The conventional wisdom of WLS

In DX's thread below, Tek laid out something that really merits a separate thread: what I have chosen to call WLS conventional wisdom (or CW for short). So many things that are discussed around here are treated as if they are carved in stone. And while they may be carved in stone, are they really true? So I would invite you offer up some of the conventional wisdom in our midst, such as the one TEK cited, 'protein first', etc. Consider them critically, and tell us where it may have exceptions, etc. Here's one that I have yet to seen proven yet is often cited as being true: You can't absorb more than 30 gr of protein at a time. Fact? Fiction? What evidence is there to support it? My suspicion is that there are a myriad of of other truisms out there that need to be vetted, debunked, validated or qualified. The floor is open ..... PH

I have researched the 30 gram protein "rule" and have never seen an actual study to support it. But, like you, I have read it a thousand times as 'fact'. Here's another one---some wls patients are told to never drink through a straw. I have used a straw from day one with no problems. Good thread, NM. Connie -147# @ goal

The lack of adequate citation does not invalidate the conclusion; it simply means that it is unsubstantiated. It may well be true. My point is that we often make statements that are really not as absolute as we would like to believe. I, for one, think we are giant walking petre dish that will serve as the sample population upon which later conclusions regarding WLS will be drawn. And like those who participate in clinical trials, some of us will have been handed placebos, ineffective or even flawed treatments. Our position must be to ferret out what works best for us and stick to it. If you find that using a straw does not work, lose the straws! OBTW: I never use straws, before or since WLS. Well unless it was attached to a beer bong, but that is a whole other matter. PH

PH--I am usually someone *****searches to find out current info--a doubting Thomas I never take anybody's word on anything. There have been so many falsehoods stated on this website as fact for so long it is amazing. The 30 grams of protein thing--I don't know, but I do know my nutritionist told me that. Remember when "they" used to say that protein drinks lost their value after sitting longer than 20 minutes. I remember asking my nutritionist about it--and she looked at me like I was nuts. Then I tried researching on the internet and sent emails to various protein manufacturers. Each response I got back said it wasn't true--no truth to the statement at all. I did try posting the info on this site and was ignorred. It wasn't until SM posted the same thing that some people finally listened--but some still did disagree. Anyway--so much for "facts". What I do know is though--for most of us we need to learn new habits from the beginning. If we don't then this is no better than any other diet we have been on and failed in the past. JMHO Oh--and I really do believe that being a couple years out from surgery has taught me things I couldn't understand early out. I thought people who struggled long term were weak--losers. Have a great day--gonna wash my windows.

What you are referring to is the celebrity pitchman. "These shoes must be good, Michael Jordan wears them". There exists a dynamic that until the right person says it, it is suspect. And once the right person says it, it must be true. Some folks are just more equal than others. Remember, if you see a guru by the side of the road, kill him! Including me! Jay

Thanks for the mention. Following is sortof a shotgon flow of thought, which are my opinion. I don't think everything applies to everyone. ----- 'Protein First' makes sense. Protein is the basic building block of the body, and especially early post-op, many of us are able to eat so little that it makes sense to focus first on this basic building block. ----- 'We only absorb 30 (40, 25) gr of protein per session'. I don't necessarily buy this one. Most of the sources I find on this are from protein drink manufacturers or sellers, hardly unbiased. Also, this would be an 'AVERAGE' meaning there are folks that absorb more, some less, some probably significantly more or less. The 'average' human does not exist. The variences from one human body to the next are more extreme than many of us would think. ----- What many people don't realize is that until recently, most nutritional studies were performed on military personel because they are easier to monitor (controlled environment). Amazingly, not everything true for a 20ish Fit Soldier applies to the general population, and even less so to the Morbidly Obese population. Then, where there is an 'indication' in these studies, nutritional companies take the ball and start running so that their product or plan has something that the next product or plan doesn't have, thus making it more scientific and better. ---- The BIG thing I have observed on topic-oriented boards is that Facts get distorted in the repeating. Modifiers get changed, enforced, and omitted. As an example: "Caffeine is a Diuretic." We've heard it time and again. Do a Google, and look at authoritative sites (not the ones repeating the 'Truth') and you will find Caffeine is a MILD Diuretic, and that this effect is non-existant in frequent users. The 4 word declaritive, though true, is none the less innacurate. ---- In my opinion, many of our (WLS) rules are designed to change our bad habit to good habits. Carbs, drinking with/before/after meals, are intended (again In my opinion) to address eating behaviours rather than nutrition or health directly. I think many people think breaking these rules will harm our pouch or weight, in reality they are intended to change our thought processes and behavior. ---- Just my shotgun of thoughts. Tek

