Protein is an essential nutrient that the body needs in order to grow, repair and form new tissue and cells, which includes muscles, blood, skin, hair, nails and internal organs. Protein also aids in wound healing (important after surgery), maintains lean body mass (which increases metabolism) and is necessary to prevent protein malnutrition. Protein is one of the three energy-producing nutrients, which provides 4 calories per gram of protein. High-protein foods slow the movement of food from the stomach to the intestine, which means you feel full longer. The body also uses more energy to digest protein than it does to digest carbohydrate or fat.
Protein in the diet can be found in mostly animal products, but there are non-meat sources of protein as well. Excellent sources of protein include meat, poultry, fish, eggs, dairy products (milk, cheese, yogurt), beans and nuts. To reduce fat intake choose lean cuts of meat, remove any skin and visible fat and pick low, reduced-fat or fat-free dairy products. Choose healthy protein sources like skinless white meat chicken and turkey, fish and shellfish (cod, flounder, tuna, trout, crab, lobster, shrimp, salmon), lean pork (fresh ham, Canadian bacon, tenderloin, center loin chop), and lean beef (ground round and sirloin).
Carbohydrate is the second energy providing nutrient, which provides 4 calories per gram of carbohydrate like protein. All carbohydrates are broken down to its simplest form, glucose. Glucose is utilized immediately for fuel by the brain and central nervous system. Carbohydrates provide all the cells of the body with the energy they need for everyday tasks and physical activity. Glucose may be converted to glycogen for later energy use.
Carbohydrates can be found naturally in a variety of foods which include milk, fruit, fruit juice, beans, starchy vegetables (peas, corn, potato, sweet potato, winter squash) and other starches (bread, cereals, grains, crackers, ect). You should avoid sweets, desserts and candies which are usually high in fat and calories and low in protein. When picking carbohydrate sources choose foods high in nutrients, low in fat and added sugars. For example, fruits, 100% fruit juices (must be diluted) and low-fat milk will provide carbohydrates, vitamins, minerals and water. Whole grains and starchy vegetables are a good source of fiber as well, but remember you may not have these starches until phase 4.
Fat is the third energy providing nutrient, which provides 9 calories of energy per gram of fat. Dietary fat is stored as adipose (fat) cells in the body, which is used for structural purposes to hold the body organs and nerves in position and protect them against traumatic injury and shock. Fat is also used as a cushion to surround your bones and protect them from mechanical pressure. Fat insulates your body, preserving body heat and maintains body temperature. Dietary fat is essential for the digestion, absorption, and transport of fat-soluble vitamins (Vitamins A, D, E and K).
Remember, fat has more than twice the amount of a calories per gram compared to protein and carbohydrates. Excess fat intake as well as excess carbohydrates will be stored in the body as adipose fat. Consuming high amounts of fat in the diet may cause a person to exceed their calorie requirements, which will lead to weight gain. Also, high fat intake can lead to elevated blood cholesterol, which is a major risk factor for cardiovascular disease.
Remember to avoid foods high in fat such as cakes, cookies, ice cream, whole milk, cream, oils, margarine, butters, mayonnaise, sour cream, fast foods and high-fat meats (hot dogs, sausage, bologna).
Remember, foods do not have to be bland. Try using spices, herbs, garlic, mustard, fat-free mayonnaise, broths, fat-free gravies, cooking sprays or sugar-free jellies to add flavor to your foods.
