Nutrition Advice For A Post-Cholecystectomy Diet | Q+A

Nutrition Advice For A Post-Cholecystectomy Diet | Q+A

Question:

I’m a long time member in Arizona. I was wondering if you have some tips for after gallbladder removal. Things tend to run right through me. It seems perhaps I’m not absorbing nutrients like I should. Plus, I tend to not get enough protein. Not a big meat fan. I’d like to bulk up a bit. I work out 4-5 times a week.

– Sherry H.

Answer:

If you don’t have advice from your surgeon/physician regarding an appropriate post-cholecystectomy diet, ask for one! Generally speaking, without a gallbladder to hold bile until it’s needed to break down fat globules, bile just constantly drips into the gut (like a leaky faucet) and fat digestion may be impaired. You do have pancreatic enzymes to digest fat, but they work best when ingested fat globules are first broken down by the bile.

My recommendations for after gallbladder removal: Consume small meals. Avoid more than 10-12 grams of fat per sitting. Chew slowly and thoroughly. Stay hydrated. Ask your doctor about taking supplemental lipase enzymes.

In regards to not getting enough protein, you can add non-meat sources such as eggs, beans, nuts, tofu, reduced-fat cheese, milk and yogurt. Vegetables are essential for consuming enough nutrients, plus they give modest amounts of protein with negligible fat (except avocados and olives).

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

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Baby & Me: Staying Healthy for Two | Q+A

Baby & Me: Staying Healthy for Two | Q+A

Question:

I work out 4-7 times a week and have been going consistently for the last 8 months. I just found out I am pregnant. I would like to continue working out and keeping my body strong and fit for the baby and myself. What do I need to do differently than I did when I was not pregnant, regarding eating and working out, to make sure I am getting proper nutrients for baby and me?

– Melinda

Answer:

Congratulations, Melinda!

As a Registered Dietitian Nutritionist, I will address the eating side of your question. For initial advice on working out during pregnancy, see our previous article Can you Exercise While You’re Pregnant? and this and this link to tips from the U.S. National Institute of Health. Of course, these suggestions shouldn’t replace the guidance of your obstetrician.

You’ll need extra fluids, nutrients and calories as your pregnancy progresses. See details from the U.S. Office on Women’s Health by clicking here. In the first trimester, folate and other vitamins and minerals are crucial for proper neural tube development, so a good prenatal vitamin is key. Strictly avoid alcohol during this time. The second trimester is when you start to expand blood volume and increase maternal stores while your baby grows rapidly from the size of a nut (3”, 1 oz.) to a football (12”, 1 lb.) while developing all of its organs and features. About 2 additional cups of fluids are needed per day. Adding around 300 extra calories from healthy foods with adequate calcium and iron will support this growth. In the last trimester, your baby is filling out to full-term weight. This is when you are truly “eating for two, ” although in terms of energy, you really only need an additional 200 calories on top of your 2nd trimester needs.

For weight gain recommendations, click  and be sure to ask your obstetrician for guidelines tailored to your specific needs.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Clean Eating: Salad Dressing Choices | Q+A

Clean Eating: Salad Dressing Choices | Q+A

Question:

Are there any clean commercial salad dressings that don’t have soybean oil or other bad oils? I also want a better mayo sub.

– Judy Y.

Answer:

The only 100% clean (raw or minimally processed) salad dressing would be to mix your own oil, vinegar and seasoning at the time of use. This is the way my family did it in the 80’s, with a spice mix in a glass shaker. Now you can get an organic, low-sodium spice mix or use an herb mix to do the same.

For a single serving, mix about 1 Tbsp. oil and 2 tsp vinegar in a small container with a tight lid by shaking vigorously. For lighter flavors use vegetable or canola oil and rice wine vinegar. For robust flavor use olive oil and red wine vinegar. Soybean oil has a fatty acid profile (high in polyunsaturates) similar to cottonseed or safflower oil  and is fine to use. Mix in 1 tsp of an herb seasoning blend. I like Italian Seasoning, Herbes de Provence or Lemon Herb mixes with no sodium added.

