ChunkCat

I took it before surgery. A powdered form mixed in Water. I didn't care for it which is funny because I LOVE beets, especially pickled or juiced with parsley and such. I worked my way up in dose. I tried to stick with it though since I bought the whole jar, might as well use it. It didn't help my blood pressure or my diabetes any unfortunately.
It gave me a bit of energy, but honestly, having the DS surgery has given me FAR more energy in 2 months than anything I ever tried for the chronic fatigue. Plus I have been off my diabetes meds and blood pressure meds since surgery, all my numbers are perfect now thanks to that intestinal rewiring. 😂

OMG you guys look awesome!! Every time I get annoyed with this process I come here and look at a few pages and remind myself why I'm doing this, it helps a lot... You are all inspiring!

The gas is probably from the carbs. Especially simple carbs, though complex carbs can cause it too. DS/SADI patients have altered small intestines and those shorter lengths digest carbs differently than the full length did pre-op. Things with sugars in them, like carbs, can cause gas to build up as part of the digestion process.
In addition to this, some people are sensitive to FODMAPS. That can happen with or without surgery. Onions are a huge FODMAP trigger food! Your gut may be reacting to these foods. You can try an elimination diet to see if it helps.
But really, cut the carbs if you want peace. DS/SADI patients need about 90-120 grams of Protein (120 grams is ideal, or whatever it takes to keep your protein levels at 7 or above) about 100-150 grams of fat depending on the surgery, and ideally we keep carbs below 50 grams during active weight loss, some go below 30 grams. But even in maintenance, we need to watch the carbs if we want to avoid gas and other digestive issues.

I remember the first time I realized I have food noise. I was given Saxenda and several weeks into it as I increased the dose, I noticed that the mental pressure to eat was gone... It was like that voice that often brought up food throughout the day was suddenly silenced. I never even realized it was there before, it was such a familiar thing in my mental landscape it didn't occur to me that not everyone has that! GLP-1 medications in general are known for this side effect. Meds for ADHD like Vyvanse and anti-depressants like Wellbutrin are also known to help with this.
When I went off my Ozempic before surgery, the voice came back with a vengeance!! I didn't have much of a appetite pre-op, but man did it come back post-op... For the first month I was sooo hungry. And the voice was SO loud. Thankfully I have a lot of techniques to manage inner voices, due to a decade of somatic based trauma therapy. I think without that, the process would have been so much harder for me.
One thing that helps me the most is distinguishing that part as a PART of me, not ALL of me. So instead of "I'm hungry!" it is "I'm noticing a part of me feels hungry." This may seem like a weird distinction, but research has shown when we do this with emotions "A part of me is angry." vs "I'm angry!") it helps us create a little space between us and the feeling and helps us remember that there are other parts of us present and not all of them are caught up in the emotion of the moment. Remembering there are parts of ourselves that are like Switzerland helps us navigate internally when voices get loud. So I apply this to head hunger too. I identify the part of me that is hungry. I ask it what it needs. I validate its experience. And then I offer to just sit with it for a while and be present with the feeling of hunger. Then I let it know when we are next going to eat and orient that part to thinking of what we might want to eat at the coming meal.
I'm sure this approach won't work for everyone, it is just what I tend to do. I notice when I hear the parts of me that feel things and give them some presence, they often start to soften, or have something important to tell me about what we are experiencing in that moment. For instance, I have severe ADHD. I get easily distracted and forget to eat. Post op it has been a struggle. That voice is there to remind me to tend my body. It may be louder than most people have it, but it still serves a purpose and when I can give it a job it tends to fight with me less. I eat every 3 hours. Without exception. If I go past 3 hours the voices get really loud and I feel sick, probably my blood sugar dropping... So I eat every 3 hours. But I eat within a 30 minute window, then I'm done. I don't snack in between. If my body tells me we need more food before the 3 hour mark I stop to reflect why this might be. If it is because I am bored, I find something to redirect the energy to and wait. If it is due to a workout or being sick and burning through energy faster. I may add in an earlier meal.
Seeing my body as something to partner with, as something I have a relationship with that I want to be a GOOD relationship, seems to help me remember to treat my inner voices with kindness and compassion instead of judgment and irritation. If someone you were closely connected to constantly ignored you or snapped at you, over time you'd either get louder or go away. That is what I did to my body. So now when I hear the voice it is a reminder that this is something I'm working to relate to in a healthier way, so I choose a reaction to it like I'd choose a reaction to a friend reminding me to eat or drink Water. Sorry for the long ramble, it just happens to be something I've been reflecting deeply on over the past 6 months!!
ETA: I do take Wellbutrin for depression. I have never noticed it affecting that internal voice, but some notice an impact. If you are struggling deeply with this voice, you might consider a medication that can support you in this. I have a good friend who has ADHD and noticed when she started Vyvanse it significantly helped with the food noise and binging behavior. It isn't a good solution for everyone, but it is a good solution for some. ❤️

