I had a 3 month post op appointment with my surgeons nutritionist yesterday and it was a bit disappointing to say the least. When I started my doctors program they had a nutritionist that was very knowledgeable but she has since left and been replaced by someone who seems very questionable in my opinion.

He claims there are NO differences in how someone should eat with the sleeve versus a bypass and some of the things he says seem a little crazy.

For example:

Eating more than 4oz at a time will eventually cause my stomach to burst and will lead to needing a revision. (When I told him I can occasionally eat 5-6 ounces he freaked out.)

You should try to never feel restriction. (Instead of eat only until you just begin to feel restriction)

We should chew our food for 20 minutes. (He said this multiple times. Who the hell chews for 20 minutes, that's not even feasible.)

We can never eat fruit with skin again, including grapes, apples, etc. (previous nut said if you can chew it to baby food consistency you can eat it.)

We can never in our lives eat berries with small seeds such as strawberries, raspberries, etc. (Maybe he's right on this one but I hope not.)

The 4 oz we eat MUST include 50% Protein (2oz) and the other 50% must be vegetables, fruit, and starch in that order. (Eating 4oz of protein is bad according to him because eating mainly protein will lead to kidney problems.)

We should only take Flintstone chewables for a Multivitamin, anything else is a waste of money.

All in all, I think this guy is close to what's right but still far enough away that he is creating confusion. Am I crazy or is he a bit wacky? I get the impression that he is only partially educated on this stuff and he's reading off a list that he is seriously misinterpreting.

Is this in line with what the rest of you have been told/educated on? I'm looking for any input you want to share as I don't trust my new NUT at this point.

I think you are right. He's close, but not quite. Sounds like an alarmist who is making things way overstated so people will land where they should be. I might mention it to the doc. Not every patient has the ability to recognize misinformation.

Some things are similar to my nutritionists rules. Yes to eating only 4 ounces thing minus the stomach bursting. Yes to eating only 2 ounces of Protein then some vegetables, but my nutritionist says skip the starches. Yes to not eating small seeds. And yes to the Flinstones Vitamins giving you the most bang for your buck.

But I think your nutritionist is confused about the 20 minutes chewing suggestion. I was told to chew each bite 20-25 times...not chew each bite for 20 minutes...as that would be impossible. And my nutritionist did mention that some patients have trouble digesting the skin of fruit. He recommended to try it and if it doesn't work, try again further down the road.

I was told similar stuff also...in fact, I can't even try veggies until 7 weeks out. And they want me to never have starches ever again...protein always first and always the main bulk of the meal...chew chew chew up to 20-30 times and make meals last 20-30 minutes. It's gonna be tough just thinking about this!

8 days to go, no preop diet except one day.

At 3months out I had no food restrictions other than what was sensible for losing massive weight.

I eat berries daily.

Some of what he said makes sense,most of it really doesn't to me either.

Truth is a good NUT is rare..I am so lucky I had a great one my first 10months or so. After she left I only visited her replacement once.... When I got to goal, I celebrated over email with the one that left.

Do you have a choice to see someone else? Just be thankful you didn't get the one that made you play with plastic food...yes....preop that happened to me....so it could be worse.

Agree, at my nutritionist we are actually told that we should be tolerating 3oz by 1 month, and then working our way up to our final goal of 6oz by month 3-6 (just however long it takes). Mine does treat the bypass and sleeve patients very similarly, but the 20 mins of chewing thing - that had to be a brain fart - you should chew 20 times, or for us people with some sense, until you feel like you have a very fine puree in your mouth.

Take it all with a major grain of salt and know that YOU are in control of your diet and your outcome, and listen to your body. I just hit 2 week post-op, and thus far, the only troubles I've had are the times I wasn't paying attention to what my body was trying to tell me.

Hope this finds you well!

I think the 4 oz rule is a good rule to help us not to overeat at each meal. But for me a clean eating, whole foods approach has worked really well. I eat lean Proteins, veggies, fruits, healthy fats and limited whole grains. I eat very few sugar free products, just a little Protein shake in my coffee each morning. I have almost no cravings and have enough energy to workout. I eat berries of all kinds and apples with the skin on. I am 3 months post up and down 60 pds. My Dr, PCP and Nut are thrilled with my food journal because it is a well balanced. My calories are between 850-1100 depending on the day and I also vary my carbs so some days are less and some more, mostly just because some days fruit sounds more appealing and other days veggies or protein does. It is the first time in 30 years I feel food is not controlling me.

