Rob_VSG

1 year follow up (brain dump)

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I saw my surgeon for my one year follow up appointment.  He was so thrilled with my progress (145 lbs) he asked if he could make me his patient of the month.

So, what I have learned over this past year?

1.  I was seriously physically, emotionally and chemically addicted to refined carbohydrates and sugars.  The post-op diet was the best time to break that addiction since soon afterwards the focus gets placed on getting in enough nutrient dense protein.  Basically, you don't have space for refined carbs.

2.  Seems like the key to controlling weight is controlling insulin as this is your bodies master control hormone that rules all of the other hormones that affect your metabolism.  Once your insulin goes up it signals your metabolism to store energy, which also means you won't burn fat.  For me, I find that a ketogenic (protein first) style of eating combined with intermittent fasting works best.  With the bulk of my food intake being nutrient dense protein and healthy fats, I feel full and satiated easily.  Being in ketosis makes fasting for 14-18 hours a day fairly easy since my insulin stays low and blood sugar stays stable cravings are near zero.  I measure my blood ketones with a home meter and if ketones are showing up, then insulin is staying low.

3.  The expression "you will crave tomorrow what you eat today" is pretty darn accurate.  While I may think about food during my fasting period, my brain has shifted from the "what can I eat now" mind set to "what tasty nutrient dense meal can I have later when  my fasting window is done".  Frankly, I didn't believe that mind set change was possible when I started this process, but I stuck to the post-op plan of protein first (lots of water too!) and slowly shifted into the keto style of eating and extending my nightly fasting window and over time, my mind set has changed.

4.  Exercise for health:  Strenuous exercise is not required to lose weight.  For the past year, I've only been walking 20-30 minutes a day for 4 days a week and most of my effort is round working on my eating patterns and nutrition.  I don't have any exercise I actually like to do, maybe one day I will find some.  If you have a physical activity you enjoy thats awesome, but don't rely on it to help you lose weight because it's really more about controlling hormones.  I am now at the point where I needed to line up a personal trainer to start making sure I am able to maintain or maybe increase muscle mass, improve range of motion and fine tune the neuromuscular system.  In short, exercise for health, not weight loss.

5.  Healthy replacements!  It is worth spending time to find healthier replacements for foods you think you will still want.  A month or two post-op I was wanting bread, so I figured out how to make low-carb "keto-bread" and that satisfied me, but then months later I haven't been making that as I don't have a strong want for bread.  I was raised by an Italian mother and have been trying to find a pasta replacement and finally tried out Shiritaki noodles, like "Miracle Noodles".  Now I can make an awesome low carb alfredo sauce with fettuccine Miracle Noodles and toss in chicken or shrimp and have an extremely satisfying meal.

6.  Addiction transfer is a real thing.  I regressed back to smoking cigarettes.  This has now moved to the top of my list of things that need to change.  This is the final remaining habit that is counter productive to improving my cardiovascular health and it has to stop and it will.

7.  The benefits of changing my eating patterns and habits go so far beyond just losing weight I am highly motivated to make this life style permanent.  Pre-op I was clearly having problems with insulin resistance.  The key indicator of insulin resistance is your HbA1C blood test (mine was 6.2), if it is above the normal range, you are becoming insulin resistance.  The issues I was having around this insulin resistance were joint pain including gout, skin tags, eczema, high blood pressure, poor sleep, low energy, brain fog, depression, degrading vision and increasing eye pressure (reaching glaucoma level).  All those issues are all either gone or greatly improved.  Incidentally, my eye doctor of 12 years told me there were no life style changes I could make to improve my eye pressure, yet at my December check up he measured the lowest pressure he has since I've been seeing him.  I'm believing doctors much less these days.  Seriously, get good at researching scientific and medical studies online.

8.  I believe that if I were to merely be struggling through a diet for the purpose to reach goal weight and then go back to eating "normal" then that would be recipe for failure.  Putting in the effort to form a new normal is what really has to happen here for long term success.  Perhaps folks who are much further along post-op than me can explain this better than I.  At this point I feel more like I am working on the new normal (permanent change mentality) and not like I am denying myself foods that I really want for a temporary period of time to just lose weight (temporary diet mentality).  This might sound strange but I am trying my best to articulate the psychological shift.

9.  Stick to the plan, success will breed confidence!  Also, the plan isn't written in stone, don't be afraid to analyze and fine tune it.  The plan should be your guide or "rule of thumb", not a bible.  I have not deviated from the two cornerstones, protein first, and I drink LOTS of water.  Think of it as sticking to the plan, not being restricted to the plan.  Don't beat yourself up if you deviate every now and then because of it.  Beating yourself up over plan deviation (falling off the wagon) begets self pity and self pity will demand cup cakes (or some other unhealthy food).  It's a viscous cycle, break it now!

Ok, I think I covered everything I wanted to.  Hope you made it all the way down here!  Remain calm and carry on.