There is nothing wrong with you... First, when we have surgery, a lot of nerves are cut that need time to heal. These are the nerves that tell us we are full, or getting full. So you are not getting accurate feedback from your stomach right now. These cut nerves take several months to heal fully. I noticed a distinct change in my fullness cues around 3 months out.
Second--just because you CAN eat that amount doesn't mean you SHOULD (I'm so thankful the regulars here remind us all of this early post-op). You aren't getting accurate messages about your restriction right now, and different foods will cause different feelings of restriction or lack thereof. Try to stick to the small portions your dietician should have gone over with you. You have a lot of sutures holding your healing tummy together, you don't want to stress them. Take your time here, there is no rush.
Third--different foods will cause different feelings of fullness. Purees often don't cause fullness, even meat purees. When you get into soft foods you might start to feel restriction when you eat denser Proteins. But again, your stomach is still healing, so it may take time to feel your restriction, and some people never feel strong restriction, or don't feel it until they are overly full. This is where it is important to measure out your portions and eat tiny bites, slowly, watching for any signs of fullness. For us post op that may feel very different than it did pre-op. For me, for the first few months, all I would get is violent sneezing, intense hiccups, runny nose, etc... It took a while before I started feeling internal pressure with fullness.
Fourth--Hunger is a b***h! Some people lose it, not everyone does. I woke up in recovery STARVING!! I was so mad. 😂I felt like I'd been given a faulty surgery. LOL But it really made me learn to work with my hunger cues and to sit with the discomfort of being hungry for a while. I was very, very hungry the first few weeks because nothing feels like it has enough substance to calm that ravenous hunger. This will ease in time as you progress your diet. For now all you can do is learn to distinguish head hunger from body hunger and learn to deal with the fact that sometimes we feel hungry and that's okay.
Lastly, many people can drink Water freely post op. You don't list your surgery, but this is very common with gastric bypass patients, though I have seen it with sleeve patients too. Once the internal swelling goes down, many can drink water easily. This is a blessing, since dehydration is the #1 reason bariatric patients end up in the ER post op!

Did the hospital give you the little 1 oz cups to drink out of? If so, fill them and try to get in 2 every 15 minutes. If not, get a few shot glasses and line them up, fill them, and try to drink 1-2 every 15 minutes . I know, it sounds crazy, but it works. 8 oz an hour means you'll have 64 oz in 8 hours! This way I was able to hit 64 oz by day 3 post op. Some people drink certain temps better than others, so try warm tea, iced drinks, and room temp to see if it makes a difference for you. My nutritionist suggested drinking out of the little cups and then graduating to an actual cup instead of using a water bottle because we gulp less air when we drink from a cup. I found this to be very true.
I had to flavor my Water to get it down post op. The sugar free Jolly Rancher water flavoring packets are my favorite. I had to water them down a good bit, but they helped a lot. I also kept an insulated cup with hot broth in it to sip on. Broth, milk, sugar free popsicles and shakes all count towards your hydration goals!

