The Pursuit of Hydration

waterSummer is here! Although, living in Texas, does summer ever stop? With all of the sweating that occurs with the heat (can’t avoid it), the first thing on your mind should be hydration. This is important for all of us, but is especially of utmost importance to our recent post-op patients. For the first few months after surgery, fluid intake will likely be lower than normal, but hydration needs remain the same as before surgery. Our bodies are made up of about 60% water and is needed for a number of imperative body functions.

It is needed to:

  • Regulate body temperature
  • Deliver oxygen to the entire body
  • Aid in digestion
  • Flush body waste/detoxify
  • Make hormones and neurotransmitters in the brain
  • Lubricate joints
  • Allow the cells in the body to grow, reproduce and maintain life

If we don’t have adequate fluid intake our bodies will not perform efficiently. Here are some warning signs and symptoms that might occur when dehydrated:

dehydration pic

Remember to always have liquids with you at all times, especially if you are planning on being outdoors for an extended amount of time or exercising. Keep yourself prepared by keeping water in your car, on the way out of the house, in your purse/work back or in the office. Try staying in a cool environment if you are having difficulty staying hydrated. Consider swimming, walking inside the mall/grocery store, or exercising in an air conditioned facility to decrease the possibility of dehydrating.

Fluids Encouraged include:


Ice ChipsCrystal Light
(or equivalent)

Sugar free popsicles


Propel Zero

Sugar Free GelatinDecaf Tea or
Decaf Coffee

Vitamin Water Zero

Almond Milk

Lactaid Milk (skim)

Soy Milk

**Alcohol does NOT count as a liquid!!

Some foods are also high in fluid, which include:




Although we can’t completely avoid the heat, we can at least prevent dehydration! Only you can prevent dehydration (please say this in your Smokey the Bear voice). Have a great summer!

P.S. for those of you spending time outdoors, take a look at the following diagram and keep yourself safe!heat stroke


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Alcohol After Surgery


So this is going to be a serious blog post. I normally like to keep these posts light hearted, there is something I’d like to share with you. With St Patrick’s Day coming, alcohol is on the top of many agendas on March 17th. While alcohol in moderation is ok, you have to remember that after bariatric surgery your ability to metabolize alcohol is greatly altered. Prior to surgery you may have been able to drink 4 beers and feel fine, but now you may be the person who can’t even finish half of a glass of wine without getting really tipsy. I love you all, so I’ve attached the following article so you can read up on the effects alcohol has on bariatric patients. While it’s focused on bypass patients, it still applies to the gastric sleeve patients too. The article is long, but worth the read. Be safe!

Alcohol and the Gastric Bypass Patient

BT Online Editor | October 22, 2006

by Cynthia K. Buffington, PhD


A 32-year-old man, four months out from gastric bypass surgery, was issued a citation for driving under the influence (DUI) of alcohol shortly after leaving his brother’s wedding reception. According to the patient, he had only consumed one glass of champagne, although his blood alcohol content was above the legal limit to operate a motor vehicle (i.e., 0.08%).

A female patient, 50 years of age and one year post-gastric bypass, hit and killed a pedestrian with her automobile after having less than two glasses of wine. When police arrived, she was staggering and slurring her words and was taken into custody. Two hours later, she was still unable to maintain her balance or to speak clearly, causing officials to suspect that she had  drunk a bottle or two of wine instead of two glasses.

Were these patients telling the truth about the amount of alcohol they had consumed, or did bariatric surgery affect the way their bodies absorb or metabolize alcohol? In order to answer these questions, we queried our gastric bypass population to identify changes in their response to alcohol since surgery. Nearly all patients surveyed (90%) claimed that they were more sensitive to alcohol postoperatively versus preoperatively. Most patients reported that they could feel the effects of alcohol after taking only a few sips of their drink. More than 25 percent of patients said that they had, on occasion, lost muscular coordination after having only one to two drinks, and several of these patients claimed that they were unable to regain control of their balance and coordination for up to two hours. Nearly five percent of the patients who completed the survey said that they have received a DUI and that the incidence had occurred in the early postoperative months and after having only one alcoholic beverage.

These findings suggest that gastric bypass alters the absorption and/or metabolism of alcohol in such fashion as to increase alcohol sensitivity. In order to determine how gastric bypass may affect the body’s response to alcohol, we reviewed the process of alcohol absorption and metabolism in the non-surgical and gastric bypass patient. This article includes the findings and, based upon such, provides the healthcare professional suggested guidelines for patient use of alcohol post-surgery.


