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.

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.

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.  

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. 

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

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.

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.

Moveable joints, where bones come together and help us move, like our knees, hips and shoulders can become damaged over time due to wear and tear, disease, excess body weight and injuries. As a result, your joints may feel stiff, painful and become swollen. But, there are several steps you can take to prevent wear and tear on joint tissue.

STAY PHYSICALLY ACTIVE. Though some forms of physical activity – playing football in the NFL for years for instance, can add to wear and tear on joint tissue, normal levels of regular physical activity can help keep joints healthy by improving or maintaining bone density, muscle strength, joint flexibility and balance. Just be sure to protect your joints with protective pads when necessary and stop if they hurt more than tollerable discomfort from the exercise itself.  Swimming is great exercise and is particularly low-impact on joints. See more on joint-related exercise do's and don'ts here.

EAT HEALTHY.  Doing so will do more than just keep your weight within normal limits (being overweight puts stress on joints), but, it will also provide a variety of nutrients necessary for strong bones and muscles. In particular, adequate levels of vitamin D and calcium are necessary for bone health while protein is essential for building and maintaining muscle strength.  Having strong muscles around joints helps support the joint structure itself.

TAKE SUPPLEMENTS. And finally, the dietary supplements glucosamine and chondroitin sulfate can reduce moderate to severe knee pain in some people. Chondroitin helps absorb water in cartilage and both chondroitin sulfate and glucosamine block the enzymes that break down cartilage and some studies suggest they may also help build new cartilage tissue. Click the "recipe" link to read about a great recipe for a fun, refreshing way to take this supplement!

What is bariatric weight loss surgery?

Bariatric surgery is a term that covers a wide range of weight loss procedures. A bariatric surgery is an option for people who have tried many traditional ways to lose weight with no success. National Institute of Health recommends bariatric surgeries for obese people with a BMI (body mass index) of at least 40 or for people with a BMI of 35 with serious medical conditions such as diabetes, high cholesterol and others. Those procedures consist of reducing the size of the stomach with a gastric band or even removing a part of the stomach   which is called gastric sleeve or by rerouting the small intestines to a small stomach pouch which is called gastric bypass surgery. A few possible advantages of bariatric surgery are significant weight loss in the long run, improvement of cardiovascular risks and recovery from diabetes (actual results vary from person to person).  However, bariatric surgery won’t make you lose weight without a healthy nutrition and an exercise plan.

Nutrition after a bariatric procedure

After bariatric surgery it is very important to adapt your lifestyle to achieve maximum results and facilitate weight reduction. A very good tip is to change your diet even before you have bariatric surgery so you can be prepared. You won’t be able to eat the same foods you ate before, at least not for a few months, depending on your recuperation and type of surgery.

Stage 1:  Liquids

Right after the surgery,  in the hospital, you will receive a clear liquid, sugar free diet. Do not use a straw to drink the liquids, using a straw can increase your gas problems and make you uncomfortable. The first few sips is normal to be hard to swallow but it will get better with time.  The portions may be regular size, but normally you will be able to consume about 4 ounces every waking hour, remember, your stomach is a lot smaller now. As soon as you will be able to tolerate it, your surgeon will decide if you can move to the next step, full liquids, which includes fat free cream soup, pudding, sugar free yogurt (no fruits) etc. You might be sent home after you tolerate a stage 1 diet, but this depends for every hospital and surgeon.

Stage 2:  Pureed or mushy  foods

This diet will go on for about 4 to 6 weeks and may vary by surgeon and the bariatric surgery type. It is very important to eat about 500-700 calories a day and at least 60 grams of protein as the proteins take an important role in your recovery. You should eat small and frequent meals;  your new stomach can only hold about an ounce at a time. It is also very important to drink enough fluids to prevent dehydration.

