076 What to Eat with Sarah Muntel, RD

by reeger on October 16, 2016


In this episode I bring you my conversation with registered dietician, Sarah Muntel. Sarah has been a registered dietician in bariatric surgery for over 17 years. She brings a wealth of information and education to you in this episode.

Covered in this episode:

  • Sarah’s role as a registered dietician and program coordinator
  • Pre-surgery nutrition plans
  • Eating like a bariatric surgery patient: More protein. More vegetables. Less fruit. Avoid bread, rice, pasta
  • Why pre-bariatric surgery classes and preparation is so very important
  • How to make changes to your nutrition when you experience resistance from family or friends
  • What role do meal replacement shakes can play before surgery
  • Alternative powdered protein recipe for those who do not want artificial sweeteners
  • Pros and cons to pre-surgery weight loss requirements
  • Her programs post-surgery protocol
  • Grams of Protein recommendation
  • Volume of Water recommendation
  • How to help people remember to eat and drink
  • Importance of food journaling
  • Changing perspective from dieting mentality to food is fuel
  • Food intolerance
  • Flavor intolerance
  • Lactose Intolerance
  • What to eat when you don’t know what to eat anymore
  • Eating on a limited budget
  • Is it possible to take in too much protein and if so why is this a problem
  • Why do we care so much about protein
  • Do calories even matter anymore
  • Indirect calorimetry testing
  • Volume of food- at 3 months out most people are eating 4 ounces per meal made up of 2 ounce protein and 2 ounces non-starch vegetables (measured cups) and supplement with protein shake between meals as needed
  • What to do about weight regain if it happens
  • Why is the second holiday season after bariatric surgery often trickier than the first holiday season after bariatric surgery
  • Holidays, vacations, birthdays, and other special occasions
  • Connecting with successful weight loss maintainers
  • Bonus Content: A message of love to my dad

Protein Brands Mentioned in this Episode

Resources Mentioned in this Episode
Cooking Light
Obesity Action Coalition
Emotional First Aid Kit Bariatric by Cynthia L. Alexander, PsyD

One more Resource: Here is a link to a Youtube video of a presentation at Your Weight Matters 2015 in which Sarah was one of the presenters. “”An In-depth Discussion on Post-Surgical “Rules” and Recommendations””

In Kindness,


PS: If you would like to support the podcast by becoming a patron, please click HERE




In this episode I have a conversation with Dr. Walter Medlin about bariatric surgery rules. You may remember Dr. Medlin from episode 53. He is a bariatric surgeon at the Bariatric Medicine Institute in Salt Lake City, Utah. He is also a bariatric surgery patient having had sleeve gastrectomy.

During this conversation Dr Medlin and I share our thoughts on bariatric surgery rules from the perspective of what is known from the scientific evidence, what we have seen in our own practices or heard about (anecdoctal evidence), and what rules Walt applies to his own bariatric surgery journey.

The Bariatric Surgery Rules Discussed In This Episode:

No Straws:
Concern: swallowing of air, stretching of stomach, too fast rapid ingestion of water or beverage
Our Conclusions: No evidence to support No Straw rule, but we both feel straw use too early can cause unneeded discomfort but after that, each person will need to explore on their own.

No Gum:
Concern: Swallowing of gum can cause obstruction, swallowing of air with gum (see above), chewing action leads to increased hunger, sugar alcohols cause bowel issues.
Our Conclusions: No published evidence that gum chewing is a problem. We are neutral on if gum-chewing increases hunger but Dr Medlin personally avoids gum after eating due to his own concern for gum chewing “chasing food out of the stomach.”

No Caffeine:
Concerns: Caffeine is considered to be a gastric acid stimulator possibly worsening reflux/heartburn/ulcers. Also caffeine is a type of a diuretic (makes you pee) and can therefore increase dehydration. It is addictive (transfer addiction?). Designer coffee drinks can come with a lot of calories. Perpetuates the cycle of stimulant/crash/stimulant crash.
Our Conclusions: We both agree the time to withdrawal from caffeinated drinks is BEFORE going into the hospital for your surgery. After surgery,Dr Medlin allows his patients to have caffeine shortly after bariatric surgery. For himself he avoided caffeine in his first year after gastric sleeve because of taste preference. I requests my patients wait 6 months after surgery before bring caffeine into their diet because I want them to focus on drinking fluids that stay in their bodies, not force fluids out.

