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Hi all -

I had my sleeve done on Thursday afternoon and came home yesterday (fri). I had expected a huge problem from the gas used in surgery as I had a hysterectomy (close to that same procedure for both) and that is what I got, a huge problem. I hardly noticed any pain in my abdomen from the surgery because of the severity of the gas-related pain in my shoulder and back. But feel like the Charco tabs worked far better than gas-x (and my husband lightly whacking my back with cupped hands (what they do for CF but not that hard). This morning most of that is better.

1. I know most all the basics, but some of the details on shaky as I put it all in play! For example: In the liquid stage is there 30 minutes between each drinks (the rules deal with food and liquid that I have seen ca. 2 liquids or 2 actual food items).

2. my surgeon/nutritionist say I can drink up to the point of eating, but I need to wait 30 minutes after eating to drink. The nutritionist for Bariatrics at the hospital, however, said I was better off waiting 30 minutes So I am going with the latter for now. But still, whether due to remaining gas or to reflux or whatever, it feels uncomfortable to eat and drink no matter how small the bites.


3. Another timing issue has happened twice - I started this morning with a Protein Shake. But about 15m waiting 30 minutes for a food item, I realized that I need to take some meds. I needed some sips to take the pills. Do those few sips mean I begin the counter again? In other words, I am curious about the experience of others on this topic and how you interpreted this (more conservative) rule.

4. In the last hour it feels as if my stomach is growling, as with actual hunger. We will continue to have hunger, but with the increase in acid and gas it much harder to interpret these sensations and feelings.

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I can't do the 30 minute timing right now. I'm eating and drinking all day long. I can't drink a whole shake at one time. I'm 9 days out. Maybe when I start eating more solid food I can do the timing.

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33 minutes ago, It's time. said:

I can't do the 30 minute timing right now. I'm eating and drinking all day long. I can't drink a whole shake at one time. I'm 9 days out. Maybe when I start eating more solid food I can do the timing.

It is hard to think about it all constantly. I gave gerd and for now can’t tell if the discomfort at times is due to acid, that horrible surgical gas, or the pouch as too much. I made it to 64g today at least, but there is so much that the information doesn’t and can’t say when it comes to an individual patient. Oh well, we will figure it all out! I wish you lots of good things on your journey!

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Personally, I drink up until eating (although not too much - maybe 1/4-1/2 cup max in the 10 minutes before). I also don't stress much about a few sips with meals. A lot of the Vitamins suggest to take them with meals to increase absorption, so I do that. (Also, sometimes my mouth just gets really dry when eating, so I eat an ice cube or something.)

The no liquid with eating rule is to avoid washing the food out of your stomach. You want your stomach to feel full for an hour or two after eating - that's what helps reset your body's weight set point. (I read on here once someone saying that she feels like its Thanksgiving after every meal - me too. 🤣) Drinking before your meal isn't going to wash the food away. A sip with your Vitamin isn't going to wash the food away either.

It's going to feel uncomfortable to eat and drink for a while, which makes it hard for you to sort out what it means to be full or feel hungry now. Even though you may be feeling the gas pain more at the moment, keep in mind there is a ~12 inch incision on your stomach - much bigger than the ones you can see on your skin. It's swollen in there. But that's going to get much better over the next month or so, and you can start really working out what works for you and your new stomach.

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16 minutes ago, rjan said:

Personally, I drink up until eating (although not too much - maybe 1/4-1/2 cup max in the 10 minutes before). I also don't stress much about a few sips with meals. A lot of the Vitamins suggest to take them with meals to increase absorption, so I do that. (Also, sometimes my mouth just gets really dry when eating, so I eat an ice cube or something.)

The no liquid with eating rule is to avoid washing the food out of your stomach. You want your stomach to feel full for an hour or two after eating - that's what helps reset your body's weight set point. (I read on here once someone saying that she feels like its Thanksgiving after every meal - me too. 🤣) Drinking before your meal isn't going to wash the food away. A sip with your Vitamin isn't going to wash the food away either.

It's going to feel uncomfortable to eat and drink for a while, which makes it hard for you to sort out what it means to be full or feel hungry now. Even though you may be feeling the gas pain more at the moment, keep in mind there is a ~12 inch incision on your stomach - much bigger than the ones you can see on your skin. It's swollen in there. But that's going to get much better over the next month or so, and you can start really working out what works for you and your new stomach.

