I had VSG surgery on August 18, 2014 -- one year and two weeks ago. Today I met with my bariatric P.A. for my one-year post-op review. She's extremely sharp and keeps up to date on bariatric surgery post-treatments, nutrition, behavioral issues and emerging news. She attends bariatric conferences often and reads all the new studies.

She was the one who encouraged me at four months post-op to move from 800 calories/day to 1,000 calories by Month Six and to 1,200 calories by Month Eight. She said that would help me to prevent my metabolism from accustoming itself to the very low calorie post-op menus we are restricted to with tiny, swollen stomachs.

Apparently, it worked: I am maintaining a 143 pound weight and eating 1,700 calories a day.

I've had an exceptional Year One. I've reached my weight loss goal and am 7 pounds lower than that. I feel great. My blood panel test results are 100% great. No shortages at all. In my opinion I've done everything right. I eat 3 meals and 2 Snacks. I don't graze. I eat nutritious food. Most days my Protein grams hit or exceed 100. I typically eat 5 healthy vegetables and fruits each day and eat at least 21 grams of Fiber (the daily requirement for women). My muscle mass is exceptional for my age (I'm almost 70). I no longer need knee replacement surgery. I walk most days, do yoga and strength training.

So today what I really wanted to know and what I asked her were these questions, along with her answers:

1. What should I expect during Year Two?

You've done really well with weight loss surgery. You've already been maintaining your weight for the last 4 months. In Year Two you can expect more of the very same challenges you've already been dealing with since you reached goal -- planning and eating nutritious meals, focusing on regular exercise, not overeating, and staying focused and motivated. It's important to stay connected to us if you have any questions or changes in how you feel or your health. Staying connected to us is one of the best things you can do. All the research shows that you're much more likely to be successful long-term if you don't "fade" away and try to deal with all the challenges you're having by yourself.

(That made me feel pretty good. )

2. During Year Two, will my body start to produce and release more ghrelin and will my pre-op hunger levels return?

No, the ghrelin doesn't come back. Yes, I know that myth is out there and considered to be true. But it's not true. Yes, you may experience "head hunger" or boredom that could lead you to start eating food full of empty calories that don't help you achieve satiety. And eating those empty "slider" calories will make you want more of them. That's the same "head hunger" challenge you've always had to contend with. Again, no, the ghrelin doesn't "grow back."

(Needless to say, her predictions about ghrelin not coming back just thrilled the hell out of me!)

3. Will my metabolism lower for any reasons, requiring me to eat less?

Not unless you stop exercising or your muscle mass goes down significantly. Also, you're already eating "good" foods, not high-sugar, high-carb foods. The nutritious foods you're eating (protein, veggies, fibrous fruits, whole grain foods) require your body to work harder to digest them. A diet high in slider foods (chips, Cookies, candy, ice cream, sugary drinks) wouldn't make those digestive and metabolic demands of your body. Just keep doing what you're doing now, and your metabolism should remain the same.

(Whew!)

I know that only time will tell how I do. But I now feel like I have a very good chance of keeping my weight down and remaining slim and healthy going forward. BTW, she told me about patients of hers who are 5 and 6 years out who are as slim now as they were when they first reached their weight goals.

So take that, b*****s!

:)

@@VSGAnn2014 - so psyched to hear that you can maintain 143 lbs at 1700 calories a day. That is AMAZING! I'm sure that those stats are not typical but CONGRATULATIONS!!! What is your exercise program like?

I don't think it's that uncommon. I mean I know I hear people on the board say they can't maintain on more than 800/1000/1200 calories and I'm sure that's true for some. But I "wrecked" my metabolism plenty yo yo'ing most of my life and yeah I exercise a lot, but I maintain my 135lbs on 1800+ calories (more on days I run) and during my six weeks of no exercise post plastics I still ate 1600 calories or so and maintained fine.

I think those stats are as typical as the others. We are all different for sure, but I think there are many of us who can maintain at that calorie level.

I haven't collected any data about how much other WLS patients are maintaining are eating, calorie- and protein-grams-wise. Most of the people I know who are in maintenance don't (and refuse to) count calories or record their food macronutrients. Honestly, it's really pretty weird to see people so opposed to collecting information about their own behavior. But what the hey.

However, in support of your thesis, my bariatric PA doesn't seem shocked at all by my maintenance 1700 calories success. She seems to think it's pretty common.

@@VSGAnn2014

Loved your post! It makes so much sense that our bodies would get used to a set point, and if that set point is 1000 calories, eventually we could gain weight even on that.

