RickM

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.

My doc's program is mush/puree/soft proteins from the outset as tolerated, along with the usual soups, protein drinks and water, water, water. That worked fine for me, and I wasn't going to argue with his twenty or so years of sleeve experience. My wife was a little slower to progress on the same basic plan a few years ago. but that's just individual variations.

I have found that some complex carb (like a slice of whole grain bread, maybe 25-30g carb) a couple of hours before a workout gives me some added endurance in the pool, but it doesn't seem to do much for me on strength training workouts. Both are in the 60-90 minute range. I have an overall carb rate of around 100g per day on 1000-1200 calories.

I did not do a pre-op diet other than the usual day before surgery thing. It all depends on what your doctor wants to do. There's lots of variation in doctors' practices - some require a couple weeks or more of liquids, some a couple weeks of restricted calories and/or carbs, some require a specific amount of weight loss pre-op, some have different requirements for different patients and some have no particular pre-op diet requirements.

It depends in good part with where your starting point is - if you're 180 now, then 100lb is probably rather ambitious, but if 100lb is roughly the amount of excess weight that you are carrying, then it is quite a reasonable goal with the sleeve. There are many women on these boards who started out in the low-mid 200's and around 100lb to get to a "normal" BMI range for their height. I'm down close to 100 now after a little less than seven months, and within a few pounds of my goal. That said, people do vary and some lose slower than others and some may have a hard time losing that much - it's hard to predict ahead of time. The overall averages for the sleeve are in the 70-75% excess weight loss range, but that's an average, and includes those who start at over 500lb and lose to 250-300 and are much healthier even though they may not be "normal" weight, it includes those who aren't compliant and eat the way they did before and come up short, and includes those who lose 100% or more of their excess. In short, 100lb is quite do-able and not overly optimistic.

I've set my goals based upon body composition, aiming for 15% give or take a bit (given the flakeyness of body comp measurments) body fat, which is midrange of the "normal" or "fitness" range for men (equivalent to low to mid twenties for women). That means that my scale weight target has shifted some as the body comp changes with the weight loss and some muscle mass is inevitably lost along with all of the fat, but for the lean mass that I am still carrying (within 10 lb of goal now) I will still be an "overweight" 27ish on a BMI basis, but to be a "normal" BMI would make me too lean to be healthy.

My wife stayed home on FMLA for my surgery and post-op time; she milked it for more than I needed the help (in part from her memory of having a harder time with her WLS a few years ago), but it was therapeutic for her to be away from work for a while longer!

You shouldn't be letting other people decide what your tastes are - Protein shakes vary all over the map in taste and texture; what's yummy to you may be ghastly to someone else. The important thing is to get in the protein that you need. To me, variety is a key, and I was lucky to be able to tolerate a variety of protein rich foods early on so that I wasn't overly dependent upon any one tiring source. Greek yogurts are a good protein source at around 10g per 4oz serving while standard yogurts are about half that - I would get awful tired of yogurt if it were my primary protein source, not to mention that I don't get along well with plain yogurt. I have used protein shakes for years and have evolved blends that work for me in providing a good level of protein and a pleasing taste; likewise with yogurts I have evolved blends that work for me - I find that the commercially available no fat yogurts are also sugar free and have a lot of artificial sweetener taste to them, and I don't care for the level of sweetness added to most products. So, I have developed my own blend of plain and sweetened vanilla greek yogurts (about a 3 to 1 ratio now) that works for me, particularly with some added fruit and nuts. Likewise with the protein shakes, they can be blended with fruit or other flavors to enhance them - I often add a little unsweetened cocoa powder to enhance the chocolate flavor and cut the sweetness of the protein powders. I also blend the Protein Powder and greek yogurt into sugar free pudding mix to make a protein rich snack. I haven't needed protein shakes to meet my protein goals since fairly early on but still use them at times for specific uses (usually strength training recovery, as they are a good source of rapidly absorbed protein) and because I like them (or at least my blends) and are part of the variety that I maintain. Do some experimenting and see what works for you!

Some docs do a low carb diet as part of their program while others do not. Likewise, some patients choose to do a low carb diet in addition to their doc's program. It's up to you what diet you want to follow as long as it meets your doc's program requirements - some people find that the ketosis state that's induced by the ultra low carb diet helps to boost the weight loss, or rate of loss, that they are getting from their WLS while others don't find much if any difference, and some find it detrimental to their loss. I never bothered trying to keep low carb, other than minimizing the simple carbs/sugars, preferring the better nutrition offered by as balanced a diet as I could have within the volume restrictions and Protein requirements that we have and never suffered any significant stalls - I've only had one week that was not a losing week over the six months plus since surgery and am less than ten pounds from goal. Indeed, that past couple of months I have been shifting some calories strategically to complex carbs to better fuel my workouts which helps burn more calories. So, both lower carb and higher carb can work to enhance the loss performance of your sleeve - it's a matter of what works best for you. Stalls are a normal thing, particularly around the three week mark (give or take some depending upon whether or not one was on any significant pre-op diet) and are usually broken, if not by time, then by changing something - intake levels up or down (not a lot of options there when so early out), or composition of intake or similar changes on the exertion front (also fairly limited when early in the process) or just by sticking it out. Your body is adapting to its new environment and it takes longer in some than others, but with the caloric deficits that we are running, it can't last forever.

