Have Celiac or Gluten Intolerance?  You are not alone!

Learning that you have celiac disease or gluten intolerance may feel at first, like your world was turned upside down. If you are the only one in your family that needs to shift their diet in a new direction, you may begin to feel very alone.  The good news is that you are not alone, there are many people just like you, and connecting to this community of people can provide you with a strong sense of support as well as many new friends you can relate to. Support can be found in and outside of your home, you’ll just need to be proactive in finding it.  

Follow these tips to help you find the support you need (and deserve) in your journey.

·        Connect with the gluten free community online.  Seek out Pages, Groups and more on Facebook.  Participate in discussions, read other peoples stories, and share your own. 

·        Join community discussions on twitter using the hash tag #glutenfree

·        Follow gluten free blogs – you may be inspired by new recipes, and the stories they share. Don’t be afraid to reach out and connect to these bloggers through comments and on their social media pages. In most cases they will love to converse with you!

·        Follow the social media of your favorite gluten free food and product companies. Their pages will be full of conversation and activity. The Wellesse page is a great spot to connect with others!

·        Connect with your local celiac and or gluten intolerance group- and volunteer to get involved. This will give you the opportunity to make new friends locally.

·        Find a skilled and understanding doctor that takes every one of your symptoms seriously.  A doctor that brushes symptoms off is not worth spending time or money on.

·        Support celiac research- volunteer to participate in walkathons etc. for the cause. Through this process you will have the satisfaction of doing a good deed and will connect with others living with the disease.

·        Try out gluten free restaurants with friends and family.  This will allow you to enjoy your meal, while also spending time with those you love.   Tips To Safely Dine Out Gluten Free

·        Be honest. Tell your friends and family about the disease. Help them understand what happens to your health if you consume gluten.  With education and understanding of the disease they will naturally want to support you in whatever ways they can.  

·        Travel to gluten free expos-you may discover new gluten free products and make new friends!

·        Start a gluten free cooking club.  Invite friends over once a month and have each person bring a gluten free dish OR make a meal together.

·        Attend gluten free cooking classes.  Learning new skills will augment your confidence to make and enjoy delicious food that works within your diet.

·        Teach your family how to read food labels and shop for your favorite foods.  There will be times when you may need someone to pick something up for you at the store. If you teach your family in advance what foods are safe to buy, they will better be able to support you when you need a favor.

·        Teach your significant other and children how to make basic staple foods so that they can cook for you sometimes too!

·        Make your families favorite meals gluten free and you will discover they will become highly supportive of mealtime again without complaints.  This may seem like more work for you up front, but the truth is that it will make your life easier on the back end.

·        MOST importantly: Be Kind to Yourself – Don’t beat yourself up, get discouraged or expect perfect health at first.  You have the potential to be your own biggest support and worst enemy.

Need Information? Here are the Top Celiac and Gluten-Free Resources

Gluten Sensitivity vs. Celiac Disease – What’s the Difference?

Celiac Disease and a Gluten Free Diet - Watch for Nutrient Deficiencies in Both

Blog post by guest blogger, Brittany Angell, of www.realsustenance.com and author of "Essential Gluten Free Baking Guides Part 1 & 2". 

What is a Workplace Wellness Program? 

Wikipedia tells us that Workplace wellness is any workplace health promotion activity or organizational policy designed to support healthy behavior in the workplace and to improve health outcomes. Generally speaking, health promotion is defined as "the process of enabling people to increase control over, and to improve their health,"^[1] and health promotion can be carried out in the workplace as well as many other settings. Known as 'corporate wellbeing' outside the US, it consists of a variety of activities such as health fairs, health education, medical screenings, health coaching, weight management programs, wellness newsletters, on-site fitness programs and/or facilities and educational programs.

Workplace wellness includes organizational policies designed to facilitate employee health including allowing flex time for exercise, providing on-site kitchen and eating areas, offering healthy food options in vending machines, holding “walk and talk” meetings, and offering financial and other incentives for participation, among many other options. Workplace wellness has been expanded over the past decade to encompass the overall creation of a “culture of health” within the worksite.^[2]

A Win-Win for Both Employees and Employers

A Workplace wellness programs not only help employees embrace a healthier lifestyle – they also benefit the businesses that put them in place.  There may be many reasons why you would sign up and get involved in a workplace wellness program; but the bottom line is if the incentives they offer help motivate you, then you will experience better health because of the program.

Better health can mean a higher level of energy, creativity, commitment and better mental outlook. This can contribute to a happier outlook, less sick days, less doctor visits, etc. 

Workplace wellness programs can help you get healthier, even if that simply means learning how to reduce stress and muscle strain when you are on the job. Depending on what your company offers, it might also help to lose weight, lower your cholesterol and blood pressure, sleep better, and save money on prescriptions. Sometimes, all you need is a little motivation to get the ball rolling and a workplace wellness plan might be it.

Teamwork

Another great benefit of wellness programs is a built sense of camaraderie with your co-workers. You’ll have a chance to experience activities with them that aren’t related to work, whether in a walking club or sports team, by having lunch together, or by going to the gym. Social support is a very important part of weight loss and getting fit. By interacting with co-workers, you’ll have others to give you encouragement when you need it, as well as to hold you accountable to your goals. Plus, you’ll be motivated by seeing other’s positive results. By using a wellness program, you’ll be an important part of the team.

Personal benefits may include:

·         Weight reduction

·         Improved physical fitness

·         Increased stamina

·         Lower levels of stress

·         Increased well-being, self-image and self-esteem

Company benefits:

·         Enhanced recruitment and retention of healthy employees

·         Reduced healthcare costs

·         Decreased rates of illness and injuries

·         Reduced employee absenteeism

·         Improved employee relations and morale

·         Increased productivity

A U.S. Department of Health and Human Services report in 2002 revealed that at work sites with physical activity programs, employers have:

·         Reduced healthcare costs by 20 to 55%

·         Reduced short-term sick leave by six to 32%

·         Increased productivity by two to 52%

But there are also direct, work-related advantages for employees and employers. More than half of program participants reported that wellness benefits encourage them to work harder and perform better. In addition, 59% credited their participation in a wellness program with giving them more energy to be productive at work. The survey also found that 43% of employees reported missing fewer days of work because of their participation.

