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    Bariatric Surgery Success

    You’ve had bariatric surgery but let’s not stop there. Your success depends on the right nutrition as part of your journey and transformation. You can conquer weight regain, cravings and emotional eating and learn to deal with all the other issues that come up. Here’s how. Join me and listen to the Bariatric Surgery Success podcast. I’m bariatric dietitian Dr. Susan Mitchell and I’ll share the nutrition information you need now for your successful transformation.

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    Copyright: © Copyright 2019 Beyond Bariatric Surgery: Everything You Need to Move On

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    Latest Episodes:
    #55 Bariatric Nutrition Q & A: Your Questions Answered #2 Jul 07, 2021
    Show notes

    The questions are listed here but the actual Q & A is in the podcast audio.

    Q1Liz asked: How much protein is too much protein? And Debra wants to know: I'm working out now, running and weight lifting, on a regular basis. Should I increase my protein? Today, we’ll answer the questions on your mind.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 55. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    Joining me via SKYPE is bariatric dietitian Gayle Brazzi Smith. Gayle has a heart-felt passion for helping people with their weight loss journey. You’ll see her posts in our private Facebook Group: Bariatric Surgery Success with Dietitian Dr. Susan Mitchell. Gayle is also certified in Obesity and Weight Management and is the bariatric dietitian at the Weight Loss and Bariatric Surgery Institute in Orlando, Florida where’s she been for seven years.

    Their website is OrlandoHealth.com/Bariatrics

    S: Let’s get right to our questions starting with:

    Liz asked: How much protein is too much protein?

    Leads us right into Q2 from Debra: I'm now working out now, running and weight lifting, on a regular basis. Should I increase my protein?

    We can’t wrap up without a mention of the current darling collagen powder. Yes, it’s super popular right now but it does not contain the essential amino acid tryptophan and is low in both the amino acids cysteine and methionine making it an incomplete protein source with a lower PDCAA score and not a great choice for after bariatric surgery regardless of the Internet hype.

    Podcast #50 discusses pea, whey and collagen protein powders

    Q3: it’s a long one so come in close…Jeanette asked: I have a huge list of foods called "caution foods" to avoid after surgery, including high fat cheeses, creamy sauces, spicy foods, sugar alcohols, and bread (including pita, tortillas, rolls, pastries, etc.). My diet plan does allow for me to start having small amounts of whole grain bread after 6 months. My question is about recipes that call for "breading" like all-purpose flour or whole wheat flour. If I am not allowed to eat bread, should I be substituting things like coconut flour, almond flour, chickpea flour or quinoa flour in recipes? And are things like panko breadcrumbs and cornstarch off limits, too? Finally, again thinking of recipes, if a recipe calls for "cream cheese," would I be able to still make the recipe if I substitute Neufchatel cheese?

    #54 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery, Part 2 Jun 30, 2021
    Show notes

    Do you need to buy a separate vitamin D supplement if it’s in your multi? What about iron? Do you need another supplement for it too? The right supplementation is so important to your success after bariatric surgery. This is part 2 of the 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 54. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    Remember in part one we talked about when you have weight loss surgery, vitamin and mineral supplementation is one of those items that will be on your daily to-do list from now on. The right supplements are part of your new lifelong strategy for success.

    So which supplements do you need? Let’s dig into more general suggestions for bariatric surgery remembering that your health care team may tweak these some based on your lab work and surgical procedure. In part 1, we looked in-depth at multivitamin and mineral supplements which give you good A-Z coverage and then we covered vitamin B-12. If you missed it, the podcast is #53. Today in part 2, we’ll discuss iron, calcium and vitamin D, and thiamine.

    The iron in your multivitamin mineral supplement may be sufficient and you won’t need to purchase a separate one. You can find doses of iron in multis ranging from 18mg up to 36, 45, 60mg or even more but these are typical. Your dose will depend on your lab work, if you’re female and still have your period, hope to get pregnant or if you’re anemic whether male or female. Your iron need is a good one to discuss with your bariatric dietitian.

    Here’s a smart strategy for you: Take Vitamin C or consume a vitamin C rich food at the same time as you take your iron to increase iron absorption. If both C and iron are in your multi, you’re good to go. If you’re eating an iron rich food such as black beans for example, also eating food containing vitamin C such as a tangerine will boost the iron absorption.

    Don’t miss this tip: Whether your multi contains iron which it usually does or you take it separately, be sure and take your calcium at a different time, about 2 hours later or the calcium will not be absorbed well by your body.

    Speaking of calcium, Calcium Citrate is better absorbed than other types such as calcium carbonate. Recommended daily dose will be somewhere from 600 mg per day up to 1,200-1,500 mg per day.

    We just said that calcium should not be taken with iron. The other important strategy for calcium is to take it in divided doses of 500-600 mg at a time. Why? That’s the maximum amount your body can absorb at one time and you don’t want to waste it.

