I have sat down to write this post maybe 5 times now. I meant to post something in June, but it flew by. Then I meant to complete something in July and it came and went before I could finish anything. Now it is August, and I'm sure you all are wondering what the heck is going on?! With work, walking the dogs, house projects, gardening, and staying safe amidst a global pandemic, I have been staying quite busy. I have been feeling really well lately and have been taking full advantage! The only problem is, I have continued to loose a bit of weight here and there. According to my Apple Watch, I have been meeting my move and exercise goals almost daily, but with those added burned calories, comes the need to eat even more. And, I’m not sure how to do that since I already feel like I’m eating constantly! Hopefully everything will even out one of these days. I think my BMI is at 21 or 22 now, so I’m still in the safe zone, but I have definitely far surpassed the amount of weight I thought I would loose initially. And, since I have some really cute clothes I can’t wait to wear in public one day, I don’t want to shrink out of them before I have a chance to wear them out of the house. Dang COVID.
This probably goes without saying, but loosing my stomach to cancer, has completely changed my relationship with food. I enjoyed my stomach for 33 years, but that came with its own set of challenges. Maintaining a healthy weight for instance, was something I struggled with from the time I was in my mid 20's into my 30's, and then through breast cancer. When I found out my stomach would be removed due to a stupid genetic mutation, and because my doctors had found cancer in there, I went on a stomach send off #mystomachbucketlist. I was the heaviest I had ever been from chemo, medically induced menopause, and eating my way through the Twin Cities. Saying no to unhealthy foods was difficult because I didn't know if I would ever be able to eat them again.
With a stomach, you don't have to worry about many unwanted side effects from eating junk. You also don't have to worry about eating the wrong kinds of calories, because stomachs are built to handle that. You don't have to worry that you won't absorb certain nutrients, or that you may not get in enough calories to maintain your body weight. Because, you can always eat more, or make up for a bad food day. This is not the case without a stomach. Each bite, literally counts. Each morsel that enters your body, needs to contain essential nutrients, or you have to be prepared to potentially suffer ill consequences.
So, although I was mentally prepared to eat smaller portions, and limit sweets after surgery, I wasn't aware of all the intricacies that eating after my total gastrectomy would entail. From the emotional trauma of feeling like I would never be able to enjoy a "normal" meal with my family again, growing up in MN, food is VERY important socially. Something I didn't realize until I thought it was gone. To the physical trauma of going through such a major surgery and then inevitably loosing a whole bunch of weight and muscle mass due to being unable to eat large quantities of food. Also, the odd guilty pleasure I took in loosing weight, without having to try, and without having to work out like a mad woman. It is like survivors guilt, but weight loss related. Yes, I know how weird that sounds.
In the nearly 11 months since my surgery, I have learned a lot about food. Not everything, but a lot more than I ever knew before. This new knowledge is out of necessity. I count every calorie that goes into my body. I learned to do this by tracking everything in a fitness app on my phone, but now I do it from memory, and could probably recite everything back to you if you really wanted to know. I count protein, sugar, and liquids, among other things. I learned early on that even thick liquids like soups, shakes, and the like, count as liquids when you are struggling to drink and plain water is nearly impossible. I read all ingredient labels. Instead of always trying to limit calories, or unhealthy foods, my whole outlook has changed to increasing things. Like, increasing liquids. Increasing grams of protein and healthy fats. Increasing calories to be able to maintain weight instead of loosing. Figuring out ways to increase calories in small portions by asking myself questions like, can I add butter to that? Does mayo go with fries? and then answering, heck yes! I look at serving sizes on food labels and set a serving as a goal which I understand is the total opposite outlook than most Americans. Instead of trying to figure out how to limit myself to ONLY get one serving I strive to reach that serving and if I do, I do a little victory dance. I also try and eat as many meals per day as possible. I usually get in about 5-7 small meals as long as I don't get too distracted or lazy. Eating is hard work! Trying to figure out what you are going to have for dinner is one thing, but trying to figure that out as well as several more meals throughout the day can be exhausting!
