What’s So Special About Protein?

By: Danielle Houston, RDN, LD

Whether you are considering bariatric surgery, have already undergone a procedure or have just stumbled upon this blog by accident, I bet you have had someone tell you to eat more protein.
It seems to be everywhere in our society today. There are protein powders everywhere you look, food labels boast about protein content and whenever you are hungry someone will always say “eat some protein”. So why has protein become so pushy? Is it really that important? And what about patients that have undergone a weight loss procedure? Do they have to worry about protein? Well, first let’s talk about what protein is, exactly.

Protein is defined by Merriam-Webster as “any of various naturally occurring extremely complex substances that consist of amino-acid residues joined by peptide bonds, contain the elements carbon, hydrogen, nitrogen, oxygen, usually sulfur, and occasionally other elements (as phosphorus or iron), and include many essential biological compounds (as enzymes, hormones, or antibodies)”.

So, that explains it…or not! To put it in simple terms, protein is a food group that is essential to the human body. No human being can survive without an intake of protein foods. Bodily organs such as the heart and tongue are made of protein and protein is what forms the basis of our skin, nails, hair and muscles. Protein is also used in healing–it helps stitch skin back together and heal other wounds, both internally and externally. Those are some pretty important functions! So if you want to maintain your body in a healthy manner, protein is definitely essential in your daily life.

Now that we know what protein is and why it is important, let’s review where we get protein and how much we need. For the general population, a person needs a minimum of 45 grams of protein per day (bariatric surgery patients will have higher requirements, usually no less than 60 grams per day). However, this number can vary greatly based on age, sex, body weight and certain disease states (refer to your physician or Registered Dietitian if you are unsure how much protein you should be consuming).

For most Americans, meeting their protein goal is not difficult. Protein is everywhere in our world and the American diet is full of sources. The best sources include meat, poultry, seafood, dairy, beans and peas, eggs and processed soy products. Given the many sources of protein, a typical American can easily consume 45 grams of protein per day and the average American consumes far above this goal.

Why then would someone who underwent weight loss surgery have a problem meeting their protein needs? Bariatric surgery causes a change in the GI system that is restrictive, malabsorptive or both. When we talk about the restrictive change, we are speaking of the change in the size of the stomach. Post bariatric surgery patients have a much smaller stomach and therefore cannot eat as much food at one time or throughout the day. So while most people can finish an entire hamburger in one sitting, it is unlikely that a bariatric surgery patient will be able to.

When we talk about malabsorption, we are speaking of the fact that some weight loss surgeries bypass an area of the GI tract. This means that not all nutrients that are consumed are actually absorbed and made available for use by the body. For these patients, if they consume just 45 grams of protein per day, they may only absorb 30 grams. Additionally, many post bariatric surgery patients do not have an appetite and will generally eat much less than other people. You can see how these modifications can cause a deficit in protein intake. These are some of the main reasons why so much emphasis is placed on protein after bariatric surgery.

Two other reasons why protein is important for post bariatric surgery patients is for healing and for weight loss promotion. Obviously, someone who has undergone major abdominal surgery will have some healing to do. Without enough protein, the body will not be able to heal itself and the person can become ill. As far as a connection between protein intake and weight loss, we have to be careful how we speak about this. If you simply increase your protein intake and make no other changes, you are unlikely to lose weight. However, after bariatric surgery, because the portions are so limited, we encourage patients to fill up on low-fat proteins instead of carbohydrates, sweets and fats. This change will cause a drop in overall calories and helps the weight to come off the way it should, without causing a loss of muscle mass.

So, have I convinced you that you should join “Team Protein”? If not, let me take one last stab at it. If you do not consume an appropriate amount of protein, you can experience any or all of the following:

• Flaky and weak fingernails
• Hair loss
• Muscle loss
• Fatigue/weakness
• Hospitalization to treat malnutrition

Considering that protein is readily available and is quite tasty, it seems a shame to put yourself through these things when they can be so easily avoided. So, when you are planning what to eat, think first about your protein and make sure you have a quality source at each meal.

For more information on protein foods and sources visit http://www.choosemyplate.gov/food-groups/protein-foods.html or http://www.cdc.gov/nutrition/everyone/basics/protein.html.

