Restriction Doesn't Last Forever?

You will continue to have good restriction as long as you do not routinely overeat thereby stretching your pouch to some degree.  I had a bowel obstruction in May, and prior to that I would always comment on how much restriction I had.  Some days I could barely eat even small portions.  However due to the complication my pouch and intestines were dilated due to the back up caused by the kink and twisting.  I definitely do not have the same restriction I did prior to that event.  The surgeon who assisted commented on the amount my pouch was dilated but said by my size I did not obviously overeat.  So as one poster mentioned,as long as you follow yhe rules and do not have some sort of mechanical issue, you will continue to have restriction.  From what I see on the boards, I never see anyone post about mechanical issues.  Most posters are honest and will say they have issues because they no long follow the rules.

 My restriction has been awful, to the point of constant nausea and retching. Eve though tey say it looks good. 

PTI am on 3 kinds of ausea meds, and 2 pain meds wich I alternate eery 2 hours to try to keep it at bay. 

Im now looking for a second opinion for next week.

RnY gives restriction for the rest of your life, but your pouch will stretch some, and possibly your stoma  too as others have mentioned above.  What does stop is malabsorption of calories....after the honeymoon period, in which you lose weight no matter what, and the weightloss slows down, your malabsorption of calories stops ( stops for some as early as one year out from surgery, for others up to two years) as your small intestine grows new villi to compensate for the bypassed part of your small intestine attached to the duodenum.  Unfortunately because most of your old stomach and duodenum are bypassed, you will have vitamin and mineral malabsorption for the rest of your life.  That's why you need regular blood tests to find out the right level of supplementation you personally need ( no one formula valid for everyone!  At over 4 years out I am now iron deficient...yet I was surgically menopaused 12 years before my WLS and had never had any problems until a blood-test last year!!!)  i take my supplements religiously, have a day/week pillbox with compartments on y kitchen counter so I know what I have taken (and not taken yet) every day...

Bye, got to get a Calcium and extra Vit D3 down right now....I do my iron last thing at night before bed.
...I wish the calorie malabsorption would last a lifetime !..

Your stomach is about the size of a two-liter bottle of soda.  Your new pouch is about the size of the bottle cap on that soda.  After about a year, the pouch grows to the size of large egg and holds about six to eight ounces of food.  You could cram 40 to 50 ounces of food into your big stomach and about eight to twelve ounces of food into your mature pouch.

You will always have restriction, just not as much as with a new pouch.  If it stayed its original size, you would starve to death.

Restriction is forever, malabsorption of fat/calories will decrease over time, or diminish completely.  The body gets "smart" and figures out how to absorb most of the those calories.

Malabsorption of micro nutrients is forever compromised-which is why it is critical that you take supplements forever-so you don't turn into a boneless chicken.

I'm sure you've been thoroughly reassured by this. But I'll go ahead and respond anyway. Restriction is forever so long as one of two things doesn't happen.

Think about it this way.... imagine two things that are designed to be blown up, a balloon blows up, stretching easily as that is one of it's functions. But then imagine something made of a much more durable less stretchy material that is merely supposed to be inflated to a certain size, but no further. (no good example comes to mind as I'm sort of in a pain-pill haze at the moment). In any case, if you try to blow the balloon up more, it gets bigger until it eventually explodes. But some other thing that is only supposed to be inflated to a certain size will resist stretching beyond it's normal size.

Our stomachs are made of stretchy material and less-stretchy material. It's supposed to expand for a larger meal, but the part that is least stretchy is the top part. Probably because that part must retain its shape so as to function properly.

When they make the pouch, they select only the stuff at the top of the stomach that doesn't stretch easily, disconnecting it from the lower part that does stretch easily. Suddenly you have an egg-sized pouch with minimal stretchability instead of a football sized stomach that can stretch quite a lot.

When you first havfe the surgery, there's swelling and of course the body has designed this part of the stomach to not be very stretchy. But the body has a level of adaptibility that is pretty awesome.

