Longer Life For Milk Drinkers Lactose Intolerance
July 27, 2009 9:56 pm
ScienceDaily — Research undertaken by the Universities of Reading, Cardiff and Bristol has found that drinking milk can lessen the chances of dying from illnesses such as coronary heart disease (CHD) and stroke by up to 15-20 %.
In recent times milk has often been portrayed by the media as an unhealthy food. The study, led by Professor Peter Elwood (Cardiff University) together with Professor Ian Givens from the University of Reading’s Food Chain and Health Research Theme, aimed to establish whether the health benefits of drinking milk outweigh any dangers that lie in its consumption.
Importantly, this is the first time that disease risk associated with drinking milk has been looked at in relation to the number of deaths which the diseases are responsible for. The review brought together published evidence from 324 studies of milk consumption as predictors of coronary heart disease (CHD), stroke and, diabetes. Data on milk consumption and cancer were based on the recent World Cancer Research Fund report. The outcomes were then ompared with current death rates from these diseases.
Professor Givens explained: “While growth and bone health are of great importance to health and function, it is the effects of milk and dairy consumption on chronic disease that are of the greatest relevance to reduced morbidity and survival. Our review made it possible to assess overall whether increased milk consumption provides a survival advantage or not. We believe it does.
“Our findings clearly show that when the numbers of deaths from CHD, stroke and colo-rectal cancer were taken into account, there is strong evidence of an overall reduction in the risk of dying from these chronic diseases due to milk consumption. We certainly found no evidence that drinking milk might increase the risk of developing any condition, with the exception of prostate cancer. Put
together, there is convincing overall evidence that milk consumption is associated with an increase in survival in Western communities.” The reviewers also believe that increased milk consumption is likely to reduce health care costs substantially due to reduced chronic disease and associated morbidity.
“There is an urgent need to understand the mechanisms involved and for focused studies to confirm the epidemiological evidence since this topic has major implications for the agri-food industry,” added Professor Givens.
- Lactose intolerance is the inability or insufficient ability to digest lactose, a sugar found in milk and milk products.
- Lactose intolerance is caused by a deficiency of the enzyme lactase, which is produced by the cells lining the small intestine.
- Not all people with lactase deficiency have digestive symptoms, but those who do may have lactose intolerance.
- Most people with lactose intolerance can tolerate some amount of lactose in their diet.
- People with lactose intolerance may feel uncomfortable after consuming milk and milk products. Symptoms can include abdominal pain, abdominal bloating, gas, diarrhea, and nausea.
- The symptoms of lactose intolerance can be managed with dietary changes.
- Getting enough calcium and vitamin D is a concern for people with lactose intolerance when the intake of milk and milk products is limited. Many foods can provide the calcium and other nutrients the body needs.
- Talking with a doctor or registered dietitian may be helpful in planning a balanced diet that provides an adequate amount of nutrients—including calcium and vitamin D—and minimizes discomfort. A health professional can determine whether calcium and other dietary supplements are needed.
- Milk and milk products are often added to processed foods. Checking the ingredients on food labels is helpful in finding possible sources of lactose in food products.
Revision of Gastric Bypass
July 20, 2009 10:02 pm
Terry had the gastric bypass operation 3 years ago in an a major referral center by an established surgeon. The surgery went well, and lasted about one hour. The postoperative course was uneventful, and the patient was discharged home on post op day 2. The 3-6 month post-op period was complicated by a stricture at the gastro-jejunostomy anastomosis. An upper endoscopy and dilation. He continued to loose weight as expected. He attended the support meetings early on and then ended up missing some of them after the third year. The follow up appointments with the surgeon were all kept. The episodes of dumping syndrome, the feeling of passing out, diarrhea, high heart rate, nausea amongst others were scary early on. They became less frequent but not any less concerning. He was told by the surgeon that it s a part of the gastric bypass operation. In fact someone at the surgeons office told him that “..you hope you have it, since it will help you with your diet and prevent weight regain..”
