Macros - A Bariatric Perspective

Updated: Aug 12

I have received quite a bit of questions concerning Macros or how many Calories should be eaten after Bariatric Surgery. The answer is it depends on various factors. I put together a set of guidelines that I follow to achieve sustainable results.


General Bariatric Food Guidelines

**these are my opinions, based on results which is quite possibly completely different than what your Bariatric Nutritionist / Dietician has told you.

Protein Sources

- Fat g should never be more than ½ of Protein g

- Can be eaten in isolation (usually will have some fat)

- Generally will not spike blood sugar or insulin

- Include some Plant protein in your day

- Dairy(Not cheese) is a good source of low fat Protein

**If not lactose sensitive/intolerant


Carb Sources

- Never eat Carbs in isolation

** Especially if you have a history of reactive hypoglycemia

- Fat g Should Never be more than ½ Carbs g

- Spikes blood sugar & Insulin

- Protein will blunt the Blood glucose spike releasing less insulin

- Insulin's job is to lower blood sugar

- Insulin also signals your body to store extra fuel as fat due to

high blood sugar


Fats

- Keep to 25% of Calories (40g is a good place to start)

- Try to focus on healthy fats

- Sugar Alcohols : Less is Better

- Fiber: Shoot for minimum of 25g per day (From Fruits &

Vegetables)

- Depending on surgery phase this may not be possible

- Water: Shoot for Minimum of 100 oz per day (5 shaker cups)

- Snacks should be balanced following food guidelines above

Instead of a snack consider adding an additional small meal


**Note : These are not forever guidelines, and these are relaxed during Refeed meals/days


Ok so that's all good & fine, but how many calories should I be eating Post Op Gastric Surgery? Well, it depends. There is no one cookie cutter answer for every individual. How you manage your individual Macros, Calories and overall Nutrition is a very individual process. Factors such as lifestyle, general activity, sleep patterns, genetics, surgery intolerances or complications all play a role in making a determination on how to setup your nutrition plan. Below is a chart that will give you a good guess depending on how far post op from surgery you are, but once again these are guidelines.


Calculating Macros

How do I personally determine Maintenance or Deficit calories? I use the data from my Polar Fitness watch. Any Fitness Tracker will work as long as it gives you a Daily Calorie TDEE.

3400 Calories (Fitness Tracker Data)

* Total Daily Energy Expenditure (TDEE) - Combination of BMR + Exercise + NEAT

This is the Data I use for reference. I adjust this number by 25%....so my adjusted TDEE would be 2550 calories per day(Maintenance). Based on Fitness Tracker data, if I wanted to lose 1 lb a week I would need to adjust my caloric intake to 2000 calories per day. For a more accurate calculation use an Avg TDEE for the last month. My watch gives me this data, if yours doesn't do an avg for a typical week based on daily data

My most recent measured RMR - 1831 Calories (Resting Metabolic Rate)

*Resting Metabolic Rate ( I had RMR test done)

-from experience/monitoring I will always lose weight on anything below 1800 calories/ day

An Online BMR calculator may be close, but lost muscle during weight loss after surgery can heavily impact this number. Personally, I have been working on body recomposition for the last 3 years, so my numbers are relatively close to online calculators, but still need adjustment.

Setting Macros ( My Method)

Protein 4 cal/g

Carbs 4 cal/g

Fat 9 cal/g

Constants

Protein : 1g per Lb of Desired Body Weight

(185g). 185 x 4 = 740 Cal ( 37%)

* For women you may want to use .70-.90g

Protein per Lb of Goal weight

Fat: 50 g

50 x 9 = 450 Cal (22.5%)

Protein & Fat Total

740 + 450 = 1190 Calories

Carbs are my Variable

2000 - 1190 = 810 Calories

* With Carbs my goal is always to hit 30g Fiber a day so that determines my Carb choices (Mainly Whole Foods)

810 ÷ 4 = 202.5 g Carbs (40.5 %)

Planned Macros:

Protein : 185g (37%)

Carbs: 202.5g (40.5 %)

Fat: 50g (22.5 %)

Total Calories : 2000 per day

This Formula has worked very well for me. Activity Trackers are not even close to being accurate, but they are a reference. After you figure out the margin of error of your specific device, you can use that data consistently to manage your weight based on monthly averages of daily calories burned.

Here are some examples of my personal results


Dexa Scan



InBody Scan




Want to maintain your weight? Set your macros up for the adjusted TDEE first, make sure your good at that level ,then gradually increase calories until you gain a lb or two....then subtract 250 calories . This number will be your upper range Maintenance calories. The reason for this is Metabolically and in terms of Daily Energy, you want to maintain on the highest number of calories possible. Your specific comfort level on food volume will certainly play a role in this as well.

If your Avg Monthly (TDEE) activity level changes you may need to adjust calories lower. Typically we are more active in Spring/Summer than in Fall/Winter. Do you have to track forever.....Hell No, but it is part of retraining yourself to understand the amount of food that is required for you to maintain your weight and have the energy to function in daily life.


If you are set on a Low Carb Meal Plan or you do not plan on being Active & Exercising......due to an existing medical condition or it's what works for you......forget everything you just read. If you want to explore doing something different & develop lifelong sustainable habits.....then keep reading


Our team of Certified Nutrition Coaches at Bariactive Nutrition help Bariatric Patients change the direction of their health and teach nutrition fundamentals that enable patients to develop a sustainable meal plan that allows them to reach their health & fitness goals. Our coaches understand the Bariatric Journey as they are Bariatric Patients themselves.


Author: Jim Laur

Jim is a successful gastric sleeve patient (09-19-17) as well as a NASM Certified Nutrition Coach and Founder of Bariactive Nutrition .



Certified Nutrition Coaches are not medical professionals e.g. Registered Dietician or Physician therefore BariActive Nutrition Coaching Services are not regarded as medical advice. Coaching Services at BariActive Nutrition are a combination of accountability , evidence based nutrition education , and weight loss processes & strategies that are tailored to the individual that produce results for our clients. Please consult with your Doctor before making any changes to your Meal Plan including but not limited to : Caloric Intake, Macros, Food Volume, Vitamins & Supplements.




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