Basic question regarding protein

I know the standard bariatric diet is protein, protein, protein, perhaps with a small side of non-starchy vegetables, but I'm curious as to why that is.

I understand protein is requred for healing, but once a patient has healed, what is the main purpose of the high protein? I often see people with protein goals of 100g-120g a day long after the healing phase, which is quite high unless someone is doing a very intense amount of exercise.

Is it primarily to fill up on protein so that you don't eat carbs?

Is it a concern about actually being deficient in protein?

Is it simply because that's what most programs recommend?

Is it something else entirely?

It's such a normal part of the day to day conversation in all bariatric communities, that I never really stopped to consider why people place such a heavy emphasis on protein long term. Perhaps it's different reasons for different people, but I was curious if there was a specific reason the majority of people embrace this approach.

I look forward to reading your responses.

Here's what I found:

The Importance of Protein After Bariatric Surgery

Protein should be included in all of your meals after surgery as it provides many important benefits to weight-loss surgery patients, including:

• Aids in proper wound healing after surgery
• Helps keep your skin, hair, bones and nails healthy
• Helps form hormones, enzymes and immune system antibodies that help your body function effectively
• Helps your body burn fat instead of muscle for healthier weight loss
• Supports your metabolism so you lose weight quicker
• Helps curb hunger between meals

Since bariatric surgery reduces the capacity of the stomach to a very small volume, high-protein foods should always be eaten FIRST or you may become too full to eat them.

Protein Goals After Weight-Loss Surgery

The recommended intake varies depending on your individual needs, your surgery type, and the bariatric diet prescribed by your surgeon or dietitian. However, basic guidelines include an average of 60 to 80 grams a day for women and 70 to 90 grams a day for men. Duodenal switch patients, however, require approximately 100 grams daily.

It's important to remember that more is not always better. Try not to exceed the range of recommended daily protein, unless instructed to do so by your physician or dietitian. Excess protein intake will result in excess caloric intake, and any excess calories that are not burned are stored as FAT.

Our post op diets really aren't all that high protein, but rather are closer to the "right amount" for our normal body needs (plus a small amount of extra for "fudge ") and not much else to keep the calories down; later on in maintenance, protein levels should be about the same, but fats and carbohydrates will be higher to attain our metabolic balance level of calories. In the early post-op weeks our diets will usually be 50% or more protein, while today my diet typically runs at about 20% protein - same basic amount of protein at a bit over 100g, but a lot more of everything else (and less supplements as that is what the food is for!) If I was engaging in a muscle building program, or healing from plastics, that would be more in the 140-150g range.

There are different approaches to determining appropriate protein levels, but most methods cluster around the same ballpark. The approach that makes the most sense to me is to look at the amount of protein needed to maintain our lean body mass' A small woman of around 5' height will have somewhere around 75 lb of lean mass to support,,which works out to around 50g protein per day; a 6' man may have around 150 lb of lean mass, requiring around 100g of protein to maintain. Add in a little extra under the premise that a little too much is better than too little, and the matter that most programs seek to simplify things so we get these general ranges that we often see - 60ish to 80ish for women and 80ish to 100ish for men.

Healing from major trauma such as major surgery or burns can increase protein requirements by 50-100%; the matter that we don't see such massive protein recommendations gives a clue as to how minor (overall) our surgery is, from a healing perspective - plastics/reconstructive surgery is much more major in that regard. Likewise, building muscle mass can boost protein needs by 50% or so, but one needs to do the work, and the right kind of work, to reach that goal - simply adding protein without the work just adds calories, taxes the kidneys and makes for more expensive urine.

Yes, many do overload on protein in preference to carbs as they haven't yet learned how to incorporate carbohydrates in their diet; most also supplement more than they otherwise would have to if they maintained a better dietary balance. Also, many may have yet to transition to a long term maintenance diet, as many programs simply emphasize the weight loss phase and may never help their patients transition away from it to something more normal and sustainable.

