So I'm 8 months out and gone from a size 18 down to a size 6. I'm 5-3 and 135# right now. I've been consuming roughly 1400 calories per day. Pre-op testing showed that I had a very high metabolism (blessing and a curse). I don't want to trash it. I have no trouble getting in my fluids and proten. I do a combo of either walking/running, yoga, and interval training 3-5 days per week. I have struggled with hunger from very early on post-op.... real hunger. Anyway, I'm still losing about a pound per week, but am thinking I want 130 to be my new goal. So I'm thinking ahead to "maintenance" nutrition. What would a healthy, balanced macro profile look like for me? I'm thinking I should do another follow-up with the nutritionist, but wanted to solicit input here too. I am not doing keto, nor do I desire to. I run and feel that I need some carbs for energy, though I stick to whole food/whole grain carbs and way less quantity than pre-op, think black beans, whole fruits and veggies. I do oatmeal and yogurt on occasion too. Anyway, I'm wanting to tweak my macros on myfitnesspal toward maintenance. Any suggestions? I was thinking 35/35/40 carbs/protein/fat??? Does that sound reasonable? Gotta figure out what maintenance calorie count looks like at this activity level. I get 12k - 15k steps per day. My lean body mass is supposedly around 96 pounds.

Oh and here are a couple pics just because. No regrets!

Edited May 29, 20179 yr by Crafty-in-Carolina

Great job! Everything you said sounds spot on. The only piece we're missing is what your macros look like currently.

Essentially, keep your protein consumption up, and increase fats (if they're low), and carbs.

As a general rule, 70g protein, 150g carbs, and 1-3 tablespoons of added fat is a healthy diet... especially when the carbs come primarily from fruit, veggies, nuts, and legumes with occasional whole grains.

But, we are such an eclectic group, where some of us gain weight on 50g carbs, that it's impossible to say exactly what your macros should be, other than to say increase the food gradually until you find the level at which you maintain.

If you aren't carb sensitive, and can meet your protein goals, I don't think the macro balance matters. Just the overall calories.

Since you are almost at your goal, it would be a good time to have your RMR/BMR tested in a lab so you know exactly what your current caloric baseline is and pin your calorie goals to that.

Looking back at MFP diary, it looks like a lot of 25/35/40 carb/protein/fat lately. I am a bit concerned for my kidneys with maintaining such high protein over the long term. I should also say that I'm just as concerned for overall health as weight maintenance, so I do want a good macro balance. I don't seem to be super carb sensitive. My surgeon tests metabolism again at 1 year, so I have a few more months before getting a precise measure. So for now I can only estimate.

Unless you are eating like 200 grams of protein a day, you aren't eating high protein and I mean high protein at dangerous levels.

A good protein goal is .8 to 1 gram of protein per pound of lean mass.

Edited May 29, 20179 yr by OutsideMatchInside

Unless you are eating like 200 grams of protein a day, you aren't eating high protein and I mean high protein at dangerous levels.
A good protein goal is .8 to 1 gram of protein per pound of lean mass.

Thank you! I'm probably around 100-120/day. Docs office says 80 grams is the goal. I'm pretty comfy with 100 as that's probably a 1:1 ratio with lean mass. I'll find out for sure at my 1 yr check up. Just not sure if that's ok long term or only for the short-term losing phase. I'm a little paranoid about my kidneys due to watching my mother lose hers. Dialysis is no way to live if you can avoid it. [emoji22]

I've been in maintenance for 8 months. I'm 5'1, 118 pounds, and consume in the 1900 to 2200 kcal range per day, although I really don't track or measure any macros other than protein.

I eat as much fat and carbs as I want. Since I run on most days of the week for exercise, I need the carbs to fuel my workouts.

I consume about 120 grams of protein per day. Anything less will leave me hungry. I also consulted with a nephrologist and had my urine and blood tested, and the 120 grams of protein per day is not having an adverse impact on my kidneys.

Tracking macros and counting calories is not really my thing because it is too reminiscent of the dieting mentality. Many of us sucked at long term adherence to diets prior to surgery. I refuse to revert back to a lifestyle that I disliked and left me feeling constant deprivation.

By the way, I am sorry to hear about your mother's kidney issues. My mother recently died of end stage renal failure, so I am paranoid about my kidneys as well. However, 120 grams of protein per day is nowhere near 'high-protein.'

