POST OPERATIVE DIET

Habits Sabotaging Weight Loss

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Regardless of how well-intentioned you are about your weight loss goals, there may be certain habits preventing you from reaching those goals that you might not even realize. It’s important to identify these habits and have the appropriate information to support your decision to change your lifestyle. This can help to prevent being thrown off track for optimal and life-long success after bariatric surgery.

Bariatric surgery is a life-long decision and commitment. It is a tool only given to you by your surgeon. Maintaining the lifestyle of a bariatric patient is up to you, and only you. You will need to be willing and able to follow the long-term plan your surgeon and bariatric clinic have provided and taught you to achieve weight loss success for your lifetime.

Sabotaging Habits

Even though some of your natural habits may seem good intentioned or harmless enough, here are eight habits to consider that you may be doing to sabotage your optimal weight loss:

Not Having a Meal Plan: Keeping to a meal plan will help you stay focused and meet the goals you have set. Not all meal plans work for everyone; i.e. nutritional needs and requirements, food sensitivities, different tastes and budgets, etc. So be sure to work with one that works best for you. If you need to, meet with a nutritionist or dietician to help you.

A meal plan can also help with meal preparation and having a shopping list to keep you from impulse buying or eating out.

Not Understanding Nutrition: There are so many different types of food out in the world nowadays. Some may claim to be “healthy” or “low” on certain ingredients, but are usually higher in sodium or sugar to make up the difference. Understanding the value of nutrition and the foods that fuel your body is beneficial to ensure a healthy and successful weight loss journey.

Not Switching Up Your Meals: After bariatric surgery, your meals don’t need to be bland or boring! Repeating the same foods could lead to boredom and you could end up reaching for something savory or sugary to cure that boredom. Add colorful veggies and different spices to your foods. Try different cooking methods to switch up your meals and create fun new recipes!

Not Getting Enough Sleep: Past studies show that individuals who get less than six hours of sleep at night are more likely to be diagnosed as obese¹. Thus, sleep-deprived people tend to choose foods that are high in calories and carbohydrates². Ensuring a good night’s rest and getting between 7-8+ hours of sleep each night can balance your hunger hormones.

Not Exercising: Physical exercise can be one of the best things you can do for your body. It is essential and necessary to maintain weight loss and your overall health. The current physical activity guidelines for Americans states that adults need at least 150 minutes each week of moderate-intensity of physical exercise³.

Not Considering Your Stress Levels: Not only can stress affect your physical health, but it can impact your emotional and psychological health as well. Stress can lead to the release of the cortisol hormone, which stimulates your fat and carbohydrate metabolism, increasing your appetite⁴. Not taking the time to take care of your physical and mental health can impact your overall health.

Not Counting Snacking: Even though “true” hunger should be the main motivation for snacking, some people don’t think of snacks as “food,” and don’t take them into account when counting meals. Snacking when appetizing food is nearby happens more often that admitted, even if the individual isn’t even hungry.

Not Focusing on What You’re Eating: The habit of eating in front of the TV or while playing on your phone can lead to overeating. You might not be noticing when you have had enough food and are full. Not eating enough during the day due to busy daily schedules or work could also lead you to being so hungry right before bed. This could lead to overeating due to extreme hunger. It may be hard to keep track of your daily intake, but it’s important that you are eating throughout the day while expending your energy⁵. If you find yourself hungry right before bed, try eating a handful of nuts.

