Research on protein

My question is about the research that suggests such large amounts of protein for post WLS. Can anyone point me in that direction? I'm familiar with the science behind the Atkins and SB diets, but is there specific research for WLS?

I'm an RN and had RenY gastric bypass (lap) on Oct. 7. I'm doing great. Lost 20lbs so far.

Thanks,
Becki

Becki,
I have researched the heck out of how the processes work post-op for the weight loss surgeries. I too am an RN and think I just needed to know everything I could. The best that I have found is first, you do go into ketoacidosis post-op with such a low intake of food and carbs. I found a few places of what protein requiements the average person needs and I want to say it was something like .5 per kg. of ideal body weight. Once I figured it out, it makes sense. I do know that with the larger amounts of protein intake it is important to maintain adequate fluid intake to help flush things through. I am about 5 weeks post-op and am losing steadily, I am not weighing mysself regularly so I am not totally obsessed with the scale! A few times recently I have been able to smell the ketosis on my breath, it is weird. The one night I thought I smelled drunk....I have not toucehd an alcoholic drink in some time! So, hope this helps, unfortunately I can not remember where I found the ratios for protein.
Sue

I'm with you on the ketosis breath, so weird.  I work in OB so I'm familiar with pregnancy nutrition needs, such as the research that suggests 80-100g of protein daily reduces the incidence of pre-eclampsia and PIH. It's just that I'm eager to read more research about WLS. I was hoping to avoid the searching if someone had already done that .  Thanks for the help.
Becki

There is SOOO much research out there regarding protein - some of it conflicting. 

Most WLS surgeons recommend at least 60 grams of protein per day for RNY.  I have seen some recommendations as high as 100 though.  (I hate to even say that because it is too high IMO, but I'm just putting it out there.)

So before sugery here's what a typical day's food might include:

Breakfast -- bacon and eggs or sausage and pancakes or an egg mcmuffin
Lunch -- big mac value meal
Dinner -- steak, baked potato, veggies or chicken breast or slice of ham

Count up those grams of protein and you'll get anywhere from 120-160g of protein based on meat having 7g protein per ounce and eggs having 6g-8g per egg.  Americans definitely do not have a problem with protein malnutrition.

Here's some references for what standard RDA levels are for protein intake: (calculates based on MY ideal body weight of 134 lbs)

U.S. RDA - Recommended Daily Allowance (same as UK's RDA)
.8g of protein per 1kg of ideal body weight per day
(Equal to 49g protein intake)

  World Health Organization (WHO)
.45g or protein per 1kg of ideal body weight per day
(Equal to 24g protein intake)

  National Academies' Institue of Medicine
10% to 35%* of 2000-calorie/day diet should come from protein
(Equal to 50g to 175g protein intake)
*35% as the upper limit is currently being challenged by other organizations

Typical WLS Program Recommendation
20% to 35% of 1,200-calorie/day diet should come from protein
(Equal to 60g to 105g protein intake)

SOOOO... really, the 60-80g of protein we are required to take in after WLS is not all that high if you look at all the facts.  When you take into consideration the malabsorption of protein it isn't even out of the realm of reality to get 100-120g of protein per day.  

I personally take in around 100g per day and feel best when I hit that goal everyday.  If I slip down to 60g for several days in a row, I can feel the drag on my energy level. 

Pam

edited to fix formating, sorry.

pam, 
i would like to address this portion of your post
" When you take into consideration the malabsorption of protein it isn't even out of the realm of reality to get 100-120g of protein per day. "

you are correct that whey protein absorbs very quickly, but if you take a product like ours, you absorb 90% of the protein and it is not necessary to eat 100 grams a day.  competitors in middle heavy body building competition ingest 100-120 grams per day of most proteins yet only take 60-80 grams of ours.  we use a natural blend of plant enzymes to help time release and digest the whey protein.  this allows the majority of the protein to actually get used rather than absorb into the large intestine.  i urge you to try our Protizyme and drop to 60 grams per day, which would be a total of 3 scoops of our product, or 2 meal replacement packets would give you 92 grams of time released protein each day.  i work out regularly, and weigh 160 lbs.  i only take one 46 gram meal replacement shake in the morning after my work out and then regular food proteins during the day.  contact me at [email protected]  or call me at 800 626 1022 and i can answer any questions you may have, or get you started
regards
scott

Scott -

Thanks for the ADVERTISEMENT --- but I prefer to eat real food rather than protein supplements.  I get about 30g of my daily protein intake from my morning whey isolate protein shake and about 70g of protein from real, honest-to-goodness food.  I has weight loss surgery to eat like a normal person, not live on supplements.

