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I have yet to see a nutritionist or dietician that truly understands the optimal diet for a SADI or DS patient. Most of the time we just get a modified version of what they give Bypass and Sleeve patients. But as you say, you aren't absorbing as much as they are, therefore to give you their requirements would leave you malnourished. 15 grams of fat is absurd by all medical standards. Most medical studies show we need 60 grams of fat for proper hormone function and even if you ate 60 grams of fat, with an altered digestive tract, you aren't absorbing that much, so you need to eat a little more than that. Even the ASMBS recommends 60 grams of fat by 1 year out!! Your dietician is not following best practices. Most SADI/DS patients I know follow the vets that have been living with this surgery for 10+ years and maintaining their weight loss. We figure they know more about optimal diet than a surgeon who has never lived with this surgery, or a dietician that has never even researched best diet for bariatric patients of various surgeries. Most patients I know are eating 100-120 grams of protein, less than 50 grams of carbs, and over 60 grams of fat, usually around 100 grams of fat for SADI and 150 grams for DS. You can increase your carbs once you have reached your goal weight, they tend to slow/stop weight loss, so in active weight loss it is important to keep them low so you stay in ketosis. A calorie range makes dieticians feel better, but it makes no sense for a SADI or DS patient because we malabsorb so much fat we can't even begin to properly calculate our calories. You could eat 1200 calories, but that wouldn't be what your body is absorbing. I'm sorry this is so complicated. In the end you have to decide what you feel best at. I don't feel good following guidelines like your dietician gave you and when I go over 50 grams of carbs I stop losing weight. So...yeah. I'm going to follow what allows my brain and hormones to function, what makes my skin, hair, and eyes feel best, what gives me the most energy, and what allows me to lose weight steadily. I'm the one that has to live in this body. It is sad these surgeries are so uncommon there are no good studies about optimal nutrition for them. But there is no way I'd go below ASMBS guidelines, they are the closest thing bariatric surgeons have to a standardizing body. Your dietician should be able to give you ASMBS guidelines for your surgery.

Happy surgery month, April-ites! I did mine in April of last year and want to share my encouragement and support, knowing almost one year out (26th) it has been an extraordinary and revelatory experience. There were some bumps and dings throughout the year (Foamies, severe stabbing pains post surgery - they subside! , gallbladder removal, fainting from dehydration, no appetite, strong appetite, hair loss and regrowth, etc). All worth the rollercoaster and 107 lbs down. Happy to answer any questions :) summer had a lot of comments, Fall was the sweet spot of people noticing and me feeling my best. Winter and now spring again- I’m starting to run and be outside a lot more. Really helps to have a 2nd chance at moving well in my body and enjoying real food. All the best to you guys!!

As the weeks & months pass we slowly but surely increase our intake so I wouldn’t think the low calories we consume is truely sustained as it’s continuously increasing. And it affects our metabolism in the way you’re thinking either. The recognised benefits of weight loss surgery include resetting your body’s set point, digestive hormones & metabolism. Of course the resetting is different for everyone but there is improvement fir everyone & I so love & appreciate how it did that for me. I spent years & years eating one meal a day or skipping lunch & only eating two meals a day. That is sustained low calorie in my thinking ( years not months) & yes it did wreck my metabolism. I could barely lose anything even following those 500 calorie a day diets (talking a couple of kilograms over 6 or more weeks). Similarity to @ms.sss, in the first weeks after surgery I was eating around 200 then 300 calories. By 6 months, at my goal I was barely consuming 900. My weight finally stabilised at 18 months when I was consuming around 1300. Now at 5 years post surgery, I eat about 1600 calories yet am still the same weight I was when I stabilised. And unlike @ms.sss, I’m not what anyone would describe as active. Just do a series of exercises using residence bands & stretches at varying times through out the day. I wouldn’t burn 30 calories. BMR calculators do give you an idea of what your caloric needs might be but as @ms.sss said the results are based on averages much like BMI & the calculators that suggest how much weight you may lose after surgery are. The averages only take into account some basic factors & don’t consuder your individual needs, medical & weight loss history, genetics, activity levels, muscle density, etc., etc. Actually, have you considered doing a dexa scan just to see where you are in regards to muscle & fat density now & repeating it in the future to see your progress? Weight loss can continue for 18 months to 2 years after surgery so don’t give up yet and you won’t actually know what your caloric needs are until your weight has stabilises for some time - months or a year. PS - My surgeon & dietician also didn’t advise to count calories. I just did it randomly out of my own interest & curiosity. Quality of the food I was consuming was more important.

