SpartanMaker

I wanted to address the GERD fears as well. Overall, I think the number of people that develop GERD after gastric sleeve is pretty low. That said, I personally am a bit concerned when you say your surgeon "pushes the sleeve". Any doctor that pushes one surgery over another is a bit of a red flag to me? I personally would want them to advise on what they think is best for ME, not what's best for them. My surgeon felt like I was pretty likely to develop GERD if I did go with sleeve, so they advised against it due to what they saw on the endo. FWIW, I didn't even have a history of GERD. It might have helped that I went into the process with an open mind and not fixated on a specific surgery? Lots of people are successful with sleeve surgery even if they have a history of GERD, but this was one I wasn't willing to risk personally. Knowing that bypass is often the revision surgery of choice for sleevers that do develop severe GERD, it made sense to me to avoid all that and go straight to bypass.

I totally get it. This is scary stuff and we humans are wired to not be very good at measuring TRUE risk. In other words, we can completely ignore the risks inherent in obesity since that's the norm for us, all the while overinflating the risks involved in bariatric surgery since that's unknown territory. It's the same reason some people are deathly afraid of flying, all the while ignoring the fact that they are significantly more likely to die in a car crash. I think at the end of the day, you have to do you. If you feel rushed, there's nothing wrong with taking longer to work your way through the process. That said, I don't think I'd advise cancelling the psych and endo appointments, since you can do those now and still put off or cancel your surgery. If you cancel those appointments and decide later you do want to go through with the surgery, you may have to restart the process. In the interim, you might consider discussing these fears with your therapist? I know you didn't ask, but I think you'll find that the vast majority of us that have that the surgery have no regrets at all. If anything, I personally wish I'd done it when I was much younger instead of wasting so many of my younger years living an unhealthy life.

My number one piece of advice would be not to compare yourself to others. I get it, it's comforting to know someone else went through the same thing as you, but when you factor in genetics, epigenetic, diet, exercise, starting weight, % lean mass, etc. any comparisons will fall short. This will become even more important after surgery when the process becomes really hard and you feel like it's not working like it should. We see multiple posts a month from people who are losing weight, but it's coming off slower than they expected and they want to know why. The response is always the same. Trust the process, we're all different and how we lose weight is going to be different. I think it's fantastic that you're losing so well right now. Keep in mind that the rate of loss WILL slow down some as you lose more. That's perfectly normal, so don't let that discourage you from continuing to eat well and exercising. I would caution you about fasting. There's no scientific evidence that it works any better than any other method of calorie restriction. Normally I'd say do what works for you, but fasting is not something you'll be able to do post-WLS (at least early on), so it might not be the best thing for you right now. Especially since your real goal at this point is to learn how to eat better, I'm not sure fasting is the best plan currently. I also think you need to include more cardio into your exercise routine. I love resistance training for lots of reasons, but cardiovascular endurance is the number one predictor of all cause mortality, so please don't skip it, even if you don't like it as much.

@Arabesque is correct. Your body is specifically designed to "detox" without any intervention from you. Anyone trying to sell you something that claims to do this is the modern equivalent of a snake-oil salesman. Don't waste your money or time. Regarding your pain, I'm sorry you're going through this. Aside from being uncomfortable, it must also be scary. If the tests you've done have so far been inconclusive, then you need to be asking your doctor "what's next". It's not acceptable for them to say "we didn't find anything, so there must not be a problem". This does require you to be an advocate for yourself, which can be hard for some people. Don't settle for "we don't know". The proper response is "we don't know yet, so let's explore other options".

