Wednesday, March 12, 2008

Protein Requirements After WLS

I've always prided myself on being an ideal post WLS patient. I take copious amounts of vitamins. I eat a blanced healthful low carb diet. I get in plenty of calories according to my BMR(basal metabolic rate) to maintain my weight. In spite of my anal like adherence to this. It still has not kept me from becoming severely malnourished.

One place I am severely lacking are my protein levels. I've checked the online protein requirements. According to those calculators I have sufficient intake. So how come I'm still deficient according to my lab work???

Those who know me well, know of my diligence for seeking out answers to my questions by doing research. So here's what I have discovered. RNY WLSers only absorb about 25-50 percent of the nutrients they take in, whether it is food or supplements.


That's right, 25-50 percent. It all depends on the length of your bypass. I am a distal bypass. Which means they bypassed the majority of my small intestine. So I am absorbing closer to 25%. Even with all the calories/protein/supplements my body still feels like it is starving. Which it is.

So now what.......

I increase the protein and my supplements. I also go back to taking in protein supplements. Plus concentrate on getting in more calories.

Why protein supplementation?
It’s about Absorption

Proteins form the body’s main structural elements and are found in every cell and tissue. Take away the water, and about 75 percent of your weight is protein.
Your body uses proteins:
● for growth
● to build and repair
  1. bone
  2. muscles
  3. hair
  4. connective tissue
  5. skin
  6. internal organs
  7. blood
  8. virtually every other body part or tissue

Besides building cells and repairing tissue, proteins form antibodies to combat invading bacteria & viruses; they build nucleoproteins (RNA & DNA). They make up the enzymes that power many chemical reactions. They also carry oxygen throughout the body and participate in muscle activity.

At least 10,000 different proteins make you what you are and keep you that way.

Hormones, antibodies and enzymes that regulate the body’s chemical reactions are all made of protein. Without the right proteins, blood won’t clot properly and cuts won’t heal.

Each protein is a large complex molecule made up of a string of building blocks called amino acids. The 20 amino acids the body needs can be linked in thousands of different ways to form thousands of different proteins, each with a unique function in the body.

Your body can’t use food protein directly. So after protein is ingested, digestive enzymes break the protein into shorter amino acid chains, and then into individual amino acids. In the gastric bypass patient , this normal digestive process is bypassed. These digestive enzymes are not available until they meet with the food protein in the common channel of the small intestine, and then have only about 5(distal) – 7 ½(proximal) ft (compared to 20 ft in a “normal” digestive tract) to do their job. The amino acids then enter the blood stream and travel to the cells where they are incorporated into proteins the body needs.

Nine of the 20 amino acids required by human beings are considered “essential” because they come only from the diet; the other 11 are considered “nonessential” because the body can make them.

How much protein do I really need???

The average person (the “normal”, NON-gastric bypass patient) needs 50-65 grams of protein each day. Considering malabsorption of at least 50%, the RNY patient will need 100-140 grams per day minimum, which cannot be eaten as food because of the small size of the pouch.

  • Note: Depending on the length of bypass, the RNY patient may absorb as little as 25% or less. But it is normally agreed that even a short proximal will not absorb more than 50%.
  • Note: Adults need a minimum of 1 gram of protein for every kilogram of body weight per day to keep from slowly breaking down their own tissues. That’s about 8 grams of protein for every 20 lbs. Malnourished, septic, pregnant, injured or burned patients will require more protein, in the order of 1.5-2.0 g/kg daily. Extra protein is also required after surgical procedures and illness.

According to Sally Myers, RD and regular contributor on nutritional issues to the WLS-related newsletter “Beyond Change”: “How to determine grams of protein you need daily when not yet at ideal weight: Subtract 120 from your current weight. Multiply that answer by .25 and add it to 120. Base your protein needs on that number. Extra protein is not needed for fat mass.”

So in my case I would need around 130gms of protein each day minimum. Which leads me to having to take in protein supplements once again.

But why....can't you get that much protein just from eating??

It all depends on the BIOAVAILABILITY of the protein in question. Which means how well your body absorbs it.

The Biological Value, or BV, of a protein is an indicator of the quality of the protein. It is a measure of a protein's ability to be used by the body (or its bioavailability). It is a percentage (though the scale is skewed resulting in some BV's of greater than 100) of the absorbed protein that your body actually uses. Biological Values are indicators of which proteins are best at aiding nitrogen retention in muscles to help them maintain or grow.

Many of the whey protein powder manufacturers claim that their products have BV values well above regular whey protein by various techniques such as ion-exchange processing, hydrolization, and adding other ingredients such as specific amounts of limiting essential amino acids.

Hydrolyzation is a process breaking large peptides into smaller ones. It is sometimes referred to as "pre-digested".

Regular undigested whey will be broken down into di- and tri-peptides via enzymes in the gut (which gastric bypass patients no longer have). This process takes a while, even in the non-gastric bypass person. Hydrolyzation is useful when protein delivery is needed very quickly so the body doesn't have to require the time and enzymes doing it. The benefit is of having a quickly absorbed protein to ensure muscle tissue is flooded with nutrients in a timely manner.


The higher on the list, the better.
The numbers are the BV. (Biologic value).
This is only how easily the (normal) body can absorb them, not the protein grams in each one. The last few need to be blended to make a complete protein.
And remember….gastric bypass patients don’t absorb nutrients from food protein very well.

