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Summer 2013 edition


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Our Staff Makes the Difference ... But Our Patients Tell the Story

106 Pounds Down: No Limits for David Breitstein after Phenomenal Weight Loss Victory


By Linda Trainor, RN, BSN

David BreitsteinAt the age of 30, David Breitstein underwent a sleeve gastrectomy at the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center and has since lost 106.5 pounds — about 86 percent of his total body weight. His body mass index (BMI) has gone from 40.9 to 28.2. Always fatigued, not being able to exercise, and dealing with severe sleep apnea were a few of the precipitating factors that encouraged David to explore having weight loss surgery at BIDMC.

Here, David tells us about the difficulties he faced before surgery, how he has since made his health the top priority in his life, and why he now feels that he can do anything.

Q. What was your life like prior to weight loss surgery?

David Breitstein: My life was definitely harder. Even the simplest tasks, such as showering, tying shoes, and getting dressed, were difficult. When I climbed stairs, I was out of breath. Even shopping for clothes was an exhausting task: I had trouble finding clothes to fit my body. I needed to go up to a size 3X before deciding to have the sleeve gastrectomy.

David Breitstein before (left) and after his gastric sleeve procedureI think the most significant impact of carrying extra weight was always being tired. Regarding self-esteem, I was always comfortable with who I am. I was simply not comfortable with carrying around extra weight — though it never ruined my day or stopped me from going to the beach. Looking back, though, I would deal with the emotional aspects by making jokes about my own weight to others. I guess you could call it a self-deprecation of sorts. But now, I feel better about my appearance and am enjoying my newfound energy.

Q. How long have you experienced a weight problem?

David: I’ve been struggling with weight since junior high school, 14 years old. I ate large portions, too many carbohydrates. I made poor food choices; McDonald's was one of my favorites, which I do not miss now. I would eat a ton of ice cream, right out of the container. I would eat probably five or six times the amount of what other people ate. It took a lot of food to fill me up, and I could eat for a long time and not be full. I ate very quickly, and took large bites — not a good combo.

Q. What diets did you try prior to weight loss surgery, and did you have any success with any of them?

David: I tried quite a few diets — Atkins, Weight Watchers. Would you believe I even tried the Caveman diet? I suppose I’m not a caveman, because it simply didn't work just eating meats. I would lose, for example, 20 pounds and gain it all back within a relatively short period of time, plus more. I never experienced long-lasting results from any diet.

Q. Why did you choose to have weight loss surgery?

David prior to undergoing weight loss surgery at BIDMCDavid: I decided not to wait until my later years of life to have weight loss surgery. I wanted to have surgery while I was young so that I could improve my quality of life and enjoy more activity. ‘Start now’ was my mantra to hopefully enjoy a long healthy life. My mother had had the Roux-en-Y gastric bypass and has been successful for a number of years. I didn't want to go through my adult years being tired and sluggish about everything from tying my shoes to shopping for clothes.

Out of the three options for weight loss surgery, the adjustable gastric band wasn't for me because I did not want to get a needle in my abdomen to tighten the band for a fill. The RNY gastric bypass has the dumping syndrome associated with it, and I didn’t want to take the chance that I would get it. The gastric sleeve was the best choice for me, after researching it, because nothing is bypassed, and there are no foreign objects in my body.

Having that smaller stomach is allowing me to have early satiety with small amounts of food. I love my new stomach, which is about 60 percent smaller, so not much room for big amounts of food.

Q. Why did you come to BIDMC to have weight loss surgery?

David: My primary care physician referred me to BIDMC; he was very supportive of my decision to have weight loss surgery. I also reviewed many sites about bariatric surgery online and felt comfortable that the bariatric surgeons at BIDMC were highly rated.

I am so pleased with my surgeon, Dr. Jones; he has been very supportive along with the multi-disciplinary weight loss team during this entire process.

Q. What can you do now that you could not do prior to having the sleeve gastrectomy?

David at his friend's wedding in FloridaDavid: I can now tie my shoes, walk up stairs and exercise without losing my breath. I can actually do an aerobic workout, walking 3.5 miles within an hour and loving it. I can buy clothes — I’m a size 30 and I used to wear a size 46 pant size.

I do adventurous things now that I wouldn’t do before. I hike, play soccer and ultimate Frisbee. I even get invited to play pick-up games of basketball and shoot hoops. I can actually jump off the ground now.

