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Cutting back on carbohydrate foods is something you start when you enter our program. This is to help you start losing weight and shrinking your liver before surgery. For this posting, the discussion will be about “net” carbs. Many of our patients enter the program with diabetes and pre-diabetes. The benefit of finding the “net” carbohydrate of a food serving is cutting back on the total amount of carbohydrates you consume, which can lead to better blood sugar control and some weight loss. “Net” carbs have also been listed on food labels as “impact carbs” or “effective carbs.” The food label can be a source of confusion, because there can be several types of carbohydrates listed under the total carbohydrates. Fiber and half the sugar alcohols can be subtracted from the total fiber to calculate “net” carbs. Fiber is a type of carbohydrate that our bodies don’t absorb and doesn’t raise blood sugars. Fiber is in plant foods (grains, beans, fruits and vegetables,) helps with digestion and leads to feeling fuller longer. Sugar alcohols are still part of the carbohydrate world, but don’t raise blood sugars as much as other carbohydrates like sugars and starches. Sugar alcohols are used to help a food product taste sweet with less ability to raise blood sugars. Sugar alcohols can be found in the ingredient list and may include sorbitol, xylitol, mannitol, isomalt, erythritol, glycerol (can also be listed as glycerine,) hydrogenated starch, maltitol, lactitol or other ingredients that end in –ol. Be aware that sugar alcohols still have calories. Consuming too many sugar alcohols at a time can also lead to bloating and diarrhea. Click here for an explanation about how to calculate the net carbs from a high fiber food item. Click here for an explanation about how to calculate the net carbs for foods containing sugar alcohols. Keep in mind that the FDA has not approved a definition of net carbs. Your dietitian will work with you to find a carbohydrate goal to help you keep your blood sugars in better control and to start losing weight.

I was really looking forward to becoming a cheap date so I was a little bummed out when my tolerance didn't really change. I find the way alcohol affects me different now???? and you should be careful re: driving. You likely would blow over after a drink or two. I like vodka and water with added flavours.. Crystal light or dasani, yum!

I had my pre op "life after surgery" class today. My husband didn't want to go with me, because he didn't want to leave our almost 14yr old daughter in charge that long. Even though it felt like an excuse, I went on by myself. When I got home, I tried to tell my husband about the things we went over in class and he didn't want to hear it. I told him he should read the booklet we were given so he'd know what I need help-wise after surgery and he said "why should I read it? You're the one who needs to know!" When I showed the kids the 2oz cup that represents how much mommy's new pouch will hold he just muttered "that's just dumb!" And wouldn't talk about it. He griped because I told him I can't use the protein powder he bought for himself for my post op because of the sugar/sugar alcohol content and he asked why so I told him and told him it's all laid out in the booklet I asked him to read and he just turned around and walked out. I don't understand what's going on!

It's the body eliminating all of the fat and impurities that have been stored up in the fat cells. It eliminates it any way it can - through urine, bad breath, sweat glands, through the skin - in any manner possible. One friend of mi e who was sleeved felt greasy for the first 3-4 months - wiping her arms and coming away with fat that had come through the pores in the skin! All sweat and secretions are a bit more offensive because they're old fat and old impurities. Consider the zits a win! I keep towelettes at hand to wipe my face, underarms and other places to ward off the sweat; maybe alcohol pads or make-up remover pads would help the zits. Drink more water; that's the best think for you.

