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Real food stage - My instructions are four years old. Not all of our plans are the same. Can you eat lentils? My plan is low carb. Yes, if it fits your carbohydrate goal for the day. Eat your protein goal first then move on to your other foods. Know low carbs will be in weight loss mode. You will be adding more carbs in maintenance phase to slow/stop your weight loss. How do you know if you have hit your carbohydrate goal for the day? My instructions were to log my food in an app. People use baritastic or myfitnesspal. Log even if its a chore and inconvenient at first. It gets to be a habit. It made things much easier. Your goal right now is to get 60 to 100 gram of protein each day and to stay with in your carbohydrate and calorie goals. https://play.google.com/store/apps/details?id=com.baritastic.view&hl=en_US https://play.google.com/store/apps/details?id=com.myfitnesspal.android Here is a link to my dietitians bariatric recipes website for food ideas. (note omit rice, white potato,bread pasta) Some of her recipes (Example clam chowder) has white potato but in minimal amounts. She is fine with. Most carbs come from plant based foods. http://insidekarenskitchen.com/bariatric-friendly-recipes/

Sounds like you have a good team! Especially the bariatric surgeon having oncology experience.

Well, there are 2 kinds of laxatives: osmotic and stimulants. Epsom salt is essentially magnesium sulfate, an osmotic laxative that replaces magnesium in the body and essentially causes your GI system to pull more fluids into the poop so you can pass it easier. Think stool softeners: colace and Miralax. I assume she cringed or made a face because use of Epsom salt isn't something we hear too much of in this day/age of products like Miralax. Also, using Epsom salt as a laxative can cause magnesium imbalance (needed for muscle contractions), increases your need for water, and can lead to dehydration if you're not careful. Just from reading all the frequent posts on BP about constipation and how to fight it, everyone has their own method that works for them. Until then, I think we all have a certain amount of anxiety with BMs. Me, I make sure I take a fiber supplement every day and I drink lots of water. If I miss more than a day, I will take a low dose dulcolax just to keep things moving. I do not wait. Waiting only increases discomfort and makes things more difficult to resolve. *In my first month or 2 after being sleeved, I used milk of magnesia for the same purpose as the dulcolax. I DID NOT want to have to strain with those first few! both Dulcolax and MOM are stimulant laxatives=stimulates the muscle of the intestines to push things along. I've heard lots of bariatric patients promote Smooth Move Tea. I haven't tried it, but I've had other teas like it. They are also stimulant laxatives and rather powerful ones if you steep the tea long enough. Hope this was helpful!

As the three surg oncs I consulted explained to me, my BMI and excess adipose tissue make robotic laparoscopic techniques more difficult and riskier. Some CYA for liability purposes perhaps, but also realistic risk assessment that the data support. The bariatric surgeon with whom I’ve initially consulted also has surg onc training, but we haven’t discussed enough specifics for me to be completely comfortable, other than to reco VSG over RnY or DS because of the residual structures. He also concurs with the surg oncs that I should have a WLS procedure first, heal and get results to reduce risk, then schedule the cancer bit. One issue I plan to raise at the next consult: since these dudes teach at the same hospital and see patients literally doors down from each other, how unreasonable is it for one of the surg oncs to observe or assist with the VSG? Onc can get the lay of the land, familiarize him/herself with the plumbing, maybe even snake the camera around and get a look at the little bugger on a fact-finding recon operation. We’ll see.

Rapid weight loss contributes to the development of gall bladder issues. If you already have stones, it's best to have it taken care of. Some doctors will remove it at the same time as the bariatric surgery. I wish mine had done that. When I had the lap band in 2005, my doctor didn't even check the gall bladder and it wasn't routine at that time to give preventative medications like ursodiol. I developed gall bladder symptoms after about a month that didn't present as "typical" gall bladder symptoms. As a result, I was misdiagnosed for 6 months until I demanded that they check my gall bladder. It lead to nothing but misery and likely contributed to my band slipping.

I had my first bariatric sleeve consult appointment today. I was told that since I have gallstones, I should have my gallbladder taken out before I have the gastric sleeve. Is it common to have problems with your gallbladder after gastric sleeve?

