I've spent HOURS reading & reading forums, now I have some questions. I am not too concerned about pre-post op diets, they are what they are while you recover, but I am curious about 24 months and years later. (Everything I ask is cause I've read it somewhere here and it may not apply to everyone..so no offense meant, I'm just throwing it out there). Any help you can give would be greatly appreciated, truly!

• Why do (some Sleeve) people eat so slowly, chew so slow? That was a turn off for the Band, so how is the Sleeve different in that way? I understand that if you eat too fast, just like before you will be overfull and feel sick, but why else, is there something different about the *new & improved stomach* that makes it hard to eat? What would happen if you ate some bites too big/fast (I read about the horrible coconut story)? I guess I don't want to spend so much of my day trying to just get in normal nutrients.
• Why is it so hard to get in fluids? One person had said they normally drink a protein shake in the morning and it takes a hour and a half to get it down, and other 30 minutes for a egg. Why so long? Why can't fluids be drank faster or in *normal* quantities? I worry about long-term dehydration, as I tend to not drink much, then drink 2 full glasses of water at one time to catch up.
• Why should we avoid to eat and drink at the same time. If fluids travel thru so fast, then what is that so? (I understand that soda/beer bubbles tend to inflate.
• I wonder about the focus on protein. I guess since the stomach is so small that we have to ensure that we get enough protein in first before everything else, but is that at the expense of fruits and veggies? Those are important too. Protein gets lame..
• What will happen 10 years down the line. I know the Sleeve as stand alone is only a few years, but will I be a old woman who can't get her Ensure in? LOL actually that might be helpful, since our metabolism slows down as we age, being able to eat less might help!
• I have seen a few of you have trouble maintaining weight, as in losing too much. That worries me a bit as I might be trading one problem for another. Those of you who don't have that issue (are above goal, slow losers) are you in that boat from *bad* choices or that you can eat more?
• Why do many have issues with bread? Smaller stomach, not Band, so how does it get so stuck?

Well, I think that was it! I am off to see Dr. Ganta and ask my list of surgery questions..

Thank you all so much and have a great day!

Colette

I might not be able to answer all your questions, but I will try. I am only 8 weeks, but I had my sleeve through a facilitator (self-pay) and they give a package of information, plus support group meetings that provide tons of resources.

• Why do (some Sleeve) people eat so slowly, chew so slow? That was a turn off for the Band, so how is the Sleeve different in that way? I understand that if you eat too fast, just like before you will be overfull and feel sick, but why else, is there something different about the *new & improved stomach* that makes it hard to eat? What would happen if you ate some bites too big/fast (I read about the horrible coconut story)? I guess I don't want to spend so much of my day trying to just get in normal nutrients.

Because the tummy is so small, you can get overfull very quickly, which can cause pain or vomiting. If I eat a bite that is too big, it hurts going down, especially if I don't chew enough. It is getting easier as my stomach heals, but I still have to be careful. Sometimes things just taste so good, and I eat too fast, and then feel sick afterward. It is a learning curve and I am slowly figuring it out.

• Why is it so hard to get in fluids? One person had said they normally drink a Protein shake in the morning and it takes a hour and a half to get it down, and other 30 minutes for a egg. Why so long? Why can't fluids be drank faster or in *normal* quantities? I worry about long-term dehydration, as I tend to not drink much, then drink 2 full glasses of Water at one time to catch up.

There is no way you could gulp down 2 glasses of water after the sleeve. At fully healed, your tummy can only hold 4-6oz. In the beginning it is hard because your stomach is swollen and can only hold 2-3 oz at a time. Also, the restriction after surgery is such that you cannot have big swallows as it is very painful. As you heal, it does get better. I can have fairly normal swallows of water now, just not too much at once or I feel sick to my stomach. Protein shakes for me are heavy, so they take me a long time to drink. Too fast, and I feel like throwing up. You have to learn to carry around a sport bottle and sip through out the day.

• Why should we avoid to eat and drink at the same time. If fluids travel thru so fast, then what is that so? (I understand that soda/beer bubbles tend to inflate.

2 reasons. First, especially in the beginning, mixing the 2 can make you vomit. Also, liquids help you digest your food faster. Thus, but not drinking with your meals, it takes longer to digest and you feel full longer.

