Protein - to eat or not to eat... nut says no. Help?

I have done a lot of reading and searches on here and I haven't quite run into the situation I find myself in.  Help.

I had rny almost 3 months ago and on my last visit with my nut she was seemingly disappointed with my weight loss ("it should be more," even though I was avg. about 5 lbs a week, don't get me started).  I told her that I don't get hungry and I had to try to get 3 meals in a day, but I was still nowhere near my 60 grams of protein.  She jumped on my usage of the word "try," told me only to eat when I'm hungry and asked where I got the 60 grams from.   She went on at length to tell me that this process is about learning my body's new signals and I had to relearn satiety, so I should ONLY eat when I am hungry, even if that means not eating for a day, or two.  She apparently wasn't listening to me when I told her that I don't get hungry (no signals at all).  Additionally, when I mentioned that I thought I got the 60grams of protein from the drs literature, she corrected me and said "you must have seen that online" and "not to believe everything you read on there."

After that I expressed my concerns about not getting enough protein again.  I told her that I'm a highschool teacher who is constantly on the move in my classroom, that last thing I need is to randomly feel faint or have all of my hair fall out.  She assured me that as long as I take all of my vitamins I"ll be fine - just don't eat if I'm not hungry.  I must have had a look of dismay on my face because her next step was to bring in the PA (my surgeon wasn't there) to regurgitate the company line - don't eat if I'm not hungry, keep drinking and taking vitamins and don't believe what you read online about protein and your hair falling out, you'll be fine.

Well it's been a few weeks and I still don't get hungry, at all.  I eat maybe twice a day, no snacks, and drink between 64-80 oz water a day.  My typical day is 1/4 c cottage cheese for brunch/lunch (not finished) and 1.5 oz chicken/seafood/meat with a bite or two of grilled veggies for dinner.  I like what I eat.  I cook and mix it up with variety, but I'm not hungry for either meal.  I'm trying to make myself eat twice a day out of general well being.  I understand this is contrary to my nuts advice, but I don't know what else to do.  I don't exactly want to test the limits of my lack of appetite and not eat for a few days, and maybe pass out along the way.

Oh also, nut says no protein shakes or protein bars - "those are for people who want to maintain or gain weight."  They do not want post-ops to suppliment with any kind of additional protein; it has to all come from your diet. 

I've been living and researching this for awhile but today I read a post where someone had linked to the ASMBS Guidelines article, and there it all was clear as day and in medical speak.  I know everyone says follow your drs/nut advice to the letter and I don't want to argue with my nut, but I also want to do what is in my best interest without being shamed or redirected.  Any thoughts?

I think you ought to print out those ASMBS Guidelines and send them to that dumb woman.

Then follow the guidelines. 

You're doing fine on your weightloss.

There are many of us who DON'T feel hunger.  I don't know where she's getting her info, but she's obviously not informed about RNY'ers.

Time for a new nutritionist. A registered dietitian. I cannot believe she suggested you not eat for two days if you don't feel hungry. I too am 3 months out and I would never eat a meal if I waited till I was hungry. She is dispensing horrible advice on her patients and has no clue what she's talking about. I second the suggestion to send her the ASMBS guidelines and then tell her to get lost. 

People blindly tell others to listen to their surgeons and nutritionists because they assume that they know what they are doing.  Unfortunately, many nutritionists do NOT.  Yours is one of them.  I would make sure that your surgeon knows that she is telling people to disregard the info from him/her.

Clearly she does not understand that some people (like me, too) NEVER get hungry after surgery.  NEVER.  So we would NEVER eat. If you were to only eat when you were hungry (or when it felt like you were going to pass out, even), you would end up malnourished and would likely eventually find yourself on the floor in your classroom out cold (or, worse, in the ER).  

She also clearly does not understand the damage that long term protein deficiency can do to your body.  (Does she know that most anorexics die of heart failure as a result of the body having already pulled all the protein it could from the other muscles and then being forced to pull protein from the heart?!?)