Did the hospital give you the little 1 oz cups to drink out of? If so, fill them and try to get in 2 every 15 minutes. If not, get a few shot glasses and line them up, fill them, and try to drink 1-2 every 15 minutes . I know, it sounds crazy, but it works. 8 oz an hour means you'll have 64 oz in 8 hours! This way I was able to hit 64 oz by day 3 post op. Some people drink certain temps better than others, so try warm tea, iced drinks, and room temp to see if it makes a difference for you. My nutritionist suggested drinking out of the little cups and then graduating to an actual cup instead of using a water bottle because we gulp less air when we drink from a cup. I found this to be very true.
I had to flavor my Water to get it down post op. The sugar free Jolly Rancher water flavoring packets are my favorite. I had to water them down a good bit, but they helped a lot. I also kept an insulated cup with hot broth in it to sip on. Broth, milk, sugar free popsicles and shakes all count towards your hydration goals!

Most programs will tell you to stick with 1/4 cup to 1/3 cup portions for the first month or two. There is a lot of swelling internally and a lot of nerves are cut that communicate fullness so it is hard for us to discern whether we are full or not. I found this portion varied per food personally though. I have always been able to eat a bigger portion of yogurt, for instance, than a pureed meat. Density seems to matter to my stomach.
You could always call your surgeon's office to find out their recommendations. But if you don't want to, I'd stick to the 1/4 to 1/3 cup range. I noticed my portions changed at around 2 months out. I can eat closer to 1/2 cup portions now. I'm assuming that is because all the swelling finally went down and there is more space now.

Yeah, very common... I gained like 4 lbs. I was so offended. LOL Then I proceeded to gain and lose the same 2-4 lbs for 6 bloody weeks!! I've just now started to lose a little again. *sighs* Weight loss is not linear and Fluid changes and stalls can really play with your mind. Put away the scale for a bit!!

Nah, I haven't had any issues with this post-op once I was past the nausea phase 3 months out. And OMG sex is so much better with less weight on your body! My boobs don't try to suffocate me quite as much... 😂
Maybe your tummy is just having an emo week? Go to bland foods for a few days to see if it settles down. I always revert back to plain foods when mine gets cranky pants, it seems to do the trick.

Alright guys, 6 months is upon us!! This pic is from the morning of my 6 month post op visit. I weighed in at 232 in office. That is 88 lbs since my highest weight, 75 lbs since surgery! Weirdly, I am smaller now that I was last time I was at this weight. The surgeon found this funny and said the way our bodies lose weight can be really entertaining. LOL I startled myself the other day because I pulled out my smallest clothes (the smallest I have ever been as an adult was 195) and my size 16 jeans fit, zip easily, and are huge in the waist!! That means my smallest size, a 14, will probably fit now snugly, or comfortably in another month. How insane is that?? How can I fit into clothes I had to be 30 lbs lighter to wear last time?? Magic, that's how. 😂
The surgeon estimates I'll be at around 200 lbs by my year mark, though he said if I don't get quite to 200 to not stress it. We each lose weight at our own pace and with my common channel length I can expect to lose weight (albeit much slower) through the second year and possibly into the 3rd year, though at that point it'll be 1 lb here and there. This is the upside of the duodenal switch, it is a long, slow burn. Most stabilize around 18 months to 2 years, but there are always outliers.
I feel pretty great! I had a hiatal hernia repair in mid April after I starting having issues choking on my food and pills not going down (I even ended up in the ER with it, which was awful, they don't get bariatric patients at all!!). I gained 15 lbs overnight and it took 2 weeks to get it off, so that on top of my stall for most of March really slowed my weight loss down. But that's okay, I'm reminding myself I have faith that it will come off in its own time. But man, it is hard to remember that when the scale goes up!!
In other news, my GP and bariatric surgeon both think I have POTS. I've had issues with it on and off since having a bad case of Epstein Barr Virus (mono) that put me in the hospital a few years ago. It seems every time my body gets stressed it reverts back to having symptoms and it seems it counts any surgery as a major stressor (understandably). She referred me to a specialist and my appointment is October 24th, 2025. Uhuh, 2025, not a typo. He's booking 1 1/2 years out. There are only 2 doctors in the state that specialize in it. So I'm not a happy camper... Meanwhile we are trying a low dose of a beta blocker to see if it helps with the dizziness when I change positions, the racing heart rate when standing/exerting myself, and the exercise intolerance... And doing the lifestyle things like compression leggings, increasing salt and Fluid intake, etc... It seems that a lot of Long Covid patients end up having POTS too. Have you looked into this @SomeBigGuy ?? How are you doing? How is everyone else doing??