He started feeling weak and tired at times after the second year. He also gained about 50 pounds back after the third year. The weight gain did not stop till I was within reach of my pre gastric bypass operation. What is worse is that he had to use CPAP machine for sleep apnea that had gone away with weight loss. He also was started back on some of his medications including those for diabetes. He went back to his surgeon, whose first reaction was that “….You must be doing something wrong…”
He was then referred to see the nutritionist, had an upper endoscopy, and an upper GI series. When he went back, he was told that there is nothing wrong and that he should eat correctly and exercise more.
This is not a story but a real example of many more patient that I see in our office all the time. As the facts are pretty accurate, clearly the name, and the specific details have been altered in this article.
What this patient has experienced is what I hear in the office all the time from patients who had the gastric bypass and they “….did not know….” about any other weight loss surgical procedure. After the surgical “honey moon” period of about 2-3 years (much longer than my real honey moon) the reality sets in. Weight regain, inadequate weight loss, nutritional deficiencies, dumping syndrome, and solid intolerance are examples of problems which will direct a patient to seek a solution.
The published data show that the small size of the pouch, in gastric bypass, does not predict excess weight loss (O’Connor et.al. SOARD 4, 2008, 399-403), (Nishie et.al, Obesity Surgery 17, 2007, 1183-1188). The size of the gastrojejunostomy anastomosis also does not assure adequate weight loss (Cottam et.al. Obesity Surgery 19, 2009, 13-17). Dumping syndrome does not improve gastric bypass surgery outcome. And the incidence of resolution of the obesity related illnesses is significantly better with duodenal switch operation that the gastric bypass or the adjustable gastric banding procedure. Patients with diabetes or cholesterol and triglyceride problem, in my opinion, should not have gastric bypass or adjustable gastric banding done.
A review of the published scientific articles in JAMA, shows that the outcome of Duodenal switch operation is far better than the alternatives with all measured parameters of excess weight loss, diabetes resolution, and improvement of hyperlipidemia.
Let me pose a question. If a patient is told that there are two antibiotics and one of them will treat the urinary track infection in 83.7% of the time and the alternative will treat it in 98.9% of the time, which one would you like to be treated with, if the overall risks all the same?
| Significant Hyperlipidemia Improvement | Diabetes Resolution |
Excess Weight Loss |
|
| Duodenal Switch | 99.50% | 98.90% | 70.10% |
| Gastric Bypass | 93.60% | 83.70% | 61.60% |
| Gastroplasty | 80.90% | 71.60% | 68.20% |
| Gastric Banding | 71.10% | 47.90% | 47.50% |
Source:JAMA, review of published data based on more than 22000 patients outcome.
As a Duodenal switch surgeon the answer is clear. I am only trying assure that no patient ever goes to the operating room without having all their options entertained. An informed consent is only valid if all the information was presented. Too often the alternative are either never discussed or barely discussed. A review of the websites demonstrates this point. Very few surgical practices that do not offer the duodenal switch operation discuss this alternative.
And to those that ask, “Why are there more surgeons doing the duodenal switch operation?” I think this a question that needs to be posed to those that do not do it. Here are some of the reasons:
- The perceived malnutrition is usually given as a reason. There is a large body of published data in the literature that documents the incidence of malnutrition to be significant in gastric bypass operation. In fact, because of the dietary restriction after gastric bypass there are as many if not more nutritional deficiencies that develop after this operation than the duodenal switch operation.
- The need for follow up. I am not clear as to why would this be a reason not to offer a surgery. The scientific evidence again shows that the more structured the follow up the better the outcome. Obesity is a chronic disease, that has a surgical, medical and maintenance phase. The broad picture of treatment plan for obesity in my opinion is no different than that of a cancer patient, who may need surgery, followed by chemo-radiation, and routine follow up.
