18 each fresh asparagus, peeled
1 tablespoon flour
1/2 teaspoon dry mustard
6 thin lean ham slices
3/4 cup cheddar cheese, low fat, grated
1 tablespoon margarine
1/2 cup nonfat milk
3 tablespoons almonds, slivered

Directions

1. In a non-stick saute pan saute asparagus until just tender. (Nonstick spray can be used to coat the pan first)
2. Melt margarine in heavy saucepan
3. Stir in flour, salt and mustard. Gradually stir in skim milk. Cook, stirring constantly until thickened.
4. Add cheese and continue stirring until cheese is melted
5. Divide asparagus into 6 portions
6. Place asparagus portions on and parallel to narrow end of each ham slice
7. Roll as for jelly roll with asparagus in the center of each roll-up
8. Arrange roll-ups in a baking dish with seam side down
9. Pour sauce over roll-ups
10. Bake at 350 degrees until sauce is bubbly, about 20 minutes

Nutrition

Per serving: 110 calories, 10 grams protein, 5 grams fat (1 gram saturated),
15 mg cholesterol, 6 grams carbohydrates, 2 grams fiber, 420 mg sodium

There has been renewed interest by the medical community recently in the role of Vitamin D in the maintenance of good health that needs to be shared with our patients. Let me first begin by stating that Vitamin D absorption from the diet is not affected by weight loss surgery, however, over 50% of the entire population of the United States has a vitamin D deficiency. This article will review facts about vitamin D; including how we get it, what happens to our body when it gets low, and how do we prevent and treat vitamin D deficiency.

Vitamins are organic substances which are essential for normal metabolism, growth and development of the body. We get vitamin D in our diet and from exposure to sunlight. It is present in milk, fatty fish such as salmon, tuna and cod, and eggs, butter, and dietary supplements.

Vitamin D’s principal function is related to our body being able to use calcium and phosphorous, which are the minerals which make up our bones. Vitamin D is essential for the normal absorption of calcium and phosphorous from our GI tract. In addition, vitamin D is necessary for normal muscle function, cardiovascular health and the function of our immune system. Deficiency of vitamin D is best known for its effect on our bone strength or bone density and can cause osteoporosis which leads to fractures of the hip and spine as we grow older. These fractures heal poorly in thin bone and are very painful. At present 50% of women and 20% of men will develop osteoporosis by age 50 (this is in patients who haven’t undergone bariatric surgery) and experience a fracture related to their poor bone density in their lifetime. Low vitamin D also results in an increase in autoimmune disorders like type 1 diabetes, multiple sclerosis and Chron’s disease and can interfere with our body’s defense against bacterial or viral infections. Deficiencies also increase the risk of some cancers (prostate, pancreas, colon, ovary and breast) and can lead to higher rates of hypertension and cardiovascular disease. Chronic muscle pain and fibromyalgia has been reported to resolve in up to 90% of patients when their vitamin D deficiency is corrected. We are just coming to understand the role of vitamin D which was rarely tested in the past. Current testing has revealed that 50% of the current population has a vitamin D deficiency. A major reason testing is not done more frequently is the current cost of the lab exam which can run from $160-400, and is rarely covered by insurance.

Vitamin D can be obtained in our diet, but requires we eat a fatty fish such as salmon 2-3 times weekly. Other foods such as milk and diary products which contain vitamin D are actually fortified artificially with the addition of vitamin D by the supplier of the product. It was previously thought that we needed only 400 units of vitamin D daily along with 800 mg of calcium, and many of the over the counter supplements contain this quantity in 2 tablets daily. We have since learned this isn’t enough and the government has suggested 800 units of vitamin D and 1500 mg of calcium daily. Even this amount may not be enough and we often have to prescribe a super strength vitamin D with 50,000 units which is taken either weekly or every other week.