By your logic we should also call DS & SADI sleeve gastrectomies. Heck, it's even in the name for SADI-S: single anastomosis duodeno-ileal bypass with sleeve gastrectomy. Either way, both surgeries probably have more in common with sleeve than traditional bypass in that they retain the pyloric valve and the bulk of the stomach is removed. Yes, they all bypass a section of the small intestine, but RYGB only bypasses the duodenum whereas traditional DS bypasses the duodenum, jejunum, and proximal ileum. SADI-S sort of splits the difference. Where and how much of the small intestine is bypassed makes a HUGE difference in nutrient absorption since the various parts of the small intestine affect absorption differently. Grouping them all together just because they bypass a part of the small intestine makes as much sense as grouping them in with sleeve gastrectomy since they also are pyloric-sparing surgeries. Aside from the technicalities of the surgeries themselves, In practice DS/SADI are pretty rare, so trying to group them in with RYGB just seems really odd to most of us here. Heck, the name of the surgery specific board here is "Gastric Bypass" not "Roux-en-Y gastric bypass". If that's not enough for you, just do a Google search for "gastric bypass". Pretty much every result you get is going to be one that is using the term interchangeably with Roux-en-Y gastric bypass. Let's get back to the question at hand and why I called this out. By you grouping all three of these surgeries together and claiming they all need additional supplementation of vitamins ADEK is factually incorrect. Gastric Bypass patients do not need this. For someone that seems concerned about taking vitamins that "aren't needed", please don't spread misinformation about what others need.

You're confusing RNYGB with DS/SADI. DS/SADI patients are the ones that need additional supplementation of the fat soluble vitamins, not GB.

I feel like you may be overthinking the malabsorption component of RNYGB? Yes, this does elevate the risk of nutritional deficiencies for some vitamins & minerals since absorption sites are somewhat bypassed. You've got to keep in mind though that ALL bariatric surgery patients are going to be nutritionally deficient, at least during the weight loss phase when you'll be eating a very low calorie diet. Very low calorie also means very low amounts of most vitamins and minerals. Even if your diet were perfect (virtually no one has a perfect diet), you just can't consume sufficient food to make up for your nutritional needs. Yes, you'll eventually get back to eating more normal amounts, but until then, bariatric multivitamins have been formulated to make sure you don't suffer from nutritional deficiencies. Keep in mind too that the supplementation recommendations are all based on averages and in reality very few of us are average. The volume of food and the nutritional quality of said food, as well as genetic and epigenetic factors all influence what you'll be able to get from diet alone, as well as how well supplementation works for you. As a result, ALL supplementation recommendations are set up to ensure ~95% of patients will have no nutritional issues. Bariatric multivitamin manufacturers also tend to over-rotate on anything that does not have an established upper limit since they know that their consumers will be having frequent labs done. If someone were to be deficient in a particular vitamin, then they're likely to seek out a different product. You can see this pretty clearly by simply looking at something like the ASMBS recommendations vs the massive amounts of many vitamins found in bariatric multivitamins. Know too that it's entirely likely your bariatric team will have you adjust your supplementation after your labs are done post operatively. Many will want to do labs around 90 days, 180 days, then annually thereafter to monitor for nutritional deficiencies (or sometimes even excesses). I for example had to modify what multivitamin I took because my B12 level was sky high. I get the cost concern, and you may be fine with just a regular multivitamin, but keep in mind your overall food bill should drop since you'll be eating so little. This should more than cover the cost difference, so personally I'd err on the side of caution and take a bariatric specific multivitamin at least while you're in the fat loss stage. Once you're in maintenance, you might be able to adjust that (with your doctor's blessing).

