Question about Dr. C and his bougie technique

I guess some of the guidelines about adding certain foods in later might be for some people who don't have a handle on how to treat their sleeve.

Perhaps you can answer this question.  I think I had posed it to someone else, but didn't get an answer back (that I can remember).

I drink green smoothies.  Here's the recipe so you can get a better picture of how I make mine.

2 whole peeled oranges
2 apples
2 bananas
2 cups blueberries
1/2 typical bunch of kale
bag of baby spinach
1/4 cup ground flax seeds

I put this all into a Vita-Mix and add enough water, usually 3 to 4 cups, to fill it to the top.  Then I blend it to a fine puree.

Then I pour it into 4 quart sized containers and fill each container to the top with more water (usually another 2 cups per container).

Then I drink a quart sized container of this green smoothie over the course of a day.

I do this because I feel this is the best way to get the total  nutritional benefit from the entire fruit or green.

Because everthing is so blenderized and then greatly diluted, and I drink it over the course of several hours, at what point after surgery do you think I might be able to incorporate this into my daily post surgery diet?

Obviously, I will speak to the MD or NUT about it also, but really would like the feedback from a vet.

Thanks!

"I guess some of the guidelines about adding certain foods in later might be for some people who don't have a handle on how to treat their sleeve."

There's nothing wrong with having a NUT on staff to help people who are having troubles with specific, personal recommendations. There is something wrong, IMO, with handing 100% of your patients a sheet of paper which says what foods to introduce each week when none of that information is based on scientific evidence and it won't apply to 90% of them.

As an example, most people have issues with raw veggies at first. Most people can handle them at 2-3 months out. OTOH, I was eating cole slaw and lettuce at 7 weeks out with no issue. But programs that micromange will say things like:
-brocoli at 3 months
-carrots at 4 months
-tomatoes at 6 months
-celery at 8 months
-lettuce at 12 months

But it's all arbitrary! If you can eat carrots at 4 months, you can probably eat lettuce. Conversely there are people who can eat lettuce just fine but can't eat raw carrots even years out.

So what purpose does having a detailed list like this serve? It makes everything that much more complicated for certain personality types and it prevents others from experimenting and working out a food routine that works for them and will serve them for the rest of their lives. Which is what you should be doing in the honeymoon period IMO.

As for your smoothie, it's really impossible to say if they are a good idea or not because food choices have to be evaluated in the context of your overall diet.

Some things to keep in mind:

For the first month or so, you'll be lucky to be getting in 400-600 calories a day and at lest 280 of them should be from protein. It's also very hard for most people to get in all their fluids and protein during the day. So you have to figure out if the shake is going to make that easier or harder

You also have to decide if you want that much sugar in your diet. We were told to keep carbs to 40 g or less a day and sugars to the bare minimum and this shake is almost all sugar (because of all the fruit in it).

As time progresses, and your calories increase, this may be less of an issue, though I avoided fruit for most of my losing phase. I didn't cut it out completely but I didn't make a point to have 1-2 servings of it a day like I do now 3.5+ years out either. I had fruit a couple of times a month for the first 6 months.

The other thing to keep in mind is that our body doesn't regulate liquid calories that well especially if they are carbohydrate-based.

In one study, they had 3 groups. One drank a 200 calorie carbohydrate drink every day, one drank a 200 calorie whey protein drink and one a 200 calorie soy protein drink. The group that drank the 200 calorie carb drink gained 2 pounds over the course of the study! Conversely, the two groups that had the protein drink either didn't gain or lost 2 pounds. This is only one study so it doesn't prove anything but it does suggest that drinking protein isn't as problematic as drinking carbs. But there are plenty of studies showing that liquid calories are not as well regulated as solid calories in general.

In the end, it comes down to what works for you. I have minimum veggies with my lunch and dinner and then my afternoon snack has a protein (usually dairy), a veggie (raw carrots usually but today I'm eating a tomato) and a fruit (banana, berries, grapes mostly). I actually don't agree with the recommendation to have 5-9 servings of fruit and/or veggies a day. Mostly because I don't think fruit and veggies are the same at all and they shouldn't be conflated like that.

In particular, I don't think our bodies are designed to handle a lot of fructose and I think most people shouldn't be eating more than 1 or maybe 2 servings of fruit a day.

This is a lot of good information.  I wondered about the fruit because even though this divides into smoothies for 4 days, it still equals 2 fruits a day, or 1/2 of each fruit used.

I could always make a savory smoothie and not use fruit at all.   I just naturally gravitate towards sweet stuff. 

Yeah, I like the sweet stuff too. Sometimes I put a banana in my protein shake but only when I'm trying to increase my calories.

I haven't tried the cottage cheese test, but I bet I could eat a couple of cups because I have done this before. I'm sure my sleeve is just as tight as others, but I believe I have a longer stomach. I've seen this when I threw up one time with too much food in my stomach. A bit embarrassing but informative.

It came out in a small tube, very compacted because I over ate. The tube was about the width of a sharpie, but it was VERY long. I am glad I have a tight sleeve because I need all the help I can get. I do get very full on chicken so I try to make that the main stay of my diet.

A lot of chicken salad with dense veggies is the staple of my diet and works well if I don't go off that (which I unfortunately have periods that I do) and the veggies make it even more dense. I can eat 3/4 to 1 cup of chicken salad which is pretty well diced chicken and veggies.

You are only allowed to eat for 5 minutes for the test. So I'm pretty sure you won't be able to eat a couple of cups in that time. Not unless you are a speed demon eater. LOL

Most of us end up in the 4-6 oz range with some getting up to 8 oz. while RnYers often get in the 12-16 oz. range. What's interesting is that the amount you can eat doesn't seem to directly correspond to successly weight loss and avoiding regain. I think the reason the larger sleeves (48-60f) had those issues were because of lack of restriction more so than absolute capacity.

That's cool about your throw-up being as wide a Pilot pen because that's about right from what I've seen of bougie sizes. 

Wow!  Some people might find the tubular vomit disgusting, but I think it's kind of interesting!  If that happened to me, I would probably have examined it closely.  Maybe even have gotten a pencil and poked at it or something!

I also wanted to add that I appreciate your VSG FAQ's.  I remember when you first started posting them on the regular VSG board about every other day.  I have looked at them many times in the past and have renewed reading them again now that I am getting pretty close to my eligibility weight (6 lbs).

Thanks again!

 You are right, he doesn't care. That has been my experience...lol 

32 Fr bougie is the golden standard. It may be worth checking. 38-40 is back when the VSG was part one of two part surgery.

Did you hear that Dr C is broadcasting a sleeve surgery over the internet on Sat? If you want to see and hear about his techniques, that would be a good thing to watch.

Check out LapSF.com for details.