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SherylWilliams
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| Joined: | 21 February 2009 |
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| Posts: | 12 |
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Posted: 22 February 2009 07:20 pm |
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I have so, so many questions. Please be patient -- I have a lot of details here!!
I had gastric bypass surgery in February of last year. In the six months prior to surgery (August 07-February 08), I took a required health education class, at which time I lost 30 pounds going from 2000 calories a day to finally 1200. I'm actually one of the few people in my class who met that goal. I was and am serious about losing weight. I've been overweight all my life, and to get to the point of having surgery, I was on board 100%. My motto was, "Just tell me what to do. I'll do it." I'd had enough.
After the surgery I lost 40 pounds in the first three months, making a total loss of almost 80 pounds. Since then, it has become an impossible battle. I have exercised so hard that my creatine kinase tests have showed muscle damage. I have done everything -- more water, more healthy fats, less fat, more protein, less protein, more healthy carbs, almost no carbs, more exercise.
I've been back to see my surgeon more times that I care to count. He finally didn't know what to tell me anymore. I've been to an endocrinologist who says, "Congratulations! You're completely healthy!"  I've never wanted to have test results showing a problem so bad in all my life!!
What's so frustrating is that it seems like no one believe me, because my blood test show no problems. Well -- I think there's a problem, but my endo doesn't. My thyroid TSH test dropped from 1.28 in October to .44 in January (the normal range is .40 to 4.00, so it's actually tending towards hyperthyroid -- I'm .04 of a point from being abnormal). But then the question is -- if my metabolism is running so hot, why can't I lose weight?! And if I'm closer to hyper, then why is my hair falling out at an alarming rate so that I have to wear hair pieces? I am on no medications.
The last time I saw my surgeon on September 2, he told me to add more exercise - which I did. I was doing 30-45 minutes of step aerobics 5x a week. At 236 pounds, that's a lot. And I did so eating an average of 1100 calories a day (he gave me no instructions to increase my food). From 9/2 to Thanksgiving, I lost NO inches, NO pounds.
I've tried different things repeatedly. When I lower my carbs, I lose water weight immediately, but then the weight loss stops. Thus, it's not true weight loss. It seems that my body's not burning fat and I don't understand why?
I have continued to press forward in the last 8 months, praying I’ll have a breakthrough. It becomes downright disheartening at some point, though, and you want to give up. I keep going to doctors who keep telling me that my labs are fine, so I should be okay, and they send me on my happy-go-lucky way congratulating me that I’m in such wonderful health (?!).
If this was about non-compliance, I'd be gaining weight, not staying relatively the same. Over the holidays I got very discouraged and just stopped exercising. I was literally beating myself up in exercise for no results, so why bother?? After the new year I tried to work the process of elimination, but still didn't really get any answers.
Two weeks ago, like I've done so many times in the last year, I got back on the horse again to give it another try. This time I'm purposely eating more (1700-1800), hoping that eating more with exercise will balance things out. I'm faithfully journaling my food, so I KNOW how much I'm eating. I started out on Monday, February 9 at 233 pounds and picked my exercise back up. Today is February 22, so I've completed two weeks.
I've lost no inches, but have GAINED 7 pounds in two weeks! That's IMPOSSIBLE to be fat. You can't gain 7 pounds of fat by eating 1700 calories a day and burning another 300-400 in exercise a day! I feel like I have no idea what my body's doing! It's crazy! I know you start gaining a couple of pounds because you're building muscle, but -- SEVEN pounds of muscle?!
And if I'm still not eating enough for my weight & activity level . . . try getting 2100 calories into a stomach that's the size of an egg. The only way to do that is to eat higher calorie food (i.e. junk food), because otherwise I'd never get in enough healthy food to equal 2100 calories. I'd have to eat a LOT of healthy food to equal that many calories, and my stomach can't hold that.
