Laparoscopic Associates of San Francisco

What does 24 grams look like?

May 28th, 2014 Posted in Uncategorized | No Comments »


The recommended daily allotment for sugar intake for women is about 24 grams of sugar and 36 grams for men. This is one fact that typically makes everyone cringe. Why? We as Americans consume way too much sugar.

Where is this added sugar coming from?

Dextrose// brown sugar // confectioners sugar // corn syrup // fructose // high-fructose corn syrup // honey // invert sugar // lactose // malt syrup // maltose // maple syrup// molasses // nectars // pancakes syrup // raw sugar // sucrose // sugar // white granulated sugar //

Besides flat out stating SUGAR, you can see there are many sources of added sugar. These all need to be taken into account!

I know that sugar is very tasty and appealing to the palate, but why work so hard to get healthy to ruin it with a wrong choice on yogurt or having a cookie every night. It is not worth the health consequences and definitely not the weight gain.

To get a better idea of what 24 grams of sugar contributes to your day, here is a list of common foods with sugar and how much sugar they actually contain.

  • 1 “small sized” 16 oz. milkshake = 84 grams  (Bye, bye In & Out milkshakes)
  • ½ cup ice cream = 14 grams
  • 1 cup canned fruit = 58 grams
  • 1 12 oz. can of soda = 38 grams
  • 1 small Tollhouse cookie = 8 grams (you know you would eat 5 versus 1 very small one)
  • 1 Hostess cupcake = 21 grams
  • 1 Starbucks Iced Caramel Venti Latte = 47 grams
  • 1 Yoplait low-fat strawberry peach yogurt = 27 grams

Start tracking your intake today and see how much sugar you consume each day. Aim to have protein at every meal, drink fluids, and exercise. All these things reduce your sugar cravings.

Research Update: Finding the link between the common obesity gene and weight gain

May 23rd, 2014 Posted in Uncategorized | No Comments »

Source: Columbia University

There is a gene, FTO, that has been commonly known to be associated to obesity and weight gain. Researchers saw that wiping out the FTO gene in mice did cause or prevent obesity nor do all humans having variants of this gene are obese. They determined there must be some other outside component that associates this gene to weight gain.

The researchers did their experiments with mice and they observed that as FTO expression increased or decreased, so did the expression of a nearby gene, RPGRIP1L. RPGRIP1L is known to play a role in regulating the primary cilium.

The researcher created mice lacking one of their two RPGRIP1L genes, in effect, reducing but not eliminating the gene’s function. (Mice that lack both copies of the gene have several serious defects that would obscure the effects on food intake.) Mice with one copy of RPGRIP1L had a higher food intake, gained significantly more weight, and had a higher percentage of body fat than controls.

The study showed that the gene RPGRIP1L appears to play a role in affecting the function of receptors for leptin which is the hormone that makes you feel full. More research needs to be done but it looks like this may be area to be further investigated to help with coming up with medications to help increase leptin and control hunger.

  1. George Stratigopoulos, Jayne F. Martin Carli, Diana R. O’Day, Liheng Wang, Charles A. LeDuc, Patricia Lanzano, Wendy K. Chung, Michael Rosenbaum, Dieter Egli, Daniel A. Doherty, Rudolph L. Leibel. Hypomorphism for RPGRIP1L, a Ciliary Gene Vicinal to the FTO Locus, Causes Increased Adiposity in Mice. Cell Metabolism, 2014; 19 (5): 767 DOI: 10.1016/j.cmet.2014.04.009

Love Tuna-But Worried about Mercury Intake?

May 8th, 2014 Posted in Bariatric surgery, Diabetes, Eating healthy, Nutrition, post weight loss surgery tips, Post WLS tips, Protein and calories | No Comments »

I don’t know about any of you, but I LOVE tuna. Canned tuna is a great “go-to”  when you need a high protein food to go on salad or even have as a snack. It is very filling and provides amazing health benefits such as omega-3 fatty acids and vitamin D. Unfortunately, tuna is a fish that can be high in mercury and that is potentially harmful to your health.

There are two main kinds of canned tuna: chunk light and solid or chunk white (albacore). Most canned white tuna is albacore. Its mercury levels are almost three times higher than the smaller skipjack, used in most canned light tuna.



  • Canned white, or albacore Adults, including pregnant women, can safely eat it up to three times a month (women, 6-ounce portions; men, 8-ounce portions).
  • Canned light — the safer choice (0.12 parts per million of mercury).  Older children and adults can safely eat it once a week. But look out for “gourmet” or “tonno” labels. They are made with bigger yellowfin tuna and can contain mercury levels comparable to canned white.

