I don't know any DSer who doesn't ever eat carbs (though some are more careful about what type they eat than others). I sure do. I have some everyday. 1/2 bagel, bread, potato chips, pretzels. Not a lot, b/c I can't & b/c I always think protein first. If you don't you'll feel very tired and not good, believe me. I could eat an entire Pepperidge Farm cake preop, too. I can't now. I could prob. eat 1/4 -- it depends how big it is. Then I'd have to come back to it a few hrs. later. I do eat junk. I think I mentioned it in my earlier post. Just not as much and less often.

Like you said, you need to get all that protein in. I eat 80-120gr/day and it's almost always over 100gr. Then I try to drink as much as I can (I'm not great about that). Then a piece of fruit (I'd like to do at least two). Then some carbs. If not, I lose too much weight. One of the interesting things about the DS is that if you want to lose wt. you eat more protein and drink more. So if you don't have some carbs, many of us find we get too thin. Hard to believe, but that's a problem I'm having for the last 9 mos. or so.

RE: the protein: I have a ticker in my head. Now for the first 6 mos. I kept a food diary my surgeon's nutrit. gave me. Once I learned the protein value of most foods I ate, the ticker in my head just kicked into gear. It isn't intrusive, I just know it's running in the back of my mind what my count is. So a day I don't have enough protein at lunch, I make sure I eat a good amt. of nuts and/or cheese (I do most days anyway) or maybe drink a protein bullet. Like I said, it's not in the front of my mind any longer (it was the first couple of years) now it's just quietly in the rear.

BTW, I don't eat 'lean, healthy meats'. Neither do many DSers I know. That'll be your choice when you're postop depending on your cholesterol and what your dr. says. I happen to be a DSer who watches it more than most b/c everyone in my family takes a statin (but me b/c my cholesterol, lipids, etc. are so good postop) due to high cholesterol (and none are obese) and heart disease in the family. I generally don't eat the skin on chicken and only eat ice cream once a week. But others eat much more in the way of fats due to the malabsorption. But I do eat fatty steak & stuff like that.

AAAA - Do you think your inability to eat an entire cake is due to your surgery, or due to not eating those things in such quantities for so long? I'm wondering if it is the SURGERY that made that particular change for you, or your change in eating habits? I'm just curious because I could have eaten a whole cake before, and I would probably get about a quarter into it now and feel sick also, but I haven't had any bariatric surgeries. So it's an interesting chicken-and-egg situation...did the surgery cause your inability to eat junk in quantity, or did the surgery cause you to change your eating habits, thus getting you out of the habit of eating junk in quantity and making your body react poorly to it?

It's an interesting point to ponder...was it the behavioral change or the physical change?

AAAA - everyone eats carbs. Personally I follow a high carb diet but the carbs I eat now are considerably different than before my weight loss. Also, like Amanda I've had no surgery but I can't eat the amount I could before my weight loss.

It is my belief though that weight loss is very individual and there are subtle differences even between those that lose via similar methods.

I agree with you, Nellie. Everyone does eat carbs and I hope I made that clear when Pat worried about eating them after a DS. You can't live without them and who would want to? Not me. It's just that with the DS they're not the first thing one generally thinks of. Protein is first, second and third. Oh, and one other thing. Part of the reason many DSers eat fewer carbs is the noxious gas. Personally, I generally only eat them in private (unless I have the probiotics going)

I also agree that it's completely individual no matter if you've had surgery or not. I seem to eat much smaller amounts that many DSers I know. When I go out to dinner with a few they eat from soup to nuts while I can eat about 1/2 my entree (always have enough for another meal, tho ). Also, just as none of us eat the same, nor have the same bathroom or gas habits.

It is an interesting question. Sounds like with you it maybe your head giving you that full feeling. That's a great thing.

With me, I have to say it's probably both but more the physical. Believe me, there are times I'd love to eat that whole cake and really, really want it, but physically I can't. I feel ill & uncomfortable if I eat too much or drink too much while eating. For the first year, I threw up if I ate too much or drank too much after eating. Nowadays, I can still hang over the sink retching if I do it, but rarely throw up. But it still does happen if I just push it a bit too far. I'm not talking about junk, but just dinner. I have to know when to stop and come back and finish and hour later. It's a physical sensation I sometimes ignore...

AAAA, no it DEFINITELY isn't my head talking. I've had that same "Wow, I really want another cookie!" feeling. It makes me nauseous, though, and shaky from all of the sugar. I think my stomach just isn't USED to vast quantities of junk, and so it rebels when I give it too much. Even if I wanted to, I couldn't eat another cookie without throwing up.

I wonder if thats a different cause of a "shrunken stomach"? Eating less for long enough?

