FAQ: Vitamins and Supplements in the Bariatric After Life

I get a LOT of questions about the vitamins and supplements I take on a daily basis. (Probably because I comment a lot about the vitamins and supplements I take on a daily basis). Most of the questions revolve around what, how much, and why I take what I take. So, I figured I’d make it easy and just encapsulate it here. Bear in mind that I am NOT a nutritionist, doctor, nurse, medical professional, healthcare practitioner, or vitaminologist. I did my research, paid attention to people I trust, and have gleaned all of this stuff from their expertise.

What supplements do I take, and why?

Multi-Vitamin. I like Celebrate chewables the very best, but I also sometimes take Bariatric Advantage multi. Either way, I ensure that the formula includes Vitamin K. Why? Because it has been suggested that Vitamin K can prevent or treat osteoporosis and the loss of bone density. Some studies also find that it might have anticancer benefits, and indication is that it prevents hardening of the arteries, which aids in preventing heart disease and heart failure. You can get Vitamin K from many green, leafy veggies, but if you can’t get them all there (and who can?), be sure your multi-vitamin includes it.

B-12 (Sublingual)
First off, the reason you take this sublingually is, that’s the best and fastest way for the body to absorb it. Now, B12 is needed to prevent anemia and aids folic acid in regulating the formulation of red bloods cells. It helps utilize iron, is required for proper digestion, absorption of foods, synthesis of protein and the metabolism of carbohydrates and fats. It’s ideal if your B12 supplement also contains folic acid (I buy mine from Trader Joe’s).

Possible signs of deficiency: Chronic fatigue, constipation, depression, digestive disorders, dizziness, drowsiness, enlarged liver, eye disorders, hallucinations (!), headaches, inflammation of the tongue, irritability, memory loss, moodiness, nervousness, palpitations, ringing in the ears, pernicious anemia (no, not promiscuous anemia) and other stuff.

Natural sources of B12: If you are veggie (like me), you must remember to supplement religiously, because B12 is found almost exclusively in animal tissue. It can be hard to spot deficiency because your body can store B12 for up to FIVE YEARS!

Folic Acid (as part of my sublingual B12)
Brain food. Folic acid is need for energy production and formation of red blood cells. It strengthens immunity by aiding in the proper formation and functioning of white blood cells. Aids in protein metabolism and may help depression and anxiety.

Signs of deficiency: A sore red tongue is one sign, but so are anemia, apathy, digestive disturbances (heck, I’m one BIG digestive disturbance since bypass – LOL), malabsorption problems (just what we need, right?) fatigue, insomnia and other junk. Important: Eat fresh fruits and veggies wherever possible because cooking them destroys the folic acid.

B-Complex (B1, B6, B12)
Why B6? Also known as pyrydoxine, it is involved in more bodily functions that almost any other single nutrient. It affects both physical and mental health and is beneficial if you suffer from water retention. This vitamin aids in potassium balance and is required by the nervous system for normal brain function. B6 helps the body absorb B12 and plays a role in cancer immunity.

Signs of deficiency: Anemia, headaches, nausea, flaky skin, sore tongue, acne, arthritis, conjunctivitis, cracks or sores in the mouth and lips, depression, dizziness, fatigue, hyper-irritability (and you thought it was all hormones!), impaired wound healing, weak memory and other stuff.

B1 (Thiamine).
This is also known as the energy nutrient and is responsible for many cellular interactions in the body. One of the key things is that it helps your cells use oxygen to convert carbs and other sugars into energy. Without adequate levels of B1, this process slows or stops altogether (eek!)

Possible signs of deficiency: Loss of appetite (okay, that might be a bonus), tiredness or feelings of extreme laziness, indigestion, constipation, muscle tenderness (like when you get charlie horses), numbness in arms and legs. It’s hard to overdose on B1, but still, you shouldn’t megadose on it

Of note: People who are at risk for B1 deficiency include: alcoholics and coffee or tea drinkers (basically, anyone who drinks more than 3 cups of coffee per day.) Why? Since you will excrete the B1 through your kidneys, you might need 5-10x the amount of B1 as other people Hmmm…maybe I should *stop* taking my vitamins with my coffee…

Natural sources of B1 include: Sunflower seeds (raw), tuna, black beans, lentils, asparagus and romaine lettuce. However, you kinda have to eat a LOT to get enough, so…while it doesn’t hurt to get B1 through food sources, it’s most likely not enough, so you must supplement!

Calcium
Okay, I’m not gonna go into the whys and wherefores of this stuff because everyone says something different. All you need to know is this: Most people agree that the best form for bariatric folks is citrate. How much you take is really going to depend upon your doctor’s advice, your bloodwork, and your own research. Again, depending upon who you talk to, you’ll be told that you need between 1200 and 2000 mg PER DAY of this stuff, over and above the calcium you get from food sources (like greek yogurt). The most critical thing you should understand is that, unless you are a professional, you mustn’t mix your calcium with your iron; separate them by at LEAST 2 hours. Also, don’t take more than 400-500 mg at a single dose, as your body will not absorb it. We all know that calcium is critical for bones and teeth, and we bariatric people don’t absorb it easily, so we are prone to brittle bone disease, osteoporosis and other stuff. Just take it, okay?

Iron
Here’s another supplement where your mileage may vary. Ferrate sulfate, elemental? Who knows, right? The bottom line is, just take it. Do your research, figure it out, and take it — BUT, don’t do it at the same time as your calcium and…try adding Vitamin C to help absorption. Some formulations will lead to constipation; others are more gentle, so find one that works for you. That’s all I’m gonna say about that (I’m no expert!)

Probiotics
Many bariatric surgeons have finally learned that probiotics are vital to the daily supplemental regimen of their patients — but sadly, many have not. Whether your doctor agrees or not is none of my business, but I’ll just tell you that I feel it when I don’t take it.

Why? Because I get bloated, constipated (especially if I take the wrong iron), am prone to yeast infections, fatigue and low immunity. Basically, probiotics (as the name implies) are the opposite of ANTIbiotics. They help put good bacteria back into your system (intestines and gut, mostly) to promote balance and good health. Probiotics keep your intestines clean and help you absorb more nutrients from the food you eat (especially protein!)

Find a good, stable probiotic (like Bariatric Advantage Chewable, or Jarrodophilus EPS capsule). These don’t need to be refrigerated, and each contains billions of live cultures — (no, you can’t see them move! LOL) The key to stability is, you want something that will last more than a year, or it loses its efficacy.

Fish Oil (EPA/DHA)
Omega 3 fatty acids are good for your heart, because they can decrease the risk of arrhythmias, lower blood pressure (slightly) and slow the growth rate of plaque in your arteries. You get Omega 3s from eating fish, but if you can’t eat enough fish, you can take capsules. Oh, you can also get it from flaxseed (which I just so happen to add to my morning shakes!) Now, you don’t want to go crazy with the capsules, just take 1 or 2 a day. This stuff also helps your skin and hair, so it’s a good thing.

