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Results for : "protein"

Chocolate Monkey Flip Protein Shake

July 20, 2017 9:45 am

Chocolatey goodness and a sweet treat when you are craving something with chocolate.  This is a healthy version of a chocolate shake. Always use protein powders that you tolerate well. These types of shakes are also great in the early post op period.  They are easy on the stomach and are considered a full liquid.

keshishian Chocolate Monkey Flip Protein Shake

Chocolate Monkey Flip Protein Shake

1/3 Cup almond milk, lactose free milk or water

1/4 of a banana

1 TBSP of peanut butter or other nut butter

1 scoop of chocolate protein powder

2-3 Ice cubes

Possible add-in: unsweetened coconut flakes, cocoa powder (more chocolate flavor)

Blend until smooth and enjoy your healthy treat! Chocolate Monkey Flip Protein Shake

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Strawberry Lemonade Protein Drink

April 03, 2017 12:57 pm

Strawberry Lemonade Protein Drink

After weight loss surgery is can be challenging  to get your protein requirements met on a daily basis. This refreshing and light Strawberry Lemonade protein drink is perfect for the spring, summer and warmer weather.  It definitely satisfies any cravings for a specialty type drink. The right protein powder can be mixed with a spoon and doesn’t require any extra equipment.

You can find further information regarding protein needs after weight loss surgery or Duodenal Switch here.


Strawberry Lemonade Protein Drink recipe:

1 scoop Strawberry flavored 100% whey isolate protein powder (We used Unjury Strawberry Sorbet)

1 packet of Stevia sweetened lemonade powder (We used True Lemon Lemonade)

8 ounce cold water (you can add more or less to taste)

ice if desired

1 Strawberry or sliced Lemon for garnish

Mix the strawberry protein powder with the lemonade  powder with the water


1-2 Strawberry mashed and mixed into drink

You could blend the whole drink with ice to make is slushy.

You could use 1/4C fresh lemon juice and stevia in place of Lemonade drink mix.

You could add 1-2 tablespoons of Greek yogurt to boost protein and make it creamy.

Freeze the above recipe or variations in popsicle forms for a frozen treat.

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Avocado Protein Spread

September 09, 2016 9:57 am

Adding unflavored whey isolate protein powder to anything is an excellent way to boost your protein intake. This is a protein boost to a condiment that can be added to a burger, fish, or chicken.  It’s a great way to increase protein. Avocado Protein Spread by BiPro USA.

Avocados are a great food post Duodenal Switch but lack protein which this recipe counters with the addition of unflavored whey isolate protein powder. Nutritional Facts of avocados.

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Pumpkin Spice Protein Shake

September 07, 2016 9:29 am

It’s almost Fall, even though here in California the temperatures aren’t reflecting that.  But you can’t have Fall without pumpkin spice!  This Pumpkin Spice Protein Shake brings all the deliciousness of fall without the carbs and sugar.  It also gives you a nice protein boost to boot.  Great for a treat, snack or breakfast.  Weight loss surgery friendly and oh so good.

Pumpkin Spice Protein Shake Recipe pumpkin-spice-protein-shake

1/2 C unflavored unsweetened Almond Milk

1/3 C pure pumpkin puree

1 scoop unflavored or vanilla protein powder

1 tsp pumpkin spice (or to taste)

Stevia to taste

6-8 ice cubes

Place the first 5 ingredients in a blender of choice and top with the ice cubes.  Blend until smooth and enjoy the season.

Nutritional Value of Pumpkin Spice Protein Shake
Nutritional Value of Pumpkin Spice Protein Shake

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Cinnamon Maple Protein Yogurt

August 11, 2016 9:52 am

Craving delicious crunchy maple goodness?  Here is your answer in Cinnamon Maple Protein Yogurt.  It’s a perfect early post weight loss surgery choice because of the protein content and the probiotic benefits of yogurt. This decadent creamy breakfast or treat can help stave off those cravings and gives your body the protein it needs for healing and maintenance.

