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I have also learned lots from people here who haven't done as well as they wanted to. Everyone has something to share. There's no shame in regain, it happens to loads of people for so many reasons. I say post away wherever you like. I suspect all you will get is well wishes. I really really hope you get a better sustainable result with your revision. You're doing a good thing for your health. 🤗

A protein shake is really a meal replacement so you are having more than a meal or two. And no, don’t load up on junky snacks or empty calories. Look too foods that will add additional nutrients: fruit, complex carbs i.e. whole/multi grains, good fats like avocado & nuts, boiled egg, cheese stick, etc. Keep the deli/luncheon/charcuterie meats intake low too - highly processed, high salt & high fat, lower protein. Better to buy a bbq/rotisserie chicken& package it up in single serves & eat that. Give your body time to settle. It takes time for your body to work out what it needs to function effectively & for you to physically be able to eat appropriate sized portions & meals. My hunger didn’t really come back until about a year so after I reached goal at 6 months & it played a part in my continued weight loss. And it took a while to work out the calories I needed. When my weight first stabilised at around 18 months I was eating 1300 odd calories - it took me all that time to eat that much. At 4 years I was eating 1500/1600 & still maintaining much the same weight so it took that long for my body to work out what it really needed. Your lowest weight may not be your final weight either. There’s the quite common 5-10lb bounce back regain around the 2 or 3 year mark. Or lifestyle choices may mean you settle a little higher. And finally, your goal weight might not be your body’s goal weight (your new set point). My new set point was 11kg/24lbs less than my goal.

I hope talking to them about it will help! It's funny because everyone knows right now I can barely eat anything, but they all catch themselves offering me food because it's "polite." I'm eating dessert, want some? I made this big meal full of stuff you can't even look at right now, can I get you a plate? And then I see it on their faces, it's like oh, wait... But since you're dealing with regain, it's good that you are figuring out your triggers and asking others to help you avoid them now so you can have the best chance for success the second time around.

That’s very true. Even as we spoke today she was researching it a bit. Perhaps it peaked her interest and she will search it a bit more. My surgeon is not at a weight loss center but he does have a NP and I am expected to do follow up appointments with her. Post sleeve I stopped going as soon as they said I could get my labs at my pcp but that’s just because I was so ashamed about my regain. I know that the malnourishment is a lot bigger of a deal with this procedure though so I will be more diligent this time around if I choose to go with the SADI.

Has anyone looked into the lower calorie options in the factor75 meals. They are not cheap but they are prepared but they are fresh and they have vegan and keto options as well. I assume this would be an option to consider for those in maintenance for busy nights but I’m not the greatest at reading labels. I am currently looking into converting to SADi and just want to get started with something while I do my research and the insurance process (I was sleeved 3/9/21 and gained the weight back). I never did learn to understand all the macros and stuff the first time around which I’m sure contributed to my regain. I’m am just curious if anyone who understands all that has researched them and has any feedback about them.

@brandycsiz - I think its pretty common. I've deifinitely gone off track, mostly due to other health issues and stress outside of the surgery itself. I was able to walk several miles without stopping in December, then after getting Covid (and I'm assuming long-Covid now), if I go more than 3 miles in a day or try lifting weights in the gym, I get physically ill for 2-3 days afterwards. I keep walking 1-2 miles in the evenings after work, but the lack of progress and regain of weight is very discouraging. I tended to stress eat before, and to be honest, the surgery was a success because at least it limits the amount I tend to binge on when having a bad time. I still have those cravings, but at least now I can drink 8-12oz of water and delay eating. I'm probably on track with my diet 3-4 days per week, but have been overdoing it or eating too many calorie/carb-dense foods when I have an off day or when I see family, who aren't the most supportive. My mom likes to drop off Little Debbie cakes and other snacks on my porch twice a week as she's driving by, and it's straining our relationship because I throw them away immediately, and she sees that as me being ungrateful and disrespectful. I am 6lbs heavier than I was around 8 weeks post-op, so its really getting me down. After covid, I developed some issues with my heart rate. It drops down in the upper 20's to low 30s in my sleep and my blood pressure drops too low, but if it get it past 100bpm, my blood pressure spikes, and I get dizzy and almost faint. I'm trying to get in to see specialists, but I can't get in with a specialist for 5+ months just for initial consult. I have to drive 3+ hours to another area to try to get in sooner, but I burned all my leave time for the year with Covid in January, so I can't take the days off to travel.

