Eating Well After Weight Loss Surgery: A Complete Guide

What is Wrong with the Sandwiches You Used to Eat?

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A typical workday might have started off with a trip through the drive-through for a breakfast burrito or sandwich, or a bagel and cream cheese sandwich at work. Lunch could have been a brown bag peanut butter and jelly sandwich or a trip to a nearby restaurant for a sandwich, burrito, or burger. Where might these options leave you?

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\\nSausage, egg, and cheese croissant or biscuit from a drive-through (600 calories with 42 grams of fat)\\n
\\nBagel with cream cheese (500 calories with 70 grams of carbohydrates)\\n
\\nPeanut butter and jelly sandwich (600 calories and 40 grams of sugar)\\n
\\nClub sandwich (1,000 calories and 2,500 milligrams of sodium)\\n
\\nChicken patty sandwich (60 grams of carbohydrates and 1,100 milligrams of sodium)\\n
\\nBeef, bean, and cheese burrito (900 calories and 40 grams of fat)\\n

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Your breakfast and lunch sandwiches could have added up to over 1,500 calories. Add in beverages, sides (hash browns, fries or chips, anyone?), and snacks, and you could have been at 3,000 calories by lunchtime!

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These Choices Don't Work After Weight Loss Surgery!

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Needless to say, these options do not fit into your weight loss surgery diet.

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\\nFirst, some of those sandwiches have more calories than you are supposed to be eating in a day, not to mention that some also contain more saturated fat, sodium, and sugar than you should have in a day.\\n
\\nSecond, those sandwiches emphasize starchy breads and fatty condiments, not the lean proteins and nutritious vegetables you need to stay full and nourished after weight loss surgery.\\n
\\nThird, they can cause complications. Doughy bagels and fried chicken, for example, can cause obstructions in lap-band patients; fatty sausage and sugary jelly can cause dumping syndrome in gastric bypass patients; and these low-nutrient foods can fill you up and cause malnutrition.\\n

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Luckily, this does not mean that you need to give up the convenience of sandwiches and the pleasure you get from biting into one. There are plenty of ways to make sandwiches that are weight loss surgery-friendly: low-calorie, high-protein, convenient, and delicious!

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Protein Fillings for WLS Sandwiches

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Start by choosing a lean source of protein, just like you do when you plan all of your meals. These are some healthier options compared to what you might have chosen before weight loss surgery. Don't forget to measure your portions if you are making your own sandwich, or eyeball your portions if you are ordering in a restaurant.

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\\n2 scrambled egg whites (30 calories)\\n
\\n2 ounces of canned light tuna (60 calories) \\n
\\n2 ounces of chicken breast, lean ham, turkey breast (80 calories)\\n
\\n2 ounces of fat-free cheese (90 calories)\\n
\\n½ cup cooked beans or 1 vegetarian burger (120 calories)\\n
\\n2 ounces of turkey or vegetarian bacon or breakfast sausage (130 calories)\\n

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Load up on Vegetables and Fruit

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Vegetables and fruit are the next food groups to add to your meals. Vegetables especially are low-calorie, so add more if you want a bigger sandwich. Try classic combinations, or get creative. You can also experiment with herbs such as fresh cilantro, basil, and dill. These are some ideas.

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\\nLettuce and tomatoes with meat and cheese\\n
\\nGrilled eggplant, zucchini, and/or bell peppers with beans\\n
\\nCucumbers and sprouts with fat-free feta cheese\\n
\\nDiced celery, carrots, onions, and water chestnuts with tuna\\n
\\nSpinach and mushrooms with egg whites\\n
\\nPear or apple with fat-free cheddar cheese\\n
\\nCantaloupe with ham and/or fat-free cheese\\n
\\nBlueberries with egg whites\\n

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Breads and Alternatives

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Most bread is high in carbohydrates and low in protein - clearly not what you need for your nutritious weight loss surgery diet. Besides adding calories and carbs, bread can cause obstructions in lap-band patients and make gastric bypass patients sick or overly full. When possible, skip the regular bread.

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\\nBagels\\n
\\nTortillas\\n
\\nSubs\\n
\\nCroissants\\n
\\nBiscuits\\n
\\nRegular sliced bread\\n

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Instead, choose whole-grain, high-fiber, low-calorie breads, and consider open-faced sandwiches, with the filling on 1 slice of bread, instead of regular 2-slice sandwiches. These are some good options.

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\\nReduced-calorie bread (45 or fewer calories per slice)\\n
\\nLight English muffin (50 calories per half)\\n
\\nMini whole grain bagel (60 calories per half)\\n
\\nLow-carb tortilla (50 calories per small tortilla)\\n
\\nHigh-fiber, light wrap (90 calories per wrap)\\n
\\nAlso, look for creative, non-bread alternatives.\\n
\\nLettuce leaves to make lettuce wraps or cups\\n
\\nEgg roll or wonton wrappers\\n
\\nSheets of dried seaweed\\n
\\nGrilled eggplant\\n
\\nYour fork (skip the bread and just eat the filling)\\n

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Keeping Condiments Under Control

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The condiments that you add can make or break your sandwich, both in terms of nutrition and taste. Skip the full-fat mayonnaise, dressings, dips, sour cream, and butter, and be wary of high-sugar jam, barbecue sauce, and honey mustard. Instead, consider the following condiments.

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\\nSalsa\\n
\\nFat-free mayo, dressing, dip, or sour cream\\n
\\nRegular mustard\\n
\\nPlain, non-fat Greek yogurt\\n
\\nHot sauce\\n
\\nShredded fat-free parmesan cheese\\n
\\nReduced-calorie, trans fat-free margarine\\n

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Some Breakfast Sandwich Ideas to Start Your Day Off Right

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\\nEgg whites scrambled with spinach, mushrooms, and fat-free feta cheese on ½ English muffin\\n
\\nCottage cheese and strawberries wrapped in lettuce leaves\\n
\\nShredded fat-free cheese and lean ham toasted on a slice of reduced-calorie, whole-wheat bread and topped with salsa and tomatoes\\n
\\nEgg whites cooked with turkey bacon and broccoli in a small, high-fiber wrap\\n
\\n½ whole-grain mini bagel spread with fat-free cream cheese and topped with canned salmon with diced celery and water chestnuts\\n

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Lunch Sandwiches

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\\nLettuce wrap filled with diced chicken breast, bean sprouts, mushrooms, and bell peppers, and soy sauce or light Asian dressing\\n
\\nDried seaweed sheet rolled around tuna salad made with fat-free mayo, chives, and celery\\n
\\nPinwheels made by layering slices of turkey breast, lean ham, and fat-free cheese slices, spreading them with mustard, and rolling them\\n
\\nBean burrito with black beans, fat-free cheddar cheese, salsa, and fat-free sour cream on a small, high-fiber tortilla\\n
\\nChicken breast with sliced apple and light vinaigrette between slices of grilled eggplant\\n
\\nTomato sauce, fat-free mozzarella cheese, and mushrooms on a light English muffin\\n
\\nToasted Rueben sandwich with low-fat Swiss cheese, shredded cabbage or sauerkraut, lean corned beef, and fat-free Thousand Island dressing on a light English muffin\\n

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Are You Ready for Some Sandwiches?

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You can eat these sandwiches at home, or make them ahead of time and carry them with you in a reusable container. As a weight loss surgery patient, you should own plenty of reusable containers with tight-fitting lids. If you do not already have some, they are worth the investment so that you can carry healthy foods with you wherever you go.

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We hope that you enjoy these sandwich ideas and that you are inspired to make some of your own healthy, high-protein sandwiches!

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Related: Fast Food: What to Eat When the Unthinkable Happens

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Don't panic. Wherever you are, you can find a healthy meal that has some protein and won't make you gain weight. Just stay calm so you can make a good choice. Here are some suggestions for the top six fast food restaurants in the U.S.

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1. McDonald's

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Some people may blame it for America's obesity epidemic, but the country's top hamburger restaurant actually offers some choices you can live with. Skip bacon, fries, sauces and dressings, anything with double or triple the meat, and anything labeled "crispy." You can always get away with ordering a burger or sandwich without the bun or bread, or eating just the filling from a snack wrap.

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The following are good bets.

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\\nAn egg white delight muffin, with or without the English muffin, for breakfast.\\n
\\nA Fruit 'n' Yogurt Parfait without the granola topping or oatmeal with apples and without cream, for breakfast.\\n
\\nA grilled sweet chicken chili or Southwest chicken snack wrap without ranch sauce and without the tortilla.\\n
\\nA grilled chicken sandwich, hamburger, or cheeseburger without the bun or bread.\\n
\\nA salad with grilled chicken.\\n
\\nApple slices or a tangerine on the side.\\n

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2. Subway

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Subway can live up to its reputation of being a weight loss-friendly restaurant, but not all menu items are good choices for your weight loss surgery diet. Watch out for their breads - none are whole grain - and skip the pizza. Also, beware of fatty fillings like seafood and tuna salad and meatballs. Of course, stay away from sides and desserts like chips and cookies.

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The following are good bets.

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\\nEgg white and ham on flatbread (or just eat the filling without the bread) for breakfast.\\n
\\nSalads with lean proteins like black forest ham, oven roasted chicken breast, turkey breast, a veggie patty, steak, or ham.\\n
\\nApple slices and water to go with your meal.\\n
\\nTons veggies to make your sandwich more filling and nutritious but still low-calorie.\\n
\\nMustard, balsamic vinaigrette, or a fat-free sauce. \\n

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3. Starbucks

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Don't blow your diet on beverages. If you're not careful, you could get 600 calories and 80 grams of carbohydrates from a single drink at Starbucks. And the baked goods? Best not to even look at them, unless you want to risk dumping syndrome. Still, you can get away with a Starbucks drink or meal that you don't need to be embarrassed to tell your surgeon about.

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The following are good bets.

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\\nDecaffeinated coffee or tea without milk or whipped cream. Use almond milk and sugar-free syrup if you want to jazz up your beverage.\\n
\\nSpinach and feta breakfast wrap, egg and cheddar breakfast sandwich, or reduced-fat turkey bacon breakfast sandwich without the tortilla or bread.\\n
\\nFresh fruit.\\n
\\nChicken and hummus bistro box.\\n

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4. Wendys

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Like McDonald's, Wendy's is another hamburger restaurant that can really do some damage if you're not careful - but you can get away with a high-protein, low-calorie meal if you do your homework first. Stick to "Jr." sized burgers and skip the fries, chicken nuggets, fried chicken, and bacon.

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The following are good bets.

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\\nSalads with grilled chicken and without high-calorie dressings or toppings.\\n
\\nJr. burgers and cheeseburgers and grilled chicken sandwiches and wraps without the bun or bread and with mustard instead of a fatty or sugary sauce or dressing.\\n
\\nA side salad and apple slices.\\n
\\nUnsweetened iced tea.\\n

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5. Burger King

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What can we say? Americans like their hamburgers. Burger King is the third hamburger restaurant that ranks in the top five fast food chains in the U.S. You know the drill. Skip the bacon, fries, onion rings, double and triple burgers, and crispy chicken, and don't even think about sundaes, shakes or pies - unless you want to feel sick from the sugar. There are plenty of options for high-protein meals as long as you skip the bun.

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The following are good bets.

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\\nMaple flavored oatmeal with apple slices for breakfast.\\n
\\nHam, egg, and cheese biscuit without the biscuit for breakfast.\\n
\\nYumbo hot ham and cheese sandwich without the hoagie bun and with mustard instead of mayo.\\n
\\nTendergrill chicken sandwich, veggie burger, or Whopper Jr. without a bun or mayo.\\n
\\nSide salad.\\n
\\nChicken, apple, and cranberry salad without the cranberries, or chicken Caesar salad without the croutons.\\n

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6. Taco Bell

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As with the other restaurants, you can get in big trouble at Taco Bell, or you can get a good meal. Stick to the smaller menu items and choose from the Fresco menu to get items under 350 calories. Taco Bell offers plenty of high-protein menu items, but you're better off skipping the tortillas, taco shells, and tortilla chips.

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The following are good bets.

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\\nA.M. Grilled Taco or Crunchwrap without the burrito or taco shell, if you must get breakfast at Taco Bell.\\n
\\nChicken taco or burrito without the tortilla or taco shell.\\n
\\nSalsa, pico de gallo, hot sauce, red sauce, or pizza sauce.\\n
\\nFresco grilled steak or chicken soft taco.\\n
\\nFiesta taco salad with chicken or steak and without rice - don't eat the shell.\\n

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Related: How to Survive Your Liquid Diet

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WHY A LIQUID DIET?

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\\nBariatric clinics use differing protocols for their patients' pre-op and post-op diets. Why? When you finish explaining that, perhaps you could also explain the meaning of life? If you asked your surgeon or dietitian, the answer would probably go something like this: "We have adapted these procedures to suit the needs of the patients in our individual practice, based on our experience of what produces the best outcome and the fewest complications." In the case of adjustable gastric band patients like us, you might expect the band manufacturers to dictate what are called "best practices" in patient education and care, but the fact is that if Allergan and Ethicon-Endo were to employ armies of band police to supervise every bariatric surgeon in the world, no one would be able to afford a gastric band.

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\\nHowever those clinics' protocols may vary, the liquid diet is extremely common part of bariatric patients' pre-op and post-op instructions. Contrary to popular belief, the liquid diet is not intended to torture the patient. The main purpose of a pre-op diet is to reduce the size and improve the texture of the liver (any weight loss is a plus). The liver is a big organ whose left lateral segment lies on top of the part of the stomach where the band is placed. The pre-op diet uses up the glycogen stored in the liver, shrinking it and making it sturdier, less slippery, and easier to maneuver with laparoscopic instruments. This not only makes the surgeon's job easier and quicker, it also reduces the risk of complications for you. If your surgeon doesn't require a pre-op diet of any type, I would have to conclude that he or she is mighty confident in their surgical abilities, but I would also want to ask them how often they have to abort a surgery or convert from a laparoscopic to an open incision technique because of problems handling the patient's liver.

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\\nThe purpose of the post-op diet is to keep you nourished while you and your upper GI tract recover from surgery. Although AGB surgery is usually minimally invasive (when done laparoscopically), it does require incisions and some internal dissection, as well as manipulation of your internal organs. All this can cause swelling. One day your stomach was fat, dumb and happy. Now it's got a collar around its neck. In order for it to digest food in any form, your stomach muscles must expand and contract to break the food down and move it along to your lower GI tract. Expecting your stomach to do that comfortably and safely while wearing its brand-new collar just isn't wise.

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\\nSo to allow everything to heal properly, and the band to seat itself against your stomach in the correct position, most surgeons require patients to follow a staged post-op diet, starting with liquids. What happens if you don't follow your post-op recovery diet?

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Food can get stuck in the stoma or esophagus and cause an obstruction and/or vomiting.\\n
Vomiting can disturb the position of the band, which can cause the band to slip.\\n
Peristalsis (the muscular action of moving food through the digestive system) can disturb the position of the band, and that can cause the band to slip.\\n

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\\nSo don't do it!

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\\n"But I already cheated!" you say? It's not the end of the world, but don't do it again!

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\\n"But I'm starving!" you say? That's too bad, but that isn't the end of the world, either. Not, it's not fun, but hunger is not a good excuse for cheating your health in such a major way. I'd guess that seven of ten bandsters starve their way through the liquid diet phase. If you absolutely cannot bear the liquid diet for another second, or you think you might be genuinely allergic to your protein shakes (which could be lactose intolerance rearing its ugly head), call your surgeon or nutritionist before you put something in your mouth that isn't on the approved list. And by the way, the same advice applies to following a liquid diet after each fill you get, so you might as well perfect your liquids survival technique now because you're going to need it over and over again in the future.

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\\nSOME PRACTICAL TIPS FOR SURVIVING YOUR LIQUID DIET

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Don't worry about how many calories you're consuming, but stay away from milkshakes, ice cream, frappes and fancy coffee drinks.\\n
Drink protein drinks (protein will keep you going longer than sugary stuff like fruit juice).\\n
If you don't like the smell or taste of protein powder, try putting the drink in the freezer long enough for it to get slushy, and/or put it in a covered beverage container. Sometimes it's the smell, not the taste, that's bothersome.\\n
If you don't care for sweet tastes, try unflavored protein powder (from various sources including Unjury®) or Unjury® chicken soup flavor protein powder (www.unjury.com).\\n
Add Unjury® chicken soup flavor protein powder to blended creamy soups (follow the Unjury® heating instructions or it will clump up and refuse to dissolve).\\n
Add fat free half-and-half or milk to prepared chicken bouillon or broth for a creamy drink.\\n
Add unflavored or fruit-flavored protein powder when making sugar-free gelatin. Check out the recipes at the Unjury website. Be aware that "unflavored" doesn't mean the protein has no flavor, so the end product isn't going to taste exactly like the original.\\n
Buy your favorite soup from a local restaurant, strain out the solids, and drink the broth (Chinese hot and sour soup is wonderful this way).\\n
Buy or make bean soups, puree and thin them with broth, water, or milk. The pureed soup must be thin enough to pass through a drinking straw.\\n
Add powdered non-fat milk to soups and shakes to boost the protein.\\n
Crunch on sugar-free popsicles, slushies, Italian ice, or ice chips.\\n
Don't hang around people who are eating real food.\\n
Experiment with the temperature of your liquids - cold may feel or taste better than hot, or the other way around.\\n
To prevent boredom, experiment with recipes for protein shakes (you'll find at least a million recipes online).\\n
Keep busy! This is a good time to address holiday cards. Who cares if it's the middle of June?\\n

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\\nAND IN THE TMI DEPARTMENT…

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\\nA few final words about your liquid diet. Don't panic if consuming liquids sends you running to the bathroom more often than you'd like. LIQUIDS IN = LIQUIDS OUT. If that happens to you, ask your doctor to suggest a safe, effective OTC anti-diarrheal medication.

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\\nAnd remember: This too shall pass. In more ways than one.

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Related: Ten Tips for Battling Food (and Family) over the Holidays

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Tis the season ready or not! The holiday season can be one of the most joyful times of the year with its dazzling colors, familiar music, social gatherings, and yes, food, food and more food! For those who have recently lost a significant amount of weight following WLS or have remained serious throughout the year about managing the healthy weight they have sustained since having WLS, the food-infested holiday season can present physical and emotional challenges. For at least five solid weeks, food is even more ubiquitous than usual in our eating-obsessed society. It's almost impossible to avoid fanciful confections almost anywhere you go from Thanksgiving until the end of the year. Cookies, candy, fudge and a host of other home-made delights in the break room at the office. Gift baskets abounding with fruits, nuts and bottles of apple cider arrive at the doorstep. Samples of gooey baked goods with sparkling decorations are handed out from kiosks in the grocery store. And bubbly libations accompany the gourmet delicacies served at every office and neighborhood social gathering.

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For people who have had WLS and are serious about maintaining a healthy weight, the fact that the average American gains 7 & 12 pounds throughout the holiday season, can evoke strong feelings of anxiety.

