I received this question for Dr. Connie: I was bullied and I hate the way it made me feel. I attended a group exercise class and was verbally bullied in front of everyone by another girl in the class. She made very mean remarks about my weight and why I was even there. Please, tell me, how do I handle these bullies? Don’t go anywhere because Dr. Connie's back! Psychologist Dr. Connie Stapleton, who specializes in bariatric surgery is here to tell you how to handle a bully. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 64. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Joining me today via Skype is Atlanta-based psychologist Dr. Connie Stapleton. If you’ve been lucky enough to already hear Dr. Connie on the podcast, you know she has vast experience in the field of bariatrics and shares practical skills for improving your post op relationships with food, other people and most importantly your relationship with yourself. She teaches you better ways to deal with life’s stuff. This week she’s taking on the bullies. Dr. Connie's Information Website: http://www.conniestapletonphd.com BariAftercare: The Podcast; available on phone podcast apps, Apple podcasts and most other podcatchers   My resources for you: https://BreakingDownNutrition.com/resources S: Welcome back to the podcast, Dr. Connie! S: You heard the question at the beginning about the woman who attended a group exercise class and was verbally bullied in front of everyone by another girl in the class. She made mean remarks about her weight and why this person even showed up. Today I want to dig deep on bullying as it’s a big problem for anyone dealing with weight issues. Questions we discuss. One of the best episodes yet with spot on information and strategies. 1. Dr. Connie, what makes someone bully another person whether it’s over weight or any issue? 2. When you’re bullied in a public venue, like this exercise class, how do you handle it? 3. What about when you’re cyber bullied? 4. Bullying also happens one on one. How do you stop it?   5. How do you personally cope, heal and then move forward from being bullied? Dr Connie, such good information. Any last thought to leave us with? I hope today’s episode has given you insight, knowledge and strategies  to handle any bully you may encounter. If you have more questions you want Dr. Connie to answer the next time she’s here, please contact me thru my website. You can also messenger me thru Facebook or reply to one of my newsletters. I read every email that comes in. Take care of you. You’re worth it!  

Beyond Bariatric Surgery: Everything You Need to Move On

#64 Bariatric Mental Health Q & A #3: Your Questions Answered

Are you into juicing? Maybe you’ve even considered replacing your coffee with a green drink. Is there a best way to juice if you’ve had bariatric surgery? You bet there is. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 63. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. If you’re looking for a private facebook group where you can ask questions and talk about what’s on your mind, please join me in Bariatric Surgery Success with dietitian Dr. Susan Mitchell. Juicing breaks down fruits and vegetables into liquid form generally by separating the juice from the pulp. But it‘s the method of juicing that makes all the difference when you’ve had weight loss surgery. Juicing can be a good option to increase your nutrient intake meaning vitamins, minerals, fiber and naturally occurring plant nutrients or what’s called phytonutrients. It’s also an easy way to incorporate additional vegetables and fruits into the diet, particularly less popular ones like kale or spinach. Ideally juicing should supplement the vegetables and fruits that you eat in whole form.  Instead juicing often replaces these whole fruits and veggies. There are two methods of juicing. First is traditional juicing, the type most common in juice bars, airports and hotels, where a fruit or vegetable is pressed or shredded. All of the pulp (another name for fiber) is removed using either a cold press or centrifuge juice extractor leaving only the juice. But for anyone and especially if you’ve had bariatric surgery, you miss out on the benefits of fiber and they’re valuable. A few benefits include helping with digestion, reducing inflammation and increasing satiety or how full you feel. Do you remember in episode #47 on fighting inflammation with food, we talked about fiber. It’s digestible by gut bacteria making short chain fatty acids. What was that fatty acid in the gut called? Butyrate. What we love about butyrate is that it provides valuable health effects such as inhibiting the growth of bad bacteria, reducing inflammation and increasing mineral absorption. Don’t forget, fiber also helps prevent constipation but sometimes it causes potential gas and bloating. Your juicing tip: start with a small portion, maybe 1/4 of a cup and see how it goes. It may be too bulky and filling to drink very much of it at a time. So we don’t want to give up fiber easily. Besides, juice with no pulp or fiber packs more calories and carbs, mostly coming from the natural sugar found in fruit in a more concentrated form. For example, a cup of pineapple is about 80 calories, but a cup of pineapple juice is about 120. Juice is the most calorie-dense part of plant foods. Did you know that the calories in a juice drink can range from 100 to 800, depending on the type of fruits and vegetables you add and the amounts? Remember that fruits tend to have more calories than vegetables so opt for more veggies and less fruit to keep calories reasonable. A good ratio is 75% veggies and 25% fruit or 3/4 veggies and 1/4 fruit. Portion size is always key too. Here’s where the second method of juicing called whole juicing is superior. Whole juice is the result of blending vegetables and fruits into a drinkable liquid without removing the fiber. Whole juicing requires a high-powered blender instead of a juicer. You may be familiar with brands for home use such as a Blendtec, NutriBullet or Vitamix. When whole juicing, whole fruits and vegetables go in the blender with extra water, and a powerful motor pulverizes them into a smooth juice with the fiber included. A study in the European Journal of Nutrition compared the effects of whole apples to apple juice in regard to the effects on blood lipids such as cholesterol. The results suggest that the fiber component found in the skin of apples is needed for the cholesterol-lowering effect and that clear apple juice is not a suitable substitute for the whole fruit. When the entire apple is used in whole juicing the benefits of the skin remain in the juice. Your take aways: 1. Juicing can work for you after bariatric surgery as long as it’s whole juicing which retains the fiber and all of its benefits. 2. Aim for 3/4 veggies and 1/4 fruit to keep calories and carbs lower. 3. Always eat protein-packed foods first as that’s bariatric gold then have the juice. 4. Portion size is always key. Start small with 1/4 cup and see how you tolerate it. Any issues with bloating or gas? Stay focused on your journey, you’re worth it.

