post-op 1+ years - stretching out pouch?

[drmeow 323]

First, this is not about me; I'm still pre-op (Sept 9!!!)

I just started a new job and a co-worker had bypass some time in the last few years, per my employer (I gather it's general knowledge; we're a small group of about 14 employees, and my boss was warning me b/c this person has developed severe anemia due to malabsorption)

Anyway, I don't know her well enough yet to ask any personal questions, but the other day I was eating lunch and she ate a 6 inch sub. I think she gave away the chips with a comment about regaining all her weight. She may also have had a soda but I wasn't positive.

What I am wondering is, is that size meal normal eventually after bypass or does it mean she has allowed her pouch to stretch out too far? I am just afraid if it's normal to stretch that much that I will end up regaining all my lost weight. I was hoping that even after the main big-loss time that it would stay smaller than a normal stomach, helping me limit my portions naturally longterm. I know that if I don't learn to eat the right things in the right amounts, I will fail regardless but am hoping there is a little more long term help?

[Djmohr 6,965]

This is a great question! There are a ton of studies that were done on line that can help you answer by googling it.

I have done this multiple times and have learned that although your pouch capacity changes in the first two years allowing some additional room, it is really not about stretching as much as it is about your body and brain learning to tolerate more. In one study I read that the average pouch size after 2 years should hold about 6 ounces at one time but they had seen pouches as large as 9 to 10 ounces. The interesting thing is regardless of the pouch being 6 ounces or 10 ounces, when the appropriate food plan is following they did not see any difference in weight gain.

This really is all about putting the right thing in your body and learning about when you are actually full.

I suspect your friend from work is both not following the eating plan nor is he/she probably taking their supplements which are required for the rest of their life to remain healthy. I am only 9 months post op so I have not yet hit maintenance but I am definately able to eat more that I was able at 4 months. That is why it is so important to make sure what is on your plate is good quality Protein and good carbs on a regular basis.

You would not find a 6 inch subway sub on my plate mostly because of the heavy bread. I simply could not tolerate it. However the insides of that sub might work for me.

I have also been taught by my nut that when eating you have to think of your food capacity post chewing. In other words, you will be able to eat a lot more than 6 ounces of salad once that salad has been chewed up. niw if I was eating chicken or steak, I will be lucky to get 3 ounces in, because it is so dense.

I use the 2 bites of Protein for every 1 bite of good carbs until I feel full. It takes the brain 20 minutes to catch up with your stomach. This is why the requirement to eat so slowly yet not go past 30 minutes. Your pouch likely starts emptying at the 30 minute mark which would give you capacity to over eat.

Google your question, there is a ton of info on this topic.

[ready2B 263]

If she was drinking as she was eating, she could have been flushing the food out of her pouch making room for more food. This is what I was told was why we aren't supposed to drink for 30 minutes after we eat. I remember the days before I had my bypass - where I could sit in a restaurant with friend and just keep eating and eating because I was also drinking 4-5 diet cokes. I just never got full. Now I really feel that fullness very quickly and I don't think I would if I drank liquids while eating.

[drmeow 323]

Thanks, that is very reassuring. I hope that by being very careful in my first year I will build good habits that will keep me from sliding down that path to regain afterwards.

Regarding the supplements, I have read online of people who just can't absorb Iron well anymore, regardless of their supplement protocol. But these are anecdotal stories, not research papers, so perhaps I should pose that question to my doctor.

[Djmohr 6,965]

@@drmeow

I am currently not even on an Iron supplement. Prior to my surgery I was anemic for over 10 years. It was severe.

They stopped my Iron supplement right before my bypass along with other meds. I was one of those people who had trouble absorbing as well.

They never put me back on iron and when I asked I was told because of my diet, I should not need them. Of course I was concerned about this but as time went by I have had multiple labs to check my iron levels. They are very healthy. Between the weight loss and diet change I am no longer anemic.

It does have a lot to do with how heavy we are and what we are eating and also whether or not we are still having our period.

I am not a doctor so I don't fully understand what happens but I find it very interesting how many things right themselves with a proper diet following WLS. But it is 100 percent up to us to make sure what we put in our new stomachs is healthy and that we stick to the rules of not drinking while we eat.

Today I only take a multi Vitamin, Calcium, Vitamin D, B12 as well as Biotin for hair. My labs have all been perfect.