In fact, before the surgery, I was in a wedding and the photographer asked us to jump in the air. All I could do was raise my arms. It was brutal. The wedding was in Florida, in June, and I was not happy trekking down the sand to take pictures on the beach under the sweltering sun shining at 94 degrees. But now I can jump without a problem for the next creative photographer!

Q. How has your life improved following weight loss surgery?

David: My health has definitely improved. My sleep apnea has significantly improved. Putting on my socks used to be a chore for me and now it is second nature. I can shower and dress now without a problem. I achieved what I most wanted from having weight loss surgery — an overall improved quality of life and better mobility.

My eating habits have tremendously changed. Now, I choose to lose weight by eating very slowly, eating small amounts and by making healthy choices. David playing FrisbeeBefore, I could not even comprehend myself eating like I eat now, because I would simply shovel food in my mouth rather than chew and taste it. I actually enjoy food more now that I’ve slowed the eating process down.

I have to admit that some days I miss the enjoyment I got when I ate to oblivion, but now I have a healthy respect for food as an energy source rather than a main source of pleasure. This is as much of a change as my weight loss. This is an invisible change to others, but very meaningful to me.

Q. What do you attribute your success? What do your friends, family, and co-workers think?

David: As Dr. Jones would say, ‘weight loss surgery is a tool, but it is your own personal motivation that will help you become successful.’ It comes down to me, or any person — either you want to do this or you don't. There are ways to sabotage that tool, like having ice cream sundaes or shakes, but the rules of eating are very clear following a sleeve gastrectomy: eat slowly, eat small portions. You have to be committed and think about your daily habits. I give my health a great deal of thought and effort to maintain my weight loss, as it means the world to me.

David BreitsteinMy parents, friends and co-workers have been very supportive. My father comes to all the appointments with me, we review what I eat for the day and my mother talks about healthy choices. Also, Dr. Jones and the dietitians, nurses and bariatric staff have been very supportive and encouraging.

Most of my friends and relatives thought that I would be heavy forever because of my past weight loss and then regaining it. But now everyone is so complimentary. Believe it or not, I have even inspired people — co-workers have followed my examples of healthy food choices and exercise. One actually lost weight with me at work. I think the general consensus was, ‘If Dave can do it, so can I.’

Q. Would you recommend weight loss surgery to others?

David: Yes, definitely, especially for those who have struggled with weight loss and weight regain. Weight loss surgery saved my life and changed it for the better, but I think it is very important for people having the surgery to know that this is not an easy way out. Having the surgery is not easy. My big challenge was during the first month afterwards. Make sure it is something that you are committed to having done, because there is no way that you will be able to eat like you previously did.

Q. What are your future goals?

David: I am a social worker, but my first and foremost goal is to maintain my weight and make my health number one on my list, which means making healthy choices and exercising. Appearance is not the major factor, I’ve never been vain, but my lifestyle is so much better. I can get up and do whatever I want. My philosophy is, there are no limits to what I can accomplish.

All photos courtesy of David Breitstein

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Expert Advice

Mindfulness Meditation: Awaken to Your Life


By Sara Chacko, PhD, MPH
Fellow, Integrative Medicine, BIDMC

"Our greatest weapon against stress is our ability to choose one thought over another."
- William James

busy blurry peopleVery rarely in our lives are we fully present to the world around us. We drive to work without seeing the route we took, we have conversations with loved ones without hearing their words, and we eat delicious food without tasting the full expression of flavors. Our minds race to anywhere and everywhere but the present moment, and we miss the beauty of our life as it unfolds before us.

And yet it can be exceedingly difficult to stay present in this non-stop and connected world. We have families to care for. We have careers to tend. We have dentist appointments and car appointments and bills to pay. We have Facebook accounts to check and Twitter accounts to update. A million and one competing demands and obligations vie for our attention on any given day. If that is not difficult enough, we are up against what Buddhists call our "monkey minds," a term used to describe the restless and unsettled nature of the human mind.

Mindfulness meditation is one way to stop, to slow down, and to become more aware of habits and tendencies that may be self-destructive. It involves a systematic cultivation of our attention to and awareness of the present moment.

mindfulness meditationIn the same way that lifting weights can strengthen muscles, our attention is like a muscle that can be strengthened through meditative practices such as sitting meditation, walking meditation, and yoga. With practice, we can have more control over our thoughts and day-to-day experience, and ultimately "affect the quality of the day," in the words of Thoreau.

