I have often been asked by patients how much protein is adequate for bariatric surgery. Our post-op resource guide details our recommendations, but I am often faced with the question, “How much protein do I need?” and “What protein shake should I drink?” The answer is you don’t have to drink any, but you will likely feel and progress better if you manage to take in a certain amount of protein.
How much protein do I need? The amount depends on the type of weight loss surgery that you have had. Our restructure patients (lap bands and sleeve gastrectomy) require a little less protein around 6 grams daily. They will absorb protein better and therefore require a little less. Our Gastric Bypass patients will generally need 60 to 80 grams daily because there is a malabsorptive component to this mixed procedure. Our Billary Pancreatic Diversion patients (BPD) will generally need 80 to 100 grams daily because this procedure involves a higher degree of malabsorption.
What protein shakes should I get? There are many protein shakes that would be adequate for our post bariatric patients; there are so many brands that it is impossible to list them all in this context. In general, it is important to look at the nutrition label, make sure that aren’t too many calories, carbohydrates, or fat grams per serving. It usually recommends less than 120 calories, less than 5grams of fat, and less than 8 grams of carbohydrates, also to be affective it should have at least 12 grams of protein. In Summary, shakes are not absolutely necessary, but they do facilitate healthy weight loss in both bariatricand non-bariatric patients. Protein is vital for all body functions; including maintenance of muscle mass. In my early years of bariatric surgery 2004-2005, I worked in a bariatric program that forbade all protein shakes. Now our program activity encourages protein shakes, I can honestly say, the patients feel and progress better.
If you are just getting started with your journey after weight loss surgery, follow the recommendations that you have been given.
Early on in the journey motivation is high, compliance is great and weight loss is at its peak. Later on, as weight loss slows (naturally), daily routine takes priority, old habits can gradually creep back in at times and exercise may even dwindle somewhat. If this seems to be happening with you, think back to what motivated you to have surgery and write down the goals that you had at that time. See how many of them you have accomplished and see which ones are yet to be realized. Maybe even set new goals.
Your number one goal was probably to get healthy. The second one was probably to lose weight, or maybe it was a combination of the two; to get healthier and lose weight. If your goal was to get healthy, realize that the only way to get healthy is to eat healthy foods most of the time (a great majority of the time) and to exercise regularly, get quality sleep, manage stress, and do things that make you happy. Make sure that you set yourself up to be successful at eating the right amount of foods and the right types of foods that have been recommended to you. In addition, make sure that you are making time to exercise five or more days per week.
Sometimes things happen that interfere with your routine, but do not let this interference become a long term hindrance to exercise. You have to figure out for yourself how you can make your circumstances allow for regular exercise and healthy eating. Use an exercise record sheet to stay on track and a food journal for your diet as needed. For example, if your work schedule changes and you have to work overtime and this is cutting into your exercise time, don’t quit, modify your exercise routine and do what you can as often as you can until your schedule permits returning to your old routine. Remember 10 minutes of vigorous exercise is better than none and you can always divide your total exercise time between two different sessions throughout the day. For example, if your goal is to exercise for 30 minutes each day, but there are several days where you do not have 30 minutes at once to exercise, complete two 15-minute sessions with appropriate intensity and you will have 30 minutes of exercise for the day. When you are sick you need to rest, but during that time continue to use your record sheet and document that you are sick. Return to more exercise as tolerated.
Gastric Bypass surgery has evolved over the past forty years and the technique used today is better than ever before. Unfortunately, previous versions of the bypass made it possible for the patient to develop an enlarged pouch or a dilated gastrojejunal anastomosis (connection of the small bowel to the gastric pouch). A dilated pouch allows the patient to eat too much and a dilated stoma removes the restrictive component of the operation also allowing excessive food intake. Both of these conditions lead to weight re-gain after successful gastric bypass surgery. Weight re-gain is terribly demoralizing for the gastric bypass patient and previously available options for treatment of weight re-gain have been invasive and only marginally effective.
I am proud to announce that there is now a non invasive option to repair the dilated gastric pouch and dilated anastomosis. The ROSE procedure is an incision-less endoscopic (through the mouth) option that allows the surgeon to plicate the pouch and or the stoma to aid the patient with losing the re-gained weight. ROSE stands for Revision Obesity Surgery Endoscopic. I was selected to be trained on this new procedure along with a small number of surgeons in the United States. I believe that it provides options not previously present for properly selected patients to help them lose weight.
Weight re-gain can occur for a variety of reasons. Sometimes the patients behavior is the cause. If a patient stops exercising and begins snacking weight re-gain will occur. Food choices and using the tool correctly (not drinking while you eat) are also important. Other causes include overeating causing pouch dilation, formation of a gastro-gastric fistula, and technical errors by the surgeon such as making the pouch too big or the Roux limb too short to begin with. Above are examples of why patients must be properly evaluated before undergoing any form of revision surgery whether it is endoscopic, laparoscopic or open. Evaluation includes:
Evaluation of Diet
Evaluation of Exercise Habits
Upper GI X-ray (can be done in office at the New Life Center)
Upper Endoscopy
For the properly selected patient, the operation is performed as an outpatient procedure. After undergoing general anesthesia, a transport tube is place through the patients mouth into the gastric pouch. The transport has channels through which an endoscope, graspers, and suturing instruments may be passed. In this way permanent suture anchors are placed to plicate or shrink down the pouch and stoma.
Post operatively, patients return home and can usually return to work the next day. Many patients experience a sore throat that quickly goes away.
Other options for treating weight re-gain exist as well. I routinely perform revision operations on patients from other practices and I know that a thorough evaluation of the patient is necessary in order to tailor the treatment to their needs. Having said that, I am also very excited to have this cutting edge technology available for the properly selected patient!
