Frequently Asked q uestions

Q I have methylenetetrahydrofolate reductase (MTHFR) C677T and do not understand what Vitamin B12 and folate supplements I should take.

A: Vitamin B12 is also called cobalamin and the cheaper form is cyanocobalamin. Yes, it contains cyanide and it is found in most multivitamins but not in sufficient bioavailable quantity to improve mitochondrial function. A liquid or powder form of methylcobalamin B12 and methylfolate or 5-MTHFR is needed for MTHFR genetic single nucleotide polymorphisms (SNPs).

Q The 2015 Dietary Guidelines for Americans recommendations are very different from the nutrition guidelines the nutritionist recommended after my bariatric surgery. What nutrition plan should I believe?

A: To quote David Katz, MD, Director of Yale University Prevention Research Center, “The 2015 Dietary Guidelines for Americans are a national embarrassment. They are a betrayal of the diligent work of nutrition scientists, and willful sacrifice of public health on the altar of profit for well-organized special interests.” The report focuses on food over nutrients but recommendations about what NOT to eat or limit is stated in terms of nutrients making it very confusing. Limiting the intake of saturated fat is prominently featured but with no indication of what foods to avoid or reduce. The same is true of added sugar. As Dr. Katz states, “Clearly advise about eating less of anything conflicts with the interests of some big industry sector of federal agencies and their bosses in Congress don’t want to get upset. So somehow, we are left to cut back on our intake of saturated fat and sugar while washing down our corned beef with Coca-Cola.”

Q Do I need to be concerned about genetically modified organisms (GMO) foods?

A: The development and use of genetically engineered (GE) foods (also known as GMOs) is a controversial subject because long-term effects on humans are unknown and no federal law requires labeling food or ingredients if they are GMOs. Several major commodity crops are genetically altered: alfalfa, canola, corn, cotton, Hawaiian papaya or “solo” papaya, soy, sugar beets (used in granulated sugar), zucchini, and summer squash. GE apples and potatoes have been approved for sale but may not be available on the market yet.

A current estimate indicates that >90% corn, soy, and cotton acreage in the United States, is grown genetically engineered with products made from them used for infant formula, snack foods, ketchup, spaghetti sauce, and beverages made with high-fructose corn syrup, candy, and chocolate.

Genetic engineering has used billions of dollars for research and yet has not produced a healthier, more sustainable food supply, so who needs GMO food when research has shown weeds are becoming glyphosate-resistant (Round-Up)? Seeds are costlier because of patents, and seeds are artificially injected with foreign proteins that have never been tested.

Buy organic or GMO-free foods as often as possible since Americans are currently not allowed to know which foods contain modified genes. The Cauliflower Mosaic Virus (CaMV35s) promoter is used in most genetically engineered crops to activate foreign genes that have been inserted into the host. Just what we need is another virus in our metabolic system.

Q: Is obesity a disease?

A: Body weight is not a response to the law of physics but to the laws of biochemistry, so it is hard to classify it as a disease since it affects and contributes to many chronic disorders like cardiovascular disease, diabetes, hypertension, and cancer. During times in human history when food was scarce, our bodies developed the ability to store fat and weather the famine. Today, we have plenty of fat to burn, but society and technology has changed our eating and activity level. With lots more food available and less time needed to prepare it, weight gain abounds.

Q: A growing number of companies are offering wellness apps for employees to help them lose weight. Should I sign on?

A: Employers have been trying to get their employees to lose weight and eat better for a long time. The apps may offer a chance to help people individually make better choices instead of participating in a group session. But any kind of educational approach is only as effective as the motivation of the person participating. Dr. Jason Langheier, CEO and founder of Zipongo: Eating Well Made Simple, points out that the United States spends $8,500 per year for health care per person and $2000 on food and is ranked thirty-fifth globally for life expectancy. The Japanese spend $3,300 on health care and $3200 on food with a ranking of second in life expectancy.

Q: I do not know how to cook and have no time to learn how, so what do I do to help me lose weight after surgery?

A: Many Americans spend more time watching television than preparing their own meals. Studies show that those who prepare food at home have reduced incidence of obesity but they must dedicate the time and effort to cook a meal. If people can spend hours watching television, searching the Internet, and standing in line for the latest coffee creation, then they have the time to dedicate to their health and wellness by cooking nutritious meals at home along with getting some exercise.

Q: What is a healthy weight and waist circumference?

A: A healthy body mass index (BMI) is 18.5-25 kg/m2 but anything less than 30 kg/m2 is a desirable goal for bariatric surgery patients. Excess fat around the midsection or “belly fat” increases the risk for chronic diseases like cancer, stroke, heart disease, and diabetes. A waist circumference of 35 in. or less for women and 40 in. or less for men is desirable.

