Social Question

GloPro's avatar

How does a person not slowly starve after bariatric surgery?

Asked by GloPro (8213 points ) April 14th, 2014 from iPhone

Inspired by a recent thread, I am curious to learn more about bariatric surgery and stomach stapling.

With permanent removal of a large part of your stomach, how does a person maintain good health on a severely reduced caloric intake for the rest of his/her life? Does the metabolism severely slow down? Are they eating 10 meals a day to try to get more calories? Are they ways feeling hungry, or is the satiety center of the brain going to adapt?

How does nutrition work after surgery?

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58 Answers

zenvelo's avatar

Most of your nutrition needs are collected and passed to the blood stream through your small intestine; the stomach is there for processing (digesting) to pass onto the small intestine.

By reducing the size of the stomach, there is a smaller amount of food that can be handled, plus one gets full very quickly. People with smaller stomachs do feel full. But they get plenty of nutrition because they are still eating plenty to live on.

What bariatric surgery doesn’t address are the psychological reasons behind over eating. That still has to be overcome. A person who has his stomach stapled may feel physically full after eating, but is still emotionally hungry for more food.

A guy here at work lost about 150 lbs after having lap band surgery. But his drinking has gone up and he has regained about 30 lbs. And while he can’t eat as much, now all he eats are foods that are heavy on sugar and fat.

cazzie's avatar

This type of surgery is useless. People are stupid and their brains are involved, so without treating the addiction center of the brain the surgery is useless.

janbb's avatar

@cazzie I think many people who have the surgery are also in programs that address the psychological dimensions of the problem. For some, it is very effective to deal with obesity both ways. It seems very arbitrary to dismiss the whole idea out of hand.

cazzie's avatar

@janbb and I’m saying that what ever treatment they are getting is useless for many of them. No magic wand or band or surgery. A girlfriend of mine from highschool has had this and her story reflects many. She lost some weight, but she couldn’t curb her impulses, so she is still morbidly obese.

GloPro's avatar

@cazzie, although I value your opinion, I chose General instead of Social to get specific answers. Please refrain from giving your opinion of the surgery. Thank you!
@zenvelo The post that inspired this one, the OP said they are restricted to 750 calories a day. I do not see how an adult body can subsist on such intake nor do I currently agree that there is enough nutrition in 750 calories, even if you are working with a dietician. That’s a large part of my question.

Judi's avatar

Some people HAVE died! It is not a ho hum surgery. I heard a statistic that 1 in 100 die. That may be less now that the surgery is more common and it has been perfected but malnutrition is a major problem post surgery. Most people I know who have had it take protein shakes to make sure they get their minimum nutritional needs met.

cazzie's avatar

@GloPro This is not an opinion. My friend’s example is very real. Also, I know a thing or two about neural psychology, so don’t simply dismiss what I say and unfounded opinion. It is not.

GloPro's avatar

It is my understanding that bypass is reversible, whereas bariatric is not. This has to be a factor as well.

GloPro's avatar

@cazzie I did not dismiss your opinion. However, it does not address the OP, and this is a general question. Thank you!

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livelaughlove21's avatar

I used to work with a girl that had the lap band. She lost 100 lbs before I ever met her, but she was still technically overweight (and still is 6 years later). For those that don’t know, fluid can be added or removed to the lap band in order to leave less room or more room in the stomach for food, respectively. I remember she could barely eat anything – she vomited every single day because she couldn’t keep anything down. I think she was down to about 500 calories per day, so they removed fluid from the band. A month later, she’d gained weight and they had to put the fluid back in. Back to puking every day. I felt so awful for her because she was miserable all the time and wasn’t even losing weight. It was as if they reduced her metabolism by 75% while they were in there placing the band.

seekingwolf's avatar

@cazzie

Uhm, just wow. It’s not useless. This sort of treatment is BEST when the person also undergoes counselling to change their thinking and habits. Many doctors require it. But just to dismiss it as totally “useless” is very ignorant and unfounded. I suggest you read up on the subject.

