Ladybug1

Last month in our Members Only Facebook Support Group we asked members if they eat their meals at the table. This prompted some fascinating and insightful discussion!


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.
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.
So what do I do?
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.
Aim to always eat while sitting down, ideally at a table or bench.
Avoid grazing while standing up, for example, when preparing meals, passing through the kitchen, ducking into the staff room, etc.
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.
Have eating free zones in your home, such as the bedrooms, study and bathroom.
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.
Only snack if physically hungry and when snacking, apply the above ‘rules’.

Remember, aim for progress not perfection. Good luck, and let us know how you go.
As always, be kind to yourself.

The weight loss surgery journey is easier for some than for others. That’s true not only mentally, but physically as well. Some patients are confident as they get the surgery, follow their prescribed diets, and lose weight until they approach their goal weights.
But most have doubts at some point. Those doubts can be strong especially in the first few weeks after surgery.


I see this lack of confidence time and time again in the forums. Weeks or a month after surgery, gastric sleeve, gastric bypass, lap-band, and other Weight Loss Surgery (WLS) patients start to wonder whether Weight Loss Surgery was the right choice. Most often, they are disappointing in the number of pounds they have lost, and they wonder, “Am I going to be the Weight Loss Surgery patient who fails?”
I can say this with confidence: If you follow the Weight Loss Surgery diet, you’ll lose weight.
“I’m Not Losing Weight Fast Enough!”
That’s a common post on BariatricPal. The poster is usually a week or a few weeks post-op, and worries their weight loss isn’t fast enough. They think their “slow” rate of weight loss means Weight Loss Surgery didn’t “work” for them. They think they will never be able to lose significant amounts of weight, since WLS was a last-ditch effort to lose weight and get healthy after years of dieting didn’t work.
But in most cases, these fears just aren’t true. Don’t misunderstand me. I’m not saying these fears are unreasonable. I understand them perfectly. I, and probably every Weight Loss Surgery patient, wondered whether it would work for me. And the answer for me, and for everyone who followed their Weight Loss Surgery diet, was “YES!”
The Perfect Storm for Frustration
So why the panic? I like to think of the first few weeks or even months after weight loss surgery as a perfect storm for generating doubts. It’s a time when the following are true.
You realize you have made a decision that led to a change to your body that is irreversible (in the case of sleeve gastrectomy) or meant to be permanent (in the case of the gastric bypass), or
You realize a lifetime commitment to changing your eating habits and lifestyle is a pretty big deal.
You have not eaten solid foods for weeks, or even more if you had a liquid diet for long before surgery, and it’s getting you down.
You are struggling in your daily life as you try to make time for exercise or you find your family members continue to eat junk food in front of you.

All that is enough to get anyone down before you even start thinking about the reason you got the surgery in the first place – to lose weight! If you doubt you’re losing weight “fast enough”, you might start wondering if you made the wrong decision when you got Weight Loss Surgery – and that’s a depressing thought.
Crunching the Numbers
Almost without fail, the BariatricPal member who posts about disappointing early weight loss is losing weight quite quickly. The only person who is disappointed in this number, typically, is the member him or herself. I’ve seen members post with concerns about losing “only” 20 pounds in the first month, or “only” 10 pounds in the first week. Guess what. That’s great!
Think about it. A general round number for great first-year weight loss after Weight Loss Surgery is 100 pounds. That’s an average of 2 pounds a week, or 8 pounds a month. If you lost 20 lbs in your first month, you’re doing fantastic! To hit 100 pounds in your first year, you won’t even lose a pound every three days! So don’t worry if the scale doesn’t plummet every single day. If you’re eating right, you’ll lose weight.
Try to keep yourself motivated by keeping it all in perspective. Another motivating thought is to consider how long it took you to gain the extra weight. 5 years? 10 years? Your whole life? And now you have a chance to lose it within 1 or 2 or 5 years? That’s a pretty good bargain, right?
Recovery Now for Weight Loss Later
Now, I know you’ve prepared for Weight Loss Surgery for a long time, and you’re eager to lose weight. But really, you’re not quite ready to focus on weight loss if you’re still recovering from surgery. It’s far more important to heal properly. That’ll help you lose weight faster later and avoid complications that’ll set you back, not to mention cause possibly serious health problems.
So, no matter how frustrated you are, stay positive, and focus on following your surgeon and nutritionist’s instructions to the letter. Continue to eat a liquid diet and then pureed foods without cheating and sneaking in solid foods. Use this time to establish a pattern for your long-term success. Learn to measure your food, and to set aside time for food prep and for exercise.
Weight loss surgery is a lifetime adventure, and that realization can really hit hard in the early days and weeks post-op. You can get through this tough period by focusing on one day at a time and not worrying about your rate of weight loss. Measure your success not by the scale number, but by how well you stick to your plan.

Nutritional deficiencies are a major concern after weight loss surgery.
You eat less food, so you eat fewer nutrients.
Sleeve and bypass patients absorb fewer nutrients.
You eat less fat, which makes it harder to absorb fat-soluble nutrients like vitamin A.

Some bariatric surgery patients take one or two multivitamins, plus an entire barrage of high-dose vitamin and mineral supplements. Others barely take any supplements. Which should you be taking? How do you even know whether you need a supplement? Can you prevent deficiencies just by eating a better diet?


VITAMIN A – Vision, immunity, and healthy red blood cells
Risk for Deficiency
Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS
Very low-fat diet

Food Sources
Orange fruits (mango, cantaloupe)
Orange vegetables (carrots, sweet potatoes,
Green vegetables (kale, spinach)
Liver

Deficiency Information
Blood test: serum retinol (vitamin A)
Consequences of deficiency: impaired vision; changes in iron metabolism

Supplement Notes
High doses can be toxic – take only if your doctor prescribes them.

