Question about portions and the Honeymoon period

So we all know I'm new to this. I'm 5 weeks 3 days post surgery. It's going great, I have no complaints so far. But the further out I get the more I'm wondering.

When we're first getting our pouches used to food, we eat whatever is soft--refried beans, yogurt, mashed potatoes. When we can we try more solid proteins--tuna, chicken salad, seafood. Gotcha. My particular surgeon offers very little in terms of volume guidelines. For weeks 2-4 we're advised to eat "a medicine cups' worth" only one time a day, and after that there is no guidance aside from eating "possibly 2-3 times a day many months down the road if you are very active".

So I guess my questions are twofold:

1) When do I start to eliminate (or at least restrict) the very carby soft options? I mean, if I could eat refried beans forever just tell me, because I'm THERE. I'm a Southern California girl and I grew up on refries. But I am aware that they're heavy on carbs (although offset by how much of that is fiber) and I know we need to be careful with those.

2) How much do I eat, starting when? I'm back to work now as a physical therapist assistant. I'm on my feet and working with patients all day. I drink protein drinks throughout the day, but by the time lunchtime comes around, 6 hours into my day, I'm happy to sit down and eat. Am I still aiming for a medicine cups' worth, at 5-and-some weeks out? I've read that some people are advised 1/4 cup, 1/2 cup, up to a cup of food...but at what point? I know how important it is to measure what I eat and keep track of everything, but I've had no guidance at all in this matter. I'm measuring and recording already in Baritastic and I've not gone above 2 ounces depending on what the food is, Qbic (my pouch) just won't take it.

I'm getting nervous about not optimizing my Honeymoon period. I know this is it, this is the chance I get. Does anyone have advice or a bit more directed guidance for me?

***When I check back with my surgeon, her post-op contact repeatedly has told me "Please refer to the Toolkit for your answers." No help there.

I'm not anti-carbs (cream of wheat, refried beans, etc) in the first few post op weeks. So for me that meant allowing for them until I was on a regular diet- which was about 6 weeks out. To me, in those initial weeks they are means to an end, just another delivery method to help you get in Protein. So for me, I dropped anything like that at the six week mark.

in terms of volume- 2oz of dense protein was my guideline to start, and if there was room 1/2 c of veggies. I gradually upped my dense protein intake, and now 5oz is my max. I still do whatever I can fit in veggie-wise.

What is your total gram of protein intake now? Carbs? 60g was my minimum intake initially

When I was on straight liquids I was 50-60 grams of protein a day. Then I started adding soft foods and that added on carbs. At my one month check up my averages were about 400 calories a day, 50 protein and 25 carb.

My surgeon told me she wanted me to get ALL my protein from food from now on, still only eating "a medicine cups' worth" 1-2 times a day. I expressed concern that I wouldn't get nearly enough protein out of 1-2 ounces of food a day, and she said we have enough protein stored in our bodies that I would be okay.

I have patients all day. I cannot be spacey-headed or unfocused. I cannot be weak. And I certainly can't work a 10-hour day on one ounce of food.

This last week, since my appointment, I've been trying to keep my protein intake at 60 grams a day. I have tea with Fairlife for breakfast, protein water through the morning, 1-2 ounces of food at lunch, protein drink til I get out of work, 1-ish (maybe, it's usually just a couple of bites) ounce of food somewhere in the evening. Carbs are around 30. Is that too high? Do I need more protein?

I'm not sure why your team is discouraging shakes so early out. I used them regularly for the first six months. When I first returned to work I always had two shakes with me, plus an actual 'meal'. I'm sure that I ate breakfast too and a dinner. That means I had 5 times a day I was getting in Protein in some fashion.

It took a while for me to find a long term rhythm with how often I eat- which is now 4 meals a day.

Your carbs sound fine IMO. But honestly, I'd be so annoyed have having to prep meals in 1oz portions, I'd give up. Almost doesn't seem worth the time it takes. I quickly moved up to 4 oz of protein, probably faster than my nut would have preferred.

I've heard of other surgeons discouraging protein drinks, but I don't get it. It's the only way to get your 60-80g minimum protein when you're that early. I'm 7 months out and I eat 4 "meals" per day plus a snack or two as needed. One of those meals is a 1/2 of a protein shake, which I still need to get in my protein.

Thank you all this information is helpful My Gastric Bypass is Wednesday. This is good to know.

Good luck, Dorothy!

Thank You

I had a shake a day for two years, still have them frequently. If you need them use them. There is a lot of bad advice out there. A medicine cup is one ounce. There is no way you can get all your nutrition on a medicine cup once or twice a day.

I never worried about having the exact calories everyday, there is going to be a range depending on your choices. Early out things like cottage cheese, yogurt and softer things go down easier so you can eat more. 1/4 to even a 1/2 cup...they are 'sliders'. When I started dense protein it was a reality check. By 5 weeks I was already on dense protein and at first I could maybe get in 1 1/2oz. My surgeon said I could eat up to 5-6 times a day including shakes... I think for a good at least 6 months I could only get in 2 1/2 oz of dense protein tops... Now? 3-4-5oz depending on the day and my pouch. I rarely ate 6x a day more like a shake and 3-4 times. I was only counting protein and fluids. Try and get your protein up to the higher end as you go along. I worked myself up to 100g a day eventually.

Protein first then veggies then IF you have room fruit and carbs. (My surgeon's mantra) Pretty much you are lucky if you get to the veggies. I also didn't count carbs per se but always made sure the individual items weren't high carb.

I agree with Peach that 2 oz is about where I started with dense protein. If there was any space left, I added some green veggies. I now eat about 3-4 oz of dense protein and green veggies. My surgeon was okay with carbs like mashed potatoes especially early on, but I've avoided them in favor of adding in the green veg.