The fact is, gout is usually diagnosed by "ruling out" other problems, not by "ruling In' your metabolism of purines and uric acid production.  This is a standard way of achieving a diagnosis in medicine - and why your doc says, 'take the medicine, if it gets better, then you have gout'. The additional information that you provided is compelling, but I don't think it's really applicable to a WLS patient.  The whey that they are discussing is protein taken as a supplement to a regular diet - whi*****reases your protein load above your needs.  This description is gout caused by excessive protein intake - irregardless of the source being whey or casein or gelatin.  It is describing a flare up of gout as a symptom of excess.  In WLS, the protein you are getting is meeting your base needs and does not often get to the point of excess. I think more accurately you could apply the idea that fasting is making the gout - or pseudogout - flare up.  The process of weight loss with WLS definitely puts your body in a fasting state and results in the circulation of increased waste products thereby putting a limit on the amount of uric acid you can remove and so it may deposit in joints causing pain. The metabolism problems of Ca and Fe (if you had them) would have likely resulted in symptoms prior to this.  I would offer the idea that waking up in excruciating pain may also be compounded by muscle cramps - often in the feet and often related to calcium deficiency, dehydration, or potassium deficiency.  All of these factors are required for proper muscle function and although potassium is often blamed for muscle cramps, calcium is more often the culprit.  Night time, rest (naps) or early morning are often the time when these painful cramps occur. Yes, gout can be worse on day and better the next - it all depends on the circulating uric acid and that changes from day to day and whether or not it is irritating a sensitive area.  Gout is an awful, debilitating condition that usually comes in waves and often with long periods of time passing between flare-ups.  Medcations have been a godsend to those who have severe cases.  In previous generations, this was a reason for a person to be in a wheelchair or bedbound - and often doped up on pain killers. (historical novels always have a bad case of gout and of tuberculosis in them - they were pretty common and very incurable).  Most people opt to use the medications.  They are effective and have relatively few side effects.  The indocin (indomethacin) is a NSAID and has the GI side effects associated with Aleve and Advil. There are other meds such as allopurinol & colchicine which may be effective with fewer side effects, that you may wish to discuss with your physician. So what can you do?  The choice is yours. You can try the herbal medications that you mentioned in an earlier post. You can increase your fluid intake to help with the "flushing" of waste from your body. You can try the medications. I hope this at least offers you some ideas to explore. Happy New Year!

Stalls can be very frustrating.  I can't tell you how long it will last, but most subside before 6 weeks.  Hopefully you are close to the end of this one. One of the important things with stalls is keeping on track.  It is so frustrating to keep your portions strict, get enough fluids, do your daily exercise and still not have the scale go your way.  But - it is very important to stick to your plan. Hopefully you set goals with your dietitian post-op about how many calories, carbs, fats, and protein.  Your supplements should also have been discussed.  The precise amounts of nutrients needed depends a lot on the type of surgery that you had.  Your surgeon and their staff should be the best people to answer these questions for you. We have posted on general guidelines many times, so check the archives on this board. I hope this gives you some direction - and let me know if you have trouble finding the earlier posts with a PM. Happy New Year!

Your goals should have been established with your dietitian - right?  I wouldn't want to get into the specifics for you without doing a complete assessment.  This really isn't the place for that. If I was going to give you a general assessment, I would say that your calories are low which are typical for your post-op period.  It looks like you are eating almost only protein foods and you are meeting the general goals for protein intake. Your fat % is a little high, but that will likely come down as you tolerate more foods and begin to add more complex carbs to your diet.  It is interesting how much a few servings of cheese can contribute to total fat.  You could consider switching to non-fat milk to lower your fat intake. Overall, you are eating a typical 3 month post-op diet. Remember to get adequate fluids and keep up with your exercise regimen. I hope this helps!

I would hate to live on cheese alone. When you say tuna chicken eggs "in any form" does that include mixing it up into a salad?  Meaning, you make the stuff a little moist with some low-fat salad dressing (or light mayo) to help it 'slide' on down. I will tell you that protein is often not well tolerated and there are plenty of post-ops that need to continue to rely on their protein supplements for a while after they are "okayed" for solids. Unfortunately, there are only so many options when it comes to protein.  You may have to find creative ways with protein powder! sorry I can't tell you better news.

I have the greatest of sympathy - steroids are no fun. What usually happens with corticosteroids is that they cause a rise in blood sugar (hyperglycemia) or they block the action of insulin (insulin resistance) which makes your cells think they are hungry - even though they are not.  So that explains what's happening, but what can you do about it? I wouldn't worry so much about the content gram per gram of your nutrients (carbs, pro, fat) but rather set a strict schedule for your meals.  Eat your meals very routinely, be careful with your portions, continue to eat your protein first, and take your time eating. If you get hungry between meals, drink no calorie beverages.  Warm drinks, like hot tea, tend to be the most satisfying to keep the hungries away a little longer. Recognize also that you may retain additional fluid with the steroids causing weight gain.  Hopefully this is a short treatment and you'll be able to get back to your old routine again soon. Good luck & hope this helps!