For a creamy dressing, I suggest substituting Greek yogurt and/or pureed avocado to avoid the harmful saturated fat from the cream used in traditional versions. Check out this recipe from the March/April 2011 issue of Eating Well magazine:

  • ½ ripe avocado
  • ¾ cup packed fresh cilantro
  • ½ cup nonfat plain yogurt
  • 2 scallions, chopped
  • 1 clove garlic, quartered
  • 1 tablespoon lime juice
  • ½ teaspoon sugar
  • ½ teaspoon salt

Blend all ingredients together in a food processor or blender until smooth.

Makes 16 Tablespoons at 16 calories each; 1 g fat (0 g sat); 0 mg cholesterol; 2 g carbohydrates (0 gm fiber, 1 g sugar); 1 g protein; 80 IU vitamin A; 2 mg vitamin C; 18 mg calcium; 0 mg iron; 8 mcg folate; 80 mg sodium; 61 mg potassium.

While I’d recommend hummus in place of mayonnaise on sandwiches, for tuna, pasta and potato salads you’ll need a mayo substitute that mimics the white, creamy original. If you’re looking for a mayo substitute without eggs or soybean oil, you’ll need to find one with grapeseed oil or coconut oil, which will often include rice as a binder. Vegetarian mayonnaise substitutes are still processed products, most with preservatives.  In the refrigerated section you might find preservative-free versions, which last about 2 weeks.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.


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Swimsuit Season Is Here – Can You Stomach It?

Swimsuit Season Is Here – Can You Stomach It?

Everyone wants a flatter belly, especially when warmer weather dictates lighter clothing. When it comes time to hit the beach or pool, will you be ready to dive in? To even head in the direction of belly-baring status, you must first know thine enemy – your abdominal fat. Afterward, read on to see what you can do to help chisel a trimmer tummy.

No matter your current physique, the following approaches may help you achieve obtaining a flatter belly.

Your abdominal fat is actually in two places or compartments – under the skin (subcutaneous) and intra-abdominal (visceral) fat. The former lies above the abdominal muscles, the latter beneath. In simple view, here’s what they look like:

It just takes a quick measurement to see how much fat you’ve got and to track changes. Waist circumference can’t pinpoint where fat lies, but this measurement does correlate with overall abdominal fat. Total waist measurement depends on your body frame size, so it’s better to look at waist to hip ratio which shows how your belly area compares to your hips.

How to measure your Waist-to-Hip ratio (either metric or customary):

  1. Standing relaxed, with a flexible tape, measure waist at the smallest area – or if this is not apparent, mid-way between the lowest rib and top of the hip bone.
  2. With feet and thighs together, measure hips at the widest portion of your buttock.
  3. Divide waist measurement by hip measurement to get your ratio. The ratio should be less than 0.9 for men; less than 0.85 for women.

1. Exercise


 

Greater physical activity is associated with lower waist circumference and waist-to-hip ratio. It’s no secret that moving muscles are the furnace for fat burning. Exercise is really essential in fat metabolism. Exercise burns fatty acids (in processes called lipolysis and oxidation), contributing to reduction in body fat. Aside from exercise aiding in fat-burning, a developing theory is that fat cells, including those in the abdomen, are temporarily ‘starved’ when blood flow is focused to moving muscles.

True, you can’t spot reduce, selectively dropping fat from only one area of the body. But new research indicates that certain types of exercise can reduce belly fat more than others. While the same level of calories are burned with each, anaerobic high-intensity intermittent training has been shown to produce greater abdominal fat reduction than continuous aerobic training.1

2. Diet


 

Energy

Calorie restriction (regardless of energy source) affects both visceral fat and subcutaneous fat. This is only true to an extent, as very low calorie diets end up with the losses of visceral fat regained weeks afterward. In fact, modest weight loss, even 5% body weight for overweight individuals, is enough to reduce visceral fat, regardless of method. One study showed that 4 different calorie-reduced diets were equally effective in reducing abdominal fat, with most loss coming from subcutaneous fat.2

Composition

A greater intake of fat and carbohydrates, typical of Western diets, is associated with higher waist circumference. Conversely, those following a Mediterranean style diet were less likely to gain abdominal fat over 10 years.3 This style reflects a focus on plant-based foods (like vegetables, fruit, and whole grains) with moderate protein intake, minimal animal fats, and a prominence of olive oil, all resulting in a low saturated fat intake. The bulk of research indicates conventional nutritionally-balanced plans are as effective as high protein diets in reducing abdominal fat.

Green Tea

Green tea (vs. black) is made with the youngest leaves, which have the most catechins. See our related article – Nutrition is Sprouting this Spring!