I concentrate on overall nutrition, Protein first of course, but can't wrap my brain around cutting out that much good nutrition to do the low carb thing - it may help some who need an extra push beyond the VSG to reach goal or those who have diabetic issues, but for me to get to goal in six months rather than seven (assuming that it works as advertised) isn't worth the added health issues. Simple carbs have been limited, and I don't have as much fruit as I normally would in order to keep the calorie count in line (1000-1200 for me) but I do work to keep as much variety in my diet as I can. And yes, that includes potatoes sometimes (a good source of potassium, which is hard to supplement without prescription, and is a more efficient source calorically than most low carb alternatives,) and whole grain breads. I'm six and a half months out and within 7 lb of goal - so low carb is by no means essential to our weight loss. As LilMissDiva notes, caloric deficit is the key to our weight loss. If adding low carb on top of the VSG works for you, great, but if it doesn't, don't agonize over it- do what does work for you.

I don't know if there is a "better" overall, but there may be a better for you at this time. If you aren't satisfied with your loss rate, or if you are stalling a lot, then try a change and see if that shocks your system into action. Initially, I needed six small meals a day but as I have progressed and could eat more different things, and more of them in a sitting in some cases, I have dropped one or two of those smaller meals to keep my daily calorie count in line. Smaller meals have classically been used to smooth out the insulin spikes during the day and to keep from getting too hungry and over-eating. Changes in intake or exertion are often used to break stalls; some find that upping their calories for a short term breaks a stall, fooling the body into thinking that it's no longer starving; trying the very low carb diet for a while, if you haven't already been doing so may do it - the shift into ketosis mode may tell your body that you're serious about this. Or try the other way around if you have been doing low carb and try adding carbs (preferrably complex carbs rather than twinkies!) - I have found that adding complex carbs in my meal (like some whole grain toast along with some meat and cheese) before a workout allows me to workout longer and with greater intensity than when I have a lower carb salad and meat. Another thing to look at is your workouts and exertion level. Simply changing a routine can often help, or varying the intensity of exertion. I found at around this three month time that my condition had improved enough that my exertion levels weren't taxing me as much as they used to - walking as fast as I could without breaking into a jog previously would get me into that 80% max heartrate zone (around 130+ at my age) that's often recommended for optimum cardiac and calorie burning effect but by the third to fourth month that same pace could barely get me to break 100 - it didn't feel all that much easier, but my body could sure tell the difference. Lots of things to try, good luck in ramping it up!

I am close at 53 and had my VSG in early May. I'm down about 95lb and within 10 to goal and overall have had an easy recovery and post-op period. I had a few days the second week where my lower GI couldn't decide of I should have diarrhea from the soft/liquid diet or be constipated from the residual pain meds and that kept me close to home and didn't get in as much walking as I should have that week, but before that I was starting to outpace my wife on the walking trails. I had very little restriction for liquids which helped in the early days which meant that in the early days I could have enough Protein drinks to be able to experiment with small amounts of other foods and still get in the requisite protein - enough that the doc was telling me to add veg to the diet by day 10. My system hasn't rejected anything that I have tried, so I have been able to keep a reasonably well balanced diet through all of this despite the volume restrictions (and yes, there sure is a restriction when it comes to solid proteins) and have been able to have a good variety of foods, both at home and when eating out. My wife had a DS (a VSG plus intestinal rerouting) when she was 55 and she, likewise, had a boringly average recovery while losing over 200lb. She wound up being lactose intolerant afterward, and still is to some extent, and had more tolerance issues than I did during the recovery and loss phase, and strangely had more liquid restriction than I ever had despite her nominally larger stomach - her Protein shakes had to be so concentrated to get in enough protein that they were ghastly to her. Just one of the variations between us all. Good luck down your chosen path,

I'm pretty much having the same things now that I had pre-op, but less, though I now choose things that are more doggie-bag friendly. Soft tacos from Chipotle were an early addition and good for when I was travelling - leave the tortilla behind, but most everything else in them were in my mush/soft Protein plan - chicken, rice&Beans, salsa, cheese, guac; you can order a single taco, or get the standard meal of three and have two leftover for other meals. Steaks work fine, and then I have leftovers that I use in salads that I make at home. Fajitas are a good choice at mexican places, as are the tacos and enchiladas - I will have the corn tortillas in the enchilada now at six months out, but I have been somewhat lucky in that protein hasn't been a big problem for me so I have some flexibility in what I have. Chicken Parmesan at our local family Italian place is also a routine dish - I can usually get three or four meals from one of Vito's dinners (and still have room for a bite of his Tiramisu)! At places like Panera, I will get their half sandwich and small soup or salad and have one for the meal and the other for a snack later or the next day. I don't have a lot of entree salads like I used to, mainly because they aren't that doggie-bag friendly. So, you are not deluding yourself on that issue - it may take you a longer or shorter time to get to the point of having semi-normal restaurant meals, but it will happen - that's one of the benefits of the VSG; it's just that, as before, we do need to be careful of the overall calorie count of restaurant meals, particularly if they are a regular thing long term.

