After weight loss surgery many patients think that carbohydrate foods are something they need to avoid. This guide to carbohydrates after weight loss surgery will clear up any misconceptions and give you the information you need to consume balanced meals.
I hear all the time "I can't have carbs, they are evil"! I hear this from just about everyone regardless of whether they are a bariatric surgery patient or not. Well, are carbohydrates evil? The truth is no.
What are Carbohydrates?
Carbohydrates are actually essential to our lives. Carbohydrates along with protein and fat are macronutrients that serve as fuel sources for our bodies. Carbohydrates are actually the preferred fuel. It is very costly for the body to use protein and fat for energy because you are breaking up body tissue (you’re eating yourself!).
Our brains can only use carbohydrates as fuel! Carbohydrates, along with the other macronutrients, are nutrients that our body cannot make and need to be supplied by our food.
How many carbohydrates should we eat after weight loss surgery?
About forty to fifty percent of our total food intake should come from carbohydrates. All carbohydrates break down to sugar in our body and this is the fuel that circulates through our bloodstream. The energy that flows through our blood is glucose, the most basic sugar. Yes, sugar!
The Recommended Daily Allowance (RDA) for carbohydrates is 130 grams per day. We do know that low intake of carbohydrates will cause a breakdown of protein. In weight loss surgery patients we stress protein to spare muscle tissue. A very low carb diet, such as a ketogenic diet, may stimulate muscle protein loss, which is exactly what we are trying to prevent.
A literature review published in Bariatric Times in 2013 recommended 90 grams for patients at 6 months and 130 grams for patients over 1-year post-surgery. At these levels, patients are able to achieve weight loss goals and maintain muscle mass.
Additional problems with low carbohydrate consumption:
Hypoglycemia can occur particularly in gastric bypass patients after the one year mark. This condition is generally a result of not consuming enough carbohydrates throughout the day. The solution is to combine protein and carbohydrates at each meal. This is very important for patients who have become regular exercisers. The body needs to refuel after physical activity.
Protein is needed to repair muscles and carbohydrates are needed to refuel. Patients still need to make sure they meet their protein requirement, but should not forget about carbohydrates.
Carbohydrates in Food:
Simple Carbohydrates also are known as “simple sugars”. These carbohydrates are called simple because their sugar molecules are small, so not much digestion and breakdown is needed in order for these sugars to enter our bloodstream. These sugars, therefore, have a greater and quicker impact on blood sugar levels. Types: Glucose, Fructose, Galactose, Maltose, Sucrose, Lactose
Simple Sugar Foods:
- milk/dairy products
- some fruits and vegetables
- processed flour and sugar products: candy, soda, snack cakes, pies, cookies and sugary drinks
Many times simple sugars are viewed as “bad” carbs. Of course, processed carbs like those in junk foods provide no nutrition benefit. Foods like dairy products, fruit, and vegetables provide a wealth of vitamins, mineral, and fiber that are essential to our health.
Complex Carbohydrates include starches and fiber. The carbohydrates in these foods are called complex because the size of the carbohydrate molecule is larger and takes longer to digest and use.
Complex Carbohydrate Foods:
- whole grains
- whole fruit
- whole vegetables
- beans and lentils
Food in this group will help us feel fuller longer because digestion is slower. Complex carbohydrates often provide more carbs per serving than foods that contain simple sugar. The impact on blood sugar is slower.
Amount of carbohydrates per serving:
½ cup Rolled Oats = 13 mg CHO
½ cup Sweet Potato = 20 gm CHO
5 Saltine Crackers = 12 gm CHO
1 small Apple = 15 gm CHO
1 cup Low Fat Milk = 12 gm CHO
Will carbohydrates make me gain weight?
Any excess of calories from either protein, carbs, or fat can lead to weight gain. Often carbohydrate foods are eaten in excess. Grain products, in particular, are easy to overeat, especially bread, rice, and pasta. After surgery, these foods often are difficult to eat anyway. Eventually, many patients can tolerate these foods in small quantities, but the fear is that if these carbs are consumed weight gain will occur.
In practice, I see weight gain not occurring because of an increased portion of rice, bread, pasta, fruit, or dairy products, but increased consumption of junk food and sugar-sweetened beverages.
This post was originally published on January 17, 2014. This post was updated in 2018.
Here is information about the two other macronutrients:
Eating Fat after Weight Loss Surgery
Protein Requirements after Weight Loss Surgery
reallyrosy says
yes they are evil if you have no control after you eat a portion. I have not had any simple carbs since 2011.
Jennifer Lynn-Pullman says
You should absolutely stay away from any foods that are trigger foods for you.
Debbie says
You have examples of what you eat daily
Jennifer Pullman says
Not sure if you are asking if I have examples, but if you sign up for my newsletter you can free menus that will give you examples of how to incorporate carbs into your diet. Hope that helps!
Lisa Lollar says
How do you sign up...
Debra Dorey says
Looking for meals for after surgery when able to consume food
Theresa Figueroa says
[email protected] I need carbs and protein for a simple meal I'm not much of a cooker I need a weight loss a long time ago . How much water should a person of a weight loss surgery drink .
Jennifer Pullman says
The general rule of thumb for fluid is 32-64 ounces, however everyone is different. An indicator of hydration is the color of your urine. Clear to pale yellow you are adequately hydrated. Dark yellow you need more fluid.
