Asked my NUT a question.

 I sent my NUT an email asking a couple of questions.  I was suprised at the response I got to them.

The first question I asked her is what my goal weight should be.  Depending on who is measuring me, my present BMI is between 24.5 and 25.5.

Her response follows:

Your first question: I usually aim for a goal of BMI 25, but really you should be very happy with the success you have achieved thus far!  I think you are almost there now:)   A BMI below 20, if you get there, should be brought to our attention.

My second question to her dealt with what my caloric intake should be in order to maintain that weight.  This was the response that really surprised me.

Her response follows:

The second question- I don't count calories- these are especially complicated after DS as we do not know your absorption. Best guidelines are to: emphasize eating lean protein foods, fruits, veggies; minimize processed carbs; include healthy-fat foods like nuts, avocado.

Liz's NUT gave her a specific calorie intake guidance during her last visit. The thing that gets me is we both had the SAME WLS but with different surgeons.  Both NUTs work at Bariatric Centers of Excellence.  Upon further reflection, I like my NUT's advice better.

This is another reason I think we need to be educated and find out what works for each one of us. We are not cookie cutter wls patients and our care can not be that way either.
But, I do know that we do need guidelines to follow and some people do better with exact terms so between you and Liz you are getting the best of both worlds.

Maria, while we technically may be getting the best of both worlds, the reality is my nut has NO clue.

What she told me was that I had to expend the same amount of calories that I took in and while that may work for a normie, it doesn't work for a DS'er. The reason is called DS math. I did track my calories for a while and here is an example of how one of those days went:

Total consumed: 1222 calories
Total allowed (adding exercise in): 1870
Deficit: over 600
Protein: 108 grams
Fat: 47 grams
Carbs: 81
Now using ds math, what I actually took in:
Protein 108 g of protein x 4 cal/g = 432 cal eaten; x 0.6 (60% of protein absorbed) = 259.2 cal from protein absorbed.
Fat: 47 g of fat x 9 cal/g = 423 cal eaten; x 0.2 (20% of fat absorbed) = 84.6 cal from fat absorbed.
Carbs: 81 g of carbs x 4 cal/g = 324 cal eaten x .7 (I used 70% since I have a longer common channel and we absorb more carbs) = 226.8 cal from carbs absorbed.

Okay so absorbed cal:
259.2
84.6
226.8
------------
570.6 absorbed calories
So my actual deficit was more like 1299.4 for that day. And yes, I counted for about a month to see what I was getting buy I never paid attention to the actual calories, just the protein/fat/carb grams. And yes, for those numbers a calorie counter is useful but it does diddly squat for me or dh or any ds'er as far as counting consumed calories.

Exact terms don't work for us as none of us fit the pattern...that's why his nut's response about the calories was dead on and mine didn't have a clue. Mine thinks in "normal" terms not altered anatomy terms.

Liz

Liz

How dare you ask them a question LOL...
There really needs to be some continuity or standard at least within the same practice.

 Liz and I went to different bariatric practices.  She went to Dr. Stephen Boyce in Knoxville, TN.  I went to Dr. Alfons Pomp in New York City.

I've read her first response over a few times and I'm confused that she wrote you are almost there.   You've made it!!!!!  

I like her 2nd response.  I don't worry to much about calories...it's the types of foods we put in our mouth that can make it or break it!

 Roz,

It depends on the height used to determine the BMI.  Dr. Pomp's office measured my height as 68.11 inches which gives a BMI of  25.6.  This height was measured with no shoes on  and with socks on.

Every other doctor that has measured my height as 69.25 inches which gives a BMI of 24.8.  This height was measured with shoes and socks on.

The height measured at Dr. Pomp's office is technically more correct.  However, I choose to reject their reality and substitute my own.  

Mythbusters fan too huh! 

The BMI calculators assume your height was taken with shoes on with a 1 inch heel though. At least that's what some of them actually say. (The rest don't say anything but it's the same formula so it should be the same.)

I agree with once you get to a normal BMI, you are there and understand what you mean by HOW you get to there.  But I have decided I'm greedy.  I want more.  We'll see if I get it.

And second, ya know, it really does matter what I eat, not how many calories.  If my carbs sneak up to even 30 net, I'm bouncing.  And that is next to nothing.