Low carb versus moderate carb

[Marquis Mark]

My protein numbers are excellent so it's just a theoretical

No, cause then you may never get to goal if eating too many/wrong kind for us while still in the rapid weight loss phase.

Right, I get that you would never get to goal if you overate carbs. What I'm trying to challenge is this weight loss window notion that keep floating around. And all I'm saying is that if you were really good and got below goal, but then started eating carbs you would, eventually, end up at the same weight. So, simply avoiding carbs in the first two years will not leave you at a lower weight than if you did that, but then indulged in the third and fourth years. You would, I believe, end up at the same weight in the 5th year. In other words, seems to me, there's no magic window, you will always have to avoid excess carbs with the DS.

I'll be delighted to be challenged!

 

[Munchkin]

I've never been able to get a clear answer to this, so I'm going to try again:

What if you were a trooper until you were 10% below goal and then started eating carbs? Wouldn't you put on weight THEN? If so, what's the difference between eating some carbs while you're losing or eating them after you've lost? Wouldn't it balance out the same in the end?

It's a combo that causes the bounceback. Not just one thing.

First of all it COULD end up the same but it's not likely. The idea is to use the time you are pretty much a bulletproof superhero to learn optimal eating for you. This gives you the skills to deal with regain down the road. Eating to maximize weightloss in the early days is pretty much the same as eating to lose down the road. Lots of people have no idea how they sneak sugar into almost everything we eat. Once you are aware, you learn how to avoid it.

If you are one of those lucky few who can make goal effortlessly by eating protein and whatever there is a good chance you will be looking to lose your regain a few years down the road. Because you were never forced to learn all this to lose in the first place. And then you had your average regain.

So I always wax poetic about the 10% under goal. This gives you some breathing room to figure out what you can eat in the carb department. You can afford to go up and down a few pounds to figure out if you can eat that snickers. Or bread, crackers, and tortilla chips. And you get to chose how important these foods are to you. Choice and control are powerful. And hopefully you still have enough superpowers left to lose whatever you gain!

As far as the surgeons are concerned, a successful WLS is 50% loss of excess weight. I can tell you for sure most of us didn't go through all this to still be fat. We want the fairytale damnit! Sure we want all the health benefits of being thinner and that's what motivated us to have surgery. But in the back of everyone's mind we also think about the joy of not being fat anymore. Lots of people get the 50% and if that's all you want, fine. For most, if you want more than that it's work. Just be aware that DS was meant to give you 50%. The other 50% is your choice. Maybe that other 50% will be a gimmee but maybe not. There is no way to know in advance. DS results are a bell curve. That means half of us are not successful. Most likely we are better off but not statistically successful.

Why do we have regain?
1) Our bodies WANT to be fat and they will try to get back to that happy place.
2) Over time the stomach gets bigger and we can eat more.
3) We absorb more than we did in the beginning. Down the road we may need to cut back on protein because we no longer need 100gr per day. I know you like studies and if you poke around you will find some. Years ago I remember reading studies that indicated many post WLS patients developed a higher concentration of intestinal villi than normies and at least 1 study that suggested some of us would eventually start absorbing protein in our large bowel. And then there is 1 interesting case I tripped over years ago where a very young woman had the DS and they found her CC had regrown! Truth or fiction? I wish I knew!

 

[CaitlynR]

DS results are a bell curve. That means half of us are not successful. Most likely we are better off but not statistically successful.

Interesting. Do you have resources? Most of what I find are just averages.

On a related topic, I notice in different studies and sources, of traditional DS, average %EWL for the DS for 12 or 18 months is listed as between 65% and 90%, which is a huge difference making determining whether you are hitting expected results difficult. I am guessing a large part is difference in how they calculate "ideal weight" to determine what is excess weight. According to different sources, my "ideal weight" as a 5'6 female is some (specific) value between 130 and 160. Of course, healthy weight is a range, but what is used as a specific value in research makes a significant difference in what the %EWL will be.

 

[Munchkin]

Interesting. Do you have resources? Most of what I find are just averages.

On a related topic, I notice in different studies and sources, of traditional DS, average %EWL for the DS for 12 or 18 months is listed as between 65% and 90%, which is a huge difference making determining whether you are hitting expected results difficult. I am guessing a large part is difference in how they calculate "ideal weight" to determine what is excess weight. According to different sources, my "ideal weight" as a 5'6 female is some (specific) value between 130 and 160. Of course, healthy weight is a range, but what is used as a specific value in research makes a significant difference in what the %EWL will be.

I think @DianaCox has this info. I probably did at 1 time. I bet it's even here somewhere.