It has been documented that patients who undergo gastric bypass surgery are at higher risk of metabolic bone disease such as osteoporosis due to reduced absorption of calcium, however, we have monitored our patients with bone density testing yearly in the office and our incidence of osteoporosis has decreased after surgery due to our insistence our patients take the calcium and vitamin D supplements and be monitored closely. Patients who don’t return to our office for follow up should ask their family physician to order a bone density study yearly to insure adequate calcium replacement. Blood tests which measure calcium are not adequate to monitor calcium supplements. Routine vitamin D blood test can be reserved for patients with demonstrated abnormal bone density tests or known vitamin D deficiency due to the cost of the test at this time.

We are just beginning to understand the importance of vitamin D for good health in all people. Remember: it’s extremely important for our patients to take their calcium supplements with vitamin D and have routine testing done yearly to insure adequate replacement of nutrients in their diet.

I must confess, I have only recently started working out regularly so the aforementioned weight loss would probably be greater had I not been sedentary.  The good news is, I recently joined a fitness club and am doing 45 minutes of intense cardio 4-5 days a week.  I will soon be incorporating strength training 3 days a week into the mix to help with muscle tone. I can’t begin to tell you how much better I feel.  Especially my energy level!

Lately, I think my brain is finally syncing up with my revised stomach.  That was the hardest thing at first.  I am now able to distinguish between true hunger and the hunger in my head.  I can definitely feel the difference without Grehlin.  I don’t feel ravenous or deprived anymore.  My stomach sort of growls like it used to if I’m truly hungry but I don’t feel the need to eat everything but the kitchen sink.  I feel like I have advanced past the experimental phase with food.  I am naturally making better choices, no sweets except fruit.  I am sticking to 3 meals a day and no grazing especially now that the holidays are over.  I don’t miss the old eating days anymore.  I did at first though.  My relationship with food has changed dramatically.

I take one Women’s Ultra Mega vitamin from GNC daily.  I still need to get in more protein.  It’s hard as I’m single and on the go.  I also need to get in more water than I should.  It’s hard because I can’t chug-a-lug anymore.  Especially after a workout!  Although I can never finish a whole can in a given day, I do have a vice and that’s sipping on diet Coke at work.  I know!…  It’s bad!  I’m working on it and trying to replace it with crystal light but I miss the carbonation.

I plan to get a physical once I find a good PCP here so I can get some blood tests and see how those look.  When I do, I will have them forwarded to your office.

I am also still smoke free and have been since Last August.  I smell better, look better, and most importantly, I feel better!  And I owe it all to Dr. Champion and his wonderful staff!  You have all given me a new lease on life and I will be forever grateful!  I have absolutely no regrets on the surgeon or the procedure I chose.

I’m so sorry for the lengthy e-mail.  I just figured since you only have a couple sleeve patients, my feedback would be helpful to you.  There is so much to talk about!

Thanks again for everything and I will keep you posted from up here in Massachusetts!

Take care for now.  Warmest regards,

Val C.

First of all it is important to eat. DON’T SKIP MEALS. Regular meals help to keep your metabolism high, thus burning calories. For best results, eat three meals and a snack. Eat within an hour of rising and every four to five hours thereafter. It is especially important to eat breakfast. Also, don’t forget to eat when you are busy. Many people eat too fast or too much when they have skipped a meal, resulting in nausea and vomiting.

Remember, that even if you don’t feel hunger, your body needs the protein and other nutrients that the meal provides, so take time out from work or shopping to eat.

Second, remember the recommended meal pattern: meat first, 2-3 ounces of meat for protein and to promote satiety. The pouch will empty too quickly if you aren’t eating enough meat. Then you get hungry too soon and start snacking.

Next, eat your vegetables. Vegetables that are lower in carbohydrates are best. The fiber in vegetables helps to make you feel fuller on fewer calories. Next, eat fruit. Fresh is best, since it is higher in fiber. Sweeten with a sugar substitute if needed. Garnish with cinnamon, nutmeg or a sprinkle of sugar free flavored gelatin.

A lot of favorite foods are served at holiday meals. Many of these foods are high in sugar, fat, and calories so they are often poorly tolerated. Plan ahead for holiday meals. For foods high in fat, limit your portion to one or two bites. For foods high in sugar, prepare using an artificial sweetener.

So give yourself a holiday gift of continuing to follow the dietary guidelines. They don’t change with the seasons. Don’t forget to exercise!