Anesthesia can mess with our bodies for a while after surgery, and it has been clinically shown that major surgery can trigger depressive episodes in people. What you are experiencing is completely normal even though it sucks. Add to that hormonal changes, and body changes, and changes in the nutrients you get, and recovering from a major surgery and yeah, you could feel pretty down!
I'm 3 1/2 weeks post op. Some days are good and some days aren't so good. I've heard the first 3 months are really challenging and the first year takes a lot of resilience and adjustment. Next time your husband starts with the "this is what you wanted" I'd kindly remind him that those words are not supportive and guilt trips are not necessary. That you are cognizant of the fact that you wanted bariatric surgery to lose weight and improve your health, but NONE of us can even begin to understand the fullness of an experience before we actually have it...and living this experience is feeling challenging right now. Even the BEST things for us often come with distinct downsides. You are allowed to be upset! You are allowed to say this is a struggle! What would be more supportive of him would be for him to validate your feelings and assure you that things won't always feel like this, but while they do, he's there for you. I'm sure he's doing what he can, but everyone deserves feedback when their words are making it harder for you to deal with what you are dealing with.
I too feel a little off kilter from the world right now. Any surgery brings grief with it when it alters your body. Let yourself grieve. You are in a liminal space right now, transforming from one version of yourself to another. Much like the caterpillar who winds itself into a cocoon, you have had to bury yourself into this new experience, and you will never be the same. Some parts of you have to die so that other parts of you can blossom forth and live. When you finally come out of this cocoon, flying will be so thrilling!! But in the meantime, the transformation sucks! LOL I don't think caterpillars think the process is fun either...

Yeah, not buying it. The medical community looks for what it wants to see. I married a statistician. They constantly remind me "Correlation does not equal causation!!"
The medical community wants to believe that more physical activity will miraculously solve obesity issues because it puts the cause and the remedy right back in our laps, instead of admitting that this is a disease that is very complex and no one smoking gun is the cause or the cure. We need holistic approaches.
I was a very active child. So were my siblings. My brother is a normal weight, my sister is often underweight, and I ended up over 300 lbs. My parents are normal weight though they both have siblings with weight issues. I gained a ton of weight while I was still active. Puberty hit and it was like someone switched on a helium tank and I just ballooned up. I've had more doctors than I care to count tell me that if I just got more physical activity and stopped eating McDonalds all would be well, ignoring the fact that I hate McDonalds and until my autoimmune disease got severe I was quite physically active. I know a lot of thin people who are couch potatoes. I know a lot of fat people who are active. These "studies" do nothing but continue to give doctors more ammunition in the shame game that is current obesity management.
My partner is Chinese, was raised on traditional Cantonese food (which is very healthy in general), in a family where everyone is effortlessly thin except their grandmother who was diabetic... Several years ago my partner was diagnosed with diabetes. They've had weight issues all their life, despite being very active for most of it. Is it genetics? Perhaps. Is it current lifestyle? It probably contributed to it. Was it due to a childhood diet based on rice? Not likely, that diet also incorporated a ton of healthy Protein options and a healthy variety of vegetables, including plenty of greens. A lack of exercise was certainly not the cause of it and increasing exercise is not going to be the cure for it either...

OMG, @BabySpoons I tried your suggestion and cracked myself up! It seems that my index finger that used to be a US size 10 1/2 is now a US size 9. 😂 There goes all the pretty rings I have for that finger... But the wedding set actually looks kind of cool on my index finger!

