Gastric bypass surgery is an invasive operation where your stomach is cut, and your intestines are shortened to reduce absorption. It’s recommended for the morbidly obese and reduces weight by 30%. This is the first article of a journey of

a single 37-year old, obese man down this path.

I am a high performing kind of guy. The kind of guy that becomes a medical doctor, then does a graduate degree at an Ivy League School, and after all that, decides to dedicate his life to something else.

So, the real reason I got gastric bypass surgery — a complicated surgery where your intestines and stomach are cut in several points and folded origami-like into a Y shape — was because I wanted to be better. Secondly, I didn’t want to spend my life whipped by disease.

But most importantly, I was sick of feeling tired — all the freaking time. It takes me a couple hours in the morning to feel like myself — which I usually blame to being night owl. I was sick of a feeling of hunger that seemed apocalyptic, and beckoned me to drop what I was doing, drive to eat for an hour or two, and recover on a bed, my soul broken by lethargy.

I was simply sick of my body not keeping up with my mind.

I am 37, 310 pounds light and 5 feet 11 inches high. This gives me a BMI of 43 which puts in the charming category of “morbidly obese,” and a stone throw from “super obese.” The people who came up with these terms clearly were Hollywood blockbuster writers. I feel the two terms should have been instead “giant lord” and “titan” but alas they did not consult me.

Yet, due to my weight, I have developed sleep apnea — which I snore when I sleep — which makes me wake up tired. I have also developed acid reflux. And I’m inching towards type II diabetes, high cholesterol and high blood pressure. My blood tests already show a reduced sensitivity to insulin. My cholesterol and blood pressure are now borderline. I am a medical doctor, and know if I don’t act now, I will be rebuilding from the wreck rather than stopping the storm.

S-Day — aka Surgery Day

God, do I love anesthesia. One moment I’m chatting with the surgeon in the OR about what he will do next week for his next vacation (go to Miami and Orland with his kids, that’s what), and boom, I wake up, groggy, knowing that my tripes have been already swapped. It transformed one and half hours into an instant. What a joy.

I am now entering and leaving consciousness — memento like. My mouth is dry like balsa wood after leaving a couple decades under sand dunes — a thoughtful after effect of the anesthesia gases. Then I sense someone has punched my left lower torso. I cannot move. I try to speak, but the waves of sleepiness onrush over me, and take me down. It takes 3-4 hours after the surgery before I can have a conversation that lasts more than 2 minutes.

I look at my belly and I see this. Six tiny holes now covered up with gause- covered man holes. The surgeon did his magic through them with chopstick like instruments and cameras. Origami, chopsticks. This does feel like a Japanese experience.

Day 0

I am told by the nurse that the first 12 hours after the surgery I need to fast. Keep in mind I had fasted 12 hours before the surgery as well. I figured I must be starving, but I couldn’t tell with the combination of feelings of pain and seeming indigestion churning in the cauldron of my belly.

I close my eyes… hoping for time to fast forward. I fall asleep only for a few hours at a time.

Day 1: The Pain

I convince the doctor I am ready to start eating — not because I am hungry, but because I figure I should be. I couldn’t tell if I am hungry or just terribly uncomfortable.

He gives his ok. I can only have liquids for the first three weeks. The nurse brings juices, jello and a soup. I take two half teaspoons of jello, and I feel full. The kind of full you have after eating for an hour non-stop — when you hit a hard wall. The kind of full that threatens to become a reversal of the eating process. I can only take a teaspoon every 5-10 minutes. Ok.

I begrudgingly continue to eat — rather drink — not knowing what will happen once I get over the feeling of indigestion and discomfort. Will I become ravenous again? Will I fear food?

Day 2: The Calming

My pain has reduced substantially when I wake up.

After a long and worrisome wait, I have passed gases. Halleluyah!

My intestines must be properly connected and working. I can leave the hospital. The nurses hungrily look at the hospital bed multiplying in their head the additional revenue. Fair enough. I have passed gases after all.

I have to drink 1.5 liters of liquid per day in small teaspoon-sized gulps. If I don’t, I will get dehydrated.

I get dressed and go home and over 8 hours take down a 1.5 liter bottle of peach-flavored diet iced tea. I drink it in a tiny plastic cup filling it up every few minutes. It reminds me Japanese restaurants and how elegant it looks to dry just a clear liquid, over hours. I feel Zen, a master of my giant temple. I have built a Japanese empire over my belly, it seems.

Then it hits me. I haven’t had a meal in now more than 76 hours.

I have been drinking colored water. And yet, I am not hungry.

This is chilling: If I forget to drink, I might die.

I am strangely focused for those 8 hours, taking my Zen-like sips every 5-10 minutes. If it was a movie, and I was watching myself, I’d know the hero is making progress in vanquishing his opponent. He has no need of a break. He types away in his computer, takes a sip, and continues typing. The punctuation of ordering food, going downstairs to get it, and then watching a movie while eating is not missed. Strange and fascinating indeed.

I take a half-hour walk downstairs to keep my legs moving.

Then, it gets from calming to peculiar. I head to sleep at midnight. Usually, I’d stay up another 30 minutes watching a film and fall asleep.

This time I stay up six and a half hours. Not because I am anxious or cannot calm my mind. My body seems to be in no need to sleep.

I panic because I know I have a call at noon the “next day.” Typically if I fall asleep at 6:30 am, I will wake up at 1 pm at best. I would then spend an hour or two feeling groggy until I get back to normal.

I set my alarm for 10 am so that at least I don’t miss it. I turn off my Mac Book Air — because its battery is now at 2%. I turn over in my bed for about another half an hour and fall asleep likely around 7 am.

