RickM

My wife before her WLS was never an exerciser, and couldn't get along with it pre-op or post-op. She was one of the "lucky" ones who lost all her excess weight despite the minimal exercise (having a DS helped, too) but now is paying the price with overall poor functional strength. When we first decided that we had to do something about our mutual weight problem, we joined the Y as part of the typical insurance company 6 month roadblock to surgery, and I found that I liked it, - liked getting back into the swimming and like the strength training bits, too - something that I had never done before. Between that and evolving dietary preferences, I lost a good part of my problem and maintained much of that loss, but not enough to be healthy and normalish weight, so I finally went with the VSG to finish the job. My improved strength and overall health certainly made the surgery and recovery easier. Seeing some positive results certainly helps it go down! As a side note, one of the long term post-ops in my doc's practice is a retired football player - typical retired athete syndrom of continuing to eat like they were still playing full time - who had ballooned up over 500lb. He absolutely hated to work out, but when he was playing professionally, it was part of the job but he swore that he would never do it again when he retired, Of course, he realized that he was wrong and that the workouts needed to be as much a part of his life now as it was when he was playing. He may have gone a bit overboard, getting to a 4%BF level (talk about obsessive-compulsive!) but he realized that that was what it would take for him to make it (he did let up after a while and let himself degrade to a 6%BF level.)

I've had it a few times, several years pre-op, so it's not necessarily anything connected to the surgery other than weakened condition and altered immune responses. Mine has always been on an ankle and the rash was preceded a day or two before with flu like symptoms and a rapid fever spike into the 104-105 range - that really gets your attention. My PCP always sticks me in the hospital for an incredibly boring stay due to the antibiotics that he prefers for it (what can I say - he's an infectious disease guy, who am I to argue?) It's certainly worth letting the Bariatric surgeon know about it, particularly anything that close to surgery.

http://www.dsfacts.com/weight-loss-stall-or-plateau.html This article gives a good explanation of what is happening to you and why stalls are typical at this point.Short answer - rejoice, because it means that you are now transitioning into fat burning mode!

In the eight years or so that I have been going to the support groups for my surgeon (between my wife's pre-op/post-op time several years ago and my own,) they never brought up the prospect of doing low carb diets other than the avoidance of simple carbs and junk food, and they have one of the best weight loss records around - so there certainly nothing essential about low carb dieting and the VSG or weight loss in general. The only time I have heard them mention ketosis is in reference to something that can happen as a result of fat burning, but was never something desirable to strive for. I never controlled carb intake, and was averaged in the 80-100g per day range through most of the weight loss period, except for these past three months or so when i selectively boosted complex carb consumption to better fuel workouts, so that brought it up into the 120g range. There is nothing particularly wrong with things like bread, rice and even (heavens!) potatoes in moderation as they all have nutritional value that often doesn't come from other sources. I am seeing occasional references posted to thiamin deficiency, which typicaly comes from lack of grains; potatoes are one of the better sources of potassium (on the order of twice the potassium per calorie than low carb avocados, and about 50% better than bananas) and potassium is difficult to supplement without presciption. As usual, the whole grain products are preferred over the overly refined white products. They all have a place in a properly balanced diet - the key there being balanced rather than the carb overload diets that are all too common. After WLS, our diets are anything but balanced with our limited intake volume and Protein emphasis, and we can tolerate that imbalance for a while when we are losing, but we do need to bring that balance back in as we lose an move toward maintenance. The weight loss industry in general (both the MDs and what passes for research that supports them as well as the infomercial crowd) go back and forth between low carb and low fat extremes, and have done so several times over the past century. Just as when low fat was the fashion of the day and they said that there were no good fats, that we don't need them and then they found that we actually do (but in moderation), now we hear the same thing from the low carb crowd. Nothing is really new, and we always have to re-learn the same things over again. There will always be some therapeutic value for some to any kind of severly restricted diet - low carb is often prescibed to counter diabetic related issues - but that is far from recommending such restrictions as a cookie cutter (sorry!) recipe for success. My bro-in-law was on a Wonder bread diet for a while - white bread, white rice, avoidance of complex carbs, whole grains and fiberous veg. It did it's job (which was certainly not weight loss oriented!) but it was a restriction for a specific purpose. We have to learn what works best for us - some have triggers that lead to overindulging some foods while others have a weakness for overall volume. The ketosis game may induce some additional inefficiencies to ones metabolism that may help in burning fats quicker, or it may not - it's certainly worth a try, particularly if one is losing slowly or is starting out at a very high BMI and need to get the most from their sleeve, but there can be costs to driving one's metabolism down too low thru starvation. For me, assuming that the ketosis diet worked as advertised, it wasn't worth making goal in six months versus seven; however it may be worthwhile if made a difference between meeting goal or not given the year or two that we typically have to work with our WLS.