Was just bemoaning how hard it is in reality to find the distinctions among the gas, GERD, and too much or too little in the remaining stomach. I am a good observer, but this feels almost impossible. My surgeon allows the drink until “meals” also, but the dietician over the hospital’s Bariatric service said it would feel better to wait before as well. Which is why it would be nice to be able to tell what each feeling might be, to help decide. Oy!

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I’m sorry you’re experiencing such terrible gas pain.

A big part of the not drinking before eating is to allow your tummy to fully empty before you start to eat. And the reverse after you eat. Remember your tummy is very small now & can only hold a small amount of food or drink.

As you just had your surgery you should be on liquids only (surgeons differ on for how long). These liquids (broths, shakes, etc.) all count to your Fluid intake for the day. So at this stage there is no real difference between ‘eating’ & drinking. I added more Water (about 1/2 cup more) to my shakes to make them thinner & easier to consume and I would take hours to finish one just slowly sipping. I would swallow my meds with the diluted shake.

The waiting before eating & drinking kicks in once you begin eating ‘real’ food from the purée stage. Even at 13 months out this is still true for me. As is being unable to drink more than a mouthful of liquid at a time. If I drink close to when I eat or drink a little when I eat, I can’t eat much because I feel full & I don’t get my nutrients in. Plus I gurgle something terribly.

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Posted (edited)

My program is no fluids 10 minutes before meals and 30 minutes after and I can definitely tell if I drink too soon. It hurts and backs up on me. However, during the liquid stage I didn't have "meals" per se but fluid goals to meet, so I drank whatever went down that got me to my goals. Within 6 hours of surgery I could drink 1 ounce of Protein Fluid and 1 ounce of Water, at the same time, every 15 minutes. I always took my meds with protein fluids to "coat" my stomach.

Now in purees (started 2 weeks out), I follow 3 meals and 2 Snacks with water all day between. Protein Shake for Breakfast and a lot of cottage cheese, greek yogurt, hummus, eggs, and pureed meats and pureed steamed veggies. I can eat way more volume than predicted in a sitting, though, and can drink 20 ounces of water in 45 minutes. I drink 70 to 90 ounces of water a day and get around 80 grams of protein.

I have atypical GERD where it only flares with my asthma, but also mild gastritis so I'm on omeprazole for 3 months. I feel "hungry" a lot but often find that I am actually thirsty (or its head hunger and habit/boredom). I also bought some antacid chews and find 1-2 of those a day really cut down on the sharp feeling in my stomach.

My doc says that the hunger and larger volume per meal will steadily decrease the more I move away from puree to soft to regular as solid food is more filling per volume. I've had a breakfast shake for years, so I will keep that to help with my protein goal but really hope to stop wanting to eat because I feel hungry soon. Plus it will be easier to make fewer separate meals when cooking for the family.

Edited by Cia2020

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4 hours ago, AlwaysCruising said:

Was just bemoaning how hard it is in reality to find the distinctions among the gas, GERD, and too much or too little in the remaining stomach. I am a good observer, but this feels almost impossible. My surgeon allows the drink until “meals” also, but the dietician over the hospital’s Bariatric service said it would feel better to wait before as well. Which is why it would be nice to be able to tell what each feeling might be, to help decide. Oy!

I had that as well after surgery. I'm just over three weeks out now and all those pains are gone. But for the first week + I just felt uncomfortable and really didn't know what specifically it was. I think if you're still feeling pain or discomfort after two weeks then it could be reflux. Hopefully you'll just be comfortable and all that discomfort with go away.

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5 hours ago, rjan said:

The no liquid with eating rule is to avoid washing the food out of your stomach. You want your stomach to feel full for an hour or two after eating - that's what helps reset your body's weight set point. (

That is so helpful. I had no idea. Knowing the why of a rule is incredibly helpful for me. Thanks!

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No drinking 30 minutes before or during meal has specifically been explained that liquid will delay the feeling of satiety or fullness. Then you will consume more food/liquid than your stomach can handle and discomfort will happen. I take my meds/pills with my Protein Shake so no need for additional liquid needed. Drinking liquids within 30 minutes after meal usually is on top of an already full stomach once eating other than liquid food. I did that once and immediately experienced felt nauseous and vomited with immediate relief of nausea and discomfort. And I didn't vomit all contents of stomach but just the liquid I just drank.