Mindfulness, or "awareness" in Pali, is not only a way to train attention. It is also a way of being and living that involves the cultivation of an open and accepting attitude toward the present moment, and less reactive ways of responding to the constantly changing nature of our experience. It involves learning how to pay attention to and look with compassion at our thoughts, feelings, and bodily sensations as they come, allowing space for gradual adjustments to behavior.

Above all, mindfulness involves a gentleness and compassion toward oneself and great patience with our efforts toward change.

Scientific research on the health benefits of mindfulness has increased rapidly since the early 1990s. Mindfulness-based approaches have been shown to improve chronic pain, anxiety, perceived stress and depression, as well as other medical conditions, in diverse populations. Changes in the brain's structure and function have been documented as well. Brain regions associated with memory, sense of self, empathy and emotional regulation have shown measurable improvements after participation in mindfulness courses.

Mindfulness is also being tested as a novel therapy to treat obesity. Several studies suggest that mindfulness strategies may help individuals improve eating behaviors, including bingeing and emotional eating. Mindful eating, the practice of slowing down while eating and creating a space around food to fully experience taste sensations, is one important part of this practice.

This fall, a four-part series of mindfulness classes will be offered as part of the regular post-op support group in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center.

Sept. 11, 2013 Introduction to Mindfulness
Sept. 26, 2013 Mindful Eating
Oct. 9, 2013 Mindful Movement
Oct. 24, 2013 Self-Compassion and Weight

Attendance at all four classes is encouraged, but not required. Classes will be held from 6 p.m. to 7 :30 p.m. in the Shapiro 1B Conference Room. Post-op patients only, please.

For more information, contact Sara Chacko, PhD, MPH, at 617-754-1443 or sachacko@bidmc.harvard.edu.

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Nutrition Corner

Healthy Picnic-Packing Essentials


By Michelle Davis, RD, LDN
Bariatric Dietitian at BIDMC

fresh watermelonPlanning a picnic this summer with family or friends and in need of some healthy options to pack? Look no further! Here’s a list of picnic packing essentials that will be tasty and fun to eat, yet easy on the waistline. Combine foods from all of the categories for your outing, or mix and match when planning different events for a fun and filling day outside! Plus, check out these recipes for some light and fruity beverages that will keep you cool when the air is hot.

Satisfying Protein

Fill up your picnic basket with quick and easy, yet delicious lean proteins like lean cold cuts, chopped chicken and tuna, or low fat dairy like yogurt and light cheese. Spice things up by throwing proteins on top of salads, in whole grain wraps, or making yogurt-based dips for fresh fruits and vegetables.

fresh fruit kabobsColorful Produce

Summer is the time for delicious and affordable fresh fruits and vegetables. Color your picnic basket with a rainbow of fruits and vegetables like chopped carrots, celery, cucumbers and peppers, as well as sliced apples, berries, pineapple, watermelon and more! Pair your produce with protein for a filling yet delicious meal or snack.

Wholesome Whole Grains

Round out your meal with heart-healthy whole grains like whole wheat wraps/tortillas, whole grain crackers, or brown rice, whole wheat pasta or quinoa. Use these foods to make quick yet yummy sandwiches, salads and side dishes packed with nutrients and fiber.

Delicious Desserts

What is a picnic without a little dessert? But instead of high-calorie foods such as pies or cobblers, try bringing fun yet easy treats such as rainbow fruit kebobs topped with sugar-free, low fat pudding; or, drip them in low fat sweet dairy dips (like plain yogurt mixed with cinnamon and vanilla extract). Another idea: make a homemade fruit salad topped with lime juice to end a great day outdoors!

water bottleHydrating Drinks

Be sure to bring plenty of fluids, such as water, Crystal Light or decaffeinated iced tea, when sitting outside on a hot summer day to maintain hydration. Spice up your drinks by adding fresh lemon or lime, or cucumber and herbs like mint for a cool yet refreshing beverage. Check out the recipes below for quick, easy and fun summer beverages to bring on your next picnic!


Strawberry Sunrise

1 serving

strawberry smoothieIngredients

1 packet sugar-free powdered drink mix (like Crystal Light), any strawberry blend
3 frozen strawberries
1 tablespoon lime juice
5 to 8 ice cubes or 1 cup crushed ice

Directions

Dissolve drink mix into 1/2 cup cold water. Stir thoroughly. In a blender, combine drink mixture with all other ingredients. Blend to desired consistency and enjoy!

