Vitamin Supplements:
What you need to know now.
You are the defender of your nutritional health

December 19, 2013
Featured In This Issue
Refresher: The B Vitamins
Using Dietary Supplements Wisely
What vitamin supplement is best for me?
Holiday Tips: Stay on Track & Enjoy
Recipe: Chicken Breasts with Apple Stuffing

December Theme:
Compassion & Kindness in Weight Management

"Always practice kindness. Be kind to yourself, our ongoing theme. Express gratitude for your weight loss tool and for your personal empowerment. Celebrate doing the best you could to find a middle ground to respect yourself and your traditions and your new WLS body. This you deserve.
~ Kaye Bailey


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Healthy lifestyle, Balanced Eating, and Supplments

"Dietary supplements are just what the name implies, not a magic bullet for fighting off illness.  Along with a healthy lifestyle, a balanced eating plan provides most of the nutrients you need for wellness and to prevent chronic conditions, such as cancer and heart disease," says Elizabeth Ward, MS, Rd and Web MD Expert Blogger.

From her blog post:
"Do you need a multivitamin? Chances are, yes. After all, nobody eats perfectly every day.  But to be sure, consult with a registered dietitian (R.D.) to better understand where your diet consistently falls short and how to fix nutrient gaps with dietary improvements and supplements, if necessary.  Even if you don't need a multi or other supplements, you may need them in the future, so review your diet on a regular basis.

"Always choose supplements tailored to your gender and age.  For example, post-menopausal women, and men, should take a multivitamin with very little or no iron. (That's the kind my husband takes.) Current and former smokers should avoid multivitamins with high levels of beta-carotene or vitamin A because studies have linked the nutrients to an increased risk of lung cancer. And people with a history of cancer should check all dietary supplements with their doctors first.

"There's a lot that dietary supplements cannot do for you. For instance, they lack energy, protein, fiber, and phytonutrients, powerful plant compounds that protect against cell damage.  And, the jury is out on the safety of large doses of certain single nutrients, such as vitamins C and E.  However, in moderate amounts, it's likely that dietary supplements, particularly multivitamins, do more good than harm as they help you to satisfy your daily nutrient requirements."

Link to WebMD Blog


5 Day Pouch Test
Tips to Make Your
Holidays Bright:

Have fun, enjoy living, and stay on track with these helpful hints

(Featured article: November 2013 5 Day Pouch Test Bulletin)

by Kaye Bailey

When I hear from someone doing the 5 Day Pouch Test during the holiday season I admire their courage and true grit. It seems that doing the 5DPT during the feasting season is about as easy and going upstream without a paddle. Yet over the years I've heard from many WLS Neighbors use this time to get cozy with their pouch and fixed on following the WLS rules in hopes of avoiding the dreaded holiday weight gain. While this time of year isn't particularly conducive to the 5DPT there are many opportunities to polish our skills using strategies we learn from doing the 5 Day Pouch Test.  I've pulled some of my favorite nuggets of empowerment from the 5DPT Owner's Manual - 2nd Edition to share with you here.  Use these tactics in a manner suited to your lifestyle and traditions: work that surgical tool like nobody's business.  Find yourself on January first having done the holidays right without forfeiting joyous fun or forsaking your healthy weight management goals.

Link to Full Article:

Featured Tips:
-Surgery is only a tool
-Pause to remember: Stand to be grateful
-Kindness from within
-Grazing and liquids
-Perfection is never the goal
-Stop Short: discomfort is a signal
-Protein First, even on Holidays

Link to Full Article

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LivingAfterWLS News

Refresher Course:
B vitamins after WLS 
LivingAfterWLS Blog
    Weight loss surgery patients are advised to compliment their diet with a vitamin B supplement often taken in sublingual tablet form or by monthly injections. Some surgical procedures for weight loss inhibit absorption of the B vitamins which may result in deficiency. In addition, the low calorie high protein diet following bariatric surgery does not provide adequate dietary intake of B vitamins. Patients should follow the specific directions of their bariatric center when taking B vitamin supplements. Annual blood tests are needed to ensure deficiencies are quickly identified and treated.

Trans-Fat Must Go,
says FDA

On November 7, 2013 the US Food and Drug Administration announced its preliminary  determination that partially hydrogenated oils (PHOs) are no longer classified as "Generally Recognized as Safe" (or GRAS*). Not only did the FDA say the PHOs are not GRAS, they determined that trans fats have "significant adverse health effects."
Continue Reading

Pork is Delicious!
 Free pdf Cookbook from Pork Be Inspired, the homepage of the National Pork Board. Learn how to get your free 50-page recipe book: Link Here.