Hi everyone, just a quick update on where I am - three months (wow) after I last posted. I was sleeved on 1st March - starting weight 292lbs and BMI of 45! Today, I am 194lbs and my BMI is 29.4! So there's been some pretty big milestones for me - falling below 200lbs, falling below 30 BMI (I'm officially not obese anymore!). I'm now fitting into jeans with a waist of 32 inches! I went shopping a week or two ago and couldn't find jeans in my size - because the jeans that I wanted were only in store in sizes too big for me! I don't think I've ever been unable to buy something I wanted because they didn't have any that were small enough. Most days I don't even remember I've had a sleeve. I can eat everything without trouble, I can drink everything without trouble. This is good because it means that when I go out to eat, there's nothing I can't order - though naturally I tend to stick to starters, or else to food that can be easily boxed home and brought away. It also means that I can go out and drink alcohol - I'm not a big drinker but there are times when I do like to go out with friends and drink and, yes, get drunk. I know it's empty calories etc - but my view from the start is that I want to be as healthy as I can be while still living the life I want to live. For the same reason, I do allow myself carbonated drinks - only diet - even though I know a lot of people on here are dead against it. Has it stretched my sleeve? I don't think so - my appetite is still pretty low. My eating habits before surgery had two big problems - Snacks and meals. Snacks is still a problem in that I can eat chocolate, popcorn, crisps etc as if I never had surgery. So I need to be really careful with them - I haven't cut them out completely. I know some people find it easier to cut them out completely rather than try and control them but I didn't want to do that (and I know it wouldn't be sustainable for me) so I focus on control and making sure I count any snacks when I count my daily calories. Meals are where the sleeve has really helped me. I loved chips (proper British chips - not American chips) but now I can't eat more than two or three with a meal, so I never order any, instead I might steal one or two from my partner when we eat out. Before surgery, I could have a big burger, big plate of chips and a side of onion rings, and still had room for a doughnut or sweets afterwards. Now, if I was going to have a burger, I might just about manage a hamburger on its own. Most of the time, I have a sandwich at work, and I can just about manage a standard sandwich (i.e. two slices of bread and some ham or chicken). So even though I'm not perfect on snacking (and I do need to be more disciplined), I've cut down so much calories on meals. So I'm pretty happy with where I am. I still have another 30 or so lbs to lose. I know that will be slow and I'm OK with that. I also know that I need to start being more and more aware of the risk of slipping back upwards. But so far so good.

I agree with @Babbs. Though it took me a minute to be ok with getting rid of clothes (out of fear of this not working) I'm glad I did. Alcoholics don't hold on to a bottle of liquor just in case they fall off the wagon... I see this no different. Bras are my pet peeve. I get they can be pricey, But they do so much for how your clothes fit. I don't mind buying bras at each Stage as I lose, I can get by with just 2. I've had every size from a 46 band, now slowly moving to a 38 band. Just like the op, I got rid of all my summer clothes, they'll be useless next year. My yoga pants were my frumpy clothes, I only keep the pair I wore on surgery day, so I can do my monthly comparison pics.

Re diet soda, I had a bad diet Dr Pepper habit pre-op. I gave it up about 3 weeks prior to surgery and then the last week (on my liquid diet), I drank a couple thinking it would be my last chance. (My soda funeral) It didn't taste quite the same. I will tell you that post-op, I probably miss carbonation more than anything BUT honestly, what I miss is the "habit" and the "choice". I am almost 4 months post-op and what I crave is that part of my old lifestyle and haven't quite found a good substitute. I drink a lot of unsweet tea. BUT it does get easier. The first month as I drove past my favorite Breakfast stop, I really had to focus to keep driving. The last few weeks, I don't even see it anymore. Years and years ago when I first started considering WLS, I said I would never do it because I couldn't have soda or alcohol. Soda will never be a good choice and alcohol can be done in moderation after the weight loss phase. I wish I hadn't let those things keep me away this long though. All the benefits make it more than worth it and the "cravings" get better. Don't let this part hold you back. Re Cookies, I have not tried this yet, but I have read lots of folks cutting up Quest Protein bars into pieces (like maybe 8 pieces) and put them in the toaster oven, and they come out like cookies. A treat and you get your protein. If it is a trigger food for you that might lead to more not so healthy cookies, then don't do it, but if you can find a substitute for that craving that fits in to your food budget (and even better helps with protein needs), then all the better.

