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It's weird to hear chicken hurts your pouch. When I had the lapband if I couldn't tolerate anything I could tolerate chicken. But it seems a lot of people with gastric bypass has trouble with chicken. Are you able to eat bread and salads. What does tomato sauce do to you. I can't wait until liquids for me are done. I have 3 more weeks then its on to pureed food. Have you guys ate baby food at all. I've been having a lot of cravings like meatballs, pizza ,salads, gyros, I guess everything lol.

Yeah, I recently injured a knee and it is not healing. No issue with the joint, but the meniscus is torn. I'm normally a reasonably active person, but now I can't do most of the things I like to do in terms of physical activity. Which is only strengthening my resolve about surgery. Thank you very much for the reassurance! I also have a torn meniscus, which has halted my favorite activities: African Dance, jazzercise and hiking. I started physical therapy and my therapist taught me all sorts of fun stuff I can do in the pool. I jog laps with various kinds of "weights" made from styrofoam and plastic, walk forwards, backwards and sidewise, kick with a kickboard, lunge walk, and do squats and heel lifts. I suspended my jazzercise membership and as soon as my PT period ends, will join the hospital gym and pool, and go after work. I am also in the process of completing my pre-requisites for bariatric surgery...I am just completing a horrid round of anti-biotics to get rid of an ulcer caused by painkillers for the knee, and will be issued my CPAP next week. I hope to have the surgery in October or November. My plan is to see if weight loss relieves the joint pain. If not, then I will look at knee surgery in the spring. Oh yeah, I'm 56.

My doctor doesn't let his patients start on the pureed stage until Weeks 3 - 4. The amount of calories he expects us to max out at due to our restriction (mine was a bypass) roughly works out to around the same amount the Mom_of_Chaos mentioned. If your doctor gave you a post op diet to follow, I'd check to see if the calories were supposed to be limited. If it is not clear, but sure to call your doctor's office and ask. I know the first 3 to 5 weeks after surgery is a time of healing and adapting so I'd ask sooner rather than later about the number of calories you can consume, but that is just my own thought. At least you would have peace of mind based on checking. Best of luck!

matalo, How are you doing now? Could I ask you if your insurance covered your bypass and how you decided to go that route instead of a sleeve? thanks.

I am now down to 180, so I am at the desired weight I want to be at. Now, I just want to tighten things up. Originally, I was going to have the plication, but insurance did not cover it, so instead BCBS of Mass covered the bypass.

American Society for Metabolic and Bariatric Surgery (ASMBS) calls for safe resumption of bariatric and metabolic surgery before COVID-19 pandemic is declared over Newberry, Fla. — Jun. 23, 2020 — The American Society for Metabolic and Bariatric Surgery (ASMBS), the leading organization of bariatric surgeons and integrated health professionals in the nation, declared metabolic and bariatric surgery "medically necessary and the best treatment for those with the life-threatening and life-limiting disease of severe obesity" and called for the safe and rapid resumption of procedures, which have been largely postponed along with other surgeries deemed elective amid the COVID-19 pandemic. In a new position statement entitled, "Safer Through Surgery," published online in the journal SOARD, the ASMBS strongly rejects classifying metabolic and bariatric surgery as "elective" and prefers the use of the term "Medically Necessary Time-Sensitive Surgery" or "Medically Necessary Non-Emergent Surgery" to better characterize the effectiveness of the intervention and the progressive nature of the many diseases it treats including obesity, type 2 diabetes, hypertension and heart disease. "COVID-19 may be a factor for quite some time and the longer the treatment of obesity, type 2 diabetes and other related diseases are postponed, the greater the chance they will become worse," said Matthew M. Hutter, MD, MPH, president of the ASMBS and professor of surgery at Harvard Medical School. "Each state, doctor and patient must make a decision as to when conditions for metabolic and bariatric surgery are right, but the sooner it can be safely performed, the more quickly obesity, type 2 diabetes and other diseases can be reduced or resolved." The ASMBS recommends that the precise timing for surgery be carefully considered based on factors including an individual patient’s health status, local prevalence of COVID-19 and the availability of resources including hospital beds, ventilators and personal protective equipment (PPE). The ASMBS statement concludes, "Before COVID-19 began, it was clear that patients with obesity were ‘safer through surgery’. In the era of COVID-19, ‘safer through surgery’ for patients with obesity may prove to be even more important than before." Obesity has been identified as an independent risk factor for adverse outcomes including death among COVID-19 patients. Metabolic/bariatric surgery has been shown to be the most effective and long-lasting treatment for severe obesity. 1 Its safety profile is comparable to some of the safest and most commonly performed surgeries in the U.S. including gallbladder surgery, appendectomy and knee replacement. 2 An estimated 252,000 bariatric surgeries were performed in the United States in 2018, which is approximately less than 1 percent of the population eligible for surgery based on BMI. 3 The U.S. Centers for Disease Control and Prevention (CDC) reports 42.4 percent of Americans had obesity in 2017-2018. 4 Obesity has been linked to more than 40 diseases including type 2 diabetes, hypertension, heart disease, stroke, sleep apnea, osteoarthritis and at least 13 different types of cancer. 5,6,7 About the ASMBS The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org. ### 1 Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370 2 Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/ 3 https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers 4 https://www.cdc.gov/obesity/data/adult.html 5 The Effectiveness and Risks of Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2003-2012. Accessed from: https://jamanetwork.com/journals/jamasurgery/fullarticle/1790378 6 Steele CB, Thomas CC, Henley SJ, et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005-2014. MMWR Morb Mortal Wkly Rep2017;66:1052-1058. DOI: http://dx.doi.org/10.15585/mmwr.mm6639e1 7 Centers for Disease Control and Prevention. (2015) The Health Effects of Overweight and Obesity. Accessed from: https://www.cdc.gov/healthyweight/effects/index.html

