Study: Surroundings Play Key Role in Diet

A new study shows that people eat how much they do because of what's available to them.

Source:  Forbes, via AP News:

How many M&MS are enough? It depends on how big the candy scoop is. At least that's a key factor, says a study that offers new evidence that people take cues from their surroundings in deciding how much to eat.

It explains why, for example, people who used to be satisfied by a 12-ounce can of soda may now feel that a 20-ounce bottle is just right. It's "unit bias," the tendency to think that a single unit of food - a bottle, a can, a plateful, or some more subtle measure - is the right amount to eat or drink, researchers propose.

"Whatever size a banana is, that's what you eat, a small banana or a big banana," says Andrew Geier of the University of Pennsylvania. And "whatever's served on your plate, it just seems locked in our heads: that's a meal."

The overall idea is hardly new to diet experts. They point to the supersizing of fast food and restaurant portions as one reason for the surge of obesity in recent decades. They sometimes suggest that dieters use smaller plates to reduce the amount of food that looks like a meal.

But in the June issue of the journal Psychological Science, Geier and colleagues dig into why people are so swayed by this unit idea when they decide how much to eat.

Geier, a Ph.D. candidate who works with people who are overweight or who have eating disorders, figures people learn how big an appropriate food unit is from their cultures. For example, yogurt containers in French supermarkets are a bit more than half the size of their American counterparts. Yet French shoppers don't make up the difference by eating more containers of the stuff, he noted.

He and the other researchers tried a series of experiments using environmental cues to manipulate people's ideas of how big a food unit is.

In one, they put a large bowl with a pound of M&Ms in the lobby of an upscale apartment building with a sign: "Eat Your Fill ... please use the spoon to serve yourself." The candy was left out through the day for 10 days, sometimes with a spoon that held a quarter-cup, and other times with a tablespoon.

Sure enough, people consistently took more M&Ms on days when the bigger scoop was provided, about two-thirds more on average than when the teaspoon was present.

In another experiment, a snacking area in an apartment building contained a bowl with either 80 small Tootsie Rolls or 20 big ones, four times as large. Over 10 working days, the bowl was filled with the same overall weight of candy each day. But people consistently removed more, by weight, when it was offered in the larger packages.

In those experiments, as well as a similar one with pretzels, "unit bias" wasn't the only thing that produced the differences in consumption levels, but it had an influence, Geier and colleagues concluded.

Brian Wansink, director of Cornell University's Food and Brand Lab and author of the forthcoming book "Mindless Eating: Why We Eat More Than We Think," called the new paper an impressive demonstration of the effect in a real-world setting. He has done similar work but didn't participate in Geier's research.

So can all this help dieters?

Some food companies are introducing products in 100-calorie packages, and Geier thinks that could help hold down a person's consumption. He also suspects companies could help by displaying the number of servings per container more prominently on their packaging.

As for what dieters can do on their own, Geier said one of his overweight patients offered a suggestion for restaurant visits: Request that the meal be split in two in the kitchen, with half on the plate and the other half packaged to take home.

In any case, an earlier experiment of Geier's shows that the unit bias effect has its limits.

He had one dining hall at his university provide 10-ounce glasses for soda, and a second provide 16-ounce glasses. He predicted that students at the first hall would drink less soda. In fact, they drank more.

Only later did he find out what went wrong.

"They were taking two glasses at a time," he said. "I guess I went below what is culturally construed as a unit of soda."

Getting Ready For Back To School!!!

Getting Ready for Back-to-School Register with ClubMom now to customize this list. Preschool--one month to one week before school:

	Spend time talking with your child about school.
	Practice separating for hours at a time.
	Read stories about the first day of school to your child.
	Plan a back-to-school shopping expedition.
	Buy or gather supplies your preschooler will likely need to bring to school.
	Buy supplies your preschooler will likely need to use at home:
	Put your child's name on her supplies, lunchbox, mat, blanket, pillow, and inside clothing.
	Teach your child important safety information and make sure she commits it to memory.
Register now to customize this list.
Preschool--one week before school:
	Whether your child will walk, ride the bus, or be driven to school, take a "dry run" of the route with your child.
	If your child will be taking the bus to school, do a practice walk to the bus stop.
	Attend an open house or get-acquainted day at school, if there is one, with your child.
	If there's no open house, schedule an appointment to take a tour of the school building with your child.
	Put your child to bed earlier each night until she's turning in at an appropriate school-night bedtime.
	Get your child used to waking up in the morning at a school-day appropriate time.
	Spend the last day or two before school starts at home with your child.
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Preschool--the night before school starts:
	Pick out school clothes for the morning.
	Tuck in your child at an appropriate school-night hour.
	Before your child goes to sleep, listen carefully to her fears and respond.
	Read a bedtime, back-to-school storybook to your child.
	Pack stay-at-school cubby supplies in a bag that can also stay at school.
	Pack your child's lunch for the next day and refrigerate it.
	Gather in one place everything that's going to school with your child in the morning.
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Preschool--the morning school starts:
	Take care of any last-minute tasks.
	Even if you can't do so every day, try to bring your child to school personally on the first day and say goodbyes there.
	Let your child get used to the environment before you leave.
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Primary school--several months before school:
	For a child, entering elementary school means entering the academic world for the first time. This brings with it a whole new set of anxieties and preparations.
	Speak to the principal in the spring or summer before school starts about what your child is expected to know by the time she enters kindergarten or first grade.
	Help her get up to speed so she can keep up academically with the rest of her class.
	If your child has any special needs, notify the school and confirm that acceptable accommodations can be made.
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Primary school--one month to one week before school:
	Try on last-year's school clothes to see what still fits.
	Go shopping for those items that have to be replaced.
	If you'll be buying a school uniform, find out from your school whether any local retailers are offering special deals. If so, you may be able to get a new uniform for your child at a discount.
	Stock up on supplies your child will need to bring to school.
	Let your child select her own lunchbox, backpack, and outfit for the first day of school.
	Stock up on supplies your child will need to have on hand at home.
	If you have a home computer, make sure it is ready to be used for schoolwork.
	Schedule an appointment with your child's pediatrician for a physical exam, if needed.
	Bring the school's medical form with you to your child's doctor appointment so it can be filled out.
	Make arrangements for after-school activities or childcare.
	If you plan to participate in any carpools, start organizing them now.
	Spend time listening to your child's concerns about going back to school.
	Sew name tags or write your child's name in indelible ink on clothing she's likely to take off during the day and small items like headbands, hats, and mittens.
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Primary school--one week before school:
	Read through and review school regulations with your child.
	Make sure all school forms have been completed and returned to school.
	Take your child to check out her classroom and say hello to the teacher.
	Attend an open house or "get acquainted" school event with your child, if there is one.
	Help your child become familiar with the route to and from school.
	Start moving bedtime back until your child is turning in at an appropriate school-night hour.
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Primary school--the night before school starts:
	Designate a place in the house for school paperwork.
	Check your child's backpack to be sure she has everything she needs.
	Go over after-school plans with your child.
	Help your child pick out clothes for the next day.
	Start the bedtime routine a bit early so your child is sure to get plenty of sleep.
	Spend some tuck-in time talking with your child about school.
	Pack lunch for your child and refrigerate it until morning.
Register now to customize this list.
Primary school--the morning school starts:
	Encourage your child to start getting her morning act together on her own.
	Take care of any last minute tasks.
	Remind your child of her after-school plans.
	Even if you can't do it every day, if possible, take your child to the bus stop or to school on the first day.
	Say a cheerful goodbye and leave promptly when the bus comes or bell rings.
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Primary school--after the first day of school:
	Prepare a snack for your child, and one for yourself.
	Get your child to talk about her first-day impressions.
	Call the school immediately if you have any questions or concerns.
	Ask for--and read--any notices that were sent home.
	Purchase whatever additional school supplies and materials are required.
	Make a special dinner.
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Middle and high school--one month before school:
	Be ready to grant your adolescent some new privileges.
	Allowing your child to do her own back-to-school shopping is a good way to show her you trust her judgment.
	Take the initiative to start back-to-school preparations.
	Encourage your child to try on last-year's school clothes and see what still fits.
	Go shopping, together if needed, for those wardrobe items that have to be replaced or updated.
	If your child will need a school uniform, find out from your school whether any local retailers are offering special deals. If so, you may be able to enjoy a discount.
	Encourage your child to shop for school supplies on her own.
	If you have a home computer, make sure it is ready to be used for schoolwork.
	Schedule an appointment with your child's doctor for a physical exam, if needed.
	Bring the school's medical form with to your child's doctor appointment so it can be filled out.
	Talk with your child about after-school activities she'd like to participate in and make the necessary arrangements.
	If you plan to participate in any carpools, start organizing them now.
	Try to take your child to school ahead of time.
	If your child has any special needs, notify the school and confirm that acceptable accommodations can be made.
Register now to customize this list.
Middle through high school--one week before school:
	Address any concerns your child may have about going back to school.
	Familiarize your child with her new school-year schedule.
	Read through and review school regulations with your child.
	Make sure that all school forms have been completed and returned to school.
Register now to customize this list.
Middle and high school--the night before school starts:
	Remind your child to pack her book bag.
	Designate a place in the house for school paperwork.
	Spend some time talking with your child about school.
	Try to get your child to bed at a reasonable hour.
	If your child lets you, pack her lunch or snack.
Register now to customize this list.
Middle and high school--the morning school starts:
	Make sure your child wakes up in time for school.
	Prepare a special breakfast.
	Go over after-school plans.
	Let your child know where you'll be all day and how to reach you.
	Say a cheerful, confident goodbye.
Register now to customize this list.
Middle through high school--after the first day of school:
	Try to be there when your child arrives home from school the first day.
	Prepare a snack for your child, and one for yourself.
	Get your child to talk about her first-day impressions.
	Call the school immediately if you have any questions or concerns.
	Ask for--and read--any notices that were sent home.
	Purchase whatever additional school supplies and materials are required.
	Make a special dinner.
Register now to customize this list.
Back-to-school resources for parents:
	"A+ Parents: Help Your Child Learn and Succeed in School" by Adrienne Mack (McBooks Press)
	"Off to a Good Start: Launching the School Year" from The Responsive Classroom Series, #1 (Northeast Foundation for Children)
	"Smart Parenting: An Easy Approach to Raising Happy, Well-Adjusted Kids" by Dr. Peter Favaro (NTC/Contemporary Publishing)
	"Smart Start: The Parents' Complete Guide to Preschool Education" by Marian Edelman Borden (Facts on File)
	"Adolescents' Worlds: Negotiating Family, Peers, and School" by Patricia Phelan, Ann Locke Davidson, Hanh Cao Yu (Teachers College Press)
	"Helping Your Child Start School: A Practical Guide for Parents" by Bernard Ryan, Jr. (Replica Books)
	"Kids Who Start Ahead, Stay Ahead: What Actually Happens When Your Home Taught Early Learner Goes to School" by Dr. Harvey Neil with introduction by Glenn Doman (Avery)
	"Helping Your Child Get Ready for School" on the U.S. Dept. of Education's Web site
	"Your Child?s First Day at School" from MetLife Online
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Back-to-school books for preschoolers and primary schoolers:
	"Clara Goes to School" (Let's Start! Series), (Silver Dolphin)
	"When You Go to Kindergarten" by James Howe (William Morrow)
	"My First Day of School" by P. K. Hallinan (Hambleton-Hill)
	"Bumble Bear" (School Zone Start to Read Book) by James Hoffman, et al (School Zone Publishing )
	"First Day of School" (A Giant First Start Reader) by Kim Jackson (Troll)
	"Kitty from the Start" by Judy Delton (Houghton Mifflin)
	"Let's Go to School" (First-Start Easy Reader) by Michelle Petty (Troll)
Register now to customize this list.
Back-to-school books for middle and high schoolers:
	"101 Surefire Ways to Start the School Year" by Joan Novelli, Susan Shafer (Scholastic)
	"Summer Start: How to Organize Your Best School Year Ever" by Pat Fellers, Kathy Gritzmacher (Tops Learning System)
	"Jump Start: How to Succeed in School and in Life" by Rafael Beer (Jump Start)
Register now to customize this list.