Once your body realizes that the upper part is all it ccan use, it adapts. The swelling subsides, and it does everything it can to become as close to a functional stomach as possible. When you move your meal size up to a full cup (in my plan I was supposed to be up to a full cup of food by 18 months, and from that point forever that was the size of my meals). So your pouch learns to handle that amount of food. It will never stretch enough to take in a full footbook sized meal... at least not without tremendous work on your part. I guess you could push the issue day after day and stretch the pouch, but more likely than not, if you push push push meals that are too large, the most likely part of your system to stretch is the STOMA that connects your pouch to your intestines. This -- when stretched -- is pretty much the death knell of the WLS. You can still be just as successful as anyone else, but you need INCREDIBLE discipline. Because if the stoma stretches, suddenly you no longer have an egg-sized pouch capable of consuming a full cup of food..... you have a huge length of small intestine acting as one enormous stomach. If that happens and you choose to consume enormous meals, you'll be able to do it.

This is why following the rules is important. They're designed to help you keep your stoma intact. There are a few procedures to try to fix a ruined stoma, but I haven't heard of any that are any good. A TINY percentage of folks who have RNY end up with a stretched SToma through no fault of their own. Physiologically speaking some people's bodies reject the entire concept of a Stoma. These individuals might struggle because of this thing that has happened through no fault of their own. Most who stretch it do so because they're having issues with the rules.

So restriction is PERMANENT in most cases. But you won't keep the restriction you have as a new-op. You CAN eat a small normal meal like a normal human. If you expect to eat 2 oz meals for life, you'll feel like you've lost restriction. But it's alive and well.

Here's what I wrote about calorie malabsorption!

When I was in college, my college roommates had a rule: "break a cookie in half and share it, and all the calories fall out" (they were joking about the calories)

In essence the RNY is something like that. I'll make up some numbers, because in truth teh percentages VARY from individual to individual and nobody can say what the EXACT amount is nor for how much. But I'll give you some basics to treat as a sort of framework for understanding.

You have your RNY and most of your stomach and some of your intestines are bypassed. This means that you're bypassing the location in your gut where MICROnutrients are absorbed, (vitamins) and this is why you must supplement with vitamins for your entire life. Also, you bypass where MACROnutrients (food) is absorbed, and this changes over time.

Your small intestine is your main "fuel the factory - body - location". In a normal person they chew and swallow. Saliva and the stuff in the stomach churn up the food and break it down into easier consumed bits and pieces. Then the stomach sends the bits and pieces into the fuel factory so that the factory workers (we'll call them VILLI) can scoop up the energy bits and send them off to do their job in your cells.

So a normal person might have 100 Protein Villi scooping out protein, 100 Simple Carb Villi, 100 Complex Carb Villi, and 100 Fat Villi.

Now even for a normal person, some of these Villi workers are sleeping on the job, so you'd expect to absorb from a normal gut all 100 (%) of the simple carbs (because they LOVE their sugar-lovin jobs!), but perhaps only 94 or 95 or 96 of the other Villi are doing their job. The result is that every sugar carb you swallow goes to energy or hips. MOST of the protein and fat and complex carbs do the same. But SOME of the calories a normal person ingests will end up exiting into the toilet bowl. This is normally how the gut does things.

Well now, imagine that the assembly line gets partially bypassed. Let's say that of your 100 Protein Villi perhaps 50 of them are put out of business and waiting around in an empty and bypassed gut. Twiddling their Villi Thumbs and sending text messages to the stomach saying "what'up?" Same with the 100 Fat Villi perhaps 50 of them have also been bypassed. Even your 100 Complex Carb Villi have about 20 or 30 that have been bypassed. Because they LOVE their job, there is just no disruption, however, to the 100 Simple Carb Villi. So lets pretend that a new-op has a meal that contains 100 fat calories, 100 protein calories, 100 complex carb calories, and 100 simple carb calories (which would be a huge meal, but we're pretending with easy numbers). That person would likely only absorb perhaps 270 of the 400 calories consumed. The rest sort of goes by too quickly in the assembly line and ends up in the toilet.

The thing is that all those text messages from Villi that can't do their job because they were bypassed? They eventually get up to the Foreman on teh job (your brain) that something's gone wrong and the assembly line is letting good calories go to waste. The Foreman says to the assembly line, "Kick it into gear, get some more Villi on the job, we can't waste all these calories" So the assembly line starts sprouting more Villi. I've read some estimates that perhaps 95 of 100 Complex Carb Villi are back on the job and 75 to 90 of the 100 Fat Villi are back on the job, with a similar percentage of the 100 Protein Villi are all back on the job within about 12 months to 18 months. So perhaps that 400 calorie meal to a person who is 18 months out might be anywhere from 345 calories to 375 calories that are used for the 18 month out person as compared to 270 or so used in an early-out.