No Carbonation:
Concerns: Stretching of the new stomach? Increasing risk of heartburn and reflux? If calorie drinks- empty calorie.
Our Conclusions: There is no evidence to support carbonation stretches the new stomach. It may cause heart burn or discomfort for some people. Avoid calorie-laden drinks.

SIDE NOTE: Both Dr Medlin and I agree that dehydration is a very common issue for people early post-op and therefore setting people up to receive a liter or two of IV fluid a few days after bariatric surgery helps them out significantly.

No NSAIDs (Ibuprofen, Advil, Aleve, etc)
Concerns: NSAIDs increase the risk for stomach ulcers. Highest risk is in gastric bypass patients.
Our Conclusions: The risk is very real. Avoid NSAIDs if at all possible. If a person must take them they should understand the risks and seriously consider a “stomach protective” medication like a proton pump inhibitor, histamine 2 blocker, +/or Carafate.

No Nicotine
Concerns: Nicotine causes many problems within the body.
Our Conclusions: Early post-op Dr Medlin has concern for increased risk of blood clots, poor wound healing, and increased risk for pneumonia. I agree. Long-term we are both concerned that nicotine increases the chances of stomach ulceration. This is a very real risk! We both want our patients to be off nicotine as much as possible, including smoking cigarettes, e-vaping with nicotine, patches, gum, chew, and second-hand smoke.

No Ice
Concerns: Ice triggers stomach spasms or cramping? Excessive cooling of a fresh staple line causes reduced blood flow and impairs healing?
Our Conclusions: Probably best to avoid excessive ice in the early post-op period for no other reason than avoiding the possibility of stomach cramping but otherwise ice is not something we are concerned about (aka- best to explore on ones own.) There is no evidence that swallowed cool or cold liquids in the new stomach reduced blood flow and impairs healing.

SIDE NOTE: Obsessive ice chewing can be an indication of iron deficiency anemia. Medically this is known as PICA- the eating of non-food items and specifically it is known as PAGOPHAGIA- the eating of ice.

Vitamins and Medicine:
The Rules: All medicine/vitamins need to liquid, chewable, or capsules (avoid extended release) AND do not take iron and calcium together AND take only bariatric-formulated vitamins AND what about transdermal vitamin patches?
Concerns: Liquid, chewable, capsules are the easier to digest than tablets. One should avoid extended release medicines because of slower disintegration times intended for full-length GI track. If medicine/vitamins are tablets they have an increased risk for getting “stuck” in the new stomach and/or slower digestion times. Regarding calcium and iron, they bind to each other thereby reducing their absorption. Is there any proof that transdermal vitamin patches work?
Our Conclusions: Follow your program and dietician recommendations but we have not encountered frequent complaints of vitamins “getting stuck.” Nor have we seen significant vitamin deficiencies in patients who are taking tablet forms. Sometimes if a person is taking an extended release medication, they may experience reduced absorption (less drug effect) if they have a shorten intestine (think RYGB). Regarding calcium and iron (together or no?) and any vitamin for that matter: The vitamin you cannot absorb is the one you do not take- best take together than to not take at all. When in doubt, take vitamins, even if they are not bariatric formulated. However, probably best to avoid vitamin patches until more evidence is brought forth that proves they actually work. Get your labs drawn at least annually, and talk with your bariatric program, dietician, and/or obesity medicine specialist.

No Alcohol
Concerns: Rapid intoxication. Impaired judgment. Addiction. Addiction transfer (food to alcohol). Less behavior inhibition can result in risky sex, risky driving, risky food/beverage choices, to name a few). Empty calories.
Our Conclusions: Rapid intoxication is proven to be worse after bariatric surgery. Alcohol is known to impair judgment and can be addictive. Alcohol is “empty” calories. Dr Medlin did not drink at all during his first year after bariatric surgery. We both agree that a hard rule of “No Alcohol” after bariatric surgery is most likely not practical. However, we also agree, be very, very careful/user-beware! When doubt, do not drink!

Bonus: Listen all the way through to hear the bonus content.

Reeger’s Take Home Message: Know Thyself (she stole this one from the ancient Greeks)
Dr Medlin’s Take Home Message: Find Your Rules

Connecting with Dr Walter Medlin
Website: Bonuslife
Bariatric Medicine Institute

Click HERE to become a member Obesity Action Coalition
Click HERE to view the winning video: A Disease Called Obesity

Connecting with me
WLSP Facebook
Southern Oregon Bariatric Center Facebook
Click HERE to become patron of the podcast (THANK YOU!!)

I believe in you!



