**willow**

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my implants have continued to flip around since my last post.  At my last ps visit I brought in pics I had taken with my left implant sitting sideways and my breast looking very deformed.  I told him I am frustrated and it is basically driving me crazy not to know what to expect to see when I look in the mirror with my clothes off. His response was that I should "wear  cute bras  and go have fun." 

I spoke to a rep from Inamed , the manufacturerer of the implants and they say if the implants are moving the pockets are too big.  the surgeon says they can't be tailored to fit the implant perfectly and maybe they will shrink.  

when he replaced the implants I had before he didn't do anything to the pockets, just used the ones that were there. he just opend the incision under my breast, pulled out the old implants and put in the new ones. 

there are a couple other issues with this. A big one being that when I got to the surgicenter - his office had not actually scheduled me  and I wasnot expected so I was fit in anyways- maybe he rushed they surgery because OR time was limited and that is making a diffeence? 

there are some others I can't even post, it is too invilved and hurtful at this time. 

As I posted below, my right implant went out of position immediately after surgery looking a little weird. then a couple weeks later my Left  flipped sideways too, I had a big bulge in my inner cleavage, the outer side was flat and had skin hanging. I was horrified to say the least and really freaked out. the right was misshapen, but the left was simply deformed looking.

then one day I got up and they had rotated back into the correct position by themselves. 
. 
Both of my implants have taken turns rotating sideways. Such fun.  Get up in the morning. look in the mirror and don't know what to expect. will they look normal?  will they be misshapen? 

On Halloween I got up and saw in the mirror the left had rotated sideways again leaving it looking very distorted and misshapen. I decided I had nothing to lose and started massaging it towards the right direction and it went back into place.

I am hoping that my surgeon is correct when he says that as the pockets tighten up a little around the implants that they will stay in position.   My PS did tell me that if they don't settle in that he would replace them with mentor round cohesive gels - His preferred company Inamed makes only anatomicals in the cohesive gels implants. 

For now - no surgery. 

I would like to add that when they are in the right position they look phenominal considering how they looked before- especially compared to my previous look.  No rippling.  I'm just praying it works out with no more surgery.

Sounds like a great idea - right? Well, think about it - it is only 100 calories but what is the nutritional benefit? all of the 100 calorie snack packs ar JUNK food - minimal nutrition, empty calories, little or no protein.they are chips, crackers, cookies. They are not what we need to be healthy. In my mind think health first. If  you think health first and do what is right for your health the weight will work out.

Choose foods that give your body something it needs, protein, fiber, vitamins, calcium. Don't waste your calories on things that do not nourish your body the way it deserves to be nourished.  We deserve to treat our bodies in the best possible way. 

I know I abused my body for many years with poor nutrition, obesity and no exercise. I often fooled myself with gimmicks like the 100 calorie snack packs, fat free processed foods, sugar free (but not calorie free) treats. All of those things contributed to my weight problems. They are gimmicks - designed to lure you in, to make you pay a lot more for a smaller portion and give you no nutrtional value, to encourage your addiction to the highly processed  junk, that leaves you hungry and craving more.

Now, I feel I owe it to myself to live better.  I fall sometimes- I am not perfect - never will be, , But I am working really hard to be healthier and stronger.

Skip the 100 calorie snack pack - try this instead 

Val's aproximately 100 calorie or less snacks

4 cups of raw broccoli ( 100 calories- if you can do it)
1 medium apple 81 calories
1 med banana 109 calories
2 oz chicken  86 calories
3 oz artificial crab 87 calories
2 oz tuna 50 calories
1 large hard boiled egg 75 calories
1/2 c oatmeal 73 calories
2 oz pork chop 108 calories
light and fit yogurt 90 calories
Low-fat cottage cheese (4 oz): 80 calories 
Raisins (50 or about 1 oz): 85 calories 
Skim milk latte (8 oz): 85 calories 
Air-popped popcorn (3 cups or 1 oz): 95 calories 
Celery (5 pieces) with peanut butter (1 Tbsp): 100 calories 
Unsweetened applesauce (1 cup): 100 calories 

peanut butter is more accurately nutritionally grouped as a fat than a protein source - it is a myth that it is a great source of protien. 

simply jif which is I believe a lower sugar peanut butter has in 2 TB  190 calories, 8 grams of protein and 16 grams of fat, 

in comparison  2 oz of tuna has 50 calories, 0.5 grams of fat and 14 grams of protein
2 oz chicken has 86 calories, 2 grams fat, and 16 grams of protein
2 oz lean grilled steak has 103 calories, 4 grams fat, and 15 grams of protein
1 cup Kash go lean cereal 110 calories, 1 gram fat and 13 grams protein


(6 months of logging on fit day almost every single day after surgery, comparing and tweaking and looking for substitutes to make the best choices,  I found when I eat peanut butter my calorie counts sky rocket. and  I still reading nutritional labels on EVERYTHING   I can, I look for the brands with the most bang for the calorie taste and nutriitiona wise.)

