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Fall 2013 edition


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Seven Years Strong

Sam I Am ... Svelte, Stylish & Successful


By Linda Trainor, RN, BSN

Seven years after having weight loss surgery, Samantha Bishop (known simply as Sam) is ecstatic about her long-term success.

Samantha Bishop before (left) her adjustable gastric band procedure and after.“Time flies when you’re getting healthy and fit,” she says.

The smile on Sam’s face as she talks about the results from her adjustable gastric band surgery could light up a room.

“I never realized, until I lost 120 pounds, how the extra weight dragged me down physically and emotionally,” she says.

Dr. Daniel Jones performed Sam’s surgery in December 2006 in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center, and Sam vividly recalls how tiring her life was, and how she let the extra weight mask her self-esteem and self-confidence, beforehand.

“Even though I played varsity sports, sang in the chorus, and was a part of student government, carrying an extra 120 pounds was debilitating,” she notes. “I wasn’t very candid about my feelings to any of my girlfriends because I never thought that they could relate to my size and how my weight negatively affected me.”

A popular teen, Sam was voted the funniest in her high school class. But she knows she was always hiding her true feelings behind her jokes and laughter. She admits to investing a significant amount of money and time into several yo-yo dieting plans, and eventually grew tired of “food fighting” and not seeing lasting results.

Through the dieting and her work with a personal trainer, Sam learned that she was both physically and mentally strong — she just needed to change her relationship with food.

Sam stretching before a run“I realized that my food intake was much greater than my expended energy,” she says. “I knew that I needed help with my portion control.”

After extensive research and discussion with her primary care physician and parents, Sam opted to have weight loss surgery. She decided that the adjustable gastric (lap) band was the right choice for her, taking into consideration that it was a less invasive procedure and could be personalized with band fill adjustments.

Although she was only 19 years old at the time, Sam was very confident in her decision.

“It may have appeared that obesity did not affect my life, but the truth was, in my future was the risk of developing diabetes, hypertension, and severe arthritis if I continued life at that weight,” explains Sam. “I was also scared of not being able to have a family of my own.”

Most importantly, Sam had recognized that in later years, being overweight and having these types of illnesses would give her a higher risk of early mortality. Though she was still in college, working towards a degree in public health, and was not afflicted with any health problems, Sam was determined not to risk her future or live life only half-filled with joy or happiness.

Now seven years later, Sam lives her life to the fullest. She has reached many milestones since her lap band was placed.

Sam running in a road raceAmong them, “I ran a 13.1 mile half marathon in Boston,” she shares. “I remember crossing the finish line, feeling so accomplished and proud of my newfound endurance.”

Another milestone was buying her first bikini. “Hard work pays off!” she says.

Sam has become well-versed in speaking about the lifestyle adjustments necessary to keeping the weight off in the long term.

“Having weight loss surgery is no easy way out from obesity,” she acknowledges. “It’s simply a great tool that helped me reach my goal weight. I don’t think that it is for everyone, because it requires a strong commitment to a complete lifestyle change. But I never looked at having surgery as a quick fix for my problem.”

Sam believes her most important accomplishment is gaining a new appreciation for whole, natural foods and staying vigilant with her fitness routine.

“I work hard and play hard. I don’t think of myself as being on a diet,” Sam, now working as an emergency room technician, notes. “Many of my co-workers notice that I am full of energy and determined to provide a quality experience for my patients."

Sam is passionate about health care and plans to further her education as a registered nurse, specializing in emergency medicine. She also plans to stay on track with her weight management and hopes she can encourage anyone to succeed with these tips for long-term success after weight loss surgery:

1. Establish a good rapport with food.

Does the food you eat fuel your body or your feelings? Examine your relationship with food and how you choose to eat it. Sam now looks at food as an energy source instead of a guilty pleasure, and takes small bites, uses small plates and utensils, and chews slowly. She also puts the utensils down between bites.

2. Hydration.

Always keep a water bottle with you and sip frequently. Try for 64 ounces or more daily. For added taste, add a calorie-free flavor mix. Sam believes drinking a lot of water is a major contribution to feeling full, early satiety, and reaching your desired weight.

