advice from vets

I'm struggling with my menu. I had surgery 3 1/2 months ago and I am not sure how to work my macronutrients. 

I don't have much of an appetite most days. I did AMAW last week and was only getting 300-400 calories a day and was exhausted every day. I think I definitely need some carbs in my diet, because I can't live with this fatigue. 

So here's the thing: any type of grains make me really nauseous so (thankfully) they're off limits. More than a little bit of fruit makes me dump. I've got a ton of peaches right now and I can have half of one without dumping if I eat it with protein. I have heard from the vets here to stay away from fruit but I am tired without carbs.

I do eat yogurt and cheese and they have some carbs. I am pretty consistently below 30-40 carbs a day. If you want, you can check out my profile on myfitnesspal. My name is ereiam there also and the account should be public.

Any advice will be much appreciated.

It might not be a carb problem. When as the last time you had your iron levels checked?

 Iron issues can become pretty serious quickly, and you might be suffering from anemia.

I'll talk to my doctor about getting my iron levels checked. Thanks.

It could also be low B12.  I find if mine dips below 1000 I am fatigued and a bit listless.  Just another thing to have chacked if you have labs done!

Are you sure it's the lack of carbs making you tired?  At three months out you still have plenty of fat to burn for energy.  The fatigue could very well be an iron deficiency.  Have you had any labs drawn since surgery?  

You don't need carbs from fruit or grains.  If you are getting carbs from veggies and dairy that's good enough.  Don't make the mistake of adding unnecessary carbs back into your diet before you reach goal.  It will stop or slow your weight loss and increase your cravings.  Please investigate other possibilities for your fatigue.

 I was told that it would be normal to feel fatigue off and on for a full year after surgery due to the anesthesia and the trauma to the body from surgery.  Fatigue is not always related to the food you eat.

Proceed with caution.

I wouldn't have suspected food, because I do indeed have plenty of fat to burn for energy. But when I'm feeling exhausted, I pep up a lot with food. Last night I was ridiculously tired, and then I had some pork, sauerkraut and cherry tomatoes and felt so much better.

I guess I'll talk to my doctor.

You may deal with subclinical (mariginal) adrenal insufficiency. Or thyroid issues,. Or mineral - vitamins- protein low levels. Or all of those combined. 

Our body needs blood sugar to function. But It is capbable to convert proteins into blood sugar... But it it slow process and it require cortisone - the steroid our body make. If your adrenals are not very efficient - it may take a real drop in BS before they react to the changes. And if your cortison is used for the process and you are already depleted (adrenal insufficiency) they you get very tired...

Low iron, B12, low protein in blood (if they are used to convert to sugar) low d, all of those can contribute to being extremely tired.  If the blood test show you are low normal with some of those - the combination of all of that can be really noticible. 

I know that from experience. Severe dumping - severe RH can also indicate adrenal issues.  

I have adrenal insufficiency- and I dealt with all of that. Still deal on some days. I learned to add carbs to my every meal.  Not a lot - just enough to balance my BS.  Intake of Proteins causes insulin release (Google food insulin index) and if you don't have enough glycogen or good adrenals - that will cause low BS (not critacly low) and feeling extremely tired. 

That why I can't participate in the meat week. I need carbs to function. Good carbs. 

You may need to add good quality salt to your diet. Adrenals need salt. 

If you see the doc - also ask him to run your thyroid - complete panel.  The, t4, t3, etc. 

Added: Btw: it took me 2 years and a great doc to get dignosed and treated. Treatment for adrenal insuficiency...is cortison  replacement therapy (taking steroids) plus rest and proper diet and supplemnts to nurish the glad and body.   And cortary to popular beliefs - taking steroids will not make some gain weight if they take just enough..plus they watch what and how much they eat. I actually lost weight while on steroids. (i no longer have to eat carbs-  sugars because of exreme RH or hypoglycemia)

Vegetables are where your carbs should be coming from. They have the added benefit of being "dietary fiber" also. Some people mistake "dietary fiber" for "bread" but it's the veggies that can keep you regular, without needing a daily laxative.

Usually I aim to have one carb per meal. So for breakfast, I'll have yogurt with fruit (not jam). Just not a lot - and it's important it be skinless (ie - 1/4 of a chopped peach or apple). Lunchtime I'll have a 1/2 cup of unsweetened applesauce with my protein, or leftover green beans, broc or cauliflower on the side. Dinner is always a green veg on the side of my protein.

This week, I'm not feeling great - I started a new med and I think that's the culprit, so I've cut back to the pureed stage of the diet - not intentionally, but that seems to be what my body wants. I'm not eating as many vegetables but the morning fruit seems to be keeping me on track for now, as does the extra water I'm drinking.

300-400 calories a day is extremely low. You really need to double that if you're doing anything more than laying in bed.

I'm curious.  Why is it "important" fruit be skinless?

Because the skins can get stuck. I'm still only 4 months out - this is a rule I was told to follow for the first 6 months.