I had bariatric surgery. I am 24 years old. I had surgery in December. I had 90% of my stomach permanently removed. I was over 300 lb. I have since lost 60 lb and am still losing.

Now, arriving at my choice to have the surgery took a couple years. I have PCOS and I was lean until I hit puberty and then my weight just ballooned. I went from someone who wasn’t that hungry to someone who was hungry all of the time. I didn’t have a preference for sweets (never been big into soda) but I was definitely an overeater at meal times because I got so RAVENOUS. I read about the sleeve surgery. They remove 90% of your stomach and your stomach cells produce gherlin, which signals to your brain that it’s time to eat. I always suspected that my gherlin levels were quite high and got worse the heavier I got. I was almost always hungry and in physical pain because of it! Then I read a paper somewhere about gherlin levels being higher in PCOS women.

I decided to take control of my life and I pursued the surgery. Insurance paid for all of it because I met the requirements. It took me a year to approved. I had to undergo psychological testing as well.

After my surgery, I have not experienced any hunger. I know what/when I’m supposed to eat, but it’s not true hunger. And it’s so much easier to make the right choices. I feel much like my old self, before I got fat.
But I also still go to counselling, to learn about how to deal with the weight coming off. I go to the gym regularly (or exercise outside, like I did yesterday) and I have revamped my diet. I eat mostly high quality protein, some dairy, some vegetables, some fruit. That’s about it. I don’t eat bread, pasta, etc.

I eat about 750 calories a day (I actually just logged my day’s calories, planning ahead, and I’m at about 770 today). I take supplements to get the nutrients I am not getting from my diet. Calcium, iron, B vitamins, multivitamin, everything. It’s SO important to get enough B vitamins, especially B12, because my intrinsic factor is gone forever. But I take a liquid supplement and do great. I even am healthy enough to be a regular platelet donor at the Red Cross and routinely give 2–3, usually 3, units at a time.

I work hard at staying hydrated too. I am not hungry and feel satisfied with the food I eat. I do not feel starving at all. Actually I just ate lunch! About 2 oz of lean steak cut in tiny cubes, and some red beans (not salted). I feel really good right now. Once some time has passed, I will drink some water that I steeped some blackberries in. I also do not throw up or anything. Lap Band people have those problems. I don’t. As long as I chew well and don’t eat too much (I can tell when I’m full), I feel great.
I would never be able to eat so little had I not had surgery.

That being said, to be successful, it is so, so, so important to 1) change your eating habits and 2) change your exercise habits. You have to keep your metabolism up. You can’t just sit around and eat and not work out. You also MUST eat enough good protein. Or else bye-bye muscles.
People who go into this thinking that they can just eat crap and not work out will not be successful. You MUST make the lifestyle changes.

I am committed to sticking with this. Of course, not feeling hungry really helps me out. I make good choices. I even go out to restaurants. I just eat very little and take a huge doggy bag home. I still enjoy foods that I have liked pre-surgery! chicken, steak, fish, bits of fresh fruit, it’s all good. I just don’t eat desserts (my choice, I could eat it, but they make me feel icky so I don’t) and I don’t drink soda or anything carbonated.

I am very thankful for being able to have my surgery but it’s not just my surgery, it’s me too. I have to make the right choices to continue to lose weight.

I recommend this surgery to obese people who are willing and committed to making the lifelong changes that they need to do.

seekingwolf's avatar

Lastly, I find it humorous when people call it “pointless” or “not worth it”. Statistically speaking, it’s the BEST way to treat morbid obesity. As in, according to studies, it is most effective at permanently reducing one’s weight.

I wasn’t about to sit around and kid myself into thinking I could lose it on my own. I couldn’t. I had tried. I didn’t want to sit and wait another 5 years for diabetes to develop.

