Dinah

Considering Plication: Am based in Europe, I have questions about everything!:)

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Hi everyone! I am based in Prague where gastric plication is not experimental -- it is a center of excellence operation and has been performed more than a 1000 times. But for the purposes of this forum, I suppose one can say the results are similar to the Gastric Sleeve. I am in talks with my public weight loss center for this operation. I am 52, 5ft. 7 and 231 pounds. 

One of the things the psychologist emphasized to me is that you have to measure the food for the rest of your life in a 5ounce container. She said once you try to estimate, you over eat. I find the prospect of measuring meals for the rest of my life unrealistic. When I read about people who have had the gastric sleeve, it seems to me they learn to understand portion size without being in a restaurant and handing the waiter a little box:). Can someone enlighten me on how this works forever?

Also, the whole avoid fat thing -- the nutritionist says no butter, no cheese unless it is super low fat. But I see there are others who seem to eat these things. Is that just based on the individual? Am trying to figure out what my future life will look like. 

The second thing I have trouble with is understanding how things work when the food cravings come back after the so-called honeymoon period. If the point of getting this operation is to limit your hunger to help you not over eat, then isn't it just like any other diet if you have to eventually fight cravings and hunger like you did during all those diets you/I tried?

I have 2000 other questions but I guess these are my main ones for now! 

Thank you!!!

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Welcome to Thinner Times Dinah!

I don't believe we've had a patient going through gastric plication surgery.  I did a search and found some members who had a gastric band with plication but none are active on the forum.

I hope that someone can help with your questions.

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Hi! I have a sleeve.

Measuring is very important in the beginning, but then you get to know what a portion size looks like for your new stomach. As you heal, you can fit more, so the psychologist probably wants you to measure so you don't overeat and undo all your hard work and results. I think being mindful of how much you're eating is important, but physical measuring is not essential after a while.

I eat butter and cheese with no problems. These have a lot of calories, so I track what I eat in the My Fitness Pal app to make sure I stay in the calorie range I need to be in to lose weight.

I'm 10 months out. Food cravings are not really a problem. A wise member here, @Stephtay, says "What you eat today, you crave tomorrow". She is so right. I avoid starchy carbs and sugar because they can trigger cravings and the desire to eat eat eat. The cravings and hunger I experience are nothing like what they were before surgery. It takes very little food to make hunger go away, and I don't get awful headaches and other physical symptoms I got when I would diet before surgery. 

It's a little surprising how very vigilant you have to be to get the results you want with surgery, but very worth it.

 

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16 minutes ago, Dinah said:

Thanks! My questions actually apply even if it is sleeve surgery--- impact is the same. :)

Hi Dinah and welcome to TT.  I had the sleeve 7  months ago. My eyes are still bigger than my stomach !! I try to weigh and measure still but you cant always do that  depending on where you are. You don't have to but its not a bad idea if you can.

I use butter still and regular salad dressing. I mainly avoid the carbs and sugar but not the fats.

I really don't have cravings and my hunger levels are low still.  Hope this helps. Good luck to you.

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I had sleeve in 2014 and have maintained goal weight.  The cravings and hunger do come back for many (including me) but seem to be more manageable than preop.  It does require more dedication and commitment than I ever had with a "diet".  Perhaps because I approached this as my last chance to change my habits and my life.  Always before I looked forward to "eating normally" after a diet, although "normal" was what got me to needing to diet in the first place!  This time I went into it with the idea that this was a forever change in the way I eat.  Period.  New normal.  And it is such a new glorious life that I don't want to go back to the way things were!

Regain happens, and the ones who gain back most of what they lost let bad habits start creeping back in.  You have to forever be vigilant.  As to fats, I do eat fat, but try to stick to healthy fats like from avocado, nuts and dairy.  I do watch it because of the calories but definitely do not strive for low fat.  I rarely measure anymore, although occasionally I spot check just to make sure I'm still on target.

Good luck!

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Awesome answer, thanks. I wonder since I never had the strength to keep weight off that I had lost in the past -- I have lost so many times and quite a lot -- how I would find the strength now after the honeymoon period is over. That scares me more than the actual operation! 

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26 minutes ago, Dinah said:

Awesome answer, thanks. I wonder since I never had the strength to keep weight off that I had lost in the past -- I have lost so many times and quite a lot -- how I would find the strength now after the honeymoon period is over. That scares me more than the actual operation! 