I kept losing for almost another year after I reached my goal. It began at a similar rate of loss as I was experiencing but gradually got less & less until it stopped. Over that time I increased my calorie intake (added more & more snacks) & my portions got a little larger. I was eating about 1300 calories when I initially stopped losing but eat about 1500/1600 to maintain at about the same weight now. Like @Spinoza, I’m a believer in our changed set point. This is the weight my body is happy at & this is the weight it wants me to be thanks to the surgery. Could I eat my set point up? Yes, if I wanted. I mean that’s what we did before - ate our set point higher. Our original set point wasn’t an obese weight. Don’t forget you may initially stop at a lower weight than you expected but it may give you wriggle room if you experience the bounce back regain around years 2 or 3. Give your body time to resettle. Lots of things change when your weight starts to stabilise. Just give it time. Slowly increase those calories. Get in touch with your dietician for ideas of what you can add or how you could adjust your current eating plan. Good luck.

Okay now that I’ve told my regain story and done as much research as I can (there is not a ton of info out there about the SADI) I have questions. Some that are white awkward tk Ask the doctor. First and foremost is how many of these procedures he had done. He is a very well knows surgeon, head of the bariatric department at the hospital even but I don’t think he has done a lot of this particular procedure. In fact the poster schematic is not yet on the wall and his office did not have any information packets to share about the procedure yet. If he says I am first I want to ask what makes him comfident he is capable? I’m pretty sure he just does sleeve and bypass primarily. So how differnt is if than a bypass?? I sorta understand the gist of it but I admit I don’t understand normal anatomy nevermind the exact differences between the procedures. also, I read some medical research on the procedure and they were talking about less complications after the learning curve a couple years later. Did that mean the individual surgeons learning curve or did they mean the field has learned from each others mistakes. I have to admit maybe being in the first few adds a little bit more anxiety to all this. Next I need to ask him, if he made my sleeve to big if he will correct that as well I have always felt like my sleeve was a little larger than everyone else’s based on how much I could eat so if he gets in there and that’s the case does he fix that as part of the procedure if so, is that now a differnt procedure and does that matter? I am not expecting anyone to know answers to these questions just help me with the way to word them so that I can feel comfortable asking I don’t want him to think I am questioning his surgical skills because I know he is really good but I still need some reassurances here

For me the decision was fairly easy, I didn't want to risk GERD chances (I have the worst luck and if there was a chance - even a small one I'd get it) and I didn't want to risk yet another surgery AND the possibility of my insurance declining another bariatric surgery. The second reason was usually you lose more weight with a bypass and I've had a few surgeries with organs removed...I just wanted at least one after a surgery (my stomach) to not being one of them, stupid I know but ...its what helped me decide. Lastly, I'm a researcher and all the numbers in the medical studies journals / research papers looked better to me they pointed to better overall outcomes with bypass, more weight lost, less weight regain, better chances of reducing my pre-diabetes etc. I'm fairly anal retentive so I knew I'd be the same way on making sure I took my vitamins so I didn't worry about that aspect of it. I listened to my surgeon who didn't really help..he said both were good choices for me, so that left me having to research on my own. Good luck on your journey!

Just checking that that isn't all you're eating! I'd also check with your team that the takeout food that you are eating fits into your overall plan. We have such a small capacity at 2 months that we really need to pack nutrients into every meal. Rice and noodles have nothing to offer at this point. The chicken definitely does. In addition, the months after your surgery, when your appetite is zero and your capacity is small, are your chance to re-train your tastes. In a year's time much bigger volumes of takeout will be much easier to get through and much more apt to cause you not to lose what you should, or even to start to regain. I totally understand that your cooking facilities are limited and that makes things hard. I hope everything goes well for you.

