Amanda Clark

Protein’s importance is widely recognized in bariatric surgery because requirements are at least as high after surgery as before, yet stomachs are so much smaller. So how much protein do we need and can we get enough at each meal without only eating meat? Protein’s importance is widely recognized in bariatric surgery because requirements are at least as high after surgery as before, yet stomachs are so much smaller. Emerging research is suggesting that the distribution of our protein intake throughout the day can be just as important for maintaining muscle mass as the total quantity. One study found that consuming more than 30g of protein at a time provided no additional benefit, with the maximum benefit achieved at 30g. Eating enough protein is essential for building and maintaining muscle mass and function. The older we get the faster our body breaks down our muscle after building it, to the point where we can almost pump ourselves up at the gym and slowly start deflating as we walk out the door. Muscle has an important impact on our metabolic rate, or how many calories our body burns in the day. Our calorie burning ability influences how easy it is to gain, lose or maintain weight. So how much protein do we need and can we get enough at each meal without only eating meat? There are varying recommendations for protein intake following bariatric surgery ( gastric bypass, sleeve gastrectomy and gastric band ) . The recommendations fall within the range of 50 – 80g of protein per day for most people. Taller individuals with higher muscle mass fall towards the top of this range and may even have needs that exceed 80g per day. If this protein intake is spaced out between three periods in the day, then this would suggest that 16 – 26g would be ideal within each period, with a maximum of 30g in any period. If a period includes a meal and a snack, then we can divide the day into Breakfast plus morning snack, Lunch plus afternoon snack and dinner plus supper snack. My assessment of the usual intakes down the track after surgery is that dinner would usually provide an easy opportunity to consume sufficient protein via intake of meat, poultry, fish, egg dishes or legumes such as black beans or lentils. Breakfast and lunch are the riskier times, where haste and convenience can influence intake. Let’s review the protein content of some common breakfast meals that equate to approx. 200 Cals: 1 slice of toast + ½ cup baked beans + coffee with milk = 10g ½ cup high protein cereal + 3 oz milk + ¼ cup fruit = 14g 1 cup yoghurt + ¼ cup fruit = 14g Smoothie with 150 ml fat free milk + 2 Tbsp yoghurt + ¼ cup fruit = 8g Omelette made with 1 large egg + 1 oz grated cheese + vegetables = 15g So, it seems it is not so easy to achieve the maximum of 30g or even 1/3 of the total requirement at breakfast after bariatric surgery, being 16-26g. This means that what we eat at the morning snack is going to make or break a well-proportioned daily protein intake. Let’s look at some options that can make up the difference and equate to approx. 100 Cals: ½ cup cottage cheese + 6 carrot or celery sticks = 21g 0.7 oz peanuts = 5g 2 Tbsp Pepitas = 6g 8 oz fat free milk based coffee eg cappuccino = 6g 1 slice cheese with tomato and cucumber = 7g 7 oz natural yoghurt = 10g Small granola bar = 2g ½ Quest protein bar or shake = 10g Morning snack options of approx 100 Cals that would not have contributed to achieving the protein target would be: 1 piece of fruit = 2g 0.7g mixed fruit and nuts = 2g 6 carrot sticks and 1/2 cup salsa = 2g 2.3 oz yoghurt = 2g 1 cup popcorn = 1g 2 fruit cookies = 2g You can see that it would take a little planning but it is achievable. I think the take home message is that mid morning is the time to incorporate a protein based snack such as a half serve of a protein shake or bar and that cottage cheese is your friend. A similar assessment of lunches reveals: 1 slice bread + 40g meat + salad = 15g 1.5 cups meat or legume based soup = 10g 90g chicken + salad = 21g burger pattie + salad = 21g This places less reliance on the protein content of the snack as the amount of meat consumed at lunch approaches a 100g serve. Evening meals planned around the bariatric plate model will result in greater than 20g protein where half the plate is filled with meat, poultry or fish. Problems arise where meat is not well tolerated, such as commonly reported in gastric banding and also in other surgeries due to reduced stomach acid from the smaller stomach size or from long-term use of anti reflux medications.

