RickM

I can't speak from personal experience as my levels hover at the top, or just over the top, of the normal range, but B12 is a component in the making of red blood cells, so a deficiency tends to show up as anemia to one degree or another. It is also a regulating element for homocysteine levels which has cardiovascular implications but no immediately noticeable symptoms. But if you're feeling lethargic, B12 is one of the things to check (along with iron, protein and carb levels.)

While some people do go thru extended stalls, it sounds like you may have gone into an early maintenance mode between your lowered activity levels and whatever dietary changes that may have snuck in during your recovery from the hernia surgery. I had already been at goal for a few months when I had shoulder surgery last year, and I lowered my intake in anticipation of lowered activity levels during recovery (from around 2000 calories to about 1600, so a 20% drop) and then let it creep back up again as my activity levels rose from physical therapy back toward more routine workouts. I am starting to do the same thing again now, with a bit more of a Protein boost, ahead of a hernia repair and TT surgery next week. Depending upon what your intake levels are and have been, you can try cutting things back a bit, or increasing it a bit as feedyoureye suggests. Whenever there is a major change in workout or activity levels there is the opportunity for changes in hydration and Water retention, so make sure that your water intake is appropriate, or even on the high side (better to be peeing excess out than having the body go into hoard mode because the intake is too low.) Changing dietary composition can sometimes do the trick - adding a bit more protein, and sticking to the protein first rule, can give you the extra protein that your workouts may need while providing good sataity and the opportunity to cut calories a bit, or adding some complex carb before workouts can improve endurance and calorie burn. There are a lot of different variations that can be played with to find the one that your system is looking for. Good luck and keep up the good work - progress is already looking good!

The low sodium V8 is the best potassium supplement that I have found (and we tend to be real short on it since it isn't supplemented well without prescription.) It's not a replacement of eating your veggies, but it's a good supplement to them and helps to get more in than we otherwise would be getting with our limited intake.

It is likely ketosis which is a result of your diet being short of carbs; it will clear up as your diet broadens, or if one is intent on doing one of the low carb diets, when you get closer to maintenance and start widening your diet. Some take it as a good sign that "you are burning fat" (which is true - sorta; it is also a sign that you are not eating your vergetables!) but it is not essential to burning fat or losing weight.

Mine started in the hospital with things like scrambled eggs and yogurt. As to what can be tolerated is a very individual thing, beyond whatever the surgeon wants you to try and when. I had no problems with anything that I tried and progressed fairly quickly, trying new things a little at a time, getting progressively thicker, chunkier and less soft. Others have a problem progressing very rapidly and that's OK - there's a wide variation between what we as individuals can tolerate and when. When my wife went through this a few years ago, she had more problems with various food tolerances, and that's just the way she is - the doc had no worries about either of us, but just somewhat different responses within normal experience.

It is abnormal if you don't hit an occasional stall - the third week is a typical time for such things and then more randomly thereafter. I am one of the abnormal ones who only had one week during my entire loss period when I didn't show a loss; even a bit of gain here and there would not be abnormal - there are lots of things that can cause a bit of temporary water retention - hormones, variations in dietary sodium, medication changes, changes in diet or exercise/activity routines, phases of the moon (jk)....

I had some oatmeal at the hotel the day after I got out of the hospital (it's on my doc's early plan) and had a few pieces of popcorn here and there when my wife made some - no problems on either. Bread will allegedly swell up but I have had no problems with it. Carbonated drinks may not set well due to the expanding gases they let off. That said, people have widely differing tolerances for different things, so the best thing to do is to test new things one at a time in small quantities to see how they work for you.

You can use some SF jam (or even non-SF for the small amounts used) to flavor the plain greek yogurt. I typically make a blend of plain yogurt, naturally sweetened vanilla yogurt (about a 3-1 ratio now), vanilla extract and a little SF sweetener to taste - small calorie increase over plain yogurt without the aftertaste problems of the SF sweeteners (particularly in the commercial SF flavored yogurts that go for overkill in the sweetness department.)

Absolutely run this by your surgeon. The big problem is the conflict between minimizing our calories (and with it the nutrition that we need, but can do without for a while,) in order to lose the weight that we need to lose, and properly feeding the little one growing inside (assuming that you can feed yourself enough to feed both at this early stage.) Pregnancies do happen during the loss phase (usually with those who were having fertility problems pre-op and weren't doing anything on the contraception front,) and the best case scenario is that their weight loss gets screwed up in order to ensure a healthy delivery. By all means, continue practicing for the main event (and the practicing just gets more fun as you go along!) but do take precautions to avoid premature joy.