Edited May 29, 20179 yr by Introversion

I've been in maintenance for 8 months. I'm 5'1, 118 pounds, and consume in the 1900 to 2200 kcal range per day, although I really don't track or measure any macros other than protein.
I eat as much fat and carbs as I want. Since I run on most days of the week for exercise, I need the carbs to fuel my workouts.
I consume about 120 grams of protein per day. Anything less will leave me hungry. I also consulted with a nephrologist and had my urine and blood tested, and the 120 grams of protein per day is not having an adverse impact on my kidneys.
Tracking macros and counting calories is not really my thing because it is too reminiscent of the dieting mentality. Many of us sucked at long term adherence to diets prior to surgery. I refuse to revert back to a lifestyle that I disliked and left me feeling constant deprivation.
By the way, I am sorry to hear about your mother's kidney issues. My mother recently died of end stage renal failure, so I am paranoid about my kidneys as well. However, 120 grams of protein per day is nowhere near 'high-protein.'

Thank you so much for this info. I'm sorry for the loss of your mother. I lost my mother 18 months ago. It sucks. I'm very relieved to hear your results from nephrology though. It's reassuring.

70 grams protein is way too much, especially for someone of your size and for someone who's got a family disease if kidney problems. I'm don't mean to be argumentative, but whoever said "unless you eat 200 g a day you can't cause kidney problems" is not correct.

In addition to kidney problems, excess protein is associated with increased cancers and osteoporosis

If you look at the US guidelines, you need only about 45 g/day (and if you look at international science-based guidelines, you need even less) in the long term (if your doc advises higher during healing, that's fine). Since you didn't have a malabsorptive surgery, you don't even need to add the the 25% extra that those of us with RNY need to add.

Good replacements for all that excess protein are things you are already eating....vegetables, fruits, complex carbs. Your body will thank you.

If you want to lose wt, go heavier on the non-starchy veggies; if you need to stabilize, go heavier on the fruits & carbs; if you neat to gain, go heavier on the high fat foods (nuts, seeds, avocado, etc) Just tweak the ratios as needed for the rest of your life

congratulations on your success and I hope you continue to enjoy great health!

Edited May 30, 20179 yr by talkingmountain
Hit send before finishing post

4 minutes ago, talkingmountain said:

70 grams Protein is way too much, especially for someone of your size and for someone who's got a family disease if kidney problems. I'm don't mean to be argumentative, but whoever said "unless you eat 200 g a day you can't cause kidney problems" is not correct.

In addition to kidney problems, excess protein is associated with increased cancers and osteoporosis.

If you look at the science-based guidelines, you need only about --- protein. Add in 25% for "malab

Her Dr office already gave her an 80 gram goal, knowing her medical history, so obviously 70 isn't too much.

And science says you need more protein. The US government says you need less because they fill the food pyramid with carbs because of lobbyists.

The only people that can advise her on proper protein levels are her medical team and they already have. No one on the internet is qualified to tell her how to eat, even if she is asking.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1262767/

Since OP isn't carb sensitive, she could switch her protein sources to 50% plant based and that is easier on her kidneys if that is a real concern for her Drs.

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While protein restriction may be appropriate for treatment of existing kidney disease, we find no significant evidence for a detrimental effect of high protein intakes on kidney function in healthy persons after centuries of a high protein Western diet.

I think this article is interesting:

http://bayesianbodybuilding.com/the-myth-of-1glb-optimal-protein-intake-for-bodybuilders/

I'm 5'7, so if I sit on my butt all day I can eat 55g protein.. if I'm athletically inclined, it goes up to 88g.

My current consumption is 70g, which is good for now. As I get to exercising more, I'll increase it a tad.

I'm a sleeve patient, if I were a bypass patient I'd increase all those #s.

In the study I linked they cite a few other studies. One of the things they notated, which seems to be true with successful who keep their weight off long term, WLS patients or not is...

Quote

Although the efficacy of these diets with regard to weight loss is still subject to debate, several studies have demonstrated favorable physiological effects

Quote

RESULTS:

More than 90% completed the trial. Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group (difference 3.7 kg, 95% confidence interval (CI)(1.3-6.2 kg) P < 0.001), and fat loss was 4.3 kg and 7.6 kg, respectively (difference 3.3 kg (1.1-5.5 kg) P < 0.0001), whereas no changes occurred in the control group. More subjects lost > 10 kg in the HP group (35%) than in the HC group (9%). The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly.

CONCLUSIONS:

Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet, improves weight loss and increases the proportion of subjects achieving a clinically relevant weight loss. More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products, and hence improve adherence to low-fat diets in weight reduction programs.