Rob

Edited by Rob_VSG

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Well written Rob, and I agree with almost all of it. Plus congratulations on patient of the month status. The one departure I have from what you have written is that a hbA1C is the indicator of insulin resistance.  Here I would beg to differ and suggest that only insulin levels can measure IR with any degree of accuracy. My highest ever A1C was 4.9. Now it's 4.2. I've been diagnosed with hyperinsulinemia...... My mind boggles how this can be done based on blood sugar levels only and no insulin testing....but there it lays. My A1C labs come back with the comment "excellent glycaemic control"  everytime and I just laugh about it and have to remind whichever doctor has ordered it that massive blood sugar fluctuations shouldn't really be described that way. So while A1Cs are a well used diagnostic test for blood sugar levels....they are just blood sugar levels in the end and in reality say nothing about insulin levels in the body, just indicate if there is enough insulin floating around to control blood sugars while giving no clue as to whether that means lots of insulin or a little doing the same job.

Edited by Aussie Bear

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Wow, @Rob_VSG, you have learned SO much!  One of my favorite lines was,  I am believeing doctors much less these days! Haha! 

It has to feel great that you have taken so much of your health into your own hands, and it shows in your improved health!  I read through this 3 times to digest it.....so many lessons learned I am glad you shared.  Some things I am really struggling with you have conquered and I want to learn from you.  Thanks again!

Congrats for a marvelous first year and a upcoming, lengthy life of success!!!!

And congrats, patient of the month!!! :) you deserve it!!!

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4 hours ago, Aussie Bear said:

Well written Rob, and I agree with almost all of it. Plus congratulations on patient of the month status. The one departure I have from what you have written is that a hbA1C is the indicator of insulin resistance.  Here I would beg to differ and suggest that only insulin levels can measure IR with any degree of accuracy. My highest ever A1C was 4.9. Now it's 4.2. I've been diagnosed with hyperinsulinemia...... My mind boggles how this can be done based on blood sugar levels only and no insulin testing....but there it lays. My A1C labs come back with the comment "excellent glycaemic control"  everytime and I just laugh about it and have to remind whichever doctor has ordered it that massive blood sugar fluctuations shouldn't really be described that way. So while A1Cs are a well used diagnostic test for blood sugar levels....they are just blood sugar levels in the end and in reality say nothing about insulin levels in the body, just indicate if there is enough insulin floating around to control blood sugars while giving no clue as to whether that means lots of insulin or a little doing the same job.

You make a valid point.  I kind of assumed since I had both an elevated A1C and skin tags, a common indicator of insulin resistance (IR) that my body was likely working over time to create insulin which, I think is one of leading causes of the pancreas to give out and put one into full T2D status.  So my conclusion was an elevated A1C is possibly an indicator of IR, but I should probably have pointed out that a normal A1C is not necessarily indicating normal insulin sensitivity.  I totally agree that FBG and A1C are not really very good metrics to use for diagnosing complex metabolic syndrome problems.  Currently I am working from the theory that if I can measure high ketone levels, then, theoretically, my insulin should be fairly low but I'm not sure how solid the science is for that theory, but you work with what you have.  IR and hyperinsulinemia seem to be tethered by certain commonalities that lead me to believe there is something else that needs to measured even beyond glucose and insulin.

Coincidentally, I did mention to my surgeon that it seems odd doctors only want to measure glucose and not insulin and that seems to only provide part of the picture.  He agreed, but didn't offer any explanation as to why it's done like that.

As always, I enjoy your thoughts.

Rob

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1 hour ago, CheeringCJ said:

Wow, @Rob_VSG, you have learned SO much!  One of my favorite lines was,  I am believeing doctors much less these days! Haha! 

It has to feel great that you have taken so much of your health into your own hands, and it shows in your improved health!  I read through this 3 times to digest it.....so many lessons learned I am glad you shared.  Some things I am really struggling with you have conquered and I want to learn from you.  Thanks again!

Congrats for a marvelous first year and a upcoming, lengthy life of success!!!!

And congrats, patient of the month!!! :) you deserve it!!!

Thank you CJ, I wanted to share because I've picked up so many useful bits from all the others posting here so I hope maybe people will find some useful bits from my sharing.  I see you are still doing very well on your progress so keep it up!  My favorite line was "self pity demands cup cakes".  :)

Rob

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Congrats Rob, you are doing so well all around.  I also had a problem with transfer addiction and went back to smoking after being smoke free for 10 days shy of my year.  I recommitted and quit Nov 6th so I could have my reduction and lift.  It is hard but this time I have to be done for good, it was too hard to quit again. In fact I quit and started several times before this past Nov.  You seem very determined and strong willed so I am sure you will get there.

I need to come to your house for dinner and try this fake noodle stuff. I eat the real thing every once in a while, but if there were something out there that was better for me and tasted good I would switch.  I don't try to be as perfect about everything as I did before I got past my goal. I also quit tracking in part because I was consumed it seemed all of the time and in the beginning I just wanted not to have to think about food all of the time. I actually went down on the scale a little more doing this

Do you still plan on losing more or have you put yourself in maintenance yet?  You are already 45 lb under goal WOW !

