Month: May 2020

Which Protein is Best After Bariatric Surgery?

When I counsel my patients that after surgery protein is the most important nutrient for them and they must include it and try to eat it first in every meal, they ask me why protein is so vital after bariatric surgery and are some proteins better than others?  So here are my answers to these!!

Surgery reduces meal portion size, though at the same time increases the demand of protein:

  • For healing,
  • To support rapid weight loss,
  • For good glycaemic control, and
  • to prevent lean body mass.

Protein is a macro-nutrient required by the human body for growth and maintenance. Besides water, proteins are the most abundant molecules in the body. Protein is found in all cells of the body and is the major structural component of all tissues, especially muscles. When fragmented into amino acids, are used as precursors to nucleic acid, co-enzymes, hormones, immune response, cellular repair, and other molecules vital for life. Additionally, protein is needed to form blood cells. Protein is a building block required for your muscles, immune system and internal organs to function properly. Protein also helps you stay full for longer and is available in various forms such as whey protein concentrates and isolates, soy protein, pea protein, peanut protein etc. The choices are endless, but which one is best is important to know and understand before buying your protein supplements.

The most significant characteristic of protein from a nutritional viewpoint is its amino acid composition. There are numerous methods which rate proteins by their usefulness to an organism based on their relative percentage of amino acids and, in some systems, the digestibility of the protein source. These include Biological Value (BV), Net Protein Utilization, and PDCAAS (Protein Digestibility Corrected Amino Acids Score). The FDA as an improvement developed the PDCAAS over the Protein efficiency ratio (PER) method. The PDCAAS is adopted by the US Food and Drug Administration (FDA) and the Food and Agricultural Organization of the United Nations/World Health Organization (FAO/WHO) in 1993 as “the preferred best” method to determine protein quality. PDCAA score of 1.0 indicates best quality protein, so whenever you buy your protein supplement, just check on the nutritional label for PDCAA score.

Whey protein isolate (WPI) is manufactured by separating components from milk. Whey is a by-product of cheese- making procedure. Whey proteins can be processed to yield whey protein in three forms: whey isolate, whey concentrate, or whey hydrolysate. The difference between the whey protein forms is particularly related to the protein, carbohydrate and fat content. Whey isolates contain highest percentage of pure protein and is pure enough to be virtually lactose free, carbohydrate free, fat free, and cholesterol free. PDCAA score of whey protein isolates is 1.0. Whey proteins are highly bioavailable, are very rapidly absorbed and have a high concentration of branched-chain amino acids (BCAAs) which are needed for working muscles and stimulate protein synthesis.

Post weight loss surgery whey protein isolate is the best choice as a protein supplement, because patients have limited capacity to eat, and at the same time protein requirements are high. Bariatric surgery also alters digestion, that is why patients need a kind of protein which is readily digested and absorbed and a complete protein in terms of amino acid made up especially essential amino acids. Animal sources such as eggs, chicken and seafoods are also good choices for eggetarians and non-vegetarians, plant-based proteins are not as high quality and would require long term supplementation to attain comparable benefits.

Hence, Protein choices should be tactical and emphasis should be on the highest quality protein based on amino acid composition and digestibility.

Why Gradual Diet Progression is Advised After Bariatric Surgery

Candidates for bariatric surgery often wonder why there is gradual progression of diet after weight loss surgery?? They ask me why they have to be on liquid diet for first 15 days, and they question me if they have to be on liquids for weight loss then why surgery is required?? It is important to make prospective patients understand that they have a key role in their healing process. They have undergone a major change physically and emotionally. The purpose of dietary phases is to provide appropriate time for proper healing. Also, gradual progression helps decrease acid reflux, provide early satiety, prevent dumping syndrome while maximize weight loss and at the same time should prevent lean body mass during the period of extreme weight loss.

That is why the gradual dietary progression must be adhered strictly in order to support tissue healing, aid in weight loss and to prevent possible complications.

The diet progresses in 4 phases, such as:

•  Clear liquids
•  Full liquids
•  Pureed diet
•  Soft to normal diet

Clear liquids include sugar free, non-aerated liquids which supply fluid and electrolytes and also helps in encouraging the restoration of gut activity after surgery. Patients usually follow this diet post-operatively during hospital stay only, i.e. 1 to 2 days. From the day of discharge, they may start introducing full liquids including skimmed milk, lassi, butter milk, strained veg/dal and chicken soups etc. and continue the same for 2 weeks. Then from week 3 they are advised to take pureed diet consisting of foods that have been blended or liquified to a puree consistency like milkshakes, well cooked and mashed pulses and vegetables, scrambled eggs and grilled fish. They need to be on pureed diet for next 2 weeks. After 4 to 5 weeks of surgery they may gradually progress from soft to normal diet including well cooked foods, avoiding sugary and fatty meals.

The post-surgery diet is designed to restrict calorie intake, as well as to help develop appropriate eating habits and diet behaviour to promote weight loss while maintaining good nutritional status.

The primary nutritional goals and diet behaviour involve:

•  Taking adequate liquids say around 1 to 1 .5 lts to stay hydrated.

•  Consume protein first in each meal to minimize loss of lean body mass and facilitate healing. It is usually difficult to get enough protein through food that is why protein supplements are recommended to meet the needs.

•  Avoid 5 “S”, i.e. Sugar, Spirits, Smoking, Soda and Straw.

Sugar and spirits are avoided to prevent dumping and also to aid weight loss, straw and soda may cause bloating and patients may suffer with stomach discomfort, pain or feeling of fullness. Smoking is prohibited to prevent reflux and marginal ulcers.

Bariatric surgery procedures alter gastro-intestinal tract, hence modifies many food related behaviours such as portion size, perception of taste and smell, likes and dislikes or food choices. Patients are advised and educated to learn new diet behaviours to easily adapt modifications. They should eat at regular intervals, by including 6 to 7 meals a day. They are advised to chew the food very well and eat at a slow pace. Avoid drinking liquids along and for 30 minutes before and after meals as drinking beverages along with meals can cause early satiety and may hinder adequate protein intake. The meals portion should be small to avoid over eating and vomiting.

At our Institute we assess each patient in detail pre-operatively to recognize their nutritional and dietary patterns as well as to evaluate their ability to incorporate nutritional changes after weight loss surgery.

Each patient may have different capacity and appetite to eat; one should listen to his/her body as to when to stop eating. Be definite to abide by the instructions of your surgeon and/or dietitian to reduce your risk of developing malnutrition and surgical complications and all of this will be well worth it!