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Another anxiety-producing holiday stressor can be the family gathering. Most of us spend time with relatives during the holiday season. Like food, there are lots of varieties of families; some food and some families are healthy and others are not! Regardless of the emotional health of one's family, nearly all family holiday gatherings revolve around a meal, featuring time-honored secret family recipes and dishes that aunts, uncles and cousins eagerly await all year long.

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At no other time of year are there so many triggers that have the potential to steer off course those who have used food as a way to deal with emotions. In her brilliant, practical book, The Beck Diet Solution , Dr. Judith Beck notes several categories of triggers that can ultimately lead to eating. Three of these categories are emotional, biological, and environmental.

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Identify the Triggers in this scenario:

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Your family has decided to have Thanksgiving dinner at your Grandma Smith's house this year. You haven't been to that house in nearly a dozen years, since moving out of state. When you were a child you adored spending time at your grandma's house. She is the person who taught you about gardening, how to sew, and how to bake. It's hard to think about Grandma Smith without recalling the smell of fresh bread wafting throughout the house. As soon as you walk in the door, the smell of her homemade biscuits mingled with the traditional aroma of the turkey and dressing takes over your entire being. Before you can turn and walk toward the kitchen, you see cousin Sally. Sally was the mean cousin when you were kids. She called you fatty Patty and always tattled to the adults when you did anything wrong. You are assaulted by her booming voice, Hey, there, fatty Patty!' What have you done to yourself? You're not fat anymore! You wish you could just punch her, but refrain from doing so as Aunt Cindy wraps you in a bear hug. That smell! Her perfume. It takes you back to the time you ate three pieces of her birthday cake before dinner. Her husband, uncle Bill had screamed at you for what seemed like an hour, but Aunt Cindy had wrapped you up in a hug then like she was doing now and she was wearing that same scent! You finally make it into the living room and see the old blue rocker that you and Grandma sat in countless evenings while she read to you. Your eyes mist with tears. However, your thoughts are interrupted by the angry sounds of two male voices coming from the next room. They were at it again. Your twin uncles. They never got along well and used to get into fist fights, scaring you when you were a child. You would take a bowl of Grandma's homemade cookies and hide in the closet upstairs until they would leave. Just the sound of their harsh tones made you turn and look for a sweet treat to take your mind off the fear you felt, even now as an adult.

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There are lots of triggers in this story with potential for thoughts and feelings that could lead to eating as a coping response. Emotional triggers include reminiscing on the happy memories of spending time with Grandma in the garden, while sewing and when baking in the kitchen. Cousin Sally's name-calling would certainly trigger an emotional response, as would the memory of Uncle Bill screaming at a young Patty who ate Aunt Sally's birthday cake.

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Biological triggers in this scenario would be the sight and smell of the food when Patty walked into Grandma's. Salivating at the thought or actual smell of the food is also a biological trigger. The sound of angry voices producing anxiety is another example of a biological trigger, as is the smell of Aunt Cindy's perfume.

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The blue rocking chair in the living room would be an example of an environmental trigger. The closet upstairs where Patty hid when she was a child is also an environmental trigger.

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Triggers and Emotional Eating

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Songs often evoke strong emotions. When you hear a song that played at your high school prom where you slow danced with your first love, you experience the joyful emotions you did when you were in that high school gymnasium-turned-ballroom. Holidays, and especially family holiday gatherings similarly evoke strong emotions. For an emotional eater, this can lead to high calorie disasters. In the scenario above, Patty experienced a range of emotions based on in-the-moment triggers and intensified by memories from the past.

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Emotional eaters often turn to food when they are experiencing emotions, sometimes as a way to avoid unpleasant feelings. It may be tempting for Patty to grab an entire pie off the counter and run to the upstairs closet to gobble the pie down in an attempt to get away from the hurt of Cousin Sally's rude remark, to forget about the smell of Aunt Cindy's perfume and the memory of being severely scolded by Uncle Tim years ago, and to quiet the sound of her twin uncles' arguing.

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Triggers are powerful. to make it safely through this minefield of eating triggers during the holiday season, a person needs to have a plan in place ahead of time and then they need to use the plan throughout the season!

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A Post Op & A Doc have created an entire program for WLS patients to help them get through the holidays while maintaining their their health. You can download the plan called APOD's GPS Great Plan for Success and take it with you as you head into the holiday season! Go to www.conniestapletonphd.com/apod/ and look on the right hand side of the page to print off your copy!

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The following Ten Tips can also help you prepare ahead of time for dealing in a healthy way if you are overwhelmed by the urge to eat after being triggered at the family holiday gathering. (You can use these to safely navigate the holiday trays in office break rooms, at neighborhood social gatherings, and any other place you are deluged by tempting holiday goodies!)

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\\nAnticipate triggers. Think about situations you are likely to encounter throughout the holiday season that pose threats to your healthy eating habits. Make a list of probable triggers you will encounter at your family holiday gatherings and use the following steps to deal with them in healthy ways.\\n
\\nVisualize healthy responses to triggers. Instead of responding to triggers in an unhealthy way (yelling, arguing, eating) start preparing now to respond to them in a healthy way by visualizing yourself calmly walking away from arguments. Imagine yourself walking outside and taking a few minutes for yourself to regroup before returning to the situation. Picture yourself finding a place to call a supportive friend and talking about how you're feeling. All of these healthy responses will keep you away from the high calorie options you may have turned to in the past.\\n
\\nLearn quick relaxation techniques. When we encounter triggers, we often become tense, anxious, scared or angry. In a highly emotional state, you are more likely to react rather than respond. Reacting may mean mindless eating of empty calories. If you can use a simple, quick relaxation tool, you will be better able to respond to triggers in a healthy, rational manner. One example of a simple relaxation techniques is to very slowly breathe in and out 12 times. You can do this in a room full of people and no one will even know! Another simple technique is to slowly count to 10, 20, or 100 however long it takes you to feel calm enough to respond in a healthy way. Get away from the crowd and mentally note ten things you are grateful for. This will definitely improve your frame of mind and you can resume your activities with a better outlook, a sure defense against harmful overeating.\\n
\\nRemind yourself why. In preparing for the holiday gatherings, write answers to these questions and have it on your smartphone or an index card to read if you feel yourself getting overwhelmed emotionally and/or feel tempted to eat things you will regret later:
- \\nWhat are the negative consequences of eating unhealthy foods and of overeating?\\n
- \\nWhat are the reasons I decided to lose weight and improve my health habits?\\n
- \\nWhat are the benefits thus far of losing weight and improving my health habits?\\n
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[*]Say to yourself, I made up my mind! When you're aware that your desire to eat/overeat has been triggered, say to yourself, I made up my mind: a. to stick to my healthy eating plan. b. to focus on relationships rather than food. c. to honor my recent weight loss by maintaining healthy behaviors during the holiday season. d. whatever else you have made up your mind about!

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[*]Focus on your own behavior. It's easy to get worked up about things other people are saying (perhaps they make negative comments to, or about you or others). It's just as easy to get upset over other people's behavior (family members who may be arguing, or drinking too much, or vying for everyone's attention). Focus on your own behavior. After all, you have no responsibility for anyone else's! And you have full responsibility for you own behavior which, by the way, includes what, when, and how much you eat!

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[*]Keep a progress piece in your pocket . A progress piece can be anything that reminds you of the progress you have made losing weight and/or improving your health. For example, if you are now able to bend over and tie your shoes after losing weight, carry a shoestring with you. If you recently flew on an airplane and no longer needed a seatbelt extender, carry your boarding pass or a picture of a plane with you. When you're tempted to engage in unhealthy eating, look at your progress piece and give yourself credit for the hard work you've done and remind yourself of the commitment you made to continue your healthy behaviors.

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[*]STOP. Imagine a large STOP sign in your mind that you can pull out whenever you need to before indulging in food (or behavior) that you will later regret.

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[*]Set boundaries. If people give you a difficult time for eating healthy (Why can't you just have one bite? or You must have a piece of Aunt Sally's pie or you'll hurt her feelings.), set boundaries by saying, I've made up my mind to eat healthy, even on Thanksgiving. I don't expect you to understand, but I hope you will respect my decision.

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[*]Plan your work and work your plan. Take an index card (or make a note on your smart phone) with any of the above suggestions or other things that work for you to help you get through difficult food and/or family situations so that you maintain your healthy lifestyle behaviors. Read your reminders any time you feel the need to and use them!

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Happy holidays to you and your families! Enjoy the relationships they last so much longer than the food!

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Related: Yes you can drink and eat at the same meal time

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There is no concern in flushing the food through the gastric band when the area above the band is empty.

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\\nRecent research has provided a better understanding of the how the gastric band works, conducted by CORE in Melbourne. We now understand that food only remains in the area above the gastric band for approximately 1 minute, it is then pushed through the gastric band via the oesophageal pressure. This takes about 3 to 6 peristaltic motions.

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\\nYou can eat and drink at the same time; however it is essential you allow sufficient time between swallows to ensure the area above the gastric band is completely empty, before you consume a sip of your drink.

\\n\\n

\\nHowever, be careful to not drink liquids with your meal to assist the movement of food through the gastric band, this is cheating. Focus on tasting and enjoying the flavours and textures which will enable your saliva to soften the food and make it easier to grind the food into a past prior to swallowing.

\\n\\n

\\nMany people feed back to me that they often do not wait long enough between mouthfuls and take a sip too early and get into trouble. So you may wish to consider an alternative option to not drink and eat during your meal, but rather eat your meal and begin drinking again once you feel comfortable.

\\n\\n

\\nChoose either option, or blend them both when it suits you as summarized below:

\\n

1.\\t Wait enough time between mouthfuls before consuming a sip of your drink

\\n

2.\\t Consume a glass of water before the meal, eat your meal then begin drinking again once you feel comfortable.

\\n\\n

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Related: WLS and the Gluten Free Diet: 5 Myths Busted

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It's no secret that one of the most prominent diets-of-the-moment is the gluten free diet. Millions have jumped on the gluten free bandwagon, including many bariatric patients. Some sing the praises of the diet, claiming the health benefits are intensive. Others claim the diet is a fad and there is absolutely no nutritional benefit to eating this way. Here we will discuss some of the myths and truths of the gluten-free diet, and how it can affect someone with WLS.

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Myth #1: A Gluten-Free diet is a very healthy way to eat.

\\n

FALSE: There are just as many UNhealthy gluten-free foods on the market as there are healthy ones. A trip down the gluten free aisle of any supermarket will prove that - cookies, cakes, pretzels, pastas, chips … There are as many gluten free choices in junk food as you can imagine. And here's the biggest problem with that: many gluten-free products have added sugar and/or fat to compensate to make the texture and/or flavor more palatable. It's also important to note that gluten free does NOT mean organic or GMO free, so if these are concerns for you, be sure to check for organic, non-gmo labels.

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Myth #2: Only people with celiac disease should follow a gluten-free diet

\\n

FALSE: While celiac disease is the #1 cause for going gluten free, it's not the only reason. There are millions of people that share a gluten sensitivity or intolerance that would greatly benefit from removing gluten from their diets. This can be characterized by bloating, digestive issues, rashes, migraines, and other health issues. The only way to be sure if you have a sensitivity or not is to undergo an elimination diet which completely removes gluten for a time period. After a period of time (generally a month or more) gluten is slowly reintroduced into the diet with notes made on any reaction that occurs.

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Myth #3: EVERYONE can benefit from a gluten free diet.

\\n

FALSE: If you DON'T have celiac or an intolerance, there really is no health benefit to removing gluten from your diet. It won't HURT you, to be sure, but it won't necessarily HELP you either.

\\n\\n

Myth #4: You can't go gluten-free without buying expensive products at your health food store.

\\n

FALSE: It's actually quite simple to eliminate gluten from your diet without having to buy anything special. Focusing your diet on fresh, whole foods like fruits, vegetables, meats, and dairy will automatically put you on the right track. It's also possible to find several breakfast cereals, snack crackers, and other items in your regular grocery store for not a huge amount of money - just be sure to read labels!

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Myth #5: Gluten is only found in wheat items, and if you eat corn, oats, or rice, you're safe.

\\n

FALSE: Many items made with corn, oats, and rice DO contain wheat or wheat by-products (such as dextrose). This is used to improve texture in many products. Additionally, some oat and corn products do contain gluten! It's very important that if you're going completely gluten free that you read labels. Of course you know to look for items such as wheat, but it's also very important to look for other ingredients you might not think of. Dextrose, barley, rye, dextrin, vegetable protein, etc. For a full list of ingredients to avoid, do a google search - there are a multitude of great sites with this information. The simplest solution is to look for items that are labeled "gluten-free" right off the bat.

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While a gluten-free diet isn't for everyone, there are still many people that benefit from it. Studies are showing that some WLS patients, especially sleevers, begin to show signs of gluten intolerance after surgery (along with lactose intolerance). If you think you might be gluten intolerant, try a gluten free diet for a time, then re-introduce wheat products slowly to check for a reaction. If you think you might have celiac disease, check with your doctor - they can run extensive tests to find out if you are.

\\n\\n

Symptoms of gluten intolerance include weight gain, bloating, depression, skin conditions, digestive issues, and a myriad of other ailments. Celiac disease is characterized by similar conditions, and also includes canker sores, numbness in extremities, and joint pain. .

\\n

Sources of this article include Web MD, Wheat Belly by Dr. William Davis, Go Gluten Free magazine, and various online websites. For a complete list of sources, contact the author at Admin@7BitesShow.com

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Related: How much should I be eating after weight loss surgery?

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Those who have had weight loss surgery often ask how much they should be eating. Whilst is seems a simple question, there is no simple answer.

\\n\\n

How much you should be eating is a hot topic on many online forums or support pages. If you have read the discussions it becomes clear that weight loss surgery clinics and support teams widely differ in how much they are recommending their patients eat. This is also clear when I chat with other health professionals at our obesity surgery conferences. If the professionals working in the area can't get their story straight, how are people to know what to do?

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Some surgeons recommend you limit meals to half a cup, some may say one cup, and others will say a bread and butter plate of food. Interestingly, one cup of food nicely fits on a bread and butter plate and this is the guide we use in our clinic.

\\n\\n

Accredited Practising Dietitians (in Australia, Registered Dietitians in the USA) are university‐qualified experts on food and nutrition. Whilst even their recommendations on what you should eat following surgery will vary, what they will generally agree on is that it is difficult to meet your nutritional requirements eating half a cup of food, three times a day.

\\n\\n

To date, there are no scientific studies on the exact amount of food people should include after gastric band and gastric bypass surgeries. Hopefully in time this will evolve. Research from Mercy Bariatrics in Perth, Western Australia, provides some excellent data to help guide serving sizes for those who have had a sleeve gastrectomy. Whilst initially very small amounts are tolerated, at six months after surgery most people will manage about half a cup of food at a time. By 12 to 18 months most people will manage about one cup of solid food. This is a guide only and will vary between people as there are different size sleeves.

\\n\\n

A point relevant to all surgeries is that the people studied found they could indeed 'fit' more food in than what they felt satisfied with. After all forms of weight loss surgery, eating to the maximum amount you can tolerate is not recommended. I have a favourite quote from Dr. Teresa Girolamo, one of the GPs in our clinic: "It's not a matter of seeing how much you can eat and get away with, but how little you can eat and be satisfied." Testing the limits of how much you can eat increases your intake, particularly if it occurs repeatedly, and can compromise your results. Tune in to your feeling of satisfaction after eating and let that guide the amount of food you need to eat. Always stop eating before you feel any discomfort.

\\n\\n

Create an environment that makes it easy for you to eat small portions. Ensure family and friends know you use a smaller plate/bowl/cutlery. Take these items with you if you travel. When eating out, order entrée size meals or if there are none available, separate your meal into an appropriate portion before you start eating. Tapas style menus, Asian or Indian eateries are often tailored to meals being shared, allowing you to dish up a small serve to suit your needs. It is fine to leave food on your plate when you have had enough, even if it is a smaller serve. Avoid the temptation to 'clean the plate'. If 'wasting' food concerns you, carry a container with you when you eat out and take a serve home to have for another meal.

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After gastric band surgery some people may find it takes some time before they feel satisfied on small amounts of food. Many people need their gastric band adjusted several times to help them feel satisfied on small serves. If small meals of solid food do not satisfy you, keep in regular contact with your support team until they do. Some people will find this will occur early in their journey, for others it may take longer. Be patient.

\\n\\n

Whilst it is not necessary for you to measure or weigh everything you eat, it may be helpful to measure the amount you are usually serving. When you eat a meal, take note how much food it takes for you to feel satisfied and how much it takes to feel full. The aim is to feel satisfied after eating, so if you know roughly how much food this is you can avoid dishing up too much in future.

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The recipes in my book and on my blog have been designed to provide approximately four, one cup serves. This does not mean a one cup serve is right for everyone, but does allows you to easily adapt the recipes to your requirements.

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Related: I know I need to eat slowly, but how?

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Clients often tell me one of their biggest challenges after weight loss surgery is eating slowly. Eating too quickly means that you are unlikely to chew foods properly. This can cause discomfort, pain and in some cases, regurgitation.

\\n\\n

To be able to eat a variety of foods comfortably after weight loss surgery, you really need to concentrate while you are eating. The following tips may help you do this:

\\n

Set aside time for meals and avoid doing other things whilst you are eating.\\n
Sit up straight and avoid slouching. Sit at the table rather than the couch. Avoid eating whilst preparing food.\\n
Move away from the television or computer. You cannot focus on what you are eating if you are immersed in something else.\\n
Avoid playing with your mobile phone or other electronic devices.\\n
Avoid getting really hungry. The hungrier you are when you start a meal, the more likely you are to eat quickly, take big bites and not chew properly.\\n
Avoid eating with your hands as you will tend to take bigger bites. Use cutlery to cut food into small pieces. The more pieces you need to cut the longer it will take to eat.\\n
Avoid eating on the run, or in the car.\\n
Put your cutlery down between mouthfuls. Wait until you have swallowed your food before cutting the next piece. Avoid having that next mouthful loaded on your fork ready to go.\\n
If you really struggle to slow down, use your cutlery in the opposite hand until the pace of eating feels more natural.\\n
Choose a relaxing environment to eat. If the staff room at work is too distracting, head outside to a nearby park. Opt for a quiet café rather than a noisy food court, where you may be tempted to rush.\\n
Be especially careful when eating socially, as during conversation it is very easy to become distracted. Eat during a break in conversation.\\n
Avoid the tendency to want to keep pace when eating with others.\\n

\\n\\n

Take notice when you do slow down your eating. Do you feel more satisfied? Do you enjoy your food more? Many people report they enjoy food more after surgery as they eat more slowly, allowing them to really taste the food and savour the flavours.

\\n\\n

Get in the habit of eating slowly. It could take up to 20 minutes to eat a small meal - between 10 and 20 minutes is a good goal. If there is food left on your plate after this time, discard it. There is a risk of eating too slowly which can turn a meal into grazing, which defeats the purpose of weight loss surgery.

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Time how long it takes you to eat your next meal. It may just surprise you!

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Related: How to Pack a Weight Loss Surgery Friendly Lunch

\\n\\n

Now is the time to step out of the above cycle and start planning and preparing some tasty, fresh and healthy weight loss surgery friendly lunches. The trick is to PLAN AHEAD, so that all you have to do during the morning rush is 'grab and go', making taking your lunch to work the easy option.

