melting mama I Product enabler.

Scary - Compliance issues in post weight loss surgery patients.

This does not surprise me.  But, it's a bit scary.

Source -

A new study released online January 27, 2010 demonstrates that compliance with nutrition is a challenge for many bariatric surgery patients.  The study, titled Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient, looked at bariatric patients admitted to a single hospital years after their bariatric procedures (admissions for other causes).  

Researchers evaluated what they were doing for supplementation at the time of admission and compared this to current ASMBS guidelines.

Most of the patients were 3-7 years post-op, 87% were roux-en-Y gastric bypass.  On admission only 33% were taking a multivitamin and only 5% were taking B12 .  Problems were also noted with iron, calcium, folic acid and vitamin D supplementation.  In addition, researchers found numerous medication errors, the primary problem being the use of slow releasing medication forms in patients with malabsorptive procedures.  Overall, this study points to the continued need for both bariatric surgery patients and healthcare professionals to be better educated on appropriate nutrition and medication protocols. 

Reference: 
Lizer MH, Papageorgeon H, Glembot TM. Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient.
Obes Surg. 2010 Jan 27. [Epub ahead of print]

Link to abstract: Click Here

Reviewed and Prepared by:
Jacqueline Jacques, ND 
Chief of Scientific Affairs 
Bariatric Advantage 

So, people do not take their vitamins.  We knew this.  "They are yucky!  They are expensive!  My labs are fine!  I had surgery a long time ago, I'm fine!  I forgot!"

Now, I was not aware that extended release meds were a no-no.  I take one.  I specifically ASKED the doctor about that.  "Don't worry about it."  (Is this why I still have issues?)  So, I need MORE information, please!

Which took me approximately five seconds to find.  @@ How do I not KNOW THIS?!  And, further, why am I prescribed it?

Reductions in drug absorption are more frequently encountered in patients who have had combination restrictive–malabsorptive procedures. Decreased intestinal length and surface area lead to the reduced absorption of extended-release drug preparations because these formulations are absorbed over 2–12 hours.^[27] The reduction in functional intestine length makes it likely that extended-release preparations have passed through the gastrointestinal tract before absorption is complete. These same principles can also apply to delayed-release and enteric- or film-coated product formulations. ^[28] To overcome this problem, the immediate-release dosage forms should be substituted, which could require increased frequency of administration.

ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient (PDF)

I had WLS - what can I eat when we go OUT?

Totally lifted this post from my foodie friend Eggface, who is maintaining her weight loss while eating real foods most of the time.  (Which impresses me to no end, you must know that.)  But today she posted about eating OUT.

The World According To Eggface - 

I'm sharing some strategies I employ when eating out after having weight loss surgery. 


Plan Ahead: If possible get a copy of the menu and plan what you are going to have in advance. That will save you from making poor choices on the spur of the moment. Most restaurants and fast food joints have a web presence, Google their website and read the menu in advance. Here's another great resource for menus.

Make substitutions: You can still order your favorite chicken fajitas, but instead of the Mexican rice and refried beans, do double beans or ask for a salad on the side. Ask for double veggies instead of the starch. At breakfast get sliced tomatoes or fruit instead of hash browns. You get the idea — this stuff will take a little extra thought at first, but in no time it will become second nature. If it's somewhere else on the menu you can probably get it as a substitution. 

Portion it: Ask the server to box half up right away. I just say, "I really want dish xyz but that looks like a lot can you box half up for me" Then get yourself one of these groovy gadgets that heat leftovers up without drying them out. We are no longer members of the clean your plate club. Facts are facts. We will sadly waste food or learn to walk out with boxes. Hopefully you can split meals with the person you are with but that isn't always possible.

My most common orders are:

Grilled Fish, Crab Legs, Shrimp with all veggies
Fajitas. No rice or tortillas, double beans
Steak with all veggies
Salads with some sort of protein, no croutons, dressing on the side

Leftover Crab becomes Crab Omelet, Crab Salad, Bites, Stuffed Mushrooms
Leftover Steak becomes Tortilla Pizza
Leftover Grilled Fish becomes a Salad
Leftover Fajitas becomes Breakfast, Salad, Tortilla Pizza

I love crab legs when I'm with a group. They take forever to eat, great protein, looks like I've ordered a lot so no one feels self conscience about my tiny portion, and leftovers are great the next day.

Enjoy! Enjoy spending time with the other people in your group and make the food secondary to the social event. 

So that's restaurants. 

What about the dreaded drive-thru? Here are some of my Fast Food orders. 


