Confused about surgery

As some of you may know, I found this site a week or so ago and have been reading up on surgery. I met with a surgeon and had a good appointment. I set up my sleep study for 6/4. Surgeon says vertical sleeve will work, meet the PA who says I’ll most likely be approved, sets me up with the nutritionist.  I think I’m good.  Then I meet my friend for lunch. I tell her I’m thinking about surgery. She lost 85 lbs. 2 years ago on Optifast, and has managed to keep it off. She completely changed how she eats and changed what’s going on in her head. She says before you do surgery, do Optifast and figure out if you can stay on it first – the surgery is going to be too much just because you cook (actually she cooks too). If all else fails then get the surgery, but it’s going to be too much for your life. And she gets me thinking maybe she’s right.  I’m the house everyone goes to during the holidays – hey, my name is terithecook for a reason! I’ve cooked, entered cooking contests and usually place (not win but place). My daughter is a pastry chef. Food is my passion. So now I’m worried. Can any of you tell me how you worked on your own journey to figure this out? What was the lightbulb, AHA moment?

I knew I had yo-yo'd myself into a corner and had to do something surgical. I could starve with the best of them but the weight wouldn't come off. I knew when I heard and started reading about the RNY and the DS I needed malabsorption to make it work. If your metabolism isn't busted and you can see yourself sticking to a low carb lifestyle but need help with volume, I see nothing wrong with the sleeve.
I think your friend is trying to validate her decision but 2 years is not enough time for her claim success.

--gina

Hey Gina!

I'm still not understanding about malabsorption, besides it means you need to take more vitamins.  What am I missing?  Why do you have to stay low carb?  I'm Italian and Puerto Rican, carbs got me in this mess  

Well, malabsorptive WLSs reset your metabolism but the length of time varies. RNY for about 2-3 years and DS about 5 years. After that, the low carb lifestyle is what keeps you slim.
Some say the sleeve also resets your metabolism for a time too but mainly the removal of the stretchable part of the stomach and its associated hunger hormones are what makes the sleeve tick. The sleevers will have to jump in and tell you the particulars. I think they also try to maintain a low carb lifestyle. They too have to supplement with vitamins since they mal-digest their food and aren't able to get all their nutrients from it. Think about a very small sleeve for a stomach and its inability to churn up the food as you can now.
RNY and DS mal-digest and malabsorb due to the way the intestines are bypassed. Also, when I say low carb, I'm talking about under 100 carbs a day not less than 25 like Atkins induction diet. I'm not sure where Optifast falls in as to carb count. It would be very very difficult for me to maintain as I do now without the benefit of WLS.
I hope I'm making sense. ;)

--gina

Yes, Gina, there's a dim light at the end of the tunnel.  I'm just making sure it's not the lights of an oncoming train! 

Maybe I'll get lucky and a sleever or two will respond!

Thanks!

Teri, I'm not Gina, but had a similar story. I could take the weight off every single time (except the last time I tried), but never keep it off. I managed to lose 67 pounds through exercise bulimia (low calorie consumption, 4 hours of intense exercise per day to work it all off until I trashed my knees with the workouts), I managed to lose 75 pounds through the Carbohydrate Addict Plan (carbs other than fresh raw veggies one hour per day, protein only the other 23. Worked until I started dreaming about crusty bread). Lost 50 through a hospital nutrition program that involved eating small salads 5 times a day and a small chicken breast for dinner 5 nights a week. Worked until I saw one salad too many.

Each time I put on more than I had lost.

My PCP had been offering me surgery for a couple years, but I wanted one last shot at doing it without cutting. I put on weight, and realized it was because I was so frightened that this time would be like the others.

I opted for surgery, and couldn't be happier!

Other than the first few months, I eat what typical people eat if they are healthy. I occasionally eat sweets and fats. I eat amounts that are smaller than some people, but not so small as to cause comment in restaurants.

I admit, I'm not the family cook. I am the family dessert maker, however, and I've been able to tweak most of our favorite recipes to be things that are ok for me to have and that they enjoy.

I do eat protein-forward, so I literally eat my protein first at any meal. I then move to veggies (I prefer fresh/raw with the exception of grilled sweet corn - I can manage a small ear at this point), and then, if there's room, a bit or two of refined carbs (roll, rice, pasta), and then fresh fruit. My snacks are fresh, raw veggies and fresh fruit with the very occasional cookie if they are in the break room.