Well I will admit I hit the wall of discouragement this week. I was having trouble going to the bathroom and then when I checked the scale I gained 2 lbs! That is NOT a good feeling after going through all that we have gone through to get to this surgery and then since. I called my Dr and was only getting through to the nurse, which is just so aggravating at times. Now don't get me wrong, I understand and appreciate nurses and they are the backbone of any Dr.....however....I REALLY WANTED TO TALK TO MY DR!!! (i'm done yelling) I know that persistance is what works with Dr's offices though so I called back yesterday telling them how I was feeling hungry all the time, able to eat a lot at one sitting. They moved my fill up a few weeks, thank goodness! I'm having my wedding reception on November 11 and was so hoping to lose more before then. I have my dress fitting tomorrow and was not excited at the thought of no fill for nearly another month! Today I have felt a little bit more full after eating but still not like I was right after surgery. My daily food intake is pretty good I think. I have either one egg with fat free cheese for breakfast or I juice a few pieces of fruit. I have a snack around 10a, either jello or yogurt or cheese stick. Today for lunch I had a cup of soup from the work cafe. Usually for dinner I make a salmon filet. I try to get my fish in everyday, such good stuff in those little guys! I've not eaten breads and hope to stay off of them. I should rephrase that, I had noodle one night. I became SOOO tired immediately afterwards that I was convinced, breads are just off limit. No need for them People are really noticing that I have lost and that is an amazing feeling. It is also an odd one because I get the comments "Oh, don't lose too much, you don't want to lose your curves" I will NOT lose any curves, I am way too curvy to begin with They just might 'tame' down a little bit, which will be great for fitting into jeans Have any of you gone through a mini makeover yet? I have already had my hair cut shorter and highlighted blonder. I lost about 20lbs and felt like I need to do something with my hair!? I guess that is normal for the body changing...other things feel like they need a change too. I even did my first 'workout' this week! I have a dance video workout that teaches latin dancing, what fun it was! Now maybe I can learn to dance and get thin! I only got about 30 min of it done, was too tired after that, but it was a great feeling. I can't wait to do it again!

Thank you. Now my next question is did you get rebanded, choose gastric bypass or any other surgery? I still need to lose 70lbs but would be happy to get to 50. I still have restriction even tho he removed the saline. Since I am 4 yrs out & have gained really concerned that I will have to have it removed. Bottom-line, I know this isn't normal & will keep making appts to get it resolved. So many posts here are saying they have the barium w/the fill & that concerns me that mine doesn't. He has a big practice and affiliated w/Baptist hospital. I guess I will break down and ask him why. To be honest he is very intimidating and patients who aren't losing the weight well get an earful from him. Not so much mean but very stern.

