I had VSG (2015) to RNY revision on January 18th due to GERD.
I also had regained almost 70 pounds from my VSG post-op low weight. I've so far lost about 20 pounds since the pre-op diet & surgery. I need to lose another 20 pounds (for normal BMI) to 50 pounds (for calculated ideal body weight).
I'm now on unrestricted food textures, and per my program's dietician, I'm supposed to be on my "maintenance" diet now. However, they refuse to discuss any calorie goals or macros other than protein. I'm someone who needs very clear goals and guidelines (thanks, long-undiagnosed ADHD), and I'm feeling very lost about what my diet should look like moving forward.
The lifelong guidelines for my program, as I understand them:
60-80g protein per day
Up to 4 oz. (1/2 cup) per meal, consisting of:
Up to 3 oz. protein per meal
Up to 1 oz. (total) veg, fruit, or starch per meal
3 meals per day
1 snack per day (the program guide I was given says 1-2, but per my surgeon I'm only allowed to have 1 snack per day and it has to be between lunch and dinner) - I have no guidelines for the amount I'm allowed for the snack. I assume it's not supposed to be as much food as the meals, but I don't know.
Protein shakes/powders are frowned upon
The only sample menu provided in my program guide is as follows:
Breakfast: Egg omelet with sautéed peppers & onions
Snack: Protein shake OR Greek yogurt with berries [removed per my surgeon's instructions]
Lunch: Lettuce wrap with turkey and avocado/cheese [it is not clear to me if the / means avocado OR cheese, or avocado AND cheese, but I assume the former]
Snack: Apple slices with 2 tablespoons nut butter OR carrots with hummus
Dinner: Pesto chicken with spaghetti squash, sautéed spinach, and cherry tomatoes
I plugged this menu into the Baritastic app to try and get a sense of what the calories and macros are supposed to look like. The sample menu gave no amounts other than the nut butter, so I used the 3 oz. protein + 1 oz. veg/fruit/starch rule.
With the carrots & hummus snack option, here are the macros for the day:
593 calories
62g protein
32g fat
17g carbs (13g net carbs)
4g sugar
4g fiber
And here are the apple & nut butter (I used natural peanut butter) macros for the day:
739 calories
67g protein
43g fat
21g carbs (16g net carbs)
8g sugar
5g fiber
So from that, I'm extrapolating that I should be aiming for the following daily:
600-750 calories
60-80g protein
30-40g fat
less than 25g carbs
less than 10g sugar
I have a few concerns...
I have already been going well over those amounts at just over a month post-op. I've typically getting around 800-900 calories per day.
It seems like a real struggle to get to the upper range of protein daily while sticking to the allowed amounts and without using any shakes or protein supplements. Even then, 80g seems low for a protein goal. I have never been a big meat eater (I was vegetarian through most of my teens and 20s), and I absolutely cannot stand any fish or seafood. I do eat a lot of dairy, eggs, and beans, but it seems like that's not going to do it.
The standard daily fiber goal I've always heard is 25g per day. I've been getting about 12-15g per day right now, but knowing that I'm overeating and already having too many carbs means even that's not sustainable. I've struggled with post-op constipation... I have gotten to a much better place recently, but if I need to cut back to 4-5g of fiber per day to be within my other limits, I'm afraid of going backwards.
That I'm limited to 1/2 cup of food per meal for the rest of my life came as a shock to me, as a revision patient. I knew that my pouch would be smaller than my sleeve, and like with my original surgery, the amount I'd be able to eat at one time would be very small initially. But with my sleeve (which was done by a different surgeon in a different program), there was definitely not the expectation that the amount I could/should eat at 1 month post-op would be the same as what I could/should be eating at 6 months or 1 year out. My bypass surgeon also told me that she left my pouch a little larger than normal so that I wouldn't lose too much additional weight, so my pouch is already larger than a regular bypass patient's.
Do these amounts seem in line with other people's experiences? Or am I way off-base?