyFitnessPal so I stick with my macros and calorie budget.

Thanks!! I am going to order it. If it helps with the constipation, I am all on board!!!

Good advice, but the idea of spreading meals out is kind of outdated. It's based on studies done with athletes and bodybuilders (which most of us are not). Having 5 or six meals a day causes you're body to increase and maintain high levels of insulin throughout the day. This is a recipe for insulin resistance, which leads to more weight gain. The current science seems to support the opposite, which intermittent fasting. Most people seem to do very well going with a 16:8 fast, with a 16 hour fast a week (no calorie consumption at all after 8pm and then next meal/calorie would be lunch at 1pm). This can be done three times a week, with the other days have three meals a day spaced at least 5 hours apart. Most people tolerate it really well and even if the calorie consumption is the same, weight loss numbers increase because of the increase in insulin sensitivity.

I beg to differ. If you put two tablespoons of apple cider vinegar (with the mother) [the real thing, not some premixed drink) into 8oz of water, add a teaspoon of lemon juice, some sea salt and a little cinnamon--then drink it all--you will feel those hunger pangs subside immediately. Also, ACV is great for controlling insulin responses and blood insulin levels (not just blood glucose levels). There are plenty of studies on this on the NPI. Problem, apple cider vinegar isn't very tasty--so, you have to take it like it's medicine. Give it a shot and see if it doesn't make a difference.

I love Dr. Berg and have been using ACG (with the mother) since I was 2 weeks post op. It helps cut cravings and I am sure it's doing other good things for me (although with so many changes happing at once, it's hard to isolcate the causes).

I understand that weight gain and loss (beyond the usual 10-15 pound swings most people experience) is based on insulin resistance rather than total calorie consumption. However, even with diets that are not based entirely on cutting calories--like Keto and Atkins--still place limits on total consumption and advocate weight food so you can track your macros. Ultimately, the idea is that the fat and protein that makes up 90% of your consumption on these diets will be more satiating, so you end up eating less because you have less cravings and hunger. Regardless of how the goal is achieved, one of the goals is a reduction or moderation in total caloric intake for someone that has weight they need to lose. Keto, in particular, focuses on insulin control, but by adding in intermittent fasting (which most strict keto people incorporate at some point), you're definitely cutting calories by limiting the window for eating. You're not strictly counting calories like you would on a diet like weight watchers (probably one of the worst diets out there IMO), but the calories are cut anyway (it's just a less painful process in my experience). Anyway, I am happy with following a keto style diet (constipation notwithstanding). It's something I can do long term, but I can't follow a therapeutic style keto with a 4:1 fat to protein ration or anything close that as a new sleever (6 weeks post-op). Based on my workout regimen, I need to get around 125-150g or protein in a day (even with the protein/muscle sparing qualities of Keto) and there's a limit to how much else I can eat (even with calorie dense fats like avocado). I also don't want to deviate too far from my doctor's prescribed diet at this point, so I doing a 1:1 fat to protein diet (sticking to clean, high quality fats and proteins) and I cut carbs to less than 20g net carbs. I pretty happy with this and it sets enough ground rules that I can easily decide what I can eat and how much of it---even when I am out a restaurant.

