After the RNY: When did your patterns normalize?

Quasita
Quasita Posts: 1,530 Member
edited April 2019 in Health and Weight Loss
Hello!
I had an RNY back in November 2016 which was considered successful. I have maintained a triple digit weight loss, though it would be great to drop about 40 more pounds. Currently, I've accepted that this last drop could be a matter of needing to fluctuate my intake to higher levels and things of that nature; that's where the catch comes in.

I cannot seem to stretch my stomach past ~4oz for the life of me. To get a "normal" diet for my body size to maintain current weight, I need to get just over 2k, so I know I'm stalled for alternative reasons, things that have happened before. When I push it in an effort to get higher food counts, I swear I feel my staples and clips, and unfortunately, sometimes results in emission.

I was under the impression that I should be working with at least a cup at this point, so I'm checking with possible community members to see if my expectations are correct? I know many people who were already struggling with regain at this point, so I'm pretty confused as to why I can barely meet my 1300 daily, let alone a maintenance amount. I should definitely be downsizing, the scales fluctuates in a way that shows I would be, but something keeps sucking the 7 pounds I'm fluctuating back in every time I lose them, despite not changing much.

So what were your experiences? Next steps? Thanks!

Replies

  • cheryldumais
    cheryldumais Posts: 1,907 Member
    edited April 2019
    Nevermind... Just realized you've been here a long time and I don't know enough about this to comment.
  • PAV8888
    PAV8888 Posts: 14,254 Member
    In just to learn more since @Quasita, based on previous posts, seems to have researched bariatric surgery and outcomes quite extensively
  • Ddsb11
    Ddsb11 Posts: 607 Member
    edited April 2019
    I'm sorry, I'm confused. Will you clarify what you mean when you say you couldn't lose weight on less calories, but when you increased them you lost weight? How does this physiology work? Genuinely interested. Thanks in advance.
  • Ddsb11
    Ddsb11 Posts: 607 Member
    edited April 2019
    PAV8888 wrote: »
    msalicia07 wrote: »
    I'm sorry, I'm confused. Will you clarify what you mean when you say you couldn't lose weight on less calories, but when you increased them you lost weight? How does this physiology work? Genuinely interested. Thanks in advance.

    Your weight loss or gain is based on your caloric balance.

    There are two sides to a balance.

    We often concentrate on the calories in side.

    Nothing stops someone from increasing both calories in and increasing calories out by more than the increase to their calories in.

    Not to mention that a follow up post also disclosed that in aiming for really low calories in, the result was not always the right amount of calories in on average. A very common issue often referred to as a restrict-binge cycle

    So are you agreeing with her statement or not, I'm more confused now. As I understand, it is impossible to lose weight without a calorie deficit, and by increasing calories when you weren't losing with less than you were taking in before would be counter intuitive. Do you see why I asked her to clarify?
  • PAV8888
    PAV8888 Posts: 14,254 Member
    edited April 2019
    msalicia07 wrote: »
    PAV8888 wrote: »
    msalicia07 wrote: »
    I'm sorry, I'm confused. Will you clarify what you mean when you say you couldn't lose weight on less calories, but when you increased them you lost weight? How does this physiology work? Genuinely interested. Thanks in advance.

    Your weight loss or gain is based on your caloric balance.

    There are two sides to a balance.

    We often concentrate on the calories in side.

    Nothing stops someone from increasing both calories in and increasing calories out by more than the increase to their calories in.

    Not to mention that a follow up post also disclosed that in aiming for really low calories in, the result was not always the right amount of calories in on average. A very common issue often referred to as a restrict-binge cycle

    So are you agreeing with her statement or not, I'm more confused now. As I understand, it is impossible to lose weight without a calorie deficit, and by increasing calories when you weren't losing with less than you were taking in before would be counter intuitive. Do you see why I asked her to clarify?

    The point being that there was a clear statement that she also increased activity substantially by exercising to excess. This means calories out increased

    And that she ameliorated the restrict-binge cycle she was in partially because she was attempting to eat unsustainably low.

    This means that her average calories in may or may not have actually increased on average and certainly didn't increase by as much as her change in goal would indicate.

    Whether it is counterintuitive or not doesn't really matter.

    What matters is the creation of a deficit.

    So you can decrease calories in to create a deficit while holding calories out steady or decreasing less than the decrease in calories in. This is the classic eat less scenario.

    You can increase calories out to create a deficit while holding calories in steady or decreasing. This is the classic exercise/move more and eat the same or less scenario.

    Or you can increase calories in while increasing calories out by more than the increase in calories in. Which is what the OP said she did.

    All of the above would result in a larger effective deficit.

