I'm solidly working toward having surgery at the end of the year. I've read a lot of excellent threads here, and really appreciate the candid things people have had to say. You're really helping educate me. Thanks for that. But for all my reading, I haven't read an answer to this question. I'm wondering if someone here can help me learn what to expect. (I hope I can explain this so it makes sense, so bear with me.)

A little background: I'm one of those people whose stomach doesn't tell me when I'm full. It seems I can eat, and keep eating, until I'm suddenly stuffed and miserable. I've learned to manage the volume of what I eat now, so as to not have this occur most of the time. I stop eating when I think I've had enough, not necessarily because I feel full. In some cases, an hour later I'm feeling hungry again. I hate when that happens.

But I'm also one of those who can't focus, function, or sleep when I'm hungry. (Or when I THINK I'm hungry.) As a result, forcing myself to eat less has always been a problem. No matter which diet I tried, I kept feeling like my hunger was never satisfied. Only after eating extra portions of things did I finally feel full. And as we all know, that makes the diet ineffective.

So here's the question: Since the sleeve removes the portion of the stomach that produces ghrelin, it's my understanding that hunger pangs are reduced or eliminated. So how do you know when you should eat, and how do you know when you're full? Does hunger ever truly happen after surgery, and how do you know when you're satiated? I've heard the feeling of satiety is one of the benefits of the sleeve, but I don't know that I've ever felt that. (I hope that makes sense.)

As for post-surgery eating, do you truly have to measure and plan everything out ahead of time for every meal? If you know your sleeve can handle 6 ounces of food, do you always eat 6 ounces at a time? They say don't graze, but how do you manage eating meals? Is it a volume thing, or forced portion control, or ? I read here about people who say they're having trouble "getting all their Protein in" or whatever. Is that because they feel full too soon? But if your sleeve should be able to handle a certain amount, and it's meal time, how does that work? Why can't you "get all your protein in?"

My concern is that if I don't ever feel full, how will I know if I've had enough? I don't want to set myself up for getting sick after every meal by overeating, but I also don't want to eat and then feel hungry again in a short time.

I hope this makes some kind of sense. Anyone have an idea of what I should expect?

Thanks very much,

Dave

Hi dave, I used to have that same issue, after 31 years of dieting on and off (I've first been put on a diet when I was 9) I lost the signals that tell me when I'm hungry and when I'm full. Apparently this is common in people who diet too much, you loose those cues so just eat till you are emotionally not hungry anymore stuffing yourself and getting fat. When I decided to have this surgery (i'm 6 weeks out now) i felt like it was my last resource, I've had a gastric balloon in a few years ago, lost about 23 pounds, put it all back on and more! I just thought that the only thing that would stop me overeating was a physical barrier, i.e. a smaller stomach, I didn't want to put my hopes up with the ghrelin thing. After surgery my hunger has diminished a lot, don't get me wrong, I do get hungry, but I try to differentiate between head hunger and real hunger. The big difference is that I get full much quicker and I don't feel hungry anymore after eating a bit, it's incredible! People react differently to this surgery though, I am not one of those people who cant get enough nutrients in, but you can feel when you've had enough. I don't weigh my food just guesstimate and pay attention now to the cues that tell me that I'm full and it works! As for the snacking I know I should stop, but i find it more comfortable to eat about 6 times a day, so when I do snack/graze I count it as a meal and count it in my daily calorie intake, roughly, and it's working for me. I'm not losing as quick as a lot of people on this forum, I lost about 25 pounds in 6 weeks, but it's good for me, I just hope I keep losing! Hope this helps, good luck to you!

Hi Dave,

Allow me to speak from the view of a pre-op patient. Over the past 50 years, I have been on just about weight loss plan known to man. Most diets provide a quick fix, but none had any lasting result. I have always been a food junkie. I would eat until I was satisfied, often to the point of being stuffed. The thought of reducing my caloric intake in preparation for the sleeve terrified me. I was sure that I would starve to death before I could have the procedure done.

I have been pre-op since mid June, and I have lost 30 pounds (as of Sept. 7th) in preparation for the surgery, and actually, I feel fine.