Macaroni and Cheese.

Pam asked what "Equal Dark" was.  I should have specified, I like my coffee with cream and Equal (insert comma here), dark.  The reason I ask for it dark, is that when doing so, you generally get it made as light as a regular coffee, because people don't listen.  So, there is no Equal Dark, if you were wondering.  I think there is a Equal Brown Sugar Substitute - though?

She also requested my macaroni and cheese recipe.  Beware, my mac and cheese is not a diet food, At All.  I actually made mac and cheese tonight, with another comfort diet food, meatloaf.  :-P  This recipe is nearly the closest to my "recipe."

1/2 pound dry pasta, whatever shape you prefer, even whole wheat or low carb (we like different shapes)

4 tablespoons butter
Bread crumbs, preferably fresh, but whatever.
3 cups whole or low-fat milk
1/4 cup all-purpose flour
1/2 teaspoon salt
1/4 teaspoon freshly ground black pepper
1/8 teaspoon cayenne pepper
10 ounces sharp white Cheddar cheese, coassly grated (about 21/4 cups)
4 to 5 ounces Gruyere cheese, coassly grated (about 1 cup)

2 ounces dry Jack cheese, finely grated (about 1/4 cup)

(You add substitute other hard sharp cheeses or add in many different kinds to use up what you've got in the fridge.  Today I used mozzarella and parmesan also, making it slightly gooey and sharp... YUMMY!!)

Preheat the oven to 375 degrees. Butter a 1 1/2-quart soufflé dish or other straight-sided casserole. Set aside.

Bring a medium-size pot of water to a boil. Add the macaroni and cook 2 to 3 minutes less than the package's directions suggest. You want the pasta to be underdone. Transfer the macaroni to a colander, drain, and rinse with cold water. Shake off as much excess water as possible and set aside. In a large sauté pan, melt 1 tablespoon of the butter. Add the bread crumbs and stir until thoroughly coated. Put the crumbs on a small plate and set aside. Wipe out the pan with a paper towel and set aside.

In a small saucepan, heat the milk over medium heat until very hot but not scalded. In the sauté pan you used for the bread crumbs, melt the remaining 3 tablespoons butter over medium heat. When the butter begins to bubble, add the flour and stir until cooked, about 1 minute. Slowly pour in the hot milk and whisk continuously until all of the milk is incorporated and the sauce has begun to thicken, about 5 minutes.

Remove the pan from the heat and add the salt, black pepper, cayenne, 1 1/2 cups of the Cheddar, 3/4 cup of the Gruyere, and all of the dry Jack. Mix well until all the cheese has melted.

Add the cooled macaroni to the cheese sauce and pour the mixture into the prepared dish or casserole. Sprinkle with the remaining Cheddar and Gruyere, and top with the bread crumbs. Bake for about 30 minutes, or until the bread crumbs are golden brown and the casserole is bubbling. Let sit for 5 minutes, then serve. Makes 4 servings.   (So, double that poop, because this isn't nearly enough for any crowd.)

FYI - not so much gastric bypass friendly, either, but it's good for a few tastes.

Pregnancy No-No's

Pregnancy No-Nos By Leah Hennen http://www.clubmom.com When I was expecting my first child, threats to my baby's health seemed to lurk everywhere. I knew, of course, that alcohol, cigarettes, and drugs of any kind were off-limits. But what about those lattes I'd chugged before I knew I was pregnant? Did I need to get rid of my beloved cats? What sort of environmental hazards was I unwittingly exposing my fetus to? Nine months of caffeine withdrawal, cat avoidance, and breath-holding-around-noxious-odors later, my strapping baby boy arrived. Unlike me, you don't have to be paranoid when you're pregnant. "You can't put yourself in a glass bottle during pregnancy—all you can do is avoid known risks," says Dr. Robert Resnik, a professor of reproductive medicine at the University of California, San Diego, School of Medicine. Since some women, such as those with high blood pressure or gestational diabetes, need to take extra precautions, talk to your doctor about special circumstances that relate to you. Also steer clear of the following: Too Much Caffeine For java junkies like me, the research on caffeine during pregnancy has been maddeningly contradictory. Some studies point to problems such as miscarriage and low birth weight, while others show no such relationship. The latest consensus is that only excessive amounts of caffeine (more than 300 milligrams a day) are likely to cause these problems, says Dr. Kathleen Bradley, a maternal-fetal medicine specialist and assistant clinical professor of obstetrics and gynecology at the UCLA School of Medicine. The caffeine content of different brews varies, but you should be able to stay under the 300-milligram mark by limiting your daily quaffing to one or two 5-ounce cups of coffee or tea or a few 12-ounce cans of soda. (Since even non-colas can pack quite a caffeine punch, check the label before you imbibe.) And while chocolate does contain caffeine, it typically has much less—1 to 35 milligrams per one ounce—than coffee. Cat Litter Cat feces may play host to a parasite that causes toxoplasmosis. The symptoms (fever, fatigue, and sore throat) are similar to those of a garden-variety flu, but the results (miscarriage, preterm labor, or serious health problems in the newborn) can be devastating. Even so, having a baby on board doesn't mean you need to send your puss packing, says Marion McCartney, a certified nurse-midwife and the director of professional services at the American College of Nurse-Midwives in Washington, D.C. It simply means you should put your mate on litter-box duty for the nine-month duration. It's also a good idea to wash your hands after heavy petting sessions with the cat and after handling raw meat. Don't feed yourself or the cat undercooked meat (which can harbor the parasite). Wear gloves when you're gardening and avoid children's sandboxes. (Roaming cats may use these as litter boxes.) Certain Foods Beware, foodies: Uncooked, soft cheeses (such as feta, Camembert, Brie, and blue-veined varieties), unpasteurized milk and the foods made from it, and raw or undercooked meats, fish, and poultry may contain listeria bacteria. During pregnancy, listeriosis (symptoms include fever, chills, diarrhea, and nausea) can cause miscarriage, preterm labor, or stillbirth. Some seafood may also contain high levels of mercury, PCBs, and other toxins. If these foods are consumed during pregnancy, the baby is put at risk for developmental delays. (Your local health department may be able to tell you which fish to avoid.) Experts recommend that expecting mothers limit their servings of shark and swordfish—which contain higher levels of mercury than other fish—to one three-ounce serving a month. Finally, lab tests have linked heavy consumption of saccharine to cancer. Though you're not likely to swill enough of the artificial sweetener to equal several times your body weight, you may still want to forgo those little pink packets for now. Aspartame (NutraSweet, Equal) appears to be a safe sugar substitute. Herbal Remedies You know that many prescription drugs are off-limits during pregnancy, but the natural remedies you can pick up at health-food stores are okay, aren't they? Guess again: Herbal remedies can have a potent effect on your body—and your baby's—cautions McCartney. Don't take anything without running it by your health-care provider first. She'll most likely tell you not to use any during your first trimester. Throughout your pregnancy, steer clear of goldenseal, mugwort, and pennyroyal, all of which have been associated with uterine contractions (which could possibly lead to miscarriage or preterm labor); Asian ginseng (which interferes with metabolism); and feverfew (though popular for migraine headaches, it has unpredictable effects on pregnant women). It's also wise to avoid herbal teas that purport to have medicinal benefits. Home Hazards If you haven't been gripped by that famous pregnancy cleaning-and-nesting frenzy, chances are you will be soon. Safety tips for those 3 a.m. floor-scrubbing and nursery-decorating sessions: Read labels carefully. Wear gloves and work in well-ventilated areas. And avoid aerosols (which disperse more chemicals into the air than pump bottles do), oven cleaners, paint fumes, solvents, and furniture strippers. Although frequent, heavy exposure to chemicals in the workplace (home workshops count, too) has been linked to birth defects, Bradley explains, home use of most products is more likely to make you feel faint or nauseous—not a great proposition when you're nine months pregnant and perched high on a ladder or wedged behind the toilet. Overheating Soaking in the hot tub or relaxing in a sauna may seem like the perfect way to pamper your pregnant body, but raising your core temperature—especially during the first trimester—may boost the odds of birth defects. It's safe to soak in a lukewarm bath, though. Just make sure that the temperature is not above 100 degrees and that you get out after about ten minutes, Resnik advises. Sustained exercise in very hot, humid weather can also raise your core temperature. When you do exercise, be sure to drink liquids before, during, and after, and if you find that you're heating up, take a five- or ten-minute breather. Lead Lead exposure has been linked to miscarriage, preterm labor, low birth weight, and mental and behavioral problems in children. Residue from the toxic metal can lurk in places you might not suspect: houses built before 1978 (the year lead paint was banned), tap water, even calcium supplements. A few precautions will reduce the amount of lead you come into contact with: Call in a lead-abatement specialist if you live in an older home with chipping or peeling paint. (Whatever you do, don't try to sand or scrape it off yourself.) Filtering your water may help, or have your tap water tested. (Call the Environmental Protection Agency's Safe Drinking Water Hotline at 800-426-4791 for a testing lab in your area.) Finally, if you take a calcium supplement, ask your doctor to recommend one that's low in lead, such as Tums 500 Calcium Supplement. Oral Sex Don't worry, you needn't swear off oral gratification entirely. (After all, when you hit that physically awkward last trimester, there may not be much else you can do between the sheets.) But when he's pleasuring you, your mate should be careful not to blow air into your vagina, if that's something that's part of his, uh, repertoire. Why? Your blood vessels are dilated during pregnancy, and, though the chances of this happening are very rare, a fatal air bubble could potentially enter your bloodstream, McCartney explains. Certain Over-the-Counter Drugs Your back is aching, your heart is burning, and your stomach is roiling—do you have to forgo all pharmaceutical relief? Not necessarily, says Bradley. But since even benign-seeming remedies, such as aspirin, ibuprofen, and certain cold preparations, can cause problems for your baby, don't pop any pill without your doctor's approval. If one medication is off-limits, she can suggest an alternative. Acetaminophen (Tylenol), for instance, is fine. Secondhand Smoke You may have given up cigarettes, but if your mate's still puffing away, your baby's getting hefty doses of the 43 cancer-causing chemicals in cigarette smoke. In fact, exposure to secondhand smoke during pregnancy raises the risk of low birth weight, sudden infant death syndrome, and other health problems. So ask your partner to quit or to cut down—if not for his own health, then for yours and your baby's. And tell anyone who lights up around you to kindly take it outside. Stress Every time you look down, your growing belly reminds you of just how much your life will change once your baby is born. Exciting, yes. Stressful? You bet. Even so, try to take it easy. Stress causes the release of hormones that reduce blood flow to the placenta and triggers contractions, and it has been linked to miscarriage, preterm birth, and low birth weight, Bradley explains. If you hold a high-pressure job, do what you can to scale back. If you're feeling the heat in your personal life, practice relaxation techniques, surround yourself with supportive people, and seek counseling if need be. Vitamin A As is the case with its chemical relative Accutane (a prescription acne drug), high doses of vitamin A during pregnancy can cause heart and facial defects, says Resnik. How much is too much? Some studies have indicated that problems can occur when pregnant women take more than 10,000 international units (IU) a day, while others list 25,000 IUs and even 50,000 IUs as the threshold. You get a fair amount of vitamin A from the food you eat, and though the dose in your prenatal vitamin should be fine, your doctor can tell you whether it's an excessive amount. Leah Hennen is a writer and editor in San Francisco and the mother of two, ages four and one. Copyright © 1999-2004 ClubMom, Inc. All rights reserved.

