Author: Heather K. Mackie, MS, RD, LD

Week of May 14, 2012

Should You Go Coo Coo for Coconut Water?

By now, I’m sure everyone has heard of coconut water and how it is touted as the “all-natural” electrolyte guru of sports drinks.  But what is the truth about coconut water – should one consume or not consume this beverage as a weight loss surgery patient?

Coconut water is often categorized as the fat-free, cholesterol-free, low-calorie, rehydrating, electrolyte-rich drink. With a price tag of around $1.75-2.75 per bottle, are all of these benefits really worth it?

What is Coconut Water Anyways? Coconut water is the clear, nut-flavored, slightly sour juice stored inside young coconuts.  It has been a staple beverage of Southeast Asian nations for years, where the fruit is also harvested for its flesh, oil, and milk.  This craze first hit the United States about five years ago through two main brands, Vita Coco, which sold $20 million of coconut water in 2009 and Zico, a brand backed by Coca-Cola.  According to Merrill Lynch, the US coconut water industry has increased from $0-$35 million in the last five years.

Unlike coconut milk, which is a high-fat emulsion of mature coconut flesh, coconut water is mostly water – about 95% water.  Coconut water does contain electrolytes: sodium, potassium, magnesium, calcium, and phosphate, and a small amount of many essential amino acids.  Obviously it has gained popularity due to the exclusion of artificial colors and preservatives.

Powerful Potassium. The biggest claim is that this nature’s sports drink is rich in potassium.  Below is the average of 3 brands (second chart) of coconut water, which demonstrated a typical serving provides 585 mg of potassium per serving.  What are the health benefits of potassium, anyway?  How much do you need a day?

Potassium is an electrolyte in the body that is responsible for regulating nerve transmissions, muscle contraction, and heart function.  It is also necessary for many enzymes’ activity, including the metabolism of carbohydrates.  The adequate intake (AI) for potassium is 4,700 mg/d for both males and females 19 years and older.  The AI is established by the Food and Nutrition Board of the US Institute of Medicine.  The AI is a recommended intake value based on estimates of nutrient intake by a group of healthy people that are assumed to be adequate.  They use an AI when an RDA cannot be established.  The AI for potassium was established in 2004 based on an intake that has been found to lower blood pressure, reduce salt sensitivity, and minimize the risk of kidney stones.  It is important to note that both potassium and sodium are needed by the body in balance (the body needs more potassium than it does sodium).

Many individuals do not take in enough potassium on a daily basis.  This potassium does not have to be supplemented for most individuals; in fact, if the general population consumed more fruits and vegetables, they would see an increase of potassium intake.  As we know, most Americans do not consume the recommended amount of fruits and vegetables on a daily basis and therefore, may not take in enough potassium.   Let’s take a look at how some fruits and vegetables compare when it comes to potassium amounts per serving:

Below is a chart showing the nutritional value of three commonly found brands of coconut water:

Replenishing. Before coconut water came along, many individuals who wanted to replete their potassium levels thought of either bananas (422 mg potassium) or Gatorade (about 53 mg of potassium).  While, coconut water clearly has more potassium than bananas I’m not sure that it is truly “healthier.”  Eating foods rich in potassium provide other benefits beyond potassium, such as fiber, and many other vitamins and minerals that our bodies need.  Eating foods instead of drinking also helps one to feel full whereas beverages don’t make us feel very full for a long period of time.

Also, if you are intending to use coconut water after a workout, you need to replenish more than just potassium.  Depending upon the climate, your individual sweat rate, and the type, amount, frequency, and intensity of exercise, it may be just as important to replace sodium losses as well.  When we sweat, we lose sodium.  In fact we lose more sodium than we lose potassium.  However, most people don’t exercise at an intense enough level to require sports recovery drinks.  Water is still the best recovery drink for the average person engaging in physical activity.  However, if you are the intense training, high-sweat rate exerciser, coconut water still may not be for you.  Typically it is recommended that recovery drinks for these types of athletes include higher levels of carbohydrates and sodium.  Another common recommendation following an intense workout session for the average adult athlete is to include about 15-17 g of protein and coconut water does not contain even close to this amount of protein.

What Does the Research Say? In one study, eight men exercised in a hot environment until they lost 3% of their body weight and then drank either coconut water, a sports drink, or plain water to rehydrate.  All three beverages replenished the men the same.  Another study followed 10 men who exercised in the heat for 90 minutes and consumed either water, a sports drink, coconut water, or coconut water with sodium.  Two hours later, those who drank the sports drink, coconut water, and coconut water with sodium were slightly better hydrated, which was measured by the amount of body weight regained than those who drank plain water.

What About the Other Electrolytes? We already discussed potassium in great detail, but coconut water also contains four other electrolytes: sodium, magnesium, calcium, and phosphorus.  When it comes to sodium, most Americans consume enough of this nutrient and don’t require any additional supplementation unless they are exercising very intensely and losing large amounts of sodium through their sweat.  The average sodium content of the three above coconut waters is 83 mg, which is minimal compared to the AI of 1,200-1,500 per day of sodium.

When it comes to magnesium, the average content in coconut water is 31 mg and the Recommended Dietary Allowance (RDA) is 320-420 mg/day and bariatric patients may require this amount or higher.  Coconut water provides a very small percentage of one’s daily need of this electrolyte.

The average content of calcium in coconut water is 36 mg and most bariatric patients require about 1,500-2,000 mg/d (or more) of calcium daily to prevent bone loss.  This is a very small amount of this nutrient from coconut water.

The last electrolyte discussed is phosphorus (or phosphate) and the average content is 29 mg.  The RDA for adults is 700 mg/d and we are still learning more about this nutrient related to bariatric patients.  As one can see, coconut water has very small amounts of all other electrolytes (except for potassium) when compared to what an individual needs daily.

What About the Other Claims? As far as other claims related to coconut water, such as anti-aging, improving circulation, fighting viruses, boosting immunity, aiding in kidney health, and reducing the risk of cancer, heart disease, and stroke, there isn’t any scientific evidence to support these such claims in humans.  There is some research being performed in test tubes and lab rats at this time suggesting certain plant chemicals found in coconut water may be powerful antioxidants, but any fruit and vegetable we eat also contains antioxidants.

Specifically Related to Bariatric Patients’ Concerns. As we know sugar may sometimes cause problems for some bariatric patients, specifically gastric bypass patients.  Coconut water contains about 12 g of sugar per serving, on average.  This may be enough to cause dumping syndrome in some patients.  Even though coconut water is touted as a low-calorie beverage, many patients can agree they don’t want to consume 60-90 calories on just a beverage when you already have a limited amount of calories to “spend” each day on food.  The above referenced numbers are from plain coconut water.  The flavored varieties may have even more sugar and calories.  If you are really concerned about rehydrating, you might save money by consuming a glass of water and some prunes or raisins.

While there is still much more necessary research when it comes to the magic of coconut water, you have to decide what is right for you and where your priorities lie in terms of reaching your goals.  We hope this information is beneficial in helping you to reach a decision and we look forward to CELEBRATING with you as you reach your goals!

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Author: Nadea S. Minet, MS, RD, LD

Week of May 7, 2012

Get Eggcited About Eggs

Is your breakfast incredible? If it’s not, then you should start your morning off with eggs. I know many people are on the fence about eggs since they have a reputation for harboring high amounts of cholesterol.  However, the good for you, bad for you debate is over, but convincing people that eggs are healthful remains a sensitive subject.  Today we will provide you with the facts about eggs so you can get eggcited about them (and maybe even add them to your diet).

Eggs are Nutritionally Incredible. Eggs are all natural and one large egg comes in at about 70 calories.  It has lots of vitamins and minerals too, which makes it a great choice for the weight loss surgery patient or anyone who is watching their weight.  In fact, studies suggest having an egg for breakfast promotes weight loss. The nutrients in eggs can play a role in weight management, muscle strength, healthy pregnancy, brain function, eye health and more. At less than 12¢ each, eggs are an affordable and delicious breakfast option.

Peak Protein Power. One egg delivers 6 grams of protein, which provides you with immense satiety.  Eggs provide the highest quality protein found in any food because they contain all of the essential amino acids our body needs in a near-perfect pattern.  While many people think the egg white has all the protein, the yolk actually provides nearly half of it.  The high-quality protein in eggs provides the energy you need to perform your best on each and everyday (especially the important ones).  And an egg helps you feel full longer and stay energized, so you’re less likely to snack on something high in fat and calories.