Exercise for Healthy Bones

Exercising You Way to Heart Health

So, how about strapping on that pedometer and just see how far you walk in a normal day and if the steps are not enough then getting out there and start moving more!  If your company offers a Wellness program then you should seriously consider enrolling.  If it doesn't’t, how about raising the question to your HR Department about starting one? How many of you participate in a Wellness Program? Leave us a comment after this blog and let us know your thoughts.

Guest blog post by Lori McKnight, B.A., busy mom and wife who enjoys living in the Pacific Northwest and has been a health and wellness advocate for many years.

Sources:

www.Wellnessproposals.com

http://wellnessproposals.com/guide-to-worksite-wellness-programs/benefits-of-worksite-wellness-programs/

http://www.sparkpeople.com/resource/wellness_articles.asp?id=246

http://hr.blr.com/HR-news/Benefits-Leave/Employee-Wellness/Workplace-wellness-programs-benefit-employee-reten

The conditions known as osteoporosis as osteopenia (“osteo” means bone) indicate that bones have become weaker. Often, both conditions are “silent” and without warning signs until you experience a bone fracture, neck or low back pain, bone pain or tenderness or stooped posture. 

According to the World Health Organization, osteopenia means bone tissue has lost minerals that make it hard and is therefore less dense and weaker (as measured by DEXA scan - dual energy x-ray absorptiometry, a test that uses a low dose x-ray to measure bone mineral content). Osteoporosis is a disease that happens when significant bone density is lost and bones therefore become weak and prone to breaking even from a minor fall or bump. Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis.

How can you prevent osteopenia and osteoporosis? Talk to your physician to see if you should get a DEXA scan and blood test for vitamin D. Also, be sure to meet the Recommended Dietary Allowance for calcium for your age group. If you are between 19-50 years old you need 1,000 mg per day. Men ages 51-70 also need 1,000 mg per day whereas women over the age of 51 need 1,200 mg calcium per day. How do your foods stack up for calcium content? Check out the calcium content of foods here. Adults ages 19 - 70 need 600 IU vitamin D per day those over 70 years old need 800 IU per day. Few foods have vitamin D in them. Check out a list of vitamin D rich foods here.

Treatment for osteopenia and osteoporosis often includes calcium and vitamin D supplements, weight bearing exercise (see a related article here Improve Bone Health with Liquid Calcium Supplements) and possibly taking prescription medications for bone density.

References

Rev Endocr Metab Disord 2010;11:237-51.

Your bones are alive!  Many people don’t realize that bone tissue is constantly shifting between breaking down and re-building. Most of the adult skeleton is replaced about every 10 years. If this were not so, a broken bone would never heal. The down side to this remodeling process is that as we get older the cells that break down bone tissue start to work at a faster rate than those that re-build it. This can lead to a serious bone loss disease known as osteoporosis.  Women typically experience this progressive condition with the onset of menopause (50+). Men maintain stronger bones for longer but can also experience severe bone loss later in life (70+).

So what can we do to help keep our bones healthy? 

Weight bearing and strength training exercise along with proper nutrition and supplementation are weapons we can use in the fight against these diseases.  Let’s review what is considered weight bearing and resistance exercise and then I will give you a few easy things you can do throughout your day to keep your bones stimulated and shifting in the right direction.

Bone Strengthening Exercise 

Bone strengthening activity is any activity that forces muscles to pull or tug on the bones with some force or load.  This can include weight-bearing activities, like walking, jogging and jumping as well as strength training exercises. One thing to keep in mind is that the stimulation of bones is joint specific. Thus, you must direct these forces towards the different parts of your body; making sure to balance the exercises that target your legs and hips with those for your shoulders, arms and spine. See this article, for more specifc joint exercise tips. Exercise Do’s and Don’ts … on a Joint-by-Joint Basis

Here are a few easy ways to stimulate your bones throughout the day with nothing more than a stable wall space: 

1.      Heel Drop: After a leg warm up (i.e. marching in place or going for a short walk), stand tall facing a wall with your hands lightly supported on the wall for balance.  Engage your core muscles (chest lifted, shoulders back and down, waistline pulled inward and pelvic floor lift). From this position lift and drop your heels down in a light bouncing action for 30 seconds (15 to 30 reps). To advance this exercise you can add a light jump off the floor. Stretch the calves as illustrated after completing the drops.       

2.      Push-Away: Face the wall and place hands in push up position on the wall. Bend your elbows and lower your torso towards the wall.  Push off the wall slightly the catch yourself back against the wall. Increase the intensity of this exercise by inclining the body to a greater degree.  Repeat this push and catch action for 30 seconds (15 to 30 reps).     

3.      Shoulder & Spine Press: Stand or sit with your backside against the wall (head, shoulders, hips). Position your arms in a ‘goal post’ position. Inhale deeply and as you exhale press your arms and spine into the wall.  Modify by placing hands down at your sides and lowering the hips. Hold that position for 30 seconds (3 to 5 deep breaths).   

*Always check with your physician before beginning a new exercise program and warm up your muscles prior performing strength specific exercises.

In some ways medicine seems so advanced. In other ways, medical science is still in the beginning stages of discovering the big picture of how our body uses nutrients and how they all interact in our bodies. There are so many little components and processes that haven’t been completely explored, and many that cannot be directly observed.

Nothing works in isolation in our body. Identifying all of the processes one antioxidant or nutrient is part of or responsible for is an incredibly difficult task. Add to that the physiological differences in every unique human body and we are left making healthy decisions using general guidelines and recommendations rather than hard numbers.

To figure out what levels of any nutrient, dietary supplement or food may be best for you given your health status, activity level, current dietary intake and goals, it is important to sit down with a registered dietitian (RD) who specializes in your area of need or type of goal. If you want to lose weight, go to someone who specializes in this, if you have Type 1 diabetes and you are an athlete, go to a RD who works with diabetic athletes. There really is no substitute for a thorough analysis, including laboratory tests of existing nutrient levels that can then be integrated into a specific diet and supplement plan to get you on the right track to a balanced, nutrient-rich body.

Following the general guidelines is a good place to start, if you don’t feel a full nutrient-by-nutrient workup is in order. Recommended Daily Intake values for common vitamins and minerals are in most retail brands.  Be sure to check the brand out thoroughly though, so you know you’ve picked a quality brand that uses quality ingredients.

As always, the type of supplement you choose should depend on personal preference and compliance – what will you continue to take on a regular basis. Because, after all, if you don’t continue taking it regularly, there’s really no point in buying it to begin with!  If you are tired of swallowing yet another pill, try taking liquid supplements instead.  It does make taking your essential supplements each day a little easier, and the quality of ingredients tends to be higher grade in order to make them work well in liquid form.  Plus, they’re easy to mix into protein shakes, morning smoothies, or to take as a straight shot!