Watermelon Frojito

watermelon frojito1 serving

Ingredients

3/4 cup watermelon chunks, seedless or with seeds removed
1 lime, cut into wedges
3 to 4 mint leaves
1 packet no-calorie sweetener (like Splenda or Truvia)
5 to 7 ice cubes or 1 cup crushed ice

Directions

Place the mint leaves, half of the lime wedges, and the sweetener in a tall glass. Squeeze the juice from the remaining lime wedges into the glass and discard those wedges. Crush and "muddle" the mixture until the juice has been released from the lime wedges, the mint leaves are thoroughly bruised, and the sweetener has dissolved. Set aside.

Place the watermelon and ice in a blender, and blend until smooth. Pour into the glass with the lime-mint mixture and stir well. Drink up and be refreshed!

Recipes adapted from HungryGirl.com

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On the Lighter Side

What's in Your 'Pic-a-nic' Basket this Summer?


By Linda Trainor, RN, BSN

picnic basket and lemonadeWhether you are visiting Yellowstone National Park out west, Franklin Park here in Massachusetts, or Yogi Bear’s home at Jellystone, are you hungrier than the av-er-age bear when packing your pic-a-nic basket this summer?

Yogi knows best when it comes to hunger and picnic baskets — and no forest ranger or happy camper can argue with that.

One of the most successful and endearing characters created by Hanna-Barbera, Yogi truly has earned his (self-proclaimed) reputation for being smarter than the
av-er-age bear. You can always find the hungry Yogi plotting to snatch an easy meal and get his goodies from packed picnic baskets, in spite of the packed-on pounds gained from eating them (and despite the trouble he has getting into them!).

"I'm hungrier than the av-er-age bear. I wish I could find a bush that tasted like a birthday cake!" is one of the many great lines from Yogi that makes me chuckle as I fondly recall Yogi, Boo Boo Bear, Ranger Smith and their delightful adventures.

It’s easy to identify with Yogi getting into mischief caused by his hunger, and boredom, while dodging a few hunters. Cartoon after cartoon, we have witnessed Yogi doing things he should not do. And Yogi often has his ways of reminding us that unhealthy pic-a-nic baskets may be delicious on our lips, but remain a lifetime on our hips.

Yogi and Boo Boo Bear hit the silver screen in 2010A few of my favorite clips from Yogi's cartoon conversations hold elements of truth and humor regarding human behavior:

Yogi Bear: Boo Boo, you've tried to stop my brilliant ideas with common sense a thousand times. Has it ever worked?
Boo Boo Bear: No.
Yogi: Then ... let's go-go-go!

Yogi Bear: They have doughnuts. DOUGHNUTS!
[Yogi has a fantasy of a giant doughnut]
Boo Boo Bear: [Interrupting fantasy] Yogi, what're you doing?
Yogi: [Determined] I'm going!
Boo Boo: No, Yogi! We promised the Ranger we would stay away.
Yogi: You're right. I'm losing control, Boo Boo. I don't know who's steering the ship!

Funny as it sounds as a cartoon, in reality, who has not heard the conscious voice of reason like Boo Boo’s, trying to unsuccessfully curtail many impulsive behaviors? How many times have you had to be accountable for your own personalized struggles and schemes towards your own version of Ranger Smith?

Can you hear Boo Boo's voice? "But Yogi, Mr. Ranger isn't gonna like this."

Summertime promises to bring many opportunities to enjoy exciting fun-filled activities for the entire family. But take care to ensure that you do not take a vacation from maintaining your current weight loss.

picnic basket with fruitWhen visiting any national or local park, savor time with family and friends by boating, fishing, hiking and swimming, while honoring the palate with only healthy foods packed in your pic-a-nic basket.

Think about your hunger prior to packing your basket for your summertime day in the park, so you won't experience any kinks in your dietary plan. Think about Yogi, Boo Boo and Ranger Smith while you’re at it.

  1. Keep your eyes on your own, healthily-packed pic-a-nic basket.
  2. Listen to the Voice of Reason: If you fail to plan, you plan to fail.
  3. Be accountable to your personal goals. Repeat and fill in the blank: "I am smarter than the av-er-age _______."
  4. Remember: Don’t feed the bears!

So go have fun on those gorgeous summer days. Think like Yogi: "It's a nice day for a pic-a-nic."

And a healthy one at that!

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Signature Series

Meet our Nurse Manager for Inpatient Surgery


By Christie Roy, BIDMC staff

John Ryan, RN, Nurse Manager for Inpatient Surgical Care, Farr 9When patients come to Beth Israel Deaconess Medical Center for bariatric surgery, one of the friendly faces they may come to know during their stay is John Ryan, RN, Nurse Manager for Inpatient Surgery on Farr 9.