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Wow!  Congrats first of all!  Am so glad you have found what works for you!  You’ve come so far!  Lessons learned.  This is truly a life’s journey.  Keep up the great work and thank you for sharing to help others who may be considering wls or who aren’t so far out.  

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On 2/23/2019 at 11:20 PM, tracyringo said:

Congrats Rob, you are doing so well all around.  I also had a problem with transfer addiction and went back to smoking after being smoke free for 10 days shy of my year.  I recommitted and quit Nov 6th so I could have my reduction and lift.  It is hard but this time I have to be done for good, it was too hard to quit again. In fact I quit and started several times before this past Nov.  You seem very determined and strong willed so I am sure you will get there.

I need to come to your house for dinner and try this fake noodle stuff. I eat the real thing every once in a while, but if there were something out there that was better for me and tasted good I would switch.  I don't try to be as perfect about everything as I did before I got past my goal. I also quit tracking in part because I was consumed it seemed all of the time and in the beginning I just wanted not to have to think about food all of the time. I actually went down on the scale a little more doing this

Do you still plan on losing more or have you put yourself in maintenance yet?  You are already 45 lb under goal WOW !

To learn about low carb noodles, I ordered "Miracle Noodles" from Amazon and then found youtube videos about how to prepare them.  They aren't exactly the same as pasta but offer a great low carb alternative.  After that, I went to the Asian market and found "Shiritaki" noodles from Japan in the refrigerated section, they are the same and cheaper but weren't available in the fettuccine form.

I'm still losing slowly.  I want to get to a "normal" BMI and percentage body fat.  Interesting side note, my calculated daily caloric expenditure should be around 1800, but the BMR (basal metabolic rate) measured by my surgeon was 2500 calories.  This seems to be consistent with the theory that intermittent fasting does not slow down my metabolism.  If anything it has accelerated my metabolism.  Probably just as well that I'm not tracking macros and calories for now.

Edited by Rob_VSG

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Congrats and thanks for the great post! Lots of VERY good information that has worked !  I plan to refer back to it often. I definitely agree with "what you eat today you will crave tomorrow". I  now actually crave turkey breast, canned sardines, and all fresh seafood. Practice "Protein first" long enough, and the cravings for it hit! :D

I have my first surgiversary doctor app't tomorrow, and I'm looking forward to seeing how the blood work will look. I haven't been great about taking all my vitamins for the last month or so, so looking forward to seeing if that's an issue. 

Do you have any big goals for this next year? I'm wondering after this first year if I should make some other big goal to work on so I won't feel a let down? What are your thoughts on that? Do you feel a let down coming or are you marching on as usual? 

I also TOTALLY agree with "Exercise for health". I exercise about 5 times per week, and it's all either for my psychological health (just puts me in a better mood), or I am teaching myself to treat it like brushing my teeth - just something I do for my health, no big deal. I try to vary it enough that I don't get too bored, but brushing teeth is boring too, so on boring days I just do it. I figure 45 minutes a day for my health is nothing. I spend way more time preparing and eating meals and drinking water, so the exercise is a minor part of it. 

Congrats again, I never noticed before you and I have such close surgery dates! WAY TO GO ON A SUCCESSFUL. LIFE-CHANGING YEAR!!!!! 

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On 2/27/2019 at 12:30 PM, Cindy Lou Who said:

Do you have any big goals for this next year? I'm wondering after this first year if I should make some other big goal to work on so I won't feel a let down? What are your thoughts on that? Do you feel a let down coming or are you marching on as usual? 

I plan to march on as usual, will focus on getting to a "normal" BMI/percentage body fat and then trying to keep my weight in a stable range.  Also started working with a personal trainer to build up my flexibility, range of motion, and muscle mass.  Seems like a substantial weight loss has thrown off my balance and its time to build up some new muscle memory.  I'm not expecting a let down since I probably have at least another year of things work on for myself improvement project.  Perhaps by then self improvement will become a habitual process?

Rob

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On 2/24/2019 at 1:37 PM, Cheesehead said:

Wow!  Congrats first of all!  Am so glad you have found what works for you!  You’ve come so far!  Lessons learned.  This is truly a life’s journey.  Keep up the great work and thank you for sharing to help others who may be considering wls or who aren’t so far out.  

Thank you!  I've been inspired by a great number of your posts and I'm glad I can share back with the community.

Rob

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11 hours ago, Rob_VSG said:

Also started working with a personal trainer to build up my flexibility, range of motion, and muscle mass. 

I've heard alot of people on this site swear by personal trainers. Good on you for your commitment! Keep us posted how you like it! 

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On 3/1/2019 at 7:07 AM, Cindy Lou Who said:

I've heard alot of people on this site swear by personal trainers. Good on you for your commitment! Keep us posted how you like it! 

I would like to call it "working out" but in my case, I am so out of shape, the personal trainer experience is more like physical therapy.  The drastic change of weight has really thrown off my neuromuscular system and lost any sort of muscle memory I have had in the past.  Only had 4 sessions so far but I can already see and feel improvements!

Rob

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