Am I blooding to death?!

The night before last, my son came running in the front door with his little sister trailing behind him.  They had just gone out to play and I was on my way out, when I heard little girl screams.

"We have a problem here!" he announces, at least three times.

From the ear-splitting decibel of her shrieking, I immediately think she's broken a body part- (we've already had a broken bone this summer from another child) and that we're off to the doctor for x-rays and a cast.  She comes in the door, holding her elbow, screeching. 

"I need you.  I need you.  Hold me." she cries.

At this point, I'm looking for injury, and she's holding her elbow and doesn't want me to look.

"Don't touch it, I need you.  Hold me." she's now whimpering.

I see blood on her shirt, and on her brothers' shirt.

"Blub!  I'm blooding to death!" she screams.

I find the injury.  It's road burn.  She got on her pink Barbie scooter sans shoes and fell in the driveway.

"I need stitches, I'm blooding to death!" she exclaims.

She didn't want a big Band-Aid, she only wanted "little ones that won't sting!"  I talked her into one really big bandage, let her use a anti-bacterial wipe on it herself and got her to take a sink bath to wash the driveway dirt out of the scrape.  Of course she didn't blood to death, it was a big scrape on the surface, and didn't do very much damage.  She's healed a bit, and has gone camping with the extended family (with the health insurance cards, just in case) and is happy to tell us "We're camping, and you didn't get to go."  Well, fine. 

We're going camping with the kids next week- and I just noticed that the campground has wi-fi.  That's roughing it.  I'll bring lots of Band-Aids.

Phlebitis.

The other night, I woke up to a stabbing pain in my thigh near my knee.  I couldn't straighten my leg out, as it was only comfortable to bend it at a full angle like I was making the number 4 with my other leg.  I stood at the corner of the bed like a number four for quite a while, bending, stretching, and trying to work the pain out.  I figured maybe it was muscular, since it wouldn't go away.  When it wouldn't, I thought maybe going up the stairs would help, so I hobbled up the stairs a few times, which is difficult when you're standing like a number 4.  After several minutes like this I decided that maybe I was officially now getting a blood clot in my leg and was going to die in my sleep if I ignored it.  I contemplated waking up the husband to let him know, but, then, the pain slightly subsided, and I went back to bed.  Magic.  Since then, it's been a dull ache.  Yesterday, I had a stabbing pain at the other end of the vein in question, near my ankle.  I figured I'd just ignore it until it became unbearable, like most other aches and pains. 

Today, since it's still aching, I went to the doctor, who sent me in for an ultrasound to rule out a clot or a deep vein thrombosis.  Turns out I don't have one, and the circulation in my legs looks okay.  The veins causing problems are mostly all superficial and just plain ugly.  The deep veins are mostly likely fine. 

They'll hurt, and I might have phlebitis, which is a nice old lady disease.

Phlebitis Causes

Superficial phlebitis can be a complication due to a medical or surgical procedure. Injury to a vein increases the risk of forming a blood clot. Sometimes clots occur without an injury. Some risk factors for phlebitis include the following:

• Prolonged inactivity - Staying in bed or sitting for many hours, as in a car or on an airplane, creating stagnant or slow flow of blood from the legs in a dependent position (This pooling of blood in the legs leads to thrombus formation.)


• Sedentary lifestyle - Not getting any exercise
• Obesity
• Smoking cigarettes
• Certain medical conditions, such as cancer or blood disorders, that increase the clotting potential of the blood


• Injury to your arms or legs
• Hormone replacement therapy or birth control pills
• Pregnancy


• Varicose veins

Low glycemic index best?

Source Reuters via Yahoo:

A diet rich in carbohydrates with a low glycemic index appears to be more effective in reducing fat mass and lowering the chances of developing cardiovascular disease (CVD) than diets with a high glycemic index or high in protein, an Australian research team reports.

The glycemic index of a food indicates how quickly it is broken down and causes a rise in sugar levels in the blood. Generally, low glycemic index foods are complex carbs like whole grains, rather than refined sugars, for example.

According to a paper in the Archives of Internal Medicine by Dr. Jennie Brand-Miller at the University of Sydney and colleagues, there have been no clinical trials comparing the effects of glycemic index and high-protein diets on weight loss and cardiovascular risk.

They therefore conducted a trial in which 129 overweight subjects ages 18 to 40 were randomly assigned to one of four weight-loss diets for 12-week. All four diets were comprised of reduced fat (30 percent of total energy intake) and held daily calories to to1400 kcal for women and 1900 kcal for men.

The diets varied in target levels of carbohydrates, proteins, and glycemic load (i.e., glycemic index multiplied by the amount of carbohydrate, divided by 100) as follows:

Diet 1: carbohydrates comprise 55 percent of total energy intake, protein 15 percent of total energy intake, high glycemic load (127 g)

Diet 2: similar to diet 1 except a lower glycemic load (75 g)

Diet 3: protein comprises 25 percent total energy intake (based on lean red meat), carbohydrate reduced to 45 percent total energy of intake, and high glycemic load (87 g)

Diet 4: Similar to diet 3, except low glycemic load (54 g).

Brand-Miller and her team report that the diets resulted in similar reductions in weight (4.2 percent to 6.2 percent of body weight), fat mass and waist circumference.

However, in the high-carbohydrate diets, lowering the glycemic load doubled the fat loss.

The investigators also found that total and LDL ("bad") cholesterol levels increased with diet 3 and decreased in diet 2.

"In the short term, our findings suggest that dietary glycemic load, and not just overall energy intake, influences weight loss," the team concludes.

In a related editorial, Dr. Simin Liu, from the University of California in Los Angeles, points out that "foods with a low degree of starch gelatinization, such as pasta, and those containing a high level of viscous soluble fiber, such as whole grain barley, oats, and rye, have slower rates of digestion and lower glycemic index values."

Therefore, the commentator continues, "Without any drastic change in regular dietary habits, one can simply replace high glycemic index grains with low glycemic index grains and starchy vegetables with less starchy ones and cut down on soft drinks that are often poor in nutrients yet high in glycemic load."

SOURCE: Archives of Internal Medicine, July 24, 2006.

Labeled

Within the context of body image issues and the societal pressure to be thin, this displays the acceptance of measurements and dress sizes as identity.

Too Fat For Medical Tests?

If you've been there - you are all too aware of the problem.  You've got a medical issue - you don't know what's going on - you go in for tests.  Then, the doctor says you need an MRI or an X-ray, and you're not able to get conclusive results because you're too fat.

When I was pregnant previously, I could never get a good ultrasound scan without the ultrasound technician pushing very hard on my quite ample belly.  These days it's easier, even though I still have quite a bit of flesh - at least we're not dealing with 300+ lbs.

Source Yahoo News:

In yet another example of how obesity is playing havoc with Americans' health, a new study finds that the number of inconclusive diagnostic imaging exams has doubled in the last 15 years -- a phenomenon experts attribute to all those extra pounds.

"Obesity is affecting the ability to image these people. We're having trouble finding out what's wrong," explained Dr. Raul N. Uppot, lead author of the study, and an assistant radiologist at Massachusetts General Hospital and an instructor in radiology at Harvard Medical School, both in Boston.

"When they come to the hospital, people are so concerned about the disease they have that they don't realize that being obese could hinder the ability to deliver health care," he said.

In fact, it could hinder it considerably, given medicine's ever-growing reliance on imaging technology such as X-rays and ultrasound. "In the past 10 years or so, medicine has become so dependent on imaging," Uppot said. "Instead of doing very meticulous clinical examinations, a lot of doctors now rely on CT scans, ultrasounds, etcetera, to tell them what's happening inside the body. What happens when you're too big to fit on a table? Or you can fit on a table but the image is poor quality?"

The new study is published in the August issue of the journal Radiology.

The findings did not come as a surprise to outside experts. "The study shows more systemically what all of us felt was true anyway," said Dr. Levon Nazarian, professor of radiology and vice chairman for education at Thomas Jefferson University Hospital, in Philadelphia.

"Patients may not realize that there are two aspects to being overweight, one of which is the increased risk of a number of different diseases," Nazarian added. "They may not realize that once they actually get sick, their size is going to limit the ability to even tell them what's wrong."

According to official estimates, about two-thirds of adult Americans are overweight or obese, and the effect on individual health and the health-care system is considerable. Obese people are more likely to develop illnesses such as cancer, diabetes and heart disease. Hospitals have also had to "super-size" their wheelchairs and beds to accommodate the new generation of sick and overweight Americans.

