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Fiber is not used by the body for energy, that is why it can be subtracted from the carb count on a low carb diet. However, lots of low carbers count everything. It's a personal preference thing. I have always paid attention to the net carbs, even though all carbs are logged. I do think subtracting sugar alcohol carbs might not be the best practice. Sugar alcohols are metabolized differently by different people. To be on the safe side, I count them.

@@OKCPirate Thank for the reading by John Grisham! Indeed, a very good narrative! As I have said, I don't have a problem with people drinking alcohol - if it's not contraindicated for them for whatever reason. I stand firm in my belief that for those who have WLS, alcohol has no place in their "diet." Very much enjoyed the video! Connie

Hi GG so happy that all went and is well for!! And for an update with me........I did horrible, horrible for the new years weekend lots of food and alcohol and because of this I have a 5 pound gain. I think I am still in shock!

I loved food too. It was my best friend and my worst friend at the same time. I could eat anything and everything and in mass quantities. Do I miss it? Hell no. It's there for one reason only now -- to live. I don't obsess about it, I don't care about it. Yes, I enjoy a good meal when I have it. But that's it. IT'S BEING NORMAL. And frankly, it's wonderful. I get to enjoy the food that I eat, but after I'm done, I'm truly done -- mentally and physically. So, you will still get to enjoy food (maybe not right away, but when you're down the road a bit) but just not in the mass quantities or the number of times you currently eat. I can eat anything now (I'm almost 9 mos. post op) -- there are somethings that I don't eat because I'm reluctant to try them (alcohol being one), but I'm sure I'll get over that hurdle someday too. But really, I can eat ANYTHING. The thing is, is that I really don't WANT to eat everything like I used to. For instance, yesterday, we went to a BBQ -- I ate steak and salad. I was happy. I didn't really have room or the desire for dessert, so I had coffee. I was happy. For dinner we went out, and I had steak again (it was a steak day) -- I was really really happy. I came home and made us all a low carb dessert with Jello pudding and real whipped cream -- it was great, but I couldn't finish it all. So I didn't feel deprived, I ate what I wanted and then stopped when I was full. And that's what will happen to you too. Hope that helps!

How interesting and true what you're all saying. The other thing I'd like to add that food is an addiction for most of us, but unlike other addictions (alcohol, drugs, gambling) we NEED to be in contact with our addiction in order to survive.So we can't give up completely on food, we have to live with it, prepare it, handle it, and try to avoid it at the same time! With alcohol, drugs you can stay away from it completely, and I'm not saying it's easy, but trust me to have the most difficult addiction to deal with

You can make your own refreezable ice pack with a gallon freezer bag. Fill it with 3 cups of water and 1 cup of rubbing alcohol and then just put it in the freezer. Make two so you can always have one ready to go while you are using the other one.

I agree, we will probably all be put in situations where we question old friendships. Recovering alcoholics and drug addicts have to revisit the foundation of friendships too.

Hi everyone, I am coming to ask all who has been sleeved if my fears are irrational or not normal. did you have these same fears? I am so scared of not waking up after surgery I am scared the surgery wont work. I am scared I will wake up and for whatever reason, come to find out the docs had to stop surgery and I am not sleeved. I am scared that after going thru surgery, my body will just have a major freak out and I will have a heart attack and die or that my body wont like the changed and just give out. I have paroxysmal atrial fibrillation (heart arrhythmia that causes the heart to quiver instead of beat. It can cause blood to pool in the atria of the heart which rises my chance of stroke by 5 fold. I have an "attack" about once a year. otherwise im fine). my cardiologist has cleared me for surgery. I have zero other health issues. I am 28, and very healthy. im just obese with my a-fib. I have never smoked and my last alcoholic drink I had was when I was 19. (not one word of a lie). for a big person I have oretty good stamina when it comes to exercise also. my cardiologist wrote a clearance letter for my surgeons and anesthesiologists. in the letter is says : "Aliesha's chances for serious perioperative cardiac complication is 1% and her Lee Index for a serious post operative cardiac complication is 0.4% equivalent to low" I know that pretty much sums up that I should be ok for surgery, but I cant help now that surgery is 2 weeks away, be absolutely terrified. TERRIFIED. I just want to live a life where I am healthy, lighter, and free from this prison. But I have to ask..........what is the risk? is it worth it?? Any insight would be much appreciated. Thank you.