I think that you are just fine as you aren't feeling any ill effects. Surgeons' progression rates on their programs vary all over the place - mine had me on mushes, purees, soft Proteins (cheeses, tuna, etc) yogurts and the like from the hospital on out. It seems that the sleeve is a lot more robust than many give it credit for (hence a lot of the worry-tales about bursting your sleeve, etc.) Most of these stories come from RNY experience, as that pouch is a more delicate structure than the sleeved stomach, even early out. From what I have seen, those docs who have been doing sleeves for a long time tend to be more aggressive in their progression rates than those who are just getting into the sleeve business from the RNY (the DS uses the sleeve as its basis, so DS qualified docs can have been doing sleeves for 20+ years, so there is a pretty good experience base in that community that doesn't exist in the bypass/band community,) Since most hospitals have been doing primarily RNYs for many years, their programs and staff are largely programmed around its requirements as opposed to the sleeve or DS. So, unless you are feeling anything wrong going on, relax and enjoy the ride; keep with your doc's program to the extent that circumstances allow. If you need to deviate, you can always puree something, or chop or chew it extensively (I never pureed anything, other than Protein shakes; even the chunkier soups just got the chunks fork-mashed.) The general rule is to try new things in small amounts, one at a time, to test for tolerance - people progress at widely varying rates even within different surgeons' programs.

Yeah, that no Water or salt thing can be dangerous - it might be something that will boost some numbers in casual exercisers temporarily instead of doing the work that they should be doing - check with a qualified MD, or at least a fitness RD, to verify what some "fitness experts" (for which there are no qualifications) say. The most common reason for that the occasional person dropping dead during a marathon is from extreme electrolyte imbalance from not enough salt intake to counter their loss from sweating. I will continue to drink during workouts (and before and after.)

You probably don't want to be working out that hard after only three weeks, but ease back into things. At that level, you probably won't have any great nutritional demands for the workout until you get back into the swing of things over the following few weeks. To the OP, I usually have a late Protein snack of greek yogurt or protein loaded pudding - it has a good protein load but is easy to digest so works well for a late snack (at least for me, as I finish my protein pudding at 10pm.)

I haven't had any vomiting events in the 20+ months that I have had my sleeve, but some do if they eat too fast or over eat. But, as I understand it from those who have revised from a band, it isn't like the band (or an RNY pouch) in that our sleeve uses our natural pyloric valve to control the flow of food through the stomach rather than a pouch with a small orifice at the bottom - the pyloris is a lot smarter than a hole in the bottom of a pouch, but you do have to learn how yours works as you heal to avoid any problems.

I was having some (creamy, not crunchy) the first week as it is an easily digested soft protein, so it should work well for whenever your doc permits soft proteins (and arguably purees.) I dropped if fairly soon thereafter in favor of denser proteins as I could tolerate them due to its high caloric content and didn't have it much until maintenance.

Quest bars work well for travelling - their protein density is as good as anything out there (20 g in 160-200 calories depending upon variety,) most of their carbs are fiber which we need and they use little of no sugar alcohols which many people are sensitive to. And, they travel well as they aren't frosted or coated so they don't care if they get heated/cooled or squashed, in fact many people will microwave them for a few seconds to warm them a bit. They are available online (http://www.questproteinbar.com/) which doesn't help you at the moment, but are also commonly available from GNC and Vitamin Shoppe (they do have a locator for local suppliers on their website.)

None of the procedures really "cures" the diabetes, but they can knock it into remission; if you regain the weight, there is a good chance that the diabetes will follow it. When my wife and I started looking at WLS almost ten years ago, it was thought that the intestinal rerouting done in the RNY and DS was responsible for the metabolic changes that drove the diabetes into remission; since then, as the sleeve has become more popular as a stand alone procedure, it has been found that it, too, has a metabolic influence on diabetes and many leave the hospital without need of meds or insulin, so it isn't strictly a function of the weightloss as previously thought, and the remission rate for the sleeve is similar to that of the RNY, typically in the 80-85% range. If treating diabetes is ones' primary concern, then one should look seriously at the DS as well as that procedure has a diabetes remission rate of around 98%. This should not come as a surprise as the DS started as an intestinal rerouting procedure targeting diabetes to which the sleeve was added to make it a weight loss procedure as well. The DS is a longer and more technically challenging procedure for the surgeon which is why many don't offer it (but those that do tend to be from the top of the class, so those are guys who are well worth investigating no matter which procedure one chooses.) It will also usually be the more expensive procedure, but its also the most powerful in terms of weight loss and regain resistance. I was talking to a woman at our support group a few months ago who had an RNY 25 years ago and by all measures has been very successful with it, maintaining her normal weight range - up until just a few years ago when some of life's stresses brought back some of her long lose weight (not the 100+% regain we sometimes read of, but maybe 50-60%) and with it her long lost diabetes. Her weight is not overly excessive (at least these days in the western world!) but it is the diabetes that has her concerned, so she is pursuing a revision to the DS to knock it out. Deciding on what WLS procedure to pursue is not easy - for me starting as a relative lightweight with around 100lb to lose and reasonable dietary discipline developed over these past few years of working to avoid WLS (but no diabetes,) the VSG was the choice for me; for my wife with her diabetes and 200+ to lose, the DS was the better choice, and she still maintains after eight years that she could not have been successful with just the VSG (or the RNY.) A great presentation on the different characters of WLS procedures is here - http://www.obesityhelp.com/forums/amos/4416773/quotDoes-the-Patient-Fail-the-Procedure-or-Does-the/action,replies/topic_id,4416773/page,1/ I fully understand the cost concerns, and the interest in only going through this once. We self paid for my wife's DS and it was definitely the way to go for us. Some at a similar starting point can get by with the RNY or VSG, but it takes a somewhat different character to do so. In the close to ten years that I have been in this world (only the past 20 months or so on my VSG,) we have seen a few three time WLS patients - band revised to RNY revised to DS to get what they needed, so it is well worth the time to research the heck out of this to get the best fit for your needs. One final bit of perspective on my VSG and why the RNY was never a serious consideration for us (beyond the basic differences that are usually brought out in threads about the RNY vs. VSG like no NSAID use, possible dumping, and misc. nutritional issue after the RNY,) is that should the RNY fail us and needs revising to something else like the DS, that is a very complex revision for which only a very few surgeons (on the order of a half dozen in North America) are qualified to do, while the VSG is an integral part of the DS so a future revision is fairly straightforward should it be necessary. Good luck on something that is not an easy decision,