#63 The Best Way to Juice after Bariatric Surgery

Want a strong and heathy immune system? Who doesn’t right? The foods you eat and the vitamins and minerals they contain play a starring role in keeping your immune system in top form. Let’s talk about 5 vitamins and minerals that are among the top contenders for supporting immunity and then, where you find them in food. Procarenow.com for free samples. Use Code: Susan10 to save 10% Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 62. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. During the covid pandemic we hear a lot about immunity and compromised immune systems. What is your immune system? Think of it like the Internet and an intricate broadband network where you have to be on guard for hackers. Your immune system is also an intricate system that goes into action when it determines that some type of foreign invader has tried to hack into your body in the form of bacteria, viruses and parasites. Your body needs numerous vitamins and minerals in order to keep your immune system strong and alert. Think of it like training for the Olympics. It takes time, practice and focus to succeed in your sport. It’s the same with your immunity. The goal is to focus on eating foods loaded with vitamins and minerals day after day over time so that when your immunity is challenged by illness, it’s optimized and ready to respond. Let’s focus on 5 vitamins and minerals important in supporting immunity along with what they do and where to find them in food. 1. Vitamin C: known for its role in the healing process and the ability to fight infection and potentially shorten how long an infection lasts. What food first comes to your mind when you think of Vitamin C? Citrus, like oranges, tangerines and grapefruit? They’re great sources but don’t forget about papaya, spinach, broccoli, bell peppers and berries like blackberries and strawberries and kiwi. It’s rare that you need extra vitamin C supplements as it’s easy to find in so many foods. 2. Vitamin D: you may have heard vitamin D mentioned a lot in the Covid conversation. It’s one one of the most powerful vitamins for your immunity. However, there are not a lot of food sources. Salmon, tuna and sardines, egg yolks and some mushrooms contain vitamin D and also fortified products like orange juice, milk and various cereals. What does fortified mean? Fortified means that the food item did not originally contain vitamin D so it was added to it similar to adding vitamin D to a multi vitamin supplement but in food. Vitamin D is one of those vitamins that you will likely need from both food and supplements in order to reach the blood level needed. Go back and listen to podcast #54 It covers the must have vitamin and mineral supplements after bariatric surgery. Part 2 covers vitamin  D more in depth and the benefits of vitamin D3. 3. Zinc: found mainly in animal foods, zinc helps the body make new immune system cells.  Oysters, crab, shrimp and mussels along with lean meats and poultry are all sources but you can find zinc in legumes, like chickpeas, lentils and beans. Don’t forget milk, cheese and nuts such as peanuts, cashews and almonds. Lots of choices for zinc so it's rare that you need extra beyond what will be in your food and daily bariatric multi. 4. Iron: your body uses iron to help carry oxygen to cells and is active in many immune processes. In other episodes we’ve talked about how important iron is after bariatric surgery and that it’s one of the minerals you’re likely to be low in. As a reminder, the body more easily absorbs and uses iron from animal products called heme iron. Plants can also be sources of iron too but it’s not absorbed and used as well by the body. Think about adding various beans such as black or kidney along with kale and broccoli to your diet. 5. Vitamin E: also helps regulate immune functions. Some food sources of vitamin E include nuts, seeds, avocado and spinach. What did you notice about nuts and spinach? They’ve  been mentioned already for their zinc and vitamin C content. This is the beauty of food. Foods are typically not just a one-vitamin wonder, but supply a team of nutrients working together for your benefit. That’s why food first is a smart focus followed by supplements rounding out what you need more of due to your surgery. So remember, vitamins C, D and E along with zinc and iron help support your immunity. Be sure and choose some of the foods we talked about for your daily diet to keep your immunity system healthy. Stay focused on your journey, you’re worth it.

#62 Support Your Immune System with These 5 Vitamins & Minerals

Procarenow.com for free samples. Use Code: Susan10 to save 10% Mohsen asks: I  have chocolates and ice cream sweetened with Stevia or Monk fruit. Is Stevia low GI and will it cause dumping? Or should it be avoided all together? Today, we’ll answer the questions on your mind. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 61. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Before I jump in with Isabel, let me remind you that if you’re looking for the latest freebie, supplements, portion control dinnerware, the newsletter and other resources, check out my resource page This week joining me via Skype is bariatric dietitian Isabel Maples. If you’re in the private facebook group, you might have seen her comments as she shares her expertise. Isabel is a registered dietitian and bariatric coordinator with Fauquier Health in Warrenton Virginia. She helps her patients navigate the weight loss surgery process to maximize success. Her focus is to help you relearn body cues for hunger/satiety, tame trigger foods, and discover the joy of movement. Guest: Bariatric Dietitian Isabel Maples, RD Fauquier Health Weight Loss Surgery Facebook: Isabel Maples RD Welcome Isabel! Thanks for joining me today. Lots of good questions today starting with first one: I started running, using the Couch Potato to 5k Program!  I'm on week 2 and I find that the last few times I finished my run, I am EXHAUSTED! I’ve been sleeping well. I drink plenty of fluids. I have a protein drink before I go and then I eat lunch about an hour after I get home. I drink plenty of water in the afternoon. What am I missing? Is it my nutrition? Do you have any advice on what I should I eat before and after I run? Q2: I have a question about portion. I’m 4 weeks post surgery and have lost around 14 kg's or almost 31 pounds since the surgery which I’m very happy about. I expected to not be able to eat more than 1/2 cup, however, I found that If I chew my food well ( during the minced diet) I could easily eat 1 full cup. Is this normal? Q3: Mohsen wants to know: I have a question regarding Stevia. I  have chocolates and ice cream sweetened with Stevia or Monk fruit. Is Stevia low GI and will it cause dumping? Or should it be avoided all together? Any last thoughts Isabel? Have a question you want answered? Contact me thru the website https://BreakingDownNutrition.com or if you receive the weekly newsletter, hit reply and send it to me that way. And remember, take care of yourself. You’re worth it!

#61 Bariatric Nutrition Q & A #3: Your Questions Answered

Procarenow.com for free samples. Use Code: Susan10 to save 10% Did you remember to download the new freebie I mentioned last week? Go get the freebie and try the three tips to help you cut down on added sugars in your food. Freebie: 3 Ways to Crack Down on Added Sugars  Podcast: Liz posted this question: “I see a lot of protein drinks that are casein-based advertised as Non-Dairy. How can they do that when casein is dairy?” I’ll explain the labeling which is confusing. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 60. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Today I want to give a shout out to Jill who posted on Facebook: “I love supporting anyone who has had surgery. It’s a tricky road to navigate. I love listening to your podcasts.” Right back at your Jill. Your kindness caught my eye right away. In a world of bullies and mean-spirited words, we need more of your attitude. And thank you for listening to the podcast. Ok, let’s get back to Liz’s question about protein drinks that are casein-based advertising as Non-Dairy. The rest of her question was: “How can they do that when casein is dairy? They always say with an asterisk that casein is dairy, but really, it’s not just a tiny amount, it’s the main source of protein for the drink.” There are a lot of us dietitians who feel your pain and frustration. Actually there are two terms for us to look at closely. Dairy-Free is one, and Non-Dairy is the other. You’ll see both of these terms on food packaging and labels. One point to put in memory right now: the terms don’t tell the whole story. What does? The ingredient label. And remember, the ingredient label in the United States lists the ingredients from most to least. In order to get clear on these terms, let’s talk about what they mean on a label. Starting with Dairy-Free. This one might shock you. There is NO regulatory definition for the term Dairy-Free. What that means is the Food & Drug Administration or FDA has not set rules or regulations for the use of the term Dairy-Free on labels. Bottom line, no definition means that food labeled Dairy-Free may or may not be free of milk proteins. So you and I become the label sleuths I talk about regularly. We need to go from the package label to the ingredients and see what’s what. Where this really matters from a health standpoint is if you’re allergic to milk. If you are truly allergic, please go straight to the ingredients. If the product contains milk derivatives like whey or casein, often in the forms called caseinates, they’re a potential problem for milk allergies. Hold on, I’m climbing on my soap box. This term Dairy-Free reminds me of the term "natural", which also has no legal definition. Basically “natural” means anything you want it to mean. So you can see why the term “Dairy-Free” should turn on a light bulb and send you straight to the ingredient label if you have a health concern. Switching to the term “Non-Dairy”. The FDA does have an older regulatory definition for the term Non-Dairy. But, the interesting, ok frustrating, part is that the definition allows the presence of the milk protein, casein. The term, Non-Dairy, is commonly used on coffee creamers made from caseinate, a milk protein, rather than milk or cream, but now you see the term “Non-Dairy” on labels for protein drinks. This feels like misleading advertising when casein, which is a milk protein and a milk allergen, is the main ingredient. However it is currently allowed, but the term caseinate must be followed by an explanation with wording such as milk derivative. Non-Dairy definitely does not mean that the product is milk-free so if you have a true dairy allergy, you need to read the ingredient label carefully for this term too. Stay focused on your journey, you’re worth it.

