Dr. Garth Davis' view on protein

Many people know my surgeon Dr. Davis does not support a high protein diet. Here is his post on facebook today:

Spent last night researching where the practice of weight loss surgery came up with the recommendation of 80-100gm of protein a day. There is actually no basis in any evidence. In fact there is evidence that less protein has no negative effect. The RDA did in depth studies looking at nitrogen utilization to come up with a recommendation for protein. They then noted that the number they calculated was for the average person so they bumped up that number to cover 98% of the population. That number is 47 gm for women and 56 gm for men. This can be further bumped up if you are heavily active, but not by much. Duodenal switch is malabsorptive so I would bump this up by 30% but gastric bypass and sleeve patients do not malabsorp protein. There is no reason they shouldn't follow RDA guidelines. The problem with excess protein is that weight loss surgery patients practice an "eat the protein first" dogma that leaves them stuffed on extra protein and thereby missing out on the absolutely essential vitamins and minerals found in plants. Proteins from animal sources, which is what weight loss surgery patients gravitate to, are very calorie dense, so this practice ends up with people eating calorie dense foods first. Not to mention the fact that animal proteins cause metabolic acidosis and inflammation.

I have seen so many patients struggling with weight gain after surgery who come to me and say they were told to eat 100 gm protein a day. They do not look healthy. In our national meetings surgeons would undoubtedly say they need a new surgery. Despite emphasizing surgery as a tool, failure with maintaining weight loss is always blamed on the surgery. We never stop and consider that maybe we are not telling people how to use the tool correctly.

I never go straight for revision in patients struggling with weight loss. I emphasize a strong plant based (though not exclusive) diet and 10,000 steps a day. This works INCREDIBLY well. Weight loss surgeries are very effective but you just have to know how to use them appropriately!

That is interesting.  I've often wondered WHY we are recommended to eat so much protein....and the pat answer is "it makes you feel full longer".  Well, that is somewhat non-sensical....ANY food in the pouch that remains in the pouch will make you feel full longer.  I've never felt like carbs were the "enemy"....pre or post surgery.  I eat an equal amount of protein and carbs each day...but I do strive for my carbs to be good, complex ones....

Thanks for sharing.

It seems to really vary from person to person.  I know that I eat about 90 grams of protein per day and my protein and albumin levels are good on that amount.  If I were to eat half of that, as he is recommending, I imagine my protein and albumin levels would drop quite a bit (although I'm not going to try it and see if that is what happens, so maybe I'm wrong about it?).

Does he think it is not necessary have to maintain protein and albumin levels at the amount typically given as the "reference range?"  I mean, I try to maintain a protein level of about 7.0 and an albumin level at about 4.0.  Is he suggesting I'd be just as healthy if  my protein level was 5.0 or 6.0 and if my albumin level was 3.0?

I'm a vegetarian and have been for more than 25 years.  Before WLS, I used to eat about 35 grams of protein per day and was convinced I did not need more than that.  My protein and albumin levels were fine on that amount, by the way.  However, now that I eat more protein, I find I have fewer food cravings and I just feel better in general.

He mentions concerns about animal proteins, and I agree that a diet high in animal protein isn't real healthy.  But I see two different questions here.  Is a low protein diet best?  Or a high protein diet that does not rely heavily on animal proteins?

It's actually a good thought.  For me I do believe more protein works best and keeps me satisfied longer; however, I don't worry near as much now if I'm eating a magic number in protein.  I try to get at least 70 grams (for no other reason than I want to) and I do try to eat more veggies and fruit. 

I don't seem to eat much fruit though, although I like it it's usually my last choice after protein and veggies (which I love pretty much any veggie) and the space available for fruit just isn't there.

Like Kim said, I believe the 100 grams of protein is basically the thought that it's dense and will keep you full longer so you don't have room for excessive snacking or grazing. 

My surgeons at Yale GI Surgery and their entire team were and are supportive from start to finish, thorough in education and follow-up and having an awesome one on one relationship with their patients.   The information they imparted and my care has led to my thorough success ... I was recommended (as an individual) a protein intake of 60-80 grams daily which works perfectly for me.  Eating my adequate portion of protein first followed by vegetables and sticking to dense healthy carbs have me fully satiated ALL the time (I was a volume eater) .. I have no tendency to snack other than on my daily portion of fruit allowed.  I am totally happy with that and entirely successful with it.  I tried going vegan and it did not work - I WANTED MEAT  ... I tried pescatarian and after a week I decided that I WILL have meat on my plate and eat it and twiddle my toes too ... to each his own I for one am definitely not planning on surviving off a plant based diet and my protein intake is adequate in maintaining my muscles,  my well being AND my weight loss ... I have no excess body fat I am nothing but flabby skin and muscles .... I got biceps to boot LOL...

To each his own and to each what works BEST for them ... it is an individual journey ... no plant based diet for me ... I shall eat my meat... 

All very interesting--thanks for sharing this!!

Very timely.  I just found out the the kidney stones I have are not calcium, but uric acid stones (X-rays showed nothing even though the ultrasound and CT show multiple stones).  The good news is that I don't have to completely eliminate diet soda, but I will need to decrease the amount of protein I get from animal sources.  When I talked with the urologist, he asked why I was eating so much more protein than a normal woman would, and the only answer I could give him, of course, is that "more protein is better and keeps you full" mantra.  My RNY surgeons's guidelines said 60-70g (and when I asked her once about the people trying to get 100g, she said that was unnecessary).  I usually get 80+g (including protein powder in my morning SF hot chocolate), and my protein at last labs was 7.9, so cutting down on some of the protein and increasing the veggies wouldn't hurt my labs (just had new ones drawn Monday, so will double check the protein levels) and  would actually help me calorie wise as well.

Lora

I've often wondered this myself, because I try and hit the recommended 60-70 grams but I just feel better if I have a combination of healthy meat and veggies....typically salad with a variety of fresh veggies and green beans are a staple at our house for a side item.  

Definitely food for thought, I'll be interested to see what my surgeon says at my 1 year appt and the nutritionist...I'll keep ya posted!!  

BTW, LOVED their show on TLC...wi****'d come back!!  :) just my two cent plug for them.  

Take care, 

Sherry

I'm very thankful my plan always included veggies and fruit! I'm equally thankful I can digest all of them.

The goal in my program is 60 grams. I usually come in under 70. Almost half of my protein comes from my protein shake in the morning.