Advice For a Relatively New Sleever

Good Morning,

I was sleeved on 2/12/18 and have lost about 62 pounds since, so I am very pleased. However, I still have about another 100 pounds to go, and I have been concerned since the early stages that I am able to eat too much.

Liquids, including soups, protein shakes, greek yogurt, etc. never seemed to fill me up much. My online research led me to believe that when I transitioned to solids this would change dramatically, and it certainly did. Lean proteins filled me up beyond belief. I had one vomiting incident where I ate about an ounce each of chicken breast and salmon, and added a couple of bites of spinach and potato afterwards, but other than that have kept food down. A couple of "discomfort" incidents, but nothing major.

Lately, now that I am getting a little further out, I find that I am able to eat more and not feel it. Last night I had 4 ounces of hamburger (no bun) for dinner and felt satisfied, but no restriction. Is this normal? I often feel restriction, but not always. For instance, earlier this week I had sushi with a coworker and could only eat about 3 pieces before feeling full, though I did have some miso soup beforehand as well.

If I could go back, I would pick my surgeon differently, but he does a ton of these and I am sure he did fine. I find his personal mannerisms odd, but more importantly his office gives out conflicting information. He tells his patients to eat less than the diet plan literature his staff hands out dictates. He expresses concern with "stretching" the sleeve and tells his patients to only eat two ounces at a time but eat more frequently.

I am most concerned with if I have stretched my sleeve already, as I wasn't expecting to be able to eat 4 ounces of protein (by weight) at 10 weeks.

Any insight from others who have experienced this are more than welcome. I am a mid-30's male who is 5 feet 8 inches tall, starting weight of 357, current weight 295. Target is 180.

Thanks,

T

First, congratulations on your surgery--wi**** was an option for me when I was in my thirties!

Sounds like you're doing fine. Don't be concerned about stretching your pouch. I find certain meats are easier to handle than others. 4oz. chicken breast fills me up fast, while a 4oz. hamburger is easier to digest. If I take one bite too many of the chicken, I get really uncomfortable for an hour or so....unless I vomit, then I'm fine. One warning sign of eating too much is a runny nose while you're eating. If you start to sniffle, stop eating because your body is sending you a message. I try to be sure my meat is moist, adding some type of sauce (tomato, sugar-free bbq, soy sauce, etc.). Many people cook their meat in a crock-pot or Instant Pot with various sauces to keep it moist.

I notice you mention potatoes and sushi--both should be avoided. The general guidelines for daily intake are Calories: Under 800; Carbs: Under 40; Protein: At least 65 grams; Water: Minimum of 64 oz. I suggest you track your food in myfitnesspal.com. You could post a daily menu here for review/input. Also, check out the "What Are You Eating" daily thread to see what others are eating.

You've got a great attitude - keep reading and keep posting!

Congratulations on your weight loss, 62 pounds in 10 weeks is awesome! I agree with everything Mary posted. The only thing that I would add is at 10 weeks out I was measuring every bite I consumed and stopping when full or the measured amount was gone. I believe I was eating 2-3oz of dense protein at 10 weeks. Steak and chicken I felt restriction almost immediately, but hamburger, shrimp and fish I stopped at the measured amount because I didn't feel restriction. At a little over 2 years out it is still the same, except now I can usually fit in a veggie as well.

Definitely join the VSG menu thread, it is such a good place for support and to see what others are eating. It really does help.

Since sleeves are created much different than RNY pouches (we do not have pouches), there isn't the ability to stretch the sleeve like RNY pouches can stretch, because we have pretty much none of the stretchy part of the stomach left. My research has shown that some slight stretching can occur but I think that depends on the size of the bougie your surgeon originally used. Your sleeve is very swollen and holds little in the beginning, but as it heals and the swelling goes down, it will hold more. I was told that when my sleeve was fully healed, it would hold 8 oz by weight. However, I find at 18 months post-surgery, if I eat more than 6 oz total (no more than 4 oz solid protein and a couple ounces of veg), I am miserable after the 20 mins it takes the stomach to tell my brain I've overdone it.

Liquids pass through your system much faster than solids, so unless you eat a ton of them and very fast, you're likely not to "feel full." Some people never feel that sense of fullness. This is why it is so critical to weigh and measure everything you eat so you can make sure you don't eat more than your still healing tummy can handle.

