Daydra

No, definitely don't delete your post. I've always valued your opinion.

So we were sitting around the office after hours talking about crapping our pants (sadly, this was weeks before this particular event)... I'm not kidding, the sewage-garbage duo is the crux of our professional lives. You probably don't want to know what else environmental health inspectors find acceptable workplace conversation topics... Anyway, the general consensus was that if you say you have never had an oopsie in your droopsie, you're a total liar! So we are in good company!

To be blunt and to not waste anyones time.. Asking a surgeon for a detailed response about the effects of bariatric surgery on an individuals metabolic rate (particularly as we're all different) is like asking a baker to fix a rare sports car. In short, you need an endocrinologist. As for the impeded weight loss. You sadly had a bit of a rough trot of it immediately after your surgery - so this would definitely have short-circuited the system - giving much credence to the points made by our learned friends on this site, that you may have to wait it out and see how your body normalises. As far as references for current academic research go, please see below. As you'll know, academic research is normally very narrow in its focus, so you'll have to go through quite a few of them in order to assimilate a potential 'ground truth' for yourself. However, there are some articles which offer the generic information you seek which might at least allay your current fears. Naturally, this comes with the caveat that without full knowledge of the endless subtleties and nuances the endocrine system plays on our bodies, it might appear attractive to propose one hypothesis for your current predicament, for it to then be incorrect because of a previously unidentified and unevaluated interaction. Consequently, if you want your rare sports car fixed? Go see a specialist mechanic Hope this helps. Any questions or queries, please do not hesitate to ask. Best of luck, Daydra x Bariatric surgery in obesity: Changes of glucose and lipid metabolism correlate with changes of fat mass Original Research Article Nutrition, Metabolism and Cardiovascular Diseases, Volume 19, Issue 3, March 2009, Pages 198-204 F. Frige', M. Laneri, A. Veronelli, F. Folli, M. Paganelli, P. Vedani, M. Marchi, D. Noe', P. Ventura, E. Opocher, A.E. Pontiroli Show preview | PDF (216 K) | Recommended articles | Related reference work articles 2 Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients Original Research Article Journal of Hepatology, In Press, Accepted Manuscript, Available online 20 September 2013 Heidi Immonen, Jarna C. Hannukainen, Patricia Iozzo, Minna Soinio, Paulina Salminen, Virva Lepomäki, Ronald Borra, Riitta Parkkola, Andrea Mari, Terho Lehtimäki, Tam Pham, Jukka Laine, Vesa Kärjä, Jussi Pihlajamäki, Lassi Nelimarkka, Pirjo Nuutila Show preview | PDF (808 K) | Recommended articles | Related reference work articles 3 Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery Original Research Article The American Journal of Medicine, Volume 121, Issue 11, November 2008, Pages 966-973 Joshua G. Leichman, Erik B. Wilson, Terry Scarborough, David Aguilar, Charles C. Miller III, Sherman Yu, Mohamed F. Algahim, Manuel Reyes, Frank G. Moody, Heinrich Taegtmeyer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 4 Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism Review Article Best Practice & Research Clinical Endocrinology & Metabolism, Volume 24, Issue 5, October 2010, Pages 745-761 Silvana Pannain, Babak Mokhlesi Show preview | PDF (355 K) | Recommended articles | Related reference work articles 5 Progressive Regression of Left Ventricular Hypertrophy Two Years after Bariatric Surgery Original Research Article The American Journal of Medicine, Volume 123, Issue 6, June 2010, Pages 549-555 Mohamed F. Algahim, Thomas R. Lux, Joshua G. Leichman, Anthony F. Boyer, Charles C. Miller III, Susan T. Laing, Erik B. Wilson, Terry Scarborough, Sherman Yu, Brad Snyder, Carol Wolin-Riklin, Ursula G. Kyle, Heinrich Taegtmeyer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 6 ESR1 gene and insulin resistance remission are associated with serum uric acid decline for severely obese patients undergoing bariatric surgery Original Research Article Surgery for Obesity and Related Diseases, In Press, Corrected Proof, Available online 14 November 2012 Weu Wang, Tsan-Hon Liou, Wei-Jei Lee, Chung-Tan Hsu, Ming-Fen Lee, Hsin-Hung Chen Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 7 American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient Review Article Surgery for Obesity and Related Diseases, Volume 4, Issue 5, Supplement, September–October 2008, Pages S109-S184 Jeffrey I. Mechanick, Robert F. Kushner, Harvey J. Sugerman, J. Michael Gonzalez-Campoy, Maria L. Collazo-Clavell, Safak Guven, Adam F. Spitz, Caroline M. Apovian, Edward H. Livingston, Robert Brolin, David B. Sarwer, Wendy A. Anderson, John Dixon Show preview | PDF (1294 K) | Recommended articles | Related reference work articles 8 Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Review Article Surgery for Obesity and Related Diseases, Volume 9, Issue 2, March–April 2013, Pages 159-191 Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 9 Bariatric surgery and the gut-brain communication—The state of the art three years later Review Article Nutrition, Volume 26, Issue 10, October 2010, Pages 925-931 Maria de Fátima Haueisen S. Diniz, Valéria M. Azeredo Passos, Marco Túlio C. Diniz Show preview | PDF (156 K) | Recommended articles | Related reference work articles 10 Postoperative Metabolic and Nutritional Complications of Bariatric Surgery Review Article Gastroenterology Clinics of North America, Volume 39, Issue 1, March 2010, Pages 109-124 Timothy R. Koch, Frederick C. Finelli Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 425] Bariatric surgery has become an increasingly important method for management of medically complicated obesity. In patients who have undergone bariatric surgery, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively. Bariatric surgery can reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergone bariatric surgery require indefinite, regular follow-up care by physicians who need to follow laboratory parameters of macronutrient as well as micronutrient malnutrition. Physicians who care for patients after bariatric surgery need to be familiar with common postoperative syndromes that result from specific nutrient deficiencies. 11 Update: Metabolic and Cardiovascular Consequences of Bariatric Surgery Review Article Endocrinology and Metabolism Clinics of North America, Volume 40, Issue 1, March 2011, Pages 81-96 Donald W. Richardson, Mary Elizabeth Mason, Aaron I. Vinik Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 425] Obesity is a disease state with polygenic inheritance, the phenotypic penetrance of which has been greatly expanded by the attributes of modern civilization. More than two-thirds of obese persons have comorbidities, many of which are characteristic of cardiometabolic risk syndrome (CMRS) in addition to other life-quality–reducing complaints. The CMRS is associated with increased cardiovascular events and mortality. Individuals with a body mass index greater than 35 infrequently achieve or maintain weight loss adequate to resolve these metabolic and anatomic issues by lifestyle or pharmacologic strategies. Data suggest that some of these patients may be better served by bariatric surgery. 12 Secretion and Function of Gastrointestinal Hormones after Bariatric Surgery: Their Role in Type 2 Diabetes Review Article Canadian Journal of Diabetes, Volume 35, Issue 2, 2011, Pages 115-122 Alpana Shukla, Francesco Rubino Show preview | PDF (1234 K) | Recommended articles | Related reference work articles 13 Cirurgia bariátrica: como e por que suplementar Review Article Revista da Associação Médica Brasileira, Volume 57, Issue 1, January–February 2011, Pages 113-120 Livia Azevedo Bordalo, Tatiana Fiche Sales Teixeira, Josefina Bressan, Denise Machado Mourão