3. Take the long route.

Park further away from stores or work and use the stairs instead of the elevator. Sam also challenged herself with a pedometer; she started by taking 10,000 steps a day and gradually increased to 20,000. And, keep an extra pair of sneakers in your car trunk or office — when the timing is right and the mood strikes, you will be ready to walk or jog.

4. Create colorful plates.

Introduce new and colorful fruits and vegetables to your plate. Don’t be afraid to experiment with different foods, like spinach leaves instead of iceberg lettuce. Since having her surgery, Sam eliminated heavy carbohydrates from her diet (pizza, bagels, pasta) and replaces them with more nutritious items like Greek yogurt, cottage cheese, rice cakes and avocados. Discuss any diet changes with your bariatric nutritionist.

5. Prep your food in advance.

Before your work week starts, put together healthy, well-balanced meals that provide a good source of energy. With her busy schedule in the emergency room, Sam says this has saved her a lot of money, calories and time. One night a week, she cooks sweet potatoes, green leafy vegetables, and chicken and fish lightly seasoned with garlic and olive oil. “I try to follow a clean eating regime,” Sam says. “I have pretty much eliminated processed foods.”Sam getting ready for another road race

6. Get plenty of sleep.

Try to get at least 8 hours of sleep every night. Sam does not eat for at least three to four hours before bed, and refrains from caffeine. After working her evening ER shifts, Sam goes home, takes a hot shower, and hits the hay.

7. Stay strong with support from like-minded people.

Develop a strong support system. Sam utilized the Weight Loss Surgery Center’s follow-up schedule and keeps her yearly appointments, but always calls the clinic with questions or concerns. She participates in group exercises as well — fitness boot camp, field hockey, fun runs — and is involved with a hiking group that meets monthly.

Sam also enjoys the company of her boyfriend of two years, who enjoys eating healthy and taking part in sports and activities, too. He can always be found running by Sam’s side as her personal cheerleader, encouraging her during all her long distance runs.

“If you are seriously considering weight loss surgery,” Sam advises, “be sure to commit to a healthy lifestyle. The long-lasting results are truly worth your efforts.”

All photos courtesy of Samantha Bishop 

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News

Patients, Staff Reunite to Celebrate Success


By Christie Roy
BIDMC staff

thumbs upIt is a unique bond shared by bariatric patients and the clinicians who have treated and continue to care for them in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center; a bond that turns the typical doctor-patient relationship into more of a friendship. After all, as many bariatric patients acknowledge, their lives have been changed, improved, and even saved by the work and support of these surgeons, nurses, and staff members.

Thus it was sense of genuine camaraderie and gratefulness that filled Longwood Hall at the Inn at Longwood Medical recently for BIDMC’s annual Weight Loss Surgery Reunion, a celebration of life-changing success. Among the Center’s staff and patients, the flowing conversations lent themselves more to jokes and talk of hobbies, leading up to a few no-holds barred speeches from patients who were willing to share their personal experiences.

As they chatted, everyone in attendance enjoyed the yummy food selections for the evening (approved, of course, by bariatric dietitians Michelle Davis, RD, LDN, and Kate Otto, RD, LDN): a colorful array of fresh fruits and vegetables and several delectable passed hors d’oeuvres, including bruschetta and watermelon cubes topped with feta cheese.

After congratulatory and encouraging words from members of the bariatric team, and wishes for continued success from BIDMC’s Chief Operating Officer Nancy Formella, several patients bravely — and proudly — took to the microphone.

Jessica Catturini, Maternal-Fetal Medicine at BIDMCJessica Catturini (left), an administrator in the Division of Maternal-Fetal Medicine at BIDMC, was first. Her surgery was performed about six years ago by Dr. Benjamin Schneider, and she is very glad to be leading a healthier lifestyle.

“This reunion is a reminder of my hard work and why I did it,” Jessica explained of her decision to speak out to others. “It’s my way of giving back, saying thank you to Dr. Schneider and the rest of the staff, and I hope to inspire others to be healthy.”

Another patient, Cecilia Roberts, noted that while she has dropped 10 dress sizes and is much healthier since her surgery four years ago, she wanted to speak for everyone who continued to make healthy choices but were still “heavy.”

“Even if you can’t lose every single pound,” she stressed, “it’s okay.”