Drop that nutritionist.  She doesn't know what the hell she is doing and she is endangering your health.  It sounds as if you are doing just fine and making healthy food choices.  (I actually kind of agree with her about the protein bars, though.  Most of them have a lot of chemicals in them, and they never have as much in the way of other nutrients as "real food" protein sources. They are fine in a pinch or as an occasional meal, but I don't think it is good for people to rely on them. That is just my opinion, of course.)

AS the other person suggested, print the ASMBS guidelines and give them to her.  THEN fire her (because she likely won't even bother to read them).

Lora

http://asmbs.org/resources/integrated-health-nutritional-gui delines   Website that has all the information you truly need. Page 22 is what you need to show them!

"Current clinical practice recommendations for protein intake after surgery without complications are consistent with those for medically supervised modified protein fasts. Experts recommend up to 70 g/d during weight loss on very-low-calorie diets [167]. The recommended dietary allowance (RDA) for protein is approximately 50 g/d for normal adults [166]. Many programs recommend a range of 60–80 g/d total protein intake or 1.0 –1.5 g/kg ideal body weight (IBW), although the exact needs have yet to be defined. The use of 1.5 g of protein/kg IBW/day after the early postoperative phase is probably greater than the metabolic requirements for noncomplicated patients and might prevent the consumption of other macronutrients in the context of volume restriction. An analysis of RYGB patient’s typical nutrient intake at one year post surgery found no significant changes in albumin with daily protein consumption at 1.1 g/kg IBW [168]. After BPD/DS procedures, the amount of protein should be increased by 30% to accommodate for malabsorption, making the average protein requirement for these patients approximately 90 g/d"

Thank you for the replies.  At least I know I'm not crazy or being a willfully bad patient. 

I was reading through the ASMBS guidelines earlier and yes, right there on pgs 22-23 was all of the post op protein info.  I felt like I wanted to scream, right here in front of my laptop. 

At this point I wouldn't even know how to get a new nut - can you just switch?  Call up another practice and see another one?

And how am I ever going to get to 60gr of protein in a day?  I feel like I can barely eat what I do.

I drank 4 Slim Fast High Protein shakes a day to get 80 grams of protein. It took me all day but I made it through. You can do it, too.

First, you do not want another nut.  You want a registered dietician.  What's the difference?  An RD must have a college degree in nutrition, pass a licensing exam, and earn continuing education hours every year in order to keep her license.  A nutritionist doesn't have to do any of those things.  You are a teacher.  You have a degree and a license, yes?  Like a registered dietician.  While a nutritionist is more like a babysitter.  See the difference?

You can find a registered dietician here: http://www.eatright.org/programs/rdnfinder/  Ask if they have experience with RNY patients and are familiar with the ASMBS nutritional guidelines.

Drink a protein shake.  It's easy to make a shake with 30 grams of protein.

Thank you for this. 

I will be starting my search for a new registered dietician this week and I will use this site as a resource. 

I am now around 8 mths post op, and losing around 5-10 lbs/mth. I too am a teacher, high school, and am very busy during the day. I have found that I rely on cheese strings in my lunch bag. I eat one in the morning between classes and then usually have cottage cheese with crushed pineapple for lunch. Also I drink the Premier Protein shakes...I have one for breakfast and always take one to school and drink it around 4pm. That seems to do the trick, whether I'm hungry (barely feel hunger) or not. I hope that helps a little.

I do my best to get my protein sources from food, such as chicken, cottage cheese, a wee bit of yoghurt, salmon, eggs and almonds. When I don't feel like eating, I will rely on a protein shake to keep my protein count above 60. I aim for 90 or more a day. And yes, my hair started thinning at month 2. Good thing I have very thick hair, and no one notices but me. My surgeon said that is normal in the rapid weight loss phase, till around month 7 or so...but said it will grow back once you start to sablize. Here's hoping.  :) I hope that helps you out a little, everyone is different.