I have been a dietitian/nutritionist with bariatric surgery centers for a long time. Over the years I have heard many false statements regarding nutrition, especially regarding protein. Today I am going to clarify some of the misconceptions about protein and bariatric surgery.
The public really does not always understand nutrition.Much of the information patients receive comes from the media, family, or friends, which many times are incorrect. Below are some of the statements that I often hear and have to clarify.
Misconceptions about Protein and Bariatric Surgery
"If you eat too much protein it turns to carbohydrates."
I read this the other day on Facebook and nearly had a heart attack. This statement prompted me to write this post. The patient was supposedly told this by her surgeon and/or nutritionist. I really hope not! Frankly, I think this person misheard or misunderstood. Carbohydrates, Fat, and Protein are all different types of macronutrients. Each serves a different purpose in the body. The one common job though, is that each is a source of energy. When we consume too much total energy, whether from excess protein, carbohydrate, or fat, are bodies will store the excess as fat. We have limited storage for carbohydrates and protein, but fat storage is unlimited. So, bottom line: excess protein will be stored as fat.
"Any protein supplement I can find is o.k."
The American Society for Metabolic and Bariatric Surgery recommended in their nutrition guidelines, published in 2008, that when protein supplements are the sole source of protein, as in the early post-surgery period, the source is complete and have a high protein digestibility corrected amino acid score (PDCAA). The highest PDCAA score is 100. Milk (whey/casein), eggs, and soy all have a score of 100 and are all complete proteins.
Collagen lacks tryptophan one of the nine indispensable or essential amino acids. Collagen is an incomplete protein source with a lower PDCAA score. I have had patients ask about the protein shots on the market. Many are made from collagen or other protein blends. These products promise a lot of protein in a small portion, however, they may not actually provide the amount of protein promised.
Tip: Look at the ingredient list of the protein supplement. Isolate and concentrates of whey, eggs, or soy have the best absorption, whereas blends may not. The amount of protein absorbed by protein blends depends on the protein sources in the blend and the concentrations of each type of protein. Isolates are a better choice.
"Once I am recovered I don’t need to worry about protein."
Protein is always important post-operatively whether you are 3 weeks out or 3 years out from surgery. The protein requirement as recommended by ASMBS should be between 1.0-1.5 gm/kg IBW (Ideal Body Weight). This means that even when you reach your ideal body weight you still need slightly more protein than the normal RDA for protein of 0.8 gm/kg of body weight.
"I can get protein from the cheese that coats Doritos."
I only heard this said once, but still need to clarify it. You can obtain protein from a variety of sources, however, the best sources are complete proteins found in meats (beef, chicken, turkey, fish, etc), milk, cheese, yogurts, eggs, and soy. Even though Doritos do have a cheese-like substance on them they are not a good source of protein.
"Fruit contains protein."
Now, this statement I have heard more than once. Fruit is actually the only food group that does not contain protein. Small amounts of protein are found in grains and vegetables. Protein is found in large amounts in dairy and meats.
"I don’t eat meat (red meat) so I can’t get my protein."
My answer has two parts:
#1 Often when I discuss “meat” with a patient they say "well I don’t eat meat", but after further discussion, I find out that a lot of people think only red meat is “meat”. However, any meaty tissue from an animal (land, sea, or air) is meat.
#2 There are other good sources of protein other than animal flesh. Of course, some are still products of animals such as milk, cheese, and eggs. Plant-based sources include soy, nuts, and beans.
"Once I can eat regular food I don’t need the protein shakes any longer."
This depends on how much protein you can eat from regular food. In my experience, it may take a long time for a patient to be able to consume 60-80 gm of protein every day from just food. Until that time an extra protein supplement is needed. The extra protein could be supplied by a shake, protein bar, or other protein food consumed sometime during the day. When you fill up quickly and stay full, bars and food may not be the best choice, whereas liquids are easier to consume.
Karen says
Somebody has told me that Collagen is not to be used by a person post bariatric surgery. Why is that as it helps with the hair and the nails so much. If that's the case, does it matter if you have had the sleeve instead of the Roen Y?
Thank you!
Jennifer Lynn-Pullman says
Collagen is not considered a complete protein as it's missing two essential amino acids. We encourage patients to consume complete protein sources in order to meet your needs.
Katie says
If I am only supplementing with the collagen is it acceptable to use so I can reap the benefits of hair and nails? I have a main protein powder that fits perfectly with the bariatric check list I will be using 90% of the time.
Jennifer Pullman says
You want to make sure it's ok with your surgical team.
Serena says
If I get my protein from dietary intake and protein shakes, and want to take collagen for its other benefits, do I count that protein in my daily intake??
Jennifer Pullman says
Collagen is not a complete protein, so is missing some amino acids. This is similar to other non-complete proteins found in plants and whole grains. We still count these protein sources to the total for the day.
Brenda McCorkle says
After my gastric bypass, I became dairy intolerant to the point where even whey protein causes severe symptoms. Are eggs a good source for me? I tolerate firm meat most of the time, but sometimes it makes me ill (no, I don't have my gallbladder). I can tolerate eggs all the time.
Jennifer Pullman says
Eggs are an excellent source of protein. Have you tried plant-based protein like nuts, nut butter, tofu, soybean, and other beans?
Vincent Brown says
My wife and consume anywhere from 90 to 170 grams of protein per day. is there such a thing as too much protein?
Jennifer Pullman says
You shouldn't exceed 30% of your total calories from protein. For example if someone was eating 1600 calories 510 calories would be protein (30%). There are 4 calories per gram of protein = 127 grams (510/4). Most patients should consume 80-100 grams. Excess protein will be stored as fat. Also, excess protein can be harmful to the kidneys in some people.
