How much protein do you really need?

[KathrynK]

If he gives you any flack, you can direct him to the Endocrine Society post bariatric nutrition guidelines. To quote, "2.1 We recommend that nutritional management should include: an average of 60–120 g of protein daily in all patients to maintain lean body mass during weight loss and for the long term. This is especially important in those treated with malabsorptive procedures to prevent protein malnutrition and its effect." https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2009-2128

 

[Munchkin]

Ridiculous!!!! Wrong! Terrible information to be giving out!

 

[Roudoudou]

From my post-op FAQ packet: "I feel like all I'm doing is taking vitamins and drinking protein all day. Can't I get what I need from what I eat?". Answer: "No, you can't. The amount or variety of food you will be eating after WLS is not enough to provide your body with the vitamins, minerals, and protein it needs to be healthy."

This is just so frustrating! I am a smart woman, but I also am the type who wants to trust the surgeon (they went to medical school, I didn't, blah blah). I just don't get why what the surgeon says and what the obviously well-informed veterans here say is so different. I've read enough now that I feel like I have a better idea of what's what but it's so stressful to feel like you have to question what is good advice, you know? Just curious what people's thoughts are. Seems like a real problem if advice is differing so radically and I will be interested in hearing my surgeon's take when I see him on Wednesday. Nervous to even bring it up, as I feel like he's going to think I'm challenging him but I suppose I am. Just the whole fear of little ol' me contradicting the super-smart surgeon and how that will be received.

 

[DSRIGGS]

From my post-op FAQ packet: "I feel like all I'm doing is taking vitamins and drinking protein all day. Can't I get what I need from what I eat?". Answer: "No, you can't. The amount or variety of food you will be eating after WLS is not enough to provide your body with the vitamins, minerals, and protein it needs to be healthy."

This is just so frustrating! I am a smart woman, but I also am the type who wants to trust the surgeon (they went to medical school, I didn't, blah blah). I just don't get why what the surgeon says and what the obviously well-informed veterans here say is so different. I've read enough now that I feel like I have a better idea of what's what but it's so stressful to feel like you have to question what is good advice, you know? Just curious what people's thoughts are. Seems like a real problem if advice is differing so radically and I will be interested in hearing my surgeon's take when I see him on Wednesday. Nervous to even bring it up, as I feel like he's going to think I'm challenging him but I suppose I am. Just the whole fear of little ol' me contradicting the super-smart surgeon and how that will be received.

Because the surgeons don't live with the DS. Most of them are much better at the surgery part than the follow up part, because in my opinion most of them enjoy the surgery part much more than the nutritional side of things.

There are exceptions to the rule. Dr K being the biggest as he just out of this world with his genuine concern for his patients' and even those who aren't his patients, well being.

Most of us just require so much more vitamin dosing than a normal person I think that it is hard for most Docs to wrap their head around it. The best advice is that your labs dictate the amount of protein and supplementing each person needs to do. I was messed up so bad by original DS surgeon that I have to get labs done every 30-60 at a minimum to make sure I am adjusting properly.

My suggestion regarding your follow up with your surgeon is to decide before your go in just how much of a battle you want to have. Most of us just nod, smile and then do what we know is right when it comes to diet and supplements. If you want to fight the battle then by all means do it. Sometimes I do and other times I just don't have the energy.

 

[southernlady]

I can't imagine that a 5' woman weighing 100 pounds needs the same amount of protein as a man double her size. Same goes for calories, fluid intake, etc.

The baseline recommendation I most often see is 0.8 grams of protein per kilo of ideal body weight. So, if your ideal body weight were 140 pounds (64 kilos) you would go 64 X 0.8 and that would give you about 51 grams day. Then you need to add 40% for a DS patient since we only absorb about 60% of our protein. In this case that's an additional 20 grams. So, if your ideal weight is 140 you need about 71 grams/day minimum. Of course, everyone is going to be different. Your labs are the only thing which can tell you whether you're hitting/missing the mark.

Finally, bear in mind that not all proteins are as bioavailable. Protein drinks tend to absorb much better than nuts, etc.

Again, follow your labs...

The problem with the mathematical part of that is each person's system is different. Doctors and Nuts use the math. We tend to use our lab values instead. My body weight is not far off of your example, and while I am not deficient in protein, I am lower than I like to be so I have been pushing protein (as in more meat). And I eat an average of 100-110 grams of protein a day.

