Nutrition requirements different than what I thought!

 Khess and Doggs pretty much stated my feelings - Sounds Wonky to me.  Is your surgeon ASMBS certified?  Is it a COE?  What are his long term rates with a policy like that?

All I can do is share my journey, my three years of observation on this board and my doctor's advice.  That is all I've got, so you may choose to listen to me or to the doctor you chose.  It is hard for me to tell you that I think your doctor is wrong, but not to tell you this would go against my experience.  Lately, as more doctors start to do the sleeve, I find myself in this situation more and more.  I never ever thought I would be telling people not to follow their doctor's advice, but I am about to tell you just that.  Sheesh, I don't like doing it.

The average weight loss with the sleeve over time is not the same from one doctor to another.  This has to do with many factors, sleeve size and eating plan as well as aftercare program.  My doctor is known for some of the very best results in the industry.  His plan calls for 600-800 cals a day, under 40 grams of carbs and over 70 grams of protein a day.  ( the more protein the better while keeping calories and carbs really low).  This plan has a proven track record and if you look at most VETS, that's what we followed.  Many people who follow your surgeon's advice, lose well for the first 4-6 months and than stall out.  I have seen it over and over on these boards.  There are some people that do just fine with it, but overall, the statistics are much worse.  My doctor wants you to reach 80-100% EWL, most plans are only shooting for 50-60%.  You can do better. 

I think the weight loss phase is as much about changing habits as it is about losing weight. I am therefore grateful that my plan was for no sugar, high protein which was not doable without protein drinks, and low carbs, none of which came from bread and such. Seems like sugar and refined carbs are sort of an addictive thing for some of us (like me) so I am really glad i got away from them for a year. Now its much easier to avoid or highly limit those things. Not sure that would be true if I had kept them in my eating during weight loss.   My  brother had a surgeon who had a program like yours but I convinced him to follow mine. He is doing very well.

So you need to draw your own conclusions. I would at least question your surgeon and ask the rates of long term success on these rules. diane

Thank you everybody! OK, so first I need to be clear on something. This was just a basic nutrition class, so I'm sure I will get more detailed info as a get closer to surgery. Also the class was for every procedure, but it appears they give the same nutrition plan for all surgeries. It is Synergy Bariatrics. The surgeon is Dr. Carauna, but I actually think a different surgeon, Dr. Cavaretta, is going to do my procedure, but I'm not 100% sure yet, I will be discussing that next week.  I have honestly only heard positive things about him, but they do a LOT more bypasses than sleeves. Dr. Cavaretta is apparently the "sleeve guy" at synergy, so that is why I think I may end up with him.  They are a COE and members of the ASMBS, they also have an excellence award from HealthGrades for getting such high scoring reviews. I know he has been doing this for a long time. He seems knowledgeable, and it's not that I think he doesn't know what he's talking about, I'm more concerned about being on the best plan for me to reach goal as a Sleever and not just get halfway as others mentioned. 

My surgeon's nutritional advice post-op is pretty relaxed, mostly a matter of what you can "tolerate", getting sufficient protein, and avoiding empty calories and too much fat.
However, he has his patients on a super-low-carb diet immediately pre-op to shrink the liver. It worked so well for me, both for pre-op weight loss and for eliminating the sugar cravings that have always been my nemesis, I knew that was the right path for me post-op.
I think you'll see as much variation in advice for post-op weight loss and maintenance as you'll see for non-op weight loss and maintenance. Low carb has a lot of converts, but it's far from universally accepted. The nutritionist my surgeon sent me to wanted me to aim for 100 grams of carbs a day!
I think it depends in part on your particular nutritional issues. If you don't have issues with simple carbs and sugar, you may be fine on your surgeon's plan. But in my experience, most of us with really serious weight issues don't fit that description. For carb addicts like me, eating everything in moderation isn't going to work long-term, it's just an excuse to continue eating the way I always have, which will lead me right back to weighing what I always did.
I haven't really gone into the details of how I eat with my surgeon, but he's amazed at my progress (I'm 10 lbs below his goal for me, and in the middle of a "normal" BMI range.), and considers me to be a "rock star" patient. Your surgeon may not require this kind of eating post-op, but that doesn't necessarily mean they'd object to you following it.