Hi, I think you can rely pretty well on My Fitness Pal or CalorieKing. My Fitness Pal has the ability for individuals to enter data on new products, so there is the potential for error, but I think it is fine for your purpose. I think we all would have a dickens of a time trying to consume 100 - 130g Protein per day in food. I would suggest you need a concentrated protein supplement - like the New whey tube that contains about 40g of protein in about 100ml. My books show the protein content of each food and each recipe - see the little blue dot in the image, though to reach the 130g mark, you would still need to add supplements because you just can't take in the volume after surgery to get protein and variety and adequate intake of other nutritional foods and live an interesting life all at the same time. Regards Amanda

Hi bonemorony, not sure what you're after. Are you wanting to subscribe to the weight loss surgery magazine or something else? Regards Amanda

It has been estimated that we make over 35,000 decisions every day. Some of them big like choosing a houseplan and some seemingly insignificant like which shoe to put on first. All these decisions can sap our strength for making small but significant health decisions that make up our daily diet. Will I cook tonight or pick up take away? Do I dish out some yoghurt for supper or open this block of chocolate? You can relieve much of this pressure through menu planning. Making food decisions earlier in the day when you have more brain capacity can change your life. Menu Planning can not only help with following through with a healthy intention, it can save you money. No more emptying out the fruit bowl into the bin each week before refilling with the fresh. You’ll actually eat that fruit if you plan to. You’ll be amazed how much time can be wasted staring into the fridge and the pantry wondering what to cook. All that time becomes yours again when you plan, write your list and shop by it. Put your menu plan on the fridge so the whole family knows what’s coming. Who knows, someone might get it started for you! What helps you put a plan in place?

Protein’s importance is widely recognized in bariatric surgery because requirements are at least as high after surgery as before, yet stomachs are so much smaller. Emerging research is suggesting that the distribution of our protein intake throughout the day can be just as important for maintaining muscle mass as the total quantity. One study found that consuming more than 30g of protein at a time provided no additional benefit, with the maximum benefit achieved at 30g. Eating enough protein is essential for building and maintaining muscle mass and function. The older we get the faster our body breaks down our muscle after building it, to the point where we can almost pump ourselves up at the gym and slowly start deflating as we walk out the door. Muscle has an important impact on our metabolic rate, or how many calories our body burns in the day. Our calorie burning ability influences how easy it is to gain, lose or maintain weight. So how much protein do we need and can we get enough at each meal without only eating meat? There are varying recommendations for protein intake following bariatric surgery ( gastric bypass, sleeve gastrectomy and gastric band ) . The recommendations fall within the range of 50 – 80g of protein per day for most people. Taller individuals with higher muscle mass fall towards the top of this range and may even have needs that exceed 80g per day. If this protein intake is spaced out between three periods in the day, then this would suggest that 16 – 26g would be ideal within each period, with a maximum of 30g in any period. If a period includes a meal and a snack, then we can divide the day into Breakfast plus morning snack, Lunch plus afternoon snack and dinner plus supper snack. My assessment of the usual intakes down the track after surgery is that dinner would usually provide an easy opportunity to consume sufficient protein via intake of meat, poultry, fish, egg dishes or legumes such as black beans or lentils. Breakfast and lunch are the riskier times, where haste and convenience can influence intake. Let’s review the protein content of some common breakfast meals that equate to approx. 200 Cals: 1 slice of toast + ½ cup baked beans + coffee with milk = 10g ½ cup high protein cereal + 3 oz milk + ¼ cup fruit = 14g 1 cup yoghurt + ¼ cup fruit = 14g Smoothie with 150 ml fat free milk + 2 Tbsp yoghurt + ¼ cup fruit = 8g Omelette made with 1 large egg + 1 oz grated cheese + vegetables = 15g So, it seems it is not so easy to achieve the maximum of 30g or even 1/3 of the total requirement at breakfast after bariatric surgery, being 16-26g. This means that what we eat at the morning snack is going to make or break a well-proportioned daily protein intake. Let’s look at some options that can make up the difference and equate to approx. 100 Cals: ½ cup cottage cheese + 6 carrot or celery sticks = 21g 0.7 oz peanuts = 5g 2 Tbsp Pepitas = 6g 8 oz fat free milk based coffee eg cappuccino = 6g 1 slice cheese with tomato and cucumber = 7g 7 oz natural yoghurt = 10g Small granola bar = 2g ½ Quest protein bar or shake = 10g Morning snack options of approx 100 Cals that would not have contributed to achieving the protein target would be: 1 piece of fruit = 2g 0.7g mixed fruit and nuts = 2g 6 carrot sticks and 1/2 cup salsa = 2g 2.3 oz yoghurt = 2g 1 cup popcorn = 1g 2 fruit cookies = 2g You can see that it would take a little planning but it is achievable. I think the take home message is that mid morning is the time to incorporate a protein based snack such as a half serve of a protein shake or bar and that cottage cheese is your friend. A similar assessment of lunches reveals: 1 slice bread + 40g meat + salad = 15g 1.5 cups meat or legume based soup = 10g 90g chicken + salad = 21g burger pattie + salad = 21g This places less reliance on the protein content of the snack as the amount of meat consumed at lunch approaches a 100g serve. Evening meals planned around the bariatric plate model will result in greater than 20g protein where half the plate is filled with meat, poultry or fish. Problems arise where meat is not well tolerated, such as commonly reported in gastric banding and also in other surgeries due to reduced stomach acid from the smaller stomach size or from long-term use of anti reflux medications.