Doctor-Patient Communication:
Why we must do a better job of talking about obesity.

There is a disconnect between physicians and patients when it comes to discussing obesity and weight management. Not surprised, are you? I think any of us sitting on the exam table feeling vulnerable in that tie-in-the-back dressing gown would prefer not to discuss our weight problem with the doctor. But research also shows that an honest non-judgmental dialog between doctor and patient goes a long way in our desire to take action to fight obesity.
Continue Reading


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A gift of nutritional wellness.
We are in the heart of holiday season and I hope this weekly digest finds you healthy, happy and enjoying all the things that you value at this special time of year.

Today we are straying from our pre-planned editorial agenda to cover a hot topic from the news: the value of dietary supplements in the average diet.

You most likely heard the news earlier this week shouting, "Stop wasting your money on vitamin supplements!" This headline was pulled from the Annals of Internal Medicine in which the authors of an editorial conclude there is no evidence that routine use of vitamin and mineral supplements brings health benefits. The editorial stated, "The routine use (of vitamins) is not justified and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries."

Those are strong words and mainstream media took notice with many news broadcasts and newspapers repeating the headline to stop wasting money on vitamins.

I've read many arguments for and against the use of vitamin supplementation over the last few days. The common factor in my research indicates these studies and expert opinions are intended for the general population of people who eat a balanced diet of nutrient dense food and who have no mitigating health circumstances. I'm not sure I know anyone who fits into that general population.

When we consented to have a surgical weight loss procedure we committed to a lifetime of following a carefully prescribed diet that most likely includes the use of vitamin and mineral supplements. We understood before surgery that our the low caloric intake after surgery and decreased absorption efficiency would require supplementation to meet our basic nutritional needs. Our bariatric surgeon and nutritionist prescribed specific supplementation to each of us. This prescription is to be followed throughout the course of our life with adjustments being made by us in collaboration with our health care team as nutritional needs change. Our nutritional needs are monitored with blood tests, overall health and well being, and life stages.

Today's digest offers many features regarding vitamin supplements and the weight loss surgery patient. I encourage you to spend time reviewing your personal vitamin and mineral supplementation. Are you getting all the nutritional support you need with diet and supplementation? Are you following the vitamin protocol prescribed at the time of surgery? Are you monitoring your nutritional wellness with blood tests and assessment of your overall health and well being?

I realize this is a particularly busy time of year to be asking one more thing of you. If you don't have time today to give thought to this topic save your newsletter to read later. Give it a good look-over when you have downtime before the new year begins. Set a goal to get your nutritional health in tip-top shape in 2014. Can you think of a better gift to give yourself?  Consider using our LivingAfterWLS Personal Self-Assessment Worksheet as part of your goal. Using it reminds us how far we have traveled and where we would like to go. Download the worksheet in pdf format: Self-Assessment Worksheet

I am grateful for all of you in the LivingAfterWLS community who work very hard every day to live healthier and manage your weight with the surgical tool. May your holidays be bountiful and celebrated with heartfelt gratitude. I wish you the best this holiday season and always.  Thanks for LivingAfterWLS with me!




Using Dietary Supplements Wisely
General Advice from a Trusted Source   
Shared with permission from the National Center for Complementary and Alternative Medicine (NCCAM) - US Department of Health and Human Services.

A word from Kaye:  The information in this featured article is written for the public at large. As with all things related to our weight loss surgery, your specific vitamin supplementation prescription should be made by your bariatric surgeon, bariatric nutritionist and/or general care physician. Annual blood tests will determine deficiencies which can be treated with supplementation. So please, be informed about your vitamin and mineral intake and visit candidly with your health care team to ensure your best health. You deserve to be your nutritional best.

Like many Americans, you may take dietary supplements in an effort to stay healthy. Vitamin shopping can be confusing. With so many dietary supplements available and so many claims made about their health benefits, how can you decide whether a supplement is safe or useful? This fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

Key Points
Dietary supplements contain  a variety of ingredients, such as vitamins, minerals, amino acids, and herbs or other botanicals. Research has confirmed health benefits of some dietary supplements but not others.

To use dietary supplements safely, read and follow the label instructions, and recognize that "natural" does not always mean "safe." Be aware that an herbal supplement may contain dozens of compounds and that all of its ingredients may not be known.