A Few Extra Tips:

• Eat your meals and sip your liquids very slowly
• Make sure you chew food very thoroughly
• Protein is very important during your recovery from surgery, make sure you eat at least 60 grams of protein every day
• Drink at least 7-8 cups of water or any other sugar free liquid between your meals every day to keep you hydrated
• It is important to drink only between meals
• Don’t eat high fat foods

Stage 3: Soft and healthy foods

After about 6 to 8 weeks you may introduce into your diet soft solid foods, it is important to continue to eat 4 to 6 small meals every day. Focus on high protein foods and avoid foods that are high in fat, sugar and fiber.  You may start to introduce one solid food per meal every day depends how you can tolerate it and remember to chew well so the food will be nearly pureed by the time you swallow. Some examples of food items for this stage are:  eggs, light yogurt, soft fish, lentil dishes and soup.

Stage 4: Solid foods

Eventually you will probably be able to eat most foods, just in smaller portions;  however, you should be making healthy food choices including lean meat or vegetable protein incorporating fruits and vegetables as you can and avoiding junk foods. The volume you can eat will always be limited so choose foods wisely.

A few more tips that you will have to take into consideration permanently

• Do not drink with a straw because it will overfill your stomach with fluid and air
• Avoid alcohol or drink wisely, you will feel the effect of alcohol more severely and it’s a source of unwanted calories
• Avoid carbonated beverages because it will fill your stomach with air and will make you feel uncomfortable
• Drink less caffeine, it can affect your iron absorption and lead to dehydration
• Eat slowly and be aware when you’re full and stop eating or you will develop chest pain and may vomit (dumping)
• Take your supplements EVERY DAY!  Because you are not able to absorb as much nutrients from food, it is very important to take your supplements every day such as calcium and vitamin D, multivitamin, iron (if recommended/needed), B-Complex and or B-12. 
• Exercise daily
• Join a support group both online and in person

Guest post by Dr. Jeremy Korman, M.D. at L.A Bariatrics within Marina Del Rey Hospital, a bariatric surgery center of excellence.

St. Patrick’s Day is right around the corner, and we want to celebrate green!  Healthy green colored foods are a fantastic way to make sure that you get nutrient-packed choices in your diet.

Limes – Super vitamin C powered, and adds a zesty, bright, tangy kick to lots of recipes. 

Kiwi – Also packed with vitamin C – more than an average orange! Not to mention it’s a good source of fiber and potassium. Fun –sized and portable too, keep kiwi in your green food lineup and feed your immune system what it needs to stay strong.

Avocado – Your green source for healthy fats in the form of phytosterols and oleic acid (monounsaturated fat) which has healthy heart benefits. For cooking, it makes for a wonderful thickening texture and mild flavor to add extra nutrition to smoothies or sauces.

Spinach – Loaded with nutrients – A, C and E antioxidant vitamins, a good source of fiber and omega-3’s and exploding with phytonutrients like zeaxanthin and lutein.  And on a food note, quite a bit can be added to a smoothie without changing its original flavor!

Check this Kiwi, Lime, Avocado smoothie recipe out, and add spinach for that extra St. Patty’s “top o’ the mornin’” nutrient kick!  To really power pack your smoothies, add a quality liquid dietary supplement, multivitamin, digestive aloe blend, vitamin D, and even calcium.

KIWI-AVOCADO SMOOTHIE WITH LIME AND HONEY  

 http://www.feastingathome.com/2013/02/avocado-smoothie-with-kiwi-and-lime.html

And if your green-tooth isn’t hungry for a nutrient-dense smoothie, why not try a savory green powerhouse recipe this St. Patrick’s Day.

Kale – A hearty, fibrous winter vegetable, kale often gets a bad rap for bitterness – but its numerous  vitamin packed, high-fiber constitution gets it high ranks in the super-green, heart-healthy food category.

Jalapenos – A little green spice is always a good thing! Jalapenos offer vitamins A, B6 and C in a kicky addition to lots of dishes.  You can keep the heat down low by eliminating the seeds (though there are nutrients in them too!)

Try this Jalapeno, Lime, Kale Tostada recipe – you can add spinach for extra nutrients to this one too!