Hi Alex that is a great project - was that inspired by my pics or completed previously? That Super Big Gulp is shocking. I think the biggest problem with that drink is that it is in an open cup with a straw, so there's no expectation that you're going to consume it over an extended period of time - and we're all naturally reluctant to put a tub still partly full of liquid into a trash bin - it feels wrong to do it, so people can be seen near the bin gulping down the last glugs so they can throw it away.

Surveys show that the general public thinks that vitamin water, fruit juice drinks and sports drinks are healthful options for themselves and their children. Here's a comparison of the number of teaspoons of added sugar in a variety of common drinks. Images: Note these images reflect the amount of added sugar per container and have had natural sugars deducted from the totals. Natural sugars include naturally occurring glucose and fructose in fruit based drinks and lactose in milk. Soda / Soft Drink, 375ml can = 10 tsp Cordial mixed 1 :5, 200ml glass = 4 tsp Energy Drink - 600ml = 12 tsp, 300ml = 6 tsp Vitamin Water, 600ml = 5 1/2 tsp Sports Drink, 600ml = 11 tsp Iced Tea, 600ml = 7 tsp Fruit juice drink, 250ml = 6 tsp Flavoured milk, 300ml = 4 tsp, 600ml = 8 tsp Vegetable juice, 200l = 0 tsp 100% juice, 250ml = 0tsp Note: We recommend that 100% juice be limited to 1 glass per day and is better substituted by 2 pieces of fruit for the value of the fibre contained in the whole fruit. Our previous article identified that the target for children is 7 tsp per day. This could be used up by a low sugar cereal at breakfast and a cup of fruit juice drink at lunch. How much sugar do your children or grandchildren drink?