Possible signs of deficiency: There are about a bajillion signs, but my favorite is listed as “aging.” Apparently, aging is a side effect of not taking enough Omega 3s. Okay, okay, I’m pretty sure that’s not what they meant, but still, it did stand out. I think they were referring to looking older than you are (wrinkles) feeling older than you are (depression, fatigue), and being prone to lots of nasty things (like alzheimers, diabetes, chorines disease, macular degeneration, obesity — um, yes, that would count, stroke, kidney disease and even cancer.) Bottom line: Just take it.

But, I hate it when I burp fish taste after taking a capsule.

Cinnamon Extract
Not only does cinnamon extract KILL the fish burps, it’s also great for maintaining health blood sugar levels! In other words, if you take one of these with each fish capsule, you shouldn’t experience peaks and valleys associated with blood sugar spikes. Oh, and it smells really nice, too.

Vitamin D3
First of all, Vitamin D3 isn’t really a vitamin at all, but is a hormone mainly used to signal the release and absorption of calcium and phosphorous from various body tissues. If you get sun, you should be able to synthesize Vitamin D3, but you can also get it in fortified foods like milk, butter, eggs, margarine, as well as beef, veal, egg yolks, liver and fatty fish. Yes, you CAN overdose on this stuff, but it’s fairly hard for us post-ops. Experts don’t agree on exactly how much you should take, and it is often contained in your quality multi-vitamin and calcium tablet, but I just take more because it can help with my depression (since I don’t get out in the sun too often) and it protects me from prostate cancer. Oh, I don’t have a prostate? Okay, then breast cancer. Either way, it’s good for boys and girls, so just take it.

Possible signs of deficiency: Rickets. Yup. You can get rickets, which is where your bones become brittle. Not good. You can also develop osteoporosis, which you won’t be aware of until the outwards signs are readily noticeable. In other words, you might not be aware of the deficiency until you break a bone, and by then, it’s kinda late.

Okay, so that concludes our presentation of the “ordinary” vitamin supplements that you hear about every day.

Now for the extra-ordinary vitamin supplements.

Ubiquinol + CoQ10
Ubiquinol is the pre-convered, active antioxidant form of CoQ10 which, when taken in this form, is ideal for those of us who are 40 and older. If you are under 40, then you can just take CoQ10.

Why take it? Well, it contributes to cardiovascular and cognitive health, increased energy and stamina and general health and wellness. It also regenerates other antioxidants (like Vitamins C and E) and may help protect your heart from free radical damage. So, what are free radicals (and why should I care, if I’m a political conservative)? Well, politics aside, free radicals are unstable oxygen molecules that every cell produces every day. In other words, our bodies generate them. But they are also available eternally (like environmental toxins) Basically, these nasty little buggers break down our bodies as we age (and the side effects aren’t pretty). Antixoidants help combat the effects of the free radicals (which is a good thing). Essentially, I take this so I have more energy, feel better, and won’t get old. Okay, I’m kidding about that last part — but…maybe?

Natural sources of antioxidants: Blueberries, blackberries, strawberries, grapes, garlic (probably best not eaten with your fruit), and extra virgin olive oil (apparently, olive oil which merely *abstains*, but does not take a permanent vow of *celibacy* doesn’t count. Be careful here).

Milk Thistle
Why? It’s for liver health, and I had hepatitis in high school. Darn near killed me, so I do lots of things to protect my poor liver. Milk Thistle not only my liver from toxins, it also helps repair cells and promotes the regeneration of new cells. If you still have your gall bladder (which I do not), this stimulates bile flow and can help prevent and treat gallstones. It is also good for your immune system, digestive system, can help smooth the uterine muscle (thus minimizing menstrual problems), and control food and sugar craving (time to up my dosage…)

Why is liver health important and how can I be at risk if I don’t drink alcohol? I’m glad you asked. Turns out that diets which contain “excessive” protein and carbs can DAMAGE the liver. We bariatric types do eat a lot of protein, even though we don’t absorb all of it, but guess what else we do? We take VITAMINS — things like A, D, E and K can be dangerous to the liver if you take too much of them; same with iron. SO, you want to just watch your liver when you get your blood work done each year, and make sure to exercise regularly. That’s the laymen’s explanation, anyway.

Amino Acids
Basically, our bodies need amino acids to function, but our bodies don’t make all that we need. Therefore, we have to consume them in food or through supplements. You’ll typically be able to spot an amino acid because it ends in an “ine” — though not always. Now, any aminos that your body cannot produce on its own are called ESSENTIAL amino acids, and they affect different things.
These are the ones I take. There are more, but I don’t want to get crazy. Whoops, too late.

L-Glutamine (Technically, this is a semi-essential amino)
Protects muscle tissue and supports immune function; also serves as a source of fuel for cells lining the intestines. It is involved in more metabolic processes than any other amino acid and can help maintain balance during times of severe stress. Yes, I have that.

Glucosamine, Chondroitin with MSM
Promotes healthy flexible joints. I work out a lot and really trashed my joints — especially knees — when I was obese. This helps with stiffness. Some people doubt its efficacy, but I truly notice it when I don’t take it. No, not right away, but that’s because I am slow to notice sometimes – LOL.

Alpha-Lipoic Acid:
Antioxidant (hey, where have I heard THAT before?) that helps detox the liver! Again with the liver. This is one that I *don’t always take* and am *not sure I notice* anyway. I may not “renew”…

L-Carnitine:
It’s an amino acid derivative which is manufactured by the body and used in energy metabolism and for proper use of fats by transporting fatty acids into mitochondria (the powerhouses of cells). In other words, it can help you recover when you work out AND it reduces the accumulation of lactic acid (all the gain without the pain).

Benefits: Good for your heart, good for your thyroid, good for your kidneys, good for immune problems, cardiomyopathy and a bunch of other stuff. Most people don’t need it, however, people with a history of liver disease (hey, that’s me – again!) seem to benefit from therapeutic use

Quercetin with Bromelain Enzymes
Allergy support that maintains the proper functioning of the body’s histamine response. Brings natural sinus support. Quercetin is an antioxidant (there’s that word again) that supports the body’s inflammation response and histamine processes, while bromeliad increases the absorption of quercetin. The ‘ole 1-2 punch It is also a powerful inflammation response supporter AND (wait for it) protein-digesting enzyme! Hey, we need that. I take it because I am allergic to everything. Simply everything. My throat likes to swell and then I cough and gag — nice. This helps.

That concludes our presentation of vitamins and supplements in Gastric Bypass Barbie’s Bariatric regimen.

SO. How much of all this stuff should you take, and do you need it all?

