Method in the Madness...

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Does this bus ride look comfortable?

Imagine this is your stomach and now I’ll ask the same question. You might be thinking no, and if so, are you thinking the bus driver could control the situation better by limiting the number of passengers being let on? Maybe I’m being a bit cryptic, but there is a moral to this story – or in other words, method in the madness. To give you a clue, let’s just say those inside the bus are called the ‘Carbohydrate Clan’ while and the chap outside is called Paul Protein…

I’m thinking it’s a good time to think about the effect of eating carbohydrates.

Ever since Christmas, I’ve been seeing more and more carbohydrates sneaking into food choices for patients all along their weight loss surgery journey. Sure, carbohydrates can carry some protein, but that worries me when the carbohydrates become more and the proteins becomes less.

For example, I saw someone the other day recalling 4 Vita-Wheat crackers with Marmite, cottage cheese and a slice of ham on the crackers for lunch. A comfortable feeling of fullness was felt half way through the meal, and so half of the protein was not eaten. Only yesterday, I reviewed another patient describing ‘real hunger’ in the afternoon. Their lunch was a whole bread roll, a slice of deli ham, and a heap of salad vegetables. That meal also led to the comfortably full feeling, but wherever you might be on your journey, can you see what’s happening here with appetite management? 


Consider a carbohydrate such as a cracker. What happens when that cracker gets into your stomach? It swells up, and that means you get the feeling of being full or over-full, much like our bus at the beginning. You might have some protein like cheese or some canned tuna on that cracker, but sadly you’re getting less protein than you could be getting.

Carbohydrates get digested faster than the proteins, and for anyone out of the ‘honeymoon’ phase, you’ll know that means ‘real hunger’ before your next meal. This is a reason for the guideline of avoiding carbohydrates for the first 8 months after surgery – it allows you to build the healthy habit of eating enough protein for appetite management, not to mention hair, skin and nail integrity, as well as muscle strength. 

Drews Hotseat – Appetite Management with Protein

What happens if you experience ‘real hunger’ between your main meals? Some might snack which can mean less protein being eaten at the next main, feeling hungry again soon after, more snacking, and so the cycle continues. Others may wait for their next meal, get hungrier, and eat more than needed with the 20/20/20 mindful eating technique being thrown out the back door. Either way, these are unhealthy habits and likely to lead down the road of regain issues. Carbohydrates are the prime suspects of this between-meal hunger, and that’s where protein becomes our hero.


Eating enough protein at all main meals can manage your appetite. This will avoid ‘real hunger’ or between-meal snacking, whereas carbohydrates are like fuel for those fires. A protein intake of at least 25g is needed at breakfast, lunch and tea, and at least 20g is advised for those in the early post-op phase too. These targets are possible with top-level or dense proteins like meat, chicken or seafood and using protein powders, but they are tough to reach when eating carbohydrates which swell up and make you feel full (if not feeling like there’s a brick in your pouch).

Let’s look at examples from Claire Carbohydrate and Paul Protein…

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Claire loves crackers. They were her danger food before surgery, but she keeps telling herself they are okay at lunch now because she has protein with them. Today, she has 6 Oat Thins with a total of 3 Tablespoons of cottage cheese (6g protein), half an egg mashed (3g protein), and some extra fillers like capsicum and onion. She gets comfortably full after eating 2 of these crackers, and that means she’s displacing her protein with carbohydrate – she’s missing the bus with her protein intake.

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Paul is like Claire. He also loves crackers, and he thought the idea of avoiding them was completely mad after his bypass. Even so, he followed the guidelines of avoiding them and established a routine of planning protein-rich meals continually. Today for lunch, he’s made ‘Pastrami Parcels’ – 3 slices of pastrami (7g protein) wrapped around a total of 1 mashed egg (6g protein), 2 tablespoons of cottage cheese (4g protein), and 2 tablespoons of unflavoured protein powder (20g protein). He also sips on a 500mL bottle of protein water (30g protein) most days between meals. With mindful eating, he enjoys his lunch and is comfortably full after eating 2 of his parcels. Paul is all set for an afternoon ahead on the road of weight loss maintenance.

The Take Home

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Avoiding carbohydrates might seem like madness to begin with. During the ‘honeymoon,’ eating them can feel completely harmless – especially if you get thoughts like ‘I don’t get hungry between my meals’ or ‘I have to remind myself to eat.’ The ‘honeymoon’ does end, and that’s where a healthy habit of protein-rich meals is important to have established for your appetite management. It’s never too late to do this - even if you’ve let the ‘Carbohydrate Clan’ sneak in, remember you’re the bus driver in control of your passengers, and that means you can save the seats for Paul Protein and his friends… 

All the best until next month.