The Sunshine Vitamin

By Dr. Charlotte Hodges

As a bariatric surgeon, I routinely recommend to my patients that they supplement their diet with Vitamin D.  But why is this essential vitamin so important?  And, not just for weight loss patients?

Vitamin D is called an essential vitamin, because it cannot be made in the body.  It must be ingested.  Vitamin D is sometimes called the “sunshine vitamin,” because it is activated in the skin by sunlight. When our skin is exposed to sunlight, the 7-dehydrocholesterol in our skin to Vitamin D3.  Vitamin D3 then travels to our liver and then kidneys to be converted to the active formulation, also known as calcitriol.  Vitamin D is found in egg yolks and some fattier fish, such as salmon, tuna and sardines.  (These fish are also naturally higher in omega-3 fatty acids).  Because sunlight is important in the processing of this vitamin, researchers have looked at people living in areas with less sunlight exposure (further from the equator) and in people with darker skin.   Studies have shown that people living further away from the equator (who get less sun exposure) are at a higher risk for Vitamin D deficiency.   Additionally, people with darker skin may also be at risk for deficiency.  While melanin is protective against UBV rays, it can interfere with the processing of Vitamin D.

The FDA has long looked at nutrient deficiencies in our daily diets.  In the late 1800s, it was found that conditions like rickets (also known as scurvy) could be cured by diet.  It wasn’t until the 1930’s that the FDA began to fortify foods such as grains, cereal, and milk with Vitamin D.  This took the approximately 80–90% of children showing varying degrees of bone deformations due to vitamin D deficiency to being a very rare condition.

Holick M.F. (2010). “The Vitamin D Deficiency Pandemic: a Forgotten Hormone Important for Health”. Health Reviews. 32: 267–283.

So what does Vitamin D do?

Vitamin D helps to regulate calcium and phosphate in the body by controlling the amount of absorption of calcium into the gut from the foods that you eat.  This is important for the maintenance of strong bones and teeth.  When you are deficient in Vitamin D, you are at an increased risk for osteoporosis.  But is that all that Vitamin D does?  Studies now show that Vitamin D plays a much bigger role than just maintaining strong bones. 

Vitamin D and Cardiovascular Disease

In 2014, a review article in Circulation Research was published.  It showed that Vitamin D acts to decrease inflammation by signaling cells in our blood vessel walls.  Increased inflammation has been shown to be a key mediator in a variety of health problems.  Inflammation within the blood vessel walls can lead to atherosclerosis (clogged vessels).  Vitamin D works to reduce plaque build-up in our arteries and the hardening of the valves in the heart.  Patients with deficiency in this vitamin have a higher risk for developing high blood pressure, high cholesterol and diabetes mellitus. 

Circulation Research. 2014;114:379–393

Vitamin D in Dementia and Alzheimer’s disease

In a 2014 study published in Neurology, results confirmed that Vitamin D deficiency is associated with a substantially increased risk of all-cause dementia and Alzheimer disease.  In the study, researchers found that people with low Vitamin D levels had a 53 percent increased risk of developing all-cause dementia.  Those who were severely deficient had a 125 percent increased risk.  Additionally, patients with a Vitamin D deficiency were 70 percent more likely to develop Alzheimer’s disease.

Neurology, August 6, 2014

Who is at risk for deficiency, and what are the recommended dosages?

Vitamin D is one of four vitamins that is fat-soluble.  Therefore, people who are unable to absorb fat well, such as bariatric patients and those with celiac disease, may need to take in more than the recommended daily allowance.  Additionally, patients who live further from the equator or spend less time in the sun are also at risk.  The US Institute of Medicine recommends a daily supplement of 600 to 800 IU daily.  While you could likely get this by eating oiler fish daily, you probably shouldn’t because of the risk of mercury found in these types of fish.  Bariatric patients who have a decreased ability to absorb Vitamin D will need to take a daily supplement of 5000 IUs.

Bottom Line

• Vitamin D is important for strong bones and prevention of osteoporosis and bone deformities.

• Vitamin D deficiency has been linked to cardiovascular disease and dementia/depression.

• Patients should include a Vitamin D3 supplement in their regimen, of at least 600-800 IUs daily.  Post-bariatric patients should take 5000 IUs daily.