Isn't there an issue though with this procedure and nutritional uptake afterwards?

Pat, I truly believe the only way to lose weight, and enough of it to get to a healthy size, is that the desire to be thin and healthy MUST outweigh the desire for the food.

You have to want to be healthy so, so badly that you pass up on all the "bad food", even though you want to eat it. It doesn't matter if you want Doritos or a cookie. You want the weight loss MORE.

I know for me, until I hit that point, longterm weight loss simply could not occur.

I'm with Manda. I used to be able to eat quite a bit of junk, but in the last year I seriously cannot eat the same volume of junk that I used to. The last time I ate about a 1/2 can of Pringles I felt sick the rest of the afternoon. And I used to be able to put down a couple of cans at a sitting.

Same with sweets. I used to be able to eat a whole piece of Godiva chocolate cheesecake at Cheesecake Factory. Now, I can eat maybe a 1/4 or less before I start to feel really icky and sugar-overloaded.

There are a lot of things that I can only eat small amounts of now w/out feeling queasy.

And it's definitely not mental - because as Manda said, there are plenty of times that I've WANTED more ... but I know that I can't eat more because it will make me feel utterly awful.

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Same for me. There's no way on earth I could ever get down a fraction of the volume that I used to eat. I get full sooooo much quicker now.

And that Godiva Cheesecake from the Cheesecake factory. I've had enough after a couple of bites. I think it's the chocolate though, because I've managed to eat full slices of other cheesecakes. Although when I did eat that full slice, I felt just horrible. Horrible. Amazing how I used to be able to eat and eat and eat. The volume was scary. Of course I DID feel horrible, but now it's just simply out of the question.

I have a few comments, as someone who has researched the DS to death and decided it is the way for me, and as someone who pretty much eats like a DSer right now due to a high protein, low-carb diet being the best way for me to control my type 2 diabetes. So, my comments come from my experiences as one not yet having had the surgery and from my extensive DS research and discussions with those who are living with the DS.
This is exactly how I used to think about WLS. I would say, "Umm, hello, if I could eat a quarter of a cup of food for each meal like you have to after surgery [thinking of RNY gastric bypass], I could lose the weight--why have surgery?"

Here's the difference: your stomach is made smaller, and the outer curvature of your stomach that produces grehlin (the hormone that increases your appetite) is removed. When you eat those 100+ grams of protein a day, you have little room left in that smaller stomach for junk food. And no, you don't have to avoid carbs and junk for forever. You can still have them--but not until you've had your protein. DS Rule #1: Protein first, second, and third. And without your stomach producing grehlin (or very very little of it), your appetite is suppressed.

Also, many people find their tastes have actually changed after the surgery (can't explain why). I've watched many many people get protein drink samples before their surgery so they know which ones they like, and then they order a bunch of their favorites. Well, come time to go home from the hospital after surgery, they find they can't stand those flavors anymore! So there's a lot more at work than just "eat this, don't eat that" diet rules.

I've made the bahavioral changes before (as I know you've seen me do multiple times!). I used to be a fast food junkie--I could put away 3 Happy Meals at once. But after going cold turkey on fast food for a while, it makes me naseous to have more than half a cheeseburger and a couple of fries. My stomach no longer likes all that grease and junk. This is due to my behavioral change. However, as I understand it (and I'll let you know in a few months for myself), after the surgery, it's not necessarily just a matter of feeling sick after eating the junk--it's a matter of your stomach literally not having the capcity to hold it anymore. Yes, the adjusted stomach can stretch over time, but never back to the size it was prior to surgery. So, I would think the answer is a combination of both. But I can also answer that the behavioral changes can easily be undone (as I've done to myself multiple times ).

If you are careful, then there is very little chance you will have an issue with nitritional uptake. However, by being "careful," what I mean is you must be proactive. The sad truth is that most doctors, surgeons, and nutritionists (even those who specialize in bariatrics) do not fully understand what DSers need after surgery. I've seen DSers told to just take multivitamins and calcium only to become severely anemic or otherwise nutritionally deficient later on. DSers only absorb about 20% of the fat they eat, so fat-soluble vitamins NEED to be supplements (A, D, E, and K). Also, calcium is a must, and it should be calcium citrate as opposed to calcium carbonate (since citrate is a more easily absorbable form--this is also true for RNYers, not just for the DS). Occasionally, I also see people with low iron, which is relatively easy to supplement as well.

The trickiest part is that you really have to do some research yourself and that you need to closely follow your own follow-up blood labs. Often, a doctor will get your lab results, and as long as everything is withing the "normal" range, the doc tells you you're fine, and you're on your way thinking you're just dandy. However, you really need to get copies of your lab results and compare them to each other. You may be in the normal range this year and last year, but if you were in the high end of th enormal range last year and are in the low end of the normal range this year, that's a sign that that nutrient is trending downward and likely requires additional supplementation. You have to be proactive, educated, and responsible for yourself.