    Calcium is often sold in combination with vitamin D which helps increase the absorption of calcium from the intestine. You can take vitamin D with your calcium or get your vitamin D in your multi. How much Vitamin D do you need? The general recommendation is to take 3,000 International Units (IU) of Vitamin D3 per day. Your dose may be higher depending on your blood test. Be sure and look at the Supplement Facts on the multi or the calcium/vitamin D product and see if the vitamin D is D3, how much is in the supplement and the percent Daily Value. Remember the Supplement Facts label is on the back of products. This Supplement Facts label is specific to the US and I realize that if you’re listening from another country things will be different. The label tells you the serving size. Plus you’ll see each vitamin and mineral listed with the amount of each one and the percent Daily Value or the percentage of your daily needs.

    What about Thiamin AKA vitamin B1: at least 12 mg should be included in your daily multi to prevent a deficiency so again check the label before you purchase.

    However, a thiamin deficiency can occur with rapid weight loss, persistent vomiting, or not getting enough thru diet and you may be treated more quickly with higher doses than found in a supplement. Also very important to have your screening for thiamine deficiency. It can make you quite sick.

    Check out various supplement companies. Try samples if they offer them. I partner with ProCare Health. Plus if you receive my Breaking Down Nutrition newsletter, there will be a 10% off code in there again this week too. If you don’t receive the newsletter, you can sign up for it on the home page of my website Breaking Down Nutrition.

    Remember, take your supplements on schedule. It m makes a huge difference in your success. You’re worth it!


    #53 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery, Part 1 Jun 23, 2021
    Show notes

    Did you know that vitamin & mineral supplementation typically begins at the time of discharge from the hospital, usually 2–4 days after surgery? Any idea what the must-have vitamins and minerals are for your body? What about when to take them and how much to take? The right supplementation is so important to your success.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 53. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    Let’s get right to it…

    Vitamin and mineral supplementation is a lifelong part of bariatric surgery. When you have weight loss surgery, vitamin and mineral supplementation is one of those items that will be on your daily to-do list from now on. Call it a behavior modification, lifestyle change or a tweak to your daily routine. However you look at it, supplements are part of your new lifelong strategy for success.

    Nutritional deficiencies are common after weight loss surgery and the type of surgery performed does make a difference. For example, vitamin and mineral deficiencies are more common after procedures like Roux-en-Y gastric bypass or biliopancreatic diversion as compared to sleeve gastrectomy and adjustable gastric banding. That’s why you always hear me say to circle back with your health care team for clarity if you’re unsure about which supplements they recommend for your procedure. Recommendations vary between surgical centers and even professionals groups so don’t be surprised if your supplements suggestions are different from someone else you know who’s had surgery.

    Let’s start with three important tips to keep in mind:

    1. As I mentioned at the start of the podcast, vitamin & mineral supplementation usually begins when you go home from the hospital which is typically 2–4 days after surgery. So if you’ve had surgery and are home now, you should have started on supplements. We’ll talk about which ones in a minute.

    2. Your body has changed in it’s ability to absorb vitamins and minerals. How much it’s changed depends on the surgical procedure. When selecting your products, chewable or suckable pills, or liquids are a really good idea the first 3-6 months. Then if you choose and your health care provider doesn’t have you on any specific regimen, you can switch to capsules or tablets.

    3. Routine vitamin and mineral screenings/lab tests should be part of your care from your health care team. How often and what they screen for will vary with your procedure.

    A lot has changed in the vitamin-mineral world. In the not-to-distant past, bariatric-specific supplements weren’t common so we combined various over-the-counter products to get what we needed. Today, many companies provide a wide variety of bariatric supplements. In fact, there so many to choose from, it’s easy to become overwhelmed or unclear about which ones to take. You’ll need to do some label sleuthing and I’ll show you how.

    So which supplements do you need? Let’s dig into the general suggestions for bariatric surgery knowing that your health care team may tweak these. Today, in part 1, we’ll talk about multivitamin and mineral supplements along with vitamin B-12. In part 2, we’ll cover iron, calcium and vitamin D and thiamine.

    First on the list. Take a complete multivitamin plus mineral supplement that is bariatric specific. What the heck does that mean? Complete means it contains the typical A-Z formulation of vitamins and minerals similar to what you find in an adult supplement but in amounts recommended for bariatric surgery. Make sure it includes both vitamins and minerals and specifically check for vitamins A, D, E, K, folic acid and thiamin along with the minerals iron, zinc, selenium and copper. If it’s a good quality bariatric supplement it will contain all of these and more.

    Here’s a need to know: you can find a multi both with and without iron. It’s fine to take your iron in the multi as long as you haven’t been put on a higher dose. Also, the numbers of multis you take everyday will vary based on the brand. Typically the dose will be one or two tablets, capsules or chewables per day. How do you know?

    Label sleuth time. This is what I want to show you. Do you have a vitamin container near by? Go get one. Now take a look at the Supplement Facts label which you’ll find on the back of most products. This Supplement Facts label is what you’ll find in the US and I realize that if you’re listening from another country, you’ll have a different label. At the top of the label you’ll see the serving size such as 1 chewable tablet. Then you’ll see listed each vitamin and mineral along with the amount per serving and the percent Daily Value. Percent daily value or DV is the percentage that chew provides of your daily needs for each of the vitamins and minerals listed. You’ll want to see 100-200% Daily Value for most every vitamin and mineral but there will likely be a few that are higher such as thiamine, vitamin B12 or even iron.