I think that it's like anything else with our sleeve (or an RNY or banded pouch) where we have to be careful about drinking our calories. With fruits you have to be careful about the amount of sugar in the fruit - I was amazed when making smoothies for my wife after her WLS how much strawberry it took to get the flavor into the drink! That's probably less of an issue with juicing veg, but it still pays to keep track of what's going into it. I don't mind things that are sliders as long as they are nutritionally dense relative to their calories.

I think that it really depends upon the doc and his plan - my doc lumps them all together along with soft proteins as the first phase and lets us pick and choose between them as our tolerances dictate. There does seem to be a lot of overlap between those categories and from what I have seen, they probably only really make a difference to RNYers.

I have seen anything from none at all to two to three weeks (maybe more) reported - I don't know if anyone has done a study on it or calculated averages, but maybe that would be a good topic for someone's grad school paper. Further, I don't know if anyone can say whether stall frequency or duration can be linked to any particular dietary program or surgical technique - I haven't been as low cal or low carb as many people do and haven't experienced much in the way of stalls on the way down, but can't say whether the two are associated or just coincidental. But, in general, long term weight loss is usually characterized as more stairsteps than a straight ramp. The linked article below gives a good explanation of what is happening, but the short answer is that as frustrating as it can be, you should rejoice because it means that you are now starting to move into actual fat-burning mode. http://www.dsfacts.com/weight-loss-stall-or-plateau.html

It sounds good to me - I've been having various salad veg along with meats for several months (about 8 months out and goal range here, too) and have recently started adding some V8 juice to help boost my potassium intake (the low salt version is particularly good on that count) - I'll have to play with making my own blend sometime. Protein has rarely been a problem for me, but adding in enough other things to balance out the nutrition within our capacity and a sane calorie count has been. One can always add some of the unflavored protein powder to the mix if more protein is needed, but I don't fret about getting protein in with every meal or snack (tho most are decent in protein content, even if the meal goal is more carb oriented.)

The general answer from most docs is whenever you feel ready for it. Most hospital nurses say that they prefer that you wait until you are home from the hospital. There may be some positions that you will want to avoid, and your body will tell you.

The main reason is that nutritionally, it is not all that dense, so there are better things to be consuming, though rice and beans were on my first month soft diet plan. Once the protein is in, other things can be added; as usual under today's thought, brown rice is preferred over white rice when possible. There are other things to add to the protein that would probably be better nutritionally overall, but having some grains in the mix will help prevent the thiamin deficiency that some are experiencing with the low carb diets.

I have the rice (brown rice when they have it, of course!) in my Chipotle tacos - it completes the Protein in the Beans. I generally don't have it at home since it's not worth making the small amount that I can have, and it doesn't get along with my wife, so it's largely a wasted effort. But at a mexican restaurant, I will generally have it along with the beans and the meat component of the meal. The rice and beans are not as high density a protein as the meats, but I don't have a big problem getting in the protein, so I can work with other components of the diet and avoid some of the deficiency problems some have with too narrow of a diet.