I'm on my two week pre-op too and it's the same. I can eat mostly normal, just no carbs, alcohol, or high fat foods. Sent from my Pixel 3 using Tapatalk

Olay so..... Most docs, NOT all docs. This is something that I spoke with MY doctor about before I started. I got the okay. Maybe I should elaborate more. I make a mixed drink with less than a single shot and have yet to finish one. I have not ever gotten drunk since surgery, barely even a light buzz. Because I listen to my body. I don't consume more than 800 calories a day, including the alcoholic drink. I have lost 31 pounds and hit onderland. I have averaged over 4 lbs of weight loss a week. Please don't criticize me and my Journey. You're not me. I'm not fooling myself. I'm not dependent. I don't get drunk. And I'm still losing weight. We are here to support each other. You may not like that I drink, but you have no right to judge or criticize. Sent from my SM-N950U using BariatricPal mobile app

Hi - my surgery was mid August and I have had alcohol ( mainly white wine) on a few occasions without any side effects. I was told that 1 drink post op would be equivalent to 4 pre-op but I can't say I have noticed any difference. I'm certainly not squiffy after one glass! I would say "a little of what you fancy etc, but then that's probably why I needed wls in the first place!

Obesity Surgery Springer Preventing Wernicke Encephalopathy After Bariatric Surgery Erik Oudman, Jan W. Wijnia, [...], and Albert Postma Additional article information Abstract Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke’s encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76.3%), and eye movement disorder (73.7%). Younger age seemed to protect against mental alterations and higher BMI against eye movement disorders. The WE treatment was often insufficient, specifically ignoring low parenteral thiamine levels (77.2%). In case of suspicion, thiamine levels should be tested and treated adequately with parenteral thiamine supplementation. Keywords: Clinical nutrition, Dietary, Bariatric, Gastric, Obesity, Wernicke’s encephalopathy, Thiamine Introduction The prevalence of morbid obesity has risen to global epidemic proportions and bariatric surgery has been shown to be the most effective treatment to achieve substantial and long-lasting weight loss for morbid obesity [1–3]. In the past decades, the number of bariatric procedures performed has increased exponentially. Currently, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are the most commonly performed bariatric procedures with more than 500,000 interventions worldwide per year [4–6]. Wernicke’s encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from malnutrition and a possible adverse complication from bariatric operations. WE is characterized by the classic triad of ataxia, eye movement disorders, and mental status change. The prevalence rate of WE is 0.6–2% of the population, but the condition is often only discovered at autopsy [7]. Current guidelines for bariatric surgery suggest preventive thiamine suppletion (12 mg) in multivitamin treatment for all patients undergoing surgery, but higher doses for patients with suspicion for deficiency [8]. The aim of this paper is to review the clinical characteristics of WE after bariatric surgery, also referred to as “bariatric beriberi” [9] and to raise the clinician’s index of suspicion about this neuropsychiatric diagnosis and its preventability. Methods We searched MEDLINE, EMBASE, and Google Scholar, using MeSH terms (WE, Korsakoff syndrome, beriberi, restrictive weight loss surgery, gastrectomy). There were no language restrictions. Studies published from 1985 to 2017 on bariatric surgery with a diagnosis of WE were included. We reviewed the title and abstract of these articles, and indexed the data for year of publication, age, sex, BMI, onset duration and progression of symptoms, radiographic findings, treatment, and follow-up. All included studies were either case reports or case series, since information on the course of illness and symptomatology was often lacking in all group studies. The maximum number of represented case descriptions in one study was five [10]. One study reviewed four cases [11], three studies reviewed three cases [12–14], and eight cases reviewed two cases [15–23]. Cases were excluded if too little information was available to confirm a diagnosis of WE or no clinical characteristics regarding the patient or course of illness were available. Since the collected data is not a random sample of cases, and not likely to be normally distributed, nonparametric statistical procedures were applied (Mann-Whitney U test for comparison of two independent means, chi-square test for multiple means). The recorded data are either number of patients (percentage) or median (range) as appropriate. Results General Overview We identified 118 case descriptions in the published literature [9–101]. The most common bariatric procedure was Roux-en-Y gastric bypass [9–13, 15–18, 24–63], followed by sleeve gastrectomy [19, 64–85] (see Fig. 1 for an overview on the characteristics of the identified bariatric cases that subsequently developed WE). [https://www] Fig. 1 Bariatric procedure case descriptions (n = 118) leading to Wernicke’s encephalopathy (left), gender and age distribution of case descriptions on Wernicke’s encephalopathy after bariatric surgery (right, n = 113) ... Importantly, new cases of WE have continuously been published since the early beginning of weight loss surgery, and the total number of reported bariatric WE cases is growing per 