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Post-surgery

WEIGHT LOSS MANAGEMENT

Why Is Protein Important?

Protein

As Dietitians at SCMWLC we believe that to get to where you want to go you need to develop nutritional knowledge and eating intuition.

People have these to varying degrees, but often by the time people walk through our doors these have been confused due to dieting.

It is a matter then of developing the knowledge and intuition and in particular how they relate to bariatric surgery.

What is the hype about protein?
At the moment protein is ‘in” and you will notice it is being put “in” everything from ice cream to cottage cheese to porridge and even water!!

Clever marketing capitalising from the latest dieting crazes of keto and paleo. Someone who has not had bariatric surgery should be able to meet their protein requirements through natural dietary sources.

So why is protein important after bariatric surgery? Let us make this clear – this is NOT yet again another diet! It is neither paleo nor keto in disguise. We at SCMWLC believe having bariatric surgery should mean the end of dieting. A lot of our clients describe their changed relationship with food from “Living to Eat” to “Eat to Live” so perhaps it is about the motivation.

Protein is especially important post bariatric surgery for healing, reducing lethargy/ fatigue that can occur in the early stages post surgery and preventing muscle loss while you are losing weight; not to mention hair loss that often occurs from 3 months post- surgery.

For all these reasons, and also the fact that your meal size is less than 1 cup, the requirement for protein is higher than needed pre surgery

(0.75-1.0g/kg ABW= adjusted body weight)

So how much is enough?
You will need:

– at least 60 gm – 90gm protein/ day ( 1-1.8g/kg ABW)

How to Calculate ABW 
Ideal Body Weight + [ (Actual Body Weight – Ideal Body Weight) x 25%]

74kg + [ (95kg – 74kg) x .25 = 79.25g protein

BUT did you know, that it is NOT a direct relationship between (protein) food weight & protein content?

Here is the protein content of some:

If you look at the table above, you can see that 90g of meat does NOT equal 90g of protein. In fact, it provides only about 20g protein.

Most standard serves of protein foods such as an egg or 1 glass of milk provide 7g of protein. To achieve 90g of protein you need to have 12 times that! Keep in mind, you need to also meet this requirement with the added challenge of altered appetite and small portion sizes.

Not all proteins have the same biological values, so you want to choose protein foods where you get the most nutritional value. You can use this table or there are apps such as MyFitnessPal or Baritastic to assist your nutritional knowledge & make informed choices.

Did you notice that whilst nuts are listed almond milk was not? Almond milk only contains 1.4g protein per cup (250ml).

You may also notice that Grains/ cereals, fruit & vegetables are not included in this table, and that is because they contain smaller amounts of protein, but clearly are part of balanced eating and need to be included in meals & snacks post bariatric surgery. Traditionally, many rely on the evening meal to get their vegetables in but after bariatric surgery this is not possible so you need to capitalise on other opportunities.

So How do I get protein in?

  • Focus on Protein rich sources:

          – Lean meat & meat alternatives-meat, chicken, fish, egg (NOT processed meats salami, sausage)

          – Dairy products- milk, yoghurt, cheese

          – Nuts, seeds

          – Legumes – lentils, chickpeas, 3 & 4 bean mix

          – Soy & tofu

          – Protein supplements

  • Include protein at each meal/ snack

          Distribute your protein between the 3 meals & 2 mid – meal snacks (5 x eating occasions).

          For example: if you need 90g protein per day this would be 18g protein per eating occasion OR 20g per meal + 15g per snack

          In real food terms this would look like: 2 egg omelette with cheese & smoked salmon with a small amount of your choice of vegetables such

          as mushroom, capsicum , tomato, or a snack such as a high protein yoghurt.

  • Protein needs to be the basis of meals/ snacks (½ of the meal) vs carbohydrates
  • Eat your protein foods first

WARNING: rant ahead

This is not a case of carbohydrates being evil (not all carbohydrates are created equal!). Carbohydrates have traditionally been used to bulk out meals or to fill us up, but clearly, following bariatric surgery carbs will limit your intake of important nutrients e.g.; protein, iron etc.

We encourage small quantities (<1/4 serve) of high-quality carbohydrates, E.g.:

– wholegrains (oats, Hi Bran Weetbix) to assist bowels, cholesterol, provide B vitamins

– Legumes, quinoa – protein & iron source

Remember – Eating post bariatric surgery is not another diet – it is NOT a NO Carb diet.

Food is complex and not just a matter of a single component like fat or protein or carbohydrates (which is an oversimplified view often presented in the plethora of dieting information adding to confusion).  Food is wholistic and we at SCMWLC encourage balanced eating of nutrient rich whole foods.

“What about protein supplements”? I hear you say

Protein supplements used appropriately allow you to eat in a balanced way.

In the initial weeks post – surgery, you follow the dietary stages of fluid, puree, soft and eventually back onto normal foods. When food is

modified in this way, it is a challenge to meet your protein needs – this is where protein supplements can help. When you are managing small quantities of ¼-½ cup it can be challenging to meet your protein needs through whole foods alone.

The use of protein supplements “kills 2 birds with one stone” as you are trying to get fluids in as well as protein (shakes – ½ as a mid- meal snack where you can add your shot of coffee or, protein waters). Protein powders can be added to milk on oats or in curry and frees you to eat in a more balanced way. Over time, food intake improves and protein supplements should be weaned as you meet your nutritional & protein needs through food alone.

“Protein Supplements” as the name suggests are to supplement food intake NOT replace it! Protein balls are a- plenty, but did you know

that Mother Nature has her own protein balls called eggs or meat balls! Just because something is promoted as containing protein this doesn’t necessarily mean it is a good choice. It is important to consider context and content.

Context in the instance of protein balls is that they are a treat and should be treated as such ie: can be eaten if enjoyed as a treat & the bonus is you get some protein BUT not to be eaten in order to get protein. Other choices could be nuts, trail mix, boiled egg, cheese & cherry tomato, cucumber etc. This is further highlighted if you think about high protein pancakes or ice cream – they are still pancakes & ice cream! Then there is content- how much protein vs how much sugar? Source/type of the protein? This is where label reading comes in.

Stay tuned for future posts.

Is whey protein as good as getting protein from collagen?

Whey protein contains all nine essential amino acids, making it a complete protein that is absorbed quickly. Whey is absorbed faster than other forms of protein, which means it also increases muscle protein synthesis.

Collagen contains 19 amino acids & is the key structural protein that ensures the cohesion, elasticity and regeneration of all of our connective tissues; it’s the essential glue holding our bodies together. Collagen, however, only has 8 out of the 9 essential amino acids whereas Whey has all the essential amino acids. Whey has a higher level of the BRCAA’s (Branched ChainAmino Acids) leucine, isoleucine, and valine.

In summary: Whey is good for building and maintaining muscle, whilst Collagen is good for muscle integrity and tone, joints, healing of

muscle and joints, elasticity, possibly hair, skin & nails. Both are beneficial post bariatric surgery, however Collagen does NOT replace whey.

Plant protein does not have all 9 essential amino acids and is regarded as lower biological grade requiring careful combing to achieve the full complement.

Both Whey & Collagen are available as water and powder form to be added to food & fluids.  

The dietetic team at SCMWLC can work with you every step of the way to help you develop your nutritional knowledge & eating intuition, to ensure quality results you deserve.