On top of this, I'm rarely hungry. I get shaky way before I get hungry. Many times I eat because I know I need to, but not because I feel like it.way
I just don't know how long to stick this out to see results. I've tried over and over and over again. I give it my all, don't see results, get discouraged, stop, and then start again. After analyzing carbs analyzing protein, analyzing fat, analyzing water, adding exercise, what's left? I really suspect something is going on with my thyroid, but my endo doesn't seem convinced. And it's not so easy to go to another endo. There's only one in my area covered under my insurance -- the next one is an hour away. After that, it would be a several-hour drive.
Am I just being impatient? How long is reasonable to see results? If what I'm gaining is water in my muscles, will I see my weight go back down??! I'm just scared to death that I won't and that the surgery has trapped me into being obese.
I never expected the surgery to be a miracle. I know I have to work it, and I am. I took a class for SIX months that drilled into me how important it is to work your tool. I'm committed to working it, and I have been. Now that I've come this far, I'm devastated that I can't lose any more and feel trapped into being at this weight.
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Nir
Senior Administrator
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Posted: 22 February 2009 08:31 pm |
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I don't know your age or height but I plugged in a couple of guesses and your unadjusted RMR works out at about 1800 so I wouldn't have gone below 75% of that (i.e. 1350) so the fact you've been at 1100-1200 for such a long time is cause for concern and would explain why your loss has stalled (and perhaps why hair is falling out). I agree with your plan to bump up calories for now though you might not need to go higher than 1800 and after stabalising it for a while it might be safe to go back down to 1350-1400.
As for weight gain, partly that will be due to bumping out calories suddenly rather than gradually, I expect it is mostly water weight but obviously if your body got used to 1100 calories and you're now at 1800 then after 5 days you've overeaten 3500 calories by your body's previous standard so that'll be a pound of fat etc. - until your body readjusts to higher food intake.
If someone has been over-exercising then the advise is to reduce exercise, not increase it, during the metabolism retraining period. Remember, this is just a temporary phase.
Taking an overview of your situation: an extreme calorie deficit worked for a while but then stopped working. Time to repair the damage and then continue working at it but 'less drastically'.
If you're willing to read a book I'd also like to recommend Eat To Live by Dr. Joel Fuhrman
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SherylWilliams
New Member
| Joined: | 21 February 2009 |
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| Posts: | 12 |
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Posted: 22 February 2009 11:18 pm |
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Wow, that's some new information that I hadn't heard before! It's never been explained to me that adding additional calories can cause weight gain because your body interprets it as overeating from the calories level you were at before! The only thing that's been explained to me is that when you add additional calorie, it causes water gain. I was told that when your calories have been low, the glycogen stores are in a state of being very low or depleted. So when you start eating more, your body pulls water from the additional food you're eating to replenish all the water you lost from the low calorie diet.
To give you more info, I'm 37 years old (today in fact!), and stand 5'6". As of this morning I was at 240 pounds, which makes a 7 pound gain in two weeks, like I mentioned.
As for my calories, I started adding more calories in late November (right after Thanksgiving) actually, so I've been eating 1700-1800 since then. It was from February to November that I had been eating 700-1100 calories a day.
So from the end of November to February 9, I didn't exercise at all to give myself a break (due to the muscle damage), but I continued to eat the 1700-1800 calories a day. I really wanted to see what would happen. That was my "process of elimination" time. I didn't lose anything during that time, but also didn't gain.
In the last two weeks, my calorie level hasn't changed at all because I've been eating the same amount of calories since November. The only thing that's changed in the last two weeks has been my exercise. After which time, my weight on the scale continues to go up. And unless I'm imagining it, some of my clothes are getting tighter on me. I wore a jacket today that I remember being loose! Is the water gain from the weight training causing this puffiness?
I sure hope my body readjusts soon. It's SO hard to keep going when the scale is going up.
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Nir
Senior Administrator
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Posted: 23 February 2009 07:02 am |
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About 'Water weight from glycogen': a typical body can hold 500g of glycogen and the water:glycogen ratio is about 3:1 so that can therefore account for 3lb of water weight. Perhaps it scales up with body size - my understanding was that it would scale up with more muscle, not with more fat, but conceivably still more than 3lb. Proof is in the pudding though once you gain the water weight you shouldn't gain it again, your weight should become 'stable'. (and from your description that seems to have happened - after your 7lb gain around November you've largely stayed stable)
in February, right?