2-year period (Fig. 2), suggesting that it is still relevant to review this differential diagnosis. Also, the total number of bariatric interventions (NHDS and NSAS databases (1993–2006) [102] and ASMBS database (2011–2016) [103]) has been rising each year [5], resulting in a relative decrease of WE cases per intervention (Fig. ​(Fig.22). [https://www] Fig. 2 Reported bariatric WE cases by 2-year period (left) and relative reported WE cases by 2-year period compared to general reference information from NHDS and NSAS databases (1993–2006) [23] and ASMBS (2011–2016) [102]. The red dotted line ... Descriptions of sleeve gastrectomy [19, 64–85] had a more recent publishing date (median 2014) than papers on Roux-en-Y gastric bypass [9–13, 15–18, 24–63] (median 2006) (U (85) = 301.5, p  [https://www] Fig. 3 Months after bariatric procedure, Wernicke’s encephalopathy was diagnosed per surgical procedure (n = 115) Vomiting We further analyzed the symptomatology in all case descriptions. Vomiting was the most frequently described presenting symptom (103 cases, 87.3%) and could be seen as the most relevant precursor of WE. From the literature, it is known that vomiting can also be a major complication in bariatric surgery and is one of the most frequent causes of postoperative readmissions [104]. Severe vomiting is not a normal situation after bariatric surgery and therefore further investigation in cases with frequent vomiting is indicated. In the present sample, non-vomiting cases were distributed throughout all onsets post-surgery, but only 5 out of 15 case descriptions were after the first year, suggesting that other causes than vomiting are likely to cause WE later post-surgery. Alcohol abuse (2 cases), a malabsorptive bariatric procedure (2 cases), and a new operation for hernia (1 case) could explain the late onset in non-vomiting WE presentations, suggesting other factors that negatively affected vitamin B1 storage. Importantly, severe infections, such as postoperative intra-abdominal abscesses leading to thiamine deficiency [78], are also a common presenting feature of WE and are likely to relate to an adverse outcome of WE [105]. Wernicke Encephalopathy: Presenting Characteristics The most profound characteristic of WE in the reviewed case descriptions was ataxia (84.7%, 100 cases), presenting itself as gait abnormalities up to the full inability to walk or move. The second characteristic was an altered mental status (76.3%, 90 cases), presenting itself as delirium, confusion, and problems in alertness or cognition. The third characteristic was eye movement disorders (73.7%, 87 cases), such as nystagmus and ophthalmoplegia, resulting from extraocular muscle weakness. The full triad was present in 54.2% (64 cases), a percentage much higher than the originally reported 16% of patients that present themselves with the full triad in literature in post-mortem case descriptions of WE in alcoholics [105]. Post hoc analysis in the reviewed sample shows that patients presenting themselves with mental status change were older (median 36 years) than patients without mental status change (median 25.5 years) (U (66) = 262, p Moreover, patients with eye movement disorders had a lower BMI (median 45.6 kg/m2) than patients without eye movement disorders (median 52.1 kg/m2), suggesting that a higher BMI can protect against this symptom of WE in bariatric cases. Male patients that did not present themselves with eye movement disorders had a later onset of symptoms (median 24.0) than male patients that did have eye movement disorders (median 3.5) (U (33) = 49, p  Imaging CT scans of the brain did not reveal any significant radiological finding in all cases undergoing this procedure (13 cases), suggesting that CT imaging is not the most suitable imaging technique to detect WE. In 65.6% of the case descriptions where an MRI was performed (40 cases) the procedure revealed radiological alterations. This percentage is somewhat higher than the reported sensitivity of 53% in an earlier study on WE [106]. Of interest, positive MRI results were more frequently associated with mental status change (χ2 (1) = 3.9, p  Treatment: Too Little Too Late According to the European Federation of Neurological Societies and the Royal College of Physicians, 500 mg of parenteral thiamine should be given three times daily until symptoms of acute WE resolute. The treatment is lifesaving and has the potential to reverse this acute neuropsychiatric syndrome [107]. A total of 57 (47.5%) case descriptions were reported in detail on the treatment of WE symptoms. Suboptimal treatment, with relatively low doses of parenteral thiamine (Importantly, a progressive clinical course was visible in 31.6% of the patients (37 cases), resulting in post-acute deterioration of neuropsychiatric and neurological symptoms. This suggests that the diagnosis was easily missed, resulting in a lower likelihood of full recovery. Moreover, the detrimental effect of not treating WE promptly is visible in Fig. 4 showing that many of the patients who developed more than one acute symptom later progressed into chronic Korsakoff’s syndrome. This neuropsychiatric disorder is characterized by severe amnesia, executive problems, and confabulations, leading to lifelong impairment [108]. Patients that developed Korsakoff’s syndrome had significantly more acute symptoms (median 3 symptoms) than patients that did not develop Korsakoff’s syndrome (median 2 symptoms) (U (99) = 703.5, p  [https://www] Fig. 4 Long-term cognitive outcome related to number of acute symptoms (left), MRI outcome (middle, n = 55), and too low levels of thiamine treatment (right, n = 52) Although this finding was not significant, in the group that presented themselves with acute MRI abnormalities, more cases later developed Korsakoff’s syndrome (Fig. ​(Fig.4).4). Also, too low dose of a dose of thiamine suppletion therapy resulted in more cases of KS despite the lack of significance. Non-compliance Of interest, in 10.3% of the case descriptions (12 cases), non-compliance to the medication and follow-up medical regimen was reported. A lack of insight into a given situation is a relatively common sign of the acute and chronic phase of WE [105]. The patients did not follow their follow-up, did not take prescribed drugs, or discharged themselves from the hospital against advice, leading to adverse outcomes. Because of the severity of the syndrome, this aspect requires specific attention in the treatment of WE patients, and at risk bariatric patients. Discussion Persistent vomiting is a common symptom suggesting a complication after bariatric surgery [109]. Nausea, vomiting, and a loss of appetite are also common, non-specific symptoms of thiamine deficiency [8]. Ultimately, vomiting and a loss of appetite are also a preventable cause of thiamine deficiency [110], leading to Wernicke’s encephalopathy (WE) in the majority of bariatric case reports. Adequate, timely, prophylactic, and substantial thiamine treatment in all patients undergoing bariatric surgery is required to prevent the development of WE, which is a rare but severe complication. The present review highlights that current treatment was neither prophylactic, adequate, timely, nor substantial in the majority of cases, leading to worsening of WE symptoms, the development of additional WE symptoms, and ultimately chronic Korsakoff’s syndrome. One of the most remarkable findings in the present review is that the initial symptoms of WE are often not recognized as such, leading to a prolonged state of emergent WE. In 31.6% of the cases, the initial symptoms progressed into more severe symptoms, ultimately leading to chronic Korsakoff’s syndrome. Prompt treatment of the first symptoms suggestive of WE with high doses of parenteral thiamine replacement therapy is necessary to prevent further damage [110]. According to the European Federation of Neurological Societies and the Royal College of Physicians, 500 mg of parenteral thiamine should be given three times daily until symptoms of acute WE resolve [107]. Interestingly, guidelines for treating WE suggest that patients suspected of WE should already be treated as such [107, 111]. Additionally, prophylaxis of WE following early signs and symptoms is only achieved by use of parenteral vitamin supplements, since oral supplements are not absorbed in significant amounts [111]. Moreover, in bariatric surgery, it is always relevant to give prophylactic vitamin therapy, according to international guidelines, to prevent patients from WE. Of interest, newer methods for bariatric surgery such as sleeve gastrectomy and intragastric ballooning still can lead to WE, despite their relative benefits for the patient. Recently, Armstrong–Javors (2016) pointed out that new techniques lead to the primary risk factor of WE, namely vomiting, despite a theoretical advantage by reducing the stomach volume without bypassing the duodenum [112]. Suspicion for WE should therefore be equally high in more traditional surgical procedures and newer procedures. Also, the risk of developing WE due to vitamin B1 deficiency is not restricted to the first half year after surgery but appears to be lifelong, given other factors such as new infections, insufficient meals, or alcohol consumption [110, 113, 114]. Preventive education on the necessity of sufficient vitamin intake should be given before bariatric surgery is performed and is relevant in long-term follow-up. Bariatric patients in their teens or twenties are likely to be more protected for mental status change in the course of WE than patients in their thirties or older, as reflected in a younger age of non-mental status change patients. This finding is in line with earlier reports showing that age is the strongest predictor for postoperative delirium [115, 116]. Importantly, pediatric patients and young adults undergoing bariatric surgery therefore require more attention for sensorimotor problems, such as ataxia and eye movement disorders, besides prophylactic parenteral thiamine treatment. In this specific group, more attention to lifestyle training should be an essential element of treatment, since non-compliance is relatively higher [50]. Relatively more cognitive reserve in combination with non-compliance can leave symptoms of WE unnoticed for a longer period. Although eye movement disorders such as nystagmus and ophthalmoplegia were much more common in bariatric cases than those in the general WE population [113], a higher preoperational BMI was predictive for fewer eye movement disorders. Additionally, male subjects with longer post-bariatric onsets often had no eye movement disorders as a presenting characteristic of WE. It is likely that eye movement disorders represent the most severe form of thiamine deficiency, since it is also the least common phenomenon of the WE triad. Moreover, females are at greater risk for full thiamine depletion than males [8]. A possible mechanism of action explaining the protective effect of higher weight is a greater storing reserve of thiamine in severely obese patients in comparison with less severely obese patients. This mechanism of action has