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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

Try to see their side. You are asking them to see it from your perspective, so it is only fair that you try to see it from theirs. What are the reasons they may be against your Weight Loss Surgery, and how can you address them? In many cases, their concerns are legitimately about your well-being, and things you should consider if you have not already. They may worry that: You will not hit your goal weight this time since they’ve seen disappointment before. You will suffer complications from surgery. You will regret having a permanent Sometimes, their concerns are selfish but still worth discussing. They may worry that: You’ll stop feeling attracted to them. You will pressure them to give up their own favorite foods while you eat healthily. They will feel left out. You will not want to spend time with them. Reassure them. Address their concerns directly. Explain why you feel the surgery is safe, and how much research you have done to learn about it as well as find a surgeon. Tell them why you think Weight Loss Surgery will work for you even if previous diets have not. Let them know that you need to do this for yourself, not for them and that this will not change the way you feel about them – you will still love your SO, and respect your parents, for example. Tell them how you see yourself spending time with them after surgery, so they can be comfortable. Write it down and practice. Starting the conversation can be the scariest part of telling them. Before you bring up the subject, write down what you plan to say. This is a good exercise for you to do anyway since it encourages you to think through all of the doubts around Weight Loss Surgery. Writing it down and practicing can make it easier for the words to come when you decide to bring it up. Include them in your plans. Often, your spouse and parents, and others who care about you, just want to help. They may be afraid if they do not how to help. When you talk to them, let them know how important they are to you, both in life in general and in this important period of your life. If you tell them specifically what they can do to support you, they may feel more at ease with your decision and more confident in their roles. You might ask them to: Pick up your children from school when you are recovering from surgery. Go with you to the store to pick out protein powders and measuring cups and spoons. Ask you each night how you are doing. Cook healthy meals with you. Prepare for anything. The conversation may be as difficult and unfulfilling as you feared. Or, your SO, parents or other loved ones may be surprisingly supportive once they realize that you have done your research and are serious about making the lifestyle changes needed for success. They may even be interested in getting healthy with you and ask for your help and support in exchange for theirs. Stay strong and independent. As much as you long for your SO and other loved ones to support you wholeheartedly, it may not happen. Try not to let it get you down, though. If you are sure about what you want, go for it, with or without them. They will come around sooner or later, and if not, you may be better off without their negative influence. Letting them know that you have made up your mind regardless of their support may actually convince them to help you since there is no point in standing in your way. Stay independent in the sense that you realize that you do not need them. Your success does not depend on their approval, and you are not doomed to fail if they stand in your way. Get the support you need from others as you move forward.

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.

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!

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.