 

[galaxygrrl]

I know it's hard not to over think this, but you are. Here is what @southernlady posted about weight loss which made sense to me.

Each person has their own journey. BUT you are a lightweight like me.
Have you read THIS thread? http://bariatricfacts.org/threads/its-not-pounds-its-percentages.1844/ What is your height and what would be your weight for a BMI of 24.99 (top end of normal)? Anything above that is excess weight. So if your normal BMI top end was 145 and 146 was overweight, then anything above 145 is excess. NOT where you want to be but what is above normal BMI. AND if you lost weight pre-op, that changes the dynamics as well.

This chart might help. (and notice, these are not by pounds but percentages)!
2 weeks - 5-10%
6 weeks - 10-15%
3 mos - 20-30%
6 mos - 45-55%
12 mos - 60-70%
18 mos - 75-85%

Lightweights of any surgery and DS'er lightweights in particular tend to lose ALL their excess by the end of the first year. BUT NOT in the first month. You are still healing, your body is pissy and things will change.

I do NOT count my highest weight since that highest was NOT even in the equation. My highest weight was in 2002. I didn't get the DS til 2011. ALMOST a decade later. So I go from my sign in weight at the surgeon's initial appt.

CHILL!!! Not chilling is stressful and stress can lead to weight GAIN!

Give your DS a chance to work...don't over think this. I know it's hard but give it a chance.
​

I"m at 14 months and hit a 25 BMI two weeks ago.

 

[CaitlynR]

Ah, I am guessing you obtained it from the "Realistic Goals and Personal Accountability" thread. I would agree with her point that an average weight loss of 75% EWL is good indication that each person cannot expect to lose 100% of excess weight. However, unless it is specifically stated in studies that the data follows a normal distribution, this can't be assumed. I also disagree with your statement that if it were following a bell curve, that means 50% are successful and 50% are not successful. In normally distributed data, 68% would fall within one standard deviation from the mean. About 16% would be above average and about 16% would be below average. This would make 84% successful (if success is measured by being statistically average or above average in weight loss). That sounds much more hopeful! None of this matters, of course, if it is not normally distributed, which I kind of doubt it is.

Not trying to criticize anyone, just a bit of a stats geek

 

[CaitlynR]

Thanks, galaxy, I've been trying to find that info!

 

[Marquis Mark]

It's a combo that causes the bounceback. Not just one thing.

First of all it COULD end up the same but it's not likely. The idea is to use the time you are pretty much a bulletproof superhero to learn optimal eating for you. This gives you the skills to deal with regain down the road. Eating to maximize weightloss in the early days is pretty much the same as eating to lose down the road. Lots of people have no idea how they sneak sugar into almost everything we eat. Once you are aware, you learn how to avoid it.

If you are one of those lucky few who can make goal effortlessly by eating protein and whatever there is a good chance you will be looking to lose your regain a few years down the road. Because you were never forced to learn all this to lose in the first place. And then you had your average regain.

So I always wax poetic about the 10% under goal. This gives you some breathing room to figure out what you can eat in the carb department. You can afford to go up and down a few pounds to figure out if you can eat that snickers. Or bread, crackers, and tortilla chips. And you get to chose how important these foods are to you. Choice and control are powerful. And hopefully you still have enough superpowers left to lose whatever you gain!

As far as the surgeons are concerned, a successful WLS is 50% loss of excess weight. I can tell you for sure most of us didn't go through all this to still be fat. We want the fairytale damnit! Sure we want all the health benefits of being thinner and that's what motivated us to have surgery. But in the back of everyone's mind we also think about the joy of not being fat anymore. Lots of people get the 50% and if that's all you want, fine. For most, if you want more than that it's work. Just be aware that DS was meant to give you 50%. The other 50% is your choice. Maybe that other 50% will be a gimmee but maybe not. There is no way to know in advance. DS results are a bell curve. That means half of us are not successful. Most likely we are better off but not statistically successful.

Why do we have regain?
1) Our bodies WANT to be fat and they will try to get back to that happy place.
2) Over time the stomach gets bigger and we can eat more.
3) We absorb more than we did in the beginning. Down the road we may need to cut back on protein because we no longer need 100gr per day. I know you like studies and if you poke around you will find some. Years ago I remember reading studies that indicated many post WLS patients developed a higher concentration of intestinal villi than normies and at least 1 study that suggested some of us would eventually start absorbing protein in our large bowel. And then there is 1 interesting case I tripped over years ago where a very young woman had the DS and they found her CC had regrown! Truth or fiction? I wish I knew!