September 25th was my 5 year anniversary from my RNY. My weight is pretty stable with 5-7 pound fluctuations depending on the day and month.  my health is very improved. My blood pressure is normal, my colesterol is normal,  I eat well, I exercise and my body is stronger than I thought I could be.

I have learned some things in this process. 

One is that  some things I thought surgery would change did not, and things I was sure would never change have changed drastically. 

I would like preops  and newer post surgicals to know that this surgery will  help you lose weight and if you address your lifestyle and emotional issues you can maintain.  

Your health will improve. Cherish it - and take care of it.   Eat for your health and  make monitoring you labs and taking your vitamins a top priority.  Make exercise a part of your life - it feels good to build  strength and endurance.

 I would recommend addressing the psychological issues early on. Having surgery is stressful on your body and your mind. You will go through so many changes, so fast you may feel like you are on a roller coaster ride.  It helps to have help to adjust to the changes and  your evolving self as the changes occur. I see from postings on the message boards that indicate some are developing new eating disorders and therapy is helpful to help yourself develop  a healthy relationship with food.  Cross addictions are so prevalent after gastric bypass so love yourself enough to get help if you are slipping into trouble.

Unfortuantely, many relationships change.  People  who were friends may not be anymore and people you least  expect may now want to be your friend.  Sometimes the changing attention may make you feel resentful and wonder why didn't they have this interest when you were morbidly obese. Remember, that as you go through change and you feel better and more confident about yourself you may be changing and behaving more invitingly. It may not only be about the weight. As you feel better  and your confidence and self esteem improve you may expect more of others already in your life in how they treat you and they may resent that.   So many of us had lower self esteem when morbidly obese and asked very little from others in our lives and now we can look at life and say hey - I deserve better.  This is another area therapy can help. You deserve the best and sometimes it takes some help to learn how to expect and accept no less than what you deserve in life.

I am glad I had  gastric bypass surgery and I would do it all over again. 

best of luck to all

I had my breast implants replaced on 8/18.  the surgery went well, and initially my only problem was some itchiness at the incision area.  3 days later went to the Drs office and saw his nurse. My right breast looked bigger - more swollen and definately more painful. Nurse assured all looked good, and for the most part it did.. The rippling is gone.  I had some redness around the steristrips over my incisons, and removed it in the shower as soon as I got home. OH MAN! it was red and totally blistered under the tapes.  Over the next few days it continued to get worse.  My right breast also continued to have significnt pain. the left was tender - the right HURT.  Back to the surgeon he said just swelling and to use 1 % cortisone on the allergic reaction. by that time the area around my incisions was red, inflamed, blistered and oozing serous fluid. (the cortisone helped pretty fast)  he said see him in 2 weeks. by the end of the week, my breast was still significantly hurting and looking swollen. called PS and he fit me into his schedule between surgeries.  He looked at my breasts and said the new anatomically shaped implant had "flipped" or turned to the wrong position.so . once I am healed - back to surgery.  He tells me it is a simple procedure - takes only a few  minutes, but to me no surgery that requires me to have a general anesthesia and cuts into my body is minor.  It has been very diffiicult. took me about 2 years  of ugly rippled breasts to get my nerve up to have the revision, and now once again  I am sucked into complications,  It is very hard, very depressing.

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SHOULD I TRY DIET PILLS TO SPEED UP MY WEIGHT LOSS / BREAK MY PLATEAU / OR LOSE MORE WEIGHT?
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I would only say that it would be as effective post op as it was preop. If there were an effective weight loss pill out there I would surely have rather done that that have my stomach transected and my intestines rerouted, and live with all the other ramifications of having this surgery for the rest of my life. But the pills etc were not effective, and I risked my health taking them. I lost a little, then as soon as I stopped them I gained all back plus extra. that diet mentality made me morbidly obese.

Surgery has had its risks as well, but I have improved many aspects of my health and the benefits have out weighed the drawbacks.