You are right Dinah.

Regardless of what weight loss surgery we have, it isn't the surgery that fails us.

Once we've gone through the honeymoon period (or sometimes earlier with the restrictive procedures), it's easy to slip back into our old eating habits and any good our bariatric surgery did can be undone very quickly.  Even with the gastric bypass, it's rare that the intolerances of fat and sugars continue so that's a good reason to stick with the programme.

Do you have a good pre and post-op programme of regular meetings?

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Thanks for asking. There are no group meetings but there is psycholigical support and monitoring. 

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38 minutes ago, Dinah said:

Thanks for asking. There are no group meetings but there is psycholigical support and monitoring. 

I had a support group post-op but it was held in the afternoon and as I worked full-time, I could not attend.

This forum has been my lifeline and other than when I've been in hospital, I haven't missed one day in getting on for 11 years.

Reading of every ones journey and sharing my experiences keeps me focused on what I have to do to have continued success.  My WLS was a one time shot so I have to make it work.

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Thanks for sharing that. I am at the point where I believe I need the operation but am still trying to make sense of all that I will be giving up. I feel angry that other people can have a healthy relationship with food and do  not have to reduce their lives to this -- tiny portions and giving up so many things forever plus thinking nonstop about food choices.

Edited by Dinah

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1 hour ago, Dinah said:

Thanks for sharing that. I am at the point where I believe I need the operation but am still trying to make sense of all that I will be giving up. I feel angry that other people can have a healthy relationship with food and do  not have to reduce their lives to this -- tiny portions and giving up so many things forever plus thinking nonstop about food choices.

I had a gastric bypass a few years ago and have never regretted having it. Now that I am at my goal weight, I do not eat “tiny” amounts of food or think “nonstop about food choices” - but instead eat sensible amounts of a balanced assortment of foods as part of healthy lifestyle. What I have given up is trivial compared to how wonderful it feels to be at my ideal weight and knowing that I should live decades longer. I am very happy, not “angry.”

Food controlled my life for a long time, but no more. 

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I feel like you're looking for a long-time veteran perspective here, and that has been supplied by others.  But from 6 months I can tell you that I feel nothing like your description of post-op life.  Quite the opposite!  *Before* surgery I felt like my entire life rotated around my food choices - and I had basically stopped dieting and given up!

Before I committed to this process, I thought constantly about food - what was I going to have, how much of it would I have, would I have enough of it to get me through X amount of time, would I have enough time to get this AND that before someone came home and caught me eating whateveritwas.  I planned out the night before what I was going to order out the next afternoon... and dinner.  And a huge amount of my thought processes went toward which drug store I was going to in the morning to get my junk food for the day.  I'm not even kidding.

What I've experienced since my WLS (gastric bypass) is freedom from all of that.  I can finally relax, because food is not constantly at the top of my mind.  I'm still in my honeymoon period, but I feel like this is the time when I can build joys in my life that have nothing to do with what I eat.  Before, losing weight was so hard and took so long, and I had so far to go, that it felt hopeless - and because it was so slow, I had nothing to replace food with when I tried to eat better.   Now the weight is coming off so easily and so fast that I can fill my life with activity, with so many things I couldn't do before, from going for long walks to taking a long bath - there's just an abundance of things in my life that make me happy that are in no way related to what I put in my mouth every day.

I feel like that is the strength of the surgery and the honeymoon period - it frees you from obsessive thoughts of food and at the same time gives you other things that can fill your life with comfort and happiness.  While dieting pre-surgery felt like deprivation and anxiety and anger, eating well post-surgery feels positive and strong.  I think that helps train us for when we're able to eat more and having hunger, later down the road.

 

 

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You start to think differently about food in your honeymoon phase.  It’s not so much about what you are giving up but what you are gaining by losing weight.  My weight no longer holds me back.  

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2 hours ago, Dinah said:

I feel angry that other people can have a healthy relationship with food and do  not have to reduce their lives to this -- tiny portions and giving up so many things forever plus thinking nonstop about food choices.

I feel quite the opposite of what you anticipate feeling (and I truly believe you will too). I feel so much freedom. I'm not constantly thinking about food or beating myself up for not being able to resist it or for eating too much of it. And I don't feel cursed. I feel lucky a procedure existed to help me.

