Calorie Counter and Diet Help Needed

by Brian
(Bar Harbor, Maine)


After my weight loss surgery of gastric sleeve, I was good with my diet for a while, but things have gotten messy and I’m not sure about my next move. I’m starting to wonder if I should be using some sort of calorie counter app or food diary template to monitor nutrient intake, or should I just stick with conventional diets.

I had about 150 pounds to lose before surgery, I then lost 75ish after the gastric sleeve. I then went on the atkins diet. I did OK, but didn’t lose more weight. Then I tried the ketogenic diet, then I tried vegan. None of them took me to the next level, and the last 75 pounds have been stubborn as can be. I never used a calorie tracker, I didn’t think I needed one. Currently, I’m not on a diet and I’m not eating very well.

Should I just use a food diary (like the MyFitness pal app) and keep it simple with no restrictions – just a balanced diet with smaller portions? Or do you have a recommended diet after gastric sleeve? What about a breakdown for carbs, proteins, and fats? Do I need to stop trying specialized diets?


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Surgeon Response to "Food Diary and Diet Help Needed"

by: John Rabkin, M.D., Pacific Laparoscopy

Dear Brian,

The Sleeve Gastrectomy (SG) is a purely restrictive Weight Loss Surgery (WLS) procedure. Consequently, if you consume more calories than you 'burn off' (metabolize) your weight loss will stop and/or you will regain weight. Therefore, your efforts at further weight loss now that your weight loss has 'plateaued' should be directed at reducing your caloric intake and increasing your metabolic rate, most commonly through increased exercise.

My usual recommendation is for SG patients to avoid liquid calories of any kind (inclusive of protein shakes) as I've observed patients are less satiated and are hungry sooner/faster after consuming an equivalent caloric load in a liquid form rather than as solid food. Also, the routine caveat of 'protein first' should be adhered to with a target of 25 to 35 grams of protein per each of your three meals.

Any additional calories consumed should be minimized. Snacking should be avoided and, if necessary, should be with very low calorie foods such as raw vegetables as opposed to additional protein which is high in calories and isn't needed if you get adequate protein with your three meals. In addition, minimizing your consumption of fats and carbohydrates will further your desired weight loss.

All of the tools that you learned about to use the diet before you underwent your SG should be pulled out of your tool chest and re-embraced: maintaining a food diary as you mention is a very good tool to add to your armamentarium! As you've already tried a ketogenic diet like the Atkin's approach without success, I believe that your best bet for additional weight loss will be through caloric restriction.

At the end of the day, keep in mind that the SG wasn't initially conceived as a 'stand alone' WLS procedure: it was originally intended as the first part of a 'staged' (two part) Duodenal Switch (DS) which adds calorie malabsorption to the restriction of the SG.

If your efforts at additional desired weight loss aren't successful despite your best attempt, you may want to consider additional WLS such as 'completing' the DS to enable you to lose the excess weight that you've been unable to lose with the SG alone.

Best regards,

John M. Rabkin, M.D.
Pacific Laparoscopy


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DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

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