8 months post, 3 months of stall and poor circulation

[Anomalia 6]

Hi there folks. I was sleeved back in September of 2023, so it's been 8 months.

In 3 months, I have lost 3 pounds. This has had me in tears. I haven't been absolutely perfect, but I'm exercising 5 times a week and maintaining a significant calorie deficit (average 1400 cal at 330 pounds).

For the last 6 weeks, my hands and feet have started getting cold, and I have been sweating excessively. I went to see my GP and we considered thyroid, which was a relief as it might explain the stalls AND the circulation. BUT the TSH test just came back within normal range. She's stressing that extreme weight loss can cause you to feel cold more often due to the loss of insulation, but my hands and feet are objectively cold (other people can feel it) so it doesn't seem this simple.

Any ideas? If I'm back to steering my own healthcare on this, it is not a new thing for me, I'm just not sure where to start.

[JennyBeez 287]

Honestly, I woke up from my surgery (gastric bypass RNY) feeling cold and it just never went away, LOL.

Did your doc do a full bloodwork panel, with Iron and all that, and check your blood pressure? Other nutrient deficiencies can have the same symptoms.

I've been told by many that it's normal after weight loss and/or WLS. Yes, sometimes it's thyroid related and it's good to check that semi-regularly just in case, but you can also just legitimately be cold from the weight loss. Think about whales and blubber -- they use that fat to keep them warm in the ocean, our fat cells do the same. My hands, feet and nose are frequently cool now, and always seem to be the first places I notice the temperature around me changing. My dad (who has thyroid disease) usually has the coldest hands in the house -- but not anymore!

[BlondePatriotInCDA 498]

On 5/14/2024 at 11:48 AM, Anomalia said:

Hi there folks. I was sleeved back in September of 2023, so it's been 8 months.

In 3 months, I have lost 3 pounds. This has had me in tears. I haven't been absolutely perfect, but I'm exercising 5 times a week and maintaining a significant calorie deficit (average 1400 cal at 330 pounds).

For the last 6 weeks, my hands and feet have started getting cold, and I have been sweating excessively. I went to see my GP and we considered thyroid, which was a relief as it might explain the stalls AND the circulation. BUT the TSH test just came back within normal range. She's stressing that extreme weight loss can cause you to feel cold more often due to the loss of insulation, but my hands and feet are objectively cold (other people can feel it) so it doesn't seem this simple.

Any ideas? If I'm back to steering my own healthcare on this, it is not a new thing for me, I'm just not sure where to start.

I completely understand your frustration, in the last 8 weeks I've lost and regained the same two pounds. I'm 9 months in..so very close to your timeframe. I read in my bariatric clinic handbook to contact the clinic if weight loss stops longer than 4-5 weeks. I have an appointment next week at which time I will be asking for answers. Like you, I am always at a calorie deficit, I watch every single calorie, fat, sugar and carb gram sticking to my 800 calories a day, 80 Protein grams, 50 net carbs a day. My labs are "perfect"... So yeah I do understand, I'm sorry you're going through this, especially for longer than I have. What did your doctor recommend/say?

As far as being cold, there are numerous posts here on the forum with other WLS patients discussing being cold all the time - do a search to find them. In fact, as I type this I have a heating pad on my back and an electric blanket on in front - its 56°F here too cold!!! Before surgery I would have been fine, I kept my heat on during the winter at 55° and was comfortable where as everyone else was chilly. So, its completely normal. I was wearing a long sleeve shirt in 76° sunshine the other day and was still chilly. So rest assured your being cold is completely normal!

Let us know what your doctor said and keep us updated!

Edited May 17 by BlondePatriotInCDA

[Anomalia 6]

On 5/17/2024 at 12:10 PM, JennyBeez said:

Honestly, I woke up from my surgery (gastric bypass RNY) feeling cold and it just never went away, LOL.

Did your doc do a full bloodwork panel, with Iron and all that, and check your blood pressure? Other nutrient deficiencies can have the same symptoms.

