calories accurate counting help
I am 9 year post RNYand I am starting to gain weight. I have decided to go back to step one and count the protein/Carb/fat I am eating. I found the calories for them but how the heck does the calories realate to the total I need for a percentage? Do I even need to worry about the calories total if I am staying in the 40 Protein, 30 Fat, 30 Carb range or do I even have the percent wrong. I cant seem to find any of the stuff from the nutritionist that I got 9 years ago. I am also wondering if I should just make an appt with my PCM and be referred to a nutritionist. My surgery was done on a Military establishment so we have moved many times and not had follow up by the surgeon in 5 years due to moves. Any help would be great. Thanks Tammara
Contrary to what some post-ops (and even some well-meaning, but less educated surgeons/NUTS/RDS will tell you), you have to worry about calories as much as anything else.
At 9 years post-op, your malabsorption is pretty much gone when it comes to calories (not vitamins, so I really hope you're still taking all yours). EVERYBODY knows:
calories IN = calories OUT = weight maintanence
calories IN > calories OUT = weight gain
calories IN < calories OUT = weight loss
So if you are eating 3000 calories a day, it does not MATTER what your percentages are, you are going to GAIN weight if you do not BURN 3000 calories a day.
I HIGHLY recommend a MedGem test for ANYONE trying to maintain. I with an RD that has specialized in WLS post-ops for years. I had to travel an hour or so to her because she is on staff at a local gym now. It was $100 and came with a 1 hour consult. I have NEVER regretted it. It is money and time well spent. It will tell you specifically how many calories you need to maintain (and how many calories you'd need to cut from that to LOSE).
She can also recommend some adjustments to your percentages. 30% is on the high end for fat. 30% is on the low end for carbs.
I have followed (per my surgeon and RD's advice) a protein/fat/carb percentage ratio of 25/25/50.
The American Heart Association recommends 20 - 30% calories from fat, so 30% calories from fat is definately on the high end - even for someone who has not been obese.
40% calories from protein (FOR NINE YEARS OUT) is high. The minimum protein requirement (according to most surgeons) is 60 grams. If you are taking in 1500 calories, 40% calories from protein would make your protein intake 150 grams per day. ((1500 calories * .4) / 4 calories per gram = 150 grams) 150 grams of protein a day is.... definately over the top IMO. Too much protein can increase the risk of certain cancers, so there's really no need to overdo it.
30% calories from carbs is definately low. This is NOT the Atkins diet. Your body NEEDS carbs to properly UTILIZE proteins it receives.
If I were you and you have no bariatric surgeon near you who would be willing to do a follow-up, I'd definately go to your local PCP and at LEAST get your labs drawn.
Good luck.
Wen
At 9 years post-op, your malabsorption is pretty much gone when it comes to calories (not vitamins, so I really hope you're still taking all yours). EVERYBODY knows:
calories IN = calories OUT = weight maintanence
calories IN > calories OUT = weight gain
calories IN < calories OUT = weight loss
So if you are eating 3000 calories a day, it does not MATTER what your percentages are, you are going to GAIN weight if you do not BURN 3000 calories a day.
I HIGHLY recommend a MedGem test for ANYONE trying to maintain. I with an RD that has specialized in WLS post-ops for years. I had to travel an hour or so to her because she is on staff at a local gym now. It was $100 and came with a 1 hour consult. I have NEVER regretted it. It is money and time well spent. It will tell you specifically how many calories you need to maintain (and how many calories you'd need to cut from that to LOSE).
She can also recommend some adjustments to your percentages. 30% is on the high end for fat. 30% is on the low end for carbs.
I have followed (per my surgeon and RD's advice) a protein/fat/carb percentage ratio of 25/25/50.
The American Heart Association recommends 20 - 30% calories from fat, so 30% calories from fat is definately on the high end - even for someone who has not been obese.
40% calories from protein (FOR NINE YEARS OUT) is high. The minimum protein requirement (according to most surgeons) is 60 grams. If you are taking in 1500 calories, 40% calories from protein would make your protein intake 150 grams per day. ((1500 calories * .4) / 4 calories per gram = 150 grams) 150 grams of protein a day is.... definately over the top IMO. Too much protein can increase the risk of certain cancers, so there's really no need to overdo it.
30% calories from carbs is definately low. This is NOT the Atkins diet. Your body NEEDS carbs to properly UTILIZE proteins it receives.
If I were you and you have no bariatric surgeon near you who would be willing to do a follow-up, I'd definately go to your local PCP and at LEAST get your labs drawn.