As when we had our old stomachs, the adage still holds true: Just because you CAN eat more, doesn't mean you SHOULD. Getting your brain used to the fact that it can only eat a certain amount is important to your continued success. At 2 months post-surgery I could barely manage 2 oz of solid protein. I was able to handle 4 oz by about 6 months post op, and that is where I have stayed.

Measure, weigh, and track every bite. Solid proteins first, then other stuff if you can manage it, but eat slowly so your brain keeps up with your tummy. Stay away from wasted carbs like potatoes, rice, pasta, and bread, and you'll do great.

Hi,

Sorry, but this is misinformation. The sleeve can easily stretch back to normal size stomach over time. What you won't have is a normal size fundus (the round bottom part)

I had the lapband for 5 years , sleeve for 10 years (revised due to severe GERD) and now RNY. When they did an endoscopy, after 9 years with the sleeve, my sleeve stomach was now of medium size, not as large as my old stomach but fully capable of handling more than 6 ounces. The first few years were great with lots of restriction. Most "LONG TERM" sleevers (more than 5 years) will attest to their ability to eat more than 6 ounces at a time.

Believe me when I tell you I was not aware that I was gradually eating more and more over a decade. All I knew was that I was hungrier. Therefore the only true way to gauge portions is to measure them for the rest of your life and track all of your food FOREVER.

I would like to see the data on this aside from your personal experience. There are always exceptions to anything, but everything I've read and have been told is contrary to what you say, and that yes, the sleeve can stretch a bit, but not back to the size of a normal stomach.

Hi,

I would like to clarify. First I stand by my original statement. Just look at how many people get resleeved or have revisions just like me. I had no idea how large my stomach had become overtime.

My MRI report said that my stomach size in 2017 was a medium sized stomach after 10 years of being sleeved. Which means it stretched more than a bit based on the volume I was able to eat. What medium sized stomach means is that I no longer had restriction. Since a normal stomach can hold 1.5 liters to 3-4 liters, it would make sense that any amount of overeating would cause the gastric sleeve to stretch.

Whether I caused it or this is normal after 10 years, I don't know for certain, but I could definitely eat more than 8 ounces of food more than 2 years out and more than 5 ounces of solid protein in a sitting. Most of my friends who are long term sleevers no longer have satiety eating 4 ounces of food.

Lets keep in mind that there are a lot of variables here such as original bougie size (mine was 34), how well a surgeon sleeves (how close to bougie), compliance etc... new surgical techniques etc I was an early sleever. I did not feel I was overeating at 3 years out, 5 years out, 7 years out and onward. I maintained my weight for sometime (at least 5 years) and regained 50 lbs over 50 years of my original 175 lost.

I thought this was an interesting study/article because in addition to stomach size with the sleeve, removal of the fundus where ghrelin is produced, size does matter and even if we don't stretch the sleeve to original size, we don't have to in order to regain all of our weight.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317257/

I'm 7yrs out and had to eat more than I should have due to getting pregnant with twins before I hit the 1 year post-op mark. My surgeon was recommending 800 calories, my OB demanded at least 3,000/day to sustain the babies and myself. Guess who won?

I never hit 3k/day, but I did manage to fit in around 2k by eating small meals, constantly, every day. For the record, the babies were perfect... full term, textbook pregnancy and they were both full birth weight (5lbs and 6lbs, no time in the NICU). My surgery, however, was pretty well sabotaged by the time they arrived.

I do still have enough restriction to keep from getting completely and totally out of control with my eating, which I am thankful for, but I volume-wise, my capacity is only slightly less than what a regular, non-sleeved (and had never been obese) person can eat. I do notice more restriction if I pare the volume way down for several days to shrink it, so it's functioning as it should, but it absolutely is possible to stretch it to the point of undoing the surgery.

Yup,

The sleeve doctors won't tell you this. THey are in the business of sleeving but I have a few dozen sleevers I am friends with who say they do not feel sleeved at all once they are more than 5+ years. That is why it is essential to measure forever and be ever so diligent of what we put in our mouths. I am a food addict and if given the chance to sabotage myself just like an alcoholic or any other addiction, I need to continue doing what made me successful.

I'm male, and pretty much a geezer compared to you. I've lost over 200 lbs. The key is to weigh and measure, and then STOP. Eat what you've weighed out or measured, and then wait until the next time to eat. If you get hungry, drink more water. Engage in an activity of some sort to take your mind off your belly. It works.