Big Eyes, Small Tummy Conundrum and NOT feeling like a stuffed sausage.

Eternally grateful for my sleeve, I still find it very often challenging (at times frustratingly so) to guage the perfect balance between what my eyes think they want to see on the plate for a meal versus what my stomach can realistically consume from a plate at mealtimes.

I weigh everything that can be weighed, measure everything that can be measured, and log each and every morsel that passes my lips on my calorie tracker.

However, I still find myself struggling to prepare the perfect amount to satisfy my body, mind and protein goal.

Take yesterday for example: I heated up one Morningstar Farms sausageless patty and prepared two eggs, sunny side up, and had three grilled grape tomatoes and a small wedge of grilled onion. The idea was to consume 24 grams of protein plus fiber in about 30 minutes and have a great end to the day with a fabulous "breakfast" dinner.

What I could eat: all of the egg whites plus 6/8 of the sausageless patty and two of the tomatoes.

I waited awhile, like 45 minutes perhaps, then finished the rest to complete the meal.

Today for breakfast I tried less volume: one egg prepared sunny side up, one sausageless patty, one oz of smoked gouda and six cherries. I found I was again able to eat only the egg whites, half the cheese and almost all of the patty, leaving behind half the cheese, the yolk and the cherries for later.

In the packet from the surgeon's office it says to make each meal at least 20 grams of protein and either eat it all spread out in one sitting or split it up to make it more manageable. So that's what I did, but it just seems strange.

Does anyone else have a bit of difficulty juggling the protein requirement VS the big eyes VS the small tummy like I do? Maybe it's just going to take me some more time. I am, after all, only a slightly more than 2 months post-op patient. I have an appointment with my registered dietician on Thursday and look forward to discussing this issue with her as well, but wanted all of your points of view from the OH end of things!

Aaaaaand, in any case, however difficult this may seem, it is billions of times easier than being back at my starting weight with high fasting blood glucose even with meds, high blood pressure even with meds, huffing and puffing up every set of stairs and feeling very much like I was a stuffed sausage myself.

I love my sleeve. :)

You have to work up to 20 grams.  You only had surgery 2 months ago, so don't expect to be able to eat that much so soon.

Egg yolks have a LOT of fat in them, and you should not be eating them multiple times in a day.  That WILL screw up your diet.

You will get there, but don't try to hurry things along.  Instead of trying to get all of your fiber in a meal, take fiber tablets or capsules between meals.

You can weigh an egg before it is cooked, and measure the shell after you dump out the egg.  Once you have done about 3-4 eggs, you will know pretty closely what each cooked egg started out as.

You can also weigh your patty, weigh your tomatoes, etc.

I found that there was NOTHING that I could not weigh.  I only measured my intake by weight, personally.  My scale lets me zero it out with the container on it, and it weighs by milligrams, so I could be very precise.  I use a plastic bowl to hold whatever I am weighing, so I could  even weigh soups.

Aaaargh! I wish they'd fix "quick reply". Let's try this again.

I never let my eyes have any say in the matter. I just measure my food out and then eat what I can from that. That said, at 3 months I could never eat a meal the size you're describing (or anything with 20 grams of protein) so I just don't try. I would probably only serve myself one egg and one sausage.

Right now I measure out 2 oz or 1/4 cup and don't regularly finish that. Once I find that is not consistently satisfying, I'll start measuring out a little more. So gradually I'll work my way up to 4 oz or 1/2 cup over the next several months. 

I'm not sure we can stretch our sleeves waaaaay out, but I believe we can have enough influence on their final capacity to make a significant difference. For example, my sleeve might have a potential final capacity of 4 oz to 8 oz - I believe if I pu**** now, it's likely to end up at the high end, but if I'm gentle it might end up at the low end.

Of course, I end up supplementing my protein with shakes - I probably always will because it looks like I may not be absorbing protein really well.

I have been kind of wondering if maybe my sleeve is a bit bigger than some other people's... like, maybe my stomach is longer. I know my surgeon used a size 40 bougie, but he's told me a couple of times that using a larger bougie only makes about a half ounce difference in volume compared to say a 32 or 34. It's mere millimeters in terms of thickness... but, if you start out with a longer stomach due to natural anatomy, then that's another story.

1/4 cup of most anything fits in there without trouble, as does 1/2 cup of most stuff. When I make tuna salad I package it in little 4oz Glad tupperwares. If that's the only thing I'm eating it goes down no problem. It's once I start eating some veggies with it that I feel the real restriction.

I think maybe it's still a matter of trial by experience over and over again of what fits and where my satiety point is compared to where my nutritional needs point is. I'm glad that, though my eyes sometimes rule how I fill my plate, it's ultimately my stomach that rules when I close my mouth.