Now, My approach is much different. I have worked VERY hard to develop the habits I need to maintain for life. It is not a diet, it is a lifestyle. I eat well, I exercise regularly, and I have my pouch to help me maintain appropriate portion sizes of the good foods I put into my body.
I am 4 years out and I have been maintaining my weight very well for almost 3 years.


the first year I certainly ate less than I do now. The pouch is intended to stretch a little so that we can eat enough to maintain ourselves long term. I still do 6 small meals and I focus on eating the right number of appropriately sized food servings from each food group, and a major focus is being sure I do ingest everything I need to. My choices focus on my health maintenance. I do allow myself treats as well.

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BODY IMAGE ISSUES
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I have to admit that before I had WLS I thought being thin would change my whole life. It did improve my health, my energy levels. I am a gym rat now that I am small enough to exercise with out pain.
I thought that being thin would make me feel pretty. Then - "the skin" it was like an alien attached to my body. I wrote above about how horrified I was by my skin, so I won't repeat it all here. I then thought plastic surgery would fix all my problems with my body image. After many plastic surgeries, I had finally come to the bitter conclusion that my body will NEVER look the way I want it to, it has been too abused and all the ravages to my body cannot be erased no matter how many surgeries I have. I was sitting in my PS office depressed and crying about how bad I still felt about my body. He did all he could to reassure me, and out of the blue I heard myself saying that more surgery was not going to fix my problems.

A lady I met on another board (a truly wise woman) about a year ago and I had been talking for a long time then, but we have lost track of each other. She had encouraged me to seek therapy, and I did. At that time I was starting to have the rippling on my implants and was very extremely depressed. She encouraged me to have counseling and get my head straight before I proceeded with any more surgeries. She was right, but I did proceed to have the thigh lift redo and held off on changing my breast implants until I feel good about the surgery, so I guess that is progress.

I have been doing a lot of reading and have some great resources to share.


here are some excellent books


Passing for Thin by Frances Kuffel

This is a memoir of a woman who lost 188 pounds thru OA, after a lifetime of obesity. Although she did not have WLS, her experience in going thru the changes from fat to thin were many times as if they were written from my life.


How Much Does Your Soul Weigh? by Dorie McCubbrey

Written by a therapist who works with people with eating disorders, This is not another diet book. The author is recovered from an eating disorder herself. It details why diets really don't work and has a lot of info on freeing yourself from emotional eating. Yes, you can recover from an eating disorder and live as a normal person and learn to eat like a "naturally" thin person. It has exercises throughout the book to help guide you to learning about yourself and finding solutions that will allow you to live a life not consumed by food. I particularly like a chapter named "feed your hungry soul" Love yourself - be true to yourself - express yourself - give to yourself - believe in yourself.

The Body Image Workbook by Thomas Cash MD

Just as the title says, it is a workbook full of written exercises to improve your self esteem, learn to feel good about your body. It is a lot of work, but I think it will be worth it. I posted above, about how attractive self confidence is and how I know people who are not "perfect" in appearance, but they radiate self confidence and that makes them very extremely attractive. I want to learn how to feel that good and to show that I feel that good!

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DIET AND NUTRITION
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BOOK RECOMMENDATIONS

8 Weeks to Optimum Health By Andrew Weil

excellent resource for improving overall health with an emphasis on diet and nutritional supplements. Although he advocates a vegetarian lifestyle, I am a meat eater and that is not going to change. But I have incorporated many of his ideas into my diet. Also strong emphasis on mind-body connection.



The South Beach Diet
South Beach Diet Cookbook
South beach diet Quick and Easy Cookbook

all by Arthur Agatston MD

excellent resources on balanced diet and eating for health. The cookbooks use fresh whole foods and the recipes are not complex, yet they are delicious.


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HOW DO I SURVIVE THE EARLY LIQUID DIET?

I started out on a clear liquid diet and progressed thru full liquid to pureed, then slowly to solid foods over a period of 6 weeks.

the clear liquid diet was the hardest. I was allowed diluted no sugar added fruit juices, I could not tolerate the taste as they seemed nauseatingly sweet. I tolerated warm stuff a lot better than cold. warm tea with splenda is still a staple of my liquid intake. I used green tea, decaf and varied flavored teas. I Love the Stash brand green tea with jasmine. I also had a lot of sf popcicles and all fruit popcicles. I also included sf jello, and was allowed cool whip even though it is not clear. I drank a lot of Chinese wonton soup with the solids strained out.

Full liquid for me included SF pudding, sf fudgecicles, I made cream of wheat and oatmeal using milk instead of water for additional protein. cottage cheese was and still is an important part of my diet. I ate a lot of dannon lite and fit yogurt. I recently discovered the Breyers no sugar added yogurt and it is so much better than the Dannon. I made potato soup by simmering a potato and couple TBs of onion in a small amount of chicken broth and pureeing with added milk and top w/ a dollop of plain yogurt.