• I wonder about the focus on protein. I guess since the stomach is so small that we have to ensure that we get enough protein in first before everything else, but is that at the expense of fruits and veggies? Those are important too. Protein gets lame..

Protein is vital for your body to function. It also helps you feel full for longer. I don't think it should be at the expense of everything else, and I try to eat a balance diet with veggies and fruit as well, as I am sure most people try to do. It is just harder in the beginning as your tummy is still healing and you cannot eat a lot.

• What will happen 10 years down the line. I know the Sleeve as stand alone is only a few years, but will I be a old woman who can't get her Ensure in? LOL actually that might be helpful, since our metabolism slows down as we age, being able to eat less might help!

From friends that have had the sleeve for a few years now, you can eat about as much as you do at 6 months out. One friend can eat an egg and a piece of toast for Breakfast. You will never be able to eat like you ate before, but you are not doomed to a life of eating so little that you struggle to get anything in. That is just in the beginning.

• I have seen a few of you have trouble maintaining weight, as in losing too much. That worries me a bit as I might be trading one problem for another. Those of you who don't have that issue (are above goal, slow losers) are you in that boat from *bad* choices or that you can eat more?

Can't answer this one, sorry.

• Why do many have issues with bread? Smaller stomach, not Band, so how does it get so stuck

For me, really starchy stuff does not sit well. It is heavy and sticky, and just doesn't agree with me. I can't really eat Pasta either. I think everyone is different. Remember, well it is not the band, your tummy is tiny, and it is a long tube, not a round pouch, so there is not a lot of room for things to slide through.

Alot of your concerns and what you are reading are especially true in the beginning, not years after surgery. It is a big adjustment, but you relearn everything as you go, what works for you and what doesn't.

Thanks! I am glad your doing so well. I wonder if I'll hear from anyone else further out.

Supersweetums hit the nail on the head. I can add a little.

• Why do (some Sleeve) people eat so slowly, chew so slow? That was a turn off for the Band, so how is the Sleeve different in that way? I understand that if you eat too fast, just like before you will be overfull and feel sick, but why else, is there something different about the *new & improved stomach* that makes it hard to eat? What would happen if you ate some bites too big/fast (I read about the horrible coconut story)? I guess I don't want to spend so much of my day trying to just get in normal nutrients.

For some reason - perhaps the elimination of MOST of the stomach area that produces the hormone ghrelin ( https://secure.wikimedia.org/wikipedia/en/wiki/Ghrelin ) - the desire for food is lost. I cannot wolf down my food any longer and have no desire to. Because the full stomach s no longer there to churn the food in a massive amount of gastric juices to start the breakdown process we must help the process along and chew the food to paste to make it easier to digest. I for the most part no longer WANT to eat but know I need to, so I sit there take tiny bites, chew the hell out of it and take my time doing this task, it's not unpleasant, it just no longer holds the desire I used to have to stuff my face - the thrill is gone. I eat to live now, not live to eat.

• Why is it so hard to get in fluids? One person had said they normally drink a Protein shake in the morning and it takes a hour and a half to get it down, and other 30 minutes for a egg. Why so long? Why can't fluids be drank faster or in *normal* quantities? I worry about long-term dehydration, as I tend to not drink much, then drink 2 full glasses of Water at one time to catch up.

Again, the stomach is just about as big as a medium banana - it used to be the size of a womans clutch purse. Fluids don't just sail through - although they do go through faster than solids. Drink too much too fast and it gets uncomfortable, like after Thanksgiving dinner packing in that second piece of pie and drink used to feel. Drink WAY to fast and you get a lot of pain as the new sleeve does not stretch to accommodate the Fluid. You can barf it up too.

• Why should we avoid to eat and drink at the same time. If fluids travel thru so fast, then what is that so? (I understand that soda/beer bubbles tend to inflate.

Again, the amount of capacity and therefore the amount of gastric juices is greatly diminished. Drink to much while eating and you can dilute hte gastric juices and cause un "treated" food to pass into the intestines where they won't be adsorbed as readily.

You also have to make a choice - LIQUIDS or SOLIDS, you can't do a full amount of either. Since we NEED the solid foods and it's caloric benefit it's wisest to NOT drink liquids and take up some of the space the solids can use.

