Tidbits and information from Dietician

[Thomas CPA 496]

Kaiser does great follow up. Today I had a 2 1/2 month appointment with dietician and physician assistant - here is

1. Vitamins - take the 1,500 mg a day on top of amount you get in foods.

2. Carbs - said don't do just a low carb diet, they had a few that did low carb diets and while they lost weight they caused problems because they were not eating the right foods and their lab results for vitamins and minerals were way off and causing other problems so they got them to eat normal.

3. Eat 3 real food meals and use Protein Shake or Protein Bars for the between meal Snacks. Keep to 1/4 cup Protein, 1/4 cup vegetable, 1/4 cup fruit and 1/4 cup starch/carb. Eventually the between meals snacks go away.

4. Calories - get 1,200 calories per day, extra protein or carbs before working out. Trainer says carbs before and protein after.

5. Weighing - keep vigilant, weigh once every couple of days to monitor process just don't become obsessive with doing it 3 times a day. Keep from putting on weight by monitoring it.

6. Even for Men, use Women's One a Day as it has more Calcium and Iron, something Men's One a Day doesn't have.

I was sleeved on August 4, 2011 at 233 pounds as of October 26, 2011 I am down to 196 pounds for a 54% excess body weight loss. The expected loss for 1 to 2 years is 50 to 55% so I have already met the full goal of the sleeve surgery and now on my back on my own to lose weight through diet and exercise. This was done by sticking to diet plan (at least 90% of the time) for post op.

Had labs done today and so far results coming in good.

Good luck everyone, we can do it.

[Rootman 1,101]

Some good thoughts here, but some need to be clarified. See below for comments / questions.

1. Vitamins - take the 1,500 mg a day on top of amount you get in foods.

1,500 mg of WHAT? Milligrams are never usually expressed as just "vitamins" but as specific amounts of EACH Vitamin.

6. Even for Men, use Women's One a Day as it has more Calcium and Iron, something Men's One a Day doesn't have.

I had always heard that calcium AND Iron together was not good that the iron actually kept the calcium from being adsorbed, therefor I take a NON iron / NON calcium multi Vitamin and then alternate my calcium and iron supplements by a couple of hours so they don't interfere.

I was sleeved on August 4, 2011 at 233 pounds as of October 26, 2011 I am down to 196 pounds for a 54% excess body weight loss. The expected loss for 1 to 2 years is 50 to 55% so I have already met the full goal of the sleeve surgery and now on my back on my own to lose weight through diet and exercise. This was done by sticking to diet plan (at least 90% of the time) for post op.

Congrats! You are practically there already! Great job!

[RickM 1,753]

Kaiser does great follow up. Today I had a 2 1/2 month appointment with dietician and physician assistant - here is

2. Carbs - said don't do just a low carb diet, they had a few that did low carb diets and while they lost weight they caused problems because they were not eating the right foods and their lab results for Vitamins and minerals were way off and causing other problems so they got them to eat normal.

I get pretty much the same feedback from my surgeon's staff and an unaffiated RD that I see. Keep the simple carbs/sugars in check but otherwise keep it balanced within the confines of the Protein requirements and calorie limitations consistent with the required weight loss. I just can't see doing the low carb diet and leaving all that nutrition on the table - we are already unbalanced enough with the limited volume we can consume during this time without compounding the problem.

As we often see with the packaged goods that advertise low carb but boost the fat to keep the flavor, (or low fat that boost the sugar for the same reason) so goes the real food world - potassium is one of the nutrients I track since it isn't conveniently supplemented and many of the best sources come attached to carbs. Some suggest low carb alternate sources such as avocado, which i do use in my salads, but avo is twice the calories per unit of potassium as a baked potato, and about 50% higher than a banana - is low carb really saving anything if one is interested in nutrition? There are specific therapeutic uses for low carb, just as there are for most any kind of dietary restriction, but it certainly isn't a one-size-fits-all complement to the sleeve, or WLS in general

I will admit, however, that the low carb fad does provide some amusement, particularly over on OH where we have the carb nannies that come in waggin their fingers at anyone having a banana! (BTW, did anyone headslap you for last weekend? lol)

3. Eat 3 real food meals and use Protein shake or Protein Bars for the between meal Snacks. Keep to 1/4 cup Protein, 1/4 cup vegetable, 1/4 cup fruit and 1/4 cup starch/carb. Eventually the between meals Snacks go away.

I don't measure by volume like that, preferring the scale, but roughly those proportions but maybe still biased a bit toward the meat. 3 real meals and 2-3 snacks of Protein Drink, yogurt/fruit/nuts, or protein loaded pudding; have normally dropped the morning snack from earlier practice.

4. Calories - get 1,200 calories per day, extra protein or carbs before working out. Trainer says carbs before and protein after.

11-1200 cal/day. Classic fitness nutrition of heavier complex carb (typically low-med fat, med protein, med-high complex carb - like meat and cheese on whole grain) before and readily absorbable protein after. I have found that the whole grain toast for lunch before the afternoon pool workout does let me work longer and with greater intensity, though I haven't noted a significant difference on my strength training days between the sandwich lunch and my more typical salad with meat.

5. Weighing - keep vigilant, weigh once every couple of days to monitor process just don't become obsessive with doing it 3 times a day. Keep from putting on weight by monitoring it.

I do weigh daily and frequently twice daily but not for obsessive'compulsive reasons; rather the impedance scales give a more accurate reading of body composition in the late afternoon when one is usually fully hydrated, but a first in the morning is a more repeatable weight measurment (ok, so maybe not ob/com but latent engineer....)

6. Even for Men, use Women's One a Day as it has more Calcium and Iron, something Men's One a Day doesn't have.

As Rootman noted, this seems odd due to the conflict between Iron and calcium absorption. I'm not overly worried about iron since we don't have the mineral absorption issues of the RNY or DS, and I'm typically getting in double or more of the RDA of iron thru my normal Multivitamin and food; calcium is my greater concern and I do space that out from the morning iron containing multi and split it up so that no more than 5-600mg are taken at a time. (Eight years of going to DS oriented support group meetings tend to hammer these things into one's brain....)

I was sleeved on August 4, 2011 at 233 pounds as of October 26, 2011 I am down to 196 pounds for a 54% excess body weight loss. The expected loss for 1 to 2 years is 50 to 55% so I have already met the full goal of the sleeve surgery and now on my back on my own to lose weight through diet and exercise. This was done by sticking to diet plan (at least 90% of the time) for post op.

I lost a net of 50lb a few years ago with the classic balanced/sane dietary/exercise adjustments when my wife was going thru her WLS, and maintained the loss but couldn't make much more progress on any sustainable basis, so that's why I went with the sleeve - I have high confidence that the maintenance issues have already been resolved, rather than depending/hoping on making the necessary lifestyle changes after the fact.

Good luck to all,