Clean Eating: Bariatric Style

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There’s so many resources about diet after bariatric surgery when you are post-surgery to about 6 months. Moving from liquid, to puree, to solid stages during weight loss comes with a lot of guidelines. What life looks like post-weight loss is not nearly as well-documented. I know when I was researching surgery, I followed so many blogs of people who were going through weight loss, and they all seem to get to a certain point and then stop documenting the journey. Even my own blogging has slowed down now that I have reached maintenance.

This week in my health coach training, one of our assignments is to create a resource for my clients about clean eating. Do you need to recreate the wheel for bariatric patients? I think not.

Here’s some guidance from our curriculum:

  1. Keep It Whole
  2. Experiment with Home Cooking
  3. Limit Refined Carbohydrates
  4. Maintain Consistent Eating Times and Try Not to Skip Meals
  5. Balance Your Plate

Let’s put the bariatric spin on this.

There are rules we have to follow as bariatric patients (and they may vary from surgeon to surgeon, so it’s important to follow YOUR program). First and foremost, we must take our vitamins and supplements. For me, this means a bariatric formulated multi-vitamin, calcium with vitamin D, vitamin B-12, and 60-80 grams of protein specifically from protein supplement. Since we’ve got through a major surgery to reroute our digestion, supplementation to ensure proper absorption of these nutrients is critical.

Emphasize Quality Over Quantity

This applies to your supplements as well as food. I have chosen bariatric formulated products to ensure maximum absorbtion. It is expensive? Not compared to feeling like crap and being 90 pounds overweight. It’s all relative. We have one body in this lifetime and we’ve already put it through a lot to get to where we are going, so invest in your health.

The same goes for the rest of the things we eat. We’re so limited on how much food we can intake. In the beginning, I was fine with 1/4 cup serving sizes for meals, but as I got more into my exercise program, I gradually increased to 1/2 cup per meal, and now that I am in maintenance, I can eat much more — depending on the food, but the quality of that food matters.  Since we can only eat so much, nutrient dense food is the way to go. So:

  1. Choose Whole Foods

When planning meals, think of choosing the most unprocessed food and keep it simple. I always include a protein source as my primary food and eat that first, followed by whole vegetables and fruits. I lean towards a plant based diet, so protein sources can include beans, lentils, tempeh, tofu, or hummus but I will also include vegetarian sources like eggs, cottage cheese, string cheese, greek yogurt, or other reduced fat cheese. Occasionally I will eat chicken or fish, but try to choose organic and sustainably raised animal products when I do choose them. I will typically pair these foods with organic fruit or vegetables, usually fresh, sometimes frozen. Simplicity is the key.  I will meal prep simple “lunchables” that are roughly the same quantities that I can mix and match over the course of the week and have prepped and ready to go to throw in my lunch bag.

Here’s a few examples:

  • Eggs with sliced tomatoes
  • Cottage cheese with sliced peaches
  • Tempeh with hummus in a lettuce wrap
  • Kale and red cabbage salad with beans or hummus
  • Roasted root vegetables with grilled chicken

You are only limited by your imagination.

2. Experiment with home cooking

Food prep keeps things fun and interesting. Typically I will find a recipe on Pinterest that I will make as an entree to have for lunch or dinner for the week, or I will find some kind of plant-based salad to make that can be paired with a protein source or just enjoyed as a snack between meals. My pinterest account has a collection of bariatric friendly and plant-based recipes that I will adapt based on my current nutritional needs.

I am still recovering from my kidney surgery, so I have had to adapt my portions and my food to a reduced intake due to reduced exercise quantity and intensity. Eating at home really helps me to control what I take in, reduce the amount of sugar, salt and carbs I eat, and the quality of food. And home cooking doesn’t have to mean elaborate meals. Choosing one or two recipes a week keeps things interesting, and helps keep things simple. Use herbs and spices and find homemade recipes for things like salad dressing to avoid any additional additives outside of “real” food. Once you find recipes that are easy, you can adapt them to fit your own nutritional needs and your creativity.

3. Limit refined carbohydrates.

Actually, really just leave these out. I’m not an “everything in moderation” advocate. For most bariatric patients, refined carbohydrates is what got us into this mess.  Sugar, flour, rice, pasta and the like. There are some people who can work these back into their diets, but I know how easy it can be to go back to old habits. My recommendation is to steer clear of processed foods and find whole food alternatives to your favorites. Bariatric Eating is a great resource for recipes to help keep those cravings at bay.

I have been experimenting with whole grains, like millet, quinoa, and freekah. I find that I can use them as a condiment. I will add a tablespoon or two to a salad to provide some density and add fiber and protein. It’s satisfying enough, but doesn’t trigger any cravings for me. I am intentionally avoiding food like edamame or chick pea pasta, because I know if will be a trigger for me. I am a realist, and I see how quickly I can gain weight if not following the bariatric diet recommendations. I don’t want to be that person who gained all their weight back and more after gastric bypass.  I’ve just worked too hard for that. Everyone needs to find their own tolerance level.