Long rant ahead sorry ... So, I'm slightly angry (understatement). I saw my french primary care doctor yesterday. She's never been great to be honest. I've been seeing her for 6ish years. 5 years ago I gained over 80lbs pounds in a year and a half going from 118lbs (that had been my standard adult weight since my teenage years with a BMI of 19) to 200lbs ( BMI 32.3) after taking antidepressants. I stopped the antidepressants after a year because the weight gain was making me more miserable than I was being slightly depressed and thin. I have been struggling to loose the weight since... loosing and regaining the same 15-20 lbs again and again. As I've mentioned before, I have slight cérébral palsy - nothing too bad but enough to make walking pretty painful on my legs when I hit over about 130lbs and to make me generally clumbsy - I also lack gross motor coordination and don't have the best fine motor skills either... I can't really do any sports that require coordination and can only really ride a bicycle in a flat straight line and it takes a lot of mental effort for me to keep my balance, crowds freak me out because I'm scared of tripping and falling and don't even mention jumpy little dogs, my nemisis as my balance is so precarious. However I've always made do and It's never stopped me having an enjoyable fufilling life and a pretty decent career. My weight gain really really made me suffer, emotionally of course, my self esteem, my self worth etc ( I live in Paris which is the thinnist city in a thin country ... and it's not a place where people are kind to overweight people at all - I checked and the mean BMI of a Parisienne woman is 22.3 - so when you hit a BMI of 30 here you're really a fat outlier and are basically scorned in all public spaces ). It also made me physically miserable and I lost the little flexibilty I had - constant pain when walking - loss of gross motor skills, trouble showering standing up at 30 years old, not being able to put my socks on etc etc. For the last 4 years I have been to my Primary care doctor about 5 times asking for a referal to a nutritionist - she's always refused as told me "but it's simple, you just need to eat less and move more, it's not magic, No need to waste money on a nutritionist if you have no willpower "No **** sherlock! She has no idea the willpower it takes to get out of bed at 200lbs with cerebral palsy when you feel like your legs are litterally going to snap, when your feet are burning with weight stress induced neuropathic pain. In January I finally cracked after a lot of introspection and thought and booked my VSG for February in Turkey. I've now lost 35lbs since my preop diet so in just under 2 months. I already feel a lot better, the pain when I'm walking is lessening, I'm fitting back into the "second round" of fat clothes I got myself. So I walked into her office yesterday ( I had the intention of "fessing up" to having had a VSG and asking her for iron supplement ideas as I'm still being sick when I try and take iron ) She took one look at me and said "ah, you've finally found your willpower, loose another 20kg (40 pounds) and you'll be an attractive young woman again" I had a surge of red rage inside me, I kept my calm, but didn't tell her about the surgery, I just smiled and told her I needed a refferal to a dermatologist for a mole on my face and left. I'm never going back to see her again. I spoke to my physical therapist on the phone this morning and he sort of helped he said "can I be unprofessional ? Honestly, qu'elle aille se faire foutre, (she can go f*ck herself)" Lets find you another doctor." My physical therapist knew about the surgery, as did my orthopedic surgeon and booth agreed that with my CP anything is better than being even slighty overweight and that the surgury was worth the risk as they've both seen me loose my mobilité over the last few years and has seen how its affected me. They said that if I could afford to go private abroad I should because If not I'd have to jump through hoops for years in france because my BMI (32) wouldn't have been considered high enough as a stand alone. So yeah... this weekend I find myself another doctor who's not a fatphobic arsehole and has a minimum of human compassion. And for the iron I'm just going to go and ask directly at the pharmacy what the have to propose. Sorry that was long but I just had to get it out, I'm slowly realising all the **** I've put up with because of my weight these last years and I am ANNNNGRYYYY!!!! Hope everyone is having an okay hump day!