At this point getting in the liquids was a higher priority to me than the protein count. I had a history of many kidney stones and I knew that dehydration comes fast, but I was not going to be malnourished in a couple of months of less than optimal protein intake.

At this point I did use some protein shakes, but discontinued them as soon as I was able to consume adequate protein from solid foods. I found every protein shake I tried had the same weird funky undertone taste to them. As one of my friends noted, they smelled like baby vomit.

I did not make very many pureed foods. texture is important to me as is appearance of my food and to me pureed foods look like, well, they were already digested and brought back up. I did try pureeing a piece of pot roast with some extra broth and serving over mashed potatoes, kind of like a very thick gravy.


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WHAT I HAVE TO EAT TO MAINTAIN MY WEIGHT AND HEALTH

on 1500 calls a day, (which I maintain nicely at)
the calorie ratio recommended to me as a person who works out regularly 4-6 times a week for at least an hour each time -
40% crabs (4 calories /gram) 30% protein (4 calories /gram) 30% fats (9calories /gram)

that is 150 grams of carbs, 112.5 grams of protein, and 50 grams of fat.


6 oz meat, fish or chicken
3 serving dairy, milk cheese, yogurt.
2-3 serving veggies. cooked or raw
2 pieces fruit. (one is always a banana)
2-3 servings complex carbs, whole wheat bread or tortilla, barilla plus pasta, Kashi high protein cereals.

I also have a treat, no sugar added ice cream or fudgecicle or pudding or sf jello w/ cool whip.

My major focus is on whole natural fresh and unprocessed foods as close to the natural state as possible.

As I have said, I work out, HARD. For me this is not just about being thin, but also about being strong, healthy and fit, a flexible body with good endurance.


I have seen posted that some docs only allow 3 meals a day, and absolutely No snacks in between. I do not understand how a WLS person can begin to have adequate nutrition on a plan like that with our very limited volume. Vitamins, pills and powders cannot even begin to make up for inadequate food intake. there are micronutrients in foods that cannot possibly be put into pills. Again, my focus is on heath and balance.

I have worked hard to not exchange one health problem (morbid obesity) for another(malnutrition or serious eating disorders)

I find it sad and scary when I see others posting that they are scared to eat, not eating, living on protein drinks, and not much else. Living in hunger because of fear of food. Eating horribly unbalanced diets. Going on "plateau busters" that just perpetuate the diet mentality that got us morbidly obese in the first place with a little quick loss that probably is not sustainable, leading to more yo-yo-ing. back in to the cycle that leads to obesity.

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SAMPLE MENUS
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Breakfast
1 C optimum power breakfast cereal with 1 cup milk

snack - 1 cup Breyers light yogurt

Lunch
3 oz chicken, 1/2 cup pea pods,

snack - 1 cup cantaloupe

Dinner
3 oz salmon, 1 cup cucumbers with 2 oz goat cheese crumbled on top

snack - 1 slice whole wheat raisin bread with 1 TB peanut butter, small banana

totals
calories - 1416
carbs - 140
protein - 125
fat - 44
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breakfast

1 cup regular oatmeal - cooked, 1 cup milk

snack - medium pear, breyers light yogurt

lunch - 1 whole wheat tortilla with 2 oz cheddar cheese and 2 oz chicken breast and 1/4 c refried beans - toasted into a quesadialla

snack- 1/2 cup cottage cheese with 1 cup cherry tomatoes

dinner 3 oz lean pork chop, 1/4 med baked sweet potato with a pat of butter, 1/2 c steamed broccoli


snack 1/2 c so jell with cool whip

totals
calories - 1217
carbs - 135
protein - 107
fat - 31


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breakfast -2 Kashi go lean waffles, 2 oz log cabin sugar free syrup, turkey sausage

2 oz chicken breast

Lunch - sesame chicken salad from Panera (restaurant)

snack - 1 medium sliced tomato with 1 oz goat cheese

Dinner - Turkey meatball - zucchini - tomato medley (recipe in South Beach diet cookbook, 2 oz barilla plus pasta - cooked = about a cup

totals
calories-1509
carbs - 147
protein -115
fats - 64

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breakfast - McDonalds breakfast burrito


snack - Medium raw orange, breyers light yogurt

Lunch - 1 slice whole wheat bread, 4 slices deli ham, 1 tsp mustard,12 baby carrots, 1 TB ranch dressing

snack - 1 cup strawberries, mozzarella cheese slice

Dinner - 3 oz broiled lean steak,1/4 cup sautéed mushrooms, 1/2 baked potato topped with 1/4 C low fat cottage cheese (make a great substitute for sour cream on a potato)

