Hello, everyone!

I had my sleeve on August 31, 2011, so I am about 2 months shy of 2 years. There have been lots of events in my life the last few months, that have added to my stress, and disrupted my eating routine, and I'd like to write a little about it. Primarily to get feedback if anyone has had a similar situation, and secondarily to put my thoughts out there into a world where people can relate.

Since I had surgery, I have had lots of time to fall into a very well planned eating and drinking routine. As a student, I have had loads of time to find what works for me, and what doesn't.

However, there were many events that took place in the month of May and June that sort of disrupted that routine. In May, I gave one of the biggest exams of my life. My appetite wasn't very good, and my calorie/protein intake dropped a bit. Following this, I was in classes from 8 to 7 for a week (also a wonky eating and drinking routine), and then I was off to India - this is where things really went downhill. I was barely hitting 50-60% of my nutritional goals, and was running around all day long.

By the end of these 2 months, I had dropped 2.5 pounds below my healthy weight range. Here's the thing, many of us might even be a little happy about going below the range, but no one wants to look sick or undernourished. Losing weight with a healthy lifestyle still leaves you glowing and energetic. I, however, looked anorexic, pale, and dull. It was seriously ridiculous, and people were commenting on how unhealthy I looked every single day.

This was new for me, because I didn't realize how easily I could become malnourished if I wasn't adequately planning out my meals. (I'm vegetarian, by the way). After coming back, there was a huge function at our house, and I was eating the bare minimum for another 2 days. This put me at 3 pounds below weight. In the meantime, the low nutrition caused a bit of muscle loss around the hips, and I started having symptoms related to a pinched nerve.

So, I started pilates and yoga classes to help strengthen my core and ease the pain. At the same time, I decided I would add some more calories, fats, and carbs into my diet, to help bring back that glow and the lost pounds. On a daily basis, I added in half an avocado, 2 pieces of whole wheat toast, and an ounce of nuts. All healthy fats and calories, no?

Well, here's the kicker. By the end of 3 weeks, I had gained back those 3 pounds, plus 1 more. 4 pounds in 3 weeks.

Yes, I'm back in my healthy range, I look well nourished, I have more energy, and no one is telling me that I look sick. I can even see the difference from the yoga. However, I am terrified at learning how easy it is for me to gain weight, even when eating healthy foods. Yes, I can convince myself that it was also easy to lose the weight, and that my body reacted quickly by replacing the lost nutrition... blah blah blah. In the end, I still gained 4 pounds with very little effort, in less than a month.

I always knew that my nutritional planning would be a lifelong process, and I have learned to enjoy it. Still, I didn't realize how quickly my weight and health could fluctuate if I did not make my intake a priority!

Lynda, the article is interesting, thank you! I've heard about the microbe theory before, but never related directly to the endotoxins released by the bacteria. I'm heading to Atlanta next month, and will be looking for medical research projects. If I can find one on obesity, I'll be sure to ****** it up!

NtvTxn and Laura, do you have Ralphs or Kroger grocery stores near you? Their 2% cheddar is the best I have found so far, and I like it so much more than regular cheddar now! It has enough fat to satisfy the taste buds, but not so much that I feel icky afterwards. As far as mozzarella/string cheese, my favorite is Precious 2%. No other string cheese company has matched the taste and quality. Laura, I agree with you on having healthy and natural fats. I also agree that American cheese is far too processed to be considered real cheese.

Terry, I understand completely. Since the day I had surgery, I have spent the first 20 minutes of my morning planning out my meals for the entire day, weighing them out, and packing them. It really helps me keep in the calorie/protein range, and portion sizes.

This surgery really has taught me the importance of having Protein in my meals, and how to stay satisfied. I absolutely love the feeling.

Cheri, I completely agree!! When I first had surgery, your posts really helped shed light on the challenges I would be facing in the future, and still do. I come back and hover around the board once a week or so. I love this vet's forum as well, it really is a huge support.