My hands are getting smaller!! Specifically, my fingers. I've had chubby little hands since I was 14 and my autoimmune disease showed up. When I was 200 lbs last time I was still an 8 1/2 on my ring finger in US sizing. Yesterday I finally took off my wedding rings when I noticed that even with the ring snuggies they are spinning around on my finger and threatening to come off. So I decided to measure them. I had gotten up to a US size 9. Now my ring finger measures as a US size 7!!! Never in my life have I ever wore a 7 in rings except maybe when I was 12?? 😂 I cannot get over how differently our bodies lose weight with these surgeries. I have to find a substitute ring to wear now because at this rate I'll be a US size 5 when I'm at goal! LOL I never thought I might have to sell my wedding rings because they can't be resized due to the difference being too much! This is so fascinating...

The things people feel they have permission to say never ceases to amaze me... Fat phobia is deeply ingrained in our society. It is a sad thing because being fat is still seen as lazy or a morality issue instead of the medical issue it truly is. Just because we need support and sometimes surgery to deal with the weight doesn't mean it isn't a medical issue. People who are thin and have been thin all their lives can be really narrow minded about weight. They think they are incredibly self controlled and virtuous to maintain their weight, instead of realizing that most times it is luck of the draw...
No one in my immediate family is as heavy as I am by any means, and in fact my sister barely touches 100 lbs. She's healthy, she's just naturally tiny. She's always been angry at the comments I get because she knows that she eats more food and more crap than I do, especially when we were younger, and yet she struggles to maintain weight and I can't keep it off. I adore her because she celebrates every win I have regarding my weight because she understands how hard it is. People can be biting to naturally tiny people too... My brother on the other hand is supportive but is very fat phobic. He gains 15 lbs and calls himself a fat ass and obsessively works out at the gym until he can get it off. He doesn't understand the struggle at all.
I've been very open with everyone I know about the surgery because that's just how I live my life. Most are wildly supportive because they know how hard it has been for me... I'm sure a few silently judge me but they can keep their thoughts to themselves. I don't make space for their bullshit. The best way to deal with that crap is exactly what you did, to tell them to stop and show visible disgust. I react that way to other discrimination too, it is very useful for shutting down a conversation! LOL

Oh, and as for your mother's concerns. They are valid. The unfortunate fact is that the same mechanisms that help us lose the weight and reverse co-morbidities also restrict nutrients and our ability to get fluids in when we are sick. Sometimes that means we end up in the hospital for fluids or electrolytes. But with a more severe illness sometimes it can lead to low Protein levels or low Vitamin levels and the body struggles with that, this can happen with ANY of the surgeries, but is of course a little more common with the malabsorption surgeries. This can complicate an illness with an already complicated clinical presentation. I can see how if it got out of hand and wasn't properly treated, it could contribute to someone's death, but it would be secondary normally to their originating condition. However, what I would invite your mother to consider is how pre-existing co-morbidities like diabetes, high blood pressure, and such contribute to severe illnesses as well. If you don't have these now, you probably will in the next 10 years. Those things can kill you too and can make your health much more fragile when dealing with an extra illness, like cancer or severe pneumonia. The only thing I can think of that would be originating from the DS that could kill you is severe protein deficiencies that go untreated, severe vitamin deficiencies that go untreated, and the possibility of bowel obstructions. All three of these things can also happen with Gastric Bypass. They are by no means common with either surgery, but they are a risk to be aware of and watchful for...
My uncle was in his 40s when he had his first heart attack. It was also his last heart attack as it killed him. He had all the co-morbidities that I have. I thought long and hard about this before deciding on the surgery. I finally decided I'd rather trade a life of medications for a life of Vitamins 4-5 times a day. And a life of being able to move and run and hike, and travel, for a life spent on the couch. And if at the end of my life I get sick and things get unbalanced and that malabsorption does me in, it will still have been a life MUCH better lived than if I had passed up the surgery. And it would (hopefully) be spared the heart attacks, diabetic and high blood pressure complications, possible amputations, etc.. Not everyone would think this way, but I like to go into things with my eyes wide open and I always have to think about the worst before I can let myself dream about the best... I wish you luck in your decision! ❤️

