sleeve vs bypass

Most of the successful people here do low carb. Thankfully my surgeon didn't recommend applesauce and mashed potatoes - that seems counterintuitive.

I -can- enjoy any food I want. But I choose not to most of the time because those things aren't going to help me reach my goal.

That said, at three years out I do make more suboptimal choices than I did at 3 months out. I had pizza for the first time a few weeks ago since I needed to eat and I was trapped in a calling center and pizza was there. It was not the amazing experience I remembered it to be :P

But I eat out infrequently and will enjoy the occasional dessert in those situations. Maybe 6 times a year.

Yes! That's exactly what I want to hear! I do Atkins 20 very well, I just want to know that that occasional 1 chocolate chip cookie or a single slice of pizza while out wont be completely off limits down the road. My surgeons diet plan they gave me is 1 protein with every meal, eat that first, 1 fruit with breakfast, 1 starch at lunch and 1 vegetable at dinner and protein shakes in between. Which I thought was kind of silly before I joined OH but after reading everyone else's stories I know is silly!

One of the things that was super helpful for me pre-op was to read the "what are you eating" daily threads because it helped me to wrap my head around how I'd be eating for the rest of my life. So I totally understand.

My plan is three meals a day, no snacks. I have a shake as my morning meal 95% of the time because that's what my body likes. Then my other two meals are 4-6 ounces that are primarily protein.

There are people who are 100% on plan 100% of the time during weight loss, but I'm probably closer to 90%. My regular meals don't involve fruit or starch. I avoid most carbs - especially the refined and processed ones.

Then there's the 10% of the time I eat off plan. I still try very hard to eat mindfully (now that my Binge Eating Disorder is managed, this is possible). I plan what I'm going to eat that's off plan. I savor every bite and don't feel guilty about it, since that's a trap that leads to more bad choices for me.

But I also know there are things I can't have and definitely things I can't keep in the house, because, for me, they're slippery slopes. Ice cream? I do not buy it or have it in the house since it will call my name until I eat it all. I'll have it as a very rare treat if I'm eating out. But I can keep bread in the house because I don't care about it. Other people here can't.

I think this sort of encapsulates what this whole WLS experience has been about for me - finally actually learning to listen to my body and my brain and taking time to figure out what it's saying.

I have 2 tubs of ice cream in the freezer for the kids, doesn't bother me at all but I refuse to cook starchy type foods for them cause I know I can't resist and mozzarella sticks or cheese curds from sheetz, yes they're low carb but just thinking about them now makes me want to drive down and get 2 orders, those are definite over indulgence triggers for me, I don't think I'll ever be able to walk into a sheetz ever again. I keep telling myself mind over matter but that only works for so long before the tummy growling becomes a ROAR, and I'm hoping with help from the surgery I can have that same ability you have to retrain my brain!

Btw...you need to understand you'll need to radically change your habits if you do this if you want to be successful. The surgery does some of the work, but a lot of it is up to you. You will be eating mostly protein and non starchy vegetables. At some point you'll be able to have a limited amount of fruit and grains. Pizza, cookies, and fettuccine Alfredo will be a thing of the past. Yes, you may be able to handle these occasionally and in small amounts, but people who let these back into their lives on a regular basis usually regain a lot of their weight. Be sure you're ready for this - It's not easy and it does take a lot of commitment. If you're curious about what we eat at various stages post surgery, follow one of the menu boards here on OH (where people post their daily menus)

Ok, first you have to differentiate between the surgeon's recommendations for the first week or two post-op and the longer-term diet recommendations. My surgeon in the liquid and soft food phases isn't as concerned about caloric/carb intake because the volume of what we're able to take in is so small, the carb/calorie content just isn't significant. At least according to my surgeon, and other information I've read. Once you transition onto "normal" food, most surgeons recommend a low carb eating plan, how low carb depends on the surgeon.

I personally cannot physically tolerate ketosis, which kicks in for most people below about 50g of carbs (total) a day. We're not sure why, but the "carb flu" that most people get for a few days transitioning onto very low carb, with me it doesn't seem to ever go away. My surgeon is not as sold on the very low carb diet plans as other surgeons and worked with me to figure out the best eating plan for me as an individual. I try to stay away from sugar and simple carbs, focus on protein and use complex carbs to stay out of ketosis.