Best choices:

Trader Joe’s Shipjack Tuna : Shipjack tuna is smaller and would contain less mercury than canned white or regular albacore tuna

Raincoast Trading Pacific Northwest Albacore Tuna: This product is found at Whole Foods and just recently got brought to my attention. Raincoast harvests the  albacore tuna at only a few years of age and have not had the time to accumulate the amount of mercury deemed unsafe by the FDA. This is frequently tested by Raincoast to ensure you are safe to eat the fish freely. There is also no oil or water added to ensure the best nutritional value possible.

Wild Alaskan Canned Salmon (multiple retailers): Canned salmon is lower in contaminents and is a heart healthy food. It also is sustainable caught in Alaska.

How to eat? Tuna is great with 2 olives cut up, 1 Tbsp. mustard, and lemon.

Celebrating Easter Brunch (Guilt Free)

April 14th, 2014 Posted in Diabetes, Uncategorized | No Comments »

Many of you may have to attend a Easter brunch this weekend and there is a way you can attend your brunch and still have fun and be satisfied.

Easter eggs

1. Drink a cup of tea or cup of coffee right when you get to the brunch.

Choose calorie free drinks so you can leave all your calorie consumption to food. Why waste sugar and calories on a glass of mimosa or coffee with cream and sugar? Also, if there are high calorie appetizers out likes scones or croissants, you have the alternative of  sipping on your cup of tea or coffee to prevent mindless eating before the big meal.

2. Wait for the food to be served and come up with a strategy.

Sometimes at a brunch or party, food might come out in a series or at different times. I recommend waiting  for all the food to be plated and scout out all the healthy options. Egg frittata, scrambled eggs, turkey sausage, roasted vegetables, and maybe some spring berries.  Stay away from dishes such as French toast, crepes, pancakes, and waffles.

3. Add or subtract what you can or can’t have from a dish to make it “on plan”. 

Many times certain dishes might be off plan just due to a simple component such as bread, or a crust of some sort. For example, if there is an egg dish with a carbohydrate component such as Eggs Benedict, ask for no English muffin and no sauce. This will save you most of the carbohydrate and fat that makes Eggs Benedict a high calorie dish.

4. Bring a healthy food option to the brunch just in case there are no options on plan. 

Always bring something that you know you can have. This prevents you from being stuck with options that which your can’t tolerate or will ruin your daily intake. Don’t assume the brunch will have healthy options.

5. Take time to converse with others rather than focus on food. 

Spending time with others rather than spending time eating will help prevent overeating throughout the whole brunch.

6. Make time for exercise that day. 

Typically those who exercise tend to be less hungry than more hungry. This will also give you energy and give you incentive to eat healthier that day to fuel your body.

7. Focus on positive healthy eating rather than feeling like you “missed out” or feel deprived. 

Those are my tips for this weekend. I hope you all have a great Easter weekend.

Latest research on carbohydrate digestion and the link to obesity.

April 8th, 2014 Posted in Bariatric surgery, Diabetes, Eating healthy, Nutrition, post weight loss surgery tips, Post WLS tips, surgical weight loss | No Comments »

The latest research shows that the way we digest carbohydrate can be linked to obesity in the general population.

The research study out of the Imperial College London and the study recently published their findings in the journal, Natural Genetics. The study investigated the relationship between body weight and a gene, AMY1. This gene is responsible for the production of the enzyme salivary amylase. Salivary amylase is the enzyme in our saliva that breaks down starchy carbohydrate into simple sugars for further digestion in the gut.

It is seen that the number of copies of AMY1 can be highly variable between people, and it is believed that the higher number of copies of the salivary amylase gene have evolved in response to a shift towards diets containing more starch since prehistoric times.

The researchers from the Imperial College in London connected with other international institutions to test the DNA of thousands of people in different locations from the UK to Singapore. What the researchers found interesting is that the people who carried a low number of copies of the salivary amylase gene were at greater risk of obesity. In fact, the change of being obese for people with less than four copies of the AMY1 gene was about eight times higher than those with 9 copies of the gene. The researchers estimated that for every additional copy of the salivary amylase gene there was about a 20 percent decrease in the odds of becoming obese.

While it is still beneficial for all individuals to keep their sugar intake low, this research shows that there might be a link to how we break down starch and how people may be more sensitive to others with weight gain due to the difference in how they digest starch.

Bottom line is that there needs to be more research to see if this genetic difference does make a difference in weights between two people with the SAME carbohydrate consumption. Also, it would be good to see what the link is between this genetic component and the occurrence of diabetes.

Whenever you think you are sensitive to weight gain from the addition of starch. Make note, and change your eating habits. Most people in general do far better with weight maintenance with a low carbohydrate, high protein diet.


1. M. Falchi et al. Low copy number of the salivary amylase gene predisposes to obesity. Nature Genetics, 2014 DOI: 10.1038/ng.2939

2. Imperial College London. “Carbohydrate digestion and obesity strongly linked.” ScienceDaily. ScienceDaily, 30 March 2014. <>.