I'll be honest. I'm skeptical of this, but before we get into that, I think you may need to clarify something? You stated that you have: This would be highly unusual, since lipoedema is normally seen over the entirety of the legs, but is typically most pronounced in the buttocks & thigh area. Have you actually been diagnosed by a physician? If it's just your calves, it would be a lot more likely for this to actually be muscle, not fat. It's extremely common for formerly obese people to have larger than normal calf muscles. This is so because basically you've spent your life doing heavy calf exercises daily just by walking around with all that extra weight. If this is the issue, your options may be somewhat limited. Eventually, with targeted diet and exercise, your calves may shrink, but it won't happen quickly. Another fairly common cause would be another type of edema such as lymphedema. Edema is common in obese people, but lymphedema specifically often goes undiagnosed. Unfortunately for some people, losing weight may not fix the problem. Bottom line, if you have not already done so, I would strongly encourage you to talk with a doctor about your concerns so you can get an accurate diagnosis. Now for my thoughts on hypoxi and the reasons I'm concerned: The basic principle here goes against our current understanding of how fat loss works. The only study linked on their website doesn't actually show ANY increase in fat loss. All it shows is a reduction in size of the "treated" area. This is a HUGE red flag. If the subjects didn't lose additional weight, even in the main study they link on the site, then what caused the size reductions? The most plausible answer is that this was simply fluid loss and thus extremely temporary. The study linked does not appear to have ever been published in a peer reviewed journal of any kind. This is another huge red flag. The fact that no one else has made similar devices seems odd? If the science were sound and the results reasonable, then copycats should be everywhere. Quality medical devices simply don't exist in a vacuum. It's also a bit sketchy to me that these devices can only be found in their "studios" and nowhere else. They seem to want to tightly control things, which seems odd if this really works as well as they claim? Why not sell them to health clubs, rehab facilities, etc? Best of luck whatever you decide.

I'd be careful here. While there have been a couple of studies now that showed a small association between PPI use and dementia, I'm not aware of any linking PPI's to Alzheimer's disease. Dementia and Alzheimer's are not the same thing. Further, the studies mentioned are observational studies, meaning they simply tallied up the number of older people in a population that developed dementia symptoms and looked to see how many of those had at some point been long term users of PPIs. There was a small, but statistically significant increase among the PPI users vs. non-users. The problem here is that these studies didn't control for other confounding factors such as diet, depression, b12 levels, socioeconomic factors, etc. Since there are studies that have linked these and a multitude of other issues to dementia, we just can't really know what the real cause of the increased dementia rate was. It's also worth noting that there have also been recent studies that have concluded there is no association between PPI use and dementia risk. I think it's reasonable to conclude that at this point the science is far from determined and it would be unwise for someone to stop using PPIs simply because they are worried about developing dementia later in life.

Blackened Salmon with Lima Bean Smashed Potatoes & Steamed Asparagus with Hollandaise:

Well done @AmberFL! I know it sounds trite, but "you are what you eat" is LITERALLY true. The food that you consume doesn't just "fuel" our bodies, it's literally the building blocks of our actual cells. You are in fact wholly made up of everything you've eaten, so it only makes sense that the better the quality of your food, the better off you'll be.

It did, thanks! I was a little slower than I'd hoped, but was able to go sub 2 hours, which was the main goal. It was also a new PR for me. 🏅

Thank you for your kind words! ❤️ Of course I'd love to get a new personal record, but I just really enjoy racing! I'm sure it will be a fantastic day regardless.

Omarice for breakfast this morning. Sorry, should have taken a pic before starting in on it, but I was hungry after a short shakeout run and didn't think about it in time.

Half. I may attempt a full this fall or maybe spring of next year, but for now I'm content getting faster at the half marathon distance. (Plus the occasional 5k and 10k). My biggest concern for the full is actually fueling/hydrating, not the distance. I have reactive hypoglycemia, so have to be careful about how and when I take in carbs. After almost passing out on a long run last year, I'm super deliberate about fueling, but it's still a challenge.

Pappardelle Bolognese with side salad. (I'm carb loading for a half marathon Sunday morning, so eating carb heavy right now.) My eyes were hungrier than my tummy tonight, so I was only able to finish about half of the pasta and most of the salad.

If your surgeon isn't worried, I don't see any reason you should be worried about it. If it will make you feel better, the best course of action would be for you to call his or her nursing staff and ask them what the results mean. They should be able to tell you if it's concerning at all, if you need to do anything different between now and your surgery date, and if this could in any way lead to delays or issues.