Are you of the age or meet the criteria to need a bone mineral density test? Read further to see if you should be investigating this critical test with your primary care physician.

Bone mineral density (BMD) tests examine bone health and can help determine a person’s risk for fractures and identify osteoporosis. The most common and accurate test used to measure BMD is the dual-energy x-ray absorptiometry machine (DEXA or DXA), which compares the bone density in your hip and spine against established norms. DEXA uses a small amount of radiation though experts indicate the radiation risk is very low.

Who should get tested?

The U.S. Preventive Services Task Force recommends all women over age 65 and those who are under 65 but have a high risk of developing fractures get tested. In addition the NIH recommends bone density testing be considered in people with medical conditions putting them at high risk of fractures due to low bone density and those who have taken glucocorticoid medications for 2 months or more.

Why get tested?

BMD testing will determine if you have low bone mass thereby helping your physician determine preventative care and treatment options if necessary.

If you have any questions about bone density testing, talk to your primary care physician, and you can decide between you if a BMD test is right for you now or possibly in the future.

References:

NIH Osteoporosis and Related Bone Diseases National Resource Center.

Though you may think your bones are just a hard and dormant support structure for your body, they are actually  dynamic, growing tissue with new bone constantly replacing old bone. How can you keep your bones strong over time?   Feed them the right nutrients and engage in regular weight bearing physical activity.  Strong bones help protect your organs from injury, allow your body to move and support good posture. 

 Several vitamins and minerals are important for bone health. However, the top two that provide the most impact  are calcium and vitamin D. Calcium, the primary mineral found in bone, contributes to the strength and hardness of bone tissue. Over time, inadequate calcium intake can lead to weak, porous bones.

National survey data shows that many Americans are not getting enough calcium in their diet.  In women ages 19-30 and 31-50 only 28% and 33% are getting above the Recommended Dietary Intake (RDI) set for calcium. The best dietary sources of calcium are dairy foods and fortified nutritional foods such as protein shakes. Green leafy veggies also contain calcium but in very small quantities. For instance, 1 cup of broccoli contains only one-sixteenth of the recommended intake for the average adult aged 19-50!   So eat broccoli too, but be aware of the proportion of calcium coming from it versus other foods and take a calcium and vitamin D supplement if your doctor recommends it. Click here for an additional article about the benefits of calcium and vitamin D supplementation.

 Vitamin D helps your body absorb the calcium you consume. Most of us aren’t getting enough vitamin D either, which has set the stage for a vitamin D insufficiency and deficiency epidemic in this country. Few foods contain vitamin D. Most milk is fortified with it and it is also fortified in some brands of orange juice, yogurt and breakfast cereal. Egg yolks, liver and some types of fish naturally contain vitamin D. 

 In addition to eating a nutritious diet packed with calcium and vitamin D, everyone needs regular physical activity including resistance training (strength training) and weight bearing exercise. Lifting weights, rock climbing, gymnastics, running and walking are examples of activities that help build bone strength. If you choose to run or walk, be sure to lift weights for your upper body too so you build those bones as well.

 References:

Calcium and Bones. NIH.

What We Eat in America, NHANES 2005-2006.

Recently the updated clinical practice guidelines for bariatric surgery were released, cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery (ASMBS).  

For us practitioners it was a welcomed document since the last guidelines were published in 2008. In those five years, we have learned a lot more through research and we are always looking for the best practices and recommendations to treat weight loss surgery patients. There has been a lack of standards as you may know since recommendations vary between surgeons and practices. If you talk to friends or family who have had weight loss surgery at a different location than yourself, you know what I mean.

The new guidelines are somewhat lengthy and technical. I would like to point out the postoperative items of interest that I have shared with my patients. Many of these are not new, but have new research to substantiate the recommendation. (My comments follow.)

• Patients should adhere with principles of healthy eating, including 5 daily servings of fresh fruits and vegetables. (Eat your fruits and veggies before eating starchy carb foods.)
   
• Minimum protein intake should be 60 grams/day and up to 1.5 grams/kilogram ideal body weight per day. (Your RD can individualize your protein needs based on your age, weight, and gender.)
   
• Take your supplements daily. Your supplement needs depend on the type of surgery you had and your individual lab values. (Get your blood work done as ordered by your bariatric provider. Just because you feel good doesn't mean you don't have to take supplements. Supplements are not optional.)
   
• Fluids should be consumed slowly, preferably 30 minutes after a meal to prevent gastrointestinal symptoms and in sufficient amounts to maintain adequate hydration, more than 48 fluid ounces. (Water is always a good choice. Flavor it with slices of lemon, lime, or cucumber.)
   
• Exercise should include moderate aerobic activity of a minimum of 150 minutes per week and a goal of 300 minutes per week including strength training 2 to 3 times per week. (Do what you can, just get started. Any physical activity is better than no physical activity. You have got to do something and stick with it to maintain weight loss.) Read more on exercise after surgery
   
• All patients should be encouraged to join and attend support groups. Patients who regularly attend support group have better weight loss.  (Better yet, be a support group leader. Then you have made a commitment to attend group.)
   
• Regular postoperative dietary counseling with an RD means greater improvement in eating behaviors. (Your RD is important in your long-term success. Stay in contact with her/him.)
   
• If you have an adjustable gastric band, adherence with follow up visits is associated with greater weight loss. (The band doesn't work by itself. In order to keep it properly adjusted and stay in the "green zone" you need to attend your follow up appointments for tune- ups.)
   
• Out of control eating and grazing are associated with lower weight loss and weight regain. (Your pouch may not hold a lot of food at one time but if you eat every hour you can eat a lot of food over the course of a day. Ask yourself if you have physical signs of hunger or do you just want to eat.)
   
• Drinking alcohol after gastric bypass and gastric sleeve surgery results in accelerated alcohol absorption, higher blood alcohol levels, and longer times to eliminate the alcohol from your body. (If you decide to drink alcohol, be very cautious. These two surgeries are not good mixers with alcohol. NEVER DRINK AND DRIVE.)

Please keep in mind that these are guidelines and recommendations, not absolutes. Follow the guidelines provided by your bariatric team since they know you and are best suited to meet your individual needs.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

*Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient- 2013 Update: Cosponsored by American Association of Clinical Endrocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.

