Category: Duodenal Switch
Vitamin D And A -Dry (Water soluble) Formulary
August 24, 2013 7:57 pm
Vitamin A and D are fat soluble vitamins. This means that in order for them to be absorbed by the GI track, them need to be absorbed by fat globules (chylomicrons). These are then taken up by the lymphatics of the GI track and taken to the blood stream. With the anatomical changes of the Duodenal Switch, the fat absorption capacity is significantly reduced. This results in excellent weight loss. It also results in much diminished absorption of the Fat soluble vitamins A, D, E and K. It is essential to use Dry Water Soluble forms of Vitamins A, D, E, and K. Bio-Tech is a brand that is formulated in this manner.
The Biotech D3-50 has 50,000IU of Vitamin D.
We recommend specific dosages of dry (water soluble) Vitamin A and D. These are not available at most pharmacies. In fact when our recommendations are presented at most pharmacies they are incorrectly dispensed with the fat soluble variety with is worth less becasue it is not absorbed by the duodenal switch patients. It is also important to not that this type of vitamin should not be taken with any dietary fat. Fat can inhibit the absorption of this type of vitamin. When ordering online, please make sure that the “Dry” or “Water Soluble” formulary is ordered.
Gastro-gastric fistula after gastric bypass operation
May 10, 2013 9:09 pm
One of the complications of gastric bypass is a gastro gastric fistula. This happens when a connection between the gastric bypass pouch develops to the remnant stomach. In a gastric bypass operation, a very small pouch is created from the stomach, and connected to a segment of the small bowel.
The purpose of this operation is to decrease over 95% of the volume of the stomach. In theory, the benefits of this is to reduce the volume of food that can be consumed. Over time, the size of the stomach pouch, and/or size of the gastro-jejunostomy anastomosis might stretch. This result in weight regain that is very commonly seen in about 3 years after a gastric bypass operation.
One of the complications of gastric bypass is a gastro gastric fistula. This happens when a connection between the gastric bypass pouch develops to the remnant stomach. In a gastric bypass operation, a very small pouch is created from the stomach, and connected to a segment of the small bowel.
The purpose of this operation is to decrease over 95% of the volume of the stomach. In theory, the benefits of this is to reduce the volume of food that can be consumed. Over time, the size of the stomach pouch, and/or size of the gastro-jejunostomy anastomosis might stretch. This result in weight regain that is very commonly seen in about 3 years after a gastric bypass operation.
Another possible explanation for weight regain may be an abnormal connection that may develop over time between the bypassed stomach and the small pouch that was created. This abnormal connection is known as a gastro-gastric fistula. In a patient who may have a gastro-gastric fistula, the food can travel down the gastric bypass path or enter the bypassed stomach and go down the path of a normal anatomy.
In these cases, the physiological effect of a gastric bypass procedure becomes ineffective.
The treatment that I favor most for correcting the complication of the gastro-gastric fistula is is to revise the gastric bypass to the duodenal switch operation.
Carbonated Drinks and Weight Loss Surgery
August 11, 2012 3:56 pm
The consumption of carbonated drinks is discouraged after weight loss surgery. In fact, there is a wealth of information that documents the detrimental health effects of carbonated drinks for each individual. These include osteoporosis, obesity, and premature dental decay, just to name a few. Indirectly, carbonated drinks have been found to increase risk of stroke and Cardiac events. There are studies that show a 48% increase in heart attack and stroke rates for individuals who drink diet sodas vs. those who drink it rarely or not at all.
There is also no health benefit to diet carbonated drinks. In fact, there are animal studies that show that rats who consume no-calorie sweeteners found in diet sodas experience an increased appetite (Susan Swithers, PhD- 2004).
There are also other factors to consider. The carbonation comes from a mixture of dissolved gasses that are released when the container is opened. The Carbon Dioxide gas dissolved in the drinks, amongst others, can distend the stomach. Potentially, stretching your stomach. There is also acidity that needs to be corrected by the body. This has been shown to result in changes in the bacterial population in the GI track, resulting in significant bloating and reduced absorption of nutrients.
Calcium loss is caused by the leaching of the calcium from the bones with carbonated drinks, which can cause osteoporosis.
Bloating and Excessive Gas
April 17, 2012 7:36 am
The relationship between the consumption of food, bloating, and excessive gas is a subject that comes up frequently. In our practice, this is a complaint usually raised 3 or 4 years after receiving the duodenal switch operation. It appears that patients eventually disregard the recommendations made for a healthier diet of low carbohydrate, high protein, hydration, supplements, and then everything else.
In general, carbohydrates, carbonated drinks, artificial sweeteners (such as Splenda®, sugar alcohols, etc.), vegetables, excessive amounts of food, and an intake of fat will cause significant gas and bloating. This is not to be taken out of context and assumed that one cannot consume any of these products. However a diet that has fruits and vegetables will cause significant gas and bloating. These can not be controlled by probiotics, antibiotics, or other products such as Beano.