been referred to as “preferential intracellular thiamine recycling” [116], leading to relatively less thiamine depletion in patients with higher body weight. Often, cases with WE following anorexia nervosa present themselves first with eye movement disorders [117], suggesting that this symptom is likely to be the result of full thiamine depletion. This suggests that both patients with lower body weight, and female patients are at greater risk for developing WE, and should guide clinicians in preventive thiamine therapy [1–4, 118]. Radiologic imaging can be employed to support the diagnosis of WE, but is not always sensitive to WE symptomatology. Often, hyperintensities were visible in the thalamic region, the mammillary bodies, and the region around the third and fourth ventricle, in line with previous research on WE [7]. Our results show that MRI alterations are frequently associated with mental status change, but not the motoric aspects of WE. This finding is relevant, because it suggests that specifically in bariatric patients with motoric problems, such as ataxia or eye movement disorders, WE should be treated despite the outcome of an MRI. Non-compliance is common in WE patients following bariatric surgery (10.3%) and could be viewed as a more discrete symptom of the disorder. Patients with WE lack insight into their situation, due to the severity of the neurological problems [108, 110]. Education on the direct adverse consequences of malnourishment should be incorporated into the provision of information before surgery. After surgery, more automated checks on vomiting are relevant. A limitation of the present review is that we only reviewed case descriptions. Therefore, predictive information regarding prevalence rates and incidence rates is limited. Despite this limitation, the level of detail in the reviewed case studies leads to new insights into WE following bariatric surgery. Recently published studies on treatment perspectives of WE in general and psychiatric hospitals are alarming: European as well as American studies demonstrated that most patients did not receive thiamine at all or only received it orally in low doses [119, 120]. Both types of treatment lead to unnecessary cases of chronic Korsakoff’s syndrome characterized by severe amnesia, executive problems, and confabulations, leading to lifelong impairment [108]. It is therefore important to highlight the clinical signs of symptoms in this specific condition. In conclusion, there is a growing number of bariatric patients worldwide. Malnourishment-related WE is a rare but severe and preventable consequence of bariatric surgery that warrants attention given its rapid onset and detrimental course. All bariatric procedures can lead to deficiencies and therefore to WE. WE can be fully prevented by supplying prophylactic thiamine given either parenterally in vomiting patients or orally in non-vomiting patients. Mental confusion, eye movement disorders, and ataxia are often missed as crucial symptoms of WE. After the initial onset of symptoms, rapid treatment with high doses of thiamine is still a life-saving measure, directly ameliorating the core symptoms of WE. The large distribution of WE onsets suggests that bariatric patients remain more vulnerable to vitamin B1 deficiency for life, and therefore require lifelong routine follow-up on their B1 status. Acknowledgements We thank Topcare for supporting excellence of long-term care. We also thank Misha Oey for her advice, and textual suggestions. Compliance with Ethical Standards This review was conducted in compliance with the ethical standards. Conflict of Interest The authors declare that they have no conflict of interest. Ethical Approval Statement This article does not contain any studies with human participants or animals performed by the authors. Informed Consent Statement Informed Consent statement does not apply. Article information Obes Surg. 2018; 28(7): 2060–2068. Published online 2018 Apr 24. doi: 10.1007/s11695-018-3262-4 PMCID: PMC6018594 PMID: 29693218 Erik Oudman,[https://www]1,2 Jan W. Wijnia,1,2 Mirjam van Dam,1,2 Laser Ulas Biter,3 and Albert Postma1,2 1Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands 2Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands 3Department of Bariatric Surgery, Franciscus Gasthuis, Rotterdam, The Netherlands Erik Oudman, Email: ln.uu@namduo.a.f. [https://www]Corresponding author. 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In response to going out for food. I also had to go out to eat for a work function about 4 weeks after surgery. It was an Italian place that serves many courses so I was a little nervous of what my workmates would think as I’m hardly eating. So as they were all drinking alcohol I was looking at my water glass not drinking anything in fear that it would fill me up and I couldn’t eat anything. Then the cheesy garlic bread came. I wanted some so bad but couldn’t. Then the soup came. I could actually have this but everyone was done and I was still sipping it down and could only finish half the cup. Then it took awhile for the main entrees to come so by then I could eat my chicken. But they gave me 4 chicken breasts. I could only eat half of one. My boss kept looking at me like why isn’t she eating. He even asked me if it didn’t taste good. Which made me feel bad because it looked like I was wasting food. I did take home the leftovers but still. It was a little awkward but still glad I went. (No one at work knows I had the surgery.). This outing made me realize how much I used to eat compared to now.

