You have made a decision to start a new life...
Candace Chemtob, our Licensed and Registered Dietitian, is sharing with you some important nutritional information that every bariatric patient should know.
High Protein After Bariatric Surgery
Protein is an important nutrient after weight loss surgery because it promotes wound healing and protein synthesis. However, weight loss surgery patients are at risk for protein malnutrition. This is due to restricted intakes and the risk of protein maldigestion.
The building blocks of protein are smaller units called amino acids. Proteins are long chains of amino acids. There are 20 amino acids and of this nine need to be provided by the diet because the body cannot make them. Since our body does not store protein, unlike fats and carbohydrates, we must consume all the necessary proteins everyday to promote protein synthesis and depress protein breakdown.
When protein breakdown occurs due to an insufficient intake or increased needs, a message is sent to the muscles, or other critical protein structures in the body (internal organs, skin, blood cells to name a few) to breakdown. This leads to a loss of lean body mass. Studies have shown that lean body mass is lost during weight loss. But that by eating a high protein diet, the amount of lean body mass lost can be attenuated.
The goal for our weight loss patients, is that you stay as strong and healthy as possible after surgery. Therefore, we feel that a high protein diet is a priority. To achieve a diet with 100 to 120 grams of protein after surgery for the bypass and 80 to 90 grams after the lap band or sleeve surgeries, protein foods need to be eaten first and in recommended amounts. The highest source of protein foods are the meats and eggs, then diary, and finally tofu and textured soy proteins. We do not suggest nuts as a protein source due to their high calories.
“Protein first” should be your mantra. But why? As explained above, protein is critical after surgery and it must be supplied in your diet. Since your new stomach pouch can hold any a small amount of food at each meal, you must prioritize. Yes, broccoli is great, but if you eat your fruits or vegetables first, and become full, you will not be able to eat your protein food. Therefore, always remember, protein foods first!
When I interview patients before surgery and try to figure out their dietary habits, most will confess to being “carb lovers”. Now, this is not a very technical name, but as of yet science has not caught up with this reality and given it a name. Most of you have told me that one form or another of carbs are your “trigger” foods also. Over the years, weight loss has been successful only if you have severely cut back on your carb intake (Atkins, South Beach, Sugar Busters, you know them all!).
After weight loss surgery, you will not tolerate the complex carbohydrates (starches, grains). They absorb water in your stomach, expand and exert an uncomfortable pressure. Your pouch is just too small to tolerate them, and we are not unhappy about that because most of these foods are “empty calories”.
The simple carbohydrates (sugars) are going to cause misery in the gastric bypass patient, as you will experience dumping. For the lap band and gastric sleeve patients, if you make the decision to eat sugary foods, you will not be eating a healthy diet and your appearance and labs will show it. So for everyone, sweets must be avoided.
As unbelievable as it seems, you do need carbohydrates, but the right kinds. Our bodies require a minimum of 130 grams carbohydrate per day (Institute of Medicine, NIH). For the first year after surgery, this will be an impossible goal because of the size of your pouch and the emphasis on protein first. However, over time, we would like you to meet this goal. The foods that should be providing carbohydrates in your diet are fruits and vegetables! Fruits and vegetables also contain many vitamin and minerals and fiber (something you will need to be “regular”). Each fruit and vegetable has a different vitamin and mineral profile, so it is best to eat a large variety of these foods. Also, after the lap band and gastric sleeve, you will tolerate milk, another great source of carbs (and protein and calcium).
We know the keys to success and they are simple but require lifestyle changes. First, you must continue to eat a healthy diet. Second, you must exercise. Exercise is the key to success in the long run and study after study have confirmed this. It is recommended to exercise a minimum of 30 to 60 minutes per day most days of the week. When you are at your goal weight, this exercise should be as strenuous as possible (and this should be determined along with your physician). Thirdly, it has been shown that keeping food logs of what you eat, can determine your success.
There are two main elements of a healthy lifestyle: what you eat, and how much you move. Exercise is an integral part of a healthy lifestyle. This is not news to anyone. But do you really understand all the benefits of exercise? The benefits of exercise are far reaching and there is “no pill” that can substitute for exercise.
Of course, exercise has the benefit of burning calories and helping you to get to and stay at your new healthy weight. But that is just the “tip of the iceberg”. The benefits of exercise are much more far reaching than that. Exercise can reduce stress, improve mood, increase self confidence, and improve sleep. It can also increase lean body mass, increase bone mass, improve cardiovascular strength, increase good chloesterol and therefore reduce the risk of cardiovascular disease, reduce risk for several types of cancer, reduce hypertension, increase the immune system... Need I say anymore? Basically, exercise is key to a healthy lifestyle.
Don’t make excuses. The President plays basketball several times a week (and if you’re a Republican, President Bush jogged)! So don’t say you don’t have enough time. It is a matter of making your health a priority, like it should be. The Nike saying is “ just remember someone busier than you is jogging right now”.
Some of you have had physicians tell you that your ideal weight is some ridiculously low weight that you haven’t weighed since you were a child. They are using the “Ideal Body Weight” charts developed by an insurance company. Our version of an ideal weight is different. Your ideal weight is your HEALTHY weight.
After weight loss surgery, our aim is to get you to a BMI of 30 or below. At that weight you should be healthy. Being healthy means that your weight related illnesses have been resolved like high blood pressure, diabetes, reflux disease, and others. Statistics show us that at a BMI of 30 and below you are at lower risk of developing these and other weight related illnesses in the future.
You really have a window of opportunity to reach your healthy weight. This window is between one year and eighteen months for most patients. Make the most of this opportunity and follow our dietary and exercise recommendations, along with making your regularly scheduled appointments.