Question about diet and observation after support group tonight

So tonight was my monthly support group at Kaiser and the topic was recipes for post ops who are eating real food. Our leader, who is a RD, first reviewed our program guidelines: 3 meals a day, no grazing, starches limited to well toasted bread, crackers, cooked potato without skin, 60-80 grams protein, under 100 grams carb, at least 64 ounces of water, etc. the question came up as to why no skin and she replied that it was to decrease the risk of blockage, and that fruits like apples should also be peeled for this reason. It made me wonder yet again if any programs have different post op diets for sleevers than for RNY patients. I think the reason Kaiser doesn't at this point is because they have only been doing a lot of sleeves for about 3-4 years, so they just base everything on what they know. So, my question is: does your program have different diets based on surgery type?  My observation from my years of seeing the insides of both RNY and VSG GI tracts is that they are very different (duh!) but I don't necessarily think that a lot of health care providers ( or patients, for that matter) understand the big differences between the two.  I know that I seem to have to explain to doctors I encounter at work that there are different types of WLS. (But not to the GI docs, thank goodness!) Maybe I expect too mush from providers at a facility that does not do WLS, but I do wonder if the general lack of knowledge is the norm. Also, I don't think it is just a Kaiser thing, or that Kaiser do s do 't know anything. I am proud to work for KP and believe that the KP model of healthcare is what healthcare should be.  

Any thoughts?

I agree.  I have noticed that so many suggestions from RNY are automatically carried over to VSG.  The timing of drinking water is a very good example.  For RNY they don't want to wash out their pouch and therefore allow further eating.  For VSG you don't wash out your sleeve.  Your pylorus decides when it empties.  Instead we don't drink when we eat because we simply won't have room for our food because the pylorus is closed, especially when you eat protein.

anyway, what I came here to mention is that I expect my PCP and other specialists to not really understand how this stuff works.  I am a specialist in my field and there is no way I can keep up with all the changes in my colleagues' specialities. We have to be our own advocates every where.  

Funny that they told you not to eat the peel.  Too bad. That's where all the fiber is! 

First off.... looking at your stats, you know whats up, congrats !!!

I'm afraid your experience tonight is pretty normal ..... "in general"

I won't comment on the "plan" cause I'm past that.

I've been to some other support groups outside my program and heard some stuff that would make your head spin !!!

Not eating the skin sounds like either early post op or a LapBand thing.

For the VSG it is actually a good thing to eat the "skins" for increased duration of satiety.

Cucumber skin for instance is very hard to digest and will tend to stay in your sleeve longer to slow down the transfer rate.

Kaiser facilities seem to be separated by hospitals, districts or regions. I've heard the range, some good and some very questionable.

I work closely with my surgeons RD on my food blog and can tell you for sure there is a big difference between an RD for normies and one that specializes in bariatrics.

The diet for the different surgeries can vary some in content and quantity, but for the most part it's a lower carb higher protein way of life with the lapband being more sensitive to texture.

frisco

eat the skins.  chew.  there is little worry of getting stuck with the sleeve.  the skin is where all the good stuff is, like fiber and vitamins.

Why doesn't the pylorus valve seem to close with some types of protein (protein drinks, cottage cheese, yogurt, etc.), but closes with others (chicken, beef, egg, etc.)?

Liquids and semi-solids don't cause the pyloric valve to close, only solids.  If liquids did it, we'd never be able to drink that much since our valve would always be closed! 

This is just a quick PSA that has nothing to do w/ the surgery itself.  If you're gonna eat the skins, make sure you know where the potatoes came from and how they were grown.  They absorb and retain from the ground around them.  If they aren't organic, or grown organically (like a local farmer who uses organic and clean gardening principles and just can't afford the certification -don't get me off on this rant) then you want to peel the potatoes and discard - not in compost.  

Thank you for this. Unfortunately too many people don't know how nasty non-organically grown foods can be.

However, I have read that it's not just the skin that contains the bad stuff, that research has shown that it's all the way through them. I read a list of the ten veg to buy organic if you can't afford to buy all organic, and potatoes was near the top of the list.

You seem to be well informed and capable of looking beyond what is 'suggested'. In reality, there are very few 'best practices' when it comes to VSG so you will get widely varying opinions on what to eat. In my case, I chose some key VSG vets who achieved a normal BMI and maintained their weight loss for more than two years and generally followed what they did. That has worked very well for me. 

Thanks for all the comments. I actually subscribed to the Elina/Frisco plan during weight loss, and continue to limit carbs. I rarely get to potatoes because there is just not room, and I don't eat rice or pasta or bread at all. As for the skins, I have been eating them ever since I was cleared for raw fruits and veggies. Frisco, thanks for the tip about cucumber skins. I had not thought about that! 

The even sadder thing, in my opinion, about support group is how many people just eat whatever they want and then are surprised that they gain weight.  I know that I will need to be vigilant forever.  It's still early in my journey, but I do try to ask myself if what I am planning to eat supports my health. It helps keep my goal of staying free of the damned cpap right up front. Man, I hated that thing, although I loved how much better I felt once I was on it. It served its purpose for me, but I do not want to go back there.

Happy weekend all.