It’s that time of year again…when the sunset gets later and later each day (leading up to June 21st which is the summer solstice) and activities move outdoors! This provides a great opportunity to add variety to your fitness routine by getting out of the gym (or the house) and exercising outside. Gone are the days of rushing home from work to savor the last few hours or minutes of daylight and battling bitter cold temperatures while exercising. With the sunset getting closer to 9 pm or later each day, you can enjoy a little “down time” after work and still have plenty of daylight left to get outside and exercise. Here are a few suggestions of what East Tennessee has to offer
1. Walking/Jogging, Cycling, and Hiking: there are miles and miles of Green ways and hiking trails in Knoxville and the surrounding counties that are perfect for walking/jogging, cycling, and hiking. You can visit http://www.connectwithtn.com/index.php to find the Green ways and hiking trails closest to you. Take advantage of the beauty East Tennessee has to offer that is unique to this part of the country! Use this time of year to get involved in your local walking/jogging community by training for and completing a 5K road event (that’s 3.1 miles for those of us that do not use the metric system). You do not have to be a runner to get involved in a 5K road event; many people walk the courses, too! The Knoxville Track Club, in partnership with many area businesses and organizations, organize 15+ road events per month that are appropriate for any fitness level. You can visit www.ktc.org for a calendar of events and contact and registration information for each road event.
2. Yard Work: this is the time of year where everything grows, blooms, and invites us to spend time outside in our yards and gardens. Patients ask me all the time if they can count their yard work as exercise. It depends on the type of yard work that you are performing and what the physical demands are. If you are push mowing and/or weed eating by hand, you can count these two yard activities toward your exercise time during the day. Other yard activities, such as light to moderate gardening, raking, light trimming, etc all fit into the “activity” category, but should not be the only form of “exercise” you get for your day or week. Push mowing can burn, on average, 400+ calories per hour based on a 145 pound person, so pull out the push mower and offer to mow your neighbor’s yard, too!
3. Swimming, Canoeing, or Kayaking: East Tennessee has miles of rivers and lakes to enjoy this time of year and canoeing or kayaking is a great way to spend your time on the water and exercise too. Swimming is another form of excellent water exercise. Spending time at the pool with friends and family is a great summer activity (not to mention a great way to get relief from the heat and humidity) and you do not have to swim laps to exercise in the pool. Water walking is a fantastic form of cardiovascular exercise that you can do in the shallow end of the pool while you are watching your children or grandchildren play. The water creates resistance that helps get our heart rates up while we are walking in the pool. Walking at a moderately out of breath pace (where you can carry on a conversation, but it is a “labored” conversation) for two sessions of 15 minutes during your day at the pool will meet the American College of Sports Medicine’s exercise recommendation of 30 minutes of exercise a day.
4. Recreational sports such as Soccer, Basketball, Softball, Frisbee, or Golf: There are numerous opportunities to join recreational leagues to play any number of sports or you can go to your local park and participate in these activities on your own. You do not have to be an athlete to reap the benefits of playing basketball or soccer and don’t worry if you’re not the best golfer. The goal is to add variety to your exercise routine and walking the golf course as you play 9 holes of golf or playing a pick-up game of basketball is a great way to exercise!
As with any outdoor activity, remember to wear sunscreen and remain properly hydrated. Variety is a key to success in maintaining a regular exercise and fitness routine and getting that variety from what each season has to offer is a great way to enjoy each one as it comes!
What is a Patient Advocate and what can this person do for you? The patient advocate at the New Life Center for Bariatric Surgery is a person that is here to help you get started and answer your questions about the practice and our program. Whether you are gathering information about bariatric surgery for the first time, or are ready to register for a seminar, your patient advocate is here to help you on your weight loss journey!
The most often asked question I hear when I talk to a potential patient for the first time is usually: where do I start? First you should establish if you are a candidate for weight loss surgery. To be candidate for weight loss surgery you must have a Body Mass Index (BMI) of at least 35. Secondly, you should register and attend one of our free informational seminars. The seminars are given by one of our physicians, and they will discuss the different procedures that are available at our office, our program that each patient will follow after having a procedure as well as insurance information.
The seminars are about an hour and half long and each person is allowed to bring a support person with them. If you are interested in pursuing a revisional procedure, but did not have your original bariatric procedure with our office, you will also attend a seminar to get started. If you have attended one of our seminars over a year from the date you wish to schedule your consultation appointment, we ask that you attend another seminar so that you will have all of the up to date information about our office and program.
As soon as the next day, after attending a seminar, you can call our office to schedule a consultation appointment with one of our physicians. You may also call the office if you have any additional questions regarding our office or our program and ask for the patient advocate. I look forward to assisting you on your weight loss journey!