Edited by Gretta

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3 hours ago, Gretta said:

I feel quite the opposite of what you anticipate feeling (and I truly believe you will too). I feel so much freedom. I'm not constantly thinking about food or beating myself up for not being able to resist it or for eating too much of it. And I don't feel cursed. I feel lucky a procedure existed to help me.

Eloquently put, @Gretta ... and echoing other great pearls from all the others.

@Dinahre: plication, no doubt it restricts stomach size... there is some significant information that when you remove stomach wall with a sleeve or bypass, you are also removing hormonally active cells that contribute to hunger.  You might want to see if there is any science about plication and changes in leptin, and the other hunger hormones. 

-> Personally at just under a year after my sleeve, I rarely  have physiological hunger. I do have head hunger, the desire to try pretty or delicious foods, or (if around them) ones that are triggers for me, like potato chips or salty pepita seeds. Those hungers are in my head, not my body, and are part of the reason why 90% of successful WLS is in your head, not your belly. But the kind of obsessive thinking about my next meals... gone. 

re: measuring - some people can eye-estimate. I can do a pretty good job but weigh things most days when home, keeps me honest for when I can't weigh but need to eyeball the portions. So it's not constant but it's frequent. I view going to restaurants as a work in progress: some places have tiny appetizers, others have huge appetizers as big as the entrees. Once I've been to a place a few times I know what to order, and the waiters know what to recommend to me. So no you don't need to go to restaurants with little plastic measuring boxes, but you do need them in your head. I find the frequent measuring kind of fun in some odd way. 

re: fats - I do not avoid them, they provide satisfaction and richness to many foods. But I do watch them so I don't exceed the caloric limits. There is new scientific data that mortality is most strongly linked to the amount of carbohydrates you eat not fats. In fact mortality goes DOWN with increases in fat intake, globally.  Turns all our paradigms upside-down. It could be your nutritionist has not yet read or digested these studies (recently published in the Lancet) about fat, protein, and carbohydrate intake. But your nutritionist could be quite right: people who eat high amounts of fats, or fail to observe limits, regain weight!!  I have cheese every day. I do eat carbs, but mostly only beans or blueberries, or rare slices of my spectacular sourdough bread, which magically appears to help weight loss. (I hope you believe that, I hope you believe that, I hope you believe that....).

I guess the 'best' diet would be high protein (think steak), and vegetables. Sounds very similar to the 1960s steak-and-martinis diet with some broccoli on the side. ;)

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Also Burgundy Boy, the way you wrote was extremely useful. I am still quite confused about the info the nutritionist gave me versus what seems to be the reality. The Czech center here is excellent but their communication style can be sometimes frustrating, so this group is quite the lifeline. I am not Czech but I am a longterm expat here. In the meantime, Burgundy Boy thanks for the Lancet study. I am a journalist and really enjoy reading articles and studies from credible sources. So much of this right now feels like a krap shoot...that is, what percentage group will I be in? The one with complications or none? The one who can keep it off or not? Am sure some of you felt the same trepidation. I love cheese but was told I could only have the low fat kind, am not sure if that was about weight loss or health. When she found out my favorite cheese was blue cheese, she basically told me I could never eat it again, which was weird. The plication by the way has about the same effect as the sleeve, but there is no sleeve and a very low rate of reflux. It is similar in that you can basically eat anything eventually. Thanks again everyone for your support. 

 

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This guide from one of the best hospitals in Boston on what to eat after a gastric bypass should be helpful to you. Note that in the US the usual post op diet is the same for all weight loss surgery types. 

https://www.tuftsmedicalcenter.org/~/media/Brochures/TuftsMC/Patient Care Services/Departments and Services/Weight and Wellness Center/GBP Diet Manual12611.ashx

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6 hours ago, Dinah said:

So much of this right now feels like a krap shoot...that is, what percentage group will I be in? The one with complications or none? The one who can keep it off or not? Am sure some of you felt the same trepidation.