- Last, and most vividly discussed is the issue of increased flatus, and loose bowel movements. There is no dispute that the duodenal switch operation does cause increase in flatulence and loose bowel movement. But here are the facts- in my more than 10 years in private practice, in an office that at times the waiting room is full of pre and post op patients, we have never had to evacuate the building because someone let one go! It has been my experience that that in overwhelming number of cases that have problem with significant gas and diarrhea the problem is easily corrected with minor changes in diet. Polish sausage, bagel and cream cheese for breakfast, deep dish pizza for lunch, and deep fried turkey may give some patients increased gas and diarrhea! With this said however, I have had patients in whom after exhausting all non surgical options (dietary modifications, medications etc) revision of the duodenal switch operation has been done.
In my opinion, the best patient is the most knowledgeable patient. Please make sure that you have taken the time to investigate not only the the surgeon, but also the available procedures.
What is Osteoporosis
July 06, 2009 8:32 pm
Osteoporosis in epidemic in the U.S. Bariatric patients can be even more prone than the average American. Both RNY/GB and DS patients have issues with calcium absorption. DS patients also have issues with absorption of vitamin D. Both populations must be compliant in supplementation on both. Calcium Citrate is the preferred form as it is far more absorbable than the carbonate form. This is not new news to most of us. Calcium absorption is also greatly enhanced by adequate vitamin D. This is also not new to the average bariatric patient. What is relatively new news is that current information is that some laboratory testing methodology has yielded false high readings in the past leading many to falsely believe their level of supplementation was adequate. In addition to false high level’s in previous lab testing procedures the “normal” ranges have been increased recently. Many now believe 50ng/mL should be looked at as a minimum. My most recent labs came back with the form showing a “normal range” of 5-58ng/mL. Recent publications show that our D levels are vitally important to immune function in fighting any number of conditions from flue (swine flue?) to cancers. I personally am making a concerted effort to raise my D value to at least 50ng/mL before next flue season.
A new and emerging factor in combating the osteoporosis epidemic is the awareness of the importance of vitamin K-2. This is not exactly the same thing as the K we all know. There are two primary forms of vitamin K, K-1 and K-2. Most bariatric supplements, even the very best,supplement only our K-1 levels. K-1 has long been known for it’s involvement in blood clotting. K-2 however is very important for Calcium metabolism. This is relatively new research coming out of Japan.
This vitamin has three very powerful effects on our Calcium metabolism. It minimizes the loss of Calcium in the urine thereby keeping what Calcium that is absorbed “on board” for recycling back into constructive purposes. It stimulates the deposition of Calcium in the bone matrix by increasing the levels of a specific hormone which “turns on” the cells that do this job. K-2 also helps regulate the deposition of Calcium in inappropriate tissues such as the walls of arteries and in ligaments.
Research out of Japan has shown increased bone mineral mass in post menopausal women. A group of women were divided into 4 sub groups. The “control” group (who added nothing to their diet) lost 1% bone mineral mass per year. At the other end of the spectrum a group using Calcium Citrate, D3 and K2 (MK-7) gained 1.5%. The most recent information regarding this very important vitamin has shown that a very specific form of the vitamin is by far the most beneficial. As I noted before this research is coming out of Japan. This form of K-2 was first observed in a traditional Japanese food. Natto is a fermented soy product that is very high in Menaquinone-7 (MK-7). This form is very important. The less advantageous and and more common form MK-4 is less well absorbed and has a “half life” (the time it takes for the blood levels to fall by 1/2) of approximately 90 minutes. The MK-7 is more easily absorbed and has a half life of well over 24 hours.
Caution must be used for patients using “blood thinners”. This vitamin will have a direct effect on their clotting time. Research shows that this can be off set by adjusting the levels of medication. Once these levels are adjusted they tend to be much more stable due to the long half life of the MK-7. One of the side effects of these blood thinners is the loss bone mineral mass. Consult your physician before starting.
