Protein. Slides will automatically advance every 60 seconds or left click on your mouse. 2/5/2014 1

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1 Protein IU Health Bariatric Online Support Slides will automatically advance every 60 seconds or left click on your mouse. 2/5/2014 1

2 Reminders for pre-op patients Liver reduction diet What struggles are you having with the diet 64 oz fluids/day No juice, sweet tea, or carbonated beverages Vitamins Multivitamin every day 1200 mg calcium citrate every day (2 tablets 2 times a day) 2000 IU Vitamin D3 Journal Expectation that you reach your goal weight or not be above consult weight before surgery. If you were told not to start the liver reduction diet until a later time, but you have gained weight, start the diet now, not later. Weight loss goal has to be maintained all the way until surgery and if you had no weight loss goal, you can can t be above consult weight even on the day of surgery If you have diabetes, be sure to get your A1C and lipid levels checked 2/5/2014 2

3 What Is the Purpose of Protein Proteins are made of amino acids. There are 20 amino acids 8 are essential which means your body cannot produce them and must be obtained from your diet. 12 are non-essential, your body can produce these. Animal based and soy yproteins are complete, they contain all 20 amino acids. Plant proteins are incomplete or lack one or more essential amino acid. Amino acids from diet are rearranged by our body to create hormones, enzymes, antibodies, hair, skin, etc. 2/5/2014 3

4 What Is the Purpose of Protein It s important to know what your food is doing for you and why it s important: t Component of every cell and tissue in your body-protein is termed the building block of the body. It is called this because protein is vital in the maintenance of body tissue, including development and repair. This is why children need more protein per pound of body weight than adults; they are growing and developing new protein tissue. Hormone- Protein is involved in the creation of some hormones. These substances help control body functions that involve the interaction of several organs. Insulin is an example of a hormone that regulates blood sugar. It involves the interaction of organs such as the pancreas and the liver. 2/5/2014 4

5 What Is the Purpose of Protein Enzymes- Enzymes are proteins that increase the rate of chemical reactions in the body. In fact, most of the necessary chemical reactions in the body would not efficiently proceed without enzymes. For example, one type of enzyme functions as an aid in digesting large protein, carbohydrate and fat molecules into smaller molecules, while another assists the creation of DNA. Transportation and Storage of Molecules-Protein is a major element in transportation of certain molecules. For example, hemoglobin is a protein that transports oxygen throughout the body. Protein is also used to store certain molecules. Ferritin is an example of a protein that t combines with iron for storage in the liver. 2/5/2014 5

6 What is the Purpose of Protein? Antibodies-Protein forms antibodies that help prevent infection, illness and disease. These proteins identify and assist in destroying antigens such as bacteria and viruses. They often work in conjunction with the other immune system cells. Except for water, protein is the most abundant substance in your body. This protein is manufactured by your body utilizing the dietary protein you consume. It is used in many vital processes and thus needs to be consistently replaced. You can accomplish this by regularly consuming foods that contain protein. 2/5/2014 6

7 How Much Protein will you need after Surgery? After surgery you need grams of protein per day, regardless of where you are in the post-op op process. To put this in perspective, the current recommended daily allowance (RDA) for protein: Women 45grams Men 60 gram Your body cannot store protein so without DAILY protein, it will begin to break down your muscles. The more muscle you have, the higher your metabolism The only way to build muscle is to lift weights, not by eating a lot of protein 2/5/2014 7

8 What Are Good Sources of Protein? Meats chicken, beef, pork; this includes all ground versions, deli cuts, canned meat, etc.. Fish shrimp, lobster, salmon, tuna, cod, flounder, etc Dairy milk, cheese, cottage cheese, yogurt Beans canned, or dried Soy based foods tofu, tempeh, edamame, soynuts, soymilk 2/5/2014 8

9 Determining Protein Content in Food Sargento Shredded Reduced Fat 4 Cheese Italian Cheese ¼ cup cheese = 8 grams of protein What if you only used 2 Tbs cheese 2 Tbs = 1/8 cup = 4 g protein 1 Tbs cheese = 2 g protein This is why it s important to measure your food after surgery! 2/5/2014 9

10 Protein Supplements When will protein shakes come into play and for how long? Gastric Bypass -- will use it for about the first year. Gastric Sleeve patients will use for several months Gastric band patients will only use for a few weeks after surgery. No matter what surgery you ve had, you will work with your dietitian individually as to when is a good time to give up the protein shake. No protein shakes during supervised weight loss. Your goal will be to obtain protein from a dietary source. Use protein shakes to supplement what you can t get from your diet. 2/5/

11 Protein Supplements Protein supplements come as pre-made supplements or powders that can be mixed into liquids. Rule of thumb for choosing a pre-made protein supplement: <200 kcal At least grams of protein per 8-11 oz serving Pre-op patients: I would visit the protein supplement section of a store or GNC and familiarize yourself with what is available. It can be overwhelming at first because there are so many options. Ask if they have samples available for purchase. 2/5/

12 What About Protein Bars? Try to avoid do not use during supervised weight loss. Protein bars only serve a purpose in your life if you are heavily engaged in exercise (training for an event) or traveling. It is best to get your protein in through food during mealtimes, and then supplement with a shake in-between. You will work individually with your dietitian on this issue. 2/5/

13 What If I m Lactose Intolerant? Common with gastric bypass patients after surgery since body cannot breakdown lactose (natural sugar found in milk). Symptoms are bloating, cramping, gas and diarrhea after drinking milk or eating dairy products. Treat with: Lactose Free or Lactaid milk. Carbmaster Milk (11 grams of protein per cup!) Lactaid tablets/dairy t Digestive Enzymes sold over the counter. 2/5/

14 Strategies to Increase Protein As a pre-op patient, start familiarizing yourself with the nutrition label. Look at the serving size, grams of protein per serving. Start counting your protein so it s not such a new concept after surgery. Center your meal around protein. After surgery goal will be to eat 3-4 ounces of meat, dairy, or other protein at each meal. This will give you grams protein. 2/5/

15 Take Away Message Before and after surgery, protein is the main staple of your diet. Should be 75% of your meal with sides comprising the other 25%. Boredom with food is a big complaint heard both before and after surgery. Start looking for new recipes now. You have a wealth of them at your fingertips with the internet. Start paying attention to food labels, counting grams of protein and measuring your foods. If you have any questions about what was included in this presentation, please call or jgregoli@iuhealth.org. Thank you! 2/5/

16 Post Test Which of the following is a good source of protein Green beans Eggs Apple How much protein will you need after surgery? It is not important to measure your food after surgery? True or False 2/5/