I’m in a place of disbelief.
I have lost 190 pounds. Twice! That isn’t multiplying several diet losses or my total weight loss since I was 10 years old. That is in one fell swoop, I have lost 190 pounds. Twice.
First was with my Roux-en-Y Gastric Bypass in 2001. And this time, it is with my hard work mixed with two different GLP-1s. The first was Trulicity for a year and the second is Mounjaro (which is a dual agonist being a GLP-1/GIP combination) for five months so far.
I want to talk about which path to wellness was easier for me; the RNY Gastric Bypass or the GLP-1s.
April 5, 2001 RNY Gastric Bypass
My starting weight was 360. My labs were terrible! My HbA1c was 8.6, triglycerides 333, my cholesterol had numbers inversed, Fatty Liver Disease, Chronic Kidney Disease 3a, and an appetite that was voracious. The only answer to not dying way before my time was by having an RNY Gastric Bypass (RNYGB).
The surgery went well and while the initial week’s recovery was rife with pain, after that first week I did okay. During the week after surgery, I had abdominal muscle spasms, tubes oozing gross juices coming out of my belly, and an incision that went from my belly button up to my sternum. Back in the olden days, I was too fat to have laparoscopic surgery. They didn’t have long enough tools to do them on super fat folks like me yet.
Eating After My RNYGB
The first month was nothing but sipping. My blood glucoses went from horrible to normal almost immediately. I sipped clear broth, water, and Isopure. We had a refrigerator full of Isopure bottles. I liked grape best. Even sipping, the liquid would sometimes clog in my now shot glass-sized stomach or the stoma (opening) that leads down to the intestines… hard to tell which.
If there was a clog, I had to, really uncomfortably, wait for the liquid to dribble down the chute because I willed myself not to vomit with all the equipment, from staples to big plastic tubes, decorating my stomach. The thought of hurling and popping a 10-inch row of staples or shooting tubes out of my gut was not appealing at all.
That clogging experience happened the entire first year.
After the first month, I was allowed to eat. It was supposed to be protein first always and forever, but getting any protein down was impossible. It got so stuck, I vomited every time. Previous to the RNYGB, I never allowed myself to vomit. 20 years later, thanks to the RNYGB, I am a pro.
So I ate what I could. Now this is the grossest thing I could have eaten, but it’s what I could keep down. I don’t even know how I thought to eat it, but there I was. Eating SpaghettiOs. I’d bought baby spoons in preparation for post-surgery eating so ate one or two Os at a time. One or two Os every 10 minutes. The thought of eating those now is revolting, but they served their purpose then. My surgeon kept telling me to eat protein first and I tried baby food chicken, but it was horrid.
My diet expanded to Kentucky Fried Chicken’s mashed potatoes and gravy, more gravy than potatoes. As I could eat more variety over the first few months, I ate chili from Wendy’s, one baby spoon bite at a time of the meat and masticating the bean until is was pulverized. Odd how we rarely made something normal to eat, didn’t whirl the food in the blender, or mash it with a fork like one does for babies learning to eat. Not sure why, but I suspect it was habit to eat fast food and continued the habit post-surgery. That didn’t bode well, but I thought I was doing amazingly well.
I was losing many pounds a week. I lost 60 pounds in my first four months. 100 pounds by six months. I couldn’t have been eating that badly, could I have been?
Dumping Syndrome (Not What It Sounds Like)
Dumping Syndrome is when the body takes food, usually sugary or high fat foods, and dumps it from the new stomach directly into the intestines without digesting it. Then the body wants to dilute it to help it digest, so fluids flood the area, pulling from other locations. This all happens in the first 30 minutes after eating the offending food.
I dumped bad. I don’t remember what I ate, but clearly it was not what I should have been eating. I thought I was going to die from the feeling. I had to lie down, curl into a ball because my guts (not my new stomach) hurt so bad. Within a few minutes after that, I had diarrhea that I never wanted to repeat. In fact, I said I was thrilled that I had dumping, not everyone does after an RNYGB, because it was great negative reinforcement for me.