First, you must commit yourself to the process. No one would know if I "cheated" but I would know that I was defeating my purpose ... so I don't cheat. A good education class prior to the surgery in my opinion is essential. In my case, as a patient of Kaiser Permanente, participant are required to complete a 12 week course called "Options" which assist in mentally and physically preparing patients for the surgery with realistic fact and information on what to expect both before and after the surgery.

Surprisingly, what has help me is planning the night before my meals for the follow day and eating at regular times. By eating five small meals through the day, I never feel hungry, even following my pre-surgery 1300-1500 calorie program. I've learn to truly recognize the difference between being hungry and just wanting to eat. I've learn to read food labels so I know the number of calories and grams of protein in each meal. I make better choices while grocery shopping. It seems like by following these tip, not only do I fell satisfied, but there are days when I have trouble eating my 1500 calories. Had someone told me this would happen six months ago, I would have considered them to be insane.

Everyone knows that the surgery is just a tool, but the real success comes as a result of lifelong dedication to the process.

For me, eating at regular times and chewing every mouthful of food at least 30 times slows my eating process down and allows me to enjoy my food, give my system a chance to signal my brain that I have eaten enough, and prepare me for post surgery eating habits. That feeling of hunger was my biggest concern, but at least for now, it is no longer an issue.

Good luck my friend. Just keep your ultimate goal in mind. It will all be worthwhile.

Everyone reacts differently, but here's what I've experienced.

Prior to surgery, I would eat until absolutely bursting. I loved that feeling of being full and I almost always ate dinner until the point of discomfort. About thirty minutes after that massive meal, I'd have my head in the fridge again, looking for more. I felt hungry all the time - all day, every day. If I thought I was hungry, I couldn't sit still, I couldn't sleep, I couldn't function or stop thinking about food until I ate something.

Post op, I'm one of the lucky people that isn't hungry at all - ever. I have to remember to eat, or I'll eventually feel a very empty feeling in my tummy that reminds me I need to eat. Some people do feel hunger. I do not. The only time I ever experience the urge to eat is when I'm suffering PMS - an issue you won't have to worry about.

Not only am I not hungry, but most food is unappetizing. I might cook all day because I want a specific dish, and then I'll eat two bites and be done. Most foods only taste good to me for one or two bites. They're wonderful for those two bites, don't get me wrong. But after that, I have to force myself to finish my food or I won't get enough calories or Protein for the day. I think I'm also in the minority on this one.

Mason is absolutely right and seems to completely have his head ready for surgery. The more of this type of "head work" you do pre-op, the easier your post op experience is going to be.

I started out weighing EVERYTHING. I made my day's menu first thing in the morning and recorded it in a calorie tracker. I then made sure I ate all of my food for the day. I couldn't eat it all in three meals, so I did four. I did not snack or graze between meals.

Now that I'm more confident about my ability to guess my food, I track my calories maybe two days a week. I have a tendency to not eat enough, so if I stall out on the scale the first thing I do is go back to weighing and tracking food. That seems to fix the problem every time. Sometimes I graze a little, but it's amazing how little I can actually eat. I try not to make a habit of it though, because it really isn't healthy.

There is no way on this earth I can eat six ounces of anything at once. NO WAY. I'd find myself running to the bathroom, because it would come right back up. I can eat about 2-3 ounces of dense protein and maybe a bite or two of potatoes or vegetables after that's done. I can drink a 12 ounce Protein Drink over the course of an hour. I have trouble getting in my protein because my stomach is very small and I'm never in the mood to eat. It's easiest for me to make a protein coffee or chai latte every morning for extra calories and a big shot of protein.

You will not be able to overeat, and if you're a stubborn learner and eat too much you'll learn not to quickly. It's not really vomiting. The term "productive burp" or "PB" like a lapband patient would use is really more accurate. But I promise, you'll be uncomfortable and you'll only do it a few times. Have you ever swallowed a huge gulp of Water and felt your esophagus expand painfully? It's just like that, only it lasts until the food goes down or comes back up.

Your new full signal could be anything from hiccups to a runny nose to sneezes. But you'll learn what it is quickly, because unlike your old tummy, your sleeved tummy doesn't have any real "give" and it will be painful to eat just one bite too many.

A lot of my eating issues were mental. Once the ability to eat endless amounts of food was taken care of, my mental desire to do so went away. Because overeating is uncomfortable, the joy in it is gone and I no longer overindulge.