    Don’t miss this tip: Sometimes you need more iron than what’s in your supplement and we’ll talk about that in part two but if you multi contains iron which it usually does, be sure and take your calcium separately, wait about 2 hours or more from the time you take the multi or the calcium will not be absorbed well by your body.

    Vitamin B-12 aka cobalamin: the dose is 250-500 micrograms (ug) a day with most suggestions in the 350-500 microgram range daily or 1000 mcg every other day. The dose depends on your surgery, your lab results and the route of administration…meaning under the tongue, you swallow it, etc. Sometimes an intramuscular injection of B12 or a nasal spray will be ordered by health care team. You can take B12 at any time or with any other supplements. It’s likely that your multi will have enough B-12 in it so check the label before you buy additional. Be sure and discuss your lab screenings with your health care team before you decide to take any extra.

    Today’s Science 101 on Vitamin B-12. The absorption of B-12 can be affected by bariatric surgery due to changes in acid production and reduced availability of what’s called the intrinsic factor. This intrinsic factor helps the B-12 to be absorbed and used by the body. When it’s not there or insufficient, B-12 doesn’t get absorbed and used as it should. You could experience neurological symptoms which include numbness and tingling of your arms, legs and skin plus feel like your coordination is off. This is a prime reason why routine screenings are so important and typically done every six months or so. These screenings help your health care provider pick up on a possible deficiency hopefully before it becomes a problem.

    Check out the Supplement Facts on a number of products to see what you like best. As I’ve shared before I partner with ProCare Health Plus if you receive my Breaking Down Nutrition newsletter, there will be a 10% off code in there this week too. If you don’t receive the newsletter, you can sign up for it on the home page of my website Breaking Down Nutrition.

    Decide what works best for you. Ask questions if you’re not sure. You’re worth it!


    #52 What's for Dessert? Jun 16, 2021
    Show notes

    Hey, what’s for dessert? I grew up in Tennessee and this was a common question. Still is. And, I have to admit, I love dessert. Always have. But wait, I’m a dietitian. But first I’m a person who loves food and good dessert. How about you? You’ve had bariatric surgery but I bet you’ve asked yourself this question too, right? Can you have dessert or do you have to deny yourself now? Can dessert be good for you? Is dessert off the menu or what does dessert look like post surgery?

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 52. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    I’d like to give a shout out this week to Christine who said this on Facebook: “Listening to your podcast every week helps keep me on track! I’m also excited about Dr. Connie joining the show.” Thank you Christine. Happy to know that the podcast helps you stay on track week to week. And yes, Dr. Connie’s spot on when it comes to mental health issues, isn’t she?

    If you missed guest psychologist Dr. Connie, the episode is #51 called Bariatric Mental Health Q & A: Your Questions Answered. Listen to it on the website or your favorite podcatcher like Apple or Google podcasts.

    Let’s get right to it…dessert or no dessert? Basically whether we’re talking about treats or goodies or desserts we’re talking about the same thing. You may eat them at different times but they all fall in the same category. Bottom line, it’s all in your smart strategy. First, the replay. Remember that your body is unique as is your surgery. So as I always mention, circle back to your surgical team to make sure certain changes will work for you. Let’s be honest with each other. How long can you eat plain ol’ chicken or fish and brown rice or broccoli? Answer: not that long. Sure, you want to continue with your wins and successes but skipping a treat or a dessert that you really want can set you up to want more of it. Can I get an Amen?

    Remember prior to the COVID pandemic, when you worked in an office and someone had that cool candy bowl always filled with M & M peanuts? Did you grab a few and feel satisfied or did you deny yourself? Did you then try to ignore them all day but those M & M’s kept calling your name? Denise, Peggy. What happened then? If you denied yourself long enough, did you go in there and grab a big handful or maybe even look in the drawer for the bag? Denial leads to feelings of being deprived, and ultimately, cravings and over eating. If you’d just had a few peanut M & M’s when you really wanted them, it’s likely you would have been satisfied and moved on.

    You’ve made terrific progress up to now and want to continue but can you fit a favorite dessert into your eating plan? You bet you can. It’s all about a smart strategy. By that I mean, think of the food choices you’ve made since surgery. I’m assuming you’re almost a year or more out now from surgery to be talking desserts or treats. You eat high protein foods, watch your processed carbs, choose healthy fats. When it comes to treats or dessert, whether you buy them or make them, try to meet those goals we just mentioned: include protein, keep the sugar low, and emphasize healthy fats. And sure, calories should be lower so you don’t ruin all your efforts with weight regain. However, before we talk more on how to do this, there will be times during special occasions, like a birthday or anniversary, when nothing but a certain dessert that you love will do. You know exactly what I mean? What is that treat for you? So, what to do? You plan your healthy meal with your normal goals, portions and foods in mind, but then allow yourself a small portion of the item you love and enjoy every single bite. The operative word here is a small portion planned as part of your day so that your favorite treat doesn’t turn into a stomach ache, dumping syndrome, or other gastrointestinal issues from too much sugar or fat. Enjoying something special should not affect your long term plan and success. It’s that denial that comes back to haunt you with cravings and overindulgence that’s the issue.

