I’m big about practising what I preach. I may not have had bariatric surgery, but I’m forever looking for experiences that give me insight into life after bariatric surgery. I may have large feet compared to some of you, but that doesn’t stop me trying to squeeze into your shoes so to speak.
Do you remember the schoolyard lesson – ‘never judge a book by its cover’??? There’s so much more than what’s on the outside. You and I are great examples of that. But what if a book cover literally said ‘read me, I’m a Mills and Boon Romance’ – would you read it? I know I’d run a mile and yet I love reading. I’d much rather read something saying ‘read me, I’m a thought-provoking thriller.’ But what does this have to do with food choice you might be asking? Well, I’m thinking along the lines of making your food choices based on their covers – judge those books by their covers otherwise known as food labels...
What are you thinking when you see this picture?
Is it along the lines of the Fred Flintstone has an amazing meal pattern for bariatric surgery considering meat is always on his menu? I sure did, but did you notice how wonderful Wilma’s hair is looking, or how beautiful Betty’s skin is compared to Barney’s? Take a closer look, Dino’s nails are looking nice and strong too.
That’s right, this month I’m thinking all about skin, nails, and so ‘hair’ come my questions…
Hello again and welcome. This month, I’m thinking about something completely different to protein. It’s no less as important for you though. So, if you don’t mind me asking - how have your bowels been lately?
You’ll soon see why I’m asking…
Welcome back to ‘Drew’s Desk.’
Thanks very much for the great feedback I’ve had from last month’s blog. This month I’m thinking outside the square slightly - I hope by the end you’ll see my thinking. As usual, let’s begin with some questions…
What is the link between Little Red Riding Hood, proteins, and carbohydrates?
Welcome back to ‘Drew’s Desk’ – this month I’m thinking about nutritional supplements. I’d like to talk about the reasons for needing a routine that’s giving your body what it requires each and every day after your surgery. Before that, let’s start with some questions…
Are you feeling tired and ready for bed more than wanting to bounce off the walls each day? Are you having problems with concentrating or thinking straight at home or work? Is your skin quite dry, or have you been noticing cracks on the edges of your mouth? If yes to any of these, are you taking supplements regularly, and are they in high enough amounts to give your body what it needs?
Just like Bob the Bulldog and Terry the Terrier are different in strength, so too are supplements.
Over the counter brands from health shops, pharmacies and supermarkets are fine for Mr and Mrs Bloggs, but the general population can absorb the nutrients in those supplements without any issue. The picture below shows where the nutrients from food and supplements are absorbed in the intestines, and you’ll see that for bypass patients, there is a detour around the region where most of them get absorbed the easiest. They can be absorbed further down, but a higher dose is needed because the body struggles to absorb them and many will pass through the system and out the other end.
Gastric sleeve patients are in a similar boat. There is no detour around the nutrient absorption region, but a smaller stomach means less food being eaten, and that means low levels of nutrients are absorbed from food. Also, all bariatric surgeries (bypass and sleeve) mean less stomach acid is made, and the acid is needed for nutrients like iron and vitamin B12 to be absorbed properly.
So, bariatric patients need more than the usual amount of nutrients in general supplements to make sure they’re getting enough of what they need to prevent nutritional deficiencies causing fatigue, skin problems, or overall poor immune function not to mention brain damage. The next table shows the recommended doses of some important nutrients for bariatric patients and the roles they play.
All nutrients are really important for your body. Iron and B12 affect energy levels for instance. Zinc will help with fighting colds and helping with hair re-growth. Deficiencies can be detected with blood testing, and that’s why you get a blood form at each of your follow up visits.
In saying that, monitoring calcium is tricky. Calcium will generally stay normal in your blood - with or without enough calcium coming from food and supplements. That’s because your body needs a stable level in your blood for making your nerves and muscles work. It breaks down your bones for calcium if not getting enough from food and supplements and that worries me considering the risk of osteoporosis. Vitamin D helps absorb calcium, and that’s why you’ll hear vitamin D being talked about as important for bone health.