I dose out my Vitamins for a whole month at a time using these pill cases: https://www.amazon.com/gp/product/B08QR78YP3 Sometimes you can find them (or a similar brand) with a coupon for a bit more off, but honestly they are cheap enough to get 4 and still not break the bank. Start with 1 or 2 though until you know you like them. I love how colorful they are, it helps me not lose them when I carry around the day's doses. Then I set a medication reminder (iphones have this in the health section, but you can get apps for it too). I have to take vitamins and meds 4 times a day, so doing this really helps me remember to take them and to not get behind.
Finding movement you enjoy is important. Gyms aren't necessary and for many of us they hold a lot of negative associations. If you love the gym then disregard this suggestion, but if you don't, you might be much more likely to do an exercise that actually feels GOOD in your body to do.
Also, I carry Protein Snacks with me at all times. And when I get off track and forget, I stop at a store or gas station to get little packets of nuts and Jerky, instead of stopping at a fast food place or eating a bunch of simple carbs. I keep reminding myself that just because I'm cleared for "all foods" does not mean that "all foods" are "right now" foods. Some things are not for us in this first 18 months, even if we can technically digest them fine. When I relax into that awareness and get myself back into ketosis, I usually feel better and stop craving simple carbs so much. Except for chocolate. I will always want chocolate. LOL

I told everyone I had the surgery. Most of my friends and family have watched me struggle for decades and have been supportive along the way, so I wanted them to be able to Celebrate with me! NONE of them think I took the easy way out because I'm very transparent about how HARD this is. I wanted to be able to encourage open dialogue about the surgery and reduce the stigma around it. Even people I don't know very well have been really accepting and encouraging and curious.... It has been interesting for me to experience. Sometimes people judge us less than we think they do. I have had a hard time most of my life dealing with other people's judgments of me. But I decided a few years ago that was a THEM problem, not a ME problem. I have a few choice phrases for people who judge me to my face. Those that do it behind my back have issues and I really don't need to know about them...

That said, I tend to live most of my life as an open book so people are used to it. LOL Every person's journey is their own and I support people who keep it completely secret the same way I support people who shout it from the rooftops! You do you. It is perfectly okay to keep it to yourself, it is your body. You do not owe anyone an explanation for how you've lost weight. Just smile, say thank you, and change the subject. If they keep asking you can give one of the suggestions here or just say it is something you are still working out and you don't really care to talk about it. People need to learn to respect boundaries! I may be considered rather blunt (or a b***h) by some but I try to be kind about it. It has taken me years to eradicate the people pleasing side of my personality and I don't really want her back. 🤣

I'm so glad you tried the muffins and liked them!! I really enjoyed mine, they kept well in the fridge and warmed up really well with a quick zap in the microwave.
Regarding the nutritional needs of a SADI patient. We don't really know, honestly. The SADI is too new to have some of the longer term studies that have been done on the sleeve, bypass, and DS. But it is commonly thought by most surgeons that the dietary needs of a SADI are more than with the bypass because SADI patients are thought to malabsorb more than a bypass patient. And their needs are most likely a little less than a traditional DS.
That said, I attended nutrition classes with all the different surgeries in one group, so we had to learn everybody's requirements!! Most good surgeons recommend that SADI patients follow the dietary requirements of a DS patient to be on the safe side. That means 80-120 grams of Protein, less than 50 TOTAL carbs while in the active weight loss phase (the dietician said "net carbs" is not an official measurement, but if you want to follow net carbs you'd need to keep under 30 net carbs since they get counted differently, most DS patients introduce a bit more complex carbs into their diets once they reach maintenance weight) and the fat grams recommended by the ASMBS is 60 grams of fat by 1 year post op.
However, SADI and DS patients malabsorb a good amount of fat, so veterans of the surgeries will tell you that you need more fat than that. I seem to feel best around 80-100 grams of fat a day, but there are veterans of the DS surgeries that eat closer to 150 grams, or whatever alleviates their Constipation and eases their symptoms of low fat like dry eyes and dry skin.
According to most studies, a DS patient only absorbs about 20-30% of the fat they consume, around 60% of the protein they consume, 60-80% of the complex carbs, and every single calorie of simple carbs!! That's why simple carbs are so important to restrict post surgery (besides the digestive drama), you can eat your way around any surgery with simple carbs... And this is why counting calories is pretty useless for DS and SADI patients.
We don't yet know exactly what the percentage of absorptions is for SADI patients as they haven't done a breakdown study (as far as I know) but it is safe to assume SADI patients absorb a little more fat and protein than a traditional DS patient would. The best way to find your own perfect macros post surgery IMO is to aim for 80-120 grams of protein and then watch your protein labs. They will tell you if you need more protein or if you can back off a little. And for me at least, I find my skin, hair and eyes are highly sensitive to when I have too little fat in my diet.

