Day 8 (LAST DAY) - Calling all Vets - questions for you all

I typed an answer, a lot of infor, and OH ate it. I guess it was too long. lol

Question #1 (Q1) - only one question today as its a long one

Vets give us your thoughts on Newbies who feel they are losing "too much weight" and "look anorexic" and start adding calories back in to stop the weight loss (before they hit true maintenance).

I remember reading from one of the Vets who stated that once you start adding calories back in, going up to 1400/1600/1800/2000 (before you are out of the malabsorption stage) and start to gain some weight & stop the loss and then you hit true maintenance (some people its year 2 and some its year 3 and beyond) and you may start to have some regain because of your higher calories and you get lax about your portions etc it is so incredibly hard to go back down to 1200/1000/800 to start the weight loss again. What are your thoughts? Agree or disagree?

Well, the answer to the first part of the question re losing "too much weight" - unfortunately, our body often would do what it wants to do as long as we follow the proper RNY diet. The following the diet and being almost OCD in that makes a huge difference form person to person. I knwo people who never got to their goal beacuse they really did not put real effort into the program. Eating off plan, grazing, drinking with meals, and drinking alcohol - any one of these may prevent the person lose all the weight they wanted.

Some people dont really care or want to get to goal set up by docs or nutritionists. The want to lose enough to be able to be more mobile, to help with health condition (diabetes, high BP, etc). And they don't want to put many restrictions on their eating or drinking.

My experience, both personal, and what I see IRL, or in support groups, when a person is committed to losing to their goal, or the goal of the doc, and really stay on eating plan their body may take them below their ideal weight. For time being - they may not look their best, almost emancipated. For some people that can be good, because maintenance is a ***** and it may take them a while to find a good balance between eating and weight stability. At the same time, if they follow a really strict routine of a very low carb diet during their losing period, and in maintenance start eating more carbs, either by adding fruits, more veggies, etc, - they may see a very drastic weight gain of up to 10 lbs because they added carbs. The added weight is not really fat but rather water weight that body need to store the glycogen from the carbs. (I think we need 8 grams of water to every gram of stored sugar in our muscles, liver, etc)

And that is also why when someone follows just normal american diet and then they start keto style diet, limiting carbs - they may see a very rapid weight loss due to loss of water as body is burning the stored glycogen.

When I am losing my regain by following very low carb diet, I try to lose at least 5 lbs below my real goal. So when I chose to add carb, my overall final weight would be exactly when I wanted to be.

Second part:

The regain: just adding more carbs after a period of very low carb diet - I will see an increase of my weight due to water needed to store the glycogen. This is very normal to me. As a matter of fact, my weight can fluctuate within 4 lbs during any 24 hours. And up to 8 lbs during any week. I have to re-carb every so often to "load my muscles and liver bank of glycogen". My typical diet is proteins plus some veggies, but when I get more active, I burn all the glycogen stores and then i have to deal with severe hypoglycemia or RH.

I feel my best when I don't eat grains, or dairy, or a lot of starches. My normal diet is proteins plus non starchy veggies. My pouch still provides restrictions when I eat dense proteins. That "diet" is rather good for losing weight or maintenance. But in maintenance I have to add some starches and fruits to maintain my weight and feel good.

To be honest- I only count calories when I am in a weight loss. In maintenance - I weight almost daily, and adjust my eating based on the number on the scale. If the number I see on a scale it at the top of my range, I limit starches and fruits for as long as I get to at least in a middle of my range or at the bottom of it. When my weight is consistently at the lowest or below my range - I add starches and fruits to reload my glycogen "savings".

BTW: weight fluctuation would also be very sensitive to hydration of the body - body ability to retain some water. Body can retain more water if we eat carbs or getting enough sodium and electrolytes. Many for us post op take in very little sodium in their diet. Protein shakes, yogurt, tea and coffee, and home cooked meals, that are not cook with a lot of salt. Our meals are often small so even if a serving of food has 600 mg of sodium, but we eat 1/4 of that - we only get 150 mg. IMO this is important to pay attention to making sure we get enough sodium and other electrolytes. Getting really low BP. getting dizzy, muscles spasms, postural hypotension, being tired, nausea, etc etc. could be a signs of severe sodium deficiency.

When I get dehydrated I can't function. In summer, if I eat low carbs simple meals, i often need to take salt capsule or 2, then drink water to help me feel better. Drinking a lot of water while not taking enough electrolytes can lead to "water poisoning". Yes, it is real.

Example: I had a stomach virus. I could not keep food down,and I had runs. Within 24 - 36 hours I "lost" 10 lbs, and I was very close to my goal. When I realized that, I knew that I need ER or quick home re-hydration with a large dose of electrolytes. I was so dizzy that I did not want risking moving around, and my guy took care of me getting me and making me drink 24 oz of warm bone broth, with added salt. Plus a drink loaded with electrolytes. I concentrated on drinking that day. Within a few hours I was up 5 lbs, and within 24 hours I "gained" total of 7 lbs from my lowest.

You always have such great & informative answers.

I didn't think I looked too thin after 3 years, but mentally I definitely felt uncomfortable in my skin. I was 32 and single at the time, I would walk into a restaurant and I would notice a guy looking at me. At that moment, I felt like every guy was "checking me out" and I was uncomfortable. What didn't cross my mind is, he was most likely waiting for his dinner partner and looked up to see if I was her. I felt so safe and secure when I was 340 lbs that I didn't know how to handle 160. It's been 15 years since that time, and my weight has been all over the board. I've been as high as 260 because of regain and I'm currently in the process of loosing that regain weight. I believe my mind is in the right place now and I would feel fine at 130 (which is where I belong).

I would tell someone who thinks they're too skinny, are you too skinny according to the doctor and BMI? or is it an emotional insecurity? There's nothing wrong at maintaining a higher weight if that's where you're emotionally comfortable, but don't be surprised if at some future point you'll want to lose that extra weight because you're situations have changed. Just know it will be harder and longer, but it's doable.

Thanks for doing this, Daisy. Good questions and interesting responses.

9.5 years post op.

Question #1 (Q1) - only one question today as its a long one

Vets give us your thoughts on Newbies who feel they are losing "too much weight" and "look anorexic" and start adding calories back in to stop the weight loss (before they hit true maintenance).

Looking anorexic and being anorexic are two very different things. If anyone ever has any concerns about their own mental health, I hope you are seeking advice from a doctor if you think you are restricting your food and obsessing over your calorie intake to the point of concern. Plenty of people really struggle with this after surgery and I worry that there are not enough mental health supports in place to screen for this phenomenon.

However, I think what we see over and over on OH, are the people who are not actually exhibiting anorexic behavior, they are just feeling concerned that weight is falling off and they might not be able to stop. Its never happened to them before and it feels just as out of control as it did to be gaining with no end in sight. They are uncomfortable in their new bodies, and lets face it--the first year or two out, a lot of us have a gaunt look and thinning hair. It is not always the prettiest look! But really, if you are not actually anorexic--you are eating the recommended number of calories and you are paying attention to your nutrients, you are going to be just fine. Our bodies stop the rapid weight loss without our permission to do so, and I have never seen a person look "too thin" if their bodies are getting what they need.