It might seem impossible to reset and rewire our brains to change these sabotaging habits, but if you stay consistent and focused, you can start to see your mindset and life start to change, too. It is possible! Your health, inside and out, are the most important things during your lifetime, don’t forget to take care of YOU, too.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Resources

Yili Wu, Long Zhai, Dongfeng Zhang, “Sleep Duration and Obesity Among Adults: A Meta-analysis of Prospective Studies”, Sleep Med, 2014 Dec; 15 (12):1256-62, doi: 10.1016/j.sleep.2014.07.018, https://pubmed.ncbi.nlm.nih.gov/25450058/
Stephanie M Greer, Andrea N Goldstein, Matthew P Walker, “The Impact of Sleep Deprivation on Food Desire in the Human Brain”, Nat Commun, 2013;4:2259, doi: 10.1038/ncomms3259, https://pubmed.ncbi.nlm.nih.gov/23922121/
S. Department of Health and Human Services; https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines
William Shaw, PhD; Susan Labott-Smith, PhD, ABPP; Matthew M. Burg, PhD; Camelia Hostinar, PhD; Nicholas Alen, BA; Miranda A.L. van Tilburg, PhD; Gary G. Berntson, Phd; Steven M. Tovian, PhD, ABPP, FAClinP, FAClinHP; and Malina Spirito, PsyD, Med, “Stress effects on the body”, American Psychological Association; 2018 Nov 1, https://www.apa.org/topics/stress/body
“5 Mistakes That Will Sabotage a Healthy Diet”, April 19,2021; Harvard Health Publishing; https://www.health.harvard.edu/staying-healthy/5-mistakes-that-will-sabotage-a-healthy-diet

Overeating Triggers and Tips

Dec 7 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

After bariatric surgery, it takes effort, persistence, and discipline to lose the weight and maintain that weight loss. You have to be willing to put forth the effort to make healthy decisions and choices, to say “no” to those tempting sugar-filled foods and tasty treats. It is a lifetime change, and it will take daily persistence to not “give in” to old habits and behaviors.

Knowingly or unknowingly, many people are simultaneously dealing with two chronic, potentially fatal diseases: the disease of obesity and disease of addiction. Both diseases affect every area of a person’s life and can leave a person feeling powerless and out of control.

Everybody manages stress differently; unfortunately, the majority of us carry stress-filled lives. We all seek distractions from stress and pain. In a 2013 survey by American Psychological Association (APA), 38% of American adults overeat due to stress. Of them, half say they overeat at least once a week.¹

Bariatric surgery is merely a powerful tool to help with weight loss. Identifying your personal triggers for overeating is the first step toward changing your mindset and habits to keep the weight off and maintain your health.

Modifying Eating Habits

There are numerous reasons why you might find yourself reaching for food. It could be due to emotional reasons, boredom, head hunger—where you “think” you’re hungry, but actually not, or actual hunger due to not filling up on the right kinds of food. The following are tips to help with modifying old habits and having more mindful eating practices.

Don’t Skip Meals: When you skip a meal, you can find yourself hungrier later in the day, which could then make you more likely to choose poor food choices or overeat. You have probably heard the saying “breakfast is the most important meal of the day.” Breakfast turns your metabolism on and kick-starts the function of your energy supply.

Breakfast Ideas:

Deli meat with melted cheese on top

Scrambled egg, grated cheese, cooked mild tomato salsa

Low-fat low-sugar yogurt

Poached eggs, canned tomatoes

Snack Time: If you’re eating at regular intervals throughout the day and still find yourself eating, stop and ask yourself if you truly are hungry. Remember that the “hunger sensation” may also be due to a lack of water. If you still find your stomach growling, it’s okay to reach for a protein-dense snack. Appropriate snacking (only twice a day) can help boost your metabolism and keep your energy levels high.

Change of Scenery: Eating in front of a television trains our minds to think about eating food every time we sit down to watch something. It can also distract you from realizing to stop eating because you’re full. Sit at a table and focus on the food and your feeling of fullness.

Chew, Chew, Chew: It could take 20-30 minutes for your brain to get the message that you are full. Slow down, and chew your food well. Chewing about 30 times before you swallow allows you to pace yourself. Use a small plate, eat slowly, and put your utensils down between bites. Try to resist the urge to clean your plate completely if you start to feel full.