I think I already answered most of this previously in my response to Manda, but I also want to add that right now, I can even overeat non-junk foods. While your stomach can naturlly shrink without surgery (since it has been stretched out from years of over-eating), it won't shrink to the size of a post-WLS stomach.

I used to be very against surgery for myself. VERY against it. Why not just eat less? Why not just stop eating all that junk? Why not just change your lifestyle? And I still agree that these things should be tried multiple times (in different variations--maybe low carb isn't the right solution for one as it is for the other; we're all different) prior to seeking surgery, as surgery should NOT be someone's first attempt at weight loss. If I were healthy but fat, I would likely still not be seeking surgery. When I bring it up to people, I say I am having surgery to possibly cure my diabetes, not that I am having weight loss surgery, but that in the U.S., the diabetes-reversing procedure is only done as part of a WLS procedure.

And, I have to say, we have some exceptional people here on 3FC. On average, fewer than 5% of people who lose 100 pounds or more can maintain that loss for 5+ years. I've seen multiple 3FC chicks do it, so I know it can be done! But some people need a stronger tool to help them.

Hey Jill. Thanks for the long response.

I think it sounds like you've done a lot of research and come to the right choice for you. I guess what concerns me about a lot of the posts I read, is that I see a fair number of people saying "I can still eat normally" or "you can eat whatever you want". Obviously, from what you've written, that's just simply not true.

I just wonder overall if people really realize what they're getting into by making these permanent changes to their bodies that will impact them for the rest of their lives. And how many of them really realize that they *cannot* "eat normally" afterward - even if there is a physical change in the desire for food as a result of the surgery, the emotional issues haven't been addressed.

I dunno ... I haven't had WLS, I don't plan to have WLS and so I don't really have a dog in this hunt. But it's just something that I wonder about when I happen to hit a thread on the topic.

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Hey Jill,

Is your surgery date set? When is it?

Also, I know with other surgeries, your stomach can expand back with certain things like carbonation and just eating too much, is that the same for duodenal switch?

For me, I never investigated surgery because my issues aren't hunger, they aren't health, they were just eating too much of the wrong thing. Now I eat mostly too much of the right things.

I think with anything we go into we just need to be informed. For me, I did a lot of research on my current eating lifestyle before I went into it. Investigated macro and micro nutrients I would require and how to get them. I think even those that don't have surgery or don't restrict their diet in some manner are in danger of being malnourished. I think it is just the overall way our eating habits are going.

I agree 110%, and the point of my writing so much about it really is to try to help people become fully aware of what it entails. I can't tell you how many posts I've read from people on other message boards who have had WLS who come in asking questions where my initial reaction is, "really? How are you asking this AFTER your surgery; how did you NOT know this before letting someone cut you open and rearrange your insides?" With the DS, there are only about 20 surgeons in the U.S. who really perform the procedure, and most of them are quite particular about who they will perform it on. Because it does require so much follow-up and close watchign of labs and such, DS surgeons tend to be quite strict about who they accept as a patient. I know when I went it, the nurse I spoke with before I even spoke to the surgeon sort of grilled me on the ins and outs of the DS. If you aren't 110% sure it's what you want and can't explain in great detail the procedure, how it differns from the RNY gastric bypass, what possible issues you may have after the surgery, etc., you're not getting a DS from my surgeon! I only wish they were all so stringent, including RNY surgeons.

No date set yet. I just finished my insurance's required 6-month medically supervised diet yesterday, so as soon as my doc is done with all her notes, they will get sent to the surgeon's office who will submit my entire package of info to my insurance company for surgery approval. Then, my surgeon is scheduling DS procedures about 3 months out since he only performs 1 per week, so, assuming I get insurance approval in my first try without having to appeal, I'm looking at around March for surgery.

Yup, the stomach can stretch out, but not back to as large as before surgery. The outer curvature of the stomach is removed to make sort of a banana-shaped stomach (a "sleeve"), which also happens to be the "stretchiest" part of the stomach. After surgery, a typical DS stomach (they do vary in size) can hold about 4-6 ounces of food and may expand over time to hold up to 8-10 ounces. The typical stomach size without surgery is about 2-3 liters, so even a stretched out stomach after surgery is still smaller than a shrunken stomach without. Oh, and the carbonation thing is a myth--carbonation does not stretch out stomachs or pouches (though some surgeons and nutritionists still tell patients it does--studies show this to be false).

Yeah, this is my exact response.

It's good to hear that the DS doctors are being so thorough and strict with the process ... at least for all intents and purposes.

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