Doctor vs nutritionist

[mxpxchik11 48]

I am beyond frustrated to say the least. Every appointment I go to I hear different information. My doctor told me to stay under 20 g of carbs a day where as my nutritionist says under 50. My doctor says I can substitute meals with Protein Shakes and my nutritionist says cut back on the Protein shakes and eat more meals. I am at a loss and I am not losing! I am having about 100 grams of protein a day and 600-700 calories 6 weeks post op. The most I can get in is 3 ounces at a time. The nutritionist told me today to eat five meals and get up to 1000 cal does this seem right, once again different then the surgeon. What are you guys doing at this stage???

[LSanchez238 52]

My surgeon didn't offer much info, and I haven't had a nutritionist. I've looked up a lot of info and kind of been doing my own thing.... which I know can be dangerous. But, I had my sleeve less than a month ago on April 18th. I lost 21 lbs pre op, and 27 lbs post op. I am on phase 4 and I am eating 4-5 small meals a day. I'll have 2 eggs for Breakfast, a Premier Protein shake for a morning snack, tuna for lunch, and a Dannon Oikos triple zero blended Greek yogurt for dinner

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[LSanchez238 52]

I get about 80 g Protein and around 700 calories

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[James Marusek 5,244]

I am not sure what type of surgery you had.

The three most important elements after RNY gastric bypass surgery are to meet your daily Protein, Fluid and Vitamin requirements. food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight.

Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as Protein Shakes.

After surgery, I found that softer foods, such as chili and Soups, went down much easier than harder foods, such as steak and chicken. So therefore, I relied on these. I have included some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

[Diana_in_Philly 1,426]

Is it a nutritionist or a registered dietician -- there is a big difference. Does the NUT only see bariatric patients in conjunction with the doc? With my team, the RDs are part of the team along with my surgeon and nurse practitioner. At about 8 weeks out, my team recommended to me that I be at 1,000 calories. I'm almost 9 months out and I still use Protein Shakes for breakfast most mornings because its portable and works with my schedule. I can drink them in the car on the way to work.

But it is important to get yourself on mostly "normal" foods. Consider adding in an Oikos Triple Zero yogurt (15 grams Protein 120 cal.) as either a morning or afternoon snack. Or some almonds or a cheese stick or two. That might help.

[OutsideMatchInside 10,166]

@mxpxchik11

I would listen to the Dr. I am not sure what kind of practice you are going to, but the one I went to has a shared dietitian. The information in the book and what the dietitian said are not the same as what my Dr said. He actually gave me a separate sheet that he just gives to his patients on how he wants you to eat.

Every Dr and Surgeon I know on a personal level (friends, family friends) all eat Paleo/Keto/Low Carb. If your Dr is telling you below 25 grams, follow their advice. It is honestly very easy to do anyway, if you are just eating Protein and veggies.

Your dietitian is right about eating more meals and getting your calories to 1000, you want to get your calories to 1000-1200 ASAP so you aren't stuck eating under 1000 calories forever.

At that stage I ate 5 times a day, and I still eat 4- 5 times a day now at almost 2 years so I can meet my protein goals.

[Airstream88 361]

In my bariatric practice, the Nutritionist is a registered Dietician who specializes in Bariatric patients. Our surgeon defers to her in the areas of what to eat and when. My plan is 4 -5 meals daily at least 3 hours apart. Each meal to have 3 oz Protein - eaten first, a multigrain or fruit serving (2 each max per day - not to be eaten at the same meal) and any quantity of green veggies. At 6 weeks I was supposed to be eating at least 800 calories and at 7 months I'm around 1200 or so. Of course it wasn't until 12 weeks that I could fit in anything but the protein and only 1 - 2 oz so I still supplemented with a Protein Shake daily. At almost 7 months, I eat only real food as I can' stand Protein Shakes any longer. They make me gag.

[mxpxchik11 48]

Thank you everyone. This is very helpful. It's good to hear that what I am doing aligns with what everyone else has done. :-)

[LSanchez238 52]

I had the sleeve. I saw a nutritionist pre op, but she only saw me once and never rescheduled me. She was also 2 hrs away from the city I had my surgery and 1 1/2 hrs from me.

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[BigViffer 3,544]

Ugh, with my limited experience with NUT's, they are basically smoothie recipe repositories. The two I had to deal with paid little attention to food allergies, knew nothing of fitness, and always pimped their little supplement store in the lobby.

Listen to your surgeon.

[RickM 1,747]

I'm kinda split on this issue as I have seen good and bad with both, so it really seems to depend upon the players in a patient's network. Our surgeons preached to ignore most RD's, as their practice was centered around the DS which is beyond their experience and training - if one was into bariatrics, that meant the bypass which is a very different animal, nutritionally speaking. They had developed their own program based upon their (and others in the DS world) long experience and patient feedback over the years, and it worked well. Their insight transferred to the sleeve as well as we are much closer to a "normal" person so it isn't difficult to back out the unique DS quirks from their recommendations.

Contrasting that, as noted above, docs can be as subject to fad diets as anyone else, maybe more so if they feel the need to be seen as being "up" with the "latest" science. MDs have been at the center of most of the popular fad diets past and present, so their advice should be taken with a few grains of salt.

OTOH, I did work with an RD associated with our PCP who did quite well in interpreting the surgeon's plan and tailoring it to my needs. She is a private practice RD with a fitness orientation and all of the Diabetic Educator certifications that are offered in the field, This meant that she fully understood the merits of low carb dieting when therapeutically necessary, but wasn't going to promote it for my use as such is contraindicated with my lifestyle and fitness needs. Many on these forums talk down RD's because they don't put out a blanket promotion of the latest fad diet promoted by some YouTube diet guru. As a profession they have seen these diets come and go, so they tend to wait for the science to catch up with them.

I also have a nephew who is studying to be an RD, and he got into it by way of his dietary sensitivities and allergies showing him how important diet can be to our overall health and well being, in areas where doctors usually have little insight (and instead would just be pushing more pills.)

As with most things, these RDs and MDs can vary widely in how they work, depending on their background, interests and practice structure. You can have an MD who has his hands in every part of the practice from end to end while others may be just the cutter in a large hospital program, with little input or insight in the total program. Likewise an RD may be just a cog in a large machine, dispensing diet sheets and conducting canned classes to which they had little input, or they may be integrally involved in the research and patient treatment of the practice. It's a big YMMV thing that we have to figure out with the practice(s) that we are using, and how best to use them. So, it's hard to make a blanket pronouncement to follow the surgeon's or the RD's recommendation when they conflict.

[SeattleLady 277]

We pay people to take care of us. Ask them to pull it together! Otherwise just change teams. This is your life.

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[Midnightsun 129]

This is a question for your surgeon and nutritionist. This is way too important to take advice from someone without the proper education in this field. Let them know of the discrepancies between the dietary information given and go from there. It is your health make sure you get the proper advice.

I will say I recently had a stall and I on my own cut back my shakes and was getting Protein thru yogurts etc. I had no idea there is a difference between how your body works with Liquid Protein and food protein. I upped my shakes to 2 a day and have been losing again. I would call and let your surgeon office know and schedule and appointment with your nutritionist. Good luck to you.