Journaling and Tracking: Keeping track of your food may help you notice patterns in your habits. Try starting a journal or using an app like MyFitnessPal or Baritastic to record your food and beverage intake. You may have emotional or environmental triggers for overeating. Are you hungry, bored, frustrated, angry, happy or sad? Documenting your emotions to identify your areas of weakness can be very beneficial and can help you develop new strategies for health.

Meal Plan: It’s well-known that restaurant portions are very large. If you ate out regularly, you could have been overeating without really realizing it. Plan your meals out in advance to avoid dining out when you think you have “nothing to eat.” Save dining out for special occasions, and remember, you can take leftovers home! You don’t have to eat everything on your plate.

Drink More Water: We can’t stress enough how important drinking water and staying hydrated is. You should be drinking a minimum of 64 ounces of water each day. Dehydration can also make you think you’re hungry when really all you need is a drink of water.

70/30 Rule: Your meals and snacks should be following the 70/30 rule; 70% protein-dense foods and 30% vegetables. Avoid any simple carbohydrates and sugars as they can slow weight loss, stop or interfere with maintenance, and if you had the Gastric Bypass, they could induce the “dumping syndrome.” You want to ask yourself what the food item you are going to eat is going to do for your body. What is the nutritional value? Does it provide you with what you need? Does this item contribute to the 70/30 rule?

Measure Your Food: Bariatric patients should never consume more than 1 cup (8 ounces) at any meal. You should be consuming 2-4 ounce meals. This should be measured in volume, not weight. If you have questions about what you should be eating and when, please review the big blue binder that was given to you at your Surgery Orientation Class prior to surgery as to what stage you are in. If you still have questions or are unsure, please call us at (801) 268-3800.

¼ cup = 2 ounces	½ cup = 4 ounces	1 cup = 8 ounces
4 tbsp. = 2 ounces	8 tbsp. = 4 ounces	16 tbsp. = 8 ounces

Bye-Bye Carbonation and Caffeine: Most carbonated drinks are high in sugar and caffeine, which can interfere with your long-term weight loss. Carbonation distends even normal size stomachs and delays the sensation of fullness. Caffeine can be an appetite stimulant, a known diuretic, and can cause gastric distress. Our surgeons recommend staying away from carbonation and caffeine for these reasons.

You won’t ever have the opportunity to relive the first rapid weight loss months again. Dedicate yourself to staying within the guidelines we set out for you from the start and develop the habits that support long-term success that can last a life time.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

org/news/press/releases/stress/2013/eating (American Psychological Association (APA))

A Thanksgiving Gratitude Attitude

Nov 9 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Americans are notorious for centralizing holidays around bountiful feasts and abundant meals with dishes that we love and have grown up with. Thanksgiving could be the first holiday that comes to mind when asked this! The holiday has become known as a celebration of the harvest and food, food, food. However, Thanksgiving is so much more than just about food.

Thanksgiving History

In 1621, the Plymouth colonists and the Wampanoag shared an autumn harvest feast that is acknowledged present day as one of the first Thanksgiving celebrations. In 1863, President Abraham Lincoln proclaimed a national Thanksgiving Day be held each November.

Believe it or not, Thanksgiving meals did not feature pumpkin pies, cakes, or other desserts as meals in present day have become known for. Things like stuffing, mashed potatoes, and cranberry sauce didn’t become popular until later throughout the centuries.

What is Thanksgiving?

So what does the word “thanksgiving” mean to you? To some, it means the act of expressing or feeling thankfulness. There might be people in your life that have helped you, become apart of your life, taught you valuable lessons, or have made an impact on you that you might want to celebrate and give thanks to.

Thanksgiving might look differently to you after having bariatric surgery. With your new tool your surgeon has provided to you, and with your changed anatomy, food will be portioned, measured, and focused on high-protein, veggies, and low-carbohydrates. Below we have put together a list of ways to still make your Thanksgiving special and memorable, and about more than just the food!

