Dietician Stuff...help me not be a jerk...

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So I've arranged my first dietician consult, which is interestingly done remotely via WebEx video conference (not relevant to this post, but just interesting). Any who...I was given a lengthy PDF packet to read through regarding general nutrition and as I read it, I find I don't agree with some of the information. I've been living relatively strict Keto, High Fat/Moderate Protein/Low Carb for nearly 2 years and I'm afraid I'm going to get into this consult and butt heads with the poor person. Not on purpose, but I really don't want to change the way I eat because I know what happens when I eat the stuff that is considered OK. I get bloated, I gain weight, my face gets puffy, my feet get swollen...etc. My body likes keto and most "health professionals" aren't on that bandwagon. Any words of advice from anyone that's gone through their diet consults would be awesome. I know the best thing is to just smile and nod, but I know this girl is going to want active participation.

[FluffyChix 17,415]

I leveled with my real life RD and told her of my needs. She set up a low carb plan. And I followed it. And I lost around 60lbs or so while on the program?

[Hop_Scotch 1,632]

Some dieticians can be quite stick by the book of what they were taught, others not so. Initially I guess its a case of one post op diet fits all, and then tweak as progress is made. I agree with Fluff be upfront, what your preferences are and why.

There is scope with the macros that are provided to those who undertake bariatric procedures, and I think there is plenty of scope for increased healthy fat intake. Work out the percentages but do allow for the minimum of Protein with the reduced calorie intake to make sure that lean body mass is maintained as much as possible while losing body fat.

[James Marusek 5,244]

I was a little confused because I didn't know where you were on your gastric bypass surgery journey. It appears that you are at the very beginning in the pre-op stage.

I went through 6 months of physician monitored pre-op dieting and exercise program. At the beginning of the program, I decided to apply the rule of "no soft drinks, no caffeine". I figured that since I had to give this up anyways, I might as well implement this change at the very beginning of the process. So I ended by 6 diet coke a day habit. I suffered through a week of withdrawal pain (severe headaches and body aches). But then I was O.K. I think I lost 20 pounds pre-op on this change alone.

During this 6 month period, I started to do journaling. I tracked everything I ate. This helped because I know how many calories foods had. It also showed me what fast food restaurants and which type of food to stay far away from.

Another aspect of this program was exercise. I began hill walking for a half hour per day. The walking was very important because it is an integral part of the program. Right after surgery, you have a massive amount of gas locked in your body. This is the root cause of much of the pain that patients experience. I took no pain meds after surgery. I didn't need to. I walked every 2 hours around the clock after surgery and I experience minimal pain as a result.

You diet will change dramatically over the next few years (pre-op phase, first couple years post-op in the weight loss phase, and then when you arrive at the maintenance phase). So be prepared for changes ahead. It is important to follow the dietary directions in the post-op weight loss phase. This phase is where you will achieve the most weight loss in a very short time. Don't second guess this phase.

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9 minutes ago, FluffyChix said:

I leveled with my real life RD and told her of my needs. She set up a low carb plan. And I followed it. And I lost around 60lbs or so while on the program?

Well, that's refreshing to know! I've always found myself having to fight to back up my way of eating so I guess I'm going into this too much on the defensive.

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17 minutes ago, James Marusek said:

I was a little confused because I didn't know where you were on your gastric bypass surgery journey. It appears that you are at the very beginning in the pre-op stage.

I went through 6 months of physician monitored pre-op dieting and exercise program. At the beginning of the program, I decided to apply the rule of "no soft drinks, no caffeine". I figured that since I had to give this up anyways, I might as well implement this change at the very beginning of the process. So I ended by 6 diet coke a day habit. I suffered through a week of withdrawal pain (severe headaches and body aches). But then I was O.K. I think I lost 20 pounds pre-op on this change alone.

During this 6 month period, I started to do journaling. I tracked everything I ate. This helped because I know how many calories foods had. It also showed me what fast food restaurants and which type of food to stay far away from.

Another aspect of this program was exercise. I began hill walking for a half hour per day. The walking was very important because it is an integral part of the program. Right after surgery, you have a massive amount of gas locked in your body. This is the root cause of much of the pain that patients experience. I took no pain meds after surgery. I didn't need to. I walked every 2 hours around the clock after surgery and I experience minimal pain as a result.

You diet will change dramatically over the next few years (pre-op phase, first couple years post-op in the weight loss phase, and then when you arrive at the maintenance phase). So be prepared for changes ahead. It is important to follow the dietary directions in the post-op weight loss phase. This phase is where you will achieve the most weight loss in a very short time. Don't second guess this phase.

Yes, I am in the very beginning of pre-op. It sounds like you've definitely gone through it all!

I have tracked my food in an app on my phone for the past 1 1/2 years fairly consistently to make sure I'm staying within my macros, so that data is definitely there for the dietician. I don't eat sugar, don't drink soda/carbonated stuff aside an occasional La Croix and use stevia sparingly in coffee. For drinks, I switch between Propel and Powerade Zero and plain Water. Don't eat bread, no Pasta, no grains, no beans/legumes, nothing inflammatory like certain oils and other ingredients. For the most part, I eat fatty meats, nuts, leafy greens, high fat dairy (sparingly) and I consume a lot of MCT oil - about 4tbsp + a day. My Protein macros are set at 60g a day (which I sometimes exceed accidentally), because I'm not a powerlifter and I don't work out. During protein metabolism, unused protein amino acids can convert to glucose which causes weight loss stalls so that macro is important to not blow. Keto is very strict and I've done well, but not well enough. My job changed insurance plans unexpectedly which happened to include bariatric for the first time ever so I'm jumping on to take advantage of it.