That struck a chord with me, so I went back to my blog from two days before surgery and found this:  "I wish I knew how it was going to go for me.  Am I going to be one of those people who has no significant pain post-op?  One of those who has agony?  One of those who can't keep anything down, or one of those who never feel any restriction?  Will I have dumping syndrome?  Will I be a slow loser or a quick loser?  Will I have a stricture? Iron-deficiency?  Will I never feel hunger or food-interest again like some people report?  Or will I be one of those people who feels hungry immediately after surgery?  Will things taste and smell the same, or will I find I don't like stuff I used to like?  Will my sense of smell go off the charts?  (I kind of hope it will; that would be cool.) Will I ever hit my goal weight?  If I do, will I be able to maintain it?"

So yes, we do all feel that - it's a big unknown, right up until you know it.  There's no way to look into the future and see how it will be for you personally.  But you can look at how it's been for most of us, and realize that the vast majority have few or no complications, that even complications are generally easy to resolve, and that life gets better long before you reach your goal. 

You'll also find, if you read through blogs and posts here from people who have been through it, that your nutritionist may not be on the same page as your surgeon or your program with regard to what to eat and what not to eat, and may in fact be totally off base.  We should totally have a sticky post titled "#@$! My Nutritionist Says" here - because some of it is pretty wacky.  Yours would be a prime candidate - never eat blue cheese again?!  People don't get fat from overindulging in blue cheese, I'm sorry!  I would definitely take that with a grain of salt (and a tablespoon of blue cheese crumbles!).

(Oh, and the answers to my questions so far are: no pain post-op, sometimes trouble keeping stuff down but mostly ok, totally feel restriction, no dumping syndrome so far, relatively quick loser, no stricture, no vitamin deficiencies, no hunger yet but I'm still interested in food, things mostly taste and smell the same, I like the stuff I used to like, and sadly I did not magically develop super smelling powers.  The last two questions will have to wait a few months... :) )

Edited by Kio
forgot to add a thing

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Kio, this was just amazing!!!!!  You nailed it all. The nutritionist is a bit of a robot but I guess I will just have to wait and figure some things out.   She also told me I could never again have chicken with skin and that sounded off to me.  I do want to be strict about portion size but I think the point of this is to eat less, not too eliminate all foods that taste good:). Thanks for your support.  And glad you are doing so well, even without smelling superpowers!:)

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7 minutes ago, Dinah said:

...  She also told me I could never again have chicken with skin and that sounded off to me.  I do want to be strict about portion size but I think the point of this is to eat less, not too eliminate all foods that taste good:). ...

I buy chicken legs, or chicken thighs, and confit them so I have something to eat without much effort during the work week. When I re-heat them to eat, I often remove the skin... and either crisp it in a pan or under the broiler, to drive the fat out and leave me with a tasty bite. Sounds like your nutritionist is focused on the calories in fats which is not irrational if that is your focus. 

WLS will be far more widely accepted once people realize that you can still enjoy food - just you need not consume the same quantities as you did in your obese incarnation!

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This sounds great even though I do not know what confit means:). There is something about chicken skin that is wonderfu.

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13 minutes ago, BurgundyBoy said:

WLS will be far more widely accepted once people realize that you can still enjoy food - just you need not consume the same quantities as you did in your obese incarnation!

BB, I may need you to teach me some cooking skills after you teach me some bike maintenance skills!  ;) 

And you're totally right about portions (you too, Dinah).  You get pretty good at measuring or estimating (I measure things that are carby, and estimate things that are proteiny - for instance, I eyeball a piece of chicken or fish - I know what 3 oz of those look like by now!  But I use my kitchen scale for cheese/cream/yogurt, or meat in a sauce, etc). 

I also don't absolutely forbid myself anything, on the theory that doing so would just make me nuts.  So when my room mate bakes an apple pancake, I eat a bite of it; when our monthly pot-luck guests bring brownies, I'll eat a bite of one. I just include it in my tracking, and don't go past the one bite.  I'm also not above a slice of bread - I buy whole wheat sandwich thins, and sometimes have a piece of toast made out of it.  But that's 11 g carb, and I put it in my tracker - which means I have to adjust my carb intake for the rest of the day so I still stay under 50 net carbs.  (Basically translates into more lean meats/eggs and less cheese/dairy for the rest of the day).

It definitely makes me more mindful of my eating, but it doesn't make me feel deprived at all.  And it also makes me way more choosy about what carbs I choose to indulge in (Life's too short to eat cheap chocolate!  And allowable carbs too few to waste on Doritos...)

Edited by Kio

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