Why would alcohol absorption be more rapid and alcohol levels higher for someone who has had a gastric bypass? When alcohol enters the stomach of someone with normal gut anatomy, some of it is metabolized in the stomach by the enzyme alcohol dehydrogenase in a process known as first pass gastric alcohol metabolism.[1-4] Conditions that reduce gastric metabolism of alcohol increase blood alcohol levels and its effects. Such conditions include female gender, aging, and various medications (i.e., H2 blockers and aspirin).[3-4]

The length of time alcohol stays in the stomach also regulates blood alcohol levels by controlling the rate of absorption.[1-3] Although a small amount of alcohol is absorbed in the stomach, most is absorbed into the circulation via the small intestines. Alcohol absorption is primarily regulated by the rate that alcohol empties into the intestines from the stomach. The longer alcohol remains in the stomach, the less is absorbed and the lower the blood alcohol content is and risk for intoxication and toxicity. Food slows gastric emptying and, consequently, reduces the rate of alcohol absorption by the intestines. Conversely, alcohol consumed on an empty stomach substantially enhances absorption and increases blood alcohol content and risk for intoxication.[5,6]

With gastric bypass, more than 95 percent of the stomach is bypassed, including the pylorus. Under these conditions, first pass alcohol metabolism is negligible because alcohol passes directly from the stomach pouch, via gravity, into the intestines where, due to the large surface area of the intestines, it is rapidly absorbed. To make matters worse, when drinking alcohol, many patients obey the postoperative dietary rule of no eating while drinking, causing alcohol to be absorbed at an even faster rate.

A 2002 study published in the British Journal of Clinical Pharmacology[7] found that gastric bypass patients have significantly higher rates of alcohol absorption and blood alcohol content than do age- and weight-matched controls. According to the study protocol, gastric bypass patients three years out from surgery and their non-surgical controls were asked to consume an alcoholic drink after an overnight fast, and blood alcohol levels were followed over time. The data showed that blood alcohol levels of the gastric bypass patients were significantly higher (about 50%) than their non-surgical counterparts and required much less time to peak (10 vs. 30 minutes). These findings may, in part, explain why, when queried, the majority of our gastric bypass patients claimed they could “feel” the effects of alcohol after having only a few sips of their drink.

The more rapid absorption of alcohol and heightened blood alcohol levels with gastric bypass would cause the patient to “feel” the effects of alcohol after having consumed less alcohol than before their surgery. Such effects may have serious ramifications with regard to driving an automobile or performing other skilled tasks, such as operating heavy machinery, piloting a plane, or any other task that could jeopardize the safety of the individual or that of others.


In the non-surgical patient, 60 to 90 percent of alcohol that enters the body is metabolized in the liver by the alcohol dehydrogenase (ADH) pathway. ADH is maximally activated by small amounts of alcohol but activity along the pathway can be reduced by an accumulation of end-products (i.e., NADH, acetaldehyde). Fasting and low calorie intake—such as occurs in the early postoperative period—as well as defects in hepatic mitochondrial function with obesity, per se, may reduce the metabolism of products of the ADH pathway, decreasing hepatic clearance of alcohol.[8-10] Furthermore, activities along the ADH pathway may be impaired by steatosis or fatty liver disease,[11] conditions that are relatively common among individuals with morbid obesity. The gastric bypass patient, therefore, may not only have higher rates of alcohol absorption, but at least in the early postoperative period, possible defects in alcohol clearance as well.

Metabolic changes that occur with massive and rapid weight loss may also affect the amount of alcohol cleared by the liver via the microsomal ethanol metabolizing system (P4502E1).[9,10,12] Activities along this pathway are increased in association with obesity[12-14] and are induced both by alcohol intake, free fatty acids and, possibly, ketone bodies.[12] Alcohol metabolism by the microsomal ethanol metabolizing system substantially increases the risk for liver damage, while at the same time making an individual more sensitive to the toxic and cancer-promoting effects of pollutants in the air, industrial solvents (such as those in household cleaners), and certain drugs, including acetaminophen.[9,10,12]

Alcohol use may cause hypoglycemia and, through reduction in the supply of glucose to neural tissue, cause possible neuromuscular and cognitive dysfunction, loss of consciousness, or even death.[15,16] To maintain appropriate glucose levels, the body stores sugar in the form of glycogen. Glycogen stores, however, can be depleted in a short period of time with fasting or a diet low in carbohydrates. Furthermore, alcohol reduces the process, glycogenesis, that allows sugar to be stored as glycogen.[15]