JALAPENO AND LIME MARINATED KALE TOSTADA

http://notwithoutsalt.com/2012/01/12/jalapeno-and-lime-marinated-kale-tostada/

Whether you pack your St. Patrick’s day with a green breakfast smoothie or save your green for a savory green evening meal, you’ll be getting great nutrition out of your green foods!

Have you ever stood in the dairy section at the supermarket and wondered how the yogurt section got to be so confusing?  Will it be Greek, Swiss, flavored, plain, liquid or even frozen? You know that yogurt is good for you and that live active cultures help maintain the necessary balance of healthy bacteria in your digestive system.  An understanding of all the probiotic cultures and their names may not be common knowledge, but you’re familiar with the basics that yogurts help aid in digestion and can help ease some digestion discomforts. Adding yogurt to your diet long with a good digestive support supplement can be your ticket to daily digestive comfort and intestinal health.

One of the many benefits of yogurt is that it's a good source of calcium, necessary for strong bones and teeth. A healthy yogurt supplies 35 to 40 percent of your daily calcium requirement per 8 oz. serving. If the calcium is below 30 percent per serving, the yogurt most likely contains large amounts of unhealthy filler. Plain yogurt without added ingredients gives you the best calcium bang for your buck.

Defining the many yogurt options out there will help you know what will work best for you. Yogurt products come in a wide variety of flavors, forms and textures. Here are the common terms associated with yogurt products available in most markets today.

Plain yogurt

• Tends to be richer in nutrients than its fruit-flavored counterparts
• No sugar is added to plain varieties
• Less calories, richer in calcium, and contains nearly twice as much protein.
• Usually made from cow's milk, but it can also be from sheep's or goat's milk.
• Comes in whole, low fat, or nonfat varieties

Greek Style

• Water has been removed by straining the yogurt  multiple times, resulting in a thicker consistency close to that of sour cream.
• Also made from the milk of cows, sheep or goats.
• Called Greek because originally, thicker yogurts were made in Greece
• Sweeter than American and European yogurts.
• Tends to hold up better when heated than regular yogurt, making it perfect for cooking
• Also referred to as Mediterranean or Mediterranean-style yogurt and is often used for dips such as Tzatziki.

Custard Style

• Generally come with fruit already mixed in the yogurt cup
• Also known as French- or Swiss-style yogurts.
• Thickened into a pudding or custard form with added flavorings and fruit, Swiss style yogurts were created to better market yogurt to the general public.

Balkan-Style yogurt

• Describes a production process where the yogurt is set to culture in individual cups rather than in a single, large vat.
• Almost always used for yogurt with fruit packaged on the bottom.
• Similar to Swiss-style or stirred except it is packaged right after the cultures are added rather than after the culture is fully fermented.
• Process adds to the unique flavour and smooth texture of Balkan-style yogurts
• Often thicker than other styles

Yogurt is a healthy addition to your weight loss efforts and your daily digestive comfort. Read the label and choose your variety wisely. It is packed with vitamins, protein and healthy cultures making it an easy daily choice. With live cultures, it is often easier for people to digest even for those that have trouble tolerating milk.

For a product to be sold as “yogurt” in the United States, a culture must include Lactobacillus bulgaricus or Lactobacillus delbrueckii subsp. Bulgaricus,and Streptococcus thermophilus or Streptococcus salivarius subsp. Thermophilus. 

There’s no right or wrong way to pick your supplements, but here are some simple things to think about when choosing which brand or company to purchase.

Dosage Form – Which form are you most likely to be successful taking long term?  Pills, capsules, gummies, liquids are available for most common things like calcium and multivitamin…try to narrow down which form you prefer, or make note to pick up a few different forms to try, if you’re unsure.  The ease of integrating your supplements into your daily routine is the best way to stay compliant ~ for example, liquids are easily added to a morning smoothie or yogurt, pills and gummies are easily portable.