4. Maintain consistent eating times and try not to skip meals

One of the most important things for me was to create a schedule/routine for myself around my meals. On a typical workday, I do a protein shake before my workouts, eat a small mid morning meal when I get to work, walk at lunchtime and then have a small lunch at 1ish, eat dinner around 6 and then have a shake before bed, or have my shake as a mid afternoon snack. This has worked well for me once I met my goal weight. I’m currently a few pounds higher than my goal weight which I attribute to being a limited activity, so I am reducing the number of snacks I have and really focusing on nutrient dense and lower calorie meals.  It’s HARD, but sticking with the routine helps me from getting too far off the rails.

5. Balance your plate

I have always tried to have a good balance of protein, carbs and fat at each meal, but the fat typically comes from healthy sources like nuts and seeds, avocado, or olive oil. Carbs are never simple carbs – they are typically vegetables or fruit, and I stick with he lower glycemic fruit like melon and berries per bariatric recommendations. I do my food prep and thinking about variety and creating balanced meals. Very often food prep for me is just making sure everything is washed and chopped and ready to go for mix/match salads, stir fries, or snacking.

So there’s my bariatric take on the IIN clean eating recommendations. When working with clients, I stress that everyone has their individual needs and can typically figure out which foods work best for them, but I look forward with helping clients with those discoveries to encourage variety, simplicity, and health — whether they choose a plant-based approach or not.

Interested in setting up a free coaching session? Contact me and we’ll set something up. You will help me develop my coaching skills, and we can work to find some tips to help you achieve your health and fitness goals too.

 

 

 

 

 

 

Staying positive in a world full of negativity 

Making lasting lifestyle changes takes work. A lot of work. And when social sites are part of the equation for your support system and connecting with helpful resources, it’s important to check in with yourself about the value of your social network and its content. 

I’m not even talking about the news and political climate. That’s a whole other ball of wax that I just can’t get into. I’m talking about your friends. We all have a friend or two who use Facebook as a way to vent, complain, namedrop, finger point, and basically bitch. 

Sometimes you just have to keep scrolling. Scroll, scroll, scroll. It’s so easy to let the negativity sink in, but if the positive support from your social network outweighs the negative, just scroll on by. Or hide them. Or de-friend. Your comfort zone gets tested every day, so do what’s best for you. 

But sometimes, life calls for a digital detox. Find sources of positivity outside of your social network. Like with nature and real people. Or give your dog or cat a hug. And if you don’t have a cat or dog, adopt one! Pets are great medicine. 

Fill your journal with positive affirmations and revisit them when you need a boost. Pinterest is always a great source of inspiration if you can’t completely break free of your phone. 

This post is brought to you by Dionne Warwicks’s “Walk on By.”

More joy, please.

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This has been a trying week for me but I’m forging ahead with my studies at the Institute for Integrative Nutrition. In this week’s module, I’ve thought a lot about the primary food of joy: the things that bring me joy, and how I can bring more joy into my life.

This level of introspection is challenging, but it’s really the key to understanding how to transform your life into one that attracts positivity, health, and happiness.

I was born in 1967, making me 50, and the same age as the Beatles’ Sgt. Pepper’s Lonely Hearts Club Band album. With the celebration of its release, I’ve been listening to a lot of their later albums on my commute. There is nothing like music you love to transport you to a different time and place, recalling memories so vivid it’s like they just happened.

Growing up in the 70s, my mom stayed home with me and my brothers. She was such an amazing mother. She taught me how to read well before nursery school, and she started my love of music with piano lessons at the age of 4. Music was always part of my life with my mom, whether it was singing along to Sesame Street or to the music in the car on road trips. The other day, Yellow Submarine came on the radio (Siriux XM has a great Beatles Channel right now), and of course I am singing along in the car and it completely brought me back to a moment driving with my mom to Northampton, MA, the little arty college town where we would have girls’ day out when I was in high school.  We sang in the car at the top of our lungs — the good old Buick Estate Wagon. Such a vivid memory, and a happy one.

I have some challenges ahead of me, but I’ve been trying to summon joy to my life where I can to help me process the shock of a cancer diagnosis. Music brings me joy, calms my overactive worrying tendencies, slows the heart rate, revisits happier times, and gives me strength. I feel less alone knowing I have these memories to power me through this, and my mother was one of the best role models in my life. Now SHE was brave. I will channel her influence in my own journey, and share my experience with my clients in the future.

I found this great quote: “Joy is a decision, a really brave one, about how you are going to respond to life.” (Wess Stafford) I will keep this in my heart in the weeks to come.

And meanwhile, back to The Beatles (Abbey Road, to be exact).

Battling Weight Bias When You are Battling Obesity

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I call myself an obesity ass-kicker because it’s a battle I’ve fought for more than 30 years. And I’m winning! But the process isn’t easy, and along the way I have experienced weight bias by the very people who are supposed to help us achieve health: doctors!