John has overseen the 35-bed inpatient surgical unit for nearly eight years, leading a team of more than 60 nurses, patient care technicians, and unit coordinators. In addition to caring for bariatric patients, John and his staff also deliver care to patients who have undergone thoracic surgery, pancreatic and biliary surgery, and interventional pulmonary procedures.

“We see the patients for such a short time but a very critical time in their journey,” John says. “On the inpatient side, we don't often get to see the long-term results of weight loss surgery, so it is wonderful when occasionally a patient comes back for a visit and we get to see the success of their surgery. It is also nice to attend the reunions and to hear our patients share their stories and how their lives have changed. It is a very moving experience.”

John graduated from the University of Massachusetts Lowell in 1991 with a Bachelor’s degree in Nursing. He began his career that same year as a staff nurse in vascular surgery at New England Deaconess Hospital.

After spending a few years as a clinical nurse in general medicine at Beth Israel Hospital, and then in the Vascular Intermediate Care Unit at the newly formed Beth Israel Deaconess Medical Center, John took on some more “overseer” roles at BIDMC, first as administrative clinical supervisor and then as nurse admission facilitator, before moving into his current role as nurse manager in November of 2005.

Over a five-year period, in between his variety of roles in Boston, John also worked as a travel nurse for months at a time at hospitals in California, New York City, and Arizona. And, in 2011, he completed his Master’s degree in Nursing Administration at Simmons College.

“I absolutely loved my experiences as a travel nurse,” John says. “I had the opportunity to not just visit other parts of the U.S. but to live other places. I am a summer person, so I enjoyed having a few years where I didn't have to deal with cold weather and snowstorms! I also learned a lot from the different hospitals I worked at during my travel assignments.

“As much as I enjoyed not having cold winters, I missed family and I missed working at BIDMC,” he adds. “Although there are other good hospitals, there is something special about BIDMC, and high commitment to our patients from all levels of the medical center.”

When John is not busy at BIDMC, he likes to bike and to travel, especially to the southwestern part of the U.S. And, he’s found something else to keep him occupied outside of the medical center: home ownership.

“I just bought a new house in June, so I am really involved in the new house this summer,” John says. “I am also interested in perfecting my gardening skills.”

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News

Bariatric Nurse Practitioner Honored for Surgical Patient Care


Our Bariatric Nurse Practitioner, Leigh-Ann Berk, ANP-BC, MSN, RD, was honored at BIDMC's Lois E. Silverman Department of Nursing Annual Nursing Awards Ceremony.

Leigh-Ann received the Department of Surgery and Joseph M. Koufman Foundation Award for Excellence in the Care of Inpatient Surgical Patients.  

Leigh-Ann Berk, ANP-BC, MSN, RD (far right), with other surgical care honorees Melissa Jones, RN, and Jeanne Carbone, RN, and Elliot Chaikof, MD, Chief of the Department of Surgery at BIDMC

Leigh-Ann was nominated by two of the physicians in the Weight Loss Surgery Center at BIDMC, where she has worked since 2010. Her colleagues note Leigh-Ann's commitment to quality patient care and say she has a "whatever-it-takes attitude and exceptional bedside manner."

Leigh-Ann says she will use her award to attend Obesity Week 2013, held during the annual American Association for Metabolic and Bariatric Surgery Conference.

The nursing awards ceremony was held on May 13, 2013, the start of National Nurses Week, at Fenway Park.

Congratulations, Leigh-Ann! 

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Ask the Trainer

Improving Muscular Imbalance


By Derek Walczak
Exercise Physiologist, Tanger BeWell Center at BIDMC

Almost everyone has some form of muscular imbalance in their body. These imbalances can cause tight muscles, impaired movement and, the worst case scenario, injury. The human body is a series of kinetic chains; therefore, a tight muscle will pull on all muscles in the chain and ultimately can put a joint at risk for injury.

As an exercise physiologist, it’s my job to identify and correct these imbalances before I even begin training someone. This not only ensures top performance for the individual, but also aims to prevent injury. A proper stretching program is key to correcting these imbalances.

Here are a few stretches for the most common imbalances people suffer from. Try each one for 10 seconds and build up your time slowly. Never stretch to the point of major discomfort, and do not bounce or roll during the stretch. These stretches should only be attempted if you have been cleared by your doctor to take part in an exercise program.