Research – If you have been told you need to take a supplement, do your research on the various companies offering the supplement you need, in the dosage form you’ve chosen.  This includes the form of the individual ingredients too, for example, calcium, which comes in many forms (calcium citrate, calcium carbonate, calcium phosphate and other forms as well.)

The packaging should have a phone number, a website or some way to contact the company.  If there’s not, it should be a red flag. The company should be able to tell you whether they are cGMP compliant (current good manufacturing practices), and what other certifications they have, such as Organic or Gluten-Free for example, which are also often listed on the label, though not always.

cGMP’s are Current Good Manufacturing Practices for dietary supplement manufacturers and marketers to follow in compliance with FDA guidelines and industry legislation.  Certification with reputable third-party organizations that audit manufacturers, allow supplement brands to prove and communicate their compliance with absorption, dissolution, purity and concentration of the supplements they manufacture, so their consumers can be assured they are getting exactly what’s listed on the product label.

Certification includes product testing, Good Manufacturing Practices (GMP) site inspections, and ongoing monitoring.  This type of third-party certification program evaluates and audits using state-of-the-art analytical laboratories and highly skilled staff of chemists and microbiologists with the knowledge and expertise to evaluate the composition of the dietary supplements being manufactured.

Samples – The best way to know for sure if you like and can take a supplement is to get a sample. Some companies offer samples of their products as part of promotions or just in response to consumer requests.  It never hurts to ask! This is especially important for the dosage forms where flavor is an issue like gummies, chews and liquids.  Though with pills, it would be nice to see ahead of time if the dosage is a very large or very chalky pill that might be hard to swallow.

Do you buy a specific brand or whichever brand is on sale? Do you check labels and if so, what do you look for on a label?

We’ve all heard how high in fat and calories nuts are in general.  But it’s becoming more widely accepted that nuts can be part of a healthy diet, and are particularly good for the health of your heart.  Here’s why:

·         Unsaturated Fats – both mono and polyunsaturated fats are the “good” fats that can help lower the “bad” LDL cholesterol level in blood – High LDL is one of the primary causes of heart disease, so bringing it down with healthy snacks is high on the list. Check out our Heart Healthy Eating post for more info on healthy fats!

·         Omega-3 Fatty Acids – Though fish is also a great source, nuts are one of the best plant based sources of omega-3’s which also contribute to the overall good health of your heart.

·         Fiber – All nuts contain fiber, which has been shown to help lower cholesterol.  Fiber is also filling, which helps you eat less overall, if that’s a goal of yours (and given the high calorie content of nuts, it’s a bonus – you won’t feel as inclined to overeat nuts since you’ll feel fuller faster!)

·         Vitamin E – Antioxidants like vitamin E are an important part of staying healthy, and vitamin E particularly, may play a role in hindering the development of plaques in arteries, which in turn will keep your heart and circulatory system operating better.

·         Extras – Plant sterols occur naturally in nuts, and are often added into products like orange juice or margarine to offer additional heart health benefits.  Nuts are also a natural source of L-arginine, which has been linked with the health of artery walls.

What Kind of Nuts Are Best?

Almonds and walnuts top the list with the highest levels of unsaturated fats.  Almonds are also one of the best food sources of vitamin E, in addition to their calcium and iron content.

Storage Tip: Buy your nuts in small quantities and eat them within a few weeks for freshness, and store them dry cool, and sealed to avoid all those healthy good fats turning bad.

Sources:

www.womenshealthmag.com/nutrition/healthy-nuts

http://www.mayoclinic.com/health/nuts/HB00085

Is there such a thing as fats that are good for your heart?

Through the years dietary fats have been scrutinized like no other ingredient. They went from bad to worse in the 1990s when everything was “fat free”. But then, logic set in and scientists combed through the research carefully to change their recommendations. Fat wasn’t the problem but the type of fats people were commonly consuming was. Fried foods, trans fat laden desserts and main dishes made with an artery clogging combination of shortening and butter led to an obese and unhealthy nation. But, you shouldn’t fear all fats, just cut down on the ones that are bad for you while increasing healthier fats.