Same here with the alcohol. No difference post op. In fact I think I felt it more before surgery because I had room for a couple of cocktails but now I can't finish one.

I must be drunk aunty. Alcohol feels exactly the same as it did pre-op

After healing from the surgery and by the time you are eating real food, you won't have a lot of problems eating out with friends. You will just always have a to go box! Many restaurants have a high Protein portion or low cal portion of the menu (lighter eaters). You would just make good choices in regards to what to order. Grilled chicken with salsa, or lean steak, the sides can be change upon request. Now, with alcohol you will need to be really careful. Cheap dates will have nothing on you. Alcohol will pass quickly from your sleeve and into your intestines. It's like shooting it straight into your bloodstream.

What's the best low sugar alcoholic beverages to enjoy???

Like alcoholism and drug addiction obesity is a disease. Thankfully one that can be conquered with interventions, but whether biological or environmental for many people is is much more than a matter of willpower. It's not something we "get over". That doesn't make the pre-op side of my life a failure. It means there were things beyond my control that required medical intervention to tend to. Attaching shame to them much like other addictions is part of what makes people reticent to seek help. Pre-op me was a cool chick. One who was smart enough to identify a problem and address it. She was never a failure.

I understand where the OP is coming from. But here's my take on it. My parents had seven children. We all had the same general childhood food options (my father's hunting and vegetable garden and my mother's cooking) and the same access to general child-rearing, medical and philosophical ideological applications. Yet we didn't turn out identically. One was a childhood diabetic. Four became heavy smokers. Two became alcoholics. Six didn't go to college, the seventh got a Ph.D. Two were blonde, one was a redhead, and four were brunettes. Two were tall, two were short, and the rest were of average height. One has a slight / petite build, and the other six are fairly muscular -- two were quite athletic. I was the only one who was overweight during childhood. By the fourth grade I weighed 100 pounds. I was the heaviest girl or boy that year in my class. In high school I weighed 165-170. In college I got up to 185. In my 20s and 30s I finally became "slim," but my weight fluctuated dramatically -- from 120 to 185. By my 40s my highest weight was 205. By my 50s my highest weight was 225. In my 60s my highest weight (just before WLS) was 235. During all those years I dieted "successfully," losing and gaining weight over and over again. And until my siblings hit their late 50s or early 60s I was still the only one of us with any kind of weight problem at all. I don't know all the medical / physiological / psychological reasons that combined to produce the obesity that my sibs didn't suffer from. But very clearly I had challenges they didn't have. I tried my hardest to overcome my overweight. But, in the OP's words, I "failed" to do so. For over 60 years, dramatic diets didn't work. Weight watchers didn't work. Exercise didn't work. Diet pills didn't work. Self-shaming didn't work. Trying harder and harder and over and over again didn't work. Honestly, the only thing, at age 68, that finally worked was becoming so unhealthy that I became more immobilized than I'd ever been. It was crystal clear to me that without some kind of dramatic intervention -- and doing something very different than I'd ever done before -- I would turn into an agoraphobic, chair-bound, miserable person and turn my husband into my caregiver. That was not a future I was willing to accept. That possible future was dire enough to motivate me to have WLS. Thus far, it has turned out to be exactly what I needed. It has been a wonderful success. My knee replacement surgery has been deemed no longer necessary. I can walk 3-4 miles without rest at 3+ miles an hour. I can stand for hours without sitting down. I am no longer agoraphobic. I am satisfied by how much I eat and physically nourished by it. And I am definitely not a failure. I just had not found "the right medicine" to treat and resolve my condition. That's how I'm looking at it -- at least for now.

Have any of you guys had an alcoholic beverage yet?