\\n\\n

To ensure your lunch is going to keep you satisfied, use the following formula:

\\n\\n

lean protein + low GI carbohydrates + salad or vegetables

\\n\\n

Prepare Ahead Options

\\n

I like to put time aside on a Sunday to prepare lunch items for the week ahead: salads, frittata, mini quiches, meatballs and patties all work well.

\\n\\n

Some ideas to get you started include:

\\n

Rice salad: Combine prepared 'Rice Plus' (a blend of white and black basmati rice, quinoa, barley and other grains), finely diced capsicum and celery, dried cranberries and mixed seeds (including sunflower and pumpkin). Dress with soy, fresh ginger, lemon and a little oil and top with a grilled chicken tenderloin.\\n
Meatballs: Prepare lean mince, chicken or turkey meat balls and bake in the oven. These can be frozen then taken for lunch with a fresh prepared salad.\\n
Vegetable and egg crustless quiche: Grate zucchini and carrot, dice capsicum, tomato and mushroom and place in baking dish. Pour in a tub of cottage cheese, half a cup of grated cheese and a mixture of 6 eggs with one quarter cup of low fat milk. Bake for 30 - 40 minutes until golden.\\n

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Leftovers

\\n

Leftovers can make great lunches, when serving up your dinner get into the routine of dishing up an extra serve into a container ready for the next day - just watch your portion.

\\n\\n

Grab and Go

\\n

There are lots of options you can either have on hand at work or quickly grab in the morning for days you haven't been able to be prepared. Following are some ideas to get you started:

\\n

Grainy crackers with:
- small (approximately 100g) tin of flavored tuna\\n
- cottage cheese\\n
- sliced cheese\\n
- nut paste\\n
- hummus.\\n
\\n
[*]Wrap or grainy bread with:
\\n\\n
- tinned tuna or salmon and salad\\n
- hard boiled eggs (boil ahead and keep on hand in the fridge) and salad\\n
- baked beans and grated cheese.\\n
\\n\\n

\\n\\n

If you need snacks over the day don't forget to take these too, or that vending machine/charity basket/staff room cake can undo all your hard work. Some ideas to get you started include:

\\n

fruit\\n
yoghurt\\n
30-40g nuts\\n
hard- boiled egg\\n
cheese and crackers.\\n

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\\n\\n\\n

Related: Satisfied versus Full - How do you know?

\\n\\n

Feeling satisfied and feeling full after eating are not the same and it is important to understand the difference.

\\n\\n

To eat until satisfied means to eat until you are no longer hungry. You feel you have definitely eaten something, but may not need to eat for a few hours. You could eat more.

\\n\\n

Eating until full is like when prior to surgery, you dined out on a delicious three course meal, so tasty you could not bare to leave any on the plate. It may be the feeling after trying to make sure you got your value for money at a buffet, or the feeling after lunch on Christmas Day.

\\n\\n

Eating until full after weight loss surgery can cause some discomfort, indicating you have eaten too much. Continuing to eat too much over a long period of time will compromise your weight loss and it can cause surgical complications.

\\n\\n

Eating until satisfied will guide the amount of food you should be eating. Whilst serving sizes may have been recommended to you, everyone is different and you need to listen to your internal cues to judge how much is right for you to eat.

\\n\\n

People who have dieted for many years may have lost touch with the signals they get when eating. It is important to re-learn how to listen to your body's signals to judge how much to eat.

\\n\\n

The following scale can be useful to help you understand your internal signals and when is the right time to eat and to stop eating. Keep this scale near where you eat. Before you start eating a meal, stop and rate how hungry or full you are. Once you are part way through your meal, pause and consider where you would be on the scale. Do you need to continue, even if you haven't finished the plate? If you are still hungry, continue eating. Pause again later in the meal and repeat. If you do finish the plate, rate yourself again.

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Try this at different meals; breakfast, lunch and dinner. It may take some practice, but is an exercise well worth doing.

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Your goal is to start to recognise the point where you reach a 6 - this is the goal.

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1. Starving, ravenous. All you can think about is how hungry you are. This is a 'danger time' for overeating.

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2. You may have a headache or feel weak or grumpy.

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3. You feel like it's time to eat.

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4. Your hunger is just starting, but you could wait to eat. Your stomach is starting to feel empty.

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5. Neutral. Not hungry, not full.

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6. Satisfied or "just right". You are no longer hungry, but probably will be in about three or four hours.

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7. You had a few bites too many. You are a little uncomfortable.

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8. Full. You definitely don't need more food.

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9. Your stomach feels stuffed, uncomfortably full.

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10. Painful. So full you feel like you could vomit.

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For some more reading on this topic we highly recommend the work of Dr Rick Kausman and his book, If Not Dieting, Then What? Find out more here.

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Let us know how you go finding your number 6 by joining the conversation on our Facebook page.

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Related: The Smoothie and Protein Drink Debate

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Among the bariatric community there is a raging debate going on:

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Smoothies vs. No Smoothies.

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Or, Protein Drinks vs No Protein Drinks.

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There are many that believe that once you get past a certain point in your bariatric life, you should be able to set aside the protein drinks and focus on actual food instead. Others think that keeping in the protein drinks and smoothies are a good and healthy way to make sure we get our protein count.

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Those that are the No-Drink advocates believe that protein from food sources such as meat, tofu, and dairy are more easily absorbed and digested, and that the protein count from drinks can be inaccurate because of how much our bodies actually absorb vs. how much the product contain. There is also the fact that many protein powders and drinks on the market are filled with chemicals and artificial flavors that wreck havoc on the body and the digestive system.

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Something else to consider from this perspective is that many of us become intolerant of things such as lactose, soy, and other foods that most protein drinks contain. Consuming these drinks can cause digestive distress and other allergic reactions.

\\n\\n

Despite these thoughts, there is a strong case for the benefits of continuing smoothies and protein drinks well after we begin our lives on solid foods.

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First off, our bodies are actually able to absorb about 30-40 g of protein per hour. If we are drinking a 25-30g protein drink over the course of a half an hour, we're likely to absorb the majority of that protein.

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Second, when we make a smoothie using our protein drinks (adding fruits and vegetables to the mix), we are adding vital vitamins, nutrients, and fiber to our diets. For some of us, there's no way we'd be able to eat what we need in one day, much less in one meal. Smoothies are a great way to get those things in.

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Third, if you have a food intolerance to whey or soy, there are other amazing alternatives that are just as easily absorbed. There are many great vegan protein powders on the market made with flax, hemp, pea, rice, and other ingredients that contain almost as much digestible protein as whey( look for a good powder that contains a combination of brown rice and pea protein). As someone who personally cannot tolerate whey or soy, these were a godsend to find!

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Lastly, there are some of us, especially those that may have a band or a sleeve, that have issues with meat and protein. For example, I'm two years out from my vertical sleeve, and often still have problems tolerating chicken and beef! When this happens, we are left with little choice for protein then to turn to drinks and smoothies.

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The choice whether or not to continue with protein drinks or smoothies is a personal one. Many people tolerate meat and other high-protein foods well, while others might still have problems with them. In these cases, protein drinks and smoothies can be a viable and important dietary supplement!

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Sources:

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http://www.precisionnutrition.com/rr-whey-too-much

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http://www.scientificamerican.com/article/how-much-protein-can-the-body-absorb/

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http://www.quickanddirtytips.com/health-fitness/healthy-eating/know-your-nutrients/how-much-protein-can-the-body-absorb

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Related: Are Hidden Calories Holding Back Your Weight Loss?

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Overeating is Possible after WLS

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You got WLS so that you could lose weight, but WLS is only a tool. To lose weight, you need to use that tool properly. If you fall into the trap of thinking that WLS automatically leads to weight loss, you might never hit goal weight. As a reminder, these are how the lap-band, vertical sleeve gastrectomy (VSG), and gastric bypass can help you lose weight.

\\n

\\nLap-band: The lap-band creates a small pouch, or stoma, to help you fill up faster so that you eat less.\\n
\\nVertical sleeve gastrectomy (VSG): The surgery removes most of your stomach and creates a small sleeve out of the remaining portion. The gastric sleeve restricts the volume of food you can eat and it reduces hunger by reducing the amount of ghrelin, which is a hunger hormone.\\n
\\nRoux-en-Y gastric bypass: The surgery restricts food intake by creating a small pouch, and reduces nutrient absorption by having food from your stomach bypass much of your small intestine.\\n

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Your weight loss surgery will not work for you if you cheat in these ways.

\\n

\\nYou eat more frequently - and take in more calories - than your surgeon suggests without feeling the restrictive effects of the adjustable gastric band.\\n
\\nYou eat sugary, fatty high-calorie foods. The lap-band, especially, is unlikely to cause you to develop dumping syndrome. That is good because you will not get the unpleasant symptoms, but it is bad because it does not prevent you from eating sugar, starch or fat. Even with a stoma size of just 4 ounces, or a meager 1/2 cup, you could fit in 400 calories' worth of M&M's in with room to spare.\\n
\\nYou drink fluids when you are eating solids so that you can consume more at a single meal or snack. Drinking fluids while eating solid foods can also cause your stomach, sleeve or pouch to empty faster so that you get hungrier sooner.\\n
\\nYou sip on beverages that provide calories but do not fill you up.\\n

\\n\\n

How Hidden Calories Might Be Throwing You Off

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What if you think you are following your weight loss surgery diet diligently? You measure your food whenever you can, you use your dietitian's food list when you go grocery shopping, and you order chicken and vegetables when you go out to eat. You get protein at every meal, and you drink plenty of water each day.

\\n\\n

Hidden calories are the ones that creep into your diet. You might not know you are eating them, or you might think that you eat so few "extra" calories that they don't matter in your diet. But, they do impact your weight loss. An extra 20, 50, or 100 calories here or there really affects your weight loss. Remember that a pound of body fat equals 3,500 calories. That's an average of 500 calories per day to lose a pound a week. If you are getting hundreds of hidden calories a day, that could easily be a pound a week that you're not losing.

\\n\\n

Where Are the Hidden Calories?

\\n\\n

Good question! They can be almost anywhere.

\\n

\\nStarches are not necessarily unhealthy, but they should only be part of your meal after you eat your protein and vegetable or fruit.\\n
\\nProtein is the first thing you should eat at each meal and snack, but it is also a source of calories. Fatty meats and poultry with the skin can have 100 or more extra calories per 3-ounce portion compared to lean meats and chicken or turkey breast.\\n
\\nHealthy foods can be high-calorie. A handful of nuts or dried fruit or a big spoonful of peanut butter can have 200 to 300 calories.\\n
\\nCondiments can wreck your diet. A tablespoon of mayonnaise has 100 calories, a tablespoon of jam has 50 calories, and a tablespoon of salad dressing has 80 calories. Ketchup, teriyaki sauce, and marinades can have 15 to 20 calories per tablespoon.\\n
\\nRestaurant foods can be tricky. Vegetables that you think are steamed can have butter in them, and chicken, fish and other proteins that you think are good choices can come in sauces with 100 or 200 calories per serving. Portion sizes can be several times what you need: a 12-ounce steak is 4 to 6 WLS-sized portions, and a 3-cup plate of pasta is 6 to 8 WLS-sized portions.
o Examples of each of the below. Carbs: toast, crackers. Eat celery. Smaller pasta, more protein meatballs.
\\n
o Protein. It's a nutrient, but it's also a source of calories. Esp. if with sugar/carbs in supplements, or hi-fat protein foods. Bacon
\\n
o Healthy hi-cal foods: nuts, pb, dried fruit (fresh). Portion sizes. Avocado.
\\n
o Condiments. Fatty dressings (choose low-fat), use less (use herbs), sugary
\\n
o Portion sizes. MEASURE. Nibbling without measuring, eyeballing. You get 60 extra calories every time you take a piece of cheese that is the size of your thumb (1.5 ounces) instead of weighing it to make sure that it is only 1 ounce.
\\n
o beverages
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o Restaurants: salads, fat added to "grilled" foods or steamed vegetables, beverages, "healthy" bagel instead of low-cal doughnut
\\n
o Eating too frequently. Tips for if you're starving (protein, no fluid with meal); tips to make meal smaller (if you're eating so many meals, don't need to be big)
\\n\\n

\\n\\n

The Good News

\\n

The good news is that small changes add up to big calorie savings.

\\n

\\nHave an ounce of low-fat cheese instead of full-fat, and save 50 calories.\\n
\\nHave a quart of regular or sparkling water instead of a quart of a sports drink, and save 200 calories.\\n
\\nSkip the bite of cookie dough after you finish baking for your children, and save 100 calories.\\n
\\nHave 3 ounces of 95% lean ground beef instead of 85% lean ground beef, and save 70 calories.\\n
\\nRinse the spoon instead of licking it after you serve yourself peanut butter, and save 30 calories.\\n
\\nSpread peanut butter or tuna on 3 large celery stalks instead of 6 triscuit crackers, and save 90 calories.\\n
\\nHave one-third of a cup of pasta with your meatballs instead of a full cup, and save 120 calories.\\n

\\n\\n

This works for exercise, too. Every little bit helps. When you walk for just an extra half-mile, or about 10 minutes, you burn 50 extra calories.

\\n\\n

Start to think about where extra calories may be coming into your diet, and see what you can do to limit them. You'll be happier with your weight loss results!

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Related: Weight Loss Surgery and Constipation: The Key Ingredients

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We often have people tell us they are constipated at their first post-surgery appointment. It is important however to realise that constipation and slower bowels are two very different things - it's not how often you go, it is how you go! After surgery, particularly during the recovery stages, the amount of food you eat is far less than pre-surgery. With less food comes less waste, so it is likely you will use your bowels less. As long as you are not uncomfortable, this is not a problem. If your motions are less frequent, hard, dry and you need to strain to pass them, then you are likely constipated.

\\n\\n

The 'key ingredients' to help manage periods of constipation are:

\\n\\n

Fibre - this helps to bulk and soften bowel motions and move them through the intestine\\n
Fluid - fibre absorbs fluid, so if you increase fibre without ensuring your fluid intake is adequate it can make constipation worse.\\n

\\n\\n

During the weight loss surgery recovery phases of the fluid and smooth puree diets, it can be a significant challenge to obtain enough fibre and fluid and for many this results in constipation.

\\n\\n

Boosting Your Fibre Intake

\\n

During the fluid phase:

\\n\\n

Blitz rolled oats and chia seeds in your food processor to form the texture of flour and add to smoothies and shakes. Don't forget to add plenty of fresh fruit as well.\\n
Add plenty of vegetables to soups. Chop up your favourites and blitz in your food processor. Make sure you blend them enough that they could pass through a straw. Onion, carrot and celery work well to boost both the fibre and flavour of almost any soup.\\n
Add legumes or lentils into soups to boost both protein and fibre. Once blended they help make soups creamy and will help keep you feeling satisfied. Chickpeas, bean mixes and lentils all work well.\\n

\\n\\n

During the smooth puree phase:

\\n\\n

Introduce porridge or Weetbix® with plenty of low fat milk at breakfast. Sprinkle with crushed seeds and/or try topping with some pureed fruit.\\n
Add plenty of vegetables and legumes or lentils into stews and casseroles. Remember to blend into a smooth consistency (much like the texture of smooth mashed potato).\\n

\\n\\n

During the soft diet phase:

\\n\\n

Naturally soft fruits such as banana, mango, ripe pears and peaches can be reintroduced.\\n
Well cooked vegetables that are soft enough to cut with a fork can also be enjoyed.\\n

\\n\\n

Longer term:

\\n

Remember to focus on wholemeal and wholegrain bread and cereal products.\\n
Include fresh fruits and vegetables daily. Include skins where you can , just chew them well.\\n
Include some regular exercise.\\n

\\n\\n

It is important in all dietary phases to focus on your fluid intake - remember to sip, sip, sip and aim for 1.5L of fluid daily.

\\n\\n

For detailed information on where to find fibre in foods speak to your dietitian or check out the section on fibre in Your Complete Guide to Nutrition for Weight Loss Surgery.

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Need Extra Help?

\\n

If you are constipated at any stage, you may find a fibre supplement useful. A soluble fibre supplement such as Benefiber® or Metamucil Fibresure® can help. These products are colourless and tasteless, hence can be dissolved in a range of fluids. They are best taken regularly, with plenty of fluid. They are not likely to be effective taken if you take a random dose once constipation is established.

\\n\\n

The following recipe for prune, bran and apple mix can be a useful addition to your diet to improve your bowels. Try adding 1 tablespoon to your breakfast, or with some yoghurt for a high fibre, high protein snack.

\\n\\n

Prune Bran Apple Mix

\\n

75g All-bran®

\\n

250g Apple Puree or apples, pureed

\\n

75g prunes, pureed

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50ml orange juice

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Blend together adding more juice if required. Freeze in ice cube trays and defrost 1 cube at a time as needed.

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If constipation persists, discuss this with your surgical team or GP. Please seek medical advice before commencing laxatives.

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Related: Learning How to Eat Slowly After Weight Loss Surgery

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It's often quite a surprise to learn how slowly you really need to eat after surgery. For those of you that have had surgery, you know that even one very small bite too many can be painful or lead to vomiting. Before surgery, we encourage you to eat slowly to learn that it takes about 20 minutes of slowly eating before your brain recognizes your stomach is full. After surgery it may only take a few bites to begin feeling full.

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The first step in slowing down your eating is to chew your food to applesauce consistency. A lot of our patients find success by making each bite last 25 chews. Chewing to applesauce consistency works better when you take a very small bite. Think of a bite of food being about the size of a pencil eraser or the size of the tip of your pinky finger. Use smaller utensils like the salad fork or teaspoon or even toddler or baby spoons and forks.

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Speaking of utensils, put them down between bites which helps you slow down your eating. A lot of us already have a bite of food loaded on a fork or spoon ready to put in our mouth immediately after swallowing bite of food. Use a saucer or salad plate to reduce portions so you have less food in front of you.

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No seat, no eat. Sitting at a table without distractions around you will help you focus on business of chewing. Remove distractions from your eating area. Eating while standing at the sink, driving, watching TV, working on the computer, answering texts or e-mails, reading, making "to do" lists or doing another load of laundry are common distractors in our busy lives.

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When you can start eating food you can chew foods like cottage cheese or scrambled eggs, start with eating 1 ounce (2 tablespoons) every 10 minutes. Discover your "I'm just about to get full" signal. Our patients report they will hiccup, sneeze, sigh quickly or just realize that next bite of food really isn't going to work. Focus on the enjoying the few bites you can have. Concentrate on the flavor and texture of the food. Many of our patients discover that chewing food well often results in finding out that the foods they really liked before don't taste as good as they remembered.

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If you are eating with others, focus on the conversation and people at the table. Many of our post-surgery patients report that the focus of the meal becomes the conversations, enjoying the company and socializing rather than the food. Learning to slow down your eating will be a difficult skill to master, but is an essential skill to have successful surgical outcomes.

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Related: Caffeine and Weight Loss Surgery: Not a Good Partnership

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For most people, this drug is about as harmless as a drug can be. It wakes you up, keeps you mentally sharp, and even helps you burn a little extra fat. There aren't many serious health risks, as long as you don't have too much.