It is easily the best choice I’ve made for myself. I’m very happy.

cazzie's avatar

My idea is that treatment begins when the problems first starts. Not after the patient has suffered such horrible weight gain. I’m not judgemental against the patient. I’m judgemental against the health care system that lets the problem get to this level. Sure, currently, I’m so glad this helps so many people, but MY hope is that the problem is treated before it gets to this level. Because, once it gets to this level, there are too large a percentage that it can’t help, but that it only helps to a certain level.

GloPro's avatar

@seekingwolf Is it difficult to try to stay hydrated when your stomach is so small? How many meals do you eat a day?
Also, this may be TMI, and feel free to not answer, but how has this whole thing affected your bathroom routine?

seekingwolf's avatar

@cazzie

Ideally, yes, that is what we all would like. Not to get so big in the first place. My PCOS was diagnosed early on too. Most people who get this surgery are much older in age and have had their health go for years. My weight really toppled on and I felt very powerless. I did physician assisted diets, went on programs, threw out all “bad” food, tried to reduce my hunger, etc. Nothing worked. This surgery is the only thing that has worked, in addition to changing my habits.

I feel there are many things wrong in our society. People are not supposed to get as big as cars. I don’t really know what’s going on or how to solve it. I just am thankful that I got it when I did.

@Judi

Many people do rely on the shakes. I get most of my protein from solid food though. My goal was to move off of shakes ASAP because I didn’t want to be one of those patients who was drinking everything. I eat normally, I really do. Just in small amounts. Boy, I save a lot on groceries, and I buy high quality stuff…fresh meat, produce, etc.

seekingwolf's avatar

@GloPro

Yeah, it’s sometimes hard. I can’t “gulp” like I used to! I don’t take tiny sips either but I “drink” normally, as in, I take a few mouthfuls and then wait a few min, and then do it again. I also can’t drink before, during, or right after meals, so I have to make sure I drink a lot.

I eat 3 meals a day, plus a snack, usually a Greek yogurt. I don’t graze through the day. You can easily “cheat” this surgery by grazing. So I don’t graze. Just 3 meals and I’m good.

As for toilet business, I take a stool softener once a day. I’m not constipated, I am just not getting the fiber I used to. I poop maybe once every other day, every 2 days. I used to go 1–2x a day, no longer! It looks/feels “normal”, not hard or difficult. keeping hydrated = regular poops.

I didn’t have the bypass. Just had most of my stomach removed. I didn’t want my intestines rerouted. I have no idea how that would affect their poops. They lack a pylorus. Luckily, I still have mine. Everything that comes out is normal and fully digested!

People really don’t get how I am not hungry/weak/tired from how little I eat. The truth is, I am doing fine. I lose about 8–10 lb a month now. I can still work out and feel great. I was worried that I wouldn’t be able to do super strenuous activity but that hasn’t been an issue.

cazzie's avatar

@seekingwolf are we talking about problems with your thyroid levels as well?

GloPro's avatar

Congratulations on your progress. I’m happy that it’s working for you. You’re being very informative!

You were very young to have the surgery. Is there any concern that when you achieve your target weight that you may need to increase your caloric intake with additional meals or snacks? Muscle requires more calories and runs a higher metabolism… Also, with strenuous exercise, again when you begin to reach target weights, do you have to monitor your hydration levels and electrolyte levels any differently?

seekingwolf's avatar

@cazzie

No, I’ve been tested for that several times throughout the years. I also was tested for Cushing’s. I just had PCOS and insulin resistance. My insulin levels were always really high and it made my body go into constant “fat storage” mode. It sucked. I am going to get tested soon to see if my insulin resistance has resolved with my current weight loss. Even if it’s improved, I’m really happy.
As of right now though, I’m not prediabetic and my A1C is 5.5. I used to take Metformin for IR but I’ve been off of that since my surgery.

