SpartanMaker

As always, @Arabesque is spot on. I see that you are are only a few days post-surgery, so the one thing I'd add is that everything you're feeling is 100% NORMAL at this point. We all start second-guessing our decision early on because having WLS is HARD! How you eat, how you feel and how you look is radically changing every day. It's physically and emotionally challenging. The good news is it gets easier as you progress. I told my wife she only had one job post-surgery. When (not if), I started doubting my decision, she needed to remind me of all the reasons I decided to have the surgery in the first place. I tell you this because I feel like you may need a similar reminder right now. You know your own reasons for taking this journey. It's easy at this point to think the challenges you're going through are not worth the hoped for end goal, but they are. Remember that it WILL get easier over time and you can absolutely reach those goals you set for yourself. Right now, it's all new and confusing and frankly most of us worry this is how life will be forever. It's not. You will make it past this, just like the rest of us did.

Honestly I don't think it matters if it's related to the surgery or not. Your surgeon just isn't going to have the requisite knowledge and experience to diagnose and treat you. If this is something that recently started (and not something you had since surgery), my guess is this is related to a systemic change in your body, possibly related to an adverse change to your gut microbiota. Regardless of cause, you really need to see a dermatologist ASAP. They'll be able to diagnose the actual dermatological condition (and there may be more than one), and devise a treatment plan. If you need to go through your PCP to get that derm referral, then go that route, but I really recommend finding a dermatologist ASAP. In the interim, you may get some relief from OTC allergy medications and/or topical creams. Good luck.

Can you better explain what you mean by "help me"? Do you need to lose weight? How much? When you say you eat very little, do you know how many calories you're consuming now? Do you know your Resting Metabolic Rate? Do you exercise? What types and how much? Do you have any other medical conditions other than your digestive disorder? Especially disorders that impact your metabolism such as PCOS, Hypothyroidism, Diabetes, etc? Sorry for all the questions, but details matter.

I also take a LOT of meds and supplements. I'm probably at about 30 per day. I had no issues whatsoever taking everything once I got home from the hospital, but I did have to space things out a bit. Early on, it was quite a chore just keeping up with everything. The biggest issue was that I was told not to take more than 1 capsule at a time since they can stick together and then potentially not pass through the stoma. More than one tablet at a time was fine, but capsules I needed to be careful with. Now that I'm further out from surgery, I don't really worry about that anymore. I currently take quite a few tablets and capsules together and have no issues.

I bought a couple and personally didn't find them useful at all. Early on post-surgery, they were suggesting things that didn't match my plan, so I couldn't make any of the recipes. An example I remember is something called "Ricotta Bake". This is supposed to be a puree stage food, but it was not allowed on my plan until later in soft food stage. By then, I didn't have to restrict myself to just the ingredients in Ricotta Bake, so I never ended up making this. There were lot's of other examples, but this is one I specifically remember. I'd also say that 75 or 80% of these recipes are readily available on the web for free, so once again, probably no need for a cookbook. I'm 4 months in now and we just make "normal" recipes. I simply eat less of whatever we make.

Here's my two cents: Obesity is a medical condition and bariatric surgery has proven to be the most successful long-term treatment option. I'm surprised that even among those of us that have had WLS, we sometimes still act like it was needed due to a lack of willpower or some sort of moral failure. We really have to get over that and acknowledge obesity as a disease state that sometimes requires surgical treatment. To me, it follows that many children also suffer from obesity and that it would be morally wrong to withhold effective treatments options. I wouldn't withhold cancer treatments from a child, so why would it be okay to withhold WLS from children if we know that it can effectively treat their disease state? Regarding all the comments about can a child understand the need or what's required long-term, that really feels like a red herring. Just like we all had to show that we were ready for surgery by jumping through various hoops like psych evals, nutrition visits, & documentation of past diet failures, I would expect the same to be true for children. Those children or parents that aren't ready would be disqualified, just like some people can't or won't complete all the requirements as adults.