Q: What is the truth about fat?

A: Saturated fats are found in meats, cheese, and butter which are hard at room temperature. Eating large quantities of these foods can increase total blood cholesterol and low-density lipoprotein (LDL) cholesterol in some individuals. Coconut oil contains lauric acid, a medium chain triglyceride fat which lowers LDL cholesterol according to some research. Trans fats are a bad choice because they increase LDL and total cholesterol, and may reduce high-density lipoprotein (HDL) cholesterol. The hydrogenation of polyunsaturated fats like soybean and corn oil is what produces artificial trans fats and they need to be omitted from the diet.

Q: What about chocolate?

A: Dark chocolate contains stearic acid which is a saturated fat that does not raise LDL cholesterol, but it does not decrease it either. The Journal of Nutrition reported on health benefits of high-flavanol cocoa (the patent process cocoa from Mars identified by the flavanol symbol and statement on the package). Unfortunately, media reports about the “health benefits” of dark chocolate have failed to identify that not all dark chocolate contains healthy flavanols. The process of heating the cocoa powder destroys the flavanols and most chocolates are an unhealthy mixture of sugar and milk with a little cocoa powder stirred in.

Q: Why are processed foods not recommended?

A: Processed foods squander water, fertilizer, pesticides, seeds, fuel, and land resources needed to produce the ingredients in them. That is not sustainable and mindful eating. Mystery “meat” predominates in hot dogs, bologna, frozen dinners, and even veggie burgers. When profit is the motive in the food industry, quality ingredients are too expensive.

Q: How do I increase my Vitamin D?

A: Certain animal foods—fatty fish like salmon and mackerel and egg yolks—are good vitamin D sources. Sun exposure from May through September in the United States can help build your vitamin D levels. More than a billion people world-wide have insufficient or deficient vitamin D levels, including those who throw away the yolk of an egg and only eat the white. The American Heart Association is probably the biggest contributor to vitamin deficiency/insufficiency in the United States by limiting eggs and recommending only whites be consumed.

Individuals with darker skin pigmentation are at greater risk for Vitamin D insufficiency because the pigmentation slows the production in the skin. Low vitamin D levels have been associated with a higher risk of diabetes, heart disease, bone loss, and many cancers.

Q: My doctor told me to take calcium for my bones. What should I be taking?

A: Bones and teeth contain more than 90% of the body’s calcium but this mineral is also important for muscle movement, nerve signaling, hormone activity, and blood flow. When the diet does not contain enough calcium from canned fish like sardines and salmon, yogurt can be a good source for those who can tolerate dairy products.

Many nondairy foods are fortified with calcium but the bioavailability has not been determined, especially in bariatric surgery patients.

Q Everyone tells me physical activity is important if I want to lose weight and keep it off. I have never been active and don’t know how to begin.

A: A support system is vital for success in starting a fitness or physical activity regime. Others serve as a support and cheering section especially as you look at low-intensity activities like walking or hiking to increase heart rate and help establish a habit of physical fitness.

Q What can I do to treat my gastroesophageal reflux disease (GERD)?

A: Chronic heartburn or GERD can affect as many as 60%-70% of the obese population. Overeating increases the incidence of reflux disease as the stomach or the pouch is stretched and food stuffs get pushed into the throat.

GERD occurs when the sphincter muscle between that throat and the stomach allows stomach contents to reflux back up into the throat. The back-wash of acid, bile, and stomach contents irritates the lining of the throat and may lead to a condition called “Barrett’s Esophagus.”

The foods that can trigger GERD symptoms include alcoholic beverages, coffee, chocolate, peppermint, fried foods, spicy foods (chili, curry, salsa), and acid foods (tomato sauce, citrus fruits).

Q: A newspaper report stated that there is little evidence that beneficial bacteria from probiotics are safe and effective. Are probiotics a waste of money?

A: Probiotics have been getting bad press for years. Many health-care professionals do not realize how many studies have been done with probiotics and their effectiveness in irritable bowel syndrome (IBS) and C. difficile infection.

Sarah H. Yi, epidemiologist with the Centers for Disease Control and Prevention has been quoted as saying, “There’s no research that definitely shows they are effective, certainly not enough to create guidelines for their use” in a recent American Journal of Infection Control. She obviously has not kept abreast of the numerous studies in Pediatrics, Nutrition Metabolism, New England Journal of Medicine, American Journal of Clinical Nutrition, and many other professional publications.

