So I am pretty new, sleeved on Nov 23rd, I was wondering if I drink 60g of Protein from a home made smoothie/shake a day. Can I eat whatever I make the kids for dinner or do I still need to make myself some fish or something?

what are your diet instructions from your surgeon?

To get 50 - 60 g of Protein a day, I was having a lot of issues hitting that number until I started making my own shakes. The milky ones I did before surgery now make me feel sick.

That's the only instruction, a Protein goal? You're cleared for a full diet? No restrictions on any types of food or guidelines regarding carbs or total calories? No information from a nutritionist or anything?

My exasperation is directed at your surgeon, not at you, by the way.

It seems too many docs are sending people out into the world without any information to help them be successful, and as an RN that just drives me batty.

If you've been released to a full diet, but not given any specific diet plan, you'll need to do some research and figure out how you're going to approach eating going forward. I suggest contacting your team and asking for a referral to a nutritionist if they don't have a plan to give you.

Most of the successful vets on this board will tell you that their success has been based on some form of a low-carb eating plan. What "low-carb" means varies from person to person and plan to plan. I can tell you that a total carb intake of less than about 50g per day will put your body into a compensatory metabolic condition known as ketosis. This is the goal of most ketogenic diets such as Atkins or to an extent South Beach or some Paleo programs.

For reasons we aren't quite sure of, ketosis makes me personally very ill. So my program is to stay away from refined sugars and carbs, but my carbs end up being about 80-100g a day, focused on complex carbs like whole grains, long grain/wild rice, some potatoes, etc. I can't give recommendations about my program, because I'm not to maintenance yet. I don't have any information about how it's going to work long-term, we're kinda playing it by ear.

Regardless of how low you take your carbs, you need to focus your limited sleeve capacity on your Protein first at every meal. Protein and fluids will always be your primary concern. If you have room, then you can get your veggies and a little bit of carbs in. food choices need to be about nutrition, and your relationship to food becomes about fuel instead of comfort or emotion.

Most programs require you to not drink anything 30 minutes after you eat, because it will essentially flush the sleeve and you'll get hungry faster. Programs vary on how many meals a day and how many total calories, the danger is in getting into a habit of grazing all day because you can load up on too many calories very quickly.

Hope this helps get you started.

Keep in mind that the body can only absorb 30g of protein at a time.

Keep in mind that the body can only absorb 30g of Protein at a time.

I actually read a study about this that said that's outdated information. The body will absorb whatever you eat, it just takes longer to do it. The 30g was what could be absorbed and converted in the timeframe that was being studied, but meals that have more than 30g are not just discarded, the remaining protein is held and converted slowly throughout the rest of the day.

That is not to say that it's good to load up 100g of protein in one meal or anything, it's best to spread it out through all of the meals for a number of reasons, but extra protein at a given meal isn't just "lost".

Thank you so much for the helpful information. I will see if I can move up my nutritionist appointment. It is currently set for the end of January. I make the Protein shake thing and drink it over my 8/9 hours at work. I cannot manage a large amount of anything at one sitting.

At 4-5 weeks out I was doing good if I could get down more than about 2-3 oz of anything at one time, and if it was solid food, not even that. It would take me hours to get through a Protein shake.

Get used to food going cold while you try to eat it, LOL.

It gets better.

I just don't understand why some docs are doling out information about the post-op plan like it's uranium or something. I walked away from my first one-on-one with my surgeon with the entire pre- and post-operative diet progression plan in my information folder.

I then met with the nutritionist who was ready to answer any questions I had about food, preparation, diet, nutrition, etc. (I didn't have any, but I've had a lot of schooling on the subject that the average patient hasn't) months before my surgery date.

I then had two more meetings with my surgeon before the surgery day and at the last one she went over the immediate pre-op diet and how to eat for the 2 weeks post (until my 1st checkup) one more time just to make sure I didn't have any questions.

I then had teaching from my nurse again before discharge with my first month's diet program printed out yet again in my discharge paperwork.

We were taught in nursing school that the patient should be presented with teaching information no less than three times, with no less than one set of printed information to be given at the first teaching (and giving it again at the last teaching was advised). I am amazed and frankly appalled that something this life-changing and serious is not being addressed with appropriate patient teaching from each and every surgeon's team out there.

As patients, we should demand no less. If anyone is reading this and has not been given information about what the ENTIRE program will look like, and what will be expected at EVERY stage of the diet plan, ask for it. There is no reason for the doc/team to wait until the very last minute to give this information.

I just don't get it. (obviously, or I'd not be on a soap box about it)

I am already used to cold food, I have a 2 and 4 year old. lol I got detailed instructions up to the 'normal diet' which for me started on the 25th. Being new I asked what questions I thought of but wasn't 100% sure other than Protein first and keep it to a 1/4 cup.

I ended up with an appointment with another nutritionist than the one I saw the whole time so that threw me off too.

I am already used to cold food, I have a 2 and 4 year old. lol I got detailed instructions up to the 'normal diet' which for me started on the 25th. Being new I asked what questions I thought of but wasn't 100% sure other than Protein first and keep it to a 1/4 cup.

I ended up with an appointment with another nutritionist than the one I saw the whole time so that threw me off too.

My initial packet included even maintenance diet examples and planning instructions. I first met my surgeon in Feburary. I likely won't hit maintenance until summer 2017. So she was giving me information I wouldn't need for some 18 months in the future. We didn't spend any time on it, but the information was there. Repetition is the key to giving information to patients, so giving them information *well before* they need it is part of that process. I've even seen programs that send a 3-ring binder "book" home with the patients so the packets don't get lost.

Patients often don't know what to ask until they're home and actually trying to figure out what to do. If the information is there, and someone with the team has at least glossed over it with them, they usually open the packet and go "oh yeah, here it is".

You went to a full diet on the 25th, but you don't have a nutritionist appointment until sometime in January. You at the VERY least should have been given written information about how to proceed into a full diet and what kinds of foods to avoid and what to focus on when you entered the soft foods phase.

I swear, I need to write a supplement patient manual and sell it on Amazon.

Actually, I'm going to strike my last statement. I remembered that when I was first researching this surgery, I bought Alex's book on the subject, and it was great. I'd forgotten it had a whole section on the post-op diet, because my doc's info was thorough enough I hadn't needed to reference it. I just pulled it down from my cloud reader and skimmed the diet sections, and it's all there. I have no need to re-create the wheel, and no time to research and write a book when it's already done.

So.... if your doc hasn't given you good/complete/thorough information, please get Alex's Big Book about the VSG. It's VERY well researched and I didn't find a single thing in there that was wrong. Obviously, if your doc has information that is contrary to the book, your doc's info should trump it. But in the absence of info from your doc, this is really good reference material: (two enthusiastic thumbs up):

https://store.bariatricpal.com/collections/weight-loss-book/products/the-big-book-on-the-gastric-sleeve

Keep in mind that the body can only absorb 30g of Protein at a time.

I actually read a study about this that said that's outdated information. The body will absorb whatever you eat, it just takes longer to do it. The 30g was what could be absorbed and converted in the timeframe that was being studied, but meals that have more than 30g are not just discarded, the remaining protein is held and converted slowly throughout the rest of the day.

That is not to say that it's good to load up 100g of protein in one meal or anything, it's best to spread it out through all of the meals for a number of reasons, but extra protein at a given meal isn't just "lost".

Good to know.

Thank you I will check out the book!