How should weight loss surgery patients count carbohydrates?
Counting carbs—not crows
There are two approaches to carbohydrates, one is to simply count them and not exceed a certain number—this works well in the early stages following bariatric surgery, but not always later on. (See Appendix One.)
For carbohydrate counters the total daily amount of carbohydrates should not exceed 60 grams, or 20 grams of carbohydrates per meal. If you go over this amount, you will risk regaining weight. Remember, carbohydrates and sugars are not your friend. The more sugar you eat the longer it will take to lose weight. Sugar is in many things that you might not even consider: fruit juices, processed food products, condiments such as ketchup, and also in canned fruits, pastry products, pasta, breads, and even some vegetables. Sugar is very well absorbed after this surgery, which means the more foods you eat with sugars and carbohydrates the longer it will take to lose weight.
Snacks cause most people to stop losing weight or their ability to lose weight to decrease. Many snacks are high in carbohydrates and low in protein. Your goal is to find snacks that are higher in protein than carbohydrates. Some protein bars make good snacks, but some protein bars contain far more carbohydrates than we would like to see you consume. Shrimp is a good single bite with protein. Nuts and seeds are fairly high in protein. We have a few snack suggestions in the menu section.
This is where you get to become a label watcher. Our goal is to limit carbohydrates and encourage high protein snacks.
Counting carbs using the glycemic Index and BMI
—Which carbohydrates to re-introduce
Another approach that has proved successful is matching the foods that you eat with your BMI. The rule is simple: If your BMI is over 35 have foods with a glycemic index no greater than 50. For a BMI between 25 and 35, have foods with a glycemic index no greater than 70. Once your BMI is below 25 then there is no restriction on foods you can have, simply to have protein first.
This is the approach I advocate for patients once they are past their first 12 weeks. It is fairly easy to follow. Of course here I can shamelessly promote my book that has a carbohydrate counter and Glycemic Index table all in one—but I will resist that urge.
Exceptions to the rules:
There are no exceptions unless you are one of those patients who have a severe need for carbohydrates because of exercise. However, one of my patients even gained weight training for a marathon! If you think you are an exception, you will have to prove yourself. You do not need a Snickers bar for walking, running, or playing tennis. If you feel you need to "load" carbohydrates, remember you need to sustain the release of glucose over time. This means you cannot load with high glycemic foods. If you want to load, then load with low glycemic items so glucose will be released slowly over a period of time.
Restaurants and eating at your in-laws
At restaurants you will find that appetizers are often the perfect portion size for your stomach and they contain good food. Smoked salmon, shrimp cocktail, oysters—are all good sources of protein. Ask for the appetizer instead of the main dish. If you really want the main dish, then once you get your food, ask for a take home box, portion out your food, and put the rest in a box. A nice 6-ounce fillet might make two or three meals, it is best to portion it out first. If you eat more than you should, know that restaurant restrooms are not as comfortable as yours at home.
When visiting friends or in-laws who may not know—and do not need to know—that you have had weight loss surgery, tell them ahead of time that you really do need smaller portions. You have had stomach surgery, and they can all understand what it means. You can tell them that you need higher protein items.