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[Dr_Adventure]

Greetings folks - so I was wondering about portion size as you get further out - I made a 2 egg white omlet with some 75% ff chedder and turkey breast and quinoa - it turned out to be 6 oz - I was able to eat the whole thing - is that normal being 4 mos out?  I know when I started I could not eat even 4 oz - Should I be worried that I've streched my pouch too far or is that about right for this far along - would love some thoughts from the knowledgeable folks here.

[MacMadame]

Everyone is different. It depends on how fast your swelling goes down, what you eat, time of day, etc.

And I wish EVERYONE would stop worrying that they've stretched out their pouches. It's a stomach... it really can't stretch that far and making it stretch is hard to do. It's not something you can do by *accident*. If you were overeating to the point where you were going to stretch out your pouch, you'd *know it*, damn it! 

The tissues in our new tummies do relax over time, which makes them bigger, but this is normal and natural and not the result of anything bad we've done. It's just how tissues react to being cut.

[Dr_Adventure]

That is why I was asking - as a newbie - these are the things I don't know - so it helps to hear perspectives

[baka]

Here's some info for ya about stretching the pouch......

Let me start off by saying:
I'm not a Doctor or Nut these are my opinions based on my research etc, blah blah.........

Stretching My Freaky Pouch

We get Freakified by having RNY our stomachs capacity reduced by well over 90%. A normal stomach can stretch, sometimes to over 1000 ml (40 to 50 ounces and is roughly the size of a person’s head), while the freaks pouch will be about 15 ml in size (1 to 2 ounces) - It's about the size of your thumb.

The Freaky pouch is usually formed from the part of the stomach at the bottom of the esophagus which is least susceptible to stretching.

Freaky Mechanics
When the patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if they had just eaten a large meal—but with just a thumbful of food. Most people do not stop eating simply in response to a feeling of fullness, but the patient rapidly learns that subsequent bites must be eaten very slowly and carefully, to avoid increasing discomfort, or even vomiting.

Food is first churned in the stomach before passing into the small bowel. When the lumen of the small bowel comes into contact with nutrients a number of hormones are released including cholecystikin (CCK) from the duodenum and PYY and GLP-1 from the ileum. These hormones inhibit further food intake and have thus been dubbed satiety factors. Ghrelin, is a hormone that is released in the stomach that stimulates hunger and food intake. Changes in circulating hormone levels after being Freakified have been hypothesized to produce reductions in food intake and thus body weight. However, these findings remain controversial.

The Freakfied Digestive Process
About 40% of the digestive enzymes required to fully break down simple starch-based carbohydrates is contained in our saliva (known as ptyalin). To break down complex carbohydrates, protein and fat, our body requires the addition of gastric acid and other digestive enzymes normally produced in the stomach. But our new Freaky pouch does not produce in any significant amount of gastric acid or enzymes. This is one of the main reasons why we need to chew, chew, chew really well.

Once food gets to the pouch, the digestive enzymes from our saliva and the limited amount produced by the stomach go to work on the food to begin breaking it down. Our pouch doesn't churn as much as our old stomach used to, but there is still some movement with that well-chewed food.

The longer food stays in the pouch, the more it is broken down and prepared for the intestines to do their work of grabbing micro and macro-nutrients from the food. If we wash the food out too quickly a few different things happen. First, if food is not properly prepared for optimal absorption (chewed well, mixed with enzymes) we risk having food move too quickly through our digestive track without the benefit of full nutrient absorption.

Second, if food is not well chewed or broken down, we are also at greater risk for intestinal blockages or constipation.

The Other Big Risk
There's also the risk of stretching the stoma (the opening between the pouch and intestines). If you have dense food that has not yet begun to be digested in the pouch and you drink fluid you are forcing dense food through the stoma prematurely. The opening is only about the size of a lady’s index finger, but if you habitually push food through the opening before its ready to go, you'll eventually stretch the stoma. This is far more worrisome than stretching your pouch. Once the stoma is stretched it can become the same diameter as the pouch itself. This would essentially create one big long tube that food can be packed into at meals. Need a visual? Stretching your stoma would give you a 20-foot long stomach.