Get Outside: Move your body by being active in a Turkey Trot, flag football tournament, or any kind of outdoor activity.
Volunteer: Spare your time by helping with a food drive or serving food at a soup kitchen or shelter.
Give a Meal to Someone Less Fortunate: There are many who are less fortunate and some who might not be able to get out and prepare a meal for themselves. Why not prepare a meal and deliver it to those in need?
Watch Movies: Gather together and watch Thanksgiving-themed moves!
Play Games: Break out the board games, trivia, card games, or charades and have a good laugh with your family and/or friends.
Go for a Drive: If it hasn’t snowed, Utah’s autumn season is filled with vibrant-colored leaves and stunning mountain views. You don’t even need to leave the warmth of your car! See the beautiful sights by taking your family for a leisured drive.
Just Be Thankful: Create a list of all the things you are thankful for and grateful to have as a part of your life.

However you spend the Thanksgiving holiday this year, remember to give thanks by celebrating with more than just food. We have much to be grateful for! It could be our improving good health, to do activities and move our bodies, our friends and family, our home, our job, education, and let’s not forget our fury or scaly friends (pets)! Embrace the gratitude attitude for your health and wellness, not just on Thanksgiving Day, but 365 days of the year.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Food Addictions and Habits

Nov 2 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

It’s no secret that food is essential to human survival. Not only does it provide necessary sustenance, it can also be a gratification component of pleasure and enjoyment through many different tastes, smells, and textures. However, for many individuals, food can become a very serious addiction.

What is Food Addiction?

Food addiction (FA) is loosely defined as the eating behavior in which the consumption of highly palatable foods, such as foods high in salt, fat, and sugar, in quantities beyond homeostatic energy requirements.¹ Food addiction is similar in symptoms with other eating disorders, such as binge eating. When foods high in fat and sugar are consumed, it triggers a chemical reaction in the brain that induces the feelings of pleasure and satisfaction.

A study led by Dr. Magalie Lenoir found that cocaine-addicted rats chose sugar when given the option to consume cocaine or sugar. 94% of the addicted rats showed a preference for sugar over cocaine.² Dr. Lenoir concluded during the demonstration that, “intense sweetness can surpass cocaine reward, even in drug-sensitized and addicted individuals…The supranormal stimulation of [sweet] receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus to lead to addiction.”

Physical and Mental Health Distress

It can be a complex ferocious cycle when we consume copious amounts of certain foods. It affects not only our physical health, but our mental health in ways we might not expect. We might experience guilt, shame, and disgust about our inability to control our eating habits and the foods we eat. When sugar is consumed, it causes a temporary rush of dopamine (hormone), which then is followed by a sugar crash, and in turn leads to more cravings. As mental health declines, another sugar fix is needed, angst and self-disgust sets in, and the vicious cycle continues.³

Signs and Symptoms of Food Addiction

Eating food even when no longer hungry
Eating in secret, isolation
Going out of your way to obtain food, obsession
Difficulty to function at work
Decreased energy, chronic fatigue
Spending significant amounts of money of foods
Difficulty concentrating
Sleeping habits change, such as insomnia or oversleeping
Irritability
Headaches
Depression, low self-esteem
Self-harm, suicidal ideations
Digestive disorders
Denial about an issue with food

Ways to Get Help

The only way to defeat the vicious cycle of food addiction is to get to the root cause of the problem. There are many outlets for help:

If you need help with food addiction, nutrition, or help with overcoming old habits, don’t feel ashamed to ask for help. We can give you referrals to dieticians and psychologists who can help! Give our office a call at (801) 268-3800.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

https://www.sciencedirect.com/science/article/abs/pii/S0074774216301106 (Science Direct, Chapter Four – Psychological and Neurobiological Correlates of Food Addiction, E. Kalon, J.Y. Hong, C. Tobin, T. Schulte)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000698 (PLOS ONE Journals, “Intense Sweetness Surpasses Cocaine Reward,” M. Lenoir, F. Serre, L. Cantin, S.H. Ahmed)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/ (National Library of Medicine, “Evidence of Sugar Addiction: Behavioral and Neurochemical Effects of Intermittent, Excessive Sugar Intake,” N.M. Avena, P. Rada, B.G. Hoebel

Weight Regain: Living with Fear and Dread

Oct 5 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

It is understandable why a bariatric patient might live in fear and dread of weight regain. Many patients have reported that at least a little bit of hunger creeps back into their lives a year or more out from surgery. Old cravings may pop up, undesired habits may try to sneak back into your daily routines. It is a critical time to re-commit to the healthy behaviors that brought on the success of your weight loss journey.

