Exercise, Nutrition, WLS, and Cooking Q&A - 1/16/2014

If you have questions, I have answers (and if I don't I will find one for you!). Regardless of where you are in this process sometimes things may become confusing or may not make sense. I have done a lot of research and tested quite a bit of what I have found on myself. Let me know if you have any questions about exercise, nutrition, WLS (or VSG in particular), or cooking.

Let's Hear It!

I will be having surgery in a few weeks and one thing I keep thinking about is after surgery and 64oz of fluids and protein shakes.  I am trying to figure out how do you balance all the fluids if you are sipping 4oz an hour?

First, stop thinking about 64oz of fluid and start thinking about 100oz. 64 is the min and really to keep from stalling you need to get more like 100 (seems to be the magic number). More is better in this case, so don't put that mental block of 64 in your head. It is definitely more difficult the first week than it is later. You will struggle with it for the first probably 3 weeks. The trick is to combine as much as possible and the best thing (especially in the 1st week) is IsoPure Zero Carb Ready To Drink. Its thin like water and in 20oz you get 40g of protein. Most of their flavors tastes like butt so pick up some Mio from your grocery to have on hand to change the flavor up. This stuff was a life savor in the first month. Don't go crazy buying a case of a flavor you think you might like. Go to VitaminShoppe store and most of them have a cooler case with different drinks you can buy singles of. I suggest buying several and trying them out. There are others as well that you might like to try if you like choc/van/straw flavors instead of fruit flavors. You just want to be sure you are getting something low carb (typically less than 5g of carbs). I think the key in the first couple of weeks is thinner is better. The thing about liquids is they basically go right through your stomach (and pyloric valve), shakes take a bit longer but not too much. So I am not sure where 4oz an hour comes from. Just keep sipping. Take a sip, swallow, wait a min or two and take another. I used to take a mouthful, hold it in my mouth and swallow a small bit at a time until I got the hang of it, that way I was sort of committed to at least that mouthful. Now I can drink the better part of a small bottle of water at once. You will figure out your tolerances pretty quickly. Don't stress over not hitting your mark those first couple of days, you will get there soon enough, just make it a priority that you are hitting your mark as soon as possible (by the 2nd week) and then get yourself up to 100oz per day as quickly as possible. One of my tricks and I still use it is when I leave the house for the day I take four 16.9 oz bottles of water with me. Before I return at the end of the day those need to be done, that's almost 80 oz right there, then I have a few more to drink at home in the evening. Water flavorings like Mio, Dasani, Powerade, Target and Walmart have their own brands too all are good ways when you get sick of the flavor of water. My favorite right now is black cherry Mio and Orange Powerade Zero flavorings.

You will also find that either cold or hot liquids work better. For me it was cold and I think when I made my drinks especially cold with ice they brought the swelling in my stomach down and I was able to drink more. Others feel the warmth relaxes the stomach and allows them to drink more. Word of warning if you are going to warm up your protein, you need to temper it by getting your water or milk (use unsweetened almond milk or unsweetened coconut milk, not regular milk) warm, adding it and then slowly heating it up otherwise you will have what looks like liquid with some special chunky treats in it.

Also another word of warning on protein powder. They are not all created equal in content OR taste. My recommendation is to try and get some samples (vitamin shoppe will have a few, nassua nutrition or maybe nashua nutrition you can order samples for like $1 a piece) that way you can taste a bunch of different brands and flavors. I was on a banana kick prior to surgery and ordered a giant tub of it and ended up only having 1 shake out of it and I had to toss the $50 tub out. I also ordered the Unjury chicken soup flavor and never even opened it. So I would wait until after surgery and finding a flavor you really like and then buying a small tub of it as your tastes will change in the weeks after surgery. The stuff I liked in the first month I can't stand now. Some of my favorites were AST VP2 chocolate and Dymatize ISO-100 Gourmet Chocolate.

Keith, thank you so much for your response and taking the time out of your day, this was truly an A-ha moment for me!  I start my pre-op diet next week and have been replacing meals trying to find tastes and brands I like.  I am headed to the vitamin shoppe as well and will check out some of their brands.  I was going to talk to them about liquid vitamins versus the chewables, love to get your thoughts.  Thank you again

Enjoy food while you still can, you will have plenty of time to sort it out over the next couple of weeks. Honestly immediately post-op I used flintstones chewables and CVS gummies and they worked great. You can chew down the flintstones better but they work fine. You will want to get the ones with iron, so just the old school flintstones. They are cheap, they taste good and they work great. After you get to full foods and can swallow pills easily then there is a brand called Rainbow something that has a great line of vitamins that are high quality, easily digestible and an all around good product. Sometimes you can find them at walgreens but if you google rainbow vitamins you should find them and find where you can get them. Vitamin Shoppe oddly enough is probably not the best place to get vitamins, they are over priced and they will sell ice to an eskimo. Vitamin Shoppe is convenient and they have good sales, so if you know what you are looking for, it is convenient. They also about once a month or so have a day where vendors come in and give out tons of samples of protein, vitamins, health products, that's a great day to go because its usually a great sale day and you walk away with like $100 in samples. 

I tried liquid vitamins once. Wellesse makes them and you can get them at target, walmart, and walgreens I believe. They are ok, but I was really sick of them after about 3 days. I found the chewables, even in the liquid phases worked just fine because you can chew them into liquid. Centrum chewables are good too but the flintstones taste better.

Perfect thank you, and I had to laugh I tried one of the isopure fruit drinks and you are right they taste like "Butt", it will be worth it to get the payload of protein! 

