RickM

Mashed potatoes are commonly on the early mushie diet list (it was on my doc's first month list) as they are usally well tolerated and easy to digest. Some unflavored protein powder can be mixed into them to help with your protein levels, and as ashleyirene noted, they can be made or mixed with chicken (or beef) broth to moisten them as needed and alter their flavor. Don't worry about the carbs at this early point (or ever, if you are so inclined,) unless your doc is on the low carb bandwagon or you have found that program to be useful for you. While potatoes aren't something that is usually recommended during the prime weight loss period when you should be having more meats, cheeses, yogurts and other protein rich foods, they are a good source of potassium which we have a hard time getting enough for our needs.

I ran 80-100g per day of carbs thru the early part of my weight loss phase (I never wanted to give up the nutrition that went with those carbs,) increasing toward the 120g level after 3-4 months when I selectively added more complex carb to better fuel workouts. That never seemed to bother my loss rate (I really wouldn't have wanted to lose any faster, with goal reached in 7-8 months).

The duodenal switch uses a sleeved stomach along with rearranged intestines to provide malabsorption along with restriction, so the second part of the DS (the malabsorptive part) can be done as a second stage if the sleeve itself does not provide enough weight loss or if there are regain problems.

With the RNY they leave the remnant stomach behind, hanging around not doing much except causing the occasional trouble, but with the sleeve (or DS, which uses the sleeve) it's gone.

I used to have a protein shake before bed long term pre-op mainly under the premise that the protein was the most hunger satisfying and that was the most digestible protein for that time and would provide satiety all night long. In my post op days, I usually have a serving of protein loaded SF pudding (made partly with protein powder, partly with greek yogurt) to serve that purpose and I rarely wake up hungry, either in the middle of the night or the next morning. Same concept, different execution.

60g is the minimum quoted by most docs; you usually see recommendations on the order of 60-80g per day, and sometimes 80-100g for men, and is generally based upon the amount of Protein required to sustain ourselves (we don't store it, so if we're short on our intake, our bodies will break down our muscles to get what it needs, much like it will strip our bones if we don't consume enough Calcium.) My roughly 155 lb of lean mass (out of 185-190lb total) requires about 105g of protein per day to maintain itself; if I was wanting to actually build muscle mass, that requirement would increase to maybe 140-150g per day Our metabolic rate is fairly closely associated with our lean muscle mass rather than our overall weight, so if we lose lean mass, our metabolism drops, making it harder to lose the fat that we want to lose; conversely, building lean mass through strength/resisitance exercise increased our metabolism making it easier to lose fat and maintain our weight in the long run - unlike fat, those muscles take energy to support even when they're not working, so increased muscle mass literally helps you burn fat while you sleep, just like the infomercials say! Building muscles is hard work and few of us can actually build muscle mass while we lose weight, but we can minimize the muscle mass that we lose (we tend to lose some muscle mass as we lose weight simply because there is less weight for our muscles to support and move, so the body adjusts.) But this is why there is near universal emphasis put on gettin in a minimum amount of protein as a priority with any kind of severe calorie restriction.

I am always suspicious of low cost mechanical devices like these - there is a reason why quality home gym equipment costs as much as it does (and professional/commercial equipment even more.) There are some things where WalMart can provide some value by their lower cost distribution system, but much of their "looks-like-the-real-thing" stuff doesn't hold up for any length of time. I know it's not an easy choice when money is tight, but the better value is often at the local gym where you can get good instruction on how to use the equipment without hurting yourself (which has been my wife's problem in this area.) Also, look at your own personality and motivations - will you consistently use a home gym, or always find something else that needs to be done? This is why home gym equipment (even the good stuff) often become clothes-hangers. Going to a gym is often better in that once you are there you have incentive to finish the job and not get distracted by what else needs to be done around the home. Personally, I use a combination of machines and free weights at the gym, along with their pool, and resistance bands and TRX (http://www.trxtraining.com) at home or when travelling. You can do a lot with those dopey resistance bands, and the TRX, while costing in the same ballpark as those walmart machines, will almost certainly outlast them and is more portable.

Irrespective the chicken-or-egg aspect if the body fat vs. testosterone issue, there is also an overlying factor of hormones that are locked up in our fat being released as we lose. The women often report this as things being even more variable than usual with them, and the same can apply to us as well.