Many patients are highly motivated in the initial 2-year postoperative period due to how quickly the patient lost weight. When you reach a certain weight and maintenance is your goal, you may need to reassess your motivation to challenge the “obesogenic” environment in which you live.

Having the knowledge and understanding that it is natural for the body to regain some weight after bariatric surgery will help you understand and have realistic expectations that many individuals don’t lose 100% of their excess weight. It is common to see a 10-20% weight regain after you have reached maintenance, this may become a new “stable” weight.

However, the good news is that the weight loss you experience as a result of surgery CAN last a lifetime. But it is essential that your entire lifestyle changes, not just a few eating habits. There are several solutions and ways to help with weight regain and getting back on track!

Ways to Help with Weight Regain

Do not React, Act: Slow your thought process. Take the time to talk with a friend, provider, and/or therapist to create rational, realistic, and achievable goals and a course of action based on facts and knowledge instead of emotions.
Reassess Your Priorities: Instead of focusing on only being “skinny,” make health your weight management priority. Have a goal to be a healthier you, not necessarily the lowest weight or ideal weight determined by what you see in others.
Keep Learning: There are hundreds of articles and books highlighting the topic of “Weight Maintenance.” The bariatric world is continually being studied. Taking the time to stay up to date on the facts and educating yourself can help you understand the changes in your body.
Remind Yourself of Your “Why”: Ask yourself why you started on this journey in the beginning. What made you want to change your habits and lifestyle and what was the recision that drove you to decide to have bariatric surgery? Ask yourself if what you are doing today is getting you closer to where you want to be tomorrow.
Change Your Mindset: Weight loss takes time, just as weight gain does not happen overnight. Have honest conversations with yourself, friends and family, your providers, and therapists about your behaviors and habits, and adjust accordingly. Avoid the “all-or-nothing” way of thinking. “Just this once” could turn into more than you bargained with yourself.
Nutritional Therapy: Track what you eat and go back to the 70/30 rule. 70% protein and 30% vegetables. Increase your water intake, cut out all sugars (fruits, fruit juices, cookies, candies, sweets), and lower your carbohydrate intake (bread, pasta, rice, chips, potatoes, tortillas, crackers). Remember to eat slowly and chew your food well. You should not be eating more than 6-8 ounces per meal. If you need more help, give our office a call at (801) 268-3800 we can refer you to nutritionists and dieticians.
Move Your Body: It is also especially important to make sure that you are moving your body at any chance! Not only will it help with weight maintenance, but it can help with many chronic diseases such as:¹
- High blood pressure
- Risk of heart attack, stroke, and several forms of cancer
- Arthritis pain and associated disability
- Osteoporosis and falls
- Symptoms of depression and anxiety

You should be exercising 30-60 minutes a day depending on the type of exercise you are doing.

Revisional Surgery: Revisional surgery may be an option, after collaborating with a clinical dietician for at least six months with the goal to get you back on track and document your efforts to make significant lifestyle and dietary changes. Have your dietician/primary care physician send us a referral with your documentation for our surgeons to review to see if you are a candidate for revision surgery. Revision surgery is considered “high-risk” and should only be considered as a final course of action. This should be discussed thoroughly with your surgeon.

Fear can either drive you and motivate you, or it can cripple you and lead you to believe in your failure. It is your choice how to use it when weight regain comes to thought. You can use it for self-awareness instead of self-destruction by always remembering that you are a bariatric patient. You do not need to let that term define you by any means as a person, but use it to identify where you were, where you went, and where you want to be, physically and mentally healthy by your standards.