    What about bariatric treats and desserts made with protein rich foods, low sugar, etc? Yes please. There are lots of bariatric recipes online but not all are good ones so what should you think about when selecting one?

    Jeanette asked this question: “I know desserts will always need to be kept to a minimum, but for special occasions I hope I can still make desserts that will be "bariatric friendly," such as using almond flour and splenda, stevia or monkfruit in a berry or peach crumble. But I have heard that one reason why white bread and pastas and sugar free angle food cake are forbidden is that they can ball up and clog my intestines. Sugar free angel food cake is spongy. Does this mean I should find something else to use instead of sugar free angel food cake? I don't want something to clog my intestines!”

    Jeanette’s question is spot on in that it affects many items you would make at home. There are two schools of thought on dessert and sweeteners. Some people hate sugar free sweeteners or don't tolerate them well or both. They would prefer to plan in a small portion of the real item. In a lot of desserts, the sugar free sweeteners don't bake well. In others they work great. It can be trial and error but they do better when used in fresh fruit items or in a pudding. Angel food cake, whether made with sugar or a sugar-free sweetener is like white bread, white pita or white pasta in that it is highly refined and has no fiber. It's the lack of fiber that is the issue and why you hear people say they get clogged up. Clogged up refers to the lack of fiber to help move the digestive process along. So you could use an angel food cake make with real sugar (just use a little less than the recipe calls for). Have a small portion with fruit to add fiber. Or, you could substitute the angel food cake for a pound cake made with almond flour. Almond flour has fewer carbs and more fat with the emphasis on healthy fat as the majority is monounsaturated. You could also find cookies made with almond flour and crumble them up.

    The process is to ask yourself a few questions when you’re baking at home:

    1. Can I cut the amount of sugar without affecting the recipe? Most of the time the answer is yes, try it cutting back by 1/4 and go from there. FYI: 4 grams of sugar is equal to 1 teaspoon.

    2. Would a sugar free sweetener work?

    3. Can the all purpose flour be partially or fully replaced with an alternative like white whole wheat, almond flour, quinoa flour, or even chickpea flour, which contains both fiber and protein?

    4.Can I alter the fat from butter or shortening to an oil or butter/oil combo?

    I cook a lot and always tweak recipes to better meet the needs of my family. And remember, it also comes down to the portion you eat. You can make yourself totally stressed, that’s not the goal. So make smart substitutions and serve yourself the appropriate portion. It's really important to be able to make recipes that you and family will eat and enjoy. Use these ideas, pre-plan and you can do just that. Decide what works best for you. You’re worth it!


    #51 Bariatric Mental Health Q & A: Your Questions Answered Jun 09, 2021
    Show notes

    Lynn asks, “How do I deal with feeling self conscious about my loose hanging skin and new found wrinkles after surgery?” And Liz wants to know, “What are ways to get yourself to enjoy exercise?” Don’t go anywhere, psychologist Dr. Connie Stapleton, who specializes in bariatric surgery and helps you deal with life’s stuff, joins me today to answer your questions.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 51. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    I’d like to give a shout out this week to Jen who made this comment on Facebook: “I am pre-op right now. I love listening to your podcast. You provide awesome insight!” Thank you Jen. I think you’re pretty awesome for taking time to tell me. I hope to continue to provide lots of insight for your journey and can’t wait to hear about your success.

    Joining me today via Skype is Atlanta-based psychologist Dr. Connie Stapleton. Dr. Connie uses her vast experience to share practical skills for improving your post op relationships with food, other people and most importantly your relationship with yourself. Basically, as I mentioned at the beginning of the podcast, she teaches you better ways to deal with life’s stuff.

    Resources:

    Website: Psychologist Dr. Connie Stapleton http://www.conniestapletonphd.com

    BariAftercare: The Podcast; available on Apple podcasts and most other podcatchers


    #50 The Best Protein Powders for Bariatric Surgery Jun 02, 2021
    Show notes

    Resources From Today's Episode:

    Bariatric Surgery Success with Dr. Susan Mitchell Private Facebook Group

    FREEBIE: 5 Tips to Packing in Protein

    Free Samples: ProCare Health FREE Samples

    Podcasts Mentioned:

    #31 Does Protein Help Prevent Weight Regain?

    #29 Should You Go Keto after Bariatric Surgery?

    #48 Is Pea Protein a Smart Choice After Bariatric Surgery?

    Protein, protein, protein! Do you feel like your head may explode if you hear that word one more time? I bet you do, for I admit, I talk about it a lot as do most dietitians. There are so many protein powders on the market…egg, soy, whey, pea, collagen. Which is the best one for you after surgery?

    There are days when no matter what you do, you can’t consume enough protein thru food, right? Maybe it’s a bad day and you’re just not feeling well. Maybe your day was interrupted unexpectedly and the meal plans you had just didn’t work out. Protein powder is an excellent way to help hit your daily protein target when eating enough protein thru food is just not happening.