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For weight loss surgery patients, though, caffeine is a bit of a bigger deal. Find out what it can do to your body, how much is safe to have after surgery, and where to find it.

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Caffeine and Your Digestive Tract

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Caffeine is an acid, and it can irritate the lining of your stomach pouch or sleeve. This is true whether you have the lap-band, vertical sleeve gastrectomy, or gastric bypass. One way to prevent symptoms is to make sure you don't have your caffeine on an empty stomach. However, that's not really possible when your weight loss surgery diet doesn't allow you to have beverages at the same time as solid food! Limiting your consumption is the best way to avoid trouble.

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Caffeine and Acid Reflux

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Acid reflux occurs when acid from your stomach comes up into your esophagus or throat, causing symptoms like heartburn or an acid taste in your mouth. Acid reflux is considered gastro esophageal reflux disease (GERD) if it persists. Weight loss surgery often helps with GERD, since obesity is one of the main factors. However, you can still get GERD after weight loss surgery, especially if you have the lap-band.

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What does all this have to do with caffeine? Coffee and other source of caffeine are among the foods beverages that make acid reflux worse. There are plenty of other risky foods, such as citrus fruits, spicy foods, fried foods, and garlic. If you do choose to have caffeine, just be watchful for signs of acid reflux and ask your doctor if you think there may be a connection between caffeine and your symptoms.

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Does Caffeine Dehydrate You?

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Staying hydrated is a big deal after weight loss surgery because it's so important and so tough. It helps keep you full and healthy, and you can only do it if you plan carefully and pay attention to your fluid intake.

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Coffee and caffeinated diet iced teas and other drinks may seem like a great alternative to water, which can get pretty boring. Unfortunately, caffeine is a diuretic. That means it increases the amount of water your body loses. That means it helps dehydrate you.

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It's not a serious problem if you don't have too much caffeine and if you're drinking plenty of other liquids, especially water. If you're already struggling to hit your 8 to 10 cups of water a day, though, you might want to think seriously about skipping the caffeine so you don't get dehydrated.

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Caffeine and Your Nutrient Status

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One of the most serious problems with too much caffeine for bariatric surgery patients is that it interferes with nutrient consumption. This comes at a time when you're fighting hard to give your body the nutrients it needs through healthy eating and supplements.

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Caffeine reduces your body's absorption of two key nutrients: calcium and iron. Miss out on your calcium, and you're at risk for developing osteoporosis and a high risk for bone fractures later on. Skip the iron, and you could get anemia, making yourself tired and weak. If you do choose to have caffeine, make sure it's not at the same time you're taking your nutritional supplements.

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How Much Caffeine Is Safe?

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There's no single recommended amount of caffeine that's best for everyone. The right amount for you depends on a variety of factors.

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How it affects you.\\n
The type of surgery you have.\\n
Your surgeon's recommendations.\\n

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A good amount for many bariatric surgery patients who can't face the thought of quitting might be a cup in the morning to get you awake.

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Cutting Back on Caffeine

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If you're addicted, cutting back on caffeine can be challenging. You can get some headaches, feel groggy and cranky, and get constipated. These symptoms only last a few days, though, and you can use them as motivation to take good care of yourself. That's because healthy behaviors like getting enough sleep, exercising, and drinking enough water can help reduce withdrawal symptoms.

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If you're trying to have less caffeine, it's helpful to know the sources. Everyone knows about coffee, but there are plenty of other places where you might find caffeine.

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Hot and iced coffee and coffee drinks.\\n
Hot and iced tea.\\n
Diet and non-diet energy drinks, including 5-Hour Energy.\\n
Some over-the-counter migraine, pain, and cold and flu medications.\\n

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Caffeine has a lot of uses in everyday life, and it's not necessarily a bad drug. But, after weight loss surgery, it can be a problem if you have too much. If you love your coffee, ask your surgeon how much you can have to make sure you don't harm yourself while you're working so hard to get healthy and fit.

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Related: Are you finding it easy to eat?

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Last year I asked my Facebook followers the foods that were always on their shopping list since having weight loss surgery. Following were the most common responses:

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\\nyoghurt\\n
\\nmince\\n
\\navocado\\n
\\neggs\\n
\\nporridge\\n
\\ncottage cheese\\n
\\nlow fat ice cream.\\n

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What do you notice about this list? What do all these foods have in common? They are all 'easy to eat' foods.

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This theme resurfaced in a similar conversation I observed recently about crackers. Following weight loss surgery, some people prefer to choose crackers over bread. It seems that easy to eat crackers, the 'puffed' varieties that dissolve in the mouth like Cruskits™, are a popular choice. You can eat them more easily, allowing you to also eat more of them, than a more challenging and nutritious cracker, like a grainy Vita-weat® or Ryvita®. So why are you choosing easy to eat foods?

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The purpose of weight loss surgery is to feel satisfied on a smaller amount of food, preferably nutritious food. So I ask, what would make you feel more satisfied? Taking time to chew, chew, chew through the higher fibre, more nutritious, grainy Ryvita® or Vita-weat® crackers? Or taking half the time and effort for the Cruskits™ to dissolve in your mouth after a quick, half-hearted chew? It is an experiment worth doing. Perhaps also note how many of each of the crackers you need to eat to feel satisfied, as well as how long you remain satisfied after eating them.

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In the hundreds of weight loss surgery clients I have seen I have noticed that after recovering from weight loss surgery some people never really progress past the 'soft food' stage of mornays, stews, casseroles and mince dishes. Or, they progress onto more solids foods but gradually slip back in to these softer, easier to eat foods, particularly those with a gastric band, as their band is adjusted and becomes tighter. I recall conversations with clients telling me they prefer the soft foods as they are "easy" and they "can eat more". However, when we discuss this further, their true hunger is satisfied just as much on a smaller serve of a food, which is more challenging to eat. Eating larger amounts of soft, sloppy food or easy to eat, 'dissolvable' food is eating to satisfy our eyes, rather than our true hunger.

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I am fully aware that some people with a gastric band have difficulty eating particular foods. I also believe however that there are thousands of people with poorly managed gastric bands that are not able to eat healthy, solid food. Unfortunately there is a misconception with gastric bands that tighter equals better, and that regurgitation is normal. Whilst I have no scientific studies to back this up, in my work the people I see who successfully lose and maintain their lost weight with a gastric band are those who can eat a good variety of solid, healthy foods, not those who must survive on protein shakes, soups and juices as their band is too tight to eat anything else. If you can't eat a range of healthy foods please speak to your team, or get a second opinion. It may be that you need to work on your eating technique, or you may need some medical intervention.

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Unfortunately the perception that easy to eat foods are necessary has become quite widespread and is not only confined to the gastric band community and with many online weight loss surgery communities these beliefs spread.

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Are you choosing easy to eat foods out of habit? Could you eat more challenging foods that will satisfy you more? Consider this 'food for thought' as you move forward on your journey.

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Related: Honesty is the best policy

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Most people who choose to undergo Lap Band surgery, do so because they want to change their body and improve their health. Most people understand what to eat to lose weight, however you need to understand how to do this in conjunction with the Lap Band. The Lap Band can behave slightly differently each day creating variability in the food you can tolerate. The most important consideration is to ensure that the Lap Band falls within the green zone. That is, the Lap Band is not too tight.

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Clients do come to me frustrated that they are not losing weight quickly enough. My response always is; what is holding you back? The band or you?

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I often get a confused looking client in front me. This question can be quite confronting and forces one to self-reflect and be honest with themselves. I believe honesty is the best policy.

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With this article I would like to discuss a common challenge faced by most lapbanders, how much and how often one should eat? My philosophy is to keep things simple and easy to digest.

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Realistically I like to see a minimum of three meals a day consumed. Rather than focusing on how much to eat, try and place the focus on eating quality healthy food that would fit on a small toddler portion plate. This portion should take 15 to 20mins maximum to eat, after which you should feel disinterested in eating more food and be happy to stop eating. Remember, it is not the role of the Lap Band to stop you from eating, this is your responsibility.

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Ask yourself, are you really using the Lap Band to its maximum potential?

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Happy eating

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Helen Bauzon

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If interested, on Wednesday night 27^th November, I will be running a 30min live webinar where you can ask me any question, plus learn a key activity you can do to prevent weight gain during the festive season.

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Related: Helping You Feel Satisfied after Weight Loss Surgery - the Power of Protein

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In a previous article I introduced the concept of getting the most from what you are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this. There are two key ingredients in helping you to feel satisfied after eating:

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1. High fibre, low glycemic index carbohydrate-containing foods

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2. Protein-containing foods.

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The previous article explored the glycemic index, or GI. This article focuses on protein. Protein-containing foods help us feel satisfied for longer after eating, which is helpful in managing our weight.

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Protein is also involved in many bodily functions including:

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\\nbuilding and repairing body cells such as bone, hair, skin, nail and muscle\\n
\\nproducing hormones to help us burn stored energy, including body fat\\n
\\nmaking enzymes to help digest food\\n
\\nhelping to protect our body against colds, hair loss, muscle weakness, and fatigue.\\n

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Not eating enough protein can result in:

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\\na weaker immune system\\n
\\nmuscle loss\\n
\\nhair loss\\n
\\ninadequate weight loss.\\n

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Why am I at risk of inadequate protein intake after weight loss surgery?

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As indicated in the protein counter (on my website), meat products contain the most protein per serve.

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An Australian study from The St George Upper GI Clinic in Sydney, Australia, found that those with a gastric band often find red and white meat difficult to tolerate whilst fish was tolerated more easily. Some people who have had sleeve gastrectomy and gastric bypass also reported difficulty eating these foods but it was far less common than it was among those with a gastric band.

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Red meat and chicken breast can be more difficult to eat if they are dry, overcooked, stringy, or if they have been reheated. Any meat can be difficult to tolerate if you are not using the correct eating technique. Some people will then avoid these foods, when working on improving eating technique may allow them to eat these foods comfortably.

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Food tolerance varies from person to person and is found by trial and error. Tolerance of all foods can be improved by following the correct eating technique as I have discussed previously.

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Following all surgeries, you will be eating smaller amounts of food. A reduced intake of food causes a decrease in protein intake. In the early stages following surgery, people who have had a sleeve gastrectomy or gastric bypass are likely to tolerate only very small quantities of food. When you eat your meals, eat the protein-containing food first to ensure you have room for this important nutrient.

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How much protein do I need?

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There is no one exact recommended protein intake following weight loss surgery. A range of 60-120g has been suggested, however your individual protein needs will vary depending on your age, gender and your particular stage of recovery. It is best to speak to your dietitian about your protein needs. You can then use the protein counter below to see how you can achieve this.

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It is easy to confuse the weight of food with the protein content. For example, some may assume 100g of meat provides 100g of protein. This is not the case. Head to my website for a simple table on the protein content of common foods.

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Lean protein foods are the best choices, as they are lower in fat, particularly saturated fat. Meat should be trimmed of fat and chicken should have skin removed. Low fat milk, yoghurt and reduced fat cheeses are recommended.

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Related: How does a sleeve gastrectomy work?

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Sleeve gastrectomy surgery reduces the size of the stomach by stapling along its length to form a long tube that looks similar to a banana. The majority of the stomach is then removed and discarded. The new banana shaped stomach is long and thin hence is often referred to as a 'sleeve'.

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About 80-90% of the stomach is removed making it much smaller, hence it holds much less food than it did previously. This smaller stomach helps you feel satisfied after eating a small amount of food. In addition, the part of the stomach that is removed is the part that secretes much of the hormone called ghrelin, which is involved in stimulating appetite. It is thought that producing less ghrelin further helps to reduce hunger after surgery. Although ghrelin levels start to rise again after surgery, they don't seem to return to their previous levels and so hunger is more easily satisfied.

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Unlike the adjustable gastric band the sleeve gastrectomy is not reversible. The stomach may stretch, or adapt to fit a little more food, but it cannot grow back. A sleeve gastrectomy therefore is a commitment for life.

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As you will be eating less after sleeve gastrectomy, making the most of your food choices is important to help you obtain all the nutrients required for good health.

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Following a sleeve gastrectomy most people will lose most of their excess weight in the first year. After this time weight loss often stabilises, so make the most of this period by making good food choices and regular physical activity a habit for life. After the first year, your ongoing success will depend on your efforts to change your lifestyle and maintain these habits in the long term.

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Whilst the size of the stomach changes after surgery, the type of foods that can be eaten does not. Choosing high-energy (calorie or kilojoule) foods regularly will hinder your progress. As with other types of weight loss surgery, snacking or grazing, lack of physical activity and poor food choices can lead to weight regain. Positive, lifelong changes to eating and physical activity will ensure your long term success.

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Poor food choices can also cause dumping syndrome. Dumping syndrome had been thought to occur only following gastric bypass surgery, however it has been seen following sleeve gastrectomy surgery. Avoiding fatty or sugary foods will help prevent dumping syndrome. We will discuss dumping syndrome in a coming edition of the newsletter, but for now you can see a simple explanation here. Avoiding fatty or sugary foods will help prevent dumping syndrome.

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A 2011 study found that those who had regular follow up after sleeve gastrectomy achieved better weight loss, health improvement, quality of life and food tolerance, than those who did not. Your support team is there to guide you to acheive the best results following surgery, so make the most of the team and keep in touch! They have all sorts of hints and tips to help you achieve success on your weight loss journey.

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Related: The Link Between Metabolism and Obesity

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As a dietitian I often find myself instructing patients to lower their intake of carbohydrates, in fact I've said it so many times, and to so many patients, that at times I feel like a broken record.

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Previous genetic studies into obesity have tended to focus on how genetic variations alter our appetites and food behaviours. However, a new study recently published in Nature Genetics piqued my interest as it suggests that there may in fact be a rather novel genetic link between metabolism and obesity.

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The study authored by Dr. Mario Falchi from the School of Public Health at Imperial College London investigated the relationship between obesity and a gene called AMY1, the gene responsible for an enzyme present in our saliva known as salivary amylase, the enzyme first encountered by food when it enters the mouth that begins the process of starch digestion.

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"We are now starting to develop a clearer picture of a combination of genetic factors affecting psychological and metabolic processes that contribute to people's chances of becoming obese. This should ultimately help us to find better ways of tackling obesity," Dr. Mario Falchi says.

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The number of copies of a gene that a person carries can vary throughout their DNA, although people usually have two copies of each gene. Yet, Dr. Mario Falchi and his team found that the number of copies of this particular AMY1 gene can vary greatly between people.

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The researchers examined the number of copies of AMY1 present in the DNA of more than 6,000 people from four different countries: the UK, France, Sweden and Singapore. And according to their results, it is those who have a lower number of AMY1 who are most likely to become obese. They determined that AMY1 was the gene that had the greatest influence on body weight and then counted the number of times the gene was repeated in each individual and how this affected their obesity risk.

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The chance of being obese for people with less than four copies of the AMY1 gene was approximately eight times higher than in those with more than nine copies of this gene. The researchers estimated that with every additional copy of the salivary amylase gene there was approximately a 20 per cent decrease in the odds of becoming obese.

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This new discovery highlights a strong link between metabolism and obesity and suggests that goes someway to proving that our bodies react differently to the same type and amount of food, leading to weight gain in some but not in others. How we deal with carbohydrates and hence, how much carbohydrate we should be consuming, must be adjusted for each individual. This research indicates genetics may play a role in obesity, and carbohydrate metabolism is very much involved.

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Related: Say (Low Fat) Cheese

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Pictures this…by choosing lower fat cheese over regular, full fat cheese, you can save calories and get more calcium and protein. In our nutrition guidelines, we highlight choosing low fat or fat free cheese. When comparing the nutrition values for full fat, low fat and fat free mozzarella cheeses, there's lot of calories that can be avoided by choosing low fat or fat free cheeses.

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An ounce of mozzarella made with whole milk has 84 calories, 6 grams of fat, 6 grams of protein and 150 mg calcium. An ounce of mozzarella made with part skim milk has 71 calories, 4 grams of fat, 7 grams of protein and 200 mg calcium. An ounce of non-fat mozzarella has 42 calories, 0 grams of fat, 7 grams of protein and 270 mg of calcium.

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This information is found on the website nutritiondataself.com, which is a great website to look up nutrition information on the foods we eat. Less fat means the cheese has more room for protein. Next time you are in the grocery store, start comparing the types of cheese you prefer and picture yourself finding the one that is lowest in calories and highest in protein.

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Related: Lactose Intolerance After Bariatric Surgery

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A fair number of bariatric patients end up with lactose intolerance after surgery. Lactose is the sugar found in milk. During the rapid weight loss phase, you do lose some muscle mass. The digestive system is a muscle. When the digestive system loses a little of its muscle mass, it loses the ability to digest lactose, because we quit producing lactase, the enzyme that breaks down lactose.

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Lactose is the type of sugar found in milk. Fluid milk and foods made from this can contain lactose. Examples of these kinds of foods include ice cream, a glass of milk, instant hot cocoa and pudding.Yogurt and cheese go through a fermentation process that actually breaks down some of the lactose. That's why people with lactose intolerance can eat some yogurt and cheese.

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Lactose can also be found in milk based protein supplements whether it's the ready to drink or the protein powders. Milk based protein supplements will have the words whey, casein or milk in the ingredient list. Some protein supplements will actually state "Lactose Free" on the label.

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Lactose can also be found in a protein product when the milk-based protein is from a "concentrate" form of whey, casein or milk. The protein is the concentrated form of whey, casein or milk. However, the protein is not isolated from the lactose. For example, whey protein isolate may have up to 1 percent of its weight as lactose. Whey concentrate may have up to 52 percent of its weight as lactose.

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You can look at the Nutrition Facts Label to see if the protein product you choose has any sugar in it. If a type of milk or milk protein is listed on the ingredients, it could mean there is some lactose. A product that has 2 grams of sugar or less per serving are often safe to drink. If you are lactose intolerance, you've now got information to start looking for lactose in all the right places.

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Related: How does gastric bypass surgery work?

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During Roux-en-Y gastric bypass surgery (gastric bypass) the top of the stomach is stapled to form a small pouch. The small pouch becomes a new, smaller stomach and is totally separate to the rest of the stomach. This small pouch is then 're-plumbed' to the jejunum, the middle part of the small intestine, bypassing the first part of the intestine called the duodenum.

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The new, smaller stomach pouch allows you to eat only a small amount of food before feeling satisfied. There are also some hormonal changes that occur help to decrease your appetite.

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bypassing the first part of the intestine means less vitamins and minerals are absorbed. This is why it is essential that you follow the advice of your team regarding vitamin and mineral supplementation.

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Maintenance

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Unlike the gastric band, the gastric bypass does not require any ongoing adjustments. However, follow up is necessary to ensure your weight loss is appropriate, you are receiving adequate nutrition and that the surgery is not having any negative effects on your health.

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One study has found the most intense weight loss occurs in the first six months following gastric bypass surgery and will slow in the second six months, stabilising in the second year. It is likely, however, that everyone will have a different experience.