To assess the effect of obesity on the quality of imaging exams, the researchers reviewed all radiology records from tests performed at Massachusetts General Hospital between 1989 and 2003. Specifically, they were looking at incomplete exams due to patient size.

"We looked at people who were able to fit on the imaging equipment and get the scan," Uppot said. "When radiologists read the film, they had trouble interpreting the film because the quality of the image was not very good because of [the patient's] size."

In 1989, 0.10 percent of inconclusive exams were due to patient size. By 2003, that number had almost doubled to 0.19 percent.

"What was most alarming was the increase," Uppot said. "The number itself was small."

Difficulties varied according to the type of imaging. By 2003, abdominal ultrasounds exhibited the most difficulty in giving a proper diagnosis (1.9 percent), followed by chest X-rays (0.18 percent), abdominal computed tomography (CT), abdominal X-rays, chest CT and magnetic resonance imaging (MRI).

Ultrasound sends high-frequency sound waves through the patient, where they bounce off internal organs and come back, like a submarine's sonar. But the thicker the fat, the less able the waves are to penetrate. A similar phenomenon is at work with X-rays, the study authors said.

CT scans and MRI have a different problem -- weight limitations of the table that holds the patient and the size of the opening on the imager.

"Many manufacturers have started to address the issue by increasing table weights," Uppot said.

The weight limit for CT scans has been increased from 450 pounds to 550 pounds. For MRI, the weight limit went from 350 to 550 pounds, he said.

But that doesn't solve the bigger problem. "We are now able to fit people on the machine. Then the issue is, what do you do?" Uppot said.

The imaging power can be increased on standard X-ray and CT machines, but this leads to an increase in radiation dose as well, he said.

"What we're realizing is that not only do obese people have increased health problems but our ability to deliver quality diagnostic imaging to them is limited," Uppot said. "A large patient can no longer walk into a hospital and say, 'I want the best quality care, let me get imaged and operated on.' If you're that big, there will be issues."

The problems don't stop with diagnosis. "It puts stress on personnel," said Dr. Jorge Guerra, professor of radiology at the University of Miami Miller School of Medicine. "X-ray personnel will be more prone to injury. We receive patients who are 400, 500, 600 pounds. It paralyzes our ability to provide care for other patients. We need special equipment, special beds, the imaging is lower quality so it takes longer to complete." Size also affects interventional radiology, or procedures meant to treat a patient, which is Guerra's specialty.

And as the University of Miami builds a new hospital, it is having to take into account that more than one-third of the patient population will be more than 350 pounds, he said.

::sigh::

Type II Diabetes in Kids is Bad News.

Children who get obesity-related diabetes face a much higher risk of kidney failure and death by middle age than people who develop diabetes as adults, a study suggests.

Source:  Yahoo News:

The study appears in Wednesday's Journal of the American Medical association. researchers have been tracking since 1965. Of the 1,865 participants with Type 2 diabetes, 96 developed it in childhood. The average age of youth-onset diabetes was about 17 years, although the disease was diagnosed in children as young as 3 1/2.

National Institutes of Health

During at least 15 years of follow-up, 15, or 16 percent, of those with childhood-onset type 2 diabetes developed end-stage kidney failure or died from diabetic kidney disease by age 55. That compared with 133, or 8 percent, of those who developed diabetes after age 20.

The researchers calculated that the incidence of end-stage kidney failure and death by age 55 was nearly five times higher in people who developed type 2 diabetes before age 20 than in those who developed diabetes in adulthood.

Most of the 20 million Americans with diabetes are adults with type 2. While a generation ago, type 2 diabetes was almost unheard of in children, the incidence has increased substantially in the past decade, largely because of obesity and lack of exercise.

Alcoholism After Gastric Bypass - A Real Problem.

After weight loss surgery, many post-ops find themselves trading the addiction that they once had to food for something even more dangerous:  alcohol.  I haven't witnessed it firsthand (hopefully never will...) but I keep reading about others who have gone down the path of either alcohol, drugs or gambling, because they can't fill the void that food filled in the good old days.  It would be beneficial for pre-ops to understand this, and have some sort of plan in place for their addictive personalities.  You need SOMETHING to do.  After the initial flood of weight loss excitement wears off - what do you do?  Start tipping the bottle?  Go to the casino?  What can YOU do?  Alcoholism after weight loss surgery is a very real problem and a very dangerous one.

Source:  ABC News

"After a five-year boom in gastric bypass surgery, many people who lost hundreds of pounds find they've now gained something else — an alcohol or drug problem.

Have they traded one addiction for another?

Patty Worrells and Jeannine Narowitz both had gastric bypass surgery, then found themselves battling alcoholism.

It's a common problem for people in substance-abuse treatment. Psychologists call the phenomenon of swapping one compulsive behavior for another "addiction transfer."

New Social Life, New Problems

Worrells, 5 feet, 4 inches, weighed 265 pounds. Narowitz, a mother of seven, weighed 274 pounds. Both women suffered from health problems because of their weight.

Worrells said she used food as "comfort," while Narowitz believed she had a food addiction. Before her surgery, Narowitz said she would often consume up to 4,000 calories a day out of boredom and depression.

"I woke up thinking about food. I went to bed thinking about food," Narowitz said. "I used it to solve many problems."

After undergoing gastric bypass surgery, both women lost about 130 pounds. They met and became friends in a support group for people who had lost a great deal of weight.

Worrells said the group met weekly and often got together socially for parties, camping and other events.

"We started doing things together," she said. "We were no longer someone who had to hide."

Because gastric bypass surgery shrinks the size of the stomach, alcohol hits drinkers much faster. Worrells said that at one point she was drinking 12 or more tequila shots at a sitting.

"I was able to accomplish in 10 months with alcohol what some people took 10 years to accomplish in a drinking career," she said.

Both women said they knew they had developed a new problem. Narowitz said she once woke up with a black eye and wasn't sure how she got it. Her teenage son was mortified, she said, and poured out all the liquor in the house, replacing it with water.

Addressing Emotional Problems

About 140,000 people have weight-loss surgery each year, and it is estimated that somewhere between 5 and 30 percent of them pick up new addictive behaviors afterward.

Dr. Keith Ablow, a psychiatrist and addiction specialist, said it's common for people to switch from one addiction to another. People who quit drinking may begin smoking, or they might take up some other compulsive behavior like gambling, shopping or exercise.

Ablow said there is usually an emotional problem at the root of addictive behaviors that needs to be addressed.

"Until people address the underlying emotional turmoil that makes them have to seek comfort from food or have to have 15, 20 shots in a sitting, they are not going to be able to overcome it," Ablow said. "You have to face your pain, not anesthetize it with shopping, food, gambling."

Gastric bypass surgery does not lead to alcohol abuse, but Ablow said that people who undergo the surgery need to be aware of and deal with emotional issues behind their weight gain.

Worrells and Narowitz said they continue to confront those emotional issues. Worrells has been sober for two years; Narowitz said she drinks occasionally but only has one or two drinks.

"If you're going to take a step to deal with addictive behaviors," Ablow said, "you need to get to the why of why you're doing it."

From Beyond Change:

Recommendations on the Use of Alcohol After Surgery

A 32-year old male 5 months out from gastric bypass surgery was issued a DUI after attending his brother’s wedding reception. According to the patient, he had only consumed 2 glasses of champagne, although his blood alcohol levels were above the legal limits to operate a motor vehicle.

A female patient, 50 years of age and one-year post-gastric bypass hit and killed a pedestrian with her automobile after having less than 2 glasses of wine. When police arrived she had difficulty with her coordination, slurred her words and seemed somewhat confused, although her alcohol test suggested that her blood alcohol levels were shy of the legal limit.

Were these patients telling the truth about the amount of alcohol they had consumed or did their surgery affect the way the body absorbs or metabolizes alcohol?

A recent study reported in the British Journal of Clinical Pharmacology (1) found that the gastric bypass procedure significantly affects alcohol absorption and its inebriating influence. According to the study protocol, a group of gastric bypass patients, three years post-surgery, and their non-surgical controls consumed an alcoholic drink after an overnight fast, and blood alcohol levels were examined over a period of time. The data showed that blood alcohol levels of the gastric bypass patients were higher and required much less time to peak than those of the non-surgical controls.

The more rapid absorption of alcohol and heightened blood alcohol levels would cause the bariatric patient to have a more pronounced feeling of inebriation during and shortly after drinking. And, such effects could have serious ramifications with regard to driving an automobile or performing other skilled tasks such as operating heavy machinery, piloting a plane or any other task that may influence the safety of the individual or that of others.
Why would alcohol absorption be higher for someone who has had a gastric bypass (or other surgical procedure that reduces the size of the stomach, i.e. biliopancreatic diversion with or without the duodenal switch, gastrectomy)? With the gastric bypass procedure, more than 95% of the stomach is bypassed. Alcohol passes directly from the stomach pouch, usually without restriction, into the intestines where, due to the large surface area of the intestines, alcohol is rapidly absorbed.

In addition to anatomical changes that influence alcohol absorption, the bariatric surgical patient may be more sensitive to the effects of alcohol because of low calorie intake. Several studies found that alcohol absorption is more rapid and blood levels higher if alcohol is consumed on an empty stomach than if provided with a meal or drank soon thereafter (2-3). During the first several months following bariatric surgery, total daily calorie intake is quite low. Drinking alcohol, even small amounts, at this time, would increase significantly an individual’s risk for intoxication.

Metabolic changes that occur with rapid weight loss, as well as the morbidly obese condition, can also alter the rate that the liver is capable of clearing alcohol from the body by the liver’s primary pathway for alcohol metabolism. Reduced clearance of alcohol by this pathway may further increase blood alcohol levels and the risk for intoxication and alcohol toxicity (4-6). Metabolic changes that occur with massive and rapid weight loss may also increase the clearance of alcohol by a secondary pathway of alcohol metabolism that substantially increases the risk for liver damage while, at the same time, makes an individual more sensitive to the toxic and cancer-promoting effects of pollutants in the air, industrial solvents (such as those in household cleaners), and certain drugs (4-6).

Alcohol use can also cause brain damage, a loss of consciousness or even death by reducing the supply of sugar (glucose) to the brain. Muscle, heart, liver and other tissues use fat and sugar (glucose) for fuel. The brain, however, needs sugar to function. To avoid a depletion of sugar, the body stores sugar in the form of glycogen. Glycogen stores, however, can be depleted in a short period of time with prolonged work or exercise, fasting or a diet low in carbohydrate. Furthermore, alcohol reduces the process that allows sugar to be stored as glycogen (7).

The bariatric patient, particularly in the rapid weight loss period and if on a low carbohydrate diet, may have low amounts of stored sugar (glycogen). Drinking alcohol could deplete those stores and cause blood sugar levels to decline. The body, however, has another mechanism to maintain appropriate amounts of sugar in the body. This process is known as gluconeogenesis and is a chemical pathway that converts certain components of protein, lactic acid and other substances into sugar. However, alcohol reduces the production of sugar by this process (4-7) and can, thereby, cause hypoglycemia (low blood sugar).

Usually when blood sugar levels fall, there are certain hormones produced that restore blood sugar levels to normal. However, when someone drinks alcohol, the response of these hormones to low blood sugar is blunted. To make matters worse, hormone responses to low blood sugar are also blunted or depressed in postoperative bariatric patients (8). The bariatric patient, therefore, would have a much higher risk of becoming hypoglycemic (having low blood sugar) than someone who drinks that has not had the surgery, particularly if the patient drinks alcohol during the rapid weight loss period.

Since the brain and nervous system need sugar for fuel, low blood levels could adversely affect neuromuscular and cognitive functions, causing a loss of coordination and balance, slurred speech, poor vision, and confusion. These are all conditions that mimic those associated with intoxication. The patient described earlier, who appeared extremely intoxicated even though her blood alcohol levels were not high, may have been hypoglycemic. Low blood sugar, over a period of time, can result in a ‘black out’ or loss of consciousness, brain and nerve damage, and even death.

The use of alcohol after surgery could also cause irreversible brain and nerve damage, coma and possible death by inhibiting the absorption of important vitamins, including B-complex vitamins such as thiamin (B1) or vitamin B12. Alcohol inhibits the absorption of thiamin and other B-complex vitamins, reduces activation of certain vitamins, and stimulates the breakdown of vitamin A, pyridoxine, and folate (4-6). These vitamins may already be deficient in bariatric patients because of nutrient restriction, malabsorption or impartial digestion of foods produced by the prospective surgery. Alcohol use, then, would compound the negative effects that bariatric surgery has on vitamin/mineral status and increase the risk for associated health problems, including nerve and brain damage, defects in metabolism, a decrease in the ability of the body to heal, low immunity, fatigue and more.

Alcohol has numerous other toxic effects in the body. Not only does alcohol cause liver disease but also negatively affects other tissues. Alcohol’s influence on the heart inflammation (myocarditis), a loss of heart tissue (cardiomyopathy), and irregular heart beats (arrthymias) that can lead to sudden death. Skeletal muscle is particularly susceptible to alcohol with loss of skeletal muscle fibers and strength. Alcohol also causes inflammation of the intestinal tract, gastritis, pancreatic, acid reflux disease and increased risk for gastric and esophageal cancer. And, alcohol causes damage, often irreversible, to the brain and nervous system.

In addition to the numerous health problems that drinking alcohol after surgery may cause, the bariatric patient should also be cautious of alcohol addiction. The prevalence of food addiction and associated eating abnormalities, i.e. binge eating, carbohydrate cravings, are high among individuals with morbid obesity. With bariatric surgery, the addictive tendency for food and aberrant eating behavior are considerably improved. However, individuals with addictions often transfer their addiction to yet another substance, such as alcohol. According to the findings of Austrian psychologist, Dr. Elisabeth Ardelt, addiction transfer may occur in as many as 25% to 30% of bariatric patients.

Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. One 12-ounce can of beer, for instance, contains 150 calories; 3.5 ounces of wine contains 70 calories; 1.5 ounces of gin, rum, vodka or whiskey contains between 97 and 124 calories; and 1.5 ounces of liquer contains 160 calories.

Are there guidelines for using alcohol after surgery? Presently, there are no official guidelines that have been established pertaining to the use of alcohol after having bariatric surgery. However, based upon knowledge of changes in the absorption and metabolism of alcohol, coupled with the metabolic state of the bariatric patient at various stages postoperatively (4), the following suggestions are recommended

• Do NOT drink alcohol during the rapid weight loss period.
• When drinking, remember that small amounts of alcohol can cause intoxication or can result in low blood glucose with serious consequences.
• Do not drive or operate heavy equipment after drinking alcohol, even small amounts.
• Eat if you plan to have a drink.
• Make certain to take your bariatric vitamin and mineral supplements.

Cynthia Buffington, Ph.D.

Help!

What is alcoholism?

According to the National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/publications/booklet.htm:

Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:

• Craving--A strong need, or urge, to drink.
• Loss of control--Not being able to stop drinking once drinking has begun.
• Physical dependence--Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
• Tolerance--The need to drink greater amounts of alcohol to get "drunk."

What are the Signs of a Problem?

From Face The Issue:

How can you tell whether you may have a drinking problem?

Answering the following four questions can help you find out:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning (as an “eye opener”) to steady your nerves or get rid of a hangover?

One “yes” answer suggests a possible alcohol problem. If you answered “yes” to more than one question, it is highly likely that a problem exists. In either case, it is important that you see your doctor or other health care provider right away to discuss your answers to these questions. He or she can help you determine whether you have a drinking problem and, if so, recommend the best course of action.
Even if you answered “no” to all of the above questions, if you encounter drinking-related problems with your job, relationships, health, or the law, you should seek professional help. The effects of alcohol abuse can be extremely serious—even fatal—both to you and to others.

Where to go for help?

•The National Center on Addiction and Substance Abuse at Columbia University
http://www.casacolumbia.org
This site offers resources, links and empirical studies regarding the latest trends and issues surrounding substance abuse and alcoholism. The following link outlines you what you need to know about tobacco, alcohol and illegal drugs: Drug Facts You Should Know

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• National Institute on Alcohol Abuse and Alcoholism. This site offers news, publications, general information, databases, and other resources.http://www.niaaa.nih.gov/publications/booklet.htm

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• Alcoholics Anonymous
An international fellowship of men and women who have had a drinking problem; it is nonprofessional, self-supporting, nondenominational, multiracial, apolitical, self-help group open to anyone who wants to do something about their drinking problem. www.aa.org

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• National Council on Alcoholism and Drug Dependence, Inc. (NCADD)
This site advocates prevention, intervention, research and treatment of alcoholism and other drug addictions. Includes information, statistics, and resources.
www.ncadd.org

Breastfeeding After Gastric Bypass

I'm a big pro-nursing advocate, and lately I've been wondering if nursing after gastric bypass will be just as hard easy as it was last time.  I nursed my third child exclusively, from birth to age 3.

(Edited to add, the post bariatric surgery baby was born October 2006, I nursed her for five weeks and gave up.  I had serious trouble with getting a decent milk supply.)

Coincidentally the third child weaned abruptly with my stay in the hospital for the actual weight loss surgery, but she was by then only comfort nursing and we were more than ready to end it. Even though we had a rough beginning, and it took a long time for me to establish a good milk supply, it worked out in the end, and she was by far my most normal-weight baby.  I formula fed the first two children after very short failed attempts at nursing, and they were both overweight as infants also. 

I've been wondering, will I be able to establish a normal milk supply?  Will I be able to provide enough vitamins, namely B-12 with the supplementation I'm recieving through B-12 injections?  Will my state of anemia cause problems - or will it gradually improve once the baby is born, and not cause problems?  Will I be able to safely lose the baby weight I've gained while nursing and ingest enough calories to maintain my milk supply?

These are things that any pregnant post weight-loss surgery patient needs to be aware of.  There are potential problems, but it seems most if any can be avoided or treated with monitoring up front.

A question from- http://depts.washington.edu/nutrpeds/faq/pregnancy/bypass.htm

"A lactation consultant referred a 3 week old infant not back to discharge weight. Mom had a gastric by-pass 3 years ago. The pediatrician wants to supplement with formula about 4 times per day and is also supportive of herbal supplements (e.g., fenugreek, mother's milk tea, brewer's yeast) for Mom or prescribing Reglan. With lactation consultant support they got a good pump, also a starter SNS, and 2 different feeding cups, and nipple shield. Still weight gain was marginal. Could the mother's gastric by-pass be a contributing factor in this problem?" This situation of a breastfeeding woman who has had a gastric bypass is probably rare.

The answer from: http://depts.washington.edu/nutrpeds/faq/pregnancy/bypass.htm

However, there have been a few cases of significant nutrition problems in infants with mothers who had gastric bypass. Two case studies were of infants who were diagnosed with vitamin B12 deficiency and megaloblastic anemia (1,2). This was secondary to decreased vitamin B12 in the breast milk; the mothers had subclinical vit B12 deficiencies. In another case, the 4 month old infant was diagnosed with failure to thrive (3). Creamatocrit analysis of the breast milk indicated only 39% of the normal fat content of breast milk, and thus the energy level of the milk was reduced. In the case described here, there may be infant factors contributing to the lactation problems, but they seem to be addressed appropriately by the lactation consultant. There may also be stress or emotional feelings in the mother that is contributing. In any case, frequent monitoring, including signs of vitamin B12 deficiency in the mother and infant, is indicated. A creamatocrit may also be useful at some point.

According to Kellymom.com:

Who needs vitamin B12 supplements?

By Kelly Bonyata, IBCLC

Infants of well-nourished mothers with adequate vitamin B12 intake do not need vitamin B12 supplements.

It is recommended that mothers who do not eat animal proteins or who are otherwise at risk for vitamin B12 deficiency get adequate amounts of vitamin B12 during pregnancy and lactation via supplements or fortified foods.

Since vitamin B12 (cobalamin) is widely present in foods from animal sources, dietary deficiency is rare except in those eating a strict vegan diet (no fish, meat, poultry, eggs or dairy products). Most infants, children and adults in the United States get the recommended amounts of vitamin B12. If a breastfeeding mother has an adequate B12 status, her baby will receive sufficient amounts of vitamin B12 via her milk. A simple blood test can diagnose current vitamin B12 deficiency.

In the US, the DRI for vitamin B12 for adults is 2.4 µg per day, 2.6 µg during pregnancy, 2.8 µg during lactation; the DRI is proportionally less for children. The DRI has a significant margin of safety built in. Unlike other B vitamins, small amounts of vitamin B12 are stored in the liver so daily consumption is not necessary.

Who is at risk for vitamin B12 deficiency?

• Anyone who is on a strict vegetarian or vegan diet (no fish, meat, poultry, eggs or dairy products) and is not getting adequate amounts of vitamin B12 through supplements or fortified foods.
• Anyone who has had gastric bypass surgery, has pernicious anemia or has certain gastrointestinal disorders and is not getting adequate amounts of vitamin B12 through supplements or fortified foods. Some medications may also decrease absorption of vitamin B12.
• An infant born to a mother who has been a strict vegetarian or vegan for at least 3 years and who is vitamin B12 deficient herself.
• An infant born to a mother who is vitamin B12 deficient due to any other dietary or medical reason.
• An exclusively breastfed baby of a woman who is vitamin B12 deficient.