#60 Non-Dairy versus Dairy-Free: What You Need to Know

Listed as a top-10 celebrity diet, the lectin-free diet has been promoted for weight loss. Should you try it after bariatric surgery to prevent that dreaded weight regain? Before I just in, I want to welcome our new podcast sponsor ProCare Health whose ad you just heard by the way. I’m proud to have them on board and know you’ll find their products helpful in your journey. Procarenow.com for free samples. Use Code: Susan10 to save 10% Also I have a new freebie for you: 3 Ways to Crack Down on Added Sugars. Did you know that added sugars are basically empty calories with zero nutritional value? They're often added to food as flavor enhancers and preservatives. Their carbohydrate-dense nature makes them a trigger for dumping syndrome. So grab the freebie and use the three tips to help you crack down on added sugars in your food. Freebie 3 Ways to Crack Down on Added Sugars One of my wonderful podcast listeners, Mohsen, sent me an email saying there’s a bit of information out there in regards to lectins and what they do to the lining of your intestines and bacteria in your gut. Dr. Steve Gundry is the big advocate against lectins and I am not sure whether I should listen to him or not. I think legumes are a really nutritious food and I love having them for my snacks including small cans of Edamame. What is your opinion? Very glad you asked Mohsen. The internet is full of lectin pseudo-science as I call it. You may have also read about celebrity Kelly Clarkson losing 37 pounds or 17 kilos on the lectin-free diet. This kind of weight loss alway creates a buzz, healthy or not. Trying to cut out lectins means cutting out grains, beans and legumes, fruits, veggies such as tomatoes and eggplant and more. First of all, what the heck is a lectin? Found in almost all food, it’s a protein that binds to carbs such as sugars and has important functions in both plants and humans. It seems that the sugar-binding activity of this lectin protein may be necessary for normal digestion and absorption of foods. In other words, according to scientists following a lectin-free diet may alter normal nutrient absorption. Let me stop right here and bring it home. Is there a downside to a lectin-free diet for you? Put on your science 101 cap. Think about this. Why would it matter to you if normal nutrient absorption is altered? It matters because going thru bariatric surgery already alters nutrient absorption. Why would you want to add insult to injury meaning add on additional issues you don’t need? There is so much research now on the benefits of consuming plants, specifically fruits and vegetables, which include supporting your immunity, fighting inflammation in the body, and just living a long life. For example, lycopene which gives tomatoes their red color, has a role in cancer prevention and heart health. This lectin-free advice is so controversial and goes against current recommendations from science-based groups including the American Cancer Society and the American Heart Association. Ok, but you heard that lectins are toxic. This is true and you hear about the toxic lectin in raw or undercooked kidney beans. Eating raw kidney beans can cause you to vomit along with other ugly gastrointestinal symptoms. Bottom line: do not eat raw beans. Fully cook them to reduce the lectins. Lectins are found in beans but when you cook the beans, the lectins are basically wiped out and don’t affect the body. But why the weight loss with this diet? I would suspect it has much more to do with cutting out carb-heavy processed foods, typically high glycemic, which also significantly cuts calories. Your take away: restricting foods with another pseudo science diet doesn’t help your journey or transformation. Restriction is not a positive lifestyle change. And lectins are not something you need to worry about. Your diet needs to be individualized for you after surgery which includes a lot of high quality protein, small amounts of high fiber complex carbs such as legumes (which includes beans, peas and lentils), vegetables, whole grains and fruit. Focus on you. Follow your bariatric-specific plan and take your bariatric supplements. Forget lectins. You have enough to focus on and you’re worth it.  

#59 Should You Go Lectin-Free after Bariatric Surgery?

Recently someone posted this question in my Facebook group: how do I stop fighting my brain over tempting food? Well, stay right where you are. She’s back! Psychologist Dr. Connie Stapleton, who specializes in bariatric surgery and helps you deal with life’s stuff, is here to answer questions about your relationship with food. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 58. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Joining me today via Skype is Atlanta-based psychologist Dr. Connie Stapleton. Dr. Connie uses her vast experience to share practical skills for improving your post op relationships with food, other people and most importantly your relationship with yourself. Basically, as I mentioned at the beginning of the podcast, she teaches you better ways to deal with life’s stuff Dr. Connie's Contact Info: Website: http://www.conniestapletonphd.com BariAftercare: The Podcast; available on Apple podcasts and most other podcatchers Dr. Stapleton’s hosts "Fair and Firm" retreats for bariatric patients. At each retreat, participants address struggles in their relationship with food, issues related to regain, and the frustration related to emotional eating and food addiction. It’s time to sign up for the next retreat, scheduled for September 1st – September 5th. Arrive on the evening of the 1st, meet your fellow retreat attendees, relax and get a good night’s sleep. The next three days are filled with education, activities, movement, relaxation (to include a massage if you would like one), discussion and laughter. Learn more about yourself, your relationship with food and how to move through barriers related to eating that keep you from fully engaging in the life you want to live. Depart on Sunday, early afternoon and take home new information about yourself and a host of skills for relaxation, mindfulness, avoiding emotional eating, and dealing with food addiction. Each participant has a full size bed. All bath and hair products, to include hair dryers are provided, although participants are welcome to bring their own products. All meals and snacks are provided and are bariatric-specific. Special food needs will be accommodated. For more information, email Connie@conniestapletonphd.com   S: Welcome back to the podcast, Dr. Connie! S: When you were here three or four weeks ago, my listeners loved your information and have a lot more questions so we’re going to get right to it. In my opinion, today’s media messages feed us unrealistic expectations of how we should look and what we should eat which then can be a part of unhealthy relationship with food. At the beginning I mentioned that this question was posted to my Facebook Group: how do I stop fighting my brain over tempting food? Dr. Connie, a lot of people refer to having a relationship with food but I don’t think the concept is well understood.. Would you talk about fighting with the brain and explain what having a relationship with food means? Q2: My relationship with food seems to flow with my relationship with my significant other. When he and I are at a good place in our relationship, I seem to be better able to stay away from sweets for the most part. When he and I argue, it seems I have a really hard time not wanting to eat chocolate, candy or ice cream. What are your thoughts about that? Q3: I do well in terms of following my food plan during the day but when I come home, I struggle to maintain that healthy daytime relationship with food throughout the evening. Do you have any suggestions? Q4: I developed an unhealthy relationship with food when I was around ten years old. I started coming home from school to any empty house. I was scared, lonely and often bored at home by myself. If I ate, I was distracted from those feelings. I recognize I am an emotional eater, but I still struggle to not turn to food any time I feel even close to how I felt when I was alone after school as a kid. How can I overcome this? S: Whether you’ve had surgery or not, these questions can apply across the board to so many of us. Take time to think about the thoughts Dr. Connie shared and how they can apply to your daily life. Decide what works best for you. You’re worth it!

