Right, I remember about your operation now.
Is that "intervention" permanent? Will you need to do regular "service" operations, say, every 5 years?

I think doing exercise regularly for more than 2 months will be the next "lightness kick". But you'd be rushing yourself if you did that.

Keep up the good work.

Nope. This is a one-time shot. I guess there are some people that have had a second surgery (though I think that is for one of the other types of common surgeries and not the one I had). I will be on calcium, B-vitamin, and iron supplements the rest of my life -- but most people over 50 are on some kind of supplemental vitamins -- because those are absorbed in the part of the intestine, the duodenum, that has been bypassed.

As with any diet and health regimen, the role of exercise can't be overstated. I'm trying to get started with regular walking but the weather has not been cooperating. Fortunately, we are finally getting into more reliable decent weather that should allow me to get out walking at least every other night. Before the surgery I was walking three miles on a sporadic basis. Right now I am back up to a bit over a mile before I run out of steam. My goal is to be back to six miles three times a week by the end of summer field session (so in seven weeks from now). Once field session is over and I am back living at home full time I'll try to get started with weight-bearing exercises another three days a week.

 

Walking is great.

Was a really lovely day here, but not the nicest of walks, being in literally right in a city centre.

 

I just went out for a walk and made it further than I expected. Since I am at home that means walking on the mountain and I was huffing real good in less than two minutes! But I made it up -- and "up" is exactly the right word! -- to the crossroads in 11 minutes (even though it is only about a quarter mile away) and then back.

 

... Right now I am up to about 600 Calories a day, though that varies from about 200 to 800. I may have broken 1000 Calories once or twice -- and felt horrible as a result.
...

Under 1200 cals a day for a man is "starvation" and will produce some very negative effects in the body including suppression of the immune system and greatly reduced ability to heal.

I would be incredibly wary of any doctor that thinks that a large man like you reduced to 600 cals a day is a good thing!

...
But what's strange is that I can't say that I really feel that much lighter. ...
...

That's because at such incredibly low calorie intake much of the 40 pounds you have lost is muscle mass. Probably two-thirds of it.

So having lost a lot of muscle you won't feel proportionally lighter. You have lost strength faster than you have lost weight.

That will be compounded by the severe calorie deficit, as one of the main side effects is lethargy and muscle weakness.

I've seen this many times with bodybuilders dieting pre-competition. The ones who reduce calories too much lose too much muscle mass; get weak, drawn, run down, lethargic and often sick. Even worse, the result of most of those symptoms is reduced muscle mass again, a vicious circle.

The bodybuilders who only decrease calories a small amount lose a much higher percentage of fat to muscle, keep their energy levels and health high which of course allows for better energy and better exercise performance, both having the effect of retaining more muscle mass during the diet.

From memory the US government did a study during WW2 reducing volunteers calories to as low as 1200 or even lower, as a study of what happens to prisoners of war in concentration camps etc. There were a LOT of very negative health effects.

 

Under 1200 cals a day for a man is "starvation" and will produce some very negative effects in the body including suppression of the immune system and greatly reduced ability to heal.

I would be incredibly wary of any doctor that thinks that a large man like you reduced to 600 cals a day is a good thing!

No offense, but I think I am going to forego your expertise in this subject and place more weight on the professional medical opinions of my three personal physicians (my primary care physician, my bariatric surgeon, and my endocrinologist) as backed up by ALL of the numerous clinics I consulted including such places as the Mayo Clinic and Johns Hopkins. Given that this surgery has been around for decades and that hundreds of thousands are performed every year, I'm willing to put a fair amount of credence in their experience.

For what it is worth, my personal experience in the past had me convinced along the same lines as you. Whenever I cut my calories down into the 1200 Cal to 1500 Cal per day range, I quickly (in less than two weeks) got very lethargic and weak plus became plagued with frequent and severe headaches.