Monounsaturated and Polyunsaturated Fats Should Replace Saturated:

• Nut oils (soybean oil, canola oil, etc.),
• fatty fish (salmon, mackerel, herring, halibut and lake trout for instance),
• nuts and seeds
• Olive Oil
• Avocados and Olives 

These fats are either healthy for your heart or neutral meaning that they won’t harm heart health (unless of course you are over consuming calories). In particular, fatty fish are associated with improvements to blood fats (triglycerides), slight improvements in blood pressure and better cholesterol levels.  For these reasons the American Heart Association recommends two servings of fatty fish per week.

Stay Away From Harmful Fats - Especially Partially Hydrogenated Oil

Harmful fats are those that are solid at room temperature particularly saturated and trans fats. Saturated fats are the kind found in full fat dairy products and the fat on marbled meat and are LCFA - Long Chain Fatty Acid Check the Nutrition Facts panel of your favorite foods. Many processed and packaged foods contain high levels of saturated fats. But, what’s worse than these? Man-made trans fats (aka partially hydrogenated oils). These lurk in baked goods and candies as well as some deep fried foods. Take a look at the ingredients list and if a food says “partially hydrogenated oil,” steer clear of it!

Coconut Oil is a Good Saturated Fat - MCFA - Medium Chain Fatty Acid

One saturated fat that can be good for you is coconut oil.  Coconut oil comes from coconuts, which have been shown to be one of the richest single food sources of vitamins, minerals, and amino acids.  Coconuts are loaded with many of the amino acids your body needs to manufacture protein, as well as important minerals such as calcium, magnesium, phosphorus, and potassium. It is also an excellent source of vitamin C and vitamin B2 (riboflavin). All of these same nutrients are also contained in coconut oil. Plus coconut oil is actually a great natural energy source making it a great addition to any weight loss program. MCFAs are stored in the liver, where they get converted into a readily available source of energy.

Your heart is the most important muscle in your body. Keep it healthy and keep all of your cardiovascular system healthy by opting for the right fats in your diet. 

photo source: fda.gov

Though not everyone will have the same set or level of nutrient deficiencies, if you have been diagnosed with Celiac Disease or are following a gluten free lifestyle, you may want to check with your practitioner to see which if any, areas of nutrition need your focused attention. 

Malabsorption of nutrients, stemming from intestinal villi atrophy and the inherent lack of certain nutrients in a specifically gluten-free diet both can lead to a need for certain nutritional supplements to help guard against common deficiencies.  The length of time you had Celiac disease before you were diagnosed,  the extent to which your small intestine was damaged, leading to the degree of malabsorption of nutrients, and any medication that may block nutrient absorption all affect nutrient levels in any one person. 

Most commonly, iron, zinc, vitamin D, and several B vitamins, along with fiber, calcium and magnesium are lacking in a gluten-free diet or are poorly absorbed in a person suffering from Celiac disease. This is in part due to many gluten-free foods not being fortified or enriched with these nutrients that would exist in a diet allowing gluten.

Critical Nutrients:

Calcium & Magnesium – Bone issues are common in celiac patients with osteoporosis in over 25% of all cases at the time of diagnosis, and even higher at 40% with osteopenia, making risk of fractures 30% higher than normal.

Vitamin D – Supports the immune system, and common decrease in the function of small intestine absorption seen often in Celiac patients, can compromise vitamin D activity and function.  In turn, absorption of adequate calcium is also impaired.

Iron – Before taking an Iron supplement, always get tested first.  Iron deficiency anemia is the most common extra-intestinal symptom of Celiac disease, however, it may be corrected after adhering to a gluten free diet.

Folic Acid – Important in the formation and maintenance of all cells, folate works with B12 to make and keep cells healthy.  Gluten-free products are lower in folate than their gluten-containing counterparts.

Vitamin B12 – Vitamin B12 becomes harder for our bodies to absorb as we age. Add the complication of absorption in someone with celiac disease and the correlation to deficiency gets much higher.

