James Marusek

Congratulations.

I am 29 months post-op RNY surgery. I put my approach to maintaining my weight loss in a short article at http://www.breadandbutterscience.com/Surgery2.pdf

Some people undergo WLS and lose significant weight only to gain some or all of it back years later. I asked my nutricianist "Why". Her response was grazing. Grazing is to eat small portions of food, as appetizers or the like, in place of a full-sized meal or to snack during the course of the day in place of regular meals. A recent study by University of California, Berkeley, may have found a correlation between sleep and body mass index (BMI). Breakfast and breakfast skipping is associated with weight gain.” This study seems to go hand-in-hand with another study. Another recent study found that reducing the eating window (the hours per day that one eats) reduces weight. http://acsh.org/2015/09/picture-this-a-food-app-that-could-improve-public-health/ The results from this study published in Cell Metabolism showed that the majority eat over a 15-hour period each day. Some research suggests that limiting the “eating window” to 10-12 hours per day may contribute to weight loss. Their sample size was small, but of their volunteers interested in weight loss researchers set the smart phone app to help them restrict food intake to a 10-hour window. Without changing the types of food they were eating over 13 weeks, this volunteer group lost an average of 3.5 percent of their initial weight per person. So it appears that to maintain the weight loss after you reach the Maintenance stage, one needs to control "Grazing". This includes limiting your "eating window" to around 10-12 hours per day and getting the nominal 7-9 hours of sleep each night.

Congratulations on quitting smoking. I think the real question is whether the minute amounts of nicotine might interfere with you upcoming surgery. I suspect the answer is no. I was wondering if you used an aid such as a nicotine patch or e-cigarette to stop smoking. I think these products might contain some nicotine and that could cause your nicotine levels to still be present.

If you had RNY gastric bypass surgery, then you have to cut out fats and sugars from you diet for awhile. This is because the part of your stomach that normally processes these fats and sugars have been cut away and your body can no longer handle these, otherwise you will experience dumping syndrome. As time goes on, your body will change and your intestines will learn to process these foods and then you will be able to eat these again. This will occur around 1 year post-op. So during this first year, you will be able to eat meat, it is just limited to very lean cuts with little fat. You may find that eating meats will be rough on your new stomach. For example, you may want to boil chicken breast in a pot for several hours on low until the meat is so tender that it comes apart readily with a fork. I personally relied on softer foods, such as homemade high Protein chili and Soups. They went down easier. So you are welcome to make foods without artificial ingredients for your meals. But the most important requirements of the program are meeting your protein, Vitamin and Fluid requirements. food IS SECONDARY. Your body is converting stored fat into the energy that drives your body. Thus you lose weight.

The most important elements of the program are meeting your Protein, Vitamin and Fluid requirements. In the beginning food is relatively unimportant. This is because your body is converting stored fats into the energy that drives your body. Thus you lose weight. So in terms of meals, my surgeon recommended 3 meals per day. But the volume of food in the beginning is incredibly small, only a 1/4 cup per meal. Making the transition to solid foods can be rough. I basically relied on softer foods such as home made high protein Soups and chili. They went down easy and had lots of flavor. I have included some recipes in a short article I wrote about my experience. http://www.breadandbutterscience.com/Surgery.pdf

Congratulations on your weight loss thus far. I think what you were trying to say was that you lost 25 pounds post-op and 15 pounds pre-op. At the 4 weeks post-op RNY, those figures sound about normal.

Weight loss is in the Weight Loss phase after surgery is due to portion control. In the beginning you are restricted to 1/4 cup per meal. If you want to gain the full benefits from surgery, you should try and restrict yourself to that amount. Your body will handle solid food different than liquids. I suspect once you get into the solid phase you may find overeating to be a little painful. After surgery the most important elements are meeting your daily Protein, Vitamin and Fluid requirements. Food is secondary because your body is converting stored fat into the energy that drives your body. Thus you lose weight.

Some patients develop strictures which cause the symptoms you are describing. One of the ways to detect this problem is with an EGD test. So it looks like you are following the right path. http://alohasurgery.com/strictures/

If you are almost positive you don't meet clinical criteria for night eating syndrome then I wouldn't worry about it. It sounds like you are too stressed out already. I remember there were times prior to surgery when I would raid the food cabinets in the middle of the night. I am 29 months post-op RNY gastric bypass surgery and I do not feel the urge to do that anymore. I wouldn't go to the extreme of buying cupboard locks at this time, just focus on the requirements for surgery.