This time is markedly different. I am now eight weeks out and feel quite good. I've had one migraine since the surgery (I was averaging one to two a week before) and I am quite alert throughout the entire day. I am not suffering from muscle weakness at all -- I can lift anything I used to lift just as easily. I can walk up two flights of stairs (commercial flights, not residential) and only be mildly worn out whereas before a single flight had me looking for a chair. The fact that I do not yet have the stamina to do the same distance of walks that I did prior to surgery is easily explained by the combination of not consuming that many calories (and very little of it being carbs -- the main "quick energy" component of a typical diet) along with the fact that I am still less the two months out of major, invasive surgery! Of course, having a hole in my heart that results in not all of my blood making it to my lungs isn't helping the stamina, either. None-the-less, today I went for a walk on the mountain that last summer I simply couldn't make when I tried it. To be sure, it was tough going today, but the main challenge by far was oxygen and not muscle strength. Last summer my legs were shaky from the hike up at less than half the distance I went today and today my legs gave me no problems at all.

I'm not saying I understand why there is a difference -- it's on my list of questions for my surgeon at my next follow up appointment -- but there are major hormonal differences that have taken place that I imagine play a big role; as evidence of that, just consider that 2/3 to 3/4 of insulin-dependent Type II diabetics are off ALL diabetic meds the very next day -- and I met several of them at the one support group session I've been to thus far. In addition, at that same support group meeting, it was the unanimous experience of everyone there (regarding being able to go for an extended period of time at such low caloric intake) and nearly everyone that was six to twelve months post surgery was still consuming 400 to 800 Calories a day and having no problems at all and most indicated that they had more energy now than pre-surgery.

 

No offense, but I think I am going to forego your expertise in this subject and place more weight on the professional medical opinions of my three personal physicians (my primary care physician, my bariatric surgeon, and my endocrinologist) as backed up by ALL of the numerous clinics I consulted including such places as the Mayo Clinic and Johns Hopkins. Given that this surgery has been around for decades and that hundreds of thousands are performed every year, I'm willing to put a fair amount of credence in their experience.
...

I'll drop the subject.

My focus was a genuine concern for your health, not looking for an argument.

You had not mentioned the health risks of severe low calorie diets so I was assuming that you were unaware of those health risks. If your doctors have made you properly aware of the health risks and have supplemented you correctly and have you on heart monitoring etc then it's not so bad.

I just don't want people reading this thread to think it's a "good diet" to decrease their calories to 600 or 880 a day!

Around 2500 calories a day is correct for an average sized man, and reducing from 2500 to 2200 is enough to healthily drop a pound of fat a week, 52 pounds a year, with no bad health effects AND be a permanent fat loss, unlike drastic weight loss from starvation.

When you're at that stage ready to drop your fat from 10% to 5% and get athletically "ripped" I'll lend some of my many years of expertise, until then I'm out.

 

Week 10 update.

It's now been 10 weeks since surgery and I'm down a total of 51 pounds and my waist size is down about six inches. My energy levels are back and even a modest amount better than before the surgery. I walk up the stairs at work most of the time, even when it is two flights. I still am a bit out-of-breath after the second flight, but before I was on the verge of passing out after just a single flight. I went out walking the other night and did the full three mile course with no problems at all except for an aching back which is due to the leaky air mattress I'm sleeping on during the week.

I'm still eating about 600 Calories a day. I'm getting much better at knowing which foods are going to cause me problems and avoiding them. I'm also getting better are listening to my body when it says, "Enough!" and ending my meal right then (though I still need to get better).

My blood sugars are looking great. I am completely off the insulin and Victoza and just taking 2000 mg of metformin a day. My morning sugars are usually in the 100 to 115 range. In another couple of weeks I will reduce the metformin to 1000 mg and see how much by sugars rise and then decide from there. My cholesterol and other blood work numbers look very good. They cut my cholesterol med in half and we'll see what the numbers look like in July.

I don't know how much longer I will keep losing at 4+ lb/wk. Hopefully for a bit longer, but I don't really care that much. I am very positive and confident that I will continue losing and that I will make my eventual goal (or get acceptably close to it).

I did ask my PCP about why people that have this surgery can go for months at ~500 Cal/day and he immediately admitted that he didn't know (remember, he is NOT a bariatric specialist) but that he would imagine that it is related to the significant hormonal shifts that accompany it. That meshes with my best guess. I have a follow-up with the bariatric surgeon in a couple weeks and hopefully he can give me a more informed answer.

 

Glad to hear you are doing well.

Sounds like you are increasing exercise levels too. That's great but you should keep an eye out for symptoms of overtraining. It's easy to overtrain when getting back into exercising, especially when calorie restricted.

