Vitamin D - Are You Getting Enough?

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses vitamin D, and how to tell if you’re getting enough vitamin D. 

Vitamin D is essential for the absorption of calcium and building and maintaining strong bones. Individuals who do not get enough vitamin D may develop soft, thin, and brittle bones, a disease called rickets in children and osteomalacia in adults.

Vitamin D is also required for the healthy functioning of muscles, the nervous system, and the immune system.

This essential nutrient may also play a role in the risk of developing many chronic diseases such as diabetes, hypertension, autoimmune disease and some forms of cancer.
How can you make sure you get enough vitamin D?

Vitamin D is unique among the nutrients required for good health because it can be made by the body when our skin is exposed to sunlight. When the ultraviolet – B (UV B) radiation of the sun penetrates our uncovered skin, vitamin D synthesis is triggered.

How much sunlight is too much or too little?

It is hard to say.

The amount of sunlight needed to make enough vitamin D depends on a number of factors:

• Time of day: For the sun’s UV B rays to adequately penetrate the skin the sun must be directly over head.

• Your location: Individuals living in more northern latitudes, where the sunlight is less intense, may not synthesize vitamin D in the winter months. But vitamin D synthesized during exposure at other times of the year can be stored in the liver and fat.
• How much of your skin is exposed: The more skin surface area exposed, the shorter the time needed to meet your vitamin D needs.
• How easily you get sun burned: The melanin pigmentation of dark-colored skin prevents UV B light penetration and limits vitamin D synthesis. Darker skin needs more sun exposure, lighter skin less time in the sun is needed to produce vitamin D.
• Factors that block UV rays: Sunscreen, with a SPF of 8 or more, will block the vitamin D – producing UV rays.

According to the National Institutes of Health, less than 30 minutes of sun exposure (without the use of sunscreen) twice a week to arms, legs or back is sufficient to maintain adequate vitamin D levels.

Getting Vitamin D Without the Sun

When sun exposure is limited it is important to include good food sources of vitamin D (e) in the diet or to take a supplement. Fish liver oils are the best sources of vitamin D. Fatty fish, such as salmon, tuna and mackerel are also good sources. Foods of animal origin contain vitamin D3 or cholecalciferol.

Most of the vitamin D in our diet comes from fortified milk and breakfast cereals. The milk supply in the United States is fortified with approximately 100 IU vitamin D per 8 ounces. Some brands of breakfast cereal, orange juice, yogurt, margarine and soy beverages contain added vitamin D. Food labels do not list vitamin D unless the food has been fortified.

Vitamin D from planted-based foods is in a different form called vitamin D2 or ergocalciferol. Vegetables are poor sources of vitamin D. Some mushrooms, however, contain vitamin D2. The amount of vitamin D2 in these mushrooms can be increased by exposing them to UV light. A dried ground mushroom powder containing 600 IU of vitamin D per teaspoon is now available and can be added to food to increase dietary vitamin D.

How much dietary vitamin D is needed for good health?

According to the Institute of Medicine1 during the first year of life infants require 400 International Units (IUs) per day. Infant formula is fortified with vitamin D. Since breast milk is not a good source of vitamin D, breast-fed infants require a daily vitamin D supplement.

The requirement for vitamin D increases to 600 IU for children one year of age and older and for adults up to 70 years. To maintain healthy bones, the vitamin D requirement goes up to 800 IU in adults 71 years and older.

Over the counter vitamin D supplements are available in a range of doses. Both ergocalciferol and cholecalciferol are effective in raising vitamin D levels. Taking a large amount of vitamin D can be harmful so it is recommended that you check with your health care professional before beginning a vitamin D supplement. The safe upper limit for vitamin D is 4000 IU/day (for children 9 years and older and adults). Vitamin D is also found in most multivitamin supplements and calcium supplements. Be sure to include these sources of vitamin D when calculating the total amount you are taking daily.