Spring has sprung! This hopefully means you’ll be outdoors more, walking, gardening, biking and all the things good weather and longer days bring.  Though your focus has turned to enjoying outdoor opportunities for healthy exercise and soaking in the spring sunshine, don’t forget about things like osteoporosis prevention, or management if you’ve already been diagnosed.  It's never too late to start getting adequate calcium and vitamin D, as well as strengthening bones with exercise.

Best form of Calcium?  Calcium Citrate
Calcium citrate has been shown to be the best form of calcium to supplement your intake. The citrate form absorbs faster and more thoroughly than calcium carbonate, and can be taken with, or without food, making compliance much easier. Look for one with 1000 mg of calcium and 1000 IU of vitamin D included in the formula. The combination aids your body’s use of calcium even further, which is all the better for your bones.

Vitamin D is also Important
Though we can manufacture vitamin D in our body when our skin is exposed to sunlight, many of us still don’t manufacture enough.  Sunscreen, darker skin, clothing and advanced age can all minimize how much vitamin D we produce.  That’s why it is important to ensure you are still getting enough vitamin D through food and/or supplements. The best form to take is vitamin D3, which is the form your body produces from sunlight.

Nutrient Rich Foods
What else can you do to ensure you are maintaining your bone mass?   Eat foods rich in soy.  Soy beans, tofu and soy protein shakes may all help build your bones.  You can also incorporate magnesium-rich foods in your diet.  Like calcium, magnesium is a mineral stored in bone tissue, and is important to maintaining bone strength.  Eating nuts, spinach, oatmeal, potatoes, beans, wheat germ and avocado are all great ways to boost your magnesium intake. 

Bone Strengthening Exercise

Weight-bearing Exercises. Any exercises where your legs and feet support your weight qualify as weight-bearing.  These exercises work directly on the bones in your legs, hips and lower spine to slow mineral loss.  If you have osteoporosis, you should avoid high-impact activities such as running, jumping, or jogging.  For example:

• Walking
• Dancing
• Gardening
• Hiking
• Low-impact aerobics 

Resistance Exercises. Any activity that uses muscular strength to improve muscle mass, strengthen bones and reduce mineral loss is considered resistance exercise or strength training.  Compression fractures resulting from osteoporosis often lead to a stooped posture and increase pressure along your spine, resulting in even more compression fractures. Exercises that gently stretch your upper back, improve your posture and focus on strengthening the muscles between your shoulder blades can all help to reduce stress on your bones and maintain bone density.  Try these: 

• Free weights
• Weight machines
• Resistance bands
• Water exercises (water acts as the resistance) 

Flexibility Exercises. Stretching is always very important as part of an overall fitness program.  It’s important for joint and bone health by reducing pain and stiffness, and supporting good posture.  It is best to do stretching once your muscles are warmed up to prevent injury, at the end of your workout for example.  Always stretch slowly and gently, without bouncing.  

There has always been a lot of buzz surrounding antioxidants. Antioxidants are compounds that can potentially protect the body from free radical induced cell damage, compounds that are produced in the body when we eat, when we are exposed to UV rays, cigarette smoke and pollution for instance. And though free radicals aren’t always bad, free radical damage  contributes to aging and may impact the development or progression of body system malfunctions.

But, antioxidants do much more than just protect the body from free radicals, they can also tame inflammation in the body, act as cell-signaling agents, and some even up or down regulate gene expression.

It is clear that antioxidants are vital to a healthy body but where can you find them and how do you know if you are getting enough? Antioxidants are found in a variety of foods including fruits, vegetables, nuts, seeds, whole grains and some meats and fish.

And though there are thousands of different antioxidants that exist in nature, scientists don’t know the exact mechanisms of action of many of these. Therefore, the best advice is to eat a diet rich in a variety of spices, vegetables, fruits, nuts, seeds and whole grains to ensure a diverse intake of antioxidants. And, consider food first, as opposed to popping antioxidant supplements (though some specific ones may help decrease the progression of certain ailments as is the case with lutein and zeaxanthin and age related macular degeneration). There may be a synergistic effect among antioxidants or antioxidants and other compounds in food. Because scientists don’t know the exact “dose” of antioxidants that may help decrease aging, the best advice for now is to do the best you can to eat a wide variety of foods naturally rich in antioxidants at each meal, and take a general multivitamin to bolster your diet with antioxidant vitamins A, C, and E.

See where to get your next B-Vitamin Boost Here!

Feeling drained and lacking energy? Analyze your B vitamin intake.  Together, the group of B vitamins commonly referred to as the B-Complex group work together to produce energy in cells throughout your body.  Fall short of getting enough, and you may feel a lack of energy.

Though B vitamins are prevalent in a variety of foods, you may not be getting what you need if you cut out certain food groups from your diet, if you are on a low carb diet or don’t get enough variety in your diet.  There are also certain circumstances that deplete your body’s available B vitamins or that don’t allow for proper absorption, such as gastric bypass surgery, aging, alcohol consumption, excessive caffeine consumption and excessive stress.  Vegetarians and vegans typically do not get enough vitamin B12.  A B-Complex supplement is a great idea if you know you fall into dietary, circumstantial or malabsorptive reasons that your body may not be getting enough B’s.

• All B Vitamins – Fortified cereals.  Can’t go wrong here, just be sure to stay away from the sugary ones, most are good source of fiber too.
   
• Vitamin B1 (thiamin) –  Necessary for energy production.  Chronic alcoholics are most likely to be deficient in thiamin.   Top food choices: grains (cereal, bread, etc.), pork, beef, rice, nuts.
   
• Vitamin B2 (riboflavin), Vitamin B3 (niacin), and Pantothenic Acid – Deficiencies for these three B’s are not very common in the U.S.  If you consume an adequate amount of protein (vegetarian or vegans may not), you are most likely getting enough B3.
   
• Vitamin B6 (pyridoxine) – Like all B’s it helps to convert energy from the food you eat in to a usable form in your body, and it also contributes to red blood cell formation and is necessary to proper nervous system function.  A poor diet, some medications and conditions could cause a shortage of this vitamin.  Top Food Choices: chicken, pork, peanut butter, black beans, almonds.
   
• Biotin – Important to skin, hair and nails, energy conversion from food and nervous system function. Pregnant women, malnourished people and those who have lost a large amount of weight quickly can all be affected by a deficiency.  Top Food Choices: cooked eggs, wheat germ, peanuts, cottage cheese, and whole-wheat bread.
   
