PollyEster

In both North America and Europe, removal of anywhere from 70% to 85% of the stomach is standard, so when you study VSG statistics, be assured that the percentage of stomach removed is not a factor in determining successful outcomes. There’s also increasing evidence that VSG induces weight loss through other physiological alterations, not just restriction, including increased intraluminal stomach pressure, which causes early satiety; increased gastric emptying for faster small-bowel transit time; and neurohormonal changes, including the reduction of both fasting and meal-stimulated ghrelin production and increased glucagon-like peptide-1 and peptide-YY, an intestinal hormone that increases satiety. The most recent study I read that assessed the stomach volumes and pressures of several hundred patients in the US who had undergone VSG, where the standard bougie size for VSG is 32Fr to 50Fr, found that sleeve volumes held anywhere from 90 to 220 ml. Normal stomach volume is approximately 1,500 ml for both adult men and women; there is actually very little variation there. When the sleeves were filled with a volume of saline, the pressure inside the sleeve rose to 43 mm Hg compared with 34 mm Hg when the stomach was intact, meaning that VSG reduces the stomach’s ability to distend, thereby increasing the amount of pressure within the intraluminal space. This increase in pressure is what leads to the feeling of fullness, and allows us to drastically reduce caloric intake. It’s quite some time after surgery before we are able to eat with anything resembling speed, and part of our pre- and post-surgery routine should be building a vigilant mindfulness practice to train ourselves to eat slowly until doing so becomes a deeply ingrained neural behavior. Once you've entered maintenance (if not well before), you'll be grateful for the small volume and the restriction as it's essential for keeping the weight off long-term.

I’m very pleased to meet another WFPB post-bariatric athlete here! Although I’m not as active as you, I’m somewhat athletic (active 7 days a week with hill hiking, race walking, distance cycling, squash, cardio, weights, sea kayaking, downhill skiing, etc. and currently training for a triathlon in August), and once I’m into maintenance, consuming enough (and the right types of) fuel for workouts is – and will continue to be – an ongoing experiment for me. If you, like me, were athletic at any point in your life prior to weight gain or WLS, then you’ll know that athletes need to eat more frequently than non-athletes, no matter what type of food lifestyle they’ve chosen, typically at least 6 meals per day – 3 meals and 3 snacks, depending on the intensity of training. So my best advice is to structure every meal and snack so that they support your workouts. The timing of all meals and snacks should support optimal performance and recovery, so for example, if you train after work, save one of your snacks for about 1 hour beforehand, and eat dinner within an hour after completing your training session. Obviously you’ll also have increased nutritional needs for optimal performance and health during long distance cardio training and events such as cycling. The typical recommendation is that endurance athletes get 60% of their calories from carbohydrates on training and event days. To calculate this, take your calorie intake for the day and multiply it by 0.6. Then divide that number by 4 to get the number of carbohydrate grams you need daily to support optimum performance. For example, on a 1500 calorie per day diet, that number is 225 grams. Carb needs will go above and beyond this on days with longer training sessions but you might not be able to hit such a high number due to space constraints or fear of dumping, so all you can do is increase your carbohydrate count slowly over time to see how your body reacts, making sure to use a variety of high quality complex carbohydrate sources such as whole grains, fruits, and vegetables. The mixed grain cereal you’ve mentioned in other posts is ideal. Immediately prior to an endurance training session or event, the typical recommendation is for an athlete to ingest 1-3 grams of easily digestible high quality carbs per kilogram of body weight (bananas, figs, etc.). Bariatric athletes won’t reach that number, so the goal would be to increase carb consumption before an event to a level at which you are physically comfortable, then note any performance improvement. Foods high in protein and fat are digested more slowly, so are usually avoided in the hour before an event. Just keep experimenting with pre-race fueling to see what works best for you. During a training session or event, endurance athletes typically take in 30-50 grams of carbohydrates per hour. Bariatric athletes will need to spread this out in smaller portions (protein bars, energy gels, dried fruit, lightweight hydration back packs with added electrolyte and carb powders, etc.). After a training session or event, endurance athletes usually consume about 15 grams of carbohydrate within 30 minutes of finishing. One to two hours later, another portion of high quality complex carb rich food with some protein mixed in is needed for muscle recovery (i.e., banana with peanut butter, a glass of Ripple milk, etc.). I have read studies that indicate that glucose ingested while exercising is less likely to lead to dumping syndrome, but this is an individual thing to be approached extremely carefully, but in general plant-based whole foods like fruit do not cause dumping syndrome as far as I’ve read and can be used in place of sports drinks and gels. To address any increase in hunger due to training, or to supplement in order to maintain weight, in the past I found that low calorie high nutrient shakes are ideal (i.e. Ripple milk, a few nuts and/or seeds, ½ c berries, a handful of raw dark green leaves, and 1-2 tbsp of blended pea/soy/rice/hemp/chia protein powder, and if needed, a handful of steel cut oats that have been soaked in water overnight to soften). Most Americans, as well as virtually all WLS-post-ops in maintenance from what I have read on these and other boards, consume too much protein, but endurance athletes actually do need a bit more protein, anywhere from are 1.0-1.2 grams per kilogram of body weight. Remember that all plants have protein in them, and to count their protein towards your daily intake. Re hydration, I monitor this closely, particularly at my early stage post-op (I use a hydration pack and will continue to). Taking a before and after workout weight on a calibrated digital scale is an excellent way to determine hydration status. If the post-workout weight is lower than the pre-workout weight, you’ll be able to track exactly how much water was lost through sweat and respiration. In terms of micronutrients, some endurance athletes may have increased needs for vits a, c, and e, as well as iron, calcium, potassium, sodium, and chloride. Get regular labs, keep taking vits, and rehydrate with electrolyte drinks or powders (I like Ultima Replenisher). Finally, investing in a WFPB bariatric nutritionist is worthwhile because calibrating nutrition for a post-bariatric athlete is both difficult and very individualized. Parts of what I’ve written here comes directly from notes I made during sessions with my own WFPB bariatric nutritionist. I will also try to put together a brief recommended reading list within the next day or two. Disclaimer: These suggestions are intended for bariatric endurance athletes in maintenance ONLY. If you are exercising at a low to moderate intensity for less than 2 hours per day for 6 to 7 days per week, you don’t need extra nutrition, calories, macronutrients, or micronutrients to support your exercise or recovery, and doing so will only hinder your weight loss or cause weight gain.