Would pancreatic surgery at a weight of 320ish be all that more dangerous than if you were at 180, assuming you aren't 4'6"? I would do a consult with a bariatric surgeon (keeping in mind they want you to be their client most likely) to see if it would complicate a treatment/surgery protocol for cancer. I've had a couple of health issues pop up just after surgery (not related to surgery) and I find that non-bariatric medical folks are unclear about the new way my body works. Such as drinking a big-to-me bottle of contrast dye before a ct scan etc. Or not producing a big cup of urine on demand for testing. That being said I have some wonky boobs that may or may not decide to go cancer that I have to have scanned every 6 months and those folks totally encouraged me to have the fastest weight loss possible to make detection and treatment easier. (And they weren't ginormous to begin with.)

Sure. Here's my diet progression: Stage 1: Bariatric Full Liquid Diet (Weeks 1-2) #1 Sugar-Free Fluids This is the number one priority after surgery—drink a minimum of 64 ounces/day. Examples: Water, herbal tea (no caffeine), Crystal Light, PowerAde Zero, etc. Liquids should be non-carbonated, non-caffeinated, and under 15 calories/8 ounces #2 Protein Shakes Goal of 60g-80g protein/day. Mix with water or unsweetened nut milk. Stage 2: Soft Protein Foods (Weeks 3-4) #1 Sugar-Free Fluids Still the number one priority after surgery #2 Food 3 meals/day of soft protein foods (aim for 60g of protein as able—compensate with protein shakes if unable to hit 60g through food). There is no set portion size—you must listen to your body. Examples of soft foods: eggs, whole beans, canned meat, shaved/thinly sliced deli meats, fish, tofu, Greek yogurt, cheese, refried beans, etc. #3 Protein Shakes You may need to drink 1 protein shake/day to meet the 60g of protein if you can't meet this goal from foods. Stage 3: Bariatric Regular Foods (Week 5+) #1 Sugar-Free Fluids Still the number one priority after surgery #2 Food 3 meals/day focusing on protein. Small bites and stop at the first indication of fullness. There is no set portion size. Try new foods one at a time and in small amounts. Focus on solid protein for best portion and hunger control. Put fork down and pause between bites.

Sorry if the lede was misleading--long intro thread, unrelated to the surgeon in GA, a former poster in the Lap-Band forum, or a grocer who sold toilet tissue. Also not a BM discussion, although I gather those are popular 'round these parts. Hello, all. Apologies for the length; maybe the info or discussions will help some in the future. Like many here, I’ve battled obesity my entire life, from Husky-sized jeans to a HW of 453 in 2017. Through a counselor, I connected with a weight loss PCP, and by working with him and a NUT have lost 130 lbs in 2 years. I was content with this method and pace, but circumstances had other plans. This past summer, I presented with symptoms consistent with gallstones. After an external ultrasound showed nothing, PCP ordered an EUS. Surprise, pancreatic neuroendocrine tumor (PNET), on my birthday, no less! Consults with surgical and medical oncologists ensued, and while I have the kind of cancer that killed Steve Jobs, as long as I don’t treat it with carrot juice and happy thoughts, it probably won’t kill me tomorrow. That’s good, since as a husband and father, I want to stick around. The (hopefully not) killer, though, is that my cancer doesn’t show up on bloodwork or CT, and only marginally on PET. Med and surg onc, per secondary and tertiary opinions, concur that the best treatment plan is to cut it out. What has this to do with WLS, you ask? As I wrote above, I was happy to keep losing my 5 lbs/month, see where I landed, and make further lifestyle changes when I plateaued. However, the cancer I have, according to World-Class Oncologists ™, can flip a switch any time and go from not-a-problem to Patrick Swayze-level, and nobody understands exactly why or how. WLS enters the picture as a catalyst to accelerate treatment. The thinking is that VSG (my recommended procedure, based on my initial consult with Dr. Hussain and the bariatric team at UC) will drastically en-rapidate my weight loss, possibly helping me drop as much as 70-90% of my excess body weight in the next 9-12 months. In that way, the surg onc should be able to operate on a healthier patient with fewer complications, especially if, as seems likely, he has to pivot to what would be, at worst, a laparoscopic Whipple procedure. Being a lesser man at the time of that surgery should make the whole process less risky overall, but that’s just one of the questions for the surgical team that I’ll begin to firm up once I start the formal pre-op process. I’ve been assessed as a near-ideal bariatric candidate by psych based on my previous work, and by NUT based on the low-carb high-protein changes we’ve institutionalized in our family lifestyle. We even gave the NUT two recipes she said she’d share with her patients! I have concerns in both areas, though, that I’m working to get a handle on—psych, given my history with depression, and nutrition, since some of the strategies I’ve used to be successful up to now might not be compatible with VSG. Anyway, thanks for letting me introduce myself and overshare. If you have any relevant thoughts or experience on the above, especially if you have had, or know anyone who has had, a Whipple procedure after a VSG, I’d REALLY like to hear from you, since there’s not much in the open literature on it. I’ll maybe post more details, questions, etc., in the relevant sub-forums if I can’t find something through search, but again, thanks for letting me vent and share.

