Life After Bariatric Surgery

Life After Bariatric Surgery
by Dr. Darren Glass

Life after bariatric surgery is not easy. Far from it, but well worth it.

The first few weeks after surgery, patients are adjusting to their new stomach anatomy and have to remain on a carefully controlled liquid diet. Their activity quickly advances back to normal. They may take a week or two off from work, but there is very minimal pain after a few days and there are no restrictions in activity for the motivated patient.

After a few weeks, we advance the diet to soft foods which includes things like tuna salad, egg salad, lunch meat, eggs, cheese and yogurt. Then over the next few months, we advance to normal foods – mostly meat, a little bit of cooked vegetables and very little else.

Exercise is encouraged. Patients are encouraged to eat their small meals slowly and regularly, even though they are not hungry, and to minimize snacking. Patients who do this faithfully will lose about 2/3 to 3/4 of their excess weight in the first year after surgery.

Along with this weight loss comes resolution of medical comorbidities such as diabetes, hypertension, acid reflux and obstructive sleep apnea.

Quality of life improves and patient satisfaction is excellent following surgical weight loss. Definitely well worth it!




Benefits of Bariatric Surgery

Benefits of Bariatric Surgery
by Dr. Darren Glass

Bariatric surgery has been around for a long time, well over 60 years. It has gone from experimental, dangerous, fringe medicine, to safe, routine, elective, standard of care. The concept of simple weight loss surgery is outdated is now seen as life-changing metabolic surgery. This means that these surgeries have positive, beneficial effects on medical comorbidities such as diabetes, hypertension, dyslipidemias, obstructive sleep apnea and a whole host of other medical conditions previously controlled and managed, but never cured.

Bariatric surgery patients get off their diabetes medicines quickly, sometimes the day of surgery. Their blood pressure medication requirements go down with weight loss. Their acid reflux is improved/cured, their cholesterols normalize and they get off their CPAP machines. Their arthritis improves, their hearts and lungs have to work less hard and their quality of life improves.

Bariatric surgery is not for everyone. But if your BMI is over 40 and/or you have the above comorbidities, your life could be changed forever!


Fruits and Vegetables that Hydrate

Fruits and Vegetables that Hydrate

by Mia Gibson RD, LD, CDE

Dietitian at Cardiac and Pulmonary Rehab at the MCHS Center for Health & Wellness Drinking water is essential especially in the summer heat, but eating fruits and vegetables can also help in hydration.

Fruits and vegetables contain large amounts of water and some are even are more than 90% water. Some that contain the highest percentage water are celery and cucumbers at 95% water, while watermelon and strawberries are at 92% water.

Not only are these fruits and vegetables high in water, but they are great sources of vitamins and minerals. Minerals are lost from the body during perspiration so adding these foods help replenish those losses.

Watermelon and summer definitely go great together!

Healthy Lifestyle

Healthy Lifestyle Tip:

If immediately after any workout, you reach for the next best snack, gulp down a big sugary drink or treat yourself to fatty foods, you may get instant gratification, but your body won’t thank you for long.

According to exercise scientists, if you work out at a moderate to high intensity level for 90 minutes or longer, you should consume a healthy snack within 30 minutes post exercise.

Here are 5 great post-workout snacks that fuel your body and should be consumed with 8-12 ounces of water:

1. Non Fat Greek Yogurt with Fruit

Nonfat Greek yogurt is loaded with protein, which helps repair muscle tissue, and low in sugar and fat, which also makes it an ideal snack at any time of the day. Top with some with fruit (1/2 cup of berries or banana) and you’ll quickly rebuild your energy needs.

2. Banana with 1 Tablespoon of Almond or Nut Butter

Banana is high in fructose (fruit sugar) and a high-glycemic carbohydrate that the body can quickly convert to energy. When you enjoy it with a small amount (1 tablespoon) of almond butter, you add protein and just a small amount of healthy fat. Almond butter is a great nut in terms of nutritional value, but is also high in calories, so you want to enjoy this treat in small servings.

3. Tuna on Whole Wheat

If you’re a sandwich lover, this one is for you! Adding four ounces of water-packed tuna on one slice of whole wheat bread gives you an ideal protein/carb mini-meal at a mere 220 calories. It’s an ideal low-calorie snack.

