Now what?

Hi. I had a roux en y laproscopic gastric bypass surgery in august  2008. it has been just over 8 months. I eat seafood for protein or i drink protein shakes for protein. i rarely eat vegetables (but when I do they are generally green such as broccoli, zucchini, spinach and salad greens). i enjoy fruit but don't eat much of it (I like green apples and mango most). For carbs I am all over the place. I eat potatoes, breads, rice, pasta, and all types of bad junk food (chips, ice cream, cookies, candies, etc). So far I have managed because I exercise. The worst effect is that I've not lost any weight in over two months (although I haven't gained any either). My question is what does a day's meal plan look like for a person who's had gastric rny bypass and is 9 months out? I'd like to cut the junk (harder than it seems, I've been trying) and add in the healthy. I talked to a lady yesterday who is over a year out and she says that I'm having too much protein (generally 60 or more grams a day) and not enough vegetables and carbs. Although I am eating the junk and shouldn't be, I still worry about the other carbs and don't know which I should eat and which I shouldn't and how much I need of all the food groups. I don't do dairy products (even the ice cream I sneak here and there, had an effect on my stomach).  I do take my vitamins daily. I would appreciate as much detailed advice as possible. I don't have a surgeon who is active in my after care. My family doctor says he isn't worried about me because I've lost enough weight to make me not obese and the rest will slowly come off (he was against my surgery in the first place).  Sincerely,  Sammy 

Hi Sammy -  It sounds like you already know the answers to your questions.  Here's what my take on things are: *  Stop eating junk food - you know better than that!  You had this surgery to be HEALTHY, not to fill your body with the crap that got you obese in the first place.  Stop it right now! * Cut out all "simple carbs" --- this is the stuff that converts fastest to blood glucose and spikes your insulin levels which then causes you to be hungry again quickly.  This is going to include all "white stuff" like white flour, white sugar, white pasta, white rice, white potatoes, etc.  Instead you should focus on whole grain and complex carbs which takes your body longer to digest and provides healthier nutrients.  These should also be limited, but will include things like whole grain bread and pasta, brown or wild rice, fruits and veggies. * Yes, fruits and veggies are carbs and these are the types of carbs you should be filling your body with instead of the startches you mention.  Your brain depends on healthy carbs to function so it's important to feed your body healthy carbs regularly. * 60g of protein is not too much.  That is a good target to shoot for daily. * Your doctor is an idiot!  (oops!  did I say that?)  why would he say eating junkfood is perfectly find as long as your'e not obese?  I know plenty of thin people who abuse their bodies with bad food - just because they are thin doesn't mean they're healthy. * Your pouch is a tool that will work for you for the rest of your life.  But you have to follow the rules and treat it with kindness.  If you fall back into your old habits, you'll end up right back in the same place you were before your surgery.  Weight regain is a very real possibility and one you need to have at the front of your mind at all times --- it'll force you to stick to the rules and eat healthy. HTH Pam

Pam, Hi and thank you for the insight. I wonder still about the carbs. I ask because I am reading (re- reading really) this book written by a woman who's also had wls, "Before and After" by Susan Maria Leach.  In the book she talks about carbs, mentioning a daily total of 25 grams per day... Is this accurate for me at 9 months out, and will it be the average amount I strive to maintain from now on? Also what about fiber? If I am getting my carbs mostly from vegetables and fruits, does that cover enough fiber? I really do not know what foods provide fiber, do you have a link to a site I could read about fiber (especially in relation to wls patients?) Fiber is what helps to keep our bowels regular correct? Again I appreciate the feedback. I am truly trying to use my new pouch to the fullest. I realize that it is so easy to fall into the old habit that lead me to obesity. I don't want that.  I have read messages on other's forum's messages, that say even after months and years you don't ruin your pouch if you've fallen back into old habits.  I don't hunger easy, and when I eat right (protein first and foremost) I get full from 6 or less bites. Yet I still worry that I've done some type of irreversible damage from the junk I have eaten since my surgery. Do you know much about that aspect of things? Okay well enough questions for now I'm sure.  Sincerely,  Sammy

Personally, I think if you're taking in a balanced diet that includes dairy products, fruits and vegetables, and even just occasional whole grains for additional fiber, 25 grams per day is ridiculously low. In fact, damn near impossible to meet a balanced diet with that low of a target. I'm almost 10 months out and my carbs are typically anywhere between 110 and 175 grams per day eating a very healthy, balanced diet of up to 1200 calories per day. Do you have a nutritionist you work with that you can ask input from? I wrote quite a bit on this in my blog just today, if you're interested in reading it: How I Do It

Sammy, First off, take a deep breath. You just need to do some regrouping and structuring and it can be rather simple if you let it be. I had Lap Band surgery but the basics are all the same.  To get the weight off you need to leave your carbs to about 25 to 30 grams a day, eat high proteins first, 60 grams is a great amount and keep your calories to between 1000 to 1200 a day. Here are some great resources for you:

www.theworldaccordingtoeggface.com  - she is an OH employee and has had RNY and has a WONDERFUL site full of info and awesome recipes she does.  She also has a lot of links to helpful info. There are sites that you can log your food and nutrition as well such as www.fitday.com and www.dailyplate.com  Another key factor is exercise. Try to get in at least 30 mins about 4 or 5 times a day. If you do this with your high protein intake as well as lowering your carb amounts you will see it start to come off. I know it is hard to keep track of it all but don't let it overwhelm you and give you an excuse to make bad food choices.  If you are like me when you get frustrated with it all you tend to say screw it and just eat whatever. The surgery took care of the interal part it is up to you to rearrage your mental state and take control.  You CAN do it, you had the courage and ability to have the surgery now you just need to get in a groove. I have faith in you, do some research on the web, talk to people and don't be afraid to ask questions but if nothing else check out eggfaces website I am sure you will be glad you did. Good luck!  Vikki