I have often been asked by patients how much protein is adequate for bariatric surgery. Our post-op resource guide details our recommendations, but I am often faced with the question, “How much protein do I need?” and “What protein shake should I drink?” The answer is you don’t have to drink any, but you will likely feel and progress better if you manage to take in a certain amount of protein.
How much protein do I need? The amount depends on the type of weight loss surgery that you have had. Our restructure patients (lap bands and sleeve gastrectomy) require a little less protein around 6 grams daily. They will absorb protein better and therefore require a little less. Our Gastric Bypass patients will generally need 60 to 80 grams daily because there is a malabsorptive component to this mixed procedure. Our Billary Pancreatic Diversion patients (BPD) will generally need 80 to 100 grams daily because this procedure involves a higher degree of malabsorption.
What protein shakes should I get? There are many protein shakes that would be adequate for our post bariatric patients; there are so many brands that it is impossible to list them all in this context. In general, it is important to look at the nutrition label, make sure that aren’t too many calories, carbohydrates, or fat grams per serving. It usually recommends less than 120 calories, less than 5grams of fat, and less than 8 grams of carbohydrates, also to be affective it should have at least 12 grams of protein. In Summary, shakes are not absolutely necessary, but they do facilitate healthy weight loss in both bariatricand non-bariatric patients. Protein is vital for all body functions; including maintenance of muscle mass. In my early years of bariatric surgery 2004-2005, I worked in a bariatric program that forbade all protein shakes. Now our program activity encourages protein shakes, I can honestly say, the patients feel and progress better.
Our very own Dr. Boyce, Knoxville bariatric surgeon, was recently awarded The Patient’s Choice distinction, an awarded given to physicians with the highest rated patient feedback. This honor is given to only 5% of U.S physicians who have received rave reviews across the board in areas such as bedside manner, doctor-patient face time, and overall opinion.
When you are just embarking on the journey to weight loss surgery, you may wonder what you can do to speed your journey along. One simple way to get things going and to increase the chances of getting your insurance company to approve your surgery as quickly as possible is to focus on the paperwork needed to start the process.
You may wonder why the paperwork is necessary and even critical to your success. Here is a little insider information about how your paperwork can make a difference!
As you may already know, the first step in pursuing weight loss surgery through The New Life Center for Bariatric Surgery is to attend our Free Informational Seminar. At the close of every seminar each patient is given a Bariatric New Patient Packet. This packet is a necessary part of your first consultation with the surgeon.
Why is it so important ??? Well,
• Having a complete packet will help us avoid delays in starting your appointment.
• Correct information about your current insurance coverage will help us know which insurance plan covers you and what it requires to approve you for surgery.
• Answering the medical questionnaire thoroughly will help the insurance company see that you have made attempts to manage your weight before going on to surgery and that all medical information has been considered.
• Parts of the insurance requirements may already be met and the forms will reflect the work you have already done.
• The medical information will be very helpful in the care you receive from your surgeon. By knowing your medical history as well as any existing health problems you may have, our surgeons can better prepare you for a safe and effective surgery.
The joy of patient paperwork does not end there, however. Even after you have had surgery, we update patient information forms annually. This is essential so that we have updated consent forms giving the staff permission to view your records and to bill your insurance for any services you receive through our office.
We try to mail this paperwork to you prior to your appointment so that you can fill it out without being rushed and bring to the office completed. This cuts down on your wait time because once we get the information; we must then transfer it to your file in our computer. Knowing your correct contact information helps us better serve you as we may need to contact you about the progress of your journey or your medical condition.
We request that all patients, new and existing, arrive ten minutes earlier than your scheduled appointment time. Even if we don’t need to update your address or phone, the clinical staff may have written questions for you to complete to facilitate your discussion that day.
Although all these forms seem redundant, especially to post-op patients, they are an essential part of the data used to track your progress and are very helpful to the clinicians you will see at your follow-up visits. The information you provide to them in this paperwork will direct them in how to advise you to be successful in our program.