Hi All, First Post I'm female in the UK and nearly 59 years old. I have been a fat toddler, a fat child, a fat teen and a fat adult. I have yo-yo dieted all my life, with each yo-yo lasting for a shorter period and resulting in a new high-point when I would inevitably bounce back. In July '23 I reached a new all time high 24st 9lb (345lb) I was about to start the diet again, about to go through the same loop but just couldn't face it. I made an appointment with a bariatric surgeon, discussed my history and options and agreed that a gastric sleeve was a good fit for me. I was told I was too heavy for their practice and I needed to lose 56lb before I could have the surgery. The surgery was booked for Jan 2nd '24 and I started dieting. As is the practice here I had an assessment with a psychologist who confirmed I was a suitable candidate and a dietician who again confirmed I was a suitable candidate but in the process managed to make me feel like I had already failed, in her words I was "Much heavier than most people who come to us" As she was a gate keeper and I needed her approval to progress I did not complain. That time will come. Following my initial consultation on the 8th Aug I started dieting to get down to the target weight. I have never had difficulty in losing weight I simply cannot maintain any losses. My normal pattern is if it takes me 6 months to lose the weight I will regain it and 10lb in the following 12-18 months. By the day of surgery I had lost 75lb and was already feeling so much better. I considered carrying on with just dieting and not having the surgery but I was already beginning to see my discipline weaken and I knew it would be the same old story. Surgery went well, I had very little pain or discomfort and by and large I cannot complain. I'm currently on the pureed stage of the diet and doing OK managing to keep protein and fluid levels up though I struggle with the fluids some day. I have lost 13lb in the last 21 days but have hit the dreaded 3 week plateau. Early days but I have no regrets - to be without hunger for the first time in my life is such a relief, I feel good and am doing more and more each day. I am already starting to live the life I want and i can see so many more benefits ahead and believe they are attainable and retainable. I wish I knew why I have struggled so much with my weight - there is no one trauma or set of childhood issues I can point at. It is not that I have a compulsion to eat everything in sight there are so many foods I can just ignore, I have no interest in sweet foods of any kind or greasy deep fried foods. But I cannot resist bread, pasta , rice etc and my down fall has always been the second or even third portion of these carbs. For this reason if no other I hope the VSG will not only prevent that behaviour but I also hope it will give me enough time to re gain control before considering a second helping. My parting thought for this post is that as I have gone through my journey thus far the one thing I have found is that my story is not that unusual, my problems are not unique and most importantly that they are not the result of some moral failing or fundamental weakness. There is more to life long obesity than can simply be solved with "diet and exercise" and having finally found medical professionals who believe that is the case I see this year and this journey as a new lease on life that I am going to grab with both hands. Koshk - newbie

I am almost two and a half years post sleeve. At your stage I was eating around 800 calories I think, but if I've learned anything it's that we're all totally different! Well into maintenance, my typical day is: Breakfast: full cream milk latte. I have never eaten breakfast at breakfast time and never will. Mid morning: one or two fried or scrambled eggs, depending on how hungry I am. Generally one. Lunch: a salad with some protein (last night's dinner meat, tinned tuna or deli meat - sometimes cheese). Or more often soup - usually homemade and usually with either chicken or pulses for protein. Or occasionally, if I'm feeling really lazy and can take the sugar hit, 100g tinned baked beans with cheese and hot sauce. Snacks, probably three a day at this point: cheese (and usually a couple of crackers with that); 150mls [approx] full cream milk kefir or a kefir yoghurt; nuts (30g approx); seeds (20g probably); deli meat; fruit (I eat at least one portion of berries or an apple every day). I tend to keep lots of meat snacks in the fridge as they're filling and help me reach my protein goal. Dinner: whatever I've cooked for everyone else but without the carb element, or just a tiny bit. Basically protein and veg - in that order. But that includes fried chicken, bolognese, casseroles, sausages, roast dinners, fish pie (no potato topping) - everything I used to eat before my sleeve. Supper: I do most of my carb intake here. Toast and butter, porridge (oatmeal to you lot) with stewed fruit, crackers with butter (or cheese if I haven't cheesed out by then). Exercise: I do a 1 hour aerobic exercise class 3 days a week. I walk between 2 and 4 miles every day and I jog about a mile once or twice a week instead of walking. I am still amazed by what my new body can do. I probably should do more. This is my diet 90% of the time. I have lots of days when I stray badly off the path and eat chips (crisps) and occasionally chocolate. I also drink wine every weekend, which I accept is totally empty calories with no nutritional value. I just track everything and try to adjust if I can. I've had a couple of regains of a few pounds now (4ish), but so far I've been able to jump on those, ditch the rubbish (carbs mainly), up my exercise and get back to 140 or thereabouts. It's no problem at all - a couple of weeks of being more vigilant about what goes into my mouth and a few runs instead of walks. I really hope I can keep doing that. I may have to accept that my set weight is higher than 140 but I am loving it here!