And since you push that your product is "time released" you obviously don't understand the new digestive tract of someone who has had RNY.  We don't do time released anything ... whether it's medication or protein supplements.  Much of our intestines are bypassed, so nutrients are not absorbed the same way a normal digestive system does. 

Maybe you should research a bit more about where you're advertising before you blast us with your sales pitch.

Pam

pam dear, i apologize if you took this as a sales pitch.  my sister in law is a gastric bypass patient and has had much success with our products.  i am just passing along her success to try and help others.  as far as your new digestive tract, i know plenty about it.  if you only knew our product is quickly absorbed then time released in the jejunum...which you still have!  i am quite familiar....but thats ok, i was just trying to help others if not you....everyone has their own proceedures in protein intake and many cannot get it through real food.....i commend you for being able to do that...CONGRATS!!!

Thanks Pam for posting. You are correct in that most typical Americans don't have to worry about getting too much protein. However, before I became obese, I was mainly a vegetarian and hovered in the WHO range of 25g a day. I am interested in reading more about the changing requirements we have now.  With supplements, I am getting my doc's recommendation of 50-60g of protein per day. It's just a subject that interests me and I have to admit, I'm a bit of a geek when it comes to reading research. Thanks again for your time.
Becki

the following information came off of the net from a doctor Jaqueline Jaques ND.  this should answer your question.  i included the part about lactose intolerance because our protein powders are all lactose, aspartame, and sucralose free.   they also include digestive enzymes and time release of proteins.  i hope this helps


Little is known about protein malnutrition as only eight percent of surgeons track labs such as total protein, albumen or prealbumen[i]. Limited studies suggest that RNY and DS patients with the most rapid or greatest amounts of weight loss are at greatest risk[ii]. Hydrochloric acid[iii], pepsinogen, and normal churning are all significantly reduced or eliminated with surgical resection of the stomach. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. Thus protein maldigestion, rather than malabsorption, is likely responsible for most cases. Some studies have also implicated low intake[iv].   Dietary recommendations following WLS minimizes carbohydrate and emphasizing protein, while lacking specificity. The closest estimations of protein requirements are taken from knowledge of low and very low calorie diets. Most caloric restriction program advise a minimum of 50 grams[v] of protein per day or 0.8 to 1.5[vi] grams of protein per kilogram of lean body mass to maintain nitrogen balance. WLS patients are challenged with a reduced stomach size, and are often advised to supplement protein, especially in the first year following surgery. Protein-rich foods at each meal areed with, supplements complete proteins such as whey or egg white.   Lactose Intolerance In the US, lactose intolerance is reported as 15 percent among whites, 53 percent in Hispanics and 80 percent in African Americans[vii]. While no scientific studies exist, it is widely reported that some percentage of patients will develop lactose intolerance after WLS.   After RNY or DS, pancreatic juices empty more distally into the small intestine, and large areas of brush-border enzymes are bypassed. It is less likely that WLS creates lactose intolerance, but rather makes it more profoundly apparent.

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11 Updegraff TA, Neufeld NJ. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981;78(2):135–140. 12 Segal A, Kino****a Kussunoki D, Larino MA. Postsurgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14(3):353–360. 13Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity.
Dig Dis Sci. 1994 Feb;39(2):315-20. 14Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–28. 15Saris W. Very-Low-Calorie Diets and Sustained Weight. Loss Obesity Research 9:S295-S301 (2001) 16Blackburn GL. Protein requirements with very low calorie diets. Postgrad Med J. 1984;60 Suppl 3:59-65. 17T. H. Vesa, P. Marteau, and R. Korpela. Lactose Intolerance. J. Am. Coll. Nutr., April 1, 2000; 19(90002): 165S – 175.