Day 3: The Surprise

I wake up at 9:30 am,

as if awakened by a refreshing Himalayan breeze.

Not only did I feel not groggy.

I felt as if I had not been asleep.

This is working. Even better than I expected. And I am not sure what is causing my reduced need for sleep or increased clarity. Is it the massive fasting my body is experiencing? Is it the lack of animal products? Is it the lack of solid food stuffs? Is it the absence of carbohydrates? Or is it the steady blood glucose my body must be experiencing?

Today, I will test it. I just made a delightful soup of boiled meat, celery, garlic, turmeric and onions. No carbs. No solids. No wild swings in my glucose to come. We will see what happens tonight.

Day 4: Carb-liberation

Last night, I felt my whole body itching. My belly, my chin, the back of my knees. So much so that my companion noticed some scratches beneath my face in the morning.

This is very good news.

I’ve always gotten a little itchy when I lose weight.

Of course, it wouldn’t last long because I’d go back to “rewarding myself” with a nice dessert. But now the itching is a sign of good things to come.

I lost 4 pounds since yesterday (306 to 302 pounds). It is unlikely it was all fat since you cannot lose that much in a day without doing the Iron man but it’s in the right direction. There’s probably some water loss as well.

Then came the sleep test from yesterday. I went to bed at 12:30 am. I purposefully did not turn on the alarm. And yet, like clockwork, I was fully awake at 3:30 am. I watched the second half of Anchorman 2 (glorious), and started doing some fascinating research (which I’ll tell you about in a second). Then I forced myself asleep at 6:30 am, and sprung up at 9:30 am, again so alert that it felt I hadn’t been sleeping. Six hours. That’s all it took.

How I feel after I wake up — before vs. after the gastric bypass

Typically, after eight hours of sleep, I still feel groggy. My mind is also swirling with many voices and ideas, leading to some difficulty to focus. This is why I usually medidate for 20-30 minutes before getting things going. But now…

Look at the picture above. The images reflect exactly how my eyes look after awakening before and after the surgery. You can see the tiredness in the top image. In the bottom one, I am ready to go, go, go.

Today, I felt no need to medidate. My mind: alert, ready, hyper-focused.

Given that yesterday I made a soup that included plenty of meat (though only drank the liquid), that kills the theory that it is meat that was making groggy. So, it could be due to the limited carbs, limited calories, limited solid food or something more fundamental about my body’s new wiring.

But this led me to wonder how have I survived now 5 days of almost absent carbohydrates. I’ve tried the Atkins diet in the past. If you haven’t, this is what happens. After stopping eating carbs, around day 3 or 4:

My mind would basically say: “Eat carbs now or die.

I will not let you think a single other thought.”

Nothing — not world peace, not money, and certainly not health —

felt more important than getting some coke — err, sugar.

So, around 3:30 am last night, I started to wonder why I was feeling so comfortable while carb-free.

My brain itself was hacked.

Now, I’ll put on my medical doctor white coat and walk you through something truly fascinating that may upend the way you feel about weight. You may stop looking at it as a choice, but as a feature of who we are, like the inborn color of your skin.

There’s a hormone in your body that causes hunger. This hunger hormone is made in your stomach and shuttled through your blood to your brain. When you haven’t eaten in a while, it rises. Right after you eat, it drops. When it is at its highest, you are hungriest. When it is injected in you, you eat more.

Take a look at the picture below. Focus on the big blue line. That’s how it swings up and down in normal weight people — driving you to eat, and then to stop.

How the hunger hormone controls you hunger cycle

Now take a peek at the green section. That’s what happens in people who have gotten a gastric bypass. It’s low and flat like a shallow rock. It does not rise before lunch, it does not fall after it.

No wonder I am feeling this way.

I have moved beyond the power of the hunger hormone.

This hunger hormone is most impacted by carbohydrates. Its their absence or presence primarily that make it swing up and down. But now, I can be carb-free and not worry a thing.

Now that we’ve gotten all sciency let me share just one more gem. Take a look at the thin, light blue section. That is how the hunger hormone moves in obese people before any sugery.

As you can see, obese make less of the hunger hormone, instead of more. This is strange and paradoxical. If the hunger hormone makes us hungry, why do obese people have less of it?

Then, the mystery deepens just a bit more. In people who are anorexic (those skeleton-thin people who refuse to eat), the hunger hormone is higher than normal. This is also strange. If they do want to eat, shouldn’t their hunger hormone be lower?

Although no one knows for sure the answer to this mystery, one thing it demonstrates clearly is that the difference between obese, “normal,” and anorexic people is not just about will power.

The chemistry itself is disrupted.

This helps explains a lot for myself. I have been told to have ample stores of willpower. I put myself through the craziness of 8 years of post-graduate education, and work extremely hard to get what I seek. Yet, I was overweight. Something didn’t make sense. It’s not about willpower alone or even mostly, there’s chemistry at work.

Day 5: Pain

Today, I did not feel very well. Let’s say my “evacuations” were very much liquid. Then, I noticed the tip of my tongue was tingly, which is a symptom I had experienced years ago when I became B12 deficient. I also felt dizzy and was having a hard time remembering things (other signs of B12 deficiency).

Turns out — from talking with the surgeon today — that it takes about a week post-surgery for the intestines to return to normal functioning. Will hope things become more “solid.”

I also ordered some injectable B12. When they cut the first part of the small intestine, you somewhat lose the ability to absorb calories (which helps with the weight loss) but also B12 and iron.

If you’d like to continue reading, the 2nd article (Week 2) is here.