Why?

[YeaMe 246]

I am 3 months out and have found so much conflicting data on basic questions. I am hoping the oldtimers will be able to answer them since they have actually lived through the phases.

1. Most of the hormone ghrelin is removed during surgery and appetite decrease is presented from the first postoperative day and lasts for more than 24 months. Why does the appetite start increasing after the 24 months? Why does the hormone ghrelin manage to find its way back?

2. Ability to eat more increases - start out 2-3 oz, then 6 oz, then 1/2 plate of food, then a full plate of food. I understand initially the stomach is healing which can take 6 months, but why do we develop the ability to eat a whole plate of food? Some say the stomach can stretch out, some say it can't. Why can we eat so much more?

3. Regain. I understand people tend to post more about negative results than positive, but it seems the regain is real. I can only assume that people are again making wrong food choices? I'm under the impression that I can never go back to eating processed food, simple carbs, sweets, sodas. I basically will be eating forever how I am now, though probably more veggies when I start having room. Are there other reasons?

Thanks in advance for your responses.

[Deactivatedfatgal 377]

I am not far out but thes are good questions! What initially attracted me to VSG was the fact that I would never feel hungry again but I have learned that the gherlin returns..as far as regain is concerned I think people fall into bad habits & thus gain weight. I have also heard of slow digestion for some as a reason but please take my 2 cents with a grain of salt as I learned this from others stories.

[Navigating the Wilderness 824]

1. Ghrelin is released in the small intestine, pancreas, and brain in addition to the stomach. Additionally Leptin is what signals your brain regarding satiety, it is common amongst larger people to have developed a resistance to the leptin hormone and thus it does not work as intended and you feel hungry. I personally have never had an 'I forgot to eat today' moment. The hunger is there, but it is easier to control.

2. Your stomach shouldn't stretch, but you can keep packing food into the sleeve and it will either make you throw up, or push through the pylorus and into your intestines. With RNY there is no plylorus in the food channel, and the pouch can most definitely stretch. This is why people can eat so much after surgery.

3. You absolutely can eat all the bad food you could eat before surgery. There is no automatic barf mechanism when you eat bad food, though in RNY and some VSG you can get dumping syndrome. Even as such, my guess is those people who have dumping and continue to eat poorly, either have learned to live with the side effect, or their bodies have changed to the point where sugar in the intestine doesn't cause them the same physiological issues it once did.

The bottom line, like said by sooooo many people is that WLS is a tool, you can use it, or not. It's fantastic to see you are using yours.

[OutsideMatchInside 10,166]

1. It drops dramatically after surgery but it does increase for most people, but not back to prior levels. The human body is an amazing thing, and it will adapt and repair itself. I'm almost 2 years out and I rarely get hungry. The biggest benefit I had from the early drop was, it created a complete disconnect between my brain and my stomach. So even though I might crave something, walk or drive past food, or see a commercial, mentally wanting it, didn't start my stomach to working and desiring food. Prior to surgery if I thought about food, my body responded and I was hungry and wanted to eat. That doesn't happen anymore. I can think about food all day, my stomach doesn't care at all. I track my food to make sure I eat enough. I can easily go 24 hours without eating as long as I am drinking fluids.

This is the study about ghrehlin.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280419/

Most people can't tell the difference between head hunger and physical hunger. It impossible to teach people if they are food addicts, impulsive and want instant gratification.

2. Well for people with RNY, their pouches stretch and since they don't have the valve at the bottom of their stomach, the top part of the connected small intestine can act as another stomach. So much of weight loss surgery information is geared towards RNY patients it is really annoying.

Properly formed sleeves don't stretch. Emphasis on properly formed sleeves, there are lots of quacks out there, but a corrected created sleeve won't stretch.

Once people are healed and swelling goes down. Yes you have more capacity. Most people still have very limited capacity for dense protein. I can still really only eat 4 ounces of dense protein, if it is fatty or moist I might be able to hit as high as 6 but I am usually uncomfortable for hours afterward. Most people that are even further out from surgery than me, still have similar capacity with dense protein.

I can eat basically an unlimited amount of veggies. I can eat 4 cups of baby spinach in one setting I can eat a whole cucumber. I can eat probably a family bag of chips if I tried (I eat Quest chips not real chips but its the same idea, there is zero restriction). Once people vary their diet from dense Protein and start adding more things into their diet, yes you can eat a lot more, especially if you eat things all together. If I eat veggies as the same time as my meat, like alternating bites, I can eat probably double my normal capacity. How much you can eat long term, is based on choices not capacity. Besides the guy last year that claimed he had a 24 ounce steak a month after surgery,

I never see long term sleevers complaining they are eating 12 ounce ribeyes and are totally out of control and regaining because they are eating 16 ounces of grilled chicken at once. They are eating sliders and carbs in large amounts. When people say they have increased capacity. Pay attention to what they are eating, not how much they are eating. When I did my pre-op research that is what really stood out to me reading forums, people were working against their sleeve. It makes a nice list of foods and habits to avoid. It is better to just never start then you don't have to stop.

My post-op eating plan has all these carbs and things that are allowed, but my Dr hands his patients a flyer of what he thinks creates lasting results, and he says not to reintroduce carbs. Almost all the Doctors I know personally (college, childhood friends) are Paleo, Keto, and in general low carb.

3. Regain is kind of like wrinkles. If you live long enough you are going to have some. Everyone is going to regain some weight at some point. How you want to define regain is important though. Regaining 10% to 15% of you lost is not really considered regain, that is fairly normal and as you age, and for women go through menopause, you are going to probably regain a little.

The problem regainers are the people that start regaining before they have finished losing. They never get to goal or anywhere near it and they start regaining in the 6 to 18 month range. Usually people like that are never going to get their weight under control from what I have seen. They never learned good habits. They usually go right back to eating how they ate before surgery just in smaller portions. They don't weigh their food, they don't track and they think restriction is going to be the same forever and protect them. It won't.

Immediately post-op is the easiest time to retrain yourself and create new eating habits. If you blow it, it is lost forever. Anyone can learn at any point, but later on you are going to have just as hard a time as you did pre-op.

Also people that never get to goal or close (like 10 to 20 pounds) seem to regain more often not just because they have bad habits but also because they seem less likely to vigorously defend their loses. Being close to goal and maybe still wanting to hit it seems to make people want to defend it more. These people also usually weigh and track their food and weigh themselves on a scale often. Weighing yourself daily is the only way to see trends. Anyone can have a weight fluctuation of a few pounds between days, but when you are solidly up 5 pounds for over a week, it is time to make some changes. If you don't weigh yourself, people don't catch the regain until their clothes are uncomfortable.

When real long term vets used to post here, one thing I noticed about them was that they just kept eating the same and lost until their body stopped wanting to lose. Going as low as you can possible go in the best defense against regain. Then you have some comfortable bounce room.

Edited May 24, 2017 by OutsideMatchInside

[YeaMe 246]

Thanks all for the information. Hitting goal right now for me is a scary thing. I keep telling myself over and over that when I hit goal, it doesn't mean I can start eating Mexican, Italian, sweets, etc. again like all my friends think I can. Maybe I will just keep it to myself when I reach it. It just means that I eat my 3 oz of Protein and then some veggies, which I have been missing. I'm not sure what is harder, training my brain or my friends, a few of which I'm thinking about trading in! I know it will be a lifelong process and one I hope to master.