(10/2 sleeved) The small sips and swallows improve really quickly. My first week I had a hard time with water and a drinking most things now I have no problems drinking and almost taking regular sips. So much changes every day! I’m ready for some substance but I have to wait until Tuesday! 😡 I am traveling from Dallas to Chicago this weekend for a wedding so please wish me luck around all of the good food and alcohol!! I really want a glass of wine!

Hi @MarceMonster. Here’s the formula I used to get to goal weight: • Start every morning with a Protein shake for Breakfast. • Eat 60–80 or more grams of protein daily. • Drink 64–120 ounces of fluids daily. (I drink tons of Crystal Light, or generic, sugar-free/decaf iced tea.) • Do not consume any starches or sugars. • Get all carbs from green veggies, legumes, and dairy products. • Do not consume empty liquid calories/sugar (fruit juices, ice cream, etc). • Try to avoid alcohol. It’s empty liquid calories that turn to sugar in your body and can lead to poor choices. • All Snacks must be protein-based (Jerky, nuts, cheese, Greek yogurt, deli meats, etc.). • Get some exercise 4-6 times a week. • Never leave the house without a plan for what you can eat and drink while you’re out. If necessary, bring food and drink with you. • Restaurant eating is not hard: 1) skip the bread; 2) order a meat (or legume/bean) dish; 3) replace the starch with a second vegetable; 4) skip the dessert. You’ll probably end up taking some of the meat and most of the veggies home for another meal. • Beef/turkey jerky is my secret weapon. It’s saved me more times than I can count, so I try to always have some in the car for emergencies. You can buy a bag of jerky almost anywhere. It’s kind of expensive and not great for sodium-restricted diets, but it’s also high protein, low fat, okay sugar, and a 3.5-ounce bag is a meal by itself! • If you fall off the horse, get back on immediately – at the next meal. Not tomorrow, and definitely not next Monday. That’s what got us here! • Go to Bariatric Support Group meetings in your area, if possible. • Participate actively in online forums like BariatricPal. • Read as much as you can about the process and the journey; and especially, read posts and articles from those who had their surgery a few years ago. Try to understand what lead to their successes and/or struggles. • Share your story and reach out to help others who are behind you in their journey. By helping them, you’ll help yourself as well. • Have a goal weight in mind and strive to get there. (I weigh myself every single day.) But also set lots of smaller goals. It’s fun and inspiring to achieve them. • Always be looking forward. Don’t look back over your shoulder waiting for the heavier person to drag you back. Let that person fade into history. • Believe that the slimmer person in the mirror is the real you. • A little vanity is okay. Enjoy how you look. Accept compliments graciously and don’t deflect them. Have fun trying on smaller-sized clothes that fit now. Compare before and after pictures. Take pride in your accomplishments! • Accept that this is a somewhat selfish process. That’s okay, too. You don’t have to apologize for it. And don’t let other people interfere with your progress. We have to make our weight loss program a priority in our lives. • But at the same time, recognize that your journey affects your friends and loved ones as well. Be sensitive to their reactions and their emotional needs, without allowing it to derail your program. • And finally, try to have fun losing the weight and getting healthy! Hold onto your determination! That's what'll keep you going during the difficult times and the stalls. Good luck!

