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“Complete” But Lacking Essential Nutrients What does a “complete” multivitamin contain? It could provide anything from all the essential nutrients to just a few. There is no legal definition for “complete.” In the case of Flintstones “Complete” multivitamin chewables, “complete” apparently means that it has all 13 vitamins, but only 6 of the more than 15 essential minerals that you need. Quantity Is Critical For bariatric surgery patients, it is not only important to get each of the necessary vitamins and minerals, but also to have the right amounts. You need high amounts of some of the vitamins and minerals, and Flintstones chewables simply do not deliver. For example, the American Society for Metabolic and Bariatric Surgery (ASMBS) suggests at least 12 mg thiamin (vitamin B1) per day, while a chewable has 1.5 mg. You will also be short on: Vitamin A Vitamin D Vitamin E Vitamin B12 Iron Calcium And more. “Doubling Up” Does Not Work If one tablet is not enough, can’t you just take two? Well, not really. First, getting twice as much as certain nutrients may still leave you short. For example, 2 Flintstones chewables provide 1,200 IU of vitamin D, while recommendations for post-op gastric bypass patients are to get 3,000 IU per day. And no matter how many chewables you take, you will never get enough of essential minerals such as selenium and chromium, since the chewables have none. Multivitamin: What Is in a Name? We usually refer to them as “multivitamins,” but most often, we really mean, “multivitamin and mineral supplements.” Sometimes, a “multivitamin” that you buy off the shelf really is literally a bunch of vitamins with few or no minerals. Do not get confused by the name when purchasing your supplement. Read the supplement facts label to see which nutrients are in the supplement, and how much there is. Safe Choices, Your Way To be sure that you are getting the right supplement for bariatric surgery post-op needs, you are best off choosing a bariatric supplement. It may be a tad more expensive, but it could prevent deficiency diseases such as anemia or peripheral neuropathy. The BariatricPal Store has Multivitamin One and a wide range of other multivitamin and minerals formulated according to ASMBS guidelines. Choosing a bariatric surgery-targeted multivitamin instead of a kids’ supplement does not mean you have to choke down capsules if you cannot stand them. You can always opt for another form, such as Powder or a Soft Chew. BariatricPal Protein One has 28 essential vitamins and minerals, along with protein and fiber, in Unflavored powder or great-tasting shakes such as Chocolate, Vanilla, Cookies and Cream, Peanut Butter, Chicken Soup, and more. For help figuring out which vitamin and mineral supplement may be right for you, you can look at the attached ASMBS guidelines or check out our Bariatric Vitamin Guide, which breaks down recommendations for each surgery type. Also, be sure to talk to your doctor about your individual needs before trying a supplement. ASMBS-Nutritional-Guidelines-2016-Update.pdf

I heard I should be avoiding carbohydrates, is this true? This is 100% false! Carbohydrates are the body’s preferred source of fuel. Just as your car needs gas to run, your body and brain rely on carbohydrates to give you the physical and mental energy that you need to get through your day. What are carbohydrates actually? The majority of patients identify carbohydrates simply as grain products (e.g. bread, pasta, and rice). When dieters say they’re going on a low carb diet, they typically plan to eliminate or reduce their consumption of these grain products. In reality, carbohydrate sources include many other foods, like milk, yogurt, fruit, plenty of vegetables, and legumes. Did you know that one cup of milk has the same amount of grams of carbohydrates as a piece of toast? Or that a large apple has twice as many grams of carbohydrates as that same slice of toast? Or that a 1⁄2 cup of chickpeas has three times the amount of carbohydrates as the toast? Confused? This is why we challenge our patients in why they want to experiment with low-carbohydrate diets. What does that mean to them? And which foods are they planning on restricting? A lower carbohydrate diet is not necessarily a healthier one! In a world where our food apps can track everything, it’s sometimes hard to make sense of all of the numbers they give us. You shouldn’t be blindly trying to decrease your total grams of carbohydrates or total grams of fat per day without understanding how that translates into food choices and your overall health. The type of carbohydrate is more important than the amount of carbohydrate.Not all carbohydrates are created equal. The most common forms of carbohydrates are:  Fibre (for the purposes of this book, we will refer to fibre as a ‘complex carbohydrates’);  Sugar (for the purposes of this book, we will refer to them as ‘simple carbohydrates’).  