Yes, I posted the same question a few days ago b/c I hadn't seen anyone mention it either and a few people responded with a yes. Mine was horrible, very sudden and severe but only lasted one day. I'm on day 6 now and it happened on day 2 or 3 but none since. Hope yours clears up quickly too. One thing I wondered - the first 2 days I'd had a serving of sugar-free pudding (allowed on my plan) and the prepared ones have sugar alcohols in them. That might be the cause for me, as I haven't been brave enough to try it again! I don't think the ones you make yourself have those.

Oh yeah Flat Whites are perfection. I haven't had one since surgery. I might splurge on one today There are lots of good options at Starbucks. I used to be addicted to white mochas, a triple venti white mocha was my drink of choice for years. It has like 900 calories though, a 1/2 day of calories, and I would get a coffee cake with it. I broke myself of that habit years ago. If you can carry your own sweetener and learn to love black coffee of very little cream, you really don't have to give up your coffee forever. You just have to be smart about it. I have given up basically everything with surgery, no alcohol and a laundry list of other things. I'm not giving up coffee. Plus after surgery your mind can be foggy and your concentration not what it used to be and coffee helps.

At a place like a comedy club with a 2 drink minimum, what the heck do I order? Literally everything has alcohol, sugar, caffeine or bubbles, or all of thee above. A seltzer with lime used to be the diet drink to order when "out" but no carbonation so that's out. Hate to pay for a glass of tap Water...

Remodeling is stressful! I remodeled this house after I bought it and it was a nightmare for awhile. Sheryl what happened to the guy you were dating who has the Harley? I thought you liked him, and did see possibilities with him. It's nice that you still have your ex to talk to and are still able to find comfort with him Sara I am so excited to hear your news about your dad. I really hope he continues to get good news after the pathology report. I got good news today too. My fusion is coming along nicely and I don't have to wear my back brace unless I leave the house. The best news is my liver doctor feels that my Hep C is not affecting me. He said my body has learned to live with it. The treatment for it is 90,000.00 and my ins would never pay for it because I don't fall under the guidelines for who gets treatment and who doesn't. But the main thing he told me is as long as I don't drink alcohol, not ever, I will die from something else, and not liver cancer. Now I go to physical therapy and I can go back to the gym as long as I am careful . I guess the PT will tell me what exercises would not be good for my back. I can do cardio though, and go back to exercising my thighs, where I have gained most of my weight. I really want to be able to wear my clothes. 15 lbs makes a huge difference in my pants. Floridna, I went to a talk on plant based diets and they talked about MS. They said diet makes a huge difference, but I am sure you have all the right books and are doing what is best for yourself.They talked a lot about eating tons of leafy greens. Please stop judging yourself because you have gained weight. You've had a lot of stress since you came back to the US and your MS is messing up your weight loss, not YOU!

I love the Atkins bars but the sugar alcohols will give you the runs if your not careful. I have to modify my tummy routine when I eat them

Congratulations on taking steps to get healthier! I think your plan to add more Protein is a good one especially as the meal replacement. Protein drinks are tricky because everyone has their own taste and that can change drastically after this surgery so I would not invest a fortune in powders and such. Also if you are a busy person and do not want to fool around with blender cups or actual blenders I would recommend giving Premier Protein ready made shakes a try. They are excellent for post surgery as well. There is no grit, no nasty taste, in fact they are actually very good. They have 30 grams of protein in 1 shake, 1 gram of sugar and are 160 calories. I turned to them post surgery when I could not tolerate most of the whey protein powders. My nut suggested them and I am thrilled she did. You can get them in smaller packs at Walmart and Walgreens or you can buy them at a higher discounted rate and larger quantities at Sam's and costco. Some of the others that are more tolerable is the syntax nectars. These are a powder and you need to use a blender cup to ensure you don't end up with that grit. Leverage things like yogurt, cottage cheese, nuts and seeds to help boost your protein as well. Focus your meals on lower carb, high protein. Leverage good carbs like fruit and vegetables. Stay away from bread, Pasta, rice, white potatoes. Leverage Beans, sweet potatoes, corn, peas, carrots, cauliflower.....pretty much any vegetables you love. Salads with some protein make an excellent well balanced meal, just watch your dressing to make sure it is not loaded with too much sugar. The goal is to remove as much sugar and bad carbs from your diet. Remove all processed foods from your house. They are not something you will be able to eat after surgery. Honestly they are so very bad for us. If you drink caffeine or alcohol you might want to stop that now because you will be required to at pre op diet and beyond. My nut had me practicing mindful eating, getting my Water intake up to 64oz. Per day, eating slowly, not drinking anything when you eat and removing all distractions. I hope some of this is helpful to you! Please keep us posted on your progress!