In the "Weight Loss" phase after RNY gastric bypass surgery, weight loss is achieved by portion control. You begin with an incredibly small portion of 2 ounces per meal (or 1/4 cup) and eventually after 18 months work your way up to 1 cup per meal. In the beginning I was consuming 3 Protein shakes per day. I concentrated on consuming high protein meals and as time went on I was able to drop off one of the Protein Shakes and then another. But I wasn't able to get off all the protein shakes until I hit 1 cup per meal. At 15 days post op, the most important (essential) elements of the program are meeting your daily protein, Fluid and Vitamin requirements. food is secondary because your body is converting stored fat into the energy that drives your body. Thus you lose weight.

Good luck on your surgery. As far as liquids all I remember was ice chips.

Congratulations.

It seems like I was losing at a 2 pound per day rate for a couple weeks and then it slowed down. It is funny first you worry that you are losing weight too fast then you hit a period of not losing weight for a week or two and then you worry about that. I guess the best advice is just don't worry.

I think I went through that stage. It was even more interesting for me because I sleep on a Water bed. It was really difficult to get out of bed in the early days after surgery.

I was told no sugar and no alcohol but sugar alcohol is an artificial sweetener and as far as I know it is O.K. There are several different types of sugar alcohols. Some can cause diarrhea if taken to excess. An example is sugar free gummie bears. Sugar free pudding was on my list of acceptable foods from the very beginning of the program.

I found out that soft foods (chili & soups) work best for me. I included some recipes in a short article that I wrote. http://www.breadandbutterscience.com/Surgery.pdf

It might be reactive hypoglycemia. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

I had RNY gastric bypass surgery. The recommended dose after surgery was 500 to 1000 micrograms sublingual B12 daily. It must be methylcobalamin. I found a bottle of 2500 microgram (mcg) B12. I break these in half, so my daily does is around 1250 mcg. Since the bottle contained 200 tablets. One bottle was more than a years supply. I have no idea what dosage they wish you to take pre-surgery. You doctor or nutritionist should have specified a dosage range.

Welcome and good luck on your upcoming surgery. Let us know if you have any questions or need any help.

There are 2 different phases to weight loss surgery. These are "Weight Loss" phase and the "Maintenance" phase. The approach on these 2 phases are different. I had RNY surgery 29 months ago. This short article describes the strategy that I used for each phase. http://www.breadandbutterscience.com/Surgery2.pdf

I am 29 months post-op RNY. I purchased a set of measuring cups with the full range of sizes for my different meal volume stages post-op. Since I choose to eat primarily Soups and chili, it was easy to measure the exact size I needed for each meal. I still use them today. I also purchased a small metal spoon which I use when I eat soups and chili.

My vitamin D levels were within the acceptable range both before and after I reduced my level of Citrical according to my blood tests. When I was taking 6 Citrical's per day, my Calcium levels were 10.2 which was barely within the acceptable range of 8.6-10.3 mg/dL. Then when I dropped down to 4 Citrical's per day, my PTH Intact (another measure of calcium) changed to 72.7 which was out of the acceptable range of 7.5-53.5 pg/mL. The PTH level was high which indicates low levels of bone calcium.

Congratulations on the results of your follow up meeting. After I lost a lot of weight, some individuals mentioned that I was very skinny or extremely thin. My wife made comments that I looked like someone from the death camps at Auschwitz. Well this was not the case. I was in no way that emaciated or starving or extremely thin. It was just that I looked that way. One of the strange effects of weight loss was in the shoulders. After weight loss all my jackets, coats no longer fit. The sleeves of my jackets now hung down to my fingertips which gave me a look like the character Dopey in Snow White. Most times when you think of weight loss you think about waistline. You don't think about the distance from shoulder to shoulder. Long story short, I bought some new suits and sports jackets and I now look just right.

With RNY gastric bypass surgery, my body no longer synthesizes calcium from food. I know because I cut back from 6 Citricals per day down to 4 and they caught me. My blood work showed I was deficient and my nutritionist recommended I increase it back to 5 per day. I suspect this may not be the same for sleeve patients. You may have significantly more latitude.