At a certain threshold, catechin compounds in green tea can impact abdominal fat. These compounds (prominently EGCG) may affect the sympathetic nervous system in a way that influences fat distribution. It takes about the equivalent of 5 cups of tea, or 500 mg catechins, for an effect. Studies with significant finding used catechin-enhanced beverages.4,5 More is not better… consuming >800 mg ECGC in one sitting would be like slamming a gallon of green tea all at once, and instead of acting as an antioxidant (as it does at lower levels), you’d get pro-oxidant effects! Also, having smaller servings spread throughout the day is more effective than a single huge dose.

For the most catechins, look for quality packaging to ensure better storage with minimal exposure to oxygen, light, and moisture. Also, don’t take highly concentrated EGCG green tea extracts or supplements while taking acetaminophen.

3. Posture


 

Though it won’t change your belly fat, adjusting your posture could improve the appearance of your midsection. Tilt your pelvis when standing so that your tailbone is in (pointed down, not out), as shown to the right.

References:

  1. Abdominal fat reducing outcome of exercise training: fat burning or hydrocarbon source redistribution?  Kuo CH and Harris MB. Canadian Journal of Physiology and Pharmacology. 2016 Jul; 94(7):695-8.  doi: 10.1139/cjpp-2015-0425.
  2. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial. De Souza RJ, et al. American Journal of Clinical Nutrition 2012 Mar;95(3):614-25. doi: 10.3945/ajcn.111.026328.
  3. Mediterranean diet impact on changes in abdominal fat and 10-year incidence of abdominal obesity in a Spanish population.  Funtikova AN, et al. British Journal of Nutrition. 2014 Apr 28; 111(8):1481-7.  doi: 10.1017/S0007114513003966.
  4. Green tea catechin consumption enhances exercise-induced abdominal fat loss in overweight and obese adults. Maki KC, et al. Journal of Nutrition. 2009 Feb;139(2):264-70. doi: 10.3945/jn.108.098293.
  5. Effects of catechin enriched green tea on body composition. Wang H, et al. Obesity (Silver Spring). 2010 Apr; 18(4):773-9. doi: 10.1038/oby.2009.256.

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.


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What’s The Best Way to Calculate RMR? | Q+A

What’s The Best Way to Calculate RMR? | Q+A

Question:

What is the best way to calculate RMR?

– Mark B.

Answer:

The best measurement of resting (awake/alert) metabolic rate is to conduct an indirect calorimetry test using metabolic equipment, as done in a research laboratory or hospital setting. In lieu of a physical test, the second best way to predict resting metabolic rate is to calculate/estimate using a validated equation. I recommend the Mifflin-St. Jeor equation or the one used by the World Health Organization. For your computational pleasure here they are:

The Mifflin St. Jeor equations are used often in the medical and weight loss fields because of their accuracy, and are recommended by the Academy of Nutrition and Dietetics.

  • Women:          (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) – 161
  • Men:                (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) + 5

The World Health Organization, as well as the United Nations University and Food and Agricultural Organization, use the following equations, which were derived based off a large database, reflecting many countries over several decades.

  • 18-30 yrs:        kcal/d = 13.3 × weight (kg) + 334 × height (m) + 35
  • 30-60 yrs:        kcal/d = 8.7 × weight (kg) – 25 × height (m) + 865
  • >60 yrs:           kcal/d = 9.2 × weight (kg) + 637 × height (m) – 302

As is true with any equation, these equations are only estimations of your needs, so you might want to try both and obtain a range that your true RMR probably falls within. Neither of the above take into consideration lean mass versus fat mass, so they aren’t practical for extremely muscled or morbidly obese individuals. For teens, the Schofield method (previously used by the World Health Organization and the US government to formulate the RDAs) has different equations for various age groups.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

LA Fitness Living Healthy subscribe button

Want more? SUBSCRIBE to receive the latest Living Healthy articles right in your inbox!

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Skin-Saving Nutrients You Need Now

Skin-Saving Nutrients You Need Now

A diet rich in nutrients and antioxidants shields your skin from wrinkles and preserves its youthfulness. Debbie James, RDN, gives us the details.

Your 2020 Fitness Bucket List!

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Take on the new year with these 20 fitness goals! Get ideas for where to start or challenge yourself to something you never expected.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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