Hey all, super new here ! I have been struggling with getting the help from google, or locals who have been sleeved, so I am looking to gather more information to help make the best decision... I was sleeved in June of 2016 - I started at 286lbs, 5ft 6 in tall. Fast forward to now, I am 140lbs, and a BMI in the low 20s. I am active, thin, little loose skin, and LOVING the new life I have been blessed with...for 99% of the time... The kicker is the GERD symptoms I have are out of this world. I was someone who had this pre-op, and had I known what I know now I would have never agreed to the sleeve vs bypass. I have been in the midst of a whirlwind of testing..first my NEW bariatric dr suggested perhaps I have a flare up of the H. Pylori I was known to have after the stomach contents were biopsied, so we started with a stool test for that, thinking we will start small. This came back negative, and I then went in for a barium swallow which showed from his report to me, a "Massive" hiatal hernia in which he defiantly was interested in repairing. Then, I went in for a CTA to look for SMA Syndrome, basically the superior mesenteric artery compressing the duodenum - this was negative. Now, I am waiting on the ph & manometer testing to determine if I am a candidate to just have the hernia repaired by normal forms...but, Here inlays the questions I have, and personal experience is worth every bit to me. IF you have a hernia now (and DID NOT) have one prior to VSG - its causing you so much discomfort that you can not sleep, eating and swallowing pills has become challenging and you basically just refuse it all...what decision do you make..is a hernia repair going to be enough to cure this without the possibility of it returning..OR do you go with the revision to bypass to FIX it once and for all ? My dr has given me a lot of literature to go over and read and things to think about. I just don't know which is best. He has agreed to do either of these to help, provided my esophagus is operating in proper order following the results of my ph probe. He has asked that I TRY to maintain this weight and not lose any more, I am at the bottom of the scale where I ever wanted to be, frequently falling into the high 130s . Other questions I have are - am I going to lose more weight if I am revised to RNYBP? Will I have an intolerance to foods with ANOTHER new tummy? Will I need an open repair to revise this? also, if I choose the hernia repair will I end up with tighter restriction again with them using part of the tiny tummy I have to cuff at the top to fix the hernia? Is mesh safe to repair a hiatal hernia these days should that be the "fix" ? Has ANYONE been through this situation with these quirks. I don't need revision due to weight gain, I am already pretty small for my height. I have been this weight for 15 months or more. Please help! any insight or personal experience either way would be amazing.

I am a sleeve, not a bypass--but my surgical uses the same post-op diet plan for both procedures, with only minor differences in terms of supplementation. It's really hard to look at one person's macro and diet and use that as a basis to determine what's best for you. We all have our own issues and challenges to deal with. We also all have issues with stalls, although I agree that a month and a half is on the long side. The fact is, however, you started off at 311 when you had surgery in late August 2018 and you're now down to 235 as of today. Since you've been stalled for one and half months, that means you lost 75 pounds in a 4 month period. That's a LOT of weight in a very short period of time. Shorter than I think is common. Maybe a long stall isn't entirely unusual in these circumstances. That said, if you're eating less than 600 calories a day 5 months out of surgery, that seems really low. I am just finishing up my soft/puree phase and I am consuming between 700 and 900 calories per day. I expect that to go up to 1200 calories or so per day over the course of this year--maybe even 1500. I have been essentially following my doctor's guidelines, which means eating three meals per day that cause me to consume at least 70g of protein per day. I am also drinking more than 64oz of fluid per day, which maybe one of the most critical ingredients to weight loss. While my post-diet (at least for this phase of my recovery) doesn't limit me in terms of macronutrients (provided I hit my protein goals), I have chosen to limit myself to 20g or less of net carbs (which does not count fiber or sugar alcohols consumed). I have also chosen to eat only foods that have good quality sources of fat--like avocado, fish (and fish oils) etc. As a result, I have put myself in a state of ketosis, which seems be really helping me make the most out of my sleeve (at least for now). I would NOT say that I am following a Keto diet, since more than 50% of my food intake is coming from protein and maybe 35-40% is coming from fat, with less than 10% coming from carbs (it varies day to day, but carbs are always under 20g). I am also trying to exercise daily--not just take a walk, but really work up a good sweat and get my heart rate of to 80% max. I am not suggesting you do what I am doing--everyone needs to find their own best path--but if you're in a prolonged stall it's best to change things up. If I were in your shows, I would try hard to get in more protein and fats (to the extent you can tolerate them) and get your calories up closer to a 800 a day. I get that you might not be able to eat the fat at this point depending your sensitivity to dumping, but you can't continue doing the same thing that isn't working for you at the moment. You need to change a couple of things up to restart your weight loss engine. If that means drinking an extra protein shake or getting in an extra little meal to reach a new calorie/protein goal, then do it. See how it goes for a couple of weeks. Also, if your nutritionist isn't helpful, is there another bariatric nutritionist you could speak to???