Sent from my SM-T580 using BariatricPal mobile app

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Posted (edited)

Hello all 🙂

I was familiar with the why’s (and physicians differ in their explanations as well). But it isn’t great to keep getting such varied advice from my own treatment team.

Only so I communicate clearly, it was not a lack of knowledge of my part that led to the questions (I’ve been doing pre-surgical evals for more than 20 year), but rather a struggle with the different rules and the various pains are not easily labeled ☹️ I knew someone else must have experienced the same. I wish IQ and knowledge would help all of us in this situation, but some of this defies logic for sure!

good luck to all of you! FYI - I’m typing this from my iPad in bed right now, so please excuse typos or iOS aided (mis)spellings!

Edited by AlwaysCruising

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Posted (edited)

Like Arabesque said, you should still be on liquids only at this stage no matter your program, so hopefully you’re not eating purees or solid food yet. Every program is different, but my program for example, required clear fluids for 3 days, followed by full fluids for 4 weeks. I skipped the next stage (2 weeks of purees) and continued with full fluids during this time (with approval from my team) because pureed foods were aesthetically unpalatable to me.

Unlike some people who never felt a sensation of fullness on fluids only, I did, so literally had to take an extremely tiny sip every few minutes to get in the required amount of Protein and fluids. During the 6 weeks of fluids, this was literally a full-time job: it took 12 to 14 hours per day, and sometimes 16. It's hard going, but you'll get through it.

Currently, I wait 20-30 minutes after drinking fluids to eat, and at least 45 minutes after a meal. I'm committed to doing this for the rest of my life. It's an easy to do, and is one of several evidence-based actions (based on the long-term outcomes of hundreds of thousands of bariatric patients) that leads to long-term success. Dr. Walter Medlin, a bariatric surgeon at the Bariatric Medicine Institute in Salt Lake City, and a sleever himself, continues to wait 45 minutes after eating, almost 15-odd years after his own surgery.

There are three reasons for this: 1) in the first year, not washing nutrients out of your small pouch, 2) maintaining satiety for as long as possible after eating as you get further out from surgery, as over65 pointed out, and 3) minimizing or preventing GERD by regulating the pyloric sphincter.

Edited by PollyEster
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Food and liquid timing, pyloric sphincter function, and how it pertains to VSG function and GERD:

The pyloric sphincter (PS) is located at the bottom of your stomach/sleeve, and connects the sleeve and duodenum. When open, this valve is roughly the diameter of a dime. When closed, it’s roughly the diameter of the tip of a ballpoint pen. In terms of VSG function, dense Proteins and foods that take longer to digest (i.e. fibrous foods) cause the PS to close and hold food in the stomach for pre-digestion, allowing acids begin to break down these foods. This is why we’re instructed to eat Protein first: to close the PS so that food stays in the sleeve longer, providing a sense of satiety. It takes ca. 30-60 minutes for food to clear the PS. This is also why we’re instructed not to drink liquids for 30-60 minutes after eating. Incidentally, "slider" foods do not close the PS: instead, these foods "slide" directly through the open PS into the duodenum.

In terms of GERD, after you consume a protein-dense meal, the PS closes, holding the contents of the meal in the sleeve for pre-digestion. If you drink liquids within 30-60 minutes after a meal, the liquid has nowhere to go but up, where it hits the lower esophageal sphincter (LES), and above that, a flapper valve. The function of both of these valves is to prevent food, bile, and acids in the stomach from backing up into the esophagus. This is an exceptionally high pressure system, and is the reason why it hurts when you eat to much or too fast, or drink too soon, after eating when the PS is still closed. Vomiting and/or foamies is the only available pressure release. Even in a full-size stomach, the addition of liquids to food speeds gastric emptying by roughly 15%-20%, and some studies indicate that the transit time is anywhere between 25%-35% after VSG.

*It’s also interesting to note that after VSG, simple carbs passing through the PS are less liquified due to fewer digestive enzymes being available than with a complete stomach, which is also what causes dumping and reactive hypoglycemia. These unhealthy simple sugars pass directly through the pylorus, causing pancreatic enzymes to flood the bowels in order to be able to digest them. The pancreas then reacts by “dumping” large amounts of insulin into the common bile duct, causing a massive reduction in sugar absorption and feelings of weakness and other diabetic symptoms. It’s very similar to dumping syndrome in RNY patients.

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