I may look "normal" now, but in my head I know that I am not.... I will forever be a bariatric patient. It's nice to know that everyone out here in the land of VST understands that feeling.

I have a 10 pound bounce range (115-125), and check my weight maybe 3-4 times a month. I hate the scale, but using it is a necessary evil. You're right, I did need the wakeup call! As long as I make my health and nutrition the highest priority, I'll be fine.

The farther we get out from surgery, the easier it is to gain weight.

I am fighting regain, and I have to be careful of every bite I put in my mouth. If I stray away and eat something off program, I gain weight immediately.

Oregon daisy or anyone- I find that statement hard to believe ( as i am not out far yet 1 year post op). The only reason I can think of your body gaining faster is if the BMR locks in at a low number from low calorie eating. If one is actively engaged in fitness and eating around TDEE amount of calories then they would never have this problem, right? This hypothesis assumes both people are eating relatively the same types of food, but at different quantities. It is all about calories-based metabolism (right?) and not necessarily about type of food ( assuming it is not sweets, cookies, cakes, pastries and the like). I would think your metabolism would stay the same if you are constantly babying it daily with mindful eating ( nutrition, timing and quantity) and fitness. Or does your body just get so efficient at maintaining status quo that you can never do enough to maintain a constant metabolism as you get further out. To maintain a constant metabolism and outwit the body's efficiency of adaptation would require increasing the point of equilibrium between calories in and calories out by balancing eating and fitness until it is not humanly practical ( or practical for people like us with VSG). Agree or disagree. I am primarily asking for myself, but I am sure everyone wants to know.

Not sure the answer, but I have heard this same thing on Obesity Help VSG forum where there are also a few that are 3+ years out. We have so few people that are more than 3 years out and still at goal or trying and still on the boards, it's hard to tell.

The general thought seems to be around year 3 it gets harder to lose the weight if any creeps back on. I've been wondering if it is because we actually have some malabsorption because they food passes so fast through our tinier sleeve and that as time goes by, the small colon gets more efficient at pulling nutrients from this food. I've been looking for studies that back that up, but I haven't found any yet.

Lynda

Lynda- interesting comment on the enhanced efficiency of the small intestine over long term post op timeline. I do suppose that would lead to more weight gain because the small intestine is the primary point of nutrient absorption in the GI tract. Never heard of this before, but it makes sense.

Not sure the answer' date=' but I have heard this same thing on Obesity Help VSG forum where there are also a few that are 3+ years out. We have so few people that are more than 3 years out and still at goal or trying and still on the boards, it's hard to tell.

The general thought seems to be around year 3 it gets harder to lose the weight if any creeps back on. I've been wondering if it is because we actually have some malabsorption because they food passes so fast through our tinier sleeve and that as time goes by, the small colon gets more efficient at pulling nutrients from this food. I've been looking for studies that back that up, but I haven't found any yet.

Lynda[/quote']

Oh dear lord! PLEASE DON'T LET THIS BE TRUE!! Well, I'm at year 3 and have lost about 20 of regain with 5-7 to go so maybe a statistic!!!!!! Lol

I find it so interesting that we are learning more and more about this sleeve every day, in regards to its long term effects. It really is amazing to hear everyone's experiences, theories, and research.

This vet's forum really is brilliant, and I hope people keep checking in at different milestones to give us updates. As for me, I've gone back to my routine eating schedule, and my body is back to being happy and balanced. Isn't it interesting how quickly our bodies let us know if we are doing something right or wrong?

Every day is a learning experience for me, because my body has something new to teach me at even 2 years out. Or perhaps I'm more open to its signals now than I was before surgery?