snack - 1 cup sf ice cream

totals
calories - 1382
carbs - 125
protein - 91
fats - 58

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breakfast - 1 large egg scrambled with 2 slices deli ham, 2 oz shredded cheddar cheese on top

snack - breyers light yogurt

lunch - healthy choice hot dog topped with 1/2 cup chili, on whole wheat bun

snack- - 1 cup cottage cheese with 1/4 c applesauce

dinner
6 large shrimp stir fried , w/ 1 cup sliced zucchini and 10 cherry tomatoes in olive oil on top of 1/2 cup cooked brown rice

snack- sf fudgecicle

totals
calories - 1400
carbs - 166
protein - 105
fats - 36

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breakfast - breyers light yogurt topped with 1/2 c Kashi crunch cereal

snack - 2 c lettuce with 1 medium cucumber sliced, w/ 2 tb ranch dressing

lunch - 1/4 of a 10 inch pizza, thin crust with sausage & cheese

snack - slice mozzarella , 4 thin slices deli ham

dinner- salad - 2 cups shredded lettuce, 3 oz chicken , 1 small apple thinly sliced , topped w/ 2 tb poppy seed dressing

snack - 1 c cooked oatmeal, 1 cup milk


totals
calories - 1446
carbs - 135
protein - 90
fats- 62








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WHAT ARE MACRONUTRIENTS?
Macronutrients are those nutrients that together provide the majority of our energy (calories) The three main macronutrients are carbohydrates, proteins, and fat. Others include alcohol and organic acids. They are distinguished from micronutrients such as vitamins and minerals necessary in small amounts to maintain health but not to provide energy.

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WHAT IS THE STORY ON PROTEIN?

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Protein is an essential nutrient. It is necessary for the maintenance of our muscles, skin and most of our internal organs. How do I know how much protein I need? 1 gram per kilo ideal body weight. take your ideal body weight and divide by 2.2 and that is your ideal weight in kilos and the number of grams of protein you need.

For example, my �ideal weight is around 120, that calculates to 54.5 Kilos, so I would round that to 55 grams of protein per day. I actually like my weight at 130 so I calculate based on that weight., giving me a requirement of 59 grams a day.


A person who works out hard and is trying to build muscle will possibly need more. I eat more because I do work out and with the number of calories I take in I also want to maintain a specific balance of macronutrients. IE, Protein, carbs and fat.

I have done a tremendous amount of research, talked to dieticians and personal trainers to learn as much as possible.

As weight loss surgery patients we place a high focus on protein. because it is an essential nutrient, we have a limited volume and in order to get enough to meet our body’s needs we place a priority on that. realize that an average woman who has an average activity level needs 50- 60 grams of protein a day. that is easily attainable by eating 6 oz meat fish or chicken. add 3 servings of dairy to meet the needs of an average woman, some kashi high protein cereal and some Barilla plus pasta and your are pushing 100+ grams of protein a day.

We do not need to focus on protein because of the published until everybody knows it is true myth that protein is a magic bullet for weight loss. (if it were I never would have been obese, I consumed several times the amount of protein I needed and it stored as fat.)

I find a lot of that type of info published by manufacturers and sellers of protein supplements. It is posted and repeated over and over until everybody knows it is true and it really was just hype to sell a particular product.

I found protein supplements put weight on me, which was helpful l when I lost too much weight with an illus and didn't eat solid food for almost a week. They may be useful in the liquid diet stage, but beyond that I stopped using them. If I use protein shakes and eat, I will be struggling with my weight. They add too many calories, and I honestly prefer to chew my protein. The shakes also do not satiate my hunger. They go right through my pouch in minutes leaving me hungry and wanting food. A piece of chicken or steak satiates me for hours.


Sources of protein
Protein is found in many plant foods, beans, nuts, seeds, and some grains. Quinoa is an excellent source of protein. I also use the Kashi High protein cereals. Protein comes from animal sources as well. Chicken, meat, fish and dairy products are excellent sources of proteins.


Protein builds muscle - right? well yes, if you also are doing some significant resistance training along with the protein. Just ingesting protein will not make you have nice buff muscles. You will have to work for those.

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THE ROLE OF CARBS IN MY DIET
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Carbs seem to be almost a dirty word. Again, many published myths about diet out there. Carbs are not evil, they are a necessary macronutrient.

Carbohydrates are your body's main energy source. Complex carbohydrates include legumes, grains, and starchy vegetables such as potatoes, peas and corn.

they are present as well as in foods made with sugar, such as candy and other sweets. These may make many of us dump. YECH. While I do allow myself and "occasional' treat, I really have worked to not make a habit of it. Avoid the processed white sugars for health as well as weight control. The foods high in refined sugar rarely have any real nutritional value.