I applaud you for working hard to make ends meet. You can only do so much in your situation, so you may not have a ton of choices, but I too am somewhat concerned about the quality of your diet. Protein shakes are not a bad choice sometimes, but you do seem to be relying on them more than you ideally should. Leaning on shakes so much, I'm specifically concerned about whether or not you're getting enough essential fats in your diet and if you are meeting your basic vitamin and mineral needs. I do hope you're taking a vitamin supplement? I know when things are tight, things like vitamins can be one of the first things to go. If you're not taking a vitamin, I'd encourage you to try to find a way to fit them into the budget since your current diet is so lacking. While a bariatric vitamin would be best, if that's just not in the budget, even a regular drug store vitamin would be better than nothing. An alternative might be to see if you can find meal replacement shakes that fit your budget instead of so many plain protein shakes. My experience is that protein shakes can be more expensive than regular food. I know time is also an issue for you, but If you could find the time on the weekends to meal prep two meals a day instead of one, that might help a lot. Alternately, are there some real food options you could consider for breakfast?

You absolutely can reach your goal weight, but you will have to work hard at it. There obviously are no guarantees in life, but there's also no reason you can't get there if you work at it. I think you're doing great so far, so keep it up! I'll be honest, maintenance is harder than losing weight. I actually just posted something about this in another thread, so rather than repost the same thing, take a look at this:

Congrats, you've done an awesome job so far! I'm going to tell you now; transitioning to maintenance is HARD. It's scary to start eating more, it's hard to know how much to eat, and it can be challenging for some to eat all the food they actually should be eating. I would also STRONGLY, STRONGLY encourage to to work up to at least 1 hour of cardio 3 days a week and 1 hour of strength training 2 days a week if you are not already doing this level of exercise or more. The data is crystal clear here. Those individuals that get at least the amount of exercise I listed are significantly more likely to be able to maintain their weight loss. Scientists don't entirely know why this level of exercise is needed (it's almost double what someone that was never obese needs to maintain weight), but the most likely explanation at this point has to do with the fact that exercise affects your body in a couple of ways: Regular exercise changes the way the brain regulates hunger and metabolism. Simply put, most of us got as big as we did pre-surgery because our brains weren't good at telling us when to stop eating. Exercise seems to help change the way your brain understands and interprets these signals. Exercise also lowers stress and systemic inflammation, two huge triggers for overeating. Best of luck!

First, let's differentiate between a stall (what you're going through right now), and a plateau. A stall is just a temporary fluctuation in overall weight and is not indicative of an issue. Stalls are perfectly normal and to be expected. After all, your bodyweight is made up of lots of other stuff besides fat, so fluctuations are to be expected. More than likely, you actually have continued to lose fat the entire time, it's just being masked by a concomitant rise in some other component of your overall body weight. The most likely candidates would be fluid retention, or stool weight. Most of the time for a stall, I wouldn't recommend any adjustments since it's unlikely that there is really any issue with fat loss. A plateau is like a stall, but longer. I typically wouldn't consider it a plateau until you've hit more like 6 to 8 weeks without any loss. In that instance, it would be hard to argue the fat loss was being masked by something else. There are things we can do to work through a plateau, but IMO it's too soon for you to worry about that yet.

As far as powders are concerned, isopure would be my favorite. I don't really love any of them tbh for many of the reasons @WendyJane mentioned. The one place I do use the isopure is in smoothies. I find it works well there when mixed with fruit, so that's probably my goto post-workout drink. In terms of protein shakes, my favorites are probably any of the Fairlife brand drinks. I don't really use them very much anymore, but when I do need some extra protein and want it in liquid form, I do prefer the taste of Fairlife vs. others like premier protein. I also use Fairlife milk in place of regular to get a bit of an extra protein boost in my coffee, recipes, etc.