Danielle Slan says
Hello my name is Daniele I had gastric bypass January this year and need help in daily intake for protein and carbs thanks in advance
Jennifer Pullman says
Sounds like you need specific recommendations for macronutrients. This is very individual and is considered MNT. I am not able to provide MNT over the internet at this time. I would suggest contacting the dietitian you met with prior to your surgery or contact your insurance company to see if they cover nutrition counseling and find an RD in your area to work with. I will say that 60-80 grams of protein per day is pretty standard after surgery and doesn't often change.
Rosemary Hofmann says
Can I get prices for your newsletter with menus?
Jennifer Pullman says
The newsletter is free to join and the menus are free when you sign up.
Miranda says
Im 6 mo poat op & eat 120 carbs per day & down 80 lbs. Tired of seeing so many bariatric patients doing keto or Atkins. We've tried all those diets before surgery. Well, most of us have, that's why we got surgery as a last resort. We need a plan that's sustainable after surgery & to me, it is all food groups in moderation.
Jennifer Pullman says
So many people still have a diet mentality. I am continually trying to change this with my patients, but it's hard.
barbara says
I just read your information and I feel this is the most informative . I was diagnosed recently with low ACTH and low cortisol after 10 months post op RNY GASTERIC BYPASS. I feel it may be diet related . I am trying to improve my nutrition . incase I am malnourished have you heard of this happening before ? Thanks so much I am following your information .
Jennifer Pullman says
I have never heard of low ACTH and low cortisol following bariatric surgery. If you are following your surgeon's diet recommendations and taking the vitamin supplements you were told to take malnutrition is rare. Patients have become malnourished if they make poor food choices and don't take their vitamins on a regular basis. This is something that you need to discuss with your surgeon.
Cunnicia Newsome says
I would like to learn more about what carbs to eat.
Clementine says
How many net carbs?
Jennifer Pullman says
I honestly do not recommend that patients track every single number. Protein yes, but other macros no. A healthy lifestyle includes lean protein, whole grains, fiber-rich fruit, and vegetables. There is no standard to date on how to accurately determine net carbs. Digestibility is different among people. It's a new term that emerged from the low carb diet culture. I try to move my patients out of the "diet" mentality and culture. If you limit junk food, sugar-sweetened beverages, and focus on getting carbs from fiber-rich sources your "net" carbs should be fairly low, but as I stated carbs, in general, are not the enemy. Too many calories from any of the macronutrients will lead to weight gain.
Laura gipson says
I’d love to sign up for your free newsletter. I’m 15 months post op sleeve and can’t seem to get in carbs. I’m needing to know what good carbs I’m needing to take in.
Jennifer Pullman says
You sign up right in the side bar!
Celie says
I'm 17 months post-op and had bariatric surgery to fix slow digestion issues. I am now struggling with reactive hypoglycemia. My blood sugar is dropping to the 60s or lower within an hour of eating even with protein 20g and fat about 15g per meal. My dietician told me to eat no more than 25g of carbs at each main meal and eat more fat and protein. This leaves me struggling to get enough carbs & I have huge issues with constant fatigue and brain fog. Am I eating too few carbs? I'm on a roller coaster of normal blood sugar then very low blood sugar (32mg -68mg). My A1C is normal at 5.1 and fasting blood sugar is between 63mg - 90mg. This reactive hypoglycemia started 1 year post-surgery but I've had hypoglycemia / thyroid issues most of my life. My weight is in the mid-range for my height so completely normal. All other blood nutrient levels like protein, B-12 etc. are normal. I would really like to get back to where I was 6 months ago blood sugar-wise. Do you have any advice carb-wise or any advice on how to eat to manage reactive hypoglycemia?
Jennifer Pullman says
Your dietitian would know your situation best to determine how many carbs you should eat per meal. There are some patients that need to eat every 2 hours to prevent drops. Also, have a carb with protein and fat. Never alone. Has anyone sent you to see an endocrinologist?
Fernands says
Buying gluten free stuff and sugar free stuff it’s still as bad than eating regular stuff ? I can’t stop eating cookies once a eeek or twice a week it’s being hard but I’m scared because I buy all gluten free and sugar free cookies and things like that
Jennifer Pullman says
Sugar-free products often contain more fat to make the food actually taste good. The calories may be just as high even though the food is sugar-free. Gluten-free doesn't mean healthier. Gluten-free foods are for people who have an intolerance to gluten (Celiac disease). Gluten gives foods it's sponginess. Without gluten, food companies have to try to use other ingredients to try to mimic the gluten-containing ingredients. Gluten-free products often have more fat and/or sugar than regular products. If you don't have celiac disease you don't need to buy gluten-free food.
Claudia P Garcia says
I just had Gastric Bypass Surgery on April 6th. How long do I need to wait before I can eat low carbs.
Jennifer Pullman says
I would follow your surgeon's recommendations. Most patients two months out can tolerate most foods.
Judy says
Would you recommend adding in the calories burned during workouts? I had gastric bypass in June 2020 and am just about 20 pounds from goal but I do work out more now than ever. I’m burning about 500-700 daily/5 days a week. Should I add those burned calories back in as I seem to be at a stand still?
Jennifer Pullman says
I think you answered your own question. If your weight loss has stopped a calorie adjustment is likely needed. How many calories are you eating? Say you consume 1000 calories per day. If you burn 500, your net is only 500 and that is not enough food for a child to live on! Your body will go into starvation mode and hold on to what it has.