4. Whole Wheat English Muffin and Hummus

Hummus, combined with a whole wheat English muffin or a whole wheat pita, makes for a great protein/carb recovery food. Note: whole wheat will release energy slower into your body than white bread. Wheat bread will also satisfy your hunger longer than the high-caloric white bread. ¼ cup of hummus on one whole wheat pita adds up to about 300 calories.

5. Protein Shake with Banana

A protein shake made with 2 scoops of whey protein powder and ½ banana is ideal for recovery. This is ideal for busy people on the go.

Remember that refueling within the 30-minute window after a hard workout is critical to reaping the full benefits of proper recovery.


John Douthitt – MIssion Fitness

Easter Leftovers

Is it okay to eat that?

Holidays like Easter bring families together and refrigerators full of leftovers. How long should you keep your aunt’s leftover green bean casserole?

Here are some tips for leftovers:

  1. Refrigerate promptly after the meal is over. Food should not sit around at room temperature.
  2. Hot food can be refrigerated-place in shallow containers for quicker cooling.
  3. Leftovers need to be reheated to 165 degrees.
  4. Leftovers need to be eaten within 3-4 days.
  5. Leftovers that have been frozen can last from 1- 6 months, depending on what it is.

If you are not sure how long the food has been left out or has been in the back of the fridge, remember “when in doubt, throw it out!”

For a free Cold Storage Chart, visit

(Sources: Food Safety and Inspection Service

 Consult your doctor before making changes in your diet. If you have a medical condition certain items may need to be reduced or eliminated. Seek the advice of your physician and Registered Dietitian before making any changes in your diet or lifestyle. Email questions on NUTRITION KNOW-HOW to


Leftover ham? Make Asparagus-and-Ham Casserole!

This speedy Asparagus-and-Ham Casserole is pure comfort food and needs only 10 minutes to bake. That’s because most of the prep work (cooking pasta and making a light cream sauce) is done on the stovetop. Simply bake to brown the breadcrumbs and make the filling bubbly. Because of the delicate flavors in this dish, we preferred using a mild baked ham to a smoked one.


1 (1-ounce) slice white bread

3 3/4 cups uncooked extra-broad egg noodles

2 1/2 cups (1 1/2-inch) sliced asparagus

1/4 cup all-purpose flour

1/2 teaspoon dried thyme

1/4 teaspoon salt

1/8 teaspoon black pepper

1 cup whole milk

1 cup fat-free, less-sodium chicken broth

1 tablespoon butter

3/4 cup finely chopped onion

1 tablespoon fresh lemon juice

1 1/2 cups (1/2-inch) cubed ham (about 8 ounces)

1/4 cup chopped fresh flat-leaf parsley

2 tablespoons grated fresh Parmesan cheese




Preheat oven to 450°.

Place bread in a food processor, and pulse 10 times or until coarse crumbs form to measure 1/2 cup.

Cook pasta in boiling water 7 minutes, omitting salt and fat. Add asparagus; cook 1 minute. Drain.

Lightly spoon the flour into a dry measuring cup, and level with a knife. Place flour, thyme, salt, and pepper in medium bowl; gradually add milk and broth, stirring with a whisk until well-blended. Melt the butter in a medium saucepan over medium-high heat. Add the onion; saute 4 minutes. Add milk mixture; cook until thick (about 4 minutes), stirring constantly. Remove from heat, and stir in juice. Combine the pasta mixture, milk mixture, ham, and parsley in large bowl; spoon into a 2-quart casserole. Sprinkle with breadcrumbs and cheese.

Bake at 450° for 10 minutes or until filling is bubbly and topping is golden.

Recipe from



Submitted by:

Mia Gibson Mia Gibson RD, LD, CDE

Dietitian at Cardiac and Pulmonary Rehab

MCHS Center for Health & Wellness

Surgical Weight Loss

The number of people in the United States who have the disease of obesity has grown rapidly over the past several years. In fact, greater than half the population is overweight or obese. Obesity is defined as having an excessive amount of body fat. The majority of people who are affected by obesity have tried numerous weight loss methods including diet and exercise, medications, fad diets and weight loss clinics without success. There are hundreds of different “proven methods” of weight loss available. These diets may be effective for people who have 5, 10 or 20 pounds to lose. But when you read the fine print on diet ads, it says “These results are not typical.” Also, studies show these diets only show consistent and permanent weight loss in about 5% of the morbidly obese population. That is only 5 out of 100 people! For the other 95 people, there are surgical options available.

Surgery for obesity is an option after other weight loss options have been exhausted. There are different weight loss surgeries available. The most important thing a person can do is become educated about each procedure to truly make an informed decision about which surgery is the best for them. The most commonly performed weight loss surgeries include the Roux-en-Y Gastric Bypass, the Vertical Sleeve Gastrectomy, and the Laparoscopic Adjustable Gastric Band.

The Roux-en-Y Gastric Bypass (GBP) has been performed since the 1960’s. It involves creating a small pouch out of the upper portion of the stomach (about the size of a small egg) and bypassing a portion of the small intestine. The GBP surgery works by restricting the amount a person can eat or drink at one time, and causing a degree of malabsorption of calories and nutrients.

The Vertical Sleeve Gastrectomy (VSG) involves removing about 85% of a person’s stomach. The digestive tract is not changed in any other way. The VSG surgery works by restricting the volume a person can take in at one time. The VSG was approved by the FDA in 2009. In the past it was performed as a “stepping stone” to a gastric bypass surgery. The VSG was found to demonstrate successful weight loss and a sense of fullness, so it began to be performed as a primary weight loss surgery.

The Laparoscopic Adjustable Gastric Band (LAGB) involves placing a silicone band around the upper portion of the stomach and “buckling” it in place. The band is attached to a tube with a small port at the end. This port sits on the stomach muscle wall under the skin. The port can be accessed with a special needle to add or remove fluid from the band, thus increasing or decreasing the amount of restriction the patient is experiencing. To get a better picture, think of an hourglass filled with sand. If the middle of the hour glass is wide, the sand will filter through very quickly. If the middle is narrow, the sand passes through slowly. A LAGB restricts the amount of food a person eats by preventing food from moving out of the upper stomach too quickly, thus promoting a sense of prolonged fullness.

No matter what surgery you choose, success revolves around adopting a healthy lifestyle. Choosing to have weight loss surgery is a major decision and ongoing education and support is crucial. Weight loss surgery offers a person the chance to experience a healthier, more active, better quality of life.  Learn about the benefits and risks associated with the different surgeries by attending free weight loss surgery seminars, support groups, and through the internet. Always ask questions and clarify information. Remember: the MCHS Bariatric Team is here to support you! Contact us at 432-640-3551 for additional information or with any questions you may have.


Kim Kwiatkowski FNP-BC,MSN,RN,CRT

Bariatrics Coordinator

Heart Month – Oil

American Heart Month – Oils are Essential for Heart Health

How often do you change the oil in your car? Every 3,000 or 5,000 miles? Just like your car, your body will benefit from preventive maintenance. Have you ever thought about the type and amount of oil you are eating?

The selection of available cooking oils has grown tremendously at the supermarkets. All oils are a combination of saturated, polyunsaturated and monounsaturated fats. Mono and poly unsaturated fats are heart healthy fats, while saturated fats are not.

There are many choices among the heart healthy fats. Olive oil, canola oil, peanut oil, safflower oil, sunflower oil, corn oil, sesame oil and flaxseed oil are all mainly polyunsaturated or monounsaturated. What kind of oil you need depends on the recipe and cooking technique.

Oils have different smoke points, which is the temperature when they begin to break down and smoke. Peanut, vegetable and sesame oils have a higher smoke point and can be used in higher temperature cooking.

Oils also have distinctive flavors and work well in different types of recipes. Canola oil has a light flavor and works well in baking recipes and for stir frying. It can be substituted for half of the butter in most recipes. Walnut, olive, and flaxseed oils work well for salad dressings.

Oils are essential for good health, but a little bit goes a long way. A cup of oil contains about 1,700 calories … so measure oil in teaspoons not tablespoons. By adding an oil salad dressing to your salads, the vitamins from the vegetables will be better absorbed.


Consult your doctor before making changes in your diet. If you have a medical condition certain items may need to be reduced or eliminated. Seek the advice of your physician and Registered Dietitian before making any changes in your diet or lifestyle. Email questions to


Nutrition Tip:   Oils can turn rancid (off smell and taste). So buy in smaller quantities to ensure freshness.

Classic Vinaigrette

Cooking Light (June 2009)



1 1/2 tablespoons red wine vinegar

1 tablespoon chopped shallots

1/4 teaspoon salt

1 tablespoon Dijon mustard

1/8 teaspoon pepper

3 tablespoons extra-virgin olive oil



Combine vinegar, shallots, salt, Dijon mustard, and pepper. Gradually add olive oil, stirring until incorporated.


Nutritional Information – amount per serving:

Calories: 94

Fat: 10.1g

Saturated fat: 1.4g

Monounsaturated fat: 7.4g

Polyunsaturated fat: 1.1g

Protein: 0.1g

Carbohydrate: 0.7g

Sodium: 178mg


Mia Gibson RD, LD, CDE

Dietitian at Cardiac and Pulmonary Rehab

Center for Health and Wellness

Heart Month – Fish

Fishing for a Healthy Heart

February is American Heart Month. A healthy diet is a cornerstone in heart health. A meal plan rich in fruits, vegetables and polyunsaturated fats from fatty fish and seed oils is the goal.

The American Heart Association (AHA) recommends eating a serving of fish twice a week. A serving is considered 3-4 ounces, about the size of a deck of cards. Although most fish are a lean protein, certain types of fish have the added benefit of containing high amounts of omega-3 fatty acids. Salmon, mackerel, herring, lake trout, sardines and albacore tuna are the highest in omega-3 fatty acids. Omega-3 fatty acids are not made by the body and are essential … so we have to get them from our food.

It does matter how the fish is prepared. Baking and broiling are the best methods for cooking fish. There are concerns about mercury poisoning in fish, but usually the benefits outweigh the risks. Pregnant and breast feeding women, and children under 12 are advised to avoid eating species of fish that are likely to contain higher levels of mercury. For more detailed information, see Fish 101 on the AHA’s website


Consult your doctor before making changes in your diet. If you have a medical condition, certain items may need to be reduced or eliminated. Seek the advice of your physician and Registered Dietitian before making any changes in your diet or lifestyle. Email questions to

Nutrition Tip:   Use low sodium herbs and seasonings for toppings on baked fish.

Cumin-Rubbed Salmon

Serves Four: 3 ounces fish per serving

Baking time: 18-20 minutes



Vegetable oil spray
4 salmon fillets (about 4 ounces each)
1/4 teaspoon ground cumin
1/4 teaspoon chili powder
1/4 teaspoon salt
1/8 teaspoon paprika


Cooking Instructions:

Preheat the oven to 350°F. Line a baking sheet with aluminum foil and lightly spray with vegetable oil spray.

Rinse the fish and pat dry with paper towels. Place the fish with the smooth side up in a single layer on the baking sheet.

In a small bowl, stir together the remaining ingredients. Sprinkle on top of the fish. Using your fingertips, gently press the mixture into the fish so it will adhere.

Bake for 18 to 20 minutes or until the fish flakes easily when tested with a fork.


Nutritional Analysis:

Calories – 145 per serving

Total fat – 4.5g

Sat fat 0.5g

Trans fat-0g

Polyunsat fat-1.5g

Monounsat fat-1.0g

Cholesterol 65mg

Sodium 230 mg

Carbohydrates 0g

Protein 25g

Heart Month – Berries

Heart Health for Women

Heart disease does not discriminate between men or women. Women as well as men can reduce heart attacks by adopting healthy habits. Changing five main lifestyle factors may lower heart disease risks as much as 83%. An article in the journal Circulation even found a specific flavonoid, anthocyanins which make food red or blue found in strawberries and blueberries may lower the risk of a heart attack in younger women. Fruits and vegetables contain flavonoids that are natural compounds that reduce blood pressure, discourage blood from clotting and improve blood flow. Three servings a week of blueberries or strawberries is associated with a reduced risk of heart attack. So, it is a great idea to add delicious strawberries and blueberries to meals and snacks during American Heart Month and throughout the year to protect your and your loved ones hearts! (Source:

 Consult your doctor before making changes in your diet. If you have a medical condition certain items may need to be reduced or eliminated. Seek the advice of your physician and Registered Dietitian before making any changes in your diet or lifestyle. Email questions to

Nutrition Tip: Frozen berries without added sugar are great for breakfast smoothies.

Superfoods Salad

Spinach, strawberries, blueberries, and walnuts sometimes are called superfoods because they are loaded with antioxidants, thought to contribute to good health.

MAKES: 4 servings



  • 1/3 cup raspberry vinegar
  • 2 tablespoons snipped fresh mint
  • 2 tablespoons honey
  • 1 tablespoon canola oil
  • ¼ teaspoon salt
  • 4 cups packaged fresh baby spinach leaves
  • 2 cups chopped, cooked chicken breast
  • 2 cups fresh strawberries, hulled and sliced
  • ½ cup fresh blueberries
  • ¼ cup walnuts, toasted and coarsely chopped
  • 1 ounce semisoft goat cheese, crumbled
  • ½ teaspoon freshly ground black pepper


For vinaigrette:

  1. In a screw-top jar, combine vinegar, mint, honey, oil, and salt. Cover and shake well.
  2. In a large bowl, toss together spinach, chicken, strawberries, blueberries, walnuts, and goat cheese. Transfer to salad plates. Drizzle with vinaigrette and sprinkle with pepper


Nutrition Facts Per Serving:

Servings Per Recipe: 4

cal.(kcal): 303

Fat, total(g): 13

chol.(mg): 63

sat. fat(g): 2

Monosaturated fat(g): 4

carb.(g): 22

Polyunsaturated fat(g): 5

fiber(g): 3


Mia Gibson RD, LD, CDE

Dietitian at Cardiac and Pulmonary Rehab

Center for Health and Wellness



Chocolate hearts, chocolates kisses and chocolate truffles – Valentine’s Day most likely brought a little bit, or quite a bit, of treats your way! 

Is it true chocolate is good for you?! Not all chocolate is the same. The dark chocolate contains more flavonoids, which have a health benefit. All chocolate starts off as cocoa. If you have ever tasted cocoa powder, it has a very strong – almost bitter – taste because of the flavonoids. Flavonoids are natural compounds found in food products like cocoa, tea, apples, cranberries, and peanuts. These special compounds help lower blood pressure, discourage blood from clotting and improve blood flow to the heart. The longer the chocolate is processed, the more the flavonoids are decreased.

So enjoy the dark chocolate your sweetheart sent!

Source (The Cleveland Clinic) – Consult your doctor before making changes in your diet. If you have a medical condition certain items may need to be reduced or eliminated. Seek the advice of your physician and Registered Dietitian before making any changes in your diet or lifestyle. E-mail questions to 

Nutrition Tip of the Day: Make that box of dark chocolates last a long time by eating small amounts. Remember too much of a good thing, may not be good! Hope you had a Happy Valentine’s Day!


Double Chocolate Cupcakes


  • 1 cup all-purpose flour (about 4 1/2 ounces)
  • 1/3 cup unsweetened cocoa
  • 1 teaspoon baking soda
  • 1/8 teaspoon salt
  • 2/3 cup granulated sugar
  • 1/4 cup butter, softened
  • 1/2 cup egg substitute
  • 1 teaspoon vanilla
  • 1/2 cup 1% low-fat buttermilk
  • 1 1/4 ounces dark (70 percent cocoa) chocolate, finely chopped
  • 2 tablespoons powdered sugar



  1. Preheat oven to 350°.
  2. Lightly spoon flour into a dry measuring cup, and level with a knife. Combine flour, cocoa, baking soda, and salt; stir with a whisk.
  3. Place granulated sugar and butter in a large bowl; beat with a mixer at medium speed until well combined (about 3 minutes). Add egg substitute and vanilla, beating well. Add flour mixture and buttermilk alternately to granulated sugar mixture, beginning and ending with flour mixture. Fold in chocolate. Spoon batter into 12 muffin cups lined with muffin cup liners. Bake at 350° for 18 minutes or until cake springs back when touched lightly in center or until wooden pick inserted in center comes out clean. Remove from pan; cool completely on a wire rack. Sprinkle with powdered sugar just before

From  Kathy Kitchens Downie, R.D., Cooking Light

Nutritional Information

Amount per serving

  • Calories: 150
  • Calories from fat: 31%
  • Fat: 5.2g
  • Saturated fat: 3.2g
  • Monounsaturated fat: 1.2g
  • Polyunsaturated fat: 0.2g
  • Protein: 3.1g
  • Carbohydrate: 24g
  • Fiber: 1.1g
  • Cholesterol: 11mg
  • Iron: 1mg
  • Sodium: 125mg
  • Calcium: 42mg


Mia Gibson RD, LD, CDE

Dietitian at Cardiac and Pulmonary Rehab

Center for Health and Wellness