Question:
Anyone been told by their doctor to eat only 4-500 cals at 18 months PO?

Saw my dr for my 18 month checkup and still have not lost 100 lbs. We went over my diet and exercise and he said it looked good but could not explain why I can't lose and haven't lost 10lbs in 10 months. He told me to stop all protein supplements (my main way of eating as real food doesn't agree too well and supplements are easier) and just get my calories from what I am currently eating (around 3-400 cals a day). He said to cut my protein from 80-100 to whatever I actually eat. I am desperate to start losing as I still have 40-50lbs to go but wondered if anyone else had been told this.    — Dianne C. (posted on November 4, 2003)

November 3, 2003
Perfect example of how little nutrition education they give out in medical school. I would advise that you go see a registered nutritionalist/dietician. Prefereable someone who has experience with post-op eating. 400-500 calories is too few to fuel you basal metabolism, much less anything extra you do. You will most likely go into starvation mode and will end up staying the same weight or even gaining since your body will think there is a famine going on and will store any calories you take in as fat. When you say food doesn't agree, are you just not interested, or is there some kind of pain when you eat? What kinds of food are you eating? I know alot of people use Atkins induction to break a platuea, so you may want to try that. You need to eat (keep doing the supplements to make sure you get your protein) but you really need to increase the calories, not cut them back even more.
   — Ali M

November 3, 2003
You need to eat. You should be eating about 1,000 calories or so daily. Going below 800 or so will put you in "starvation mode" as the previous posted mentioned. I looked at your profile and it mentioned that you could have had a stricture back in Jan. 2003. Did you ever get that checked out? If not, you need to. There's no reason why you shouldn't be able to eat normal food, just smaller amounts. At this point, if you've been living primarily on liquids, your body probably doesn't know how to react to real food. I agree with the previous poster - see a nutritionist. This surgeon appears to be at a total loss as to what to do for you. A nutritionist/dietician would be a huge help. If you can't find one your insurance covers, many gyms, YMCA's, etc. have a nutritionist on staff that you can see for a reasonable fee (I pd. $20 for 30 minutes at my local YMCA).
   — Carolyn M.

November 4, 2003
The other posters gave you good sound advice but i can't condon going over your physcians head. he knows you better than anyone else knows your situation. However, I would call him and ask him to refer you to a dietician that is familar with wls. Please forgive my spelling errors. Kind of in a hurry. Good luck
   — Delores S.

November 4, 2003
I must disagree with the last poster. Doctors are not gods, no matter what they've been taught in med school! They're no reason not to go over your surgeon's head, if he's not giving you the help you need, and obviously yours is not. Have you discussed this with your primary care physician as well? You need to start eating some FOOD!
   — MsBatt

November 4, 2003
In my opinion, you've stopped losing because you're not getting in enough calories. 18 months post op, I would think 1200 a day, correct?
   — mrsmyranow

November 4, 2003
I believe your doctor is trying to force your body back into ketosis based on what you have written. This is likely the fastest way to get the process moving again. Your malabsorption benefit is likely gone at this point or almost gone. So you will need to do something more like a diet. Essentially this would be the early part of a strict Atkins diet. But it likely should work. You need to go for 100% protein so that your body burns the fat stores because no carbs are coming in. I did this for 4-1/2 months after surgery, with my surgeon's approval and it worked wonders. It also helped me tame that carb monster significantly. Going total protein will help you feel full longer also and hopefully allow you to lower your portion sizes. It will be more difficult. If it's impossible to do total protein then keep the carbs below 10 grams per meal and closer to 5 grams. When I say carbs, I mean all carbs - veggies and fruits included. Make sure you are getting tons of water though or else it could cause kidney problems. This would likey be safe for a while and then slowly advance the carbs again. I would call the doctor back and discuss this some more so you understand what is trying to accomplish by telling you to do this and if indeed he is trying to force you into ketosis. If I was in your situation, this is the way I would go, but not without my doctor's knowledge. For me I believe it would work as my body has responded to high protein very well since surgery. As long as you stay in max ketosis then it is not critical that you get in 60 grams of protion, as the whole process of ketosis forces your body to use fat stores for energy and not protein. I'd try this for a few weeks to a month and then very slowly increase it. It will also likely help shrink your pouch some get your portion sizes down. I'm assuming that your portions may have grown too big, but this is just a guess. I know everyone's take on this is different and many run like he!! from ketosis, but used properly it is safe and get this weight loss train moving again and quicker than a good ole diet. JMO so don't kill me!
   — zoedogcbr

November 4, 2003
How many calories a day were you ingesting with protein supplements? You may have, along with the food calories, been taking in too many calories and therefore no weight loss. Its still a calories game, after all. And what about exercising? You don't mention it. Heart pumping cardio exercise, a good 30 minutes, 4 times a week will start that metabolism burning those calories at a faster rate. I agree that at 18 mo you should beable to eat much more than 400 calories a day and I can't help but wonder if that is part of the reason your loss has slowed.
   — Cindy R.