There are several issues with alcohol, and different docs have differeing concerns about them. The basic initial concern is healing of the stomach, and that's where many docs come down to something around a three month limitation. Empty calories, too is a concern during the weight loss period, but that's no different than talking about Twinkies or any other kind of junk food. The biggie that some docs fret over is liver health - as obese patients, our livers are generally in pretty poor shape to begin with, and then they are further taxed with their role in metabolizing all of the fat that we are losing - they don't need any more stress from metabolizing the alcohol. So, that's where some docs come up with a no alcohol during the entire weight loss period policy - this is my doc's plan, and he's a bit more anal about liver health than most WLS docs as he also does liver transplants, and he doesn't want to see his bariatric patients coming back as transplant patients. The other concern is the prospect of transfer addiction - many of us were addicted to food, and with that taken away by the surgery, that addiction can be transferred to something else that was never a problem pre-op, like alcohol or gambling - so that is something to watch out for. The other thing to watch is that most find that their body's response has changed - usually feeling the alcohol's effects sooner and with less (things tend to go thru quicker, particularly liquids), but then they tend to recover quicker, too. Those are the major issues that influence the differerent surgeons' policies on alcohol and WLS, so take them for what you will. Overall, the occasional drink is not likely to be any more harmful than the occasional twinkie, but there are potential problems with it being a regular thing during the post-op period. Good luck, and may you have something to celebrate!

In this article: http://www.dsfacts.com/weight-loss-stall-or-plateau.html Diana does a great job of explaining the mechanism of what's going on with you at this point. The short story is that you should be happy, as this marks the time when you start burning fat rather than your short term stores of glycogen/carbs/proteins. Some will experience the stall earlier than others, particularly if they lost weight on a pre-op diet - the clock really starts when you change your diet and start losing weight rather than at the time of surgery. Your weight loss will also slow down some after this initial stall, as you will be burning primarily fat at a rate of around 3500 calories per pound rather than glycogen at a rate of around 2000 calories per pound. I never really stalled at this point (which may be my individual metabolism, or may be that I wasn't running as low cal and carb as many do so the transition wasn't so abrupt,) but the loss did certainly slow down at the three week mark.

A couple of things that you can try - one is to take Lactaid before or with any dairy products; it works well for my wife who has been lactose intolerant since her DS surgery several years ago. Another thing to try on the protein front is to look for protein drinks or powders that are 100% whey isolate. The isolate form doesn't have any lactose in it, but is more expensive than non-isolated whey, so most whey protein drinks are a blend of isolate and non-isolated whey to keep their cost down. There are some on the market that are 100% whey isolate, but you may have to go to a specialty store like GNC or Vitamin Shoppe to find them.

I just use weight and don't bother with volume measurements. In theory, your stomach has a specific volume capacity, but in pracatice it depends upon the density of the food and how quickly it goes thru - liquids go right thru me, though they don't for everyone. From a practical perspective, i have weighed food for a long time as it's just more convenient (assuming that you have a decent scale,) and more repeatable - just how much is a half cup of spinach (or green beans) - how finely chopped, how compressed? Even relatively early on I was having somewhat complex meals that would have messed up too many measuring cups and spoons - much easier to put the bowl on the scale and add an ounce of this, 10grams of that, 15grams of something else... You soon learn what your comfortable capacity is for different foods and combinations.

As I recall, I was on clear liquids for one meal, and then it was on to other liquids, puree and soft proteins - I think that the second hospital meal was some broth, yogurt and scrambled eggs - and after that it was the liquid/mush/puree/soft proteins as tolerated at home for the next month. I tolerated things well and had no issues - nothing has come back up since surgery - though others progress more slowly. This is pretty much the same regimen that my wife was on about six years ago (our doc's practice has been doing sleeves for around twenty years) though she progressed a little more slowly, having a few more tolerance issues at first.

Liquids like that go right thru me - I put down a cup of broth and half a cup of juice in a sitting in the hospital, but my wife, after her DS a few years ago, could only put down her nominal stomach size in fluids for a long time. Doc says it's just one of the variations between us. The soft foods like yogurts and puddings a couple days later went down a lot slower, so no worries there.

I think that it just indicates that you aren't carrying as much fat in your legs as elsewhere in your body, since the fat provides extra bouyancy. My wife was somewhat dismayed after losing so much weight after her WLS that she had to work harder to stay afloat! So, this will change as you lose weight, and everything will sink more evenly.