Laura Fritz, a personal trainer and dance instructor, spoke with exuberance about her transformation after undergoing lap band surgery approximately a year and a half ago.

“My clients have seen me go from big to small,” she said. “Dr. Jones will always be my hero!”

Nancy Del Prato, known as 'Del,' underwent lap band surgery nearly 10 years ago and has kept off 178 pounds.One of Dr. Daniel Jones’ first bariatric patients also spoke to the group. Nancy Del Prato, known simply as “Del,” (right) had lap band surgery nearly 10 years ago at BIDMC. At the time, she hardly told anyone what she had decided to do; now, she's ready to inspire others.

“People make judgments,” was her matter-of-fact reason for initially staying quiet. “This is not an easy way out. I weighed more than 350 pounds and with the way I was going, if I hadn’t had this surgery, I would either be dead or I’d have severe health issues.”

Del, who has lost around 178 pounds overall and kept it off, said her feelings of hunger disappeared the second she woke up from the procedure and haven’t come back. She recalled sitting in her living room in those first weeks after surgery, carefully measuring everything she ate and waiting to see what would happen.

“I didn’t care about the numbers really,” she said. “I cared about the process and believed in the process.”

Attending support group meetings were helpful in that process, Del added, and it was the “little things” that continuously put a smile on her face: the first time she could see the seat between her thighs in the car, the first time she didn’t need an airplane seatbelt extender, the first time she walked into a store and the clerk looked directly at her, not through her.

“I don’t know how someone can look through you when you weigh 350 pounds, but they did!” Del quipped, bringing about cheers, laughter, and encouraging words from fellow patients as they all recalled similar moments.

George Blackburn, MD, PhD, Director of the Center for the Study of Nutrition Medicine at BIDMC and a pioneering force of bariatric surgery in New England, was pleased by the reunion’s turnout and noted that such gatherings carry many advantages for patients.

“The more you come to our support groups and activities, the more successful you’re going to be with your health,” he said. “A group allows you to ‘show and tell’ your life activities and hear from others. It makes you more mindful of what you’re doing to be and stay healthy. Those patients who are the most mindful are the most successful.”

Dr. Schneider ended the evening with brief, yet thoughtful, remarks to this extraordinary group of people who have achieved so much since their first visit to the Weight Loss Surgery Center.

“It is a privilege,” he told them, “to take care of you.”

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Nutrition Corner

Slow Cookers = Quick and Easy Cuisine


By Michelle Davis, RD, LDN
Bariatric Dietitian at BIDMC

slow cookerHello, Fall! Although it is hard to say goodbye to summer, I am always happy to welcome in my favorite time of year. Fall is a time full of cool (but not freezing!) temperatures, beautiful foliage, apple picking, pumpkin carving and so much more. We all also know that fall is a time to get back on schedule after the summer months and for some, this means refocusing on weight loss efforts.

One recommendation that will always come with weight loss and weight maintenance is dining in. When we prepare our own meals, we can control what we eat and make substitutions as needed to change the nutrient content of our dishes. But do you feel that cooking every night is close to impossible when your week is filled with work, carpools, sports practices and more? Then say hello to the best batch cooking agent out there: the slow cooker.

slow cookerSlow cookers are a wonderful invention, allowing us to cook simple yet hearty and delicious meals. Many recipes using a slow cooker are one step only — meaning you add all the ingredients at the same time, turn the pot on, and let the magic happen! Not only do you not have to do the work, but the “low and slow” cooking method of allows all of the ingredients to blend together, making the dish very flavorful.

The slow cooker can be used for many different dishes and meals; from chili and stews to homemade breads and oatmeal, this awesome kitchen tool can do just about anything.

Have I convinced you to pull that slow cooker out from the back of the cabinet and start batch cooking? I hope so! Try and take some time during the weekend to make one or two dishes for quick and easy meals for the whole family to enjoy all week long. Here are a couple of recipes to get started!