I don't know how to feel about this. Not because she's taking weight loss medications, but because she's taking these 2 together. I've done about 4 hours of research and 95% of what I read says NOT to take these 2 meds together. The other 5% is from people who take them together and have had excellent results. She gets the phentermine from her doctor and the Tirzepatide from a compounding pharmacy (they mix it with sterile saline and not B12 or niacinamide). I don't think she's told either provider that she's taking them together, and I can't help feeling like there's a reason she's hiding it. I'm on here partly to vent because I've shown her the research and expressed my concerns and she isn't listening, but also because I'm wondering if anyone here has combined phentermine with either tirzepatide, Zepbound, or Monjauro, and if so, how did it go?

I honestly don’t think them smart scales are super accurate. I’ve seen a few people on here say they got DEXA scans and that their scale was not the same. That being said. They do warn that we will lose muscle and that’s why it’s important to start with some strength building as soon as we are cleared to do so. About the stall, some people do actually gain a little. Usually it’s followed by a quick drop of that gain- plus some. I think it’s your body trying to hang onto every single calorie it gets because it thinks it’s starving. Sorta has to recalibrate for a short time and then you should be back on the downward trend. If my google search is correct 1kg is only 2.2 pounds. Honestly you could see that fluctuation any day. Doesn’t even have to be a stall. Could be your body retaining water or your bowels are full or you weighed at a differnt time of day. Virtually anything can cause that. That’s why they say it’s best to not weigh daily. I know it’s hard not to and I’m guilty of it too but we really do just cause ourselves unnecessary stress by doing it. When I had my sleeve my daily loss fluctuated several times by a couple of pounds. Even 3 or 4 a couple times because I weighed daily. But I did only record my weight once a week and that made it way easier to see the overall downward trend.

hi Christine. I find the reverse is just as true too. Where the most commonly experienced effects of surgery just aren’t shared with patients by their team. How many post do we see from people upset, depressed & frustrated about stalls, hair loss, foamies, etc. Though I know there could be things missed simply because there is so, so much information we’re given & have to absorb. I do advocate sticking to the plan given to you by your team but we know there is no one size fits all (in life, clothing or plans). If something isn’t working for you, ask for alternatives, other options or suggestions as to what you can do or eat or drink, etc. Take suggestions & experiences people offer here & ask your team if you could try them. They’re supposed to know you & are best placed to advise what will support you without compromising your recovery or progress. Hope your upcoming surgery is successful & everything is put back to where it’s supposed to be. PS - Fellow teacher here too - well was one of my careers. What year levels or subjects did you teach? Congrats on your retirement.

I totally understand the anxious mind, trust me. That’s awesome your weight loss. A great start to this truly amazing journey. I am a little over three weeks post op. Not sure I if I said that before but I have a friend of a friend that had her surgery like a year ago. I touched base with her today and told her how excited I am that I ordered pants that are a size smaller and they come today and they already Fit!! Also I ordered new walking shoes and my friend and I are planning to walk at the same time everyday and chat on the phone since we live over an hour apart. We are starting tomorrow. The goal is 30 minutes but I am going to just do loops around my block the first time so I’m not far from home if it’s too much. She replied and said that she has been biking several miles and that I will soon need to get myself a bike so I can join her. I was like no way. I’m wondering if I can do a half hour walk between the heat and my knees. She was like I started with 15 minutes walking and worked my way up. She said this surgery is Life Changing. She said she has SO much energy now and she feels amazing. She has lost well over100 pounds and has only 8 more to get to her goal. I Just thought I would share a positive story that you can take and try ti picture what your version of amazing looks like. Then you can use that when the anxiety starts to creep in. Seriously. I’m telling you. One step at a time. You’ve got this. ❤️

@Hiddenroses you are getting sooooo close. Hows the preop diet going? Bitten anyone’s head off yet? I’ve lost my temper a couple of times. Ticked off one worker so bad that when I called back to ask another question they must’ve seen me on the caller I’D and kept putting me back on hold for over an hour. Oopsie 🙊 I would’ve tried to explain but I figured unless they were in this boat they really wouldn’t get it anyways. Luckily I was home just purging my pantry from stuff I shouldn’t have around anyways so i just put it on speaker phone and listened to the hold music until they finally picked up. i am not sure if I mentioned that I am having lunch with a friend tomorrow at a steakhouse. I am still allowed one meal a day of lean meat and veggies till Monday. Then it’s all liquids. I called the office to make sure it was okay to do the shake for dinner instead and they said no biggie. I’m sure my friend will order exactly what I would rather have so it’s going to be a bit of torture but I figure I may as well get used to it since choosing the healthier option while others are living their non diet lives is going to be my new normal. I am officially done cleaning out the fridge, freezer and Pantry ridding it if all temptation. I just remembered that I do have some stuff stashed in the cabinet above the microwave though. Mostly nuts and salad toppings and stuff that are okay to have around but may expired before I can actually eat them so I may as well give them away too. I also deep cleaned all the floors since it will be a while before I can do that again and i plan to do all my bedding and the bathrooms on the day before so they are as sanitary as possible when I get home. I think I may actually be ahead of schedule and have the day Sunday to relax. I’ve got a lot of calls to make Monday and Tuesday will be all about last minute stuff before surgery but Sunday I think I will do something fun. A pedicure maybe. I could really use one. Without polish I guess. Did they tell you no polish? They used to always say that but I don’t think she did this time. She said nothing on your body or hair but didn’t say to remove nail polish. Guess I will go with clear just to be safe. Anyways, I hope that you are doing well and that you are organized and relaxing a bit yourself this weekend. Good luck Monday.

Hi everyone, how are y'all getting with your post op diets, exercise and wellbeing? Here's my experience so far after getting the Gastric Sleeve procedure on 13th June 2024... Immediately after surgery It was pretty rough for me, I woke up in a lot of pain, so much so that the nurses had to give me 30mg morphine for the pain. I was in a recovery room for the first 24 hours (standard procedure for the private hospital in the UK i went through) After the initial 24hrs I was moved back to my room where I felt a lot better. Even able to eat an ice pop and a small cup of tomato soup (sipping of course) and sipping water every 5-10 mins. Week 1-2 I quickly moved onto the liquids phase, in which I must have taken in around 2-300 cals per day through protein shakes and watery soups. I must admin this phase was the hardest for me, managing the pain meds as well as trying to drink as much liquids as I could in a day. It just so happened there was an international football (soccer) tournament on in Europe in my first 2 weeks' recovery so was engrossed in that! I also started walking 1 mile per day and upping that to almost 2 miles by the end of it. My weight loss was drastic in this phase but my word I was lethargic/got tired v easily and not up for doing much. Week 3-4 Puree stage - finally I felt I was able to get some proper food in me, and a few days after starting this phase, my weight slowed right down - the dreaded (but expected) 3 week plateau kicked in. I went around a week and a bit without any weight loss, despite me sticking to the recommended diet. I am not going to sugar coat this, it was a bit disappointing standing on those scales after a week, but I knew this would happen so meh I guess. Still walking 2 miles per day during this phase and now feeling I have a lot more energy. Week 5-6 Week 5 started with me starting to lose a pound every 2 days or so, so my body seems like it has adjusted to the inro of more foods for the 'soft foods' stage. I also started back at the gym doing some cardio work on top of my walks, and oh boy I have so much more energy for it! I am now around half way through week 6 and had my first appointment with my nutritionist and he is blown away by the progress I have made/am making. He gave me further chewing tips to make sure I am not overeating as I have been sick a couple of times when I've eaten too quickly and not realised I'm full/satisfied. He is now happy for me to start introducing more fibred meats and more complex foods, like a little pasta and a little bit of rice, to test the waters. Struggles so far: Reminding myself I have a new stomach not eating what family members are eating e.g. Sunday Dinner Eating too fast resulting in vomiting Extra attention from people who have noticed a loss in weight (47lbs and counting since pre-op liver diet). Since I've been overweight most of my adult life, I carried a lot of shame internally, so its in my nature not to talk about myself/get photos taken etc Wins so far Losing a lot of weight and all the benefits that go with it. Being more present with my family. Having the energy to do everything they want to do (I have a wife and 2 kids, girl 11, boy 7) Clothes! I have dropped from XXXL to XL already. Which was a surprise when I packed to go to a 5 day getaway with my fam in week 5 Mental health - the mental benefits come as such a relief. I no longer feel down about my weight (although I know I still have a ways to go) Confidence - generally just feel I can be more myself - hopefully some here will resonate with this. be great to hear of your journey so far, so let's have it folks, we're all in this together

Hi Sarah! I did not have that fear at first, but I can tell you that if you do not meet your fluid and protein goals you will run yourself into the ground. Trust me! I am 6 weeks post op, and after 2 weeks, I didn't drink my fluids or have my protein. When I took a shower one night, I came VERY close to passing out. The plan is so important (and sometimes really annoying) to follow, but it is for your safety, health, and to achieve the weight loss that you desire. Drinking fluids (all 64 ounces +) will really help your weight loss. I worry about stretching my stomach out later on. Like, if I succumb to mental hunger and have something that I should not have, and I just keep eating it because it tastes good - but I am told it will take a LOT to get it stretched out. I know it will eventually stretch out some, but nothing like it was. Good luck on your journey! I hope the worrying subsides and you are able to heal and start seeing the good things. My first non-scale victory was putting on a pair of jeans I hadn't worn in years and they fit...comfortably. Those are the kinds of things that keep you going. I'm down 38lbs since 4/10 (pre-op diet) and 23lbs since my surgery. I haven't weighed in a bit, so hoping it's more like 25-30lbs since surgery, but as long as it keeps going down, I'm good.

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For all my currently stalled folks, I want to offer some hope. I hopped on the scale this morning (like I do every morning) and I was down another 2 lbs. Since yesterday! That makes 6.4 lbs in a week, which is more weight than I've lost in one week since my very first week on my pre-op diet. I am in shock because I was so convinced deep down that the stall was going to be the beginning of even slower weight loss for me, especially now that the magical "first three months" was over. So don't lose hope! In other news, I finally bought that air fryer I've been thinking about for a year, so hit me with your simple, go-to air fryer meals!

(I love your username!) I feel like the majority of us turned to WLS as a last resort after many other WL-options didn't work out for us. I've done WW, Dr Bernstein, raw diets, different drugs, intermittent fasting, all sorts of fad diets / cleanses, etc. I feel you. This is different. This is a diet not as a noun, but as a verb -- a healthy way of eating for life. This resets our hormonal responses to food. It gives us a blank slate to re-learn those healthy habits of portion control, of prioritizing nutrients, etc. It gives us the opportunity to look at our old habits and realize we don't need them anymore. It gives us a jumpstart into weight loss so we start off with great momentum / kicking ass. Good luck to you -- but you don't need it. Good mindset is all you need.

Congrats on the weight loss and the anniversary! The most important thing is to find something you enjoy because the likelihood you will continue to workout will go up tremendously. As such, I'd actually recommend trying a lot of different things. From a health perspective, I'd strongly recommend at least 3 days (though 4 or 5 would be better!), of some sort of aerobic activity (a.k.a. cardio). This can be walking, running, elliptical, biking, hiking, rucking, as well as group classes. Really anything that gets your heart rate up and keeps it there during the exercise is fair game. Start with where you are on this. If you can only do 5 minutes right now, that's fine, but do try to increase that over time to about an hour per session. I also recommend at least 2 days a week of strength training. That again would be a minimum, because just like for the cardio, more days would be even better. Just be careful that you give yourself enough time in between training to let your muscles recover. My number one suggestion would be to enlist the help of a GOOD Certified Personal Trainer to assist you with program design. Note that there are some really good CPTs and unfortunately some really bad ones. You might want to ask around your network to see if anyone has a recommendation? There are just too many variables involved in developing a good strength training plan to provide a recommendation here. At a minimum, a plan has to consider exercise selection, exercise form, effort level, volume, intensity, frequency, and tempo. Some of these variables are highly dependent on things like your current gender, age, strength level, mobility, trainability, as well as any physical limitations you may have. The point is that program design should be tailored specifically to YOU, and that's really not something I could do via a forum like this. Also, in my many years of experience in the gym as a competitive powerlifter, I've seen way too many beginners make horrible mistakes that could have been avoided with some guidance. These are generally mistakes a good personal trainer can help you avoid. Some of those mistakes will just lead to poor results, but some can end up really hurting you. If a personal trainer is just not in the cards at this point, I would caution you to avoid weight machines or free weights for now. As a beginner, you can make tremendous gains just doing bodyweight exercises and there is a lot less risk of injury taking that approach. Feel free to Google bodyweight beginner routines, just keep in mind that some (just like the CPTs), are really good and some are really bad. At a minimum, I'd want a program that has all of the following: Bodyweight squats of some sort A lunge movement of some sort (I'm partial to front foot elevated rear lunges, but the actual type is not really that important at this point.) If lunges are painful for you, an okay alternative might be a bridge exercise A pressing exercise (probably pushups, but if you can't yet do regular pushups, start with elevated pushups) A pulling exercise (Ideally, this would be pullups, but I recognize these are hard for most beginners, thus an inverted row might be a good alternative Some sort of core exercise. A lot of programs have people doing planks, but I'm personally not a huge fan of planks in any form. I'd much prefer to see something more dynamic like a mountain climber, dead bugs, or hanging knee or leg raises. Best of luck!

Yep, I'm 9 months post-op and may or may not just be coming out of about a 3-week stall. It's very normal and expected to start slowing down, stalling, and having small weight gains at this point. I hit a low of 170.2 toward the end of October, immediately bounced up a pound, and didn't drop below that low point until 3 days ago. Personally, I find that whenever I hit a new low after a little bit of a stall, especially if it involves a large one-day drop (I went from 170.8 to 169.0 in a day), I'll usually bounce around a little before seeing any steady declines. Most people continue losing weight until at least 12 months, and sometimes a little bit more until 18 or 24 months. But with a lot more stalls, especially the closer you get to a "normal" BMI. (I'm about 14 pounds away from not being considered overweight by the medical charts). The important thing is to develop a healthy eating and exercise routine that is sustainable no matter what the scale says. If you're doing what is reasonable and recommended, keep doing it. There's no need to change what isn't broken. On the other hand, if you know you've been straying from your good habits, focus on getting back to where you know you should be. Eating healthy foods in the correct portions on a regular schedule, moving your body throughout the week, getting the right amount of protein, taking vitamins, and drinking water are all things you will be doing for the rest of your life, even though at some point the scale will stop going down. The advice I am giving myself these days is to try to separate those good things I am doing from the number on the scale. Because for me, if I start seeing weight loss as a "reward" for "being good", it makes it harder to continue the good lifelong habits when that "reward" inevitably goes away. It also won't do you any favors in the long run if you try to introduce a bunch of things you know you will never be able to maintain just to get the scale moving faster. I might be able to drop a few pounds really fast if I went back to 500 calories per day or re-did my 2 week liquid diet, but I can't live like that forever, so it's a false victory. I think we all have to find the right balance of habits we can maintain fairly steadily for a lifetime and a healthy weight we can maintain without torturing ourselves. And remember that just because you hit the 12-month mark doesn't mean the game is over. You can always introduce improvements to your nutrition or your exercise that will result in slow and steady changes over time. You don't have to workout 5 days a week for 2 hours a day if that isn't your thing, but if you add some resistance training a few times per week or an extra walk after dinner, you will see those results down the road.

Of course. I am by no means an expert. I never spoke with a dietician except about the post surgery diet so I could be wrong but I’m thinking 1400 may be a little high for weight loss if your not very active. The dietician should be able to give you an exact goal.