For optimal health, get your grains intact from foods such as whole wheat bread, brown rice, whole-grain pasta, and other possibly unfamiliar grains like quinoa, whole oats, and bulgur. I focus on whole grains and high protein, high fiber cereals and pasta, as well as my daily fruit. Milk also has some carbs.

Start the day with whole grains. If you're partial to hot cereals, try old-fashioned or steel-cut oats. If you're a cold cereal person, look for one that lists whole wheat, oats, barley, or other grain first on the ingredient list. I eat Kashi Go Lean, Kashi Crunch, Kashi 7 grain, Natures path Flax plus multigrain, or Natures Path Optimum Power Breakfast cereals.

Use whole-grain breads for lunch or snacks. Check the label to make sure that whole wheat or other whole grain is the first ingredient listed.
Bag the white potatoes. try a baked sweet potato. Try brown rice or even "newer" grains like bulgur, wheat berries, quinoa, millet, or hulled barley with your dinner. Beans are an excellent source of complex carbohydrates as well as protein and fiber.

Pick up some whole wheat pasta or Barilla plus pasta. I taste tested several brands side by side and preferred Barilla plus hands down over any other high protein, high fiber pasta.

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NET CARBS / ARTIFICIAL SWEETENERS

The term net carbs seems to be the "diet" buzz word these days. Many people seem to read that as lower in carbs or no carbs and as a "free" food. Well, this is not exactly how it works.

Simple carbs and complex carbs affect our blood sugar differently. Simple carbs (refined sugars, honey, molasses, maple syrup, brown sugar, etc) enter our blood stream very quickly, raising our blood sugar levels. That causes a surge of insulin which brings the blood sugar down and some people then experience strong hunger at that point leading them to consume more simple carbs - and the vicious cycle of over eating begins.

Complex carbs do not enter the blood stream as rapidly or raise the blood sugar as high, keeping the blood sugar at a stable level and give a longer feeling of satiety. High fiber complex carbs take longer to digest and leave us feeling full longer.

Net carbs was a term invented to reflect the number of simple carbs in a product., by subtracting fiber and other carbs, such as sugar alcohols that have a lesser effect on the blood sugar levels.

A real deceptive part of this terminology is that some people seem to feel that the carbs subtracted do not have calories. In the case of fiber that is true. Fiber does not add to our calorie count.

However, some others do. Sugar alcohols are one example. Sugar alcohols are artificial sweeteners. They do in fact have calories, in general about half the number of calories per gram as sugar. BUT, they are also less sweet than sugar, so many products use twice as many grams of sugar alcohol than the amount sugar in the original product. If you carefully read the labels, the products that are flavored with sugar alcohols have just as many calories as the original product, if not more.

Net carbs subtract the sugar alcohols from the carb count giving a misleading impression that this "low carb" "sugar free" food is a lower calorie diet food. Not true!

These artificially sweetened foods may be helpful in limited amounts for diabetics who must keep their blood sugar levels in control, or those who have dumping syndrome, but want a "treat" - as long as they count it in their daily calorie count. These foods, generally candies, cookies, cakes etc, have a LOT of calories with no real nutritional benefit. For a person whose weight is in excellent control and who can limit them selves to a small portion, it may be useful as a small treat, if they can tolerate the sugar alcohols.

the main side effect (besides weight gain from ingesting too many empty calories) is digestive upset. Many people get abdominal cramps, gas, and diarrhea from sugar alcohols. Now that is a REAL treat....

Other artificial sweeteners such as Splenda and Nutrasweet have no calories, and for most people no side effects. I have had good luck using Splenda. It works well in drinks such as tea, home made lemonade etc. I have successfully used it in baking fruit crisps, and pies. The moist fruity dishes tasted excellent and have served them to company with out them noticing it was a "diet" food. the best results, I found were using about 3/4 of the amount of splenda, IE if a recipe calls for 1 cup sugar, to substitute 3/4 cup of Splenda. I found if I use the full amount it tastes too sweet, and a bit artificial. I tried using Splenda in cookies and found the results miserably disappointing. They were very dry, crumbly, and the taste was funny. I tried modifying by substituting with 1/2 splenda and 1/2 sugar and found improved results. Splenda works well for my banana bread, I think because the natural sugar of the bananas brought moisture into the bread.

There is a Splenda for Baking out and it is half sugar and half Splenda. I have not tried this product, yet.