As it seems to be a normal part of most bariatric communities, I think that this is mostly a reflection on the demographic of most such forums - most on them are within their first year or so post-op where protein is a big concern; the monthly dinner/support group meetings that my wife and I attend is largely made up of veterans 10-20 years out, and there is very little concern about protein and carbs.

Thank you for the detailed and thoughtful reply.

I am surprised to hear your protein intake is about 20%, as I agree that is very typical for the Standard American Diet (perhaps even a few percentage points lower). If most vets are at that level, then I was just incorrect in my observationss, and that pretty much answers the question!

You raise a good point that online communities skew towards the pre-op or more recently post-op patients. Although, while completely anecdotal, it does seem a lot of vets are stll very protein focused (we do have regular AMAW challenges around here!). But perhaps that appearance is due to them often giving advicce to the recently pre-op as well.

I'm glad you brought up the potenitl need for increased supplementation due to a less balanced diet. I've often considered that, and even wrote it up as part of my origiinal post here, but decided to remove it to keep the topic focus on protein. But it's an interesting point as well.

Edit: typos

Most vets are going to have a somewhat higher percentage protein than I do, both due to a lower overall caloric level (protein requirements don't change markedly with lower intake) and the generally carbohydrate averse diets that many evolve into. If one needs 80g of protein, that is a bigger percentage of a 1200 calorie diet than a 2000 calorie diet,

There is also the belief that protein provides better satiety, which it does to a point (it generally has more enduring satiety, but slower to take effect,) but as with most things, the world is more complicated than what the diet books present, and most foods are not just simple protein, or fat, or carbohydrate, but combinations of them, and they all play together. Learning how to use them to best effect (i.e., nutrition science) can take time, and is more difficult if one is into avoiding one macronutrient or another. Such eating disorders seem to be fairly common amongst intermediate term post-ops (say, 1-5 years or so out) who often have a difficult time transitioning away from the more extreme weight loss diets they adopted.

Granted, the transition to maintenance is the weak point of most weight loss programs, particularly the non-surgical ones, so staying on a weight loss oriented diet is probably better than the alternative if they can't move to something more sustainable, but seems to be one of the costs of going the extreme dieting route which WLS should be able to help one avoid - that is one of the reasons that WLS has been so successful over the years, as it is relatively insensitive to diet so that one can concentrate on adopting healthy habits rather than agonizing over macro counts or whatever the fad of the day happens to be.

It does seem to be somewhat anecdotal, but when the subject of supplements and vitamins comes up, most of the VSG vets seem to report supplement levels more akin to a bypass or DS patient than a sleeve patient, so either they haven't been adjusting levels as their labs indicate, or they aren't getting as much nutrition from their food as they should be getting.

Love your replies - super well thought out and insightful.

I completely agree with you on nutrition science, and the benefit of a more holistic effect of nutrition as opposed to just macro or micro nutrients, but alas, that's probably a conversation for another day!

As an RNY patient myself that's two years post-op I only take a Centrum Multi vitamin along with a B-12 and Iron supplement. The Iron is no surprise given that it's a known issue with RNY patients and their malabsorption. The B-12 is also no surprise given the diet I chose to eat. My labs have been, and continue to be quite good. Obviously, I will monitor them over time.

I hope your centrum also includes calcium citrate. Seeing more and more posts about osteoporosis where people are not taking citrate.

A close family friend was just diagnosed with it.

The calcium in Centrum is in the carbonate form as opposed to citrate. My calcium levels have been good and I also get DEXA scans that allow me to monitor bone health. Also, being male, my risk for oseteoporosis, is reduced over that of a female. But it happens, and I try and monitor all health indicators available.

Dexa scans should help monitor...our family friend with it is a man. Blood calcium levels are not a good indicator from what I've read....only a Dexa scan.

Centrum (and most multi-vitamins) contain calcium carbonate, which is why you need to supplement with calcium citrate, and because multis don't contain enough calcium for bariatric patients. It is also recommended to buy multis that don't contain iron as iron blocks the absorption of calcium, and then to take the iron separately, hours later. Additionally, iron and calcium impede the absorption of thyroid medication so if you're on any, you will have to take all of them at different times.