#58 Bariatric Mental Health Q & A: Your Questions Answered #2

My hair is falling out atrociously since my surgery. What can I do to stop it? Are you experiencing this too and have the same question? I have three things to share about hair loss and nutrition after weight loss surgery. You’ll be glad you listened. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 57. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Let me put your mind at rest. The good news is, hair loss is very common, not permanent, and your hair should  grow back. I know it seems terrifying but it’s totally normal to lose 5-15% of your hair from bariatric surgery and the rapid weight loss that follows. Typically it does’t last more than 6 months then it grows back. It’s just a pain in your patootie to go thru. You might be wondering why this hair loss happens. There are many causes that include stress, thyroid issues, extreme diet changes, too little protein, too few calories, hormonal imbalance and iron or zinc deficiency. Even medication like a beta-blocker or too much vitamin A can cause hair loss. So think about your situation. You’ve had surgery, cut your calories very low, possible too little protein, maybe an under active thyroid. Sprinkle in low levels of iron, zinc, biotin or folate and you have a recipe for hair loss. Your science 101 for today: there are three stages in hair follicles known as anagen or growth phase, catagen or the transition or degradation phase and telogen or dormant, hair loss phase. Any guess which phase bariatric hair loss is tied to? You got that right, telogen or the dormant and hair loss phase. It seems the hair follicles are pushed into this dormant phase which typically lasts 3-6 months and then the hair falls out. Are you within this window? To be even more specific, hair loss is more common with gastric bypass and gastric sleeve because you tend to experience a more rapid weight loss and increased chance of vitamin / mineral deficiencies. The physiological stress of surgery and rapid weight loss can cause the body to focus vitamins and minerals on the heart, brain and other functions instead of hair growth. This is when you see the growth phase end and the telogen or dormant phase start. The dormant or telogen phase kicks in causing hair loss to occur. As your body adjusts to the changes, the hair loss slows and then stops. The caveat: your hair should grow back normally if there are no vitamin and mineral deficiencies and you are consuming adequate protein. So, the three important things to know and act on: 1. Follow up with your health care team for blood work to make sure there are no underlying health issues such as hypothyroid that would affect hair growth and loss. At the same time, lab work can check for vitamin and mineral deficiencies such as iron or zinc. 2. Take your bariatric-specific vitamin and mineral supplements daily or as your product recommends. It should contain iron, zinc, biotin, copper and other nutrients tied to healthy hair. Don’t miss this…if you do not have a deficiency, taking more of these supplements will not make your hair grow back any faster and excessive levels of vitamin A and zinc for example can be potentially harmful. If you’re wondering if you take the correct bariatric supplements that your body needs after surgery, listen to podcasts #53 & #54. Links to the podcast, newsletter, private Facebook group, etc on my resource page. Besides your recommended supplements, food choices can make a difference in your hair too. Sweet potatoes, spinach and tomatoes all contain vitamin A plus spinach is also a source of iron and vitamin C. Nice trifecta, right? Oysters contain zinc and eggs may surprise you but are a source of biotin. Beef contains very absorbable heme iron while lentils and black beans also contain iron and when eaten with a vitamin C rich food like red peppers or tomatoes, will help it to be absorbed better. These are just a few foods that you can pick from to give your diet a boost in the hair department. 3. Be sure you consume 60-90 grams of high quality animal, soy or dairy based protein and protein powders every single day. Lack of protein causes your hair to become thin and fall out which you don’t need if surgery has already pushed your hair into the dormant stage. I hear you. This hair loss isn’t fun with all of the other changes you face in your journey but it will end and sooner than you think. Time has a way of passing by quickly. Focus on you. Take your proper supplements, plan your protein daily, check in with our health care team if something seems amiss. You’re worth it.