Rather than determine what you can eat to "satisfy" that craving, maybe it would be better to try and first understand why you're craving sweets at all? Some thoughts on possible things that may be driving this feeling: Forbidden foods: If you think of sweets as "forbidden", this can actually intensify your cravings for them. You might need to rethink your relationship with certain foods if this is true. Stress or a desire to self-soothe: Stress as well as physical and/or emotional pain can definitely drive you to crave things you see as comforting. For many, sweets may do this because eating them can trigger endorphins and dopamine in your brain in the same way powerful illicit drugs can. Contextual associations: We sometimes associate certain food with certain things. Examples would be people that feel they have to eat dessert or the meal isn't "done". Another example would be people that eat popcorn at the movies. Boredom: Typically boredom doesn't drive specific cravings, but can absolutely drive you to eat when you're not really hungry. Nutrient deficiencies/poor hydration: While there's a lot of anecdotal references for the idea that your body will crave certain things if you have a specific nutrient deficiency, there's not much scientific evidence for this belief. (In fact there's a lot of evidence that it's not correct. If that was actually driving cravings, we'd all be craving kale and broccoli instead of sugary, salty, fatty foods) That said, there are studies that show both poor hydration or insufficient protein or fiber will increase hunger. In this case however, your cravings would most likely be less specific and more "I'm hungry", vs. "I want sweets". i think once you understand the WHY, you'll be better armed on what you can do to address the craving. In some cases, distractions like @Arabesque mentioned may actually work better than finding a sweet thing that "satisfies" your craving. In other cases, you might be better off eating off plan if the "forbidden" food is the culprit. Only you can really know what's driving this and how best to deal with it.

I don't have any experience with this particular product, but it's probably best to talk to your surgical team. Some are a lot more strict about caffeine than others. For those plans that want you to avoid it, at least early on, the rationale given is typically based on a few things: Caffeine is a diuretic. Since most people struggle to get in sufficient fluids early after surgery, it's probably best not to make the problem worse. Caffeine can lead to diarrhea, also exacerbating problems getting in sufficient fluid. Most caffeinated drinks are acidic, which can contribute to gastric reflux. Note that caffeine can also contribute to reflux. Especially for sleeve patients, reflux can be a significant issue. although the effect is minor, caffeine can impair the absorption of certain minerals like iron, calcium & magnesium. This is more so an issue for bypass patients that are already at a disadvantage for malabsorption. Best of luck.

I'm curious, is this just a sleeve thing? I'm a bypass patient, but I've not had anything like this?

Not sure about this one? Unlike most of the rest of your skin, your lips have no oil glands, meaning they don't rely on sebum for lubrication. I do think there could be something to the comments above related to protein drinks, especially if you find yourself licking your lips more. (Excess saliva can actually cause chapped lips.) In addition, this could also be due to nutrient deficiencies. If you're not currently taking a multivitamin, a lack of B vitamins can lead to dry, chapped lips.

The 2019 clinical guidelines from the American Society of Metabolic and Bariatric Surgeons (ASMBS), calls for bariatric surgery patients in active weight loss eat 1.2 g/kg of bodyweight. For those in maintenance, the range should be .8-1.2 g/kg. I don't know how much you weigh, but 135 g a day sounds like it might be a bit on the high side based on those recommendations? There is research that intake levels between 1.2-1.5 g/kg may maximally stimulate muscle protein synthesis, but there's not a lot a data to suggest rates over 1.5 g/kg are beneficial. Rates above that might be necessary in certain people such as if are a professional strength athlete or top tier fitness competitor trying to maximize muscle growth. Especially if you're just trying to lose some fat, you probably can't metabolize that much protein. I can tell you from experience that many trainers will push this recommendation up to 2 or even 2.2g/kg of lean mass, because they believe if some is good, more must be better. The reality is that your body can't store extra protein, so any above the minimal needed just gets converted to fat. My recommendation would be to follow the ASMBS guidelines for your weight. Unless your trainer has extensive experience working with bariatric surgery patients nutritional needs, I'm afraid their recommendation may be targeted more at a different population.

Everyone is different. A lot of where you both gain first and where you lose last is genetic.

Just avoid something with lots of calcium like milk because that could impact your ability to absorb the iron in the multivitamin. Both SG and RNYGB patients are at increased risk of issues absorbing both iron and calcium, so it's best to take every precaution.

Are you able to swallow larger capsules? I think the majority of folks on here just use capsules because most of the chewables taste nasty.