074 Unedited Cut

What you are about to hear is the unedited version of my most popular episode to date: Episode 34, titled “Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley.” I first published the edited version of this conversation on August 17th 2014. Over the past two years that episode has had the most download of all my episodes. Beyond the download numbers, I know you find this content important because you email me and tell me how much the information in this episode has helped you. If you have never heard this episode before, you are in for an informational treat!

Dr Seeley’s research is helping to shine light on weight regulation, energy-balance, and set-point. Beyond that, his research is helping us understand the complex interplay between our internal human biology and our external environment that can result in obesity. Additionally, his research also looks at the critical differences between losing weight through nutrition and exercise alone and losing weight through nutrition, exercise, and bariatric surgery.

In this episode:
00:00 – 05:24 Introduction by me including THANK YOUs! to my new Patreon.com patrons and attending the 2016 Your Weight Matters convention in Washington DC
05:25 – 11:19 Initial chit-chat before Dr Seeley and I begin the official interview
11:20 – 1:07:56 Official Interview Covering the following:

  • What Dr Seeley tells people he does for a living
  • How he became interested in bariatric surgery
  • How is the answer changing to the question: Why do human struggle with obesity?
  • Set-Point Theory and Defended Weight
  • The role of the hormone Leptin: what is it, what it does
  • What happens when we go on a diet
  • Is Set-Point really set
  • Biology and Weight
  • Environment and Weight
  • Food as a hormone: WHAT we eat matters as much as how much we eat
  • Exercise: The difference between healthy muscle and sick muscle
  • What is the greatest myth about obesity
  • How does biology push back against weight loss and towards weight re-gain
  • When we regain weight, we regain fat, not muscle
  • Our brain cares about FAT, not weight
  • The important role of gut hormones and how those hormones talk to the brain
  • Why simply taking Leptin as a pill does not work
  • The “Bath Tub” analogy
  • What the research shows how bariatric surgery helps a person lose weight (It’s not exactly what we thought)
  • Bariatric surgery can be thought of as an Anti-diet
  • Does the type of bariatric surgery matter
  • Is there a test a person can take to help determine if one surgery will be more effective for them instead of another?
  • After bariatric surgery, why cravings and hunger go away, for a while after surgery
  • Why does hunger and craving come back for some people at some point after surgery and why that is actually a normal physical response that does not have to mean the person will regain all their weight
  • Reeger’s “Rule of Thirds”
  • Some weight regain after bariatric surgery is natural and to be expected
  • Where is the research going in the future

1:07:57 – 1:12:45 Bonus Content Post Official Interview
1:12:46 – 1:14:24 My Concluding thoughts
1:14:30 Bonus After the Conclusion

Mentions in this Episode
Obesity Action Coalition Your Weight Matters Convention

Connect with Dr Seeley on Twitter

Connect with me at
WLSP Facebook

I Believe in YOU



073 How to Choose a Bariatric Surgery Program with John Bukenas

July 12, 2016

In this episode I welcome back John Bukenas. We explore how to choose a bariatric surgery program. If you are new to the podcast, John and I have talked about his obesity and the possibility of bariatric surgery in episodes 26 and 45. Topics discussed in the episode John’s struggles and declining health First Step: […]

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072 “Hey Reeger..,” A Letter from a Listener

June 17, 2016

Welcome to the weight loss surgery podcast where we talk about obesity and bariatric surgery one episode at a time. I’m your host, family nurse practitioner, Reeger Cortell. This episode is brought to you by you, my listeners. I am so touched by the love you show me, whether that is iTunes rates, sharing the […]

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071 Jeff Newell: On Gaining a New Life

May 31, 2016

In this episode Jeff Newell returns to the podcast to catch us up on his life since having Roux-en-Y Gastric Bypass on 12/1/2014. Jeff has been on the podcast before on episodes 055, 049, 043, and 042. He is now 18 month out from his surgery and 300 pounds down from his pre-surgery weight of […]

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070 Reeger Cortell FNP: An Interview by Rob Portinga

May 9, 2016

Presenting Your Host, Reeger Cortell, FNP Over the last 18 months or so, I, Rob Portinga, have had the pleasure of going from being a guest, to being a contributing host on the Weight Loss Surgery Podcast (WLSP). It was started by Reeger Cortel, FNP nearly three years ago now. One of the driving themes, and […]

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069 Talking about the Fear Factors of Bariatric Surgery with Dr Raul Rosenthal