Keep in mind that it is important to have realistic goals and think of long-term success!

“Bariatric surgery procedures are merely tools and not the solution. They require a lifetime commitment to exercise and a good diet to keep the weight off,” Dr. Steven C. Simper, MD, FACS

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

https://www.cdc.gov/healthyweight/physical_activity/index.html (Centers for Disease Control and Prevention (CDC))

What is “Junk Food”?

Sep 7 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

It’s been studied and here it is, “Junk food is twice as distracting as healthy food.” According to a study at John Hopkins University, researches found when food is irrelevant or not even a part of the person’s task, and even when people are focused on their work, food can still sneak in and grab that person’s attention, distracting them. The study also shows that after a few bites of candy or chips, junk food is no more interesting than cabbage.¹ It also goes to prove that food shopping while hungry can cause you to pick out less healthy options than if you’d eaten, even a little snack, beforehand.

First Geth and lead author Corbin A. Cunningham, Distinguished Science of Learning Fellow in the Department of Psychological and Brain Sciences, created the study and shows that after divulging in junk food, those cravings aren’t always satisfied, leaving behind the guild feeling of having done something you shouldn’t have.

Cunningham states, “While it is hard to tell, I think some of the rewarding nature of high calorie foods might be that we know we should only occasionally indulge in them. Thus, they become more “rewarding” than foods that we could eat as much as we want.”

When foods are consumed in their natural and unprocessed form, it promotes healthy responses, supports digestive and immune systems, and minimizes inflammation of organs, capillaries and joints. When we eat processed foods, the taste hijacks our neurotransmitters and causes us to be unable to judge when we have consumed sufficient calories and nutrients, thus leading to overeat.²

Our body, brain, tongue and palate have formed an identification for these foods found in its natural form. Due to this, we have hardwired our brain to identify 3 different tastes from our food: fatty (a dense source of energy), sweet (a quick source of energy), and salty (facilitates conservation of body fluids).

It’s important to identify these food items that trick our brains into overeating and minimize them, if not to stop eating them altogether.

So, what is “junk food”? When you hear the words “junk food,” you might think of candy, chips, cookies, cake, sugary drinks, hamburgers, hot dogs, French fries, ice cream, and most items served at fast-food restaurants. “Junk food” are foods that are high in calories (or empty calories) with little to no nutritional value.

A study done by Joseph Schroeder, associate professor of psychology and director of the behavioral neuroscience program at Connecticut College, found that their theory of high-fat/high-sugar foods stimulate the brain in the same way that drugs do by doing an experiment with rats that formed an equally strong association between the pleasurable effects of eating Oreos and a specific environment as they did between cocaine or morphine and a specific environment. They also found that eating cookies activated more neurons in the brain’s “pleasure center” than exposure to drugs of abuse.³ “It may explain why some people can’t resist these foods,” Schroeder said, “despite the fact that they know they are bad for them.”

Over the years, healthier food choices, such as fruits and vegetables, have gotten a reputation of being more expensive, though the USDA says this is not always the case.⁴ Arguably, it can be said that “junk food” can end up being more expensive due to the negative impact on general health.

When you feel or think of the need to eat “junk food,” just for the pleasure of eating, remind yourself that you eat for nutritional purposes. Find ways to form new habits. When “Head Hunger” hits you, develop a strategy to avoid this behavior. The best way to help this is simply to drink more water.

If you have any food questions or concerns, please call our office at (801) 268-3800, or the Weight Treatment Center at St. Mark’s hospital (who we work with closely) at (801) 268-7479. If you need help with nutrition or help with overcoming old habits, don’t feel ashamed to ask for help. We can give you referrals to dieticians and psychologists who can help!

