Marilyn's Mobility Journey

On Tuesday we ordered in Chinese food. I was able to eat egg drop soup (which also had mushrooms, carrots, and peas), some of the chicken from the chow mein (but not the noodles) and some of the moo-shu chicken (with sauce, without the pancake).

On Wednesday we went to Celia’s for Mexican food for Simcha’s birthday. I had refried beans, guacamole, sour cream, and pork carnitas. In very small quantities, of course (have a lot of leftovers!), and chewed the pork very thoroughly. I had a little bit of heartburn, but it was temporary.

Oh, and I had a VERY tiny taste of ice cream and whipped cream. Like 1/4 of a teaspoon. Just enough to get the flavor. That was nice.

So excited to be able to find things I can eat in a restaurant! The hardest part was not having any chips. Some day I’ll be able to have some, but only a little, or I won’t have room for the important nutritious food.

A couple of days ago I decided to try eating cherries. I figured I’d just spit out the skin. But when I started chewing, the skin just disintegrated, so I ended up swallowing it. My stomach noticed, but was ok. I could only eat about 3 of them, but that was enough!

Today I tried eggs. I lightly scrambled some. I was able to eat about 1-1/2 eggs, with no ill effect. Yay!

I previously talked about what I eat, but it turns out there are different eating processes that are needed after surgery.

Speed, or lack thereof: Because my stomach can’t hold much, I want to put only a small amount there at a time. So it’s important to eat slowly to allow my stomach to process food effectively. I typically use teaspoons and salad forks, which helps me take smaller bites.

Chew, chew, chew: By taking away part of my stomach, I don’t have the digestive capability I used to have. Digestion starts in the mouth, so I need to utilize that digestive path more. This means chewing food much more thoroughly than I ever did. This is the hardest for me! But if I don’t, the food will pass through my stomach without me getting optimal nutrition from it.

Small plates: This is purely psychological. A full plate is satisfying, so having a small plate means I can more easily fill it.

Not drinking when eating: Related to chewing, I need to give my stomach a chance to do its work. So I don’t drink while eating, or for 20-30 minutes after, to avoid pushing the food out of my stomach before it can be fully digested. This was a really hard habit to change; I’ve been working on this for months. I do allow myself a tiny swallow to rinse my mouth after finishing, but I don’t drink anything significant until I’ve waited a while.

This one gets weird when eating soup. I am used to sipping the soup while eating the chewy stuff. I need to get used to eating the chewy stuff, and then pausing before finishing up the wet stuff.

Some people have asked about the special eating after surgery; why and how, so I figured I’d post on that. This post is about what I eat. A later post will be about how I eat.

If you’re eating significantly less, you need to make sure you are getting proper nutrition in small packages.

Protein: is extremely important to muscles, brain function, and a lot of other bodily functions. Plus if you are getting enough protein, you will usually feel satisfied longer. Because of this, at every meal, I need to eat the protein first. If I don’t, I may get full before I’m consumed enough protein. By “enough” I mean about 25-30 grams of protein in a meal, totaling about 90 grams a day. Because of my long-term my diabetes, my kidneys aren’t doing as well as they could, and processing a large amount of protein is hard on the kidneys, so my doctor doesn’t want me to go over 90 grams in a day. Also, your body can’t really process more than 30 grams in a single sitting. So I’m shooting for about 20-25 in my 3 main meals, and that leaves me some at other times I need to eat.

To understand how I get my protein, here are some common sources:

• Animal meat (chicken, beef, lamb, pork): about 25-38 grams per 3 oz
• Tuna/salmon: about 22 grams per 3 oz
• Eggs: about 7 grams per egg
• Greek Yogurt: about 18 grams per 1/2 cup
• Cottage cheese: about 11 grams per 1/2 cup
• Beans: about 9-11 grams per 1/2 cup
• Peanut butter: 7 grams per tablespoon
• Cashews: 4 grams per 1 oz

Protein shakes are also used initially, when it’s easier to digest liquids, and later, as a supplement. The shakes I use are those that are high in protein (20-30 grams) and low in calories (below 200). My favorites are Premier Protein and Fairlife. My kids like the Caffe Latte flavor of Premier so much that they’ve asked to keep them stocked in the house on a regular basis. It’s best to get protein from real food, so over time my doctor wants me to have no more than one of these in a day. They should not be drunk in addition to food, but as a small snack or to supplement protein. It’s really easy for me to go over my 90 grams of protein if I use shakes too much. However since they are pretty sweet and yummy, I use them as a dessert sometimes; they freeze OK, as an ersatz ice cream treat.

One of the downsides of a high protein diet is constipation, so I, as is the case with many surgery patients, need to take fiber supplements and natural stool softeners.

