am I doing everythign wrong??? I don't think so... 10 years out

I have been having a rare complication "Bile Reflux"  I have been refluxing bile from  into my trachea and then breathing it into my lungs, causing pneumonia and lung damage.  I have had all the tests medically and have now been referred to surgery.  The head surgeon doesn't think it's really bile even though bile was found in my stomach during my upper GI.  (they have only had one other case EVER & it's a tertiary care teaching hospital

You see I had a proximal RNY-175cm and then a loss of 50 more cm with a bowel infarction so the liver hooks up pretty far away to get bile clear to my pouch.   I go Wed for a HIDA scan where thy put a nuclear tracer that will follow the bile from the liver tracking where it goes. 

Anyway they had me meet with a dietitian to see if she could suggest any dietary changes & I really failed her test.

I should eat 800 cals not 1200 cals per day

I still use protein shakes (a BIG NO NO) I should be getting all my nutrition from food.

I snack on Greek yogurt and almonds when I should only have 16 oz skim milk 3x day for snacks.

I do not chew my food to a baby food consistency.  -is she whacked?

It takes me 20 min to eat a meal- not 30

I don't stop drinking 30 min prior to eating and don't start drinking until at least an hour after eating (I'm waiting too long)

According to her I am non-compliant because I don't shoot for 20-30 gm carbs and 8-12 gms pro each meal.  (I have way too much protein)

 

At 10 or so years out do you guys eat the way she is saying?  Chewing to baby food?  & the lack of protein.  You'll never see me drink that much milk aaak

 

I'm interested in your input

 

Pup

Is this dietician in a bariatrics office? What she is saying might work for normies but not us! It's against the pouch rules. Does she understand malabsorption issues of RNY? Blah. I would be very upset with being called non compliant and would raise holy hell about it! Non compliant for following pouch rules? For not drinking with meals? For eating too much protein? For supplementing with protein shakes? Ad you are to eat 800 calories a day? Seriously? 800?
Bah humbug!!!!
Blessings,tamilynn

This is the bariatric dietitian. 

 

Totally not what I was taught.

 

Pup

I found 800 calories per day, 50% of calories from protein, and exercise 5 days a week to be perfect for losing weight.

So the real question is: are trying to lose or maintain?  If you're trying to maintain, eat whatever you want, however you want as long as you don't gain.  If you do gain, then consume less calories and get more protein and exercise a little more.

If I eat like she suggests - it is not even possible.  you would be consuming up to 164 carbs a day ( food and milk) and only 84 gr of proteins. (3 meals at 30-12, plus 3 x 16 oz of skim milk) That alone will be 982 calories. How about fat?  is fat even allowed?  can she add and multiply? 

16 oz of milk - even is you do not have RH - you will get that with liquid 24 gr of milk sugar (16 oz of milk is actually 24 gr of sugar - that would kill me) 

Milk - may be good for babies... babies from cows... ouch...

I drink 30 min   -1 hr or longer after I eat.  But I can drink 5 min before I eat. Drinking is OK before, for a mature pouch. I chew well, but baby food?  is she for real???  Sometimes it takes me 10-15 min to eat my meal. depends what it it.

I am almost 5 years post op and carbs - are not my friend. I need proteins 120-150 gr or my blood test show low normal.  I need fat to stabilize my blood sugar.  I  do drink protein shakes, eat nuts and yogurt.  So ... milk is OK, protein shakes "no-no"?  yea... I don't think so. If kidney was your issue - then proteins may be a problem, but not like that....

800 calories... even her own recommendation gives more than that.  

Seems to not understand how our systems work.  I don't drink milk at all, it makes me feel nauseated.  If I ate the carb/protein ratio she recommends I'd be gaining weight and tired constantly from carb overload.

No I don't take 30 minutes to eat, usually 15-20 minutes.

I don't stop drinking 30 minutes before a meal but do wait 30 or so minutes after, sometimes up to 1 hour if I'm still full.

I eat normal and chew normal not to baby food consistency.

I do get most of my protein from regular food but on days I just can't eat enough I'll have a shake or two.

 

I am pretty sure she does not usually work with "graduates"  1-2 years out maybe.  She was not able to wrap her mind around a different way of eating.  Sure I chewed each bite 20 times, never had caffeine or soda, took in 600 - max of 800 Kcals per day and followed all my doc's rules when I was in the losing phase.  After I was a size 4 I moderated things to stay healthy.

I still- 10 years out...

Don't drink with meals or after for at least an hour.  I will drink right up to the meal.

Do at least one protein shake a day.

Stay away from carbs (white carbs especially)  I haven't had a sandwich in 10 years

I eat something every 2 hours.  a shake, almonds, cheese, yougert.  Or I drop my blood sugar- she called that snacking (though I was supposed to drink 16 oz of milk at those times-that's a snack)

I always do protein 1st.

 

Another slam is she said my I was %157 over my "goal wt"  (#120) so I HAD to be non-compliant or I would be at goal.  When I wore a size 4 I was a bag of bones and weighed #150.  I looked much better at #160 and a 9-10.  

I'm a 14 now and am working on getting the regain off, but that wasn't the reason I saw her.  

She suggested supplements but poo poo'd me telling her DRY vitamins work better.

 

I swear all dietitians are skinny and have never had a weight problem.

 

Pup

I'm sure there must be some dieticians out there that really know how we need to eat.  But I haven't met one yet.  I have learned more from research and this site than most of them will ever have the pleasure of knowing.  The ones I've met with just recite info from a text book-they don't "know" the information, and they haven't "lived" it.

At 4 years out...in maintenance with no regain:

I do not drink milk

I consume 1,600-2,000 calories per day, depending on my workout

I eat a Greek yogurt EVERY SINGLE DAY

I eat fast-always have, always will

I drin****il I eat, then wait 45-60 minutes to resume

I chew, but not to baby food consistency, and I eat protein first

I eat 6-7 small meals a day (a sticking point with my surgeon too-he said "3 meals a day"-I said no thanks- I don't love RH-he says I'm grazing, I say I 'm living a healthy life...we agree to disagree)

I do not use protein shakes and never have-my plan didn't call for them.  I've tried some, but don't like them.  I don't see how using it for an occasional meal could hurt.

Sometimes you have to go with your gut and with what you have proven WORKS.

Edited to add:  I'm 158 lbs most days and a solid size 8.  I'm overweight by the BMI charts.  I don't lose any sleep over it. 

I have developed extraordinary reflux as well 7 yo.  I would question this dietician.  She seems to be working with the new patient rules.  Lliving in the real world for years after surgery requires a very different long-term view.  Hard to live on 1200 much less 800 and still work and have activities.  As a long term we all need to incorporate our requirements into our lives and each one has foods that we tolerate or not.  I never drink milk altohoug I like greek yogurt, cottage cheese, etc.  I eat almost every 2 hours.  Try to keep count but most days get distracted. 

How did they discover the Bile Reflux.  Please advise.  I take Dexilant after many other tries, but last night another bad reflux episode and now I want a GI evaluation.

What is your story to diagnosis?  Thanks foryour help.