As far as malabsorption, Gina and I have had surgeries that mess with our intestines, which is where calories and nutrients are absorbed. As a result, we don't necessarily absorb everything that goes in, and need to supplement and be careful about getting that protein in. Because our surgeries are different, we need to supplement different things, but that's what it's all about. The sleeve does not mess with the intestines. It just takes out a lot of your stoma*****luding the part that produces ghrelin which is the hormone that sends the hunger messages. You would still need to watch labs to insure that you don't become malnourished, but the risk is a bit smaller than for a malabsorptive surgery.

I thought long and hard, and determined that for me, I needed the malabsorptive component to, essentially, reset my metabolism. Other people don't need that. Only you can tell what works for you and your life.

Thanks Rebecca.  Exercise is not my friend, more like an enemy.  I will do what I need to, but that's about it.

I usually was able to diet down and of course, not maintain it and gain it back.  I love to eat.  Perfect example - this morning I had toast with low fat cream cheese and a lowfat yogurt.  I get to work, there are small bagels out and of course I had to take one.  The surgeon mentioned that with the sleeve it removes gherlin and that's what helps with the not being hungry because lets face it, my brain doesn't get that I'm not hungry.  So I'm not sure if that means I need malabsorptive or not.

One time I lost 62 lbs. on WW, a second time 37, last time (5 years ago) it was 16 lbs.  This time for 2 months I lost a total of 5. 

I remember when I could diet for a couple of days and lose 10 lbs.  FEH

Oh, my head just LOVES secret eating!  If I'm alone in a room, my head immediately starts suggesting I find goodies!

I have a very sick head.

Almost always I stop the talk, or I leave the room, and only eat if I'm with people.  My brain has no interest in whether or not I'm hungry, it just wants goodies.  So for me, particularly since I'm one of the rare ones who hasn't had actual hunger since surgery, lack of ghrelin would have made no difference.

Yeah, those days when the metabolism worked and I could drop weight easily - those were nice!

We have some really awesome cooks on here that come up with all kinds of WLS friendly recipes.  Look over eggfaces account. 

I also have joined WW numerous times and every time I lost less weight and it returned quicker each time.  That's great that your friend has lost on Optifast and has kept it off for 2 years.  I've known a lot of people on WW (including myself) who could stick to it for 2 years but the pounds gradually came back on.  Is your friend at goal or still working on it?

I don't understand the sentence..."the surgery is going to be too much just because you cook".  I don't know how the Optifast diet works but I'm assuming that you limit your food intake and follow the Optifast plan. I am guessing that you have to rely on your own will-power (which doesn't work in my case).  If you have that much willpower why didn't the WW points work? WLS is a tool that helps you limit your food intake.  It depends on which surgery you get as to how it works.  I have the RNY which limits the amount of food that I can eat at one meal with restriction and limits my sweets and fats with symptoms called dumping.  Everyone's dumping symptoms are different.  I get hot flashes and  tired if I over do it on sweets and fats (which is where my weakness lies).  I am over 3 years out and  I can eat anything I want I just have to stay within the limits of what my body can handle at one time. 

I'm not a great cook but all of our family gatherings are also at our house because we live in the country.  I know for a fact that if I had to cook and use my own willpower I would fail.  I actually have more fun now during all of our family gatherings because I am enjoying my family rather than overeating at the food table.

Do you have to do a pre-diet before surgery for insurancre approval?  That would be a great time to try the Optifast. 

Our pre-surgery diet was Optifast, 5 shakes a day, one small food meal, unlimited celery and cucumbers.  boring.  I wasn't hungry but boy was I bored.  We had to do it for 4 weeks.  I was religious about it and I think I lost 8 lbs that month.  I couldn't have stuck to it for long enough to lose 100 lbs.  And I I don't know how drinking shakes gets you to change your eating habits. 

I had lost and gained the same pounds over and over.  I knew I couldn't do that again.  I cook daily.  Not huge meals anymore but I make good healthy food and make a lot of what I have always loved but made more healthy.  I still go out to eat, go to friends for dinner, have folks over.  My quanity has changed but I can have a bite or two of anything I want.  Nothing taste better than skinny feels.

Has this changed my life?  Yep, for the better.  I can be more active, I am off all meds for all my co-morbidities.  I eat pretty normal or what a normal person should be eating.