This is an interesting question. I've read quite a lot of the scientific literature on Intermittent Fasting (IF) and I think it can be summarized as follows: IF has similar and many times better results vs. daily calorie restriction if the goal is weight loss. A lot of this additional benefit is due to the inherent ketogenic nature of IF. Compliance with IF is typically better than daily calorie restriction. If weight loss is the goal, IF can fail spectacularly if the subject overeats when not fasting. This is problematic for some people because they feel like IF gives them an excuse to eat badly on refeed days/times. IF really only works if you eat "normally" when not actually fasting. While there are numerous studies showing improved biomarkers with IF, almost all of those were done with either animals, or with overweight subjects. When compared to daily calorie restriction, many, if not most of the benefits are explained simply by underfeeding, not by IF specifically. (I should note here that IF can be extremely beneficial for certain specific medical conditions. I'm excluding a discussion on that subject and assuming we're talking about otherwise healthy adults.) Taken as a whole, the conclusion I've personally come to is that IF can be beneficial for the right people, but it's not for everyone. Which leads me to your question: Is Intermittent Fasting good for maintenance after WLS? Assuming by "maintenance" you mean you'd be at or under a normal body weight, I'm not sure how beneficial IF would be? After all, IF is typically talked about as a diet or weight loss strategy. My point being that if instead, you are worried about or are actually seeing weight regain in "maintenance" then IF may work for you. Keep in mind however that IF & daily caloric restriction should both technically work. The question I can't answer is which is best for you. Only you know which eating pattern you can best comply with. Also, there are genetic and epigenetic factors at play here as well. Some people just do better with different eating patterns. The best advice may just be to try IF and see how you like it. Don't forget there are lots of different IF eating patterns and while 16/8 may work great for one person, someone else may need 5:2 or even alternate day to be successful. If gaining weight is not an issue and you're looking more for the potential health benefits, I'll point out again that most of the scientific literature seems to support that both IF and underfeeding in general have the same benefits. This means it really comes down to you again. Can you avoid overeating when refeeding? Do you struggle with compliance on a "normal" diet? Your answers will determine your success with IF.

Do you have a way to check your blood pressure? This sounds to me like it could be low blood pressure (hypotension). It's not uncommon post WLS surgery. There are of course other possible causes of your symptoms, but I'd start here since it's easy to check.

Walking = awesome. Walking with dumbbells = not so awesome. This can actually cause gait or balance issues, which means you're more likely to injure yourself. Also, while it adds a tiny bit of resistance, it's not really enough to make much difference. IMO, keep walking, but lose the dumbbells. Add in a separate strength training routine 2-3 times a week. If you need some help figuring out where to start, Google "bodyweight strength training for beginners".

There's actually a entire forum dedicated to this topic. It doesn't see a ton of traffic, but there are definitely folks doing this: https://www.bariatricpal.com/forum/1101-vegetarian-or-vegan-eating/

Awesome job! Major milestones like this are so important and you worked really hard for this one!

Don't forget prebiotics too! These may be even more important.

Sorry you're dealing with this. Sounds like your team has ruled out most of the physical issues. but I wanted to throw a few more things out there that might be worth considering: Have you ever been evaluated for sleep apnea? This disease can absolutely wipe you out physically if left untreated. It would be odd for it to start post-surgery, but maybe it was masked before for some reason and you've had it for a while? Obviously eating a severely restricted diet means you're not getting a lot of calories in. Now this is as designed to drive weight loss, but your body should adapt to that and use fat to fuel your cellular processes. This should mean, if everything is working properly, that you get plenty of energy from the chemical decomposition of fat. Depending on what specifically you're eating, there could be something going on diet related here that may not have that process working as designed. Your gut microbiome is often overlooked as a source of issues, primarily because it's not well understood by physicians. What I mean here is that it's possible you don't really have the proper balance of good bacteria in your gut to deal with what I assume has been a significant shift in how you eat. At the very least, adding in both prebiotics and probiotics could help shift your microbiome in the right direction. This one will sound bad, but it's possible this is psychosomatic. If you're not familiar with the concept, the mind is an extremely powerful thing and can absolutely make you feel like you're exhausted, even when there's no physical cause. This does not mean you're crazy, or faking it, or anything like that. The physical manifestations of psychosomatic illness are very real. FYI, stress is a huge driver of this process, so working on stress reduction would be a good first step. If needed, there are even doctors and therapists that specialize in treating psychosomatic diseases.

