How do you know when you are full?

I just started soft food/ protein after two weeks of liquids. My surgeon said I should eat until I feel full. I was planning on measuring and weighing. I ate about 2 ounces of baked salmon and stopped. It went down easy with no problems but I never had a feeling of fullness. What signs should I be feeling? My new stomach makes lots of gurgling sounds when I eat or drink but that's about it.

At this point your stomach is still healing, so you can't trust anything it tells you for around 6 weeks post op. In addition, it takes 20 or so minutes for the "I'm full" signal to get to your brain, so eating until you're full is literally the worst way to eat.

Good for you for measuring instead.

Even now, at 3+ years post-op, I've rarely felt full. I try to never get to that point.

Thank you, Gwen. That is excellent advice!

Great question and great reply Gwen. Good to know for the future.

Penny

The easiest way to find your capacity is to eat until you throw up, and then back off a couple of bites. Needless to say, that isn't the most practical approach. The problem is that our satiety signals are crossed up for a while - the vagus nerve has usually been cut, so there goes the signal to your brain that your stomach is starting to stretch, so time to stop. Carbohydrates also provide an early satiety signal, but we aren't eating much of them, so that's out the window, too.

We can go with limiting ourselves to our nominal stomach size (if you know - mine was 2.5 oz) and that's a good start, but our capacity is a combination of basic stomach size or capacity, and how much passes through it during the meal. This is what gets deceiving about these early stages, as we can usually eat a fair amount of liquids and mushy things with relatively little restriction as things tend to flow right through, but as we move into solid things, then that physical stomach capacity comes into play as the pyloric valve is closing up to let the stomach process those solids, so we need to be aware of these things as we progress toward solid real foods.

I know you qualify it by saying it isn't practical. But it is NEVER a good idea to eat until you vomit. Just had to put that out there for anyone else reading.

On the contrary, carbohydrates generate cravings, not satiety. Fats are most satiating, followed by protein.

Sugars tend to create cravings, not carbohydrated in general. If only broccoli created cravings for more broccoli. Fats in excess can also create cravings and have addictive qualities - its just that few these days abuse fats to the degree that they abuse sugars - they got their hands slapped enough during the low fat phase of the fad diet cycle.

Carbohydrates do send the earliest satiety signals to the brain, in part from the insulin response. However, it is also short lived; protein provides the longest lasting satiety but takes longer to be felt, and fats fall in between. This is why, at least in the "normal" non-WLS world, a relatively balanced meal works best as, in addition to better nutrition, one gets earlier satiety signals to avoid over-eating the meats and other protein and fat containing foods that provide more lasting satiety. It's that balance and compromise thing that permeates much of our biochemistry and physiology. In our WLS world, they dynamic changes some, at least for a while, where satiety signals are generally messed up along with our diets.

Two pieces of broccoli is one thing, however most people post-op *****gain aren't eating just broccoli or spinach or the 1-2 tablespoons of rice nutritionists say to eat. It's far more than that.

Any processed carbohydrate will create cravings and overstimulation of insulin. As for fats in excess creating cravings, typically if they are consumed with protein only they will not. Fat and carbohydrate will, especially after the inclusion of salt. Carbohydrates immediately start being digested from amylase in saliva; fat and protein are not. Biochemistry-wise, fat and protein stimulate more satiety-inducing hormones (PPY, etc). I'd be interested in seeing what hormones fat stimulates that are not addictive and induce cravings. I would love to see any information you might have.

As for a "balanced meal" working best, assuming no history of obesity or addiction, perhaps. Many people who are obese will not do well with the inclusion of starches. And, there is a big difference between being super morbid obese and "just" obese in terms of cravings and the neuroendocrine response. I see many more people fail after surgery who try to eat rice, potatoes, etc, again, than people who stick to a very low carb diet. The lucky ones can eat a balanced diet. Not everyone is able to.

Many people who eat primarily fat and meat, say zero carb, have little to no cravings and high satiety. Many doctors (Fung for instance) have discussed this occurs much earlier than when eating starches and higher-carbohydrate foods.

You don't even need exogenous carbohydrate to survive; much less for satiety.

As for macronutrients post-op, everyone has a different brain, a different neuroendocrine response, and different nutritional needs. Once addiction to food, or an eating disorder is formed, that radically changes the ability to eat what is considered "balanced." Someone with a different personality, different neurology, and different levels of damaged mitochondria (from the obesity) will likely not be able to eat a high quantity of carbohydrate for some time, particularly if they have impulsivity or compulsivity traits, as many of us do pre-op.

That is so true. If I give into any carb cravings, it becomes a monster that wants more and more and then I am miserable for denying it. I do allow bread into my diet and have been doing good to have it not create cravings. I generally have half a serving of what it says on the bag (so usually 1 slice instead of 2). Anything other than that, anything remotely chip like has to be a no or I will want more and more! Better to just never ever try to put them in my body (easier said than done!)