There are many factors that dictate what our final stomach capacity ends up being. The first is bougie size. A 36Fr bougie with 75% stomach removal will give us a lot more restriction than, for example, a 50Fr bougie with 85% stomach removal. The tightness of the staple line against the bougie, and whether or not the surgeon oversews the staple line will further decrease the diameter of your sleeve. My surgeon uses a 40Fr on all of his patients, but staples extremely tightly along the bougie, meaning his patients should have greater restriction -- and fewer complications -- than those who have, say, a 34Fr with no oversewing. At 3.5 months for example, I still cannot eat more than 2.4 to 2.8oz per meal, and it takes at least 75 minutes to comfortably eat it. Those who had strictures requiring removal during surgery would likely have marginally more restriction. Scar tissue and gastric motility also play a role in restriction. More critical than any of these, however, are our eating habits, since they play the most significant and influential role in sleeve capacity, amount of weight loss, and long-term maintenance.

AZhiker, have you tried plain unsweetened Ripple milk made from pea protein? 1 cup/240ml = 70kcal, 8g protein, 0 carbs, plus iron, vit d, and dha omega 3's. It makes nice thick smoothies, but is delicious on its own over ice (or try it with a few drops of pure vanilla or other natural extract mixed in to switch up the flavour profile). As for protein powder, you might want to try the plain unsweetened pea protein powder, or one of the plant protein blends, from Canadian Protein (canadianprotein dot com). They've sustained me well since my VSG on Oct 15 - my labs are perfect. I've been WFPB for 7 years, and it's the best thing I've ever done for my physical health and mental well-being; at least as beneficial as my surgery and perhaps moreso in other ways. There are less than a handful of people on these boards that I follow, but I've very much enjoyed reading about all of your experiences and experiments here, and am excited about the continued benefits you'll reap with a WFPB lifestyle. All the very best you!

In the second image, is that a countertop water filter/purifier? If so, that's a great design. Can you please tell me what brand and model number it is? Thanks!

I lost 51lbs in 6 months while waiting for surgery, and I'll be 3 weeks out tomorrow and have lost 20lbs.

You look stunning! I'd believe you had an 11 and 2 year old, but kids... not grandkids. That's crazy 🙃 So well done and congrats!!

The first week after surgery I weirdly had loads of energy and was easily walking 2 km/1.25mi per evening, but over the last two days I'm observing some fatigue by mid-day. This is inevitable when you're taking in under 400kcal per day but still have a large body to move through space. I prefer walking at night when it's quiet and peaceful, but think I'll have to switch to mornings for the foreseeable future because I have more energy then. I intend to slowly work my way back up to 15,000 steps per day over the next little while, energy levels permitting. Will remain on a full liquid diet for the next couple weeks, but can't say I'm actually enjoying anything, even the cream soups. I have to eat protein, so I am eating it. As far as I can determine, my sense of taste and smell remain unaltered, but I neither like nor dislike any of the full liquid flavours. It's gradually getting easier to get in 8 cups of water per day. I'm following my two fellow Oct 15 sleever twins here 😊😊, and hope we all adjust easily and quickly without issue as the days go by and different foods are introduced.