@GloPro

I have to keep up on my hydration when I work out. And I increased my hydration when I started to work out. I have some information on how to maintain but I don’t see myself losing weight past what I want to. I have about 90 lb left to go. I think I would try to maintain by increasing my amount of healthy fat intake, avocados, nuts, maybe a little more fish. I would not go the carb route. Given the fact that I have IR, I would not want to do that. Maybe I’ll add an extra snack or something.

I see a nutritionist regularly and I’ll make it a priority to see her again once I get closer to my “goal” weight.

JLeslie's avatar

They are very overweight so their bodies have a lot of fat storage to live off of. They do have to be careful to take extra vitamins and minerals and have that sort of thing monitored, because on a severly reduced calorie intake there is a very high risk of not getting the “nutrition” you need daily. The body can take fat and convert it into energy. The most ideal thing for moving around and partly for the nervous system is carbs, but when the body does not have enough carbs it uses fat.

LuckyGuy's avatar

@JLeslie Makes a good point. Let’s look at it from the 50,000 ft level – ignoring dietary rules and nutrition.
We know a pound of fat contains 3500 calories. If someone is carrying around 100 pounds of excess fat that means they have 350,000 calories in storage. If their lifestyle and activity levels require 2500 calories per day, they can theoretically go for 350000/2500 = 140 days without eating anything. Of course that ignores essential nutrients, vitamins, etc. but the fat can be a source of calories for a long time. Once can eat 1000 calories per day and let the other 1500 calories per day come from body fat. At that rate the process can take 233 days.

GloPro's avatar

So why do obese people starve to death? If they took nutrition supplements and water would they live that 140 days?

Or, even more, 750 calories is undeniably a caloric deficit to expended energy for a normal adult. @seekingwolf doesn’t expect to ever go past the target weight and live with this diet forever (starting at 24). I just get confused as to how that will be possible?

seekingwolf's avatar

@GloPro

It’s more than just nutrition supplements. You need protein too. Have you ever heard of TPN? It’s what we use in the hospital with very sick patients who can’t even have tube feed. You basically supply them with everything they need to keep on living JUST through an IV. You hydrate them via IV and the TPN bag contains a special mix of amino acids, some fats, some dextrose for sugar, and vitamins and minerals. And with that, you can keep them nutritionally sound.

However, for someone like me who WANTS to lose weight (unlike most of the people on TPN), I require water, nutritional supplements, and a good amount of protein for amino acids to keep going.

(that being said, I still consume some healthy carbs in the form of fresh fruits/vegetables, and I consume some fat too)

Maintenance at my target weight will require more calories than I am eating now. And the thing is, no one can know for sure. It depends on my activity level and general health. I’ll have to see a nutritionist when the time comes and play around with it a little. I also will have to see if things change with time. My hunger is gone completely so I have to “remind” myself to eat. Even eating 750 a day requires reminding. It’s my life now. I just ate a 80 calorie Greek yogurt but I actually had to remind myself “Hey, it’s yogurt time” because my stomach won’t remind me.

I imagine maintenance may be around 1000 calories, maybe more. I don’t think I will ever be able to get to 1500 or beyond without grazing all day. Remember too that my metabolism is different now. You’re used to eating 2000 (or so) calories a day and can burn it off. My body is trying to be more efficient. That’s why I have to keep going to the gym to lose weight. Maybe once I’m at “maintenance” level, I can back off the gym and only go a few times a week.

My metabolism was actually pretty good before the PCOS hit. I was thin actually until I hit 12. I went into this surgery not knowing the future. I’m a young patient, I get it. Most people who get this done are 40s and well above. I figured, if I need caloric “meal supplements” as I get older to make sure I don’t get too thin, fine. I’ll need to take vitamins for the rest of my life, that’s fine with me too. I’ll need to get yearly blood work for the rest of my life, fine. I’ll have to watch everything I put into my mouth because one day of “bad eating” can screw me nutritionally. Hey, it’s all fine.

I am going to keep myself educated and keep in touch with my doctor and bariatric surgeon as I get older and I’ll deal with things as they come.

wildpotato's avatar

@GloPro “If [obese people] took nutrition supplements and water would they live that 140 days?”