One of the main symptoms is difficulty going to sleep. A better indicator is to measure your resting pulse rate upon waking, but before getting out of bed. Elevated resting pulse rate upon waking is a good indicator of overtraining.

 

Oh, I'm not in too much danger of overtraining. I'm walking at 3 mph and only getting out once or twice a week, though the weather is finally getting to the point where I am trying to get out three times a week.

My heart rate has been elevated for years and resting is seldom below 80 and often above 90. When resting in bed upon waking it is generally in the 60's to low 70's though sometimes in the 50's.

When I was jogging regularly (and twenty years old) my resting heart rate was in the 50's and my waking heart rate was often in the 40's. Doubt I will ever see those numbers again, but I would love to get my resting heart rate back into the 60's.

 

Ha, I just typed long response to this thread sharing my experiences of post accident rehab exercise and it didn't load so in bullets.
1. Kettlebells are great. Choose lady sized ones 8-12kg if you are unfit. Don't be ashamed I wasn't. Now I'm still 75kg 180cm but swinging 28+kg.
2. Google FMS Gray Cook. Take an interest in your movement quality before hammering your knee joints etc. I'm walking jumping rolling crawling proof.
3. Yoga and Pilates should be done by all who can. You are welcome to argue the toss but I won't believe you. Yoga is not a religion or a sin. (unless you are always at the back of the class looking up).
4. Mark Lauren wrote a great (and simple) book on body weight exercises. You are your own gym.
5. Do it, don't think about doing it. Intelligence is a barrier to good health sometimes and I assume you all are at least as smart as me.
6. Gyms are evil mostly. Your body will not like fixed resistance machines but they will make your arms as big as your belly (at least they seem to in the UK). Google posterior chain, functional fitness etc etc. Challenge your body with asymmetric training which is how your body actually works.
7. Vegetables are food too. Try some daily - as many non starchy ones as you like. Be a veggie a few days a week.
8. Juices are ok in moderation. Alchohol is not a juice but moderate it.
9. Drink water when you wake up, an hour before you eat and fairly often as a between meal snack.
10. Tabata has an equal or superior fitness benefit to endurance training. Running for the bus is kind of tabata. Jogging endlessly across the bush after the wounded springbok is for Zulus. Take it easy initially whatever you do or you'll dislike the effect.
When you were a baby you lifted your head (abs), rolled over (posterior chain), squatted then stood. Try that NOW before pumping iron and getting all vain. Function over form.

 

I fired my new doctor and went back to the old one. His scale says I weigh 199 lbs!
Well, one of the reasons I fired the new doc is that she had 2 scales and they didn't match each other or reality.

 

That's disgusting that a doctor has faulty measuring equipment.

Years ago the surgeries would have an expensive calibrated scale, I remember standing on it seeing numerous calibration approved stickers on it from the cal man that would come every month. The last time I saw a "proper" scale like that was in the last gym I went to.

These days the doctor has a little electronic $40 K-mart scale, who know how accurate it is? Probably suspect.

I recently did a health assessment and the nurse used two blood pressure meters (cheap crap ones) and both read wildy different, and nowhere near my proper blood pressure. Then 20 mins later the doctor checked me on his BPM (which was also a cheap crap one) and it read different again but closer to what my home BPM reads.

These idiots are supposed to be examining us and taking care of our health, and they're not even competent to have WORKING measurement equipment. It would be like hiring an electrician that was so bad his multimeter read 30% out, and he just kept using it.

And not to mention everytime I ask the doc a question, he just googles it right there in front of me! That means his level of skill is about the same as mine? I can google my own medical questions thank you... Grrr.

 

There is a really big scale at the Publix food store. It has hand rails on both sides of the platform you stand on. The dial is about 2 feet in diameter.

If the size is any indication of quality, that is the one I want to calibrate to.

 

I'm always suspect of digital scales, but some are definitely of good quality. Given what they charge, you would certainly hope that a doctor's office would invest in a decent scale (and other equipment).

I have much more faith in a beam balance, which is what I have at home because I got so fed up with even fairly expensive digital scales. My doctor has a good digital scale and it consistently reads five to six pounds less than mine, which is pretty much right on the money since I weigh myself with no clothes and they weight with full clothes (including shoes and whatever you have in your pockets). Every time that I have weighed myself in clothes on my scale just before or after a doctor's visit they have agreed to within a half a pound.