I can’t answer that question; only you and your healthcare professional can make that determination. What I would suggest is this: If you are taking the vital supplements as outlined by the bariatric surgery guidelines, and still don’t feel “quite right,” look into adding some supplements (responsibly), based upon your medical history and particularly symptoms. I’d recommend adding slowly, doing your research, and monitoring your blood work closely. It is important to determine the proper dosage for your body, and also recognize that you can take too much (or too little) of something to derive the benefit, so be educated.

I hope you found this information to be useful, but if you didn’t, that’s okay too. You don’t need to ask me why I take all of this stuff, and you don’t need to tell me I shouldn’t be taking it, and you don’t need to tell me I misspelled “rickets”, or something.

After a year and a half of studying it, I KNOW why I take it, how much to take, and how to spell it — LOL.

GOOD LUCK AND GOOD HEALTH!

AS MUCH CALCIUM AS A GLASS OF MILK!

(So proclaims the packet of Swiss Miss Hot Chocolate)

What’s your first impression when you read that? If you’re like MOST people, it’s: “Hey, it must be healthy! As much calcium as an entire glass of milk?! Who knew?”

Right.

So, here’s how my little brain works now (because it is skeptical and questioning of EVERYTHING):

1. How BIG a glass of milk? 8 oz.? Too much for me.
2. What TYPE of milk? Skim? Whole?
3. How MUCH calcium is actually in that glass of milk?
4. How much calcium do I NEED each day?

Now, understand that I would never dream of using this product — aside from the fact that it is loaded with sugar, it’s nothing I need — but my point is, in my Bariatric After LIfe™, I have learned to apply the same healthy logic to ALL products — EVEN those targeted directly to us bariatric types!

I guess it’s funny that, in this “sound bite” world where we all have the attention span of fleas sometimes, marketers have learned to whisper nonsense into our ears, and we believe it! Case in point:

• Fat Free! (Not sugar free)
• Low-Calorie! (Not fat free)
• No Added Sugar! (But has sugar)

If there is one thing I hope for all of us, it’s that we learn to ignore the headlines and go immediately to the fine print. Read the “second-to-the-last” paragraph of the article; turn the page; do whatever it takes to get the FULL story. Our bariatric bellies do not forgive us for ignorance of the law; when it comes to our bodies, we will GET exactly what we GIVE.

As much Calcium as an entire glass of milk? Who cares? I take Calcet Bites or chew my Celebrate wafers and do just fine (thank you).

Just some random thoughts for a Wednesday hump day afternoon. Now, off to my mani-pedi.

Is it possible to weigh what you want and never regain?

Probably the most common fear among WLS patients is WEIGHT REGAIN, followed closely by FEAR OF NOT MAKING IT TO GOAL. Well, I have some good news for you that should take the guesswork out of the process for you. You just have to answer some simple questions, then determine what you can commit to, in terms of activity and eating, and go from there.

Let’s get started!

In thinking about your life BEFORE you became obese:

1. Were you ever an ideal weight in your life?
2. If you were, how old were you?
3. How active were you at that time?

Now think about life AFTER you became obese:

Now think about life AFTER you lost your weight:

1. What was your lowest weight?
2. Was your lowest weight the same as your ideal weight?
3. Were you able to maintain this weight, or have you regained?
4. How active were you at your lowest weight?
5. How active are you now?

Okay. Time to put it all together.

Let’s say that you are a 5′4″ woman who weighed 125 pounds for most of her young adult life. You were active at least 4-5 days a week, by going to the gym, running at the park, or riding your bike.

Now, let’s say you gained a lot of weight and, by the time you were 40, you weighed 305 pounds and didn’t move much.

Next, let’s say you had bariatric surgery and shed 150 pounds. You now weigh 155 pounds, exercise moderately 3-5 days a week, and are following a fairly healthy bariatric eating program.

• Is it possible to reach your formerly “ideal” weight of 125 pounds?
• Is it practical or reasonable?
• What if you just want to maintain your 155 pound body and not regain from there?

Here are the factors to consider:

1. You are older.
2. Your metabolism is different — slower — but not impossible to “fix”
3. You are malabsorptive post surgery, but you still have to eat less than an “ordinary” 155 pound, 42 year old, 5′4″ woman, because you are formerly obese, and have fat cells the other woman doesn’t have to contend with.
4. You are probably not as active as you were when you were a young adult.

BUT…

• What if you are more active than you were when you were younger?
• What if you never weighed an ideal amount in your youth?
• What if you’re taller now than when you were a young adult?

Okay, these are variables to your equation. No problem.

What you have to do is figure out how active you must be in order to achieve/maintain the body weight you desire. If you were a size 8 as a moderately active young adult, then ballooned to a size 28 as an inactive obese adult, then lost weight and now are an moderately active woman who wears a size 10, what will you have to do to wear a size 8, or even 6?

You’ll DEFINITELY have to increase your activity level — but it will have to be manageable, something you can maintain, something your lifestyle will permit. Remember, when you were a young 20-Something, you might not have been married or had children. Things are different now, so you have to consider those factors in your activity plan.

If you are currently active 5 days a week for an hour a day, can you add 30 minutes 2-3 of those days?

If you can’t, then you will probably need to come to terms with the fact that a size 10 is probably the most reasonable size for you to maintain. If you CAN increase your activity level, do it at manageable intervals — don’t do it overnight, or you won’t keep it up!

The next area to consider is your eating.

If not, maybe you can tighten that up a bit. Cut out the coffee with creamer; make sure you’re getting enough protein and fluids; watch those carbs and sugars.

The point is, if you want to maintain your weight (or reach a lower weight), you need to be sure:

1. It’s a reasonable weight for your body size/shape/height
2. It’s a reasonable weight for your level of activity
3. It’s a reasonable weight for your eating program.

if those three things are true, then you CAN do it. You just have to stay active and watch what you put in your mouth.

Hey, that sounds like advice from every fitness or medical professional on the planet.

I guess there must be something to it

Suck It Up.

You know, if I had a nickel for every time someone told me they “don’t like protein shakes,” I’d have at LEAST $.50.

“But, I just don’t LIKE protein shakes.”
“They don’t taste good.”
“They make me gag.”
“It’s a texture thing.”
“I don’t have time to make them.”
“I hate chocolate.”
“I hate the grittiness.”
“They’re gross and disgusting.”
“I get all of my protein through food.”
“They’re too much work.”

I have one thing to say to all of those complainers: SUCK. IT. UP.

Okay, okay, in all fairness, maybe some of those complaints are well-deserved, I mean, how many of us were tortured by gritty, disgusting protein drinks while trying to lose our weight on the latest liquid diet craze? We were tortured with SlimFast and OptiFast and whatever other junk is out there. But, I contend those aren’t REAL protein shakes at all; they are pretenders to the protein throne; crap in a can (as my friend, Dave would say).