Symptoms of vitamin D deficiency in adults include osteomalacia, causing bone pain and muscle weakness. Vitamin D deficiency can be determined by checking the concentration of 25-hydroxyvitamin D in the blood. If a deficiency or insufficient amount is found, a prescription form of vitamin D is required. It takes several months to treat vitamin D deficiency.

Food sources of Vitamin D

Foods containing Vitamin D and International Units (IUs)/serving

Cod liver oil, 1 Tablespoon 1,350 IU
Salmon, sockeye, canned, 3 ounces 715 IU
Dole Portobello Mushroom Powder, 1 teaspoon 600 IU
Mackerel, Atlantic, raw, 3 ounces 547 IU
Swordfish, raw, 3 ounces 474 IU
Sardines, canned, 2 ounces 150 IU
Tuna, light, canned in water, 3 ounces 40 IU
Egg, 1 large (vitamin D found in the yolk) 40 IU

Foods Fortified with Vitamin D

Milk, skim, reduced fat and whole, fortified, 8 ounces 115 - 124 IU
Yogurt, fortified, 8 ounces 120 IU
Margarine, fortified, 1 Tablespoon 50 IU
Orange Juice, fortified, 1 cup 100 IU
Fortified, Ready to eat cereal ¾ - 1 cup 40 -100 IU

1. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
2. U.S. Department of Agriculture, Agricultural Research Service, 2011 USDA National Nutrient Database fir Standard Reference, Release 25. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl


NOTE: While time in the sun is good for vitamin D production, it does increase the risk of developing skin cancer so it is prudent to wear protective clothing and sun screen with an SPF of 8 or more when in the sun for any length of time. Anyone with a history of skin cancer should avoid the sun exposure and protect themselves from UV rays.

reade more... Résuméabuiyad

Your Daily Dose: Vitamin B12 Supplements after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the importance of the vitamin B12 supplements after weight loss surgery.

Vitamin B12 is the most common vitamin deficiency people experience after weight loss surgery. That is why it is important to supplement your diet with vitamin B12, especially after gastric bypass and sleeve gastrectomy.

Vitamin B12 is essential for proper nerve function, metabolism and red blood cell production. Deficiency can lead to B12 deficiency anemia, which causes fatigue, rapid heart rate, easy bruising and bleeding, stomach upset and diarrhea or constipation.

If the deficiency remains unaddressed, it can result in permanent nerve damage, including tingling or numbness in fingers and toes, difficulty walking, mood changes, memory loss and dementia.

Weight loss surgery reduces the acidity in the stomach, which makes absorption of vitamins and nutrients more difficult. That is why vitamin B12 deficiency is particularly common after surgery and supplementation is often required long after recovery.

Proper supplementation involves taking a daily form of vitamin B12 that dissolves under the tongue or getting a monthly injection, which is typically done by your primary care physician. 

To prevent vitamin B12 deficiency, follow the dietary recommendations for supplementation after weight loss surgery and get your blood work checked regularly by a primary care physician or bariatric care team.

If you experience the symptoms associated with B12 deficiency, please check with your health care team.

- Cara Stewart, RD, LDN

reade more... Résuméabuiyad

The Perfect Summer Meal: Arugula, Grape and Sunflower Seed Salad

A refreshing salad can be a perfect meal on hot summer day. To top it off, this recipe combines a variety of healthy ingredients, so the delicious salad also provides the important nutrients your body needs. 

With antioxidants from the grapes, healthy fats and vitamin E from the sunflower seeds and oil, folate and vitamin A from the arugula, it’s hard to beat the nutrition profile on this summer salad.

You can also try topping the salad with a protein like salmon or tuna to make a well-balanced dinner entree.