First of all, I love how you wax poetic. Wax away!

My own experience has been that it's not a matter of knowledge. I KNOW what to eat, But I don't always do it. My hunch is most overweight people also know cookies and carbs are not good, whereas lean protein is. In fact, obese people tend to know more about it than normies because they're obsessed with it and have had it explained to them over and over by well-meaning health professionals. But, as they say, "Self-knowledge avails nothing."

Anyway, I'm still trying to find a PHYSIOLOGICAL explanation for the weight loss window theory. Yours is a behavioral one, which is fine if, indeed, people REALLY don't know the difference between Oreos and salmon. I suspect most do, but the compulsion is so powerful that it overcomes us. Frankly, if I could have resisted it on a consistent basis I wouldn't have submitted to weight loss surgery in the first place.

Am I alone? How did people suddenly find the will to live a virtually carb free life after WLS, but not before? Kind of a cruel irony, no?!

 

[Munchkin]

First of all, I love how you wax poetic. Wax away!

My own experience has been that it's not a matter of knowledge. I KNOW what to eat, But I don't always do it. My hunch is most overweight people also know cookies and carbs are not good, whereas lean protein is. In fact, obese people tend to know more about it than normies because they're obsessed with it and have had it explained to them over and over by well-meaning health professionals. But, as they say, "Self-knowledge avails nothing."

Anyway, I'm still trying to find a PHYSIOLOGICAL explanation for the weight loss window theory. Yours is a behavioral one, which is fine if, indeed, people REALLY don't know the difference between Oreos and salmon. I suspect most do, but the compulsion is so powerful that it overcomes us. Frankly, if I could have resisted it on a consistent basis I wouldn't have submitted to weight loss surgery in the first place.

Am I alone? How did people suddenly find the will to live a virtually carb free life after WLS, but not before? Kind of a cruel irony, no?!

The numbered statements are physiological.

As to the cruel irony *I* think many are willing to live a moderately carb free life in return for having a lower weight and being more healthy. Most thin people do not eat as they please or they would be fat too. Of course there are exceptions and I have known a couple myself. Find a woman over 40 who doesn't at least give lip service to trying to lose a few pounds.

When I was the elephant in the living room I couldn't help but notice over and over that there were lots of thin people who ate more than I did. I eat more today than I did back then. Back then dieting was a waste of time. All I got in return for extreme deprivation was tiny losses that were not sustainable. Reaching that magic number and staying there would never happen. And it still hasn't happened.

Back in my university days, a damn long time ago, my best friend who had seen me dieting for ages, found she had gained a few pounds and decided to go on a diet. Her first diet. Keep in mind she is not stupid and is educated. So what was her diet? Doritos and chocolate milk. And she couldn't figure out why it wasn't working. She figured it out and today she is still wearing the same size 6 she wore back then. But she runs, swims, and has to eat like a bird to do it. Her mom was MO and it scares the crap out of her. That's her motivation.

 

[Marquis Mark]

The numbered statements are physiological.

As to the cruel irony *I* think many are willing to live a moderately carb free life in return for having a lower weight and being more healthy. Most thin people do not eat as they please or they would be fat too. Of course there are exceptions and I have known a couple myself. Find a woman over 40 who doesn't at least give lip service to trying to lose a few pounds.

When I was the elephant in the living room I couldn't help but notice over and over that there were lots of thin people who ate more than I did. I eat more today than I did back then. Back then dieting was a waste of time. All I got in return for extreme deprivation was tiny losses that were not sustainable. Reaching that magic number and staying there would never happen. And it still hasn't happened.

Back in my university days, a damn long time ago, my best friend who had seen me dieting for ages, found she had gained a few pounds and decided to go on a diet. Her first diet. Keep in mind she is not stupid and is educated. So what was her diet? Doritos and chocolate milk. And she couldn't figure out why it wasn't working. She figured it out and today she is still wearing the same size 6 she wore back then. But she runs, swims, and has to eat like a bird to do it. Her mom was MO and it scares the crap out of her. That's her motivation.

I absolutely appreciate you and your positing, but I guess I don't see how the numbered items support the idea that you have an opportunity in the first two years that you won't have again. I'm just suggesting that even if you were carb free in the first two years, if you ate lots of carbs in the following years you would end up at the same weight eventually. Therefore, no magic window I can see. The better thing, I think, for people to understand (and one I'm sure we can all agree upon) is that, even with the DS, you're going to have to deal with a carb addiction if you hope to have any hope of reaching your goal. There's no way around it. And being exceptionally good the first two years will not help you if you're not good thereafter.