#57 Help! My Hair is Falling Out after Surgery

Are you confused and don’t know what to believe about eating carbs? One friend tells you carbs are evil, don’t eat them and another friend loves carbs and says you need them too. Who’s right? Maybe you fear carbs and think if you do eat them, you’ll regain weight. Let’s cut thru the carb confusion together. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 56. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. The message that carbs are bad or evil, something to fear and to avoid at all costs is flat out incorrect. To add to this confusion, carb advice varies from one bariatric office to another. Should you be fearful or concerned about eating carbs? No, they’re not evil, not at all when put in the proper perspective. Carbs are one of the three main macronutrients including protein and fat needed by your body. Carbs provide energy to your body and brain and without them, you’ll feel like you’re crawling the carpet? You know what I’m talking about. During the digestive process, carbs are broken into glucose for energy and are the perfect source for your brain. So if you’re foggy or forgetful, I ask you, have you cut out carbs? The brain is only 2% of body weight but it gobbles up glucose. So a restriction on carb can result in muscle break down to feed the brain. Repeat after me: carbs are an excellent fuel source for the body and brain. If you’ve been avoiding carbs, here’s how to add them back. And the 50-million dollar question. How many grams of carbs should you eat? As we’ve talked about before, your number one focus is on your protein selection first then add high fiber complex carbs and fat choices. You might be thinking, no way! You want me to count grams of protein now carbs too. Do I really have to do this from now on? No, you don’t. More on this in a minute. But first, start by choosing high fiber complex carbs that I often refer to as ‘smart’ carbs. Your total grams per day should be somewhere in the 90-130 range depending on how far out from surgery you are right now. Often at 6 months out, the carb suggestion will be around 90 grams a day working up to 130 grams 1 year or so down the track. However this can vary with the surgery so a carb discussion with your dietitian is one to put on your list. As I mention every week, your body, your hormones, and your genetic makeup is different from someone else who had surgery the same day as you did. Include 1/2 -1 carb serving per meal or snack. This may vary as you may need more if you work out daily. 1 carb serving is 15 grams. If you have a can of beans or refried beans, go grab them so we can be label sleuths together. Look at the Nutrition Facts label here in the US or check the label you have in your country to see what it says. I have a can of refried beans and it says the serving size is 1/2 cup and under Total Carbohydrate there are 23 grams of carbs in that 1/2 cup. If 15 grams is equal to one carb serving, you know that 23 is equal to about 1 & 1/2  carb servings. If you’re trying to stay at 1 carb serving of 15 grams, you would want to cut the portion back from 1/2 cup to 1/4 cup or so. But look a little closer at the label. What makes this a smart carb? Notice fiber listed under total carbohydrate. There are 5 grams in this 1/2 cup serving. That’s significant. This fiber slows how fast the beans are digested, makes you feel full and is good for your microbiome. Benefits galore. This is why I call it a smart carb. What is a smart carb? Smart carbs are the carbs that best fuel your body and brain. This mean vegetables, fruit, whole grains, ancient grains like faro and quinoa, beans and lentils. All of these contain fiber and are referred to as complex carbohydrates because they take longer to break down and are more satisfying.  When consuming these smart complex carbs, you tend to lose more weight too since they contain fiber and help you to feel full similar to protein. Plus these complex carbs contain a who’s who list of vitamins and minerals along with naturally occurring phytonutrients that help fight inflammation in the body. But what about those refined or empty-calories carbs which have no nutritional benefit for you? You know the ones. Those goodies we love to hate but reach for when stressed such as candy, cakes, cookies, soda, etc. Never say never. Why? Because when you avoid them totally, you want them more than ever, right? And your desire for a cookie becomes a desire for five or six cookies. Your favorite treats need to be just that…treats. Instead of reaching for treats as an outlet to stress or overeating them because you deprived yourself, plan to have a small portion as part of your menu for that day such as your favorite dark chocolate or birthday cake or dessert on Thanksgiving. If you deny yourself totally, it only leads to deprivation and then potentially overeating and that’s not a win for your transformation. Just remember, less is more when it comes to refined carbs and your health so portion size is super important. Here’s where the light bulb should go off. Basically you differentiate between healthy and less healthy carbs or treats by the added sugars. How do you know? You got this. You’re a label sleuth. Remember, look at the Nutrition Facts label every time you can in the US or your particular label in another country. Again, look at the serving size such as 1/2 cup, then total the carbohydrate in grams in that 1/2 cup. Look below carbohydrate to see if there is fiber and then look for those added sugars. The added sugars will be listed in grams as well and remember that four grams is equal to one teaspoon of sugar. By the way, coconut sugar, brown sugar, raw sugar, honey, agave, and maple syrup all act the same in the body so don’t be mislead to think one is better. It’s a personal choice. If the added sugars says 16 grams for example, how many teaspoons of sugar is that? Right, four. Now, look at the ingredients and see what type of sugar is added. Remember the ingredients go in descending order from most to least. If there are zero added sugars on the label, then the carbs are coming from natural sugars like lactose in milk and fructose in fruit. Remember that too many carbs or the wrong type of carbs at a meal or snack can cause havoc in your gastrointestinal track or let’s just say your gut. This havoc is known as dumping syndrome which is rapid emptying of food from the stomach into the intestines and results in very unpleasant symptoms. If you suspect this is an issue for you, go back and listen to podcast #34 on 4 Ways to Prevent Dumping Syndrome from Dumping on your Day. Check out my new resource page with links to many of the items we talk about like podcasts, newsletter, freebies. Big question, don’t miss this. Do you always have to count carb grams or add up calories? No. What was that? No! But it’s a win-win for you if you learn about carbs, grams of carb per serving, what the serving size is and what that serving size looks like. Once you cement this into that glucose-eating brain, it will be easy for you to choose and eat healthier carbs in the right portions as you live life whether you’re preparing food or eating out or eating with other friends or family in their homes. The more you know the more successful your journey and transformation. Learn to pick and choose your carbs well. You’re worth it.  

#56 Love, Hate, Fear or Evil: Cutting thru the Carb Confusion

The questions are listed here but the actual Q & A is in the podcast audio. Q1Liz asked: How much protein is too much protein? And Debra wants to know: I'm working out now, running and weight lifting, on a regular basis. Should I increase my protein? Today, we’ll answer the questions on your mind. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 55. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Joining me via SKYPE is bariatric dietitian Gayle Brazzi Smith. Gayle has a heart-felt passion for helping people with their weight loss journey. You’ll see her posts in our private Facebook Group: Bariatric Surgery Success with Dietitian Dr. Susan Mitchell. Gayle is also certified in Obesity and Weight Management and is the bariatric dietitian at the Weight Loss and Bariatric Surgery Institute in Orlando, Florida where’s she been for seven years. Their website is OrlandoHealth.com/Bariatrics S: Let’s get right to our questions starting with: Liz asked: How much protein is too much protein? Leads us right into Q2 from Debra: I'm now working out now, running and weight lifting, on a regular basis. Should I increase my protein? We can’t wrap up without a mention of the current darling collagen powder. Yes, it’s super popular right now but it does not contain the essential amino acid tryptophan and is low in both the amino acids cysteine and methionine making it an incomplete protein source with a lower PDCAA score and not a great choice for after bariatric surgery regardless of the Internet hype. Podcast #50 discusses pea, whey and collagen protein powders Q3: it’s a long one so come in close…Jeanette asked: I have a huge list of foods called "caution foods" to avoid after surgery, including high fat cheeses, creamy sauces, spicy foods, sugar alcohols, and bread (including pita, tortillas, rolls, pastries, etc.). My diet plan does allow for me to start having small amounts of whole grain bread after 6 months. My question is about recipes that call for "breading" like all-purpose flour or whole wheat flour. If I am not allowed to eat bread, should I be substituting things like coconut flour, almond flour, chickpea flour or quinoa flour in recipes? And are things like panko breadcrumbs and cornstarch off limits, too? Finally, again thinking of recipes, if a recipe calls for "cream cheese," would I be able to still make the recipe if I substitute Neufchatel cheese? 