Whenever you start any kind of a weight loss program, not just surgery, you tend to lose very quickly the first couple of weeks or so because initially you are burning mostly glycogen - your quick reserves of primarily carbs which burn at a rate of around 2000 calories per pound; after those reserves are exhausted, then you start burning primarily fat which burns at a slower rate of about 3500 calories per pound. People often stall during this transition period, which is what is usually referred to as the dreaded three week stall. So, if you are already in that longer term fat burning mode when you go into surgery, then you won't see as big of an initial drop immediately post-op that those who didn't lose anything pre-op did (though you may see an initial gain and quick loss from the fluids they pump into you during your hospital stay.) Either way - pre-op or post-op, weight loss is a good thing and what we are here for! Good luck.

Things like egg noodles and rice/beans were on my first month mush/soft list. A lot of people here, and a few docs, are seriously into low carb diets which are in fashion today, so that pretty much eliminates those foods for them, but there's nothing inherently wrong or sleeve incompatible with those foods. I didn't have them much because they aren't all that nutritionally dense, so there were better things to have with my restricted intake. My wife did make some kind of a lasagna type dish for a club meeting that went down fine - I just had to make sure that I was otherwise OK on my Protein for that day - and I occasionally had a Chipotle soft taco when I was out and that had some rice and Beans in it as well as the meat and veg (though I normally left most of the tortilla behind out of stomach space considerations. When I did Italian, I usually added other veg to the mix rather than Pasta out of that nutrition/space considerations, but would sometimes have a little bit of pasta when it was served up with chicken parmesan at a restaurant. So, yes, you can enjoy those foods in some moderation; just try to maintain your protein priorities!

AFAIK, the issue would be taking the excessive amounts of Protein supplements that body builders typically take(frequently 200-300 gm) without doing that kind of workout program; keeping the protein intake at the normal levels typically recommended by our surgeons (60-100g per day range is the normal range) shouldn't be any issue, and is in the range of what the body needs for basic tissue maintenance and replacement. At this point, the most important thing is to get the requisite protein intake to maintain ourselves during this weightloss process, and we use the supplements until we can get our protein thru our normal food sources. In short, take the advice of the professionals, and particularly the ones closest to the bariatric issues that you are/will be facing.

Beyond the prospect of adding some calories, it may make a difference to you what those calories are. I found that as my exercise routine ramped up, I needed to add some complex carb to my pre-workout snack/meal - a common bit of fitness nutrition advice is to precede a workout with a something that is relatively high in complex carb, medium Protein and low to medium in fat; I used a small sandwich of whole grain bread, meat and cheese and hour or two before working out and that made quite a difference when I was swimming beyond a mile, though not much of a difference when doing primarily weights. At your current intake, you don't have a lot of room to play with since protien is still the most important component, but there should be some room to play with the remaining calories, or increasing them a little: 600-800 cal is a very common level used in VSG plans, and while some will specify higher limits (I ran 1000-1100 thru my loss phase), I haven't seen many plans recommending below that level. Good luck on getting to the new you!

Something doesn't sound right here - an ounce of cream cheese is 100 calories, (even the lowfat stuff is 65 or so per ounce,) and if you are getting 12 muffins from 16oz of cream cheese and an egg or two... that's more like 150 cal per muffin. Am I missing something? That's not bad for a muffin-ish type treat, but still something to budget.

Actually, the stomach is muscle, which is why the extensive liquid diets that some are put through probably isn't such a great idea - it needs rest and healing, but also physical therapy and exercise; it is a much more active organ than a flaccid rny pouch. But I digress.... The concern with post op execise isn't so much the threat of leakage, but that of hernias around the incision sites and that's why we have lifting restrictions, etc. for a period of time post op. My doc was fine with getting back to some general exercise after 3-4 weeks, starting gently of course, but avoiding doing crunches and other significant ab/core work for 12 weeks, which is about the most conservative that I have seen mentioned on these various boards - so the OP is right in that window where more work is appropriate (as always, check with your doc on these matters. I would expect that a trainer with any sort of rehab credentials would be familiar with handling someone recovering from abdominal surgery in general, which is really the main concern here. Both s/he and you should be starting out gently and working up from there, being sensitive to any adverse feelings that you get - if something doesn't feel right, don't do it; work at it from a different approach and try again later. I'm working around an injured shoulder with my trainer, so if something doesn't feel right, we back off and do something a bit different. Good luck and happy training!

Like you, I had some apprehension about the catheter, maybe not to the phobia level, but still a potentially unpleasant unknown for me. Yes, it is usually put in once you are under, and it was a non-issue once I woke up again. It was actually somewhat of a blessing in that getting up and out of bed was an uncomfortable effort that needed assistance that first day, and given the amount of fluids that they are running thru you, I was glad that getting up was an optional thing for the sake of exercise and not a necessity to relieve bladder. Removal wasn't a real big deal, either - it felt odd but not particularly painful or anything. I remember telling the nurse that, 'gee, most things coming out of there feel rather pleasant, but this.... ' done. I know that none of us are overly enthused about having others play with our equipment down there for non-recreational purposes, but it was really a non-issue and an overall positive. I have read that some patients have protested their use and their doc has accomodated, but that's an individual doc thing - it can't hurt to ask if it's that big of a concern. Good luck and welcome to the club!