(Female, 37, 5'6", 240lb) => unadjusted RMR 1790 (so my previous guesses that got 1800 were not far off). Remember 1) this is an approximation 2) it represents what your metabolism should be if it wasn't damaged not what it currently is 3) the forumla has a 'natural bias' which makes it be an over-estimate and this is more noticable the more obese one is (hence why it is safe to go to 75% of the value for such BMIs as per my original post).
With your surgery obviously some of what you eat is calorie-dense (lots of calories per unit volume) and for the sake of accuracy I recommend that you WEIGH such foods with a digital food scale rather than use the less efficient methods of 'eye balling' or using measurement units like cups and spoons. The more calorie-dense the food the more small visual mistakes (e.g. heaped cup/spoon) can create systematic error which will reduce confidence in the calorie figures you're presenting. So my question is: are you weighing your food or using volume or eye-ball methods?
There is a relationship between muscle weight and exercise. You've just come back to exercise after a 2-3 month layoff so yes it is possible that a gain is explainable by that (again the test is to see if this continues: if it is related to exercise we don't expect such a gain to continue, obviously that is a body builder's dream but it doesn't continue indefinitely).
Given you've had your higher calories and less exercise for 2-3 months I think that the extra exercise and SLIGHT calorie reduction plan can go ahead. Perhaps it would be best if the reduction was also gradual, say 1-2 weeks at 1700, 1-2 weeks at 1600, 1-2 weeks at 1500 and then SETTLE at 1400, making a note of how your daily weight responds to the changes (and how you feel in your workouts at different levels)
(regarding the book I mentioned I thought about it some more, it is a good read but some of it would be hard to directly apply with the small stomach you have - you'd have to "ration" the nutrient-dense foods that were also high-volume, unless you liquidised them to get around your stomach's limitations)
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SherylWilliams
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| Joined: | 21 February 2009 |
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| Posts: | 12 |
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Posted: 24 February 2009 06:05 am |
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From November to February I stayed in the low 230s without exercise but just eating 1700-1800 calories a day. Starting 2/9 I added exercise while at 233. Weight went up to 240, and is now tottering between 238-240 on a daily basis. Today makes 11 days of exercise.
I'm measuring my food in cups, because that's how my nutrition book from the dietitian shows things -- in cups rather than weight. I do have a digital scale, though.
Am I exercising too hard? MWF I do 20 minutes of strength training followed by 20 minutes of step cardio. T/Th I do 30 minutes of just step cardio. I saw no results during the time I increased calories and didn't exercise.
Am I calculating this correctly? -- If my RMR is 2,775 because I'm exercising 5 days a week, I'm creating a calorie deficit of 1000 calories by eating 1700 a day. I'm then further reducing that by another 400 calories by exercise, taking me to a net of 1300 a day? Is that right?
Is it all about calories in/out or is it necessary to analyze carbs, protein as well? I don't want to overly obsess about this -- probably because I already have until I was nearly cross-eyed, and it still didn't do me any good. I do know I need 80-100g of protein a day, but the carb thing kind of has me stumped. In the last two weeks (since 2/9), I no longer count carbs, just calories.
What actually puts you in starvation mode? Is it the lack of CALORIES, the EXERCISE, or a combination of the two?
For instance (just as an example), if I eat only 1400 calories and exercise to burn 400 calories, that leaves me at a net of 1000 calories eaten that day; therefore, I think I can safely assume that that's going to be starvation mode for me at 240 lbs, since it creates a -1775 calories a day from my RMR.
Now here's the question -- will my body "do the math" when I exercise, even if I've eaten enough, and interpret the calories burned as if I was missing food/calories for that day, and plunge me into starvation mode? Or, as I've read, the safeest thing to do is to now lower your calories too much and create that deficit through exercise, because exercise "tricks" your body when you get you calorie deficit this way, and doesn't go into starvation.
I can't believe my life got so incredibly complicated and difficult after a surgery that was supposed to help me, not make it harder.