In 2017 I had a bad car wreck and nearly lost my foot and broke a ton of other bones so I haven't dared to exercise. Things still hurts from time to time, but I can walk. Even before the wreck I wasn't actively working out so pretty much all I can do is walk.

I expect dietary changes post-op, that's a given. I just don't want to sabotage everything I've done on my own so far just because the dietician doesn't believe in Keto/LCHF. I might just be overthinking and assuming too much which is why I was curious about other people's experiences with their dieticians.

[toodlerue 452]

Just curious, what sort of things were in the diet pack that you don’t agree with?

It sounds like you have been paying attention to your body and know it very well. Share your concerns with your nutritionist & trust that they will listen.

[James Marusek 5,244]

26 minutes ago, Kimmie K said:

I expect dietary changes post-op, that's a given. I just don't want to sabotage everything I've done on my own so far just because the dietician doesn't believe in Keto/LCHF. I might just be overthinking and assuming too much which is why I was curious about other people's experiences with their dieticians.

I think you are overthinking it. You are already showing a 55 pound weight loss in the pre-op stage, although this may be spread out over a couple years. You seem to know how your body works. I only lost 20 pounds pre-op, so you are far ahead of me at that stage. So in the pre-op stage, what works for you WORKS.

But post-op, this is where you will need to follow their directions to a tee if you want to see the dramatic results. I lost 80 pounds in 6 months without much effort on my part. For me it was easy because I lost my hunger.

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41 minutes ago, James Marusek said:

I think you are overthinking it. You are already showing a 55 pound weight loss in the pre-op stage, although this may be spread out over a couple years. You seem to know how your body works. I only lost 20 pounds pre-op, so you are far ahead of me at that stage. So in the pre-op stage, what works for you WORKS.

But post-op, this is where you will need to follow their directions to a tee if you want to see the dramatic results. I lost 80 pounds in 6 months without much effort on my part. For me it was easy because I lost my hunger.

That's what I figured. I do that to much so I figured that was the case. I'm just so scared of sabotaging this process and not ending up getting surgery.

Post-op will be a whole new world. Definitely aware of that. 80lbs in 6 months is awesome!!!!

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52 minutes ago, toodlerue said:

Just curious, what sort of things were in the diet pack that you don’t agree with?

It sounds like you have been paying attention to your body and know it very well. Share your concerns with your nutritionist & trust that they will listen.

Well, I won't say "disagree"...I do know that overeating Protein can cause weight loss stalls (in the pre-op world). What's not used by the body during protein metabolism is converted to glucose by the liver. I don't work out or powerlift and I know once I reach about 100g of protein for the day, I've over done it and better chill out. I know fat satiates me, not just protein. The idea of a high protein, low fat diet (without having surgery) scares me. I don't believe in calories in/calories out (CICO). That's an antiquated method of achieving weightloss (for the pre-surgery people), it's not sustainable, doesn't work for everyone especially those with insulin resistance and it eventually ruins metabolism. Soo...that's the kind of stuff I'm afraid will bite me in the butt in conversations LOL However...I did email the dietician and let her know my eating habits. Hopefully she'll message back with some supportive words.

[FluffyChix 17,415]

Keep in mind they may have their own goals for you...such as they may not want you to lose too much in the next 6 months...Some report on weight at the 1st visit to compute BMI, and some report at the end to compute it. If you are below 40BMI, you have to have 1 comorbidity that is recognized by the insurance company as a comorbidity.

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9 minutes ago, FluffyChix said:

Keep in mind they may have their own goals for you...such as they may not want you to lose too much in the next 6 months...Some report on weight at the 1st visit to compute BMI, and some report at the end to compute it. If you are below 40BMI, you have to have 1 comorbidity that is recognized by the insurance company as a comorbidity.

Yep, here's what the surgeon's office lady said, "Insurance reviews what we send in based on the weight/BMI you were on your first visit. The only way that you would not be approved for losing weight is if your BMI ends up under 35 (and surgery wouldn't really be appropriate at that point any way). However, you are likely to lose about 25 pounds in those 6 months and insurance will look at this in a good way because it means you will be successful with surgery so they won't be wasting their money paying for it."

So I doubt they expect me to lose too much on whatever meds they have in mind considering I'm so close to 40 BMI already.

Edited January 3, 2019 by Kimmie K

[FluffyChix 17,415]

I was 222.4lbs the day of surgery. I was circling the drain at 5'4" and close to going under the 35BMI level. Everyone was a bit nervous. Just fair warning. But it sounds like you've got it figured out...so I'ma jump off the thread.

Good luck!

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2 minutes ago, FluffyChix said:

I was 222.4lbs the day of surgery. I was circling the drain at 5'4" and close to going under the 35BMI level. Everyone was a bit nervous. Just fair warning. But it sounds like you've got it figured out...so I'ma jump off the thread.

Good luck!

Bahahaha "circling the drain" Girl, I have nothing figured out...at least not in the bariatric world LOL

[elcee 3,341]

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At this stage of the process I would be listening to what they say and not trying to second guess them.