Protein Source---------------------------BV

Whey Protein Isolate Blends -----------100-159
Whey Concentrate (Lactalbumin) -----104
Whole Egg -------------------------------100
Cow's Milk -------------------------------91
Egg White (Albumin) -------------------88
Fish ---------------------------------------83
Beef ---------------------------------------80
Chicken -----------------------------------79
Casein (a protein from milk) ------------77
Rice ---------------------------------------74
Soy ----------------------------------------59
Wheat ------------------------------------54
Beans -------------------------------------49
Peanuts -----------------------------------43

So, because we(gastric bypass patients) don't have a stomach and the stomach acids, etc, anymore, we don't process the undigested proteins properly and malabsorb most of them. The same is for the normal food we eat. We don't absorb most of it. We, therefore, need the more highly absorbed, pre-digested protein supplements.....whey which is pre-digested (aka hydrolized) order to get the proper nutrients our bodies need and are no longer able to get from food.

So, whereas whole egg, cow's milk, egg white are near the top of the list of bioavailability for "normal" people, they are not pre-digested (hydrolized), so for us, they are not as high on the list as pre-digested whey protein. Our bioavailability list would be quite different from the "normal" person's list.

So, make sure your protein powder or drink states that it is pre-digested or hydrolized. And the best kind of protein would be a whey blend protein. Second best would be a 100% whey protein. Isolates, though good for a quick acting pick-me-up, are not sufficient alone for the gastric bypass patients on-going maintenance requirements.

If I drink protein shakes and eat too, won’t I gain weight from the added calories?

Hello!!!! So what if you do. I'm not one of those who believes in dying to be thin. In this case, dying in the literal sense of the word. Without getting in the proper amount of nutrients my body begins to feed off of itself.

Following a very low calorie diet (like most post-ops do) will only drop your metabolism to zero. Our bodies want to hold on to our stores of energy for survival. It thus preserves fat by lowering the metabolic rate whenever food intake drops.

You mean I had this surgery for nothing???

There are things you can do to help you maintain weight loss if that is your focus.

All you need to do is speed up your damaged metabolism. You may gain some weight initially from the extra calories. But you did have this surgery to better your health right not just to be thin, RIGHT???

The extra calories will make your health much better. But increasing your metabolism, while still maintaining the higher calorie intake will help to rid you of those pounds.

I personally think my health is more important than a number on the scale. But to each his own.

Back to increasing your metabolism......

Increasing your protein intake reduces the drop in metabolic rate, and also leads to a greater feeling of fullness.(increasing fat intake too, if tolerated)

Begin to exercise and stop dieting. You can increase your muscle mass by doing some type of resistance work (i.e. lifting weights, using exertubes, rubberbands, dynabands, hand weights, etc…). You can also decrease your level of body fat by doing some type of aerobic exercise at least 3 days a week for longer than 20 minutes. This is exercise such as walking, jogging, step aerobics, hi/low aerobics, biking, swimming, etc, that will increase your heart rate and keep it there for the duration of the exercise session.

You also need to eat!

Do not diet, just watch the types of foods you eat, and drink your protein!!

For more info download these 2 files.

Protein Seminar Paper(doc)

Gastric Bypass---The Untold Story(doc)

Thanks to Jen for the heads up about the pdf is now a doc file and should download without trouble.

Documents courtesy of OSSG-gone_wrong


Jen said...

Excellent post, but there seems to be a problem with downloading the second paper.


OhYeahBabe said...

I wish people didn't need to learn this stuff on their own, the heard way! I'm proud of you for doing your homework and sharing the information you find.
My blog: Kimorexia

recovering fatty said...

And to think that nutritionists tell wls patients to eat only 3 meals a day... with that tiny tummy, how can we get in that much protein on 3 meals a day, no "snacks", and with 20 minutes to eat food, like nuts suggest? Not to mention, nuts and surgeons are telling patients NO MORE protein supplements... wrong!!! I'd have to eat all day long from the time I got up out of bed til the time I went to bed in order to get in 100-130 protein grams a day just by food alone! Thanks for this info.

Anonymous said...

Bama Gal I do feel for you. I am 8 years out from WLS and have had none of these problems. Wasn't the malapsorption explained to you by your surgeon and nutritionist before you had surgery? It was explained in detail to me and of course if you are going to malapsorb fats and calories you are going to malapsorb everything else and have to follow a prescribed eating and supplementation regimen. I hope you get better and feel better soon!

Anonymous said...

I had gastic bypass done when it was just becoming known. Of course more is known about it now in the area of nutrition and protein needs. For the past 6 months I have been feeling horribly tired and my hair is falling out in massive amounts. Now I know why thanks to you. My body is so protein starved that it is feeding upon itself. Starting tomorrow I am going to up my protein intake dramatically. I was told 80 grams of protein per day would be enough but according to my weight and your scale that is not near enough to stay healthy. Thank you for the insight. PO

Jacque said...

I'd like to download the two files but I'm getting "Internet Explorer cannot display the webpage". Can this be fixed?

red said...

On Oct 25,2009 I will be 4 years since WLS. I think the instructions you get is all in where you have the surgery done. I was told by my doc that he would not even do the surgery for me unless I would commit to a lifetime of protein supplementation and vitamins, also NO carbonated beverages ever again. Different docs, different instructions, same operation. I don't understand this, however, I am very happy with my result, very healthy and will continue to follow the instructions doctor had me commit to.