I never seriously considered the RNY because it doesn't really do anything performancewise that the sleeve doesn't do but has a lot more downsides. If I felt that I needed something stronger (I had about 100lb to lose and had good weight stability), then I would have gone with the DS, as unlike the RNY, its continues malabsorbing calories for the long term while the RNY only continues malabsorbing minerals, so the DS does demonstrate better regain resistance than the RNY or sleeve. My wife is almost seven years out on a DS and is doing well, down over 200lb with good weight stability (which she never had before.) A word on the prospect of using the DS as a backup for the sleeve - by my surgeon's experience, this works best if one makes the decision to revise (or complete the DS, as some would say) early rather than waiting for most or all of ones weight to regain - the results of waiting rarely work out as well as a virgin DS. This makes for a tough decision - after all, who is going to pull the trigger to revise if they have only regained 10lb, and they probably aren't heavy enough yet to get insurance coverage? I felt that my weight was stable enough thru well established my diet/exercise habits that this was worth the risk of just doing the sleeve. Time will tell if that was the right decision.

http://www.dsfacts.c...or-plateau.html This is the best explanation that I have found. We typically stall or at least slow down, 2-3 weeks after the start of a major weight loss effort because that is when the body shifts from burning its short term energy stores of glycogen (basically carbs,) and starts burning its long term stores of fat. Glycogen burns relatively quickly at a rate of around 2000 caloried per pound, while fat burns more slowly, at a rate of around 3500 calories per pound, so we lose slower once we start burning the fat. As noted in the article, as we start to rebuild our glycogen stores, we have to retain some Water to keep it in solution, and this can be compounded by the matter that our bodies typically don't want to dig into their fat reserves (it has to be convinced that you are really serious about this starvation thing!)

Have you had a sleep study done, to see if you have sleep apnea? That could be your ticket to insurance coverage for a sleeve. I was in much the same boat as you - I had adopted the classic healthy lifestyle changes to drop a good part of my weight and maintain it, but couldn't get past a certain point due to the volume issue - good healthy diet except for the portions required for sataity. The sleeve works very well for us relative lightweights (BMI 42 to start here,) and if you already have decent dietary habits, you don't need to make overly radical changes to make the sleeve work - during the loss period you will be emphasizing Protein, but you can keep the remainder of your diet well balanced if that is your desire (it was mine,) rather than going to any special diets like the ultra low carb/ketosis diets that are popular now. Good luck, and welcome to the prospective club!

emlefe has hit the nail on the head - we are anything but average. One of the main reasons that we got fat in the first place is, that by a combination of genetics and environmental triggers, our metabolisms are more efficient than normal - we derive more energy from our food than normal people. There is also the hypothesis that those who have done a lot of yoyo-ing in their weight have further damaged their metabolisms. One of reasons why the DS works better long term on average than the other WLS is that it resets the metabolic rate back toward normal; with the VSG we have to adapt to maintaining ourselves at a lower metabolic rate and/or work to increase our metabolic rate by building muscle mass.

I was on mushies/puree/soft proteins, as tolerated, from the hospital on out. Lots of variations in programs out there.

Anything is possible, but the sleeve procedure is quite flexible in that regard - you can readily add calories when you want to, to the degree that some fail because of it. It is easy to drink calories since liquids don't offer much, if any, restriction and many foods are "sliders" - so called because they slide right on thru the sleeve with little restriction, while other foods, dense meats in particular, sit in the stomach for an extended time while the stomach works on breaking them down before allowing them to proceed to the intestines. So, by altering the composition of your diet, it is fairly easy to tailor the amount of calories that you consume. I was also a relative lightweight, with 90-100lb to lose and was also concerned about a large overshoot on the loss front, which is why I went with the VSG over the DS - which offers better regain resistance, but can be harder to stop when you get to goal due to its malabsorptive component. It was fairly easy to start adding more calories as I approached my goal (particularly since that was right around the holidays!) I added back the morning snack that I dropped after the first month or two post-op, increased the fat content thru more avocado in my salads, lowfat rather than skim milk in the Protein loaded puddings that I make, more whole grain breads here and there, so that now I'm consuming 1800 calories or so per day rather than 1100 when I was losing. Also, it's not unusual, or particularly undesireable, to overshoot the mark some as there is inevitably some bounce back after losing so rapidly - most natural systems will do that to some degree, unless they are very slow moving ("overdamped", in engineering vernacular - our bodies are often like a car with bad shocks, bouncing around some before settling at its' new level.)