Pumpkin Chicken Chili

6 to 8 servings

pumpkin chiliIngredients

1 can (14 oz.) diced tomatoes
1 can (14 oz.) pumpkin puree
2 cups low sodium chicken broth
1 large onion, diced
5 cloves garlic, minced
1 Tbsp chili powder
1 tsp ground cumin
1 heaping tsp dried oregano, crushed between fingertips
1 tsp sea or kosher salt
1/4 tsp black pepper
1 1/2 lbs. chicken breast or cutlets, skin and visible fat removed
1 to 2 chipotle peppers in adobo sauce, seeds removed, minced (optional)
2 cans (14 oz. each) chickpeas, rinsed and drained
1 cup corn kernels (thaw if frozen)
2 Tbsp fresh cilantro, chopped

Directions

Add tomatoes, chicken broth and pumpkin to a 4- or 5-qt. slow cooker. Whisk until well combined; add onion, garlic, chili powder, cumin, oregano, salt, pepper and chipotles; combine well. Add chicken, chickpeas and corn. Cook 4 to 5 hours on high or 6 to 8 on low.

When ready to serve, remove chicken and chop into bite-size pieces or shred with two forks. Add back to pot, stir in cilantro and serve with low fat/fat free sour cream or plain Greek yogurt, shredded low fat cheddar cheese and green onions.

Recipe adapted from CinnamonSpiceAndEverythingNice.com


Slow Cooker Apple Cinnamon Steel-Cut Oatmeal

apple oatmeal7 servings (3/4 cup each)

Ingredients

2 apples, peeled, cored, and cut into 1/2-inch pieces (2 1/2 to 3 cups chopped)
1 1/2 cups fat-free milk (or substitute non-dairy alternative like almond milk)
1 1/2 cups water
1 cup uncooked steel-cut oats
2 Tbsp brown sugar (or sugar substitute like Splenda or Truvia)
1/2 to 1 tsp cinnamon
1 Tbsp ground flax seed (optional)
1/4 tsp salt
Optional garnishes: chopped nuts, raisins

Directions

Coat the inside of 3 1/2-qt. (or larger) slow cooker with cooking spray. Add all ingredients (except optional toppings) to slow cooker. Stir, cover, and cook on low for approximately 7 hours (slow cooker times can vary). Spoon oatmeal into bowls; add optional toppings, if desired. Store leftovers in refrigerator. Note: this dish freezes well.

Recipes adapted from TheYummyLife.com

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On the Lighter Side

The Hungry Horrors


By Linda Trainor, RN, BSN

The Hungry HorrorsTummy to Tommy ... Tummy to Tommy …

Does not compute ... Does not compute …

Has your brain, like Tommy’s, ever failed to receive the message from your gut, letting you know that you are full and satiated after eating a well-balanced meal?

Have you ever thought, “Something is wrong in my world today, because everything on this planet seems so very tempting to munch, crunch, chew and swallow,” even though you’ve already had a good meal and healthy snack? You may wonder, do I have a bottomless pit for a stomach? Or, even if you’re well into your 30s, maybe I’m having some sort of growth spurt?

Have you had difficulty explaining an indescribable feeling of hunger during these spooky moments? Most importantly, has your hallowed day ever turned into a hallowed month? Have your holidays ever become Holi-months?

If so, this is the time to be forewarned about the phenomenon known as the Hungry Horrors. Make no mistake; feeding into this type of hunger could result in a global horrification as everyone steps on to the scale on January 1, 2014. So take action now!

plastic spiders on celery sticksIn the days and months ahead, you need to be armed and ready to face the Hungry Horrors. Don’t be tricked — treat this creepy and sometimes scary uprising hunger with these tidbits:

  • Free yourself by repeating or pasting this mantra on your refrigerator to escape the alluring food frenzy: One bite is too much, a thousand never enough to fill this type of hunger.

  • No need to buy a crystal ball; take a magic carpet ride and flash forward with your keen visualization skills to January 1, 2014. Imagine stepping on the scale and seeing your desired weight (or close to it) on that day. Just because you took a PEEK without the BOO into the future, you’ll remember to bite right rather than bite fright.

  • Use H2O to trap your hunger and pave your way through the maze … until that signal from your gut reaches your brain and reminds you that you’re most definitely full.

  • Ascend into gladness with a fun activity that requires two hands — arresting the temptation of descending into the Hungry Horrors madness.

Hunger beware: This lethal line-up will assure that your body is not haunted but deliciously healthy!