Tek, The only point of contention with your statements is the one about drinking with/before/after meals meant to address eating behaviours. Every diet I was on before the ultimate diet of WLS had the instructions to drink lots of water right before and during the meal. This was to induce a feeling of fullness and prevent overeating during the meal. The pyloric valve helps with this, as it keeps the stomach from emptying too rapidly. After surgery (RNY), we no longer have a pyloric valve to keep that full feeling. Since protein is the most dense food we eat, it will stay in the stomach longer, keeping us from overeating. Water consumed during a meal or immediately following a meal will push the food out more rapidly. I think that is why long-term postops who follow the rules of protein first and no liquids during or immediately after eating experience more success in keeping the weight off. Of course, this statement has no science behind it, just observation of the past couple of years. Who knows what the future holds. Carole

It is reasonable to expect that (as you pointed out) post-op anatomy is different than non-op anatomy, thus 'healthy' behaviors for each may be different. It is clearly a rule designed to change our behaviour, as abandoning the rule will not harm, stretch, or break our pouch, nor cause us harm in any way other than the indirect effect eating more or less has on our weight and health. If you drink before/during/after meals, it will not harm your pouch. It MAY: -> Wash food through, which MAY you to eat more; -> Wash food through, which MAY cause you to get hungry, sooner; -> Take room you need for food, which MAY cause you to eat too little; -> Take room you need for food, which MAY make you uncomfortable; These are POSSIBLE effects (perhaps even LIKELY, but definately not CERTAIN). Obviously, each of these effects may not be desirable, but none of them would harm the pouch. The behavior, however, may undermine our weight loss (or maintenance) by allowing us to eat more, or may undermine our health by keeping us from eating enough. On the other hand, for post-ops unable to eat enough to maintain weight, or to eat a 'healthy' amount, drinking with meals MAY allow them to consume the necessary calories. By pointing out that it is a behavioral rule is not intended to minimize the importance of the rule (or any other behavioral rule). On the contrary, it is yet another example that long term success is up to us and our new behaviors. Tek

Great thread, PH! I find myself believing the conventional wisdom stuff all the time--particularly if it matches something I think I remember one of my doctors saying or just seems logical on any level. Intellectually, I know that some significant percentage of it is very likely to be bunk. Here's one: Don't mix whey protein with milk because the protein in milk (casein) hinders absorption. Here's the URL that was given to me to back this one up: http://www.fortius.ca/wheyandmilk.htm It's a manufacturer's website, but the info does not seem to benefit their sales at all--just information to help customers get the most effective use out of their products. I haven't gone to look for more back-up on this one, but it seems reasonable to me. My surgeon tells his patients not to use protein supplements and to get all protein from food. But because so many people here at OH insist that ALL of us MUST use protein supplements or we WILL suffer terrible consequences, I've been researching the protein thing a lot lately in an effort to make an informed decision about whether or not I should follow the doctor's advice on this one (I acknowledge that doctors are human and fallible, so I double-check anything that concerns me). After asking a lot of questions, reading a lot of info, and filtering out the emotional, mindless supporters of one point of view or the other, I've decided to follow my doctor's advice in general but to use protein supplements on days when I don't get enough protein through food (just to hedge my bets, so to speak). We do have to be our own health advocates after WLS and be as informed as possible about the long-term effects and prevention strategies. Tek is right--there is no "we" because each of us is different in many ways. But it certainly doesn't hurt to know some good generalizations about post-WLS health, either. I really like this thread because it gives us a chance to figure out if there is any research/truth behind some of these things we hear so much they seem like they MUST be true but may not be... ---- Leslie

I subscribe to the idea of the relative superiority of chewable protein. Chewable protein sources have longer transit times (amount of time in the system) and provides longer periods of satiety (fullness for lack of a better term). I suspect that because they are in the system longer, more of the protein is actually absorbed (but I can't prove that). Besides, you get to chew them, and for some folks, being able to chew something is important. Just so I am clear in what I am saying: I am not opposed to protein supps; I simply see them as a transitional step toward chewable protein sources. The preferred dinner ware for the WLS patient is a plate with a knife and fork and not simply a shaker cup. PH