Thank you for answering my post about depression. So sorry you have to go through this too. It is horrible. I have my good days and bad days I do take wellbutrim and t does take the edge off. I am lke you without my faith that there is a living God who loves and cares about me that I can talk to everyday I would not get out of bed. I have had my Band 2+ years and the Band helped with the weight but not the depression. The weight is not the cause of the depression but a side affect of the depression. But my husband and I agreed the depression is not something I can cure myself but the depression and the weght were too much for me. I was 251 and am now 169 a tight size 18 to a loose size 10, so that does make me feel better. I am still believeing God will not make me live the rest of my life living like this. I am waiting for healing, I know He can and I want it. So you are thinking about the Band? It Is a good thing. I might would have done the Bypass but I was self pay and could not afford it. But now I am glad I went with the Band. With the Bypass I could have lost even more weight but too many risks. I have really had no problems with the band, too tight twice but no biggie they just take some out and I do throw up but always have and no slip or problem. I have been married for 31 years to a wonderful supportive man and have a great son and a wonderful daughter-in-law and the most beautiful grandbabies Olivia 5 and Isabella 2 both blond hair and blue eye and both left handed like my son. They all are the joy I have in this world. I fear my depression will ruin their lives too. I spend a lot of time faking happiness as to not ruin their time. But it is hard sometimes. But I would never want to cause my grandbabies any unhappiness or set a bad example. The oldest one Olivia does know that grandma does get sad sometimes but that it is okay. She is more concerned about my Band, she tells everyone, people in the store, or when we are out to eat everyone, does not bother me. She thinks she can feel the band because she can feel the port really easy. (it is by bra line). She always ask me if I am going to eat something “Is that healthly grandma”. She is so funny. So you see I have a wonderful family my husband and I made, but really no relationship with my family. They are all into drugs and drinking which I do not do. My daddy died when I was 10 and my brother who also suffered from depression overdose last Christmas on prescription drugs, his and someone elses. It was a terrible death he would have never wanted people to see him like that in a coma on life support for 2 days it was terrible but he was one of the saddest people I have ever known but would not accept help. I have been throught 3 years of counseling and learned a lot of coping skills and that I have probably been depressed my whole life but was too busy being a mom to care about myself and kept it all inside. When my son married I kinda lost my identity and it opened the door for the depression to surface. I am gonna stop writing now as I have written a book, more than you wanted to know I am sure. So sorry it took me a few days to answer you but like I said I have my good days and bad days. Cheri

WOW! I don't know if I am going to have the patience for this process that my insurance company is requiring. I finally get to start my 6 month medically supervised diet on the 21st...only two weeks away but seems like it is forever. I have been going to so many Dr. appointments lately I might as well move into the medical office building. I finally get to meet with a surgeon tomorrow, but he is only going to refer me to another surgeon. He only does bypass and no surgeons in my medical group do banding. So I will have to wait for a referral from him and approval so I can then see another surgeon. I am hoping after I actually see a surgeon I will have a better attitude about this whole thing. I am trying to keep a good attitude about all of this but it seems like it take everyone forever to do any thing. I know I need to be patient....it took years to get here and I can't get back over night. My biggest fear is that I will lose too much weight on the supervised diet and my insurance will deny the surgery. AGHHHHHHHHHHHHHHHHH!!!!!!!!!:eek:

Like I said earlier in this thread, I still do 2 or 3 protein shakes a day, 2 of them are 4 oz and one is 16 oz. There are some great flavors out there, and if you get a little creative they are even better. My favorite at this time is Summer Melon mixed with Sugar Free Watermelon/Kiwi Koolaid. I purchase the Summer Melon at Bariatric Eating. That is my afternoon drink, it is a mixture of flavors of Watermelon, HoneyDew and Cantalope. I also have 2 mocha latte's a day just a simple scoop of vanilla powder, or sometimes chocolate, a mazel coffee packet and 4 oz water, sometimes I will add a shot of sugar free caramel syrup. I have an Atkins shake when I wake up in the morning, and then the others are if I get to want a snack during the day, I bypass the snacks and grab the protein, sometimes I will grab a cheese stick, or a babybell round but normally a drink.

I agree that at the start of the journey it is easier than later on. Initially you are excited, fired up and committed but you eventually get tired of that. Also the longer you have been banded the easier it becomes to eat many foods that were difficult before. It is not something that a fill would fix as that would probably make you too tight .I am a grazer and always have been. I only work casually and spend a lot of time at home so it is easy to go back and fore to the fridge. Luckily my grazing doesn't seem to have reached the level where it is causing problems. I am obviously not consuming as much as I think I am because I am still maintaining. However this is what I think is going on. The initial period after banding is the honeymoon period. You don't normally see this term associated with banding it is normally talked about with a sleeve but I believe the same thing happens with all WLS. This is the timeframe when you will have the most benefit from your surgery and are able to lose the most weight. Gradually over time you will find that you get hungry quicker, that you can eat more and a wider variety. If you had a bypass and had dumping syndrome that may no longer happen etc. People need to make the most of this period to lose their excess weight or as much of it as they can. They also need to try and learn good habits in the hopes that once the period is over some of the habits will remain. Once your honeymoon period is over you can still lose weight but it will be a bigger struggle. Hopefully if you have lost all the excess by then the band/sleeve/bypass will still give you enough assistance that you can maintain without too much effort. It is normal to eat "unhealthy/sometimes foods" sometimes. The trick is to make sure that you don't break all your newly learnt good habits and go back to the way you were preband.

This is not to slam anyone, but I really would like some input. I read here so many that say the band doesn't work, or that 20,30,or 40lbs have come off and now nothing. I realize that many of you have had problems with slippage or some other medial issue, so I'm not thinking of you, I have been reflecting and I'm finding some greal gray areas for myself. I started to make my food changes the day of my seminar, I cut out sweet tea, sodas, starting taking smaller portions , no drink with food and soon started to feel bertter. And I was working hard to drink my Water. I choose the band because the bypass scared me, and I didn't like the look of those who had it. I followed my own changes from Nov. until my 2 week pre op diet.in Feb. I was down 18lbs on that day. I was good about following the instructions and the weight keep coming off. I didn't exercise much, just watched what I ate. When I finally lost 63 lbs. and was in a size 12....I lost my mind. I got lazy and stopped following the rules. I lost my commitment to the program. I stopped loosing . Even knowing this I can't get on track. I say these things because I don't think we are all as commited as we once were, we are not as honest with ourselves as we need to be. For me candy keeps wandering into my home, coffee creams are the devils inventtion and sugar has rentered through a back door. Still knowing this, I can't seem to shake things back in the right places. I started this journey because I didn't want to be on a diet for life, and I don't feel I am. One of my problems is that even though I don't have ture restriction, I don't have a problem with hunger, I thought if I wasn't hungry I shouldn't eat...very wrong. I am stumped about how to fix where I am, I need to loose anthore 30-35lbs to be in the guidelines. I would like to loose about 15 to feel like I had a true result for my effor. I don't think doc will do a fill since I'm not hungry. I try to eat meat & veggies but it is usually only once a day. Yogurt and Protein drinks to try to get the protein in. My life schedule is strange and gym time never seems to come. So, is it not working or am I doning something wrong.

I don't think the idea that you should exercise for the band to work well should scare you off the surgery. Frankly, though I'm 52 years old, I have had no regular exercise program at all until the last 6 weeks, and lost over 100 pounds in 14 months anyway. If you follow the food rules stringently, you can still lose rapidly. And as you slim down, you will feel more energy and will become more active. I love my walks now, becasue my knees don't hurt and I don't feel like I'm struggling for breath. It feels good. I don't work out an hour or more a day, I just walk for 40 minutes 5 days a week, and now am incorporating some mild strength exercising 3 times a week. It's what every healthy person should do, even bypass patients, that's all. The beauty of the band is most people can lose the weight by doing what works for them, as long as they follow the basic rules for eating.