Some dietary supplements may interact with medications or pose risks if you have medical problems or are going to have surgery. Most dietary supplements have not been tested in pregnant women, nursing mothers, or children.

The U.S. Food and Drug Administration (FDA) regulates dietary supplements, but the regulations for dietary supplements are different and less strict than those for prescription or over-the-counter drugs.

Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Dietary Supplements:
Dietary supplements were defined in a law passed by Congress in 1994 called the Dietary Supplement Health and Education Act (DSHEA). According to DSHEA, a dietary supplement is a product that:

Is intended to supplement the diet

Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and certain other substances) or their constituents

Is intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel, gelcap, or liquid

Is labeled as being a dietary supplement.

Herbal supplements are one type of dietary supplement. An herb is a plant or plant part (such as leaves, flowers, or seeds) that is used for its flavor, scent, and/or potential health-related properties. "Botanical" is often used as a synonym for "herb." An herbal supplement may contain a single herb or mixtures of herbs. The law requires that all of the herbs be listed on the product label.

Research has shown that some uses of dietary supplements are beneficial to health. For example, scientists have found that folic acid (a vitamin) prevents certain birth defects. Other research on dietary supplements has failed to show benefit; for example, several major studies of the herbal supplement echinacea did not find evidence of benefit against the common cold.

Link to full Article on National Institute of Health Website: Using Dietary Supplements Wisely

From our LivingAfterWLS Newsletter Archives: Should taking vitamins be Rule #5?


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Please Note:
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  Making wise choices.
What Vitamin Supplement  is Best
for Surgical Weight Loss Patients
Dietary Supplements and Vitamins LivingAfterWLS Article Archives

The multi-vitamin market is rich with choice. It's also very confusing. There are mega's, potents, super all-day's, vegetarian formulas, geriatric formulas, athlete's formulas, recipes for men and women and teens! There are some things gastric bypass patients must consider when selecting a multi-vitamin supplement. First and foremost, follow the advice of your bariatric center, your general care doctor and/or nutritionist. They have your health records in hand and they are working in your best interest to promote your overall health and wellness beyond weight loss.

The weight loss surgery patient must first ask, "Can I swallow this with a small amount of water?" The next question, "Will it absorb quickly enough for my short circuited system?" Adult chewable tablets are available, but the taste is often unpleasant. However, these may be used during the first few months after surgery. Capsules and gels are a good choice because they are more likely to absorb quickly. Time released tablets should be avoided, they dissolve slowly, that's what makes them timed release. They will pass through the shortened intestine before absorbing into the body.

There is no right or wrong form of supplement, just make sure to select a form you will take routinely.

Choose a gender and age specific formula. The more that is learned about nutrition, the more obvious are men and women's different dietary needs. For example women need more calcium and iron in their diets. Men, particularly over 50, must be careful to limit iron intake. Geriatric vitamins often included chelated minerals for better absorption in addition to glucosamine to help with bones and joints and herbs to improve memory and wellness.

Finally, look for a supplement that contains most of the vitamins and minerals essential for good health - but does not exceed the U.S. RDA by more than 150 percent. (Most multi-vitamin supplements do not contain vitamin K - it is naturally synthesized by the body.) The label on the supplement bottle lists the weight in milligrams of the vitamin and minerals contained in the supplement.

The label also shows the percent of the U.S. RDA the supplement supplies. Natural and synthetic vitamins are virtually identical and most supplements are synthetic. It would require heaps of natural foods to extract enough vitamins for supplements and the cost would be prohibitive. One exception is vitamin E: the natural form is actually biologically more active and better absorbed and utilized by the body.

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*These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease.  

Stay on Track Tips
Enjoy the Holidays without the Guilt
Holiday Dinner

I am pleased to tell you that the mainstream media is wrong when they say every one of us will gain five to seven pounds between Thanksgiving and Christmas. It simply doesn't have to be that way. Over the years I've learned a few things about working the WLS tool in harmony with the act and pleasure of celebrating the season with food, family and friends. Take a look and see if you can work these tips into your holidays and prove the weight gain wardens wrong.

Protein First is our WLS Rule #1 and our best friend during the holiday season. When we keep our protein intake above 80grams a day, spread throughout the day, we fuel our metabolism into high burn; we have increased energy and fewer cravings. Gastric bypass patients avoid dumping.