But you have to understand that everyone is different. There are some people who aren't as happy with their sleeve because their hunger DIDN'T disappear, so they're still hungry without the ability to eat those massive portions.

Good luck whatever you decide. I think the sleeve is an awesome tool, but you have to really understand that your life is going to change and you have to be willing to learn how to eat properly.

~Cheri

I really love the fact that I found this group, thank you all for being so imformative!

Hi Dave, I have the same thing as you! My husband and I would eat a meal, and within an hour, my stomach with be literraly in pain like I hadn't eaten anything! For most of my life I can eat a nice big plate of food. I've never stuffed so bad I vomited, but I can eat alot. So before deciding on surgery, I decided to try and listen HARD for clues. Some people say to stop eating when "are NOT empty" vs. eating till your full. I found out that this would happen to me on very small amounts of food, I could be - done. However, I would be hungry VERY quickly. If I want to, I can easy ignore and push on throught eating. My frustration was over the top when my hubby and I eat a meal, and within the hour my stomach hurts like it went right though me and I am starving again!

So that is one reason why I decided my body was working against me (my whole family is big, my sisters diet and exercise hard daily and they are not thin by any means. WHAT I ALSO FOUND OUT EXPLAINED A LOT.. YOUR HUNGER PAINS MAY BE ACID REFLUX. In talking to a couple Drs, I found out that most likely I have that! MOST OVERWEIGHT PEOPLE DO! I thought acid reflux and heart burn are the same thing, but actually I've had heart burn high up in my chest - it does feel different. I just didn't know that for most people I think acid reflux is in the normal stomach area. Can you imagine I never knew I had this and I am 34 years old? Bottom line, many Dr.s can fix it while they are doing the surgery.. it is REALLY important that they do.. read below from Dr. Watkins..

Originally Posted by eac

Dr. Watkins,

What is your opinion on the viability of the stomach after the plication surgery. I was informed that eventually the stomach would adhere to itself and really could not be taken down after a month or two. I ask this as a Barretts esophagus patient that would need the use of my stomach should my Barretts progress to esophageal cancer.

Excellent question.

The stomach will always be viable after plication. Since it is just folded in on itself and there is no cutting or stapling, there really is no issue with its viability. Reversing it would involve cutting the stitches and the subsequent bit of scar tissue around the stitches and you would be left with your normal stomach. We know this can be taken down even after many years because we've been doing this for many years when we take down plicated stomach after Nissen fundoplication (a stomach plication operation for severe reflux - heartburn) or after Lap Band surgery (the stomach is plicated over the band).

Barretts esophagus, for anyone who hasn't heard about it, is when the esophageal lining changes due to chronic reflux (heartburn, GERD). The esopagus (swallowing tube) is made to handle neutral pH Fluid such as spit and mucous and food. It really doesn't want to see gastric acid or bile. In the case of bad heartburn, the lower esophagus gets exposed to so much acid and bile that it gets irritated and chronically inflammed and has to change its cells to protect itself. These cells look more like stomach lining cells than esophageal lining cells and this is what they call Barrett's esophagus. Dr. Barrett is the physician who discovered this interesting protective mechanism by morphology in the wonderfully designed human body.

The problem with Barrett's is that it can form pre-cancerous cells over time and these can progress to cancer. This is why it is a good idea to have an endoscopy (stomach scope, EGD - esophagogastroduodenoscopy) if you suffer from severe heartburn to rule out Barrett's. If biopsies show Barrett's with low grade dysplasia (pre-cancerous change) you need to have more frequent endoscopy to monitor for progression. If you have high grade dysplasia or frank cancer cells this is when esophageal resection (cut the affected area out) is recommended. Moderate grade dysplasia is either more closely watched with frequent endoscopy or treated surgically.

The good news is that if the heartburn is treated surgically, in some cases the Barrett's will resolve (go away, cured). I have seen this many times in my own practice. Treatment typically involves addressing the associated hiatal hernia. Hiatal hernia is when the hiatus - the opening in the diaphragm (breathing muscle) - is too large and there is no "valve" to prevent acid and bile from backing up into the esophagus. With that operation, the esophagus is mobilized to ensure that an intra-abdominal portion of the esophagus is below the diaphgram. This is what we call an intact anti-reflux mechanism.