I'm almost as your measurements I'm 5' 2.5" and I weight 211# my BMI is 38 I'm a stress and a sweets eater I'm a plastic surgeon and my figure is very important for me and my clients I hv been obeese my whole life This year I got hypertension and knee pain and decided that enough is enough My surgeon who is a colleague recommended mini gastric bypass obviously bcs I'm a sweet and stress eater But I totally refused it I'm a surgeon and I know that is it a malanatomical procedure and I can't handle malabsorption syndrome or dumping syndrome!! My friend had 3 car accidents due to damping syndrome and almost died So I promised myself and him that I will control myself post op and I hope I can control the cravings after I start loosing weight and seeing results Sent from my iPhone using the BariatricPal App

Yea i want to have a baby slso thats why i didnt get sleeve got bypass instead didnt want my stomach cut either You guys are correct about the sleeve not being reversible; however, I don't think it has a negative impact on becoming pregnant (providing you are willing to wait a year after the surgery to stabilize weight): http://www.ncbi.nlm.nih.gov/pubmed/23306797 http://www.marinahospital.com/blog/will-i-be-able-to-get-pregnant-after-gastric-sleeve-surgery Studies stated, "Barring very uncommon complications of surgery, this should eventually make it easier both to conceive and to carry a child to term with less risk of negative consequences."

Welcome! Sorry about the bleeding trouble. I'm sure your scars will fade to nothing-much. Mine did. I had 5 incisions twice and only about three of those are visible. Don't be in too much of a hurry for that first fill, you are still healing. It's important to let yourself heal completely to avoid trouble down the road so follow your doc's instructions about exercise and foods to the letter. (please) I'd bet you will bypass your goal weight and keep going. I'm 5'7" and 150 and you are just a tiny thing. (soon to really be tiny) I'm four years out from my surgery and the best advise I can give is to be patient with the process and with yourself. You are attempting a major lifestyle change and that is SO difficult. Cut yourself a break when you falter. Just pick yourself up, dust yourself off, and get back on the "bandwagon" without recriminations. It takes a long time to lose a pound of fat. That's a deficit of 3500 calories. Unless you workout like a mad fool, losing 1-2 lbs a week is just fine. The band really helps with the patience. It keeps you from the "oh what the heck" moments that wreck a weeks efforts. Good luck on your journey,

I had bypass and went to work in 10 days. Could have gone back in 5 .

Well, I'm on day 14 of my stall, and it's weird that I'm not stressing. I think I expect it to last a good 3 to 3 1/2 weeks since each stall lasts about a week longer than the previous one. My scope is next week, and I'll be glad to finally get it done. I seem to be doing ok with 40mg of Nexium twice a day, although I have to really watch what I eat still, and I have to take the GI cocktail when I start having bad problems again. I took it for a week before every meal. Now I take it as needed. The shedding from my hair is getting pretty heavy now. It's not worrying me because I knew it was coming, but it's really getting on my nerves!!! My hair is literally getting EVERYWHERE!!! I have to clean it a few times a day. If I run my fingers through my hair, I shed. If I brush my hair, I shed. If I wash my hair, I shed. When I get up in the morning, the movement on my pillow through the night caused me to MAJORLY shed. It's really aggravating. I'll be glad when it slows down. Now that I'm almost 4 1/2 months out from surgery, I noticed I'm able to eat larger portions of food. That's tripped me up a few times, so I have to be extra mindful of that. I really wish I had lost my hunger, and I really wish I had restriction. I didn't get any of the useful benefits or "extras" that most get with the surgery. BUT, I'm still working out and doing what I'm supposed to. I just wish it wasn't such an uphill battle everyday. I definitely wish I had gone with the bypass. But I didn't, so I'm going to do everything I can to make this work.

I am a year and a half out and I sorta wish I had gone with the bypass too. Not cause of any complications, just cause I didn’t lose as much as I had hoped and I wonder if the grass would’ve been greener on the other side. I chose sleeve because I am on medications though and have to remind myself that I may have issues with that had I chosen differently. I think it’s pretty natural to wonder if things could have been better if we had made a different choice but who knows. I have to think that everything happens for some reason. That’s what makes me feel a little better about it.