I use some commercial products with Nutrasweet, but it is not suitable for cooking.

Another product out is AcesulfamineK, which I have seen sold under the brand name "Sweet One" It is in a LOT of commercial products, has no calories and has a very natural taste. I bought a box of individual serving packets and have tried it in tea and added to my oatmeal and it is very good. It is supposed to be heat stable and good for baking. I have not tried baking with it yet, but will update when I do.

My overall feeling is that I need to look at the total carbs, and more importantly the total calories. I feel the "net carbs" terminology is a marketing ploy, deceptive, and not really helpful in weight control.

Artificial sweeteners can have a place in a balanced, healthy diet in limited quantities, but they are just that. Artificial. In the journey to health and fitness, I think it is important to be aware and thinking as far as the quantity of artificial ingredients we place in our bodies.




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DO WE NEED FAT IN OUR DIET?
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Fats help your body absorb many essential vitamins, maintain the structure and function of cell membranes, and preserve the integrity of your immune system. But fat is a very concentrated energy source, providing twice as many calories per gram as carbohydrates and protein. Fats add flavor to food and help you feel a sense of satiety for a longer period of time. Too much of certain types of fat � such as saturated fat and trans fat � can increase your blood cholesterol levels and your risk of coronary artery disease.

Limit fat to 20 percent to 35 percent of your daily calories. Emphasize fats from healthier sources, such as nuts and olive, canola and peanut oils. Salmon and ground flax seed also are sources of healthy high quality fats. Try adding the flax seeds to cereal or oatmeal. I try to eat salmon weekly and eat nuts 4-5 times a week in small controlled portions.

Saturated fat is most often found in animal products, such as red meat, poultry, butter and whole milk. Other foods high in saturated fat include coconut, palm and other tropical oils. Saturated fat is the main dietary culprit in raising your blood cholesterol and increasing your risk of coronary artery disease.


I personally malabsorb fats (don't ask how I know this- I have visual evidence, enough said. ) I still severely limit fried foods, especially anything breaded to only a few times a year. I use the trans fat free margarines such as Take Control in limited amounts. I occasionally eat real butter, but it is rare. the majority of the fats in my diet are from nuts, peanut butter, salmon and olive oil. I want a health low cholesterol, with a good balance of the good and bad cholesterols in my blood.

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HOW ABOUT THAT FIBER INTAKE?
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Fiber is the part of plant foods that your body doesn't digest and absorb. There are two basic types: soluble and insoluble. Insoluble fiber adds bulk to your stool and can help prevent constipation. Vegetables, wheat bran and other whole grains are good sources of insoluble fiber. Soluble fiber may help improve your cholesterol and blood sugar levels. Oats, dried beans and some fruits, such as apples and oranges, are good sources of soluble fiber.
Recommendation: Women need 21 to 25 grams of fiber a day, and men need 30 to 38 grams of fiber a day.

Kashi Good Friends cereal has close to 50% of the daily fiber requirement in 1 serving. I also love my oatmeal. You can also add ground flax seeds to your cereal or oatmeal to add fiber and omega fatty acids.



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SUPPLEMENTS/MICRONUTRIENTS
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WHAT ARE MICRONUTRIENTS?
Simply put - vitamins and minerals. Elements needed to sustain life that are required in very small quantities.

Trace minerals include iron, cobalt, chromium, copper, iodine, manganese, selenium, zinc, and molybdenum. They are dietary minerals needed by our bodies in very small quantities (generally less than 100mg/day) as opposed to macrominerals - calcium, magnesium, sodium, potassium, and phosphorus. Macrominerals are dietary minerals needed by the human body in high quantities (generally more than 100 mg/day) as opposed to microminerals (trace elements) which are only required in very small amounts.

Vitamins are organic chemicals that are required in trace quantities for good health, but which we cannot produce with in our own bodies, and therefore must obtain from diet or supplements.

I was recommended the Flintstones and Tums route to supplementation.

I am sure the Flintstones are fine, and I did use them initially when I needed a chewable.

Tums - never. There is too much evidence that the calcium in Tums is poorly absorbed. At a seminar on Osteoporosis I was taught that the bioavailablitiy (amount our body can actually absorb and utilize) of the calcium in the tums is less than 5 %. The speaker said we would need 50 tums a day to meet our requirement, and he was speaking to normies, not gastric bypass patients with even less absorption! Also the type of calcium in the tums needs stomach acid to absorb. Tums suppress stomach acid. While our stomach acid does meet up with the calcium lower in the intestine, it is missing the area where it is most absorbed, in the duodenum which is bypassed. our food/calcium no longer goes there.