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As with all forms of weight loss surgery, success is not guaranteed. Lifestyle changes including healthy eating and regular physical activity are key ingredients in your long term success following surgery. Whilst the size of the new stomach helps prevent overeating, the food choices you make are important. People who maintain their weight losses long term generally avoid high fat, high-energy foods.

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As well as improving weight loss and maintenance, it is important to avoid high sugar and/or high fat foods as following gastric bypass surgery they can lead to a side effect called dumping syndrome. See a simple explanation of dumping syndrome here.

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A 2012 study showed that following gastric bypass surgery, those who kept in closest contact with their support team achieved better results. Your team is there to guide you to get the best results following surgery, so make the most of them and keep in touch! They have all sorts of hints and tips to help you on a successful journey.

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Related: To Snack or not to Snack - Ask your Dietitian the Question

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It would seem to make sense that the less you eat the more weight you lose, but there is a limit to that effect. Research shows that no additional weight is lost when calorie intake drops below 800 Calories per day. If there's no benefit why do it? Food is enjoyable, so enjoy as much as is reasonable. With most surgeries, it is impossible to consume the volume represented by 800 Cals of healthy foods in only 3 meals in the early days. As time goes by, volume tolerance increases but this is likely caused by the nutritional and recreational drive to eat, resulting in larger volumes being consumed and stomachs effectively stretching.

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To me, this suggests that you can afford to eat 800 Calories but only if the volume never exceeds 1 cup.

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I recommend planning for a mid morning, mid afternoon and supper snack from the list of vital snacks. The vital snacks contain nutrients that are critical for those on a very low calorie intake and include fruit, dairy, nut and vegetable based snacks in approximately 100 Calorie portions.

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What's your favorite fruit, dairy, nut or vegetable based snack?

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Related: Transitioning to Solid Foods

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Our goal is to help patients transition as quickly and safely as possible to more solid foods. A common report from our patients is that it only takes a small bite or two of solid food to feel full. That's the point. You will feel more fullness with more solid foods. That is surprising after being on liquid and soft sources of protein for so long.

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Solid foods stay with you longer, which is another way of controlling calories as you transition to more solid food. Try a new food per day. Start with a soft version before moving to a more solid version. For instance, try a meatball made with ground turkey breast before you eat a slice of turkey breast. Try that same food for two to three days before you put in on your "safe" or "tolerated" food list. And always… chew, chew, chew to applesauce consistency.

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Related: Four things we can learn from watching kids eat

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I recently came across an article online titled '5 Things We Can Learn About How to Eat by Watching Kids'. Interestingly, four of the five tips are topics I often discuss with my clients undergoing weight loss surgery. The five tips were as follows:

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1. Be picky - only eat your favourites

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2. Slow things down

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3. Keep it simple

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4. Eat with your hands

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5. Eat when you're hungry and stop when you're full.

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Whilst eating with your hands is one I tend to skip, the other four tips are very relevant.

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1. Be picky - only eat your favourites

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Have you found yourself scouring the supermarket for the perfect fat free, sugar free but still deliciously tasty chocolate? Dark chocolate of course, so it still provides all the antioxidants. How did that search go? I'm guessing you're still searching.

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There is no substitute for the real thing and that is not only true of chocolate, but a whole range of foods.

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After weight loss surgery you have less space to fill with food, so it makes sense to fill it with food you enjoy. Sure, you need to make sure you are eating a balanced range of foods to get all the nutrients you need, but you should be doing this with food that is pleasurable.

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Tania, a gastric bypass client puts it very simply: "I do what the French do, I eat everything I want, but I eat in small portions."

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2. Slow things down

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Eating too quickly and not chewing foods properly are both problematic after weight loss surgery. Many of you would have learnt very quickly what happens when you eat too quickly - discomfort, pain and regurgitation.

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Have you ever told your child to hurry up when they are eating? Well perhaps they are the ones that have it right. I'm currently feeding a nine month old baby. I happened to watch the clock last night as she ate. Dinner took us about 20 minutes. Perhaps these children are on to something!

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It should take up to 20 minutes to eat a small meal. If there is food left on your plate after this time, discard it.

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Concentrate while you are eating. Sit up straight and avoid slouching. Set aside time for meals and avoid doing other things whilst you are eating. Put simply, slow down.

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3. Keep it simple

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Many clients of mine will have heard me say that there is 21 meals in a week, so they don't all have to be perfect.

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Do you need to serve meat and three different coloured vegetables every night? No. Do you need to cook a full roast meal every Sunday? No. Do you need to know exactly how many grams of carbohydrate you eat each day? No.

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Sure, you need to ensure you eat a balanced range of foods and your dietitian can guide you with that. But if you can't be bothered cooking is there a problem with throwing a tin of tuna and some pre washed salad leaves in a wrap for dinner? No.

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Keep a supply of simple foods on hand that you enjoy for those times when you just need to throw something together. Here are a few of my favourite staples I keep on hand to throw together a whole array of meals:

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§ Eggs

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§ Tinned tuna or salmon

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§ Lean sliced meat

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§ Oven ready/microwave ready frozen fish

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§ Baked beans

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§ Pre-washed salad leaves

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§ Avocado

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§ Mixed frozen vegetables

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§ Tinned corn

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§ Tinned 3 bean mix

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§ Tinned beetroot

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§ Diced tinned tomatoes

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§ Wholegrain/multigrain crackers

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§ Wholegrain/multigrain wraps or mountain bread.

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4. Eat when you're hungry and stop when you're full.

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Have you noticed that a child can eat almost all of a sandwich, pushing away the last two mouthfuls announcing that they are full? Our instinct is often to tell them to finish what is on the plate, remind them of the starving children in Africa, but is this doing more harm than good?

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Children have an innate ability to interpret their hunger and satiety signals, but we often encourage them to override this. What does this teach the child? To eat whether you are hungry or not.

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I have spoken to hundreds of people undergoing weight loss surgery and many were told to finish the plate, or were not allowed to leave the table until they were finished their meal. Many have also said that they have felt truly hungry for some time.

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To successfully manage our weight we must be able to interpret the hunger and satiety signals our body gives us. (Satiety is the feeling of satisfaction after eating.) No matter how healthy food is, too much of it is not good for us.

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Do you need to spend some time following surgery re‐learning how to listen to your body's signals? Perhaps you need to watch a child eat and follow their lead.

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Related: When Too Much of A Good Thing isn't Good.

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You take your supplements every day because you know deficiencies are a risk following weight loss surgery. You might also know that insufficient levels of certain vitamins and minerals can slow down your metabolism-and your weight loss. Have you ever wondered though about that saying, "Too much of a good thing, isn't so good?" While it's true that deficiency is a concern for health, vitamin and mineral excesses can be very serious as well.

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One vitamin that hasn't historically been a major concern for bariatric patients is B6. That's changing however as dietitians across the country are reporting more and more cases of B6 toxicity.

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Here's what's happening: B6 is often part of the B complex supplements most patients take every day. There's also B6 in most multivitamins. Additionally, more food manufacturers are fortifying their products with vitamins (like B6!) to appeal to health-conscious consumers. [Fortifying means adding vits/mins that weren't there in the first place.]

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The Recommended Daily Allowance or RDA for B6 is 1.3 milligrams to 1.7 milligrams per day for adults. The maximum daily intake is no more than 100 milligrams/day. When you start adding up your intake, it's easy to see how you could be getting more than you need-a lot more!

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What about the B6 naturally occurring in food? Typically, natural sources of vitamins and minerals in food and drink are not the cause of toxic levels in humans.

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Signs and symptoms of excessive B6 include pain and numbness of the arms, legs, fingers and toes. In severe and advanced cases, difficulty walking has been reported. Even more alarming? Some of these symptoms are irreversible if not caught early.

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So take the time to do a quick check of your personal supplement intake-not just B6. Share any concerns with your healthcare provider.

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One thing is for sure. You can't know where you stand without regular bloodwork. Make sure you get blood taken at all the scheduled times following your bariatric surgery. Often, it takes more than a year for deficiencies and/or toxic levels of vitamins and minerals to appear.

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Protect your bariatric investment -- stay in touch with your bariatric medical team and get those labs done!

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Related: Breaking the Fast

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A common meal pattern seen with new patients is skipping breakfast. The most common reasons include lack of time and not being hungry. Once a patient starts eating breakfast, the lament is "I'm so hungry about an hour after breakfast!"

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You are likely experiencing physiological hunger. If you go too long without eating, your body will start breaking down your muscle to convert to blood sugars. When you lose muscle mass, you burn fewer calories. Your muscle mass is like the idle on a car. When the idle is set high, the engine burns more energy. When the idle is set low, the engine needs less energy to run. Good muscle health is like having a higher idle set point for your body.

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Skipping breakfast to lose weight backfires for two reasons. The first problem is that you lose muscle mass, which decreases your ability to burn calories. The second problem is that you will get too hungry by the next meal which leads to overeating. Eating too many calories at one time leads to storing fat. Research shows that starting your day with a high protein meal leads to eating fewer calories throughout the day. A high protein breakfast can be eggs, light Greek style yogurt, low fat or fat free cottage cheese, string cheese or other low fat cheese, a high protein shake or high protein cereal like Special K Protein or Kashi Go Lean with skim or low fat milk. Start eating a high protein breakfast within an hour after waking to get your metabolism started.

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Related: Spring into Action with Water

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Just as plants need water to grow, water is essential to our overall well-being. By living complicated lives, we have lost our way in using simple, basic resources like water.

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\\nIf the question was posed to people walking on the street, "Which is healthier - this glass of water or this glass of soda?" most would point to the water. Though the majority of people know water is the healthier choice, current statistics show more people drink soda. So the real question is, if we know that water is the better choice, then why are we grabbing for its alternative?

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\\nWater helps to maintain hydration, metabolize fats in maintaining energy balance, and eliminate toxins from our bodies. There are multiple drinking water options as well: adding carbonation to make seltzer water, adding citrus wedges (like lemon, lime or orange), adding mint leaves or cucumber, adding herbs to make iced or hot herbal teas, and many more.

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\\nMaking healthy choices, like drinking water as opposed to drinks with added sugars or that are processed with ingredients we can barely pronounce, requires action. For a lot of us, the step toward living a healthy lifestyle by acting upon the basic knowledge we have has become more complex than we anticipated. In fact, the opportunity to make healthier choices exists within us.

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\\nHow does water fit into your health plan? Let me know by leaving comments below.

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Related: Food after WLS...it's not just about eating less!

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Losing and keeping the pounds off after weight-loss surgery largely depends on not just eating less, but upon eating the right foods, with the right nutrition, in the optimum amounts. But finding the food you can, and moreover want, to eat, and making the transition from your 'old' life to a healthy new one, can be challenging.

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\\nEven if you know a great deal about nutrition, putting this into practice is hard. From the early post-op days on fluids and soft foods, moving onto what I call 'Food for Life', it is important to practice 'mindful eating', making sure that you eat right with just about very bite.

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\\nIronically, this can often be easier in the early 'honeymoon' period after surgery when you might not have any real appetite or hunger for food, than the later stages, although there can be the danger of not eating or drinking enough. During this time you can maximise your weight-loss results by eating right and exercising regularly.

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\\nProtein will be your greatest priority during this time and it is fair to say will always be. Most patients are told to aim for 70g per day to help good healing. Carbohydrates come next, and although these vary by surgical procedure as well as medical issues (like diabetes), 130 g per day is often what is quoted in bariatric surgery literature. The aim here is to ingest many of these as complex ones, found in plant-based foods, rather than as simple sugars. This figure may seem overwhelming and most likely won't happen in the first few months after surgery, but it is certainly something to aim for at least 6-9 months post-op.

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\\nFats, often labelled the bad guys, also have a place but vary enormously according to procedure, and the mantra here is to steer clear of saturated fats (and most definitely trans-fats), keeping the level down to under 3g fat per 100g.

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\\nAdd to that the advice about eating '5 a day in the UK'; keeping up the fibre; hydrating well with at least 2 litres/9cups water every day; not forgetting the daily taking of multi-vitamin and calcium+ supplements, and you have a regime that is more than a little testing.

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\\nIt has been my challenge as a food and cookery writer to develop recipes for all these stages of post-op eating, taking some of the guesswork out of cooking on a daily basis. The recipes on my website www.bariatriccookery.com and in my books 'Return to Slender' and 'Return 2 Slender...Second Helpings' have all been devised and tested to not only work (a minimum requirement) but also to adhere to these nutritional guidelines and to be deliciously tasty too.

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\\nRecipes are however one thing and general eating is another. I would still advocate that patients become avid, if not fanatical back-of-pack or label readers. Understand and be aware that food manufacturers add, sugar, fat and salt to foods to make them taste better (and become addictive?). Check out the best nutritional options -take a little extra time in the supermarket/farmer's market etc to find them; speak to other bariatrics for advice; and pass on anything you find that is good at support groups and forums for everyone to benefit.

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\\nHowever, the best advice has been left until last. LEARN TO COOK - that way you can control your food intake, know just what you are eating and still have a good, healthy relationship with food.

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\\nRemember it's not just about eating less, although you will undoubtedly have a smaller plateful than your non-weight-loss surgery counterpart, but about nourishing yourself with inspiring dishes to ensure sucess, long term.

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Related: Hydration…Watch Out for Liquid Sugar!

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We're at the end of summer, but not the end of hot weather. Hydration will continue being important, especially if you do a lot of sweating. If you haven't had surgery, you may be in the habit of reaching for pop, juice, lemonade, sports drinks or sweet tea to quench your thirst. Stop and rethink those drinks.

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A 12 oz. can of regular pop has about 40 grams of sugar, which is 10 teaspoons of sugar. A 12 oz. glass of 100 percent juice has the same amount of sugar as a regular pop. Ten teaspoons of sugar is just under a ¼ cup of sugar. If you are drinking 4 cans of regular pop per day, you're getting close to a full cup of sugar. Yikes!

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Lemonade and sweet tea can have similar amounts of sugar. Sports drinks aren't as sugar laden, but can have up to 12 grams of sugar (3 teaspoons of sugar) in an 8 oz. serving.

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Higher sugar intake leads to high blood sugars. High blood sugars lead to more insulin being released by the pancreas to get your blood sugars into a normal range. Too much insulin can actually lead to more of the calories stored as fat. Yikes, again!

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Good old plain water is a great first choice. Need some flavor? Consider using one of the many powdered or liquid, sugar free flavor options. If you have headaches, avoid any with aspartame. Infused water is taking berries, citrus, cucumbers, mint and other fruits and vegetables and steeping them in water to draw the flavor into the water.

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Start with at least 64 ounces of water per day. You will need more depending on your size and activity level. Read labels or go online to check out the sugar content of some of your favorite beverages. There are lots of ways to stay hydrated, as long as you stay away from the sugars lurking in your liquids!

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Related: Helping you feel satisfied - the Low GI approach

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Recently I have found myself spending a lot of time talking with my weight loss surgery clients about getting the most from what they are eating, in particular, feeling satisfied after eating. Whilst the purpose of weight loss surgery is to help you feel satisfied on a smaller amount of food, the type of foods you choose is important to help maximise this.

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There are two key ingredients in helping you to feel satisfied after eating:

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1. High fibre, low glycemic index carbohydrate-containing foods 

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2. Protein-containing foods. 

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This post will demystify the glycemic index, or GI. Protein will be the focus of a later post. 

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The GI is a measure of the effect that different carbohydrate-containing foods have on blood glucose (blood sugar) levels. It describes the way our body digests and absorbs these foods. Carbohydrate-containing foods include:

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\\nbreads, cereals, rice, pasta and noodles\\n
\\nstarchy vegetables including potato, sweet potato and corn\\n
\\nlegumes including baked beans, kidney beans, chickpeas and lentils\\n
\\nfruits and fruit juices\\n
\\nmilks, yoghurts, custards and ice cream\\n
\\nany food containing flour or sugar.\\n

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Some carbohydrate-containing foods are broken down and absorbed quickly, so they raise our blood glucose level faster and higher. These are high GI foods. Other carbohydrate-containing foods are digested and absorbed more gradually, causing a slower, longer lasting rise in blood glucose levels. These are low GI foods. Low GI foods keep us feeling satisfied for longer after eating.  

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Often people experience a 'honeymoon' period following weight loss surgery, where weight loss seems automatic. Unfortunately this may not last forever and weight regain can occur with all surgeries. Maximising the satisfaction you get from the food you eat is crucial to keep losing weight and maintain that lost weight. A lower GI eating pattern also helps us feel satisfied for longer after eating, which can help with losing weight. For example, if you eat high GI foods at your meals, you are likely to become hungry sooner after the meal than if you eat low GI foods. This can make you more likely to snack and if you have not planned for this, you may be forced to grab something from the biscuit barrel or vending machine.    

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Appetite control is not the only benefit of a lower GI diet. Research has shown that people eating a lower GI diet can reduce their average blood glucose levels, which is particularly important for people with diabetes. Lower GI foods are often also higher in fibre. A high fibre diet helps prevent constipation, decreases the risk of heart disease as soluble fibres can help remove cholesterol from the body and helps protect against bowel cancer, haemorrhoids, irritable bowel syndrome and diverticulitis.  

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Foods are classified as low, moderate or high GI.  

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To follow a low GI diet, try to choose one low GI food at each meal. Eat high GI foods in small amounts, or less often.  

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Head to my website to see a simple table of low, moderate and high GI foods.

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Go to www.glycemicindex.com for further information.

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Related: Your New Stomach is a Set of Training Wheels

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In the forum, I've seen a lot of concern about cheating on the pre-op diet and eating certain foods too soon after surgery. I understand these temptations. (Oh, boy, do I understand.) It is natural to crave what we can't have. Foods like pizza and pasta suddenly seem preternaturally delicious. If we give in and eat something that's not on our diet plan, we react with guilt and shame--and we usually realize that pizza is not as awesome as we remembered.

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Unfortunately, cravings come back again and again, promising a taste explosion. If we don't learn to resist most of these cravings, we can derail our weight loss efforts.

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The next time a craving hits, try thinking about your smaller stomach as a set of training wheels instead of a set of restrictive rules. Your current body--your bicycle--is functional, but you have your heart set on that sleek racing model or muscular mountain bike. You yearn to zip down the street or take that rugged path through the forest. Before you can master the better bicycle, though, you have to learn to balance on the one you have--under all road and trail conditions. You have to be ready for the challenges ahead.

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Training wheels are boring, but they help us avoid the worst of the bumps and bruises that can happen when we lose our balance and fall off the bike. We can still slip up and take a spill, but it's likely to be much less painful than if we were careening down a street unchecked, with no extra wheels to keep us upright.

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Our smaller stomach does the same thing for us: it helps us maintain our balance while we're learning to nourish our bodies again. Before surgery, most of us had the freedom to eat a large variety and amount of food. We lost our balance repeatedly, and we paid for it with increased weight and medical problems. We injured our body--and mind--over and over.

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We've already invested a lot of resources in our weight loss surgery, and we have a limited amount of time to make use of these training wheels. If we take the extra time and effort to learn the fine art of balance, we will be better prepared to handle the freedom that comes with the new, better models of our bodies. The excitement and adventures waiting for us down the road are worth a little boredom with the training wheels now.

