Recovering from weight loss surgery? Take your vitamins!

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the importance of vitamin and mineral supplements after weight loss surgery.

For optimal health, the body needs 13 essential vitamins and nine trace minerals daily. Typically, the best way to get these nutrients is through a varied diet, as outlined in the USDA Food Guide Pyramid. The dietary restrictions following weight loss surgery make it difficult to obtain the daily recommendations of vitamins and minerals from food alone. Therefore, people recovering from weight loss surgery are strongly encouraged to take vitamin and mineral supplements for proper nourishment and to aid their recovery.

Vitamin and mineral supplements are particularly important during the post-surgical period. Weight loss surgery restricts the amount and type of food that can be consumed. Solid foods are reintroduced into the post-surgical diet slowly and gradually, which means it can be an extended amount of time before patients are able to eat a healthy, nutrient-rich diet.

In addition, gastric bypass can cause malabsorption of important nutrients, making it even more important to compensate with vitamin and mineral supplements. Gastric bypass and sleeve gastrectomy can impair the release and absorption of vitamin B₁₂. By bypassing part of the intestines, gastric bypass can also lead to intolerance of calcium-rich dairy and impaired iron absorption. Taking sufficient supplements can prevent irreversible nutritional deficiencies.

The American Society of Metabolic and Bariatric Surgery provides guidelines for vitamin and mineral supplementation following weight loss surgery.

Multivitamin and mineral supplement:

• The supplement should contain 100 percent of the daily value for at least two thirds of the nutrients listed on the nutrition facts label. The product you select should be reviewed and approved by your bariatric team before surgery.
• Chewable tablets are recommended for the first two to three months after surgery.
• Start taking vitamin and mineral supplements on the first day home from the hospital.
• After adjustable gastric band surgery, one multivitamin a day is typically required.
• After gastric bypass or sleeve gastrectomy, two multivitamins a day are typically required.

Calcium with vitamin D:

• For optimal absorption post surgery, take a product with calcium citrate and vitamin D₃.
• Chewable tablets are recommended for the first two to three months after surgery.
• Calcium intake should be between 1500 and 2000 mg daily.
• Doses should be divided. Take no more than 500 to 600 mg at one time.
• Do not take calcium and iron supplements at the same time. They must be taken at least two hours apart.
• Start taking calcium supplements on the first day home from the hospital.

Vitamin B₁₂:

• A sublingual (under-the-tongue) tablet containing 500 micrograms of vitamin B₁₂ can be taken daily or monthly intramuscular injections of B₁₂ can be given by a primary care physician.

• While the body does store vitamin B₁₂, it is recommended that supplementation begin on the first day home from the hospital.

Iron:

• Additional iron may be needed for menstruating women or those at risk for anemia.
• The amount of additional iron required is determined on an individual basis.
• Do not take iron at the same time as calcium supplements. They must be taken at least two hours apart.

Essential Vitamins:

1. Vitamin A
2. Vitamin D
3. Vitamin E
4. Vitamin K
5. Vitamin C
6. Thiamin
7. Riboflavin
8. Folic acid
9. Niacin
10. Vitamin B₆
11. Vitamin B12
12. Pantothenic acid
13. Biotin

Trace Minerals:

1. Iron
2. Copper
3. Zinc
4. Fluoride
5. Selenium
6. Iodine
7. Manganese
8. Chromium
9. Molybdenum

Make sure to consult your health care team before starting or changing vitamin and mineral supplementation following bariatric surgery.

- Karen Buzby, RD, LDN

Eat Meals Slowly: It’s Worth the Time!

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, recommends slow eating for weight loss, especially following bariatric surgery.

Today’s fast-paced world leaves little time for enjoying a leisurely meal. The lack of time for eating meals can be problematic, especially for people recovering from bariatric surgery. Eating slowly is an essential component of successful bariatric surgery. Eating too quickly or not chewing food thoroughly can result in gastric pain, pressure and vomiting.