In at least one case – with the addition to your list of some small amount of calories and, as @seekingwolf points out, protein – yes and then some.

Judi's avatar

@seekingwolf, without surgery I start going above my goal weight (135) if I eat more than 1400 calories a day.

seekingwolf's avatar

My goal weight is 165ish. I’m 5’ 7’’.

I definitely have to work to eat everyday. Can’t imagine eating 1000 or more. I would have to set timers and would maybe need to eat more meals a day. I currently eat 3.

Like I said, it’s a bridge that I am going to have to cross when I come to it. I’m confident I can get to my goal weight with time. There are things I can do to maintain. It may or may not be a challenge but I’m going to do it.

Judi's avatar

Your courage and determination are inspiring. :-)

seekingwolf's avatar

D’aww thanks I just don’t like being fat and I’m looking forward to being a “normal” weight again. :)

JLeslie's avatar

I don’t think most deaths from the surgery are related to starving. My exboyfriend’s cousin died three weeks after surgery. She was in her 20’s. I doubt in three weeks it was starvation. I don’t know the details though. I know her cousin cancelled his surgery after she died. This was about 10–15 years ago.

GloPro's avatar

@Judi Agreed. This has been a very interesting conversation.

@seekingwolf Your lack of appetite, as I understand it, is related to the lack of ghrelin. Does that affect PYY production? Do you feel full because of a smaller stomach or the PYY hormone? Do you see an endocrinologist in addition to a dietician?

seekingwolf's avatar

@JLeslie Sounds like she may have died from a leak. Patients are at their greatest risk for developing a leak up until about 1 month after surgery.

I was worried about developing a leak but decided to go through it anyway. I didn’t have a lot of risk factors that would increase my chances of dying on the table. I’m not diabetic. I’m young. I was only 315 lb. I didn’t have pulmonary issues rather than occasionally inhaling my own upchuck in my sleep (from GERD).

People who are EXTREMELY heavy with many, many, many health problems are at higher risk of dying during or after surgery, or suffering complications. I actually took care of a woman in the hospital (I had my surgery at the same hospital I work at) who ended up in the ICU after surgery. complications do happen, sadly.

@GloPro

I’m not currently seeing an endocrinologist, no. PYY does play a part in bariatric surgery. Check out this article: http://www.ncbi.nlm.nih.gov/pubmed/18376181

If you’re wondering about the differences in appetite between the bypass and the sleeve, it probably has to do with the stomach. Bypass patients have a “pouch” formed with their stomach and then the surgeon leaves the gastric remnant in. With sleeve patients (like myself) the stomach is formed into a “sleeve” and then the remnant is removed completely. With the remnant gone, I’m sure that’s why sleeve patients tend to experience a lower gherlin level than bypass patients.

Not saying one is better than the other, just different. It’s very interesting. There’s a lot we don’t know.

I’m like a guinea pig in a way.

jca's avatar

As someone who had bariatric surgery (but has not yet read the rest of the answers here) I can tell you that a bariatric surgery patient is probably going to need nutritional supplements (i.e. vitamins) for the rest of their lives. I often slack with taking my vitamins and some of my levels are low. My protein level is good because I strive to eat protein first in most, if not all meals.

Sometimes the amount of food that I eat is less than what my 6 year old daughter can eat. It depends on the consistency of the food and what and when I ate previously. If I want to, if I get full, I can eat something a little while later. The period of eating only very tiny portions is only about a year long. Then the quantity increases (like I said, it’s somewhat around what a child can eat, which is actually a decent amount of food). It’s not like you’re only eating 3 bites. I can eat a banana. I can eat a container of yogurt (not the banana and yogurt at the same time, mind you). So a container of yogurt with added walnuts is a decent amount of food. I can go to a restaurant and eat about 10 or 12 small bites of steak and some baked potato. That’s a decent amount of food and not “starvation level.”