Cinnamon Maple Protein Yogurt Recipe Keshishian Cinnamon Maple Protein Yogurt

1 scoop vanilla whey isolate protein powder (low carb)

1/4 C almond milk

1/2 C Greek yogurt

1/4 tsp cinnamon

1/4 tsp maple extract

for garnish 1 Tbsp sliced almonds & 1 Tbsp coconut flakes toasted


Mix together they yogurt, whey protein and almond milk in a bowl with a whisk or fork until well blended. Mix in one half of the cinnamon reserve the rest for garnishing the top along with the maple extract.  You can also mix in the maple extract rather than using it for a garnish.  Top with toasted almond and coconut flakes if desired or omit if you are not at the point of tolerating nuts.

Nutritional Value of Cinnamon Maple Protein Yogurt
Nutritional Value of Cinnamon Maple Protein Yogurt

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Strawberry Cheesecake Protein Shake

August 03, 2016 1:17 pm

Sometimes you just need to shakes up your protein shakes and give yourself a treat after weight loss surgery!  This recipe  for a Strawberry Cheesecake Protein Shake is refreshing and gives you a great protein boost while feeling decadent too! Protein is an important part of recovery and daily life after any type of weight loss surgery. Here is a link to a previous blog on the importance of protein.Keshishian Strawberry Cheesecake Protein Shake

Strawberry Cheesecake Shake

1 scoop of strawberry flavored whey isolate protein powder

4 ounces almond milk

2 strawberries

2 TBSP of sugar free Cheesecake flavored pudding mix

6 ice cubes

Add almond milk, protein powder and pudding mix to a blender then top with the remaining ingredients.  Blend until smooth.

You can also freeze this Strawberry Cheesecake Protein Shake in popsicle forms for a great frozen treat. Enjoy!Keshishian Strawberry Cheesecake Protein Pops

Nutritional value of Strawberry Cheesecake Protein Shake
Nutritional value of Strawberry Cheesecake Protein Shake

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Protein Iced Mocha Coffee

July 22, 2016 3:00 pm

Protein Iced Mocha Coffee is a great way to keep cool in the summer heat while still getting your protein and curbing those cravings.  Enjoy this anytime for a delicious coffee treat. You can also freeze this mixture in popsicle molds and enjoy a tasty frozen treat!



1 scoop Chocolate flavor whey isolate protein powder (low carb)

8-10 ounce cool coffee

1-2 Tbsp Almond milk (any flavor or unflavored)

1/2 C ice

Mix protein powder in coffee until well incorporated with a shaker bottle or whisk in a large glass.  Stir in almond milk and pour over ice.

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Fat, Protein – Post Duodenal Switch Diet

May 23, 2016 6:43 am

Fat and Protein after weight loss surgery…. This is a subject that seems to come up all the time.

What I recommend is “…Water, protein, vitamins, supplements and every thing else….”

Dehydration can cause a lot of problems, stay hydrated.

Weight Loss Surgery (WLS) is a surgically imposed catabolic state (surgical induced starvation).  The weight is lost by not allowing enough caloric intake/absorption and forcing the body rely on stored sources of energy, mostly fat mass.  The rationale for the high protein intake is to minimize net muscle mass loss during the catabolic state.   Low carbs and low fat further push the body into catabolizing the fat mass, and reducing the net loss of protein content. As the fat mass is broken down it will release hormones and other byproducts that the body will eliminate. Hydration is crucial to every bodily function and even more so in the weight loss phase to allow for elimination of some of these byproducts.

The mechanism by which Duodenal Switch works during the weight loss phase is by limiting the caloric intake.  Long term  Duodenal Switch keeps the weight off due to the malabsorptive component as the caloric intake increases. Protein intake, Vitamin/Mineral supplementation and diligence in surveillance of vitamin/mineral levels is imperative and a life long commitment after WLS.