The problem was I didn’t know in that first year, what was going to cause dumping and what was not.
Two months after surgery, I met a friend at Napa Rose, a beautiful brand new restaurant in the new Grand Californian Resort. The Grand Californian is a Disney Resort and I knew it was going to be a great night.
I had been a food writer for a few years, mostly reviewing restaurants at Disney World and Disneyland, so was used to talking to chefs. When the chef came out, I explained my new situation and he offered to make me a wonderful tomato-cream soup. Nice!
My friend and I were talking when the chef brought the soup and, oh my, was it delicious.
Then I began to dump. I was mortified and ran to the bathroom, going into the handicapped section (these restrooms had doors that closed from floor to ceiling) and sat on the toilet to suffer in private. Then I felt so ill, I had to lie down on the floor. I did not even consider how gross that was until I was safely back home. I could only pacify myself with, “It was brand new and was pretty clean.” What I could remember of it.
My friend came in to check on me and when she heard me moaning and crying, told the manager to call 911. Within minutes, EMS guys were there, in the bathroom space with me, taking my blood pressure, my blood glucose, checking my heart, etc. I could hear them telling me they were going to give me insulin and I told them I had low blood glucose, not high, to please not give me insulin. One guy said, “She’s right!” There I am, writhing on a bathroom floor, trying to explain dumping to EMS. Today, they are well-versed in dumping, but this was the early days of gastric bypasses.
Once they left, I sat in the bathroom with horrific diarrhea, but once I was feeling better, paid my check and drove back home to San Diego, feeling like crap.
It took talking in the forums to figure out it was the cream in the soup that had done it. I did not even know one could dump from fat at that time! And I was very well-versed in the surgery and after effects, but that was a new one on me. I dumped on Fettucine Alfredo once at Olive Garden a couple of years later. That was fun. I did not get on the bathroom floor, but sat in the car until I could drive the mile home, praying I didn’t poop while driving. I did not.
Some negative reinforcement, eh?
One Year Anniversary of the Gastric Bypass
At one year, I had lost 190 pounds. It was crazy how different I looked!
But best of all, every lab was normal. I was no longer on diabetes meds, my fatty liver had healed, my kidneys had not gotten worse (the best I could ask for), my cholesterol labs were normal, my triglycerides were at 100, and I was incredibly mobile. Enough that I was finally able to finish becoming a Licensed Midwife and could move around at births easily. I was at the gym three times a week, riding a bike a couple of miles a day, and walking everywhere.
I had been thrilled with my surgery. Until I started gaining the weight back. I gained back all, plus much more. (Another post for another day why and how.) And still, 23 years later, have ongoing negative effects from the RNYGB. You can read about that here.
Losing 190 Pounds with GLP-1s
When I started this GLP-1, 190 pound weight loss excursion, I didn’t know I was on the road to weight loss. All I knew was I needed to save my own life and change everything I had been doing up to that point. You can read about the path to changing my life’s trajectory in “What I Eat (& Don’t Eat) on GLP-1s.” Know, though, that I was oblivious to Trulicity’s ability to help me get healthy beyond thinking it would help me use less of the two insulins I was on.
I had lost 40 pounds in four months just by stopping Uber Eats, then another 86 while on Trulicity. I know it’s crazy to think someone didn’t pay any attention to that kind of dramatic weight loss, but I was not on any social media. I don’t watch TV. I don’t search out ways to lose weight anymore, having given up on diets many years ago. I did not know weight loss was a side effect of Trulicity beyond a few pounds. I thought I was doing a great job with clean eating and not drinking any more amaretto. I still think I was!
However, when I learned about Mounjaro from my daughter (who is also on the medication), I was intrigued and wanted to know more. That was six months ago and I have become a voracious reader of anything GLP-1 related, including poring over the GLP-1 studies. I also read dozens of first-person stories a day. I also read as much as I can about all aspects of the medications… from social, psychological, and medical, to the dietary, scientific, and economic parts of the GLP-1 puzzle. The last time I was this immersed in a topic was when I was studying to be a midwife.