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Find something you enjoy doing. While I have been a gym rat forever, I always take up things that I look forward to and it has to always be sustainable for me. So some years ago I took up tennis and would go twice a week, I also took up Taekwondo, martial arts and now Pilates. My two Pilates classes a week are the highlights of my week, I look forward to them and I shop cute workout outfits weekly because I like to look good when I go. It is much easier to build on the workouts (movement) you enjoy, so if you enjoy a certain activity (swimming, cycling, tennis, padel, Pilates, yoga, hiking, dancing, whatever it is) you will always feel a bit more motivated to build on that. So for me, I go for Pilates twice a week and I lift and do strength and conditioning another 3 days a week to add to my classes. I love jogging, HIIT and plyos and do that for my cardio, but even brisk walking is really really good to maintain weight loss. Keep it simple. Also, I find it much draining to workout after work, so I workout at 5:30 AM before work (except for my Pilates classes because my studio doesn't run classes that early), this allows me to get it out of the way and have my evenings free to do what I like (which is be with my kids, bake, chill). It also helps that I have a fully equipped gym at home that I have built. I always kept weights, a bench, jump rope and resistance band at my old house and would mostly workout at home early in the morning, if you can keep some weights, a walking pad and some resistance bands at home (if it is an option) do that, it works great for busy days or mornings where you don't have time/the will to go to the gym. This is what has worked for me. It has to be enjoyable and sustainable for you.

I had set my final health goal to achieve a normal BMI. While I’m a bit skeptical about the BMI as the ‘end-all-be-all’ of health indicators, it sure is an effective way to keep my doctors from turning every appointment into a weight-loss seminar lol. But in all seriousness, it’s not just about the numbers on a scale or a chart. It’s about feeling comfortable in your own skin and not having your health sidelined by weight-related comorbidities. That’s the real victory for me. No more worrying about the extra risks that come with excess weight.

Thank you all for your suggestions. It helps to just know that I am not alone in this. Some of these options I have never even heard of and others that I had forgotten. For starters, I am one of those people that has the tv on 24/7 just for the background noise and I always turn it to a familiar show at night so the tones do not wake me. I absolutely cannot sleep when it’s quiet but I’m sure the light from the tv is not helping me now. If I go to a friends house or the power is off or something, I listen to podcasts and I think maybe I need to switch to that to eliminate the blue light for starters and I definitely want to do some research on that red light as well Also its curious you mention the hot shower at night @ms.sss because I recently started sweating at night dampening my hair and bed clothes (I assume it’s the beginning of the change) so I switched to morning showers… maybe that’s playing a part In all this. Perhaps until I get back on track I need to take a second shower or bath. I guess I won’t have the sweating excuse for not doing a little cardio at night either. I had a really bad experience with Ambien years ago so I want to steer clear of the prescriptions if at all possible. Two of you mentioned the ashwagandha. I hadn’t heard of that one. I will have to ask my dr about that with my other meds too. Another friend just told me that she has had luck with that magnesium that you spray on your feet for anyone reading this later. I am so relieved to know that there are so many things to try. Something has to work so I can get some 💤. Thanks again.

I'm not sure...surgeon just said that tightening that opening alone would not cause major weight loss. Unsure if during a full blown revision if they also reduce the size of the 'pouch' and tighten that opening. I would think 'pouch size' is a possible element as well but this doctor did not elaborate, I'm assuming since the goal of my revision if not to lose more weight maybe? If I ever get time with him outside of the investigation in the OR, I will ask.

I've been impatient because I lost 79 lbs. leading up to my surgery day. About 39 lbs. From surgery to today. In nearly the same time frame. I was expecting more weight loss after surgery. It's moving in a positive direction, as long as it keeps doing that surely good things to come. 😃

That’s such silly advice. Make high protein choices. We make those choices every day. Okay up your protein but also up your calories. Your calories or volume of food you eat should be slowly but steadily increasing as you progress until you get to the point you’re maintaining. Until that time, you will keep losing but the rate slows & slows. Like many of the others above I kept losing for almost another year after I reached goal so about 18 months in total. (Wasn’t intending to lose more but it took time to increase my portions & calories to a point it the loss stopped plus it was obviously where my body wanted to be as I’m still there.) And the loss in those last months was grams a week (or none) not kilograms. It’s not over until it’s over.

According to my physician, if the ovaries are removed it is. PCOS is a hormonal issue caused by the ovaries. Once the ovaries are removed (in my case 13 years after my hysterectomy) the issues are resolved. (There was a lot more detail I don't remember as it's been a couple of years but I had asked her about PCOS in my physical and she said no ovaries no PCOS.) Hormones do play a large part in our weight - from grehlin in the stomach to stress hormones. Any HRT is going to have an effect on our weight loss journey as it helps regulate the hormones. It sounds like the combination has put your body on the path to health again!