Starch. Starch is calculated by taking the total carbohydrates and subtracting both the fibre and sugar from it (for the purposes of this book, we will refer to starches as ‘complex carbohydrates’). Foods that are high in carbohydrates but contain a fair amount of fibre and starch, and a low amount of sugar (i.e. high in complex carbohydrates and low in simple carbohydrates), are typically healthier choices. Complex carbohydrates take longer to digest, which is why they make you feel fuller longer. Examples include:  Barley;  Oats;  Quinoa;  Whole-grain products;  Legumes. Similarly, foods that are high in carbohydrates but contain high amounts of sugar and low amounts of fibre and starch (i.e. high in simple carbohydrates and low in complex carbohydrates) are typically less healthy choices. Simple carbohydrates are quickly digested, which is why they give you a quick boost of energy, but also why you don’t feel satisfied for very long. Examples include:  Pastries;  Donuts;  Chocolate;  Candy;  Juice;  Regular soda;  Sugary cereals. After WLS, protein should always be eaten first, followed by your vegetables and then your grain products (e.g. rice, quinoa, pasta) or starch (e.g. potato, sweet potato, squash). Eating in this order will naturally limit the amount of carbohydrates you consume at each meal because of the limited space in your stomach. Patients who restrict their carbohydrate intake, in our experience, typically have a harder time finding a healthy balance and joy in eating again. One of the biggest consequences of skipping out on carbohydrates at mealtime is that your blood sugar is less balanced, which can result in sugar cravings later on in the day. Remember: All foods fit, but it’s the portions of food that should be the focus in a healthy diet, post WLS. - Lisa & Monica

How you may wonder, can you make this the most wonderful time of the year if you cannot celebrate it with the same food, drink, and abandon that you may have before your WLS journey started? Keep your chin up! We’re not promising that these holidays will be the same as ever, but you can make them great. They may even be better! Here are our thoughts on loving the holidays while staying healthy. We’re Not in Kansas Anymore! As with the rest of your life, the success of the holidays can no longer best be measured by how much you ate. There is so much more to it than that! Now, pleasure from food contributes to “success,” but so do so many other things, including the activities you do, the quality of your time with loved ones, and the pride you have in yourself. Give up your former conceptions of what holiday happiness is, and you will have a lot to gain (but not weight). Just Say, “No!” – But How? There is no denying that a good deal of the holiday cheer – and the holiday struggle – revolves around food. Eat it with abandon, and you will set yourself back months. You are almost sure to be offered more than you should eat and foods that are not on your diet, so you will need to learn to say no. Be prepared with different ways to say, “No,” without hurting anyone’s feelings, and practice the before-hand so you are not caught off guard. “No, thanks.” “No, thanks. I’m not hungry.” (If you’re in the middle of lunch so you cannot claim that you are not hungry:) “No, thanks. It’s not in my diet.” “I would love to, but my doctor said I cannot have that!” “Thank you! How kind! I will save it for later.” Later, give it to someone who will love it. Be Confident. Be polite but firm when refusing food or insisting on getting in your afternoon walk. You may be surprised at how easily people accept your decisions. They may even make them easier once they see you are serious by, for example, offering to bring you a diet-friendly version of a treat or asking to come on your walk. If you waver initially, though, they may not take you seriously, and instead, keep prodding you to abandon your good intentions. Be Proud of Yourself. A barrier to success that is present year-round, but more intense during the holiday season, is the natural desire to help others – and this can come with a feeling of guilt if making your health a priority makes you worry that you are not giving your best to your family. Remember that you can give your best only when you are at your best, and to be at your best, you need to be healthy. You will have more energy, think more clearly, and even be happier when you are taking steps towards health, and all that will enable you to give more to others. You Are Not Alone The grass may seem greener on the other side of the fence, but is it really? It probably is not, even though you may feel that your holiday season is hard while others have it easy. The truth is that millions of others are facing the same challenges as you. Even people who appear not to have weight problems are sure to have major concerns in their lives. They may be fighting just as hard as you to avoid eating the whole pie, or they may have non-food challenges. You do not know, but what you can safely assume is that everyone has challenges. You will feel better about yourself if you always treat others with respect and not with jealousy. Rather than feeling sorry for yourself, you might as well embrace the holidays for what they are worth: an opportunity to overcome hurdles and strengthen yourself; a magical time of year when people come together; and a chance to experience new feelings and participate in new activities that may not have been possible before you got serious about your health.