    Let’s take a quick look at the most common ones. Soy, eggs, whey, and casein are all complete proteins with a high PDCAA score. The highest score is 100 which all of these have. If you’ve listened to some of the other podcasts where I’m talking about protein, you may recall that PDCAA means Protein Digestibility Corrected Amino Acid score which measures quality of protein. A complete protein contains all nine essential amino acids. It isn’t missing, or low in any one of the nine. Essential amino acid means that it cannot be made by your body and must be taken in thru food.

    Soy protein, made from ground soybeans is a quality complete protein. It’s a good choice if you prefer a plant based protein. Soy, egg, whey and casein all taste a little different so it comes down to your personal preference.

    Egg protein comes from the egg white or albumen. It’s also a high quality complete protein and is popular with people who can’t have dairy or just want to change it up.

    I’m going to spend most of our time together on whey protein powder as it’s so popular. It’s often called the gold standard of protein powders. But remember what we just said…egg and soy protein as equally as good just not as popular.

    The protein in milk is 80% casein and 20% whey. Whey is a complete protein containing all nine essential amino acids and is digested faster than casein. Just like egg or soy protein powder, it isn’t missing or low in any one of the nine essential amino acids.

    Science 101 for this week. Whey powder comes in several forms: whey concentrates, whey isolates and whey hydrolysates. In whey concentrate the water has been removed but the remaining product usually still contains lactose, fat and cholesterol which are naturally found in whey. Whey protein isolates usually have a little more protein but less of lactose, fat and cholesterol than whey concentrates. Whey hydrolysates are pre-digested and assimilate into the body more quickly. Isolates and hydrolysates are typically more costly due to processing.

    Most containers just say whey protein on the front. How do you know what’s what? Look at the ingredient label. The ingredients go in descending order most to least. The first words should be whey protein concentrate or whey protein isolate, the two most common forms. It’s up to you which you purchase.

    Because whey comes from milk, anyone who is truly allergic to milk proteins should avoid whey. A milk allergy is not the same as lactose intolerance. They’re two different things. Because the lactose level is low in whey concentrate and lower in whey isolate, they often work for lactose intolerance.

    Casein is also a complete protein in milk. Studies suggest that since casein is absorbed more slowly than whey and releases amino acids over time, it may be beneficial to consume before bed. This will supply protein through the night. A combination of whey and casein works well too.

    Make sure your whey protein doesn’t have a lot of other added ingredients that you probably don’t need, like herbs, coffee or guarana, and particularly vitamins and minerals which typically are not added in the amounts specific to bariatric surgery. Generally the fewer ingredients the lower the cost too.

    There are so many brands to choose from. I partner with ProCare Health because many of their products are tested by a third party, are made in the US, and meet or exceed current ASMBS guidelines. That’s important to me and for your care. If you want FREE samples, see the link above in the resources and you can try them out.

    Let’s move on to pea protein which is an environmentally friendly plant-based option that’s easily digested and most people are not allergic to it. It’s dairy-free for vegans and people with a true dairy allergy. For a lengthy explanation of pea protein be sure and listen to podcast #48 Is Pea Protein a Smart Choice After Bariatric Surgery. The link is above in the resource list. A plant-based protein powder like pea may have all nine of the essential amino acids but be limiting in one or more. Remember this means that the level is not high enough to meet the body’s requirement. Because you had bariatric surgery and your body needs high quality complete protein. Pea protein has a limiting amino acid or one in a very low amount which is methionine. You can add the amino acid methionine to your diet by eating foods such as brown rice, sunflower and pumpkin seeds. Adding these to your diet increases the carb and fat grams too. Some pea protein products add sunflower or pumpkins seeds directly to the pea powder which then pushes up the total calories along with carb grams of a serving of that powder to around 8 grams compared to 1 or 2 in whey protein. When you have a gold standard protein like whey, egg or soy, you can save those carb and fat grams and use them on real food. This is so important to the enjoyment of food when your portions and calories are limited. I’m a fan of protein powder, it certainly mets a need but I’m a bigger fan of eating real food and maximizing the benefits to the body.

    We can’t wrap up without a mention of the current darling collagen powder. Yes, it’s super popular right now but it does not contain the essential amino acid tryptophan and is low in both the amino acids cysteine and methionine making it an incomplete protein source with a lower PDCAA score and not a great choice for after bariatric surgery regardless of the Internet hype.

    The nice thing about protein powder is that it can be mixed with water, juice, milk or other beverages. Most protein powder mixes best in warm liquid so mix your powder with a small amount of warm water or other warm beverage and then mix into your cold beverage if that’s what you’re having. Or, do you have a frother? This tool works really well for blending in protein powder. Combined with a warm liquid it’s a win-win.

    So cut thru all the hype and go straight to the ingredient label to see what’s what. Find a protein powder without all the unnecessary added ingredients that you don’t need and push the price up. Whey protein concentrate is whey protein concentrate. It doesn’t need a bunch of added items. Compare prices and the label and look beyond the hype. Save money. It’s all part of taking care of yourself. Decide what works best for you. You’re worth it!