Piriformis Stretch

stretchThe aim here is to place your hand behind your opposite knee and then gently pull your knee closer towards your chest. As you do this, maintain a slight pressure upon your other knee (the one on the side being stretched). This should increase the stretch across the Piriformis muscle (deep to the glutes) and you should begin to feel a stretch in the buttock region. This can help with low back pain due to stiffness or tight hips and glutes, and relieve pain associated with sciatica.

  1. Lay on the ground, flat on your back with feet flat on the floor, knees pointed to ceiling.
  2. Place your left foot on your right knee.
  3. If you are flexible enough, raise your right leg and pull your right knee into your body at a 90-degree bend in the knee.
  4. You can lightly push out on your left knee.
  5. Hold stretch for 10 seconds; repeat with the opposite side.

Easier variation (seated)

  1. Sit up straight in a chair with both feet flat on the ground.
  2. Place your left foot on your right knee.
  3. If you are flexible enough, push down lightly on your left knee while pushing up on your right toes.
  4. Hold stretch for 10 seconds; repeat with the opposite side.

stretchWall Stands and Chest Stretch

This stretch will help to increase the range of motion in your shoulders and chest cavity.

  1. Stand with heels 6 inches from a wall.
  2. Maintain three points of contact with the wall: butt, shoulders and head.
  3. Keep arms and hands against the wall at all times.
  4. Begin with arms bent at 90 degrees and run up the wall, then return.
  5. Repeat 10 times, and complete 2 sets.

stretchChest Stretch

  1. Stand at the end of a wall or in a doorway facing towards the wall.
  2. Bend your arm at the elbow and place the inside of your forearm on the surface of the wall, positioning your bent elbow at shoulder height.
  3. Turn your body away from positioned arm. Hold the stretch for 10 seconds and repeat with the opposite side.

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

Summer Picnic Recipes


Q. What can I pack for my picnic that's healthier than the typical fried chicken?


Michelle Davis, RD, LDN: If you’re thinking about having a fun picnic this summer, spice it up with these quick, easy and healthy recipes!

Quinoa Salad with Mango, Avocado, and Tomatoes

Source: TwoPeasAndTheirPod.com

Serves 8

quinoa saladIngredients

1 cup uncooked quinoa
2 cups water
1 large mango, diced
2 large tomatoes, diced
3 green onions, sliced
1/2 cup chopped cilantro
2 medium avocados, diced
1/4 cup fresh lime juice
1 tablespoon olive oil
1/2 teaspoon cumin
Salt and pepper, to taste

Directions

Using a strainer, rinse the quinoa under cold water. Add quinoa and water to a medium saucepan and bring to a boil over medium heat. Boil for 5 minutes. Turn heat to low and simmer for about 15 minutes, or until water is absorbed. Remove from heat and fluff with a fork. Let quinoa cool to room temperature.

In a large bowl, combine quinoa, mango, tomatoes, green onions, cilantro, and avocados. In a small bowl, whisk together lime juice, olive oil, and cumin. Pour the dressing over the quinoa salad and gently stir until well combined. Season with salt and pepper. Serve at room temperature or chilled.

Mayo-Free Tuna Salad Lettuce Wraps

Source: TastyKitchen.com

Serves 6

tuna lettuce wrapsIngredients

12 oz. tuna packed in water, drained
2 scallions, finely chopped
12 small dill pickle chips, finely chopped
2 tablespoons fresh basil, chopped
4 tablespoons freshly squeezed lemon juice
3 to 4 teaspoons extra virgin olive oil
Salt and pepper, to taste
6 leaves Bibb or Boston lettuce

Directions

Place the drained tuna into a bowl, and use a fork to break it up into small pieces. Add the scallions, pickles, basil, and lemon juice. Mix until everything is combined. Drizzle the extra virgin olive oil into the tuna mixture. Add salt and pepper to taste, and serve on top of Bibb or Boston lettuce leaves. Enjoy!

Confetti Slaw with Poppy-Seed Dressing

Source: MyRecipes.com

Serves 4 (2/3 cup servings)

slawIngredients

2 tablespoons cider vinegar
Drizzle of honey or agave (or 1 packet
no-calorie sweetener)
1 1/2 teaspoons Dijon mustard
1 1/2 teaspoons chopped fresh dill
1 teaspoon poppy seeds
1 teaspoon olive oil
1/4 teaspoon salt
1/4 teaspoon pepper
1 cup thinly sliced green cabbage
1 cup thinly sliced red cabbage
1/2 cup pre-cut matchstick carrots

Directions

Combine the first 8 ingredients in a bowl. Add cabbage and carrots; toss to coat. 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 July 2013