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Going Caveman: A Paleo Diet Primer for Weight Loss Surgery Patients

By Dana Babeu, R.D. | April 17, 2015

If you’re looking to start the Paleo diet after Gastric Band, Gastric Sleeve and Gastric Bypass surgeries, be prepared to make some moderations to ensure you are getting enough protein and other essential nutrients.

What do cavemen and good health have in common? If you’re asking a follower of the Paleo (or Caveman) diet, the answer would probably be “everything.” And unless you’ve actually been living in a cave for the past few years, you’ve probably heard of this diet that claims to promote optimal health by mimicking the food choices and behaviors of Paleolithic humans. As much a lifestyle as a diet, Paleo has been touted as a cure for digestive disorders, food sensitivities, autoimmune disease and, of course, as a way to lose weight. With all the buzz, you may be wondering how a Paleo lifestyle fits with a weight loss surgery lifestyle. Maybe you are a few years out from your Gastric Bypass, Gastric Sleeve or Gastric Band and want to jumpstart weight loss again. Or perhaps you are about to have surgery and have been told by your surgeon that you need to lose some weight prior to surgery. Before you run out and buy a Paleo cookbook, let’s take a closer look at what Paleo eating is, what it isn’t and what weight loss surgery patients should know before trying this new (or very, very old!) way of eating.

What is Paleo?

The Paleo diet’s basic premise is that we should only be choosing “biologically appropriate” foods that replicate those consumed by our pre-agricultural, hunter-gatherer ancestors. Paleo advocates argue that foods requiring cultivation and farming, like wheat or corn, have only recently become part of the human diet and may be responsible for the rise of obesity and many other diseases. Paleo eaters typically consume about 25-35 percent of their calories from protein and 35-45 percent from carbohydrates. Moderate to high fat intake − 20-40 percent from natural, unrefined sources − rounds out the calorie distribution.

Acceptable Paleo foods include:

  • Properly raised meats, eggs and fish (I’ll get back to what “properly raised” means in a minute.)
  • Fruits and vegetables
  • Nuts and seeds
  • Minimally processed fats such as olive or coconut oil, avocado and olives
  • Raw honey and coconut palm sugar in limited quantities
  • Water and pure coconut water

Foods not allowed in a Paleo diet:

  • Dairy
  • Refined or added sugars
  • Legumes and beans
  • Salt
  • Processed foods or artificial ingredients of any kind
  • Refined vegetable oils, such as canola

There is no need to count calories on this plan. Regular exercise is considered a vital component of this lifestyle, and strict devotees believe low to moderately intense activities are preferred, as they most closely mimic the way our ancestors would have moved and worked.

So is Paleo a viable option for people who have had or will have weight loss surgery? As with any diet plan, the answer largely depends on individual needs, preferences and circumstances. But let’s explore some general pros and cons of the Paleo diet for weight loss surgery patients.

Paleo Pros for Weight Loss Surgery

  • High Protein. This plan is high in protein, and since protein is the most important macronutrient for weight loss surgery patients, this is a positive thing. Even pre-surgical candidates looking to lose weight can benefit from Paleo’s reliance on meats, eggs and seafood.
  • Low carbs. Paleo’s lower carbohydrate, grain-free emphasis is in keeping with the type of diet prescribed for optimal weight loss post-surgery and beyond. This is because even so-called “whole grains” tend to be less nutrient dense than other carb-containing foods such as fruit, veggies, nuts and seeds. Paleo is also extremely low in added sugars, a huge positive for weight loss surgery patients as sugar is the Number-One enemy of weight loss.
  • All-natural. There are essentially no artificial ingredients on this plan, which is beneficial from a health-promotion/disease prevention viewpoint. If you go Paleo, you’ll greatly reduce your intake of prepared or packaged foods, which can be landmines of excess sodium and empty calories.
  • No calorie counting. The elimination of several food categories limits options and theoretically reduces calories, particularly empty calories, so there is no need to strictly count your calories in most cases. However, some Paleo experts recommend limiting intake of starchy vegetables, fruit and calorie-dense fats when weight loss − surgical or otherwise − is the primary goal.

Paleo Cons for Weight Loss Surgery

  • Cost. Paleo can get expensive. Animal protein, especially the type recommended in the Paleo diet (organic, grass-fed, free-range, pastured) carries a premium and can be difficult to find.  Add to that the price of nuts, high quality oils and lots of fresh (ideally organic) produce, and it may be cost-prohibitive for many.
  • Time. In addition to the financial premium, going Paleo also requires a significant investment of time. Because there are few to no processed foods permitted, frequent trips to the grocery store and food prep will be high on your to-do list.
  • Limited protein options. Restricted protein choices may pose a challenge, especially for someone recently post-op. Protein powder, a post-weight loss surgery staple, is a processed food, and would technically be off-limits. Eliminating dairy also takes many high-protein, low-fat foods such as milk, yogurt and cheese literally off the table. And since plant-based protein sources such as beans and legumes are not permitted, it would make following Paleo virtually impossible for a vegetarian undergoing weight loss surgery.
  • Tough nuts and seeds. Fruits, veggies, nuts and seeds should comprise a large part of a Paleo eater’s diet. But due to their fibrous nature, they may be difficult to digest post-weight loss surgery, particularly during the first few months. Removing the skin and cooking can help reduce some of the gas and bloating these foods may cause.

So what’s the take away from all this? Done well, Paleo is essentially a clean, low-carb diet that may work well for those looking to make positive changes and shed some pounds prior to having weight loss surgery. Adhering to a Paleo diet after weight loss surgery is possible, but would require modifications to allow for adequate protein intake in the necessary forms. An example of this might be incorporating dairy foods or legumes to increase options. Modifying to include protein powder, a necessity after surgery, would permit a patient to follow a version of Paleo while still supporting adequate nutrition.

As with any diet, sustained and lasting lifestyle changes are the only way to safely lose weight and keep it off.  But if you’re looking for a more defined pre- or post-weight loss surgery plan, Paleo might be worth a try.  Just be sure to consult with your doctor and dietitian to make any modifications required for proper nutrition.  Happy hunting!

Dana Babeu, RD, is a registered dietitian at New Jersey Bariatric Center, a medical & surgical weight loss center with offices in Springfield, Somerville, Hoboken, East Brunswick, Hackettstown and Sparta, New Jersey. She provides pre-operative and post-operative nutritional counseling to New Jersey Bariatric Center’s Gastric Bypass, Gastric Sleeve, LAP-BAND (gastric band) and revision patients, in addition to dietary counseling for patients in our Medical Weight Loss program.
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