Steps for Entering Maintenance

April 2nd, 2014 Posted in Uncategorized | No Comments »

For many patients who have been in weight loss mode and consistent with their intake for 6 months up to 1 year, it can be difficult to transition to their maintenance goal because either they have no idea where to begin, or they are afraid to gain weight. Maintenance is sometimes more difficult to patients because it is not as straight forward as weight loss and that can be scary.


Here are some steps to help you ease into maintenance and stay there:

1. At goal, assess your current intake. This means you need to start tracking your intake for at least 1 week and see what your current calorie, protein, carbohydrate, and fat intake is. This will be used as the baseline on how to proceed.

2. Once you have determined your average current intake, start to make monthly goals on how to increase your daily target goals.  I usually recommend increasing calories by 150-200 calories per month, carbohydrate by 10-15 grams  per month, and fat by 15 grams per month.

3. Most patient’s will aim to have 25-30 calories per kilogram (IBW) ideal body weight as their starting maintenance calorie range. (Weight in kilograms= Weight in pounds divided by 2.2.)

4. Those who are active should aim for 1.8 grams per kilogram of protein for maintenance. For those less active, 1.3 grams/kg – 1.5 grams/kg would be recommended.

5. Non-diabetic patients prior to surgery should never consume more than 100 grams of total carbohydrate per day and never more than 24-36 grams of sugar per day.

6. Diabetic patients prior to surgery should limit carbohydrate consumption to less than 40-60 grams per day and should limit sugar intake as much as possible.

7. Patient’s should consume a high protein, low glycemic diet long term and focus on whole foods.

8. Processed and refined foods should be limited as much as possible.

9. Alcohol should be consumed in moderation.

10. Weigh yourself daily or weekly long term and track your intake if you notice a change in your weight to get back on track.

11. Fiber should be your main concern when increasing carbohydrate in the diet and should aim for 15-30 grams per day.

12. Always keep your meals less than 5 ounces of dense protein and vegetables and 6-8 ounces for soft foods such as yogurt, soups, and cottage cheese.

13. Watch your fruit consumption! It is still sugar so you need to limit this to at the most 1 serving per day.  Blueberries, strawberries, raspberries, blackberries, limes, lemons, grapefruit, melon and avocado are your best choices.

14. Give yourself 1 cheat meal per week and keep it small. Do not give cheat days.

15. Understand what your trigger foods are and remove them from diet completely (even in maintenance).

16. Set up a consultation to go over this with Gabriella, our registered dietitian. She will help you with personalized goals and have a personal discussion with you.

Plant Based Protein Lovers Choose Tofu

March 26th, 2014 Posted in Uncategorized | No Comments »

It may be very difficult to be a vegetarian post-WLS, but there is one staple in the vegetarian diet that does pack a nutritional punch. Tofu is a soy based protein that is highly adaptable, cheap, and low in fat. It is also a good source of calcium and iron. Though this is a vegetarian protein, I think that even meat eats should incorporate some plant based proteins in their diet to increase variety and decrease cholesterol and saturated fat intake.

Let’s crunch the numbers:

3  oz. of silken tofu: 50 calories, 2 grams carb, 3 grams fat, and 6 grams protein

3 oz. extra firm tofu: 80 calories, 3 gram carb, 4 grams fat, and 9 grams protein

*These are probably the two most consumed types of tofu, but there are other degrees of firmness in between the two that can be consumed. They range from 60-70 calories per 3 oz., and 7-8 grams of protein.

Nutrition and What to Look for:

Soy is a high GMO product so if that is a concern for you as it is for me, I highly suggest you pick an organic sprouted tofu. Not only does an organic sprouted tofu use non-GMO sprouted beans, but it also typically contains more nutrition than regular tofu.
The sprouted tofu does have more fat and calories, but it contains more protein, and calcium and less carb.

Regular Super Firm Tofu (79 mg): 80 calories, 4 grams fat, 2 grams carb, 8 grams protein, 6% RDA calcium, and 8% RDA of iron                                                                

 Super Firm Sprouted Tofu (79 mg): 130 calories, 8 grams fat, 1 gram carb, 14 grams protein, 15% RDA calcium and 10% RDA iron 


Tofu is basically a blank canvas for any flavor. You can use it in soups to stir-frys. I personally enjoy mine cooked with a bunch of different spices and Sriracha sauce and paired with zucchini or yellow squash.