Nutritional Information:
Amount per serving 

• Calories: 81 
• Calories from fat: 34% 
• Fat: 3.1 g 
• Saturated fat: 0.3 g 
• Monounsaturated fat: 0.5 g 
• Polyunsaturated fat: 2 g 
• Protein: 1.6 g 
• Carbohydrate: 13.1 g 
• Fiber: 1.2 g 
• Cholesterol: 0.0 mg 
• Iron: 0.7 mg 
• Sodium: 124 mg 
• Calcium: 47 mg 

Ingredients:

• 3 tablespoons red wine vinegar 
• 1 teaspoon honey 
• 1 teaspoon maple syrup 
• 1/2 teaspoon stone-ground mustard 
• 2 teaspoons grapeseed or olive oil 
• 7 cups loosely packed baby arugula 
• 2 cups red grapes, halved 
• 2 tablespoons toasted sunflower seed kernels 
• 1 teaspoon chopped fresh thyme 
• 1/4 teaspoon salt 
• 1/4 teaspoon freshly ground black pepper 

Preparation:

1. Combine vinegar, honey, syrup and mustard in a small bowl. Gradually add oil, stirring with a whisk.
2. Combine arugula, grapes, seeds and thyme in a large bowl. Drizzle vinegar mixture over arugula; sprinkle with salt and pepper. Toss gently to coat.

The recipe is courtesy of Maureen Callahan, Cooking Light (May 2008). 

reade more... Résuméabuiyad

Healthy Mexican Cuisine: Black Bean and Cheese Enchiladas with Ranchero Sauce

This recipe for enchiladas combines various traditional Mexican flavors into one exceptionally delicious and healthy dish. Black beans provide protein, fiber, folic acid and magnesium, while the corn tortillas, chiles and cheese add crave-worthy Mexican taste.

So get cooking and thank your South of the Border neighbors for this delicious dish!

Nutritional Information:
Amount per serving

• Calories: 302
• Fat: 12.9 g
• Saturated fat: 5.3 g
• Monounsaturated fat: 3.9 g
• Polyunsaturated fat: 1.3 g
• Protein: 17.3 g
• Carbohydrate: 36.1 g
• Fiber: 6.4 g
• Cholesterol: 32 mg
• Iron: 1.7 mg
• Sodium: 574 mg
• Calcium: 426 mg

Ingredients:

• 2 dried ancho chiles, stemmed and seeded
• 2 cups water
• 2 teaspoons olive oil
• 1 cup yellow onion, chopped
• 5 garlic cloves, sliced
• 1/4 teaspoon kosher salt
• 2 cups organic vegetable broth
• 2 tablespoons fresh oregano, chopped
• 2 tablespoons no-salt-added tomato paste
• 1/2 teaspoon cumin, ground
• 1 tablespoon fresh lime juice
• 1/8 teaspoon red pepper, ground
• 1 (15-ounce) can black beans, rinsed and drained
• 2 cups (8 ounces) reduced-fat Mexican-4-cheese-blend, divided and pre-shredded
• 3 green onions, divided and thinly sliced
• Cooking spray
• 12 (6-inch) corn tortillas
• 6 tablespoons light sour cream

Preparation:

1. Preheat oven to 400 degrees.
2. Combine chiles and 2 cups water in a saucepan; bring to a boil, reduce heat and simmer for 5 minutes. Remove from heat; let stand for 5 minutes. Drain chiles in a colander over a bowl, reserving 1 cup cooking liquid.
3. Heat oil in a medium saucepan over high heat. Add onion; sauté for 1 minute. Reduce heat to medium; add garlic and salt. Cook for 5 minutes or until golden, stirring occasionally. Add broth and next 3 ingredients (through cumin); cook for 8 minutes or until thickened, stirring occasionally.
4. Pour onion mixture into a blender; add chiles and reserved liquid. Remove center piece of blender lid to allow steam to escape; secure lid on blender. Place a clean towel over opening in lid. Blend until smooth; stir in lime juice and red pepper.
5. Combine the beans, 1 cup of cheese and half of the green onions in a bowl. Spread 1/2 cup of sauce in the bottom of a 13 x 9-inch glass or ceramic baking dish coated with cooking spray. 
6. Warm tortillas according to package directions. 
7. Spoon 3 tablespoons bean mixture down center of each tortilla; roll up. 
8. Place seam-side down in prepared dish. 
9. Pour remaining sauce over filled tortillas. Top with the remaining cheese. Bake at 400 degrees for 15 minutes or until lightly browned. Sprinkle with remaining green onions; serve with sour cream.