VITAMIN D – Calcium metabolism and bone health, affects immune function and heart health
Risk for Deficiency
Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS
Very low-fat diet
Little skin exposure to sun, live in northern climate, or older age

Food Sources
Fatty fish (salmon, herring, mackerel)
Fortified milk
Egg yolks (if you are a bariatric surgery patient, you might mostly be eating egg whites)
Some fortified cereals

Deficiency Information
Blood test: 25-hydroxyvitamin D
Consequences of deficiency: osteoporosis (low bone mineral density and higher risk for fractures); possible higher risk for heart disease

Supplement Notes
High doses can be toxic – take only if your doctor prescribes them.
Need for supplementation is very common.

VITAMIN B12 – Healthy red blood cells, homocysteine metabolism (important in heart health)
Risk for Deficiency
WLS that reduces nutrient absorption: gastric bypass, gastric sleeve, BPD-DS.
Plant-based diet.
Heavy bleeding: e.g., complication after WLS)
Older age

Food Sources
Animal-based foods: meat, fish, poultry, dairy products, eggs
Some fortified cereals

Deficiency Information
Blood test: vitamin B12
Blood test: CBC (complete blood count)
Consequences of deficiency: risk of heart disease; megaloblastic anemia; permanent neurological damage; osteoporosis; depression

Supplement Notes
High doses not likely to be toxic.
Supplements may be necessary if you are on antacids such as proton pump inhibitors

FOLIC ACID – Healthy red blood cells, homocysteine metabolism (important in heart health), prevention of neural tube defects (for pregnant women)
Risk for Deficiency
Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS
Low dietary intake – especially when grain intake is low after weight loss surgery

Food Sources
Fortified grains (most grains in the U.S.): including spaghetti, bread, cereal
Lentils
Asparagus
Orange juice
Spinach
Lima beans

Deficiency Information
Blood test: serum folate
Blood test: homocysteine
Consequences of deficiency: cognitive dysfunction; neural tube defects; megaloblastic anemia

Supplement Notes
High doses can hide vitamin B12 deficiencies.

CALCIUM – Bone health, muscle function
Risk for Deficiency
Nutrient malabsorption procedures: Roux-en-Y, gastric bypass, BPD-DS
Diet low in dairy products – either because of lactose intolerance or other reasons (such as avoiding milk because of the calories).

Food Sources
Dairy products: milk, cheese, yogurt (choose fat-free)
Fortified milk substitutes (almond milk, soy milk)
Fortified orange juice
Canned bony fish (salmon, sardines)
Green leafy vegetables (absorption is poor)
Some fortified cereals
Tofu

Deficiency Information
Blood test: calcium levels – note: this is not a good test for adequate calcium! You can have normal test results and still not have enough calcium in your diet!
Dietary intake analysis: see if you get at least 1,200 to 1,500 milligrams per day from your diet.
Rough estimate of dietary intake: at least 4 servings of high-calcium foods each day
Consequences of deficiency: decreased bone mineral density (osteoporosis and higher risk for bone fractures)

Supplement Notes
Taking too much calcium can cause kidney stones and be bad for the heart.
Ask your doctor how much calcium you should take in a multivitamin and as a calcium (or calcium and vitamin D or calcium and magnesium) supplement.
Don’t take your calcium supplement at the same time as iron because you will interfere with absorption

IRON – Healthy red blood cells, energy and other metabolism
Risk for Deficiency
Nutrient malabsorption procedures: Roux-en-Y, gastric bypass, BPD-DS
Vegetarian or vegan (plant-based) diet
Adolescents and women of child-bearing age.
Individuals with excessive bleeding (such as with a post-op complication)

Food Sources
Fortified grains (most grains in the U.S.): including spaghetti, bread, cereal
Meat, seafood, and poultry (animal-based sources have a more absorbable form of iron)
Beans and lentils
Green vegetables, such as spinach, kale, broccoli
Potatoes
Raisins
Deficiency Information
Blood test: serum iron/Fe
Blood test: ferritin
Blood test: total iron binding capacity (TIBC) (high value means low iron status)
Blood test: hemoglobin and hematocrit

Supplement Notes
Iron supplements can be toxic even if your dose is not that high. Don’t take them unless your doctor prescribes them.
That includes iron in multivitamins.
Don’t take iron supplements at the together with calcium supplements.
Try to take supplements with vitamin C (in food or as a supplement) to increase absorption.

THE OTHERS
The above deficiencies are most common among weight loss surgery patients, but other deficiencies are possible. You are at risk because of your low food intake as you restrict calories. Malabsorptive procedures, such as gastric bypass and gastric sleeve, also put you at risk. Ask your doctor if you are concerned about any of the following vitamins and minerals. Often, a simple blood test or even a run-through of your daily diet can help you figure out if you need an additional supplement over your daily multivitamin and mineral supplement.
B vitamins: B1 (thiamin), B2 (riboflavin), B3 (niacin)
Vitamin C
Vitamin K
Magnesium
Zinc

The Bottom Line
Nutritional deficiencies are a big risk after weight loss surgery, but they depend on a few different factors.
Type of weight loss surgery – sleeve and bypass patients are more prone to nutrient deficiencies than lap-band patients.
Your diet – eat protein first and choose nutritious foods to lower your risk of deficiencies.
Genetics and other uncontrollable factors – women are more likely to need iron supplements, for example, than men.

Megadoses of vitamin and minerals can be toxic, so don’t prescribe them for yourself. Instead, contact your surgeon or regular doctor. Simple tests can often let you know your nutrient status so you can know which nutrients to supplement.