Sugar seems to be the talk of the town and celebrities claim to be avoiding it completely. We all know it's not great but how much is too much for us and our children. How do we help our children to be more discerning? A recent intake survey in the US which was published in The Journal of Public Health showed that almost everyone (96%) had given their child a sugary drink in the previous month. Categories included Fruit Juice Drinks ( eg. 25% juice) / Carbonated sugary drinks / Sports Drinks / Flavoured water eg. Vitamin Water / Energy Drinks / Iced Tea so it seems we’re all doing it. Some more than others with the most common choice being fruit juice drinks or carbonated soda / soft drinks. Parents answered questions on which drinks they believed to be healthy alternatives to water. Almost all identified 100% fruit juice and milk as healthy options ( note that even 100% juice is ideally limited to 1 glass per day and is better substituted for 2 pieces of actual fruit so that fibre is consumed.)Many parents also reported that fruit juice drink, vitamin water or sports drink were also healthy options but are they right? The World Health Organisation has recommended that all nations reduce their intake of added sugars to 10% of calories and suggest it would be even better if we could make it down to 5%. To put this into perspective, if we just take the 10% goal this sets a target of: Men: 12 – 14 tsp added sugar per day Women: 10 tsp added sugar per day Children: 7 tsp added sugar per day. This still sounds like a reasonably generous limit until we look in children’s lunchboxes and find well meaning parents providing a 250ml fruit juice drink with 6tsp in that alone The current estimates suggest that the average American consumes 32 tsp of added sugar per day and the average Australian consumes 25 tsp. About half of this intake comes from sugary drinks. We are way off the mark. Never mind the current trend to aim to cut out sugar altogether, just getting it down to 10% is going to be a battle. We need to start young with our children and give them water to drink. When my children were young, I gave them pocket money and if we were out and they requested a sugary drink or a fast food meal – I let them choose whether to buy that with their own money or I would be happy to pay for water or a sandwich. I found this an easy option for kids to decide how important those foods were to them. Usually they went with the healthy meal option but they knew they were free to choose, so there was no deprivation involved and no tantrums. Stay tuned for the next entry showing clearly the number of teaspoons of sugar in various drinks so you can be on the lookout for unintended sugar. What strategies do you use to encourage water or milk intake amongst the children in your life?

Images: Note these images reflect the amount of added sugar per container and have had natural sugars deducted from the totals. Natural sugars include naturally occurring glucose and fructose in fruit based drinks and lactose in milk. Soda / Soft Drink, 375ml can = 10 tsp Cordial mixed 1 :5, 200ml glass = 4 tsp Energy Drink - 600ml = 12 tsp, 300ml = 6 tsp Vitamin Water, 600ml = 5 1/2 tsp Sports Drink, 600ml = 11 tsp Iced Tea, 600ml = 7 tsp Fruit juice drink, 250ml = 6 tsp Flavoured milk, 300ml = 4 tsp, 600ml = 8 tsp Vegetable juice, 200l = 0 tsp 100% juice, 250ml = 0tsp Note: We recommend that 100% juice be limited to 1 glass per day and is better substituted by 2 pieces of fruit for the value of the fibre contained in the whole fruit. Our previous article identified that the target for children is 7 tsp per day. This could be used up by a low sugar cereal at breakfast and a cup of fruit juice drink at lunch. How much sugar do your children or grandchildren drink?

A recent intake survey in the US which was published in The Journal of Public Health showed that almost everyone (96%) had given their child a sugary drink in the previous month. Categories included Fruit Juice Drinks ( eg. 25% juice) / Carbonated sugary drinks / Sports Drinks / Flavoured water eg. Vitamin Water / Energy Drinks / Iced Tea so it seems we’re all doing it. Some more than others with the most common choice being fruit juice drinks or carbonated soda / soft drinks. Parents answered questions on which drinks they believed to be healthy alternatives to water. Almost all identified 100% fruit juice and milk as healthy options ( note that even 100% juice is ideally limited to 1 glass per day and is better substituted for 2 pieces of actual fruit so that fibre is consumed.)Many parents also reported that fruit juice drink, vitamin water or sports drink were also healthy options but are they right? The World Health Organisation has recommended that all nations reduce their intake of added sugars to 10% of calories and suggest it would be even better if we could make it down to 5%. To put this into perspective, if we just take the 10% goal this sets a target of: Men: 12 – 14 tsp added sugar per day Women: 10 tsp added sugar per day Children: 7 tsp added sugar per day. This still sounds like a reasonably generous limit until we look in children’s lunchboxes and find well meaning parents providing a 250ml fruit juice drink with 6tsp in that alone The current estimates suggest that the average American consumes 32 tsp of added sugar per day and the average Australian consumes 25 tsp. About half of this intake comes from sugary drinks. We are way off the mark. Never mind the current trend to aim to cut out sugar altogether, just getting it down to 10% is going to be a battle. We need to start young with our children and give them water to drink. When my children were young, I gave them pocket money and if we were out and they requested a sugary drink or a fast food meal – I let them choose whether to buy that with their own money or I would be happy to pay for water or a sandwich. I found this an easy option for kids to decide how important those foods were to them. Usually they went with the healthy meal option but they knew they were free to choose, so there was no deprivation involved and no tantrums. Stay tuned for the next entry showing clearly the number of teaspoons of sugar in various drinks so you can be on the lookout for unintended sugar. What strategies do you use to encourage water or milk intake amongst the children in your life?