#55 Bariatric Nutrition Q & A: Your Questions Answered #2

Do you need to buy a separate vitamin D supplement if it’s in your multi? What about iron? Do you need another supplement for it too? The right supplementation is so important to your success after bariatric surgery. This is part 2 of the 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 54. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Remember in part one we talked about when you have weight loss surgery, vitamin and mineral supplementation is one of those items that will be on your daily to-do list from now on. The right supplements are part of your new lifelong strategy for success. So which supplements do you need? Let’s dig into more general suggestions for bariatric surgery remembering that your health care team may tweak these some based on your lab work and surgical procedure. In part 1, we looked in-depth at multivitamin and mineral supplements which give you good A-Z coverage and then we covered vitamin B-12.  If you missed it, the podcast is #53. Today in part 2, we’ll discuss iron, calcium and vitamin D, and thiamine. The iron in your multivitamin mineral supplement may be sufficient and you won’t need to purchase a separate one. You can find doses of iron in multis ranging from 18mg up to 36, 45, 60mg or even more but these are typical. Your dose will depend on your lab work, if you’re female and still have your period, hope to get pregnant or if you’re anemic whether male or female. Your iron need is a good one to discuss with your bariatric dietitian. Here’s a smart strategy for you: Take Vitamin C or consume a vitamin C rich food at the same time as you take your iron to increase iron absorption. If both C and iron are in your multi, you’re good to go. If you’re eating an iron rich food such as black beans for example, also eating food containing vitamin C such as a tangerine will boost the iron absorption. Don’t miss this tip: Whether your multi contains iron which it usually does or you take it separately, be sure and take your calcium at a different time, about 2 hours later or the calcium will not be absorbed well by your body. Speaking of calcium, Calcium Citrate is better absorbed than other types such as calcium carbonate. Recommended daily dose will be somewhere from 600 mg per day up to 1,200-1,500 mg per day. We just said that calcium should not be taken with iron. The other important strategy for calcium is to take it in divided doses of 500-600 mg at a time. Why? That’s the maximum amount your body can absorb at one time and you don’t want to waste it. Calcium is often sold in combination with vitamin D which helps increase the absorption of calcium from the intestine. You can take vitamin D with your calcium or get your vitamin D in your multi. How much Vitamin D do you need? The general recommendation is to take 3,000 International Units (IU) of Vitamin D3 per day. Your dose may be higher depending on your blood test. Be sure and look at the Supplement Facts on the multi or the calcium/vitamin D product and see if the vitamin D is D3, how much is in the supplement and the percent Daily Value. Remember the Supplement Facts label is on the back of products. This Supplement Facts label is specific to the US and I realize that if you’re listening from another country things will be different. The label tells you the serving size. Plus you’ll see each vitamin and mineral listed with the amount of each one and the percent Daily Value or the percentage of your daily needs. What about Thiamin AKA vitamin B1: at least 12 mg should be included in your daily multi to prevent a deficiency so again check the label before you purchase. However, a thiamin deficiency can occur with rapid weight loss, persistent vomiting, or not getting enough thru diet and you may be treated more quickly with higher doses than found in a supplement. Also very important to have your screening for thiamine deficiency. It can make you quite sick. Check out various supplement companies. Try samples if they offer them. I partner with ProCare Health. Plus if you receive my Breaking Down Nutrition newsletter, there will be a 10% off code in there again this week too. If you don’t receive the newsletter, you can sign up for it on the home page of my website Breaking Down Nutrition. Remember, take your supplements on schedule. It m makes a huge difference in your success. You’re worth it!

#54 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery, Part 2

Did you know that vitamin & mineral supplementation typically begins at the time of discharge from the hospital, usually 2–4 days after surgery? Any idea what the must-have vitamins and minerals are for your body? What about when to take them and how much to take? The right supplementation is so important to your success. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 53. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. Let’s get right to it… Vitamin and mineral supplementation is a lifelong part of bariatric surgery. When you have weight loss surgery, vitamin and mineral supplementation is one of those items that will be on your daily to-do list from now on. Call it a behavior modification, lifestyle change or a tweak to your daily routine. However you look at it, supplements are part of your new lifelong strategy for success. Nutritional deficiencies are common after weight loss surgery and the type of surgery performed does make a difference. For example, vitamin and mineral deficiencies are more common after procedures like Roux-en-Y gastric bypass or biliopancreatic diversion as compared to sleeve gastrectomy and adjustable gastric banding. That’s why you always hear me say to circle back with your health care team for clarity if you’re unsure about which supplements they recommend for your procedure. Recommendations vary between surgical centers and even professionals groups so don’t be surprised if your supplements suggestions are different from someone else you know who’s had surgery. Let’s start with three important tips to keep in mind: 1. As I mentioned at the start of the podcast, vitamin & mineral supplementation usually begins when you go home from the hospital which is typically 2–4 days after surgery. So if you’ve had surgery and are home now, you should have started on supplements. We’ll talk about which ones in a minute. 2. Your body has changed in it’s ability to absorb vitamins and minerals. How much it’s changed depends on the surgical procedure. When selecting your products, chewable or suckable pills, or liquids are a really good idea the first 3-6 months. Then if you choose and your health care provider doesn’t have you on any specific regimen, you can switch to capsules or tablets. 3. Routine vitamin and mineral screenings/lab tests should be part of your care from your health care team. How often and what they screen for will vary with your procedure. A lot has changed in the vitamin-mineral world. In the not-to-distant past, bariatric-specific supplements weren’t common so we combined various over-the-counter products to get what we needed. Today, many companies provide a wide variety of bariatric supplements. In fact, there so many to choose from, it’s easy to become overwhelmed or unclear about which ones to take. You’ll need to do some label sleuthing and I’ll show you how. So which supplements do you need? Let’s dig into the general suggestions for bariatric surgery knowing that your health care team may tweak these. Today, in part 1, we’ll talk about multivitamin and mineral supplements along with vitamin B-12.  In part 2, we’ll cover iron, calcium and vitamin D and thiamine. First on the list. Take a complete multivitamin plus mineral supplement that is bariatric specific. What the heck does that mean? Complete means it contains the typical A-Z formulation of vitamins and minerals similar to what you find in an adult supplement but in amounts recommended for bariatric surgery. Make sure it includes both vitamins and minerals and specifically check for vitamins A, D, E, K, folic acid and thiamin along with the minerals iron, zinc, selenium and copper. If it’s a good quality bariatric supplement it will contain all of these and more. Here’s a need to know: you can find a multi both with and without iron. It’s fine to take your iron in the multi as long as you haven’t been put on a higher dose.  Also, the numbers of multis you take everyday will vary based on the brand. Typically the dose will be one or two tablets, capsules or chewables per day. How do you know? Label sleuth time. This is what I want to show you. Do you have a vitamin container near by? Go get one. Now take a look at the Supplement Facts label which you’ll find on the back of most products. This Supplement Facts label is what you’ll find in the US and I realize that if you’re listening from another country, you’ll have a different label. At the top of the label you’ll see the serving size such as 1 chewable tablet. Then you’ll see listed each vitamin and mineral along with the amount per serving and the percent Daily Value. Percent daily value or DV is the percentage that chew provides of your daily needs for each of the vitamins and minerals listed.  You’ll want to see 100-200% Daily Value for most every vitamin and mineral but there will likely be a few that are higher such as thiamine, vitamin B12 or even iron. Don’t miss this tip: Sometimes you need more iron than what’s in your supplement and we’ll talk about that in part two but if you multi contains iron which it usually does, be sure and take your calcium separately, wait about 2 hours or more from the time you take the multi or the calcium will not be absorbed well by your body. Vitamin B-12 aka cobalamin: the dose is 250-500 micrograms (ug) a day with most suggestions in the 350-500 microgram range daily or 1000 mcg every other day.  The dose depends on your surgery, your lab results and the route of administration…meaning under the tongue, you swallow it, etc. Sometimes an intramuscular injection of B12 or a nasal spray will be ordered by health care team. You can take B12 at any time or with any other supplements. It’s likely that your multi will have enough B-12 in it so check the label before you buy additional. Be sure and discuss your lab screenings with your health care team before you decide to take any extra. Today’s Science 101 on Vitamin B-12. The absorption of B-12 can be affected by bariatric surgery due to changes in acid production and reduced availability of what’s called the intrinsic factor. This intrinsic factor helps the B-12 to be absorbed and used by the body. When it’s not there or insufficient, B-12 doesn’t get absorbed and used as it should. You could experience neurological symptoms which include numbness and tingling of your arms, legs and skin plus feel like your coordination is off. This is a prime reason why routine screenings are so important and typically done every six months or so. These screenings help your health care provider pick up on a possible deficiency hopefully before it becomes a problem. Check out the Supplement Facts on a number of products to see what you like best. As I’ve shared before I partner with ProCare Health Plus if you receive my Breaking Down Nutrition newsletter, there will be a 10% off code in there this week too. If you don’t receive the newsletter, you can sign up for it on the home page of my website Breaking Down Nutrition. Decide what works best for you. Ask questions if you’re not sure. You’re worth it!  