KeyLady42, we've all been in your shoes--or we wouldn't have needed bariatric surgery. I don't think there is such a thing as "trying to stick to your diet plan". That's like being a little bit pregnant. You either are or are not sticking to the plan--no in between. Since you're five years post-op, the original post-op plan may not be the right plan for you. Your nutritional needs may be different now. You should probably make an appointment with your surgeon for a follow up and meet with your practice's nutritionist to come up with a plan that may be better for you. Personally, I think a keto style diet would be a really great option for someone that's five years out and has regained a little (15 pounds regain after losing 220 isn't a huge amount, but I understand your concerns about how that can snowball). You need to find a dietary lifestyle that will be sustainable for your now and into the future. Also, regardless of what dietary lifestyle you are following, are you tracking your marcros and calories using an app like MyFitnessPal??? Some dietary lifestyles place less emphasis on calorie consumption (which is ok), but calories always matter in the end. You can't lose weight on even keto or atkins if you're eating 4500 calories a day of healthy fats and proteins. If you are getting out of that habit of tracking your macros and calories, it's time to start it up again. It's hard to know how much you are consuming if you're just eyeballing your food and guessing how many calories your eating. If you do that, chances are that you'll be off by hundreds of calories at the end of the day (usually underestimating your consumption). It's time to get that food scale out so you know what you're putting in your mouth. It's ok to go off diet every once in a while, but you can't let one bad meal turn into one bad day, turn into one bad week etc. You need to get right back on the bandwagon and double down on your discipline. Finally, are you sticking with your exercise program or have you given up on that? Weight is lost in the kitchen, not the gym---but it still helps a little with weight loss and it's very important for overall health. Physical fitness and regular also helps motivate most people to eat better (particularly when they see and feel how hard it is to burn off those calories). I wish you the best of look with the continuation of your WL journey!!

Thanks for the tip on the MCT oil. I am going to look into getting some. It's pretty high in calories though?? Does that concern you at all? Even on keto, you still have to watch your calories.

I love eating the keto diet, but it does have some negatives. For me, it's constipation and bloating. They are constant companions for me lately. I have been getting in 75-100oz of water and have been upping my fiber consumption, but hasn't been helping much. Have you had any issues like this?

Another 12/17 person!! Great job on the 5 pound loss!!! You're kicking ass!!!

Well, it sounds like your nut is giving you some good advice. I am pretty much doing what you are suggesting. Because of the amount of exercise I am getting, I need to consume more than the 90g protein goal that is recommended by my doctor [as a guy]. My nut suggested that I should be consuming around 125g of protein per day as my goal. That's 500 calories right there just in protein. Even though protein is the most important macro, it can't be the only one or you would never go to the bathroom and you'd have other problems (see more below). So, I need to try to get at least some additional calories in the form of fat. I have been eating 1:1 fat to protein, so that's a 1000 calories right there, plus an extra 15 or so net grams of carbs that slip in. So, I am somewhere between 1,000 to 1,100 (which includes 15 or so net grams of carbs). I could try cutting back on fat sources and add in more fiber and see how that goes. I definitely need to up the fiber because I can't freakin' move my bowels and when I do it's like passing a baseball. I am drinking between 75 and 100oz of water a day sometimes more and rarely less. I can try upping that, but this 75 to 100oz seems like a pretty reasonable amount to me???? I think constipation and bloating are my biggest problems this week and probably have a lot to do with the "stall".

I wouldn't call my diet a true therapeutic keto diet, since I am basically doing 1:1 fat to protein. I would call it more of a keto inspired diet. It's the best I can do keto, while I am limited to about 1000-1200 calories a day at this point. Since I still have to get around 120-150g of protein to meet my daily needs (since I am working out a lot), I just can't eat enough fat and still stick to my calorie goals (and I don't want to go too high on calories this early post-op). Nevertheless, I am still in ketosis, but I get kicked out if I have too much protein in one meal. Since I am hitting my protein goals daily, I do try to prime the pump by eating some good fats first (like avocado) before I eat my protein. As for keto sticks, they aren't the most reliable tests, but if you're in your first month to 6 weeks of a very low carb diet (20 or less grams), they are helpful in letting you know if you're in ketosis. However, if you get a reading on them doesn't show acetate (which is a by product of ketosis) in your urine, that doesn't mean you're not in ketosis--so, in the sense they aren't reliable. Of course, they are only reliable in the beginning. Once you become fat adapted, you shouldn't have any acetate in your urine. The blood test is obviously the most accurate way to check, but I am just not up for spending $60 bucks for a blood meter kit and just 10 test strips, since the test strips are so freakin' expensive. The keto sticks are good enough for my purpose and there are plenty of physical signs that you're in ketosis after the 6 week mark anyway. Frankly, with or without a ketogenetic diet most early bariatric patients are going to be in ketosis anyway because they are consuming barely any calories. A ketogenetic diet essentially stimulates the benefits of a fast, without having to actually fast (although you would want to mix in intermittent fasting with keto if you want to maximize losses---if you are NOT a bariatric patient or are more than a year post-op). Also, even you are a bypass patient, you can still do keto--but you have to start a little differently by phasing in fats over the course of a few weeks rather than making sudden transition which a non-bariatric patient might do. There are plenty of resources online for bariatric patients (including bypass patients) that would like to transition to a keto diet.