Q Fasting has been recommended for quick weight loss while I await my bariatric surgery date. Is it safe to do?

A: David Ludwig MD, professor of nutrition at the Harvard T.H. Chan School of Public Health, says that a definite benefit of fasting is that it forces the body to shift from using glucose for fuel to using fat. The fat is then converted to ketones for energy that burns more efficiently than glucose. Long-term effects of fasting on weight loss have not been studied. Keep in mind that it takes a very disciplined person to skip meals everyday—whether those meals are breakfast, lunch, or dinner.

Q Why do I have to eat whole fruit when drinking juice is easier?

A: Over the past 50 years, the concept of “juice” has changed from a beverage squeezed by hand to a commercial product that has been heated, pulverized, stored in large tanks, and reconstituted into “juice” before bottling. The concept of freshness has been replaced by a highly processed food devoid of the nutritional benefits found in whole fruits. Alissa Hamilton in her book Squeezed: What You Don’t Know About Orange Juice reveals the shocking truth about the orange juice brands on the supermarket shelf. Cold pressed juices are more expensive and nutritious but whole fruit is your best choice.

Q: Why is alcohol restricted?

A: Gastroenterologist Bernd Schnabe and colleagues of the University of California San Diego School of Medicine found that chronic alcohol consumption suppresses a mouse antibacterial defense system in the intestine by blocking the ability to produce natural antibiotic proteins called regenerating islet-derived 3 beta (REG3B) and regenerating islet-derived 3 gamma (REG3G). According to their research, intestinal bacteria not only proliferate but migrate through the intestinal wall and can affect the liver. These mice had more severe liver disease as a result of the alcohol consumption. The study was reported in Cell Host & Microbe in February 10, 2016 issue.

Q: It feels like I am spending more and more on food with prices rising. Do I have to break the bank to provide nutritious food?

A: Plan your meals, use a shopping list, and skip convenience items to balance your food budget. If you prepare enough food for leftovers the next day, money can be saved. Shopping without a list leads to impulse buying instead of buying only what is needed. Convenience comes at a cost—about three times more expensive—so factor that in before buying. Skip the bags and tubs of pre-washed and cut produce and buy whole fruits and vegetables.

Organic foods cost more on average than conventional foods, so check out the Environmental Working Group’s annual list of “dirty Dozen” fruits and vegetables that have the highest amount of pesticide residues.

Q I buy only food that has “natural” on the label so that I know it is not processed and full of chemicals and GMO organisms. Is that the best guide?

A: People generally believe the word “natural” refers to food grown “in a natural way” like organic farming but nothing could be further from the truth. The use of “natural” on the food label is unregulated and food companies can use it to mean whatever they want. Kellogg’s Kashi brand misled consumers with its natural claim for GoLean® Shakes that were composed of entirely synthetic and unnaturally processed ingredients according to a lawsuit filed on August 31, 2011. The Cornucopia Institute released a report “Cereal Crimes” in November 2011 detailing the presence of genetically engineered grains in a number of “natural” cereal brands, including Kellogg’s Kashi. Purchasing organic is the safest and healthiest choice and, remember, the healthiest foods do not come with a label!

Q: What about the cellulose in grated cheese?

A: The addition of wood pulp cellulose to grated cheeses has been going on for many years but recently has gained consumer interest. Processed foods are not the safest and healthiest foods to select. Shaking a can of grated Parmesan cheese in a cardboard shaker to break up the lumps is made easier with cellulose but what about the economic fraud! Consumers believed they were buying a container of grated cheese—not a diluted cheese product containing wood pulp. Food And Drug Administration (FDA) even allows wood pulp from new trees to be called “organic.” Check out chocolate syrup labels and most salad dressings. You will find cellulose as a thickener. Real food does not need a wood pulp thickener.

Q: Why is sleep so important?

A: Each day the brain, a small mass weighing only 3 lb., has to get rid of toxic protein wastes and debris as it gets ready for a new neurological challenge the next day. This waste disposal goes on nightly during sleep. If this plumbing system did not flush out waste products, protein clumps would form in the brain cells and lead to irreparable harm like Alzheimer’s, Parkinson’s, or other neurological diseases.

Sleep is just as important for the brain as for muscles. It is just that we know less about the astrocytes in the brain and spinal cord than we do about muscle cells. Jeffrey P. Barash, MD, medical director of the Valley Hospital Center for Sleep Medicine in Ridgewood, New Jersey warns that losing 2 hours of sleep is similar to the effect of alcohol intoxication, like difficulty in focusing, deterioration of work productivity, and impaired creativity.

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