Muscle Strength and Repair/Preservation. Research indicates high-quality protein, such as the type found in eggs, may help active adults build muscle strength and middle-aged and aging adults prevent muscle loss.  Consuming eggs following exercise is a great way to get the most benefits from exercise by encouraging muscle tissue repair and growth.  Egg protein helps to build and maintain muscle fiber, which is important as you follow an exercise program.

Brain and Eye Health. Eggs are an excellent source of choline, a water-soluble essential nutrient, which is involved in many functions throughout the body, including memory and muscle control.  It aids the brain function of adults by maintaining the structure of brain cell membranes and it’s a key component of the neuro-transmitter that helps relay messages from the brain through nerves to the muscles.  The yolk is where choline is found, so don’t toss it out.  You’ll be missing out on these nutrients if you do.

In regards to eye health, lutein and zeaxanthin, two antioxidants also found in egg yolks, help prevent macular degeneration.  Although eggs contain a small amount of these two nutrients, research show the lutein from eggs may be more bioavailable than lutein from other food sources.

Concerned about Cholesterol. One of the drawbacks to all the benefits of an egg is the cholesterol it contains.  Many people have avoided eggs-despite their taste, value, convenience and nutrition-for fear of dietary cholesterol.  A large eggs contains ~186mg of cholesterol, which may seem significant, but one egg is not going to raise your cholesterol.  And actually, eggs are lower in cholesterol than previously recorded.  While being aware of the cholesterol you consume, it’s more beneficial to watch the total fat in your diet rather than focusing on an egg’s cholesterol content.

Egg Safety. Eggs should be cooked until the whites and yolks are firm, and for dishes containing eggs, cooked until an internal temperature of 160°F is reached to decrease the risk of Salmonella.  While it’s important to thoroughly cook your eggs, simple food handling practices are imperative.  Washing your hands and sanitizing the surface and utensils that come into contact with raw eggs is a vital step for avoiding cross-contamination.  Eggs should be stored in the main section of the refrigerator at a temperature between 33-40°F.

If you’re looking to cut calories, fat and cholesterol from your diet, you may choose to use an alternative such as an omelet made of egg whites instead of whole eggs for breakfast.  But is choosing egg whites instead of whole eggs really the best choice nutritionally?  Here’s a chart to help you compare:

Choosing egg whites alone does lower the calories, fat and cholesterol content.  However it decreases or eliminates some very essential nutrients.  A great alternative would be to make your omelet with one whole egg and two egg whites.  It’s still low in calories, fat and cholesterol, but you’ll get the essential nutrients from the egg yolk.

Eggs can provide the solution to the many daily challenges we face, from sticking to a weight-loss program to obtaining enough protein to getting sufficient nutrition through your foods to preparing dinner on the fly.  They are inexpensive, convenient, and easy to add to your diet to help you reach your weight loss goals so you can Celebrate your success.

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Author: Heather K. Mackie, MS, RD, LD

Week of April 30, 2012

Combatting Fatigue with Food, Part II

Last week we viewed timing and frequency of foods related to energy levels.  This week we will review types of foods and beverages that might also assist in optimizing your energy levels.

Types of Foods. Just as our body needs enough fuel to run properly, the type of fuel is just as important.  The body derives energy from carbohydrates, fat, and protein in very different ways.  Therefore, it is important to consume the right mixture of fuel from each of the sources to get your body functioning as best as possible.  General recommendations are about 15% of calories coming from protein, 55% from carbohydrates and 30% from fat, however this may vary slightly as a weight loss surgery patient.

It is recommended to maximize foods that are full of nutrients to meet your calorie needs as well.  Another term used to describe these foods is nutrient dense foods.  For example a glass of cola and skim milk are similar in calories, but the skim milk provides protein, calcium, vitamin D, and other nutrients that benefit the body, while cola doesn’t provide any nutrients that are beneficial to our health.  Another way to maximize foods that are full of nutrients is to incorporate fruits and/or vegetables at each meal and snacks as tolerated.

Glycemic Index. Glycemic index is the ability of a certain, measured amount of food’s ability to raise an individual’s blood glucose.  While this is still a controversial topic, many people think eating according to glycemic index or glycemic load (the glycemic index of all the foods combined in a meal) may help some individuals with energy levels.  However, we do know for sure that changing out higher glycemic index foods, such as white bread or juice, for lower glycemic index foods, such as whole grains or fresh produce is beneficial.  The consumption of lower glycemic foods may help slow the release of insulin and be one way to increase energy levels.