Vitamin B6 - Damaged intestinal villi for those with Celiac cause issues with B6 absorption as well.  B6 is involved in over 100 enzyme reactions in the body, mostly related to protein metabolism.

Fiber – If your gluten-free diet happens to be completely grain-free as well, a lack of fiber could be a health concern.  A prebiotic fiber source may be helpful for providing added dietary fiber and for promoting the growth of good intestinal bacteria.

The best possible course of action to make sure you’re getting the right nutrients at the right amounts and how many, if any, nutrients you may need to supplement is to rely on your gastroenterologist for testing, and develop a program with your gastroenterologist and dietitian to cover nutrient gaps with diet and supplementation. 

Should your doctor and/or dietitian recommend a vitamin/mineral regimen to bolster your health and raise levels of key nutrients, be absolutely sure that the supplements you are taking are Certified Gluten Free, as many tablets and pills contain small amounts of fillers which could contain gluten.  A liquid supplement is less likely to have those fillers and is more bioavailable, since it does not need to be broken down in the stomach first.  This will help improve your overall health and may help reverse nutrient deficiencies developed over course of undiagnosed Celiac disease.

Sources:

Doherty C, Dennis M. Nutritional Supplements For Celiac Disease: What you need to know.  New England Celiac Conference 2011.

Malterre, Tom, MS, CN.  Digestive and Nutritional Considerations in Celiac Disease: Could Supplementation Help?  Alternative Medicine Review Vol. 14, No. 3, 2009.

Bored of the same old meals?

Getting tired of making the same meals every night for dinner? Try something new this week that’s quick and easy! This gluten free Sweet Potato Leek Soup boasts vitamin A, vitamin C, calcium, and iron, making it part of a healthy meal for your family.  The Center for Science in the Public Interest even rates sweet potatoes as the number one most nutritious vegetable!

Sweet Potato Leek Soup

Simple and fast, you can have this healthy gluten-free soup ready in 30 minutes. Serve with a side of gluten-free French bread and a salad with protein for a complete meal your whole family will love.

Ingredients:

1 tablespoon butter, coconut oil or olive oil

2 leeks, white parts only, sliced thin

1 large sweet potato, diced (skin on)

4 cups chicken or vegetable broth

¼ teaspoon ground cinnamon

Sea salt and freshly ground black pepper, to taste

(Optional) Dollop of yogurt (dairy or non-dairy)

Directions:

1. Heat a soup pot on medium and add butter. Add leeks and cook for 5 minutes.

2. Add sweet potato and broth. Bring to a boil, then turn down to a gentle simmer. Cover pot and cook for 20 minutes.

3. Puree soup, then add cinnamon and salt and pepper to taste. Stir in a spoonful of yogurt before serving if desired.

Serves 4.

Guest Blog Post by Iris Higgins, gluten-free cook book author and blogger of www.thedailydietribe.com, hypnotherapist with master's degree in psychology plus a Women's Wellness Wizard. 

Do you drink any of the "vitamin flavored waters" that are now available in stores?  There's everything from multi lemonade to energy waters to antioxidant boosts.

Many of them are loaded with sugar and other ingredients we don't need.  And have you calculated how much sugar and calories are in the entire bottle (usually 2.5 servings) not just 1 serving?  Whoever drinks just the one serving and not the whole bottle?    Yikes!  Most of them contain very little or NO actual juice either.  Yes, there are some with "zero" calories that are sweetened with Stevia but they are all really just flavored water with very little actual nutritional value. 

Why make your own vitamin water at home?

