Coming up on 3 months since VSG to DS revision with Dr. Esquerra

[Marquis Mark]

Well, 700 is quite a bit of SB. So you may not need more than 40% absorbing anyway. I'm also a sleeve revise (see my stats below) and have been pretty liberal with the carbs (some days as bad as 300-400). In my experience, I think I probably would have lost a bit more weight by now had I kept it strictly below 100, but I don't think that much more (based on some months when I was very good and didn't lose much more). I'm not sure I understand the arguments for the "magic weight loss window" which makes people feel like they'd better lose it now or they will regret it later. That stress doesn't help. Just keep up with your exercise, do the best you can on high protein and low carbs and stats say, you'll be OK. Easier said than done, of course as I think most of us have had thoughts like yours but then things seem to resolve.

 

[hilary1617]

@Marquis Mark, I think the arguments for losing early in the "magic weight loss window" center around our bodies' abilities to adapt over time and counteract the effect of the surgery - longer villi, etc. It is the experience of many vets (including me) that it is far easier to lose in the first 18-24 months post surgery than after that time frame. I think it is generally attributed to the timeline for the body to adapt to counterbalance the surgery. Here's an article on mucosal changes in general, that provides a reasonable basis for this hyptothesis ---> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508630/

Intestinal mucosal atrophy and adaptation
Darcy Shaw, Kartik Gohil, and Marc D Basson

"Mucosal adaptation in such patients is a slow and gradual process that may require up to 1-2 years to reach maximum."

"Such bariatric procedures generate initial weight loss, but many patients gain back weight later. Some failures are attributed to behavioral changes as patients learn to “outeat” the surgical procedure. However, it seems likely that postoperative intestinal adaptation to the functional short gut also ameliorates weight loss by increasing the absorptive capacity of the intestine that remains in continuity."

 

[Marquis Mark]

@Marquis Mark, I think the arguments for losing early in the "magic weight loss window" center around our bodies' abilities to adapt over time and counteract the effect of the surgery - longer villi, etc. It is the experience of many vets (including me) that it is far easier to lose in the first 18-24 months post surgery than after that time frame. I think it is generally attributed to the timeline for the body to adapt to counterbalance the surgery. Here's an article on mucosal changes in general, that provides a reasonable basis for this hyptothesis ---> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508630/

Intestinal mucosal atrophy and adaptation
Darcy Shaw, Kartik Gohil, and Marc D Basson

"Mucosal adaptation in such patients is a slow and gradual process that may require up to 1-2 years to reach maximum."

"Such bariatric procedures generate initial weight loss, but many patients gain back weight later. Some failures are attributed to behavioral changes as patients learn to “outeat” the surgical procedure. However, it seems likely that postoperative intestinal adaptation to the functional short gut also ameliorates weight loss by increasing the absorptive capacity of the intestine that remains in continuity."

Thanks for that. I do get the part about losing more weight during the first 18-24 months until intestinal adaption occurs. But, embedded (for me anyway) in the notion of the magical weight loss window is this idea that somehow whatever weight you manage to get down to is where you will stay, minus the 10% bounce back. So there's a lot of stress to get it off quickly. That's the part I don't get.

So, for example, if you were really good for the first two years but went carb crazy thereafter this theory seems to suggest that you would still end up lighter than someone who wasn't so good for the first two years, but was very disciplined thereafter.

I would think that, given enough time, both examples would end up at about the same weight, unless we're saying that whatever weight you can get down to in the first two years establishes the body's new set point. And, if that's the case, I'd love an explanation for that.

 

[hilary1617]

@

Thanks for that. I do get the part about losing more weight during the first 18-24 months until intestinal adaption occurs. But, embedded (for me anyway) in the notion of the magical weight loss window is this idea that somehow whatever weight you manage to get down to is where you will stay, minus the 10% bounce back. So there's a lot of stress to get it off quickly. That's the part I don't get.

So, for example, if you were really good for the first two years but went carb crazy thereafter this theory seems to suggest that you would still end up lighter than someone who wasn't so good for the first two years, but was very disciplined thereafter.

I would think that, given enough time, both examples would end up at about the same weight, unless we're saying that whatever weight you can get down to in the first two years establishes the body's new set point. And, if that's the case, I'd love an explanation for that.

I don't think the theory lends itself to the conclusion that "if you were really good for the first two years but went carb crazy thereafter this theory seems to suggest that you would still end up lighter than someone who wasn't so good for the first two years, but was very disciplined thereafter." I think instead, that the theory is that if you don't reach your ideal weight within 2 years, it will be far more work / restricted diet needed later to get there, if such is even possible. In other words the common theory I've seen expressed and subscribe to is that behaviors in the first two years can be a limiting factor in the maximum weight loss attained.

I think the explanation of what we see in practice is likely three-fold. (1) If you are good for two years, you aren't likely to go carb crazy thereafter. Behaviors that have been established for 18-24 months tend to become embedded as habits, so early behavior tends to chart a later course, (2) restriction puts a ceiling on how much one can comfortably ingest, limiting future regain potential, if one listens to one's body and there isn't some tendency to binge. (3) Probably there is a new set point, based on a combination of the ultimate extent of malabsorption, the intestinal adaptation and whatever size to which the sleeve stretches, the absence of a lot of the fundus and related hormonal cocktail.

Anyway, it would be interesting to see a study, but it would be diffcult to establish a control, let alone measure and manage with so many variables...

 

[Marquis Mark]

@


I don't think the theory lends itself to the conclusion that "if you were really good for the first two years but went carb crazy thereafter this theory seems to suggest that you would still end up lighter than someone who wasn't so good for the first two years, but was very disciplined thereafter." I think instead, that the theory is that if you don't reach your ideal weight within 2 years, it will be far more work / restricted diet needed later to get there, if such is even possible. In other words the common theory I've seen expressed and subscribe to is that behaviors in the first two years can be a limiting factor in the maximum weight loss attained.

I think the explanation of what we see in practice is likely three-fold. (1) If you are good for two years, you aren't likely to go carb crazy thereafter. Behaviors that have been established for 18-24 months tend to become embedded as habits, so early behavior tends to chart a later course, (2) restriction puts a ceiling on how much one can comfortably ingest, limiting future regain potential, if one listens to one's body and there isn't some tendency to binge. (3) Probably there is a new set point, based on a combination of the ultimate extent of malabsorption, the intestinal adaptation and whatever size to which the sleeve stretches, the absence of a lot of the fundus and related hormonal cocktail.

Anyway, it would be interesting to see a study, but it would be diffcult to establish a control, let alone measure and manage with so many variables...

Thanks again for that. Definitely agree that it's a good time to establish new behaviors and can certainly understand the "window" from the point of view. It just seems that some people have suggested the idea that you can somehow lower your physiological set point with low carb only in the first two years and that you wouldn't be able to do it after that. If that's the case, I can't find an explanation/support for it. But maybe I'm misinterpreting what they're saying.

What's odd to me is that many people come to a DS because they are compulsive over-eaters (at least, that's me). How ironic then that they only develop the capacity/willingness to eat paleo AFTER they have the surgery! If I could have consistently followed a strict no/low carb diet, I might not have needed WLS in the first place.