View a TMC Campus Map. The Fireplace Room can be found at the bottom center of the map.

Calcium is mostly absorbed in the first part of our small intestine, called the duodenum.  As food is diverted from this area following Gastric Bypass, daily calcium supplementation is needed.

An article published in Obesity Surgery examined the difference between two different calcium supplements following Roux-en-Y Gastric Bypass.  In completely random fashion, patients were supplemented with either calcium citrate or calcium carbonate.  The patients, and even the surgeons, did not know which supplement each was taking, so the experiment is considered a randomized, double-blinded study.

Only eighteen patients completed the study, however, it was well designed.  Careful statistical analysis revealed calcium citrate had significantly better blood evidence than calcium carbonate.

Just remember, if you need additional supplementation beyond two daily multivitamins, stick with Calcium citrate.  It is typically sold over the counter as Citracal®, or Citracal® Liquitab.

Be realistic. Set appropriate short-term goals for weight loss during the holidays, and be sure to at least maintain your current weight.

• • Gravy — Refrigerate the gravy to harden fat. Skim the fat off. This will save a whopping 56 gm of fat per cup.
  • Dressing — Use a little less bread and add more onions, garlic, celery, and vegetables. Add fruits such as cranberries or apples. Moisten or flavor with low fat low sodium chicken or vegetable broth and applesauce.
  • Turkey – Enjoy delicious, roasted turkey breast without the skin and save 11 grams of saturated fat per 3 oz serving.
  • Green Bean Casserole — Cook fresh green beans with chunks of potatoes instead of cream soup. Top with almonds instead of fried onion rings.
  • Mashed Potatoes — Use skim milk, chicken broth, garlic or garlic powder, and Parmesan cheese instead of whole milk and butter.
  • Quick & Healthy Holiday Nog Recipe — Four bananas, 1-1/2 cups skim milk or soy milk, 1-1/2 cups plain nonfat yogurt, 1/4 teaspoon rum extract, and ground nutmeg. Blend all ingredients except nutmeg. Puree until smooth. Top with nutmeg.
  • Desserts — Make a crustless pumpkin pie. Substitute two egg whites for each whole egg in baked recipes. Replace heavy cream with evaporated skim milk in cheesecakes and cream pies. Top cakes with fresh fruit, fruit sauce, or a sprinkle of powdered sugar instead of fattening frosting.

Enjoy the holidays, everyone! Keep up the great work!
Dr. M

You will often hear that our bodies digest complex carbohydrates (i.e. starches) slower than simple carbohydrates (i.e. sugar), suggesting that they are healthier for us. In truth, we metabolize some simple carbohydrates (fructose) slower than many complex ones. It is more accurate to gauge carbohydrates by their glycemic index (GI) and glycemic load (GL). A measure of nutrient behavior during digestion, foods with higher glycemic index cause a greater rise in our blood glucose (‘blood sugar’) levels. The glycemic load combines the quality and quantity measurements together by considering the glycemic index as well as the amount of carbohydrate consumed (GL = GI X the amount of carbohydrate available in a 100 gram serving / 100). Watermelon is an example of food with high GI, but because it does not contain much carbohydrate, the GL is relatively low. A GL of less than 10 is considered low, 11 to 19 is medium, and greater than 20 is considered high.

Here is a Table of Common Foods with Associated GI and GL. Choose and balance wisely!

Remember, keep the portions small! Load your plate with vegetables first, and keep in mind that there are often greater than 300 calories in just one piece of pumpkin pie! I know, it’s not fair.

PS - The Ironwood Room is located near the Marshall Conference Room, which is located on the east side off of Craycroft. Here’s a helpful TMC Campus Map.

Protein function is typically dependent upon its shape. The ‘tertiary structure’ refers to how amino acid sequences are folded upon each other to give each protein its unique shape, and therefore function.