1. Less sugar and calories
2. Save money - most are between $1.50 - $2.50 each
3. Go green - no plastic bottles, less waste
4. Know exactly how much vitamins you are actually getting
5. Know that its Gluten Free
6. Adjust dosages or amount of water if needed or wanted
7. Customize it - you can put in whatever supplements you want! (except calcium and iron)
8. Convenience - make it whenever and wherever you want
9. Faster than making a smoothie if you don't have the time or ingredients
    

Brittany Angell of www.realsustenance.com came up with and posted this recipe on her blog

How to Make Your Own Homemade Vitamin Water

• 8 oz water
• 1-2 Tbs Lemon Juice
• I serving of Wellesse Liquid Vitamin of Choice (My favorites are the Multivitamin & Vitamin D)
• Nunaturals Liquid Stevia (a few drops) to taste.

Mix together and enjoy! Serve over ice, or pour it into a water bottle to go.   Repeat as needed

Make Your Own Homemade Energy Drink or Shot - no caffeine or sugar!

• 2-8 oz water - 2oz for quick shot or more for sipping
• 1 serving of Wellesse Liquid B-Complex Complete

Give your bottle a good shake or stir and you are set to go! 

I like to put the B-Complex in my water bottle at work to sip on throughout the day or in my workout water bottle for a really nice sustained energy with no spikes and dives like you get from coffee or energy drinks.

Try substituting these homemade versions for any kind of store bought soda or drinks.  Not only will it save a lot of money and calories, but you'll feel better too! 

You have had Bariatric Weight Loss Surgery, now what? 

One of your next big challenges is learning portion control.  You will systematically measure out your food for each meal, use one of the new measuring containers or serving ware available, or get really good at eyeballing what the portion size should be.  The last is really hard to do for any of us since the typical American diet is not anywhere near a correct portion size.  It is something we could all stand to learn – surgery or not. 

Here are a few tips to get you started on your learning journey.  Your physician will give you information through your process and you will likely receive a set of measuring cups after you surgery to help measure out the food you should be consuming at each meal. 

Food portion:  4 oz. of food. 
Your physician will direct you when it is safe to move to more solid foods after surgery.  When you start eating more solid food your meals should consist of no more than 4 oz. of food at each meal.  Your new measuring cups will help you measure out exactly 4 oz.  This sounds relatively simple but most people have tended to over-fill the cup because they are not sure how to visualize “enough.”  How much is 4 oz. of food anyway?  For example a serving of meat or fish will be the size of a deck of cards.  Visualize a domino piece, which will be your one oz. serving of cheese.  You could also purchase a small scale to weigh your food.

Photo source: ultimatefitnessbreakthrough.com

Why is the measurement so critical?  If you don’t measure out your food correctly many bariatric patients will experience a “dumping” after eating.  This means you may vomit from eating too much and the pouch fills to overflow and the extra has to come out. This may happen frequently until you get used to the portions.  Certain foods may also trigger this especially those high in sugar or fat.  Be sure to ask the doctor what foods to avoid especially at first.

Tools that have been designed to help you measure your food:

1. Diet dinnerware: http://mydietdinnerware.com/
2. Portion control bowls: http://www.mytinytank.net/portion-control-bowls/
3. The diet plate: http://www.thedietplate.com/
4. Bariware: http://bariware.com/

Eating tips: 

1. Take a small portion of food and serve it on a small plate/bowl.
2. Sit down at the table.
3. Sit down and focus on what you are eating.  (Avoid eating while standing, driving, or working. Avoid engaging in other activities at the same time that might cause you to become distracted, such as watching TV, reading, or using an electronic device.)
4. Take small bites, chew thoroughly, and avoid overeating or eating too quickly.
5. Cut food in small, pea size bites. Read why
6. Eat slowly.  Take a bite with a child size or baby size utensil and chew 25-30 times.
7. Allow 30-60 minutes for each meal.
8. Allow 1-2 minutes between bites.
9. Allow 10 minutes to finish every 1 oz. of food
10. Pause. Really pause.
11. Repeat.
12. Only continue eating until you feel a slight pressure in your chest.
13. Stop eating.