The bariatric patient, particularly in the rapid weight loss period and if on a carbohydrate-restricted diet, may have low amounts of glycogen. Drinking alcohol could deplete glycogen stores and reduce glucose homeostasis. The body, however, has another mechanism to maintain appropriate glycemic status, gluconeogenesis, the chemical pathway that converts certain components of protein, lactic acid, and other substances into glucose. Unfortunately, alcohol also reduces the production of glucose by this process.[9,10,15] A decline in blood glucose usually increases the production of glucagon and certain hormones of the autonomic nervous system and hypothalamic-pituitary-adrenal axis to restore blood glucose levels to normal by stimulating glycogenolysis or gluconeogenesis.[16,17] However, when someone drinks alcohol, the response of these hormones to a fall in blood sugar is blunted. To make matters worse, counterregulatory hormone responses to low blood sugar are also blunted or depressed in postoperative bariatric patients.[18] The bariatric patient when using alcohol may have a higher risk of becoming hypoglycemic than someone who has not had the surgery, particularly in the early postoperative period when calorie intake is substantially reduced and glycogen stores are likely to be low.[19]

Since neural tissue requires glucose for fuel, low blood levels could adversely affect neuromuscular and cognitive functions, causing a loss of coordination and balance, slurred speech, poor vision, and confusion.[16,17] These are all conditions that mimic those associated with intoxication. The patient described in the introduction who appeared extremely intoxicated even though she had not consumed a large amount of alcohol may have been hypoglycemic. Hypoglycemia could also have possibly accounted for the loss of coordination and balance that some of our surveyed patients claim they experienced hours after drinking alcohol.

The use of alcohol after surgery may cause irreversible brain and nerve damage, coma, and possible death by inhibiting the absorption of important vitamins, including B-complex vitamins, such as thiamin (B1) or Vitamin B12. Alcohol inhibits the absorption of thiamin and other B-complex vitamins, reduces activation of certain vitamins, and stimulates the breakdown of Vitamin A, pyridoxine, and folate.[9,10] These vitamins may already be deficient in bariatric patients because of nutrient restriction, malabsorption, or impartial digestion of foods produced by the respective surgery.20 Alcohol use, then, could compound the negative effects that bariatric surgery has on vitamin/mineral status and increase the risk for associated health problems, including neuropathy, an irreversible loss of various cognitive functions, defects in metabolism, a decrease in the body’s ability to heal, low immunity, and fatigue.[20,21]

Alcohol has numerous other toxic effects in the body. Not only does alcohol cause liver disease, but it also negatively affects other tissues.[1,8-12,22] Alcohol’s influence on the heart includes myocarditis, cardiomyopathy, arrythmias, and increased risk for sudden death. Skeletal muscle is particularly susceptible to alcohol toxicity with loss of muscle mass and strength. Alcohol causes inflammation of the intestinal tract, gastritis, pancreatitis, acid reflux disease, and increased risk for gastric and esophageal cancers. Alcohol also causes damage—often irreversible—to neural tissue.


In addition to the numerous health problems that drinking alcohol after surgery may cause, the bariatric patient should also be cautious of alcohol addiction. The prevalence of food addiction and associated eating abnormalities (i.e. binge eating, carbohydrate cravings) are high in association with obesity.[23,25] With bariatric surgery, aberrant eating behaviors are considerably improved.[18] However, individuals with addictions often transfer those addictions to yet another substance, such as alcohol.[23] Our data, presented as a poster at the 2006 meeting of the American Society for Bariatric Surgery, showed that approximately 14 percent of gastric bypass patients have increased alcohol consumption post-surgery.

Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. For instance, one 12-ounce can of beer contains 150 calories; 3.5 ounces of wine contain 70 calories; 1.5 ounces of gin, rum, vodka, or whiskey contain between 97 and 124 calories; and 1.5 ounces of liquor contain 160 calories.


Are there guidelines for using alcohol after surgery? Presently, there are no official guidelines that have been established pertaining to the use of alcohol after having bariatric surgery. However, based upon knowledge of changes in the absorption and metabolism of alcohol, coupled with the metabolic state of the bariatric patient at various stages postoperatively, the following suggestions are recommended: 1.    Do NOT drink alcohol during the rapid weight loss period. 2.    When drinking, remember that small amounts of alcohol can cause intoxication or can result in low blood glucose with serious consequences. 3.    Do not drive or operate heavy equipment after drinking alcohol—even small amounts. 4.    Eat if you plan to have a drink. 5.    Make certain to take your bariatric vitamin and mineral supplements.