In & Out Burger: "Protein-style" Single Cheeseburger with grilled onions (Protein style = wrapped in lettuce instead of a bun)

Taco Bell, Del Taco: Order of Pintos & Cheese/refried beans with a scoop of meat or chicken added

El Pollo Loco: Grilled Chicken Breast (single piece - they are huge) or $1 side salad minus tortilla strips & the $1 Chicken Taco El Carbon. I discard the tortilla and dump the chicken on the salad. Great meal for $2

McDonald's: Premium Caesar Salad with Grilled Chicken 

Carl's Jr: Cranberry, Apple, Walnut Grilled Chicken Salad (ax the walnuts if you are sensitive to sugars they are glazed) or they will wrap any of their burgers in lettuce. Just ask for the "Lettuce Wrap" version

Wendy's: Chili

Jack in the Box: Denver Breakfast bowl minus the hashbrowns & white cheese sauce, Southwest Chicken Bowl or Teriyaki Chicken Bowl minus rice

Subway, Submarina, Quiznos: They will turn any of the subs into salads. Watch the dressings, ax the croutons/breadsticks/flat breads. I like Quiznos soup too

Starbucks: Egg White Whole Wheat Feta Wrap, Oatmeal, Protein Plate giveaway the date bread, Soy Lattes. Here's my Starbuck's Post WLS Guide.

Jamba Juice: Oatmeal w/ Banana

Chipotle: Burrito Bowl minus rice (this will feed an Army)

Baja Fresh: Tortilla Soup (minus tortilla strips)

Chick-fil-A: Chargrilled & Fruit Salad (newly discovered)

Diners, IHOP, Denny's: Scrambled Eggs with Cheese is my standard. If they have turkey sausage even better.

That's about all I can think of right now. I'll add others if they come to mind. Feel free to post your orders or restaurant adaptations in the comment section. These are just things as a post-op I personally have eaten.

Hey and don't feel guilty if you make a poor choice. Life happens. You can't rewind time, so you might as well get over it. Start planning your next healthy meal and love yourself.

-Eggface

NuVal Nutritional Scoring System

This is a tool I would use: NuVal - a nutritional scoring system of foods that you can utilize even while grocery shopping.  If given the choice of two similar items with different scores -- I'm much more likely to buy the higher scored item, which should be, BETTER overall for my family.  

18% More For Your Fat Cells! Calories in commercially prepared foods don't match the labels.

Makes me want to really re-consider bothering to add the calories up each day.  Not that I DO, but when I do, I want it to be relatively accurate!  I am not surprised though -- especially for restaurant foods -- it calories cannot be an exact science or amount without being weighed and tested every. single. time.  

The Accuracy of Stated Energy Contents of Reduced-Energy, Commercially Prepared Foods

The accuracy of stated energy contents of reduced-energy restaurant foods and frozen meals purchased from supermarkets was evaluated. Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased from supermarkets averaged 8% more than originally stated. These differences substantially exceeded laboratory measurement error but did not achieve statistical significance due to considerable variability in the degree of underreporting. Some individual restaurant items contained up to 200% of stated values and, in addition, free side dishes increased provided energy to an average of 245% of stated values for the entrees they accompanied. These findings suggest that stated energy contents of reduced-energy meals obtained from restaurants and supermarkets are not consistently accurate, and in this study averaged more than measured values, especially when free side dishes were taken into account. If widespread, this phenomenon could hamper efforts to self-monitor energy intake to control weight, and could also reduce the potential benefit of recent policy initiatives to disseminate information on food energy content at the point of purchase.

A little extra splootch of Mac Sauce here, a smidge of cheese there, it happens.  That's why my suggestion is, OVERESTIMATE or round up.  And if you don't think this matters, because "dieters" shouldn't be eating fast food -- this study was also done on foods like "Lean Cuisine" frozen diet meals, which, also had more calories than indicated.

Fooducate Blog -

If you’re scoffing and thinking that people wanting to lose weight shouldn’t be in a fast food joint to begin with, we’ve got more bad news. The researchers also checked 10 popular frozen meals and found an average 8% discrepancy, again skewing to a lower calorie count than was actually present. Lean Cuisine’s shrimp and angel-hair pasta claims 220 calories, but clocked in at 319 (45% more!).

Let’s have some back-of-an-envelope math fun, shall we?

If a supposedly 2000 calories-a-day diet is actually 18% higher in calories, that means 2360 calories or an extra 360 calories a day consumed. Since every 3500 calories are equivalent a pound to our body weight, approximately every ten days we’d gain one pound of body weight. In one month, we’d be up 3 lbs. In one year, a whopping 36 pounds!

I wish I could blame my recent gain on poor Lean Cuisine math.