Thank you, I agree that the dietician would likely give me better insight than the surgeon, however, she's already given me her recommendations, so I'm sticking with them. I think I indicated in my post (if not, I did in one of these responses) that I didn't believe that I actually need a change in diet. I believe it's some combination of increased hydration and my body's reaction to the calorie normalization. But, at any rate, the post was about the interaction with the surgeon, not any "failure" to lose weight. The entire issue was that I was angry at being marginalized. I saw a therapist for a few months before surgery, but we determined that there wasn't really a need for me to continue seeing her unless I ran into something I felt I needed to work out. All of my closest friends are therapists and social workers. I talk to them about everything. It will be pretty easy for me to identify when/if I need to see a therapist. So far, I haven't had the emotional sh*tstorm I expected. No tears, no increase in depression, no sense of loss or grief. Short tempered at times, but that's pretty much my baseline. I used the clinic therapist for my psych eval. I would not consider seeing her for therapy. She was very nice, but her idea of a psych eval was a 25 minute telephone conversation. Thank you very much, $275, please! I didn't know that was what I was in for until she didn't make it to the scheduled appointment and rescheduled me for a phone "interview". I would have used my regular therapist, but she couldn't do it, so I just used the one at the clinic because I figured it would be less hassle. That part was definitely true... All of that is neither here nor there. At any rate, a therapist isn't going to tell me all the deep dark secrets of how the metabolism works, and I'm not stressing over weight loss. I'm just angry about my interaction with my surgeon during this appointment.