Editors Note: It is worthwhile to address a few issues raised in this article by Dr. Caya. The first issue is related to the efficacy of the types of calcium. This issue is addressed extensively in our website and summarized in a table at the FAQ section. The summary of the above table is that, Calcium Citrate is absorbed easier, but more of it needs to be takes to get the same amount of elemental calcium. Less of Calcium Carbonate is needed to get the same amount of elemental calcium, however the absorption is less efficient. A search of the medical literature will provide supporting data for recommending one or another type. I believe that most people at least in the beginning could take either type. The decision of which one to take should be based of which is tolerated better. Later on recommendations for changes will be made.
The other point to remind every one is that this information is not static and continuous to change. It is important the patients stay well informed.
Ara Keshishian, MD
Gastric Bypass Linked to Abnormal Glucose Tolerance
June 29, 2009 12:45 am
By Charles Bankhead, Staff Writer, MedPage Today
Published: June 26, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
DALLAS, June 26 — Patients who undergo gastric bypass surgery often have undiagnosed glucose abnormalities that can lead to bad eating habits and regained weight, a small clinical study suggests.
Almost 80% of the patients had glucose abnormalities, including hyperglycemia, hypoglycemia, or both, Mitchell Roslin, MD, of Lenox Hill Hospital in New York, reported here at the American Society of Metabolic and Bariatric Surgery meeting. Patients were alarmed by the weight regain, but at the same time, they often had a ravenous appetite soon after a meal, accompanied by an almost uncontrollable urge to eat.” Our hypothesis is that . . . patients may have an enhanced insulin response,” said Dr. Roslin. “They have rapid emptying of the pouch that leads to reactive hypoglycemia. The combination of an empty pouch and low blood sugar leads to hunger.” The findings have led him to question whether gastric bypass surgery should remain the gold standard procedure for treating obesity, he added. At the very least, surgeons should consider the possible need to include a valve in gastric bypass.
The study evolved from clinical observations during patients’ periodic postoperative visits. A growing number of patients complained of weight regain and loss of restriction. The complaints often had a common ring.” Patients were saying that one or two hours after eating, they were ravenously hungry,” said Dr. Roslin. “It sounded a lot like hypoglycemia to me.” To investigate the origin of the symptoms, Dr. Roslin and colleagues studied 63 patients who had undergone gastric bypass procedures. All the patients had a 100-g glucose tolerance test, wherein the maximum/minimum glucose ratio was assessed one to two hours after the glucose challenge.The investigators defined reactive hypoglycemia as a glucose value <60 mg/ dL, or a decrease of 100 mg/dL or more within two hours and no glucose value exceeding 200 mg/dL. They defined hyperglycemia as any value >200 mg/dL and no value <80 mg/dL. Follow-up from surgery averaged about four years. The mean age of the group was 48.5, and 81% were women. The patients’ average preoperative weight was 138 kg, with an average body mass index of 49. One-third had preoperative diabetes. The percentage of excess BMI lost averaged 55%, and the patients had regained an average of 12 kg. Glucose tolerance tests showed six patients with hyperglycemia, including five who had normal fasting blood glucose levels. In addition, 35 patients had reactive hypoglycemia, while eight had hyper- and hypoglycemia. “The hyperglycemic cohort was characterized by a rapid rise to high sugar levels,” said Dr. Roslin. “The fact that most of these patients had normal fasting glucose means we need to be very careful of what we call cure or control of diabetes.” Reactive hypoglycemia manifested as a rapid upsurge of glucose levels that correlated with a rise in insulin and then a rapid decline during the second hour after the glucose challenge. Patients with both hyper- and hypoglycemia had even more pronounced swings in glucose and insulin levels, said Dr. Roslin.