So I'm wondering if the more effective message might be simply: avoid carbs as much as possible if you hope to get and stay at, or close, to goal. I felt (and feel) a certain amount of pressure to be really good during the first two years or forever lose an opportunity. That is not helpful for me. But that's just me.

 

[Munchkin]

OK. Different tack. Let's say immediately postop your stomach holds 4oz food. After you eat 3oz you start feeling full and hopefully quit eating. At 1 year postop, your stomach holds 12oz food and you start feeling full at 10oz and hopefully stop eating. But you still ate 3 times more food than you did immediately postop. It is much easier to overeat at 1yr than immediately postop. You have to have more control down the road than you did at first.

Therefore it is easier to lose in the beginning than it is down the road. At first it's hard to even get in all the protein you need. You have little room for anything else. Right after surgery you could eat 1 package of twinkies for 44 gr carbs. A year down the road you might be able to eat a whole box for 440gr carbs. And these are the new smaller twinkies not the old ones we grew up with. At 1 year postop you can cheat enough to sabotage yourself easily. I am pretty sure I could eat a whole box of twinkies.

A nasty little enzyme called maltase starts digesting sugars in your mouth. We don't malabsorb sugar like we do protein and fat.

 

[CaitlynR]

My impression is that the window theory comes from what we see in study after study of what happens after the switch. There is very rapid weight loss for 6 months, slower but still rapid weight loss until 12-18 months. Then that's it. Statistically no change or slight (fortunately for DS patients versus other WLS!) weight regain.

Honestly, I don't know if the researchers or surgeons themselves can explain exactly how it all works. The oversimplified explanation is restriction and malabsorption. These do not explain the window phenomenon, or many of their effects (like ultra rapid changes to how insulin is being handled). There is information on how different hormones and such are effected but much is still not understood.

 

[Marquis Mark]

OK. Different tack. Let's say immediately postop your stomach holds 4oz food. After you eat 3oz you start feeling full and hopefully quit eating. At 1 year postop, your stomach holds 12oz food and you start feeling full at 10oz and hopefully stop eating. But you still ate 3 times more food than you did immediately postop. It is much easier to overeat at 1yr than immediately postop. You have to have more control down the road than you did at first.

Therefore it is easier to lose in the beginning than it is down the road. At first it's hard to even get in all the protein you need. You have little room for anything else. Right after surgery you could eat 1 package of twinkies for 44 gr carbs. A year down the road you might be able to eat a whole box for 440gr carbs. And these are the new smaller twinkies not the old ones we grew up with. At 1 year postop you can cheat enough to sabotage yourself easily. I am pretty sure I could eat a whole box of twinkies.

A nasty little enzyme called maltase starts digesting sugars in your mouth. We don't malabsorb sugar like we do protein and fat.

All logical and agreed to. But still doesn't address the notion that you have two years to lose as much as you can as fast as you can because once your stomach stretches and you can eat more you will then be able to put back everything lost during the first two years.

I think we may just be talking about two different things, so let me try it like this:

First two years you lose 100 lbs on a no-carb diet. Third and fourth years gain back 40 on a high carb diet.

Now, what would be the difference if, instead of that, you:

First two years you lost 80 on a moderate carb diet. Third and fourth years gain back 20 on a moderate carb diet?

Wouldn't you be at the same weight when all is said and done? If so, why the pressure in the first two years instead of emphasizing long-tern success will be owed to a low-carb diet forever?

 

[Munchkin]

All logical and agreed to. But still doesn't address the notion that you have two years to lose as much as you can as fast as you can because once your stomach stretches and you can eat more you will then be able to put back everything lost during the first two years.

I think me may just be talking about two different things, so let me try it like this:

First two years you lose 100 lbs on a no-carb diet. Third and fourth years gain back 40 on a high carb diet.

Now, what would be the difference if, instead of that, you:

First two years you lost 80 on a moderate carb diet. Third and fourth years gain back 20 on a moderate carb diet?

Wouldn't you be at the same weight when all is said and done? If so, why the pressure in the first two years instead of emphasizing long-tern success will be owed to a low-carb diet forever?

Absolutely you would but here is the rub. There is no guarantee you will be among the lucky ones who drop 100 or even 80 the first year. No one starts out knowing where they will fall on the curve. You don't know your DS is good for an X pound loss with no carbs and a Y pound loss with moderate carbs, and a Z pound loss on high carbs. The idea is to lose as much as possible when it is the easiest to lose. Before I can eat the whole box of twinkies. Before I lose a lot of my restriction.