Hi Keith,

I am still in the beginning stages of this journey. I should be having surgery in a couple of weeks and I'm on the preop diet now. That, coupled with my lack of conditioning (I'm 261 pounds), doesn't give me a lot of stamina. Today I will be doing 20 minutes on the treadmill and 20 minutes on the recumbent bike but that's all I'm capable of doing.

I see the intensity of your workouts (and others on the forum), and I just can't believe it. How in the world am I expected to take in enough calories post-surgery to get a good workout? My trainer gave me a series of upper body exercises to do on the machines but there's just no way I'm capable of that now. I just get too tired. I'm eating about 800 calories a day now and that will go down quite a bit after surgery. I don't want to crash and burn at the gym. When my blood sugar gets too low, not only do I have the physical symptoms but I also get anxiety attacks.

Carbs will have to be factored into this somehow. How am I going to have room for carbs when the golden rule is protein first? There's no way I can work out without carbs.

I know that these goals are long-term and I need to be patient with myself, but I'm concerned. I'm not really interested in becoming a gym rat, but I would like to reach a higher level of cardiovascular fitness and retain as much muscle mass as possible.

Thanks for your help.

OK, first stop thinking about calories in/calories out right now. Take a look down. See that thing hanging just below your chest? That's a whole lot of stored calories. The idea is to use those. How does that happen? You have to get your body used to burning fat for fuel. How does that happen? You don't eat carbs. When your body doesn't have carbs it uses other things besides carbs for fuel, fat and protein. It's second favorite source of fuel over carbs is fat. So, yes you feel yucky now when you exercise because you are carb adapted and you need to become what is called keto adapted. This means your body gets used to using ketones (the output from when your body uses body and nutritional fats) for fuel. So forget about carbs, you don't need them and I promise you can do this without them. I eat less than 60g of carbs per day and around 1000 calories. 

Have you been diagnosed with hypoglycemia? Unless you actually have hypoglycemia I doubt your blood sugar is causing that problem. My blood sugar is typically between 50 and 60 these days and I function just fine. What you may well be experiencing is either dehydration or more of a mental block. I promise you can physically do these things, they are just very uncomfortable. I still struggle with this and there are certain exercises that I actually experience a flight response from. That feeling you are getting could also be dehydration. Make sure you get enough water before the gym, while you are at the gym, and after the gym (or your exercise where ever it is).

If you can do 40 mins of cardio right now, you are WAY ahead of the game, so kudos to you and you need to eliminate a few things from your mindset and vocabulary. Stop saying "that's all I'm capable of doing" (because 40 min is a lot at 261), "there's just no way I'm capable of that right now", and "There's no way I can work out without carbs". I'm here to tell you that you absolutely can. I weighed 384lbs and couldn't walk to the end of my very short driveway without breathing hard and breaking a sweat. This morning I ran for 2 mins a 4% incline  at 7 mph and yesterday it was 5mph at 15% incline.

OK, one final suggestion for now ****il after you get cleared to exercise post-op) walk as much as you can. You don't need to jog on a treadmill or hit the bike, walking is the best fat burning exercise you can do right now. Also you don't want to increase your cardio capacity very much right now because it will keep your resting metabolic rate higher longer. Once you can run for 20 mins without stopping your resting metablic rate drops a lot which means you burn more calories at rest. Walking on the road or sidewalk requires much more muscle than walking on a treadmill, so if that is an option for you that is better. The best thing you can do right now is walk and lift weights. Lifting weights isolates muscles which require more calories than using them in unison with other muscles. Also going into surgery (and coming out) you want as much lean muscle mass as possible because that burns more calories at rest. Also you want to protect what you have. Pre-op diet, surgery and the first post-op stages do not allow for enough nutrition to preserve muscle so you lose a lot of it, in fact that accounts for some of the huge losses people see in the first couple of weeks. Consider using a BCAA supplement like Scivation Xtend to preserve your muscle. Your loses in the first couple weeks will not be as great as some others, but your loss in the long run will be much greater.

Thanks so much. I actually did buy the Scivation Xtend and have been drinking it after every workout. I seem to recover better after using it.

I'm not Keith, but I feel the need to chime in here as well. (I second everything Keith said).

First of all, please do not say that you CAN'T or that you are not capable. This is a journey of amazement at what you CAN do. I started out at 280 lbs, I couldn't do crap for exercise except pool exercise (and look, you are already doing 40 minutes of cardio and that's awesome!) and I had frequent low blood sugar incidents. In my case, the low carb diet completely resolved the low blood sugar issues. I haven't had a single episode since surgery. Am I guaranteeing that will be the case for you? Of course not. But it's possible. And just another great benefit to the low carb lifestyle, in addition to it forcing your body to burn fat for fuel.

I resumed water aerobics after surgery, then a few months later I started working with a personal trainer who taught me I can do WAY more than I ever thought possible. Pretty soon I was working out 6 days a week, doing high intensity cardio, the stair machine, spin bikes, hundreds of squats, step-ups, deadlifts, all kinds of stuff I thought I'd NEVER be able to do. I never thought I'd turn into a gym rat either, but that's exactly what happened. 

And I can tell you I did all this stuff while eating less than 800 calories a day. Now, exercising at a high intensity does force you to plan your eating in a structured manner - I did have a couple times where I got dizzy. But planning your meal times out helps with that. Keith knows a lot about what to eat and when - I am out of the game a bit due to surgeries I had last month. It's hard being on your pre-op diet. It will be different post-op surviving on less than 800 calories. Your sleeved stomach will give you an advantage. You just have to feed it the right stuff.

So please, please, please take "can't" out of your vocabulary. Dream big. Think of all those things you thought you'd never be able to do but want to do...because you CAN do them. Allow yourself to consider the possibilities. You are going to be amazed at what you CAN do.