I'm new here and haven't even introduced myself yet, so forgive me for skipping that part and jumping straight in with a question, but my surgery is scheduled for exactly 1 week from today and I'm feeling the need to get a decision made quickly. I've been in preparations for bariatric surgery for a year now. The plan was always for sleeve. The intestinal rerouting thing just scares the bejeezus out of me, but it's really the rates of longterm complications that scare me the most about RNY, especially the "lightning strike" complications like internal hernia that can pop up unexpectedly years down the road, probably when you're hiking and about 100 miles from any decent hospital if you have my luck. I was much more comfortable with the idea of VSG. However... I have a long history of GERD. It's milder when I lose weight but still there, and I had to switch from ranitidine to a daily PPI (omeprazole 20 mg) several months ago because the ranitidine just wasn't doing it for me anymore. Even with the PPI, I've sometimes had breakthrough heartburn and admit I've taken a second omeprazole later in the day every now and then for it. I figured I'd just have to stay on a PPI after surgery and convinced myself that would be a better option than taking on the added risks of RNY, but my pre-op EGD this morning showed LA grade A esophagitis (i.e. mild esophagitis) and a small hiatal hernia. Those were just the initial impressions and the final report and biopsy results aren't in yet, but the surgeon showed me about how big the hernia is and I'd guess it's 2-3 cm. He says no problem, it can be fixed during surgery and we can treat GERD with medications or, eventually, even LINX if needed, but I'm concerned for a few reasons. It seems ominous to me that I have even mild esophagitis after several months adherence to a PPI regimen that's supposed to heal acid damage. I'm thinking that means I'd have to be bumped up to a higher/more frequent PPI dose after surgery just to keep things stable if I'm lucky. I'm a research person, so I've reviewed most of the recent research regarding GERD and the sleeve, and it looks like there is a large chance of the esophagitis worsening in grade after VSG. It also looks like there's a huge chance of recurrent hernia despite repair and as much as a 1 in 8 chance (according to one small study) of needing revision to RNY later. With that factored in, my chances of needing additional surgery after a sleeve actually appear to be the same or higher than my chances of needing additional surgery after RNY. I also wouldn't look forward to having to pay for EGDs every year to reassure myself that my esophagitis hasn't turned into Barrett's. The general consensus of everything I've read leans toward RNY over sleeve for preexisting GERD, but this doesn't match my surgeon's encouragement to go with sleeve. Then again, he might have that can-do attitude because he knows how much I originally wanted the sleeve? I don't know. Anyway, needless to say, I'm having major second thoughts about the sleeve, but I have so little time left to decide and I'm worried about making the wrong decision. I was hoping my EGD results would give more clarity, but they just seem to have made the waters even murkier. If you made it through that longgg post, I guess my question for you guys is: Am I being overdramatic about a little heartburn? Did any of you have esophagitis on your pre-op EGD? Which surgery did you choose and how did it work out? All opinions and anecdotes welcome and thank you in advance!

http://positively-healthy.com/bariatric-patients-why-you-shouldnt-drink-while-eating/ We need time for the nutrients in the small amount of food we are eating to have the ability to be absorbed to the fullest. Adding liquids flushes it through our system quickly. Sent from my SM-G965U using BariatricPal mobile app

I love Bariatric Eating Inspire as well, but I like the vanilla. I also like the PB cookie, the butter mint, cafe amore, not the Mexican Chocolate vegetable protein based one though. I recently bought their unflavored one but haven’t tried it yet.