The most dramatic rises and falls in blood glucose have been associated with small pouches and wide anastomoses, he added. The findings suggest a need to consider alterations in the standard gastric bypass procedure, such as use of valves, or possibly abandonment of the procedure in favor of another approach. “I believe that vertical-sleeve gastrectomy and duodenal switches that are not severely malabsorptive will be the best options in the future,” said Dr. Roslin.
A Few Extra Pounds Might Bring Extra Years
June 25, 2009 10:19 am
June 23 (HealthDay News) — A new study finds that being overweight — but not obese — might help you live longer.
In the study of more than 11,000 Canadian adults, overweight people lived longer than normal-weight people, while those who were either extremely obese or underweight died at an earlier age than normal-weight people.
The findings do not mean that normalweight people should try to pack on extra pounds, the researchers said. “It may be that a few extra pounds actually protect older people as their health declines, but that doesn’t mean that people in the normal weight range should try to put on a few pounds,” said study co-author Mark Kaplan, a professor of community health at Portland State University.
The study followed 11,326 adults in Canada for 12 years. Compared to normal-weight people, those who were underweight were 70% more likely to die and those who were extremely obese were 36% more likely to die, the researchers found.
On the other hand, overweight people were 17% less likely to die than those of normal weight. The risk for obese people was the same as for people of normal weight, the study authors noted.
Overweight was defined as a body mass index (BMI) between 25 and 30, and obesity was defined as BMI of 30 and above. BMI is a measurement based on weight and height. For example, a 5-foot 10-inch man weighing 181 pounds has a BMI of 26; a 5-foot 6-inch woman weighing 210 pounds has a BMI of about 34.
The study was published online June 18 in the journal Obesity.
“It’s not surprising that extreme underweight and extreme obesity increase the risk of dying, but it is surprising that carrying a little extra weight may give people a longevity advantage,” co-author David Feeny, a senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore., said in a Kaiser news release.
But Kaplan noted that there’s more to health than just living longer. “Our study only looked at mortality, not at quality of life,” he pointed out, “and there are many negative health consequences associated with obesity, including high blood pressure, high cholesterol, and diabetes.
Being healthy involves more than body mass index (BMI) or the number on a bathroom scale, said Dr. Keith Bachman, a weight management specialist with Kaiser Permanente’s Care Management Institute.
“We know that people who choose a healthy lifestyle enjoy better health: good food choices, being physically active every day, managing stress, and keeping blood pressure, cholesterol and blood sugar levels in check,” Bachman said in the news release.
Robert Preidt
SOURCE: Kaiser Permanente, news release, June 23, 2009
Editorial:
The above information is nothing new. This is one of the issues that I most frequently discuss in our group meetings. “….it is healthier to be a10-15 lbs over weight that 10-15 lbs underweight…” I realize that almost all patients who have weight loss surgery, are afraid of the continuos weight gain after heating a low point on the scale. After all every single diet and exercise plan and diet pill has resulted in a transient weight loss followed by the weight regain. I emphasize that it would be very very unlikely for patient to gain substantial amount of weight after duodenal switch operation. This is not however the case for patient’s that have had the Gastric bypass, adjustable gastric banding or other procedures.
Ara Keshishian, MD, FACS
Study: Vitamin D may boost heart health during weight loss
May 25, 2009 10:27 pm
Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.Supplements of vitamin D may improve cardiovascular health during weight loss, without impacting on how many pounds are shed, suggests a new study.
“The results indicate that a vitamin D supplement of 83 micrograms/d does not adversely affect weight loss and is able to significantly improve several cardiovascular disease risk markers in overweight subjects with inadequate vitamin D status participating in a weight-reduction program,” wrote the authors, led by Armin Zittermann from the Clinic for Thorax and Cardiovascular Surgery in Bad Oeynhausen.
With obesity rates still high – not only in developed countries but also, increasingly, in newly wealthy emerging markets, there is considerable attention to ways to trim down waistlines. The results of the new randomised, double-blind, placebo-controlled trial indicate that vitamin D supplements may be useful as a means of boosting heart health during weight loss.