So put your thinking caps on, practice that penmanship and welcome to the TEAM!
Thank you from the administrative staff!
Donna Hicks
Stephanie Hamilton
Melissa White
“When Dr. Rosalind Cadigan decided to have surgical weight loss surgery, she didn’t have far to go.
Cadigan, who specializes in obstetrics and gynecology at Parkwest Medical Center, would find herself as a patient on the same floor where she often makes patient rounds. She entrusted her own health to the same caregivers she works beside each and every day” Click Here to Read Full Article
“Weight regain after surgery. Why does it happen?”
I often get asked by patients and their families at the pre-op visit “Why do people regain weight after surgery”? So, why does this happen? While observing a few older patients (some from our practice and some from others), I have noticed several poor dietary behaviors develop, such as eating in between meals, overeating, and eating wrong combinations of foods. It is never a good practice to snack in between meals. This will lead to a great amount of calories. Also, I would find that patients would choose high carbohydrate snacks, such as starches and simple sugars. Both of these lead to a lack of satiety and increased hunger as they are quickly digested and burned. High carbohydrate snacks also lead to hypoglycemia in the bypass patient with nausea, sweats, and dumping like symptoms a couple of hours later. If the calorie load is higher than the need, then the remainder is stored as fat. Folks tend to snack for a variety of reasons. Examples could be stress, loneliness, and boredom. For those who cannot seem to understand why they overeat, I recommend psychological counseling. A licensed psychologist can take a closer look into the causes behind the overeating and help the person find other alternate forms of stress relief. For those where boredom is an issue, I recommend taking up a new hobby. If loneliness is an issue, try joining a support group, working out at a fitness center, chatting online or volunteering time and services. All of these things will expose one to many different and interesting people and will help foster friendships.
Overeating at meal times is another cause of weight regain. Several things can lead to this, but I will only name a few. To avoid overeating at restaurants, half the portion served and immediately ask the server for a box. Not only will one be cutting portion sizes to a normal size, there will be leftovers for another meal. If an extended time is spent socializing, get refills on non-caloric beverages such as decaffeinated tea, coffee, and lemon water instead of opting for more high caloric drinks such as cocoas, smoothies, and alcoholic beverages. When dining at home, fill your plate from the stove. Research has shown that people are less likely to overeat if extra food is kept in cooking ware and not served at the table. Finally, if taking too much time to eat is a problem, set a timer for 20-30 minutes for each meal. This is sufficient time to allow one to eat and prevents excessive intake.
Finally, proper food combinations are essential to weight loss, weight stability, and satiety. Many patients have heard our dietitian say, “There are no wrong foods, just wrong combinations of them.” For each meal, make sure that 50-70% is protein. Research has shown that a higher protein diet promotes weight loss. Because proteins make us feel satisfied longer. Proteins come from a variety of sources: low fat dairy products, eggs, lean meats, seafood, legumes, nuts, seeds. In addition to protein, choose low fat and low carbohydrate sides such as dairy products, fruits, vegetables, whole grain snacks, and whole grain pastas. Limit starchy vegetables such as potatoes, corn, and peas. Many empty calories and fat grams come from some of the things we use to prepare our foods such as butter, dressings, sauces, and condiments. A few suggestions would be using spritzers instead of dressings for salads, opting for light sour cream in place of butter for a potato. One may also want to consider diluting marinades or asking for sauces on the side if eating out.
Let’s get the new year off to a good start with good eating behaviors and lifestyle choices!
THE IMPORTANCE OF PROTEIN AND WATER BEFORE AND AFTER SKIN REDUCTION SURGERY
After successful weight loss, many of our patients inquire about body contouring and what to expect afterwards. You may read about the different types of procedures performed by our surgeons on this website; however, I’d like to make a specific reference to something you can do to facilitate the healing process after surgery. There are always some variables which affect the rate and ability of our bodies to heal such as age, certain disease processes, condition of the skin related to smoking and sun damage, and personal hygiene. However you can play a significant role in improving your outcome by maintaining a proper, nutritionally sound diet to aid in your healing process relating both to the speed and overall satisfaction of your recovery.