So, a daily routine of taking all your supplements is needed for meeting your nutritional needs – and that leads me to my ‘Hot Seat’ for this month.
Drew’s Hot Seat – establishing a healthy habit of daily nutritional supplementation
I can hear your frustrations as I write iron and calcium can’t be taken together. I’m not saying it to be difficult, I swear! Sadly, as you may already know, iron and calcium get absorbed in the same area in the intestine. They basically pass through the same entry gate, and just as we line up to get into a rock concert or sports event, iron and calcium need to line up for their entry into your body. At least two hours is needed between them entering, but that can make a routine that works for you quite difficult – especially if your multivitamin contains iron. On the bright side, vitamin B12 can be taken at any time, but the plot thickens with calcium.
Your body can only absorb up to 500mg at one time. Taking any more than 500mg will simply be wasted. Calcium comes as citrate or carbonate, but calcium carbonate must be taken with food for absorption while calcium citrate can be taken between meals and still get absorbed. In other words, calcium citrate makes life a lot easier for finding a routine that works for you. You’ll see below I’ve suggested some supplementation routines to show you how supplementation can work within the space of a day. I’ve used the Celebrate range (www.amsnutrition.co.nz) which is specifically formulated for bariatric patients, so beware if using any over the counter products like Centrum or Healtheries - you’ll need a higher dose than mentioned on the packaging. Over everything else, make sure to discuss your needs with a Dietitian.
The Take Home of Today
To wrap up today, I’ll go into broken record mode. That’s my signal for saying something again and again because it’s so darn important. Your nutritional supplements are as important as taking any other medications you may have. I hope you can see my reasons for thinking so, and I really hope the example routines help you feel a daily routine is quite achievable as a habit. Wishing you all the best for another month and looking forward to next month already.
National Bariatric Link. (2018). Nutrients from Food After Gastric Bypass Surgery. Retrieved September 1, 2018, from https://www.nationalbariatriclink.org/bariatric-blog/nutrients-food-gastric-bypass-surgery/
Parrott, J., Frank, L., Rabena, R., Craggs-Dino, L., Isom, K., & Greiman, L. (2017). American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surgery for Obesity and Related Diseases, 13(5), 727–741.
What am I? I’ll give you some clues. I can be difficult to eat enough of, especially in the first few months after bariatric surgery. The hardest time of the day seems to be breakfast, although lunch can be a problem when I’m restricted to only a few options on top of a Cruskit. I’m important to eat first, and that’s because I help you feel full until your next meal, and also because I look after your muscles, hair, skin, and nails like a mechanic looks after your car.
Yes, you win the trip to Fiji, I am protein, and here I’ll talk about ways of improving your intake without necessarily having to eat more food. In other words, I’ll try to inspire you with ideas of sneaking more protein in at breakfast, lunch and dinner - only you’ll know how well I’ve done at the end of this blog.
I’m thinking you already know that breakfast and lunch can be tough times for eating enough protein. Some people say they “just don’t do breakfast” while others are saying there’s simply no time. Of course, that makes me sad for two reasons. Why? Firstly, as a creature of habit I’m a diehard breakfast fan – it really is my favourite meal of the day. Secondly, it’s one of your three regular meals each day without snacking, and that means it’s your time to achieve at least a 20g intake of protein for getting you through until lunch time. Ultimately, it’s a long-term habit we’re aiming to establish as normal, so let’s start talking about increasing protein at breakfast.
Are you a breakfast skipper? Is that because of time, habit or both?
· What time are you getting up? Do you think you could get up an extra half an hour earlier to make and eat your breakfast? That extra half hour can mean preparing a protein-rich breakfast and then having time to do your 20/20/20 for enjoying that meal without suffering from eating too fast.
· If an earlier rise is out-of-the-question, can you prepare your breakfast in the evening so it’s ready to put together and eat in the morning? For example, mixing up some Calci-milk with flavourless protein powder and soaking rolled oats or Weetbix in it overnight in the fridge? Adding two tablespoons of skim milk powder to that mix will increase your protein and calcium intake without adding more volume too. In the morning, you can zap your breakfast in the microwave for a warm start to your day as these Winter days roll on.