Total preparation time, one hour and 10 minutes. Hands-on time is 55 minutes. 

This recipe is provided courtesy of David Bonom, Cooking Light (October 2011).

reade more... Résuméabuiyad

Nutrient-Rich Wheat Berry Salad with Raisins and Pistachios

Wheat berries are a health buff’s dream come true. The whole wheat kernels are filled with fiber, protein, iron, vitamin E and magnesium and remain virtually unprocessed, packing a nutrient-rich punch to your diet.

Wheat berries can be ground into whole wheat flour and develop a chewy consistency with a nutty, mild taste when cooked whole. You can add wheat berries to hot cereal, as a healthier alternative to rice or to make a creative salad.

In addition to its delicious taste, you can prepare all of the ingredients for this salad while the wheat berries cook.

Nutritional Information:
Amount per serving

• Calories: 240
• Fat: 8.9 g
• Saturated fat: 2.3 g
• Monounsaturated fat: 4.8 g
• Polyunsaturated fat: 1.3 g
• Protein: 7.2 g
• Carbohydrate: 36.8 g
• Fiber: 5 g
• Cholesterol: 4 mg
• Iron: 0.7 mg
• Sodium: 284 mg
• Calcium: 28 mg

Ingredients:

• 1 cup uncooked wheat berries (hard winter wheat)
• 3/4 teaspoon salt, divided
• 3 tablespoons pistachios, shelled
• 2 tablespoons olive oil
• 2 tablespoons fresh lemon juice
• 2 teaspoons honey
• 1/2 teaspoon ground coriander
• 1/2 teaspoon fresh ginger, grated and peeled
• 1/2 cup golden raisins
• 1/4 cup thinly sliced green onions
• 2 tablespoons fresh cilantro, chopped
• 1/2 cup (2 ounces) crumbled goat cheese

Preparation:

1. Preheat oven to 350 degrees.
2. Place wheat berries and 1/2 teaspoon salt into a medium saucepan. Cover with water to 2 inches above wheat berries and bring to a boil. Cover, reduce heat to medium-low and simmer for 1 hour or until tender. Drain.
3. Place pistachios on a baking sheet. Bake at 350 degrees Fahrenheit for 8 minutes, stirring once. Cool slightly and chop.
4. Combine oil, juice, honey, coriander, ginger and remaining 1/4 teaspoon salt in a large bowl, stirring with a whisk. Add hot wheat berries and raisins; stir well to combine. Let stand for 20 minutes or until cooled to room temperature.
5. Add nuts, 1/4 cup green onions and cilantro to wheat berry mixture. Transfer to a serving bowl and sprinkle with goat cheese.

This recipe is courtesy of Jackie Mills, MS, RD, Cooking Light (April 2010).

reade more... Résuméabuiyad

Crispy, Crave-worthy and Low-Calorie: Kale Chips Recipe

You know those days when carrots or low-fat yogurt just won’t cut it and you need a snack with a satisfying crunch? Fear not, there’s no need to resort to potato chips. Instead, try this recipe for kale chips. They’re low-calorie, filled with powerful antioxidants, a good source of calcium, fiber and vitamins A and C and they’re oven-baked, not fried. Sound too good to be true? Give them a try and you’ll be raving, too.

Ingredients:

• One bunch of kale, any type, rinsed and dried
• 2 to 3 tsp olive oil
• Salt or soy sauce, to taste
• Seasonings of choice - try chili flakes, paprika, garlic powder or Parmesan cheese*

Directions:

1. Preheat oven to 375 degrees.
2. Remove the kale leaves from the tough end and inner stems. Cut longer leaves in half or bite-size pieces. 
3. Place kale pieces in large bowl and toss in about 1 teaspoon of olive oil. The kale leaves only need to be lightly coated with oil. Too much oil makes the chips limp and greasy. If more oil is needed, add about 1 teaspoon at a time. Sprinkle in salt or soy sauce and seasonings of choice.
4. Put the kale pieces in a single layer in a baking sheet lined with parchment paper for easier cleaning. 
5. Bake for 12-15 minutes or until crisp.  Toss halfway through for more even baking. Watch carefully as they can burn easily.