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Signature Series

Meet our Administrative Manager


By Christie Roy
BIDMC staff

Yara Davila, administrative manager of the Weight Loss Surgery CenterPatients coming in to the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center may not interact with her often, but Yaramalies (Yara) Davila is always there behind the scenes, making sure the clinic’s day-to-day operations are running smoothly.

As the Administrative Manager for the Divisions of Acute Care Surgery and General Surgery at BIDMC, Yara oversees the work of the multidisciplinary team in the Weight Loss Surgery Center, helping to make what can be a very long and confusing process for a patient as easy as possible.

“Working with the team around workflows and polices, customer service expectations, access issues, and process improvement — all this impacts the patient,” explains Yara. “It can be as simple as making sure that the person who answers the phone has the training to answer all the questions a current or prospective patient might have.”

Yara has worked at BIDMC for nearly three years now and loves the fact that here, the patient is at the center of everything.

“At other hospitals, I felt that it was easy to lose sight of the reason we are in healthcare,” she says. “Here at BIDMC, the patient is really at the core of all that we do. The Human First campaign really reflects the way we have always worked here, at least in the time I have been here.”

Born in Puerto Rico, Yara and her family moved to New York when she was five and then to Brockton, Mass., a few years later. Yara earned her Bachelor’s degree at nearby Stonehill College and still lives in Brockton (with her dog, Nino). A family-oriented person who loves to spend time with her mom and grandmother, Yara cites her grandfather as the reason she pursued a career in healthcare.

“When I was in college, my grandfather became really sick and the healthcare system in Puerto Rico really failed him,” Yara says. “He was not treated with courtesy, dignity or respect. Going through that experience with him made me realize the importance of an administrator’s role in healthcare.”

That’s why Yara takes her role seriously in the Weight Loss Surgery Center, working hard with the rest of the team to ensure that all of the clinic’s patients are treated with courtesy and compassion while always looking for ways to continuously improve care.

“I wanted to work with bariatrics because I believe in the work this team is doing,” Yara says. “This is a great team to work with!”

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Ask the Trainer

Increase the Weight or the Reps?

Q. I am about six months post RNY gastric bypass.

I used to be a couch potato. Now I do cardio five to six times a week and weight lifting (machines) every other gym visit. In addition to weight loss, I am trying to tone and build strength. As a general rule, is it better to increase the amount of weight lifted or to increase the number of repetitions, or both?
- Carolann

Derek Walczak, Exercise Physiologist:
This is a great question and one that confuses many gym goers. To answer it, we must first understand the relationship between training load (weight), repetitions and the training goal. First, let’s get a little technical.

lifting weightsBasically, the heavier the weight = the fewer repetitions one can perform in a given set. The heaviest weight one can lift for a single repetition maximum is referred to as a 1 rep max or 1RM.

According to the National Strength and Conditioning Association’s (NSCA) repetition maximum continuum, the closer you get to 1RM (lifting a heavier amount of weight), the training becomes geared more toward strength. The further away you get from a 1RM (lifting a lighter amount of weight), the training focus shifts more toward muscular endurance.
Examples:

Increasing
Strength
Increasing
Muscular Growth
Increasing
Muscular Endurance
More weight/fewer reps:
Perform 6 or fewer reps at an intensity of 85% or greater of 1RM*
Keep it about even:
Perform 6 to 12 reps at an intensity of 67 to 85% of 1RM 
Less weight/more reps:
Perform 12+ repetitions at an intensity of 67% or less of 1RM 

(Note that these are optimal guidelines and the training goals do overlap. All three training goals will still be achieved on some level no matter the load and repetitions.)

So, how does this translate to your exercise program?

Whenever you try a new exercise, you should always learn the proper form by beginning with light weight and a higher number of reps. Once this has been mastered, you can increase the weight (2.5 to 5 lb. increments are recommended) and lower the reps until this becomes comfortable. Then, repeat.

Example — Seated Row Machine

Week  Sets Reps Weight 
Week 1 10  60 lbs.
Week 2 10 to 12 60 lbs.
Week 3 12 to 15 60 lbs.
Week 4 10 65 lbs. 