Foods to avoid:

1. High calorie foods:  desserts made with sugar or fat, fried foods, many fruit juices, full-fat dairy products, milkshakes, candy and pastries.  Read more:
2. Foods that are difficult to digest: pasta, rice, fibrous vegetables, soft bread and tough meat, dried fruit, nuts and seeds, popcorn  Read more:
3. Certain beverages:  Most patients receive instructions to avoid consuming caffeinated, carbonated and alcoholic beverages.  Read more:

Take Your Supplements!

Be sure to always take your recommended vitamin and mineral supplements. Because a portion of your small intestine is bypassed after surgery, your body won't be able to absorb enough nutrients from your food. Talk to your doctor and nutritionist to find out what supplements you will need to take probably for the rest of your life such as multivitamin and calcium.  The ASMBS offers guidelines for how much you will need for each type of surgery.  Liquid supplements are a great alternative as they absorb easily and do not need to be digested in the stomach. 

You too the biggest step and had surgery so now make sure to use these suggestions and those of your physician and support groups to heart to take the next steps that are necessary for success.  If you are used to inhaling your food or mindlessly eating you will need to re-program your eating behavior to make sure you set yourself up for success after your surgery.  Set yourself a nice pleasing table, set down and relax and stop eating as soon as you feel full to avoid getting sick. 

Feel proud as you see the pounds melt away and know you are setting yourself up for a healthy lifestyle with your commitment to a healthy eating pattern. Don’t worry if you have a few setbacks – that is normal.  Join a support group either in person or online like www.bandedliving.com or webinars to help you get back on track.  Or attend a great event such as the upcoming WLSFA Meet and Greet in May in Vegas and meet Carnie Wilson!

Featured Speaker Carnie Wilson, Sponsored by Wellesse Liquid Supplements!

While there are plenty of potential routes to go with bariatric surgery, the process of preparing for weight loss surgery is fairly uniform for most patients. Your surgeon will provide specific instructions to follow, however the general preparation can be broken down into four core categories: meeting with specialists, lifestyle changes, “the week before” and “the day before.”
 

Meeting With a Variety of Doctors and Professionals

There are a number of healthcare professionals you will meet with during the process of preparing for weight loss surgery. Depending on your health, you will meet with some combination of specialists, including a dietitian, psychologist, cardiologist or pulmonologist to ensure the surgery is appropriate and can be accomplished safely. The nutritionist and psychologist will help you manage your post-surgery expectations and implement healthier eating and lifestyle habits.

Lifestyle Changes

When preparing for weight loss surgery, there are a handful of lifestyle changes you may be required to make. You should stop smoking at least six months before the surgery and reduce your caffeine intake. Many surgeons will also ask you to lose 10-30 pounds before the bariatric surgery to ensure you are serious about keeping the weight off.  Also make sure you sure you have plenty of psychological support both before and after surgery.  Having support to keep you grounded and in check is essential.

The Week Before

The week before the bariatric surgery includes a variety tasks to complete. The most common steps include:

• Purchasing post-surgery supplies. This typically includes a variety of nutritional supplements such as calcium and vitamin D3 and a Multivitamin, bandages, Neosporin and certain types of easy-to-eat foods.

• Find someone to drive you home and help out for a few days. After your surgery, you aren’t going to feel like doing a whole lot. Make sure you have a friend or family member who can drive you home. They should also be available for a few days to help out as needed.

• Fill all postoperative prescriptions. Nothing is worse than getting home after bariatric surgery, only to realize you forgot to fill your prescriptions – especially your pain medication.

The Day Before

Effectively preparing for weight loss surgery ensures you don’t have to do much the day before. All you need to do is get packed. Your surgeon will give you a list of items to bring with you. Common items you will need to bring include:

• Comfortable clothes
• Insurance card
• Driver’s license
• List of current medications
• Toiletries
• Socks/robe
• Lip balm

This list is not meant to be all-inclusive, so always talk to your surgeon about any concerns or questions you may have. If you’re preparing for a weight loss procedure, best of health and good luck in your new healthier lifestyle to come!

by guest blogger Jason Knapfel who manages web content for Oregon Weight Loss Surgery in Portland, Oregon.