VSG Q&A

People ask me ALL the time what I’m “allowed” to eat. The answer is “any damn thing I want!” Then they look confused and usually ask me what kind of diet I’m on. Answer: NONE. Then they still look confused and think I just don’t want to talk about it. Ha! Me? The Queen of Oversharing?? Not even!

So in the vein of TMI, here is the second installment of Things People Ask Me About VSG:

1. What are you allowed to eat?
A: Anything I want, just not much of it.

2. So what kind of diet are you on?
A: NONE. I just eat like a child, portion-wise. I do, however, take very few carbs other than crackers and chips. Carbs fill me up like crazy, so when I eat pasta or rice, I can only eat a couple of ounces. And it’s hard to eat anything else with them. Which is why I don’t drink a lot of beer, it simply fills me up.

3. How much can you eat?

A: I can handle about 8oz of liquids at a time and I can handle 3-5oz of what I call “hard” proteins like chicken, beef, whatever that is not ground. I can eat a little more ground than not, but not much. For instance, I can eat 3, maybe 4 chicken wings at a time. I can eat a small chicken thigh. I can eat about 3oz of steak. I can eat a 3-4oz burger patty. And if I do eat mostly protein, I won’t eat much of a side.

4. How big is your stomach now?
A: The pouch can hold around 6 oz, I’m told. As I’ve described, it depends on what it is. I don’t really know the actual size, but it’s 80-85% less than it was pre-VSG.

5. Wow! You better take vitamins since you don’t eat!
A: Well, YES, all VSG patients should take vitamins! Hell, EVERYONE should take vitamins IMO. But VSG in particular requires that you take a LOT of B12. Why? Because it’s absorbed in the stomach and guess what you just lost 80% of? YOUR STOMACH. I read a study that indicated B12 deficiency may lead to dementia, so yeah, just take the B12. I take a full regimen of vitamins and supplements every day. Details in this post.

6. Do you exercise?
A: Yes I do. I began exercising at the 6 month point. I walk on the treadmill (I’ve just started jogging and I didn’t die!!), I do Kathy Smith DVDs (aerobics + dance + kickboxing) and I started lifting weights – Kathy Smith again, her stuff is great.

7. No, really, what is your diet?
A: Sigh.

I generally get two reactions from folks who’ve not seen me in a while: “Hey! You look amazing!” or no reaction at all. I’ll admit, it does disappoint me when people don’t seem to notice. I mean, really? I’ve only got ONE chin now! You can see my eyes! But I try not to take it personally, I guess some people are just oblivious. Meh. But if you are afraid to say something to a lady that’s lost weight: DO NOT BE AFRAID. Trust me, we WANT to hear about how good we look. It makes it allllll worth it! Anyone who says otherwise is a LIAR.

I’ve just broken a 2 month stall and gotten below 190#. As of the other day I’ve lost 62# since the beginning. I feel great and I’m liking the way I look. I’ve still got about 20# to go to get rid of this stomach, but I’m getting there. With appropriate undergarments I can get everything smoothed down pretty well. I’m in a straight 14 and mostly L sizes, which is fucking amazing.

One other thing that no one asks about, but has been a whole new thing for me is the lack of inflammation. When I went into surgery, I had terrible inflammation in my wrists, hands and shoulders. The day after surgery, those issues disappeared. I’m not joking, the inflammation stopped dead. And it is still gone. THAT has made a HUGE difference in how I feel day to day. I no longer take naproxen every day. I’ve even cut back turmeric to every other day – I don’t think I need it at all now, but I hedge my bets. THIS has been probably the most important benefit of VSG for me. The weight loss is secondary. I kid you not.

This is why I’m keenly interested in the research regarding gut flora. Since my experience with completely rebooting MY gut flora, I strongly believe that we’re going to find out that gut flora is the root of many of our inflammatory diseases: IBD, colitis, Crohn’s, dementia, Alzheimer’s, arthritis, etc. I think it’ll turn out to have something to do with cancers and other diseases that are not exactly inflammation, too. This is the area we should be spending millions to research, IMO.

VSG benefitted both myself and Nick, too. It changed our lives. We took a big leap of faith going to Mexico and getting this done. We thought it was just for me, but turns out, it has been huge for both of us. Nick started diet and exercise and has lost 35#!! It pushed both of us out of our comfort zones and it propelled us into pursuing our side business with gusto as well as being just more fearless in general. This surgery has energized us in ways we never imagined it would. I recommend it to people all the time, but not ONLY for weight loss, but for the surrounding benefits. I firmly believe that sometimes you need to be fearless and just DO SOMETHING. Just PICK a direction and DO IT. It will change your fucking life.

I see SO MANY people who just wallow in their ruts. They are miserable, fat, unhealthy and on a ton of meds. Just like we were. I’m not saying everyone needs to do VSG, but dammit, do SOMETHING.

When I preach the gospel of VSG, what I’m really preaching is doing something different to change your life and get out of your rut.

That is message I’d like to give to EVERYONE: if you want to change your life, sometimes you gotta go big. We did it and we are different people than we were this time last year.

So get out there and DO SOMETHING. I promise you won’t regret it.