1.    West Virginia University School of Medicine. Alcohol Metabolism and Absorption. Available at: Access date: September 7, 2006.
2.    Buffington CK A review of alcohol absorption and metabolism in non-surgical and bariatric surgical patients., 2005.
3.    Sharma R, Gentry RT, Lim RT, Jr., et al. First-pass metabolism of alcohol. Dig Dis Sci 1995;40:2091–7.
4.    Palmer RH, Frank WO, Nambi P, et al. Effects of various concomitant medications on gastric alcohol dehydrogenase and the first-pass metabolism of ethanol. Am J Gastroenterol 1991;86:1749–55.
5.    Jones AW, Jonsson KA, Neri A. Peak blood-ethanol concentration and the time of its occurrence after rapid drinking on an empty stomach. J Forens Sci 199136:376–85.
6.    Hahn RG, Norberg A, Jones AW. ‘Overshoot’ of ethanol in the blood after drinking on an empty stomach. Alc Alcohol 1997;32:501–5.
7.    Klockhoff H, Naslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery. Br J Clin Pharmacol 2002;54:587–91.
8.    Merck, Inc. The Merck Manual of Diagnosis and Therapy, Chapter 40. Alcohol Liver Disease. Available at: Access date: September 7, 2006.
9.    Lieber CS. Alcohol and the liver: Metabolism of alcohol and its role in hepatic and extrahepatic disease. Mt Sinai J Med 2000;67:84–94.
10.    Lieber CS. Metabolism of alcohol. Clin Liver Dis 2005;9:1–35.
11.    Zorzano A. Effect of liver disorders on ethanol elimination and alcohol and aldehyde dehydrogenase activities in liver and erythrocytes. Clin Sci 1989;76:51–7.
12.    Lieber CS. From ASH to NASH. Hepatol Res 2004;28:1–11.
13.    O’Shea D, Davis SN, Kim RB, et al. Effect of fasting and obesity in humans on the 6-hydroxylation of chlorzoxazone: A putative probe of CYP2E1 activity. Clin Pharmacol Ther 1994;56:359–67.
14.    Emery MG, Fisher JM, Chien JY, et al. CYP2E1 activity before and after weight loss in morbidly obese subjects with nonalcoholic fatty liver disease. Hepatology 2003;38:428–35.
15.    Mokuda O, Tanaka H, Hayashi T, et al. Ethanol stimulates glycogenolysis and inhibitis glycogenesis via gluconeogenesis and from exogenous glucose in perfused rat liver. Ann Nutr Metab 2004;448:276–80.
16.    Mitrakou A, Ryan C, Veneman T, et al. Hierachy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol 1991;260:E67–74.
17.    Cryer PE. Glucose counterregulation: prevention and correction in humans. Am J Physiol 1993;264:E149–55.
18.    Guldstrand M, Ahren B, Wredling R, et al. Alteration of the counterregulatory response to insulin-induced hypoglycemia and of cognitive function after massive weight reduction in severely obese subjects. Metabolism 2003;52:900–7.
19.    Heymsfield SB, Stevens V, Noel R, et al. Biochemical composition of muscle in normal and semistarved human subjects: Relevance to anthropometric measurements. Am J Clin Nutr 1982;36:131-42.
20.    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci 2006;331:219–25.
21.    Gollobin C, Marcus WY. Bariatric beriberi. Obes Surg 2002;12:309–11.
22.    Eriksson CJ. The role of acetaldehyde in the actions of alcohol (update 2000). Alcohol Clin Exp Res 2001;25:15S–32S.
23.    Simansky KJ. NIH symposium series: Ingestive mechanisms in obesity, substance abuse, and mental disorders. Physiol Behav 2005;86:1–4.
24.    Wurtman RJ and Wurtman JJ. Brain serotonin, carbohydrate craving, obesity, and depression. Obes Res 1995;4:477S–89.
25.    Herpertz S, Kielmann R, Wolf AM, et al. Does obesity surgery improve psychosocial functioning? A Systematic review. Int J Obes Relat Metab Disord 2003;27:1300–14.
26.    Buffington CK, Warthen RT, Daley DL, et al. Changes in alcohol sensitivity and effects with gastric bypass (abstract). SOARD 2006;2:317–8.

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Valentine’s Day is Upon Us!

Valentine’s Day is right around the corner. What is more symbolic of Valentine’s Day than a box of chocolates, dinner and flowers?  Celebrating Valentine’s Day with the ones you love can be tons of fun, but we can show our love in ways that aren’t centered on food. I’ve got some tips and some simple snack ideas to get you thinking about the day with a healthy spin.

  1. Be smart: Let’s face it, most of us like to go out to eat on Valentine’s Day. Find a restaurant you enjoy. Get a salad and split the main entrée with your loved one.
  2. Be creative: Get a picture of the two of you, of the family, of a favorite vacation spot, or whatever it is you love and frame it. If you are creative, decorate a frame for it!
  3. Be mushy: Buying chocolate isn’t the only way to show you care. Try writing down your feelings in a letter. Tell the person how much you care. Who doesn’t love to be lavished with compliments?
  4. Do something you love: Be active and get your energy flowing. Those endorphins from exercise give off a feeling euphoria, so take advantage of your body’s natural ability to make you feel happy. Love dancing? Dancing burns off a great deal of calories, so hit up the dance floor doing the tango, line dancing or whatever! Like hiking? Drive to a nearby park with trails.
  5. Keep smart snacks around (or make them!): I want to share 2 super cute ideas that I thought of … and by “I thought of”, I mean I found them on Pinterest… Seriously, Pinterest is the only reason I am creative at all.

