Is “Eat Your Protein First” the Best Advice for Weight Loss Surgery Patients?

For the last few decades, the most common nutritional advice given to weight loss surgery patients is to “eat your protein first.”  Many patients proudly report to me about all of the chicken, fish and low fat dairy foods they’re eating after surgery, believing that this is the key to post-surgical success.  Before I explain why I think that there is a better approach, it’s important to note that everything that I recommend applies only to patients who’ve had a traditional gastric bypass, sleeve gastrectomy or gastric band procedure and is not recommended for anyone who has had a duodenal switch procedure or a gastric bypass performed before the year 2000.

The advice to eat your protein is offered for two reasons:

  1. Initially after surgery, you are very restricted in your ability to eat anything, so focusing on protein ensures that you won’t suffer from malnutrition
  2. Weight loss surgery started around the same time that the Atkin’s diet was popular and low-carb eating was thought to be the best approach for weight loss

When I see patients in the office who have concerns about their weight, 99% of them want to lose additional weight – it is exceptionally uncommon that weight loss surgery patients have lost too much weight and are suffering from malnutrition.  Malnutrition after weight loss surgery almost always points to a significant complication like an ulcer or an obstructed sleeve and generally does not occur in otherwise healthy patients.  Our body is extremely well designed to protect us from malnutrition and it will figure out a way to ensure that you get enough food to survive.  For over a decade, I’ve closely followed my postoperative patient’s nutritional labs where we look for signs of starvation and can thankfully say that malnutrition after weight loss surgery is exceptionally rare.

Because malnutrition is not a concern after surgery and some weight regain is unfortunately more common that we’d like, postoperative nutrition should be targeted at preventing weight regain, not at preventing starvation.  While a high-protein, low-carb diet can be an effective long term tool for some, I believe that it is not the best nutritional advice that we can offer our post-surgical patients.  Instead, once someone is six months or more out from surgery, I encourage them to “eat their veggies first.”  As patients progress through the four stages after weight loss surgery, their appetite increases and their ability to control their weight, which came easily over the first few years after surgery, decreases.  A diet that consists mostly of plants is scientifically the best way to control food cravings, ensure cardiac health and lose weight.  If you have any doubts about this, I challenge you to follow my Metabolic Reset Diet for two weeks – you will lose weight and your cravings for processed and sweetened foods will decrease.

Many patients have reservations about endorsing a vegan style diet, and understandably so – I’m not 100% vegan and have no plans to avoid meat altogether.  Back in the 70’s vegan and vegetarian diets stemmed from animal rights and religious movements.  When the decision to not eat meat comes from moral or religious beliefs, a single bite of an animal product is considered a failure.  However, when your decision to change your diet is to help with weight loss or health, a single bite of an animal product is largely irrelevant.  If someone was 100% vegan for 364 days and then ate a steak on day 365, from a nutritional perspective, this person will obtain 99.9% of the health and weight loss benefits of a strict vegan.  When we look at veganism as a spectrum, rather than an absolute mandate, adopting a plant based eating strategy becomes much more reasonable.  Understandably, very few patients are interested in adopting a strict vegan diet, however, nearly every patient I’ve discussed this concept with has been willing to focus on eating less meat.  You can obtain most of the benefits of a vegan diet if you limit you consumption of all animal products to 1-2 small servings per day.

It’s important to note that animal protein consists of all foods that come from animal products.  Traditionally, dairy products and eggs have been given a free pass because consuming them does not require you to kill an animal – remember, this nutritional approach started as an animal rights movement.  However, dairy products and eggs have the same negative health effects that beef, pork, chicken and even fish do.  In fact, non-organic dairy products may be one of the worst things you can eat after weight loss surgery.

Eat your veggies first
The meal I ate writing this article

A key component of adopting this eating strategy is not just to eat less meat, it’s to start eating lots of fruit, vegetables, nuts, seeds and beans.  The best part about this approach is that you no longer have to look at eating as the problem and controlling your hunger as the solution – this will always fail in the long run.  Instead, you get to eat as much as a you want, and if you learn some delicious new recipes, you’ll learn to enjoy your food too.

So, if you’re struggling with weight regain, looking for the best nutritional plan to maintain your weight loss or are just interested in identifying the healthiest diet possible, Eat Your Veggies First!

4 thoughts on “Is “Eat Your Protein First” the Best Advice for Weight Loss Surgery Patients?”

  1. I had Gastric Bypass Surgery 1998 280lbs 5”1 and now weigh 115lbs, I’m 64 yes and I have struggle until last year in this FA Program.. I am in a Food addiction Program Bright Line Eating… I am vegan and eat typically this
    Breakfast : 3oz beans, 1/4oz of chia/flax/hemp seed ground , 2oz almond or soy milk,
    4-6oz (supergreens heated in micro,
    4oz butternut squash or sweet tater, wild rice or oat groats
    4oz fruit

    L: protein: 4oz beans, (3oz if tofu or tempeh, edamame, black soy beans
    Fat: 1/4oz nuts or 1oz hummus or avocado or olives
    Veg: 10 Oz cooked beet, cauliflower, broccoli, red peppers
    Fruit: 4oz fruit

    D: protein: same as lunch
    Veggie 10oz broccoli, cabbage , Brussels sprouts cooked..
    fat: same as lunch

    I am very full and takes time to eat my food… I love a big salad and all veggies raw but Gastrienterologidt says I have esophageal motility and no restriction from endoscopy recently and on 40mg omaprozole 1 before Breakfast and metaclopramide before lunch & dinner…. I’m up 10lbs … like to get back down to 105lb or 102-104… I’ve never been this small .. I have bad OsteoArthritis.. 2partial knee replacements, 2Cervical discs replaced and fused, Patella tendinitis, bad shoulder and arthritic hips, Osteoporosis, Chronic iron deficient anemia, my gallbladder was removed with GBP surgery, I have a large non cancerous tumor on my thyroid.. 3cm and numerous nodules , had total lower body lift 16yrs ago with hernia repair, breast lift and augmentation last year . Wish I could afford to get skin on arms removed.. have been micronutrients tested last 2yrs and deficient I almost all if not TSH test come out ok. But not tested for reverse T3,4. I’m getting tested next week for all my nutrients again I exercise 6 days a week.. class at senior.. I have a tight core

    What food do I add for maintenance, which would reduce in some veggies… Should I be eating more for protein?? Add some more … eat less veggies at a meal and eat 4meals help me, Endocrinologist’s doesn’t know crap nor Dietician at a Bariatric office.. another functional nutritionist told me I should be eating animal protein but I don’t like it like I do my beans Is soy 1-3times a day too hard for digestion.. raw veggie out , just cooked.. can you help me? $ is an issue year ..sad to say .. I don’t take any supplements… I don’t want to waste money on what I don’t need.. been Vit d deficient Endo Dr gave me Rx for vitd2.. duhh i did take it for a while took it… help answer some question …

    1. Most importantly, take your supplements as prescribed. It sounds like you should get in touch with a bariatric surgeon’s office and get a full nutritional lab evaluation and meet with their dietitian.

      1. Thank you for answering.. unfortunately the Bariatric Surgeon in my area has a Dietician and knows nothing! I was wondering what your comment about pre 2000 Gastric Bypass Surgery.. mine was 1998 and that office has no records. Your comment about Protein first after a short period then it’s veggies except in long term pre 2000 patients … is more of my intestines removed in the RNY Gastric Bypass??? than post 2000… who REALLY help me.. more risk of malnutrition? All the Bariatric vitamins are low quality and need a good one. Can you help me?

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