The 6-800 calories is a common level amongst those plans that provide specific numbers, and it's a good place to start. If you run on the high side (and 1000 is on the high side,) the risk is that you move into maintenance mode before you reach your goal. Your calorie burn will be declining some as you lose weight and don't have as much to carry around, so if your normal calorie burn that provided a stable weight before surgery was around 1500 calories (not an unusual number for women of lighter "should be" weight or build,) then you don't have much of a caloric deficit to drive your weight loss, and little room for the common calorie creep as you progress. I ran at about 1100 during my loss phase, but I have a guy's metabolism with fairly high lean mass and was stable at 26-2700 calories, and am now a fairly lean 185-190, so had a lot of room to play with. If your "should be" weight is in the 100-120 lb range, then you probably don't have a very high calorie burn and will need to stay on the low side of the calorie range to get all of the weight off; if you are a taller, larger build woman with a healthy weight of 150-160, then you have a bit more to play with (and be honest on your build assessment - we all are "big boned" to start with!)

Yep, it is most likely ketosis which just means that your diet is low on carbs. It will pass as you get more variety in your diet, or if you choose (or your doc instructs you) to continue being low carb then try the various masking techniques suggested. Some may take it as a badge of honor that just goes with the burning of fat, but the two do not need to go together - you can merrily go on burning fat without being so low in carbs that you become aromatic (it's mostly slick marketing on the part of the purveyors of low carb diets - take an objectionable side effect and make it a selling point, much like dumping is often sold as an advantage of the RNY.)

Here is a great article on what's happening - http://www.dsfacts.c...or-plateau.html You will note that she mentions that the depleted glycogen and the Water that keeps it soluble accounts for about ten pounds of body weight, so there is that much in play that your body is trying to restore, so a bit of gain is not unexpected. I routinely gain 3-4 lb when I travel for a week, which is primarily water retention from (presumably,) the higher sodium in restaurant food and my altered exercise and activity routine - there is no way that my caloric deficit has shifted the 10-14,000 calories to account for that being genuine weight gain (and it drops off a few days after resuming normal routines at home.) Glycogen and sodium influences are just two factors in our biochemistry that influence water retention that can create temporary scale weight stalls or minor increases. Stair step loss is usually the word of the day - some will lose more smoothly while others will be a 2-3 down, 1 up type of loser. Ensuring that your water consumption if in good standing, (the classic 64 oz per day, more if exercising or in hot, humid conditions) will counter-intuitively help relieve such water retention as the body tends to hold on to water more aggressively when it is in short supply. These early stalls do tend to break themselves since it's hard to get the calories high enough to stop the genuine weight loss. Later on, the main thing to watch for is that your calories haven't crept up to the point that you are putting yourself into maintenance before intended. There are all kinds of advice on how to break stalls and I don't know if any of them have any real validity (it's tough to measure the effect of a change when it takes some time to recognize that you are in a stall, take some action in response and allow some time for it to take effect - how much of the break was your response to the stall and how much was your body's normal response had you done nothing?) Lots of ideas are out there - ultra low carb, higher carbs, carb or calorie cycling, increasing or changing exercise routines, etc. From my experience (with a study sample of one!) I never really had any stalls (my definition being a week without loss,) and I maintained a moderately high carb intake (relative to the classic low carb under 40g rule) in the 70-100g range, and somewhat higher later on during loss when I selectively added a bit more complex carb to improve exercise endurance, Speculatively, I never let that glycogen level totally deplete and maintained a more constant fat burning rate - the hypothesis behind the Atkins/ketogenic diets is to keep the glycogen levels at a minimum so that it depletes and forces the body to burn more fat more quickly to make up for it. As I was also a relative lightweight (5'10" and 290 to start) I didn't feel the need speeding things up any more than what the VSG already does on its' own, and didn't want to get involved in the common side effects of those diets (I lost the 105 lb that I needed to lose in about seven months, and have been maintaining that for the past year.) A further note - once you do start losing again, your loss rate will be somewhat lower as the glycogen that you burn initially burns quite quickly, while the fat that you start burning after the glycogen depletes burns more slowly, but you will be doing what you are here to do - burn fat! Good luck!