First off, I just want to say this very important thing, if you take nothing else away from this article, let it be this- People’s reactions to you are based on their relationship with themselves, not you. Always. Someone who is living at peace with themselves will have no need to harshly criticize, no desire to humiliate, and no feelings of unresolved jealousy. Sadly, once you understand this, you also realize how many people in your life are unhappy with themselves on some level. It makes it a little easier not to take things personally, but I would be lying if I said those things don’t hurt anymore. So how do you deal with friends and family members who are not living at peace with themselves? What practical steps can you take to be at peace with yourself so that you are able to reject those statements and hurtful judgments instead of internalizing them? Here’s the bottom line- You will always have people in your life who do not wish you well, who want to see you fail. If you do not learn to look past them and stay focused on you and your progress, and live at peace with yourself- you will experience re-gain. I love the words from Eleanor Roosevelt, “No one can make you feel inferior without your consent.” 1) Start with yourself- You need to be at peace with yourself. Who you are, what you weigh, your progress level, etc. Easier said than done, I know. But working towards that will allow you to bypass other’s opinions of you because you know who you are and where you’re going. A simple way to begin embracing yourself is positive self-talk. Start by looking into the mirror as often as you can, and saying things to yourself like, “I am a beautiful, peacefully person and I love me.” Say hello to yourself. “Hi Ash, you are a wonderful, beautiful person and I am SO proud of you.” It’s going to feel super painful and may trigger some emotions. Process those as they come, don’t shy away from the feelings that embracing yourself brings. If you need to cry, do so. If you smile, embrace it. Enjoy yourself. Changing that negative narrative in your head that so many of us carry around, is step one. 2) Be honest- When someone says something that’s offensive, it usually comes from one of 2 places: a poor relationship with themselves, or a lack of education. Use your best judgment to determine which it is. Keep in mind, there are a LOT of myths and misinformation surrounding bariatric surgery. Don’t assume people know more than they do. Think back to before you became an expert on Bariatric Surgery. How many questions you had, how many myths you thought were accurate. Seek to educate. But be honest, if someone makes a hurtful comment, let them know. Keep it simple, “Hey, that was uncalled for.” or “Please don’t say things like that to me.” Try to stay calm and in control. 3) Take a break- If you need a break, take one! Go for a walk, get out of the house, go listen to music alone. Don’t feel bad for needing a break. Family time can be stressful, don’t allow others to jeopardize your progress. When you’re stressed and anxious, you’re more prone to overeating which puts you back on that harmful cycle you’re working so hard to stay off of. Give yourself permission to stay home sometimes too, you don’t need to be at every single family gathering. It’s okay to opt out. People may get offended, they may try to make you feel guilty, but remember- it’s not about you. It’s all about how they feel about themselves. Those who are at peace with themselves will support you and do their best to understand where you’re coming from. 4) Stay focused- This is a tough one. Holidays pull our focus in so many directions, it’s easy for us to lose focus on our goals. Be proactive about making plans for yourself for food and exercising during the holidays. Being ahead of the game and staying on top of your plans will make you feel peaceful and accomplished. When you feel this way, your confidence is harder to shake and you will feel more secure. When you’re focused on a goal, it consumes your focus and the other things that pop up to derail you just fade into the background. Stick to your routine, take your supplements, and stay on track. You can do this! 5) Stay connected- Join a support group in-person or online, find an accountability buddy, hire a coach, or grab a friend who will keep you focused without judgment. Someone you can call, text or write to keep them updated so they can provide you with the encouragement you may not be getting from others this season. Having connection fills an emotional need that many try to fill with food. If you’re getting that need met, you won’t be as tempted to eat for comfort. Connection is something we all need, so make it a priority to have someone in your corner this holiday season. Remember, at the end of the day- this season is temporary. All the food, all the family, all the hustle and bustle. The things that can make or break this season. It’s all temporary. You are what you carry into the New Year. Your health journey is what lasts. Keep your sights on the long term. You can do this, I believe in you!