The details on D
Vitamin D refers to two biologically inactive precursors – D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.
While our bodies do manufacture vitamin D on exposure to sunshine,
the levels in some northern countries are so weak during the winter months that our body makes no vitamin D atall, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.
In adults, it is said vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type-1 diabetes.
Study details
Zittermann and his co-workers recruited 200 healthy overweight people with average 25(OH)D levels of 30 nmol/L (12 ng/mL) and randomly assigned them to receive either placebo or vitamin D for one year. All the subjects also participated in a weight-reduction program.
At the end of the study, 25(OH)D levels increased in the D group by 55.5 nmol/L, but by only 11.8 nmol/L in the placebo group. Furthermore, a 26.5 per cent reduction in levels of parathyroid hormone (PTH) were observed in the D group, compared with 18.7 per cent in the placebo group. “High blood concentrations of parathyroid hormone […] are considered new cardiovascular disease risk markers,” explained the authors.
Improvements in triglycerides levels were also observed in the vitamin D group, with a 13.5 per cent decrease noted compared with a 3.0 per cent increase in the placebo group.
Finally, levels of the marker of inflammation TNF-alpha decreased by 10.2% per cent following vitamin D supplementation, compared with 3.2 per cent in the placebo group.
“The beneficial biochemical effects were independent of the loss in body
weight, fat mass, and sex,” noted the researchers.
On the downside, the researchers noted that participants receiving the vitamin D supplements did experience an average 5.4 per cent increase in their levels of LDLcholesterol.
Source: American Journal of Clinical Nutrition
May 2009, Volume 89, Pages
1321-1327, doi:10.3945/ajcn.
2008.27004
“Vitamin D supplementation enhances the beneficial effects of weight loss on
cardiovascular disease risk markers” Authors: A. Zittermann, S. Frisch, H.K. Berthold, C. Götting, J. Kuhn, K. Kleesiek, P. Stehle, H. Koertke, R. Koerfer
May 25
Bowel Obstruction after Weight Loss Surgery
May 18, 2009 3:00 am
What is bowel obstruction?
Bowel obstruction describes a condition in which the normal flow of gastrointestinal content is either completely or partiality blocked. This could be caused by medical conditions or medications, otherwise known as an ilius. A common example of this is seen in patients that are taking pain medications or narcotics. Another common condition is post surgical scar tissue, or adhesions.
These will cause a point around which a twist of the bowel will cause a compromise of the blood flow to it and eventually result in “dead bowel”. Just
imagine what would happen if you were to place a tight rubber band around a finger? In a very short period of time, the blood supply to the finger is
compromised and if it is not quickly restored then it will result in the loss of a finger.
One of the problems with the diagnosis of bowel obstruction is that there is no absolute set of studies, such as X-ray, Cat-Scan, laboratory studies
that will be diagnostic in all cases. This is even more so in patients that have had weight-loss surgical procedures. The anatomy is modified after all weight-loss surgical procedures. This varied anatomy means that there are instances that the expected findings of bowel obstruction are not present, or there are findings that are highly suspicious for bowel obstruction if the treating physician is acutely aware of the altered anatomy.
The most critical issue regarding the treatment of bowel obstruction is early diagnosis and treatment. Blog with CT Scan images here. Further pictures of bowel obstruction here.
The treatment options are also different when treating a patient with bowel obstruction if they have had weight loss surgery. There are non surgical treatments that may be attempted for partial bowel obstruction (such as the nasogastric tube) that will be useless in post gastric bypass or duodenal switch patients. This is because in the duodenal switch and the gastric bypass operation, the anatomy is altered so that a partial segment of the gastrointestinal track has only limited access to outside. This means that the only way to decompress that segment is by surgery and not the naso-gastric tube.