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Nir
Senior Administrator
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Posted: 24 February 2009 09:07 am |
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The extra weight from 233 to 238-240 didn't come immediately after you increased calories but somewhat later on so it is unlikely to to be fat. I think it is irrelevant whether it is extra muscle or water weight or extra content in the colon = it is fat weight that we are wanting to avoid.
I'd like to once more make the point that some food is more calorie dense than other food. For example skimmed milk is 35 calories per 100ml so a 250ml cup is going to be 88 calories. On the other hand, my Muesli for example is 360 calories per 100g and so it is going to be a lot more per volume measure like a cup and therefore subtle small mistakes can lead to wide variation in calories. So I suggest you go to the extra trouble of obtaining per-weight calorie values for the calorie-dense foods that you eat (let's say calorie-dense is anytyhing that is more than 100 calories per 100 grams or more than 200 calories per cup). The information is available from many sources. For example the calorie counter on our website gives both volume and weight information, as does the one at nutritiondata.com. You could always switch to counting-by-weight for a few days just to see if you get identical figures and if you do and prefer to do things by volume switch back
I don't think the exercise regime you describe is excessive, it can only help you in the long run.
Although your unadjusted RMR is 1790 one of the reasons why it will be OK for you to be eating less than (up to 25% less) is because the formulas used to calculate this figure are broken and give results that are simply too high for obese people. So that means that your non-exercise sedentary maintenance of 2148 calories might be an over-estimate, and 2775 is almost certainly an over-estimate unless you're burning an extra ((2775-2148) * 7 / 5 = 878) on the 5 exercise days in your workout - which is unlikely. On non-exercise days your maintenance is probably somewhere between 1600 and 2100 (to account for the mistake in the formula) and if your workout burns say 400-500 calories then add those directly on. No need to use a formula that mistakenly over-inflates your calories burnt and then worrying that you've created too large a deficit.
So if assume you are actually burning 1800 (picking a number in the middle) calories plus 500 in exercise (on an exercise day) then 1800+500 = 2300. And then you're eating 1700 so deficit is 2300-1700 = 600.
In my opinion the key things to count are calories and protein. Certainly this is what I used to do when I counted things on paper. I now use a computer so everything gets counted for me but the things I worry about are calories and protein where I make sure I hit my specific targets
'Starvation mode': I guess you can get there sooner by exercising more so technically it will relate to the calorie deficit, but most people look at it as relating to the absolute calories consumed. There is a relationship between excess fat on the body and maximum calorie deficit. One paper quoted in an article by Lyle McDonald puts the maximum calorie deficit as 31 calories per pound of excess body fat, it therefore follows that a person who is more overweight can get away with a larger deficit. We are all affected by a 'metabolism adaptation' as soon as we reduce calories to create a deficit however small our metabolism adjusts downwards (proportional to size of deficit and length of time at deficit).
Independently however it is worth mentioning that adequate nutrition is important, for example adequate EFA (essential fatty acids) to prevent skin from drying up and hair falling off, adequate protein etc - which means that below a certain number of calories eaten, it makes more sense to create the deficit with extra exercise rather than lower calories. And I've already given you a number-not-to-go-below, which was 1350 calories. (and you already know what happened when you ate 1100).
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SherylWilliams
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| Joined: | 21 February 2009 |
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| Posts: | 12 |
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Posted: 24 February 2009 06:03 pm |
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Thank you SO much!  For the first time in eight months someone has given me more in-depth information than I've ever been given. For the first time I feel like I have hope of my metabolism healing.
I think part of this is that my metabolism has really been affected through this process. The initial six months before the surgery when I lost the 30 pounds and went from 2000 calories to 1200 calories gradually over that 24-week period, my body had no problems losing weight. But then you have this surgery and for two weeks you barely eat anything -- just liquids. Then you start eating soft foods, etc. It took 6-8 weeks before I could eat any solid meat.
So basically I went from 1200 to nearly nothing overnight. Then I went from nearly nothing and ate 700-1100 calories for eight months and exercising like a maniac on that amount of food. That's a LONG time to be eating that little and exercising on top of it at the instruction of my surgeon, who is the expert in bariatric surgery! 