One of the healthiest ways of eating (I don't want to call it a diet) I have come across is in a book called the Pound of Cure by Dr. Matthew Weiner. Last summer, I hit my highest weight ever. That's when I started looking into WLS. I was watching a lot of YouTube videos about it and came across an interview with Dr. Weiner, which led me to his books and videos. He also has a weekly podcast that I love with new episodes every Wednesday. I started implementing a lot of the advice in Pound of Cure (you can get the book on Amazon) and lost close to 15lbs between July and January, which on the one hand is slow, but on the other hand it felt completely natural and not like a diet at all. It's just a sustainable way of living that focuses on healthy foods and good habits that lower your body's set point. He has a lot of resources for dealing with weight regain, too. Congratulations on still being over 100 lbs lighter than where you started! I have every confidence that you can continue to do well and meet your goals over time!

If you have access to therapy, this is something that would be good to address because this mindset of guilt and shame is neither healthy nor productive. I know that not everyone can get therapy, but there are other resources available. Perhaps your clinic has a support group you can join. I highly recommend the podcast, “We Only Look Thin,” which has a lot of great advice relating to mindset. The bottom line is that no single meal is going to make you regain 36 pounds. Beating yourself up over it isn’t going to accomplish anything. You’re new to post-WLS eating and still learning, so learn for next time. Recognize that you weren’t prepared for the event not having food that meets your needs and learn to be prepared next time. Maybe keep a “just in case” protein bar in your car. One of my strategies for an unknown food situation is bringing my own Skinny Girl salad dressing and/or a couple of low-carb tortillas, so I can make a salad or wrap out of what’s available. Also, nowadays people are pretty sensitive about dietary restrictions and won’t be offended if you ask what will be served and even request a special meal if you’re comfortable (though I understand not wanting to call attention to your diet). Having an all-or-nothing mindset where you equate two fries and half an onion ring to failure is really harmful. You made a couple of decisions, in seven whole weeks, that weren’t on track. That’s not going to derail all of your progress. There’s no reason you can’t continue to stay on track aside from those isolated instances. This is a marathon, not a sprint. Don’t quit the race just because your shoe came untied once or twice.

same, same, as the other posters above. i am really, really good at losing weight. I am (was) also really, really good at finding that weight again. i've lost 50-75 lbs three separate times prior to wls, and each time managed to regain it within a year or so, plus a few more pounds for good measure, until i finally hit my highest weight of 235 lbs (i'm 5'2" so thats alot of weight for my height). with WLS (sleeve for me), i lost 120-ish lbs and kept it ALL off (give or take 5lbs) since reaching goal...almost 5 YEARS ago... whats more, maintaining this weight seems relatively effortless compared to before. because i eat so very little in volume (added to the fact that i somehow developed an affection for exercise and activity!), i have quite a bit of leeway in food choices to reach my maintenance calories. i am very grateful for this aspect of my surgery experience, i tell ya. BUT... i will add a disclaimer here that not everyone has the same WLS experience. you won't know what yours will be until you know. though we all of us here already sort of know that low calorie diets alone aren't sustainable long term for us. i mean, that's why we are all here, no?