The Last Five Months on Mounjaro
I know it might seem premature to judge whether the RNYGB was easier or the GLP-1s, but I have been on them for 17 months, so I think that’s a fair shot to use as a comparison.
I never had any side effects with the Trulicity and have barely had anything but some firmer stools with the Mounjaro.
One fantastically great thing about Mounjaro is not having food noise anymore. I call it Food Cacophony. My mind can think now. I am not continually on the hunt for food, more food, and even more food. I don’t obsess about when or how I can get more food. I no longer hide food. If you haven’t had food noise before, it’s a ticker tape of continual bullying to eat more, find more, make more, get more of anything we can put into our mouths. Glorious silence reigns and just for that affect alone, the GLP-1s are worth it.
The absence of food noise has a sister called Just-Not-Hungry-Anymore. I always laughed about how naturally thin folks would say, “I forgot to eat lunch,” or “I have to remind myself to eat.” I could not comprehend what they meant and even thought they were lying. And now, here I am, having to set an alarm to eat something and check it off in my planner to make sure I ate that day. I know some people call this a “side effect,” but I think it is the normalization of our bodies’ biochemical makeup. I know that I do discover hunger after walking a couple of miles, but generally don’t feel that urge, or even desire, to eat if I have not been moving around a lot during the day. I eat anyway, but very small amounts. Not as small as after the RNYGB, but infinitely smaller than I used to eat.
Stability & Happiness
I have Bipolar Disorder 1 and have on and off issues of mania and severe depression, but I have been my most stable while on the GLP-1s. I’ve looked at my records to see if this stability happens when I am losing weight, but that has not correlated with when I was on Fen-Phen or after the RNYGB. The first year after starting Fen-Phen and the first year after the Gastric Bypass, I had severe bouts of depression five and seven months in.
Whether it is changing my eating habits, not drinking, my labs correcting themselves with or without my weight loss, whatever it is, I feel amazing. I have stresses (and some very worrisome ones), but I have been able to compartmentalize them and deal with things one at a time. I’ve completely redone my room including decluttering stuff I didn’t need but kept for decades. I sit at a desk instead of working from bed. I no longer need wheelchairs, my walker, my canes, or people to drop me off at the front door.
I’ve only recently begun to walk every day. Starting when I took myself on a two-hour stroll around the EPCOT Resorts the 29th of December 2023, I have walked almost every day since. Before that, the walks were infrequent. Now I feel weird if I don’t go for a walk. Last month, I could walk a mile at a time. Now, I am at 2.5 miles in one trip. Last week I walked 11.76 miles. MILES! I am walking MILES in a week. It’s shocking.
I’ve been using the resistance bands for months and just got myself some hand-weights. I have lost a good deal of muscle (one down side of Mounjaro, but one I can live with), so am going to lift weights (light as they are) to regain some muscle and concurrent strength.
The True Test: Lab Results
I did have a great deal of lab improvements with the RNYGB. But I also have life-long deficiencies that I need ongoing medical help to remedy.
My labs are amazing with the GLP-1s. Diabetes is in remission. Lipid Panel all within normal limits. Chronic Kidney Disease 3b has lowered to a 3a. My liver values are okay, better, but I have a spot on my liver that needs a biopsy, so that might be something. My blood pressure is on the low side of normal. No more heart palpitations. I am off five medications since starting Trulicity, leaving me with just my psych meds and a heart medication (COVID bit my heart). I am in Physical Therapy for the osteopenia hip issues and am able to do my exercises easily and as prescribed.
Final Verdict?
Unless I end up with lifetime issues like I did with the RNYGB, it’s easy to say that being on GLP-1s is far easier than any of the experiences I had with the Gastric Bypass, especially if we look at the first 18 months of each. Reading the research of GLP-1s over the last 20 years, I would say things are looking great to land deftly into the GLP-1/GIP camp.
I love my GLP-1 and GLP-1/GIP life.
Onward Ho!