Okay, protein lab values (and different labs use slightly different ones) are 6.0 to 8.3 (according to the NIH (Medline Plus). We, as DSers need to be above 7 ideally. Are you in trouble if it's below 7 but above 6, no, BUT you can get into trouble very easily in the lower end of the range.

Bottom line...watch your labs, watch your labs!

 

[southernlady]

From my post-op FAQ packet: "I feel like all I'm doing is taking vitamins and drinking protein all day. Can't I get what I need from what I eat?". Answer: "No, you can't. The amount or variety of food you will be eating after WLS is not enough to provide your body with the vitamins, minerals, and protein it needs to be healthy."

This is just so frustrating! I am a smart woman, but I also am the type who wants to trust the surgeon (they went to medical school, I didn't, blah blah). I just don't get why what the surgeon says and what the obviously well-informed veterans here say is so different. I've read enough now that I feel like I have a better idea of what's what but it's so stressful to feel like you have to question what is good advice, you know? Just curious what people's thoughts are. Seems like a real problem if advice is differing so radically and I will be interested in hearing my surgeon's take when I see him on Wednesday. Nervous to even bring it up, as I feel like he's going to think I'm challenging him but I suppose I am. Just the whole fear of little ol' me contradicting the super-smart surgeon and how that will be received.

Yes, they went to med school...BUT on the other side of the coin, even the person at the bottom of the class who passed is also called Doctor.

Doctors are not gods...altho many treat them that way. They are PRACTICING medicine, it's not an exact science.

I am far more willing to listen to MY body, question the doctors I can, fire those not willing to listen to my concerns, and listen to people who walk this life day in and day out for years.

 

[Clematis]

I have kidneys full of stones (again), so while I do understand that everyone should follow their labs, one must keep in mind that there is such a thing as too much protein. If you've ever had a kidney stone before DS and want the joy of more kidney stones (or want to experience your first one), follow that crazy doc's excessive protein requirements! But if you want to prevent kidney stones, limit your protein to .8 gram per kilo of body weight PLUS 40% to account for DS malabsorption. For example using .8 gram per kilo: 150lb weight = 68kg x .8 = 54g of protein + 40% (22) = 76g of protein a day. Those without history of stones may get away with 1 gram per kilo: 150lb weight = 68kg x 1 = 68g of protein + 40% (27) = 95g of protein a day. Remember to readjust your protein intake downward as you lose weight.

[Stone formation is complex and protein is only one piece of the puzzle. I have been researching kidney stone prevention -- and even contacted THE intl' known kidney stone researcher to ask about malabsorption procedures -- and am working on a detailed thread to post on kidney stone prevention for DSers.]

 

[aaa]

I drank one protein shake per day for the first 2 years, bc I couldn't eat enough to hit my protein target. Years 3-5, I had a shake occasionally. Since then, not at all.

 

[Munchkin]

From my post-op FAQ packet: "I feel like all I'm doing is taking vitamins and drinking protein all day. Can't I get what I need from what I eat?". Answer: "No, you can't. The amount or variety of food you will be eating after WLS is not enough to provide your body with the vitamins, minerals, and protein it needs to be healthy."

This is just so frustrating! I am a smart woman, but I also am the type who wants to trust the surgeon (they went to medical school, I didn't, blah blah). I just don't get why what the surgeon says and what the obviously well-informed veterans here say is so different. I've read enough now that I feel like I have a better idea of what's what but it's so stressful to feel like you have to question what is good advice, you know? Just curious what people's thoughts are. Seems like a real problem if advice is differing so radically and I will be interested in hearing my surgeon's take when I see him on Wednesday. Nervous to even bring it up, as I feel like he's going to think I'm challenging him but I suppose I am. Just the whole fear of little ol' me contradicting the super-smart surgeon and how that will be received.

Here's the hard truth. MOST docs get maybe 20 hours total of education on supplements/vitamins/minerals. And that 20 hours might be a bit generous. Next add in the surgeon factor. Surgeons are cutters. See problem, fix problem. Most don't have or want long term patients. Yes there are a few exceptions like Keshishian. After you are sliced and diced, you are pretty much on your own. You have to be willing to learn and advocate for yourself.

I'm sorry they gave you poor advice. But that's pretty standard. Most of us just sit and nod because we know better.