Valentine’s Day Fruit Wands

Healthy, Fun, and Simple. Try these Valentine Fruit Wands this Valentine's Day.

Strawberries, Watermelon, Small heart shaped cookie cutter, skewers

To Do:
Prepare the fruit: Slice watermelon ¼ inch thick and cut out heart shapes using the cookie cutter. Then using a paring knife, slice the stems off of the strawberry (in a V shape) to look like a heart. Then layer them onto the skewers for a delicious treat! Super easy, super adorable, and really tasty!

Heart Shaped Veggie and Cheese Platter*
*This one is an adaptation of an idea from Pinterest!

Valentines Day Blog

Cucumbers, Low-fat cheese, Small heart shaped cookie cutter

To Do:
Slice up cucumber and cheese to about 1/2 inch thickness. Use cooke cutter to make heart shaped designs!

It’s easy to make finger foods that are cute, delicious and healthy, too! There are a million more ways to use that cookie cutter, so have fun with it!




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New Year’s Resolutions

Happy New Year!! I hope everyone enjoyed their holidays! Sorry I’ve been MIA for the past few months. Today, I’m going to talk about New Year’s Resolutions, so my first one will be writing on this blog more routinely. Promise I’ll keep it!

New Year’s Resolutions: We all make ‘em, most of us break ‘em before January is halfway over. Most of us make ones that improve our health, whether it’s to lose weight, exercise more, eat healthy, or learn how to crotchet (oh wait, that was mine last year: I didn’t start to learn until Christmas. Still done in 2015, so it counts as success!) One of mine this year is to improve my fitness level. This year my husband and I were inspired by some friends who ran the Houston full and half marathon, so we signed up to run the half! We literally signed up the day of the marathon so we couldn’t change our minds.

It is already almost the end of January—the time when most people give up on their resolutions. Are you still following the ones you set for yourself?! The problem with resolutions is that we tend to set ourselves up for failure. To keep you motivated and help you meet your goals, I’ve got some tips to help you keep the resolutions you’ve set for yourself.

Be specific: Set up a plan. We tend to do better when we have things spelled out for us. It gives us less room for excuses or ability to rationalize poor behaviors.  If weight loss is your goal, then you need to say, I’m going to eat xx foods, with xx meal plan, with a goal of xx pounds lost in a month. Do research. Call your dietitian (that’s what I’m here for!). Our main goal in the office is the patient’s success, so please feel free to call or e-mail (

Be reasonable with your expectations. It’s frustrating, but it takes some time before you see changes.  You won’t really see results from diet and exercise for about 4-6 weeks. Don’t just look at weight as an indicator. Take your measurements. How are your clothes fitting you? Sometimes our bodies improve, but the scale doesn’t show these improvements.

Find someone to hold you accountable. Most of us need others to keep us honest with ourselves. It can be with family & friends, friends who have had surgery, a support group, or even me! Join a fitness group with a trainer. Create a group with friends. You can even consider spending some money as a motivator. Hey, whatever works for you, go with it.

Make it fun! Don’t set yourself up for failure. If you want to exercise, but hate running, don’t run! Like to dance? Go to Zumba. Hate to work out at home alone? Go to a boot camp. Find the foods or activities that you love, so you enjoy the changes you’ve made, not resent them.

Resolutions are all about making improvements in ourselves. I’d say you are worth the investment! So let’s make this year a success. You can be one of your only friends to be able to say you actually completed your resolution! Good Luck!

How do you keep up with your New Year’s Resolutions?

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Surviving Halloween

Halloween is coming in about a week and sugary treats have been on the shelves for over a month already (Before you know it, Christmas decorations will be out…Oh wait, they already are!). Halloween is the ultimate holiday for testing our self-control, but this candy filled holiday doesn’t have to be a total calorie trap! Check out the tips below to help keep you from a total sugar high, Dumping Syndrome and diet derailment.

Survival Tips

  • Don’t buy candy until Halloween Day. It’s less expensive and the candy won’t be calling your name from the cupboard beforehand.
  • Buy the candy you hate… if you love M&Ms buy Sweet Tarts or something you wouldn’t eat.