• Vitamin B12 – An outlier of the B vitamin group, B12 is the only one that can be stored in the body. Strict vegetarian/vegan diets run the risk of B12 deficiency since it can only be sourced from animal-based foods, as are those who have had certain kinds of gastric bypass surgery in which parts of the small intestine where B12 is absorbed have been removed.  Top Food Choices: liver, salmon, clams, trout, beef, yogurt, haddock, tuna, milk, and cheese.

What happens if you get B vitamins from food and from a supplement?  Can you get too much?

Because B vitamins are water soluble, what your body needs will be excreted, so there’s a low risk of getting too much. Look for a good liquid multivitamin or B-Complex supplement that contains at least 100% of the recommended daily intake for each vitamin. It’s the best way to insure you get all the essential vitamins and nutrients you need to stay healthy.

Learn how to snack in a healthy way!

Snacking can help keep hunger pangs at bay and contribute to your overall nutrition intake if you choose wisely. Think of a snack as a “mini-meal,” a smaller portion of something you might have at mealtime. By doing this you are likely to think of healthier foods versus “snack foods” like chips, cookies and less than healthy baked goods.

Though there are many health snack ideas, here are my top 5:

• Nuts – nuts contain heart healthy fats, fiber and an array of vitamins and minerals.

* Keep in mind that children under 3 should not eat nuts or nut butters due to the potential for food allergies. By age 3 you can introduce nuts slowly one type at a time (check with your pediatrician). Never give small kids whole nuts as they can choke on them.

• Cereal –high fiber, low sugar cereal is a great snack option for kids and adults alike. It’s portable and filled with vitamins, minerals, fiber and antioxidants. Plus, you can eat it by the handful or put it in a bowl and add some milk or vitamin D and calcium fortified milk alternative such as a higher protein soy milk.
   
• Fruit – fruit is packed with vitamins, minerals, fiber and antioxidants. Try topping cereal or yogurt with berries, serve slices of apples topped with cheese and try in season fruit like watermelon to stay cool and hydrated on hot summer days.
   
• Vegetables – start your little ones on vegetables early and they’ll develop a lifelong taste for produce. If plain veggies sound boring, add a little natural peanut butter or dip veggies in hummus or guacamole for a delicious snack.
   
• Dairy – add string cheese, yogurt and cottage cheese to your snack list and you’ll be doing your bones a favor. Dairy foods are packed with bone building calcium and some yogurts and cottage cheeses also contain vitamin D (check the label). This is especially important for growing kids who are not only growing upward but are also building bone density (we build bone density up until our early 30s).

If you are preparing snacks for kids, let them pick out a new fruit or new vegetable to try. By giving them a choice, they are more likely to dig in. Also, set a snack spot aside in the refrigerator and cupboard. Keep healthy snacks at eye level and put the less than healthy ones behind other foods in the back your cabinets and refrigerator – doing this will encourage you to reach for better options. 

Congratulations!  You've just had bariatric surgery and you're excited to get started with your new life (or you are researching for after your surgery).  Part of that new life includes exercise.  If you want to keep the weight off, you need to make physical activity a regular part of your life.  It may be one of the most important lifestyle changes you make for long-term success. Where do you start?

Start with walking a little bit at a time...

• While you are in the hospital, the nursing staff will have you up and walking as soon as possible to help with your recovery. When you get home, you may be fatigued and that is normal. You've just had surgery! While you are at home recovering, the goal is to walk every day and every day walk just a little bit further. Maybe you can only walk to the end of the driveway and that's OK. As time goes on you will be able to walk further and longer. Just keep working at it.

Download your free Beginner Walking Chart Here!

• If you like to go to the gym or have exercise equipment at home, you will be fine on a treadmill or stationary bike right after surgery. You will want to avoid the cardio equipment that can put a strain on those recovering abdominal muscles, like a rowing machine and an elliptical if you use the arm attachments. You will want to get clearance from your surgeon for swimming or other pool exercise. Those incisions need to be healed and your surgeon will give you the go-ahead when he/she feels you are ready.
   
• Strengthening exercise is crucial to maintain muscle mass but you need to allow those core muscles to heal.  General recommendations for abdominal surgery are not to lift over 10 pounds (about the same as a gallon of milk) for two weeks. In the practice where I work we also recommend no abdominal exercises (crunches) for a month. Always check with your surgeon for clearance with any activity that involves lifting or putting a strain on those abdominal muscles.
   
• Just move!  Any exercise is better than no exercise. New recommendations from the American Society of Metabolic and Bariatric Surgery (ASMBS) include a minimum of 150 minutes a week of cardiovascular exercise with a goal of 300 minutes a week, plus strength training two to three times a week. Do what you can but do something. I have patients who are running half marathons a year out from surgery and would never have imagined that it was possible before their surgery. You may never run a half marathon but I am willing to bet you will be more active, walking further, and have more energy as you travel down the road of weight loss.

Be sure to take your supplements each and every day to help keep your energy levels up as well as getting enough protein.  B vitamins are especially helpful for energy and even help metabolism.  

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Liquid Supplements Bariatric Expert

Ever wonder whether you're getting the most out of your daily walk?  Wonder if there's a proper way to hold your body to get the most benefit?  While there are many and varied ways of walking, from speed walking to a leisurely stroll, there are basic body positions that will help keep your body safe and maximize your walking effort.

HEAD POSITION – Chin parallel with the ground, not tucked to your chest or tilted out.  Eyes/Focus should be straight ahead.  Looking at the ground is not good form as it pulls your chin toward your chest and tilts your head forward too far.  Your head and neck should be aligned naturally, with your head held high and neck at a natural extension. 

ARM/SHOULDER POSITION – Your arms should swing freely with each stride, with a slight bend in your elbows. Your shoulders should move naturally with the swing of your arms.  Be careful to watch your shoulder position. It is common for shoulders to inch toward your ears, breaking the long line of your neck position, and adding tension in your shoulders.  Make a conscious effort to keep shoulders loose and down.

CORE POSITION – Keep abdominal muscles engaged, with stomach muscles gently tightened as you walk.  This will also help keep your back straight, which is important to keeping all parts in good form as you walk.

FOOT POSITION and STRIDE – Walk with a smooth, even stride, rolling your foot from heel to toe. Your stride can be extended over time, with proper stretching before and after each walk, and lengthened each walk once you have had time to warm up. 

 Whether you’re just beginning a walking program, or you’ve been at it for years, it’s never a bad idea to remain conscious of proper form during each walk.  It’s the best way train your brain to default to the feel of good form and optimize the health benefits of each walk.  