Simple carbohydrates/sugars (sugar, candy, cakes, cookies, pies, regular soda pop, jelly, jam, syrup, ice cream, sherbet, and sorbet, etc.) are easily absorbed. Simple carbohydrates/sugars can increase diarrhea due to the Duodenal Switch allowing more undigested sugars/fuel for intestinal bacteria to feed upon, multiply and form gas. The end result can be gas, bloating, and diarrhea.
Complex carbohydrates have more structure than simple carbohydrates/sugar which are harder for the intestinal bacteria to break down and may cause less bloating, gas and diarrhea. Also, complex carbohydrates usually contain higher fiber content. The fiber in the colon will help to absorb water from the stool and can reduce diarrhea. However, this is not the case for all Duodenal Switch patients.
When a patient reports these problems, I recommend that the consumption of all carbonated drinks should be stopped. No patient should consume carbonated drink of any sort. Artificial sweeteners should also be avoided all together. A good alternative would be honey, maple syrup or Stevia. Minimize or reduce the carbohydrate intake.
It has been our experience in the majority of cases that excessive gas and bloating is a result of dietary indiscretion. In some patients, once the dietary sources have been ruled out, it should be further evaluated by a barium enema to rule out the diagnoses of a redundant colon.
The best approach would be to first go back to a high protein and low carbohydrate. This should allow a patient to rule out any dietary sources for the bloating and excessive gas. It is recommended to next be seen by your physician for a further workup.
To summarize, when a patient has excessive amount of gas, diarrhea and bloating, the first line of treatment is elimination of all of the possible causes. These include carbohydrates, fruits, vegetables, artificial sweeteners, carbonated drinks and milk products. I can not overemphasize the importance of this step prior to anything else such as antibiotics or probiotics.
Feeding Jejunostomy TubeExclusive Member Content
February 06, 2012 3:38 am
Gastric Emptying after the Duodenal Switch and the Sleeve Gastrectomy
January 19, 2012 1:10 am
How do different medication that treat constipation work?
December 26, 2011 9:27 pm
|
Treatment option |
Pros |
Cons |
|
Lubricants (Mineral Oil) |
Facilitated bowel movements
Promotes soft bulk |
Limits fat soluble vitamin absorption
Interaction with Birth control pill and Coumadin |
|
Emollients (Colace, Docusate) |
Penetrates stool
Effective for painful anal fissure |
May cause increased gas and bloating |
|
Hyperosmolar Laxatives (Miralax) |
Promotes water retention in stool |
May cause increased gas and bloating |
|
Saline Laxatives (Fleet, MOM, Mag. Citrate) |
Rapid acting |
May cause electrolyte imbalances |
|
Stimulants (Dulcolax, Senekot, Ex-Lax) |
Increased water in stool |
Prolonged use can cause dependence of the GI track |
|
Herbs (Green Tea) |
Natural in origin |
Prolonged use can cause dependence |
|
Bulking agents |
Absorbs water, softens, and bulks the stool |
May cause increased gas and bloating |
Yearly lab and medication requests
October 17, 2011 5:28 pm
First, we now have preferred laboratories that have partnered with us. The laboratory results are expected to be sent to us electronically, which should cut down on the time between the blood draw and when the results are available to us. The information on the preferred labs is located at: https://www.dssurgery.com/lab. Needless to say, there are no financial incentives for us. You should also check with one of the labs, as well as with your insurance company, to make sure that they are a contracted facility and that the order is covered under your policy. It is your responsibility to make sure that your insurance company will pay for the labs ordered. We are in no way responsible for the verification of benefits for the laboratory services that we order.
Second, we have had to change the way we order our yearly lab work. As most of you are aware, it is critical that weight loss surgical patients have continuous yearly follow-up care and monitoring. It is critical that the patients continue to receive yearly follow-up care, not only by doing their scheduled laboratory studies, but also by a yearly follow up in office exam. We provide a comprehensive follow-up plan to the patients who have had the the Duodenal Switch or Revision from other failed weight loss surgical procedures. This includes ordering the laboratory studies, review and interpretation of the results, as well as office visits as frequently as required or deemed necessary.
Vitamin D supplements
August 01, 2011 1:12 am
Vitamin A
May 17, 2011 7:20 pm
Vitamin A occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Disorder yellow and red carotenoid pigments can be changed to vitamin A in the liver.
A number of functions for vitamin A have been found, including defense mechanisms, maintenance of healthy epithelial tissues, and most importantly, a function in the visual system. A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle. A deficiency may also represent a decreased visual acuity, and more specifically, night blindness. This was found in a patient who complained that they were unable to read a particular sign at night while driving, but was able to read it during the day
Vitamin A Deficiency Treatment
When a patient is diagnosed with a deficiency, the treatment will require aggressive oral supplementation. For cases in which vitamin A levels do not respond to “Dry” Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize their level, as well as resolving the symptom of night blindness.