When at Halloween Celebrations

  • Bring your own side dish. Pretend like you are being a wonderful guest, but really ensuring you have something healthy that you can eat.
  • Eat mindfully.  The average person eats more calories than normal in a group setting.  Choose fruits and vegetables over high fat foods such as chips, cheeses, and fried items.
  • Eat a healthy snack or meal before heading out to the party.  Feeling satisfied will take away the desire to eat all of the high fat food items offered at the party.
  • Use the dessert plate, instead of the dinner plates when getting your meal. Smaller plates= less food. Do not go back for seconds.
  • Drink water or low-calorie beverage throughout the party.  This will cause you to feel fuller throughout the evening.
  • Avoid alcohol at the party. Not only are alcoholic beverages high in calories, it causes you to let down your guard, leaving you open to making poor meal choices.
  • Focus on socializing rather than eating.  By drawing your focus away from food you will be less likely to mindlessly eat throughout the party.

Healthy Snacks to Choose (in moderation of course):

  • Sugar Free Jelly Beans
  • Sugar Free Candy Corn
  • Apples dipped in sugar free caramel

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Mmmmmmm, Pasta….

I have a confession. I am a carbohydrate lover. If I could live off of penne pasta I would. I seriously cannot eat pasta without supervision because I may eat the entire box myself. You think that all dietitians love to eat just veggies and grilled chicken? Guess what, we love the other stuff too! The good news is that there are always creative ways to make the foods you love in a healthier version.

Since I am such a huge pasta fan, I have looked into tons of ways to use vegetables in its place. Of course there is the ever popular spaghetti squash, but there is another vegetable that is incredibly versatile. Zucchini!  Today, I am going to talk to you about my new favorite tool, called a vegetable spiralizer. For those of you who have no idea what that is, it’s basically a cooking tool that will take your zucchini (or other vegetable) and cut it to look just like spaghetti. I have wanted one of these forever. Soooooo, for my birthday my lovely husband actually listened to my cries and bought me one!!! You have no idea how excited I was to get this.  I have been telling my pasta loving patients for the longest time to buy one. Up until this time, I hadn’t used one, but knew that it would be awesome.

I mentioned vegetable spiralizers to some of our staff and they found some relatively inexpensive options at grocery stores like Kroger and HEB. Below is one that our business manager bought at HEB and loves!

More sophisticated vegetable spiralizers can also be found in fancy kitchen stores and online. I chronicled my first experience using mine. It was quick, easy and delicious! Here are a few pictures I took during my first use of the spiralizer.

*Please excuse the poor photography. I’m a dietitian, not a photographer!

pic 1

As soon as I opened it, I ran to the refrigerator and got started. The spiralizer was pretty easy to use.  You get the blade in place, cut the ends of the zucchini, stick it on the spikes and turn the handle. It’s seriously the easiest tool I have ever used. I knocked out the “spaghetti” in about 2 minutes.

pic 2

I kept it simple the first go round. I made “spaghetti” with turkey meatballs. I’m sure most of you on here have already seen my dinner, since I have shown my creation to every patient who will look. I literally cooked the “pasta” for less than 5 minutes, added salt, pepper, garlic, and Italian spices and voila! How easy is that?

pic 3


What other recipes do you use to substitute healthier options for unhealthy ones? Let us know!

Have a vegetable spiralizer and a great recipe? Share it with us!

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Vitamin Deficiencies

Ever thought that having numbness in your legs sounded like a good idea? Or were you hoping to be lethargic every day? Maybe even looking for hair loss and brittle nails? No? Hmm….

If you aren’t taking your vitamins or taking the appropriate supplementation, there is a good chance that these problems can happen to you.


People often underestimate the importance of vitamin supplementation. The basic principle of bariatric surgery is to restrict food intake and decrease the absorption of food in the stomach and intestines. This modification of your digestive tract requires not only a change in diet, but a change in vitamin supplementation as well. Once the surgery is performed, vitamins are no longer able to be absorbed as they once were. Gastric acid is required for the absorption of many vitamins and minerals. Once it is removed (with gastric sleeve) or detached (with bypass) you are no longer able to absorb all vitamins in all forms. This is the reason we instruct our patients to take a bariatric specific vitamin.

There are a few I want to focus on because these are the deficiencies we have been seeing most recently: Thiamine, B12, Vitamin D and Iron.

Thiamine (Vitamin B1)

Thiamine is a water soluble, B-complex vitamin that aids the body in converting carbohydrates into energy. It is also essential for proper heart and muscle function. Proper supplementation is most critical in the first several weeks after bariatric surgery or at any point that persistent vomiting may occur. Thiamine deficiencies are best known for causing beriberi. Although most societies have virtually eradicated beriberi through Thiamine enriched foods, the disease is still a potential hazard for surgical weight loss patients. Since your diet is greatly restricted and your body cannot store large amounts of thiamine (enough for about 3 weeks), it is possible to suffer a deficiency. These deficiencies can be very serious and sometimes irreversible.