Nutrition Information: Amount per serving

• Calories: 47
• Total Fat: 1.5 g
• Total Carbohydrate: 6 g
• Protein: 2 g
• Fiber: 2 g

This recipe yields 10 servings (5 large chips).

*Adding Parmesan cheese increases calorie and fat content.

reade more... Résuméabuiyad

Struggling to Lose Weight? SuperTracker to the Rescue!

Karen Buzby RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, introduces a new online weight management tool to help people achieve and maintain their weight loss goals.
You have probably heard before that weight loss is a matter of eating less and exercising more. Easier said than done – right? Anyone who has attempted to diet knows that translating healthy lifestyle advice to practical changes isn’t always so simple or straightforward.

SuperTracker is a new online tool that can help you plan, calculate and record caloric intake and physical activity, making weight loss easier than ever before. As part of the U.S. Department of Agriculture’s MyPlate program, SuperTracker is user friendly, interactive and contains a wealth of information to help you make smart choices about food and exercise. And it’s free.

Key features of SuperTracker include:

Daily calorie limit - Calculated based on height, weight and personal weight loss goals.

Food tracker - Record food items and portion size from an extensive database in an electronic food diary to review eating patterns and calorie balances each day.

Food group targets and graphs – Provides recommendations about number of servings from each food group based on a person’s daily caloric allowance. It also graphs food choices to show how dietary choices measure up to goals.

Personalized nutrient report – Customized reports of individuals’ average carbohydrate, protein, fat, vitamin and mineral intake. Helps identify which foods to eat more of and which to cut back on.

Physical activity tracker – Compares weekly physical activity totals to pre-set targets for moderate-intense and muscle-strengthening exercise.

Virtual healthy lifestyle coach – Advice, inspiration and support from a virtual coach helps people stay motivated and reach their weight loss goals.

Don’t wait another day. Start tracking your diet and activity goals with the SuperTracker today! 

- Karen Buzby, RD, LDN

reade more... Résuméabuiyad

Shape Up Your Plate in Honor of National Nutrition Month

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a new government-sponsored program to encourage better food choices and provide tips for eating healthy.
March is National Nutrition Month and the Academy of Nutrition and Dietetics is providing you the information you need to achieve a healthier lifestyle. But even after you make the commitment to eating healthy, figuring out how to achieve that on a meal-to-meal basis can be tough and confusing. The U.S. Department of Agriculture has developed a program to help.

MyPlate is an online resource that provides dietary advice based on the 2010 Dietary Guidelines for Americans. Unlike other diet guides, MyPlate uses an actual place setting to visually illustrate a healthy meal made up of all the major food groups. That means no more confusion about how to translate dietary advice to an actual meal and no more guessing about portion size.

Follow these tips to get your plate in shape*:

Balance calories
If you’re unsure how many calories you need to manage your weight, there’s no need to guess! Go to www.ChooseMyPlate.gov to find out your daily caloric needs. MyPlate provides the recommended number of daily servings from each food group to help you make smart and healthy dietary choices.

Enjoy your food, but eat less
Take your time to eat and pay attention to feelings of fullness.

Avoid oversized portions
Use smaller plates to encourage smaller portions. When eating out, opt to share a meal or take home part of the serving.

Fill up on nutrient-rich foods
Make vegetables, fruit, whole grains and low-fat dairy products staples in your diet. They’re high in nutrients and vitamins and low in fat, making them ideal food choices for good health. In fact, experts recommend covering half your plate with fruits and vegetables and ensuring that half your grains are whole grains.

Always choose low- or non-fat milk
By choosing fat-free or 1 percent low-fat milk, you cut calories and fat without losing the flavor or important nutrients like calcium and vitamin D.

Curtail your sweet tooth
There’s no doubt that sweet foods and beverages are both tasty and addicting, but they’re also high in fat, sugar and salt. Eat them only occasionally and in small quantities to satisfy your sweet tooth without compromising your healthy diet. One easy way to do this is by replacing sugar beverages with water and unsweetened drinks. 

Pay attention to sodium
You might be surprised by the sodium content in everyday foods. Before making a food selection, read the nutrition facts label and stick to foods that are low in sodium to help promote cardiovascular health.

For more information, visit the MyPlate website. 

- Karen Buzby, RD, LDN

*USDA, Center for Nutrition Policy and Promotion, DG Tip Sheet No. 1, June 2011.

reade more... Résuméabuiyad

Having a Baby After Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, and Monica A. Mainigi, MD, fertility specialist at Penn Fertility Care, provide important information for women trying to become pregnant and maintain a healthy pregnancy after weight loss surgery.

Many women struggle with fertility as a result of their weight. In fact, obesity puts women at greater risk for ovulation dysfunction and menstrual irregularity, both of which can interfere with fertility. In addition, obesity can lead to an increased risk of miscarriage and decreased success with fertility treatments. For overweight women who are having a hard time conceiving, weight loss surgery may be an option to consider.

For women considering pregnancy after they have had bariatric surgery, it is important to keep the following information in mind.


Fertility boost
Obesity can interfere with hormone production, making it more difficult to get pregnant.  Weight loss after bariatric surgery can lead to regular cycles and ovulation, and improved fertility. In fact, a 2005 study published in the Journal of Clinical Endocrinology and Metabolism found that surgical weight loss for women with PCOS often resolved their reproductive and metabolic abnormalities. 

Healthier pregnancy, healthier baby
After weight loss surgery, medical conditions such as high blood pressure and diabetes are significantly improved or resolved leading to a lowered risk of developing serious complications during pregnancy or delivering a baby born with complications.  Many women are still obese after weight loss surgery which places them at a higher risk for gestational diabetes and preeclampsia, but the risk is far less than before surgery.  Pregnant women who have had bariatric surgery should see a high-risk obstetrician to best manage prenatal care.

Give it time
It is important to wait at least 18 months after surgery to start trying to get pregnant. In the period immediately following gastric bypass or sleeve gastrectomy, rapid weight loss causes stress on the body, including diminished nutrition intake, which can cause complications for an expecting mother and growing baby. Effective contraception is absolutely critical for women pursuing weight loss surgery.  For women with an adjustable gastric band, fluid may be removed from the band during pregnancy to accommodate the need to eat more calories.

Keep supplementing
Good nutrition is especially important for women trying to conceive.  After weight loss surgery, patients are at a higher risk for deficiencies of certain nutrients, including vitamin B12, folic acid, calcium, iron, and vitamin D. It essential to continue taking vitamin and mineral supplements as recommended by the bariatric team.

Be ready for weight gain
After having weight loss surgery, it can be difficult to accept that pregnancy is a time when it is normal, healthy and necessary to gain weight.  Healthy weight gain during pregnancy is important to nourish a growing baby, but work with the program dietitians to avoid unhealthy weight gain during pregnancy.

The Penn Metabolic and Bariatric Surgery Program offers lifelong follow-up care and nutritional support for patients who have had weight loss surgery. Women considering pregnancy after weight loss surgery should discuss their plans with the bariatric surgery team.

For more information on fertility services at Penn Medicine, visit the Penn Fertility Care website.

- Cara Stewart, RD, LDN and Monica Mainigi, MD

reade more... Résuméabuiyad

Savor the Tastes of Fall: Roasted Pumpkin and Sweet Potato Pilaf

Roasted pumpkin and sweet potato pilaf presents the perfect opportunity to mix warm, cozy and delicious fall flavors with healthy ingredients. Pilaf is a form of grain that gets its flavorful taste from cooking in broth. With fiber-rich brown rice and vitamin-packed vegetables like pumpkin and sweet potato, this tasty side dish adds important nutrients to your meal.

Ingredients:

• 2 cups (1/2-inch) cubed, peeled fresh pumpkin (about 12 ounces)
• 1 1/2 cups (1/2-inch) cubed, peeled sweet potato (about 1 medium)
• Cooking spray
• 2 teaspoons olive oil
• 1 cup diced onion (1 small)
• 1/3 cup diced celery (about 1 rib)
• 2 teaspoons minced garlic
• 4 cups fat-free, less-sodium chicken broth
• 1 cup brown rice (not instant)
• 2 teaspoons chopped fresh sage
• 1/2 teaspoon freshly ground black pepper
• 1/4 teaspoon salt
• 1 bay leaf

Preparation:

1. Preheat oven to 400 degrees.
2. Arrange pumpkin and sweet potato in an even layer on a jelly-roll pan coated with cooking spray. Bake at 400 degrees for 18 minutes, stir and return to oven for another 17 minutes or until the vegetables are tender and begin to brown.
3. Heat oil in a large saucepan over medium-high heat. Add onion, celery and garlic to pan; sauté 3 minutes or until onion is tender. Add broth and remaining ingredients to onion mixture, stirring to combine; bring to a boil. Cover, reduce heat and simmer for 50 minutes or until rice is done and liquid is mostly absorbed. Remove from heat; discard bay leaf. Add pumpkin mixture; stir gently to combine.

Nutritional Information:
Amount per serving

• Calories: 200
• Calories from fat: 11 percent
• Fat: 2.5g
• Saturated fat: 0.4g
• Monounsaturated fat: 1.4g
• Polyunsaturated fat: 0.5g
• Protein: 5.9g
• Carbohydrate: 38.8g
• Fiber: 3g
• Cholesterol: 0.0mg
• Iron: 1.3mg
• Sodium: 428mg
• Calcium: 45mg

The recipe makes 6 servings. Serving size is about ¾ cup.

This recipe is courtesy of Jaime Harder, MA, RD, Cooking Light (October 2007).

reade more... Résuméabuiyad

Coping with Constipation after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for achieving bowel regularity after weight loss surgery.

It may not be an appropriate topic of conversation in many circles, but constipation is relatively common among people who have had weight loss surgery, especially immediately following their surgery. Irregularity can be caused by a lot of things:

• Decreased fluid and fiber intake
• Reduced physical activity
• Narcotic painkillers
• Iron or calcium supplements
  

Many people report only having a bowel movement every two or three days following weight loss surgery. This can lead to constipation. It is important to keep track of your bowel habits and try to have a bowel movement every day.

To relieve constipation:

If it has been more than three days since your last bowel movement, you can take one dose of milk of magnesia or two Dulcolax^® tablets. Repeat every four to six hours. If you do not have results within 24 hours, you should call your bariatric nursing team to discuss.

To prevent constipation and promote bowel regularity:

• Stay hydrated. Drink adequate fluids to help soften your stool. You should drink at least 48 ounces per day.
• Exercise. Take frequent short walks throughout the day, as tolerated.
• Consume adequate fiber. Because your eating is primarily focused on high-protein foods following bariatric surgery, your consumption of high-fiber food is limited. Take fiber supplements as needed to help you get at least 15 grams of fiber per day.
• Use laxatives when necessary. Stick with Metamucil^® and other bulk-forming laxatives based on whole psyllium. Make sure to follow the mixing instructions for optimal results.
  

- Cara Stewart, RD, LDN

reade more... Résuméabuiyad

Taking Vitamin and Mineral Supplements: Make time even if you feel fine!

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, outlines the important vitamin and mineral supplements to take after weight loss surgery.

After weight loss surgery, you need to commit to taking a regimen of vitamin and mineral supplements for the rest of your life. Eating smaller amounts of food means your body receives fewer nutrients. In addition, after gastric bypass or sleeve gastrectomy surgery, your system does not absorb some vitamins and minerals as well.

This table highlights the functions of several key nutrients and the symptoms of their deficiency. The damage to your body from many of the deficiencies is permanent, so be sure to follow your dietician’s instructions for taking supplements and have your lab values checked routinely with your primary care physician.

NUTRIENT	WHAT IT DOES	DEFICIENCY
Vitamin B1 (thiamine)	Helps all cells of the body produce energy from carbohydrates	Fatigue, weak muscles, nerve damage
Vitamin B12	Works with folate to make red blood cells Vital part of every cell Helps body use fatty acids and some amino acids	Anemia, fatigue Permanent nerve damage including tingling or numbness in hands and feet
Folate (folic acid)	Plays essential role in making new body cells Works with B12 to form hemoglobin in red blood cells Helps reduce risk of neural tube defects (spina bifida) in developing fetus	Anemia caused by malformed blood cells that won’t carry as much oxygen Increased risk of neural tube defects in developing fetus
Vitamin A	Promotes normal vision, helps eyes see normally in the dark Promotes growth and health of all cells Keeps tissues healthy to prevent infection Works as an antioxidant	Night blindness Dry, scaly skin Reproductive problems
Vitamin D	Promotes absorption of calcium and phosphorus Regulates amount of calcium in blood	Osteoporosis (loss of bone mass) Osteomalacia: softening of bones
Calcium (**NOTE: Supplements are still needed even if blood levels are normal)	Helps bones remain strong by slowing rate of bone loss with age Helps muscles contract and heart beat Promotes normal nerve function	Osteoporosis
Iron	Essential part of hemoglobin that carries oxygen in blood Supports healthy immune system	Iron deficiency anemia Fatigue Infections

- Cara Stewart, RD, LDN

reade more... Résuméabuiyad

Feeling Tired or Sluggish? The Culprit Could be Iron

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses the impact bariatric surgery has on iron levels and provides tips for iron supplements.

Your body uses iron to produce red blood cells. Insufficient iron in your diet may put you at higher risk for developing iron deficiency or iron deficiency anemia. Iron deficiency is a condition in which the body does not produce enough normal red blood cells for optimal health. Symptoms of iron deficiency include:

• Tiredness
• Shortness of breath
• Decreased physical performance
• Learning problems in children and adults
• Increased risk for infection

People who have had bariatric surgery are more prone to iron deficiency because of their reduced intake of iron-rich foods, such as red meat, seafood, and poultry. In addition, gastric bypass and sleeve gastrectomy patients produce less stomach acid, which can interfere with iron absorption. Maintaining an optimal iron level is particularly challenging for people who have had gastric bypass, as the surgery circumvents the primary site of iron absorption.

While some people with bariatric surgery are still able to obtain adequate iron from food, others rely on iron supplements to maintain a healthy iron level. For those who require iron supplements, the following tips can help maximize iron absorption while minimizing any unpleasant side effects.

• Take 250 mg of vitamin C or consume foods rich in vitamin C when taking an iron supplement. Examples of good sources of vitamin C include:

- Bell Pepper
- Broccoli
- Brussel sprouts
- Citrus fruits
- Cantaloupe
- Cauliflower
- Kale
- Parsley
- Strawberries

• Take iron supplements with food to prevent nausea or abdominal discomfort.

• Prevent constipation by consuming adequate fiber through your diet and supplements, drinking enough fluids and exercising regularly.

• Avoid calcium supplements and dairy when taking an iron supplement or consuming iron-rich food. Calcium can inhibit the absorption of iron. Separate consumption of calcium and iron by at least two hours.

• Avoid tea, cola, coffee, red wine, pomegranates and berries when taking an iron supplement or eating iron-rich food. These foods and beverages contain tannins, which can inhibit iron absorption.

Make sure to check with your healthcare team to determine whether an iron supplement might be helpful for you.

- Cara Stewart, RD, LDN

reade more... Résuméabuiyad

Recovering from weight loss surgery? Take your vitamins!

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

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

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

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

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

Multivitamin and mineral supplement:

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

Calcium with vitamin D:

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

Vitamin B₁₂:

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

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

Iron:

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

Essential Vitamins:

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

Trace Minerals:

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

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

- Karen Buzby, RD, LDN

reade more... Résuméabuiyad