I use Bariatric Eating's Inspire protein. I don't love the vanilla, though. It has a weird vanilla flavor to me. The cookies and cream one is okay. For peanut butter, I use their unflavored protein and 1-2 tbs of powdered peanut butter (I like Peanut Butter & Co more than PB2—less grainy). I've also been using Crystal Light with the unflavored (orange, cherry, raspberry lemonade). SF pudding mix is also good for flavoring.

Here is her instagram. Its not all Bariatric, but she does tell us to adapt per our requirements and portions https://www.instagram.com/nutritune/

Every insurance policy is different. From what you are saying, your Cigna policy has an exclusion. Submitting paperwork will not do you any good - it is not covered. You either need to wait until you can change carriers to someone who does cover (check before enrolling) or go self pay. There probably are Cigna policies which cover bariatrics, but it appears yours does not. Having the doctor submit won't change that.

I use Journey Bariatric Chewable Multivitamins that I purchase from the Bariatric Center where I had my surgery done. I am sure I am probably paying more for them, getting them through the surgery center but something as important as my success is worth it. This is the only brand the surgery center sells so it is what they recommend. I pay $25 a month.

Here's the whole slew of things I'm taking pre-op and supposed to continue post-op (aside the biotin/collage - that's my choice). So far I feel like a million bucks just after a few days! : - Multivitamin capsule (BariatricPal 1xday) - B-100 Complex (NOW brand 1xday) - Vitamin D3 (Zahler brand - 3000iu 1xday) - Calcium Chewy Bites (Bariatric Advantage 3xday) - Biotin (Sports Research 10,000mcg 1xday) - Collagen Peptides (Sports Research 1 packet daily - taken this for 4 months already, makes my hair and nails grow super fast) - 50 billion Probiotic (Renew Life Extra Care) - B12 chewable (Radiance Platinum 5,000mcg)

Hey! I'm taking the ProCare Health one a day bariatric vitamins with 18mg iron. I started with Opurity chewables and could not stand them for more than a few weeks. I haven't had my first labs yet (those happen @6 months out for me, I am currently 3mo). Hoping the labs are fine. I also switched from Opurity chewable calcium citrate (too chalky) to the Celebrate chewables and love them. I'm using Bariatric Fusion sublingual B12 also and so far that's it. The Opurity sublingual B12 is decent too. I always find it interesting to see what others have tried. Sent from my Pixel 3 using BariatricPal mobile app

Try to focus on the now. Worrying and fretting about something like plastics when you are not at goal may just stress you and depress you further. Most people recommend being at a stable weight for about a year before doing plastic surgery. Is there a Bariatric support group near you that you could visit in person since you seem to have no real life support system?

Sounds like you’ve got s good variety. When do you start? Bariatric Eating sells a powder that’s tastes great, but you can only buy it from their site. The brand name is Inspire. They have lots of flavors and all of the ones I’ve tried have been excellent. They also sell a bone broth one they call beef stroganoff that has 15g of protein as well. They have other soups but the carbs are too high on those, I never bought them.

I’m having RNY on Feb 5th! I have a 2 week liquid pre-op diet where they want me to drink 4-5 protein drinks a day. That makes me nervous. I barely tolerate the ready to drink premier protein. I bought the sample pack of Unjury and syntrax nectar and also Isopure vanilla and genepro unflavored. I’m sure I will find something in there I like. I also have a variety of crystal light, sf jello and sf popsicles, and broth for my fluids. Anyone have suggestions for something else I need? Oh, and I have my post op bariatric advantage multi vitamin, calcium, b12, and iron.

Like most things, you just never know until you try. I just self paid for my revision because my insurance denied removal and revision. They deemed it “medically unnecessary “. I am on my second appeal, with the help of an outside advocacy firm. I am praying this works to get me reimbursed! I too had the problems of reflux, pain, and night coughs. As a result, my esophagus was getting irritated. I am 18 days out from revision surgery and I feel great! Reflux is gone and I have already lost about 26 lbs! My BMI, at time of surgery was about 33. Not your typical 40+, like most bariatric surgery candidates. Good luck to you Kerri, hopefully you can get your insurance to pay for it! Believe me, I know firsthand, the negative outcomes of lapband!

Thank you! Ahhh! I know what you mean..I watch alot of youtube bariatric patients that are cooking away with super healthy and yummy bariatric meals. Meal prep is key to stay focused. If it wasnt for that i would totally fail. I sometimes cook for my family without tasting the food (I have them tasting it)lol its crazy but anything to stay focused. In the fridge I have my own section that i fill every wknd with stuff i can eat. We got this![emoji6] Sent from my SM-G950U using BariatricPal mobile app