I don't understand why eating so little works for the majority of patients and not for me. I also don't understand why I spent six months in a health class taught by nurses, doctors, and dietitians, and was never told that my metabolism could be damaged in this process. And then to go to your doctor, who can't tell you what's wrong with you, never mention that your metabolism might be damaged -- they just take your blood tests and tell you you're fine. I don't understand why I, who have no medical background, had to find the answers myself and talk to someone halfway around the world to do it?! I'm just a little irked. 
I read another post you posted for another user (I think it was you!) where you talked about metabolism damage. Do you think that's really what this is? I also read this article today. Tell me what you think about it. It really does line up quite a bit with what you've told me. Make sure you also read Part II (the link for that is at the top right corner of the Part I page). http://leanbodiesconsulting.com/blog/2008/02/25/metabolic-slowdown-part-i/
How's the weather in England these days?! I spent six years in Germany in the late '80s/'90s with my dad in the US military, and I had the privilege of seeing England twice. I LOVED it and still think it's my favorite place in the whole world to visit! We toured London of course, but also got to go out to the countryside to Stratford-upon-Avon. I'll never forget that tour -- the tour guide told us about the miles and miles of bright yellow flower called rape (of all things) where you get much of your oils from. BEAUTIFUL country in April! The last time I went in '90. . . I actually saw the queen! I went to see the changing of the guard at the palace, and couldn't figure out why there were so many people standing there. Before I could ask anyone, a cheer went up, the gates opened, and she pulled out in a Jaguar, seated in the back. Unforgettable experience.
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Nir
Senior Administrator
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Posted: 24 February 2009 09:49 pm |
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You do raise an interesting point (regarding other patients not being affected). What you effectively did (eating 700-1100 calories) is called a VLCD (very low calorie diet). This is something which should ideally be supervised by a Doctor. In some versions of these, a company provides shakes and soups and obviously these schemes do work for a while. The question of course is whether they work for a majority or a minority of those that it is inflicted upon. In your case you don't need to wonder though, you know you're one of the people for whom it doesn't work for (logically speaking) you can't prove causation, it is PROBABLY the case that the sum total of what you did (surgery, low calorie, exercise) is what brought you to your plateau.
The blog you linked to is reasonably spot-on (for example I agree that it good to think of damage as reversible) but regarding the details: just as some metabolisms 'slow down' (adjust to fewer calories) relatively quickly and some relatively slowly, it is probably the case that repair takes longer for some than for others (the article mentions using a 2-week repair period at maintenance and one has to wonder whether that is enough, mind you, you've had a lot longer than that so that's enough for you). The other wishy-washy thing (again in Part II) was the formula for obtaining maintenance calories. For me at 125lb, 125x14=1750 is reasonably spot-on, but 240x14=3360 and I wouldn't want you to think that this is what you should be eating. This is an extreme example showing that a formula that works quite well at a narrow range simply doesn't work for people more at the extremes, so beware.
Thankfully things are back to normal but a few weeks ago we had snow everywhere and much of the UK had ground to a halt.
Rapeseed oil has a different name in the US = it is called Canola oil (exactly the same thing)
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Hellrazor
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| Joined: | 6 July 2008 |
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| Posts: | 872 |
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Posted: 26 February 2009 12:24 am |
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Kinda personal but during you 7 lb gain was their a special friend on it's way?? Women can put on weight prior to their monthly friend showing up?? My wife has noticed hers go up during week before
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rettalynn
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| Joined: | 24 September 2009 |
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Posted: 24 September 2009 02:39 pm |
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| I just found this website today, thank goodness. My situation is only slightly different than yours. It will be six years since my bypass this Nov. I made it down to 165 from 303. After that our stories are almost identical, except that when I get in a funk about not being able to lose anything and eat everything that doesn't crawl away I will gain 7 to 10lb. So in the 6 years since the bypass I've put back on 30lb. I am so relieved to finally have an answer. I do have one question, how long should I stay at the 1700-1800 cal a day before I start lowering it again. My height is 5'4
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