As a gastric bypass patient living a successful (and healthy) after life, I’ve learned that if I want to keep my weight off and not develop nutritional deficiencies, protein supplements — especially shakes — are critical to my long-term health and success. Aside from the fact that I simply cannot get all of my protein in through chicken, beef, cheese or eggs, shakes are quick and easy, taste great, and keep me satisfied longer than ordinary food. Basically, I figured out pretty quickly after surgery that being healthy was gonna involve stuff I didn’t really like, so I’d better find a way to tolerate (and even enjoy) it.

Case in point: FISH.

Anyone who knows me will tell you how much I have always hated fish. Even tuna, if I get a fishy batch, will cause me to wretch. So, how do I get those healthy Omega-3’s down the hatchet, if I won’t eat fish? Simple: Find a fish I DO like and run with it. Of course, this means that I must TRY fish and run the risk that I still don’t like it. For example, I recently learned that I actually like mango mahi mahi, love fresh grilled Washington salmon in wild meat sauce, and still hate tilapia and cod. (Then again, maybe I just haven’t found a WAY to like those last 2?) Whatever the case, if I hadn’t been wiling to try, I never would have known that there is actually fish out there with my name on it!

Here’s another one: ASPARAGUS.

I cannot tell you how long I have hated asparagus. It’s stringy and tough and limp. Yuck. How can anyone eat a vegetable that is better used as dental floss? Simple: By blanching it (to retain greenness) and BBQing it (with a touch of olive oil and ground lemon pepper). Then, it’s crisp and tasty. Then, I love it. But, as hubby learned, it’s a fine line for me; if he grills it and kills it, I can’t touch the stuff.

So, the moral of the story is: Find a way to prepare (whatever it is) right, and you might find something (whatever it is) you’ll actually like (but thought you hated!)!

At the end of the day, there are ways to make things work — if you’re willing to put forth the effort and actually give it a try. What’s the worse thing that could happen? You decide you still don’t like it. What’s the best thing that could happen? You find that you might kinda sorta like it — given a little more massaging. Or, in my case, you could learn that protein shakes are like CRACK and you can’t get your day started without one. I am secretly terrified that my blender will break, leaving me high and dry, unable to feed my addiction…but I digress.

Cardinal Rules of Quality Protein Shake Making:

1. Begin with a quality, good tasting protein, like: Jarrow Whey, Whey Gourmet, Dymatize Elite, 100% Designer Whey
2. Get a good blender. Lots of people swear by the Magic Bullet, but I prefer my little JCPenney 5-in-1. If you have the money to spend, Allie (protein girl) swears by her Vita Mix.
3. Use a good liquid base. I like Soy Milk, but others use Almond or Rice Milk. I stay away from milk because I’m allergic to it, but it’s also a bit heavy. When you pick your liquid, just make sure it’s not loaded with sugar!
4. Be creative! Try adding things like spinach leaves, shredded carrots, cherry tomatoes, strawberries, cucumber, sugar free Jello or Pudding, instant coffee, blueberries and flax seed meal! Each of these makes your shake that much healthier, and keeps things “fresh.” Nothing worse than a boring old chocolate or vanilla shake, day in and day out!
5. Have fun and enjoy!

The bottom line is: Health involves taking risks, trying new things, and doing the work. It isn’t free and it isn’t always easy, but, MAN, is it ever worth it!

• Do you shun protein supplements?
• Are you guilty of limiting yourself?
• Have you been lazy or unwilling to try something new?
• Have you ever given protein a fair shake (pun intended)?

I guarantee you there is a shake out there that you will love. It might have strawberries, blueberries and carrots, or maybe vanilla with some peach flavored sugar free jello. Maybe it’s pistachio with a hint of cucumber? Maybe it’s a chocolate cafe mocha supreme. Whatever your “thing” is, you’ll never find it, unless you’re willing to try.

If you don’t believe me, ask Allie (Protein Girl) or Deb (Smoothie Girl). They’ve found heaven in a cup, just like me!

Starbucks or Bust:
Barbie Goes to Seattle

So, Me and “Ken” are winging our way to Seattle (home of Starbucks) tonight to visit our very best friends on the planet (Helllooooo Mark & Jan!!!) I am so excited I can’t SEE straight! It’s been 2+ years since we were able to “get out of sight,” — both due to money woes (“Ken” wasn’t working for 5 months, but thankfully landed a new job last week. Yes, I know that it’s bad form to take time off the 2nd week of your employment, but you can’t just cancel non-refundable plane fare…), and because of all of my surgeries (4 since December 2007). So, this has been a long time coming.

Exciting Changes
Here’s the cool thing: This is the first time flying since my gastric bypass surgery! Last time I went anywhere, I weighed 270 pounds and had to spend 2 weeks (during the hottest month of the year, in the middle of typhoon season) in China/Hong Kong/Japan and Singapore for business.

Now, for the first time in my life, I will fit in the MIDDLE SEAT and not ooze onto the person on either side of me (well, except “Ken” — but that’s only to cuddle and look out the window). I will have legroom and the tray will not touch my lap (or go downhill, making my drink slide into the back pocket of the seat in front of me if I dare to let go of it). I will be able to walk up and down the aisles without having to contort my body into strange positions to avoid stuffing my butt in people’s faces, and I will not be winded from walking to and from my gate — no matter HOW far out in the terminal it is! Needless to say, I’m pretty giddy about the whole trip.

And don’t think I’ll be taking a vacation from exercise!!! No way! My friend belongs to CURVES, so we’ll be starting our mornings there (yea!) and throwing in little walking trips to Seattle and local wilderness areas.

Making It Work
About the only downside (or at least challenging part) of this journey has been packing my protein!!! I do not eat like most gastric bypass people, so I REALLY have to prepare before I go anywhere. For starters, there’s my shakes…I am OCD about my shakes. They must be a certain flavor and consistency, and the only way to achieve this is by following a secret recipe containing a proprietary blend of fresh spinach leaves, chile powder, Splenda®, Jarrow Whey Protein, soy milk, Egg Beaters, and PRECISELY 8 ice cubes (from an automatic ice cube maker.) All of this must be blended to perfection in my JCP Handy 5-in-1 Blender. If this doesn’t happen, then I am a very cranky Barbie for the rest of the day.

Embracing the Pack-Out
After I made my morning shake this morning, I packed up my blender and shoved it into my check-in bag (which is getting bigger and bigger by the minute, thanks to the aerosol hair products and other junk that exceeds 3 oz, and cannot be stored in your carry-on bag). I then had to pack up my protein mix (which fits neatly into individual little ZIPLOK snack baggies) and shove it into my carry-on. My dear friend, Jan, is going to buy the fresh ingredients at Trader Joe’s for me, so all I had to do was pack the “dry ingredients.”