Jennifer says
Would you recommend taking collagen peptides post op to help curb hair loss?
Jennifer Pullman says
There are no studies that I know of that show that collagen peptides are the miracle that many believe them to be. Collagen is a protein source, but not generally a perfect one. Hair will fall out or thin in most weight loss surgery patients due to the fast and large weight loss. Consuming enough protein will help, but not stop it. I don't think collagen would hurt, but may not help more than whey protein or whole protein from food.
Nicole says
I am concerned about not getting enough protein right after surgery. I have been researching protein shots, but as you stated, all I have found are ones made with collagen. Is there a specific brand you could recommend? I thought the shots would be great because it's such a small volume of liquid with so much protein, and I know it can be hard to drink a lot right after surgery.
Jennifer Pullman says
Generally when you are permitted to start protein shakes you are able to handle traditional shakes. They do count toward your fluid goal for the day! I don't recommend any protein shots and honestly, don't know any other bariatric dietitian who do. Your fluid goal should be 48-64 ounces. We expect you to drink enough, but you will not be able to drink a lot at one time.
Colleen says
I found your article very interesting and I would like to follow you on social media if I could. I do have a question though. I had gastric bypass and I was told Collagen peptide would be good to use to help with the hair loss . Is this true for regrowing hair? What do I look for in a label to know if the protein supplements I am taking are truely providing adequate protein as they say they are on the front packaging
Jennifer Pullman says
No supplements will help regrow hair. Hair loss is a normal issue after weight loss surgery. It won't last forever. Make sure you are eating sufficient protein and take the vitamins your doctor told you to take.
Kevin says
Is there any harm or benefits of taking collagen pre surgery?
Jennifer Pullman says
You want to talk to your physician. Many providers don't recommend supplementing with any nutrients unless you are actually deficient.
John says
I am 5yrs post op gastric bypass, I've been lifting weights about 4yrs now and try to consume at least 100 grams of protein a day for some muscle building, I eat eggs just about everday and try to eat some meat whenever possible. I also eat protein bars ( 20 grams protein with just 2 grams sugar ) and shakes as well, I was told not to consume to much protein shakes because it's a liquid and it won't be absorbed in the body like a solid protein meal is. Is that true? I have no problem taking 2 protein bars a day but I know that might not be as healthy as say a healthy meal or even a shake. What do you recommend? Thank you..
Jennifer Pullman says
I have never seen any research that states that liquid protein is less absorbed than solid.
Rachel says
I'm 4 months out from my gastric bypass surgery and my hair isnt just thinning, I've lost 70% of my hair. I'm getting my protein and vitamins. I take biotin and collagen as well extra vitamin B3 and use shampoo that is supposed to slow down the hair loss. What am I doing wrong?
Jennifer Pullman says
Have you talked to your surgeon? Sounds like you are doing all you can. I would reach out to your surgeon to see if there is any other issues causing hair loss.
Johnette Teid says
I am 20 years post Rouen y gastric bypass and I lost 180 pounds my biggest problem except that of loose skin on my thighs and stomach is my hair is still thin. I take vitamins and iron supplements daily. Now I have gone to keratin hair vitamins, biotin and collagen supplements daily to help. I was 46 when I had my bypass. I have done a pretty good job keeping the weight off. I do work out at the gym on a regular basis do you have any other suggestions for my hair?
Jennifer Pullman says
Feel free to email me [email protected]
MELICIA WASHINGTON says
Hi Jennifer, I am 3 months post-op gastric bypass. I am taking Vital Protein w/ Collagen. You stated that Collagen is not considered a complete protein as it’s missing two essential amino acids. Do you know what the missing two essential amino acids are?
Jennifer Pullman says
The latest research is that collagen is missing tryptophan, which is one of the 9 essential amino acids.
Jennifer Pullman says
As stated in the post collagen is missing tryptophan, one of the 9 essential amino acids.
Cindy says
If you consume too much protein then this can be converted into glucose by a process called 'gluconeogenesis'.
Jennifer Pullman says
Excess protein is stored as fat. We only use protein from our muscles when the intake of carbohydrates is not sufficient. Gluconeogenesis is not a concept we generally teach patients, because it's not as simplistic as you stated. Our bodies use carbohydrates first for fuel and it is the preferred source. Using other macronutrients as fuel is very costly to the body. Using protein as fuel decreases body protein volume such as muscle and organs. Utilizing protein for fuel may also take protein away from doing the nutrient's main functions of tissue growth and maintenance, and production of hormones and antibodies. Using fat as fuel can lead to ketosis. Ketosis is a build-up of ketone bodies, which are produced from fat breakdown. Where advocated for a keto diet thing that ketosis is a good thing, long term can damage the body. Extreme ketosis can lead to coma and death. So, basically eating too much protein give you a ready source of carbohydrates.
Cindy says
Gluconeogenesis refers to synthesis of new glucose from noncarbohydrate precursors, provides glucose when dietary intake is insufficient or absent. It also is essential in the regulation of acid-base balance, amino acid metabolism, and synthesis of carbohydrate derived structural components.
Gluconeogenesis - an overview | ScienceDirect
Jennifer Pullman says
I am familiar with Glucneogenesis as every dietitian studies this and other processes during our training. Gluconeogenesis only occurs when the intake of carbohydrates is insufficient. The body will first use up glycogen stored in the liver and muscle, however, we only store enough for about a day. Once glycogen is depleted our body has to use its own tissue to produce energy for our brains and vital organs. To utilize protein we are breaking down muscle. As a result, we risk decreased lean body mass, decreased organ volume, and also insufficient protein and amino acids for vital body functions. The excess protein someone may eat doesn't automatically get used as carbohydrates. Excess protein beyond what the body needs is converted and stored as fat.