#53 6 Must-Have Vitamin &b Mineral Supplements after Bariatric Surgery, Part 1

Hey, what’s for dessert? I grew up in Tennessee and this was a common question. Still is. And, I have to admit, I love dessert. Always have. But wait, I’m a dietitian. But first I’m a person who loves food and good dessert. How about you? You’ve had bariatric surgery but I bet you’ve asked yourself this question too, right? Can you have dessert or do you have to deny yourself now? Can dessert be good for you? Is dessert off the menu or what does dessert look like post surgery? Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 52. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. I’d like to give a shout out this week to Christine who said this on Facebook: “Listening to your podcast every week helps keep me on track! I’m also excited about Dr. Connie joining the show.” Thank you Christine. Happy to know that the podcast helps you stay on track week to week. And yes, Dr. Connie’s spot on when it comes to mental health issues, isn’t she?  If you missed guest psychologist Dr. Connie, the episode is #51 called Bariatric Mental Health Q & A: Your Questions Answered. Listen to it on the website or your favorite podcatcher like Apple or Google podcasts. Let’s get right to it…dessert or no dessert? Basically whether we’re talking about treats or goodies or desserts we’re talking about the same thing. You may eat them at different times but they all fall in the same category. Bottom line, it’s all in your smart strategy. First, the replay. Remember that your body is unique as is your surgery. So as I always mention, circle back to your surgical team to make sure certain changes will work for you. Let’s be honest with each other. How long can you eat plain ol’ chicken or fish and brown rice or broccoli? Answer: not that long. Sure, you want to continue with your wins and successes but skipping a treat or a dessert that you really want can set you up to want more of it. Can I get an Amen? Remember prior to the COVID pandemic, when you worked in an office and someone had that cool candy bowl always filled with M & M peanuts? Did you grab a few and feel satisfied or did you deny yourself? Did you then try to ignore them all day but those M & M’s kept calling your name? Denise, Peggy. What happened then? If you denied yourself long enough, did you go in there and grab a big handful or maybe even look in the drawer for the bag? Denial leads to feelings of being deprived, and ultimately, cravings and over eating. If you’d just had a few peanut M & M’s when you really wanted them, it’s likely you would have been satisfied and moved on.  You’ve made terrific progress up to now and want to continue but can you fit a favorite dessert into your eating plan? You bet you can. It’s all about a smart strategy. By that I mean, think of the food choices you’ve made since surgery. I’m assuming you’re almost a year or more out now from surgery to be talking desserts or treats. You eat high protein foods, watch your processed carbs, choose healthy fats. When it comes to treats or dessert, whether you buy them or make them, try to meet those goals we just mentioned: include protein, keep the sugar low, and emphasize healthy fats. And sure, calories should be lower so you don’t ruin all your efforts with weight regain. However, before we talk more on how to do this, there will be times during special occasions, like a birthday or anniversary, when nothing but a certain dessert that you love will do. You know exactly what I mean? What is that treat for you? So, what to do? You plan your healthy meal with your normal goals, portions and foods in mind, but then allow yourself a small portion of the item you love and enjoy every single bite. The operative word here is a small portion planned as part of your day so that your favorite treat doesn’t turn into a stomach ache, dumping syndrome, or other gastrointestinal issues from too much sugar or fat. Enjoying something special should not affect your long term plan and success. It’s that denial that comes back to haunt you with cravings and overindulgence that’s the issue. What about bariatric treats and desserts made with protein rich foods, low sugar, etc? Yes please. There are lots of bariatric recipes online but not all are good ones so what should you think about when selecting one? Jeanette asked this question: “I know desserts will always need to be kept to a minimum, but for special occasions I hope I can still make desserts that will be "bariatric friendly," such as using almond flour and splenda, stevia or monkfruit in a berry or peach crumble. But I have heard that one reason why white bread and pastas and sugar free angle food cake are forbidden is that they can ball up and clog my intestines. Sugar free angel food cake is spongy. Does this mean I should find something else to use instead of sugar free angel food cake? I don't want something to clog my intestines!” Jeanette’s question is spot on in that it affects many items you would make at home. There are two schools of thought on dessert and sweeteners. Some people hate sugar free sweeteners or don't tolerate them well or both. They would prefer to plan in a small portion of the real item. In a lot of desserts, the sugar free sweeteners don't bake well. In others they work great. It can be trial and error but they do better when used in fresh fruit items or in a pudding. Angel food cake, whether made with sugar or a sugar-free sweetener is like white bread, white pita or white pasta in that it is highly refined and has no fiber. It's the lack of fiber that is the issue and why you hear people say they get clogged up. Clogged up refers to the lack of fiber to help move the digestive process along. So you could use an angel food cake make with real sugar (just use a little less than the recipe calls for). Have a small portion with fruit to add fiber. Or, you could substitute the angel food cake for a pound cake made with almond flour. Almond flour has fewer carbs and more fat with the emphasis on healthy fat as the majority is monounsaturated. You could also find cookies made with almond flour and crumble them up.  The process is to ask yourself a few questions when you’re baking at home: 1. Can I cut the amount of sugar without affecting the recipe? Most of the time the answer is yes, try it cutting back by 1/4 and go from there. FYI: 4 grams of sugar is equal to 1 teaspoon. 2. Would a sugar free sweetener work? 3. Can the all purpose flour be partially or fully replaced with an alternative like white whole wheat, almond flour, quinoa flour, or even chickpea flour, which contains both fiber and protein? 4.Can I alter the fat from butter or shortening to an oil or butter/oil combo? I cook a lot and always tweak recipes to better meet the needs of my family. And remember, it also comes down to the portion you eat. You can make yourself totally stressed, that’s not the goal. So make smart substitutions and serve yourself the appropriate portion. It's really important to be able to make recipes that you and family will eat and enjoy. Use these ideas, pre-plan and you can do just that. Decide what works best for you. You’re worth it!

#52 What's for Dessert?