Oregon daisy or anyone- I find that statement hard to believe ( as i am not out far yet 1 year post op). The only reason I can think of your body gaining faster is if the BMR locks in at a low number from low calorie eating. If one is actively engaged in fitness and eating around TDEE amount of calories then they would never have this problem, right? This hypothesis assumes both people are eating relatively the same types of food, but at different quantities. It is all about calories-based metabolism (right?) and not necessarily about type of food ( assuming it is not sweets, Cookies, cakes, pastries and the like). I would think your metabolism would stay the same if you are constantly babying it daily with mindful eating ( nutrition, timing and quantity) and fitness. Or does your body just get so efficient at maintaining status quo that you can never do enough to maintain a constant metabolism as you get further out. To maintain a constant metabolism and outwit the body's efficiency of adaptation would require increasing the point of equilibrium between calories in and calories out by balancing eating and fitness until it is not humanly practical ( or practical for people like us with VSG). Agree or disagree. I am primarily asking for myself, but I am sure everyone wants to know.

Fiddle...I'm in the camp that calories in vs. calories out is only half the story. It DOES matter what types of foods you eat, and I'm not just talking about sweets. There isn't much difference between a twinkie and mashed potatoes once you eat them. The insulin response is still the same. And in some people it's vastly different than others. If you're insulin resistant, eating high GI foods will increase the insulin response which among other things, prohibits fat burning and encourages fat storage. So 100 calories of potato has a totally different effect than 100 calories of turkey on weight and body composition. And the more insulin resistant you are, the more profound the difference.

Additionally, I have a healthy skepticism about TDEE calculators. Most of them do not consider the fact that a person may have lost 100 pounds or more which does have a profound affect on metabolism. Unless you are a heavy exerciser...especially resistance training, it can change the caloric requirements drastically.

Then there is the whole theory of setpoints. Whether you believe in those or not...not sure I do....but the body may indeed be looking for a point of homeostasis and fight to get there. And that point may be a few pounds above where you want it to be. And let's face it, everyone here has a body that likes to hold onto weight...otherwise we wouldn't be here right?

Alright...end of thread hijack.

Having had surgery 7/22/13, this thread has been VERY insightful as well as helpful. Thank you all for your postings, it's valuable information for my new eating lifestyle.

Fiddle...I'm in the camp that calories in vs. calories out is only half the story. It DOES matter what types of foods you eat, and I'm not just talking about sweets. There isn't much difference between a twinkie and mashed potatoes once you eat them. The insulin response is still the same. And in some people it's vastly different than others. If you're insulin resistant, eating high GI foods will increase the insulin response which among other things, prohibits fat burning and encourages fat storage. So 100 calories of potato has a totally different effect than 100 calories of turkey on weight and body composition. And the more insulin resistant you are, the more profound the difference.

Additionally, I have a healthy skepticism about TDEE calculators. Most of them do not consider the fact that a person may have lost 100 pounds or more which does have a profound affect on metabolism. Unless you are a heavy exerciser...especially resistance training, it can change the caloric requirements drastically.

Then there is the whole theory of setpoints. Whether you believe in those or not...not sure I do....but the body may indeed be looking for a point of homeostasis and fight to get there. And that point may be a few pounds above where you want it to be. And let's face it, everyone here has a body that likes to hold onto weight...otherwise we wouldn't be here right?

Alright...end of thread hijack.

Really great points BTB! You always have such great insight! I especially agree with not all calories are equal and our bodies respond differently to different fuels.

And I also want to add, and maybe not all will agree, but if you notice a lot of the people struggling with weight gain, or gain weight easily are women. It is true and it is just plain crappy. It is harder for us to lose weight and easier for us to gain weight. And our hormones have a role as well. Not only as we age, but from month to month. Hormonal cravings are very real and not just a "sweet tooth", and bloating and Water retention are common in almost all of us.

I can gain weight very easily, within a week if I do not watch what I am eating. That being said, could I always gain so easily. Probably, but I just never paid as close attention and just quit weighing in the past if I started gaining (I actually did not even own a scale for a long time).

And like Puja said, it is too easy to gain weight, and it is very scary. But it is reality.