Good luck.
Wen
Wen,
I just had labs done for Vitamin defeciencies and that is a whole nother mess as the mal absorption gets worse the farther out you are. We are trying to get them corrected but is has been a three year process.:) I am feeling lots better after this last round of labs and some things were up some were down.
The protein I was given was always high due to my anemia to begin with and the fact I do not eat red meat. I understand it is not the ATKINS diet but do not process carbs well that is why they have always been low and the fat I was trying to remember it. I am going to call my PCP tomorrow and see about getting a referral.
Thanks.
Tammara
I just had labs done for Vitamin defeciencies and that is a whole nother mess as the mal absorption gets worse the farther out you are. We are trying to get them corrected but is has been a three year process.:) I am feeling lots better after this last round of labs and some things were up some were down.
The protein I was given was always high due to my anemia to begin with and the fact I do not eat red meat. I understand it is not the ATKINS diet but do not process carbs well that is why they have always been low and the fat I was trying to remember it. I am going to call my PCP tomorrow and see about getting a referral.
Thanks.
Tammara
Something doesn't make sense.
The lack of red meat in your diet should not impact your protein recommendations AT ALL. Several people choose not to eat red meat and some CAN'T because of tolerance issues. There are so many OTHER places to get protein though, that that should not have caused them to recommend MORE protein for you.
As far as the anemia goes, unless the anemia was "protein anemia", your protein recommendations should not have been increased for that either. (Increased protein does not help with other types of anemia OTHER than protein anemia.) So were you protein anemic going INTO surgery???
Actually, research shows that malabsorption gets BETTER as time goes by with regard to the absorption of macronutrients. While it does NOT get better for micronutrient absorption (vitamins), it does NOT get worse. This has been extensively studied with intestinal bypass patients (not gastric bypass patients specifically, but all intestional bypass patients generally). Compensation for malabsorption takes approximately 3 years to complete for macronutrients. Micronutrients are affected minimally by this adaptation. The absorption of micronutrients (vitamins) gets no better or worse as time passes. Studies show that long-term vitamin/nutrient deficiencies can be directly tied to a patients non-compliance with a strict vitamin regimine or lack of dietary intake of nutrient-rich foods. How is your dietary intake?
The lack of red meat in your diet should not impact your protein recommendations AT ALL. Several people choose not to eat red meat and some CAN'T because of tolerance issues. There are so many OTHER places to get protein though, that that should not have caused them to recommend MORE protein for you.
As far as the anemia goes, unless the anemia was "protein anemia", your protein recommendations should not have been increased for that either. (Increased protein does not help with other types of anemia OTHER than protein anemia.) So were you protein anemic going INTO surgery???
Actually, research shows that malabsorption gets BETTER as time goes by with regard to the absorption of macronutrients. While it does NOT get better for micronutrient absorption (vitamins), it does NOT get worse. This has been extensively studied with intestinal bypass patients (not gastric bypass patients specifically, but all intestional bypass patients generally). Compensation for malabsorption takes approximately 3 years to complete for macronutrients. Micronutrients are affected minimally by this adaptation. The absorption of micronutrients (vitamins) gets no better or worse as time passes. Studies show that long-term vitamin/nutrient deficiencies can be directly tied to a patients non-compliance with a strict vitamin regimine or lack of dietary intake of nutrient-rich foods. How is your dietary intake?
Wen,
Thank you for all the information. I have had anemia two different kinds and it is getting better now after an iron infusion. The vitamin issue has just been since my surgery. I eat good food but lots of small meals and my body does not absorb alot either way.
I have an appt with my PCM on Thursday for a referral to the surgeon here for a follow up and then for a referral to a Nutritionist. The test you recommended how did you find someone who did it?
Tammara
Thank you for all the information. I have had anemia two different kinds and it is getting better now after an iron infusion. The vitamin issue has just been since my surgery. I eat good food but lots of small meals and my body does not absorb alot either way.
I have an appt with my PCM on Thursday for a referral to the surgeon here for a follow up and then for a referral to a Nutritionist. The test you recommended how did you find someone who did it?
Tammara
You can call your local hospitals and find out if they have an RD on staff that does them.
My WLS support group leader (who I am good friends with) found the one I used and we drove over there together.
A RD or NUT for a local weight loss support group or bariatric surgeon may know of someone who does them.
My WLS support group leader (who I am good friends with) found the one I used and we drove over there together.
A RD or NUT for a local weight loss support group or bariatric surgeon may know of someone who does them.
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