Most people I know (and probably stats will show for the majority of bariatric surgery patients) will lose rapidly for about a year and then the body says “Whoa! Slow down! Starvation mode!” and then, the patient plateaus. I am happy with the amount I lost and would definitely recommend bariatric surgery for people looking to lose a lot. I would still like to lost about another 30 lbs. Now I’m at the point where I would have to exercise in order to do so.

@cazzie: I don’t agree that this type of surgery is stupid and useless. If it were stupid and useless, thousands of people would not have been successful with it, and insurance companies, not known for their generous natures, would not be paying upwards of 30,000 dollars per patient for the surgery (that does not include follow up). The majority of people who have this surgery who are on cholesterol medications, high blood pressure medications, diabetes medications, reduce or discontinue use of most meds within only a few days of surgery. Yes, there are risks, like any other surgery, and yes, it’s possible to regain the weight if one wants to drink milkshakes and eat cheesecakes instead of doing what is recommended, but the majority of people who choose a good doctor (what was told to me was to make sure the surgeon is a “Health Grades Bariatric Center of Excellence,” not just someone who has only done a few of the surgeries in their career) will do very well very quickly, compared to “yo yo dieting” which is what happens when most people lose weight on their own.

jca's avatar

I just read the rest of the responses.

@GloPro: You’re correct about the amount of ghrelin. That’s a hormone I never heard of until I took the pre-surgery class. It’s true – I can go half a day, if not longer, without eating and not be hungry. Prior to surgery, I was hungry all the time, thinking about food all the time. The smaller the stomach, the less ghrelin that’s produced.

As far as previous discussion about being able to survive on fat storage alone, yes, one might be able to live but one’s hair would fall out, teeth would fall out, one might become blind and other fun things from malnutrition. Although we might have enough fat to survive, we still need proper nutrition to keep everything working.

To answer the bathroom question, in the beginning, for about 8 months post-surgery, I only defecated about once every four days. Consuming less liquid from food, less fat from food, less fiber from food, it all played a factor. I didn’t feel bad from not going to the bathroom, because there was nothing in my intestines to make me feel bad. Now that I can eat more, it’s back to normal (once a day). I make a concerted effort to try to eat things in all of the food groups.

JLeslie's avatar

@jca Did your triglycerides go up the first year post surgery? I have always wondered about that with bariatric patients.

seekingwolf's avatar

I am due for blood work soon. I will come back and tell you my values if you are curious as to what may change after surgery. I was tested in Nov prior to surgery so I am going to get the same tests done to see how I am doing. I’m ~4 months out now.

JLeslie's avatar

@seekingwolf Thanks. I ask because of something sort of not related. My aunt had extremely high tryglicerides at one point and they said it was because she had lost a lot of weight. They put her on drugs for it, along with a lot of other medication for other things. I was pissed! We finally insisted she be tested again and the triglicerides were low. She went off the medicine and they have always been nornal. I don’t believe for a second they were ever high, and I am angry the doctors just accepted such a ridiculously high number. They tried to explain to me that sudden weight loss, and extreme weight loss cause a rise in triglycerides. I have yet to find that to be true among people I know, but their weight loss usually is not so extreme. People with the surgery do have rapid weight loss, and they are monitored, so I figure you or @jca might have some interesting information regarding your numbers.

seekingwolf's avatar

Yeah I’ve never heard of triglycerides going up after surgery or massive weight loss. I had 118 prior to surgery. I have no idea what it is now but we’ll find out soon.

Massive weight loss, either due to bariatric surgery or other things, can cause complications. Like gall stones. Those are surprisingly common. I was put on a medicine to prevent gallstones but my doctor had me stop taking it because it was making me so. damn. nauseous. I wasn’t consuming enough calories because of it! So now I am off of it, fingers crossed I don’t get stones!

JLeslie's avatar

I guess maybe the body pulling fat from storage in the body maybe causes more fats in the blood. I think with very obese people they consume so many fats daily the amount floating in the blood is likely still less than what they were eating.