And if you are experiencing joint discomfort either from walking or need to start a walking program to help ease your joints, try a glucosamine and chondroitin supplement.  A liquid form of glucosamine and chondroitin is readily bioavailable to your body, and can help with joint stiffness and inflammation to keep you walking for years to come.

Part 3 of our Buying Local Series - read Part 1 and Part 2

Buying local has become a term we are all getting used to as we become aware of the personal, community and economic benefits of choosing locally owned businesses first. What better way to support your local economic climate than supporting your local farms. If you are not a dig in the dirt and a get your hands dirty gardening type then how about supporting a local CSA Program through a local farm near you?

Community Supported Agriculture or CSA

CSA stands for Community Supported Agriculture. Purchasing locally grown produce and other farm products gives the consumer fresher, tastier and more notorious food while supporting your local economy - buying direct from local family farms and supporting their business and investing in your community.  Here are the basics:

• A farmer offers a certain number of "shares" to the public.
• Typically the share consists of a box of vegetables, but other farm products may be included.
• Interested consumers purchase a share (aka a "membership" or a "subscription") and in return receive a box (bag, basket) of seasonal produce each week throughout the farming season.

Support of Local Farmers & Community

With the CSA model you are directly supporting the success of the farm.  When you purchase your farm share at the beginning of the season you become a shareholder in that farm, the farmers can invest the money in the growing season and it fosters the idea that “we are all in this together.” Since the first CSAs started in 1986, more than 2,500 have sprung up across the country, their memberships numbering in the tens of thousands, according to www.localharvest.org. With their increasing popularity, many farms offering a CSA program have waiting lists.

By being involved in a CSA program you support the farmer, but you also accept some of the risks of farming. If the weather doesn’t cooperate and a crop doesn’t do as well, there will be less for the shareholders. But if the harvest brings in an abundant crop of a certain item you will receive more than normal amounts of that one item.  The CSA model helps connect the farmer and the shareholder by encouraging the idea that “we are all in this together”.

Learn to cook and eat new foods

I have personally been involved in a CSA program for the last 6 years. I can’t wait for “sign up” season every year. I can visualize my beautiful box of nature’s bounty as I open it up and see all the beautiful vegetables and fruit my local CSA offers. I look at it as a privilege for my family to receive such wonders from our local farm land. We don’t currently have our own garden so this option allows us to eat fresh, local and teach our daughter about supporting local farms. We learn to cook with new items that arrive in our box and explore new recipes for items we never purchased at the local supermarket before becoming involved in a CSA.

Every CSA program is a bit different in choices or selection, delivery and payments.

• Some CSA programs allow you to pick up your farm share at their farm once a week or from a drop-off pick up site, delivery of your farm share can be to your door, or a “Market basket” option where you pick up your share or select your share from the weekly local farmers market.
• A newer option is the workplace CSA option. With this option you sign up for your shares with a handful of coworkers and the farm delivers all the shares to your workplace once a week. This economical option allows for the workplace staff to conveniently pick up their share at their workplace and allows for the farm to deliver multiple farm share boxes to one site for pick up.
• Many CSA’s are even offering options and add-ons that include more than seasonal vegetables such as, meat, eggs, dairy products, flowers, fruit, bread, pasta and coffee.

Make sure you have realistic expectations and an open mind

For some people, belonging to a CSA has become the “in” thing to do. But before you go CSA shopping, make sure your expectations are realistic. Remember the risk-sharing aspect of a CSA: You might pay your CSA share in January and, depending on the weather, might not get in return the quantity or variety you expected. You will be eating seasonally so if eating something new isn’t something you like to do then you will want to search out a CSA that gives you the option of picking the selection you want or one that allows you to have “farm credits” and pick out your produce at the local farmers market.

In addition, produce from an organic-minded CSA doesn’t always look as picture-perfect as that on the grocer’s shelves. If you’re put off by a blemish on a tomato or by carrots that aren’t uniform in size, a CSA might not be for you. Buying produce from a CSA isn’t the same as going to a Whole Foods Market and picking the best of everything. Blemishes aside, if you’re seeking a diet with a smaller environmental impact, you’re up for a little culinary adventure and you are ready to taste some of the best fresh local produce - CSA membership is a great local alternative.

CSA's benefit the community by helping to ensure the survival of small farms — and thereby a local supply of food — at a time when local farmers face increasing competition from supermarkets.

To find a CSA near you visit http://www.localharvest.org/csa/.

Guest blog post by Lori McKnight, B.A., busy mom and wife who enjoys living in the Pacific Northwest and has been a health and wellness advocate for many years.

There is a fair bit of conventional wisdom about how much vitamin D your child might need, and where they will get it. Primarily, that vitamin D levels will take care of themselves as long as children play outside to get sun exposure to some degree and drink milk regularly.  Surprisingly, this isn’t necessarily true. 

“We’re seeing evidence of vitamin D deficiency in infants and children of all ages as well as adolescents and adults,” says Carol Wagner, M.D., FAAP, professor of pediatrics at the Medical University of South Carolina. “We know more about vitamin D than we did even five years ago. Because of lifestyle changes and sunscreen usage, the majority of the population shows signs of deficiency as determined by measured vitamin D levels in blood.”

Vitamin D helps calcium absorb and helps your body retain calcium and phosphorus, both critical for building bone.  Vitamin D is important at all stages of life, but especially as children grow.   For more information on how vitamin D3 works with other vitamins in your body, check out this article.

To meet the new 400 IU recommended daily intake for vitamin D, it helps to know what foods at snack and meal time can help add an extra kick to any Vitamin D supplement you or your children may already be taking. Vitamin D₃ is the preferred form when supplementing for optimal bioavailability, but it also helps if you can get your kids involved and be creative with the food choices you offer.

Think Presentation - Food presentation makes a big impact on kids.  Make healthier snacks, more fun by creating shapes, arranging by color or spelling words or initials with the food you offer.  A cute idea to add more vitamin D containing egg yolk or oily fish would be egg salad or tuna salad sandwiches, cut into stars or other fun shapes.

Be Prepared - Being on the go or traveling can really limit healthy options, so be prepared in the car with things like vitamin D fortified cereal bars and individual servings of fortified orange juice.