Legal Trouble for Premier Protein Premier Protein sells all kinds of protein shakes. The ones whose labels state that they have 30 grams of protein per serving are the ones in the settlement. Analysis has found that they have 26 to 29 grams. The flavors that are in the settlement are Vanilla, Chocolate, Strawberries & Cream, Banana & Cream, Peaches & Cream, Cookies & Cream, Mixed Berry, Organic Chocolate, Organic Vanilla, and Caramel. While the company is not admitting wrongdoing or ceasing the sale of these products, there is a class action settlement. You may be eligible for a cash payout if you purchased any of the misleading shakes in the past 7 years, since 2011. Pre-op or post-op, you need to know how much protein is in your shakes. Not Best for Bariatric Patients Every gram of protein counts, but the deception in amount of protein per serving is not the only problem. Even if you are willing to overlook the shortfall in the amount of protein, Premier Protein has a problem with type of protein. Read the ingredients carefully, and you will see that less than 1% of the product is “whey protein concentrate.” Whey protein is the type of protein that you should be looking for because it absorbs more quickly than casein. Whey protein has been shown to increase weight loss and body fat loss in bariatric surgery patients. Another glance at the list of ingredients of Premier Protein shows that “milk protein concentrate” and “casein” are the major sources of protein. Casein is slow-acting. If you had a bariatric surgery type, such as gastric bypass, that interferes with absorption, you may not get all the benefits from casein. What’s Better? We know that you need a protein supplement, so what can you find that has the amount and type of protein you need and the great taste that will encourage you to take care of your needs? BariatricPal Protein One gets our vote. 27 grams of whey protein. 28 vitamins and minerals. Great-tasting French Vanilla, Cinnamon Swirl, and Double Chocolate Fudge. It has a few more advantages over Premier Protein. Over twice as much dietary fiber for fullness and digestive health. Choose from convenient single-serving packets or multi-serving tubs. Comes in powder so you can add water or your favorite beverage. Has an “unflavored” option so you can add it to anything, from soup to smoothies. When it comes to bariatric products, quality counts. Any purchase you make should be from a trusted source because there are a lot of poor-quality or misleading products out there. The few grams of difference between Premier Protein’s claims and reality may not be a lot, but along with the poor choice of casein instead of whey as the main protein source, you might want to seek another source for your protein. Look for a trusted vendor and name brand as you make your choice. What you put in your body really does matter.

Key Point: · Products listed were chosen to make preparing food easier to achieve. Slow Cookers: Small · Small slow cooker brands include TRU (0.65 quarts), Proctor Silex (1.5 quarts) and Crock-Pot (2.5 quarts). Prices range from $10-$30. · Smaller slow cookers make cooking for one or two people more practical. There will be leftovers for bariatric patients. Slow Cookers: Large · Crock-Pot, Proctor Silex, Hamilton Beach, Elite, Cuisinart and West Bend slow cookers with 4-8 quart capacities. Prices are less expensive for manual controls when compared to digital/programmable controls. Prices range from $25-$200. Microwavable Dishes · Nordic Ware – Makes micro ware to cook eggs (poached, boiled, omelet), heat soup, plates and bowls to heat meals and other containers to cook or reheat a casserole. Check out www.nordicware.com. · Poached egg cookers also made by Walter Drake and Miles Kimball. · Look for a variety of microwave cookware that can steam fish and vegetables, reheat food or have protective screens to prevent splatters. · Plastic storage containers are now more often able to go in the microwave. Check the label to make sure the plastic is microwave safe. · Pyrex -type cookware and measuring cups are microwave friendly. Other Stuff · Spiral cutter for making zucchini pasta (“zoodles”). Helps maintain low carb eating. There are handheld and tabletop versions. Spiralizer and Veggetti are brands to make veggie noodles. · Good set of knives for chopping and cutting. · Meat tenderizing mallet. You basically pound your meat to make it thinner, and it helps tenderize the meat making it softer to chew. Nice way to burn a few calories, too!