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

https://hub.jhu.edu/2017/10/26/junk-food-twice-as-distracting/#:~:text=Even%20when%20people%20are%20hard,new%20Johns%20Hopkins%20University%20study (John Hopkins University)
https://link.springer.com/article/10.3758/s13423-017-1375-8 (Psychonomic Bulletin and Review)
https://www.conncoll.edu/news/news-archive/2013/student-faculty-research-suggests-oreos-can-be-compared-to-drugs-of-abuse-in-lab-rats.html#.Yw_DC3bMKUn (Connecticut College)
https://www.usda.gov/media/blog/2012/05/16/healthy-foods-not-necessarily-more-expensive-less-healthy-ones (U.S. Department of Agriculture (USDA))

Vitamins and Minerals for Bariatric Life

Aug 18 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Before weight loss surgery it is recommended that all patients start on a daily adult multivitamin, along with any supplements recommended by a treating physician. It is also recommended that you have blood work done to check for any deficiencies before weight loss surgery. This will allow time for treatment of any deficiencies, and prepare your body for weight loss surgery.

After weight loss surgery taking required vitamins everyday must become a habit that continues for the rest of your life. By taking these supplements, you can assure that your body is getting the nutrients it needs. Below you will find a list of vitamins required for weight loss patients.

Here are the vitamins and minerals you should be taking:

Multivitamin:
The surgeons at Rocky Mountain Associated Physicians (RMAP) do not recommend a certain brand in vitamins. Find your vitamins where it is most convenient for you; your local pharmacy or grocery store are great options. For about the first four months after surgery all large pills will need to be cut into smaller halves, or in a chewable or liquid. Taking children’s vitamins are okay, as long as you take the recommended adult dose as indicated on the bottle.
***Avoid gummy multivitamins as they lack in B vitamins, a vital mineral you need after surgery.

Sublingual Vitamin B-12:
1,000 mcg/day. Take sublingually (a small pill that is placed under the tongue and absorbed directly into the bloodstream) daily or by intramuscular injections, monthly. Take at a time that can become a habit for you.

Calcium Citrate:
500-600 mg three times a day. Our bodies only absorb a small amount of calcium at a time. This is why it’s required to take in divided dosages to get in surgery, this pill cut into smaller halves, or in a chewable or liquid. Calcium Citrate chews are okay to use, but be aware of any extra added sugar.
***Do not take your calcium supplement until you are drinking at least 64 oz. of water.

ADEK:
Duodenal Switch (DS) patients are required to take a supplement high in vitamins A, D, E and K. This vitamin needs to be fat-soluble and contain 10,000 IU of Vitamin A, 2,000 IU of Vitamin D, 22.5 IU of Vitamin E, and 300 micrograms of Vitamin K. This supplement can be difficult to find. ADEK vitamins can be purchased at RMAP’s front office: 1160 E 3900 S, Salt Lake City UT, 84124.

Iron:
Anemia can occur if you don’t ingest enough iron. Many times it’s necessary to take iron (ferrous sulfate). Sometimes multivitamin preparations don’t contain enough iron to meet daily requirements. Your physician needs to determine if an iron supplement is appropriate for you. Don’t start an iron supplement until you have consulted with your physician.

3000 IU Vitamin D3

Visit RMAP on Pinterest to find vitamin online resources.

As you can see vitamin supplementation is very important. This is because restrictive and malabsorptive procedures like the gastric bypass, sleeve gastrectomy, and duodenal switch carry risk for nutritional deficiencies. Severe complications can result if vitamins are not taken as directed.

Please contact Rocky Mountain Associated Physicians if you have any questions regarding vitamin supplements before or after weight loss surgery.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Protein Bars and Shakes

Jun 9 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Our philosophy at Rocky Mountain Associated Physicians (RMAP) is to build healthy habits that will last a lifetime; point being to utilize natural/real food for energy sources. We recommend eating between 40-60 grams of protein/day after bariatric surgery, which equates to 160-240 calories/day. This is very achievable by eating more natural sources of protein such as yogurt, cheese, beans, tofu, deli meats, chicken, ground beef, steak, and even vegetables.