    Whether these strategies will work for any particular person that's a different story.

    The vast majority of people probably just have to reduce their calories in to achieve results.

    People in restrict-binge cycles, or with long histories of restricting calories, or who have been severely under-eating may be better served by using different strategies.
  • Ddsb11
    Ddsb11 Posts: 607 Member
    edited April 2019
    Okay, so she was saying she was practicing CICO by increasing her exercise. That's what I wanted clarification on. Thank you.
  • L1zardQueen
    L1zardQueen Posts: 8,753 Member
    If you want to eat more, try a few extra calories every day. It takes practice.
  • Ddsb11
    Ddsb11 Posts: 607 Member
    Quasita wrote: »
    msalicia07 wrote: »
    Okay, so she was saying she was practicing CICO by increasing her exercise. That's what I wanted clarification on. Thank you.

    Yes and no. I mean, technically it was still CICO, but there are a lot of nuances behind it.

    I was technically in a severe caloric deficit to start with. I averaged at 900 calories a day with "binge" days getting to about 1500-1800 calories. At high weight, I was 535lbs. The math didn't compute from a pure CICO approach, so we did some testing. In discovery, we had found that my extended complex anorexia/bulimia had altered my thermogenic burn to such a degree that if I did not eat, I did not burn anything except was was absolutely necessary. My adapted basal metabolic rate was significantly lower than other people my height and size.

    When I increased my calories to be closer to my "maintenance" as determined by average scales, which at the time was over 3k, things changed significantly. I made a cognitive promise to my doctor that I wouldn't drop my calories in under 1800 calories in order to accommodate bare minimum nutritional needs.
    I slowly increased this amount to 2300, then to 2800, and that's when significant changes started to occur, primarily in the fact that I felt hungry for the first time in years, and voraciously so. We're talking, painfully hungry, wake up in the middle of the night, have to eat every hour kind of hungry. This continued as I increased my exercise, and in order to keep up with the significant amount of training I was doing at the time, I couldn't eat less than a typical 4k day, with many going up to 6k when I did aquatics. This being because while my base metabolic rate was much lower, my average burn per minute was significantly higher than average, due to having a much above average muscle tissue % and pure lethargy and pain preventing me from exercising prior to that.

    My caloric deficit didn't actually change that much in the sense that the number attached to the deficit was the same. The difference was that my lower number, the calories in, was at a level that was high enough to not trigger survival responses. Before this gets jumped on, please again note above, this was medically documented... Prior to blood work and hormone therapy to correct it, I had been refused care for my pervasive complex EDNOS because everyone likes to say "there are no fat anorexics" and turn you away.

    ANYWAY. I lost over 100lbs working on that and tracking every number very specifically, but then I hit a wall that I could not get past, not with medical help or professional assistance. We eventually agreed to do the RNY because it removes a portion of your digestive tract and literally alters your ability to absorb certain parts of your food, most importantly the fats, which then, in theory, forces your body to remove its needed fats from your stores. I originally wanted a sleeve but was deemed a poor candidate since I was prone to restrictive problems, and I had to have a certification of 3+ years clear of any anorexia/bulimia relapses before I could be considered a candidate. Very few people with my history, no matter their weight, are allowed to do this, because most cannot go that long without relapse but I have worked extremely hard to battle my demons and make progress.

    To date, I'm a little over 250lbs down and it's been extremely rewarding yet one of the most medically dangerous things I've ever done. It cost me my ability to have my own children, nearly cost me my life even, and there are people here on MFP who have heard the story, read my posts and respect where I come from with it... So I guess sometimes I forget what it's like to come into the public without much other direction. MFP has been an incredibly vital part of being this person I am now... from helping me track my changes to giving me friends who sent me flowers during my many hospital stays since I targeted 210 as my find number all those years ago.

    I know this is a long response, but I felt it was important to explain that CICO works, but where you set those numbers is important from a medical perspective. I would never, ever give the advice I see some give those very large people, which is "you can handle a much larger deficit than most, you have more weight to lose." It is always, always better to figure out what those numbers should look like, and not fall to the temptation that is chronic under nourishment. I promise you, it's not a fun recovery.

    Not to mention that clinically speaking, those who have recovered from anorexia tend to have to eat MORE to maintain after achieving a healthy weight because their metabolism has been permanently hyped up. There's no study about people like me to say what the experience did to permanently change things chemically... but I don't doubt that it did. My surgeon believed it did too, which is why RNY was done, so we could reverse if necessary and allow me to eat 2400 calories a day if I have to. I'm just trying to do it in a smarter way before we start having conversations like that.