Mine's a 40 bougie too.

I firmly believe that lots of things - length of the original stomach (surgery doesn't change the length), surgeon technique and eating behavior - have more influence on our capacity than the bougie within the normal 32-40 size range.

There's a video by Dr. Alvarez (I think) from YouTube that shows how original stomach size can influence capacity. By technique I mean how tight they sew or oversew and how close to the top and bottom they start - I saw a post from one user who said their sleeve was shaped like a barbell, a sign that the surgeon started a ways from the openings at the top & bottom.

Dense proteins do tend to fill us up more than meat salads with mayo.

You're doing great it looks like to me.

I know I have to work up to 20 grams, but I feel like I'm already there. I only drink protein shakes immediately after a heavy workout, so I get most of my protein and other nutritional requirements from food.

I think you're right about not worrying about fitting my produce in with my meals. When I'm at work, almost all of my food is in plastic resealable baggies and in my pocket (I'm on my feet for 11.5 out of my 12.5 hours at work and only get to stop for my one 60 minute break), so I eat (sneak) an eggwhite only omlette with low fat string cheese melted into it every morning for breakfast while I'm working. At some point in the late morning I try to snack (also sneak) on steamed/grilled/roasted/sauteed veggies also in a plastic baggie in my pocket. Lunch is often baked salmon, prepared canned tuna salad, prepared shrimp or meatless meat sauce with shredded cheese. Then in the afternoons I try to have either 2oz cheese or some pepitas (also all in a plastic baggie that I'm sneaking-- there's a theme with my meals at work!).

All this I do trying to also fit in my water, a lot of which I have to cram in at night because I can't have a drink anywhere near me while at work except in the room I take my one 60 minute break... during which I'm generally focusing on eating protein.

After work I go to the gym, and if it was a hard workout I drink a protein shake, then go home and shower and sleep.

Wash, rinse, repeat.

On my days off is when I end up cooking like I described in the original post and struggling more with how much I should be eating versus how much I want to eat versus how much my body can physically hold.

As far as the fat content in the egg yolks and everything else, I'm not really worried. I eat whole eggs about twice a week or less, and make sure to have no more than one serving daily (if even that) of whole fat cheese. Other than that, the only real fat containing foods I eat are the occasional avocado... maybe once every 3 to 4 weeks, the spoonful of peanut butter I've had I think three times in total since surgery, and the butter or olive oil I cook with my foods that aren't baked or grilled. It's really minimal and my calorie tracker keeps me in check.

I don't worry too much about fat - If I'm watching my calories, I reckon the fat will watch itself! We do need a little in our diet.

Mornings are still the time I'm least interested in eating, but my dietitian was fussing at me because I wasn't consistently getting in at least 20g of protein in the morning.  She insists that the body uses and needs more protein in the am than the pm.

My solution - protein coffee as part 1 of breakfast.  I drink it when I get up and immediately have 20g or more of protein.  Then I get ready for work (which takes more than 30 minutes) and have a small food breakfast - 2 oz of something - often leftovers from dinner, or some shrimp, or an egg.  So, by the time I'm in the car on my way to work, I have had a minimum of 30g of protein and usually a bit more.  It's hard when you're early out to EAT all of your protein, but it's easy enough to supplement with a protein drink of some sort.

A large egg is about 2oz by volume.  A sausage patty will vary, but figure 1-2oz.  If you had eaten the whole thing, you would have had 4-5oz of protein food plus probably an ounce of cherries.  That's a lot of volume at 2 months out -- at least by my plan.  At that point, I was on 1.5-2oz of protien per meal, and frankly, I can barely eat more than 2oz of protien at a time, now, and I'm almost 6 months post-op. It's pushing it for me to try and eat 3oz of soft protien (tuna salad or 4oz of fairly wet cottage cheese). 

I plan by volume AND nutrition.  If I choose to make something like an omlette that is larger than my allowed intake, I plan ahead to split it in too and save half for another day.

Here's what I am eating today @ 25 weeks post-op:

Breakfast:  1/2 cup 1% cottage cheese

Lunch: 2oz swiss cheese

Dinner: 2.5oz pork loin chop with a Thai Peanut crust and a couple of pieces of broccoli..

I will also have 2 Muscle MIlk Protien H20 drinks (10g protien, each)  half and half in my coffee, and 1-2 Sugar Free Popsicles. 

638 calories
68g Protien
26 Carbs, 16 net carbs.

I'm still losing 10lbs a month or so, down 110lbs overall, 78 post-op. I still have great restriciton.