According to Nutrition During Lactation (Hamosh 1991, p. 157-58), a full-term infant of a well-nourished mother will be born with a store of vitamin B12 sufficient to meet his needs for about 8 months. If the mother is not vitamin B12 deficient herself, then her milk is an excellent source of vitamin B12 and is more than sufficient for baby’s needs through the first year.

There is evidence that babies born to vitamin B12 deficient mothers have low stores of vitamin B12 at birth. Studies have shown that mothers who are vitamin B12 deficient have low levels of vitamin B12 in their milk.

Breastfed infants may develop clinical signs of vitamin B12 deficiency before their mothers do. Vitamin B12 deficiency may develop in the breastfed infant by 2 – 6 months of age, but may not be clinically apparent until 6 – 12 months. Signs and symptoms of vitamin B12 deficiency in infants include vomiting, lethargy, anemia, failure to thrive, hypotonia (low muscle tone), and developmental delay/regression.

There have been anecdotal reports of low milk supply in vitamin B12 deficient mothers, which improved when the B12 deficiency was corrected. Mothers with pernicious anemia are also at higher risk for thyroid problems, which can affect milk supply.

For mothers who are vitamin B12 deficient, increasing vitamin B12 intake increases the amount of the vitamin in her milk."

What are the caloric demands for a nursing mom?  Some moms worry that they won't be able to physically eat enough calories to maintain a solid milk supply after gastric bypass.

From:  http://newton.nap.edu/books/0309043913/html/213.html

Nutrient needs during lactation depend primarily on the volume and composition of milk produced and on the mother's initial nutrient needs and nutritional status. Among women exclusively breastfeeding their infants, the energy demands of lactation exceed prepregnancy demands by approximately 640 kcal/day during the first 6 months post partum compared with 300 kcal/day during the last two trimesters of pregnancy (NRC, 1989). In contrast, the demand for some nutrients, such as iron, is considerably less during lactation than during pregnancy.

I'm trying to find good information regarding breastfeeding after weight loss surgery.  There doesn't seem to be much, if any, out there.  Today, I found this article, for dieticians:

Breast-feeding After Bariatric Surgery
By Julie Stefanski, RD, LDN, CDE
Today’s Dietitian
Vol. 8 No. 1 P. 47

Lactating mothers and their infants have special nutrition needs. Can women with limited food intake after bariatric surgery meet those needs?

An outpatient dietitian at Bellevue Woman’s Hospital in Niskayuna, N.Y., Karann Durr, RD, CDN, searched the Internet, consulted personal resources, and contacted other RDs for advice and information. She was left with nothing substantial. In the end, she and her hospital’s lactation consultant were forced to make professional guesses on the issue—lactation after gastric bypass surgery.

Durr explained, “I had to take the evidenced-based practice guidelines for lactation and the nutrient recommendations for gastric bypass and put the two together. Basically, because this is new, people are reluctant to venture there.”

The human body can adapt to the changing demands of lactation by increasing nutrient intake, improving absorption, decreasing excretion, or using tissue stores. For the patient who has undergone bariatric surgery, it is questionable whether the body’s natural adaptations for lactation can overcome the physiological changes the surgery has created.

According to Jeanne Blankenship, MS, RD, an expert in bariatric surgery and reproductive health from the University of California, Davis Medical Center, “We need to promote breast-feeding to this population—more than 80% of the women who have surgery are of child-bearing age. The numbers are going to keep going up.”

Blankenship further elaborates that “we do know that obese women are less likely to initiate breast-feeding and, if they do, they are less likely to make it to the major marks—three and then six months—let alone one year. What we don’t know is if a woman who was previously obese behaves like an obese woman or like a normal-weight woman in terms of lactation. There are definitely success stories, but I think a lot of these women fall through the cracks.”

Gail Hertz, MD, IBCLC, pediatrician and certified lactation consultant, points out that not all healthcare practitioners may be familiar with the long-term effects of bariatric surgery. “The average pediatrician probably isn’t aware of the impact of gastric bypass on nutrition because typically our patients aren’t undergoing the procedure themselves. In our practice, we do ask breast-feeding mothers about any breast reconstruction or reduction, but if the mother doesn’t volunteer information about her past surgeries, we may not know.”

Surgical Ramifications
Weight-reduction surgeries are classified as restrictive, malabsorptive, or a combination of the two. Operations such as vertical banded gastroplasty (VBG) and gastric banding aim to limit the amount of food that can be ingested and reduce the emptying rate of the stomach.

The Roux-en-Y gastric bypass (RYGB), bilio-pancreatic diversion (BPD), and the now uncommon jejuno-ilial bypass combine restriction and malabsorption. The RYGB utilizes a 30- to 50-milliliter pouch, formed by surgically separating the stomach. A gastrojejunostomy is created by anastomosing the stomach to the distal end of the jejunum. The BPD utilizes a subtotal gastrectomy to create a larger pouch than the VBG or RYGB. As a more complicated surgery, the small intestine is divided to create a gastroileostomy, bypassing the lower stomach, duodenum, and jejunum and leaving only the distal ileum for nutrient absorption.

Due to the surgical alteration of the gastrointestinal tract using the RYGB and BPD approaches, patients require perpetual supplementation to meet minimal nutrient needs. If eating habits are too restrictive after VBG or laparoscopic banding, deficiencies may occur.

Habits Under Investigation
Conduct a survey of bariatric practitioners and you will find varied vitamin and mineral prescriptions. In terms of pregnancy and lactation, the general nutrient recommendations may not meet increased requirements. Additionally, compliance with recommended supplements can be poor.

Total weight loss averages 25% to 35% of initial body weight at 18 months after surgery. Pregnancy is not recommended within the first 18 to 24 months after surgery due to the active weight loss occurring. After 24 months, weight loss has stabilized or regain may begin to occur. Several articles have been published that address the needs of pregnancy after gastric bypass.

Calorie consumption has been shown to be approximately 1,100 calories per day at one year post-op and 1,300 calories per day at 18 months. Post-gastric bypass patients’ diets have also been shown to be low in nutrients vital to pregnancy and lactation, such as iron, calcium, and folate. Actual vitamin deficiencies, other than vitamin B12 and folate, have yet to be quantified. Due to the absence of standardized follow-up of patients after surgery, there is inadequate information regarding the effects of bariatric surgery on many aspects of health.3 Women who have achieved healthy pregnancies face challenges when it comes to breast-feeding. Limited data exists to help practitioners guide mothers in the right direction.

Will the Maternal Diet Affect Milk Production?
Human milk is a symphony of nutrients that varies between mothers and changes with lactation duration or even time of day.16 In studies of lactation during famine conditions, malnourished mothers were able to produce sufficient breast milk and support normal growth in their infants.17,18 In several instances, maternal nutrition stores suffered as breast milk quantity and quality remained adequate.

“It is definitely true that there is no reason that they can’t breast-feed if their diet is adequate. Compliance with vitamins and minerals is important. It really depends on the type of surgery, how long it has been since surgery combined with their breast-feeding history, age, and, of course, all the factors that affect breast-feeding in the general population,” explains Blankenship. When combining breast-feeding with a history of bariatric surgery, there are several key nutrients practitioners must focus on to achieve success in the breast-feeding relationship.

Calories
For lactation, the dietary reference intake is 500 calories higher than guidelines intended for women who are not breast-feeding. This recommendation of 2,700 calories per day is based on energy needed for milk production, energy mobilized from fat stores, and estimated metabolic rate. It is assumed that 66% of calorie needs will be provided by oral intake and 34% will come from fat stores gained during pregnancy.

In one study, participants consumed approximately 1,500 calories per day for the first six months of lactation. Although these women had not undergone weight-loss surgery, their low calorie intake did not affect breast milk production and prolactin levels remained within normal limits.

Vitamin B12
Several important steps in vitamin B12 absorption are affected by RYGB. Deficiencies have been discovered in 30% to 70% of patients one to nine years after RYGB. Hemoglobin or mean corpuscular volume levels may not reveal this deficiency. Secretion of hydrochloric acid may be nearly absent in the surgically created pouch. With decreased acid and pepsin exposure, vitamin B12 can not be cleaved from foods such as meat, milk, and eggs. B12’s attachment to glycoproteins and subsequent coupling with intrinsic factor is also hindered by the pathophysiology of the RYGB.

Mothers who are B12 deficient during pregnancy may give birth to infants with subnormal B12 stores. Further depletion may occur as the infant is undersupplied via human milk from a B12 deficient mother.

In a case study presented in 1994, a 10-month-old, exclusively breast-fed infant was found to have a vitamin B12 deficiency. Two years prior, the mother had undergone bariatric surgery. Although the mother was asymptomatic, she was also deficient in vitamin B12.

In a similar scenario, a 12-month-old, exclusively breast-fed infant of a semivegetarian mother, presented with developmental delay, macrocytic anemia, low folate and B12 levels, a positive urinary methylmalonic acid peak, and a high homocystine level. The infant’s B12 deficiency was corrected parenterally. Two months later, the mother revealed she had undergone bariatric surgery six years earlier. Although the mother consumed vitamin B12 and iron supplements, the vitamin B12 level of her milk was found to contain only 42 picomoles per liter compared with a normal level of 184 to 812 picomoles per liter.

Folate
Absorbed primarily by the proximal one third of the small intestine, folate absorption must now occur in a smaller surface area under modified conditions. Folate deficiency has been documented in up to 40% of patients after RYGB and is of great concern in regard to the onset of neural tube defects. Both serum folate levels and red blood cell counts should be evaluated to detect deficiencies and patients supplemented appropriately.

Calcium
Due to the circumvention of the duodenum in RYGB, the primary absorption site for calcium is omitted. Passive diffusion of calcium must occur along the remaining small intestine. Serum levels may remain stable, as calcium is leeched from maternal stores.6 Reductions in maternal bone content occur during the first three to six months of lactation, but this loss is replaced in later lactation and after weaning. Breast milk calcium secretion does not appear to depend on the current calcium intake of the mother, nor does the intake of phosphorus, magnesium, or sodium. Maternal intake during pregnancy may predetermine the calcium content of breast milk after delivery.

Vitamin D
The ideal amount of calcium and vitamin D gastric bypass patients need to maintain stable parathyroid hormone and 25-hydroxyvitamin D has yet to be determined. Typical amounts of 800 to 1,000 international units (IUs) are provided upon initiation. Infants may be influenced more by the vitamin D status of the mother during pregnancy and by the amount of sun exposure received rather than by vitamin D levels in breast milk. Human milk naturally contains low levels of vitamin D. Additionally, there is little evidence to suggest that lactation increases vitamin D needs in the mother.