Lynn asks, “How do I deal with feeling self conscious about my loose hanging skin and new found wrinkles after surgery?” And Liz wants to know, “What are ways to get yourself to enjoy exercise?” Don’t go anywhere, psychologist Dr. Connie Stapleton, who specializes in bariatric surgery and helps you deal with life’s stuff, joins me today to answer your questions. Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 51. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening. I’d like to give a shout out this week to Jen who made this comment on Facebook: “I am pre-op right now. I love listening to your podcast. You provide awesome insight!” Thank you Jen. I think you’re pretty awesome for taking time to tell me. I hope to continue to provide lots of insight for your journey and can’t wait to hear about your success. Joining me today via Skype is Atlanta-based psychologist Dr. Connie Stapleton. Dr. Connie uses her vast experience to share practical skills for improving your post op relationships with food, other people and most importantly your relationship with yourself. Basically, as I mentioned at the beginning of the podcast, she teaches you better ways to deal with life’s stuff. Resources: Website: Psychologist Dr. Connie Stapleton http://www.conniestapletonphd.com BariAftercare: The Podcast; available on Apple podcasts and most other podcatchers

#51 Bariatric Mental Health Q & A: Your Questions Answered

Resources From Today's Episode: Bariatric Surgery Success with Dr. Susan Mitchell Private Facebook Group FREEBIE: 5 Tips to Packing in Protein Free Samples: ProCare Health FREE Samples Podcasts Mentioned: #31 Does Protein Help Prevent Weight Regain? #29 Should You Go Keto after Bariatric Surgery? #48 Is Pea Protein a Smart Choice After Bariatric Surgery? Protein, protein, protein! Do you feel like your head may explode if you hear that word one more time? I bet you do, for I admit, I talk about it a lot as do most dietitians. There are so many protein powders on the market…egg, soy, whey, pea, collagen. Which is the best one for you after surgery?   There are days when no matter what you do, you can’t consume enough protein thru food, right? Maybe it’s a bad day and you’re just not feeling well. Maybe your day was interrupted unexpectedly and the meal plans you had just didn’t work out. Protein powder is an excellent way to help hit your daily protein target when eating enough protein thru food is just not happening. Let’s take a quick look at the most common ones. Soy, eggs, whey, and casein are all complete proteins with a high PDCAA score. The highest score is 100 which all of these have. If you’ve listened to some of the other podcasts where I’m talking about protein, you may recall that PDCAA means Protein Digestibility Corrected Amino Acid score which measures quality of protein. A complete protein contains all nine essential amino acids. It isn’t missing, or low in any one of the nine. Essential amino acid means that it cannot be made by your body and must be taken in thru food. Soy protein, made from ground soybeans is a quality complete protein. It’s a good choice if you prefer a plant based protein. Soy, egg, whey and casein all taste a little different so it comes down to your personal preference. Egg protein comes from the egg white or albumen. It’s also a high quality complete protein and is popular with people who can’t have dairy or just want to change it up. I’m going to spend most of our time together on whey protein powder as it’s so popular. It’s often called the gold standard of protein powders. But remember what we just said…egg and soy protein as equally as good just not as popular. The protein in milk is 80% casein and 20% whey. Whey is a complete protein containing all nine essential amino acids and is digested faster than casein. Just like egg or soy protein powder, it isn’t missing or low in any one of the nine essential amino acids. Science 101 for this week. Whey powder comes in several forms: whey concentrates, whey isolates and whey hydrolysates. In whey concentrate the water has been removed but the remaining product usually still contains lactose, fat and cholesterol which are naturally found in whey. Whey protein isolates usually have a little more protein but less of lactose, fat and cholesterol than whey concentrates. Whey hydrolysates are pre-digested and assimilate into the body more quickly. Isolates and hydrolysates are typically more costly due to processing. Most containers just say whey protein on the front. How do you know what’s what? Look at the ingredient label. The ingredients go in descending order most to least. The first words should be whey protein concentrate or whey protein isolate, the two most common forms. It’s up to you which you purchase. Because whey comes from milk, anyone who is truly allergic to milk proteins should avoid whey. A milk allergy is not the same as lactose intolerance. They’re two different things. Because the lactose level is low in whey concentrate and lower in whey isolate, they often work for lactose intolerance. Casein is also a complete protein in milk. Studies suggest that since casein is absorbed more slowly than whey and releases amino acids over time, it may be beneficial to consume before bed. This will supply protein through the night. A combination of whey and casein works well too. Make sure your whey protein doesn’t have a lot of other added ingredients that you probably don’t need, like  herbs, coffee or guarana, and particularly vitamins and minerals which typically are not added in the amounts specific to bariatric surgery. Generally the fewer ingredients the lower the cost too. There are so many brands to choose from. I partner with ProCare Health because many of their products are tested by a third party, are made in the US, and meet or exceed current ASMBS guidelines. That’s important to me and for your care. If you want FREE samples, see the link above in the resources and you can try them out. Let’s move on to pea protein which is an environmentally friendly plant-based option that’s easily digested and most people are not allergic to it. It’s dairy-free for vegans and people with a true dairy allergy. For a lengthy explanation of pea protein be sure and listen to podcast #48 Is Pea Protein a Smart Choice After Bariatric Surgery. The link is above in the resource list. A plant-based protein powder like pea may have all nine of the essential amino acids but be limiting in one or more. Remember this means that the level is not high enough to meet the body’s requirement. Because you had bariatric surgery and your body needs high quality complete protein. Pea protein has a limiting amino acid or one in a very low amount which is methionine. You can add the amino acid methionine to your diet by eating foods such as brown rice, sunflower and pumpkin seeds. Adding these to your diet increases the carb and fat grams too. Some pea protein products add sunflower or pumpkins seeds directly to the pea powder which then pushes up the total calories along with carb grams of a serving of that powder to around 8 grams compared to 1 or 2 in whey protein. When you have a gold standard protein like whey, egg or soy, you can save those carb and fat grams and use them on real food. This is so important to the enjoyment of food when your portions and calories are limited. I’m a fan of protein powder, it certainly mets a need but I’m a bigger fan of eating real food and maximizing the benefits to the body. We can’t wrap up without a mention of the current darling collagen powder. Yes, it’s super popular right now but it does not contain the essential amino acid tryptophan and is low in both the amino acids cysteine and methionine making it an incomplete protein source with a lower PDCAA score and not a great choice for after bariatric surgery regardless of the Internet hype. The nice thing about protein powder is that it can be mixed with water, juice, milk or other beverages. Most protein powder mixes best in warm liquid so mix your powder with a small amount of warm water or other warm beverage and then mix into your cold beverage if that’s what you’re having. Or, do you have a frother? This tool works really well for blending in protein powder. Combined with a warm liquid it’s a win-win. So cut thru all the hype and go straight to the ingredient label to see what’s what. Find a protein powder without all the unnecessary added ingredients that you don’t need and push the price up. Whey protein concentrate is whey protein concentrate. It doesn’t need a bunch of added items. Compare prices and the label and look beyond the hype. Save money. It’s all part of taking care of yourself. Decide what works best for you. You’re worth it!  

#50 The Best Protein Powders for Bariatric Surgery

The Beyond Bariatric Surgery podcast delivers tools to help support your weight loss surgery. We follow patient stories and talk to experts about the issues important to you plus some you haven’t thought about. Host registered dietitian nutritionist Dr. Susan Mitchell and bariatric dietitian Amanda Clark point you in the right direction to move on.

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Beyond Bariatric Surgery: Everything You Need to Move On

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