Okay... 2 things. 1 - I hope you are not implying that by looking for information from professionals and published resources, I am somehow searching for the answer I "want" to hear, because I feel that it would be foolish to blindly accept advice on my health decisions from someone on a forum that I have never met or particularly noticed the quality or tone of their posts, just because they say they know what they're talking about. Perhaps that part of your response wasn't directed toward me... 2 - You seem to indicate here that you believe I must be gorging or stuffing myself when I eat. You stated in your previous post that you often were so full you felt sick after you would eat. I admit to having made some mistakes on tolerable volumes and the appropriate speed which I can eat without discomfort during the learning process, but I currently rarely feel ill or any discomfort when I eat and am especially careful when eating any dense protein because I am still adjusting to that. Perhaps you assume I am doing the same thing you did? Okay, maybe 3 things... I actually do take offense to the implication that I am somehow trying to "cram" in calories. I am eating under my nutritionists guidelines. If you think it's silly to follow that recommendation, so be it. I would recommend that you don't follow it. Let me be very clear here. I understand that you believe you are right. And since you have been very successful, you clearly are right for you. However, I've never me you. To me, you are "a random". I'm unlikely to take your advice over someone I know to have a degree in nutrition, and that I found to be reasonable after lengthy discussion.

Thanks! I appreciate the response. I linked an abstract in a previous response stating that there wasn't any clinical benefit to going below 800 cal. Not likely to be true for every single one of us, but it was true of their test subjects (obese women). I have heard the "starvation mode is a myth" statement before. This 2013 article from Clinical Science states otherwise, well depending on how you define "starvation mode", but I think of it as the reduction in TEE as described in the paper. It's under Energy Expenditure in "Physiological Adaptations to Weight Loss" http://www.clinsci.org/cs/124/0231/1240231.pdf Leibel, R. L., Rosenbaum, M. and Hirsch, J. (1995) Changes in energy expenditure resulting from altered body weight. N. Engl. J. Med. 332, 621–628 Sorry, that tiny font was the citation for the article that was used to support their claim. I tried to make it bigger, but the copy and paste just doesn't seem to want to play nice. Now I've got funky font size that seems resistant to change in my regular text, too! Your statement of your calorie balance actually lends support to my belief that there should be no reason for me to drop any lower in calorie intake than where I am to lose weight. You weigh almost 100 pounds less than me, are 2 inches shorter than me, 18 years older than me, and I can all but guarantee you are built (what... finer than me? Smaller boned? Less stocky? None of that sounds good...) At any rate, I probably have a bigger bone structure, yet you lose at up to 1050. Yet, my doctor believes that I was telling her that I wasn't able to lose at 1100 (not exactly the impression she would have been left with had I been allowed to finish any of my attempts to explain my concern or answer her questions.) Her response was that I should eat less than 1100. I just can't buy that without some proof, because I don't believe that is the problem.

Pre op was rough! Thanks for the support. Truly, though, my post wasn't intended to ask for advice, though I am always willing to considering something offered in good spirit. I was primarily just throwing my bad experience with my surgeon out into the universe to vent, but I always hope that whatever I share might in some way benefit someone else (if only in that misery loves company...) I have been doing a ton of reading. I actually bought the books my surgeon suggested. The one I didn't list was "Why We Get Fat" (I forgot about it until I went back over my notes from my appointment). Turns out, this one seems like I may find it valuable. However, I found it hilarious that the first couple chapters seem to be dedicated solely to how doctors have been blaming patients for their obesity for decades when there is a significant amount of research that directly contradicts "calories in/calories out" and that most research indicates that neither calorie restriction, nor increased exercise actually works to keep weight off, except rarely. Yet there she was, adamant that I must be doing something wrong if my body wasn't responding the way we expected. I don't know... maybe she was sick the day she read those chapters... Just like I was sick that day in Kindergarten when we learned sharing...