Guidelines have previously encouraged two hours per week of direct sun exposure or 30 minutes per week wearing only a diaper to stimulate adequate vitamin D production in the exclusively breast-fed infant.41 The American Academy of Pediatrics now recommends that infants less than 6 months old be kept out of direct sunlight to limit UVA light exposure and suggests that “all breast-fed infants receive at least 200 IU of vitamin D per day beginning in the first two months after delivery.”

Iron
Decreased intake of sufficient sources of heme iron, a reduction in the acidic environment required to release heme iron, and changes in absorptive surface area impact iron stores. Iron deficiency may occur in up to 50% of patients after RYGB, especially in women who are still menstruating. Amenorrhea from sustained lactation can actually benefit women as decreased blood loss via the menstrual cycle can boost depleted iron stores.

Although breast milk is a poor iron source, iron from human milk is better absorbed than formula. Lactoferrin, a whey protein connected with infant immune response, has been found in greater concentration in breast milk from iron-deficient women. It has been hypothesized that this increase may help protect the infant from iron deficiency.

Some evidence suggests that standard multivitamins will not prevent a deficiency after bariatric surgery. Women who have undergone restrictive procedures may not require additional iron beyond the standard recommendations.

Fat-Soluble Vitamins
Vitamin A deficiencies have only been reported to occur after biliopancreatic diversion in the nonpregnant population.15 Vitamin A levels should be tested early in pregnancy and patients should be counseled to consume adequate amounts of vitamin A via food. Women who oversupplement may be at risk of consuming intakes of preformed vitamin A in amounts greater than 5,000 IUs, which may cause birth defects. Fat-soluble vitamin content of breast milk has been found to be minimally impacted by recent intake of the mother.

Water-Soluble Vitamins
Maintenance of adequate water-soluble vitamin levels in the body, especially thiamine, requires a continuous supply in the diet. Even patients who have undergone restrictive procedures can develop a deficiency if oral intake is inadequate.

Vitamin C, niacin, thiamine, riboflavin, and vitamin B6 levels in human milk are greatly influenced by the mother’s diet. In studies of maternal supplementation of water-soluble vitamins, vitamin levels increased in human milk and then leveled off. High doses of vitamin B6 should be avoided as production of prolactin may be inhibited.

Protein
No consensus has been reached on the extent to which protein energy malnutrition may develop after gastric bypass surgery. A protein intake of 65 grams per day is recommended for the first six months of breast-feeding. Patients’ diets and lab values should be evaluated, and patients should be encouraged to focus on high-quality protein sources to meet minimal guidelines.

According to Kelly O’Donnell, MS, RD, CNSD, nutrition support specialist with the University of Virginia Medical Center, “Our average patient, two to three years out, is consuming about 900 to 1,000 calories per day. Specific food choices are one of the most essential points to stress. Snacks become very significant. Choosing low fat, high protein choices, which are good calcium sources, are very important.”

Fat
Lipid comprises one half of breast milk calories and is highly variable. The total lipid content of human milk is not affected by daily intake in normal mothers, although it has been correlated with maternal fat stores.

Breast milk contains arachidonic acid (ARA) and docosahexaenoic acid (DHA), which have been associated with improved cognition, growth, and vision in children.55 Some experts recommend supplementation of ARA and DHA in the diets of both pregnant and lactating mothers, especially for those with limited diets.

A patient who failed to follow nutrition guidelines provided after her gastric bypass several years earlier suffered from anemia during her pregnancy and gave birth to an infant weighing little more than 5 pounds. Growth milestones were not reached and, upon assessing the mother’s breast milk at four months postpartum, an analysis of the fat content, or creamatocrit, revealed a low mean fat and calorie content. After the mother supplemented with formula, adequate growth was displayed in the infant at 6 months of age.

Should We Wait for Weight Loss?
Exaggerated concern with reinitiating rapid weight loss after birth may cause some women to forgo breast-feeding altogether. Blankenship points out that there may be significant psychological issues to consider. “Many pregnancies are unplanned and women just want to get back to the weight loss. Patients have misconceptions about weight loss during lactation and they want to be able to drastically cut calories.”

Regardless of the fact that many studies have reviewed the impact of lactation on weight maintenance, true consensus has not been reached. Greater weight loss has been shown in breast-feeding mothers vs. women who choose to use formula, while other studies have been inconclusive.

Gradual weight reduction, in amounts no greater than 1 pound per week, does not appear to negatively affect the quantity or quality of breast milk produced, though environmental pollutants stored in maternal fat tissue may be released into breast milk with extended weight loss.

Vitamin and Mineral Supplements
Women of childbearing age should be advised to consume a prenatal vitamin containing 1 milligram of folate, 350 to 500 micrograms of crystalline vitamin B12, plus calcium citrate in amounts of 1,200 to 1,500 milligrams and vitamin D. Patients who have had gastric bypass surgery should consume 40 to 65 milligrams iron in the ferrous form daily.8,37 Some guidelines suggest that, during pregnancy, the prenatal vitamin should be given in addition to, not instead of, a daily multivitamin.10 The consumption of two prenatal vitamins may not be advisable because some combinations may exceed vitamin A and iron guidelines.37

Maternal lab values, including CBC, albumin, folate, vitamin B12, calcium, phosphorus, and 25-dehydroxy-vitamin D, should be tested during pregnancy and after birth to detect deficiencies and supplemented accordingly. Infants should be evaluated for appropriate growth, adequacy of B12, calcium, and folate levels throughout the duration of breast-feeding.

Careful Monitoring Equals Success
Carla Woodard, MSN, WHNP, nurse practitioner with the University of Tennessee Medical Center, emphasizes the importance of educating both patients and practitioners. “The challenge for healthcare providers lies in educating women pre- and post-operatively regarding the ramifications of stopping vitamin supplements, which a good number do. Lifelong B vitamin and calcium supplementation is a must for these patients, especially those planning a pregnancy. Pediatricians and pediatric nurse practitioners, as well as women’s healthcare providers, should also be made aware of these dangers.” The increased risk of nutritional deficiencies induced by bariatric surgery, coupled with the demands of lactation, requires careful monitoring by knowledgeable professionals familiar with both bariatric surgical procedures and the nutritional needs of lactating mothers and their infants.

— Julie Stefanski, RD, LDN, CDE, is a clinical dietitian, adjunct professor, and freelance writer in York, Pa.

Stop Your Heart With The King

Burger King has a new line o'meaty sandwiches.  I'm sure you've seen the signage out at BK for these - The Stackers!  These are your options:

Photo from Flickr:

• Double Stacker - 2 beef patties, 2 slices of cheese, and 2 pieces of bacon for about $2.49.
• Triple Stacker - 3 patties, 3 pieces of cheese, and 4 pieces of bacon for $3.29
• Quad Stacker - 4 meat patties, 4 slices of cheese, and 8 slices of bacon for $3.99.

From Komo:

As you'll notice, there's not a shred of produce on any of these sandwiches. In its news release about the Stackers, Burger King says it hopes to satisfy "the serious meat lovers by leaving off the produce and letting them decide exactly how much meat and cheese they can handle. The BK Stacker is "really easy to eat on the go, because the cheese and sauce hold it all together," says spokeswoman Adrienne Hayes. "It's not slipping and sliding around with tomatoes and lettuce. You have to know you're eating a ton of calories and fat when you order a sandwich like this. But let me run down the numbers for the Quad Stacker, which has a half a pound of meat in between all that cheese and bacon. It has 1,000 calories, 68 grams of fat and 30 grams of saturated fat. That is more fat than most adults should have in an entire day. An average adult should have 65 grams of fat or less per day, and 20 grams of saturated fat or less.

Are you hungry yet?  Do you crave a taste of the King?

Enough With The Pickle.

School starts early this year - first day is actually in August, before Labor Day.  Before that we're going "away" twice - which we haven't done in a very long time.  I figure going anywhere next summer will be more difficult when we're a bit more outnumbered.  I have a feeling it will be more difficult, but at the same time easier, because two of the kids are at particularly difficult (stubborn?!) ages rightthisverymoment and will be much more mature in one year especially when the little one is magically turned into a "big sistah" in 97 or so days.  You know your summer is already wearing thin when the conversations at 8am go like this:

"Please stop doing that with your pickle."

"You're really bothering me with that pickle."

"Enough with the pickle."

"If you do that with the pickle one more time, it's going in the trash."

Now, later, it's:

Dad:  "Go close the door.  Close the door.  The air conditioning is on, please go Close The Door.  Close the door.  Close the door."

Difficult child #1: "I wasn't the last one in."

"Please just close the door."

"But I wasn't the last one in!"  ::pouting ensues::

"If you don't close the door you're not (insert next activity here), so just close the door."

"But I Wasn't The Last One In!"  ::tears begin::

What you've been looking for!

Number one way to find this silly little blog in the last few days?  Go to Google, and search for FAT ass.  Thanks.  That's really special.  So, if you're looking for FAT ass - let me find you some:

Here are some FAT ass quotes from South Park, if you dig that sort of thing.  FAT ass Pictures from Ebaums World.

Most other results bring up naughty things, so that's all I have for you.

I'm not posting my rear - so g'way now.  Back to the keyword list.

Fattening Factors?

Twenty researchers reviewed studies to identify possible causes for obesity other than overeating and lack of exercise. The evidence for these 10 is as compelling as research implicating eating and exercise, they say, and the combined effects may be significant.

1. Sleep deprivation.
2. Pollution. Man-made chemicals in foods, plastics and pesticides can disrupt the body's hormones, which control weight.
3. Air conditioning. Your body burns more calories if you're too hot or too cold.
4. Decreased smoking. (A new study suggests quitters gain about 20 pounds.)
5. Medicine. Certain contraceptives, steroid hormones, diabetes drugs, antidepressants and blood pressure drugs can cause weight gain.
6. Population age, ethnicity. Our population is getting older and more ethnically diverse; obesity rates are higher among middle-aged adults, African-American women and Hispanic Americans.
7. Older moms. Some studies suggest that the older a woman is when she gives birth, the higher her child's risk of obesity.
8. Ancestors' environment. Some influences may go back two generations.
9. Obesity linked to fertility. Some evidence suggests people with a genetic tendency toward being heavy have more children.
10. Unions of obese spouses. Obese women tend to marry obese men, leading to obese children.

Source: International Journal of Obesity online

Nutri Melt Pure Protein Sugar Free Bars

We got a shipment of protein bars today - they're called "Nutri Melt" and Bob found them at a website I've never seen before.  I haven't given them the dump test, I just tasted a teensy corner (and didn't like it) but - I'll give them another shot, since the ingredient list isn't too scary.  I know these bars will cause bowel uproar - with 20 grams of sugar alcohols, and that tasty white kidney bean extract.

