Post Op Protein Malnutrition: A Word or 2 From Hans and Franz

From  SNL

We should hire Hans and Franz for the office.

Our post op patients could use some motivation ("I WANT to PUMP YOU UP") at times, as we commonly see varying degrees of protein malnutrition after surgery, most notably the Gastric Bypass, and lesser so after the Sleeve and the Band.

Protein malnutrition can be a result of the same causes as Fe deficiency: Malabsorption, and/or preferential food limitation by the patient for proteins, which are usually texturally more difficult to eat after surgery due to newfound gastric restriction.

Patients who don't follow our slogan of "Protein First" when they eat a meal start out with CHO-rich foods, and end up with little room for proteins by the end of their 1/2 - 3/4 cup meal.  They need to maintain focus on protein intake preferentially, as to get to the recommended 60-80 grams of protein intake every day.

Studies have shown that 60-80 grams per day will encourage weight loss by sustaining a reasonable metabolic rate, maintain a good amount of satiety to lessen hunger, and uphold lean body mass as weight loss occurs.

Of note, out preoperative weight loss program is essentially a high protein / low CHO diet of either Medifast shakes, and/or a Lean and Green diet as instructed by our Nurses or our Dietician.  It works!

As referenced earlier in this Blog, we check labs regularly in our patients after surgery, every 3 mos for the first year in Bypass and Sleeve patients, and roughly every 6 mos in our Band patients.  Included in our post op panel is a PreAlbumin level.  Albumin is not as sensitive in the short term, whereas PreAlbumin is a better marker of acute protein malnutrition.  Advising our patients to increase (or adhere to) their suggested protein intake will often positively effect a low protein level in a short amount of time.

Our Registered Dietitian has developed an excellent resource for our patients that describes the reason protein is so important, how much they need daily, types of foods and serving sizes that a patient may try to get their protein in, and how to read labels on protein-containing foods and supplemental shakes to get the best ones out there.

A word about supplemental proteins.  Most shakes out there from any reputable source (Price Chopper, Walmart, GNC, etc.) are "Complete Proteins" that have all the 9 essential Amino Acids necessary for human biological function, and are usually Soy or Whey based.  The best ones for weight loss patients are those with low CHO, as to not add extra calories, or induce Dumping Syndrome, as can occur after a Bypass and a high CHO load.

Signs of insufficient protein intake may include anemia, asthenia, edema, and alopecia. Physical exam evidence of muscle wasting, if it is severe and chronic in nature, can be seen in the dorsal hands as well as the major muscle groups.

So, in summary, as far as protein intake goes...Just Do It, or else...