@@FinallyFit50s - good list, plus guys near your age understand gravity wins, so relax, you look great and you are healthy. I'm not kidding that this is a number's game. It's not personal. The search means you have to almost ruthlessly cut lose people who don't match your criteria. I don't mean careless hurt people, I mean you have to stay focused on what's important to you so you are not distracted by the enabling alcoholic who worms his way into your life because you felt sorry for him (See http://www.bariatricpal.com/topic/352466-they-seemed-sanedating-horror-stories/). Its a process, it can be fun if you let it. It can be rewarding if you are so blessed. But I am always humbled by the reality that you have to be open for the blessings that fall into your lap unexpectedly. Somehow the universe seems to reward our efforts in unexpected ways.

2 months post op. Down 81 pounds. I tried the insurance route 3 times and all 3 times the ins.co would pull the no bariatric rider at the last minute. I paid out of pocket for mine, $13k. I gave them a check on 10/01 and was on the table 10/15. Dr required 2 visits. One was a “physical” more or less and the other was a sales pitch, the next day he was playing with my innards. 10/15 the day of surgery i was 381, 12/15 I’m 300. do what your dr says and the procedure will work. Water is critical, lots of protein, as few carbs as possible. I try to stay under 1000 calories and 20 carbs a day, and I’m usually able to do that the key is reading labels. Meat has few/no carbs- cook it simply and it’s perfect. Sauces and seasonings are the devil. I use a lot of garlic, salt, pepper and rosemary. And I grill everything beef, bird, fish... everything Dont graze eat. Figure out what you can “hold” and then only put 75% on your plate. i guess I got lucky- I have had ZERO complications post op. No bleeding, no dumping, no major pain, nothing. I went back to work after a week off... I was bored silly sitting at home that week I live and die by my 30oz yeti. I drink 3 cups plus a day. One before lunch, one before dinner, one before bed. Sometime I shoot some MIO or lemon in it. Somedays I have unsweet tea. I’ve been able to keep the soda and alcohol monsters away, but somedays I’d kill for a ginger ale Pouches of tuna and salmon and chicken are easy to carry in the car or work bag. A little thing I do is when I’m on dinner duty, I hit the free sample display at the deli. One cube of meat, one of cheese and I’m half full, keeps me from over indulging with actual dinner for a sweet treat, sugar free popcicles are just sweet enough to do the trick. Atkins has some good low carb/high protein bars. One thing I learned is the more you pay, the better they are. Exercise is difficult for me due to the nature of my work- I’m on a seagoing tugboat 9 months a year. So the whole boat is my gym- everything is 100 pounds or more, it’s difficult to get the cardio in though- you can walk only so many laps around my 150’ steel island.