Easter Egg Tips: 1. Don't buy chocolate in advance - you may find yourself having to replace them before easter. 2. If you're organising a hunt for the kids, substitute some stickers and make the eggs an occasional find. 3. Forewarn relatives and friends that lots of chocolate in the house is not something you want - suggest an easter book for the kids. 4. Consider the gift of an activity - maybe a sporting gift or game that introduces an inedible interest for the holidays or plan on decorating real eggs. 5. Dark chocolate options may have some health benefits but you may not be choosing for health on this occasion so go for a small portion of your favourite! 6. Get the portion size right. 20g / 0.7 oz equates to 1 hollow egg ( real egg sized) or 4 solid mini eggs or 2 filled mini eggs and contains 100 Cals. This is a suitable amount for a midmeal snack. Note that only one snacktime belongs between consecutive meals and be wary of grazing. 7. Eat mindfully - enjoy every bit. Marvel at the wrapping, appreciate the markings and shape, inhale the aroma, take in the texture and savour the flavour. When you're finished get up and do something else! 8. Having chocolate in the house can be an anxiety causing condition for many. Hide it, freeze it, throw it or give it away if it arrives unplanned or causes you grief. Recognise that although chocolate can be great in small amounts, it is causing you some stress and tension and that is not helpful to you. Drop your shoulders and reassure yourself that you can feel relaxed now whether you've eaten chocolate or not and whether others are eating it or not. How is your relationship with chocolate and is easter a problem time for you?

Easter is approaching so it's time to think about enticing the kids and ourselves with more than just chocolate. Have you thought of one of the latest fitness gadgets as a valuable holiday gift? If you've decided to indulge in the easter food-fest, then here's a few quick facts and tips that can really help. Share with your friends so they know what you're planning. Knowing your friends are aware of your plan can help you to follow through. Easter Egg Tips: 1. Don't buy chocolate in advance - you may find yourself having to replace them before easter. 2. If you're organising a hunt for the kids, substitute some stickers and make the eggs an occasional find. 3. Forewarn relatives and friends that lots of chocolate in the house is not something you want - suggest an easter book for the kids. 4. Consider the gift of an activity - maybe a sporting gift or game that introduces an inedible interest for the holidays or plan on decorating real eggs. 5. Dark chocolate options may have some health benefits but you may not be choosing for health on this occasion so go for a small portion of your favourite! 6. Get the portion size right. 20g / 0.7 oz equates to 1 hollow egg ( real egg sized) or 4 solid mini eggs or 2 filled mini eggs and contains 100 Cals. This is a suitable amount for a midmeal snack. Note that only one snacktime belongs between consecutive meals and be wary of grazing. 7. Eat mindfully - enjoy every bit. Marvel at the wrapping, appreciate the markings and shape, inhale the aroma, take in the texture and savour the flavour. When you're finished get up and do something else! 8. Having chocolate in the house can be an anxiety causing condition for many. Hide it, freeze it, throw it or give it away if it arrives unplanned or causes you grief. Recognise that although chocolate can be great in small amounts, it is causing you some stress and tension and that is not helpful to you. Drop your shoulders and reassure yourself that you can feel relaxed now whether you've eaten chocolate or not and whether others are eating it or not. How is your relationship with chocolate and is easter a problem time for you?