Protein shakes are very calorie dense for a small volume and they will empty your pouch faster than regular food, leaving you hungry sooner. The habit of drinking your calories and your stomach emptying faster can lead to weight gain after surgery. Protein supplements are also not always available wherever you may go in the world. Learning how to eat appropriately on food is the best route to making lifestyle changes.

There are several patients after weight loss surgery who have been very successful at weight loss and maintenance by choosing to use protein supplements on a more regular basis. Who are we to argue success in that circumstance? Our philosophy simply stems from the success we have seen in the majority of our patients, and not the exception.

There are circumstances after weight loss surgery when protein supplements are recommended. Please discuss the use of protein supplements with your surgeon/provider before adding them into your routine meal plans.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Artificial and Natural Sweeteners

Apr 21 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Patients often ask if they can use artificial or natural sweeteners after having weight loss surgery. They both can be a great option to spice up your water if you are having a hard time getting in the recommended 64+ ounces. But remember, artificial sweeteners, such as Splenda, Aspartame, and Sucralose that are found in Crystal Light and Propel, along with natural sweeteners, such as Stevia or fruit are known to be potent appetite stimulants. Because of the powerful cravings they can cause, sweeteners should be diluted and used sparingly.

Dr. Steven C. Simper talks more on the topic of artificial sweeteners and what it does to your body here: Why Are Sugar Free Drinks and Artificial Sweeteners Bad?

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

The Positives of Protein

Jan 27 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

Protein is important to not just weight loss surgery patients, but to all individuals. It gives us energy and is essential for the development of new cells. Consuming enough protein helps with the prevention of muscle loss and may even help prevent hair loss. Protein found in meats provides iron which is necessary for red blood cell production and the prevention of anemia.

Muscles are made of protein. When you don’t eat enough you break down muscle to use stored protein instead of using stored fat. You need enough protein to help fight infections, recover from illnesses and to slow muscle loss. Because organs are made of protein, protein intake affects the health of your organs as well.

You want to replenish your body with protein daily. The limited capacity of your pouch/sleeve makes it difficult to eat enough high protein food at any one time. This is why it’s critical to eat protein-based foods at each meal. We strongly advise that you eat all of the protein items in your meal first, and then proceed to the veggies.

Sometimes meats have a tendency to not “sit well” with some weight loss surgery patients. Chewing protein dense foods until they are smooth in your mouth may help with any stomach discomfort.

So, what are good sources of protein? A food must contain at least 30% protein to be considered a “source of protein.” Look to see if the food is high in fat. Is it a good source of other nutrients such as iron or calcium?

Powerful Protein Choices

Soy nuts
Sunflower seeds
Tofu
Cottage cheese
Turkey
Chicken
Egg whites
Legumes
Skim milk
Kidney beans
Lamb
Beef jerky
String cheese
Mozzarella cheese
Refried beans
Halibut
Veal
Bacon
Tuna
Crab
Catfish
Beef
Ham

Protein needs

Eat a diet that consists of 70% protein foods and 30% vegetables to ensure that you are getting all the protein that you need after surgery.
Eat protein-based meals three times daily
Add two 1-ounce protein/vegetable snacks between meals

Increasing Protein in Your Diet

Think of meals in terms of which proteins and vegetables you can eat. Egg whites are pure protein and you can eat as many as you like. Egg yolks, however, are high in fat. Limit the yolks to once or twice a week. Here are some suggestions for increasing protein in your diet:

Melt cheese on refried beans, meat or any kind of veggie
Eat an omelet, scrambled egg, slice of meat or yogurt for breakfast
Mix or add cottage cheese with eggs, tuna, turkey or chicken
Eat tuna or chicken salad made with light mayonnaise
Add cottage cheese and small pieces of meat to a tossed salad
Use legumes such as lentils, pintos and kidney beans
Eat a few nuts (no more than four) on occasion
Add tofu to soups
Use dry milk powder

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

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