And Puja, you are beautiful, you really need an after gallery at least!! Congratulations!

Really great points BTB! You always have such great insight! I especially agree with not all calories are equal and our bodies respond differently to different fuels.

And I also want to add' date=' and maybe not all will agree, but if you notice a lot of the people struggling with weight gain, or gain weight easily are women. It is true and it is just plain crappy. It is harder for us to lose weight and easier for us to gain weight. And our hormones have a role as well. Not only as we age, but from month to month. Hormonal cravings are very real and not just a "sweet tooth", and bloating and Water retention are common in almost all of us.

I can gain weight very easily, within a week if I do not watch what I am eating. That being said, could I always gain so easily. Probably, but I just never paid as close attention and just quit weighing in the past if I started gaining (I actually did not even own a scale for a long time).

And like Puja said, it is too easy to gain weight, and it is very scary. But it is reality.

And Puja, you are beautiful, you really need an after gallery at least!! Congratulations![/quote']

As a man who is married to a perimenopausal woman, I agree....it's ALL about the hormones. Oh Gawd the hormones. I have seen my wife do everything under the sun from a sensible diet, Atkins, extreme fasting, running marathons....the scale simply won't move for her.

.

And Puja' date=' you are beautiful, you really need an after gallery at least!! Congratulations![/quote']

Oh....and definitely agree with this.

I have found this topic to be fascinating. I am only 18 months out but already recognize many of the maintenance challenges. I feel like the line between maintaining and gaining is a very very fine one. Like it doesn't take much...

My doc made a comment that he heard from a maintenance patient - that "Fat people will always be my tribe". The meaning is that we have the disease of obesity and losing weight just means we currently have good control of our symptoms. Never ever forget that for most of us, the body is just pulling to become obese again. I think this is especially true of women who are post menopausal, but in truth it applies to probably everybody on this forum to some degree.

What gets me is I have a girl friend who weighs about the same as me, she is about my height. I am way more active and she eats at least 50% more, but i think actually more then that as she tends to meter her eating around me. I spend alot of time with her on weekends and she has told me her weekday eating routine (daily hot mocha, daily pastries in addition to "meals") I watch carbs, she does not. We are both maintaining our weights... The differences besides our genetic makeup, she is a few years younger and not in menopause and she has never been morbidly obese.

I am not sure I believe in "calorie math" at all. In otherwords, there is something genetic, something efficient about some of our systems that we just glean more nutrition from food or we seriously just don't need as much as "normal". It is the "famine gene" or something like that because it simply defies logic otherwise.

I am not sure I believe in "calorie math" at all. In otherwords' date=' there is something genetic, something efficient about some of our systems that we just glean more nutrition from food or we seriously just don't need as much as "normal". It is the "famine gene" or something like that because it simply defies logic otherwise.[/quote']

Totally agree. I tend to think insulin is a major player in this but there are so many other hormones at work here. It has to be joint effort. If calorie math was the same for everyone, we could all just drink diet cokes and be skinny.

I am not sure I believe in "calorie math" at all. In otherwords, there is something genetic, something efficient about some of our systems that we just glean more nutrition from food or we seriously just don't need as much as "normal". It is the "famine gene" or something like that because it simply defies logic otherwise.

I also agree. I really do think genetics have a large roll. Many of us come from families that also struggle with weight, even if they eat healthy. I have an uncle that the second he stops being super diligent, he starts gaining weight.

And I was always one that (in my humble opinion) had to work harder than many to just lose the weight. Before I had my son, I was trying to lose because I knew it was healthier for pregnancy. I worked out 1-2 hrs 5-6 days a week and restricted my calories. Sure, I lost, but slowly, taking me 2 years to lose 70 lbs and I actually became exhausted and had to cut back. Then I read stories of some people (not all, obviously) just starting to walk around the block and losing weight easily. There are truly people out there that eat what they want and never gain, and I honestly think they are just genetically blessed!