Thiamine deficiency


Vitamin B12

Another water soluble, B-complex vitamin, vitamin B12 is responsible for maintaining red blood cells and nerve cells, as well as assisting the body in making DNA. It is probably the most talked about vitamin following weight loss surgery. Following a malabsorbtive procedure such as a gastric bypass, the body’s ability to absorb vitamin B12 is greatly reduced due to the lower levels of gastric acid and intrinsic factor (IF) . Symptoms associated with a B12 deficiency include weakness, fatigue, dizziness, and brittle nails. A deficiency can lead to pernicious anemia. In the case of a severe B12 deficiency, neuropathy may develop, resulting in irreversible neurological damage. It is important to note that while many people believe that it is impossible to absorb vitamin B12 in an oral tablet following surgery, this is actually not true. Vitamin B12 is absorbed orally through a process known as passive absorption. However, only about 1-2% of intake may be absorbed through this process.

Vitamin  B12

Vitamin D

The primary function of vitamin D is to aid the body in the absorption of calcium, which is critical to ensure healthy bones and teeth. Vitamin D also promotes normal cell growth, weight loss, and aids in the prevention of some cancers. While it is a fat soluble vitamin, the levels associated with toxicity are fairly low, in part because vitamin D is found in almost no foods. Symptoms associated with vitamin D deficiency may include muscle pain, bone fractures, fatigue, low immunity, depression or problems sleeping.

Vitamin D



The most important function of iron is to carry oxygen in red blood cells to muscles. It is also essential to the production of energy. Iron deficiencies are common among patients that have undergone a malabsorbtive surgical procedure but can be a potential risk associated with any bariatric surgery. Symptoms associated with iron deficiency include fatigue, lowered immunity, restless leg syndrome and pica. Pica is a condition in which a person has a desire to eat chalk, ice, dirt or other strange items. Iron deficiency can lead to anemia. When taking a separate iron supplement, it should contain vitamin C to increase acidity in the pouch.




*Vitamin information provided by Celebrate Vitamins

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Trans Fatty Acids: What Are They?

You may have read the recent headlines that the FDA is requiring fatty acids be removed from food as they are no longer considered safe.

We know they’re bad, but what exactly are trans fatty acids? 

Trans fatty acids are a type of unhealthy fat made through the chemical process of hydrogenating oils. This basically means it will change a liquid fat into a solid fat. Its main purpose is to increase shelf life and cause stability in oils and foods. Trans fat can be found in baked goods (cookies, crackers, pie, etc.), vegetable shortening, stick margarine, potato chips, and some fried foods, just to name a few…

But, you are all so well behaved and avoid all of this stuff already! Right?!?!

There are three different kinds of fats:

  1. Unsaturated or Polysaturated fats: Also known as the “good fat”
  2. Saturated fats: Often referred to as the “bad fat”
  3. Trans fat: The worst kind of fat because they cause much more damage than saturated fats, as they interfere with the body’s ability to regulate cholesterol. Trans fats increase LDL (“bad”) cholesterol, which significantly increases the risk of coronary artery heart disease and stroke. These are the leading causes of death in men and women in the United States.

What does the FDA regulation mean for you?

You will have one less fat in your food supply attacking your heart. However, removing trans fats does not mean that all of the bad fats have been removed from everything you eat. There is still fat in food products, both good and bad; it just won’t be made up of any trans fats. The FDA has allowed companies 3 years in which to remove trans fats from their products.

Please make label reading a normal part of your food selection!

Aim for foods that have:

  • Less than 5 grams (g) of total fat per serving
  • Aim for less than 10 g of saturated/trans fat per day
  • Try to pick foods with heart-healthy fats (monounsaturated and polyunsaturated fats)
  • Read the ingredients list. If a food contains partially hydrogenated oils, then it has trans fat.
    • If it has less than half a gram per serving, the label may still say trans fat-free.

To read the FDA’s press announcement, click here.




As always, let us know what you think!

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Keeping it Mindful

Anyone who has ever dieted or tried to change their eating habits knows that eating isn’t just about nutrition. It also requires mental focus. We all know that when we are motivated, we can do anything. And I mean anything. Want to cut out carbs? Done. Portion sizes measured out? Done. Avoid all things with white flour? Done. Now, try maintaining those goals a few months when the excitement of dieting has started to peter out and now requires more effort. Healthy eating becomes a chore and people become resentful of having to follow stringent rules. The good news is that there are always tips and tricks to making healthy choices with minimal thought.

