Years of diet plans, programs and books make most WLS patients nutrition gurus.

Much of that information is great to have but it's important to separate out the unofficial diet 'rules' that might be unsafe to practice after bariatric surgery.

Today, bariatric dietitian Elizabeth Anderson continues her series on 5 of the most dangerous dieting myths for weight loss surgery patients.

Salad. The food most synonymous with the word ’diet.’ Many people LOVE salad. Others eat it because they feel like they should if they’re on a diet.

Nutritionally, the darker the greens, the more brightly colored the vegetables—the healthier the salad.

High volume, low calorie salads make a lot of sense for the average dieter. You feel full on very few calories, provided you skip the high calorie dressing.

But there’s one ingredient many people forget that prevents salad from being a balanced meal---the protein.

I tell my weight management clients if they really enjoy salad, it’s a great meal AS LONG AS there is at least 3 ounces of a lean protein included in, on or with the salad.

The protein piece is vital because it helps the meal digest more slowly. This leads to less hunger between meals. The protein is also important to protect lean muscle from being used for fuel when calories are cut.

I tell my weight loss surgery clients, the need for protein is more than just a recommendation, it’s an absolute must.

At least 3 ounces of lean protein (about 15-20 grams of protein) with your salad. I urge you to actually measure out the chicken, cottage cheese, beans....to ensure you are hitting the mark.

A bariatric salad ‘meal’ should look like protein with a little salad on the side rather than a huge bowl of greens with a sprinkle of cheese or half an egg.

As we’ve seen with the other diet myths, standard operating procedures for dieting do not translate after WLS.

Tomorrow, dangerous diet tip #5: It’s all about the calories.

Such an amazing article. Very good, Thanks so much. I am wondering when I| can eat salad? Its been over 2 months and to be honest I crave a salad ( go figure)!!!! I tried a few bites last week and it hurt my pouch. Any info would be so appreciated.

I Love salad! I probably have one at least every other day. In fact I had one for dinner. Kale, edamame, almond slivers, hard boiled egg. I've been eating salads since 5 - 6 weeks post op.

I would love to hear your take on how much Protein is essential for WLS patients long-term.

My concern / question is whether we can eat too much protein. If so, how much is too much? 80 grams daily? 100 grams? More than 100 grams?

My concern / question is whether we can eat too much protein. If so, how much is too much? 80 grams daily? 100 grams? More than 100 grams?

Good question--I wonder that, too. My understanding is that too much protein can cause kidney damage, but I don't have a sense of how much that is, and over what kind of time frame.

Such an amazing article. Very good, Thanks so much. I am wondering when I| can eat salad? Its been over 2 months and to be honest I crave a salad ( go figure)!!!! I tried a few bites last week and it hurt my pouch. Any info would be so appreciated.

You are the expert on you so always listen to what your body says.

Now this can be confusing in your case because on the one hand it's saying, 'Must. Eat. salad.' On the other hand, your stomach is saying, 'Ouch.'

Also, timelines on when you can tolerate what, are very individual. I think you're wise to wait a bit longer.

When you do try again, go slowly, like you've been doing and remember, Protein first.

Let me know how it goes!

I would love to hear your take on how much Protein is essential for WLS patients long-term.

My concern / question is whether we can eat too much protein. If so, how much is too much? 80 grams daily? 100 grams? More than 100 grams?

The standard protein recommendation is 60-80 grams of high quality protein daily. I don't know your individual circumstances so I can't say what's wisest for you.

You absolutely CAN have too much protein however.

Check in with your bariatric team or dietitian and see if they can make a personalized recommendation.

All things being normal, anything over 90 grams per day for a healthy female would make me ask some questions.

Good luck!

My concern / question is whether we can eat too much Protein. If so, how much is too much? 80 grams daily? 100 grams? More than 100 grams?

Good question--I wonder that, too. My understanding is that too much protein can cause kidney damage, but I don't have a sense of how much that is, and over what kind of time frame.

In case you didn't see my response to VSGAnn2014, anything over 90 grams of protein per day would make me concerned.

