Feeling insecure about dietitian's advice

[mistysj 1,939]

First, I want to say that I am happy with my weight loss so far (23 pounds in 7 weeks), although it is slowing significantly to less than 1 kg (2 lb) per week the last three weeks.

Next, I want to say that I understand that there seem to be as many diet plans after the sleeve as there are dietitians. I actually have an appointment with a different dietitian who was recommended to me by a friend who has also had VSG, as a "second opinion" on what my primary dietitian (who works with my surgeon) has told me. When I spoke with this other dietitian on the phone she agreed with me that the diet my current dietitian has me on might not be the best choice for me. My current dietitian also uses basically the same diet for people with the band and sleeve, just reducing the calories a bit for the sleeve versus the band.

The liquid stage was fairly standard. In the puree stage I was told that half of every puree should be lean Protein, a quarter should be non-starchy veg, and a quarter should be grain-based starch (rather than potato or other starchy veg), because the grain-based starches give us B1 and other important Vitamins. OK. This worked fine, even though it seemed a lot more specific than most people have for the puree phase.

Then, he didn't really have a soft food stage, but just moved me straight to full foods, giving me some advice about things that I may have trouble tolerating at first. It turns out I haven't had trouble tolerating anything.

The thing I am having trouble with is the composition of the full food diet. His advice is a lot different from almost everything I see here. Here is the guideline he told me:

1. I am to have a balanced meal, not particularly high in protein or particularly low in carb or fat. This is to make sure that I'm getting all the nutrients I need.

2. I should be eating around 1000 calories a day. He reckons I am burning around 1800 calories a day and this will promote a 2-4 kg (4-8 lb) loss per month.

3. I should not count calories. Instead I should be using an exchange diet as follows:

a. 3-4 servings a day of grain-based carbs. A serve is one slice of bread, 1/2 cup rice, 1 cup Pasta (1/2 cup if it's dense or small), or 2-4 whole grain crackers depending the size.

b. Max 1 serving starchy vegetables a day. A serving is 1 medium potato or 1/2 cup mashed potato

c. 4 servings other vegetables a day. A serving is 1/2 cup cooked veggies or 1 cup of salad

d. 1-3 servings fruit a day. A serving is 5-6 strawberries, 1 medium apple, 1 medium orange, 2 small mandarines, 2 plums, etc.

e. 4 servings dairy a day. A serving is 1/2 cup milk or yogurt, or 1 slice of cheese (like the Kraft slices)

f. A palm-sized 1 cm (1/2 inch) thick amount of protein, spread over 2-3 meals, per day.

g. One teaspoon of fat or oil per day, or 1/8 avocado

h. A max of 2 alcoholic drinks per week, and a max of 2 Desserts or other "treats" per week

I am nervous that this diet has too many calories and too little protein. I am also nervous about the idea of not logging my food (he is strongly against logging and counting calories, because he doesn't think it is a natural behavior for live). I am also nervous that it is so different from what most people seem to be doing.

Is anyone else here on a similar "exchange" type diet, instead of having a set number of calories or protein per day? Is anyone else on a diet that is radically different from the high-protein low-carb low-fat diet that most people seem to use?

[mokee 588]

Sounds a lot like weight watchers. Seems like a lot of food. If we were able to eat like this our whole life we would not have needed surgery. My self when I eat carbs I crave more food and that is my problem. He told you not to count calories but wants you under 1000 a day, duh! Go with the advise of your dr, then if that does not work try this. Good luck.

[Beach Lover 1,084]

I would seriously doubt this guy also! You couldn't possibly eat all of that! My doctor told me no more than 800 calories and I can't even do that! I would definitely take a 2nd opinion! I have a hard time believing this guy knows your limitations. Keep us posted!! Good luck !

[JoiaRox 430]

Heck, I'm scared at just the "no Protein requirement" piece of it! I've been told to consume a minimum 70g/day to help with healing, Hair loss, muscle development, etc. I've seen the protein requirement, although varied, from just about everyone on this board. How can this NUT not have one?!