IBD Diet Similar to my VSG Diet

A friend posted about this Irritable Bowel Disease (IBD) diet and as I read the study, I recognised the diet immediately: it was very similar to the VSG diet I created for myself! I was surprised, but after thinking about it, it makes sense. You want to present food in the way that it will be best absorbed and with as many nutrients as possible. MY goals for post VSG surgery!

This is the study: An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report.

Here is part of the foods chart from the study. It is strikingly similar to my plan (click to embiggen, go to study to see the whole chart):

As you know, you start off with purees then progressively go towards “whole” foods that have not been ground, canned or otherwise altered. I went from purees to canned things like tuna and chicken, then to ground meats then to solid meats. I was on “regular” foods by around 2 months. I wrote all about that in my early posts.

I just thought I’d make a post about this to strengthen my assertion that you do not have to eat yogurt and canned meat for 3 months after VSG, as the Mexican nutritionist would suggest. I did give the info to her, in the hopes she might rethink her approach to VSG patient nutrition, but she probably won’t.

Anyway, I hope that this study’s findings and their method of getting the most nutrition into the body in the easiest way for the stomach and digestive tract is helpful to VSG patients who just want to eat something besides yogurt smoothies. Fruit and yogurt is not nutritionally dense enough, IMO. You need vitamins along with that protein to heal. Fruit is not vitamin dense, it’s just sugar, and canned meat is just fat. So if you’re doing VSG and don’t agree with the diet you’re given, look over this IBD plan and my recipes and make your own diet that suits your tastes. You’ll be happier and I promise it will not ruin your VSG healing – despite the drama you’ll hear from your nutritionist and team for going “off plan”. It’s my opinion that you’ll heal up faster when you are eating vitamin dense foods and lots of protein. I was on to regular foods at about 8 weeks, a few weeks faster than their plan and I feel that this is because I was eating a better diet, which got me healed up faster. As always, your mileage may vary. :)

Back to Working Out!

As promised, at the six month point, I started working out again. I’d been walking on the treadmill, but I wanted to get back to the aerobics and kickboxing I used to do. We’re now past the seven month mark and I’ve been working out for real for about a month. Loving it!

The DVDs I use are by the famous Kathy Smith, who has been doing exercise stuff since the 80s. Her DVDs are high quality and her workouts are really solid. I’ve tried other DVDs and keep going back to KS.

I use the Foundation workout on her Project You DVD. I just bought some new KS DVDs for weight lifting and I’m currently doing Arms on her Staying Strong DVD. I’ll add in the other three sections of the weight lifting after the New Year.

I’m down to 192.5! Inching towards my next goal of under 190!

Still taking Nexium 2x a day, but I’m feeling like I can probably drop the daytime one. I plan to experiment after the new year. I added Maca root by my gyno’s suggestion and I think it’s helping me with menopause sleep issues. It is supposed to help with energy levels all round and I think it is!

This is my current supplement regimen:
1 Vitacost (VC) multi
1 high potency turmeric VC
1 300mcg selenium VC
1 Kyolic KyoDophilus
1 gelantinized Maca root, 500mg, Gaia brand
1 CoQ10, alternating weeks on that one (SO many capsules!!) VC
4 calcium/magnesium caps (half dose, VC) and 2 Pioneer brand Cal/Mag chews (half dose)
OR 4 Pioneer Cal/Mag chews (full dose) if I don’t feel like taking all those caps
1 Quickdots B12 chew 1000mcg VC
1 Quickdots D3 and K2 chew VC (to aid Vit B12 absorption)

I’m feeling good in general. I owe everyone a video, I know, and I’ll do one after the New Year, PROMISE!

For now, Happy Yule and Happy New Year everyone!
burns12-17-16

VSG Six Month Update

I could do a video for this, but I’m not in the mood. So stills you’ll get!

My six month anniversary was yesterday, Nov 17, 2016.

I pulled a still from my first video and I just took a couple for comparison.

Beginning:
I started at 250# and lost 10# before surgery. My waist was 51″.

May 2016
May 2016

Today:
I am at 192.4# (total lost 57.6#) and my waist is 44″.

Nov 2016
Nov 2016


Nov 2016
Nov 2016


I’m taking 20mg Nexium 2x/day to keep the GERD in check, still on the same vitamins and I’m having little issue with the VSG. My volume is still around 6.5 oz, still small, but doable. I’ve learned to adapt to the small portions and usually eat 4-5x a day. When I remember. ;)

My problems now all revolve around the Mirena and hormone imbalances from menopause. BAH. If it ain’t one thing, it’s another.

Overall, I’m doing well. Can’t wait for the next 50# to come off. It’s going to be glorious!

Managing GERD Longterm

As I’ve talked about several times, GERD is a fact of life after VSG surgery. I am averse to taking medications for the rest of my life, but it appears I’ll have no choice. I don’t mind taking supplements, I’ve done that for decades, but medications that alter my body make me uncomfortable. Even if I’d been told about the GERD (I WAS NOT), I’d still have gone for the surgery. The benefits far outweigh (ha! PUN!) the GERD.