Sorry ahead of time, this is going to be a long post! Let's talk a bit about what causes stalls/plateaus: The most common reason for any stall (including the dreaded 3-week stall), is simply that you are retaining more water. There are a few reasons this happens, from hormonal shifts, tissue repair, illness, or changes due to glycogen vs. ketone metabolism. This post would be even longer if I spent too much time here, but suffice it to say that for many people (especially early in the process), they are just retaining water and not actually failing to lose fat. As you lose more weight, your overall metabolic rate will slow down. People sometimes think fat is not metabolically active, but that's not true. Losing fat means your metabolism slows down, even if you retain the same amount of muscle mass (which most people don't). This means that as you lose weight, it takes less effort to move or even just live, so the amount of calories you burn both during exercise and just living also drops quite a bit. On the intake side as you progress after bariatric surgery, you'll be able to eat more. This isn't a bad thing and is by design, but obviously you should be able to see the problem here. Your metabolism has slowed down and now you can eat more. This can lead to you basically eating as much as you're burning. When that happens, weight loss stops. Especially if you're not tracking intake closely by weighing and measuring your food, you can easily be eating a lot more than you think. Some studies have shown people underestimate caloric consumption by several hundred calories on average. This is more than enough to cause a stall. This one may be TMI for some, but you may simply be retaining more stool. Feeling constipated? That will definitely impact your weight. This is going to be hard for some people to hear, but I can tell you one thing it's not, and that's hormones. Yes, various hormonal processes negatively impact weight loss in a myriad of ways, but they don't overcome the basic fact that if you eat fewer calories than you are burning, you'll lose weight. What these hormones can do if they're out of whack, is bad things like slowing your metabolism even more, increasing your hunger, screwing with water weight, or even fooling you into thinking you're eating less than you are. So, that's all great, but what do we actually do if we're in a stall? Well, I think it depends on when it happens and how long it lasts: If it's early (a.k.a. the 3-week stall), just keep doing what you're doing and you should be fine. I know people don't like that advice, but as I said it's just water, so don't worry about it. Later on, especially if the stall is lasting longer than 2-3 weeks. that's when I think it's important that you look closely at what you are actually burning, as well as really tracking what you are eating. If you don't know your RMR (Resting Metabolic Rate), you should. The closer you are to goal, the harder it is to get the balance right between intake and output to make sure you're not eating too much, so fixing this starts with knowing your RMR and accurate food logging. There's a lot of anecdotal advice thrown around about "ways to break a stall", but there seems to be little scientific evidence for any of it. It certainly won't hurt to try things like breaking up your routine in terms of diet or exercise, but just understand that this change may or may not have any impact. If it makes you feel better to be proactive, go for it. Longer term, there is one piece of solid advice that's backed up by lots of research: Even if you don't really like working out, do it anyway. Those WLS patients that make a regular habit of exercising for 45 minutes to an hour most days a week are significantly more likely to reach their goal and maintain the weight loss. (One caveat here: significantly changing your exercise routine can make you retain water and possibly even add muscle, so don't freak out if you see a stall or even a gain.) I'll take that exercise advice one step further and say you really should be doing some form of strength training. This is also backed up by lots of studies, but the great thing about strength training is that it makes your burn more calories even at rest (in other words, it increases your metabolic rate). There are lots of other benefits, but the metabolic benefit is the most germaine to the stall question. Those that do strength training are less likely to stall during weight loss and are more likely to reach and then maintain their goal weight long term.

OK folks, I really need some humor right now! Let's see those funny GIF & Memes related to weight loss & weight loss surgery! I'll add a few to get us going:

Awesome job! You are an inspiration to many of us, so I'm thrilled you're still here and posting! I wish more veterans stuck around too. I'm hoping I can, but life has a way of taking us all to different places.

I'm curious how much you're exercising? This may sound counter-intuitive, but, getting regular exercise may actually help you have more energy. Also, I think you'd be better off getting a bit less protein and more water. Dehydration can really sap your energy, but 70-90 grams of protein may be more than you really need at this point?