    #49 Is Fat Taboo after Bariatric Surgery? May 26, 2021
    Show notes

    You’ve had bariatric surgery and know that protein plays a major role in your recovery. But what about fat. Can you have some or is it taboo? Let’s talk about the macro we love to hate…fat.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 49. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    If you haven’t joined me in the private Facebook group, what’s holding you back? It’s called Bariatric Surgery Success with Dr. Susan Mitchell. Lately we’ve talked about pea protein versus whey protein and how many grams of carbs you need after surgery. Lots of questions and feedback so if you need a safe place to ask, join us.

    Fat and carbs are two words that make many of us cringe. But they shouldn’t. Both are needed by the body to be healthy and both add to the enjoyment of food. Let’s focus on fat today and how much you need after surgery.

    So much confusion and so little time. Let’s get right to the big issues. Fat is a macronutrient just like protein and carbohydrate. You might find this hard to believe but fat plays numerous positive roles in your body as it acts as an energy source, protects your organs, regulates body temperature and helps to absorb vitamins A, D, E and K which are known as the fat-soluble vitamins. Fat also increases your feeling of fullness or satiety. And we surely can’t forget that fat improves the taste and mouth feel of so many foods.

    The big question is how much fat should you eat after surgery? The broad answer 25-30% of your total calories per day. Let’s dig deeper. Put your math hat on. Let’s say that you’re eating 1200 calories per day. Use 25% fat calories in this example. So 25% of 1200 calories is 300 calories. If you like to log calories fine but more about that in a minute. If you’re more into grams and prefer to keep an eye on them, then do you recall how many calories per gram are in fat? Nine. To convert those 300 fat calories into fat grams divide by 9 and you get about 33.5 grams. To review once more, if you’re consuming 1200 calories a day and want to eat about 25% of those calories from fat then 25% of 1200 is 300 calories. To convert to fat grams, divide by 9 and your have 33+ grams. The math changes as your total calories change and the amount of fat you desire changes. For example, if you’re eating 1400 calories per day and 30% fat, then 30% of 1400 is 420 calories. Divide by 9 calories per gram and you have about 47 grams of fat per day. Notice there is not one and only one answer. Why? Your body varies from your friend’s as perhaps your surgery does too. You also may eat more or less grams of protein per day in the range of 60-120. And then you have carb grams of up to 130. Each macronutrient takes up part of the total calories per day so your individual needs juggle within these ranges.

    Beside the calories and fat grams per day, the type of fat you eat is equally important. Your focus: unsaturated fat instead of saturated. If you listen to the podcast, you’ve heard me say that saturated fat can raise your total cholesterol level as well as the lousy LDL cholesterol. Unsaturated fat which includes monounsaturated and polyunsaturated fats are found in foods such as nuts, seeds, olives, fish, avocado, and oils from these foods such as olive oil, peanut oil, etc. Unsaturated fats tend to be more health protective especially when it comes to your cholesterol level and heart health. Plus some of these foods such as fish, avocado and nuts have anti-inflammatory effects too. Another bonus.

    A few minutes ago I mentioned you can track fat grams or calories if you want. You can easily become frustrated if you try to track everything and will want to give up. Eating and food are meant to be enjoyed not be a pain in your patootie every day. What to do? Let’s go back to the main focus macro. Protein. If you track or count your protein intake for the day and then just make smart fat choices with your focus on unsaturated fat and realistic, smaller portions and do the same with high fiber carbs, things fall into place without feeling overwhelmed and saying forget about it.

    And remember, this sanity with your daily calories and macros is part of taking care of yourself. Decide what works best for you. You’re worth it!


    #48 Is Pea Protein a Smart Choice after Bariatric Surgery? May 19, 2021
    Show notes

    Does pea protein contain the nine essential amino acids? And if so, is this a good source of protein after bariatric surgery? Let’s look closely at popular pea protein.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 48. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    If you haven’t joined me in the private Facebook group yet, what are you waiting for? It’s called Bariatric Surgery Success with Dr. Susan Mitchell. There is good conversation happening in there. Lots of questions and feedback going on.

    With so many protein supplements on the market, how do you know what to choose? Plus you’ve had bariatric surgery so do all protein supplements provide what your body needs to thrive?

    Recently in our private Facebook group, someone asked if pea protein contains the nine essential amino acids and if so, is this a good source of protein after bariatric surgery. In this podcast, I’m not covering vegetarian or vegan diets as they’re more difficult to follow after surgery due to the limits on carbs and calories. After bariatric surgery, the big focus is and continues to be on protein, high quality protein which comes from animals or soy. So let’s talk a minute about whey protein. In a whey protein powder for example, it's typically just whey protein and not a lot of other added items you probably don’t need. Plus whey protein tends to contain a few more grams of protein per serving than pea protein. It’s a complete protein with the correct proportions of those nine essential amino acids needed by the body. It isn’t missing or low in any one of the nine. Essential amino acid means that it cannot be made by your body and must be taken in thru food. You probably know of amino acids for their role in making and repairing muscle. But these aminos do a lot more in the body from hormone production and the absorption of calcium to roles in immune function, sleep-wake cycles and sexual function.