· Is breakfast first thing in the morning a habit you’re struggling to make fit for your lifestyle? Would you rather go to the gym or go to work first? Can you consider a time later in the morning to have your breakfast? Any time up until about 10am is fine, especially if that means you can sit down and enjoy your breakfast at home or at work.
· Are you used to nothing except say coffee or tea for breakfast? Does chewing food of any type before midday seem really strange? If so, can you consider a protein shake or smoothie for breakfast? What about a pottle of single-serve protein yoghurt? For some texture, you can add some oats but remember the protein will be the hero of this dish. For a lovely aroma and flavour, how about sprinkling cinnamon or nutmeg on your yoghurt to get those taste buds going without adding sweeteners like fruit or honey?
· Are you “so over” the idea of protein shakes or eggs at breakfast? How open are you to ‘out of the box’ ideas right now? As you may know, I’ve been living in Korea and I’ve returned to NZ with my eyes opened to the world of tofu as a source of protein, calcium and iron in my cooking. As an example, I use soft tofu instead of scrambled eggs at breakfast or lunch.
Speaking of lunch, are you eating more carbohydrates than protein at lunch because there’s just not enough protein options available? Let’s put tofu in my hot seat for opening up a whole new world of protein options at breakfast, lunch and dinner.
Drew’s Hot seat – Tofu
Tofu is a great way of increasing your protein intake. It comes in two forms - soft or firm, and it’s really affordable. Sadly, tofu seems to cop a lot of flak for being bland, but that’s what makes it a real gem in my mind. It can be added to soups or stews for taking on those flavours, or it can be eaten alone if you’re having taste changes and feel unable to tolerate cooking with any flavour. Also, tofu is perfect for adding to soups or broths that either already have or may be lacking any protein like the hearty vegetable soup you may have made for getting you through this Winter.
The two textures of tofu are an asset. If you’re struggling with chewing some textures like steak, chicken or some fleshy fish, you may like to try firm tofu as an alternative ingredient for your evening meal. Firm tofu can be revved up with whatever herbs or spices you might like to try - and cooked in soy sauce or even fish sauce can make it a meal to remember for you and your family. Soft tofu can be used in the same way, or it can be hidden or melted into foods like cheese without adding more volume or affecting the taste. Remember, you can add other legumes like lentils or chick peas to your dishes with tofu, and that can give your meal some crunch while boosting the protein even more. Cook enough, and you’ll have some leftovers for lunch the next day too.
Here’s a recipe you might like to try for breakfast, lunch or tea – if you’re interested in learning some more, please feel free to email me and I’ll happily guide you to some great ideas.
Simple Scrambled Surprise
Prep & cooking time: 10 minutes
Ingredients: Soft tofu (1 pack), ¼ teaspoon turmeric, salt & pepper
1. Add soft tofu (without water) to your non-stick frying pan
2. Break large pieces with wooden spoon
3. Mix and add turmeric, salt and pepper
4. Fry on high for 10 min - stirring every now and then so it doesn’t burn
5. Serve with a garnish like parsley
· Use a block of firm tofu instead of soft
- Slice into 1-inch cubes & then crumble it with a fork or fingers, to your preference
· Add other vegetables for variety & flavour while cooking
- E.g. cherry tomatoes, spinach, green onions, capsicum, mushrooms
· Add extra condiments for flavour
- E.g. soy sauce, fish sauce, garlic sauce, lemon juice
· Add flavourless protein powder for an extra hit of protein
The Take Home of This Blog
At the end of the day, it’s the habit of three regular protein-rich meals each day you’re working towards as your normal. As a meat lover, I never thought I’d go near tofu – but daring to try it has let me see the value it has for meat-lovers and vegetarians alike. You can get it from most supermarkets, although I get mine from the local Asian grocery store which is a great place for finding neat spices too (and the tofu is much cheaper).
So, how well have I done? Are you feeling like you can increase your protein intake after reading this blog? I hope so. I’m looking forward to the next instalment from Drew’s Desk next month. All the best until then.