In most whey based proteins there is virtually NO lactose left. The drying process of the protein burns off the sugars.  If you mix the powder with milk - well that's a different story. Look at some of the studies about soy yourself.  The contribution of "phytoestrogens" was significantly overestimated.  Really, soy is not the answer to hormone replacement therapy.  Though it is true that the data shows women in countries where they eat a lot of soy have fewer complications associated with menopause, the methods by which they came to that information is skewed.  Rather than worrying about phytoestrogens, I would consider that soy does cause more allergies in this country than milk (though milk allergies are usually more severe). And not to put down the guy at GNC, but what are his credentials in recommending anything?  I'm sure he went to the GNC school of nutrition, but does he have a formal education?  I guess I'm saying - consider the source of your information.  Your health is too important to leave it up to the opinions of others. Do the research and make the best decision for yourself.  Google it, check out the NIH website, check out the ADA website - there are great resources out there from reputable agencies. Good Luck!

Total carb content and added sugar content.  I think that added sugar is probably more of an issue.  According to the guidelines, you should aim for less than 5 g of added sugar - but that doesn't count the carbs already present in the food naturally. Let me use the example of a protein shake made with milk.  An 8 oz serving of milk has 12 gram of naturally occurring sugar (lactose), but no added sugar.   A shake/protein powder may or may not have added sugar (usually lower carb but sweet options are sweetened with sucralose, aspartame, etc) .  If you are adding your protein supplement in to milk, you are going to have a total carb count that is higher and you will get a little more protein (mixing with milk is often a little more palatable for people - not everyone though) The magic number for dumping is often around 20-25g sugar - but not everyone dumps. If you are eating a grain or cereal product, the highest contribution of calories is going to come from carbohydrates - but it also provides key nutrients and fiber. For many people it helps to look at your whole day goals.  Make sure you are eating your protein first, especially in these early days.  Try to keep your carb intake at your goal level - this means some foods will have higher carbs and that's okay but they are paired with lower carb foods throughout the day. I hope this helps!

Did you ever have an appetite post op? I'm asking this because I wonder if the area on your stomach where you feel hunger (known as stretch receptors) were destroyed by the procedure. No appetite is a common thing post-op, especially years out. It seems to be more common in those that got to goal weight (or below).  My personal suspicion is that there is a mental component to it as well as a physical difference - but I have no data to back that up. But you are doing the right thing, are maintaining your weight and adjusting up or down as you need to with both your food or exercise.  So I don't see the problem.  You are successful and are maintaining your success - an enviable position some would say! Congratulations to you!

It's not as much about the carbs and fat as it is about the total number of calories you eat. If you want to lose weight, reduce your calories. Usually this starts with you starting to journal your daily intake.  Plug it into one of the on-line programs to calculate calories - get an idea of where you are now.  Then, look at it and see where you want to cut.  Maybe change your calorie drinks for no-calorie.  Maybe cut your portions. Maybe visit a dietitan :) good luck!

Great ideas! Thanks for sharing!

As a nut, I get to give my 2 cents back on nuts. :) Peanuts are technically not a nut, but a legume.  They grow on bushes, not on trees.  There is a lot of data out on the benefits of nuts in the diet (I know this because I trained at Loma Linda University, and they did a HUGE study on walnuts). The nuts that give you the most benefit are "tree nuts" such as walnuts.  They are higher in fiber, lower in fat, and higher in the antioxidants/phytochemicals you mention. My caution in having nuts as a staple in the diet is that it is easy to over do them.  I understand that you have this issue under control, but others reading this may see your post and think peanuts are a free food.  As we used to joke in school - it's 9 peanuts to the mile (corny dietitian humor...) what this means is that peanuts are a dense source of calories and you have to walk a mile to get rid of just 9 of them.  Something for a person to consider when planning their diet and exercise. I additionally caution the use of nuts because the people on this site are mostly trying to lose or control their weight.  It's nice to know which foods may cause you problems.  And I'm here to help! Thanks for your comments - this has been an interesting thread! Happy Holidays - yikes 4 days left!

Great advice on the previous post. My only addition is that if you have had a cold or infection, your iron levels may be low from that.  Low hemoglobin and low iron are not necessarily the same problem.  Make sure that other nutrients such as folate and B12 aren't an issue by checking your MCV (mean corpuscular volume).  If your MCV is high, you may be losing hemoglobin because your blood cells aren't able to mature before they are sent out to carry oxygen around. (ask your doc). If iron is the issue - add the Vit C  and recognize that iron from animal products is better absorbed than that from plant-based foods. Good luck!

The last response was great!  Let me add a few thoughts.  The RMR or BMR is a measured value, analyzing your body's use of fuel.  This measurement can change from day to day (with activity) and based on the type of foods you are eating (this affects the efficiency of fuel burning somewhat).  The activity factor on the other hand is a calculation - based on some decent data, but generalized to a population of people. I wouldn't suggest for a second that you bump your calories up to 2300 - at least not until you start running marathons. You can clearly see that your body can utilize 1600 calories per day. You have an excellent knowledge of nutrition, types of foods to eat, etc. Start slow, add more calories and see the results. I'm not sure I completely agree with the sabotaging your BMR - but studies have shown long term effects of very low calorie diets.  The fact is many WLS people may already have long term effects on their BMR from chronic dieting (pre-op) or the starvation of weight loss (post-op). What do you need help with - are you reluctant to increase your calories?