I can't take any oral iron, so I'm not sure, really. I can't imagine a reputable company like them would put a fatal amount of iron in their product, as it would be very bad for business. 🤣 I just get iron infusions when my iron gets low, but it is ideal to take it in pill form if you can absorb it... You could try a few days a week and then have your levels checked to see if they are responding to the dosage. It is not usually a bad thing to start slow and ramp up if you aren't getting your levels up. And be sure to talk to your surgeon about it, as they can help guide you to what is a safe dose and do labwork regularly to be sure you aren't getting too much. ❤️

I can't take any oral iron, so I'm not sure, really. I can't imagine a reputable company like them would put a fatal amount of iron in their product, as it would be very bad for business. 🤣 I just get iron infusions when my iron gets low, but it is ideal to take it in pill form if you can absorb it... You could try a few days a week and then have your levels checked to see if they are responding to the dosage. It is not usually a bad thing to start slow and ramp up if you aren't getting your levels up. And be sure to talk to your surgeon about it, as they can help guide you to what is a safe dose and do labwork regularly to be sure you aren't getting too much. ❤️

I think many of us have our own places where we self-sabotage. For me, going into this surgery, I knew consistency was going to be a challenge because I have ADHD and my brain really struggles with routine, even though routine helps my life flow better... The biggest thing I've done to help myself is to not allow things into the house that I'm not supposed to be eating. I put them all in a basket and put them in my partner's office. Out of sight, out of mind. LOL To support me, they keep the snacking in their office, thank the gods.
The other thing I did was educate myself on what will happen to my body if I consistently fail my Protein, Vitamin, and hydration goals. Some other surgeries can get around this, but DS patients cannot. It is a very unyielding surgery. When I was younger I had a friend who had an old school bypass and was non-compliant with the dietary advice and Vitamins. She'd sit there and chat while eating M&Ms, breathe through the dumping symptoms, and keep on eating them. Her hair was falling out and brittle, her skin was dry, she'd get heart palpitations with the slightest bit of exertion because her Calcium was off. I can't even imagine what was happening to the strength of her bones... I don't say this to scare you, I say this to illustrate what can happen long term when we can't get our habits under control.
I know for her, she just had the surgery. She had no aftercare. No psych care. No mindfulness coach. No dietician. No one supporting her through these difficult changes and helping her understand what was happening to her body when she was making less than stellar choices. Every time I'm tempted to ignore my vitamins or skip a meal I think of her and march my ass to the fridge and eat some cheese. 😂
You have a good list of things to help course correct. I've seen you post before, I know you are trying. Where is your support system to help you achieve your goals? If you have no one local, where and how can you cultivate them? I find when it is hard for me to act in my best interest, that's the time when I most need my support system to kick in and give me a helping hand...or a kick in the ass.

Instead of focusing on what you need to NOT do, how can you frame those things as a list of supportive things you can add to counter those behaviors? It is so easy with our dieting history to get into a restrictive mindset, but I've been working with a mindfulness coach who has been encouraging me to be additive instead of subtractive and that helps a lot with the mind game that surgery is! So instead of fussing at myself for missing my 3rd snack of the day, I've instead added a morning protein cocoa made with Fairlife milk, GENEPRO protein, collagen, and a hot cocoa mix. It packs almost 30 grams of protein in one go and soothes my queasy early morning tummy. Plus by front loading it in my day, I increase the chance of having time for that post dinner snack! And yes, dehydration and lack of protein will make you snack and feel hungry... Try a snack/meal with protein and fat.