Look at the state of health in our country. According to a recent New York Times article, one in every three people is obese. I can’t even imagine how much money is spent treating obesity-related diseases. That’s what doctors are trained to do. Treat diseases.

Raise your hand if you’ve been told by a doctor you need to exercise more and eat less. I know I have. Countless times. It took me years to get someone to actually look at me as a whole person and try to connect the dots between obesity, thyroid issues, a pituitary tumor, and the inability to lose weight, in spite of the 1200 calorie a day diet. Just treat the symptom and there’s no need to investigate the root cause.

That’s why it’s more important than ever to empower yourself to be your own advocate through the healthcare system. I’ll have a story on that in the future.

The driver for this post is this article shared by the Obesity Action Coalition, Barriers to Obesity Care and How to Create a Support Team. I react when I read that someone isn’t being offered the best medical options because of their weight. As an overweight person with knee pain, I was told it’s arthritis and there’s nothing to be done and I should stop running. Oh, and lose weight. That’s it. No guidance, no alternatives, nothing. I’ve been there.

However, I have also been lucky to have physicians who advocated for me, helped empower me to make decisions that led me to a healthy weight, helped me work with the insurance company to appeal bariatric surgery denial, and get me to a bariatric surgeon who understands the science of obesity and the challenges for someone who has struggled their entire lives and fighting an uphill battle against their metabolism and co-morbidities.

It takes work to build a support team, to research so you know how to ask the right questions, to understand not just “diet” but nutrition and lifestyle changes needed to be successful, and to navigate the complexities of insurance and the healthcare system.  This gives me hope that the rise of holistic health coaching can be a compliment to medical care for people like me who battled obesity. There’s some great suggestions in this article about how to put together a medical team for support, but kicking obesity’s ass requires so much more support. I was fortunate to have a mentor through my weight loss process — another bariatric patient who could answer questions or tell me what to expect, cheer me on, or kick me in the butt when I needed it. That emotional support really completed the picture for me and launched me on this journey to becoming a health coach.

Completing the puzzle for bariatric patients

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When I was researching bariatric surgery for myself, I was initially given very little guidance from the referring doctor. Pinterest became my friend, and I discovered a few valuable resources, namely Reeger Cortell’s Weight Loss Surgery Podcast, which I recommend for anyone considering bariatric surgery and for post-surgery patients at any and every stage. I have links to a few other resources on my personal blog. I also joined a number of different Facebook “support” groups.

On these groups, you’d see questions like:

I’m six weeks out from surgery. When can I eat pizza again?

No joke. This is the one that I always cite as an example of a SMH moment. You’ve undergone major surgery, with many risks, and you’re thinking about pizza? I see people making taco shells out of cheese or pizza with wonton wrappers — basically continuing the same eating patterns that resulted in the need for surgery.

A few things about bariatric surgery: whether you choose a sleeve gastrectomy or Roux-en-Y gastric bypass, the surgery is on your stomach, not your brain. Your sleeve or bypass is just a tool and part of the equation. And it’s a very powerful tool! To some degree, the weight loss will continue over the course of 12-18 months. Some people lose with easy, while some people have to follow the dietary guidelines to a T (that’s me — more on this later). And incorporate exercise immediately post surgery. Behavior change is key. And building healthy habits needs to happen before surgery.

Some bariatric programs have amazing support. Orientations, nutrition classes, guidelines for supplementation following surgery, meetings with psychologists and nutritionists, and active support groups. It’s obvious, however, from observing the conversations in these Facebook groups that people are not researching this surgery prior to permanently altering their bodies, nor do they receive proper pre-surgery education or post-surgery follow-up. This education and support is something I see as a gap in the bariatric surgery process.

I’m one of the most fortunate patients. Not only am I a rule-follower who thrives on structure and rules, but I also had a fantastic surgeon who provided excellent guidance both before and after surgery. She teaches the nutrition classes herself, and is far more knowledgable about nutritional needs, malabsorption, quality of supplementation, adjusting for stubborn metabolisms, and other guidance following surgery. Her practice now has a private support group ( which I’ll add that I helped start up and function as an admin), and she is actively participating in the discussion.

As a health coach, I can help close that gap by coaching from experience. I am still working on reinforcing the positive lifestyle changes required for being an obesity ass-kicker. The most important thing I have learned is that everyone has their own unique journey. People lose weight at different rates, people have difference medical co-morbidities that may change how their bodies’ metabolism functions, and people react differently to certain foods. Guidelines are just that – guidelines. Everyone has a unique prescription for unlocking their optimal health, even bariatric patients. They just need to discover what that is. I still have more discovery to do in order to hit that sweet spot, but I am enjoying what I am learning from the process.

And the answer to the question “when can I eat pizza again?” — for me, it’s never. However, the exploration of more appropriate options is all part of the fun.