    Sooooo there's the long answer to your short question. Sorry to ramble, but maybe this will help people understand. If they bother with it anyway. My goal is information, not instructions. It always worked best for me when I figured out what special combination was the best fit for me as an individual.

    Good luck! Let me know if I can help.

    Thank you for your response and for understanding why I was confused and needed clarification- you are a very unique case, and I wish you nothing but the best. Well done with your methodical attention to detail during this whole process as well. It's clear you're motivated to be as healthy, mentally and physically, as possible. I can imagine you would be a phenomenal resource for others in your position.
  • L1zardQueen
    L1zardQueen Posts: 8,753 Member
    Quasita wrote: »
    L1zardQueen wrote: »
    If you want to eat more, try a few extra calories every day. It takes practice.

    Is this your experience in stretching a post-op stomach? I am currently hitting a wall when I hit a certain level of calories. I cannot seem to get past that point because it makes me physically ill. I'm trying to stretch the stomach to facilitate larger meals and longer hold times.

    How is your fluid intake? Maybe add some fruit juice to your diet to get some extra calories.
  • ruqayyahsmum
    ruqayyahsmum Posts: 1,513 Member
    I had rny
    I found pregnancy oddly was a time I could eat larger amounts..... Until HG kicked in

    I can eat larger volumes when having a hypo (1.1 in hospital...... Ate 2 bits of toast with jam, pack of 3 biscuits and a whole cheese sandwich)

    Other than that I can eat more in the biscuit/cracker catagory, the things we were warned not to eat

    My exercise has taken a massive hit thanks to arthritis kicking my butt so I'm having to reduce calories but when I was able to be very active I could get 2000 calories in but I needed to eat little and often to get to that number instead of traditional 3 meals a day kinda thing

    So on a hike I would take a box with cheese strings, boiled eggs, crackers and cheese etc to have at intervals

    I also have no access to the team (here in the UK you get 2 years and then cut off) so alot of what I do is trial and error, in my second pregnancy 2 years post op (lost the first baby) the team wouldn't even help the maternity team, I was hospitalised alot and they decided I needed to eat 3 biscuits hourly, it became really tedious being woken at 3am for biscuits
  • cheryldumais
    cheryldumais Posts: 1,907 Member
    No not negative just thought it might be redundant since you have been around a while but just in case you didn't know, there are a few groups on here for bariatric surgery patients. I think they might be a lot more help as they can relate to your particular situation. I just searched on bariatric and several came up. Here's one that seems to have alot of members:
    https://community.myfitnesspal.com/en/group/14613-bariatric-surgery-support-group-central
  • KimShea01
    KimShea01 Posts: 23 Member
    I'm post RNY about maybe 10 or 12 years. I still cannot eat as much volume wise as I could pre-op. I could maybe eat more close to normal person portions after a couple of years, but still not a large volume to this day. If I get a small burger, with bun, for example, I can maybe eat half. My thinking is that if you need to increase calories at this point, increase frequency of eating rather than volume at meal times. Multiple small meals or snacks a day, with a few hours between. Careful tracking of macros.
  • psychod787
    psychod787 Posts: 4,099 Member
    Just a thought... I have researched bariatric surgery some... there are some doctors that think it might help readjust the BF set point after surgery. Maybe... your body has hit comfortable weight. That and with the restricted stomach size, might be why you have trouble taking on more calories. Many body builders in a massing phase talk about having to just eat plain "junk" to get enough calories in at the end of a bulk.
  • Strudders67
    Strudders67 Posts: 989 Member
    A frequent topic on here is from people seemingly struggling to eat their allocated number of calories. The usual response seems to be to eat calorie dense foods and peanut butter gets mentioned a lot. If you're trying to eat more calories but struggling with volume, because your stomach hasn't stretched post-surgery, would these more dense food items help? If so, I'm sure someone has a link to the list of calorie dense foods. If nothing else, they'd be better than protein shakes. I hope you get more responses from people who are really able to help.
  • garber6th
    garber6th Posts: 1,890 Member
    I am over 5 years out from WLS (sleeve) and I have been in this group from the beginning, they are very helpful, honest, and informative and speak from experience.

    https://community.myfitnesspal.com/en/group/637-gastric-bypass-vsg-lapband

    I still can't eat the amount of food I could pre-op, but I can eat about a cup full volume wise, or when it's richer or more dense food like meat I can eat maybe 5 ounces. On days when I struggle to get my calories, I might add something more calorie dense like peanut butter, avocado, protein bars, real cream in my coffee, maybe add a tablespoon of butter or olive oil to my cooking, things like that - low volume calorie dense foods can help fill in the gap.

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