I've been told by many that it's normal after weight loss and/or WLS. Yes, sometimes it's thyroid related and it's good to check that semi-regularly just in case, but you can also just legitimately be cold from the weight loss. Think about whales and blubber -- they use that fat to keep them warm in the ocean, our fat cells do the same. My hands, feet and nose are frequently cool now, and always seem to be the first places I notice the temperature around me changing. My dad (who has thyroid disease) usually has the coldest hands in the house -- but not anymore!

Thanks for the response! We did full bloodwork (my surgeon orders labs every 3 months). My Iron was low but not to the point of anemia, everything else was in normal ranges.

I guess I may have misunderstood what to expect here. i was told that you'd *feel* colder in general with the reduced insulation, but I didn't hear or understand that your extremities would actually get cold. I was over here worried it was a circulation problem.

[Anomalia 6]

On 5/17/2024 at 1:44 PM, BlondePatriotInCDA said:

I completely understand your frustration, in the last 8 weeks I've lost and regained the same two pounds. I'm 9 months in..so very close to your timeframe. I read in my bariatric clinic handbook to contact the clinic if weight loss stops longer than 4-5 weeks. I have an appointment next week at which time I will be asking for answers. Like you, I am always at a calorie deficit, I watch every single calorie, fat, sugar and carb gram sticking to my 800 calories a day, 80 Protein grams, 50 net carbs a day. My labs are "perfect"... So yeah I do understand, I'm sorry you're going through this, especially for longer than I have. What did your doctor recommend/say?

Thanks for the response! Yeah I feel your frustration.

When I last saw my doc I was a month into the stall and she said she wasn't worried about it at the time. It's another month or so before I have my next check-in. I was just going to tell them then, but maybe I will get in touch sooner.

[JennyBeez 287]

9 hours ago, Anomalia said:

I guess I may have misunderstood what to expect here. i was told that you'd *feel* colder in general with the reduced insulation, but I didn't hear or understand that your extremities would actually get cold. I was over here worried it was a circulation problem.

Don't get me wrong, I'm grateful for my care team and they have done a wonderful job for the most part in preparing me and responding to my post-op queries... but they've also missed things along the way that I think could've/should've been a simple thing to cover in one of the many pre-op lectures, booklets, etc -- or been wrong about 'minor' things (aka: "Take this specific Multivitamin dosage/brand with your Breakfast each day, and your SSRIs & BP meds, your B12, and your iron" when the multivitamin package explicitly says "DO NOT take this with Iron because it inhibits iron absorption, wait until 2 hours afterwards to take any iron supplements")

In other words, I think it's always in our best interest to do some research ourselves, ask around, and seek the opinions of other health professionals. My pharmacist, for example, always seems to know way more about drug & supplement interaction than any of my doctors who do the prescribing.

[SleeveToBypass2023 2,637]

Ok I'm the QUEEN of stalls lol So here's what I can say. Take from it what you will.

Cold hands and feet: I have that, and for me, it's due to weight loss AND low Iron. I'm anemic, so I take a bariatric Vitamin w/ iron and an additional iron supplement w/ vit c and it keeps my iron levels at the lowest part of normal. When it dips down, my hands and feet are like literal ice cubes.

Breaking a long stall: So I tend to gain 3-5 pounds when a stall hits and then lose the same 1-3 pounds over and over until it breaks (and I lose like 6 or 7 pounds all at once). My stalls can last anywhere from several weeks to 3 months. It SUX. When I have a stall, I change up my work out routine to confuse my body. If you do the same things in the same order every day, your body gets used to it and gets complacent and the work out becomes less affective. So I add new things, take things out, add or take away reps, etc. I pay extra close attention to what I eat and when. On work out days, my fluids, Protein, calories, and carbs MUST be higher because if not, my body thinks it's starving and holds on to everything. I prioritize fluids, protein, and low carb above all else, but I still make sure that I'm at a calorie deficit while getting in enough to prevent my body from thinking its starving. I also only weigh myself once per week and pay special attention to NSVs, because even when the scale isn't doing what you want, your body still is. Fat gets redistributed, you slim down, that's when you see you drop sizes in clothes, rings, etc...