I started at around the same level as you, 292 at surgery, after having lost and maintained around 50lb several years before while my wife was going thru this. I lost about 33lb the first month, 14-15 each of the next couple months, and then about 10lb per month thereafter until I hit goal at about 190lb (actual goal was mid teens body fat %, the scale weight goal moved around some as I lost to account for the inevitable loss of some lean body mass.) Overall, the journey has been smooth sailing - some constipation issues early on (pretty much any of the WLS procedures will have some sort of GI issues simply from the change in dietary habits,) and I'm just now successfully cutting back and weaning off of the PPIs for reflux (most people seem to get off of them within a few weeks, but YMMV.) Threat of complications is always on one's mind when going into these procedures and that is where there are some significant differences. While the bands tend to be simpler and quicker to install, they have a lot more complications down the road (on the order of 25% of the bands are ultimately removed due to poor weight loss or regain performance or to structural damage done to the stomach - there is a reason why most of these forums have boards dedicated to band revisions.) The sleeve, on the other hand can have some initial surgical complications by way of leaks or kinks/strictures in the stomach (and we're talking under 1% here,) they are overall rather trouble free as time progresses. Someone on one of these boards posted a great comparison from their surgeon: he told them that if they were to call him in five years time complaining of nausea, vomiting or other digestive distress, if they had a band he would tell them to go to the emergency room, but if they had a sleeve, he would tell them that they ate some bad fish. Long term, the success of any of these WLS procedures comes down to a combination of personal efforts to adopt the lifestyle changes needed to maintain your weight once you have lost it, and the compatibility between you and the procedure. One may experience regain problems with any of these procedures (the DS to a lesser extent, but still possible,) but getting put back into the hospital for surgical complications months or years down the road is very uncommon except with the bands. Long term nutritional issues are going to be similar with both the bands and sleeve as both restrict the amount that you can consume which puts a premium on adopting healthy dietary habits and staying on top of whatever supplements are needed to flesh things out; supplementation is less of an issue than with the RNY and DS which have malabsorptive components that need to be compensated for (heck, most Americans are somewhat malnourished and should be supplementing some simply due to the crappy average American diet, so the sleeve and bands aren't a real big change from pre-op in that regard.) Good luck and welcome to the club (whichever one you join,)

I never controlled to carbs, only protein and water. I was typically running 70-100 per day the first three months or so and 100-120 per day after that, when I started adding some complex carb to better fuel workout endurance. Now, in maintenance, I'm typically running in the 150-200 range. Not playing the low carb/ketosis game certainly didn't slow down my weight loss (or at least I sure didn't want to lose any faster.)

One good book that we used in establishing the foundation for our efforts when we started our journey several years ago is: Sports Nutrition Guide: Minerals, Vitamins & Antioxidants for Athletes by Michael Colgan http://www.amazon.com/Sports-Nutrition-Guide-Minerals-Antioxidants/dp/0969527284/ref=sr_1_3?s=books&ie=UTF8&qid=1330465262&sr=1-3 It provides a good rundown of the various nutrients, how the body uses them and appropriate levels for them. In contrast to the standard govt RDAs which have been established primarily to avoid deficiency disease, he has tried to understand and present what levels are needed for optimum health and performance, which can be quite a range given the differing demands of various athletic activities, but you can also get a good idea of what's needed for us less demanding types. It's certainly worth having in your library. The Nutribase program (we use the "Personal Plus" version) is availabe from Cybersoft at dietsoftware.com and can be downloaded for a free trial so you can compare it to some of the online diet trackers that are available, and decide if it's worth its' cost. I don't know how it compares to some of the popular programs like myfitnesspal, but when we got started in all of this it fit our needs better than the online programs available at the time.

B12 is the only Vitamin that we don't absorb as well post-op sleeve as normal; everything else is dependent upon your dietary habits over the long term. Many people in our society need to supplement without WLS simply because the typical American diet is deficient in many areas. During the loss phase, we are normally getting so little in beyond Protein that we need a lot of supplements, more so if one is doing one of the popular low carb diets, but long term it gets to be pretty individual based upon dietary preferences along with the usual age, sex and medical condition considerations. Now, in maintenance mode, I sometimes see days when I don't need any calcium supplements to reach my 2000mg target, though one 5-600mg supplement is the norm now (two was my doc's standard plan recommendation) and I can usually get in 70-80% of the RDA of potassium (which is difficult to supplement without prescription.) So, what you will need for life will vary, which should be good incentive to continue doing regular labs and tracking your intake to see what you really need to supplement over time. Good luck,