It's one of those 'it depends on how you use it' things. The typical before entree salad at a restaurant gets in the way (I may have a few bites of my wifes salad these days, a year into maintenance,) but as an entree itself with some meat added in, it can be a very satisfying way to get in some additional nutrition without many added calories. This works well once you have the protein consumption down well (I was told to start adding veg by day 10 since my protein intake was doing well, and was starting to play with salads by the end of the first month - YMMV.) I typically use chopped spinach instead of lettuce for its somewhat better nutritional profile, and add in whatever salad veg I have around - peppers, grape tomato, avo, green onion, snow peas, carrot. It's maybe 10g of each, but keeps your feet on the ground of a healthy diet that can be built on later. To me, the salad veg tends to be a bit of a slider (the good kind of slider that's high nutrition and low calorie!) where my capacity for meat by itself may be about 3 oz, if I cut that back to around 2 oz, I can add around another 3 oz or so of salad veg to it for a satisfying meal without being overly full.

It most certainly does - my wife lost around 200lb from her WLS several years ago and that made a substantial difference (not least of which was the joy of being able to get my arms and legs around her!) and now with the deletion of my fatpad as well, we have hit bottom. Ah, the trials of life!

My wife and I are in much the same boat with bottoming out. It is something that we continue to experiment with to find the right positioning to tickle both of us without the problem (just gotta keep doin that homework!) I hear you on the visibility aspect, as the common "enhancement" procedures only really improve the locker room image, but this really does improve the functional aspect of it too.

The various issues are as follows - Initial healing of the sleeve - a few weeks or months. Empty calories - avoid throughout weight loss period. Liver health - our livers are typically in bad shape to begin with from being obese (hence the "liver shrinking" pre-op diet that some surgeons impose,) and the liver is further taxed during rapid weight loss by its role in metabolizing all that fat that we are losing, so it doesn't need any more stress from alcohol (my doc is also a liver transplant specialist, so he's a bit anal on this point!) - no alcohol throughout the weight loss period. Transfer addiction - many/most who are obese can be considered to be food addicted (as can many "normal" weight people,) so when the focus of the addiction (food) is removed it is very easy for that addiction to move to something else - alcohol, gambling, shopping, etc. - avoid alcohol forever. These are the major issues regarding alcohol and the sleeve - different docs will emphasize some or all of these issues in their recommendations. We are all adults here, so you can make your own decisions in following or exceeding your surgeon's guidelines.

At Chipotle I usually get the standard three soft taco meal, have one taco for the current meal (sans tortilla early on, but usually have the corn tortilla now in maintenance,) and then have two more for future meals. I usually get them with whatever meat I feel like, brown rice and black beans, veg, cheese, salsa and guac.

What you need for maintenance is what you need for maintenace, which is quite individual (probably more so than for the loss phase,) The calculators on MFP and other such sites are pretty general and are optimized for semi-:"normal" people, while there is good evidence that overweight and formerly overweight people tend to run lower metabolic rates than the quoted rates, sometimes substantially so. If you are still losing at 1200 per day, then 2000 is a good guess as to what you might maintain on, but I wouldn't depend upon it - you basically have to increase your intake to the point where you are no longer losing, but not gaining either. For me, that is around 2000, but I was losing fairly rapidly on 1100-1200 (down about 105 lb to goal in about seven months) and my old fat self was stable in the 2600-2700 calorie range. I also have the advantage of a guy's metabolism (which tends to run a bit higher than women's) and a fairly high lean body mass, which is a major factor in establishing one's resting metabolic rate (and why most successful weight loss programs emphasize strength training as a major part of the exercise portion of the program as that helps to maintain lean mass while burning fat.) As long as you are trying to lose, try to keep that caloric deficit as high as tolerable and when you get to your goal start increasing intake to the point where things are stable. If you are struggling to still lose at 1200, then your maintenance intake may be 1200-1500 range.