Would you mind sharing what a typical day's meals look like? I'm just 23 days out and having a hard time visualizing how I'll ever be able to eat 100 grams of Protein, 5 servings of fruit and veggies, and 21 grams of Fiber. I'm struggling to get my 60-80 grams of protein (hitting it, but have to work hard at it) and I am WAY under on fiber. My only veggies right now are in V8. Which I can drink a 5.5 oz can of!!!

More worrisome, I can eat 5 ounces of mushies/puree no problem. And if my stomach is empty, I get nauseated. I'm finding I eat a small something every couple of hours just to keep from feeling nauseous and having a feeling that my tummy is gnawing itself away. As a result, I'm eating about 800 calories a day. I'm worried that's too much this early. I'm starting soft foods tomorrow (which my Nut distinguishes from pureed, although I'm not exactly sure that the difference is!)

Don't worry about any of that stuff at three weeks. I think you're doing fine for now. I certainly was not doing many veggies and fruits or fiber at that point. And 5 ounces of mushies is fine. No problem. But real, hard, dense food would probably be a challenge. Mostly, just do right now what your team is asking you to do. And no, 800 calories a day is not too much right now IMHO.

Just trust me when I say that a year out you'll be able to eat as much as I am. A typical day looks like this:

Breakfast - Protein shake (I still love GNC Lean 25 shakes)

Morning snack - Wasa crackers, cheddar cheese

lunch - turkey / cheese sandwich (on whole-grain bread); baby raw carrots

Afternoon snack - sliced apple, cheddar cheese

dinner - grilled salmon brushed with BBQ sauce, green Beans, brown rice, 4 ounces chardonnay

Dessert - blueberries and peach, Greek vanilla yogurt

(The above is just a simple, healthy way to eat, without spending all day cooking or meal-planning)

For now, just focus on eating as well as you can for the phase you're in. Dream about being slim and healthy. (I still dream about that, and then wake up and find I'm living the dream!)

told to knock it off with Protein drinks, get my protein from real food.

quick hi-jack

@@Miss Mac

haven't talked to my NUT in a llllllong time (she was never helpful)

i was wondering about Protein shakes

i usually do have one for breakfast

i love my swiss chocolate protein shake (25 gr of protein!!)

why are Proteins in food better???

i have heard to get protein from real food

don't understand why shakes are no longer good/recommended to drink for us VETS

thanx

kathy

@@VSGAnn2014 thanks so much for your thoughtful response. I'm trying so hard not to obsess, but I don't want to screw this up, and I read about people eating 500 calories a day. Even with this sleeve, I feel like I'd starve on that. I still do get hungry, although now a 1/4 cup of refried Beans fills me up.

That meal plan looks like a dream. I hope I will be able to eat apples and baby raw carrots -- but I'm not going to try for a while!

@@Thinside ... and everybody else ....

You guys DO understand (I hope) that my daily meal plan above is a MAINTENANCE meal plan, not a WEIGHT LOSS meal plan. That's what I eat more than a year post-op, after losing 92 pounds and exceeding my weight loss goal.

Just want to be clear about that. 'Kay?

@@jess9395

How many calories were you losing on?

I was very low calorie at first bc of restriction--didn't top 400-600 calories till maybe six months out. Methodically worked up to 900-1000 by then and up to 1200 by nine months. Started maintenance at just almost exactly 12 months out.

@@VSGAnn2014 - so psyched to hear that you can maintain 143 lbs at 1700 calories a day. That is AMAZING! I'm sure that those stats are not typical but CONGRATULATIONS!!! What is your exercise program like?

I don't think it's that uncommon. I mean I know I hear people on the board say they can't maintain on more than 800/1000/1200 calories and I'm sure that's true for some. But I "wrecked" my metabolism plenty yo yo'ing most of my life and yeah I exercise a lot, but I maintain my 135lbs on 1800+ calories (more on days I run) and during my six weeks of no exercise post plastics I still ate 1600 calories or so and maintained fine.

I think those stats are as typical as the others. We are all different for sure, but I think there are many of us who can maintain at that calorie level.

I haven't collected any data about how much other WLS patients are maintaining are eating, calorie- and protein-grams-wise. Most of the people I know who are in maintenance don't (and refuse to) count calories or record their food macronutrients. Honestly, it's really pretty weird to see people so opposed to collecting information about their own behavior. But what the hey.

However, in support of your thesis, my bariatric PA doesn't seem shocked at all by my maintenance 1700 calories success. She seems to think it's pretty common.