I'm disappointed if I can't get at least two (if not three or four) meals out of a restaurant meal. The main change from pre-op times is that i give more consideration to how well something keeps and reheats - I haven't had a restaurant entree salad since surgery since they just don't keep well and are too big by themselves (but I sure make use of leftover steak or chicken in the salads I make at home!) Sometimes I'll order a larger size steak if offered (and if it makes sense $$wise) if I need more in my leftover stash,

Remember that it takes about 3500 calories to gain, or lose, a pound of fat, so one day off isn't going to blow it for you. As long as you don't make a habit of it, you'll be fine. Some diet plans, and even my wife's WLS surgeon (my guy's older brother) suggest taking a day off from counting every week or so.

I did some noodles early on in some chicken noodle Soup that we made - egg noodles were on my early soft menu along with mashed potatoes, rice and Beans, etc. I haven't used them much since due to their fairly poor nutrition/calorie ratio (though I would do potatoes sometimes for their potassium content.) I got burned out on the soup pretty quick, too, but just made some more since it's six months on and soup weather.

My goal have been based upon body composition, aiming for a nominal 15% body fat (which is low/mid range of the normal or "fitness" range, depending upon whose charts one is using) for men; realistically, given the flakiness of body fat measurements, and the effect of the residual excess skin, anything in the mid-teens is a healthy range. My personal trainer thinks that the upper teens where I am now is low enough; anything in this range is plenty healthy, but still a few points "overweight" on BMI and still above the various averages noted on the site linked by the OP, but that shows the difference between what's healthy and appropriate for an individual versus the averages. At two pounds above my nominal weight goal and upper teens on body fat, I'm now into maintenance transition mode and will see how things settle out as I arrest the weight loss and let my body comp adjust and stabilize - maybe allow a bit more loss and/or work to build back a bit of muscle mass, but we're talking about a couple pounds here or there at this point.

I think that it's more that you are experiencing the classic three week (give or take some) stall, which happens when you have pretty much used up your stock of glycogen and are transitioning to burning primarily fat. Your body needs to start storing replenishing its glycogen stores, which takes some Water to keep in solution, so you are hanging on to some water now, too, until you finish changing gears to fat burning mode. Some people will stall for a few days or even weeks at this point, and others will barely pause, so don't worry about that, either, if it happens. So, relax and enjoy experimenting with new things again.

I started seriously experimenting with whole grain bread at about 4 1/2 months, when I was looking to add complex carb to my diet for specific nutritional purposes. While filling, it settled well and when toasted up with some meat and cheese provided a good pre-workout meal that noticeably improved my workout endurance and intensity in the pool. I've never had much of a problem getting in enough Protein, so I have had flexibility from early on to add some variety to my diet. I've never been a breadaholic (that's my wife's job!) and didn't have a lot of it before then other than in some french onion Soup early on (fully expanded in the broth, so no real problem there,) and some occasional rice and Beans in a Chipotle soft taco (with varying amounts of the corn tortilla depending on capacity; rice and beans are on surgeon's early soft diet list). Next I will try some whole wheat Pasta with some sausage or meatballs as an alternate meal of similar nutritional profile to the sandwich to see how that works on the energy front. So, in short, whole grain breads are entirely compatible with the sleeve - at varying points for different people depending upon individual tolerances and progression rates. Of course, if breads and the like are a trigger food, then some caution is appropriate to keep from over-doing things. Some docs are still looking at the sleeve from an RNY perspective, but they will come around as their patients and more experienced sleeve docs show them the way, but there is really nothing, in general, that the sleeve can't handle long term - it's up to us as individuals to learn to control ourselves, with the help of our sleeves.

I was down about 32lb the first month, starting at 292 & BMI around 42. I'm now down about 100 at seven months and just about at goal (we'll see how the body comp settles out - that's the actual goal.) Whether you stall or not at the typical three week mark, your loss will slow markedly at that point. Initially you are burning mostly glycogen (some stored carb and protein) which burns at a rate of around 2000cal per pound. Once those stores are consumed, you actually start burning the fat that we are trying to lose, but it comes off slower, at around 3600cal per pound. I never had the dreaded three week stall, but the loss curve sure flattened out some right at that time.