The BEAUTY in this particular system is many-fold. (prepare yourself for some more numbers I'm sort of making up, to make a point)

See, if you weigh 300 pounds, you might need, (example) 5000 calories to fuel your body..... open your eyes, blink, power your lungs and heart, wiggle your toes, read a magazine or the internet. It takes fuel to keep that many cells alive. So the person who needs 5000 calories just to wake up in the morning and do nothing all day won't GAIN weight if they consume 5000 calories. By the same token, they won't LOSE anything either. When we have the WLS we do several things... so let's say you're 300 pounds, and your body needs 5000 calories to survive. You have the surgery, and drop your calories to 500. (which you also malabsorb some of them)... so you eat 500, and your body uses 400 calories. Well.... your body MUST fuel your heart to keep it pumping, your lungs to keep them breathing, your brain, evverything. It won't do without fuel and shut down until the fuel starts again. So, the cells send out a "RED ALERT" and the body checks the bank vault (your fat cells) and breathes a DEEP sigh of relief and starts doling out energy chunks from the fat cells. On day one, you will likely lose more than one full pound of fat cells alone! Your body is having a MASSIVE defecit even if you only wake up and blink all day long.

Now, technically speaking, if you weigh 299 pounds on day 2, then your body doesn't NEED 5000 calories to keep it going. It might need 100 fewer calories.... so if you eat the same meal, you won't lose QUITE as much....

This goes on and on and yet, you can't live off your fat stores forever. It's healthy to have a certain amount of fat in hte body. SO several things happen to the postop going from NEW postop to AT GOAL and staying there:

Month 1 you consume FAR less than what you need, and you lose a LOT of weight. (you also malabsorb a HUGE amount)

Month 2, you weigh less, your pouch is healing up so you can eat more (but not too much) and you're being protein forward so the simple carbs aren't still pouring out onto your hips. You lose a little less because your calorie NEEDS for your lighter body have gone down, and your food has gone up, even though your activity has also increased.

By Month 3 a pattern emerges, and you start to lose in a semi-predictable manner with ups and downs and merry-go-rounds throughout the month. As you step up exercise or even just movement, you push your body to do more and use more calories, even while the calorie NEEDS just to wake up and blink continue to drop, and the new Villi are starting to come online (a few at a time).

Fast forward to quickly approaching goal. By this point in your journey you've worked on your mind issues to help avoid the mental part of massive weight gain, and you've worked OUT physically to tone muscles and use calories, you have a steady diet that is mostly is a fixed number of calories close to the number of calories that you burn. You WANT your maximum Villi to come back online so that you can reach a nice maintenance level where you eat enough to fuel your body, but not much (if any) more. People often dip below their goal weight as part of getting to goal. It's natural for you to go below goal as you figure out your new lifetime food habits. As the villi come online that amount of calories will produce more calories for your system. It's very natural to fluctuate at this point. If you aren't where you want to be you have to either up your calorie use (exercise) or decrease your calories to drop further weight. 99% of those who have RNY will get to the right weight (according to your body not your doctor or the scale) without any need to do anything to change your eating. This isn't a diet, it's a lifetime habit you're forming, and if you don't think of it as something that is going to come to an end at some point or other, then your body will adjust and you'll be maintaining.

SO.... for those who lasted this long, congratulations. Tomorrow there will be a quiz.

You should be a teacher, oh yeah, you are a teacher!!! You do good work.

You should see my "Geometry Show" :) I love finding ways to get information out there.

Thank you all for helping me!  You all inspire me and you are so courageous.  I don't have much support, other than my husband, with having this WLS.  I am told by my family members that it's all in my head and I should be able to lose this weight without surgery.    When I told the psychologist this during my evaluation for insurance purposes, he asked if they  were over weight, which made me stop and think-none of them were.

I was always the little chubby cousin/sister/daughter, etc., while the rest of my family was avg. in size.  It's nice to know you're all here to lend a helping hand.  Thanks again for taking the time to share your knowledge and personal stories-I sincerely appreciate it!!!