Vitamins and Minerals and Fiber: We get a lot of vitamins and minerals and colon health from fruits and vegetables. Vegetables are the second thing I need to eat at meals. “Starchy” vegetables like corn, potatoes, sweet squash (like butternut or acorn), and sweet peas, tend to provide less nutrition and more calories relative to the amount of “space” they take up in my stomach. These are therefore discouraged. High nutrient vegetables like spinach, broccoli, carrots, and asparagus are encouraged.

Many people who’ve had surgery can’t tolerate sweets much, if at all. (This is especially true for people who’ve had the bypass surgery, but some sleeve patients, like me, also have trouble.) Since fruit is often sweet, this means that I need to limit my fruit intake, and target fruits that aren’t as high in sugar. (see Sugar below, and the issue of constipation, above)

Because it’s possible that I won’t be able to eat enough to get all of the nutrients I need, I must take vitamins specifically engineered for people who have had surgery. I am also taking calcium supplements (100 mg a day, coupled with vitamin D).

Bread, Crackers, Pasta, and Rice: These are pretty much no-go. Later on, when I’ve lost the weight I want to lose, I might be able to occasionally have these in small quantities, but they just fill up my stomach too much, pushing out other more nutritious food. Plus many people simply don’t digest grains well after surgery.

Removing these foods from my diet has been hard. I especially love bread and crackers. The 6-month preparation process before surgery was important to me to decide if I could do this. I found alternatives to satisfy my desire for a “vehicle” that bread often acts as as, as well as the “crunch”. I found foods like Egg Wraps and pork rinds. I will likely be able to eat these at some point

Fats: This includes butter (and other spreads), cheese, avocados, fatty foods, and more. Many people have a problem with digesting fatty foods after surgery. I haven’t eaten many of them yet, but thus far I’ve been able to digest them well. This is great because I love many of these foods. However, back to the space limit: I can’t use space in my stomach for fats. So I can only use them sparingly so I can get in the protein and vegetables.

Sugar: As described above, many people who’ve had surgery don’t metabolize sugar well. Sugar is also kind of a “gateway drug” in that it’s a road to consuming empty calories. So I need to avoid sugar as much as possible. Does that mean I will never be able to have birthday cake or ice cream again? I will likely be able to tolerate these in small quantities, but the key is doing it only occasionally. For the most part, I will not have sugar in my day-to-day eating.

Water: Water is a key element of my eating. In order to keep my digestion healthy, I need to drink 64-90 ounces of water every day. I get bored with plain water, so I use sugar free water flavorings a lot.

Sodas: I haven’t had sugary sodas in years, so was surprised to hear that sugar free carbonated beverages are not OK for several reasons.

• The gas in carbonation can cause discomfort in smaller stomachs.
• Some of the chemicals in many sodas can cause digestion discomfort.
• Many sodas contain caffeine, which is a diuretic, so can cut down on the effectiveness of the water we need to drink.
• Sugar free sodas can also be a “gateway drug” to sugary sodas.

I haven’t complete bought into the issue about sodas, but I haven’t had any so I don’t know how my stomach will handle it. However the only soda I used to drink on a regular basis was Sunkist Diet Orange, so for now I’m just using a water flavoring that tastes the same, so I’m fine.

I continue to be really worried about this surgery not working. By “not working” I mean that the restriction from my smaller stomach won’t be present enough to keep me from eating more, which will keep me from losing weight. Additionally, I know I won’t be successful at eating less if I am hungry all the time.

I guess at this point I’m having mixed results:

Hunger: Almost from the beginning I’ve had hunger. At first I had the sensation of heartburn, which read a little bit like hunger. I think that was from healing because that has subsided, but the hunger is still present. Then I thought my hunger might be “head hunger” or thirst, but these days I’m doing better telling the difference, and I’m clear when I am hungry. Some people don’t experience hunger much, if at all, after this surgery, but unfortunately I appear to be an outlier, and I am getting hungry every few hours. I’m trying to a) keep my protein input high enough, as that can stave off hunger longer; b) eat only a small amount between meals; and c) try flavorful but lower calorie foods, such as broth or sugar free jello.

Restriction: Most people at this point can eat about 1/2 cup of food at a meal. I have days where that is true. However at other times, like yesterday, I can eat up to a cup of food. I know it doesn’t sound like a like, but if I can eat that much, I will have a harder time losing weight.

As expected, my moods around success are all over the map. Two days ago I was feeling good about my prospects for success, but yesterday I was hungry almost constantly and ate a lot more than I had been eating, so I got very worried.

As some of my friends have told me many times in many situations: One Day At A Time.