• I wonder about the focus on protein. I guess since the stomach is so small that we have to ensure that we get enough protein in first before everything else, but is that at the expense of fruits and veggies? Those are important too. Protein gets lame..

Protein is "hi test" food, carbs are "lo test". Protein provides a longer term energy and the building blocks for muscle and carbs quick energy. Again, the stomachs capacity requires us to make a choice, better longer term energy in the form of protein or quick energy food for the here and now in the form of carbs. You SHOULD make the choice in the favor of protein. Later as the stomach heals and you can eat a tad more you can indulge in more carbs.

• What will happen 10 years down the line. I know the Sleeve as stand alone is only a few years, but will I be a old woman who can't get her Ensure in? LOL actually that might be helpful, since our metabolism slows down as we age, being able to eat less might help!
• I have seen a few of you have trouble maintaining weight, as in losing too much. That worries me a bit as I might be trading one problem for another. Those of you who don't have that issue (are above goal, slow losers) are you in that boat from *bad* choices or that you can eat more?

Since it's only been around about 5 years there is no concrete data. You SHOULD be able to eat sufficient foods at normal meals to keep your weight stabilized. 3 meals plus 2 Snacks is all it takes - but the RIGHT meals and snacks too. I don't think anyone is going to pass away from malnutrition but we will always have to watch what we eat and make right choices. To ME this is a far better choice than being obese with diabetes, congestive heart failure, high blood pressure and myriad other obesity related diseases and THEN try to make a good choice on what to eat. As far as a "trade" it appears to be a good "problem" to have compared to the alternative.

• Why do many have issues with bread? Smaller stomach, not Band, so how does it get so stuck?

I am not sure on this one but I think that it balls up and may be harder to digest than protein. It IS mainly carbs too.

Well, I think that was it! I am off to see Dr. Ganta and ask my list of surgery questions..

Thank you all so much and have a great day!

Colette

At 20 months out, the eating slow, chewing things to mush is not my life. I do not eat slower than my girlfriends or family UNLESS, I want to eat more. Stretching the meal over 45 minutes, allows me to eat more food.

I haven't been chewing food to mush for a year now. I did it until I got into maintenance because I had to get in more calories until my body was settled.

As for Protein first, I don't always, and will never follow that rule 100%. I love veggies/fruit, and especially salads. I eat salads 2-3 times a week, I get in plenty of spinach, and other veggies. Never was a big fruit eater so I have it on occasion.

This whole difficulty with drinking is short term as well. Yesterday, I slammed 20oz of Water in 3 minutes. I think that's pretty normal. I had zero pain, I did burp once, but no discomfort.

As for the drinking/eating simultaneously thing, I sip during my meals. Again, this is a way to eat more. If I eat a bunch of dense protein, the water kind of just sits there. But, if I eat meat and veggies, liquifying my meals can lead to that empty feeling because food gets soft faster and can pass through the pyloric valve faster. I never get hungry so I can not comment on getting hungrier faster if eating and drinking at the same time. I do drink wine with my meals sometimes, and alcohol relaxes my stomach and allows me to eat more food as well. Avoiding "drinking" with meals helps you keep a good satiety level with your meals.

There is plenty of data out on partial and full gastrectomies for stomach cancer and ulcer patients that indicates they have zero issue consuming enough calories/protein/fat/carbs over their lifetime. Even though the "sleeve" is fairly new, it's actually been performed as a stand-alone since 2001-2002, research is slow to report, but gastrectomies have been performed for decades upon decades.

The concerns you are reading about are for people that are still early out with major swelling/trauma from the surgery. Some heal faster, some take longer. I was one of those that took longer, and I relied on soft Proteins to get in my calories/protein goals. It was boring, but my body did not suffer. My labs have never been anything short of stellar.

Bread, Pasta, rice, crackers are all sliders for me at 20 months out. Nothing gets stuck. Cornbread causes some discomfort, but all other types of bread really go down just fine. Early out bread did expand in my sleeve and I had zero room for anything else. Now, not so much. If I eat bread and meat together, say a hamburger, the bread goes right down without issue, and I can actually eat the same amount of meat, it's like it gets mushed up along with the protein and goes right down.