Protein First: Why it works and how to get enough

Get your protein from real food as much as possible in order to experience the process of eating and digestion. Protein shakes and protein bars are fine in a pinch, but they should be no more than 1/3 of your daily protein intake.

For a quick protein fix try tuna with hard cooked eggs; chopped lean chicken or meat tossed with a small amount of salad greens and dressed in low-fat yogurt or cottage cheese, chilled ready-to-eat shrimp, vegetables with humus dip, or a measured portion of dry roasted nuts.

Enjoy your favorite holiday classic appetizer, starchy side dish or dessert only after eating three to four bites of lean clean protein. In so doing we decrease the amount of treat we are able to consume thus maximizing our pouch space. The few bites we are able to comfortably eat are that much more delicious. We avoid glycemic overload and in the long run the dreaded holiday weight gain. This is a powerful way to work the bariatric pouch so that it works for us.

Coping: When guilt gets us down

Have dessert within 15 minutes of your meal. Waiting any longer results in a larger serving and the satiation factor of your healthy high-protein meal is lost. Do you remember back in our morbidly obese days when we enjoyed our hearty meal, took a nap and enjoyed a second hearty meal starring dessert(s)? That's a tradition we don't need to bring back because we all know what comes with it.

Be mindful of your liquid restrictions. While it is often necessary to sip during meals where conversation is enjoyed pay attention to avoid turning sips into gulps. Gulps with food will wash the food through your pouch before any of the nutrients are absorbed. You will be able to eat more and will not reach that comfortable satisfied feeling that comes with a properly fed pouch.

Learn more: Liquid Restrictions
Chose your indulgences carefully and proceed to enjoy them wisely. Give yourself a pat on the back when you do well. Be rational about events when you stray from your eating plan. Forgive yourself, learn from the event, and consider your next meal an Opportunity for Improvement.

nobody ever gained 5-7 pounds in 6 weeks
from enjoying a few wisely selected holiday treats.


Chicken Breasts with Curried Apple Stuffing
From our Recipe of the Week Archive: October 21, 2007
There is no question that boneless skinless chicken breasts play a leading role on the post-weight loss surgery plate. It is easy to rely on this ubiquitous food for clean lean protein that is healthy and quick to prepare. It is also easy for this food to become monotonous. Often we find ways to pretty up the outside using fresh herbs, spices and vegetables to add flavor and variety. Today's Recipe of the Week takes a different approach: moist and healthy fillings tucked inside the breasts to improve flavor and texture while adding variety to our menus. Give these recipes a try and enjoy your lean clean protein in a whole new way.

2 teaspoons vegetable oil, divided
1/4 cup finely chopped onion
2 tablespoons finely chopped celery
1 3/4 cups chopped peeled Granny Smith apple (about 3/4 pound)
1 3/4 teaspoons curry powder, divided
1/4 cup golden raisins
1/2 teaspoon minced garlic
1 (10 1/2-ounce) can low-salt chicken broth, divided
4 (4-ounce) skinned, boned, chicken breast halves
3/4 cup apple juice
1 large garlic clove, minced
1 teaspoon cornstarch

Heat 1 teaspoon oil in a non-stick skillet over medium-high heat. Add onion and celery; sauté 5 minutes or until tender. Add apple and 1 teaspoon curry powder; sauté 3 minutes or until apple is tender. Stir in raisins, 1/2 teaspoon minced garlic, and 1/3 cup broth; cook 4 minutes or until liquid almost evaporates. Spoon apple mixture into a small bowl; set aside.

Cut a horizontal slit through the thickest portion of each breast half to form a pocket. Stuff about 1/4 cup apple mixture into each pocket. Heat 1 teaspoon oil in skillet over medium-high heat. Add chicken; sauté 6 minutes on each side or until done. Remove chicken from skillet; set aside.

Add 3/4 teaspoon curry powder, remaining broth, apple juice, and garlic to skillet. Bring to a boil; cook 5 minutes or until reduced to 1 cup. Combine cornstarch and water; stir well. Add to broth mixture in skillet; stir with a whisk. Bring to a boil; cook 1 minute, stirring constantly. Return chicken to skillet; cover and simmer 2 minutes or until heated. Serve sauce with chicken.

Serving Size: 1 chicken breast half and 1/4 cup sauce. Per serving: 240 calories; 30 grams protein, 5 grams fat (1 saturated), 22 grams carbohydrate and 2 grams dietary fiber.


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