This caution from surgeons is not a scare tactic. This rule is about biology and medical science because now you have to manually do the work of the pyloric valve that has been bypassed. By following this rule for the rest of your life, you’ll properly prepare your food to give your body the best chance of absorbing the vital nutrients it needs for survival as well as achieve the level of satiety needed to reduce hunger between meals.

How big will my Pouch Get?
A Surgeon did a study over ten years, He had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave him an idea of the size of their pouch at three month intervals. He found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs.

He then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.

How Much Food Should I Be Consuming?
You want to eat until you are satisfied. 1-1½ cups is pretty much the amount that most postops will eat when they are further out but some of that will depend on what you are eating (Salad vs. Dense Protein etc). Generally speaking regular meals larger than 1½ cups will result in eventual weight gain.

It is common to get to your goal and experience a bounce-back regain of 10% of your excess weight. The great news is that you can always lose the weight you gain.

It will be more difficult the second time around to lose weight because your malabsorption rate is at the highest it ever will be immediately after having your surgery. That is why you lose so quickly and easily the first year or so after getting Freakified. 

Remember
As we know to gain the maximum benefit from our surgery, it is important that we eat only at mealtimes and avoid snacks/grazing between meals, which can effectively "bypass the bypass".

This requires a major change in eating behavior, and alteration of long-acquired habits. The cause of regaining weight in the majority of cases is eating between meals, usually high-caloric snack foods and forcing food through the stoma prematurely by consuming fluids too soon after eating - Stick to the 30/30 rule!.

There is no known operation/procedure which can completely counteract the adverse effects of destructive eating/drinking behaviors.

Ian

[lolita1971]

It is, but the good thing is that you made a great choice in foods.

[shepkatt]

I would bet that on any given day you might be able to eat that same amount again.. but you might not.  It changes constantly.  Sometimes I can eat 2 eggs... Sometimes I can barely get one in.. and I am almost 9 years out. 

Be patient..  Don't stress out.   You can't screw things up this early out .. you just need to focus on following the rules to change your habits so that when you CAN screw things up a bit - you have changed your habits so you won't!

[mommchan]

Be patient..  Don't stress out.   You can't screw things up this early out .. you just need to focus on following the rules to change your habits so that when you CAN screw things up a bit - you have changed your habits so you won't!

Thanks for that since I'm getting closer I am stressing a little because I haven't kept up with all the updates and posts. But you are the Shepkatt after alll..... ha ha.

[lesliethequeen]

Ya know, I worry about this too occasionally...then I have a day where I can barely eat! I don't get it...it's a freaky journey, that's for sure...

As a former nutrition professional (doesn't that sound fancy?), I'll say Dr A, your breakfast sounds really healthy, lots of protein and low fat and not all that much volume. You did not get heavy eating that nice, healthy breakfast.  Don't worry - that evil/friendly pouch will give you a whack soon enough and you will be wondering if you will ever get to eat again!

Thanks for the good info Ian. I loved the story about the doctor measuring the pouch size every 3 months and it making no difference. I think after all the healing is done, the thing the pouch give us is the ability to think "Wow, I really do want that next bite, but I can live without it..." and to put the food down and walk away. I never could do that before.

You are doing great, Dr. A (What IS you name, anyway?) You should be proud of your success and your good choices! I'm proud of you!!!
Leslie

[Dr_Adventure]

Ian - that is exactly what I was looking for!  I was not really stressing over it = just curious - the eating is going well - have a good handle on eating this way (did Atkins for about 2.5 years) - but did not have portion size down (as that was not a part of Atkins - NOR did I have this tool).  I'm also starting to add more carbs (in the form of veggies, and whole grains - as I'm back in the gym) - so just having a sense if I'm in the right ballpark was what I needed.

The name is Christian (European Pronouciaiton - not the religion)

[Army Wife]

I would bet that on any given day you might be able to eat that same amount again.. but you might not.  It changes constantly. 

I couldn't agree more!!

[chellebee]

Once again, just great information. I have been wondering the exact same things...and it's reassuring to know that things are "normal"...some days I feel like I can eat and eat and eat...other days, a couple of bites is more than enough...I am so grateful to all of you that have gone first and are sharing your experiences and knowledge with all us newbies...you are all such inspirations!

[chellewins]

Huzzah Ian - I just love your freaky brain!
Good luck Dr. A - that was a great question!

I learn from all of these posts really.

Michelle