RE: Re: CHO recommendations

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Dana:

I recommend patients aim for 100-130grams carbohydrate minimum per day as most literature and dietitian experts say that is the minimum needed for protein sparing, however I would look at that in the context of her entire diet, if she is only eating 500 calories (which is unlikely for a band patient) she will need to meet protein needs first and then may not be able to get that much carb, however if she is able to or is eating 1400 calories then you might want to set a maximum for her (maybe 50% of her total calorie intake?!). In my experience most people with lap-band can eat pretty normally so I guide them on nutrition the way I would other people trying to lose weight. I have found in a few patients that very low carbohydrate did cause more lean body mass loss (based on BIA testing) and when they introduce more carbohydrates and reach the minimums I recommend they have only small or no loss of lean body mass....plus they are usually happier with their diet! My thoughts on the matter.

Best Regards

Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135

-----Original Message-----From: [mailto: ]On Behalf Of jtkotrysSent: Wednesday, January 02, 2008 12:39 PM Subject: Re: CHO recommendations

Hello Dana,Our practices suggests the patient remain below 40 grams per day. >> Does anyone know of good recommendations for CHO g/day? The reason I ask is because a patient post gastric banding wanted an exact # or range for CHO grams/day to aim for. I know they are restricting so many kcal and focus on getting the protein recommendations..so I told her to try to get at least 80-100 g CHO/day to prevent ketosis but to focus more on making sure she gets in enough protein at mealtime and eat nutrient dense/low sugar/low fat carbohydrate sources (whole grains, fruits and veggies, etc.). Any ideas/suggestions? Thanks!> > Dana Pearson RD, LD> on Healthcare Foodservices> DanaPearson@...> > > > > ---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.>

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Do you recommend the 100-130gm CHO initially or at a certain time after surgery (LB or GBP)? Also around how many calories are most of your patients on at least 6 months after surgery for both procedures? Thank you, Marissa Spady, MS, RD Weight Loss Surgery Center of Hampton Roads "Laschkwitsch, :LPH Obes Inst" <KLaschke@...> wrote: Dana: I recommend patients aim for 100-130grams carbohydrate minimum per day as most literature and dietitian experts say that is the minimum needed for protein sparing, however I would look at that in the context of her entire diet, if she is only eating 500 calories (which is unlikely for a band patient) she will need to meet protein needs first and then may not be able to get that much carb, however if she is able to or is eating 1400 calories then you might want to set a maximum for her (maybe 50% of her total calorie intake?!). In my experience most people with lap-band can eat pretty normally so I guide them on nutrition the way I would other people trying to lose weight. I have found in a few patients that very low carbohydrate did cause more lean body mass loss (based on BIA testing) and when they introduce more

carbohydrates and reach the minimums I recommend they have only small or no loss of lean body mass....plus they are usually happier with their diet! My thoughts on the matter. Best Regards Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of jtkotrysSent: Wednesday, January 02, 2008 12:39

PM Subject: Re: CHO recommendations Hello Dana,Our practices suggests the patient remain below 40 grams per day. >> Does anyone know of good recommendations for CHO g/day? The reason I ask is because a patient post gastric banding wanted an exact # or range for CHO grams/day to aim for. I know they are restricting so many kcal and focus on getting the protein recommendations..so I told her to try to get at least 80-100 g CHO/day to prevent ketosis but to focus more on making sure she gets in enough protein at mealtime and eat nutrient dense/low sugar/low fat

carbohydrate sources (whole grains, fruits and veggies, etc.). Any ideas/suggestions? Thanks!> > Dana Pearson RD, LD> on Healthcare Foodservices> DanaPearson@...> > > > > ---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.> IMPORTANT NOTICE:This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

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Do you recommend the 100-130gm CHO initially or at a certain time after surgery (LB or GBP)? Also around how many calories are most of your patients on at least 6 months after surgery for both procedures? Thank you, Marissa Spady, MS, RD Weight Loss Surgery Center of Hampton Roads "Laschkwitsch, :LPH Obes Inst" <KLaschke@...> wrote: Dana: I recommend patients aim for 100-130grams carbohydrate minimum per day as most literature and dietitian experts say that is the minimum needed for protein sparing, however I would look at that in the context of her entire diet, if she is only eating 500 calories (which is unlikely for a band patient) she will need to meet protein needs first and then may not be able to get that much carb, however if she is able to or is eating 1400 calories then you might want to set a maximum for her (maybe 50% of her total calorie intake?!). In my experience most people with lap-band can eat pretty normally so I guide them on nutrition the way I would other people trying to lose weight. I have found in a few patients that very low carbohydrate did cause more lean body mass loss (based on BIA testing) and when they introduce more

carbohydrates and reach the minimums I recommend they have only small or no loss of lean body mass....plus they are usually happier with their diet! My thoughts on the matter. Best Regards Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of jtkotrysSent: Wednesday, January 02, 2008 12:39

PM Subject: Re: CHO recommendations Hello Dana,Our practices suggests the patient remain below 40 grams per day. >> Does anyone know of good recommendations for CHO g/day? The reason I ask is because a patient post gastric banding wanted an exact # or range for CHO grams/day to aim for. I know they are restricting so many kcal and focus on getting the protein recommendations..so I told her to try to get at least 80-100 g CHO/day to prevent ketosis but to focus more on making sure she gets in enough protein at mealtime and eat nutrient dense/low sugar/low fat

carbohydrate sources (whole grains, fruits and veggies, etc.). Any ideas/suggestions? Thanks!> > Dana Pearson RD, LD> on Healthcare Foodservices> DanaPearson@...> > > > > ---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.> IMPORTANT NOTICE:This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

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Not initially as they are on a liquid diet and most are having less than 800 calories so meeting that carb level may be more difficult. Calorie range varies dramatically depending on the patient....with lap-band it is literally all over the board from 800-2400....I mean really some people (few but some) are gaining weight some are losing very fast and certainly what they are choosing determines their calorie level. With bypass I see a little less variance....at 6 months I would estimate most are around 1000-1200 calories give or take depending on exercise, their size etc.