@home alcohol & stress free kiss are grown ,husband on call 24/7 til Sunday plus I been working 7days a wknd since returning to work in September so a day of rest is in order for this girl.. plus I don't drink anymore

Hi all- I am a ER nurse and I have access many ports in my career and hand sanitizer is not a normal standard of care- Every healthcare professional who is giving you a fill should use cloraprepp which is a clear soap (alot like rubbing alcohol) or iodine. The hand sanitizer is weird and puts you at risk for an infection in my opinion. So on that not I would tell you to speak up, if you think what they are doing is not right ask questions. Now I will get off that soap box, I haven't posted much since my surgery but I love reading everyones input, I feel great now, I too, struggle with my diet at times, I am just trying really hard to stay positive and active. I am running a half marathon next weekend and I haven't done that for a few years, I am having a great time training, and I love that my body doesn't hurt all the time. Thanks for all of your positive energy and GG thanks for your recipes, I'm excited to try the chile. I think my kids would love it. I have been eating a lot of beans and legumes for there protein power. I hope all is well- stay strong all you A11's

It's pretty normal for all of us on the liquid stage. It goes away when then you will most likely have the opposite problem.. But the last poster has a good point about the sugar alcohols not helping.

I bought little 1oz and 2oz cups w lids to easily measure food. I made sf jello "shots" to be ready when I get home. Was odd making Jell-O shots without alcohol

Your post really got me in my feelings. I'm 27 and i know that's only a 6-year difference but the things i would do to go back to 21 and have wls then. I spend nights crying and thinking about it. The amount of things i have lost in 6 years because of my weight, it has taken my old friends, career and life opportunities. It hurts me to think about it. From 16 -21, I was pretty sociable but as the weight started creeping on, I wasn't even bothered about partying or alcohol, I started to fear going out to the shops never mind a bar or club. Regardless of whether my WLS outcome is successful or whether I am fortunate enough to get plastics, i'm always going have deal with mental and physical scars of being fat for so long, you have chance to nip it in the bud and spend the rest of your twenties being happy, healthy and still having experienced your fair share of alcohol and parties.

168! Spent last week on a cruise with its never ending food and alcohol. Still managed to lose 2 lbs! I love my sleeve!! Sent from my SM-G920V using the BariatricPal App

I like Syntrax Nectar powders. You can get samples of the different flavors, I find them less sweet than the ready-to-drink ones and no sugar alcohols to anger my healing tummy. BariatricPal also sells protein shots that are 3 ounces, fruit flavors, and pack a nice protein punch. They are sweet but go down easy when I need something quick.

Hi, I have not yet seen anybody talk about the lack of fizzy's in their diet?! And by this I mean that I was told that I could not have anything fizzy post-op. I have also experienced that fizzy drinks causes me to blotter out and feel really uncomfortable. Gazes have nowhere to go??? Anybody out there having similar problems? When I came back home after the op, one huge problem was what to drink if we went out socially. I am not big on orange juice and let's face it it isn't a low fat option! Coke is out of the question and so it lemonade! We experimented down my local pub with various drinks! My tipple is Brandy...like you wouldn't have guessed that! LOL. Very hard to make a long drink with a non fizzy option. After various unsuccesful (and sometimes hilarious or disgusting!) attempt, I am now having Brandy and coke but I flatten the coke first. That's ok when I am in my local as they put it in a pitcher and I have a great band of friends who take it in turn to stir the coke until it is flat. Sometimes a bit dangerous when some lovely landlord decide to put sugar in to flatten it quicker!!!! Do they not get the meaning of diet pepsi!!!!! Very annoying when we are going around town or when visiting friends. I normally end up carrying bottles of already flat coke with me! I also found that however well the coke is stirred, there are still remnants of fizz in it and it eventually still makes me feel blottered. My surgeon says that I should not find it a problem as I should not be drinking much alcohol as it is fattening...one I gave up my food, not my alcohol altogether as well!....two, I still need to have a soft drink option when socialising...or should I stay home as well!!!! Any kind soul out there who would like to share their wisdom on the subject?