{{$title = \IPS\Output::i()->title;}} {$title} Roux-en-Y gastric bypass (RYGB) is the most common type of gastric bypass weight loss surgery.1 It is usually laparoscopic. It is reversible if necessary, but is designed to be permanent. The surgeon first divides your stomach, leaving a smaller upper portion and stitching shut the larger remainder of your stomach so that it can't be used any more.2 Normally, food in your stomach empties to the upper portion of the small intestine. In RYGB, the surgeon attaches the small stomach pouch to a place lower down on the small intestine, thus "bypassing" the majority of your stomach, the duodenum (upper portion of your small intestine) and at least part of the jejunum (middle portion of your small intestine). A long-limb RYGB procedure bypasses more of your intestine; in this case, the surgeon attaches your newly formed small stomach pouch to a place even lower on your small intestine. The long-limbed RYGB procedure can lead to faster weight loss because of greater nutrient malabsorption (fewer nutrients absorbed). Why is the procedure called "Roux-en-Y?" The gastric pouch is called the "roux limb," and the "Y" shape is formed by the three arms coming together at a junction. The three parts are: The small stomach pouch that holds food The large stomach pouch that secretes digestive juices The far portion of the small intestine that the two portions of the stomach are connected to Buchwald H. ASBS 2004 consensus conference statement: bariatric surgery for morbid obesity: health implications for patients, health professionals and third-party payers. Surgery for obesity and related diseases, 2005;371-381 Ibid. Advantages and Disadvantages of the Gastric Bypass Advantages of the Roux-en-Y Gastric Bypass No bands, staples or other foreign objects in your body An established procedure with more research on safety and effectiveness than the vertical sleeve gastrectomy and sleeve plication More weight loss in the first year than the gastric sleeve and the adjustable gastric band (lap-band)1 Reversible if necessary (but not easily) Can be revised to a longer-limb Roux-en-Y gastric bypass if an initial short-limb procedure does not lead to expected weight loss. Quick improvements in your health, especially in your blood sugar control with better insulin resistance, lower blood sugar levels and possible resolution of diabetes May be a good choice for individuals with a sweet tooth because sweet foods are not typically tolerated Jackson TD, Hutter MM. Morbidity and effectiveness of laporscopic sleeve gastrectomy, adjustable gastric band and gastric bypass for morbid obesity. Advances in Surgery, 2012;46:255-68. Disadvantages of the Roux-en-Y Gastric Bypass Higher risk of nutritional deficiencies due to malabsorption than the lap-band, sleeve plication and vertical gastric sleeve Weight regain can occur after a couple of years if appetite levels increase and/or the stomach pouch is stretched High-sugar and high-fat foods can cause dumping syndrome, with symptoms of shakiness, nausea, vomiting and diarrhea Stomach pouch can be stretched if patient overeats, leading to less restriction and less effectiveness Complications are less frequent, but are more likely to be serious Possible Complications/Risks of the Gastric Bypass Intolerance to certain foods Gastroesophageal reflux disease, or GERD, with severe heartburn Nutritional deficiencies due to low food intake and nutrient malabsorption Dumping syndrome Staple line leaks from the stomach and intestines where they were cut and stitched during the procedure Vomiting, nausea, diarrhea Strictures Weight Loss and the Roux-en-Y (RYGB) Rapid weight loss in first 6 to 12 months About 65 to 70% of excess weight loss (EWL) within 2 years Often more than 100 pounds lost Many RYGB patients regain about 20 or more pounds after the first two years of weight loss The RYGB is restrictive and malabsorptive and it affects your appetite hormones. Restrictive: Right after surgery, the top portion can hold only about one ounce, or two tablespoons, of food. This forces you to have smaller meals you fill up faster Malabsorptive: With RYGB, food doesn't go into your duodenum, which is where a lot of nutrient absorption usually occurs. Absorbing less protein, fat and carbohydrate leads to fewer calories and faster weight loss. Hormonal:1 2 changes in your hormones after RYGB can decrease hunger. Ghrelin: a hormone that causes hunger and whose levels decrease after RYGB PYY: (neuropeptide YY) a hormone that reduces hunger and whose levels increase after RYGB GLP-1: (glucagon-like peptide 1) a hormone that reduces hunger and whose levels increase after RYGB Mechanick MD, Kushner RF…Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity, 2009;17(S1):S3-72. Morinigo R, Moize V, Musri M, Lacy AM, Navarro S, Marin JL…Vidal J. Glucagon-like peptide-1, peptide YY, hunger and satiety after gastric bypass surgery for morbid obese subjects. JCEM, 2006;91(5):1735.

{{$title = \IPS\Output::i()->title;}} {$title} Side effects and complications more specific to bariatric surgery may appear soon after surgery or months after surgery. These are some of the common ones. Nausea and/or vomiting Diarrhea and/or constipation Gastroesophageal reflux disease (GERD) Leakage from stomach staple or suture lines (RYGB, vertical sleeve gastrectomy, sleeve plication, BPD-DS) Leakage from gastric band or connection tubing (lap-band) Band slippage or erosion (lap-band) Bowel obstruction Infection at the access port site (lap-band) Hernia Ulcers Weight regain Nutrient deficiencies Osteoporosis (low bone mineral density and increased risk for fractures) Anemia Gallstones from rapid weight loss Dumping syndrome Psychological concerns, such as addiction swapping or depression Many of the above complications are caused or made worse by going off of the proper diet. Choosing the appropriate foods for your stage of weight loss during the postoperative recovery diet progression or longer-term weight loss diet, chewing slowly, separating fluids from solids and taking nutritional supplements as recommended can prevent or reduce many of these complications.