Lactose Woes Pregnancy after Gastric Reduction
May 04, 2009 9:58 pm
LACTOSE WOES
Lactose intolerance is a set of symptoms resulting from the body’s inability to digest the milk sugar called lactose. Lactose is commonly found in dairy-based foods and is digested in the intestines by the enzyme lactase. The production of gas and the presence of fluid create the cramping and digestive distress that are the symptoms of lactose intolerance. Yogurt, although made from milk, is often well tolerated by people who have lactose intolerance because yogurt bacteria produce their own lactose-digesting enzyme of actase. If you have a strong reaction to lactose, you will have to become an avid labelreader. Look for words, such as whey, lactose, nonfat milk solids, buttermilk, malted milk, margarine, and sweet or sour cream. Some breads, dry cereals, cookies instant soups, breakfast drinks, and milk chocolate contain small amounts of lactose. The good news is if you are lactose intolerant after surgery it is because the area in your small bowel where lactase is secreted has probably been diverted over to the bile-containing channel. In time, your intestine may adapt by producing lactase enzymes again—if not you can always take Lactaid, a lactase supplement with your food. Hard cheeses like cheddar, low fat cottage cheese and yogurt may be tolerated better. Milk and ice cream may be tolerated the least. Remember that lactose is a milk sugar and we ask you to stay away from sugar during your weight loss period.
Leslie Patterson MS. RD. LD. CNSD.
EXERCISE HABIT—You Don’t Have To “Exercise”!
We can all make small changes that increase our daily physical activity. By adopting a more active lifestyle, we reduce the risk of chronic disease and have an enhanced quality of life: walking 3 to 4 mph, carrying baby up stairs, swimming moderate effort, using stairs instead of elevator, general house cleaning, walk to lunch, golfing while carrying the clubs, go shopping (walking, not buying) play on playground with your kids, dance to the radio, ride a bike to friends house, crawl around with your kids, walk your dog, baby-sit your grandchildren, play sports (don’t watch), mow the lawn, walk at the beach (don’t lay) wash your car (instead of the car wash), gardening, surf the water not the web, bag your own groceries and carry them out to the car, at work, take a walking break instead of a coffee break, volunteer at a local daycare community center.
Erin Nelson RN, BA, MS, Exercise Scientist
Pregnancy after DS
As patient who are getting past or close to their 18 month to 2 years post-op
anniversary they may start thinking of getting pregnant. What every potential
mother to be should consider is: Has my weight loss stabilized? Have I had my vitamin levels checked and have I followed up with my weight loss surgeon before attempting to conceive? Is my OB/GYN aware of my weight loss urgery procedure and do they have experience with patient who has had weight loss surgery? Have I informed my surgeon of who my OB/GYN is? These are all important questions to consider and resolve before getting pregnancy as a post weight loss surgical patient.
Due to the nutritional imbalances that may follow all weight loss surgical procedures it is imperative to make certain that your weight loss has stabilized and you have made it past your 18-month to 2 years postop anniversary. During the weight loss period a patient is in a negative nutritional balance not getting enough calories are absorbed to support the patient’s own weight and therefore would not be able to support the addition of a growing healthy fetus. There is a possibility of birth defects if you become pregnant prior to weight stabilization and your 18-month to 2-year anniversary. The decision absolutely needs to be discussed with your weight loss surgeon prior to any attempts to conceive.
After all the above questions have been dealt with and resolved and you have been cleared by your surgeon to attempt to conceive there are extra steps needed for a post weight loss surgery pregnancy. We will inform you of these steps during the decision process with your surgeon. You always have to keep in mind that you anatomy has been changed and how your body works also has been changed. You should also start your preparation to become pregnant several months prior to attempting to conceive. You will need to be more diligent with follow-up with your OB/GYN and your weight loss surgeon during your pregnancy. Our office will work closely with your OB/GYN in your monitoring your lab work and the progression of your pregnancy
Drug Interactions Herbal Remedies
May 04, 2009 12:23 pm
Drug Interactions with Herbal remedies:
Today, one of the fastest growing supplements is the herbal remedy. Experts estimate that approximately 60-70% of the population in the United States is using some form of herbal products. What is concerning about this figure is that only a small portion of the people using herbals are communicating that fact to their health care provider. The majority of people using herbals are unaware of the potency and the interactions that herbals can have with many prescription and non-prescription medications. There are many medications that are derived from plant or herbal products such as digitalis, morphine and several anti-cancer medications. These medications easily achieve toxic levels and have very strong effects. Plant and herbs are not necessarily harmless supplements or treatments. Patients need to be aware that there is a potential for interactions with other medications and it is imperative to let your health care providers know what type of supplements or treatments you are taking over the counter.