Next: My vitamins – You know, that fistful of vitamins and supplements that I must take every day. I bagged those up in individual ZIPLOK snack baggies (one for morning; one for evening) and then put all of those into a quart size bag. That went into my check-in baggage (Lord help me if they lose it!).

But, that’s not all! I still had to pack my Atkins bars and my Revival Soy chips (those went into my carry-on bag so they won’t get crushed in my luggage). I figured I need to have a bag handy for when the flight attendant hands out the bags of peanuts…

What else? What else? Protein? Check. Hair products? Check. Make-up? Check. Fluids in little 3 oz. clear bottles? Check. Bags of healthy snacks? Check. Toiletries? Double Check.

What, on EARTH could I have missed? There wasn’t much room left in my bags, but I just had this nagging suspicion that I was leaving something out…Oh yeah! Clothes.

Did I mention it has been about 51º in Seattle? Did I mention that I have no insulation on my bones and live in Southern California (where we throw a down comforter on the bed when the temperature dips to a chilly 71º)? So, there’s layering involved; and coats — lots of coats…and warm jammies….and shoes…and hiking boots (you can’t go to Seattle and not bring hiking boots). Needless to say, my suitcase weighs more than me now, but that’s okay because it has wheels. And, besides, I had to pay an extra $15 per check-in bag, so I had to make it worth my while.

DONE.

After that, it was off to work to try and wrap things up before I leave town. Do you realize how hard it is when you have to USE things that have to be packed, and then you have to remember to leave certain things out to wear on the plane, and — aaaacccckkkk!!! When did packing become so complicated? I thought it would be a breeze, now that my clothes are teeny tiny and take up no space whatsoever. I thought it would be a walk in the park.

Maybe it’s just that I traded one sort of “bulk” for another, so instead of “FAT” I now lug around PROTEIN & LAYERS!

Anyway, that’s my little story. I’m off to Washington and won’t be back in LA until Sunday night. Between now and then, if I am so motivated, I will be posting stuff on Barbie. If not, you will have to wait until I return to hear of my fascinating exploits and see pictures of my very best friends in the whole entire world. (No, I’m not exaggerating!)

My Daily Supplemental Regimen

Many people think that they can take one multi-vitamin every morning to ensure good health and a long life. Others think they are a good idea, but “don’t like taking pills,” so they don’t take them at all. Somewhere in the middle is the crowd that takes them…sometimes…when they think about it.

As bariatric patients, we don’t get a vote on the matter. We MUST take supplements every day for the rest of our lives, period. Why? Because our new digestive systems are malabsorptive, making us highly susceptible to brittle bone disease, osteoporosis and anemia.

the best way to protect from these serious conditions is:

• Have your blood checked regularly (at least once per year, but more if you are having problems, such as iron or calcium deficiency.)
• Get plenty of exercise
• Sleep at least 8 hours a night
• Eat a healthy, well-balance diet filled with non-processed foods
• Take the very best supplements you can find.

For today, I’m just going to discuss the last point: Take the very best supplements you can find.

A little history…Immediately after surgery, I took a generic chewable multi-vitamin from Trader Joe’s, in order to get my “vitamins” out of the way. Then I’d chew some Sugar Free Tums (for Calcium), toss in a chewable iron tablet from Bariatric Advantage, and pop a B12 under my tongue. I’d usually take them all around the same time — one after the other, as space in my pouch became available. I had no idea that calcium couldn’t be taken with iron, or that calcium citrate would work better than calcium carbonate. I didn’t realize that my chewable vitamin was not good enough for a five year old, or that I really was absorbing more B12 than I needed. The surgery manual told me I only needed to take it once a week, but I took it more like three times per week, just to be sure.

At some point, it occurred to me that I might not be supplementing as well as I should, so I started doing some research and ended up buying Bariatric Advantage vitamins and supplements. I figured that anything specifically formulated for my post-WLS body would be a fool-proof way to get my vitamins in without really thinking about it.

The first sign of trouble was when I learned that I needed to chew SIX of the calcium tablets — not THREE, in order to get my recommended milligrams in each day. Then, I learned that I could not chew them one after the other, since our bodies are not able to absorb more than about 450 mg at a time. Next, I realized that the recommended serving of 6 tablets was still lower than the new guidelines — by about HALF!

Next, I learned that I was seriously anemic, which told me that my body was not absorbing all of the iron I was taking. Clearly, the formulation was not correct for my body.

Finally, after reviewing my lab work with my nutritionist, I learned that the mass quantities of protein I have to eat every day, combined with my vitamin supplements, was having a negative affect on my liver and kidneys, meaning that, all of the “good” stuff I thought I was doing wasn’t really that great at all.

Needless to say, I was pretty confused about the whole problem and didn’t know where to turn. I mean, I followed the directions from the Bariatric Center, and that was almost as bad as taking nothing at all. Then, I tried supplements specially formulated for bariatric patients, and found that they weren’t really formulated well for ME. Finally, I learned that I was taking everything at the wrong time, so it wasn’t really working anyway!

Back to the drawing board.

The more I researched the problem, the more I realized that finding a solution to my supplement problem would be like trying to nail sugar free jello to a wall! For starters, the more “experts” you talk to, the more “answers” you’ll get — but those answers are usually caveat-ridden, as no one can ever really say with 100% certitude what YOU should do for YOUR particular situation. They’ll always tell you to “Start with this, see how you feel, and adjust accordingly.” Well, HOW DO I ADJUST WHEN I DON’T KNOW HOW I’M SUPPOSED TO FEEL!?

Aside from the fact that I am NOT a particularly structured person (outside of my office, anyway), I’m not especially OBSERVANT either. Oh, and I forget stuff, too. With all of these handicaps, you can imagine how hard it is to build a program that I can stick with. I mean, not only do I need to remember to take stuff every day, I have to take it at the right times, and in the right amounts, and make sure that the formulations are correct, so I’m getting maximum benefit. A daunting task, for sure, but one which was made considerably easier by my good friend, Mark Becker — Director of Communications for Jarrow Formulas in Los Angeles.

When I told him about the problems I was having, he immediately suggested that I add a probiotic (Jarro-Dophilus EPS) to my supplement regimen. He thought I should do this before anything else, as it would aid my digestion, control the bloating, and enable my body to get better use of the small amount food I’m able to eat.

The effects of the probiotics were immediate and powerful: The bloating went away and I started to feel better and more balanced. Clearly, that was a good first step.

Next, he suggested adding Glucosamine with Chondroitin and MSM, some SAMe, and a good Co-Q10. In doing so, he said that my joints would feel better after my workouts, I would recover faster between exercise sessions, I’d be more emotionally stable, and my overall energy levels would increase. I will go into greater detail on each supplement in separate postings, but for now, I’m just giving you the “big picture” of my noticeably improved health.