Check with your bariatric team to see what they recommend for you personally.

The standard Protein recommendation is 60-80 grams of high quality protein daily. I don't know your individual circumstances so I can't say what's wisest for you.

You absolutely CAN have too much protein however.

Check in with your bariatric team or dietitian and see if they can make a personalized recommendation.

All things being normal, anything over 90 grams per day for a healthy female would make me ask some questions.

Good luck!

Elizabeth, thanks for your response (just saw it now).

What would cause your concern about more than 90 grams of protein/day for "a healthy women"? Is it that more protein than that would stress one's kidneys?

BTW, yes, I am a healthy, active female (nearly 70 years old).

The reason I asked about the protein is that there's considerable interest on the part of WLS patients in maintenance wanting to avoid eating highly processed, sugar-laden carbs. And given our stomachs' smaller sizes, there's a bit of a limit on how many cruciferous vegetables we can eat per day.

We've learned to eat high protein during weight loss -- and been highly rewarded for doing so: meats of all kinds, dairy products, Beans, and protein supplements.

There's also some alleged evidence and plenty of talk "out there" that eating more than 150 carbs a day will put us in weight gaining mode.

So for active, healthy women in maintenance who are eating 1500 - 2000 calories a day (that's me) should I focus on adding more fats?

I realize I've expanded my question a bit, but would appreciate hearing your thoughts on all of this if you are able. Thanks in advance.

@@VSGAnn2014, this is where I get really confused, too. I'm not in maintenance yet, but I'm at 1000 calories a day now, as per my dietitian's instructions. She said I should still be keeping my carbs to 50 grams or fewer, and my Protein should be at least 60 grams, and another handout I have says to keep fat under 30 grams per day. That... doesn't add up.

I have my macros in MyFitnessPal set to a goal of 50% protein, 25% fat, and 25% carbs, which for 1000 calories per day ends up being 125 g protein (!!!), 63 g carbs, and 28 g fat. I never make that protein goal (and it sounds like I shouldn't, according to @ElizabethAndersonRD), and I nearly always end up going over the fat allotment every day in trying to keep the carbs close to 50 g. The fat is mainly from cheese, olive oil, and nuts.

@@lauraellen80 ... I agree that nutritional guidelines widely available are confusing.

There are major points of disagreement between (1) standard nutritional advice (which I figure is what certified nutritionists dispense), (2) Atkins / low carb lifestyle eating advice, and (3) other plans like Paleo, vegetarian, and vegan.

This morning I did some online research and learned that standard nutritional guidelines generally advise that healthy women should eat daily:

60 grams of Protein

170 grams of carbohydrates

70 grams of fat

2,000 calories

4-5 cups of vegetables and fruits (yeah, I'm working on that ... )

I also read (on various sites -- and I'm reporting ONLY that I've read this, not that I'm a nutritional researcher who's done any actual research) that too much protein in one's diet can be tough on kidneys, liver, bones, cause cancer, feed yeast overgrowth, cause dehydration, degrade brain functions, and God knows what else.

There's so much emphasis after WLS on eating such a big proportion of protein during the losing phases that this focus carries over to maintenance. I've seen so many posts by WLS patients who report they're maintaining their weight loss (after losing all their excess weight) by continuing to eat high protein / low carb diets. And when anyone gains weight, the greatest proportion of advice given online is to "eat low-carb!"

And, of course, no one is advising us to eat sugar and lots of starchy foods, but eating 4-5 cups of vegetables and fruits is surely harder for sleeved patients. At least, that's how I feel at 14.5 months post-op. Maybe I'll find eating 4-5 cups of veggies / fruits a day easier as the years roll on.

???

As a vegetarian in my prep-op life I strived for 50 grams of protein on a 1200 - 1500 calorie a day diet. I never did much else with the micros except make sure I didn't go over MFP default settings. Sodium was the only one I manually set to a lower rate. I was thinking I would just go back to those levels once I reached maintenance. However I think I could manage 60 grams of protein. I knew too much protein was hard on the kidneys. That's part if the reason WLS patients need regular blood work.