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Related: Perfectionism breeds failure

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The less perfect you are, the more weight you will lose.

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\\nChange your thinking and lose weight successfully with the Gastric Band, by proportioning 80% of your time follow eating well and being physically active and the remaining 20% let the rules relax. The Gastric Band does not stop emotional eating or grazing, you must do this yourself.

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\\nWhich categories do you relate to?

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\\n1.\\t I experience good or bad days with my eating

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\\n2.\\t Once when I start eating the wrong food, I can't stop

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\\n3.\\t I often crave food I shouldn't be eating

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\\nA great starting point is for me to help you stop feeling guilty about your food choices and stop you from starting yet another diet, as this mentality makes you crave and over eat the wrong foods. That is foods that slide through the Gastric Band very easily. The 7 steps below, illustrates what I describe as the dieting cycle. When this is broken, you can control your habit and stress eating with more ease.

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Dieting Cycle

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(1) You decide to start losing weight

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(2) You stop eating "Bad" Food

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(3) You crave "Bad" food

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(4) Eat some "Bad" food

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(5) Feel guilty and unhappy with self

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(6) Feel like broken diet & over eat

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(7) Will start again on …….. and the viscous cycle begins of trying to start again

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How To Break The Dieting Cycle.

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\\nSOLUTION: Step (1)

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\\nWe need to stop the cravings, and the only way to do this is to STOP viewing food as being either "good" or "bad". You may hear yourself making comments such as, "I can't have that; it is bad" or "That is a bad food" for example.

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\\nInstead, you need to describe the food for what it is. If there was a blind person who had also lost their sense of taste and smell and they asked you what chocolate tasted like, your description of: "oh, it is a bad food!" would leave them with no idea or understanding of the food.

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\\nRather, you should respond, "It is plain dairy milk chocolate in the shape of a small square, which has a rich chocolate taste". Even having read this last phrase, have you felt your shoulders drop? Chocolate is just a food. Describe the food in a neutral manner.

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\\nSOLUTION: Step (2)

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\\nThe second mistake we need to correct is to stop giving yourself permission to overeat. You must stop making the comment, "I will start again on …"

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\\nThis must be changed to, "I am not starting anything; I am not on a diet!" Then, you do not give yourself permission to continue eating the easy foods.

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\\nImplementing both Solutions, Steps (1) and (2), takes practice and commitment. The more often you try to see the benefit of how it works, the faster you will obtain control of your weight with the Gastric Band.

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\\nSlowly with practice you will gain more control confidence and you will begin to shine.

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Related: Cooking with Eggs

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Last week's posting updated our information about the excellent nutrition that eggs provide. Let's cover how to cook with eggs. How many know the basics of hard boiled or scrambled eggs? Our patients have a wide variety of cooking skills.

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For novice to gourmet cooks, you'll find plentiful recipes on the website www.incredibleegg.org. From the home page, click on Recipes & More. Scroll down until you see Eggs 101-Cooking School. From there, you can select how you want to cook your egg.

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You'll find a picture and video presentation about the various cooking methods from the humble hard boiled egg to sophisticated soufflé. One type of egg cookery is making a custard. If you've ever had pumpkin pie, you've had a baked custard.

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For a bariatric friendly recipe, click on Low carb, Low Fat Pumpkin Custard for an idea you can use this Thanksgiving. This recipe is for patients that are at least 6 weeks out of surgery. Once the ingredients are assembled, it takes about 15 minutes to mix and get into the oven. In the hour it takes to bake, you could take a walk around you neighborhood or write a list of things for which you are thankful. Enjoy!

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{Image: incredible egg.org}

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Related: Eggs - A Change of Heart

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Once upon a time, eggs yolks were the bad guys in heart disease. What's up with eggs, these days? So, what's the good news? 70 calories. 13 essential vitamins and minerals. 6 grams of a high quality protein. All of the essential amino acids, which are the ones we have to eat because our bodies can't make them. 210 mg cholesterol in the egg yolk. 5 grams total fat, mostly unsaturated. Zero carbohydrates. Less than 20¢ per egg.

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Brown eggs are not healthier than white eggs. Omega-3 fats are present only if the chickens eat a special diet. The yolk contains a strong array of nutrients that help with our health from when we are conceived to when we are old. Protein and nutrients in an egg can aid in muscle strength, brain development and function, weight management and eye health.

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Not bad for a food that's about the size of your new stomach pouch after bariatric surgery. Research now points to genetic and lifestyle (nutrition, exercise, smoking) factors having a much greater impact on the development of heart disease than how much cholesterol from egg yolks you are consuming. Newer research indicates about a third of us need to limit cholesterol. Tracking your labs is a good way to find out if you should avoid eggs or enjoy them. Those with an egg allergy need to avoid eggs.

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Weight loss after bariatric surgery is one significant lifestyle change that improves cholesterol numbers. More information and recipes are available on www.incredibleegg.org or www.eggnutritioncenter.org. For bariatric patients, you can start having eggs again when you start the soft/puree foods. This means 1 week after RNY gastric bypass and 2 weeks after sleeve gastrectomy.

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Image: Incredibleegg.com - Easy Hard-Boiled Eggs

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Related: Great Summer Meals to Keep You Chillin'

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It's summertime again! Which means hot sun, cold drinks, and trips to the beach, the pool, and to the lake (camping, anyone?). Summertime is a great opportunity to get back on track with protein-rich meals that will help you beat the heat!

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Grill Baby!

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Grilling is one of the best ways to cook meats and vegetables in the summer - it won't heat your house and you can be creative with marinades! We love to marinade chicken in a simple mixture of 1/4 C olive oil, 1/4 C lemon juice, 1 T garlic, and 1/2 C water. Steak gets a bath in 1/4 C soy sauce, 1/4 C Worcestershire sauce, and 1 T garlic. Pork and fish can get a similar treatment as chicken, as can vegetables. You can also use store bought marinades and salad dressings to add bold flavor. Be sure to watch for added sugars and salt, though! A great tip for grilling - for fish and vegetables, invest in a grill basket. It will keep your food from falling through the grates of the grill!

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Meat Salads

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Meat salads are absolutely fabulous in the summer. Tuna and chicken are super popular, but you can also use salmon (remove the bones if using canned), mixed seafoods, and shrimp! A great cold shrimp salad that is full of flavor, protein, and good fats is shrimp, avocado, and red onion in a summery lemon vinaigrette. You can find the recipe here! You can also play with flavorings, adding herbs, different sauces, and condiments to your meat salad:

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Southwest Tuna Salad

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1 T Greek Yogurt

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1 T salsa

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1 can chunk light tuna, packed in water, drained

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chopped onion to taste

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2 T black beans (optional), rinsed and drained

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Combine yogurt and salsa in a bowl. Add onion and stir. Allow to sit for 2-5 minutes to marinate onion. Add beans (if using) and tuna and gently stir. Serve chilled.

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Speaking Of Salads ...

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Another great salad option is a salad-in-a-jar. These are all the rage on Pinterest and Facebook, and are as customizable as you'd want. Just layer your salad with dressing on the bottom, followed by any chopped veggies such as tomatoes or onions, then whatever meat you're using, followed by cheese, then your salad greens. The formula we use is (in a 1 pint jar):

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1 T dressing

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2 T chopped veggies

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2-3 oz cooked meat

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1/2-1 oz shredded or crumbled cheese

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Salad greens packed into the top of the jar.

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Don't have a jar? No worries, just throw your stuff in a bowl and give it a toss! Pre-chopped veggies can be stored in an air-tight container for a few days, so you can still do prep work earlier in the week.

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Soup? In SUMMER???

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Yes! You can even do soup in summer! Light broth-based soups and cold veggie soups can help you stay hydrated in the heat. A super easy throw-together light soup I love is:

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(About 4 bariatric servings of 1/2 C)

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1 C shredded chicken

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1 box chicken broth or stock

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1/4 C frozen corn (optional)

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1 chopped zucchini

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You LITERALLY throw it all into a pot, bring it to a boil, cook it for 10-15 minutes and you're done! Soup eating tip - if you have the gastric band or the RnY it may be helpful to drink the broth first then eat the solids.

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Sip Sip Sip!

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Yes, keeping those fluids up is STILL important. Even more so during the summer! Water is best for hydration, of course, but sometimes you want something a little different. Try making your own fruit-infused water or tea! There are some great infuser bottles and pitchers on the market right now, or you can just muddle (shmoosh a bit) the fruit in the bottom of your glass or pitcher and pour your liquid right over it. This is also a great way to use up that leftover fruit you might have sitting in your fridge!

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Summer is all about staying cool, calm and collected - all the while keeping our nutrition and hydration going! You can do it! Share your ideas below in the comments section!

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Related: How to Make One Dish Work Many Ways

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To overcome this meal time monotony I like to freeze 'meal bases' that I then present in a variety of ways to create different meals.

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These 'meal bases' are protein based making them perfect for managing meals post weight loss surgery. Below are three options I love to have on hand in the freezer.

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Option One: Bolognaise Sauce

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Make a large batch of your favourite bolognaise sauce (don't forget to grate in a few vegetables to boost nutrition) and freeze in individual or family size portions.

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Serve with a small portion of pasta (try risoni if you find pasta hard to tolerate).\\n
Serve over couscous with a small side salad.\\n
Pour over a baked potato and top with grated cheese and Greek yoghurt.\\n
Pop in a wrap with shredded salad and cheese.\\n
Serve on a grainy slice of toast - Burgen is a great option at approximately 4-5g protein per slice (depending on the variety).\\n

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Option Two: Mexican Style Chicken Mince

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Cook onion, garlic and grated carrot with ground cumin and coriander. Add lean chicken mince and brown. Add one drained can of five bean mix and pour over a jar of your favourite salsa. You can add spinach, peas, mushrooms or any other of your favourite vegetables. Don't be afraid to add some extra salsa if you need a little more moisture.

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Place mixture into halved red capsicums and bake - top with avocado, Greek yoghurt and chilli flakes if you enjoy a little spice.\\n
Serve in a taco shell with shredded/diced salad.\\n
Serve in soft tortillas with shredded/diced salad.\\n
Serve over 'zucchini pasta' (using a vegetable spiralizer).\\n

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Option Three: Tandoori Chicken

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Marinate chicken tenderloins or chicken thigh fillet in a mixture of tandoori paste and Greek yoghurt.

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Serve in wraps with raita, cucumber, carrot, coriander and chilli.\\n
Serve with rice and steamed vegetables.\\n
Top pizza base with mango chutney, add cooked chicken, red onion, spinach, chopped raisins, cashew nuts and cheese. Bake in the oven, then sprinkle with fresh coriander and extra Greek yoghurt.\\n
Add to a salad of cucumber, carrot, coriander, mint and cashews. Dress with a mixture of Greek yoghurt, mango chutney and lemon juice and top with microwaved pappadams.\\n

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Happy cooking!

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Related: Make Your Own 100 Calorie Snack

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The 100 calorie snack packs are easy, convenient and portion controlled. However, have you read the ingredient list? The first ingredient is enriched flour, which is another way to say white flour. Other ingredients high in the list include sugar, saturated fat and salt. For bariatric patients, this kind of a snack provides little in the way of protein or fiber.

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Eat too many of these snacks and you'll see your weight loss slow down or you'll hit a weight plateau. With a little thought and planning, you can make a healthier version of a 100 calorie snack. Here are a few ideas for nutrient packed snacks that are about 100 calories each:

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•8 oz. glass of skim milk or light soy milk

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•2 tablespoons hummus and 5 pretzel crisps or 10 baby cut carrots

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•2.5 ounces flavored tuna with 3 reduced fat Triscuit crackers

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•6 oz. container of light yogurt with 2 tablespoons blueberries

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•14 unsalted almonds

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•Half a medium pear or small apple (peeled) with 1 ounce low fat cheese

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•½ cup fat free cottage cheese with ½ cup raw veggies

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•10 large strawberries and 1 oz. goat cheese

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•22 pistaschios

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•15 grapes and 1 wedge Light Laughing Cow cheese

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The goal is to combine protein and carbohydrate. You will get protein for your muscles. Combining protein and carbohydrate for a snack will provide sustained energy. Keep in mind the post-surgery diet phase you are in to pick out the snacks that would be appropriate for you. If you have an allergy or food sensitivity, avoid the snacks that contain these foods. Snack happy, but snack smart!

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Related: Is Eating Fruit Like Eating Candy?

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Is Eating Fruit Like Eating Candy?

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In my opinion as a bariatric dietitian, no.

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Is fruit nature's candy?

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Well, I don't know about you, but I haven't yet confused blueberries with blue jellybeans.

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Many of my post-op WLS clients are nonetheless extremely nervous to incorporate fruit back into their diets.

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Some have even been told 'fruit is dirty' by their providers.

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Most feel they ought to avoid fruit-- like mosquitoes in Florida.

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Now I think I know where this is coming from. Many folks with the best intentions believe the sweetness of fruit can prime the appetite-pump for MORE sweets-the high fructose kind.

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If you feel fruit might lead you to return to sweets with wild abandon then you are better off skipping it.

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But for those of you post op gastric sleeve and bypass clients, fully healed from surgery, and hankering for a small piece of watermelon to beat the heat or a tiny bowl of pineapple while vacationing in Hawaii, I say, enjoy.

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When I became a dietitian I took a solemn vow that I would always encourage well-balanced nutrition. To me, that means recommending to my WLS clients: lean proteins, whole grains, fruits and vegetables.

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I understand and encourage my clients to limit carbohydrates. I follow the bariatric plate guidelines and suggest 2 tablespoons of starch at lunch and dinner or, about 10 % of these meals.

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It's late summer. This is your opportunity to enjoy the starchy vegetables of the season like sweet potato, fresh summer corn or green peas.

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And the delicious fruits of summer like Maine blueberries, Georgia peaches and succulent summer melon-in WLS portions.

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Fruits and vegetables, especially the deeply colored varieties like beets, raspberries, kiwi and tomatoes, are packed with disease-fighting antioxidants and nutrients that are so vital to good health.

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Plus, the loads of vitamins and minerals in fruits and vegetables are much better absorbed by our bodies than the version we get in supplements.

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I know many pre-surgery eating habits need to change after surgery. I sincerely hope that doesn't mean you have to avoid some of nature's tastiest treats of the season.

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Related: Eating: The Rules of Engagement

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Lots of people were eating away from the table on a regular basis, eating everywhere from in front of the TV to in bed. Of course there are occasions where this is completely appropriate, such as breakfast in bed on Mother's or Father's Day, or pizza in front of the footy on grand final day. However, when this is happening more often than not, it is difficult to be mindful and eat in response to your body cues. Boundaries are merged and eating flows over into times not meant for eating. This can result in over eating and poor weight loss.

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After reflecting on the comments from our members, we wanted to break the concept of mindful eating down to some basic 'rules of engagement' to help you improve your eating habits and achieve your goals.

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So what do I do?

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Over the next month, try following these 'rules'. Like most rules there is room for flexibility; as an adult you know when a rule doesn't work for you, or when it is time to bend it.

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Aim to always eat while sitting down, ideally at a table or bench.\\n
Avoid grazing while standing up, for example, when preparing meals, passing through the kitchen, ducking into the staff room, etc.\\n
Put anything you want to eat on a plate so you can see your portion. Avoid eating straight from packets, grazing from platters, nibbling at buffets, etc.\\n
Have eating free zones in your home, such as the bedrooms, study and bathroom.\\n
Set a time to signal it is time to stop eating for the day. This will vary from person to person but it helps limit the amount of mindless evening eating that happens so often.\\n
Only snack if physically hungry and when snacking, apply the above 'rules'.\\n

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Remember, aim for progress not perfection. Good luck, and let us know how you go.

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As always, be kind to yourself.

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Related: Oh Nuts!

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This study tracked eating patterns over a 30-year period for over 100,000 people. Nuts are a great source of healthy fats, protein, protein, fiber, antioxidants, vitamins and minerals. Because they are high in fat, nuts carry a lot of calories. High fat intake in one snack or meal can also lead to fat dumping, so be careful about the amount you eat. Nuts come back into your eating as peanut butter or other nut butters after surgery when you can have soft and puree foods. Our patients can have nuts starting two months after surgery. This is also the time they can bring protein bars back into their eating. All nuts have health benefits. Enjoy your favorite nuts…within reason, that is!

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Related: Top 10 Signs of Junk Science

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The missing details often missing include information about how many people were in the study, who was studied (gender, age, ethnicity, socioeconomic level, education level, genetics), how did researchers pick the people to study, how long did the study last, what type of study was conducted, was the study done on humans or lab rats, what question was being studied, were the subjects paid or did they volunteer, who paid for the study and what statistical method was used to evaluate the data. National nutrition and health recommendations are made when a lot of studies agree with each other.

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How can you figure out if the science is valid or junk science? The Food and Nutrition Science Alliance (FANSA) developed the "Ten Red Flags of Junk Science" to help you recognized misinformation about nutrition and health. FANSA is a partnership between the Academy of Nutrition and Dietetics, American Society of Clinical Nutrition, Institute of Food Technologists and the American Society for Nutritional Sciences. The red flags are:

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1. Recommendations that promise a quick fix.

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2. Dire warning of danger from a single product or regimen.

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3. Claims that sound too good to be true.

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4. Simple conclusions drawn from a complex scientific study.

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5. Recommendations based on a single study.

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6. Dramatic statements that are refuted by reputable scientific

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a. organizations.

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7. Lists of "good" and "bad" foods.

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8. Recommendations made to help sell a product.

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9. Recommendations on studies published without peer review.

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10. Recommendations from studies that ignore difficulties among individuals or groups.

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Next time you hear some nutrition or health information, ask "where's the proof?" You might get a surprised reaction from somebody trying to sell you something.

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Related: Highlights from Obesity Week 2014

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Just attended a lecture on food cues and impulsivity. MRI scans showing brain activity were done on obese-prone and obese-resistant rats. The results? After two days of being over-fed, obese-prone rats had continued motivation for food. The obese-resistant rats motivation levels were nearly zero-and the effect lasted for days.

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Researchers are hopeful this research translates to us humans AND that we can make positive changes. Promising changes to appetite hormones and specialized behavioral changes could be the key. Believe it or leave it, MRIs on obese-prone people showed that after just six months of exercise motivation centers in the brain are reduced!

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Related: Are you missing the crunch?

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Kay's Naturals Protein Chips come in single serving bags. Each single serve bag has 12 grams of protein from soy protein isolate. This is a good quality protein source. There are a total of 15 grams carbohydrate and 4 grams fiber. That makes the net carbs 11 grams. So, these chips have more protein than carbohydrate.

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Another protein chip is the Quest Protein chips. Each single serve bag has 21 grams of protein from milk and whey protein isolate. These are good quality protein sources. The Quest chips have a total of 5 grams carbohydrate per single serve bag. Both the Kay's Naturals Protein Chips and Quest Protein chips come in a variety of flavors. Quest chips can be found at GNC and online. The Kay's chips are available online.