There are a number of different types of  Fatty Acids.  Our bodies naturally produce, from other components,  all but 2 essential fatty acids: Omega 3 and Omega 6.  Most fatty acids require bile salts to be absorbed within the small intestines.  Those are the fatty acids that are absorbed to a lesser degree after Duodenal Switch.  Medium chained fatty acids do not require bile salts and can be absorbed into the blood stream from the small intestines. Medium chained fatty acids are used for energy as they are processed in the liver. Medium chained fatty acids are actually given to patients with Short Bowel Syndrome to decrease fatty stool and increase their body weight.  This is also a possible reason some fats cause DS patients more loose stools and others do not (medium chained fatty acids). Adding fats is a purely individualized process.  Each person has a different length of small bowel, alimentary limb, common channel, percentage of excess weight to lose and metabolism. Patient’s tolerance for fat in regards to vitamin/mineral levels, stool consistency and frequency is completely individualized.

Fats and Fatty acids can be divided according to their structure in groups:

A) Saturated  Fat (animal fats, butter, lard- solid in room temperature)

B) Unsaturated Fat (liquid in room temperature)

           1-PolyUnsaturated Fats
                    a)Omega 3-fattty acids (fish, shellfish, soybean, walnut, flaxseed)
                    b)Omega 6-fatty acids (corn oil, sunflower oil)
            2-Monounsaturated fats
                    a)Omega 9-fatty acids (olive oil, avocados, peanuts, almond

The main focus in the weight loss phase should be hydration, hydration, hydration, protein, low carb, low fat and vitamin/mineral supplementation (page 22).  Rest is key in the early post op phase but gradually adding exercise is also important in ensuring the body does not breakdown muscle mass.  Adequate intake of protein and use of muscles diminishes the bodies natural response of breaking down muscle mass in a low caloric intake state.

Post Surgical Needs for the first 90 days in order of importance:
This is to allow healing to take place before adding additional stress on the body and surgical sites.
Minimum of 64 ounces of fluids daily
Minimum 80-100 grams of protein daily (protein requirements are based on ideal body weight)
30 gms by 30 days post-op
60 gms by 60 days post-op
90 gms by 90 days post-op
Vitamin/Mineral Supplements
Low carb
Low fat
Rest (early Post-op)

Proteins are important, not only for structure (muscle) but for functions. We know that proteins and amino acids are involved in all aspects of our body’s function. This is even more critical during the rapid weight loss phase. Protein needs may increase and change based on health status, pregnancy, surgeries, healing, etc.

When it comes to fat, I do not recommend patients consuming excessive amounts of fat- At the same time I do not recommend patients go on a low fat diet.  There is this misconception that since DS is causing fat and fat soluble vitamin malabsorption, then taking more fat (in excessive amounts) can solve the problem of vitamin deficiency. How about the possibility that some patients are causing their own vitamin deficiency by taking large volumes of fat which may results in more frequent bowel movements and decreased vitamin absorption.

It is not to be forgotten that each patient will respond differently with dietary changes after duodenal switch. Some patients may tolerate more and some less fat in their diet.  After the initial 90 day post op phase I recommend that patients go slowly in adding new food items by giving it several days before adding another food item. i.e.; add carrots for 3-5 days to see how your body handles it before attempting to add another new item.  The above is not the entire weight loss process or education and is only a small portion of the education needed before undergoing any WLS procedure. These recommendation are my recommendations for my patients with the Hess technique for Duodenal Switch.

Protein Malnutrition Protein Part 2

July 31, 2014 1:25 pm

Protein energy malnutrition (PEM) or Protein Malnutrition is a problem that can effect a few after weight loss surgery (WLS) and Duodenal Switch (DS). In our previous blog post on protein  we discussed  the types of essential and non-essential Amino Acids and  possible sources. We also discussed  how to choose the best bioavailable protein and to vary protein sources to achieve adequate protein levels.  There are cases even with adequate protein intake that can result in PEM due to inadequate protein absorption. The early signs of low protein may be low energy, muscle weakness, moodiness, inability to sleep well, joint pain, changes in hair and nails and carb craving. It is imperative after WLS that you maintain your protein levels throughout your lifetime. The minimum protein intake is 80-100 grams per day after WLS.  There is no leeway where protein is concerned.  It is important in almost ever function in the body.