The First Thing You Can Do. One of the most important recommendations regarding boosting energy levels is one we have all heard many times.  Eat breakfast; it is the most important meal of the day.  Eating a balanced breakfast is also important.  A healthy breakfast starts one’s metabolism and helps to keep you satisfied until lunch, but it may help you to make better choices throughout the rest of your day.

What About Energy Drinks? Many people are probably thinking I’m going to discuss items like 5-Hour Energy, but I’m actually going to discuss water or H₂O!  Many people don’t think about water as helping to energize you, but let’s review.  Drinking water consistently throughout the day may help to increase your energy levels by optimizing your hydration status.  Even mild dehydration may make you feel less energized and/or have headaches.  Even though the amount is important, it is also important to drink it throughout the entire day; not all at one time.  A good goal is to try to drink 1-2 cups if you feel tired or have a headache and then aim to drink ½ cup to 1 cup every couple of hours to maintain energy levels.

Oppositely, alcohol consumption may contribute to lower energy levels.  Alcohol is a depressant, but it can also act as a stimulate several hours after consumption, which may upset your sleep leaving you feeling fatigued the next day.

So what about true energy drinks and caffeine?  While these highly popular drinks may temporarily provide energy, it doesn’t last long-term.  The mind and body falsely think it has received fuel and when the caffeine buzz wears off, the result is a body that realizes it has nothing for fuel, which leaves you feeling hungry and tired.  However, other professionals state that caffeine can be used correctly to aid in alertness in short time periods.  A couple examples of where caffeine might be beneficial is test-taking, meeting a deadline, or increasing alertness during a long drive.  However, we can all agree that at one point in our lives, we feel we consistently have to meet deadlines and that is where this cycle of caffeine, energy, fatigue, and overeating begins.

We all know it is hard to make many lifestyle changes at one time, so focus on one change as discussed above at a time and then once that feels natural, incorporate another change so you don’t feel overwhelmed.  Slowly, but surely, you will begin to see and feel the benefits of these changes and feel motivated to continue to make other changes.  Remember to set small, attainable goals to achieve success and we can all CELEBRATE together!

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Author: Heather K. Mackie, MS, RD, LD

Week of April 23, 2012

Combatting Fatigue with Food, Part I

Many patients report increased energy levels after weight loss surgery and while weight loss will increase your energy levels, can food and/or other behaviors have the similar effects?

Possible Factors. There are many factors that may play a role in your energy levels – lack of sleep, hectic lifestyle, stress, lack of exercise, poor eating habits, certain health conditions, and medications may all contribute to energy levels.  Keep in mind evaluating your energy level is mostly subjective and hard to define and measure, but oftentimes one can say if they feel more or less energized than normal.

Nutrient Deficiencies and Energy Levels. Being a weight loss surgery patient puts you at risk for vitamin and mineral deficiencies.  Some nutrients may contribute to fatigue if deficient.  A few examples include essential fatty acids (omega 3 fatty acid), iron, vitamin D, B vitamins, zinc, and magnesium.  Almost 60-80% of pre-op bariatric patients are vitamin D deficient so it is important to continue to monitor your labs and make changes as recommended by your physician.

Mood & Cognition Related to Energy. Does improved cognition, especially mood, related to energy levels?  Animal studies have taught us that diets high in antioxidants and omega-3 fatty acids improve memory and cognition scores.  Human studies have demonstrated that nutrition status is a predictor of mood, cognition and memory.  Therefore, being well nourished, eating plenty of antioxidants and omega-3 fatty acids may contribute to better moods, cognition, and therefore perceived energy levels.

Frequency of Eating & Energy. Some studies report eating adequately throughout the day will increase stamina and endurance in physical activity.  However, with this said, I’m always cautious when saying eat 6 small meals throughout the day.  We all categorize “meals” differently, as well as “small.”  What is small to one person may not be for the next.  I have always recommended 3 meals per day and possibly a couple snacks throughout the day, but in order to do this and lose weight or maintain your weight loss you have to categorize the difference between meals and snacks and incorporate both into your daily eating plan (with plan being the crucial word here).  Talk with your surgeon and/or dietitian prior to making any changes to your daily eating plan.

