Discussion: Maintainance

OK.  A little about me so that you know that this info is legit.  I am in nursing school.  I am currently taking a course on Human Nutrition and my instructor has a PhD in nutrition from the University of Texas.  And we just covered this exact topic in class on Thursday. Carbohydrates typically fall into two categories - simple and complex.   What makes a carbohydrate simple is that it takes 1 step in the digestion process to convert them into glucose and be absorbed into the blood stream. They impact blood sugar very rapidly.  Some examples of simple carbohydrates are:  sugar, REFINED white flour, REFINED white rice, and white potatoes.   Basically, the more processing that man does to the food makes it easier for the body to digest it. What makes a carbohydrate complex is that it takes several steps in the digestion process to convert them into glucose and be absorbed into the blood stream.  They impact blood sugar slowly, or not at all.  Some examples of complex carbohydrates are:  fruits and veggies, whole GRAINS and whole GRAIN products (like barley, wheat, and rye), brown rice, and legumes (beans).  They bring MANY important nutrients to the table - folate, thiamine, iron, niacin, and FIBER, which helps keep you full for longer periods of time.  In addition, fiber helps lower cholesterol and protects against many GI diseases, like cancer, diverticulosis, and appendicitis. So, when we severely limit carbohydrates, we are cutting off some very important nutrients that we don't get from dairy and meat, the main food source of a lot of WLS patients.  I know most of us are very good at taking our supplements, but food sources are so much better for our bodies.  Don't get me wrong, I supplement.  I just try to get as many nutrients from my food as possible. ideally, our (the general population) diet should look like this: Carbohydrates - 60% Fat - 30% Protein - 10% As a WLS patient, I strive for a mix that looks more like this: Carbohydrates - 50% Fat - 25% Protein - 25% These are my own figures.  I know that my body needs the carbohydrates.  And I know that we don''t digest protein very well, since we no longer have access to the hydrochloric acid (the first step in protein digestion) in the stomach, so our needs are increased because of that.  We need some fat to absorb some vitamins (A, D, E, and K) and to make some hormones, etc. I am currently doing a research paper for my nutrition class and my topic is the long term nutrition needs of the gastric bypass patient.  So far, I have NOT found a lot of information on this.  I don't think there has been very much research dedicated to it.  The focus has been the weight loss phase, not long term maintenance.  As more and more people have this surgery, hopefully someone will see the need to study us, long term.  We can only hope.  Anyway, I hope this helps answer some of your questions. XOXOXO, Sharyn

Sharyn,   Thank you for the valuable info. I think you have found your passion (calling). I would love to read your paper when you are finished.  There are a lot of grants out there for medical research, all you have to do is find a program, dr. or university that will back you up. There is a lot of info on the net about research grants, the only catch is if you don't know how to write the grant you really need to find someone who does. Because you basically have to sell yourself and your idea. Just a thought.   Thanks, Toni

I was just saying to my partner the other day that I maybe wanted to focus on nutrition and maybe get an RD in addition to my BSN degree!!  That way I could work as a dietician and nurse in the WLS field.  We'll see.  I will actually start nursing school in August.  And that will take 2 years to complete.  I've got a little time to think about it. XOXOXO, Sharyn

[QUOTE]... Carbohydrates typically fall into two categories - simple and complex.  ...

Some examples of simple carbohydrates are:  sugar, REFINED white flour, REFINED white rice, and white potatoes.   Basically, the more processing that man does to the food makes it easier for the body to digest it. ...As a WLS patient, I strive for a mix that looks more like this:

Carbohydrates - 50%
Fat - 25%
Protein - 25%[/QUOTE]

First of all, Sharyn, thank you for sharing your studies.  I, too, would love to read your paper when it is done.  I hope you don't mind if I pick your brain a bit more.

I have a question about simple carbohydrates as listed above, does a baked potato fall into the same category as 'white potato' since it is not processed?

Also, your carb ratio is double your protein.  Why isn't it the other way around?  I think I understand that you said the complex carbs are needed for proper nutrition, but I thought we should be at 50% protein, 25% complex carbs, 25% fat.  Can you elaborate more as to why you choose the 'mix' you do?