Hi James, that is one way to cut down decisions and your recipe sounds good. Many people are happy to eat the same thing repeatedly and for the most part there's nothing wrong with that. As you say breaking from the routine happens, and that keeps things interesting and also gives nutritional variety. Cheers Amanda

Will I cook tonight or pick up take away? Do I dish out some yoghurt for supper or open this block of chocolate? You can relieve much of this pressure through menu planning. Making food decisions earlier in the day when you have more brain capacity can change your life. Menu Planning can not only help with following through with a healthy intention, it can save you money. No more emptying out the fruit bowl into the bin each week before refilling with the fresh. You’ll actually eat that fruit if you plan to. You’ll be amazed how much time can be wasted staring into the fridge and the pantry wondering what to cook. All that time becomes yours again when you plan, write your list and shop by it. Put your menu plan on the fridge so the whole family knows what’s coming. Who knows, someone might get it started for you! What helps you put a plan in place?

Snacks can contribute vital nutrients after bariatric surgery, keep you from overeating at mealtimes and keep blood glucose levels and mood stable. On the other hand snacktime may be an opportunity for poor nutritional choices, loss of control and the start of a grazing style of eating or multiple snacks in place of meals. So what to do? It would seem to make sense that the less you eat the more weight you lose, but there is a limit to that effect. Research shows that no additional weight is lost when calorie intake drops below 800 Calories per day. If there’s no benefit why do it? Food is enjoyable, so enjoy as much as is reasonable. With most surgeries, it is impossible to consume the volume represented by 800 Cals of healthy foods in only 3 meals in the early days. As time goes by, volume tolerance increases but this is likely caused by the nutritional and recreational drive to eat, resulting in larger volumes being consumed and stomachs effectively stretching. To me, this suggests that you can afford to eat 800 Calories but only if the volume never exceeds 1 cup. I recommend planning for a mid morning, mid afternoon and supper snack from the list of vital snacks. The vital snacks contain nutrients that are critical for those on a very low calorie intake and include fruit, dairy, nut and vegetable based snacks in approximately 100 Calorie portions. What’s your favorite fruit, dairy, nut or vegetable based snack?

It would seem to make sense that the less you eat the more weight you lose, but there is a limit to that effect. Research shows that no additional weight is lost when calorie intake drops below 800 Calories per day. If there’s no benefit why do it? Food is enjoyable, so enjoy as much as is reasonable. With most surgeries, it is impossible to consume the volume represented by 800 Cals of healthy foods in only 3 meals in the early days. As time goes by, volume tolerance increases but this is likely caused by the nutritional and recreational drive to eat, resulting in larger volumes being consumed and stomachs effectively stretching. To me, this suggests that you can afford to eat 800 Calories but only if the volume never exceeds 1 cup. I recommend planning for a mid morning, mid afternoon and supper snack from the list of vital snacks. The vital snacks contain nutrients that are critical for those on a very low calorie intake and include fruit, dairy, nut and vegetable based snacks in approximately 100 Calorie portions. What’s your favorite fruit, dairy, nut or vegetable based snack?

Hi there, many people report that when they eat they end up hungrier than if they didn't - do you find that generally? What I've noticed over the years is that a low appetite equals a slow metabolism. Those with a fast metabolism are generally very hungry and that the hunger you can create by eating a small amount can be very beneficial in the long run. As a bander it is really important to protect yourself from the need to overeat - when your desire for food is greater than the capacity of your stomach pouch the first thing that happens is your stomach stretches with the extra food, the second is that you regurgitate. It's the first step that does the longterm damage to appetite control because you possibly have a stomach that has stretched before and can do it again. Once there's repeated stretching, the tension in the stomach wall is not so tight after a standard amount of food and so the message to your brain to say you're satisfied weakens. Regards Amanda

Hi Arlene, apples are mainly carbohydrate and water - not much fat or protein in there but you certainly need the nutrients in fruit - you can't get all the protective factors and the fibre from a nutritional supplement. Did you mean that when you eat fruit as a snack you start grazing or that when you don't have a snack at all you start grazing? Cheers Amanda

That sounds just fine too Jess!