I too went to see the surgeon convinced I wanted the sleeve and I was afraid of the bypass. The surgeon told me I would benefit more from the bypass. This is because I have diabetes and he said people have more success putting diabetes into "remission" (not having symptoms anymore) with the bypass. I also have a high BMI. On 11/10, I am having the bypass because if I can kick diabetes to the curb I will. I have many diabetes complications; nephropathy, a damaged retina, an amputated toe, etc. To get off insulin and live without diabetes is like a dream. I have been reading about people who have had the bypass and now I no longer fear it, I'm looking forward to it! If you have something like diabetes, I would take the doctor's advice. I've had it almost 20 years and it gets worse with age. I am more afraid to get older and older with my all health problems than of getting the bypass. Just my $.002, I wish you well with whatever decision you make.

Hi there. For me it was the other way around - I really wanted the bypass but my care team determined that it was medically contraindicated for me. I tried hard to change their minds but in the end I went with their recommendation. I was disappointed, but it turned out okay, I didn't have any major complications and the surgery has been effective so far. However, in my case, there was an actual medical reason why the bypass was extra-risky for me. I got a 2nd opinion and the 2nd doctor agreed it was contraindicated. In your case, it sounds like the surgeon just feels the bypass will be more effective? If there is no medical contraindication, it seems like after being told the pros and cons, you would be allowed to choose the surgery you want. What would happen if you just said, "Look, I understand your reasoning, but I'm not comfortable with the bypass. I want the sleeve."? Would he refuse to do it? Could you get a 2nd opinion? Maybe if another doctor indicates that the sleeve is a viable option for you, your surgeon will relent. Have you shared your concerns about the bypass with your surgeon? Maybe with more information, you'll be more comfortable with it? In any case, it doesn't seem right for you to be forced into a surgery you're not sure you want. You're the one who has to live with it, so you should be calling the shots (assuming there's no medical issue preventing the sleeve). I'd revisit the issue and get more information, then decide for myself one way or the other. Hope it all works out for you!

Went for my fill - lost 5 pounds since November , better than nothing. But I have increased my exercise ! I'll keep plugging along !! Now my total loss is 38 pounds !!!

There is a woman in my support group who had the bypass,she tells us that to maintainher current weight,which by the way she looks awesome,she strictly adheres to 1200 calories without fail.any less she would lose more which she doesnt want to do,.

Of the mainstream procedures, the sleeve will be the most benign of them when it comes to supplement needs and the amount of trouble one can get into by ignoring them and the labs. Supplementing with the sleeve is largely an individual thing - there is much more influence by individual variations and dietary habits than there is from the surgery. I've never heard of B1 being a particular problem, but given that the primary dietary source is from the grain complex, and many people are into low carb dieting (Atkins, Keto, etc.) that minimizes that food group, it isn't surprising that such deficiencies would be showing up - not from the procedure, but from the chosen diet. My wife is chronically low in Potassium, but that is just her, not her WLS (as DS in her case.) That is managed by checking levels periodically and adjusting supplements as needed - just as if she had never had WLS. I have heard it hypothesized that there might be some iron absorption issue with the sleeve owing to the somewhat more rapid transit times of food through the stomach, but I haven't seen any validation of that concern. The malabsorbing (RNY, DS) procedures specifically do malabsorb minerals such as iron to varying degrees as much of the mineral absorption happens in the duodenum which is bypassed entirely (in the RNY) or partially (in the DS) so iron levels can certainly be more of a challenge with those patients. I had a bleed a few years ago that sapped my iron/ferritan levels, but was able to restore them to normal in a few months by doubling my oral iron supplement; most with an RNY or DS would need iron infusions to recover from those levels. I tend to lose a bit of D normally so have been supplementing that since before my VSG and continue to do so at moderate levels (2-5k IU) both from that perspective, and also our surgeon prefers to see us in the higher end of the normal range on the blood levels; some in the malabsorbing camp will use 50k IU supplements to keep things in line (particularly the DS folks who specifically malabsorb fat soluble vitamins such as D) I know quite a few long time DS people (10-20+ years) and have seen very little problem as long as labs are regularly taken (annually usually) and responded to; however ignore those at your peril as weird things can happen if you don't. And that's with the DS, which is the fussiest of the procedures in that regard. With a sleeve, you are much more likely to get into trouble by something that you bring to the table - whether that be intrinsic or behavioral - but that is good reason to keep up with periodic lab checks just the same (my labs are a lot simpler than those of a typical DS or RNY person, as there is less that is needed to be monitored with the VSG.)