I still have the sleep apnea six months out and almost 100lb down (almost to goal) though it's not nearly as bad as it was. I slept without the machine three nights this week and am getting reasonable rest, though my wife says that it's still there sometimes. So, I'll use it a while longer and try again. On the diabetes front, which my wife had for about twenty years before her DS a few years ago, just short of needing insulin, it resolved in her over a few months, sometime between 6 and 12. Our doc said that in his experience, typically the longer that you have had the diabetes, the longer it will take to resolve post-op. So some will drop their meds in the hospital and never need to pick them up again while others will take a few months for it to resolve, though the meds can usually be decreased during that time.

As my doc's program instructs, try new things one at a time, testing for tolerance, and if it doesn't sit well, try again in a couple of weeks (or later, as you feel like it.) Good luck,

As Thomas noted, carbs (preferably complex carbs) before and Protein after a workout is the common nutritional advice. I've never been into the low carb game (was never mentioned by doc or his program) but continued working on high density nutrition along with the requisite protein intake. I have started experimenting with more complex carb (rather than my typical lunch salad) before workouts and do find that it helps with my endurance and intensity in the pool, though haven't seen much difference in the weight room, even though it is typically a 75-90 minute workout. I do still use the Protein shakes after the strength workouts, but a more typical greek yogurt/fruit/nuts after the pool. At the level that most of us are working strengthwise, I suspect that we won't see much benefit from overloading either carbs or protein in our Quest for lean mass preservation, as opposed to serious body building, but a more normal carb/protein/fat profile is probably better than the trendy ultra low carb/ketosis diets for those into fairly serious exercise. At this point, as others have noted, just getting started at a measured pace to get used to things without overdoing it is probably best; once you get comfortable in a routine and building intensity after a couple of months you may find the need to start tweaking the diet to better fuel things.

Like Thomas, I was starting to play with salads somewhere around the four week mark - mostly chopped spinach instead of lettuce, and other chopped veg - avo (ok, a fruit...) tomato (a maybe fruit...) green onion, pepper, carrot along with a couple ounces of leftover meat.

I believe that it is one of the facets of whether or not a surgeon requires it - some require them for all, some only for their heavier patients, and some not at all. My doc doesn't require it and I don't know of any of his patients who were required to go through it, even the SMO 60+BMI ones like my wife was. But then, he also does biliopancreatic transplants aside from his bariatrics practice, so it seems as if crappy liver condition doesn't particularly bother him, or that there is enough change from the diet to make it worthwhile for him to require it (though he is rather anal about liver care post-op) and it is likely that he has skills and experience in that area that exceed the norms for most bariatric surgeons. My general point, however, is that while some docs seem to be comfortable with things as they are without pre-op diets and others feel that they do better with them, that you should follow your doc's instructions - he's the guy with his hands (directly or remotely) inside you reworking your insides and you want him to be as comfortable as possible while he is doing so. If your doc doesn't require it (and he is an experienced at bariatrics) while others do, don't agonize over it; just as one shouldn't agonize over their doc not requiring a trendy low carb post op diet while others do - if his experience with his patients indicate that it's not necessary, there's little need to argue about it, but if it makes you feel better, then have at it.

No need to worry about it - if your doc needed you to do it, he would ask you to do it. Some docs have the skills and experience to work around any such problems while others need all the help their patients can give them. If you doc gives you such instructions, follow them as you want him to be as comfortable as possible while he's messing around with your insides; if he doesn't, then be thankful for his skills and experience.

It mostly depends upon how soon you are able to get enough Protein from "real" food, and that's a variable depending upon different doc's programs and individual patient tolerances. i was usually able to get enough in after about three weeks that I didn't routinely need the Protein shakes, though I still do sometimes use them now, at six months, for workout recovery as they do have rapidly available protein which is useful after strength training. As to other supplements, those are also dependent upon how well you can get them from food, though some supplements will probably be needed long term/permanently due to our reduced food volume. B12 is likely to be a permanent supplement as our small stomachs don't produce enough of the intrinsic factor that's needed to properly break down and absorb what we eat. Calcium will depend upon what your long term post-op diet looks like - I used to get enough in pre-op but long term post-op it is unlikely that I will have as much dairy or other calcium rich foods as I used to. Likewise, postassium - which is difficult to supplement without prescription - I used to get in the typical RDA of 4700mg through my normal diet, but am only at 40% that level these days (and low carb diets would make that worse); so far blood levels are fine, but it is something that we are watching.