My prior doctor's office use to always have you remove your shoes and empty your pockets, but then they stopped doing that and I asked why and they said that it was too much hassle and didn't improve the quality of the measurements enough to justify it. When you figure that the variation due to different shoes and what someone might have in their pocket is probably on the order of a pound or so and a person's weight varies by a few pounds over the course of a day, that is probably a pretty reasonable stance. They aren't concerned about a few pounds give or take, they are looking for significant trends.

My doctor's office does not use any automatic blood pressure cuffs, but instead the old fashioned pressure cuff and stethoscope method. Even then, two readings taken one right after the other can result in noticeable differences. Apparently, based on discussions with a clinical researcher about twenty years ago, all non-invasive blood pressure measurements suffer from that problem. According to my current PCP, the diastolic is particularly variable and is generally disregarded as long as it is anything reasonable.

 

I gain 3 pounds each day, but it's gone the next morning. I assume it's about water content, a very important aspect of survival in Florida. I weigh myself in the morning just because it seems to be consistent. Then I do my typical intake of morning liquids and go to work, sweating like crazy in the summer heat. No surprise to sweat 2 or 3 pounds a day.

 

Speaking of liquids ... they weigh liquor bottles to determine how many ounces a bar sells. Liquid, like water, weighs approximately 1.04 oz per liquid oz. I know I have a higher weight in the evening. It is not uncommon for me to have a 52 oz drink over a couple of hours in the summer. I've added approximately 3.38 lbs from that drink alone.

A 12 oz drink is a little over three-quarters of a lb. One gallon, 128 oz, is over 8 lbs.

I'm not suggesting you measure in intake and outlet of liquid ... but, just pointing out the approximate weight of liquids. At this time of year, I like my iced coffee and iced white tea. I'm sure the net between intake and outflow is not conducive to weight loss.

This happened a lot this weekend, as my team played in the Local Team Championships and we are one of four teams heading to the Nationals (August) in Las Vegas. I'm sure the liquid intake there will not compute in my favor.

 

August in Las Vegas?
I went there. As an air conditioning contractor, the sounds of the air conditioners grated on my nerves because I could tell by the pitch that they were struggling. High temperatures and low humidity make compressor a sad machine.

 

I don't know, we have a fair share of 100+ days here ... so I don't know if there will be much of a difference.

I lost two compressors in one year at my last unit where there were high temps and low humidity. You know it's bad when you walk inside a building that has humidifiers and you smell the moisture in the air.

 

There is a really big scale at the Publix food store. It has hand rails on both sides of the platform you stand on. The dial is about 2 feet in diameter.

If the size is any indication of quality, that is the one I want to calibrate to.

Yeah they are good old scales. You should check it for a cal sticker. They are supposed to get them calibrated regularly and the sticker should be placed where the public can see it.

Commonly found in large pharmacies, stores, and good doctor's offices.

...My doctor's office does use any automatic blood pressure cuffs, but instead the old fashioned pressure cuff and stethoscope method. Even then, two readings taken one right after the other can result in noticeable differences. ...
...

Yeah that's a more accurate way to do it, human skill listening and an inches of mercury glass tube on the wall. Hard to go out of calibration.

I pulled apart one of these little auto BPMs and the pressure sensor was a capacitive type, incredibly cheaply made. Junk. The sensors are not even calibrated, the device itself has a few cal trimpots so some Chinese teenager calibrates it in a hurry at the end of a production line.

Yep I know about the problem with taking two consecutive readings, from using my own BPM. But the first one the nurse used on me read 110/60 or some ludicrous reading, considering my BP had been at 135-140/75-80 for many years.

It was only when I complained about it being so far out she said "Yeah, I think this one has been playing up" (she knew it!) and went and got another one that read differently but still very far out. And that was during an official health assessment test. Clowns. Really overpaid clowns.

 

About the blood pressure machines...The, "tube of mercury on the wall" is the gold standard. It is physically impossible for it to be wrong. That machine is the standard by which all others are measured. That is the machine that was the original and sets the standard. That machine is why your blood pressure is declared in "millimeters of mercury".

If there is any error, it is in the person operating it.