Conflicting Instructions

[GMaJen 79]

I had my 2 week post op appointments yesterday with my Nutritionist and the Dr. in charge of the Nutrition Clinic, the pharmacist and my surgeon. The Nutrition Doc put me on the bariatric scale and my body fat % is the same, so I'm losing as much muscle as fat. During the full liquid phase I was consuming an average of 534 calories a day, 66oz of water/shakes and 72.4g Protein. I didn't just drink shakes, I ate yogurt 2x a day and pudding/protein too. I walked around my house quite a bit, but I only got about 2 hours of "exercise" because THAT incision was so painful the first week, and the second week somehow I triggered my back pain (the surgeon said that since it started hurting when I tried to increase my walking time, that the surgery could have triggered it).

OK, that's the background. My Nutrition Doctor was disapproving of my calorie intake and told me I should have been getting at least 800 calories a day (she never told me that, my goals were 48-64oz of Fluid and 60-80g protein). She said if I needed to, to sip on Protein Shakes during the day to bring my calorie and protein up. My surgeon said that getting less than 600 calories a day isn't unusual and not to worry about it, don't make myself eat. That I should take it easy until the episode with my back ends and then try to start walking and use some light weights to start building muscle.

So, it wouldn't be a problem if I could do both, but now I'm on pureed/soft foods and as much as I was looking forward to it, I just don't want to eat. I didn't feel hungry during the last phase either, but I ate and drank as scheduled. It wasn't a problem, but it did take ALL day. Now, I get a few bites down and I don't feel full, nauseous or in pain, I just REALLY don't want it. It's confusing because I don't know how to read the signals anymore. Since the surgery, my stomach will growl and my mind says "I must be hungry" and at the same time "I don't feel hungry". So now, am I full or am I just repulsed because my tastes have changed? I used to drink plain Water all the time, now it tastes bad. Do I go back to full liquids and add more shakes so I can get the 800 calories or do I press on with Phase 3 and try to find soft foods that I can make a whole meal out of and not worry about the calories? I don't feel like I can do both because while I had no problem with Phase 2, I don't think I can get the extra calories/protein while trying different foods that I may not want to eat after a few bites. I'm supposed to get at least 32oz of fluid from water, not shakes.

Edited April 8, 2023 by GMaJen

[catwoman7 11,212]

this is a lot to unpack, but one thing I wanted to mention is that most people lose their sense of hunger for up to a year, so that is not unusual. Mine came back at five months out, and honestly, even though it was weird to get used to, I wish I'd been one of the small minority whose hunger never comes back. It was so much easier to stick to my plan and lose weight when I was never hungry and didn't give a flying flip about food. I actually found it pretty liberating after awhile.

you won't start feeling restriction until you're on solid food. Purees and fluids go through your stomach pretty fast. As far as hunger and fullness signals, again, if you're like most of us, you're going to lose your sense of hunger for a few months - up to a year. And when those signals return, they might be different than before. I don't feel "full" the way I did pre-surgery. It's hard to describe, but when I start feeling pressure in my chest, I know it's time to stop eating or I'm going to be sorry. Some people have even weirder signals, like sneezing or a runny nose.

[Arabesque 7,240]

Your experiences are quite common at this stage. I wasn’t hungry or interested in eating either and I too just sipped my shakes & Soups for hours in the liquid stage. I got in less than 300 calories in the beginning. I only ‘ate’ two meals during the liquid stage & from purées started to eat to a routine so I could better get my nutrients in. However, I was never given a caloric goal only Protein & fluids & portion size recommendations. And it took a while to regularly reach those goals & that was okay.

You can only physically eat what you can especially this soon after surgery. Doesn’t matter how much someone tells you you should be eating. If your tummy can’t tolerate more then you just can’t. I was barely eating 900 calories by 6 months. My surgeon & dietician were okay with this because I was eating a variety of nutrient dense foods & my blood work never showed I was lacking or low in anything. It was almost my 3rd year before I could eat 1400/1500 calories. Many eat more but this is fine for my age, height, gender, weight & activity level. That was my experience but others will have very different stories because we’re all different.

Keep working at getting in your protein & fluids. Try explaining to your dietician that your surgeon is okay with what you’re doing. That you physically can’t eat that many calories at the moment while you’re still healing but you’ll keep working at it. If they won’t listen maybe try to find another dietician who is more understanding & willing to be more flexible for you & your needs. No one way will completely suit everyone. Plans should be flexible enough to be modified so it works for you whether it be your calories, portions, activity level, specific nutritional needs, medical needs, progress timelines, etc.

PS - Try diluting your shakes, broths etc. & count the extra towards your 32oz Water goal. Fluids don’t have to be just plain water. Try green or herbal teas, squeeze some lemon, lime or orange juice into your water, protein water, milk, yoghurt drinks, electrolyte drinks (an little boost of energy too) & then rotate the ones you enjoy throughout your day.

Edited April 9, 2023 by Arabesque

[summerseeker 2,139]

I hate Water too. I have always used fruit juices in it, all unsweetened, cranberry, orange, grape, apple are my favourites. I also drink unsweetened diluted blackcurrant squash and I make up my own potion that I keep in a jar in the fridge. I make it with Ginger root and lemons. I have this in winter with lots of boiling water and honey to sweeten it

[GMaJen 79]

Thank you for your responses. I wish I could change my nutritionist, but I go to the VA so I can't. I do like the girl I talk to, but not the doctor, who seems all about the statistics. I really want to be successful at this so I've been trying my best to hit all the goals and not cheat. I guess I need to be OK with not being able to reach the goals right away.