Basic question regarding protein

Your surgeon doesn't recommend you follow ASMBS guidelines on supplementation? It might behove you to do some "research" on this subject too.

No, he doesn't. His standard approach is to start with a multi vitamin and add in any needed vitamins based on blood test results. I'm familiar with the guidelines, and I also not only review my blood work results, but track them over time to look for any concerning trends. It was based on blood work results that he added B-12 and Iron.

The B-12 was the very low end of acceptable, but bounced back very quickly with supplementation.

The Iron never reached low levels but was trending down over a few visits so he added Iron. It has stabilized at mid-normal ranges.

All other levels have been good and holding steady. I don't, personally, feel a need to add supplements if my blood work shows my levels are good. I will, of course, regularly monitor and track my blood work and take any corrective action as needed.

Maybe bear in mind that it's easier to maintain a level than to attempt to right a deficit. Not all deficiencies are as easy to correct as B12. Also, bear in mind that deficiency in one vitamin often correlates to impending problems with other vitamins and minerals, even when those levels appear normal.

I get that you admire your surgeon, but remain vigilant yourself; noone cares about your health more than you should and his program sounds rather cavalier and somewhat egotistical.

Aside from the cavalier and egotistical part, I completely agree with you. And you are certainly entitled to your opinion regardless. That's why i monitor and track all my results to watch for any trends. While only 2 years out at this point, my blood work has been very consistent to date. The the B-12 and Iron were addressed within the first 6 months and things have been very stable since.

I'm really disappointed that your surgeon's practice didn't bother to explain this to you. The reasons are pretty standard:

You need to consume extra protein because your RNY is inducing malabsorption of protein and other nutrients. This is also why you are required to take extra vitamins, but there are no pills that give a megadose of protein, so eating or drinking it are your only options.

Bariatric eating dissuades starchy vegetables because they are higher on the glycemic index and more easily absorbed by your body than green vegetables. The green vegetables also help with digestion, unlike starchy vegetables. As you lose your weight, you can enjoy them more but find that balance as you learn the effects of them (some get consitpated) or when you see your weight rising, cut back on them.

My surgeon has an extremely high emphasis on nutrition and spends a lot of time educating his patients on his nutrition program. It?s just that his program is not a ?protein first? approach, therefore I didn?t get the same instruction that those who are on a ?protein first? approach get, which is why I was curious. I realized I didn?t often see/read the background on why so much protein was required and was curious what people in those programs were told. I definitely understand my surgeons approach and his views on amounts of protein and why.

Appreciate your response/info. Thanks.

What does your surgeon say about non-vegetable carbs? I really like his veggies first philosophy.

He's strongly advises avoiding all refined carbs. Added sugar and flour are definitely to be avoided. Sugar in fruit is fine, in fact fruit is recommended.

He is not a big advocate of whole grains either, and to be honest I'm not entirely sure why. He did recommend I add in oatmeal and brown rice as I was transitioning into maintenance given my weight continued to drop.

I actually have a follow-up appointment with him on Tuesday, and the main topic I plan to discuss with him is whole grains. I've been adding them into my diet in moderation, and plan to continue doing so, but am curious as to why he doesn't promote them (even moderately discourages them) on his plan.

I'd be happy to let you know what he says. I'm sure he will support me adding them in given my current weight and duration of weight consistency (although I've actually lost a few more pounds, which i know he will not be pleased about, but this is an area in which we are not in total agreement ;-) ). What I'm not sure about is what he'll say in regards to why he doesn't promote them more broadly.

My macro goal is 25% protein and I still do eat low-carb. So, overall it's not really any more than 'normal' but I do get 100-120g of protein/day.

I always focus on consuming it before anything else, because it keeps me full the longest. I generally can't eat much more than the protein and then a few veggies.

You're going to get completely different answers depending on the type of WLS someone had. For me personally, the answer to all of your questions is yes. I had the DS, which means I have a shorter common channel and don't absorb everything I eat (or take in as with vitamins). If I didn't eat a high protein diet I would become severely protein deficient, which will lead to all kinds of problems. I limit carbs because carbs turn into sugar, which I absorb 100%. The amount of carbs I eat is in balance with maintaining my weight loss.

You had the RNY so depending on the amount of malabsorption you have (distal or proximal) you need higher protein amounts because you're malabsorbing some of what you eat. For those people with the VSG, they have no malabsorption so once they're healed its finding the balance for weight loss and maintenance.