Any patient undergoing bariatric surgery will discuss the need for vitamin and protein supplementation after surgery. In fact, I have a lot of patients who have misconceptions as to why they need it and what happens if they don’t take it. If patients know why protein is so important and can find ways to incorporate it into their diet, they will be more likely to add protein to their daily routine.
WHAT DOES PROTEIN DO?
The building blocks of proteins, amino acids, are involved in almost every process in the body. They function as enzymes and are catalysts to numerous pathways in the body. There are some amino acids that cannot be synthesized by the body. These are called essential amino acids and must be ingested in order for your body to process them.
Proteins can be found, of course, in meat and dairy products. There are also plant based sources of protein as well, such as in beans, legumes, and soybeans. Every person, whether they have had bariatric surgery or not, needs 1 gm of protein per kilogram of body weight. So, if you weigh 140 lbs (which is about 70 kg), then you need 70 gms of protein daily. If you weigh 200 lbs (which is about 100 kg), then you need 100 gms of protein a day!
WHAT HAPPENS WITH LACK OF PROTEIN?
When patients begin to lose weight, it is important to keep up with protein needs because of how the body reacts to calorie deficits. The tendency is to not just utilize fat stores for energy, but to break down muscle as well. In an effort to minimize muscle wasting, it is critical for bariatric patients to maintain proper protein supplementation.
Muscle wasting is not the only potential complication from lack of protein. Patients can experience asthenia (weakness) and alopecia (hair loss). In fact, the most common causes for patients to have continued hair loss and thinning after surgery are iron deficiency, anemia and low protein. Patients who suffer from protein malnutrition can suffer from anemia related to iron, B12, folate, and/or copper deficiency. Deficiencies in zinc, thiamin (B1), and B6 are commonly found with a deficient protein status as well. In addition, catabolism of lean body mass and diuresis cause electrolyte and mineral disturbances with sodium, potassium, magnesium, and phosphorus.1
Muscle wasting, hair loss and vitamin deficiencies are not the only consequences of inadequate protein intake. Patients not ingesting protein can suffer from severe nausea and fluid build-up (edema) in their legs and tissues. Severe nausea can begin to occur as early as three weeks after surgery. The nausea can feel very similar to morning sickness. As it progresses, it makes it increasingly difficult for patients to swallow and tolerate foods. Often when a patient presents early after surgery with nausea and difficulty swallowing, I have to work them up not just for strictures (narrowings along the staple lines that obstruct food from passing) but for protein malnutrition as well. If patients have not been taking their protein supplementation for just a few weeks, they can typically be managed with oral medications to help with nausea as they begin to increase their protein intake. However, if patients have gone for longer periods of time without adequate protein intake and have significant nutritional issues, they may need supplemental nutrition in the form of TPN (IV nutrition) or a feeding tube.
HOW MUCH DO BARIATRIC PATIENTS NEED?
Bariatric patients need a DAILY MINIMUM SUPPLEMENT because you will not be able to meet your daily protein requirement simply by eating food. (A chicken breast is about 15 gm of protein. If you weigh 200 lbs, you need 100 gm of protein a day. You would need to eat 6 ½ chicken breasts to meet your protein requirement!) Since surgery restricts the total volume of food that you eat, you need to have an easier and LEANER way to reach your protein goals.
We recommend that gastric bypass and sleeve patients take in 60-80 gms of protein supplement a day. Duodenal switch and revision bypass patients are advised to take in 100-120 gms of protein supplement a day. You can choose protein shakes or protein bars.
IDEAS FOR PROTEIN SUPPLEMENTS
There are a variety of protein supplements on the market today. There is whey, soy, and other vegetable based protein powders. Patients can choose to make their shakes with water/milk or have a pre-made shake. Some ideas to improve the taste are as follows:
Add extracts to vanilla or chocolate shakes. Try cherry, vanilla, even root beer extract!
Add fruits such as blueberries, strawberries and bananas.
Try a peanut butter powder, such as PB2. A tablespoon of peanut butter is 100 cal and only a few grams of protein. Selecting a powder like PB2 gives you the peanut butter taste without all the calories.
Add unflavored protein powder (genepro.com, dochalenutrition.com) to tea, sugar-free lemonade or even a high protein milk like FairLife Milk. (I really like their 1% chocolate milk)! You can even make your own protein “shot” with unflavored protein powder. Genepro and Dochale only require a small amount of liquid to dissolve the protein. Use these in a ¼ cup to ½ cup of your favorite liquid (low sugar juice, etc) and bottoms up!
Mybariatricpantry.com has numerous high protein snacks, treats and foods to help maintain a high protein diet.
L. Aills, J. Blakenship, C. Buffington, M. Furtado, and Julie Parrott. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surgery for Obesity And Related Diseases, Sept-Oct 2008. 4(5) S73-S108.