To help rebuild my ferritin levels (and hopefully avoid iron transfusions), Mark suggested IronSorb, and for Calcium, he recommended Bone Up. I haven’t had my blood work done yet, so I don’t know the net effect of these two supplements, but at least I know that I’m getting quality formulations into my system, so the results should be positive.

In addition to the items above, he also suggested that I add a few things (some of which I just haven’t bought yet, because they cost money) like: Fish Oil (MAX DHA), a Women’s Multi, and Ribose.

For now, here’s how my day looks:

Jarro-Dophilus EPS (Enhanced Probiotic System)
Enteric Coated; 5 Billion Organisms per capsule.
3 per day (1 after each meal)
Benefits: Aids digestion, can help metabolize protein and breakdown lactose (milk sugar) supports intestinal health, boosts immune system

Jarrow SAM-e Joint (includes glucosamine)
200 mg SAM; 535 Glucosamine HCI
1 Tablet on empty stomach
Benefits: Joint strength, brain metabolism, longevity, liver function

Jarrow Q-absorb CO-Q10
200 mg/1 per day (morning)
Benefits: Improved heart function, can reduce cholesterol from oxidation, antioxidant protects mitochondrial membranes , more energy

Jarrow IronSorb
18 mg elemental iron – IPS (iron protein succinylate)
2 tablets per day (morning with protein shake)
Benefits: Protects against anemia; critical for transport of oxygen to tissues

Bariatric Advantage Chewable Multi-Formula with Vitamin A, D, E & K
2 Tablets (morning with protein shake)

Jarrow Bone-Up Calcium w/Vitamin D & Magnesium
1,500 mg per 9 capsule serving.
(Bariatric patients need 2,000 mg per day including calcium from food sources)
3 Capsules (afternoon, early evening & bedtime)
Benefits: promotes bone growth to reduce osteoporosis and brittle bones

JarroSil Silicon Drops

10 Drops (in protein shake)

Benefits: Essential partner of calcium for bones, glucosamine for joints and antioxidants for arterial health. Promotes healthy skin, nails and hair.

Jarrow Milk Thistle
150 mg/1 Capsule (morning with protein shake)
Benefits: Protects liver function

Glucosamine+Chondroitin+MSM
2 Capsules (morning with protein shake)
2 Capsules (evening)
Benefits: Protects joint tissue; helps produce synovial flud (which lubricates joints

Stool Softener (Generic Colace is fine)

Trader Joe’s B-12/Folic Acid/B-6
Sublingual; 1 tablet (morning with protein shake)
Benefits: Promotes energy, stamina, mental clarity, improved mood; helps metabolize carbs and burns fat; combats some detrimental effects of stress.

Spring Valley Organic Flaxseed Oil with Omega-3 Fatty Acids
1000 mg/2 Softgels (morning with protein shake)
Benefits: Good fats with heart-healthy effects. Contains lignans with plant estrogen and antioxidant qualities; may have a protective effect against cancer (especially breast, prostate and colon), helps cardiovascular system (anti-inflammatory action which normalizes heartbeat), improves blood sugar (good for type 2 diabetics), reduces inflammation.

Jarrow Femdophilus
5 Billion Organisms Per Capsule
1 Capsule (morning with protein shake)
Benefits: Urinary & Vaginal Health

Jarrow Acetyl L-Carnitine Arginate & Alpha Lipoic Acid
1 Capsule (morning with protein shake)
Benefits: Mitochondrial (heart valve) nutrition for energy production

Trader Joe’s Odorless Garlic
400 mg/1 Tablet (morning with protein shake).
Benefits: Lower total cholesterol (but raise HDL); increases immunity, lowers blood pressure, reduces risk of blood clots, regulates stomach function, improves blood circulation

Now, I’m not going to tell you that this is easy or fool-proof, because it’s not! It’s really challenging to stuff a bunch of supplements into a tiny pouch, at just the right times each day. But, I will promise you that, as long as you manage to accomplish this feat at LEAST 80% of the time, you’ll notice a dramatic improvement in your overall health, and most likely see better lab results on your next blood draw!

Oh, and you probably noticed that I have a LOT of Jarrow products in my list. Well, that is because they are a trusted name in the health supplement industry and have a long-standing and excellent reputation for manufacturing stuff that actually works. As Mark would say, their products are “ROCK-STAR” quality  – Who am I to disagree?

Now for the tricky part: Starting your own program and making it stick. I’m all about making things as easy as possible, so I’ve set up some “fool-proof” systems for getting my supplements in — every day:

1. I bought one of those big, stackable plastic drawers, loaded it up with all of my bottles and put it in the closet.
2. Then, I took a big Sharpie marker and wrote a letter on the top of each bottle: “M” (for morning), “N” (for night).
3. Next, I added a number (currently it starts at “1″ and goes to “15″ — but I know that number is gonna go up!) In other words, I have “M1″ which happens to be my Iron, “M2″ (multi-vitamin), “M3″ (Co-Q10), “N1″ (Calcium), etc.
4. I also created little baggies of everything (for when I’m in a hurry and don’t have time to sit and count everything into a little cup). The little snack-size Ziplok bags work GREAT! I have one for mornings and one for nights. So far, it’s been working great, and I’ve been at it for about 2 months.

BOTTOM LINE: You only have one body and one life. Making the decision to have bariatric surgery was the first most important thing you could have done to save them both — eating right is tied for second — right there with taking proper supplements!

DISCLAIMER: I am NOT a certified ANYTHING. I’m just a girl who happened to have gastric bypass surgery to change her life, and wants to share her successes with the online world. If you have a nutritionist you like to work with, talk to him or her about your particular needs, so you can work together to formulate a solid program. You can also talk to your doctor, but remember that many doctors are not well-versed in the discipline of vitamins, minerals and other health supplements, so don’t be discouraged if they aren’t as helpful as you might hope.

Oh, How I LOVE My: Ball Mason Jars!

One of the greatest ideas anyone has given me since I began living the gastric bypass after life came from a dynamic, creative, structured, vigilant, committed and resourceful woman in my Thursday night support group. Trish always seems to have the neatest solutions to every day struggles, but they don’t always fit my less-disciplined lifestyle. In other words, if it ain’t blatantly simple for me to do it, then I won’t do it!

Well, her blatantly simple idea was to use BALL MASON JARS (or Jelly Jars) in the 4 oz. size to help portion out meals! As it turns out, 4 oz. is equal to 1/2 a cup, which is pretty much the pouch perfect portion for just about anything we can eat! When you pack your cottage cheese, or fage, or tuna into one of these handy little jars, magical things happen:

• You don’t need to measure
• You can go from fridge to microwave in one container
• You can pack liquids and they won’t spill
• Since they are made of glass, the jars won’t pick up food smells (like plastic containers do).