Snacks are important for many bariatric patients.  However, oftentimes, snacking is used anytime someone experiences a drop in energy.  While this might be acceptable, many individuals reach for common snacks from the vending machine, which we know are not the best choice when trying to watch the waistline.  Instead reach for foods that provide energy and a mental boost.  It is recommended to combine complex carbohydrates with protein and fat for lasting energy levels.  The fiber, protein, and fat together help to slow the release of blood glucose, which helps to prevent the energy crash later (or what I call a “carb coma”).

To further help you with your eating plan, it may be beneficial to use a food log to target your hunger time when you typically reach for that caffeine or high carbohydrate food for a quick pick me up.  Once you realize this time period, “pre-plan” a snack about 20-30 minutes before the hunger time that combines lean protein, healthy fat, and complex carbohydrates.

Eating & Exercise. Another very important time period that is extremely crucial to eat adequately is prior to an exercise session.  If you don’t eat enough to get through your workout and feel sluggish you will end up burning less calories and not getting the optimal output from that exercise session.

Calories & Energy. Undereating, in general can cause inadequate energy levels throughout the day.  Standing up from a chair or staying awake during a meeting may be difficult if you do not consume the minimum amount of calories that your body needs daily to function properly.  Not only does not eating enough not make you feel well, but may also lower your metabolism.  This is why it is important to not skip meals, as the body will actually preserve energy.  As your metabolism slows, the body burns fewer calories, making it easier to gain weight.  Think about the campfire analogy:

When you have a great campfire burning and no one continues to “feed it” overnight (add logs), the fire will go out (not burn as many calories).  However, the first person to wake up usually adds logs and restarts the fire (restarting the calorie burn).  The opposite is also true – if you put too many logs (calories) on the fire, then the fire can actually smolder out (cause weight gain).  Also, think about the right type of fuel for the fire – it takes starting with small twigs up to bigger logs to get a fire going.  It also takes the right kind of fuel (food) to help a person feel energized appropriately.

Just as we saw from this analogy, it is just as important to eat enough calories, but not eat too many calories.  Eating too many calories causes the body to work really hard to digest and absorb the large amount of calories.  Think about how you felt after overeating and stuffing yourself prior to weight loss surgery?  You don’t feel energetic and ready to take on the world; you want to take a nap on your couch or in your favorite recliner.  This overeating results in insulin overproduction, which may leave too little blood sugar available for immediate energy, which leaves you feeling lethargic.  Therefore, it is not shocking that chronic overeating makes individuals feel as though they have low energy levels.

However, it is important to remember that fatigue, alone can cause individuals to overeat, which creates a vicious cycle.  If you find yourself in this cycle, it is hard to break it, but just by reading this you are taking the first step.  The next steps are to work to control your portions, get adequate sleep, and look at ways to manage your stress levels.

Join us next week when we look at the specific types of foods and beverages that will help you to build your energy levels.  This week focus on your timing and frequency of eating.  Also, if you need to get your blood work done, call and make an appointment to ensure there are no vitamin deficiencies contributing to your energy levels, or rather lack thereof.

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Author: Nadea S. Minet MS, RD, LDN

Week of April 16, 2012

Is Going Gluten-Free for Me?

If you asked a friend 5 years ago if she avoided gluten, she’d probably have answered “Glu-wha?” But since then, there’s been a lot of talk about the gluten free diet among celebrities and people alike.  With its increase in popularity and obtainability, gluten free foods are one of the fastest growing sectors of the food industry.  They have multiplied over the last few years, mostly due to the growing need of people with celiac disease, which is 4 times more common today than it was 50 years ago.  However, many people are opting to go on a restrictive gluten-free diet because they think it’s healthier.  But in fact, is it??

First Things First: What is gluten, anyhow? Gluten is a protein “glue” that gives wheat, barley and rye flours their stretchy texture when kneaded into dough. You can think of it as the glue (glu-ten) that holds all your favorite bakery confections together—everything from baguettes to biscuits get their flaky, doughy, fluffy, chewy texture from the little gluten particles binding their flour base to all the other ingredients. But one in 133 Americans suffers from a severe gluten allergy called celiac disease, and many more have gluten sensitivities that leave them feeling tired, achy and bloated.  But before you bid yummy bread good-bye, find out if it’s worth it for you.