Honestly thesis is too strong a term LOL! It just seems to be the common thought on this board that we will never be able to eat more than 900-1200 calories even in maintenance and that isn't my experience with people I know in real life, so I was just trying to throw out there that the 1500-1800 maintenance people DO EXIST and aren't mythical unicorns LoL!

told to knock it off with Protein drinks, get my protein from real food.

quick hi-jack

@@Miss Mac

haven't talked to my NUT in a llllllong time (she was never helpful)

i was wondering about protein shakes

i usually do have one for breakfast

i love my swiss chocolate protein shake (25 gr of protein!!)

why are Proteins in food better???

i have heard to get protein from real food

don't understand why shakes are no longer good/recommended to drink for us VETS

thanx

kathy

Kathy I am right there with ya and have a hard time getting enough calories and protein in without my shake or two a day!

I think the idea is the same one behind eating clean, unprocessed foods--protein shakes are processed by definition and ideally we would all eat whole clean unprocessed foods. Plus getting protein from dense food can keep you full longer than drinking your calories IF that is an issue for you.

My medical professionals are fine with me continuing the shakes in maintenance and I do add frozen fruit or yogurt to them, it's part of my plan and it works for me and meets my nutritional needs well.

You can have rice I can't wait lol I was told rice is a no no..

@@Thinside ... and everybody else ....

You guys DO understand (I hope) that my daily meal plan above is a MAINTENANCE meal plan, not a WEIGHT LOSS meal plan. That's what I eat more than a year post-op, after losing 92 pounds and exceeding my weight loss goal.

Just want to be clear about that. 'Kay?

Oh yeah, totally understood that! Just dreaming… and of course worrying!

VSGAnn2014, first of all, congratulations on hitting your one-year surgiversary, and on getting there with flying colors! You are a model patient, and your doctor must love seeing and talking to you because you’re so successful and because she knows you’ll follow her advice!

Wow, thanks for much for all of this insight! You got a lot of good news, which you deserve. Great news about the continued low ghrelin levels. I’ve seen some varied information from different studies – some with good news and some with predictions that it might rise again – but your doctor should know best!

I’m not surprised, but I am glad, to hear that your metabolism should stay consistent. That makes sense, as long as your body and activity stay consistent.

So it sounds like now, “all” you need to worry about is the rest of your life. Welcome to maintenance! As I am sure you already know, the biggest thing (at least for me and many others) is staying motivated and focused when the scale isn’t going down all the time. But you can do it!

@@proudgrammy - There are some myths out there about too much Protein at one time hurts your kidneys and somehow a 25g shake is supposed to make that happen. But some myths die hard ...

SHOW OF HANDS how many people believe:

• drinking coffee dehydrates you,
• you have to wait 30 minutes to swim after eating,
• the "official" government food pyramid was not influenced by the wheat and dairy and other food industry lobbyists,
• Santa is real? (I mean despite die hard Utopians)

I prefer food, but with limited stomach space and occasionally limited time, shakes work well. And trying to get over 120g a day without it is almost impossible.

Edited August 29, 201510 yr by OKCPirate

myth -too much Protein at one time hurts your kidneys and somehow a 25g shake is supposed to make that happen.

@@OKCPirate

thanx for responding to my post

always heard that max protein at a sitting is 40 gr

i never heard/knew that too much protein can hurt your kidneys

its soooo frustrating, upsetting for me to "know what to do"/who to believe (not talking about you @@OKCPirate)

so many different opinions/advice

of course everyone says "THEIR" rules are right - don't listen to anyone else but me

Protein Shake 25 gr

i usually eat my chicken, fish, meats with plenty of protein

why or is it better to eat your protein, instead of drinking

i enjoy drinking my protein shake for Breakfast

not understanding why some NUTS etc say "that's" not good

i am in a "mood" now that is bothering me about all the different rules/answers/opinions written in articles/computer boards, links etc.

people, docs/NUT says their way or the highway

venting now

no smileys

gotta get away and have my Fage yogurt

kathy

OKC Pirate - it's generally true that consuming excess Protein won't harm healthy kidneys, but it can in fact, further impair damaged kidneys. Excess protein does force your kidneys to work harder and can cause problems for people with existing medical conditions.

Proudgrammy, my doctor believes to get your Protein from solid food instead of shakes because shakes won't keep you full for long since they are liquid. He thinks that if you drink them that you'll still eat solid food later to get full, thus consuming more calories than you need. I kinda understand that, but I still drink them on some days, especially if I do some strength training.

He also thinks it's some kind of dangerous precedent, drinking a liquid with calories. I just look at it that he deals with all sorts of people and comes up with rules 'for the masses' and puts them out there without worrying if people have any common sense about what they are doing... so sometimes I apply common sense (and other advice from this board - since he doesn't give protein gram requirements, either) and not necessarily the letter of his rules.