[Bec101 227]

Hey Misty, i was told to have 60g Protein a day and so many serves of each group of foods. Also told not to count Cals. But not to eat too many carbs. I'll scan a few pages of my booket I was given and send it to u tonorrow

[mistysj 1,939]

Heck' date=' I'm scared at just the "no Protein requirement" piece of it! I've been told to consume a minimum 70g/day to help with healing, hair loss, muscle development, etc. I've seen the Protein requirement, although varied, from just about everyone on this board. How can this NUT not have one?![/quote']

He says to have a palm-sized serve of protein over 2-3 meals and one Protein shake or bar a day. Just no actual number.

[mistysj 1,939]

Hey Misty' date=' i was told to have 60g Protein a day and so many serves of each group of foods. Also told not to count Cals. But not to eat too many carbs. I'll scan a few pages of my booket I was given and send it to u tonorrow[/quote']

Thanks Bec that would be great. Who is your dietitian?

[Threetimesacharm 1,400]

Doesn't sound like he understands the limitations of the sleeve. Way too many calories and carbs. I ate from 600-800 calories during weight loss phase and very low carb(veggies only).

[Fiddleman 4,376]

I agree with Amazon that 600-800 calories is a good target for calories by the time you are at month 2. Low carb and high Protein is going to help you achieve the fastest and most consistent weight loss month over month. Be really careful about the type of carbs you do eat making sure they are low on the glycemic index. As for counts, a good goal Is to eat no less then 80 G protein a day and no more then 30-50 g carb a day. You will need to get your required nutrients from Vitamins so do make sure you are taking a good one with 200% RDA on everything along with Calcium, fish oil, Vitamin D and b vitamins. Do keep in mind that around month 5 or 6 you re going to want to transition into eating more calories, slowly working up to TDEE - 300 for your height, weight and activity levels. It will take a few months of slow adjustment to reprogram your BMR after eating 600-800 calories a day for months so it is best not to rush it. That is my advise from one VSG post op to another.

[HatheryOnHerWay 603]

That sounds like a good "regular" diet, but not a good WLS diet.

[mistysj 1,939]

That sounds like a good "regular" diet' date=' but not a good WLS diet.[/quote']

And yet he says he had worked with more than 1000 sleeve patients. It is hard to understand. My surgeon likes him and you would think surgeons would like successful outcomes. Maybe his plan works. I just wish someone else in the world was on a similar plan and I could ask them and see how they have done.

[NoOrganicForMe 40]

I have always been told by all (surgeon, dietician, support groups, etc.)

Protein, first..... then if you have room veggies..... then if you have room whole grains.....

Always protein first.......

Good Luck to you

[JoiaRox 430]

FYI - I had a follow up with my doctor and NUT today and asked, specifically, about calorie intake. They told me that they could care less how many calories I eat or how much weight I'm losing (or not - he said "I don't care about weight loss right now, it will come later") - it's all about Protein, fluids & Vitamins. I told them I'm eating roughly 800-1200 calories a day...not even an eye blink from them on that. I love my people .

[mistysj 1,939]

FYI - I had a follow up with my doctor and NUT today and asked' date=' specifically, about calorie intake. They told me that they could care less how many calories I eat or how much weight I'm losing (or not - he said "I don't care about weight loss right now, it will come later") - it's all about Protein, fluids & Vitamins. I told them I'm eating roughly 800-1200 calories a day...not even an eye blink from them on that. I love my people .[/quote']

I am a bit further out than you. My surgeon definitely cares about weight loss. Your 1200 calories also line up with my dietitian's guideline.

[Butterthebean 8,146]

The amount of calories doesn't bother me, but the lack of Protein seems concerning. Maintaining muscle has got to be a concern for WLS patients. Protein and resistance training are the only things that will do that. If your muscle go catabolic, yes you'll lose weight but it won't all be fat, and in a year from now your metabolism will not be in good shape. Just my opinion but I think you're making the right decision to seek out another dietician.