There is some evidence emerging that those of us on acid reducers such as Nexium, Prilosec, Protonix, may be at risk of even poorer calcium absorption due to the lower stomach acid levels.

All evidence points to Calcium Citrate being the best absorbed calcium in wls people and non ops as well. One advantage of calcium citrate is that it does not require the stomach acid to absorb.

So I take Citracal Plus with vitamin D. total 1500 mg in divided doses of 3 doses 500 mg each. Vitamin D is essential to absorbing our calcium into our bones. I recently started the Citracal chews and really like them. I eat one after each meal as a treat with some powerful benefits. Our bones are not just inert things. they are constantly remodeling, breaking down and rebuilding. We need consistent calcium intake to keep them strong. Gastric bypass increases our risk of osteoporosis. I have osteopenia (reduced bone density, to less than normal, but not quite to the point of osteoporosis) at this point. I figure I had 42 years of bad nutrition prior to wls, very inadequate calcium intake in the years I was supposed to be building my bone density (up to age 35) and therefore I am now on Actonyl to help my bones increase density.


I also take 2 Centrum complete a day.

I take 1 Ferrosequal a day. It is Iron with a stool softener added. Iron can be constipating and so can calcium and I feel better since I switched to this form of iron. I take 1000 mg of vitamin C with my iron. Vitamin C increases absorption of iron.

Do not take iron and calcium at the same time, they each block the absorption of the other.

I take 400 IU of vitamin E a day. I take a form of Dry E. I was concerned with the E that is an oil based vitamin capsule would not absorb properly with my obvious fat malabsorption. this is available at any GNC or Vitamin Shop. I take the E as a precaution for heart attack prevention. My dad died in his 30's from a heart attack from high cholesterol/hardening of the arteries.


I use a liquid B - Complex from GNC. the B-12 is already broken down and does not require intrinsic factor to absorb. Intrinsic factor is produced in our stomach and makes B-12 absorbable from our food. With the wls, our intrinsic factor is affected, we may not be able to absorb that B-12 and may need supplements. In my case my b-12 level was in the "normal" range (200-800 in my lab) but had dropped from over 600 to 300, so I chose to add this supplement before it dropped further. My liquid B-complex keeps my level around 700. Some people will have to receive injectable B-12.
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MY EXERCISE ROUTINE

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Monday 1 hour cardio and about an hour of weights

Tuesday - 1 hour Yoga and 30 min to an hour of cardio if I have time

Wed, same as Monday

Thurs - same as Tuesday

Fri off - I work a 12 hour shift , but if I get cancelled at work, I go do an hour of cardio.

If I work Saturday, I stop after work If I don't have an early "date" w/ DH and do 30-60 min of cardio, otherwise if I am off I go and just do what ever looks good to me at the time, sometimes a yoga class.

Sunday, if I am off work I go to the morning yoga class. If I work, I might or might not go, depends on if I went Friday or not.

HERE ARE SOME GOOD REFERENCES TO HAVE ON DIET AND FITNESS

Have you ever been frustrated by the conflicting reports on how much exercise you need? Not up to the hours long heavy workouts? Intimidated by the complex training schedules? Not sure where to begin?

Here excellent article on the benefits of moderate exercise, you have to register on Medscape to read their articles, but it is a good source of legitimate info, they are not selling you any thing. I did sign up for the newsletter and there is almost always something in it I can use.

http://www.medscape.com/viewarticle/524377?src=mp

The article is related to the book below.


Harvey B. Simon's, MD, FACP, newest book, The No Sweat Exercise Plan. Lose Weight, Get Healthy, and Live Longer, was published by McGraw-Hill in 2006



Here are some no - nonsense, fad free books with reliable info on being healthy and fit, which for me was the purpose of weight loss surgery, and these are helping me feel, (and look) my best! I got them from my local library and looked them over really good before I bought them. Great references to have around the house.


Mayo Clinic Healthy Weight for Everybody
by Donald D., M.D. Hensrud


Mayo Clinic Fitness for Everybody
by Diane, M.D. Dahm (Editor), Jay, M.D. Smith (Editor)



Shape Yourself
by Martina Navratilova

The woman is 50 and looks better than many 25 year olds. She is still working as a professional athlete at 50 and winning! The book is a common sense approach to diet, and eating for health. Obviously she has never been obese. It seems from reading the book she is a natural instinctive eater who listens to what her body needs. Lots of detail on choosing foods, avoiding additives and processed foods.

The fitness routine uses minimal equipment, and no need to belong to a gym or health club. there are lots of photos demonstrating the exercises. I wish she had a DVD that I could follow along with.