I try to stay away from sugar and simple carbs, and eat protein first always. It's impossible to tell if this is going to be effective long term, because I'm still really benefitting from the "honeymoon stage", and it's entirely possible once I'm past that, this may backfire big time. I don't have the experience to say it's workable or not, so please don't take my story as validation for eating carbs, and certainly not simple carbs and sugars, especially during the losing phase.

Most of the people here who have had really good long-term success advocate low-carb or very-low-carb eating, and I would say if you don't have a weird situation like mine, go with what history has shown works. You will most likely physically be able to eat anything you want down the road, but that doesn't mean it will work with your weight loss plan/goal.

Well I guess I am the odd ball here but I had vsg 7 years ago. I did have gerd (had to take antacid to tie my shoes) but it was due to a hiatal hernia which was discovered pre op. So that was repaired during vsg. I took a ppi for a couple of months after surgery and then stopped. No more gerd. My DH has some and sleeps with head elevated. So keep reading and questioning. I chose sleeve because I was 58 and it seemed less invasive for an older person. Plus I hated the idea of all the rearranging of things. Just my 2 cents. GL Diane S

It's a complicated decision. Malabsorption is typically better with a higher BMI. I have the VSG despite my 78 BMI pre-op because the intention was always to second-stage later if necessary. I have maintained and not regained over the past two years, but I will be revising to another procedure with malabsorption (as this was always my intent).

As for GERD and the sleeve, I have seen and spoken to RNY folks with GERD, some of whom have it worse than I do. All this depends on the cause of the GERD. About 25% of VSG patients develop GERD due to the surgery, however what's interesting is that a lot of DS patients, who also have a sleeve, see GERD remission. The reasons for this are poorly understood. I developed severe GERD post-op, however what I eat directly affects it. Dairy will always cause me GERD, for instance. Since going dairy and grain free (I have Celiac) I have no GERD.

And, again, an RNY is no guarantee you will be GERD-free, but there is a good chance that you will be. It is also worth considering the SADI or DS, too, if possible, as they have the best weight loss statistics across the board.

There are fewer complications that are due to surgical error in that there is no intestinal anastomosis. This is a surgical connection made in the intestines as a part of the bypass in the RNY. The sleeve has fewer because these connections are inherently weak. Statistically the complication rates are higher for the RNY as it's a more complex surgery. Many surgical complications are preventable with patient compliance - what this basically means is not doing stupid crap. Like, don't eat what you shouldn't, don't take NSAIDs, don't drink, take your vitamins. The malabsorption of the RNY can cause more issues over time, which are easily preventable. While NSAIDs are contradicted outright with an RNY, you can likely occasionally/rarely take them with the sleeve. I've seen patients with a bypass who have to take NSAIDs (neurosurgical implants, like skull plates require them) and they have to be carefully monitored as a result. The VSG is a bit more durable once healed, but you still have to be very careful. NSAIDs are risky with any malabsoprtive procedure because the bowels become fragile if you do not supplement well, and so anything that can irritate it can damage it far more easily - just like someone with osteoperosis can break a bone easier. Note that these are preventable side effects, but they can happen if you don't keep up with vitamins and if you do take too many NSAIDs.

As for A1C results, these are affected by consumption directly, despite surgery type. The DS/SADI resolve it the fastest, the RNY next, and the sleeve last of all, however the VSG does also resolve high A1C. Mine was 11 and currently goes between 4.8 - 5. It may take longer, however it will resolve. A bypass procedure, any bypass, changes the way the intestines manufacture hormones and bile acids. The VSG does not. Arguably, the bypass mechanics are more long-lasting and permanent despite diet because of this.

I've also seen people with an A1C of 10 get it to like 5.5% just from diet. It's definitely possible, too. I would still track what you are eating now, because even though surgery will help, you absolutely can probably make a positive difference pre-op.

I had GERD before my RNY 9 years ago use to take nexium daily. after surgery and now.... I take 2 Pepcid max strength daily each morning... I have no symptoms of gerd when I do that. My acid reflux did not improve but did not get worse. Same.

However, I went off blood pressure medication it has been wonderful.

Stay positive, follow the diet rules and exercise right out of the gate and you will do well!