My first reaction when I unwrapped the bar was, "It looks like poop."  It's not very pretty, though it may have melted a bit in transit since it came with no thermal packaging in very hot weather.  The coating was not shiny, very dull and pasty looking.  The bar itself tasted pasty, thick, and not sweet.  I've got it in the freezer now, hoping that frozen, it might be more palatable.  I'm sure it would be a filling meal - since it is so thick.

From the website:

Description

Loaded With 20 grams of hunger-satisfying protein--preferred 5 to 1 in taste tests.

Excite your taste buds and appease your cravings with these delicious low carb high protein food bars, while simultaneously letting fat stores ebb away and define that lean tight body that people drool over. Nutrimelt® pure protein bars delivers a smooth taste, fulfills your desires and bring your goals within your reach.

What's the difference between Nutrimelt® Pure Protein Bars and other leading brands?

Almost all low-carb, high-protein bars contain a decent balance of essential vitamins, minerals and proteins. If that was all that mattered, any bar would do. The difference comes in Nutrimelt's ability to release smooth, steady boosts to your metabolism to enable continuous fat loss over time.

How does it work? Nutrimelt pure protein bars are formulated with a low glycemic index to prevent blood sugar surges that results in immense cravings and low-carb content that reduces the tendency of our body to "hoard" instead of burn fat.

The overall strengthening that Nutrimelt pure protein bars provide allow your metabolism function at optimal levels. Your body can concentrate on burning fat and building muscles rather than fighting fluctuations in insulin and blood sugar levels.

The question we receive from thousands of satisfied clients is...How do you get such power-packed protein bars to taste so great?"

It's simple. The more natural the ingredients, the smoother the taste. Free from the chemical trappings of other leading brands, our all-natural bars blows the competition out of the water in taste, ease of digestion and weight loss.

Our made-from-scratch formula contains:

• NUTRITION FACTS:
  Serving Size: 1 bar 56.7g (2.00 OZ)
  Calories: 190
  Calories from fat: 36
  Total fat: 4g
  Saturated fat: 2g
  Cholesterol: 6mg
  Sodium: 141mg
  Potassium: 170mg
  Total Carbohydrates: 2.5g
  Sugars: 0g
  Protein: 21g>

• INGREDIENTS: soy protein isolate, whey protein, glycerine, sugar-free chocolate flavored coating (maltitol, cocoa butter, chocolate liquor, calcium carbonate, dairy oil, calcium caseinate, soy lecithin, vanilla), hydrolyzed protein, maltitol, water, graham cracker, polydextrose, marshmallow flavor, peanut flavor, stevia, and potassium sorbate.
• Since our ingredients are not processed or chemically treated, Nutrimelt bars do not have the harsh taste of other brands. No wonder it's preferred 5 to 1 in taste tests.

You're so vein.

Hello out there.  It's me.  I'm alive.  It's freaking hot outside, and we spent the day in the pool making like dead fish.  You know it's warm when no relief from the heat comes from getting in the water.  The water was like swimming in pee.  Warm, strangely comforting and nearly body temperature.  Swimming makes you feel lighter, though, even if you have excess skin from weight loss that floats up and makes you look alien.  No, that's currently not my problem, it's Bob's.  My skin is nearly taut again from the actual alien growing in my abdomen.  He's the one with the loose skin, since he's still nearly at his weight goal and skinny-ish.  My problem?  Besides being fat and cranky?  The freaking veins in my legs.  If I drop dead, it WILL BE THE RESULT of the gigantic varicosties in my legs that are refusing to send blood back to the region of my heart.  You have no clue how awful they've become.  Last summer, they were ugly and obvious, but didn't look so bad since I was overall a smaller person with no reason to swell.  This summer, they're so sexy, green and blue bulging veins snaking around my thigh and calf to my ankles, looking as if they'd burst open at any time and I'd bleed to death.

About these super sexy leg veins:

What are varicose veins?

Arteries bring oxygen-rich blood from your heart to the rest of your body. Veins return oxygen-poor blood back to your heart.

Varicose veins are swollen veins that you can see through your skin. They often look blue, bulging, and twisted. Left untreated, varicose veins may worsen over time. Large varicose veins can cause aching and feelings of fatigue as well as skin changes like rashes, redness, and sores. As many as 40 million Americans, most of them women, have varicose veins.

You have two kinds of veins in your legs. Superficial veins lie close to your skin. Deep veins lie in groups of muscles. Deep veins lead to the vena cava, your body's largest vein, which runs directly to your heart. Perforating veins connect superficial veins to deep veins. Varicose veins occur in the superficial veins in your legs.

The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. The entire process of sending blood back to the heart is called the venous pump.

When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and the pressure in your veins can increase. Deep veins and perforating veins are usually able to withstand short periods of increased pressures. However, if you are a susceptible individual, your veins can stretch if you repeatedly sit or stand for a long time. This stretching can sometimes weaken the walls of your veins and damage your vein valves. Varicose veins may result. Spider veins are mild varicose veins. They look like a nest of red or blue lines just under your skin. Spider veins are not a serious medical problem, but they can be a cosmetic concern to some people.

What are the symptoms?

If you have varicose veins, your legs may feel heavy, tired, restless, or achy. Standing or sitting for too long may worsen your symptoms. You may also experience night cramps.

You may notice small clusters of veins in a winding pattern on your leg, or soft, slightly tender knots of veins. Sometimes, the skin on your legs may change color, become irritated, or even form sores.

If you have severe varicose veins, you have slightly increased chances of developing deep vein thrombosis (DVT). DVT may cause sudden, severe leg swelling. DVT is a serious condition that requires immediate medical attention.

What causes varicose veins?

High blood pressure inside your superficial leg veins causes varicose veins.

Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, or having DVT. Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70.

Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins.

So, yes, I've determined that I'm going to die of Deep Vein Thrombosis at some point.  It's no wonder I can't sit down without my legs aching and twitching.  Sleeping is becoming difficult, my legs wake ME up!

Oregon Chai Sugar-Free Original Chai Latte

Found something new today:  Oregon Chai's Sugar-Free Original Chai Tea Latte Mixer.  You mix it with milk to make a Chai Latte.  I'll let you know how it is - I'll probably give it a whirl tommorrow - with either a smaller amount of milk and I'll also try it with my Hood Calorie Countdown Milk - because I'm still having issues with regular skim milk.

"After all these years, The Original has lost it. Now she's sugar-free. She's still the same sweet girl you've always loved, with all her subtle spice, black tea and creamy richness, she just doesn't pack the wallop of those pesky carbs and calories. She's Sugar-Free Original and she's offering you a guilt-free ride. She travels light, so you can too.

Chai Power Blended

• 4 oz. Oregon Chai Original Chai Concentrate
• 2 oz. Half and Half
• 1 oz. Sugar-free Vanilla syrup
• 2 scoops Sugar-free Vanilla protein powder
• ice
• Blend Chai, Half and Half, Sugar-free vanilla syrup in blender. Add protein powder continue blending. Add ice until thick and creamy.

Power-Packed Protein Shake

• 4 oz. Oregon Chai Slightly Sweet Chai Concentrate
• 4 oz. Vanilla Soy Milk (low fat or regular)
• 2 oz. Protein Powder, Vanilla-flavored
• 5-7 ice cubes
• Sprinkle or two of cinnamon
• Combine all the ingredients in a blender. Mix on high speed for 45 seconds. Pour into a tall glass, sprinkle some extra cinnamon on top, serve and enjoy this great morning or mid-day protein shake!

A recipe to try: Sugar-Free Vanilla Latte

• 4 oz. Oregon Chai Sugar-Free Chai Concentrate
• 4 oz. Heavy cream
• 1 oz. Sugar Free Vanilla Syrup
• 1/2 teaspoon of Splenda or sugar substitute
• 4 ice cubes
• Ground cinnamon
• Mix together Chai Concentrate, cream, syrup, splenda, ice cubes. Place in blender blend until smooth. Pour into 2 or more tall glasses, whip cream, dust with cinnamon.

Glucose Tolerance Test

I'm scheduled to take a Glucose Tolerance test today. Instead of the usual Glucola drink, I was told to use the "Jelly Bean Test":

In a study published in the American Journal of Obstetrics and Gynecology, results for a sample of women showed that the consumption of a specific number of a specific kind of jelly bean may be used as a screening test for gestational diabetes. The 50 gm oral glucose tolerance test (GTT) is typically administered as a thick sugary-sweet liquid. Well-known side effects from this cola or orange beverage include nausea, vomiting, sweating, abdominal pain, and even bloating. (For women with NORMAL digestive systems! -Beth)

Patient noncompliance with this test or vomiting are as high as 10 to 15 percent. Therefore, some patients are not adequately screened for the potentially serious disorder of gestational diabetes. Jelly beans were used as an alternative to the 50 gm GTT with a cola beverage. This is how the study was conducted. Each woman had all three tests: jelly bean, glucola and three-hour glucose tolerance test. In this way, they all acted as their own controls. Each was asked to consume 18 jelly beans within two minutes and a one-hour venous plasma glucose value was obtained. This test was done without regard to the time of the last meal. Jelly beans (Brach & Brock Confections, Chicago) with a count of 150 per pound were used. Food and Drug Administration quality control standards for nutrition labeling and internal quality-control standards by Brach Brock Confections regulate the size and dextrose or carbohydrate content of each jelly bean. Only Food and Drug Administration-approved dyes are used by Brach & Brock Confections in the manufacture of jelly beans. It is of importance to note that only Brach jelly beans with a count of 150 per pound were tested. Other brands of jelly beans may not yield the same result. Overwhelmingly, jelly beans were preferred to the cola beverage in this study. However, this may in part reflect bias on the part of the subjects who voluntarily participated in the study. This study, with its limited number of subjects, suggests that jelly beans may be used as a well-tolerated and acceptable alternative to a cola beverage containing 50 gm of glucose for screening of gestational diabetes.

Now, it sounds like a good alternative, since there is no way I'd consume the Glucola, it would make me pass out, but...  There are 35 grams of sugar in 18 Brach's Jelly Beans.  I would NEVER eat that much sugar in one sitting let alone in a two-minute time frame.  I dump on anywhere from 10-18 grams of sugar, depending on the type of food it comes from.  If I'm eating a simple carb, (like graham crackers)  I dump if I ingest two crackers (11 grams of sugar in two sugar/cinnamon crackers).  So, tripling that sugar amount may make me violently ill in one sitting.  I will get dizzy, sweaty, shaky, nauseous, diarrhea and an overwhelming urge to lay down while my heart beats out of my chest.  I really don't want that to happen outside of my bathroom - and I'll have children with me. 

So, I'm denying the test.  I know, bad, non-compliant me.  There has to be another way to test my blood sugar.  I've yet to have gestational diabetes, why would I now?

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