Yes, white potatoes are simple carbohydrates.  MOST simple carbohydrates are ones that are full of sugar or have been processed so much that they bear little resemblence to what they where when they were picked off the stalk, so to speak.  BUT, the main thing that makes a carbohydrate simple or complex has to do with the digestion process - how many physiological "steps" it takes to be turned into glucose.   The simple carbohydrates are monosaccharides and disaccharides.  The monosaccharides (single sugars) are glucose, fructose,and galactose.  The disaccharides (sugars composed of pairs of monosaccharides) are maltose, sucrose, and lactose.  Maltose consists of 2 glucose molecules.  Sucrose consists of 1 glucose and 1 fructose.  Lactose consists on 1 glucose and 1 galactose. These simple carbohydrates break down into glucose and enter the blood VERY rapidly.  They impact blood sugar very fast.   Complex carbohydrates contain MANY glucose units and, in some cases, a few other monosaccharides strung together as polysaccharides (many sugars).  Since there are many glucose units or polysaccharides strung together, it takes many more steps to digest them, therefore they enter the blood much more slowly.   They affect blood sugar very little, if at all.   They glycemix index measures food according to their potential for affecting blood sugar.  Foods athat are low on this scale do not affect blood sugar quickly - peanuts, soybeans, beans, milk.  Things that are high on this scale affect blood sugar rapidly - white bread, white potatoes, watermelon, doughnuts, etc. I choose the mix of total calories that I do based on sound nutrition principles.   RDA for carbohydrates is 65% of total calories because: The brain and nervous system use ONLY glucose as a fuel source.  That is why when one experiences a low blood sugar episode, they feel light-headed and cannot think straight.  The brain is starving.  In times of starvation, the body can convert protein into glucose.  That is why we lose so much lean muscle mass during our weight loss phase.  When the body cannot spare anymore protein, it can use ketone bodies, which are made from fat.  This is a last resort, though. RDA for protein is 10% of total calories because: The body cannot store excess protein.  Everything that the body does not use immediately is excreted in the urine.  But, first it is turned into uric acid by the liver.  It is very hard on the kidneys and liver to do this.  It can cause enlargement of the kidneys and liver.  BAD! RDA for fat is 30% of total calories because: We need fat for the absorption of vitamins A, D, E, and K.  And to make the sex hormones testosterone and estrogen, among others. I just don't buy the high protein/low carbohydrate fad.  It is not based on sound nutrition.  It is very hard on the body and deprives us of many nutrients that only come from carbohydrates, like thiamin, folate, niacin. I compromise with the 50-25-25 mix because I know that I need more protein.  But ONLY because our bodies cannot digest it properly without access to the hydrochloric acid that our intact stomach used to provide.  But our BRAIN needs the carbohydrates - a MINIMUM of 150 grams per day. When I complete my paper I am willing to post it here.  I hope that I have answered your questions.  If not, feel free to PM me. XOXOXO, Sharyn

Thank you!

Hey Sharyn,  Yes, by golly, I would say this is your calling...lol.  I hope you don't mind but I am going to use this info for the support group I lead I think we all could benifit from this info. Again thanks for letting us pick your brain. You have been very helpful. ----Toni

Everything that I posted came straight out of my text book and lectures.  It is not "mine," so feel free to use it.  I just hate to see carbohydrates "villianized" when they are needed by the body for so many reasons. XOXOXO, Sharyn

  excellent info.  I would say the long term nutritional needs of a wls patient are very similar to the long term needs of any human being, with a  a little extra on B-12, iron and calcium, but maybe not even that  when you consider the regrowth of the villi. I take them anyways "just in case"  altho  where I go i was told the calcium is less of an issue than many think, that at least with my procedure The gastric fluids/acids  do in fact connect with my food, just a little lower on the digestive tract. and that the calcium, protein etc  will absorb at that point. it may well vary dependiong on the length of the intestine bypassed etc and all should follow thier own docs advice on that. Controversial, but it made sense to me. i supplement more because I am a menopausal woman and all menopausal women need increased calcium.

Great question... I am 18 months out. I started at 336 and am now down to 165, give or take 2-3 pounds on either side. I've been maintaining this weight for about 3 months now. My surgeon's goal was 185, which would have been 85% of my excess weight lost. According to the BMI scale, I should get down to 159 to have a BMI of 25 and in the normal range, however my clinic's goal is to get a BMI between 25-30. My personal goal started out at 190. and once I hit that, I changed it to 170. Now, I just concentrate on staying between 162 - 167. I was weighing every day, but finally got comfortable with weighing 2-3 times a week, although I know my therapist would love if I could get down to once a week. I work with a nutritionist outside of my surgeon's program. Although they provide access to a nutritionist, the ones in the group are pretty rigid (she didn't want to make adjustments once I became lactose intolerant after surgery and insisted I drink 3 8-ounce glasses of milk a day no matter what) and they have never battled a weight problem. The one I choose to work with was obese as a child so has understanding of the psychological aspects of weight loss/weight gain/food addiction. My typical day looks like this: B - 1 scrambled egg, 3 flatbread crackers, skim latte or black coffee S1 - AchievOne protein shake, fruit L - 1/2 wrap (turkey & cheese, tuna), 1 c. salad, V-8 or veggie S2 - nuts or cheese stick & fruit D - 3-4 ounces of protein, 1 c. salad, veggies I get 80+ ounces of water a day and will often include a 20-ounce Vitamin Water (by Glaceau) which is 150 calories, but I account for it. I am terrified of regaining my weight, so I am pretty strict about my diet. I do allow myself small treats on occasion so I don't feel totally deprived. I have wine once or twice a week and can tolerate sweets in small amounts (a few bites at most). I know if I reach more than 167, I really need to get back to basics to make sure it doesn't stay. My exercise routine leaves a lot to be desired mostly due to a hectic work schedule, but when I'm in the groove it's weights 3-4 times a week, cardio 4-5 times a week and yoga 1-2 times a week. I enjoy exercising, and really appreciate being able to move so much easier now that I've lost 170 pounds. Anyway, like others, I apologize for rambling a bit, but this is near & dear to my heart. I don't want to be one of the ones who gain so much of their weight back. I've worked too hard to come this far.