These little gems are available virtually anywhere (grocery stores, WalMart, Amazon.com, Target) and they’re CHEAP! I picked up a dozen for $7.84, and they come with the handy preserve lids (you know, the kind with the lids and bands?) But, in case you don’t like the metal lids, you can also pick up 6 screw on plastic lids for about $1.50.

I’m telling you, it’s the little hints like these that make WLS after life easier to live.

Gastric Bypass Barbie’s Biased Opinion:

JC Penney 5-in-1 Power Blender

Anyone who’s spent anytime on WLS boards knows that the Magic Bullet is the gold standard of personal blender products. Truth be told, you’d be hard-pressed to find anyone who isn’t in bubbling-blender-bliss over theirs, unless, of course, you’re talking to me.

I am the 1-person-in-1-bazillion who does NOT like the Magic Bullet. But, since this isn’t really an article about why I don’t like the Bullet, I’ll give my reasons as part of my product review of the JCPenney Handy 5-in-1 Power Blender.

I learned about this nifty unit many moons ago, when someone posted a link to it on a discussion board. Apparently, there was quite a good discount that made it an ideal fit for my budget. It was so cheap, as a matter of fact, that I was able to purchase 3 for the price of ONE Magic Bullet.

Power Blender

FEATURES
The JCPenney Handy 5-in-1 Power Blender is a personal blender that chops, grinds, mixes, whips and blends. It comes with a 200W high-power base, 4 tall drink cups, 2 blending cups, assorted lids (shaker tops, resealable lids and comfort lip rings, so you can drink straight from the blending cup) and 2 blades.
Grade: B+


PRICE
$24.99 – $34.99 (But I got mine for $19.99 by using a % off coupon at a special sale event.)
Grade: A

QUALITY
The unit is sturdy and reasonably quiet, but much louder than a standard blender. I will admit that I managed to burn out 1 unit within the first 2 months, because I use 1-2 times every day. My subsequent unit has been buzzing along just fine for more than a year and shows no signs of slowing down. The cups are heavy duty plastic and wash well. They don’t seem especially “scratched” or “clouded,” despite the volume of usage. My only complaint is the “snap on comfort lip rings,” as they are quite challenging to pry off. I would think a threaded ring would be better, but at least it hasn’t broken with all the force.
Grade: B – I took points off because all of the rings are the same color (the Magic Bullet has different color rings, so people don’t confuse their drinks at a party) and they are challenging to remove for cleaning (the Magic Bullet rings are threaded).

USABILITY
The unit is easy to use and requires no explanation. Just put your liquid and add-ons into the cup, screw on the appropriate blade, tip it upside down, and twist and lock into position on the blender base. The blender will start automatically, once the unit is rotated clockwise into position in the slots (like a food processor). It will stop instantly, if you twist the cup counter-clockwise out of the slots.
Grade: A

PROS

• Large cups precisely fit one protein shake. I’ve even perfected the recipe so well, I can whip up a concoction that would rival the finest Starbuck’s, Wendy’s, Jack-in-the-Box or McDonald’s can offer in under 3 minutes — and it will be healthy!
• Easy to clean.
• Everyone in the house can have their own, unique drink.
• Chops ice beautifully
• Not as loud as the Magic Bullet. Trust me, the Magic Bullet sounds like an FA-22 taking off in your kitchen. By comparison, this unit is more like a Stealth Bomber!
• Diameter of comfort rings is perfect for my mouth. By contrast, the Magic Bullet comfort rings are square and thick.
• Cups fit the car cupholders! The Magic Bullet mugs have big honking handles, so you can’t drink your protein shake in the car on your way to work!

CONS

• The cup and blade unit inexplicably become unscrewed in the middle of blending, if the liquid inside becomes thick. This makes for a real mess when you try to remove the unit from the base, but fortunately, the base is sealed, so none of the mess gets into the mechanical workings.
• The gasket in the blade base sometimes comes loose in the middle of blending which prohibits you from unscrewing the lid. My husband is an incredibly strong guy (we call him Shrek and Monkey-Grip), and he has really struggled to get it undone on the 2 occasions this has happened. It can be really frustrating if you are dying to get your hands on your protein shake, but it’s STUCK in the cup and you can’t make another one, because the blade is stuck, too!

BARBIE’S BOTTOM LINE
I simply cannot live without my JCP 5-in-1 Power Blender. As a matter of fact, I’m considering buying a back-up, just to have on hand for when this one (inevitably) dies. I hate the thought of reverting to my Hamilton Beach countertop model with the heavy glass pitcher. For WLS people, this is a great investment, and you won’t miss the handles that the Magic Bullet cups have!

FINAL GRADE: A-

Disclaimer
I have never tried to chop, grind or generally mix anything other than protein drinks in my 5-in-1 Power Blender, so if you are considering this as a replacement for your coffee grinder, food processor, or juicer, I can’t give you any advice!

Protein

Protein supplements are available in many forms and are useful for bariatric surgery post-ops, as they help us meet our total daily intake requirements. Since our stomachs are so small, most of us have a hard time consuming proteins from native food sources, like meat, fish, poultry, dairy or legumes. Therefore, protein shakes (Ready-to-drink or RTDs that come in cans or boxes), clear drinks (like Gatorade), powders (for blending into creamy shakes or adding to water), and bars can be extremely useful. Since all of us like different things, it’s good to know that there is a wide variety of high quality options available.

The first thing you should know about supplemental protein is, it is available from several, different sources, most especially: Whey, Soy, Rice, Egg and even Micellar Casein. Some are better sources of protein and are more readily available than others; some taste better than others; and some don’t work for people who are allergic to dairy or soy, and so on. You will soon find out what works for you, but until that time, it is recommended that you NOT stock up on any particular protein type, until you know you tolerate it well!

The second thing you should know is, not all proteins are created equal! Many protein supplements are geared toward weight lifters and athletes looking to “bulk up” and “build muscle.” These products contain HIGH carbs, HIGH sugars and HIGH fats. These are NOT the proper products for bariatric post-ops!

When looking for an appropriate protein supplement for yourself, look first at the total grams of PROTEIN. A good average number for a drink is 20 grams per serving. Many people choose drinks that contain 30-40 grams per serving, but not everyone can tolerate that much in one sitting. Through trial and error, you will learn what works best for you. Whatever the case, it is BEST to shoot for at least 20 grams in your drink as a starting point, and go from there.

The next area on the label is SUGAR.  How many grams of sugar are there? Many post-ops report that they cannot tolerate anything over about 9 grams per serving, as it can cause dumping (for gastric bypassers). A safe rule of thumb is to keep it under 3 grams, but every body is different. If the grams of sugar exceed 10, it’s probably best to steer clear of the product. There is no magical “ratio” of protein-to-sugar, but you will be amazed to find many products claiming to be “healthy” which contain 15-20 grams of sugar and only 10 grams of protein! That is almost 2:1 SUGARS leading PROTEIN! Not a good combination! Look for a product that has at least twice as much (if not more) protein as sugar.