Hi pssk, We had surgery the same day and I'm happy to hear you're doing well. My understanding is that a lack of energy is fairly common after surgery regardless of age; you'll have your mojo back -- and more! -- soon enough. My surgery was uneventful, and I'm very fortunate to be feeling well, too. Able to get in all clear fluids, water, and supplements, though it takes 15 hours to do it by taking the tiniest sips all day long. I walked 1.5km yesterday and today, but at a pace of someone with a walker 🙃 Down 4.2kg since Tuesday, which keeps blowing me away when I think of how much effort it took to lose this much weight before surgery. All the very best to you for your continued recovery!

I've tried Protein 2o (sucralose) and Ready Nutrition (stevia), but they need to be diluted with water to cut the sweetness. Syntrax Nectar powders work best for me, because I can mix them with whatever volume of water I prefer to adjust the flavour stength and sweetness.

Here's the calorie recommendation chart from my bariatric patient guide:

Well, it looks easier in print (and in hindsight) than when you're trying to live it. You're right, the struggle is real, but the result is worth it. Hang in there! In just over a week neither one of us will be hungry, and newly preoccupied with how to ever get all of those fluids and protein in 😬

Congratulations on that weight loss, 46lbs wow! I think your approach is very smart. Your actions now will improve your surgical outcome, and you'll be well prepared for the post-op phases. Hope you post updates here after your surgery. Wishing you all the very best!

This is the best possible news and I'm so happy and excited for you! We have similar stats and I can't wait for your updates to see what you achieve. Go, go, go Panda333!

So very pleased for you, well done! This is a fantastic surgery result, exactly how you wish it to be for everyone. I'm going in expecting a not-too-uncomfortable experience, but well informed and prepared to manage anything that isn't. I hope you'll post further updates here, and that you continue with good health and great results!

Linda, you are going to do this. Actually, scratch that. You ARE doing it! Even though I'm not on liquids before surgery, I have done this diet 3 times before, including for 90 days once (lost 80 lbs). The first 3 days are the hardest and you're two down already. As your body transitions into ketosis, any fatigue, hunger, lack of concentration, etc. will dissipate. No. 1 is to drink water like it is going out of style, staying super hydrated. No 2 is to go to crazy lengths to distract yourself from thinking about food - walk as often and as far as you can, see a movie, binge a few seasons of your fave show, read, get out of the house as much as possible, etc. No 3 is to stock your place with any allowable liquids such as sugar-free fluids, jello, popsicles, and clear low-sodium broth. Make your shakes more interesting by adding a squirt of Mio or a natural extract. Get lots of sleep. And keep the end goal in mind: you are taking compassionate, good care of your body and mind so that you have an optimal surgical outcome and a solid platform from which to spring into the post-surgical diet. In the overall scheme of life, 10 days is a blink of the eye! Hard at the beginning, but you'll persist and the rewards will be worth it. YOU are worth this.

Also Oct 15 🤜🤛

I'm wondering how you felt about rescheduling? For me, am surprisingly neutral about it, perhaps because this process has been going on so long that it's yesterday's news. It's like I have some sort of... sleeve fatigue. Maybe I'll feel a bit excited about it again a day or two before surgery.

Grass is always greener 🙃 I hope it turns out to be lot more comfortable that you think it will.

My surgery was rescheduled from Sept 23 to Oct 15. No liquid diet, just continuing to eat clean plant-based whole foods. Possibly am some sort of bariatric alien because I feel a bit envious of the Opti-Fasters. I love protein powder mixed with plain water and am actually looking forward to not having to bother much with food and food preparation for a couple of months after surgery. All the very best wishes to my fellow Oct sleevers 😊

Hi Linda, I just logged on to hopefully find out how you were doing after surgery, and see that it was rescheduled. So was mine, to Oct 15. So our surgeries are still only a day apart. Too weird!

You can let it go flat before drinking it if you can't tolerate the carbonation. Another alternative is to brew your own. It's fun, and allows you to completely control the amount of carbonation as well as the length of the ferment. A longer fermentation time increases the amount of pre- and probiotics, and decreases the amount of sugar leftover after fermentation. There are many online resources on how to make your own, and you can even buy a high-quality SCOBY on Amazon. It costs very little to get started, no more than $20-$25, and you can drink your first batch in 5-10 days. I brew my own, using fresh fruits and herbs as flavoring during the second ferment, and an 8oz serving costs just under 23 cents. Measured with a brix refractometer, it contains less than 1 carb (the SCOBY utilizes all of the sugar during longer ferments, but this also makes the drink more sour, which may be an acquired taste). I also make kombucha jello and gummies with agar agar powder, and add protein powder after the mixtures have cooled but before they start to set. Tasty, super healthy, protein-packed energy shots!

Thank you Linda72 😊 We're almost there! All the very best wishes to you for a safe surgery, speedy recovery, and all the support and encouragement you need to reach your goal.

Hi! September 24. With just a few weeks to go, I'm simultaneously excited (massive weight loss!) yet scared (no complications please!). Round and round and all that...