I recently watched a short video where portion control and mindful eating were discussed. In one of the studies they reviewed, the test subjects were provided with a plate and told to fill it up with as much food as they wanted. The server then took their plate and “accidentally” sneezed on it, therefore requiring a new plate. Unbeknownst to the patient, they were then provided with a smaller plate and told to refill their new plate. The study showed a 25% decrease in food intake. Twenty five percent! That would mean saving 125 calories if the original meal was 500kcal.  Doing that for 3 meals a day means ridding yourself of 375 unnecessary calories a day. That is huge! One particular subject actually thought she was taking more food the second time. Think about it, just keeping smaller plates at home, requires no thought. That is a simple change that will lead to a decrease in calories without any effort. Zero. Zilch. Nada.

Here are some other useful tips to keep you mindful when eating:


TIP #1: Use smaller serving bowls and utensils

Studies consistently show that people will take about 25% less food from smaller serving bowls and serving utensils than larger ones. This combined trick with a smaller plate? Wow!


TIP #2: Change your habits

If passing a particular grocery store triggers you to stop for your favorite guilty pleasure, than don’t drive past that store. Drive in a different direction. Reading a book on the couch makes you want to snack? Go sit in the family room chair and drink water. Sometimes making minor adjustments to behaviors make all the difference in the world.

TIP #3: Record your intake

This is an oldie, but goody. Writing things down will hold you accountable. Knowing and seeing your intake are two very different things. We tend to underestimate the amount we’ve eaten when they are not in our face. There are tons of apps that you can use for this purpose, such as


TIP #4: Don’t watch TV when eating

How many times have we sat in front of the tv and eaten an entire bag of food without even realizing before it was completely empty? Eat your meal at the table. Listen to your body. Feeling full? Stop eating. You can’t pay that kind of attention when you are distracted.


TIP #5: Don’t keep trigger foods at home

If there are certain foods that you cannot control yourself with, don’t buy them. We all have our moments of weakness, so why test your self-control if you don’t have too?


TIP #6: Drink adequate fluids

A lot of times we are so busy focusing on eating right, that we forget about fluids. Did you know that feelings of thirst can be confused with feelings of hunger? Next time you are hungry, grab something to drink to rule out the possibility that you just needed a drink. Avoid sweet/sugary drinks as they do not quench thirst and provide unnecessary calories. Stick with water and zero calorie beverages.


TIP #7: Don’t skip meals

People who skip meals tend to overcompensate with calories at the other meals. This leads to higher overall daily intake. When we are hungry, our bodies don’t crave low calorie, nutrient dense food items. It wants food NOW. You will likely chose higher fat and more calorically dense items to quickly satiate yourself.


Life is full of obstacles. We can choose to let these barriers be our excuse for failure or we can overcome them. Hopefully these strategies seem painless and you’ll be able to use these tips at home!

Second Call to Action



Try some of these tips from Michele’s Blog at home and let us know how they work for you!

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And So It Begins

I am super excited! This is my first official blog entry and don’t know where to start. I’ve never written a blog and there is just so much info that I need to share with you! For those of you who have not met me yet, my name is Michele. We will get to spend some time together, working on nutrition, while you go through the insurance process on your way to bariatric surgery. I take pride in making you comfortable and listening to your eating/exercise habits without judgement. I promise I won’t bite if you don’t have a perfect eating schedule and workout routine. I love to hear honesty when you come to see me, because if I don’t know what the problem is, I can’t help you. For those of you who do know me, hey there!

I have been a practicing dietitian for the past 15 years, as mentioned in the introduction, and have been working with Dr. Turnquest now for 2.5 years. I won’t lie, when I first started as a dietitian, I didn’t believe in bariatric surgery. I was an idealistic new dietitian and believed that everyone could lose weight and maintain the loss if they really wanted to. After working in the real world for a few years, I realized that bariatric surgery was necessary for some patients and it wasn’t just the “easy way out”.

Proper eating and vitamin supplementation after surgery is more important than ever! And it takes discipline and hard work to maintain weight loss after surgery… but I digress…

I truly love my job. I love getting to know my patients and help get them on their journey to better health. Not just on the outside, but on the inside too. This surgery isn’t just a way of getting “thinner”. It’s a way to regain your health. I feel no more pride than when our patients are able to bend over and tie their shoe for the first time in 10 years or walk around their block for the first time ever without stopping. I consider you all like family and love to see your successes, as well as empathize with your disappointment when things don’t go as planned.

My goal with this blog is to keep you updated on recipes, diet guidelines, protein, vitamins and many other fun nutrition topics I can provide!

Bariatric Diet Guidelines

Proper diet before and after surgery is essential to ensuring less complicated surgery, achieving proper weight loss and maintaining optimum health. Following nutrition guidelines immediately before surgery and post-surgical diet advancement will also help to avoid nutrition complications and aid in healing.

Download the PDF