April 17, 2016

My guest today is Dr Raul Rosenthal. Dr Rosenthal works at the Cleveland Clinic Florida in Weston Florida, where he is a bariatric surgeon, chief of surgery, chief of staff, and the director of the Cleveland Clinic Florida Metabolic and Bariatric Institute. In addition to all those good works, he is also the current president of […]

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068 Understanding Lipedema with Sarah Bramblette and Karen Herbst, MD, PhD

March 15, 2016

In this episode I bring you my conversation with Sarah Bramblette. As you are about to hear, Sarah is many things but above all she is an inspirational mix of hardwork, intelligence, grit, compassion, and determination. She is everything you would want in a loved one, a friend, a daughter, and an obesity advocate. Sarah’s […]

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067 The Bariatric Surgeon Episode

February 20, 2016

In this episode I bring you my interviews with six different bariatric surgeons. I conducted these interviews while I was at ObesityWeek in Los Angeles, CA in November 2015. I asked each surgeon one or two of the following questions: How do you help people decide which surgery to choose? And, If you could wave […]

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066 Connie Stapleton, PhD- Healing Your Relationship with Yourself

January 25, 2016

In this episode I bring you my conversation with clinical psychologist, Connie Stapleton, PhD. Dr Stapleton has been working in the field of bariatric surgery for 11 years and as you would image, and are about to hear, she has a wealth of information and insight and information to share with you. Discussed in this […]

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065 After the After with Nikki Massie

January 2, 2016

In this episode, I bring you my conversation with Nikki Massie. Nikki is many things within the bariatric surgery community including a bariatric surgery patient who had Roux-enY Gastric Bypass in 2008, the creator of the ever popular website Bariatric Foodie where she encourages you to “play with your food,” a prolific blogger, a storyteller, a […]

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064 Scott Monte, PharmD on Medications Just Before and Just After Bariatric Surgery

December 6, 2015

  In this episode I bring you my conversation with pharmacist, Scott Monte, PharmD. I met Scott at the 2015 Obesity Week conference in Los Angeles. Since 2009 Scott has worked as a pharmacist with the bariatric surgery program known Synergy Bariatrics in Buffalo, NY. After talking with him at the conference I knew I […]

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063 Pandora Williams on Feelings and Fitness

November 15, 2015

  After a lifetime of struggling with obesity, Pandora Williams underwent Roux-en-Y Gastric Bypass on October 19th, 2010. Now, five years later and through a lot of hard work and dedication, she is a fitness and wellness coach, blogger, avid runner, and motivational speaker. In this episode with interviewer Rob Portinga, Pandora tells her story […]

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062 “I Have a Disease; It’s Called Obesity” Video Contest Winner!

November 1, 2015

  This episode is a quick update telling you about a video I produced called “I Have a Disease; It’s Called Obesity.” The video won the American Society for Metabolic and Bariatric Surgery “It Starts Now” video contest! In this episode I tell you a little bit about how I came to write the script, […]

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061 Sandi Henderson: You are More Than Enough

October 18, 2015

  After a lifetime of yo-yo dieting, in 2004 Sandi Henderson’s weight was up to 425 lbs. She had uncontrolled high blood pressure, sleep apnea, asthma, and significant daily pain from bone-on-bone arthritic knees. After a significant health scare, Sandi decided it was time to make some lasting changes. As part of her decision to […]

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060 Pre-Op Education Part 2

September 28, 2015

  In this episode I go the second part of the Pre-Op education I teach to our patients who are getting ready for bariatric surgery. The focus of this second part is on the psychology of life after bariatric surgery. Discussed in this episode: The 7 right ingredients to live a Bari Great Life The […]

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A Thin Person Responds to Nicole Arbour

September 9, 2015

  I’ve attempted to avoid the whole Nicole Arbour  “Dear Fat People” thing. In general, 99% of the time I do not respond to hatefulness, whether it’s on the internet or elsewhere because I know that people who spew this kind of hatred are just energy vampires who feed off of other peoples responses, no […]

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059 MBSAQIP Accreditation

September 8, 2015

In this episode I am going to take you on a walk of sorts, an MBSAQIP walk. If you don’t know what I’m talking about, you will soon. For starters, MBSAQIP stands for Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. What you’re about to hear are my reflections, sort of “A day in […]

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058 Texas Tell ’em! Interviews from #YWM2015

August 24, 2015

  This episode I brought my mic to the people! Specifically the wonderful people at the Obesity Action Coalition’s Your Weight Matters Convention in San Antonio, Texas in August, 2015. While I was there I interviewed eleven different people about their bariatric surgery journey. Part of the interview included a game I invented called Texas […]

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