Recipe: Sriracha Glazed Tofu ( 


-1 cup Sriracha sauce

-1 Tbsp. soy sauce, low sodium

-1 Tbsp. rice wine vinegar

-2 tsp. garlic powder

-1 tsp. ground pepper

-1 tsp. ground ginger

-1 (12 oz. package) of super firm tofu, cut into small cubes (Wildwood Organic Sprouted Extra firm tofu)

1. Place all of the marinade ingredients into a bowl and mix.

2. Add the cubed tofu to the marinade and let it sit for at least 1 hour in the fridge or up to 24 hours.

3. For grilling, place grill to a medium-high heat and grill the tofu on each side for a couple minutes. Add any more sauce if desired.

Now go make some tofu! :)

Energizing Superfood Salad

March 10th, 2014 Posted in Uncategorized | No Comments »

Many patients ask about snacks ideas and what immediately comes to mind for a healthy snack that might not for most is a yummy salad! Eating vegetables can be somewhat of a difficult task post-VSG especially if you add a protein on top of it. Utilize snacks as an opportunity to boost your micro-nutrient nutrition with non-starchy vegetables. This recipe includes healthy fats from avocados, grapeseed oil, and seeds as well as a little sweetness/tartness from the pomegranate seeds. This is great for a patient in maintenance because it has vegetables + healthy fats + low sugar fruit. Make the dressing separate from the salad and dressing sparingly as needed. When taking with you to work, use separate Tupperware containers.



-3 cups raw baby spinach

-2 cups raw baby watercress

-3 large florets of cauliflower, thinly sliced (can used cooked/blanched)

-10 small florets of broccoli, cooked

5 red radishes, thinly sliced

-1/2 cup pomegranate seeds

-1 avocado, diced

-1/4 cup toasted pumpkin seeds or linseeds


-1/4 cup grapeseed oil

-3/4 cup white wine vinegar

-salt + pepper


1. Toss the baby spinach with the raw cauliflower, small florets of cooked broccoli, and thinly sliced red radishes.

2. Dice the avocado and add to the bowl along with the pomegranate seeds and linseeds.

3. Make a simple dressing of 1/4 cup grapeseed oil, 3/4 cup white wine vinegar, and salt + pepper.

Recipe is adapted from Mews of Mayfair, London.

Great Foods for Healthy Skin and Hair

February 24th, 2014 Posted in Uncategorized | No Comments »

Not only does what you eat show on the scale, but it also show in your skin and hair. What you eat can have a good or bad effect on the appearance, sensitivity of your skin as well as growth of your hair.

Typically, for your skin the best foods to eat are those that are “anti-inflammatory” which help with decreasing your chance of having sensitive skin or dry skin and hair. Many of these foods also contain essential amino acids which help with hair health and growth.

Here are my tips to decrease inflammation and bring healthy skin and hair!

1. Cut out the junk-these foods tend to increase inflammation. Biggest culprits are packaged foods with added sugars, processed meats or high fat dairy, and white processed grains.

2. Eat fish 2-3 times per week. Best choices: salmon, tuna, and mackerel. These are great sources of omega-3 fatty acids which moisturize your body from the inside out!

3. Don’t like fish? Add in 1 oz. of almond or walnuts to your snack daily or take a fish oil supplement such as Nordic Natural omega-3 supplements. 

4. Opt for whole, non-processed, high fiber carbohydrates instead of processed, white/sugary carbohydrates. Best options: organic rolled oats, quinoa, winter squash, potatoes, bran, sprouted wheat, etc.

5. Add in all different types of proteins to your diet including eggs, tofu, fish, lean chicken, and grass-fed beef. The different sources of amino acids will help with hair growth and collagen production.

6. Add in chia seeds to your shake which provide omega-3 fatty acids, calcium, and protein.

7. Add in 1-2 cups of leafy greens to your diet daily. These pack a nutritional punch of Vit. E and B vitamins to help promote glowing, beautiful skin.

You are what you eat! Eat well and it will help you looking beautiful. :)

Protein Pancakes Perfect for Post-Workout Breakfasts!

February 19th, 2014 Posted in Uncategorized | No Comments »

*Note: This recipe is for a patient in maintenance due to the sugar content from bananas. It works perfectly in a diet for a patient who is very active and need a good post-workout meal.

Since we have forced you to say goodbye to pancakes which you might have loved and adored. Try this recipe for protein pancakes. For patients who are doing high intensity training, this will provide some carbohydrate necessary for your muscles but a lot of protein to help fuel your muscles and having you burning calories the rest of the day!



(makes 1-2 servings)

-1 scoop protein powder (vegan, egg white or whey based)

-1/2 banana, mashed

-1/4 cup egg whites

-1/2 Tbsp. almond milk, vanilla, unsweetened (may need more if too thick)

-1 tsp. cinnamon

1. Mash banana with almond milk before stirring in remaining ingredients.

2. Spray pan with cooking spray and heat over medium-low before pouring in batter evenly.

3. Cook until you see bubbles rising.

4. Carefully flip and cook on the other side.

5. Serve with 1 Tbsp. all natural almond butter.

xoxo Gabriella