Proteins are essential in wound healing and tissue regeneration. If the body’s cells aren’t properly nourished, they lack the ability to adequately regenerate (recreate lost or damaged tissues). Increasing your consumption of high quality protein in the weeks before and after surgery will help your body do the repair work it needs to do more effectively and quickly. Ensure an adequate intake of lean protein found in lean beef, chicken, fish, seafood, eggs, low-fat dairy and soy products. When time is an issue and you need a quick source of protein, take advantage of the protein supplements available on our website in the forms of shakes, bars and liquid additives in preparing yourself for your surgical recovery.
Another important ingredient to proper healing is water, water, and more water. Making sure your body is well hydrated will make you more comfortable during the time when you can have nothing by mouth in the hours before surgery. Most importantly however, it will help you move the anesthesia and other surgery drugs more quickly out of your body after surgery. Increase your water consumption to 10-12 glasses of water per day in the weeks before surgery, as well as after, to facilitate your healing process. This will also help reduce water retention which can make you feel uncomfortable after surgery. Water helps to keep your skin turgor at its best while your body is adjusting to its new form.
Be proactive in your health and put yourself as a priority in living your “New Life” to the fullest!
Happy Thanksgiving, Merry Christmas and soon to be New Year. With the holidays comes the “the holiday weight gain” and then of course those New Year Resolutions. We all think of ways to better our life and accomplish goals with our resolutions, but I feel we always forget one thing when looking at our health in the New Year, Vitamins. As we make our resolutions to eat healthier and exercise more, we forget to include vitamins to the list. Many of us are deficient in a vitamin or mineral, whether it is Iron, Vitamin D, or a B vitamin, and we most likely don’t even know it. As we start to exercise and eat better we forget to add in a multivitamin which can help us maintain or achieve the proper vitamin levels, and thus make us more energetic and healthier. The two deficiencies we see most commonly are Vitamin D and Iron.
Vitamin D is very important in our calcium absorption and a great reason to get out into the sunshine. Studies show that up to 1/3 of adults and 2/3 of those under 18 are deficient in this vitamin, those are staggering numbers. D helps us in many ways, mostly for us to stay healthy, not only for our bones but our immune system as well. Because one of the best ways to get D is by sunlight it is estimated that the number of those with deficiencies rise in the wintertime when many people are not out in the sun due to the weather. So what can you do? Take supplements…Vitamin D3 to be exact. This can benefit you not only if you have had surgery but after surgery as well.
Iron: many of us feel fatigued and run down at times, especially with all the holiday running! But, for some of us it could be an iron deficiency, which is the most common nutritional deficiency worldwide and here in the United States. Taking an iron supplement can help boost those numbers and help your overall well-being.
Now don’t get me wrong I am not saying everyone has a deficiency, but some of us might, and it is always a good idea to be on a supplement. After you have surgery it is a MUST, but prior to surgery it is HIGHLY recommended (wink, wink.) So what can you do? Begin taking a good multivitamin with iron (unless you have a medical condition and have been instructed not to take iron – then get on a good multivitamin without iron.) We have a few here in the office. We have our Perfect Pak II for Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy patients and our Perfect Pak Plus for Bilio-Pancreatic Diversion with Duodenal Switch patients. We also offer a chewable vitamin that is a complete multivitamin appropriate for any patient at any stage of their process. The number of chewable vitamins you would take each day is dependent on whether you are pre-op or post-op and on what surgery you’ve had.
We are always looking for ways to help improve your health and to do it in a way to fit your needs. Remember, no matter where you are in the process, in the famous words of Dr. Boyce “We are ready to commit if you are.” So to end this I wish all of you and yours a Merry Christmas, a Happy Hanukkah, a Happy Kwanza, and a Wonderful New Year!
Sarah Grimes RN, CBN
Our very own 