It always makes me a bit sad when medical professionals that should know better tell you what you can expect from surgery based on averages. Please know, there are no limits on weight loss after bariatric surgery of any kind, thus saying that you'll only get to 300 is in my opinion doing you a huge disservice. Whether you get to 300, 200, or beyond is all up to you and your behaviors post surgery. As you leaned the first time around, bariatric surgery does not fix your brain, so I would strongly encourage you to work with a mental health professional to understand your eating behaviors and how to address your unhealthy relationship with food. It would really be a shame to go through with a revision to bypass, and end up back at 400 again. As far as dumping, some people dump, and others don't. For some, dumping can be a blessing in disguise because it forces them to eat better. Most people that dump tend to dump on either simple sugars and/or fats. The vast majority of people that do have an issue with dumping can manage it well with diet modifications alone. For those that need it, there are some medications that can help, and in the worst cases, there are even surgeries that can help dramatically. My advice would be to not continue to put your life at risk by staying at your current weight simply because you're worried about something that may not even happen.

Again, If what you're doing is working, then I don't see anything that needs changing. If you're in the range of 100-115 grams per day, then you're already eating what I'd call protein forward diet and about where I'd typically recommend for most people. Keep in mind what I mentioned, calories are king. You only lose weight when you eat fewer calories than you burn. Thus if you did want to add more protein, you'd have to do so at the expense of other nutrients. When eating as few calories as you are right now, dropping any more on carbs & fat could have negative effects on health. It's important to get sufficient essential fatty acids since your body can't make these (that's why there called "essential". Technically you can live without carbs since your body can manufacture glycogen from fats and protein, but the problem is that if you reduce these even further, you're going to also have to reduce your intake of fruits and veggies and these convey a lot of other benefits to you nutritionally. Here's what I'd ask your nutritionist about. The most up to date clinical practice guidelines from AACE/TOS/ASMBS/OMA/ASA say to focus on protein intake of 1.2g/kg of bodyweight. https://www.soard.org/article/S1550-7289(08)00163-9/fulltext I recognize that you are not from the USA, but I dare say these organizations have a significant level of money and experience going into these recommendations since obesity is rampant in the USA. For what it's worth, some recent data I saw showed that the USA does far more bariatric surgeries than any other country. In fact, it was roughly the same number of bariatric surgeries as the next 10 countries combined. An impressive but sad statistic. Protein is highly satiating compared to carbs & fats, plus protein takes longer to digest, meaning you'll be full longer. Being full longer equals less cravings and better dietary compliance. Protein has a small but meaningful effect on overall energy balance because on average, for every 100 calories of protein you eat, you burn about 20 calories just to digest it. This is way more than carbs or fats which range from 0 to 3 for fats and 5 or 10 for carbs depending of fiber content. This means the more protein you eat, the better your overall energy balance compared to eating the exact same calorie amount of other foods. Granted, this isn't a lot, but it all adds up. Higher levels of dietary protein help you preserve more muscle mass as you lose weight. (It helps prevent muscle catabolism which is a real risk when eating a very low calorie diet.) Because muscle is more metabolically active than fat, the more muscle mass you preserve as you lose weight, the more calories you'll burn, even at rest. Studies suggest anything above about 1.2g/kg (95% CI), is sufficient for most people to stave off catabolism, which is probably where the dietary guidelines linked above came from. You mentioned something about body recomposition, so I want to touch on that briefly. I LOVE the idea, but you need to understand it's extremely hard (bordering on impossible), to add muscle mass while on a very low calorie diet like you're eating right now. For most people, you actually need to be eating a significant surplus to add muscle mass, so I honestly wouldn't even try until you get closer to your goal weight. If you do decide to add mass, then yes, higher protein amounts than what you're eating now would be recommended (Roughly 2g - 2.5g per kg of bodyweight). This also would require a dedicated hypertrophy training plan though, and that's a bit out of scope for our discussion here. Best of luck.

Crawfish Étouffée tonight: