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I had gastric bypass surgery around 6 years ago and I am very pleased with the results. It is sort of like the gold standard for bariatric surgery. They have most of the bugs worked out. Mini-gastric bypass is somewhat new so I can not really assess it. In general, many people try various kinds of diets prior to eventually getting gastric bypass surgery. Most of the time these are referred to as yo-yo diets. Because the individuals will lose some weight but then over time give up the diet and then gain the weight back and then some. So it is like a yo-yo. In your case it went to the extreme and you slid into anorexia. So the only advise here is that the psychological treatment component is very important for you for the surgery to work. (the package with the 12 phycologist sessions). Also if things go south sometimes after surgery then reactivate the physiological component. The three most important elements after gastric bypass surgery are to meet your daily protein, fluid and vitamin requirements. Food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight.

Most any surgery that you can contemplate, in addition to the basic risks associated with surgery, hospitals and anesthesia, will have some risk of side effects that may be less than desirable, however we take those risks in order to correct a problem that we have created by injury, disease or genetics, with the intent that the result will be much better than what we started with. The various bariatric procedures have different predispositions to consider - conditions that happen more commonly than in the general population. The VSG is predisposed to GERD as the stomach volume is reduced much more than its' acid producing potential, and while usually the body adjusts and corrects the problem, sometimes it doesn't completely. Similarly, the RNY is predisposed to marginal ulcers (typically around the anastomosis) because the part of intestine to which the stomach pouch is attached is not resistant to the stomach acid like the duodenum is (the part of intestine immediately below the stomach outlet, which is bypassed along with the remnant stomach.) Likewise, it is also predisposed to dumping and reactive hypoglycemia owing to more rapid stomach emptying due to the lack of pyloric valve. Usually, these problems don't hit most patients, or don't persist if they do, but sometimes they are long term problems. These are things to consider ahead of time, particularly if one has any relevant pre-existing condition. Another consideration is that the VSG is fairly easy to revise if it does run into a problem that can't be resolved otherwise, while the RNY is difficult to revise or reverse. Another point to consider is that while the sleeve leaves behind a relatively "normal" anatomy, the bypass leaves a blind stomach and upper intestine which is more difficult to examine endoscopically, so some problems may not be diagnosed until they are more advanced and symptomatic. For instance, if one is subject to stomach polyps, that is a pre-cancerous condition that should be monitored, but is difficult to do after a bypass. An pre-op endoscopy is a good idea to understand what is happening inside you, even if your program doesn't require one. On the diabetes front, they both do well, typically seeing 75-85% remission rates (remission is what it is, rather than a "cure" - it can come back, particularly with some weight regain) though the bypass is generally considered to be marginally better. The best results come from the Duodenal Switch which typically shows remission rates in the 98-99% range, but that is a more complex procedure that few surgeons offer. However, if the diabetes fails to go into remission, or comes back, after a VSG, a revision to the DS is straightforward (as the DS uses the VSG as its basis) while revising an RNY to a DS is very complicated, which only a handful of surgeons are able to perform. So, while the VSG may not be quite as good as the RNY in that respect, it has a much more viable "plan B".

That is curious, and beyond my limited experience! I suppose that is can be strictly an esophageal problem, though as I noted, I have only seen such things as they related to other root causes. No, I haven't had such a revision, though it was suggested at one time for another issue, but I have avoided having to go that route (with the help of some second opinions that basically said to leave well enough alone for now.) I do have minor GERD, which is readily treated with low level OTC meds, so there is nothing worth fixing at this point on that account. The sleeve is predisposed to GERD by virtue that the stomach volume is reduced a lot more than its acid producing potential, but the body usually adapts to that over a few months, and most surgeons prescribe a PPI for the initial few months and then wean off of them. (Similarlly, the RNY is predisposed to dumping, reactive hypoglycemia and marginal ulcers, so there is no free lunch in that regard, no matter what procedure one goes with - there is always some risk there.) I would prefer to keep the sleeve as long as it cooperates, as the RNY is a little bit fussier to live with, but it's not the end of the world, either, and certainly preferable to what you are going through; my wife has a DS which is a bit fussier still, so I'm familiar with all that entails if I need to go there. The surgeon who has adopted our local support group does quite a few oddball and esoteric revisions (like the complex RNY to DS), people come from across the country to see him, and he sometimes pulls up scans on his laptop of one of the wonky sleeves that has come his way, so we get some feel of what can be done, that other surgeons pass on. That's why I brought up the stricture idea (beyond your regurgitation sounding like that might be it,) because that is something that many surgeons prefer to revise away rather than correct. I does seem like you are heavily restricted, much more so than normal for a normal sleeve, or RNY. 500 calories isn't so bad - it's not that unusual for people with any of these WLS to still be down there, though more commonly somewhat higher in the 6-800 calorie range; it's the water intake that I would be concerned with as dehydration will get one thrown into the hospital a lot faster than low protein or other nutrients in the short to intermediate term. The vast majority of people go through this, an RNY, or VSG, or a DS, with little or no complications, but sometimes they crop up; hopefully, you have had your share of them now and that's it. In some respects, the RNY is a more familiar procedure for the surgeons,, even if they don't do as many of them as sleeves, as it has been around in bariatrics for 40-50 years, so most started out with them; the basic procedure upon which it is based has been around for some 140 years in treating gastric cancer and other GI maladies, so it is familiar territory for most; the VSG on the other hand, had more limited application until it was created/adopted for WLS as part of the original BPD/DS, so it was not as widely used until the DS guys started using it some by itself (usually as part of a two stage DS) and saw that it offered good weight loss all on its own, so I wouldn't worry too much about your surgeon's experience with it, as that was the default WLS in Canada until fairly recently.

yes. It's probably reactive hypoglycemia (RH), which isn't that uncommon among RNYers. It usually appears when you're a year or two out. I have to eat something every 3-4 hours and limit my sugar intake. If I eat a carb, I have to eat a protein with it. As long as I follow these "rules", I rarely have the problem oh - if you're getting sweats and dizziness right away after eating, it's more likely dumping. If it's an hour or two later, it's most likely RH.

I haven't been on this board in over a year, but I see this thread has been reactivated so wanted to put in my two cents. I was sleeved by Dr. Kelly in March 2012. I booked directly with him and had no problems doing so. I was originally going through a Lighter Me, and then chose not to do so after the Dr. they wanted me to see after they stopped working with Dr, Kelly had some really negative issues posted on this forum. I did know about the patient death with Dr. Kelly but did my research and found many people who had been happy with their experience with him. I have absolutely nothing negative to say about him, he came to see me several times before and after to make sure that all my questions and concerns were answered about the surgery. I felt that he honestly cared about my well being. As for my surgery, he did a great job. I had no complications, and my incisions healed really well. Weight loss surgery is hard, don't kid yourself otherwise. You can't eat very much for quite a long time afterwards, and it takes a while to kind of return to feeling "normal". I did have my sister go with me to Tijuana so I didn't go by myself. Anyway, just wanted to voice my opinion that Dr, Kelly is a good surgeon in my opinion and I have no reservations about recommending him to anyone who is considering surgery in Mexico. As for my weight loss, I am down seventy pounds from my surgery. Should be more, but...that's me, not Dr. Kelly! Currently a size ten, started out at a size 18. Very happy I had the surgery, it changed my life. Everyone has to make the right decision for themselves, but if you are considering a surgeon in Mexico, I would definitely recommend you consider Dr. Kelly.

Denmark, Norway, Sweden,Finland and Iceland. Trolls are Scandinavian in origin. Ever notice how people who have lost their favorite coping vice....and are really freaking hungry...can be really really...bitchy? And also really touchy and reactive about other people who they perceive are being bitchy? Hell, I'm guilty of it. Probably of both. Sure don't mean to be. I'm not pointing fingers at any particular party....just something I've noticed. People get extra angsty and on edge when they're stressed and have one of their main coping mechanisms missing. This whole adventure has tough moments you don't expect. Emotionally difficult spots that might show up as fangs instead of tears. Something to keep in mind. PS...if anyone asked me if I went to the gym in real life, I'd probably smack the **** out of them. If they're not a close friend whose kind intent I was certain of...without the context of real love and support....it's a rude question. Just sayin'

Hi thank you for this. I'm only two weeks out but have already reactivated my membership at the gym. I will start with light weights when I start next week...thanks again....

I've been banded for 2 weeks now and I'm having some problems with low blood sugar last couple of days. Been feeling kind of "out of it" and unable to concentrate so my formerly diabetic friend (she's had the gastric bypass) tested my blood and my sugar was in the 50's and it said that I was hypo-glycemic. This morning I was craving more ruffage and ate a bowl of Kashi high Protein Cereal with some plain soy milk & grapes. Up till this point I've been sticking to my post-surgery diet - Proteins, cooked vegies & fruits. Cereal (starches), even low sugar, wasn't suppose to be on that list. Still waiting for my Dr to contact me. Hypo-glycemia runs in my family. Anyone have any thoughts? Could I have made it worse by what I ate? :confused2:

I don't know how many are "many" (there is something called "adverse selection" that is common in online forums, where negatives outnumber positives because everyone with a complaint will post about it, but those with nothing to complain about are largely silent, so things tend to seem worse than they are,) but it does happen for a few reasons. The sleeve is predisposed do reflux problems due to its geometry and physiology. The volume of the stomach is reduced much more than the acid producing potential, so it takes a while for the body to adapt, and sometimes it doesn't. Also, the sleeve is considered to be a "high pressure" system in that the stomach is often closed off by the pyloric valve at the bottom, so excess gas, fluids or solids have no place to go other than back up; the bypass is a "low pressure" system as there is no pyloric valve in the system, so excess gas can vent down into the intestines. In contrast, the RNY due to its geometry and physiology is predisposed to dumping, marginal ulcers, reactive hypoglycemia and bile reflux. With either procedure, this does not mean that everyone will experience these problems, just that this is the natural result of the anatomical changes that have been made. Another compounding factor with the sleeve is the relative experience level of the profession - in the US, the sleeve has been routinely approved by insurance for about the past 6-8 years, while the bypass has been routine for around 40 years. This means that there has been some revisions needed due to inexperience in some of those early sleeves - the surgeons may have been well experienced doing bypasses and bands, but a new procedure, even a straightforward one such as the sleeve, brings along its own subtleties and nuances that take practice to master. Resultant shaping issues can promote or exacerbate the reflux problem. In the US, most bariatric surgeons are now far enough up the learning curve that most are now making routinely making functionally competent sleeves (one should always seek out a surgeon who has several hundred of whatever procedure one is interested in under his belt.) However, now the problem is, as it has been since early on, is that many are not very experienced in correcting any problems that may crop up with a sleeve, so the natural inclination is to stick within their comfort zone and revise to a bypass when a problem occurs, rather than correct the sleeve. So yes, the OP is correct in some respects that there are some unnecessary revisions being done, though not necessarily just for the sake of charging for two procedures. As time marches on and the industry gets more experience with sleeves, I would expect that the revision rate will decline as both the sleeves will be made better overall, and the surgeons learn how to repair them when necessary rather than revise them, much as the bypass has matured over time and some of its predisposed problems are less common as they have learned how to mitigate them to the extent they can (bile reflux isn't too common anymore as they have worked out techniques to minimize its occurrence, for instance.) Another factor that may skew the impressions some is that the bypass is a difficult procedure to revise - it is something of a dead end surgically speaking. If poor weight loss performance or regain is experienced, there is little point in reversing it and revising it to a sleeve as they are both so similar in performance that there isn't much to be gained. There are minor tweaks that are offered - tightening of the stoma or intalling a band over the bypass - but overall results are generally pretty poor. Revising it to a DS, which can offer improved weight loss and regain resistance, as well as diabetes remission, is a very complex procedure that only a handful of surgeons are capable of performing. So, we don't see a lot of bypasses revised for that reason, though sometimes they are reversed if there are significant complications that can't otherwise be resolved, though that isn't a trivial option, either.

Unfortunately we cannot change the behavior of others. She is probably very concerned and maybe even miffed that you "did this to yourself". I suggest you find a way in your own head to let these comments pass right by you without being reactive. It's sometimes the same thing we have to do with most negative comments people make regarding our choices. You've done something very proactive for your life. Be proud of that, and over time as you heal, you will be able to resume normal eating in small but healthy portions. Good luck on your journey!!

I am not a doctor nor do I have medical experience. So take what I say with a grain of salt. I am 3 years post-op RNY gastric bypass surgery. It seems like you have multiple conditions, so let me talk about these individually. General The three most important elements after RNY gastric bypass surgery are to meet your daily Protein, Fluid and Vitamin requirements. food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight. Weight loss is achieved after surgery through volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as Protein shakes. It looks like you have lost the weight are in the Maintenance phase. So generally your meal volume allotment is now large enough that if you concentrated on eating high protein meals, you might not need to add protein supplements (protein shakes, protein bars). I found it difficult to transition to solid foods (such as steak and chicken) after surgery so I primarily relied on softer foods such as chili and Soups. I fortified these with extra protein. I have included the recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf But if you are having difficulty keeping food down, then you may have to go back to protein supplements just to ensure you get the proper amount of protein in daily. Ulcers Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present. So the general advice from above if I am interpreting it properly is to eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed. Also avoid NSAIDs (such as Aspirin, Ibuprofen, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indomethacin, Ketorolac, Ketoprofen, Nimesulide, Piroxicam, Etoricoxib, Mefenamic acid, Carprofen, Aspirin/paracetamol/caffeine, Etodolac, Loxoprofen, Nabumetone, Flurbiprofen, Salicylic acid, Aceclofenac, Sulindac, Phenylbutazone, Dexketoprofen, Lornoxicam, Tenoxicam, Diflunisal, Diclofenac/Misoprostol, Flunixin, Benzydamine, Valdecoxib, Oxaprozin, Nepafenac, Etofenamate, Ethenzamide, Naproxen sodium, Dexibuprofen, Diclofenac sodium, Bromfenac, Diclofenac potassium, Fenoprofen, Tolfenamic acid, Tolmetin, Tiaprofenic acid, Lumiracoxib, Phenazone, Salsalate, Felbinac, Hydrocodone/ibuprofen, Fenbufen] and but use proton pump inhibitors [Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole, Rabeprazole, Dexlansoprazole, Rabeprazole sodium, Pantoprazole sodium, Esomeprazole magnesium, Omeprazole magnesium, Naproxen/Esomeprazole, Esomeprazole sodium, Omeprazole/Bicarbonate ion] and/or sucralfate [Carafate] antacid. After RNY gastric bypass surgery, my surgeon put me on Omeprazole [Prilosec] for a year to lessen the affects of surgery on my stomach. Passing Out The fact that you have passed out a few times might be due to a condition called Reactive Hypoglycemia. This is a low blood sugar condition that affects some RNY patients. Here is a link that describes the condition. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass

I have had thyroid disease since I was 15 yrs old. I am hypothyroid as I had my thyroid removed surgically. My endo told me as I lost weight she would most likely reduce my thyroid medication. I had a check with her recently and have lost 30 pds and I am more hypo than I was before the weight loss. I have decided to keep my meds the same for the time being and recheck again in 2 mths. As you lose weight typically you should need a lower dose of thyroid medication. This thyroid business had a mind of it's own and can be quite fickle at times.

Prior to surgery I had Idiopathic hyperhidrosis, or excessive sweating for several years. Shortly after surgery this condition went away. I am now 5 years post-op and that condition is no longer a problem. This weblink list 10 causes of night sweats. http://www.activebeat.co/your-health/10-common-medical-causes-of-night-sweats/ #4 and #10 look interesting. Do you have other symptoms that pair with these conditions. Many people develop a condition called reactive hypoglycemia after bariatric surgery.

I will be four years out from sleeve surgery this June. Maintained at 130's first two years easily. My third year I had a gain 10 to 15 pounds. I got it back down. Maintaining for me is chasing the same 10 pounds up and down the scale. My health is fantastic, Type one pre surgery my a1c is in the non diabetic range. I'm in the best shape of my life, I am making up for lost time. Only one small complication. Reactive hypoglycemia ( Low blood sugars ) Its manageable with food. I've been managing my blood sugars all my life so this is nothing new.

I always have a 1/2 lara bar before workout and 1/2 after. Complex carbs make a complete Protein and so therefore will bring sugars back up. Don't do this starving thing too often because we are susceptible to reactive hypoglycemia.

Yeah I see a lot of people say they only had to do a few days before and my doc nutritionists is scary the daylights out if us saying if we have anything at all then there will be stomach residue which makes me think then how do other people only do a few days. Doesn't make sense to me. I Have lost 5 pounds in 4 days. But I have reactive hypoglycemia and the nausea and headaches are killing me.

Here are a few potential causes. 1. If you were diabetic prior to surgery and on meds, you may have to reduce your meds at this point. 2. You may be experiencing reactive hypoglycemia. Here are a few links that might help. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/ http://www.todaysdietitian.com/newarchives/060415p48tip.shtml https://www.healthline.com/health/hypoglycemia-without-diabetes 3. Dehydration can also cause dizziness and lightheadedness. https://www.emedicinehealth.com/dehydration_in_adults/page3_em.htm

I was never a ketosis kid either. I was very intent on avoiding post-bariatric reactive hypoglycemia, so I always tried to eat at least as many carbs as Proteins (grams). I reached goal (150 pounds at 5'5" and 69 years old) at 8-1/2 months post-op. And now I'm 3 pounds below that while trying to stop losing. I'm averaging about 1400 calories/day the last few weeks. But still losing very slowly. I eat extremely healthy -- lots of good veggies and fruits, typically 100 grams of Protein daily, whole grains, very little refined sugar and other refined carbs. Always take my vits/mins, and my big four-page blood panel results found everything was normal and good. Feeling good. Looking good. All going good here. So here's my challenge of the moment: It's a challenge for me to mentally *agree* to stop losing. Seeing the scale go down, even 0.2 pounds, is definitely a more positive feeling than seeing it stand still. Honestly, I'm a little worried about that. The idea that I could become anorexic is ridiculous to me. But I do realize that I've got to change my attitude into one that feels rewarded by seeing my weight stabilize. Anybody got any thoughts on that front? BTW, many thanks to @@Rogofulm for lobbying Alex to open this maintenance forum. Thank you, Rog.

i'm 26. My bmi is 36 (going by my home scales anyway, which are always a little bit lower than the hospital scales) and i dont care to gain weight to make sure it's any higher :S I don't have any co morbidities *sp* that i know of.. unless depression and hypoglycemia count and i've never been actually tested for the latter, a dr otehr than my pcp told me he thought i was hypo and i should eat that sort of diet.. I can't really think of anything else that might be considered a co-morb...... It seems like my ins covers the surgery IF i'm approved, but i don't see that happening, ya think? the last line on the answer on this link has me wondering if i should just give up... or go ahead and gain the weight and be a hermit until then.. darnit, the goal is to get INTO pants, not get big enough that i can't fit into any of mine.. Answers.com - Will blue cross and blue shield pay for weight loss surgery with a thyroid problem

@@Daisee68 Yes, I kept my beta blocker for "just in case". I have both propranolol and atenolol, and I am glad that I kept both. This disease can make life so much harder, especially when trying to get back on track with all the responsibilities, and social interactions. I have been on 100mcg of Thyroxine since January this year. 4 months after my RAI and thyroid destroyed, I swung to TSH 17.4 Now, back to square one .... My Endo doesn't want me to cut my pills (ironically I got another refill for more 100mcg script, recently, and still have 1/2 box of the currrent 100mcg .....) She just wants me to take my med for 6 days, then not take it on 1 day per week. So, I am to take it Monday-Saturday, then not take it on Sunday My blood tests are due in 6 weeks time, then again 6 weeks later. Yes, I have to monitor it carefully. If in 2-3 weeks I don't see a change, I may have to cut the tablet, and try it that way. I don't want to go hypo, but hyper is tough too ..... Thank you for your support.