Judi's avatar

My triglycerides went DOWN when I lost weight. I always thought it was an indication of fat in the diet.

seekingwolf's avatar

My nutritionist told me that triglycerides #s can be affected by how much fat you eat, how much sugar you eat, and also, alcohol use.

Your body will break down fat for energy as its needed but just because that happens doesn’t mean that the fat is floating around freely in your blood in bigger amounts, not broken down or anything.

JLeslie's avatar

@Judi My triglycerides went down when I ate fewer sweets. That’s what I was advised when I saw a nutritionist as a teen and it helped and they have stayed in normal range. I really don’t believe the triglycerides go up with weight loss. Just another thing to make me angry. I feel like they were sloppy prescribing so much stuff for my aunt and just believing an incredibly off the charts test result without run it again. More and more I see blood work that I believe is a mistake. It happened to me when I was in the hospital. I asked them to do my TSH which was high as I thought, because I was symptomatic. They saw fit to run it again, which pissed me off, because I didn’t want it retested and I am not happy to pay for it. It came back over 4 points different, which is a lot for that test, now in normal range, and the doctor told me the first one was wrong. Why do they think the first one is wrong? Why not the second? A week later I had my doctor run it again and it was high with almost the same numbers as the first test. Off by .1 or .2. I know I will never ever take a new medicine based in a single bloodtest.

poofandmook's avatar

I skipped most of this… it was a lot to read.

@cazzie: Whether you meant to be or not, you came across as incredibly rude and judgmental in your first statement.

I had gastric bypass in March of 2013. Gastric bypass does have a physiological aspect to it too; it’s not just the physical. After surgery I was satisfied with my small portions, whereas before the surgery the same amount of food would have left me feeling starved. I wanted different foods afterward. When I DID have a craving for an old food (like pasta or rice), I tried it. And most of the time, I regretted it because I either had a lot of pain and vomiting, or it just made me feel bad. Now, beforehand, I could eat a sack of White Castle, have terrible gastrointestinal issues, and then go back the next day for another and do it all over again. The physical discomfort was nothing compared to the craving. Now, knowing what I will experience if I eat that item is more than enough to keep me from doing it.

Now, I will say that I think Lap Band has the potential to be useless because it is adjustable and reversible. It’s very easy to gain back all lost and then some.

However, with bypass, you have to be a serious glutton for punishment. To overeat your “pouch” enough to become obese again, you have to make yourself very sick many times over, or you have to literally sit and eat all day long. It’s not possible without causing pain, vomiting, etc. to “eat through” bypass surgery. Period. That person has to have SERIOUS issues with food that, frankly, most bypass patients don’t have. This is something that should be determined in the required pre-op psychiatric evaluation… that’s most of the purpose of requiring this eval before surgery.

That being said… to address the OP:

Frankly, I can’t answer about the nutrition. I do know I’m on vitamins for the rest of my life because a great deal of the bypass functionality is malabsorption. For that reason, I can’t glean my nutrition solely from food anymore. Sure, I get some, but a good deal of it isn’t absorbed. Fun fact: GBP patients also can’t take oral birth control, as it’s mostly not absorbed and so there’s a strong chance it will fail. On that note, I need to steer clear of tablet vitamins; I take chewables and I take double the recommended amount to combat the malabsorption. I have quarterly bloodwork done to monitor my levels.

I saw a question about bowel movements: yes, mine are different. They are smaller and more difficult to push out, because I have more protein and less fiber. At times my pouch gets finicky, and has a difficult time digesting high/straight protein items like meat and eggs UNLESS I have carbs in the meal as well. The pain associated with these times is enough that I try to incorporate some carbs in every meal, and this has made my bowel movements daily or every other day as opposed to once a week before I started having the occasional difficulty with proteins. (Incidentally, that started after a terrible week long stomach virus I had two months post-op).

poofandmook's avatar

Also.. interestingly enough… the malabsorption also causes some wonky blood results.