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For those of us that adore chips and dips, these chips are great dipped in salsa or a Ranch style dip. To add more protein to your Ranch dip, you can mix plain Greek style yogurt (a 5.3 ounce cup), 1 tablespoon low fat mayonnaise and 1 or 2 teaspoons Ranch dip mix. Finally, we've got a way to have crunch with a punch of protein!

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Related: Where's the Beef?

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After surgery, beef returns to the menu six months after surgery. Beef is a good source of protein, iron and zinc. We emphasize the low fat cuts of beef when you get to have them back in your diet to save calories and avoid saturated fat that can contribute to heart disease. The leanest, or lowest fat, cuts include any cut of beef that has the words "round" or "loin" in the name. These cuts include top sirloin, round steak, eye of round, tenderloin (ex: filet mignon), ground round or ground sirloin.

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Look for ground beef that is 90 percent lean or higher. Choose "select" cuts of beef over "prime" or "choice." The select cuts have less fat than prime or choice cuts. Leaner beef can dry out and work best by using moist methods of cooking like stewing, braising, boiling and crockpot. Use a lid on your cooking dish if you microwave, sauté or stir fry to trap moisture. Dry cooking methods include grilling, broiling, roasting and baking which can dry out the beef. You can prevent beef from drying out by covering with a moist sauce or marinade like salsa, low calorie dressing or low fat or fat free yogurt mixed with herbs and spices. Beef, it really can be what's for dinner!

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Related: Holiday Travel and Bariatric Nutrition

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Does your holiday or business traveling include involve an airport? Healthy food choices for choices for bariatric patients are not abundant in airports. As a bariatric patient you have to plan ahead to have appropriate nutrition available. If your holiday or business traveling involves an airplane, keep in mind what diet stage you are in. After reviewing the Transportation Security Administration's (TSA) policy about bringing food through the security check points, it states that you can bring food through the security checkpoint as long as is wrapped or in a container. Always check with TSA to make sure the current policy accepts the food item you want to bring through the security checkpoint, as the policy can change.

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Consider pre-packaged, single servings of protein powder, light yogurt, cheese sticks or low fat cottage cheese. Pack plastic spoons for the yogurt and cottage cheese or to stir the protein powders into a liquid. Eat the yogurt, cottage cheese or cheese sticks within a couple of hours after you take them out of the refrigerator.

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of single servings of protein powders are available online. Brands include Bariatric Advantage meal replacements, Nectar Grab N Go and Unjury. These are whey protein isolate powders and come in flavors from the standard chocolate, vanilla and strawberry to other flavors like fruit, cookie, chicken and de-caf cappuccino. Protein powders can be mixed with water or low fat milk. The chicken and de-caf cappuccino can be mixed with very warm water. Vanilla or chocolate protein can be mixed with decaf coffee for a mocha or latte. Unflavored protein powder can be added to a broth based soup or hot cereal to boost protein. Remember that whey protein must be kept under 140 degrees Fahrenheit, or it will curdle. For every 6-8 ounces of liquid, add up to 10 grams of protein powder.

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Protein bars are also options. Look for Quest, Nature Valley Protein bars, Pure Protein or Premier Protein. If the protein content in the protein bar is the same or higher than the carbohydrate, then it's an acceptable choice. Search for a food service that offers scrambled eggs, grilled chicken or fish. If you've had success bringing bariatric friendly foods through the TSA checkpoints or found healthy food options in an airport, please let us know what has worked for you.

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Related: Hydration… What counts?

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True or False: You can let thirst be your guide for getting in fluids.

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False. If you are thirsty, you are already dehydrated. Sometimes we think we are hungry when it's really thirst that is getting your attention. Water is the most essential nutrient humans need, meaning you can't go very long without enough water. Water helps regulate body temperature, keeps blood volume up to transport nutrients into cells, allows waste products to be excreted, keeps blood pressure in healthier ranges, aids with digestion, helps prevent fatigue and keeps your mental function in good order.

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Unless you take a diuretic (water pill), you can use your urine color to evaluate hydration. If your urine color is clear or pale yellow, you are hydrated. After surgery, it's a real struggle to get in enough water. Looking for all sources of water is important after surgery. Keeping a water bottle with you at all times is an important strategy to keep hydrated.

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You can count fluids that don't have caffeine, calories or carbonation towards your water intake. The no-calorie flavor powders and drops can be used if plain water gets boring. All those protein drinks you have contain mostly water. Count 80 percent of your protein drinks as water. Clear liquids count as well. Clear liquids include broth, sugar free gelatin and sugar free popsicles you focus on during the clear liquid diet phases before and after surgery.

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You have a limited stomach pouch after surgery. This means your foods and fluids after surgery have to become nutrient dense, which means you need to pack in a lot of nutrition in a small volume. Hydration is a habit of very high importance. Remember, if you think you are hungry, it might be hydration that needs to be handled.

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Related: Is your drink really caffeine free?

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Caffeine can irritate the stomach pouch and interfere with sleep. These are some reasons we ask you to eliminate caffeine before surgery. Coffee and tea are well known sources of caffeine. These must specifically state "de-caffeinated" on the label to be considered caffeine free. Many patients assume green tea is caffeine free. It is not. Check the label of all tea and coffee sources to make sure it states "de-caffeinated."

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Where else does caffeine lurk? Energy drinks will have caffeine in them. One ingredient in energy drinks is guarana, which is another plant based caffeine source. Green coffee bean extract has gotten a lot of attention in the media this year. It's still coffee and it will still have caffeine in it.

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Caffeine is a central nervous system stimulant, not truly an energy source. True energy sources are carbohydrate, fat and protein. Chocolate will also contain a little caffeine, but is allowed in the bariatric nutrition guidelines. Three cheers for that, right?

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Some medications can also contain caffeine, so you must check the ingredient labels to make sure it's caffeine free. These medications can be both prescription and over the counter medicines. Caffeine can also serve as a diuretic in some people if too much is consumed. Start checking out those labels to find caffeine free drinks.

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Related: Fall Produce to Enjoy

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Front porches are beginning to be adorned with colorful pumpkins and gourds, which makes me stop to think about the array of fall produce to enjoy this time of year. In the fruit category, consider apples, pears and cranberries. Did you also think about fall squashes? The commonly found squashes include butternut, acorn, Hubbard and pumpkin.

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How can bariatric patients enjoy these foods? Very carefully! Most of these foods are rich in natural sugars and complex carbohydrates. Combine them with a protein source and you've got a healthy snack to enjoy. Try half of an apple (peeled and sliced) topped with 1 tablespoon creamy peanut butter. Use a fourth of a cup pear chunks mixed with a third cup low fat or fat free cottage cheese.

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Keep in mind fresh produce comes back to your eating 4 months after surgery. Search for "sugar free cranberry sauce recipes" on the Internet and you'll get millions of hits for recipes. A few ounces of roasted turkey breast topped with a teaspoon or two of a sugar free cranberry sauce would make a great way to enjoy Thanksgiving dinner if you are 2 months or more out of surgery.

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The fall squashes (butternut, acorn, Hubbard, pumpkin) are good sources of vitamin C, fiber and beta-carotene. Cut the squashes in half vertically (stem to blossom end), scrape out the seeds, place cut side down on a foil lined baking pan and roast at 350-400 degrees F in a pre-heated oven for 45-60 minutes until tender. Let these cool enough for you to cut into chunks or scoop out to puree to serve as a side dish. The chunks or puree can be served as a side dish. You can use the puree to make a soup by starting with 2 tablespoons of the puree thinned with 3 to 4 ounces chicken broth and stirring in 5 to 7 grams worth of an unflavored protein powder.

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Too busy to cook from scratch? Try the canned puréed pumpkin as a soup base or just stir the protein powder into canned butternut squash soup found among the gourmet soups in the grocery store. May your eating this fall be carefully planned and bountiful.

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Related: Cold Weather Check up

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How many of you had your furnaces checked for the upcoming cold weather? It's nice to have a warm, cozy home when the temperatures plummet outside. How does this affect a bariatric patient? The air both inside and outside air become very dry, which can lead to dehydration. The thought of drinking something cold doesn't sound as appealing when it's cold outside.

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Happily, there are many decaf, sugar free drink choices on the market. Look online or in your grocery store for herbal teas, sugar free apple cider and sugar free cocoa mixes. These are water based and can count towards your fluids. There are decaf, sugar free drink mixes in packets and the convenient K-cups. If you have a chocolate protein drink you like, try warming it up for warm cocoa.

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The most abundant nutrient in a protein drink is water. If your chocolate is whey based, keep the temperature under 140 degrees Fahrenheit, or the protein will curdle. When looking at herbal or decaf teas, make sure the tea is caffeine free. A cup of decaf coffee or tea can count towards your fluids as well. Warming a cup of water with a lemon slice or a squeeze of lemon juice can make a cozy cup of lemon tea. Another choice is sipping on warm cup of low-sodium broth. Keep sipping . . . . even when there's frost on the pumpkins.

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Related: Sugar- start with the children

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A recent intake survey in the US which was published in The Journal of Public Health showed that almost everyone (96%) had given their child a sugary drink in the previous month. Categories included Fruit Juice Drinks ( eg. 25% juice) / Carbonated sugary drinks / Sports Drinks / Flavoured water eg. Vitamin Water / Energy Drinks / Iced Tea so it seems we're all doing it. Some more than others with the most common choice being fruit juice drinks or carbonated soda / soft drinks.

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Parents answered questions on which drinks they believed to be healthy alternatives to water. Almost all identified 100% fruit juice and milk as healthy options ( note that even 100% juice is ideally limited to 1 glass per day and is better substituted for 2 pieces of actual fruit so that fibre is consumed.)Many parents also reported that fruit juice drink, vitamin water or sports drink were also healthy options but are they right?

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The World Health Organisation has recommended that all nations reduce their intake of added sugars to 10% of calories and suggest it would be even better if we could make it down to 5%.

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To put this into perspective, if we just take the 10% goal this sets a target of:

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Men: 12 - 14 tsp added sugar per day

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Women: 10 tsp added sugar per day

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Children: 7 tsp added sugar per day.

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This still sounds like a reasonably generous limit until we look in children's lunchboxes and find well meaning parents providing a 250ml fruit juice drink with 6tsp in that alone

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The current estimates suggest that the average American consumes 32 tsp of added sugar per day and the average Australian consumes 25 tsp. About half of this intake comes from sugary drinks. We are way off the mark. Never mind the current trend to aim to cut out sugar altogether, just getting it down to 10% is going to be a battle.

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We need to start young with our children and give them water to drink.

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When my children were young, I gave them pocket money and if we were out and they requested a sugary drink or a fast food meal - I let them choose whether to buy that with their own money or I would be happy to pay for water or a sandwich. I found this an easy option for kids to decide how important those foods were to them. Usually they went with the healthy meal option but they knew they were free to choose, so there was no deprivation involved and no tantrums.

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Stay tuned for the next entry showing clearly the number of teaspoons of sugar in various drinks so you can be on the lookout for unintended sugar.

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What strategies do you use to encourage water or milk intake amongst the children in your life?

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Related: 8 Diet Myths Debunked!

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8 Diet Myths Debunked!

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Our number one priority is to lose weight. In search of a new healthy lifestyle, we often self sabotage our well-intended efforts by investing in diet myths and misinformation about weight loss. Don't fall into the trap! Check out these 8 Diet Myths.

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1 Negative-calorie foods

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Some high fiber foods like celery and citrus fruits are claimed to be negative calorie foods. The presumption is that it takes more energy for the body to digest these foods, and thus burns more calories than the calories in the food itself. The truth is that the amount of calories it takes the body to digest food are minuscule compared to the calories in the food.

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Read a counter-viewpoint and decide what is true for you, "Eating Foods that Burn More Calories."

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2. Muscle weighs more than fat

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Don't fool yourself. A pound of muscle and a pound of fat weight the same - 1-pound! However, because muscle is more dense than fat, having more muscle on your frame will make you look leaner. Also, 1-pound of muscle burns 50 calories a day whereas 1-pound of fat burns only 2 calories - so muscle increases your metabolic rate.

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Learn about "Metabolic Syndrome and Weight Loss."

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3. A diet is the best way to lose weight

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In the short-term "dieting," that is following a prescriptive plan of eating fewer calories for a period of time, results in weight loss. But the weight loss is only temporary and weight is regained when former eating habits are resumed. Instead, find a way to eat healthy forever. That's the way to lose weight and keep it off.

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More articles on Eating Healthy after weight loss surgery!

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4. An entree salad is the low-cal choice on the menu

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Salads can be a very healthy choice - or a very unhealthy choice! A general rule of thumb might be the yummier that you make a salad the less healthy it becomes. Watch those toppings: cheeses, candied walnuts, dressing - yikes! Panera Bread's Fuji Apple Chicken Salad has 580 calories, and 30 grams fat, 7 grams saturated fat. Compare that to a McDonald's double cheeseburger with 440 calories, and 23 grams fat, 11 grams saturated fat.

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More Unhealthy Foods we think are healthy!

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5. Skipping meals speeds up weight loss

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Not eating actually slows down metabolism. So to keep your metabolism going eat a healthy breakfast, followed by healthy lunch and dinner, several hours apart. Not eating also can cause ravenous hunger later in the day, which may drive you to overindulge.

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Check out this Healthy Lunch Solution after Bariatrics!

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6. "Light" foods are better

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Light foods may contain fewer calories or fat, but not without increasing sodium, sugar, chemical additives, or artificial sweeteners. A serving of fat-free cream cheese is only 15-calories less than the real, full-fate version. But the sodium content is 11 milligrams more. Sodium is a major cause of bloating. Add to that, when people perceive a food as light they tend to eat more of it, sometimes consuming more calories than if they had eaten the real version.

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Read "The Bitter Truth about Aspartame"

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7. A gluten-free diet will help you lose weight

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A gluten-free diet is assumed to be a no-carb diet. That is not true. A gluten-free product replaces gluten-containing grains like wheat flour with non-gluten-containing grains like rice flour. Both wheat flour and rice flour are high in carbohydrates - and gluten-free pastries are high in calories. A gluten-free diet was designed for people with Celiac Disease, an autoimmune disorder in which the small intestine cannot digest gluten.

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Read "Gluten-Free is Unhealthy and Expensive"

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8. Over-the-counter diet pills help weight loss

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The Federal Trade Commission charged four weight loss companies with fraud. The companies charged with deceptive marketing practices include diet products we've all seen nationally-advertised: HCG Diet Direct, Sensa Products, LeanSpa, and L'Occitane. Talk to your doctor about your options for safe and effective medications for weight loss, combined with dietary and physical activity improvements.

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Learn about Getting Active after weight loss.

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This information was sourced from authoritative sources and is shared for informational purposes only. Use your best judgement and consult with your trusted healthcare provider before changing your diet and exercise habits.

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Living larger than ever,

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My Bariatric Life

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Related: How Not To Be Tricked by Halloween Treats

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Halloween is right around the corner. It's the opening event for the holiday season. This means it's time to start planning your eating for the holidays. Successful patients alter their eating behavior in all areas of life, including holidays. One of the behavior changes involves changing traditions.

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It's tradition to offer candy to children on Halloween night. Can you avoid eating any of the leftover candy? Those little fun size candies can take 10 minutes or more of vigorous exercise like rowing or jumping jacks to burn off.

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*One strategy many patients use is to hand out candy they don't like to avoid eating it.

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*Throw away any left-over candy once you realize the last Trick-or-Treater has left.

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*Put the leftover candy in the big trash can that you set by the curb instead of the trash can in your kitchen.

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Keep in mind it's better to waste the candy than for it to end up around your waist! Think outside the usual box or bag of candy for treats. Think about Halloween themed party goodies like pencils, temporary tattoos, individual bottles of bubbles, stickers, glow sticks or creepy spider jewelry. You can find these in stores like Dollar Tree, Dollar Store and Party City. Check out the party sections of Walmart, Target, Hobby Lobby and Michaels. The online store, Oriental Trader, has dozens of non-candy ideas.

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Remember to have items that kids under the age of 3 won't choke on. If your tradition is going to a Halloween party, think through how you will deal with food and drinks at that party. Check the post-surgery diet phase to see what foods you are allowed and keep to that list. Have a healthy snack or dinner before going to the party. Sip water during the party to keep you feeling fuller through the party. Focus on socializing, rather than eating. Bring a protein shake and pour over a cup of ice to sip through the party. Move away from the food table to avoid being tempted by all the goodies.

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A new tradition can be avoiding that first party after surgery by treating yourself to something indulgent like curling up with a good book, taking a bubble bath, getting a message, scheduling a session with a personal trainer, taking a walk at the mall on Halloween night to window shop or pretend you aren't home by turning out all the lights and watching a movie or a football game. Football games seem to be on every night right now. Even Friday night high school football games are streamed online these days. The holiday season can certainly be a time of trickery and temptation. Now is the time to plan how you will survive and thrive during the holiday season.

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Related: Coffee Controversy: to Drink or Not to Drink

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"Elizabeth, regular coffee after surgery or decaf for life?

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Let's keep this simple. If you can drink a cup of regular coffee every day without trouble, go for it.

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This isn't my opinion folks and that's why it's so magically delicious.

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There is a ground-swell movement among bariatric dietitians to fact-check some of the standard nutrition no-no's we've been sharing with clients.

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If there's no science to back up the recommendation, we're not going to keep promoting it.

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The latest worn-out bariatric rules without evidence? No straws, no gum, no soda.

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Today I'm dispelling the no coffee/caffeine rule.

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A recent review of the scientific literature reveals no evidence supporting the avoidance of caffeinated drinks to prevent dehydration or stomach lining damage.

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"Here I come quad espresso over ice???" Whoa, Nelly.

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Sane caffeine consumption after WLS means:

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1. waiting six weeks post op or until you are fully healed from surgery

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2. aiming to limit regular coffee to one cup per day

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3. groping with the painful truth that a medium pumpkin spice latte with whip = 420 calories

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Dietitians are working hard to create nutrition plans individually based on client's unique needs and wants.

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The next time you hear one of those bariatric no no's, ask the provider if the current science is still robustly supporting that recommendation.

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It might take them aback a bit but a good provider will thank you for your smart thoughtfulness and self-advocacy.

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Related: Easter - a trap for the unwary.

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Easter Egg Tips:

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1. Don't buy chocolate in advance - you may find yourself having to replace them before easter.

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2. If you're organising a hunt for the kids, substitute some stickers and make the eggs an occasional find.

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3. Forewarn relatives and friends that lots of chocolate in the house is not something you want - suggest an easter book for the kids.

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4. Consider the gift of an activity - maybe a sporting gift or game that introduces an inedible interest for the holidays or plan on decorating real eggs.

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5. Dark chocolate options may have some health benefits but you may not be choosing for health on this occasion so go for a small portion of your favourite!

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6. Get the portion size right. 20g / 0.7 oz equates to 1 hollow egg ( real egg sized) or 4 solid mini eggs or 2 filled mini eggs and contains 100 Cals. This is a suitable amount for a midmeal snack.

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Note that only one snacktime belongs between consecutive meals and be wary of grazing.

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7. Eat mindfully - enjoy every bit. Marvel at the wrapping, appreciate the markings and shape, inhale the aroma, take in the texture and savour the flavour. When you're finished get up and do something else!