    Science 101 today: One of the reasons why animal protein which includes whey protein works so well after bariatric surgery is that it has a high protein digestibility corrected amino acid score known as the PDCAA. Basically it measures protein quality. Why does that matter to you? The highest PDCAA score is 100. Milk (whey/casein), eggs, and soy all have a score of 100 and are all complete proteins. Also important is the quantity of leucine found in protein. It’s one of the nine essential amino acids which helps maintain lean tissue and the amount varies widely in products. Animal products including whey protein and soy products are very good sources of leucine.

    Let’s look at pea protein closer. What exactly is it? Pea protein powders or supplements are made by extracting protein from yellow peas making it naturally vegan and also gluten-free and dairy free. Both whey and pea proteins are relatively low in carbs, fat, fiber, and sugar when nothing else is added to it. Plus pea doesn’t contain any of the top food allergens such as fish, shellfish, eggs, and soy. So it’s very popular with those following a vegetarian or vegan way of life. It’s also a good source of iron from the peas. Pea protein powder is good quality and works for many people but not as well as animal protein specifically in the case of bariatric surgery. It's does contain the nine essential amino acids but here is where we dig a bit deeper. Quality matters. A product may have all nine of the essential amino acids but be limiting in one or more. This means that the level is not high enough to meet the body’s requirement. Pea protein has a limiting amino acid or one in a very low amount which is methionine. You can add methionine to the diet by eating foods such as brown rice, sunflower and pumpkin seeds. Here’s where the issue is specific to weight loss surgery. Some pea protein powders contain just pea protein. Then brown rice or seeds need to be added to the diet to boost the methionine level. What happens, the carb and fat grams get a boost up too. Other products add sunflower or pumpkins seeds directly to the pea powder which then affects the total calories along with carb and fat grams in a serving of that powder. This addition often pushes up the total carb level in a serving of pea protein powder to around eight grams compared to one or two in whey protein. I would prefer you to have the choice of those grams of carbs and fat and to use them on real foods that you love since you have to watch carbs and fat each day.

    Other pea protein products also contain various vitamins and minerals but not in amounts appropriate or specific to bariatric surgery. A specific bariatric vitamin-mineral supplement would better meet your needs than those added to a product not designed for weight loss surgery. Bottom line, in this case, it’s all about the very specific needs of bariatric surgery and choosing protein powder that leads to the best outcome. Pea protein is a good protein but not the best choice for post surgery.

    And remember, it’s all about taking care of yourself. You’re worth it!


    #47 Fight Inflammation with These 7 Foods May 12, 2021
    Show notes

    What do black beans, bing cherries, avocado and nuts have in common? These foods fight inflammation in the body. But isn’t Inflammation a good thing or is it a not so good thing? Let’s talk about the type of inflammation you don’t want in your body and how you can fight it with food.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 47. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    I want to give a big shout out and say thank you this week to lilurameshi. I so appreciate your 5 star review on Apple podcasts which says: “Awesome…great podcast for bariatric nutrition. It’s a quick podcast that is packed full of information. Have a pen and paper handy to write down some of the great tips.” Well, I’m glad to know that I’m not the only one who takes notes these days and happy you like the quick format. Thank you for taking time to post the review.

    210 million! That’s the number of results that came up on Google when I searched the words inflammation and diet.

    Inflammation can be good thing or a not so good thing. Inflammation is good if it’s short term such as when cut yourself and your immune system sends in white blood cells to jump start the healing process.

    Inflammation is not so good when it becomes chronic or on-going inflammation in your body. This type of inflammation, which is invisible to your eye, gets all the media attention because it’s been implicated as an underlying cause of many common diseases from heart disease and autoimmune illness like lupus or rheumatoid arthritis to some cancers, diabetes, and even stroke.

    Chronic inflammation can damage your blood vessels, which increases your risk for heart problems. In cancer, inflammation can damage your genes or increase the development of blood vessels that let’s cancer cells spread and grow.

    Did you know that chronic inflammation and obesity are linked too? Recent studies have shown that obesity may be causing chronic inflammation which in-turn causes insulin resistance. Insulin is a hormone that helps your cells take up sugar. If your body becomes resistant to insulin, your blood glucose or blood sugar remains high. Insulin resistance could be a factor in both diabetes and weight gain. These effects make obesity and inflammation like a case of the chicken and the egg. Which comes first? Obesity causes inflammation and chronic inflammation can eventually lead to obesity.

    This inflammation in the body raises the level of a marker known as C-reactive protein or CRP for short. The liver produces this CRP during periods of inflammation so it makes sense that if the body has chronic inflammation going on, the CRP level will be elevated. Doctors measure this level of general inflammation in the body with a blood test called high-sensitivity C-reactive protein or hs-CRP.

    Numerous foods are touted to single handedly fight inflammation. But that’s just not how it works. For your diet to have an anti-inflammatory effect the key is not to focus on a single food or food component. The ultimate success of the anti inflammatory diet approach is based on synergy. Think of your favorite team, basketball, soccer, football, whatever it is. To win and to continue to win, the team must work closely together. In the same way, the synergistic effect of nutrients and bioactive compounds consumed together from a variety of healthy foods provides the best anti-inflammatory outcome.