Gluten Has To Go If…You Have Celiac Disease.  Individuals with celiac disease have an immune response to gluten that causes inflammation in the small intestine, which often results in the breakdown of tissue in the small intestine.  Side effects of eating gluten for people with this disease include diarrhea, fatigue, rashes, headaches, nausea and vomiting, and severe abdominally cramping.  Thanks to improved testing, the disease is getting easier to diagnose and as a result, the number of people with positive diagnoses has gone up.  Whether the rise is due to better testing or to a greater incidence of the disease is difficult to tell.  Wheat is used in a lot of products in which it doesn’t occur naturally, such as soy sauce, and our bodies could just be getting overwhelmed.  Whatever the cause, gluten-free foods have helped to make it one of the fastest growing segments of the food industry.  If you suspect you have celiac disease, you should consult your doctor.  Your doctor will do blood work to see if you have antibodies for it and then do an intestinal biopsy to diagnose it.  The only treatment for this disease is to omit gluten completely from your diet.

Are You Gluten-Sensitive? It’s a little more difficult to pinpoint as compared to celiac disease.  Basically, individuals who are gluten-sensitive suffer very similarly to people with celiac disease but the blood test (which identifies and diagnoses celiac disease) returns negative and there is usually no damage to the intestine. The only way to confidently diagnose gluten-sensitivity is through a gluten free diet.  If your symptoms improved after banning gluten, you may be sensitive.  But don’t change your diet before you consult your doctor; you can’t test for celiac if you don’t have gluten in your system.

Bring On The Bread If… A doctor clears you of both celiac disease and gluten sensitivity.  There isn’t any evidence that people who aren’t celiac sufferers benefit from eating gluten-free food, and there’s no research to support that it’s healthier or will lead to weight loss.  In fact, avoiding grains with gluten could make you miss out on key nutrients such as fiber, iron, zinc, and vitamin B such as niacin and folate.  In fact, because they’re highly processed, commercial gluten-free products tend to be higher in sugar, fat, carbohydrates, and sodium than their traditional counterparts.  Some people swear that a gluten-free diet helped them slim down, but odds are they succeeded if they focused on whole foods and limited all high-calorie packaged and processed foods.

For instance, replacing wheat flour with potato starch will not lead to weight loss, but replacing white bread with quinoa or another high-fiber grain may lead to weight loss. In other words, replacing gluten-containing processed foods with gluten-free processed foods is not likely to result in weight loss. On the other hand, replacing any processed foods with whole foods is likely to encourage weight loss.  Or some individuals lose weight by avoiding gluten-rich foods and not replacing them with other carbohydrates.  Simply limiting carbohydrates may lead to weight loss, which many weight loss surgery patients already do because of the many food intolerances related to carbohydrate foods.

If you’re considering going without gluten, here are a few things to keep in mind.

1. Don’t’ do it blindly - Obtain a blood test to confirm the diagnoses rather than jumping headfirst into a gluten-free diet simply because you think you have a gluten problem.
2. Don’t assume it’s healthier - Remember, just because it’s gluten-free doesn’t make it healthy. A cookie is still a cookie, gluten-free or not. People who go gluten-free may gain weight if they rely mostly on highly processed gluten free foods, since they tend to be higher in fat, calories, and sugar than their gluten containing counterparts.  Also, if you’re shelling out extra cash to get gluten-free processed foods without a diagnosis, you might be wasting your money.  Gluten-free foods tend to be more expensive than regular foods, and there isn’t any scientific proof that they are healthier for the general population. A gluten-free diet tends to contain more fruits and vegetables than the average American diet does, so that may be a reason some people report feeling better after cutting back on gluten-containing foods.
3. “Gluten-free” is still pretty vague - The FDA is currently proposing guidelines for “gluten free” labeling. The agency has not set any standards on the use of the term.  The fact that it’s unregulated means that deceitful marketers can use it to sell products that could contain small amounts of gluten.  Stick to reading labels and avoiding wheat, rye, and/or barley, or products made in plants that produce these ingredients.

Saying no to the obvious suspects, bread, pasta, and cookies, as well as some not so obvious sources, like soy sauce and certain condiments isn’t as easy as it may seem.  In fact it may be better for many of us to keep gluten in our diets.  Gluten-free eating is definitely important for some, but not necessary for everyone.  So before you bid yummy bread good-bye, find out if it’s worth it for you and Celebrate you weight loss success.

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