1. My weight does not determine my success nor worth. “If you accept your personal best at everything else in life, why not weight?” – Yoni Freedhoff Isn’t that SUCH a good quote? Is your WLS team happy with your progress, but you aren’t? Why are you still pushing for and obsessing over those next 10 lbs? Reflect on why you feel that you must lose those extra pounds and what will happen if you don’t? 2. I acknowledge that a healthy lifestyle (i.e. eating healthy most of the time and moving my body often) is a part-time job. Some weeks it doesn’t feel like work, but often it does. It is important to accept that doing well after WLS is not an accident. You have to make the time for your new habits. 3. I see meal planning, grocery shopping, and cooking as acts of self-care. This mindset shift is HUGE. Embracing this shift requires practicing gratitude. For example, this means being able to acknowledge that although you may not enjoy cooking, you are thankful to have food to put on the table. Or, as another example, maybe you don’t enjoy meal planning, but you can acknowledge how much smoother getting organized on the weekend makes your week flow. Try viewing these chores from a place of gratitude this week, and watch how much lighter they all of sudden feel. 4. I move my body because it feels good and helps me to re-charge. I don’t exercise to control my weight. If you are exercising solely for the purpose of controlling your weight, it is only a matter of time before you burn yourself out. Moving your body should come from a place of self-care. The activities that you choose should be enjoyable and energizing. They shouldn’t feel forced. 5. I am not on a diet. I eat foods that I enjoy. I practice moderation and flexible eating to the best of my ability. All foods fit. If you feel restricted, if you’re counting your calories daily, if you’re always hungry, or if you often feel guilty or ashamed about your food choices, you are going to burn yourself out! If you have dieted for most of your life, you likely have a lot of baggage in this department to work through. For many of our patients, it takes years to work through this mindset shift, so don’t be too hard on yourself. So, how many of these mindset shifts have you fully embraced? Which ones are still a struggle? Where do you feel stuck? Try posting these 5 mindset shifts up in your office or home to keep them top of mind as you go about your day. Envision and journal about what it would feel like and look like to embrace all of them. Click HERE for a FREE printable of these 5 mindset shifts! Click HERE to read more about this kind of content. Click HERE to follow our Facebook page for up-to-date videos and nutrition information. If you need help working through these shifts, speak with your WLS dietitian or psychologist. Wishing you all much happiness in your WLS journey! – Monica & Lisa

Any “successful” Weight Loss Surgery patient will tell you that weight loss is only one measure of success. There are many other ways to win, so keep your eyes out. Recognizing your non-scale victories (NSVs) will keep you motivated and let you get the most you can out of WLS. Here are just a few ways you know you are winning. 1. Your clothes fit (or don’t fit). You fit into clothes you “outgrew” on the way up, and your pre-WLS clothes are so big they are falling off. Better yet may be the feeling you have when your wedding ring fits again or you can slip into your high school prom dress again. 2. You are happy to go to the doctor. After years of bad news about your health, ranging from vague warnings (“You can get heart disease because of your weight.”) to scares (“You will be lucky if you live to see your children graduate from high school.”), things are different. You may get good news, such as being able to reduce your medications and seeing your numbers improve. 3. You like other activities besides eating. You will know success when you treasure your morning walk more than doughnuts, you want to focus on the movie without a tub of popcorn, and you are happy to talk to your friends instead of eating fast enough to serve yourself second helpings at dinner. It is a good feeling when you realize that the thing you will enjoy most about your granddaughter's birthday party is seeing her open her presents, not tasting her birthday cake. 4. Shopping is fun. You can go to regular stores, see a nice selection of fashionable clothes, and try them on without cringing when you look in the mirror. Plus, you have the energy to enjoy the experience. 5. It’s fun to focus on yourself. For some, getting a massage or going to the hairdresser can be a reminder of how unhappy you are in your body. You know WLS is working if you find yourself enjoying these activities again instead of avoiding them because of poor body image. Going to the doctor can also be embarrassing when you are overweight if you know that your health concerns are caused by your extra weight. 6. You do what you want to do. You make your plans based on your schedule and desire rather than which venue has the biggest seats and bathroom stalls. The size of booths at restaurants, the width of airplane seats, and weight limits at amusement parks become less important than the menu choices, the cost of the airfare, and who your favorite cartoon characters are. 7. You are bigger. You may be shrinking physically, but your personality is bigger. You no longer try to hide. You are confident in stating your opinions and being yourself, even if that means standing out a bit from the rest of the group. You have a voice, and you are prepared to use it.