To find products that are low in sugar, look for products that do not contain: corn syrup, honey, cane juice, fructose or other “natural” sweetening agents. Low sugar grams usually come from aspartame (Equal™), sucralose (Splenda®), saccharine (Sweet N’ Low™), maltodextrine, maltitol, etc. These are sugar alcohols, which are often (but not always) called out separately on the label. These can affect post-ops in multiple ways, including causing dumping, so many choose to avoid those products with HIGH sugar alcohols (i.e., 10g >). There is also debate about artificial sweeteners being unhealthful, etc., so as with everything in your new life, moderation is the key to success and health!

After you have examined the protein and sugar content, you can look at the total carbs, fats and calories. A good rule of thumb is to target about 200–300 calories for a meal replacement type protein shake. This number would include any skim soy milk added in place of water. If the protein, sugar and calories look “pretty good,” then chances are, the fats and carbs will fall into line nicely. Havng said that, never assume anything, and ALWAYS read the label. Your body will not give you a free pass, just because you don’t “know” something. Carbs tend to be higher (15 grams +) in things like protein bars and chips, and these are not necessarily going to be the “good” or “complex” carbs found in fruits, veggies and beans. As long as you are aware of this number and factor it into your overall daily allowance, you will be fine! Keep fats around 5 grams or less per serving.

Consider blending different forms of supplements into your diet, to add variety, texture, taste and options to your life. Post-op living is NOT a diet; it’s a lifestyle, so there is no excuse (or room) for boredom!

Here are some brands that seem to work well for a large number of post-ops:

Whey Based Proteins

COSTCO BRAND (PREMIER)

Costco seems to be a winner for most post-ops, so I’ve listed it first. Their Premier brand offers RTDs, blendables, bars and water additives.

Premier Bars
Carry them with you for on-the-go, at your fingertips protein.

Premier RTD Shakes
No blender required. Just chill, shake and drink!

Premier Protein H2O Drink Mix
Add these to water, like Crystal Light.

Clear Whey RTD Proteins (like Gatorade)

CytoSport Pure Protein
This is available at GNC, Vitamin Shoppe, Mothers, and several online locations.

WheyUp!
Protein drink with an added Energy boost. This one does contain caffeine, so not recommended for early post-ops, or those abstaining from caffeine.

Isopure
Available in 6 yummy flavors.

Blendable Whey

(Make in a blender or shaker bottle). Since there are so many of these, I’m just going to include a single link to BariatricEating.com protein page, but I’ll also lists names of the proteins that people in our group swear by!

• Protein Sample Starter Kit
• BSN Syntha-6
• IDS Multi Pro
• Elite
• Matrix
• Nectar
• Whey Gourmet!
• Inspire (BE’s private label)
• 100% Designer Whey
• Trader Joe’s Brand Protein

Protein Shots/Bullets

Super portable protein in a test tube. Add to water or shoot ‘em straight. Most people suggest serving chilled.

IDS Sports New Whey Liquid Protein
Also Costco Premier Brand.

Coffee Type Proteins

(Like Starbuck’s Frapuccino with Protein). These drinks do contain caffeine, but for those post-ops who are further out and can handle this once in awhile, this is a nice treat.

Believe (BE’s private label; replaced AchieveOne)

Vitamins

The jury is still out on vitamins, depending upon who you talk to. One thing is sure: You must take vitamins everyday, without fail, for the rest of your life. Case closed. How much of each you take will be up to you and your doctor, but regular blood tests will ensure you stay healthy and don’t end up needing iron transfusions or suffering from brittle bones. The current recommendation is: Iron, Calcium Citrate, B12 (sublingual), B1, and a Multi-Vitamin. There are vitamins formulated specifically for bariatric patients (gastric bypass or band), and they are available as chewables. Note that some doctors will say “Tums, Flintstones and some iron” are all you need, but successful post-ops will encourage higher-quality calcium and a better multi-vitamin. Think: Citracal and Centrum.

• Bariatric Advantage
• Celebrate!

Protein Bars

• Pure Protein Bars (Trader Joe’s)
• Atkins Advantage Bars
• Power Crunch Bars
• Rockin’ Roll Bars (by Labrada)
• Oh Yeah! Wafer Bars

Protein Snacks

• Kay’s Naturals Pretzels
• Kay’s Naturals Cereals
• Revival Soy Chips
• Kefir
• Fage Available at Trader Joe’s

Soy, Rice and Other Proteins

Some people are lactose intolerant, which means they cannot tolerate WHEY protein. If you are one of these people, fear not! There are protein sources for you!

• Trader Joe’s Soy Protein Powder
• SoySlender Milk (chocolate, vanilla and cappuccino) Available at Albertsons, WalMart, Vitacost.com, Netition.com
• Trader Joe’s Unsweetened Soy Milk
• Soy SilkNutriBiotic Vegan Brand Brown Rice Protein

Shopping!

Don’t know where to buy pouch-friendly foods?

Online stores:

• BariatricEating.com
• VitaCost.com
• NutritionExpress.com
• Revival Soy

Brick and Mortar Stores:

• Trader Joe’s
• Costco
• Mothers
• Henry’s
• Sprouts
• Herbies
• GNC
• Vitamin Shoppe
• 24-Hour Fitness

Physical Fun (Like Gas and Other Stuff)

Gas is a way of life for most post-ops, either because we are malabsorptive, or because we just have trouble with things like lactose and fiber! Whatever the case, there are lots of OTC (over-the-counter) remedies you can try, including:

• Gas-X
• Gaviscon
• Devrom
• Phazyme
• Lactaid

For constipation and irregularity (that often comes with iron supplementation), try a stool softener, fiber additive or healthy bacteria – every day:

• Colace
• Phillips
• Kirkland Brand (Costco)
• Benefiber
• Probiotic

Food Tricks

• Jazz up it up! Add Sugar Free Pudding Mix to Yogurt or Protein Shake. Hint: try pistachio pudding in your vanilla shake, or cheesecake with your fage!
• Lunch-Time Favorite: Lunchmeat roll up with fat free cream cheese and a slice of ham or turkey
• Afternoon Pick-Me Up: Wrap reduced fat natural peanut butter inside butter leaf lettuce (like celery and peanut butter, but without the fiber strands!)
• Instant Nachos! Melt reduced-fat cheese on fat-free refried beans. Add a dollop of fage and some salsa. Scoop with a few spicy, flax tortilla chips from Trader Joe’s!
• Need a natural iron source? Add some baby spinach leaves to your morning protein shake! You won’t taste it, but you’ll get more iron bang for your buck!