When I work out, I keep my calories at around 1300 - 1400 depending on what work outs I do. I drink an electrolyte drink (Propel or gatorade zero) and an additional 64oz of fluids at LEAST. I keep my protein at 80-90g, my carbs at 40-50g, and healthy fats at 40-50g. When I'm not working out, I keep my calories at around 1000 - 1150, my fluids at around 64oz, my protein between 60-70g, my carbs between 20-30g, and my healthy fats between 20-30g. We need less when we aren't working out. We need more when we are. Just keep at a deficit while still providing more when working out. And make sure you change up the work outs.

Right now, your body is really confused. You have to be patient with it, but at the same time, show it who's boss and shake things up to get it going again. You still have time to get where you want to be. Make sure you're not grazing through the day, be mindful what you're eating, when, and how often. Go back to your bariatric diet basics if you need to. You got this.

[Anomalia 6]

On 5/23/2024 at 9:09 AM, SleeveToBypass2023 said:

Cold hands and feet: I have that, and for me, it's due to weight loss AND low Iron. I'm anemic, so I take a bariatric Vitamin w/ Iron and an additional iron supplement w/ vit c and it keeps my iron levels at the lowest part of normal. When it dips down, my hands and feet are like literal ice cubes.

Okay first, thank you so much for such a comprehensive answer. I've seen some of your tips in the forums before but this really lays things out. I'll start varying my routine more and see if I can trip things up a bit.

This iron thing in particular is interesting. In my last series of labwork my iron came back very low, but not quite anemic. (The range was 50-170, I came in at 55.) I have upgraded to the bariatric Multivitamin with more iron and started also taking the iron melts with Vitamin C, but I struggle to do this consistently due to how often I have dairy, and I haven't felt much of an improvement yet. I get re-tested in ~5 weeks to see if the numbers are better (or rather, to make sure they're not getting worse). Interesting lead either way.

[SleeveToBypass2023 2,637]

2 hours ago, Anomalia said:

Okay first, thank you so much for such a comprehensive answer. I've seen some of your tips in the forums before but this really lays things out. I'll start varying my routine more and see if I can trip things up a bit.

This Iron thing in particular is interesting. In my last series of labwork my iron came back very low, but not quite anemic. (The range was 50-170, I came in at 55.) I have upgraded to the bariatric Multivitamin with more iron and started also taking the iron melts with Vitamin C, but I struggle to do this consistently due to how often I have dairy, and I haven't felt much of an improvement yet. I get re-tested in ~5 weeks to see if the numbers are better (or rather, to make sure they're not getting worse). Interesting lead either way.

It takes a good 30 - 60 days to really feel a difference, but you will. I tend to stay away from dairy and I use almond milk for anything requiring milk. I do use shredded cheese in my eggs and in my modified shepherd's pie (we use mashed cauliflower instead of potatoes, and omg I swear it tastes even better). No matter how much dairy you have, you're still going to want to take the extra iron w/ vit c. And the Multivitamin is a must no matter what. As for changing things up, that is the best way I've personally found to confuse my body into doing what I want. That and making sure I'm getting enough calories on work out days. I'm glad I was able to help, and good luck!!! Let us know how it goes!!

[BigZ 102]

I haven't hit a stall yet and I am 9.5 months post op. I still extremely limit my carbs. typically less than 40 carbs per day, net carbs are less. I am still high Protein. I am still losing 2+ pounds per week. My daughter had the surgery the same day I did, and she has been stalled for a two months, she also eats whatever she wants. She isn't limiting what she eats. She is under 1400 calories per day and not losing. I am ~1000 calories a day still.

As far as being cold, yes, I am cold a lot. I used to die from heat, if my office was 75 degrees I was sweating. Now at 75 degrees I can be comfortable if not slightly chilled. I have lost a lot of insulation. All my blood work comes back perfect. It will take some time for your body to regulate. (although my friend is 4 years PO and she is still always cold and has been goal weight for 2 years).