The key in training for any goal is program variation. For example, if resistance training is performed three times a week, you can vary the load and repetitions in each workout. On Monday you may focus your goal on strength by performing 8 to 10 reps, while on Thursday focus on muscular endurance by lessening the weight and performing 15+ reps; on Saturday, repeat the process. This will keep your workouts fresh, and lessen the strain on joints and connective tissues while reducing the risk of an overuse injury.

lifting weightsIt is recommended to allow a day in between resistance training workouts for rest and recuperation. It is also worth noting that as you become stronger, it takes longer to recover: sore muscles groups will need up to 48 hours to recover.

So as you can see, weight and repetitions are inversely related — as the weight increases, the repetitions will decrease. Start with light weight and higher reps to master your form, and then slowly increase the weight while decreasing the reps. Be sure to vary your workouts and always give your body adequate time to rest and recover.

The NSCA recommends to never go below 8 reps for assistance exercises (single joint or isolation movements, such as the biceps curl), and fewer than 6 reps should only be attempted by those with proper training under a qualified fitness professional.

* This load and repetition assignment should only be performed with primary compound exercises (multi joint), such as the bench press and squat. Never with assistance exercises (single joint) such as biceps curl and machines.

Please consult a physician before starting any exercise program.

Derek Walczak is an Exercise Physiologist at BIDMC's Tanger Be Well Center. He holds a BS in Kinesiology from UMASS Amherst and is a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association.

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Ask the Dietitian

Fabulous Fall Food


Q. I'm looking for some simple and healthy recipes that incorporate seasonal fruits and vegetables.


Michelle Davis, RD, LDN: Look no further! Here are a couple of light and delicious recipes to try out for dinner and dessert this fall season. 

Spaghetti Squash with Roasted Brussels Sprouts and Chickpeas

Source: Blog.FatFreeVegan.com

Serves 5 to 7

spaghetti squashIngredients

1 spaghetti squash
1 lb. Brussels sprouts
1 medium onion, halved and thinly sliced
3 cloves garlic, pressed
1/2 cup vegetable broth
15 oz. chickpeas, rinsed and drained
2 tsp dried basil
1/4 tsp red pepper flakes (or to taste)
salt and black pepper, to taste
1 1/2 tsp lemon juice
Sliced almonds (optional)

Directions

Preheat oven to 400°F. Pierce the spaghetti squash 8 to 10 times with a skewer or thin knife (pierce deeply through flesh into center). Place on a baking sheet on center rack of oven; bake for 30 minutes and then rotate the squash a 1/4 turn. Bake another 30 minutes or until outside has browned in places and shell feels soft. Remove from oven and set aside until cool enough to handle. Once cool, cut it in half, remove and discard the seeds, and scrape the strands of squash out with a fork. Put the squash into a bowl and set aside.

While the squash is cooking, prepare the Brussels sprouts. Trim and discard the ends and cut the sprouts in half (quarter larger sprouts). Place on a baking sheet and spray with olive oil. (This prevents burning; if you don’t want to use the oil, cover loosely with a sheet of aluminum foil.) When the squash has almost finished cooking, put the sprouts into the oven and bake for about 15 minutes, stirring halfway through. Remove them when they are just beginning to brown but are not burning.

In a large, deep, non-stick skillet, cook the onions over medium-high heat until they turn golden, about 5 to 6 minutes. Add the Brussels sprouts, garlic, and vegetable broth and cover tightly. Cook for 3 to 5 minutes, adding more broth or water if skillet becomes dry. Add the chickpeas, basil, and red pepper flakes. Stir in the spaghetti squash, and toss gently to mix. Cook until heated through. Add salt and pepper to taste along with lemon juice. Serve topped with crushed or sliced almonds, if desired.

Autumn Spiced Apples

cooked spiced applesSource: SparkRecipes.com

Serves 10

Ingredients

10 Gala apples, cut into 1-inch slices
1/4 tsp nutmeg
1 tsp cinnamon
6 tsp Splenda
2 Tbsp light butter or margarine

Directions

Put all spices into small bowl and stir; set aside. Melt the butter in a medium size saucepan and add apple slices. Spoon spice mixture over apples, stirring to cover completely. Cover and cook on medium heat for 20 minutes, stirring frequently. Serve and enjoy!


Michelle Davis is a bariatric nutritionist in the Weight Loss Surgery Center at BIDMC.

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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Originally posted October 2013