For instance, I had some hamburger the day before one of my blood checks, and it resulted in a 30 point jump in my cholesterol. I was mortified… because just a few weeks before, I had my cholesterol done and it was much lower. I asked the surgeon about it, and showed him the results from before, and he said that if I eat something fattier, it will hang around for several days as opposed to being filtered out naturally. My next bloodwork, I made sure I ate nothing at all fatty for a full 5 days before the draw and sure enough, my cholesterol was not only back down to the first result, it was even lower, making it nearly 40 points lower than the “faulty” result after eating hamburger the day before.

JLeslie's avatar

@poofandmook My cholesterol is like that and I never had that surgery. Do you know whether your cholesterol has always been like that? You probably never tested it so carefully before.

poofandmook's avatar

@JLeslie: My cholesterol was 190something for years. I had a biometric screening for my employer health plan annually, and it was always 197–199. I always found it interesting how 200 would put you in the “high” range and I NEVER hit 200… always 197–199 so it was still high, but in the normal range. It dropped significantly by the time I had my first bloodwork—163. The bad result was 190. Four months later, at my next test, it was 159 I think.

It’s hard to say if it was always like that, because I ate garbage constantly… which is why I was up to 280lbs at the time of my surgery. But since I was in the same narrow range for several years, my guess would be that it was baseline and not so much what I’d eaten before.

JLeslie's avatar

The one bad test could have been a wrong result. Labs come back incorrect more often than you might want to believe. 190 something might be your number if you are eating cholesterol foods in “regular” quantities. Mine is 270 when I eat what I want, always has been since age 16. If I Reduce my cholesterol intake in half the number is 225 in less than a month. My guess is it probably goes down quicker than a few weeks, but I never test it just a week later.

poofandmook's avatar

well when I told the surgeon what I’d eaten the day before, he said that it was likely an accurate number, but not accurate for my baseline. He also said that it’s remarkable that my cholesterol wasn’t over 200 for the weight I was at.

JLeslie's avatar

Some people have great mechanisms for handeling cholesterol. My body sucks. I’ve never been technically overweight. I weigh more than I want to now, but I am not overweight by any measures the experts use. My cholesterol is the same weather I am 125 pounds or 150.

seekingwolf's avatar

I just had my first post op blood work done.

Cholesterol: 136 (220 before in late 2013)

LDL: 89 (141 before)

HDL: 32 (55 before, but I’m told it goes down when you lose weight and will stabilize later)

Triglycerides: 73 (118 before)

I’m so happy I had this surgery. I am over 65 lb down now and still counting.

seekingwolf's avatar

Oh, and my diet is very much about protein. I eat tons of chicken and fish. Beef and pork once in a while. I don’t eat that many vegetables because I don’t have room. I eat fresh fruit once in a while and also consume dairy products. So I’m ready happy about my cholesterol results. Extremely happy

JLeslie's avatar

@seekingwolf Wow! Did they test vitamins and minerals also?

seekingwolf's avatar

Yeah, they tested for my calcium, Vit D, and Vit B1 and B12. Also magnesium. Hope I’m not forgetting any.

Now, all of those values were great (B12 was over 700!!) but I attribute that to the fact that I am on supplements, not really my diet. I take liquid calcium/D3/magnesium twice a day (sugar free, 1x in the morning, 1x in the evening) and I also take a liquid B complex supplement once a day (1x in the evening).

My iron was on the “low” end of normal but not abnormally low or anything like that. I was told I was okay. I am on a small iron supplement (concerned about constipation) so I will just continue taking that.

I’m super excited because I have an appointment to donate my platelets (my count was 420, btw!) on Saturday and it looks like I am good to go. Just need to load up on extra calcium today and tomorrow morning.

GloPro's avatar

@seekingwolf Congratulations! I’m happy you are enjoying the results and feeling great.

seekingwolf's avatar

Thanks. :) I’m definitely stoked!

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