MONDAY, April 15, 2019

Ooh, so much to say about those questions, but I'm just not up to it. I don't think my answers would differ too much from what Ann said. Maybe nuances, but ...

Do we worry that going very low calorie slows our metabolism? My take on this is yes, but I also have seen the evidence that it is short term, especially when one gradually ramps up the calories and exercise.

If we keto, do we worry that too much protein can cause an insulin response? No. Keto keeps blood sugar levels fairly steady with minimal ebbs and flows. You also have to know what your personal KETO LEVEL is. For some it is below 50 carbs per day. For others, they might have to be as low as 20 carbs per day to hit a ketogenic state.

Do we think there is such a thing as too much protein? Yes, I do because one must consider long term kidney function. However, it is hard for us with sleeves to get too much protein, if we are eating whole, real, natural foods.

Do we think 60 grams generally recommended by WLS literature is enough protein? Macro targets can be generalized or individualized. 60 grams of protein is certainly enough to keep your body in a good state of repair and function. Yet, if you are wanting to build lean tissue, 60 grams of protein is too low. A rule of thumb is for building lean mass men can eat between 1 and 1.5 grams of protein per every pound of body weight. For me that is too much because I want to lose weight, but if I were thin and wanted to add only lean muscle, that would be a good target. Women would want to stick to .75 to 1.0 grams of protein per pound of body weight. My experience has shown me that if I want to lose weight at a faster clip, 80-100 grams of protein is needed. Too low a level of protein and I stall.

Do we think a food eating window of 8 hours is desirable, or is it okay to eat many small meals? This is intermittent fasting thinking. I'm not a big proponent of limiting my eating to 8 hours per day. Research shows that for anyone who has had any type of disordered eating, limiting the hours during which you can eat triggers disordered eating patterns. Research has shown that restrictive eating in general is a trigger for anyone with disordered eating habits or patterns.

Is low carb high protein lower fat as effective or better than low carb, high fat, moderate protein? I think that depends again on the individual. Liz is really good at the super duper low carb high protein regimen. Ann is a believer in fruits and vegetables and eats a lot. What you can NEVER do is eat a low carb, low fat diet. That type of diet is a road map to failure. Brain science has shown your brain will accept either low carb or low fat, but NOT BOTH simultaneously. It works for us post WLS because there is nothing we can really do, but the science explains why around 8-12 weeks out post WLS patients often tend to start craving and caving on their eating regimens. I had a lot of will power and didn't falter until basically 5-6 months out, but I did. I actually know very few people who were "perfect" during their losing stage. As a WLS patient almost 7.5 years out I can not handle both low carb and low fat. Heck, I can't handle High Carb, low fat, low protein either (think Weigh****chers). I can handle high protein moderate fats and moderate carbs well, but I HAVE to stay away from sugar, if I want to be successful.

Is there a scientific metabolic thing going on that causes WLS patients to start gaining around 3 years? Or is it just increased capacity, diet fatigue etc. ? All of the above. Though, by 3 years out, your metabolism should be recovered. Hopefully, it will have increased as you have added back calories and exercise. If you have not, you might have a pretty low level calorie need, much like Liz who maintains on a calorie level that is close to "starvation" level to me. LOL, not really, but pretty darn close. I lose on 1800 calories per day. I REALLY lose on 1200-1300 per day. Diet fatigue, loss of will power, increased capacity all play factors in regain. I think complacencies about diet are the biggest factor - lack of tracking, thinking we are "cured", slow, gradual slips down the path to "sudden" weight gains, etc... all play a part.

Hope that is helpful.

Very interesting and informative response, Peps. Thanks for this.

Thanks for so many things for me to think about ... great insights and info.

On the subject of supplements, what are we all taking? I take one multi vitamin, sub lingual b12 and lots of vitamin D. I feel my immune system is stronger because of the D. I should be taking calcium, but I mollify myself with the fact I eat a lot of high quality dairy. I wasn't taking my supplements, and recomitted to them about 4 weeks ago. I feel better, I'm not sure if that's actually physical, a response to the melting snow, or because I feel virtuous, having resumed. :)

I am the pill popper of the group:

Daily: multi vitamin, calcium citrate, fish oil, vitamin E, vitamin D3, copper

MWF - B1

W, Sat - sublingual B12 (2500 mcg)

Here are the supplements and Rxs I take daily. Rxs are in bold, the others are over-the counter (I buy them all at Walmart). Note that the two antacids could be bought over the counter, but they're cheaper in Rx form.

One hour or longer pre-breakfast: Levothyroxine (125 mcg MWF; 112.5 mcg TTSS)

With breakfast: Pantoprazole (a PPI antacid)

With lunch: Multivitamin (Walmart generic)

Fish oil (1,200 mg)

Probiotic (10 billion CFUs)

Iron (elemental) (27 mg)

Stool softener

Biotin (5,000 mcg)

With dinner: Ranitidine (40 mg) (an antacid)

Caltrate chewable (calcium, vitamin D)

I used to take B-12 until blood tests a few years ago showed I was above normal limits, so I stopped. It's in high-normal range now. Apparently, my tummy's "intrinsic factor" that's involved in B12 absorption (if that's the right way to say that) hasn't been compromised by WLS.

FYI, I don't count the calories in the fish oil (although I just realized I should), but I do count the calories in the Caltrate chewable because chocolate. ;)

Before you read the next paragraph, I want to say there is some evidence for Vitamin D. There are some associations, too. For example, a thought that the excess levels of MS in this area of the country is related to low Vitamin D. More personally, when diagnosed with breast Cancer, mine was ultra low (single digits? it was long ago...) I just ordered some from Amazon recently because mine was again low (upper 20's) at last check so I need more. I would be thrilled to get some sort of boost from it.

Did you all hear that a fair amount of the feel-goods about vitamin D was based on bad science derived from one unethical researcher? I have no details stored in my head, but, as always, this is dismaying and irritating.

My Calcium/PTH are messy but that is unrelated to VSG. I finally proved even to myself that I can not eat enough calcium to compensate so I finally take 2 Citracal max daily which has some vitamin D in it. I also take Magnesium as an insurance policy because if magnesium is low one can't absorb calcium and my mg was low when initially checked. (I'm all about the calcium!) I will add extra vitamin d when it arrives. And that is it for supplements.

My VSG nurse recommends more supplements -- she follows guidelines as it is her job. My surgical doctor and endocrinologist (also an obesity expert) are aok with what I (don't) take.

I love it when you talk like this! :)

(From one Questioner to another Questioner)

I have another theory about vitamin D completely devoid of any research or scientific information on my part. Both my paternal grandmother and my own mother grew up on dairy farms. They were poor, but one think they had plenty of was milk. Both had a lot of bone building sorts of activities, yet both had/have osteoporosis. They also lived in northern Minnesota. I hypothesized that all that raw milk and lack of sun exposure for large parts of the year, lack of vitamin D, made it difficult to use all that fine dietary calcium. On another odd supplement note: my Grandma had a filter caused by lack of iodine.Apparently there is a lack of iodine in the soil in certain parts of the Great Lakes region, such as northern Minnesota.