You see, I cannot eat the quantities I once could. Without a stomach (or food holding and mashing chamber) my food goes directly from my mouth, to my esophagus and into my intestines without passing through any valves or chambers. This means I have to chew everything to a mush. When's the last time you sat and chewed an entire meal to a puree? I know I never did before it became a necessity. Try it some time. See how long it takes you to eat. See how sore your jaw feels after eating a tough piece of meat. There isn't much room in my newly formed digestive tract, so small and frequent meals are just a part of life now. Sometimes if I eat too much, I feel like I used to after a huge holiday meal. It is like a mini food coma that goes away surprisingly fast. Sometimes my now flat abdomen protrudes like I'm several months pregnant because the food has nowhere else to go but out. But, this too goes away quickly, in fact, if I just go for a short walk, it goes away. I like to explain it as, I either feel like I am going to burst because I feel so full, or I feel like I am starving, and there is very little in between.
When every bite counts, you have to choose what is best for your body. It is no longer a choice, and in a way that makes it easier. You automatically cut down on carbs, because they don't contain protein, they fill you up, and have little to no nutritional value. No one has to tell me to go on a low carb diet, because I just can't eat them for the sake of not having the room. There are no cheat days, so I don't have to worry about feeling guilty about that brownie, or entire pan of brownies I just devoured. I can't do that even if I wanted to. It's amazing how cravings go away when your mind realizes it just isn't possible. I also think my body has adapted to this new plumbing, and knows what it needs, so I try and listen. If only there were a pill that could switch your mind over to how I now look at food. It is like classical conditioning in a way. I try something, it makes me feel horrible, so I don't eat it again, or at least not for a long time. Now, that is a million dollar idea if there ever was one!
So, let me summarize the stomachless "diet" for you. And, by the way, I put diet in quotes because unlike most diets, I cannot cheat or else I pay the consequences which can sometimes be severe. I cannot stop the diet whenever I please, or because I want to go on vacation. And, most importantly, I cannot get lazy and ignore this diet, or rely on what those around me are eating, because every bite and calorie counts, and I cannot afford to loose more weight.
The stomachless "diet,"as defined by my own experiences over the course of the last 11 months:
Aim for 50-70 grams of protein per day;
Limit filler foods, these are foods that have limited caloric value (i.e. carrots), or take up a lot of physical space with limited nutritional value (i.e. bread, rice);
Strictly limit added sugars. Natural sugars are fine in my experience (like those in fruit), but added sugar is dangerous. Too much, too quickly can lead to early dumping syndrome which happens about 30 minutes after eating (very unpleasant feelings of racing heart, nausea, diarrhea, profuse sweating, etc.). If early dumping doesn't happen, then 2-3 hours later, something which I learned about much later in my recovery, is what is called late dumping. Late dumping happens when your blood sugar rises quickly while eating the added sugars, and your body releases insulin to cope with the sudden rise. That insulin, in turn, lowers the blood sugar over time, but often results in it being lowered too much. At that point, usually several hours after eating, you start to feel light headed, tingly, shaky, start to feel really hungry, crave sugar (go figure), feel thirsty, and break out into a cold sweat. At this point, it is vital to eat a protein rich snack along with simple carbohydrates to raise the blood sugar quickly, and then maintain it with the protein source. I have found that plain greek yogurt works really well in these instances. I learned all of this after trial and error. It is important not to give in to the sugar cravings during late dumping because it turns into a scary cycle that repeats itself every couple of hours. That only had to happen to me once before I frantically called my amazing dietician and she helped me work through what I was eating and what the problem foods were.
Eat 5-7 small meals per day. And, I mean small. Like, half of a sandwich, and some chips. A serving of greek yogurt. A piece of string cheese, a hardboiled egg, and a few pretzels. Or, 4 small meatballs and a 1/4 cup of mashed potatoes with bone broth gravy. To name a few.
Aim for 1800+ calories per day. Right after my surgery, I was lucky if I could shove down 600 calories in a day. Now, I am averaging 1500. On really good days, I can get in over 2000. On my worst days now, I still manage at least 1200.
Sip fluids between meals, all day long. With a goal of getting in 60 ounces. This is one goal I still haven't reached. I am getting close, but I get really full with liquids still, and I usually prioritize food because it contains more calories and nutrition.
Don't forget those pesky vitamins. A specially formulated multivitamin with Iron and mega doses of b12 is a must. Along with calcium citrate, since it is the only calcium that can be absorbed in stomachless folks.
And, that's it in a nutshell!
I am going to be better about writing you guys. I am off to the NIH at the end of this month for my 1-year post operative appointment. Should be interesting to fly and stay in a hotel after being holed up in my house for the past 5 months. Also, the NIH is on COVID lockdown, so I have to go to my hospital appointments alone (weird).
Hope you all have enjoyed your summer thus far, and are staying safe during this trying time. I will talk to you soon.