[laguerr13 993]

@ DJMOHR : you sounded right on point, I did research for atleast two years because of all the horror stories, surprisingly 85% of those stories were from people who had not committed or followed their plan, I is always interesting to hear people say "I don't wanna stretch out my sleeve" it is virtually impossible, as a rule of thumb and pulling various studies the number for me was 6 -8oz of size ( sizes always vary due to how much a surgeon pulls), depending on food type I can generally hold 3-4oz and on the 10th I will be one month out, I don't ever wanna go over 5-6oz so I am training myself to eating the amounts I hold now, I think the only drawback so far is that even though I get in my 64oz of fluids and learned how to sip, I still occasionally get the strong urge to chug a drink especially after my workouts.......... Oh well could be worse, I could still be trying to avoid booths at restaurants.....lol

[TXMissy 211]

I had a friend that had gastric bypass surgery years ago. She was very anemic (requiring transfusions twice per year), suffered from dental issues, and dumped constantly (I didn't know that was what she was doing). I was very unsure about doing rny because of her. It was the very first thing I told my surgeon. However, knowing what I know now, she didn't take any Vitamins, she ate what she wanted to and usually things I will not eat again, her sugar intake was scary. She blamed the surgery, but she should have been blaming herself. She is everything I don't want to be. I haven't hit my 3 month follow up, I'm scared but excited at the same time. My changes in my diet make me happy and I'm so worried about not being her that I work harder. It's choices you have to make and commit to. I would not eat a subway sandwich. As a matter of fact I was in a situation where it was subway or pizza. I decided to get a salad with tuna from subway. It beat all the carbs and I still ate less than a quarter of the salad and maybe half of the tuna. I can't talk for anyone else who has had rny, but bread and sodas are definitely not on my plan.

[drmeow 323]

@@Djmohr, after your first post I started googling research papers on Iron deficiency after RnY and it does appear that many cases are due to not taking supplements, although there is still a small population who had it despite their supplements. But, I think most of them were also pre-menopausal. I'm post-menopause so that should help a lot, b/c I used to get anemic off and on when having heavy periods. I'm much relieved about that. I don't mind taking supplements at all, just want them to work!

I don't understand people who put all this time and effort into having the surgery and then refuse to follow directions! I totally get messing up sometimes, getting caught up in conversation and overeating or picking at something you shouldn't have. But to make it a habit and just ignore the guidelines?

[Djmohr 6,965]

@@drmeow

I hear you, it is frustrating that you would go through all of this pain and work to lose the weight to get healthy only to stop doing what you are supposed to further down the road.

My bariatric team shared with me a lot of information about RNY. I was really scared about going the RNY route because of all of the negativity surrounding malabsorption. That's when I began to learn that the majority of folks that have issues forget to use the rules. After they lose their weight, they think they don't have to continue to take supplements or follow up with the doctor. They also start doing terrible things like drinking soda, drinking while they eat.

I started researching like crazy and realized it is completely up to me on how well I do or don't do. Yes there are times when I crave a certain food and yes sometimes I will have a small portion of that food. As my nut says, there is no reason we can't live a normal life and have some ice cream or a bit or two of cheesecake. You just don't do it everyday. Save it for when you are really craving something.

I am with you, I just don't get it and I don't have a lot of sympathy for those that choose not to follow their doctors instructions.

[InspirationMySon 135]

You can stretch the opening from your new stomach to the small intestines. This is especially true if you consume a beverage less then 30 mins before eating, less then 1 hour after eating and if you drink while you eat. Doing this things will cause your body/stomach to push your food more quickly into your small intestines. Drinking beverages from a straw can do it for some as can carbonated beverages.

Your stomach about 1-2 years out can typically hold 1-1.5 cups of chewed food. If you continuously ignore the new feeling of full which is in a different spot you will over eat, will likely regain weight. Just avoid over eating and always track your food intake even if your calories one day are much higher then you should consume. It's always good to stay checked into your eating, since many of us in the past where anything but mindful of how, what & how much we really are before.

[drmeow 323]

I had a chance to talk with the person I was originally asking about. Turns out she had surgery in 2008. She lost all her weight and even got below her personal goal, but then had some other health problems that required steroids, and started regaining. She's regained 40 lbs on her original 160 lb loss, which isn't terrible, and she does want to work on those pounds. however, it sounds like she never really changed her eating habits - doesn't like fruit and vegetables, eats a lot of fast food, though not large quantities at a time- just picks at it all day. BUT, worst things - she drinks a LOT of soda, way more than ever did in the first place. She admits to having about 4 cans of Coke (full sugar) each day, and that fills her up, leaving little room for nutritious food.< /p>

she knows she has to stop the soda but so far is unmotivated enough to do it. I am relieved for myself to know that her situation is not something I'd be prone to, and that hopefully I can learn a lesson from it and avoid this.