-----Original Message-----From: [mailto: ]On Behalf Of Marissa BealeSent: Wednesday, January 02, 2008 1:52 PM Subject: RE: Re: CHO recommendations

Do you recommend the 100-130gm CHO initially or at a certain time after surgery (LB or GBP)? Also around how many calories are most of your patients on at least 6 months after surgery for both procedures? Thank you,

Marissa Spady, MS, RD

Weight Loss Surgery Center of Hampton Roads

"Laschkwitsch, :LPH Obes Inst" <KLaschkeLHS (DOT) ORG> wrote:

Dana:

I recommend patients aim for 100-130grams carbohydrate minimum per day as most literature and dietitian experts say that is the minimum needed for prote! in sparing, however I would look at that in the context of her entire diet, if she is only eating 500 calories (which is unlikely for a band patient) she will need to meet protein needs first and then may not be able to get that much carb, however if she is able to or is eating 1400 calories then you might want to set a maximum for her (maybe 50% of her total calorie intake?!). In my experience most people with lap-band can eat pretty normally so I guide them on nutrition the way I would other people trying to lose weight. I have found in a few patients that very low carbohydrate did cause more lean body mass loss (based on BIA testing) and when they introduce more carbohydrates and reach the minimums I recommend they have only small or no loss of lean body mass....plus they are usually happier with their diet! My thoughts on the matter.

Best Regards

Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135

-----Original Message-----From: [mailto: ]On Behalf Of jtkotrysSent: Wed! nesday, January 02, 2008 12:39 PM Subject: Re: CHO recommendations

Hello Dana,Our practices suggests the patient remain below 40 grams per day. >> Does anyone know of good recommendations for CHO g/day? The reason I ask is because a patient post gastric banding wanted an exact # or range for CHO grams/day to aim for. I know they are restricting so many kcal and focus on getting the protein recommendations..so I told her to try to get at least 80-100 g CHO/day to prevent ketosis but to focus more on making sure she gets in enough protein at mealtime and eat nutrient dense/low sugar/low fat carbohydrate sources (whole grains, fruits and veggies, etc.). Any ideas/suggestions? Thanks!> > Dana Pearson RD, LD> on Healthcare Foodservices> DanaPearson@...> > > > > ---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.>

IMPORTANT NOTICE:This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

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IMPORTANT NOTICE:

This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

Thank you all who gave me feedback regarding CHO recs!"Laschkwitsch, :LPH Obes Inst" <KLaschke@...> wrote: Not initially as they are on a liquid diet and most are having less than 800 calories so meeting that carb level may be more difficult. Calorie range varies dramatically depending on the patient....with lap-band it is literally all over the board from 800-2400....I mean really some people (few but some) are gaining weight some are losing very

fast and certainly what they are choosing determines their calorie level. With bypass I see a little less variance....at 6 months I would estimate most are around 1000-1200 calories give or take depending on exercise, their size etc. -----Original Message-----From: [mailto: ]On Behalf Of Marissa BealeSent: Wednesday, January 02, 2008 1:52 PM Subject: RE: Re: CHO recommendations Do you recommend the 100-130gm CHO initially or at a certain time after surgery (LB or GBP)? Also around how many calories are most of your patients on at least 6 months after surgery for both procedures? Thank you, Marissa Spady, MS, RD Weight Loss Surgery Center of Hampton Roads "Laschkwitsch, :LPH Obes Inst" <KLaschkeLHS (DOT) ORG> wrote: Dana: I recommend patients aim for 100-130grams carbohydrate minimum per day as most literature and dietitian experts say that is the minimum needed for prote! in sparing,

however I would look at that in the context of her entire diet, if she is only eating 500 calories (which is unlikely for a band patient) she will need to meet protein needs first and then may not be able to get that much carb, however if she is able to or is eating 1400 calories then you might want to set a maximum for her (maybe 50% of her total calorie intake?!). In my experience most people with lap-band can eat pretty normally so I guide them on nutrition the way I would other people trying to lose weight. I have found in a few patients that very low carbohydrate did cause more lean body mass loss (based on BIA testing) and when they introduce more carbohydrates and reach the minimums I recommend they have only small or no loss of lean body mass....plus they are usually happier with their diet! My thoughts on the matter. Best Regards Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of jtkotrysSent: Wed! nesday, January 02, 2008 12:39 PM Subject: Re: CHO recommendations Hello Dana,Our practices suggests the patient remain below

40 grams per day. >> Does anyone know of good recommendations for CHO g/day? The reason I ask is because a patient post gastric banding wanted an exact # or range for CHO grams/day to aim for. I know they are restricting so many kcal and focus on getting the protein recommendations..so I told her to try to get at least 80-100 g CHO/day to prevent ketosis but to focus more on making sure she gets in enough protein at mealtime and eat nutrient dense/low sugar/low fat carbohydrate sources (whole grains, fruits and veggies, etc.). Any ideas/suggestions? Thanks!> > Dana Pearson RD, LD> on Healthcare Foodservices> DanaPearson@...> > > > >

---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.> IMPORTANT NOTICE:This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. Looking for last minute shopping deals? Find them fast with Search. IMPORTANT NOTICE:This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. Dana Pearson RD,LD on Healthcare Food Services @ Singing River Hospital DanaPearson@...

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