Also they define a high protein diet as 1.5 g per kg per day of total weight not lean mass, 1.5 is still within the acceptable recommended limits. I am roughly 84 Kilos total weight that is 126 grams (which is about what I eat in a normal day). The .8 recommendation would put someone like me at 67 grams of protein a day. My issue with that is less the low amount of protein but the low amount of calories. Protein is 4 calories a gram, that is 268 calories a day. I have not idea where I would find another 1200 to 1400 minimum calories a day just so I could function, then if I wanted to maintain, I would need to find another 1800 is calories that were not protein. I can't eat 1800 calories a day in spinach.

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In the following review, high protein (HP) diets will be defined as a daily consumption of greater than or equal to 1.5 g/kg/day, which is almost twice the current Recommended Dietary Allowance but within the range of current Dietary Reference Intakes (DRIs) for protein. The Institute of Medicine DRI report concluded that there was insufficient scientific evidence for recommendations of an upper limit of protein intake but suggested an acceptable macronutrient distribution range of 10–35% of total energy for protein intake .

This is a really long PDF and pages 609-696 deal with protein recommendations.

https://www.nal.usda.gov/sites/default/files/fnic_uploads//energy_full_report.pdf

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Protein deficiency has also been shown to adversely affect kidney function, where it has adverse effects on both glomerular and tubular function (Benabe and Martinez-Moldonado, 1998).

At the bottom of page 692 in the PDF they start talking about high protein diets. The first few paragraphs deal with it. Basically you can high protein if you have enough fat, but you can't eat just super lean meat and keep your fat low, because in the past people have became size doing this (top half of page 693).

Page 694

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With increasing protein content of the meals, a maximum rate of urea synthesis of 65 mg of urea nitrogen/hour/kg body weight 0.75 was observed. At higher intakes, the rate was not increased further, but the maximum rate continued longer. In a 70-kg sedentary person, this maximum rate corresponds to about 250 g/d of protein, or about 40 percent of energy

The uppers limits of what counts are possibly high protein is 3 to 3.5 grams of protein per kilogram of total weight. I don't think any weight loss patient could eat over 200 grams of protein a day unless they were drinking it and eating protein bars.

Even at that high rate...

Quote

High protein intakes have also been implicated in chronic diseases such as osteoporosis, renal stones, renal insufficiency, cancer, coronary artery disease, and obesity (see “High Protein Diets” in Chapter 11). However, the current state of the literature does not permit any recommendation of the upper level for protein to be made on the basis of chronic disease risk.

The data on the potential for high protein diets to produce gastrointestinal effects, changes in nitrogen balance, maximum urea synthesis, or chronic disease are often conflicting and do not provide dose–response information or clear indications of a lowest-observed-adverse-effect level (LOAEL) or no-observed-adverse-effect level (NOAEL) for these endpoints. Thus, there are insufficient data to establish a Tolerable Upper Intake Level (UL) for total protein. Because of the current widespread use of protein supplements, more research is needed to assess the safety of high protein intakes from supplements; until such information is available, caution is warranted.

However, in those who have idiopathic hypercalciuria, the occurrence of kidney stones is much increased, and although there is no evidence to indicate reducing protein intake will decrease the risk of developing kidney stones, these individuals should not be encouraged to consume more protein than the Recommended Dietary Allowance (RDA).

Based on distribution data from the 1994–1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII), the highest mean intake of protein from diet for any gender and life stage group was estimated to be 104 g/d (Appendix Table E-16) for men aged 19 through 30 years of age. For the 70-kg reference man (Table 1-1), this would equate to 1.5 g/kg/d. This life stage group also had the highest reported protein intake at the 99th percentile of intake at 190 g/d, or 2.7 g/kg/d, for the reference 70 kg-man.

This is all a lot to say there is no recommended upper limit, there is no data on it really. People can eat massive amounts of protein over 200 grams a day without adverse effects, that doesn't mean that people should eat that much. Still eat 100 grams or so a day is fairly normal and not a cause for alarm. So people should consult with their Doctors, keep up with the regular blood work.

I am going to keep consuming my 1g per pound of lean mass because it has allowed me to maintain my lean mass without regular weight training while losing a large amount of fat. I have lost 95% fat and only 5% muscle all with just walking and eating high protein.

That might not be right for everyone but scaremongering people into eating low amounts of protein which may be counter productive for weight loss and maintenance is not necessary.

People should consult with their medical team and find a way they can eat for life without feeling deprived.