That said, I’ve been on a quest to find the right balance of PPI and/or H2RA to manage the GERD with the smallest dose possible. In case you’re new or unsure about all these acronyms, here is a quick primer to bring you up to speed:

GERD – Gastroesophageal Reflux Disease
VSG – Vertical Sleeve Gastrectomy, often called gastric sleeve surgery (not an actual sleeve, refers to shape of stomach)
PPI – Proton Pump Inhibitor, a drug that binds with certain enzymes and prevents the pumps from producing acid in the stomach
H2RA – Histamine Receptor 2 Antagonist, an antihistamine that blocks acid production in the stomach
NAB – Nocturnal acid breakthrough
-zole drugs – any reflux drug that ends in -zole is a PPI class drug
-dine drugs – any reflux drug that ends in -dine is an H2RA class drug

There is a goodly amount of research and studies on both PPI and H2RA drugs, but there is still much unknown about long term use of them (paper HERE). Doctors tend to prescribe these drugs liberally, without taking into consideration their side effects and long term issues that will arise from taking them (paper on this HERE). I was not told a single thing about the PPI I was given, other than take it twice a day. That’s it. They also did not go into detail about other supplements a VSG patient should take for the rest of their lives. A passing mention was given to Vitamin B12, but no documentation was offered. The useless nutritionist never once mentioned Vit B12 supplementation, either.

Fortunately for any VSG patients reading this, you have ME to root through the reams of research and give you the info I’ve rounded up in a convenient blog post. :)

After finishing the initial month of Mexican omeprazole (Prilosec) in capsules, I switched to American omeprazole in tablets. I had already done the reading about the long term issues with omeprazole, such as calcium and magnesium blocking, which is very problematic. I tried switching to Zantac (ranitidine) twice a day and the side effects were horrible. I had ringing in my ears, constipation, diarrhea. I felt awful. And I still had some reflux. This lasted about two weeks, then I gave up and went back on omeprazole 20mg in the morning and famotidine 20mg (Pepcid) at night before bed. I spoke to the pharmacist about it and decided I’d split the difference (paper about PPI and H2RA HERE). I’ve been on this combo for about 2.5 months. The famotidine also gives me some buzzing in my ears, but milder than ranitidine. But it’s got to go.

Today I’ve been reading about using PPI and H2RA drugs together and mostly it’s a wash. There is little evidence that taking the H2RA at night will help with Nighttime Acid Breakthrough (NAB). It’s pretty much worked for me, but the last couple of weeks it has been less effective. Most of the studies I read indicated that taking a PPI twice a day is more effective in general than the combo.

I also read that Nexium (esomeprazole) is slightly more effective than Prilosec (omeprazole)(papers HERE and HERE) and the newer drugs Protonix (pantoprazole) and Aciphex (rabeprazole) are even better, but they are Rx and likely very expensive (Aciphex is $800/mo at retail and no insurance covers it, FYI). The good news is that Aciphex is available in generic, but there is a wide variety of quality amongst the manufacturers (more about that HERE). I will revisit trying them out if Nexium poops out on me in a few months. I’m betting it will, but I’ll save my $65 Dr visit for now. Article with comparisons HERE.

So I’ve decided to switch to Nexium 20mg once a day to see how the NAB is. (I ended up taking Nexium 20mg twice a day.) I hope I can keep the dosage to a minimum, although one study said that the dosage is irrelevant to the nasty side effects. Calcium and magnesium are blocked just the same with 20mg as 60mg+ (paper HERE). But hopefully the ear buzzing will cease when I discontinue the H2RA. (It did, mostly, but I still have light buzzing.)

To offset the calcium/magnesium issues, I take a cal/mag supplement as well as a D3 and Vit K2 supplement. D3 and K2 (NOT just K, but K2) help a lot with absorption of calcium and magnesium. I’ve listed details of what I take daily here.

I’ve found that taking Kyolic Kyo-Dophilus daily has helped with my gut issues. Taking PPIs and H2RAs wreaks havoc on your gut. Diarrhea, constipation or BOTH should be expected. Taking the gut flora caps seems to offset some of this. I recommend taking probiotics! Your gut is a mess after VSG. Between no food, antibiotics and taking 40mg of Prilosec a day, you pretty much kill off your gut flora. I wish I’d started the Kyo-Dophilus immediately after surgery, but of course, Drs (and apparently nutritionists) are not trained in supplements, so it was not mentioned. You should start this before and right after surgery. Get the yogurt with probiotics in it at the very least (Activia, I think it is).

My adventures in managing GERD after VSG have been informative if nothing else. I know more about how the stomach works that I ever did! I hope my blog posts are helping others who have gotten VSG and not been told all the facts. I know that Drs here AND in Mexico are extremely uninformed about the long term use of PPIs and how to supplement. I’ve spoken to people who’ve gotten VSG in both places and they have been told ZERO about what to take afterwards. Vitamin B12 supplementation is VITAL. So is calcium and magnesium! Not getting these vital nutrients can cause terrible side effects in the long term. B12 deficiency has been linked to dementia and of course calcium deficiency means osteoporosis. Magnesium imbalance can cause heart issues. So do your reading and TAKE YOUR SUPPLEMENTS. It is important to your long term health!