After doing laparoscopic weight loss surgery for 8+ years, I have learned that essentially 100% of patients have a hiatal hernia or at best a weak hiatus that needs repair. This is easy to do because it simply involves mobilizing the esophagus to achieve an intra-abdominal portion and stitching the hiatus until it is the appropriate size. This is very important to do in any stomach-reduction surgery because if you give a patient a smaller stomach without an intact anti-reflux mechanism, this creates more severe heartburn and frustrated patients and less successful weight loss.

I feel very strongly about creating an intact anti-reflux mechanism with each weight loss operation and I know this is important from personal experience. Many surgeons don't do this - they don't believe in it - to the detriment of their patients.

All of this to say, by fixing your hiatus, you may very well achieve resolution of your Barrett's esophagus. Even if the worse should happen and it progresses, you could still have an esophageal resection with gastric reconnection to re-establish continuity with no problem even after plication.

Brad Watkins MD

I don't ever feel full either. Its my understanding that you'll still feel hungry when you are, you'll just lose a lot of the excess hunger crap. You'll learn to know what feeling full feels like, and what actually being hungry feels like would be my guess.

Hi Dave

I'm only 7 days post op but this is me so far...... Before surgery I could EAT, and I really loved doing it. I am a true foodie, I love to cook, and would eat out several times a week. There were days that if it didn't run away from me I would eat it, (poor kids, scurrying around the house LOL). I watched my weight go up, up and up, then came the high blood pressure, type II diabetes, high cholesterol, and the 7 month prego belly!!!!

I am feeling great! Do I get hungry, I think so, but mostly I will just feel alittle "empty" and right now about 3oz fill me up. I don't plan out my food or measure it out, if it is too much of a project I might not do it, yup, I just admitted that. You KNOW when you are filling the pouch. You can tell when you have had enough, and if you really want that next bite you will probably think twice the next time. I have not thrown up, or had any real pain, it's just a tight almost like an ache. I have not had any heart burn or acid reflux, I know alot of our sleeve family take an anti acid but I have not had the need. The reason I'm having a hard time meeting the liquid and Protein goals is because there are only so many hours in a day LOL. It takes me about an hour to drink 8-10 oz of liquid, it takes me about 45 mins to eat 3-4oz of Soup, and with the whole don't drink and eat at the same time thing there goes my day.

Hope this gives you some idea of life at 7 days post-op. Would I do it again, you bet!! Do I see commercials for food and feel a little sad that I would ever eat a "whole" meal, YES but then I remind myself that I will be able to eat those things again and have leftovers!! What a deal. :biggrin0:

Edited September 15, 201016 yr by Wedding Planner

Thanks, everyone. These posts are invaluable to me. I sincerely appreciate your candid remarks. There is no replacement for real-world experience. Keep them coming.

My concern about having the sleeve done is whether I'll be required to make a big deal out of eating during my workday. The "put down the fork between bites" thing will take some serious planning. I work as an IT support tech for a busy hospital, and I'm on the go for a lot of my workday. lunch has always been done on the fly, when and if I can squeeze it in. Making time to just sit and focus on eating is going to take some work. It's a challenge I'm looking forward to facing. After all, crawling around under desks hooking up PCs when you weigh over 320 pounds is not something I like doing very much... :thumbup:

Dave

Thanks, everyone. These posts are invaluable to me. I sincerely appreciate your candid remarks. There is no replacement for real-world experience. Keep them coming.

My concern about having the sleeve done is whether I'll be required to make a big deal out of eating during my workday. The "put down the fork between bites" thing will take some serious planning. I work as an IT support tech for a busy hospital, and I'm on the go for a lot of my workday. lunch has always been done on the fly, when and if I can squeeze it in. Making time to just sit and focus on eating is going to take some work. It's a challenge I'm looking forward to facing. After all, crawling around under desks hooking up PCs when you weigh over 320 pounds is not something I like doing very much... :scared0:

Dave

Hi Dave

I`m in IT. When its busy I can even forget to eat quite easily, its not a problem. After the four week point its just not a hassle.

Making time to sit down and eat is also making time to sit down and focus on yourself, a trait that we overweight folks often aren't good at. The world will still be there after you have paused to take a moment for yourself and because you have taken care of yourself, you will be better able to respond to the world!:scared0: