Bariatric Newsletter

NOVEMBER

2016

Happy Thanksgiving!

INSIDE THIS
ISSUE:
Introduction

Article:

Why Calcium
Citrate?
Recipes:

Black Bean
Chili
Wok-Seared
Chicken
Tender
Article:
Stay Well &
Hydrated
Recipe:

45

Pumpkin
Shakes
Support Group 6
Meetings

PAGE 1

THANKSGIVING IS NEAR! It is
definitely a big holiday to celebrate
with family, but dont forget about
portion control and prioritizing
protein. When you express
gratefulness to your family and
friends, remember also to thank
yourself! Thank yourself for all the
healthy choices youve made, for
all the hard work youve been
doing, and for how far youve
already come on this journey.
Congratulations!
Our November issue reemphasizes the importance of
hydration and calcium citrate, both
of which are highly recommended
after bariatric surgery. The
benefits of each, useful tips, and

myths & facts are also included.

Check it out!
Black bean chili and wok-seared
chicken tenders are the highlights
of this months recipe section. At
last, make a pumpkin shake to
celebrate thanksgiving! You can
have all the fluid, protein and
holiday in one shake.

Why Calcium Citrate is a Must

ROLE OF CALCIUM

We all know that calcium is a

critical component to keeping
our bones strong. Besides the
structural role of calcium,
another fundamental function
of calcium in our body is to
regulate a wide range of
essential cellular processes
such as contraction of muscle,
r e l e a s i n g
o f
neurotransmitters, secretion
of endocrine hormones and
cell proliferation. Our body is
really good at adapting to
changes and will use its own
resources to keep processes
working efficiently. To ensure
the rudimental function of our
cells, our body develops a
tight regulation mechanism to
maintain blood calcium levels.
When there is not enough
calcium entering our system
from diet or supplements, our
body extracts calcium from
our bones, which over time
results in osteoporosis &
other long term health issues.
Therefore, it is very critical to
get enough calcium from diet
or supplements.

ABSORPTION

Calcium absorption mainly

occurs in the small intestine;
however it has to be in the
soluble ionized (brokendown) state beforehand. The
two major forms of calcium
are calcium carbonate and
calcium citrate.
Calcium
carbonate, which is abundant
in food sources and is
primarily used in many dietary
supplements, must first
become ionized with gastric
acid in the stomach before it
can be absorbed in the
intestine. On the contrary,
calcium citrate does not
require this process and can
be readily absorbed in
the small intestine
intact.

SUPPLEMENTS

Bariatric surgery patients are

at high risk of calcium
deficiency, especial for elderly
people and postmenopausal
women.
After bariatric
surgery, there is less gastric
acid in the revised
gastrointestinal track, making
it difficult to absorb calcium
carbonate from food and
meet
the
calcium
requirement. Hence, calcium
citrate supplement is an
alternative way to ensure
adequate calcium intake for
our body. The recommended
daily dose of calcium for
bariatric patients is 1,2002,000 mg a day2. Our
p r o g r a m
recommendations are:
1500-1800mg per day
for gastric bypass, and
1000-1200mg per day
for sleeve gastrectomy
patients.
For many
brands of Calcium Citrate,
2 tablets, 2-3 times per day is
needed to reach the
recommended dosage.

Keep in mind the crucial functions of calcium in the body and high
risk of calcium deficiency after bariatric surgery. Take your calcium
citrate supplement every single day as recommended!
TIPS FOR TAKING CALCIUM CITRATE
Our body is not able to absorb a large amount of calcium at one time. In fact, taking any more than
500-600 mg of calcium at one time results in the excess being excreted through urine, thus not
absorbed. To maximize absorption, take 500-600mg three times a day for gastric bypass
procedure or two times a day for sleeve gastrectomy procedure.
Calcium interacts with Iron and inhibits Iron absorption. To prevent this interaction and maximum
the absorption of Iron, calcium supplements should be at least 4 hours apart from an ironcontaining multivitamin or iron supplement.
Regular calcium tablets may be too large for some people to swallow. Cutting the tablets in half is an
option for some people. There are petite varieties available, but the smaller size means more
tablets are needed to meet the 500-600mg dosage (usually 3 tablets). In addition, there are
chewable, chewy and liquid calcium citrate products on the market, which are better tolerated for
some people.
PAGE 2

Black Bean Chili

Recipe found on allrecipes.com
Makes 6 servings

Per Serving
Calories: 366 kcal
Fat: 9 grams
Protein: 30 grams
Carbs: 44 grams

Ingredients:
1 pound ground turkey
3 cans black beans, undrained
1 can crushed tomatoes
1 onion, diced
2 cloves garlic, minced
1 Tbsp. dried oregano
1 Tbsp. dried basil leaves
1 Tbsp. red wine vinegar
1 1/2 Tbsp. chili powder
1 Tbsp. vegetable oil

Directions:
1. Heat the oil in a large heavy pot over medium
heat; cook onion and garlic until onions are
translucent.
2. Add turkey and cook, stirring, until meat is
brown.
3. Stir in beans, tomatoes, chili powder, oregano,
basil and vinegar.
4. Reduce heat to low, cover and simmer 60
minutes or more, until flavors are well
blended.

Recipes
Wok-Seared Chicken Tenders
Recipe found on wedmed.com
Makes 4 servings

Ingredients:
1 lb. chicken breast, cut into bite-size pieces
1 1/2 lbs. fresh asparagus, cut into 1-inch
pieces
4 scallions, trimmed & cut into 1-inch pieces
1/4 cup shelled salted pistachios, coarsely
chopped

1 teaspoon chile-garlic sauce

1 tablespoon oyster-flavored sauce
1tablespoon toasted sesame oil
2 tablespoons minced fresh ginger

Directions:
1. Heat oil in a wok or large skillet over high heat.
2. Add asparagus, cook and stirring for 2 minutes. Add
chicken, cook an stirring for 4 minutes
3. Stir in scallions, ginger, oyster sauce and chile-garlic
sauce
4. Cook, stirring until the chicken is juicy and just cooked
through 1-2 minutes more.
5. Stir in pistachios and serve immediately
PAGE 3

Per Serving
Calories: 246 kcal
Fat: 9 grams
Protein: 32 grams
Carbs: 12 grams

Stay Well and Hydrated

BENEFITS OF WATER
Water is essential for life and comprises 50-70% of total body weight in
adults. However, the importance of adequate water intake is always
undervalued. The benefits of hydration is far beyond normal cell
metabolism and function. Hydration status is critical to the bodys process of temperature
control, especially in the hot and humid environment. Additionally, hydration has been
considered as a cornerstone of weight loss. One study shows that people who are in wellhydrated are less likely to be obese1. One of the possible reasons behind this finding is
adequate water intake in between meals keeps people full and makes people tend to eat less at
a meal. Whats more, adequate water intake is associated with a lower risk of a number of
chronic disease, such as kidney stones and constipation.

THIRST
Many people drink only when they feel thirsty. However, this
perception is totally wrong and even dangerous. Thirst is not a
sensitive sensation. In fact, it is an important emergency sensation
indicating the body cannot tolerate a great deal more fluid loss. Usually
when the thirst sensation first occurs, one has already typically lost 1.5
to 2.0 liters of fluid. In other words, thirst actually is a late warning sign of the body, rather
than a early reminder sign. Thus, do not wait until you feel thirsty to start drinking - it is too
late for your body to be well-hydrated. This may be particularly important for older people.
Research suggests people over 65 years old dont feel as thirsty as younger people, even when
they are dehydrated2.

INDICATOR
Urine is a good indicator for hydration status. Decreasing of urination is
an early sign of dehydration3. Also, the color of the urine is another easy
objective measurement. If your urine is light, almost like the color of
water, you probably are well hydrated. If your urine is dark, it means you
need to drink more. Although urine color is not as precise as biochemical
measures, it is an easy-to-follow method for general population to get a
crude idea of hydration status, especially for people who are at home.

RECOMMENDATION
The Institute of Medicine determined that an adequate intake (AI) for men
is roughly about 13 cups (3 liters) of total fluids a day. The AI for women is about
9 cups (2.2 liters) of total fluids a day4. USDA recommends 2.7 liters (11.5
cups) of fluids for adults3. People who have higher BMIs are expected to
have higher water needs, given the total fluid intake is calculated based on
total body weight. Our program recommends a minimum of 64 ounces of
sugar-free, decaf fluid a day. For people who are physically active or
exposed in hot and humid environment, higher intake of water is required.
PAGE 4

Stay Well and Hydrated, continued

WATER REMINDER APP
To stay well and hydrated, one should drink frequently. It may be hard for people to start and get
use to this habit. Always forget to drink water? Dont know the amount of water youve taken in
throughout the day? Check out one of these free phone apps: Water Drink Reminder,
Waterlogged, Water Alter, or Daily Water. Using the technology, those apps remind you drink
fluids and track your drinking habits.

WHAT TO DRINK
Water is definitely the first choice of staying well in hydration. For people who really dont like
water, flavored water is another option. Crystal Light, Vitamin Water Zero, Powerade Zero, MIO,
those are some examples of what you can purchase in stores or online. As long as it has no added
sugar and contains zero calories, it is an good alternative for water.
Also, you can make your own flavored water at home. Put several
pieces of lemon, watermelon, cucumber, or whatever fruits you like
into water and sip on it. You can have decaf coffee or tea.
Additionally, milk and protein shakes also count for fluid, and you get
extra protein besides getting fluid in. Remember to stay away from
alcohol, caffeine, carbonated beverage and straws.
References:
1. Drinking water is associated with weight loss in overweight dieting women independent of diet and activity. J.D. Stookdy, F. Constant, B.M. Popkin, et al. Obesity Society, Nov 2008 11(16): 2481-2488
2. Reduced osmotic thirst in healthy elderly men. P. A. Phillips, M. Bretherton, C. I. Johnston, L. Gray. American Journal of Physiology
- Regulatory, Integrative and Comparative Physiology Jul, 1991, 261(1): R166-R171
3. Water, Hydration and Health. B.M. Popkin, K.E. DAnci, I.H. Rosenberg. Nutrition Reviews, 2010,68(8), 439458.
4. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Food and Nutrition Board; Institute of Medicine

Per Serving
Calories: 230 kcal
Protein: 17 grams

Add extra
protein: A half
scoop of vanilla
protein powder
increases protein
per serving to 27
grams!

Fat: 1 gram
Carbs: 38 grams

Pumpkin Shake
Recipe found on allrecipes.com
Makes 1 serving

Ingredients:
1 cup skim milk
1/3 cup pumpkin puree
1/3 cup vanilla Greek yogurt
1/2 frozen banana, cut into chunks
1 pinch ground cinnamon, ginger, nutmeg
and allspice respectively
Ice cubes, if desired
Directions: Blend all ingredients in a blender until smooth.

PAGE 5

November Support Group Meetings

Saturday,
November 5

10amNoon
Neuropsychology

Thursday,
November 10

6pm8pm
Dominos Farm

Monday,
November 14

10amNoon
Neuropsychology

Cancelled until 2017

Two weeks earlier due to Thanksgiving. School of Public Health
Student Presentation (topic TBA) with Julie Jing, followed by
Instructor-led Open Discussion

TBD

Please Note:
The support groups held at the Neuropsychology Building are at 2101 Commonwealth Blvd, Suite C. Park

on the north side of the building. Please follow signs to the conference room once inside.

The support groups held at Dominos Farms are in Lobby G, MEND large conference room. There is no

exterior sign for Lobby G! Park in lobby H and take stairs/elevator down 1 level. This is a long walk and
there are no wheelchairs available in lobby H. Follow signs once inside the building to the conference room.

Doors open 15 minutes prior to the meeting, to allow staff time to set-up. Please do not arrive earlier than
that time. There is limited space and we are unable to pre-register participants unless noted. Also, please do
not bring children. If you are pre-op and fulfilling your 2 required meetings, you must attend the entire 2 hour
session. Please print your legal name on the sign-in and sign-out sheets.

References:
Page 2: Modern nutrition in health and disease, 133-149
Page 3: Black Bean Chili Recipe found at http://allrecipes.com/recipe/23336/fantastic-black-bean-chili/
Page 3: Wok-Seared Chicken Tender found at http://www.webmd.com/food-recipes/wok-seared-chicken-tenders-with-asparagus-andpistachios
Page 5: Pumpkin Shake Recipe found at http://allrecipes.com/recipe/236614/pumpkin-shake/

Visit Our Website at:

www.med.umich.edu/
bariatricsurgery

Contact Us:

Contributor:

Adult Bariatric Surgery Program

Julie Jing, UMHS School of

Public Health Intern

Dominos Farms, Box 424

24 Frank Lloyd Wright Drive
Ann Arbor, MI 48106

Check out CTools

for more info!

Phone: (734) 936-5738

Fax: (734) 232-1241

Issue Editors:
Darlene Bellers, MS, RD
Amy Lockwood, MPH, RD