If I am one of the really lucky ones, I will get to 10% below my goal the first year. Perfect! I have some time to find out what I can eat without gaining. Then the idea is to move into maintenance mode and if I am above my number for 3 days in a row, no carbs till the weight is gone. Lather, rinse, repeat. Even though I am a really good DSer I still have to watch it because I know that over time I will absorb more and have to eat less to maintain. Some people have issues about weighing every day and use other indicators like how their jeans fit. Or weigh once a week. But if I have a 10% regain I am still fine because that puts me at my goal.

If I am really unlucky I never reach my goal at all. Then I certainly can't afford regain because I am still fat. But if I truly lost as much as possible when it was the easiest it's ever going to be I am at the lowest possible weight my DS is willing to give me. At this point I have a choice to make. I can choose to be happy with what I got or fight every single pound. In other words, diet. But I still have a lower weight than what I would have had eating moderate or high carbs and failing to meet my goal.

I know 4 people(1 is almost 20years out) who are more than 10 years out who can eat protein plus whatever. I know a lot more people who can gain at 10 plus years out and they have to be careful. Some more careful than others but they know they can gain. As time passes we become more like normies who can gain weight. We have to be careful restricting things we malabsorb like protein and fat and that leaves us restricting sugar/carbs. The very thing we were told from the get go not to eat.

A million years ago someone explained it to me with this analogy and I liked it so I never forgot. Let's say you win a contest and the prize is 5 minutes in a bank vault and you get to keep all the cash you can get. The no carb strategy is to run into the vault and get as much as you can as fast as you can. You go flat out for the whole 5 minutes. The I love carbs strategy is to walk into the vault, meditate for a minute and then grab as much as you can get. Both people will walk out with a lot of money but the person who didn't waste any time will probably have more because they didn't give themselves a 1 minute handicap when they went in the vault.

We all get to pick what we think is right for us. To me, a 10% regain from 10% below goal looks pretty optimal!

 

[Marquis Mark]

Absolutely you would but here is the rub. There is no guarantee you will be among the lucky ones who drop 100 or even 80 the first year. No one starts out knowing where they will fall on the curve. You don't know your DS is good for an X pound loss with no carbs and a Y pound loss with moderate carbs, and a Z pound loss on high carbs. The idea is to lose as much as possible when it is the easiest to lose. Before I can eat the whole box of twinkies. Before I lose a lot of my restriction.

If I am one of the really lucky ones, I will get to 10% below my goal the first year. Perfect! I have some time to find out what I can eat without gaining. Then the idea is to move into maintenance mode and if I am above my number for 3 days in a row, no carbs till the weight is gone. Lather, rinse, repeat. Even though I am a really good DSer I still have to watch it because I know that over time I will absorb more and have to eat less to maintain. Some people have issues about weighing every day and use other indicators like how their jeans fit. Or weigh once a week. But if I have a 10% regain I am still fine because that puts me at my goal.

If I am really unlucky I never reach my goal at all. Then I certainly can't afford regain because I am still fat. But if I truly lost as much as possible when it was the easiest it's ever going to be I am at the lowest possible weight my DS is willing to give me. At this point I have a choice to make. I can choose to be happy with what I got or fight every single pound. In other words, diet. But I still have a lower weight than what I would have had eating moderate or high carbs and failing to meet my goal.

I know 4 people(1 is almost 20years out) who are more than 10 years out who can eat protein plus whatever. I know a lot more people who can gain at 10 plus years out and they have to be careful. Some more careful than others but they know they can gain. As time passes we become more like normies who can gain weight. We have to be careful restricting things we malabsorb like protein and fat and that leaves us restricting sugar/carbs. The very thing we were told from the get go not to eat.

A million years ago someone explained it to me with this analogy and I liked it so I never forgot. Let's say you win a contest and the prize is 5 minutes in a bank vault and you get to keep all the cash you can get. The no carb strategy is to run into the vault and get as much as you can as fast as you can. You go flat out for the whole 5 minutes. The I love carbs strategy is to walk into the vault, meditate for a minute and then grab as much as you can get. Both people will walk out with a lot of money but the person who didn't waste any time will probably have more because they didn't give themselves a 1 minute handicap when they went in the vault.

We all get to pick what we think is right for us. To me, a 10% regain from 10% below goal looks pretty optimal!

Thank you for indulging me in this discussion. I love the bank vault analogy and agree with it. I did not do a terrific job limiting carbs and that's probably why my weight loss came to a halt 9 months after my revision from sleeve and why I'm about 25 lbs away from goal. I fantasized the DS would be magic. It's is great, but there's no free pass.