I started drinking at 18 months and 3 sips hit me like 3 glasses. be careful. alcohol also adds a lot of calories. I started to drink more and gained 6 pounds

Also talk to your primary physician. Are you having any obesity related issues such as diabetes, high blood pressure, joint pain, etc? Insurance may not cover wls unless you have exhibited obesity related issues especially at only 20 years old. Ask your dr what he/she thinks of you having wls surgery, because you will need him/her in your corner to do it. Do you have a family history of obesity, diabetes, etc? My family is the poster child of obesity and heart disease. Research research research. I can't stress that enough. You need to research the different types of surgery, the short term and long term risks involved, what the day to day life is for post surgery patients both in losing mode and maintenance mode. Are you good about taking daily pills every single day? After surgery, Vitamins are not optional and are essential to keeping you healthy. This is a tool, not a solution. You can gain weight even after sleeved if you don't continue to follow the eating plan and make good choices. Drinking is almost prohibited due to how quickly alcohol enters the bloodstream post surgery. Losing weight rapidly will increase the likelihood of loose skin, even at your age. You can't expect to have a bikini body just because you lost weight. Basically, this is a serious decision you need to make and before you do so, you need to take the time to do your research.

I'm 2 years out and initially lost over 110 lbs. I more than passed the expectation of my surgery team. Over the past six months I have gained back more than 15 lbs. My surgeon is okay with my weight gain because I'm still within my expected range, but I am not. He also said that they do expect some weight gain about 2 years out as your body adjusts to its new size. What I also learned from my team is that you need far less calories post surgery than a normal person. Because you have essentially flushed your system out, your heart, lungs, muscles need much less energy just to work normally. They compareded it to a car needing less fuel after a tune up. So translate fuel or energy to calories. Much less calories are now needed and that as time goes on and my body continues to adjust, I may continue to drop in the amount of calories I can tolerate. So it appears that I need to limit my daily caloric intake to approx. 1500 calories to simply not gain. Even though I'm active, running, walk, kayak, ski etc on a regular basis. Doesn't seem to matter. In fact it was suggested that I might not be able to tolerate 1500, that as time goes on I may need to reduce my caloric intake even more. I still find I need 5 smaller meals a day. Do the math, that means 250-300 calories a meal. I know I've been eating more than that. So I struggling with accepting that if I want to keep the weight off, I need to live on a highly restricted calorie diet, which basically severely limits my intake of sugar, alcohol, carbohydrates, meat and fats. I lost the weight on low fat cottage cheese, greek yogurt, salads with vinegar or yogurt dressing, fish, Beans and low-fat cheese as my primary nurishment. I am realizing that I need to follow that diet for life and it is challenging, particularly when it comes to social events and dining out. I am praying for fortitude and solice to accept this as a permanent lifestyle change and would greatly appreciate hearing your stories and knowing that I am not alone.

Don't you think there will be chicken or some form of Protein at the wedding? I have been to several weddings and fancy parties since I was sleeved three months ago, and there was always something good to choose. (Lots of bad stuff, too, but plenty of fine choices if I chose to make them). Personally, I would lay off the alcohol for a little while longer.

When looking for a Protein supplement I look for less than 200 cals (but really not more than 175) 23g of whey protein or more very little fat, less the better and no more than 2 sugars, including sugar alcohols