Health care professionals recommend learning to eat slowly in the months leading up to bariatric surgery. This helps make slow eating a habit. In addition, slow eating often results in a sense of fullness from a smaller portion of food, which contributes to weight loss. It takes roughly 20 minutes for the brain and stomach to register fullness, so taking time to eat a meal can help you realize you are satisfied before you overeat.

Tips to help you slow down:

- Eat smaller but more frequent meals to keep you from feeling too hungry at any point in the day. Focus on protein- and fiber-rich foods to keep you satisfied.

- Sit down when you eat and reduce distractions. Turn off the television or computer and focus on enjoying your food. Take time to appreciate the look, smell, taste and texture of the food.

- Cut food into smaller pieces and use a smaller utensil, such as a baby spoon.

- Put your utensil down and chew thoroughly between bites.

- Look at the clock when you begin and finish eating or use an egg timer. Gradually increase your meal times.

Get more tips on how to slow down your food consumption pace at the next support group meeting. Click here for a list of upcoming support group meetings.

- Cara Stewart, RD, LDN

Organic Produce: Is it worth the price?

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains when the higher cost of organic produce is a good value.

Incorporating a variety of fruits and vegetables into your daily eating plan is an essential component of a healthy diet. Organic produce has become more widely available in major grocery stores, but it is often sold at a higher price. When is organic produce worth the price?

The Environmental Working Group (EWG), a nonprofit research and advocacy organization, developed lists of the most and least important fruits and vegetables to buy organic. The “Dirty Dozen” lists the produce containing significant amounts of pesticides even after high-pressure washing. The higher price of organic produce is worthwhile for all of the items on this list.

Choosing organic for produce on the “Dirty Dozen” list can reduce pesticide exposure by as much as 80 percent, according to the EWG. Pesticide exposure has been linked to cancer, nerve damage, reproductive problems, birth defects and more.

The “Clean 15” refers to the fruits and vegetables containing the least amount of pesticides. The EWG recommends foregoing the higher price of organic produce for these items since they are safe to eat even when conventionally grown.

Next time you’re in the produce section at the grocery store or farmers’ market, refer to the “Dirty Dozen” and “Clean 15” lists to determine when it is worthwhile to buy organic and when it is not. For quick reference, download the EWG’s “Shopper’s Guide to Pesticides.”

Dirty Dozen

• Peaches
• Apples
• Sweet bell peppers
• Celery
• Nectarines
• Strawberries
• Cherries
• Pears
• Grapes (imported)
• Spinach
• Lettuce
• Potatoes

Clean 15

• Onions
• Avocado
• Sweet corn (frozen)
• Pineapples
• Mango
• Asparagus
• Sweet peas (frozen)
• Kiwi fruit
• Bananas
• Cabbage
• Broccoli
• Papaya

- Cara Stewart, RD, LDN

Banana Berry Smoothie: Healthy, Tasty and Easy to Make!

Homemade fruit and yogurt smoothies make a refreshing and tasty addition to your diet. They can be a healthy breakfast option or replenishing post-workout snack. Quick and easy to make, fruit and yogurt smoothies are a good source of protein and fiber. They can even be part of a post-operative liquid diet. For an extra nutritional boost, use Greek yogurt in place of regular yogurt to double the protein content without increasing the volume or calories.

Ingredients:

• 6 ounce container of fat-free plain Greek yogurt
• ½ cup frozen berries (any type, organic if possible)
• ½ frozen banana
• ½ cup skim, 1 percent or soy milk

Optional additions:

• 1 packet of no-calorie sweetener such as Splenda® or Truvia™
• Dash of cinnamon or nutmeg
• Splash of vanilla extract

Directions:

1. Put ingredients in blender and blend until smooth
2. Pour smoothie into glass or to-go cup
3. Enjoy!

The recipe produces one serving and contains 215 calories, 20 grams of protein and 3.5 grams of fiber.