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8. Having chocolate in the house can be an anxiety causing condition for many. Hide it, freeze it, throw it or give it away if it arrives unplanned or causes you grief. Recognise that although chocolate can be great in small amounts, it is causing you some stress and tension and that is not helpful to you. Drop your shoulders and reassure yourself that you can feel relaxed now whether you've eaten chocolate or not and whether others are eating it or not.

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How is your relationship with chocolate and is easter a problem time for you?

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Related: Sugar Blues Part 2

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To find out how to compare products to better understand added sugars, click on Natural vs. Added Sugars. Use the chart on the second page as a guide to compare products.The chart compares applesauce and Greek style yogurt. You will see the products with only naturally occurring sugars, products with added sugars and "light" versions of the product. You will also see that the product with the most amount of sugar has the most calories.The front part of the food label usually doesn't have any clues that the product can have a lot of added sugars.

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You must be a detective and investigate the Nutrition Facts Label and the ingredients list. Start your sugar hunt by using foods and beverages in your pantry or fridge to discover where added sugars are lurking in your food choices. Like any hunting expedition, it will take some time and practice to find the healthiest products to use on your journey towards health.

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Sugar Comparison Chart

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We are born with a preference for sweet tastes. However, sugar carries calories without any fiber, vitamins or minerals. Sugar is basically empty calories. For bariatric patients, too much sugar can lead to dumping.

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Natural Sugars vs Added Sugars

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Naturally occurring sugars are in fruits (fructose) and milk and dairy (lactose). The current Nutrition Facts label doesn't tell us the difference.\\n
A teaspoon of sugar = 4 grams of sugar.\\n
If you drink a 12 oz. can of regular pop or 12 ounces regular fruit juice, that means you've consumed 40 grams of sugar. This translates to 10 teaspoons of sugar. That's almost 1/4 cup of sugar!\\n

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Other names for sugar

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When you read the ingredient list, look for words like syrup (corn, high fructose, maple, pancake, maltose), corn syrup solids, agave, molasses, beet sugar, brown sugar, turbinado sugar, invert sugar, cane juice, fruit juice, fruit juice concentrate, nectar (peach, apricot, pear), powdered or confectioner's sugar, raw sugar, maple sugar, date sugar, malted barley, honey and anything ending in "-ose" (maltose, dextrose, glucose, fructose). These are all types of sugar.

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When you see these words in the ingredient list, look for foods that have sugar listed after the 3^rd or 4^th ingredient. When you see several sugar ingredients, look at the total amount sugar. Decide if it's worth it to eat that food.

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Sugar alcohols

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These have less impact on your blood sugars. They are more slowly digested than sugar. Sugar alcohols have anywhere from 2 to 4 calories per gram. If your weight loss stalls, check to see if your "sugar free" foods have high amounts of sugar alcohols. You may be getting more calories than you think. Caution…eating too many sugar alcohols can laxative effect!

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Alternative Sweeteners

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Artificial sweeteners include Splenda (sucralose), Sweet 'N Low (saccharin), NutraSweet (aspartame), Sweet One (acesulfame potassium) and Neotame.\\n
Stevia is extracted from the stevia plant and is considered a natural sweetener.\\n
Monkfruit is extracted from the monkfruit and is considered a natural sweetener.\\n

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Natural vs. Added Sugars:

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Comparison Chart

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How do I find the amount of added sugars in a food?

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One way to find out what the added sugars are is to compare similar products. Comparisons of applesauce and Greek yogurt are detailed below. The order of appearance is the unsweetened, sweetened and light or low sugar version.

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Use this chart to compare other products you might choose.

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Remember that natural sugars are in milk/dairy and fruit.

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Is all that sugar worth it?

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Related: Reducing Reflux

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Chew your food to applesauce consistency. Eat smaller meals. Stop chewing gum and drinking out of straws to prevent air from getting into your stomach. Stop using tobacco. Avoid high fat foods. Fat takes longer to move through the digestive system so food stays in your stomach longer. High-fat foods include using lots of cooking oil when cooking, whole milk instead of skim or 1 percent milk, regular fat cheese, deep fried foods and the fatty meats used in fast food hamburgers.

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Other strategies include avoiding foods that can irritate the esophagus. Irritants can include hot peppers, spicy foods, carbonated beverages and acidic foods like citrus or tomato juice. Avoid peppermint and spearmint, because these will relax the opening between the stomach and the esophagus.This allows stomach contents to be pushed up into the esophagus.Sit or stand for several hours after the last meal before bedtime to allow food to pass into the small intestine can also help. Invest the time to have healthier eating habits. The payoff is feeling better right now!

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Related: Natural Sweeteners

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Several powder and liquid forms of water flavors now use stevia. These are easily available in grocery stores. Stevia can be plain stevia or listed as Truvia, which is a combination of stevia and erythritol. Erythritol is a naturally occurring sugar alcohol and will have a few calories. For powder forms of water flavors, look for the Crystal Light Pure and the Great Value version from Walmart. Crystal Light Pure does have four grams sugar per half-packet, so some patients may not be able to tolerate this product. In the liquid drop form, brands to look for include MIO with stevia, Great Value version, Skinny Girl, Sweet Leaf and Stur.

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Add enough of these products to taste right for you. Too much can get super sweet in a hurry. For protein powders, look for Jay Robb and Syntrax Nectar Naturals. Even yogurts are joining in the natural sweeteners trend. Look for the Greek style yogurts Chiobani Simply 100 (has stevia and monk fruit) and Oikos Triple Zero (has stevia, look for black label). Experiment with different stevia or monk fruit sweetened products to see what you like.

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Related: Don't Let the Holidays Derail Your Weight Loss

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Whether you're maintaining your weight or trying to lose those last few pounds before Thanksgiving, I'd like to share my thoughts on how to manage your weight the same way you would manage a project at work, school or home.

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In the real world, it's admittedly difficult to prep healthy food in advance and squeeze in a trip to the gym between commuting to work, dealing with home projects, driving kids to football or dance and trying to get to bed by 11 p.m. every night.

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Add in the additional responsibilities of holiday activities and-no surprise here--watching your weight plummets on the priority scale.

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But you can do it nonetheless, it just takes a little planning.

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My most successful patients, who face losing hundreds of pounds after bariatric surgery, organize their lives to put nutrition, exercise and other healthy endeavors on equal ground with the other aspects of daily life-no matter what.

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Here are some of my favorite tips and tools to plan a more organized strategy that will support your path to a healthier holiday season:

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1. Figure Out What Needs Fixing

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Everyone has periods of time when eating right and exercising goes off kilter. Take a few minutes to figure out when and why this happens. Are you running out of healthy foods too often? Are you stressed at night dealing with the kids and eating to calm down? Are you so exhausted you can't be bothered with working out? Once you identify these triggers, you can create a plan to overcome these challenges.

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2. Organize Your Surroundings

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Without a doubt, living or working in a chaotic environment is stressful. If the kitchen is a mess, there is no food in the house and you can never find your favorite sneakers, you're putting yourself at an unnecessary disadvantage. Get your home and office back under control; start with the most disorganized space and clean it up. (This can usually be accomplished in less time than you think and the results will make you feel five pounds lighter).

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3. Schedule Your Workouts the Same Way You Schedule a Meeting

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Pick a specific time during the weekend to review your calendar for the days ahead and schedule your workouts accordingly. And then actually go-no matter what.

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4. Plan Meals, Grocery Shopping and Cooking Once a Week

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Reviewing your schedule for the week will help figure out where and when you'll be eating meals, what foods you'll need, and how much time you need to cook. Look at the weekly grocery store circular and stock up on healthy items that are on sale. Planning saves money.

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5. Go to Bed-No Excuses

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Sleep deprivation interferes with weight loss by confusing hormones that signal hunger and fullness levels. Research shows that people who stay up late consume more calories than those who go to sleep at about the same time each night. When you're tired, your willpower wanes. Even as adults, you still need to aim for eight hours of quality sleep per night.

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Managing your weight during the holidays is like taking medicine-you train yourself to do it every day, just like brushing your teeth and eating lunch.

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Which areas of your life could reap the biggest improvement if they were just a little more organized? Start there. In a few short weeks, you are going to realize the positive impact on your life-and your waistline.

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When January rolls around, you'll be starting a new year looking and feeling your best. Now that's the way to welcome 2016.

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Related: Antibiotics and Nutrition

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There are a couple of nutrition related areas to be aware of regarding antibiotics. Some antibiotics will interact with certain minerals. These minerals include magnesium and aluminum, which are found in anti-acid medications. Other minerals that can interact with some antibiotics include iron, calcium and zinc. Check your supplements to see if these are included.

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Some ready to drink protein shakes can be fortified with these minerals. Calcium, iron, magnesium, zinc and aluminum will interact with some antibiotics and make them less effective. You will need to take these minerals several hours apart from the antibiotic.

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Something else to be aware of is that antibiotics kill bacteria, both the good ones and the bad ones. Therefore, do not take an antibiotic at the same time you take something with probiotics in it like yogurt, kefir or a probiotic supplement. Your antibiotic can kill some of the good bacteria and not have enough left to kill all the bad bacteria. Take the time to read the insert that comes with your antibiotic. If you need further help, consult with your medical team, including your pharmacist. Taking your antibiotic correctly will allow your body to have the best chance to get rid of a bacterial infection.

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Related: Milk and the Differences in Fat Content

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Milk that has no fat is also called skimmed, fat-free, non-fat or 0 percent fat. The USDA National Nutrient Database uses the terms nonfat, fat-free and skim as descriptors for milk with no fat. The fat content of the milk refers to the percentage of weight that the fat contributes to the serving size. It does not refer to the percent of calories the fat contributes. Each 8-ounce cup of milk, no matter how much fat, will have 12 grams of carbohydrate as milk sugar.

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Milk sugar is also called lactose. Each 8-ounce cup of milk will also have 8 grams of protein. An 8-ounce cup of skim milk has 80 calories. Milk with 1 percent fat is also referred to as low-fat milk and has 100 calories and 2 grams fat. Milk with 2 percent fat is also referred to reduce- fat milk and has 120 calories and 5 grams fat. Whole milk is also called vitamin D milk and has 150 calories and 8 grams fat.

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Most of the fat in milk is saturated, which can contribute to elevated cholesterol. Increased fat also means increased calories and a potential for dumping issues. Along with protein, milk also packs in calcium, potassium and water. There are several lactose free milks on the market if you are lactose intolerant. For those that enjoy milk, you are getting a nutrition-packed fluid. Next week's tip will be an overview of the other milks on the market like almond and cashew milks. Stay tuned!

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Related: Time for Obesity Week 2016!

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The official opening ceremony for the 5th annual Obesity Week started first thing this morning in beautiful downtown New Orleans.

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More than 4900 obesity surgeons, researchers, clinicians and policymakers gathered from 53 countries for this epic scientific meeting.

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Keynote speaker Dr. Sadaf Farooqi delighted the huge audience by sharing a shocking one on one exchange she had with Queen Elizabeth's husband Prince Phillip. Let's put it this way--his understanding of the disease of obesity is horrifyingly ignorant.

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Dr . Farooqi's main address covered her landmark work in understanding the pivotal role the hormone leptin plays in hunger, weight and satiety.

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Other highlights of the day included big wig researcher, author and policy shaper, Dr. Kelly Brownell from Stanford University.

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Brownell discussed how "strategic science" or strategic studies allow scientists to use their research results to actually improve our quality of life instead of merely being showcased in obscure science journals.

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Also today we heard from patients that we still have a long way to go in eliminating weight bias in and among healthcare providers.

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Encouraging news from healthcare giant Kaiser Permanente however. Dr. Trina Histon shared that KP has totally overhauled their physical facilities to ensure a safe and respectful experience for patients of all sizes.

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One of the most exciting pieces of this year's meeting is the encouraging results and promise for many of the obesity meds on the market. There is a positive shift in attitude about the role this line of treatment can offer patients with obesity.

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More tomorrow, stay tuned!

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Related: 10 Things I Learned from the Top Docs in New Orleans.

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Here are just a few fascinating facts from the world's leading obesity researchers, scientists and surgeons gathered in NOLA for ObesityWeek2016:

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1.\\t There are 3 centers in the brain driving the 'eat' or 'not to eat' decision: the 'I'm so hungry I would steal candy from a child' drive, the 'Ben and Jerry's will make this sucky day, better' drive and the 'Oh, that cinnamon bun is so crazy gooey I need to eat one NOW' drive.

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2.\\t The good news? Researchers have discovered that our hormone, Oxytocin or the 'Love Hormone' helps reduce our impulse to eat AND reduces calorie intake by rewiring the reward center in our brain. Only problem? It doesn't last long in the bloodstream before breaking down. But researchers will try to make something similar.

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3.\\t People struggling with obesity are STILL being treated horribly by some healthcare providers. One study shows providers across the globe associate obesity with poor hygiene and dishonesty!??

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4.\\t The medical and research experts treating obesity now understand it is definitely a more complicated issue than balancing 'calories in' with 'calories out.'

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5.\\t If a state like North Carolina charged a one cent tax on sugar sweetened drinks, they could raise 400 MILLION DOLLARS in one year!

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6.\\t Visits to registered dietitians are covered by the Affordable Care Act.

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7.\\t Employers can 'opt out' of covering obesity medications. I don't think this option exists for blood pressure meds, do you??

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8.\\t One of the hormones in our gut actually raises H. E. double toothpick when we lose weight through dieting. It sets off bells and whistles begging us to eat!

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9.\\t Up to 70% of patients have copper deficiency pre-op and it's usually due to taking zinc supplements!

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10. More and more providers are adding obesity medications to their therapy regimen for WLS patients 'stuck' in their weight loss efforts.

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Related: The Eating Season

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One of the first nurses I ever worked with told me about the Eating Season.

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Spanning from the time you buy your first bag of Halloween Candy until you consume your last nacho during the Super Bowl-this puppy runs 3 full months and includes the daunting period from Thanksgiving to Christmas or Hanukkah.

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The last month of the Eating Season provides both a lifeline for the overindulgent and a guilty reminder of the time-tested principle of cause and effect-courtesy of incessant ads for diets.

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Is there a different way? Oh yes my friends, there is. And it allows you to fully enjoy goodies of the season without gaining weight.

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Sound too good to be true? It is if you're not willing to do some pretty close self-examination.

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Are you up to the challenge?

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#5 Eat Your Damn Protein

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WLS post-ops, you are SICK of hearing it but if you're living it, you know it's vital to success. At every meal, at every snack, seek protein foods and eat them first.

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Loop-hole alert: meals should be about 20-30 grams of protein and snacks at least 8 grams.

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#4 No Rules or Restrictions

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Following strict diet rules during the holidays actually makes perfect sense. It makes shopping easier, meal planning a breeze and decision making is a piece of cake? You've got enough to worry about; this is no time to be worrying about what to eat.

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Problem is, it's a short-term strategy. Rules work when you use them but they're not sustainable long term. That means a period of rule-following always leads to overeating.

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Don't do it.

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Decide what you want to eat and after your protein, enjoy it--fully. Eat it slowly and with full attention. Stop when you've had enough and you're not overfull. You've got limited room, so fill it with great discrimination.

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Avoid the stale store-bought cookies, the picked-over cake in the breakroom and savor mom's monkey bread with bliss.

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#3 Honor Your Hunger

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Don't be skipping any meals to save calories or because you're 'too busy' to eat.

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You've got to eat something every four hours to keep your metabolism in fighting shape and your blood sugar level.

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Caveman hunger does not serve you well. Your body, brain and bloodstream are all conspiring to get you to eat because it perceives a threat to your survival. Seriously! Don't let this physiological mechanism take over. Take charge with self-care and regular eating.

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#2 Speaking of Self-care

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It's impossibly busy this time of year but you'll be one hot mess if you don't sleep 7 plus hours a night, exercise your heart 15 minutes per day and take your vitamins.

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You compromise your weight when you skip any of these vital self-care essentials.

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#1 Believe Something is Different

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Research exploring the thought patterns of women with obesity revealed a consistent lack of confidence in their weight maintenance skills/capacity.

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You've seen the platitudes: 'If you think you can or if you think you can't, you're right.'

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Buddha knew it, positive psychology researchers know it but… you doubt it?

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Grab a Dr. Wayne Dyer book or Google byronkatie.com and begin to notice what you're telling yourself and what you believe about yourself and your weight.

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Once you uncover some of those self-limiting beliefs, you might find fighting off the desire to have a piece of cheesecake has more to do with avoiding Cousin Charlie than your 'weakness' for sweets.

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Related: Riced Vegetables

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"Ricing" refers to vegetables cut up into small pieces about the size of rice. Cauliflower has gotten the most attention, but other veggies are getting in on the trend. Years ago, the South Beach Diet included a recipe for mashed cauliflower to take the place of mashed potatoes. The new kid on the block is riced cauliflower. The color is similar to rice and can be cut to look like rice. Some say it has a similar taste to rice, but use your own taste buds to figure this out. For bariatrics patients, riced cauliflower doesn't have the type of carbohydrate that can swell in your stomach pouch, like regular rice does. Once you can add vegetables back to your food choices, you've now got a vegetable choice that can be seasoned many ways. Click here for a Riced Cauliflower recipe from www.whatscookingamerica.net, which also includes several flavor options. For an easier version, Green Giant and Birds' Eye already have riced cauliflower and other riced vegetables in the freezer section. You'll be able to whip up a vegetable side dish in a jiffy! Pizza crust recipes with riced cauliflower have also been enjoyed by our patients for several years. Yum! You now have a trendy, fun and tasty way to eat your veggies. Enjoy!

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Related: Super Bowl: Ideas for a Healthier Menu

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Chips and dips are frequent guests at Super Bowl gatherings. These are basically fat and salt. There are bariatric friendly versions you can make a part of your lifestyle. Try using hummus, refried beans or a healthy version of Ranch dip as a menu item instead. A bariatric friendly Ranch dip is thoroughly mixing a 5.3-ounce container of plain, fat-free or low-fat Greek yogurt, 1 tablespoon of low-fat mayonnaise and 2-3 teaspoons (or to taste) of powdered Ranch Dip mix. You can use crackers like Ritz, Club or Saltines as dippers if you are on the soft and puree food part of the post-surgery diet. Once you can have fresh veggies, think about using bell pepper strips, snow peas, cucumber or carrot sticks or slices to dip in the Ranch dip. If you'd like more Super Bowl ideas, check out the www.bariatriceating.com website. Click "recipes" and check out "Super Bowl Food." That Southwestern Bean Dip is super easy and looks delish. Hope your team wins!

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Sources and references

Combined guide (67 sources). Source IDs: 4, 28, 29, 42, 48, 83, 120, 132, 133, 136, 137, 138, 139, 140, 149, 162, 164, 183, 193, 199, 222, 236, 246, 255, 273, 275, 282, 283, 285, 289, 292, 294, 299, 300, 307, 320, 336, 354, 358, 359, 371, 374, 378, 380, 384, 390, 487, 510, 513, 532, 535, 546, 558, 564, 579, 589, 606, 607, 621, 629, 631, 632, 637, 639, 644, 652, 659.

Where are you in your journey?

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Sources and references

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