    The good news is that inflammation can be reduced with a diet that includes lots of anti-inflammatory foods. Remember these foods are for after surgery when you’ve progressed thru the various diet phases and now eat a regular diet. Let’s talk about seven of these anti inflammatory foods and food components.

    1. Garlic, herbs and spices. These contain various anti-inflammatory phytochemicals or naturally occurring plant nutrients. Until exact amounts are determined, you can include garlic, turmeric, ginger, oregano, rosemary, thyme and pepper as part of your daily diet.

    Note: Did you try the Golden Turmeric and Ginger Latte that my intern Pitchaya created? It’s great day for a cozy day.

    Also find it on the website under recipes.

    2. This one may surprise you. Fiber ranks as one of the most anti-inflammatory components. Fiber is a type of carbohydrate that is not absorbed by your body so it helps to keep you full without adding extra calories. Foods rich in fiber include whole grains (oatmeal, quinoa, whole wheat), nuts, fruits, and vegetables.

    What about beans such as black, kidney or garbanzo and lentils? Also a good source of fiber and low on the glycemic index, they help keep your blood sugar in check. And when you eat more beans and lentils you tend to crave and eat less processed or foods that have zero nutrition such as cookies, cakes, chips and pastries which by the way can make your blood sugar level spike and have been tied to inflammation.

    Science 101: beans and whole grains contain fermentable fiber, which may be particularly helpful to the microbiota of the colon. This fermentable fiber produces butyrate, a fatty acid that assists in maintaining the intestinal wall and protecting from substances that could increase inflammatory reactions.

    Bottom line: when you are choosing the carbs for your day, choose smart ones that will make a difference in your health after surgery.

    3. Vegetables and fruit. For best benefits, a wide variety of fruits and vegetables is the goal due to the powerful assortment of naturally occurring phytochemical or plant nutrients found in them. One easy tip: choose a colorful combination of fruits and vegetables to know you are eating a variety. You still need to limit the portions to the amounts that fit into your plan for the day.

    Spinach, blueberries, raspberries and strawberries are all good examples. Don’t forget Bing cherries and tart cherries. The Agricultural Research Service has conducted studies on Bing cherries and found that regular consumption lowers the CRP inflammation marker in the body. Anthocyanins are one of the natural phytonutrients in tart cherries that give them their bright red color. These phytonutrients are linked to reduced inflammation.

    4. Seafood such as tuna, salmon and sardines which are rich in omega-3 fats that play various beneficial roles in the body such as suppressing inflammation. Eating fish once or twice a week is a smart goal.

    5. Flaxseeds, algae, walnuts and pumpkin seeds which are plant sources of omega-3 fats. The plant source is called alpha-linolenic acid or ALA and converts in the body to omega-3 fats but the conversion rate is low, about 10-15%.

    6 and 7. Avocados and nuts: both are rich in monounsaturated fats, the more heart healthy type of fat and both contain anti-inflammatory components. Eating these also helps you to cut down on saturated fat as which can raise the lousy LDL cholesterol level and promote inflammation. Bonus: both are filling so help you feel satisfied.

    Your big take away today is that the secret to the success of the anti inflammatory diet is the synergistic effect from a variety of foods such as beans and lentils, herbs and spices, fruits and vegetables, nuts, avocado and fish…all rich in various vitamins, minerals, healthy fats and bioactive compounds.


    #46 Bariatric Nutrition Q & A: Your Questions Answered May 05, 2021
    Show notes

    Jenna asked, “Does the tea I drink need to be decaf?” And Shelly wants to know, “When can I start drinking diet soda again?” Today, we’ll answer your burning questions.

    Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 46. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

    I want to give a shout out and say thank you this week to Christine for her comment on Facebook. She said: “I love this podcast, it’s quick yet packed full of information.” Christine, my goal is to not waste your time and get right to it with information you can use. Glad you like the short format too.

    This week joining me on the podcast is bariatric dietitian Isabel Maples. If you’re in the private facebook group, you may have seen her comments as she shares her expertise. Isabel is a registered dietitian and bariatric coordinator with Fauquier Health in Warrenton Virginia. She helps her patients navigate the weight loss surgery process to maximize success. Her focus is on making food fun again by relearning body cues for hunger/satiety, taming trigger foods, and discovering the joy of movement.

    Guest: Bariatric Dietitian Isabel Maples, RD Fauquier Health Weight Loss Surgery Facebook: Isabel Maples RD

    Welcome Isabel! Thanks for joining me today.

    Questions we answer: 1. Jenna asked, “Does the tea I drink need to be decaf?” Reference: Podcast Episode #34: The Buzz on Bariatric Surgery and Caffeine 2. Shelly wants to know, “When can I start drinking diet soda again?” 3. What about sugar free jello and sugar free pudding? Reference: LiquaCel liquid protein

    Thanks so much for joining me today Isabel. And remember, take care of yourself. You’re worth it!


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