There are two types of protein energy malnutrition,  Kwashiorkor and Marasmus:

Kwashiorkor is a lack of protein intake with adequate or slightly lower caloric intake.  It’s symptoms are edema (swelling in legs, ankles, feet) enlarged abdomen, irritability, anorexia, hair discoloration and loss, muscle weakness, changes in psychomotor function, mental lethargy, ulcerations, brittle nails, rash or discoloration of the skin, bradycardia (slow heart rate), non-tender parotid enlargement, enlarged liver with fatty infiltrates that are similar to alcohol liver disease.  The edema is caused by osmotic imbalance in the intestinal system causing swelling of the gut.  Protein, primarily albumin is responsible for the colloidal pressure within the circulatory and tissue systems.  The lack of protein within the circulatory systems cause fluids to “leak” into tissues causing edema. Gastro-intestinal symptoms can include nausea, vomiting, dehydration, diarrhea and increases in appetite.  People who have pathological bacteria or parasites and/or after WLS diarrhea can precipitate lower levels of protein. If left untreated can lead to protein malnutrition.

Marasmus is characterized by a lack of protein and caloric intake.  The symptoms are an emaciated appearance with edema. There is no liver changes as in Kwashiorkor.  This is a starvation mode and can be difficult to treat and can progress to a point of no return.

Catabolysis is the bodies response to lack of protein and or nutrition.  This biologic process breaks down muscle and fat to maintain bodily functions. Catabolysis is the body’s last resort to keep it alive.  It is a starving body eating itself to keep vital organs alive.

Laboratory Studies are needed to determine the level of malnutrition and treatment routes.  These studies include:

Protein is an extremely important nutrient within our bodies and is considered the workhorse in cells and organs.  They are responsible for catalysts, messenger duties, structural, immunoprotectors, transporters, buffers, fluid balancers and many other roles. Protein has a hand in synthesizing other proteins, regulates protein turnover, enzyme activity, neurotransmission, gene transcription, transport of other nutrients, messenger and signals for growth hormone and insulin, structure, storage for other nutrients and immunity.

The muscular system is the most obvious structural protein in our bodies, 40% of the total body protein, as is hair, fingernails and cells. Our organs also require protein in order to function appropriately. However, protein’s role in red blood cell formation, size and health is extremely important.  If you don’t have adequate protein levels your body can not make red blood cells. Transferrin is a protein that carries iron to receptors.  Ferritin is an intercellular protein that stores iron until it is needed. Glycine is a protein for heme synthesis. B12 is also transported via a protein for red blood cell production. Protein is also important in blood clotting and plasma.

Cardiovascular health is also reliant on protein for structure and function. Also, proteins can have a protective effect at the mitochondrial level.

Kidney function relies on protein to regulate the acid base balance and ammonia disposal. The kidneys are also the site of amino acid production.

Protein is also important in bone health as a carrier for Vitamin K and calcium binding, tissue repair, healing and growth. Proteoglycans play a role in extracellular structures such as skin, bone, and cartilage. Also related to the skeletal system are glycoproteins, which also aid in building connective tissue, collagen, elastin and bone matrix.

Central Nervous system relies on proteins for neurotransmission, hormone production and other functions.  Protein deficients can lead to neurologic problems such as altered behavior and mental function among other manifestations. The neuorpeptides have actions on transmission functions, mood and behavior. They can also effect a wide range of functions such as blood pressure, body temperature, pain sensation, and learning ability.

Immonoproteins are the group of proteins that provide immune protection such as immunoglobulins and antibodies.

Protein also have storage roles for copper, iron and zinc called metalloproteins. Copper and zinc are considered neurotransmitters, important for iron metabolism, and connective tissue formation in heart, blood vessels and skeletal.

There are situation where your protein needs will increase. In cases of wounds, burns, surgery, stress, sepsis or other illnesses, protein requirements increase. Also age, pregnancy, lactating and increased exercise increases protein needs.

Protein Energy Malnutrition is protein deficit that can and should be avoided after WLS.  PEM, if left untreated, can lead to organ failure and death. Protein is crucial in almost every function of the body and without adequate levels there will be symptoms and side effects. Please take care to maintain your protein levels throughout your life.  We have discussed several of protein’s function, however, there are many more.