What surgery have you had?? It is much easier to find a support group for, say, a sleeve patient than for a DS patient. I agree with @Kri-star, check with the local hospital that does bariatric surgery. Austin is big enough to have a few support groups around, but a lot of the hospital support groups still meet online thanks to Covid!
I'm in a DS support group on FB that I love. So you might want to check around on FB and see if you find one you love. Often you can post in the big ones looking for people in the same area and plan a meet up!

I remember the first time I realized I have food noise. I was given Saxenda and several weeks into it as I increased the dose, I noticed that the mental pressure to eat was gone... It was like that voice that often brought up food throughout the day was suddenly silenced. I never even realized it was there before, it was such a familiar thing in my mental landscape it didn't occur to me that not everyone has that! GLP-1 medications in general are known for this side effect. Meds for ADHD like Vyvanse and anti-depressants like Wellbutrin are also known to help with this.
When I went off my Ozempic before surgery, the voice came back with a vengeance!! I didn't have much of a appetite pre-op, but man did it come back post-op... For the first month I was sooo hungry. And the voice was SO loud. Thankfully I have a lot of techniques to manage inner voices, due to a decade of somatic based trauma therapy. I think without that, the process would have been so much harder for me.
One thing that helps me the most is distinguishing that part as a PART of me, not ALL of me. So instead of "I'm hungry!" it is "I'm noticing a part of me feels hungry." This may seem like a weird distinction, but research has shown when we do this with emotions "A part of me is angry." vs "I'm angry!") it helps us create a little space between us and the feeling and helps us remember that there are other parts of us present and not all of them are caught up in the emotion of the moment. Remembering there are parts of ourselves that are like Switzerland helps us navigate internally when voices get loud. So I apply this to head hunger too. I identify the part of me that is hungry. I ask it what it needs. I validate its experience. And then I offer to just sit with it for a while and be present with the feeling of hunger. Then I let it know when we are next going to eat and orient that part to thinking of what we might want to eat at the coming meal.
I'm sure this approach won't work for everyone, it is just what I tend to do. I notice when I hear the parts of me that feel things and give them some presence, they often start to soften, or have something important to tell me about what we are experiencing in that moment. For instance, I have severe ADHD. I get easily distracted and forget to eat. Post op it has been a struggle. That voice is there to remind me to tend my body. It may be louder than most people have it, but it still serves a purpose and when I can give it a job it tends to fight with me less. I eat every 3 hours. Without exception. If I go past 3 hours the voices get really loud and I feel sick, probably my blood sugar dropping... So I eat every 3 hours. But I eat within a 30 minute window, then I'm done. I don't snack in between. If my body tells me we need more food before the 3 hour mark I stop to reflect why this might be. If it is because I am bored, I find something to redirect the energy to and wait. If it is due to a workout or being sick and burning through energy faster. I may add in an earlier meal.
Seeing my body as something to partner with, as something I have a relationship with that I want to be a GOOD relationship, seems to help me remember to treat my inner voices with kindness and compassion instead of judgment and irritation. If someone you were closely connected to constantly ignored you or snapped at you, over time you'd either get louder or go away. That is what I did to my body. So now when I hear the voice it is a reminder that this is something I'm working to relate to in a healthier way, so I choose a reaction to it like I'd choose a reaction to a friend reminding me to eat or drink Water. Sorry for the long ramble, it just happens to be something I've been reflecting deeply on over the past 6 months!!
ETA: I do take Wellbutrin for depression. I have never noticed it affecting that internal voice, but some notice an impact. If you are struggling deeply with this voice, you might consider a medication that can support you in this. I have a good friend who has ADHD and noticed when she started Vyvanse it significantly helped with the food noise and binging behavior. It isn't a good solution for everyone, but it is a good solution for some. ❤️