Over consumption is how we all get ourselves in trouble. It's going to happen no matter what in the beginning because the line between feeling comfortably full and puking is a fine one (at least for me and I think must of us 6 weekers). I still can't get used to chewing small bites 20 times before I swallow. I end up eating like I did pre-op which is not good. I really need to be more mindful of how fast I am eating. Btw, my scale tricked me yesterday. The stall is not broken. I was back to 208.2 today. It's not officially a week stuck at 208. I know it's to be expected, particularly with the gym and all--but it still sucks!!! I am guessing it could stay stuck for a few more days and then hopefully I'll drop a couple of pounds overnight. I like to be optimistic.

I had the glue--so same here (no covering). However, this week the big incision over my belly button started to bleed (6 weeks post-op) from the right edge after rubbing against a shirt when I was at the gym. It was the kind of bleeding you get when you cut yourself shaving--looks worse than it is. I cleaned the area well, put some anti-bacterial cream on it and covered it with a bandage. Now, I put a bandage over the areas when ever I work out. It takes a while for the big wound to fully heal apparently.

I started walking on the treadmill at the gym two or three days after I was released from the hospital (it's too cold to walk outside where I live). After two weeks, I was taking spin classes and doing some high intensity, low impact cardio. My surgeon had me go straight to purees and soft foods, when I was released from the hospital, so I had enough calories and nutrients to be more active earlier in the recovery process. I don't think I could have been as active if I had been on a clear liquids, then transition to full liquids before moving to purees/softs 2 weeks post op. If you're surgeon has you on liquid diet, you should still get your exercise in, but make sure you take it extra easy and always listen to your body (which you should do anyway), If you're consuming less than 600 calories a day, you have to go a slower even if you feel you can do more. As you are able to consume more calories (over 600), you can start increasing intensity and getting your heart rate up. As for my progression, my surgeon said I had no restrictions on physical activity at my one month follow up (Jan. 16). I started weight training the next day--lighter weights and higher reps at first. I am now about 6 weeks post-op and I am working out the same as I would if I hadn't had surgery, including working on my abs. I honestly feel great in the gym and I see and feel significant improvement in my physical fitness and muscle tone. My joints feel better and I have a lot more energy than I had before the surgery. I have been doing cardio every day and weight training 4-5 times a week (three on, one off). I am not going crazy with the weights--I am just listening to my body and making sure I am lifting as much weight as I can, while maintain proper form. FYI, if you are going to go from the operating room to the gym (figuratively speaking) like some of us have done, you may find that you stall out on your weight loss sooner or more often than other WLS patients. You're still going to lose that fat, but the additional muscle mass you add (even if you are only doing cardio) will slow the downward momentum of your scale (which doesn't distinguish between fat and muscle). This is actually a good thing. Sure, we all want to get the weight off as quickly as possible, but if you don't add exercise to your weight loss program a larger percentage of your weight loss will come from you muscle mass. The idea is to lose fat, not muscle tissue. Nevertheless, it is annoying to see the scale stall since you want to get to certain weight loss goals and benchmarks that you set for yourself (at least that's how I feel)--even though I know I am getting huge benefits from the exercise.