Proteins serve as the major structural component of all the cells in our bodies, and are second only to water in abundance. We need proteins for proper growth and maintenance, and for many routine body functions including the production of hemoglobin (our blood cells that carry oxygen), formation of antibodies to fight foreign threats, and supply the nitrogen needed to make DNA and RNA.

(Hormones and enzymes are also formed from amino acids; they help regulate metabolism, support the immune system and other body functions.)

There are many different sources of protein ranging from whole protein foods (such as milk, meat, fish, egg, and vegetables) to a variety of protein powders (such as casein, whey, egg, rice, and soy).

Digestion of protein begins in our stomach. The acid activates an enzyme called pepsin, and further digestion occurs by enzymes called trypsin and chymotrypsin. After these enzymes cleave the protein into amino acids, the intestines absorb them.

So, how much protein do we need? You will hear considerable debate upon this issue. Simply put, our protein needs mirror our overall energy needs and expenditure. Our body weight and composition, growth rate, physical activity, and presence of illness or injury determine our protein needs to a great extent. According to the Unites States and Canada Dietary Reference Intake Guidelines, the average sedentary female aged 19 to 70 requires 46 grams of protein per day. Equivalent males require 56 grams of protein per day. This amount of protein intake will average 0.8 g/kg/d. Athletes, extremely physically active people, and those with inflammation or infection will require 1.6 to 1.8 g/kg/d. Maximal daily protein intake may reach 25% of total energy requirements (for example, in severely burned patients), and may climb to 2 to 2.5 g/kg/d.

Our ability to metabolize protein depends a great deal upon our kidney function. After protein is digested into amino acids, they enter our bloodstream, and are converted to functional molecules in the liver. The liver also converts nitrogen in amino acids to ammonia, and then urea (a waste product). Our kidneys are responsible for excreting urea; and, if kidney disease is present, protein restriction may be needed.

Our body will utilize as much protein as possible for energy (see Dietary Energy for more details). If, however, we take in far more protein than our body needs, it will convert to glycogen or fat cells, or occasionally combine with calcium to increase the risk for kidney stone formation.

Food allergies are typically due to different protein sources (casein – milk, gluten – wheat and grains, peanut proteins, and those found in shellfish and other sea foods).

Proteins were first described by the Dutch chemist Gerardus Johannes Mulder, and named by the Swedish chemist Jöns Jacob Berzelius in 1838. In 1958, Frederick Sanger sequenced the first protein in insulin, and Max Perutz with Sir John Cowdery Kendrew solved the first protein structure in hemoglobin. Using X-ray diffraction analysis, they determined the three-dimensional structures of both proteins in 1962, and shared the Nobel Prize for Chemistry.

1 calorie equals the energy needed to raise the temperature of 1 gram of water 1 degree Celsius.  Dietary energy refers to the amount of energy released when we metabolize what we eat, and it is expressed in calories per gram (or kcal/g).

Carbohydrates and protein provide 4 kcal/g

Ethanol provides 7 kcal/g

Fat provides 9 kcal/g

The easiest way to avoid unnecessary calories is to leave the bags of candy at the store! If you insist upon handing out edible treats, buy them on the day of Halloween and give them ALL away (whatever sits around or is left over will be eaten eventually, you and I both know it).

If you have unrelenting cravings, it is often better to allow yourself an occasional small treat than to avoid them all.  Use the opportunity to count calories, and set aside 50 to 100 for something small at the end of the day.  Stay strong!

Here are some calorie and fat contents of common candies to contrast:

You can, however, make it even simpler.  To best avoid these calories, here are some suggestions to stock for trick-or-treaters:

• Glow sticks and bracelets
• Bubbles
• Mini magnifying glasses
• Decoder rings
• Super balls
• Mini deck of cards
• Playdough
• Pencil toppers
• Temporary tattoos
• Stickers
• Origami paper and instructions
• Any of the different Halloween novelty toys around

Remember…If you are trick-or-treating or not, it’s a great time to get out and walk!

Happy Halloween!