With a little planning, the vitamin D your kids need can come from a combined one-two punch of a quality supplement and fun vitamin D packed snacks and meals, making the risk of deficiency much less of a worry.

ref. http://www.healthychildren.org/English/healthy-living/nutrition/pages/Vitamin-D-On-the-Double.aspx

Read Part One Here

As with all exercise programs, we need to consider the potential risk of injury or dropout. The main risk of HIIT training, as in any advanced training protocol, is the inherent mechanical stress that high intensity movements can create on the joints and connective tissues. In order to hit those higher intensities you will be performing some extreme movements like jumping, bounding, sprinting, burpees, mountain climbers and suicide push-ups. These moves may not be appropriate for everybody; in particular those with compromised joints. To minimize this risk you will need to prepare your body and progress into the program properly. If you plan on adding HIIT to your regime you will definitely want to build up and condition your speed and power muscle fibers—with HIIT Pre-Conditioning Exercises.

HIIT Pre-Conditioning Exercises

1. Regenerate your jump-ability
2. Train your turnover time
3. Clean up your core control

Regenerate Your JUMP- Ability

If you haven’t done any high impact or jumping for a while you may find that you have lost your ability to propel and descend your body properly. Women may also find that jarring causes the dreaded “ring around the crotch line”. So it may take some re-training to get your body mechanics and pelvic floor muscles back in order. One of the best preconditioning exercise is to simply stand with your hands on a wall or sturdy chair back and perform a set of heel drops (bounces). Concentrate on absorbing the shock with tall upright spinal alignment and a lifting contraction in the pelvic floor muscles. Keep you knees and hips slightly bent.

Once you are comfortable doing heel drops you can progress to low jumps where you bend through the ankles, knees and hips and spring up a small distance off the floor (extending the joints), then land with a shock-absorbing bend in the same three joints. Think about keeping the spine erect and pelvic floor muscles lifted. Progress this by either jumping higher, further (bounding) and /or in more rapid succession. These exercises should be practiced several times a week using 1 to 3 sets of 30 seconds.

 

Train Your Turnover

Turnover is the speed and agility of foot movement, or the number of times your feet strike the ground per minute. To train your turnover you need to keep track of the amount of footfalls you can complete in a 60 second period.  You can start with marching in place and work your way up to sprinting in place or running up and down on a platform.  Again you should practice this drill several times a week using 1 to 3 sets of 60 seconds.

 

Clean Up Your Core Control

Core control is your ability to move your limbs and body through space without compromising spinal alignment. As we perform high intensity whole body movements the core muscles (muscles surrounding your spine, shoulder girdle and pelvis) are taxed well beyond their normal function. Add speed and a little competition and you have the recipe for disaster in terms of form and execution.  Thus it will be important to condition your spinal support muscles prior to attempting the types of moves often used in HITT based workouts.  To do this start with holding wall planks for 30 to 60 seconds, then progress to hand and knee planks, forearm planks and planks with one or more limbs either lifted or moving. Vary the planks as well including front, rear and side positions. Practice this drill as many days a week as you can. Since the core muscles are an endurance group, you need to train them often with minimal external load (in most cases your body weight alone against gravity is plenty).

By pre-conditioning your jump, sprint and core control you will soon find that you have the strength and endurance needed to protect your joints as you challenge your system with these exciting and effective HIIT workouts. When in doubt, modify or opt out of any particular move you find too stressful! If you are not ready for them they can cause more pain than gain; and the last thing anyone wants from a new training program is to wake up the next day feeling like a dead duck rather than a spring chicken!

Don’t forget to feed your joints with the proper nutritional support to get the most out of your body over the long haul such as a liquid glucosamine and chondroitin supplement for healthy joint support.

Obesity can take a toll on the body, increasing a person’s risk for heart disease, certain types of cancer, fatty liver disease, osteoarthritis and many other diseases. And, to add insult to injury, obesity appears to launch an attack on the body’s defense network, the immune system. And, this attack appears to be multifaceted – there are several ways in which obesity may negatively affect the immune system, some of which haven’t been totally elucidated just yet.

Vitamin D Deficiency Link

• First, obesity is a contributing factor to vitamin D deficiency – a vitamin that has several effects on cells in the immune system. Vitamin D doesn’t just alter immune responses but a deficiency in this vitamin is associated with increased autoimmunity and an increased susceptibility to infection. Yet a recently published study found every 10% increase in BMI was associated with a 4.2% drop in vitamin D in the body. And therefore, monitoring vitamin D status in people who are overweight and obese may be critical for also maintaining a healthy immune system.
   
• Obesity also decreases the body’s production of specific immune system cells while altering the functioning of others. Is this due to vitamin D deficiency? This part of the picture isn’t quite clear. And, factors that can contribute to obesity – including over consumption of fat, sugar and calories can increase both inflammation in the body and oxidative damage to cell membranes (healthy cell membranes are critical because they are like gate keepers regulating what molecules can pass into and out of cells and therefore).

Given the impact obesity has on the body’s defense network, it shouldn’t come as much of a surprise that research often shows obese hospitalized patients are more likely to develop secondary infections and complications.

If you have pounds to lose, don’t fret. Start by cutting down on sugary snacks, baked sweets and fried foods. Add vegetables to every lunch and dinner and fresh whole fruit to your breakfast. In addition, drink at least 8 glasses of calorie free fluid per day and get exercising. If you don’t exercise now, start by taking the steps instead of the elevator everywhere you go and take the long route when possible (park far from the store entrance for instance). Build up your exercise routine slowly (by 10% per week) to give your body time to adapt and minimize the likelihood of developing injuries.

If you have struggled with your weight for many years and still unable to lose the weight you need to for your health, consider weight loss surgery.  Talk with your healthcare professional about the options available to you.  Bariatric Weight Loss Surgery can be the needed tool for those who are obese and are unable to lose the necessary weight.  It can be a critical step towards a healthier, longer life.

Keep in mind that malnutrition and deficiencies can occur even if you are overweight, due to poor diet and/or inability to absorb enough nutrients from food.

For those that have already had bariatric surgery, be sure to always take your recommended bariatric vitamins and supplements for the rest of your life to protect against deficiencies such as vitamin D and calcium for immune and bone health.  Vitamin D is very important for the absorption of calcium for strong bones to prevent osteoporosis.  Make sure to get your blood levels tested regularly.  

References

PLOS Medicine 2013;10(2):1-13.

J Clin Invest 2003;112:1796-1808.

J Investig Med 2011;59:881-6.

Clin Exp Immunol 2006;146:39-46.