Absolutely! We always have to decide how much to trust, which advice we're going to take, what recommendations we can live with, the list goes on and on. At the very base, we have to be willing to learn enough and be confident enough to be our own advocates when we feel like something is off. We should never be made to feel that there is a question we shouldn't ask or a concern that we shouldn't voice. Thanks!

Thank you! I appreciate your well wishes and sharing your experience. Excellent example of how everyone and every program is different! I would like to respectfully point something out in your response. As I read it, it seemed like because of your specific experience or paradigm, your statements allude to the exact kind of judgement I received from my surgeon that infuriated me so, though I'm sure you didn't mean for it to come off that way. You state that you can't imagine how I can make it to 1100 without eating high calorie protein shakes and remind me (more than once) that I should eat protein first. You state that if I were doing that, there wouldn't be any room for any of that carby foods and junk. You can't know what I have room for, because you can't know the exact size of my sleeve, and you can't know what and how I eat, because I haven't told you other than the number of calories and macronutrient ratios over the week previous to my appointment. I'm not offended, I just wanted to point it out, because my recent interaction made me particularly aware of this. I also know that I have unintentionally made judgements based on my own paradigms and am going to have to work at identifying and stopping it whenever I can in the future. Intake not even as low as yours didn't work out for me too well. I was managing to get my protein minimums in most of the time (though, admittedly, my tracking was beginning to get a bit dicey. It seemed hardly worth doing when my intake was so low.), and my lab results showed that dehydration wasn't the issue, so that pretty much leaves me with calories as the culprit, as my doctor also believed. I do make use of a protein supplement most days to make sure I get it all, but no, they are not particularly high cal. If I make something higher calorie like a smoothie, it balances out because it replaces a midmorning snack and takes me until afternoon to finish it. Some solid protein sources still feel a bit like rocks, so I'm still relying somewhat on plain greek yogurt, kefir, cheese, and milk. Not ideal, but it gets the job done. My nutritionists plan provides some servings of carbohydrates, and some carbs come with protein-rich foods as well (dairy, beans). Also, your surgeon may have made your sleeve smaller than mine. I discussed sleeve size with my surgeon before the procedure, and she stated that she feels that going slightly larger reduces risk of stricture. A goal I can enthusiastically get behind, and since I would prefer to lose slower rather than faster, that was a-ok with me. I believe I read an article that stated that ultimately, the capacity of any one person's sleeve is someone affected by their height, basically due to the slightly longer length of the stomach in taller people (I may be off on that statement because it seems like it was one of the early things I read when I was researching, so if someone recalls a paper that said something different, I apologize.) I also recall reading an article that stated that the size of the sleeve doesn't indicate patient success. This paper states that there is "no clinical advantage" to reducing caloric intake below 800 cal. in a VLCD http://ajcn.nutrition.org/content/55/4/811.short My original post really wasn't about my diet or intake, so I'll just stop here, except to say that I'm not comparing the way I used to eat to the way I can eat now. It would have been extremely foolish to think that I would eat the same after surgery. My calorie comparison from before surgery was simply to illustrate the idea that the surgeon seemed to be under the impression that my body virtually instantly took a nearly 60% crash in it's caloric expenditure (if we take the possibility of me lying off the table). If that were truly the case, it would warrant more investigation that simply being told to eat less. Thanks again for your thoughtful response.

Thank you, I appreciate it! I definitely do overthink... everything!!! I am constantly recalculating plans and responses in my head at every turn for whatever I'm dealing with, weight loss included. It has served me well in most cases, but I'm sure I could have benefitted from not trying to control things so much, and I'm sure when action was required, I would still have made good decisions. Unbelievable that a surgeon (not just a general practitioner, but a surgeon) wouldn't have kept up at least on bariatric surgery in general... Good grief!