As far as total calories go, I was probably in the 600 - 800 range for the first six months, working up to 800 net of exercise, and eventually 1000 - 1200 net calories. That's not nearly as low as Dr Cirangle's patients, and I certainly admire their discipline and success, but I've been very pleased with my steady weight loss progress, and since I never entirely lost my hunger and wanted to fuel my workouts, I've found a higher calorie range has been a better fit for me. I started out at a more moderate BMI, so I didn't feel under a time crunch to lose the weight fast, and didn't need the motivation of speedy loss to keep me on track either. Just my two cents.

I too did my pre-op nutrition class and in our class we were told that the first 2 weeks they are not concerned with calories.  My. Doc is more concerned with Hydration and getting the protien in.  1 protien shake a day and at least 64 ounces of fluids.  he suggests 4-5 meals a day and each meal should only be about 4 ounce.  And definetely no sugar for a few months.

 I'm 3 months out and couldn't dream of even 1000 calories right now without adding some majorily dense foods like avacado and nuts.  I reguarly stay at 700, and trying really really hard to keep my protein around 100g but really it's holding steady at 80-90g.  I exercise heavily and at least 3 days a week I have a negative calorie defecit.  I have had no stall yet, only one week with a 1lb loss and the rest have all been 2-4lbs.

My surgeon has a much more lax approach but it's also written for RNY patients who DO have malabsorption.  I choose to follow Cirangles plan because time and time again it gets the best results.  May not work for everyone but the large majority would see 80%-100% losses if they followed it.  I don't accept anything less than a normal BMI so I'm donig everything I can to stack it in my favor!


That being said because I do exercise heavily on my heavy run days (3 days a week) my carbs almost double to 80g a day because I found without it I was unable to exercise well.  If I didn't exercise as heavily 20g a day would be my norm.

hi!  just my thoughts:  sugar stuff kinda weird -- don't know about that.  1200 calores:  it will be a while before you can get that much in -- probably a few months.  my doc/NUT have told me not to go below 1200 cals.  i've lost 105 lbs.  i feel good about the process and the point i'm at now.  i'm not a tiny personm (at 53, that person is probably gone anyway), but i'm still losing, just more slowly.  and for myself, i know i literally couldn't function/do my job/be calm with 600-800 cals.  i think it's great if you can do it, don't get me wrong.  and it may even be a better way to do it.  this is just my journey so far!

good luck!!!  lots of perspectives here and lots of people like elina and diane who know A LOT!!!!

((((((((((hugs))))))))

i don't want to repeat what has already been stated. 

How often do you see an overweight doctor?  Not very often.  And even then, the few overweight doctors are slightly overweight, maybe just from living the good life and sloppy eating habits, maybe combined from lack of vigorous exercise. 

So i don't think most doctors can relate to the addictive nature of sugar, refined wheat flour, the fat-salt combination which is difficult for most of us in snacky type foods, the effect of high glycemic food like white potatoes, rice, bread, corn chips, etc.

i have a feeling your doctor is clueless about how intense eating urges are for us with longstanding overeating problems.  i don't think your doctor understands how some foods trigger us to eat more and more, especially foods with sugar. 

i don't have an opinion on the 1200 calories a day except to say you should lose with that number of calories, but it will be slow, and it is easier to stay motivated when the pounds come off at a faster clip.  The first few months it will be difficult to get close to that number of calories unless you are adding a lot of oil and butter to your food, and why would you want to get in the habit of adding all those fat calories? 

So if i were in your position, i would try the approach that the vets on this board have used to get to goal.  If you find that you are not getting enough calories to match your active lifestyle down the road, you can always up your calories.  But it better to start low, see how you do, rather than start higher.

I am 8 1/2 months out and I have tried guidelines like that based on what some other OHers were saying. I found out that . . . I should have just listened to my doctor & nutritionist in the first place! That type of structure actually helped me to gain almost 10 lbs and I wasn't eating an extreme # of carbs!

A lot of foods you should avoid actually are easier to eat than those you should be eating. Everything postop you put in your mouth is so important because you can eat so little and your body desperately needs solid, good nutrition. I have found that if I increase my carbs just an add'l 20 grams this helps me retain fluid regardless of the extreme workouts I have.

Bottom line: Do your research. Every body is different and you should find the surgeon & diet plan that you are comfortable with and can be 100% on board with. However, if something sounds too good to be true, it probably is.

Best of luck to you!

P.S: I am really troubled by that protein drink issue. A lot of us find that we cannot get protein in by just eating it--I have this problem as far out as I am. Shakes, especially in the beginning, are vital to you getting your protein in since you often find it very challenging to eat or drink anything else.