Below is a list of a number of herbal products and their interactions with other medications both prescription and nonprescription. It is not an inclusive list and therefore anyone taking an herbal supplement or treatment should do research and always let your health care provider know what you are taking.
Patient follow up….
Follow up of patient that we have operated on takes different forms. They include review of the laboratory studies that ordered, follow up office visits, and communication with your other health care providers to name a few. None of these however are suppose to replace the routine office visits. We are very much aware of the long distances that some patient have to travel to come for their office visits. Then there are times that more time is spent waiting in our office for a relatively short visit. I can not however emphasize the importance of the a face to face office visit.
The lab results that are sent to our office are reviewed as they are received. When abnormal labs are noted appropriate measures are taken, including sending out letters that explain the abnormalities noted with recommendations that may include prescription medication. The prescriptions are also included. More frequently than not the lab results are received in our office in batches. This is why some patients receive their letters describing the deficiencies noted in their labs not all at once.
One last note regarding the follow up. We strive to be accessible at all time to patients and to their health care providers alike. We can be reached either via phone at 661-725-4847, or via email [email protected] . Every single inquiry, be from patient or another health care provider is responded to in a prompt and timely fashion.
Normal Bone Anatomy and physiology
March 11, 2009 2:42 am
Used with permission:
Susan M. Ott, MD Associate Professor, Medicine University of Washington
The bones in the skeleton are not all solid. The outside cortical bone is solid bone with only a few small canals. The insides of the bone contain trabecular
bone which is like scaffolding or a honey-comb. The spaces between the bone are filled with fluid bone marrow cells, which make the blood, and some fat
cells.
You can see the difference yourself at the grocery store meat department. Here is a photograph of a T-bone steak Below is a close-up picture of a piece of the pelvic bone. It was put into a special kind of xray machine which gives lots of details.
The photograph is used with permission from Dr. Yebin Jiang from University of California, San Francisco.
If all the bones were solid, think how heavy they would be. It would be hard to run! The next page is about the cells inside the bones.
There are three special types of cells that are found only in the bone. These cell names all start with “OSTEO” because that is the Greek word for bone.
are large cells that dissolve the bone. They come from
the bone marrow and are related to white blood cells. They are formed from two or more cells that fuse together, so the osteoclasts usually have more than one nucleus. They are found on the surface of the bone mineral next to the dissolving bone.
are the cells that form new
bone. They also come from the bone marrow and are related to structural cells. They ave only one nucleus. Osteoblasts work in teams to build bone. They produce new bone called “osteoid” which is made of one collagen and other protein. Then they control calcium and mineral deposition. They are found on the surface of the new bone.
When the team of osteoblasts has finished filling in a cavity, the cells become
flat and look like pancakes. They line the surface of the bone. These old osteoblasts are also called . They regulate passage of calcium into and out of the bone, and they respond to hormones by making special proteins that activate the osteoclasts.
are cells inside the bone. They
also come from steoblasts. Some of the osteoblasts turn into osteocytes while the new bone is being formed, and the osteocytes then get urrounded by new bone. They are not isolated, however, because they send out long branches that connect to the other osteocytes. These cells can sense pressures or cracks in the bone and help to direct where osteoclasts will dissolve the bone.