I do take a multivitamin, fish oil, Probiotics, Vitamin d, Calcium citrate and sublingual b12

Good luck on your journey!

he is close but confusing a few things i think. i do have a problem with fruit skins, for sure. the Protein kidney thing is somewhat true but only if you eat well in excess of 2 grams of protein per pound of body weight daily. 1.5 grams per pound is what athletes and body builder types eat , we should be around .5 grams per pound at optimal levels. But my advice is just that, advice. Every Nutritionist has Vitamins they like, and mine likes the Centrum chewables with Iron. cheap and effective, The 20 minute thing is impossible, not just impractical, after a certain amount of time, you cant break down food anymore without digesting it, I would defy anyone to chew food for that long.

Some things are similar to my nutritionists rules. Yes to eating only 4 ounces thing minus the stomach bursting. Yes to eating only 2 ounces of Protein then some vegetables, but my nutritionist says skip the starches. Yes to not eating small seeds. And yes to the Flinstones Vitamins giving you the most bang for your buck.

But I think your nutritionist is confused about the 20 minutes chewing suggestion. I was told to chew each bite 20-25 times...not chew each bite for 20 minutes...as that would be impossible. And my nutritionist did mention that some patients have trouble digesting the skin of fruit. He recommended to try it and if it doesn't work, try again further down the road.

Pretty much what I was told too.

Sounds nuts to me! All of that stuff is ridiculous, as far as I'm concerned.

- Eating more than 4 oz at a time? I couldn't if I tried unless it was soft/liquidy food. Like I can eat my 5.3 oz. container of yogurt, but I couldn't come close to that with anything solid.

- Never feel restriction? For me I really do try to avoid it, because I have no real feeling of "full". I just have "not full" and "OMG I'M GOING TO DIE". So I work very hard to avoid the overfull feeling.

- Chew for 20 minutes? That's just completely insane.... unless you are stuffing your entire 4 oz. meal in your mouth at one time I guess?

- Fruits with skin? I was eating apple slices at about 2 months out. I've eaten grapes as well, no problem. This is one where I think you have to try a little, see how it goes, and maybe wait before trying again if it doesn't go so well.

- Berries with seeds? I've eaten strawberries and raspberries with no issues. One of my greek yogurts I eat regularly is one of the "fruit on the bottom" types and has small raspberry and/or strawberry seeds in it.

- Only 2 oz. of Protein per meal? How are you supposed to get all your protein in if you do that? I aim for 3 oz. at lunch and dinner. I don't eat veggies or starches though....

- Only Flintstones Chewables? While that *might* be okay for your multivitamin (I take a bariatric multi), what about your other supplements like calcium, Vitamin d, and b12? What about a probiotic? If you are only taking Flintstones, I would definitely advocate getting regular blood work done to make sure you aren't developing any deficiencies.

Eating more than 4oz at a time will eventually cause my stomach to burst and will lead to needing a revision. Not likely after the 2 month mark. Eating past full is BAD for you no doubt, but to actually use the words, "You're gonna burst your pouch". Errr, No.

You should try to never feel restriction. Eh, it can be a good thing to actively try to "under eat" your sleeve to a point, but you need to get an much nutrition as you can too. Depends on what I'm eating I guess. If it's high quality I may try to get a few more bites down. If it's bar food, I may try to stop earlier.

We should chew our food for 20 minutes. That's just stupid.

We can never eat fruit with skin again, including grapes, apples, etc. Again. Just stupid. Most sleeves digest fruit skins and strawberry seeds just fine after the break in period. I know mine does. Test it out and if yours does, no problemo. If these things don't sit well, avoid them. Simple. Sounds like advice for someone with diverticulitis.

The 4 oz we eat MUST include 50% Protein (2oz) and the other 50% must be vegetables, fruit, and starch in that order. Really? It matters HOW we get the protein in? Why? Most of us are told "protein first", yes. Personally, I tend to do protein first, but there are days I wouldn't get the recommended amount without supplementation. I LIKE variety in my diet so I supplement protein. It's rare I don't get at least 80g per day. Sometimes, when I make my favorite pork roast, or roast a chicken, its ALL I eat. About 3-4 oz of it and I'm done.

We should only take Flintstone chewables for a Multivitamin, anything else is a waste of money. There's a lot of sugar in chewable Vitamins. That's the recommendation? I used chewables for the first few months until I could take pills easily. Today, (and for life) I take a "petitie" multivit 2x day, extra D3, B12, Calcium and Iron on the schedule prescribed by my doc.

Partially educated sounds accurate. You should have all of this stuff (post op care and feeding) documented by your surgical team somewhere. ow does the Nut's advice jive with that?