As we “think local” we increase the awareness about the personal, community and economic benefits of choosing local, independently owned businesses first. As you start thinking “Buy Local First,” consider the food purchasing choices you are making.

Part 2 of our BUY LOCAL series - read Part 1 here.

1.       Locally grown tastes better. Have you ever tasted a local tomato?  It was picked at its peak and not weeks before and didn't have to travel miles before being sold.  The flavor is like no other.

2.       Local food is better for you. The shorter time between the farm and your table means more nutrients for you. Food imported from other places was picked early and has sat on trucks and planes for who knows how long.

3.       Local food preserves genetic diversity. In the modern agricultural system, plant varieties are chosen for their ability to ripen uniformly, withstand harvesting, survive packing and last a long time on the shelf at the store, so there is limited genetic diversity in large-scale production. Smaller farms have the options of growing many different varieties of crops to provide a long harvest season, array of colors, and the best flavors. Back to the tomato, some of the most “interesting” tomatoes by modern standards have been the best ones I have tasted. 

4.       Local food is safe. There is something to be said about meeting the farmer that grows your food at the farmers market or when you pick up your weekly selection at the farm. They are not anonymous and they take their responsibility to their customer seriously.

5.       Local food supports local families. Wholesale prices often give larger farmers only near cost of production. Local farmers who sell direct cut out the middleman and most often get full retail value for their food – helping local families stay on the land.

6.       Local food builds community. When you buy direct from the farmer you engage in a way of doing business that has been happening for years between the eater and the grower of the food.  Knowing the farmer gives you insight to the growing season, the current conditions and access to the farm where your children or grandchildren can go to learn about agriculture.

7.       Local food preserves open spaces. When farmers get paid more for marketing their products locally they are less likely to sell their land for development. When you buy locally you are helping preserve the local landscape.

8.       Local food keeps taxes down. According to several studies by the American Farmland Trust, farms contribute more in taxes than they require in services, whereas most development contributes less in taxes than the cost of required services.  For example, cows don’t go to school and tomatoes don’t dial 911.

9.       Local food benefits the environment and wildlife. Well managed farms produce ecosystem services: they conserve fertile soil, protect water sources, and remove carbon from the atmosphere. The local farm environment includes fields, meadows, ponds, buildings and woods creating habitat for wildlife in your communities.

10.   Local food is an investment in the future. By supporting local farms today you are ensuring there will be farms in your community in the future. This is important for food security, especially in light of an uncertain energy future and our current reliance on fossil fuels to produce, package, distribute and store food.

Find a local farm you can visit this weekend or a farmers market in your area. Meet the farmers and enjoy Buying Local.

Resources: Ten reasons to buy local food (adapted from ‘Growing for Market’ newsletter) by Vern Grubinger, vegetable and berry specialist, University of Vermont Extension.

Photo source:  www.livelocalsource.com

When I hear people say they need to get back on track or get refocused, my first recommendation is to start tracking food intake. But recording isn't just for those folks, it plays an important part in your diet progression right after surgery too.

There is so much research on the benefits of recording to prove it makes you more successful, and if you've kept an honest record, you know this to be true. Notice I said an honest record. I've had people tell me they don't record "the bad stuff".  It's not calorie-free because you didn't write it down or had selective amnesia.

1.  Track Protein Intake as well as Calories

Many people think the most important thing to track is calorie intake, and for some people, it is. But after bariatric surgery, it's equally important, if not more important, to track your protein intake. Recommendations vary depending on your surgeon, but typically the goal is 60-90 grams of protein a day. This can seem daunting in the early post-operative stages if you've had a gastric bypass or sleeve. This is a time when it is critical to track your protein intake. Further out from surgery, it might be more important for you to know where your calories are coming from: the distribution between protein, fat, and carbohydrates.

2. Use Easy Electronic Tools to Track

There are different tools to track your intake. Paper and pencil is better than nothing but to have any sort of meaningful analysis you have to look up your foods for their nutrient value. Let technology do the work for you. All you need to know is what did you eat and how much, and let technology figure out the rest. In a study presented at the American Heart Association meeting last year, a group of 210 obese adults tracked food and activity intake with either a handheld electronic device or a paper diary. Those who used an electronic device had significantly more weight loss than those using a paper record.

Most of us have cell phones and 15 percent of us have a health app for our Smartphone. There are also online programs like WebMd and Spark People and 27 percent of internet users track weight and fitness goals online. If you have looked at using an app or an online program you know there are a multitude of choices. So, how do you pick the best one for you?

3.  Know what you need to track

There are many free programs available or apps that are a minimal investment. You will need to know what is important for you to track. Are you good with the basics of calories, protein, fat, carbs, and exercise or do you want more detailed information to include fiber, sodium or other nutrients? Read the reviews, comments, and look at some sample pages. Most programs allow you to enter custom foods or labels, but a feature I find helpful is the one that allows me to enter a meal. For example, when I make a leafy salad I usually use the same veggies. I entered my salad into my meal program as Vicki's Salad. Now when I eat it, I can just enter Vicki's Salad rather than spend the time entering each salad component.

4.  Take the time to set it up right for most accurate tracking

It may take a while for you to be comfortable with the program or app you select. Initially you will be spending more time recording as you enter your custom foods. If you don't like the program after a few days or a week, it's easier to switch to another before you get too many of your custom foods entered. If you have a lot of time invested in setting up your database, you will be less likely to switch and if you don't like the program, you will be less likely to use it. Keeping track with technology isn't time consuming after you've got your custom foods and meals entered. You should be able to track your food and activity in less than five minutes a day. Recording as soon as you have eaten something makes it easier than trying to remember at the end of the day and you will less likely to forget what you ate.

It's also a great idea to track when you take your supplements especially those that you need to take more than once such as calcium.  
Set a reminder on your phone to help remember or use a post it note if you don't have a smartphone.  

Whichever program or app you settle on, just use it. Remember, research continues to show that people who record are more successful.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Nutrition Expert

Here are a few apps to try and most have fitness trackers as well:

Spark People Diet and Food Tracker

MyNetDiary Calorie Counter

MyFitnessPal

WebMD Tracker

Shroomies Nutrition Menu

www.MyFoodDiary.com

Resources:

Pew Research Center, Pew Internet & American Life Project. (2011). Half of adult cell phone owners have apps on their phones. Retrieved from www.pewinternet.org

Styn M. Et al. (2012, March). Overweight, obese adults use electronic device to stick to diet, exercise. Meeting report presented at American Heart Association scientific meeting.