Weight Loss Surgery - WLS and Carbs

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04-10-2013, 11:34 PM
So, being a "newb" in the world of WLS, I have been meeting so many new people online and in person who have gone through many different WLS programs. They are all SO different, which seems odd to me. But it just goes to show you that there is no one right way to go about weight loss.

One of the things that has kind of been bothering me is that there are so many people who are 100% against carbs. Whether it be of their own conclusion or because their surgeon specified no carbs. My question to these people would be, do you think that is realistic?

Personally, having studied nutrition and after working in health care, I am well aware that in order for your metabolism to to work efficiently, carbs are an essential part of your diet. More specifically, complex carbs. Natural sugars (fruits and veggies) and whole grains, etc. Realistically, the majority of your calories should come from complex carbs in order for your body to run properly. So I find it odd that so many surgeons and weight loss professionals are essentially pushing "Atkins" on WLS patients.

The way I see it, no carbs, for myself anyway, is not a sustainable, lifelong lifestyle change. I believe it is all about balance and making healthier choices. Should we restrict our carbs and choose better carbs? Of course. But to cut them out entirely doesn't make any sense. I was told by one girl today who is 6 months out that she can't have any fruit. So I am curious to know where she gets all of the essential vitamins and nutrients that we get from fruits. I wonder if this is not why many of the WLS patients I have met who have maintained a significant amount of weight loss for years are unhealthier now than when they were overweight, due to lack of those vitamins and nutrients.

I'm just curious to hear other's opinions on this matter, and what your particular WLS program stipulates regarding carbs. As it is, I am only averaging 40-50 grams of carbs daily at the moment, but my personal aim will be for close to 80 grams daily once I am into solid foods and working towards healthy eating (my program wants us under 30 grams, which I don't think is realistic long-term).

Thoughts? Comments?

04-11-2013, 06:18 AM
I can't speak to the other surgery types, just what I've learned/been told about RNY.

Because of the malabsorption component, when trying to lose weight, protein and fat may never be fully absorbed and they keep you full longer. Carbs are always absorbed, they are typically slider foods that don't keep you full as long, and they may ignite further cravings for more carbs (because you are not fully satiated or desire simple sugars).

But that doesn't mean NO carbs. I think I was told to keep my carbs less than 100, with the emphasis on carbs coming from fruits and vegetables. 60-80g of carbs seems to be where I do best.

Again, speaking only from the RNY prospective, I was told to stay away from fruits and vegetables for about 6 months and then could slowly reintroduce them. First, many fruits contain small seeds and are acidic and could irritate the healing pouch. Second, because they don't contain any protein, and your body is healing from a major surgery and needs protein to heal, as well as your pouch space is still very limited, it is better to eat protein forward and then, after six months, if pouch space still exists, one can start to reintroduce them. However, in the long run, fruits and veggies are highly encouraged, and most are eating regular portions of them by 8 months.

Finally, if you are morbidly obese, you are already unhealthy. Yes, at first, you are malnourished and the rapid weight loss does make some look unhealthy. But saying all surgery patients are unhealthier after because of malnourishment is false/fear mongering. Some are lax in following their surgeon's protocol regarding supplementation. Some went to surgeons who don't follow ASMBS guidelines and recommend false supplementation, like Flintstones, because they think patients will more likely take vitamins if they are cute and sweet. Sometimes, the weight loss uncovers hidden issues.

I'm not unhealthier now than I was before, but I have more health concerns now. My WLS uncovered Barrett's Esophogus. It also uncovered a cancerous tumor that I've apparently had for awhile, but didn't know about until I lost the excess weight and could see it. But overall, I am much healthier. My blood pressure and lab values are much better than they were preop. I'm not an abnormality in this regard.

04-11-2013, 10:43 AM
VIVID - first, much depends on the type of surgery. RNY patients have malabsorption [including water soluble vits] + restriction, and no pyloric valve. DS patients have a larger stomach [still restricted] + malabsorption [including fat soluble vitamins] and they keep their pyloric valve. Lapband and sleeve are both restriction only, except that the lapband is removable and the sleeve is larger [you keep your pyloric valve].

One of the reasons I raise the pyloric valve is that it serves as a meter for your food out of your stomach. The reason RNY pts have to limit their carbs is because of dumping syndrome. Too many carbs dumped at once into the duodenum sets up a physiological reaction - and believe me, once you've had it, you NEVER want to go through it again.

Having said that, though, even RNY patients EVENTUALLY start eating carbs again - after about 18 to 24 months, everyone should be eating a bit of fruit, and veggies at every meal, even breakfast [so said my dietician], and some whole grains as well. things to avoid - or severely limit [and they shouldn't be a surprise to anyone]: cake, ice cream, candy, soda, white bread, white rice.

The caution about carbs in ALL surgeries is because of the limited calories that ANYONE is physically able to take in right after surgery [and for a variable time afterwards]. Protein FIRST because you need it for healing, and then as there's space, some veggies, and if there's STILL space [and your surgeon isn't telling you you're overeating], a little bit of fruit or whole grain something or other.

And that's why we MUST take vitamins - we can't eat enough to get in all the nutrients we need. And those of us with a malabsorption component MUST continue them for life, and get regular bloodwork.

in other words, people who have surgery live by a slightly different set of rules than people who lose weight the old-fashioned way. but it's not unhealthy, unless, of course, we choose that path

04-14-2013, 07:51 AM
Having consumed a bit too much bread yesterday, I forgot to mention that eating too many carbs for many post-RNY folks can lead to great discomfort (for not only the consumer, but also for anyone else in the room). :)

04-14-2013, 10:40 AM
:lol: i've heard the same thing happens with some DS folks

04-18-2013, 08:59 PM
I had a VSG, and my surgeon and nut say 600 calories a day, 15 carbs. Obviously this isn't a lifelong way of eating :) but after surgery you have a "honeymoon phase" where weight loss is easier. I hear the first 6 months. If you can stand it, make the most of it. :)

04-21-2013, 11:41 PM
My program calls for 600-800 calories (6 weeks out, solid foods) and less than 30 grams of carbs. Personally, I can't make it through a day with so few carbs, for the fact that I get hypoglycemic. I average around 50 grams of carbs, and I am quite happy with that. Considering I used to eat HUNDREDS of carbs, the majority of which being sugar, I consider this a vast improvement.