Metabolism???

After my TT I was like you for the first week or 10 days...then I dropped suddenly.  And was hungry and eating all the time.  

Hi Laura
Just the opposite is happening to me.  I am 5-wks post-op but have struggled with eating since surgery.  I just eat a few bites and I am done.  I feel like I have new restriction of the tummy.  I have lost approx 18 pounds whi*****ludes the 14+ of skin that PS removed.  

I have had alot of swelling off and on, last few days lots of swelling.  Today I have little to very little.  This is just too wierd.  Every day it is different but appetite wise I get really hungry, take a coupld bites of food and I am done. 

I hope when I am allowed go back to my walking routine that I can drop 20-30 more pounds over the next year and be done. 

Carla

The body's metabolism actually changes pretty radically after surgery for a period of time. The old-fashioned term for it is "post-aggression syndrome". It doesn't seem to be called that in papers published after the 1980's so maybe they came up with another term for it that I haven't found. Anyway, here's what I found on THAT:

"The metabolic situation of the so-called "post aggression syndrome" related to operations or trauma is elucidated in terms of two out of three phases described by a working hypothesis. It is governed primarily by anti insulin factors and can be identified by the resulting catabolism. The leading phenomena are increased of general turnover rates, glycogenolysis, gluconeogenesis, lipolysis, and protein degradation. An "ergotropic situation" results, obviously being an important basis of survival. On the other hand, changes in the protein metabolism do not exclusively concern proteolysis, but also a flow of substrates from the periphery to visceral organs and wound healing tissue. In these tissues important synthetic processes are still prevailing, despite the general catabolic state."

So basically, they're saying that your body goes kind of nuts after surgery. All of your catabolic processes (the ones that break things down for energy; the opposite is anabolic processes, which build things) go into overdrive, such as burning of fat, breaking down protein to turn it into sugar or other protein building blocks, and a mess of other processes. Your body starts stealing bits of protein and nutrients from your peripheral organs (legs, feet, arms) and shuttling them to your core and/or the wound site.

Also, from a medical text on surgery:

"The main focus of postoperative nutritional therapy has to be on sufficient supply of proteins. The healthy adult needs approximately 0.8 grams protein/kg bodyweight/day. Patients after big surgical interventions need between 1 and 1.2 grams protein/kg bodyweight/day..."

"...Remission of the post-aggression syndrome and increase in substrate metabolism can be expected between day 4 and 6 postoperatively, if no complications occur..."

At least according to this text (which I found on google scholar) your protein needs alone will increase by about 25%. That sounds reasonable. I'm highly suspicious of their claim that your metabolism goes back to normal within 4-6 days after surgery. That makes no sense to me. Because healing of the tissue, depending on the size of the surgery, takes weeks, if not longer.

So, in terms of protein alone, we know that: 
1 gram protein = 4 calories

I weigh 157lb = 71.2kg, so my normal calculated protein needs would be
(71.2)*(0.8)= 57g protein/day =228 calories from protein/day

According to their guidelines, my postoperative protein needs would increase to
85.44 g protein/day = 342 calories from protein/day

That's only a difference of 114 calories (in terms of protein). Not a whole lot. 

Realistically, everyone on these boards should already be getting more protein than the minimum recommended (I know my doc wants me to get at least 70g/day, and I usually don't have a problem getting there).

I couldn't find any unambiguous information about increased needs for other nutrients (carbs, fat) so I guess there's still the possibility that, even though you theoretically don't need that many more calories from protein, you might need a lot more calories from carbs and fat, which could explain your ability to eat like a horse and not gain weight. 

Just think about how many extra calories you must be burning through, since not only are you eating more, but you're also sedentary and not getting any strenuous exercise.

Just remember that no matter how many protein shakes you chug down, your body's altered metabolism combined with your lack of exercise is going to result in some degree of muscle loss. So some of that weight you're losing is muscle, which is why you need to be vigilant about not continuing to overload on calories, because when your body DOES finally switch back to 'normal' mode, you'll have less fat-burning muscle on your body and you'll have to work harder to lose any weight you might gain in the readjustment period. You might even find that you need slightly fewer calories than before to maintain your weight, since your BMR would go down slightly (less muscle needing to be fed).

Very interesting and related: studies found that a person's chances of surviving major trauma (crushed in an earthquake, impaled on a fence, major infection, that kind of thing) increase with muscle mass. So the more muscle you're carrying on your frame, the more likely you are to survive. Because your body has more protein stores to draw from for healing. Woah!

I found some really fascinating articles about using insulin and hGH to spare muscle mass after surgeries. It is so tempting to order some hGH from the online pharmacy. But my doc probably wouldn't be thrilled if I started juicing myself with growth hormones after my tummy tuck. Sigh.

I was meaning to just google a few simple terms and maybe add a thought or two and look where it got me, my post has completely run away on me. Sorry. Hazard of having a science degree.

I'm having BA/BL and tummy tuck in less than 2 weeks, so I'm looking forward to being able to eat a little bit more!! Maybe I'll finally squeeze into those size 8 jeans *without* the help of spanx. A girl can dream! 

Hi Lizzy, Thanks for your post. I'm having a umb hernia repair and abdomilaplasty on 9/8/11. My plan was to have  at least 120grams of protien a day and drink plenty of H2O. I'm a little over 6months past RNY. I've lost almost 87# and still would like to lose at least 40 more. Going against me : I'm 65 years old and have bad back from years of being overwieght. I'm not allowed to twist my back . So I walk or swim in the pool. You can understand why I was happy to see your post.  I know that I have to make myself walk and move my body to keep from losing any more muscle. You really helped me understand the danger of sitting on your butt after surgery. Joy

Joy,
I'm so glad you found it helpful! Good to know that my obsessive little research quests don't go totally for naught.

My surgeone told me that there's a delicate balance between moving enough and moving too much. He said after the tummy tuck, for the first two weeks he wants me completely sedentary. Only getting up to go to the bathroom or eat, no doing chores or walks on the beach. After that I can slowly start re-introducing more movement into my routine. He said "I'm like Santa Claus, I'll know if you're good or bad, because it will be reflected in the amount of drainage coming from your drains." Yikes! There's also the very real concern of blood clot formation. He said he's not too worried about that with me since I'm young (27), don't smoke, don't take birth control, and exercise a lot. For you, simply because you're older that will be a bigger concern. You should definitely ask your surgeon how much they want you walking to prevent blood clots. They might recommend you wear compression stockings. I plan on doing that anyway (better safe than sorry).

I think my challenge will be making myself rest enough to heal properly. If you overdo it too soon, you'll compromise your healing. So really focus on your nutrition and on preventing blood clots for the first 4-6 weeks. After you're sufficiently healed from the surgery, you'll definitely want to bring some strength training into your routine. It's so so vital. Just doing cardio is not enough. Schedule a session with a trainer so they can show you how to properly use the machines without hurting yourself. And start off slooooow with weights that feel a little too easy.

I felt like a complete fool doing bicep curls with dinky little 8lb handweights but I worked my way up and didn't hurt myself.

You gotta remember, if you don't have a lot of muscle mass, you can work to gain it. You ain't dead yet! You might not put it on as quickly or easily as a lithe little 18 yr old, but it can definitely be done. You'll look and feel so much better.

And when you start to get discouraged by how slow the process is or how much work it is (the healing, the exercise, the diet, the training), remember that even if it takes 2, 3 years to get to where you want to be, you'll be around anyway in 3 years. So you might as well have the body you want then, even if you can't have it now. That's what I'm constantly telling myself.