You're probably right about ignoring the scale, but I can't help it!!! I need to get my daily weigh in!!! I could probably do every other day, but I couldn't do weekly weigh-ins at this point (which I know some people do). I nice to know I am losing, but it's more important for me to know if I doing something to screw myself without consciously realizing it at the time. The scale holds you accountable.

congrats on your successful surgery and welcome to the forum. :-)

What you are experiencing is totally normal and should be expected. If you start a diet/lifestyle and don't incorporate exercise in that new lifestyle, you can lose plenty of weight with diet alone (with or without bariatric surgery). The moment you change your lifestyle habits by adding in what sounds like a new and reasonably intensive exercise regimen, you're going to probably experience what appears to stall or slow down in weight loss. Your body will begin to increase your volume and percentage of skeletal muscle--which is a good thing. Muscle burns calories at rest, which enhances your metabolism even when you're not at the gym. At the same time, muscle is more dense than fat. You can lose inches by adding muscle, but your total weight stays the same (depending on the rate that you burn through your fat reserves). In the beginning of your new exercise regime, you may initially gain muscle faster than you lose excess fat. This could look like a gain or stall on your scale, since a regular scale only tells you how much you weigh--without distinguishing fat from muscle or considering body composition. If you have a good BIA scale or invest in something like an Omron Body Fat Monitor (Omron HBF-306C Body Fat Monitor) you'll see a change in your body composition over the course of a few weeks of moderate to intense training (with a drop in body fat % and increase in skeletal muscle). As long as your body fat is dropping and your muscle mass is increasing, you're making progress in your weight loss journey. After a few weeks, you'll see the scale drop as your body (including your new muscle tissue) needs to burn more calories to meet your daily requirements and turns to fat tissue to get the job done (provided you are sticking closely to your diet). Here's a tip--never fall into the trap of thinking that because you're hitting the gym, you can eat more calories--that's how you get into a true stall or end up gaining weight. Adding calories with exercise only applies to certain types of athletes and bodybuilders (which should exclude pretty much everyone on this forum--myself included!!). Another tip is to keep your cardio to a reasonable amount, but don't over do it. Most experts and trainers would advise that a non-athlete do no more than an hour of cardio a day at a moderate to reasonably intense level (spending most of your cardio time getting your heart rate into zone 3 or 4 (your BPM changes with age, so you should look into this for yourself using this Target Heart Rate Chart. Also, you may want to increase your weight training from 2 days a week to 4. Even better, you might want to try doing something like a boot camp class or orange theory, which combine weight training and cardio into a one hour class so you're doing both at the same time. This is called High Intensity Interval Training (HIIT) and it's probably the most effective and time efficient way to get fit (and lose weight). Don't let the name scare you, what's high intensity is always relative to your age and fitness level so anyone can do it. [P.S. I worked as a certified personal trainer for about 4.5 years when I was in my 20's--seems like a lifetime ago. I know what to do, just haven't been doing the right things for myself for a long time!].

The purpose of the pre-op diet is to shrink your liver (most obese people have fatty livers) so that the surgeon can more easily access your stomach. In higher BMI patients (over 50BMI), fatty livers can be so large as to deny access to stomach entirely through non-invasive surgery. This usually isn't the case for lower BMI patients such as yourself. Still, most doctors require a 14 or 7 day pre-op liquid diet because it makes their lives easier on surgery day, but not all find it necessary. I have heard of doctors that dont' require a pre-op diet. If your doctor has a lot of experience with sleeves, I would just follow his guidelines and trust that he knows what he's doing. That said, make sure you only have clear liquids (chicken broth, bone broth etc.) the day before surgery and no food or liquid after 8pm the evening before surgery. Your doctor should have given you this instruction (maybe in your packet of information???). This is intended to reduce the risk of nausea after surgery and, obviously, you can't have any food or liquid in your stomach during surgery. If you have not been given this instruction already, call your surgeon's office to get clarification on your pre-op instructions. If they don't have any tell you to do this last instruction, ask them why???