Good on you for walking out. She's a f**king idiot -- uninformed and passing along wrong information to people who need good info. Jeez! Yes. I also forgot to mention that she made me climb on a machine supposed to calculate my muscle mass, fat, water and bones weight. It seems that I have around 90 pounds of muscle. Then I was trying to explain that it is physically not possible for me to have the same Protein intake (the famous 60-70 grams a day) as for a woman of 160 pounds that would have 60 pounds of lean muscle. Any fitness instructor, website or magazine would also customized to protein intake in function of the activity and goals. Giving the same recommendation for everybody is just dumb. Anyway, I am looking for a different NUT, but not easy to find one that is experienced with VSG patients. I've seen another one that wanted to put me on a regular hypo caloric diet...of 1200 Cals a day when I am barely reaching 900 a day. I guess I need to contact other clinics / surgeons that are used to VSG to get names of the NUT they work with. I'd it does not work, I will stick to the program I found on the web (Ottawa hospital) which is very detailed. For anybody can recommend me a website or program, it would be great.

I was 199 when I decided to be sleeved. I'm 5'2". I've been fighting my weight battle for more than 10 years. I was extremely depressed and unhappy. My knees hurt, my back hurt, and I was pre-diabetic. I've lost 20-30 and gain 40+ more times than I can count. Both my parents are extremely morbidly obese. I could see my future in them and it wasn't pretty. I could guarantee that my weight would only continue to escalate so I decided to be proactive rather than reactive. Why wait and waste more of my life? I needed a weapon for my weight battle, and the sleeve was it. Today I am 138 and feel like I am living for the first time in more than 10 years. I feel healthy, mentally and physically.

I was connected to sliding scales with insulin pump in hospital. My insulin was monitored by my diabetic consultant. My rates dramatically changed after operation. No complication post op! No problems with infections. No leaks. Had a test 6 weeks after my op. All was good. Left hospital 48 hours after surgery. Weight loss was spectacular in the first 6-8 months. It slowed down later on but with help from yoga and pilates classes plus lots of walking body shape is continuously changing, for better! Took me up to 4-6 month to up my energy levels. Problem mostly with finding a correct balance between carbs an proteins. Not enough carbs means very tired and slowing down with a weight loss. You will soon learn by trial and error! Had a great support from my pump clinic: meeting with my nurse every month to change my pump's settings. Insulin resistance "vanished" after 6 months!!!! Wonderful! Today, over 2 years after my surgery, I'm nice UK size 16. I'm full of energy and my body is still changing shape. I eat absolutely everything in small portions.I eat in public places and attend dinner parties. I don't advertise that I had VSG. It's my business only! When pushed and questioned: "have some more" I very firmly respond- "no, thank you". No explanation added. I love my life and wish I had this done years ago. No bigger problems with hypos now than before sleeve if anything situation is better. Good luck!

I start my pre-surgery diet in just over a week (one day before my 50th birthday). Blossom requires protein shakes for breakfast and lunch and a lean meat for dinner. My biggest fear is how to survive on that few calories for two weeks. First, I don’t sleep if my stomach is growling. Second, my blood sugar is going to tank which makes driving unsafe bc it makes me want to fall asleep at the wheel (I have reactive hypoglycemia). How on earth do people deal with these types of issues on so few calories?! If I could subsist on 600 calories a day I’d have been doing it a long time ago. 🤦‍♀️🤦‍♀️🤦‍♀️ So I’m more worried about the peripherals then anything. Forging ahead no matter what but a bit concerned about the pre-diet.

@ Grave's disease here too. Had my thyroid destroyed by RAI (radioactive iodine) swallow when I was in the Navy Sometime in 1999. Been Hypo and on Synthroid since 1999. I am Pre-op and hope my thyroid does not hinder my weight loss progress. Time will tell. Currently on 300 Mcg tablet once a day and skipping Sundays. I never knew about taking it with Calcium..will have to watch for that. I take it everynight at bed time and my levels have been steady ever since. I see an Endo once every 6 months, I find the Endo knows a bit more about Graves then my PCP.