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Category: Nutrition

Fluids and Electrolytes After Weight Loss Surgery

January 29, 2016 7:06 am

Fluids and Electrolytes after weight loss surgery are an important part of recovery and lifestyle after undergoing a weight loss surgical procedure. Potassium is an important electrolyte found in higher concentrations within the fluid of the cells. It is important in muscle contraction, heart rhythm, nerve function and co-enzyme function.

Fluids and Electrolytes

The following webinar (link) discusses the balance of fluids and electrolytes with particular attention to post weight loss surgery concerns. Deficiencies can cause heart arrhythmias, muscle weakness and cramping, intestinal paralysis, and neurological deficits.

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The Daily Recommended Amount for Potassium is  4,700mg

Here is a list of Lower-carb potassium sources: This is not meant to be in inclusive list.  There are many higher carb sources of potassium also.

  • Beet Greens- 1/2C 655 mg
  • Trout 3oz – 375 mg
  • Salmon  719 mg per average filet
  • Halibut or Yellowfin Tuna 3oz – 500mg
  • Clams 3oz- 534 mg
  • Avocados 1 whole- 974 mg
  • Squash 1C- 325mg
  • Broccoli 1 cup 475m
  • Watermelon Radish 3 oz – 233mg
  • Sweet Potatoes- one potato 694mg
  • Yogurt 1C – 579mg
  • Tomato paste 1/4C – 342 mg
  • Whole milk 1C – 366 mg
  • Chicken breast meat 1 cup chopped – 358 mg
  • Cauliflower 1 cup raw– 303 mg
  • Peanut butter 2 T – 208 mg
  • Asparagus spears 6 – 194 m
  • Daikon Radish – 3″ – 280 mg
  • Nuts  100-300 mg per 30g / 1 oz serving, depending on the type
  • Dark leafy greens  160 mg per cup of raw, 840 mg per cooked
  • Kohlrabi 3oz- 98mg
  • Mushrooms 1 C- 273 mg
  • Spinach – 1 cup 167 mg Potassium
  • Walnuts 2 oz-250 mg

Neuromuscular Disease After Weight Loss Surgery

June 08, 2015 11:30 am

Weight loss surgical procedures may result in varying degrees of nutritional deficiencies. Some of these nutritional deficiencies may cause neuromuscular disease if left untreated, these include vitamins, minerals, and protein. The long-term effect of these deficiencies may presents as neuromuscular conditions including, weakness, numbness, confusion and all others if not-diagnosed and untreated. It is important to note that all weight loss surgical procedures require lifetime vitamin, mineral supplements and protein monitoring and possible supplements.

The table below outlines some of the specific neurological and neuromuscular disease complications following bariatric surgery. The most common deficiencies seen with the duodenal switch operation are fat soluble vitamin deficiencies. These include, Vitamin A, D, E and K. Duodenal Switch patients need oral supplements of Dry “Water Miscible” type of Vitamin A, D, E, and K based on their laboratory studies and needs.

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The neurological deficiencies are manifested much more frequently with the Gastric Bypass than the duodenal switch operation. The most common nutritional deficients are that of B1, B12, Folate deficiencies that are common in Gastric Bypass. A list of possible neurologic deficiencies and there associated symptoms were summarized by Becker (2012). Another article with Nutritional Neuropathies.

Nutritional deficiencies are seen in a number of illnesses including weight loss surgery patients.

Duodenal Switch and Fat in The Diet

May 21, 2015 12:35 pm

When I perform the duodenal switch operation,  the common channel is a percentage of the total small bowel length and  I also account for the  patient’s metabolic rate. Two individuals with a BMI of 50, should not have the same common channel. If  we compare two patients, one of them is a 20 years old male who is 6’2″ and the second patient is a 60 year old female who is 5’4″, we can see how this applies. These two patients have very different metabolic needs and requirements. When the Duodenal Switch is performed in this fashion, the common channel based on a percentage of total small bowel length and metabolic needs, the patients post op diet works best when it is a well balanced, protein based diet. The basic principals are : Hydration (water), Protein and Everything else, low carb,  avoid artificial sweeteners, avoid carbonated drinks,  have frequent smaller meals and avoid processed food.  Listen to you body as to what it tolerates and what it doesn’t. This is what I recommend for my patients.

I am not aware of any scientific evidence that proves any benefit to excessive amounts of fat for DS patients who have had their length of the common and alimentary bowels based as a percentage of the total length.

My recommendation are to have a well balanced high protein diet. I do not recommend a  low fat diet, except in the healing phase after surgery.  However,  there is no reason to consume excessive amounts of fat long term.

High fat diet is used to facilitate bowel movements for some patients who have constipation. It may be prudent to try and identify what may be causing the constipation and correct or eliminate them before one resorts to a very high fat diet as a “treatment” for constipation after Duodenal Switch. The possible causes for constipation after duodenal switch may be metabolic-organic (where some patients have infrequent bowel movements before DS, hypothyroidism), length of the common and the Alimentary channels and medications (pain meds, narcotics, antidepressants).

In addition, Medium Chain Fatty Acids do not require bile salts to be absorbed and are directly absorbed into the Portal Vein in the liver. Medium Chain Fatty Acids are not malabsorbed post Duodenal Switch. Medium Chain Fatty Acids included Caproic acid, Caprylic acid, Capric acid, and Lauric acid. Commonly found in varying amounts within coconut oil and palm oil. MCT supplement is made with Medium Chain Fatty Acids.

In summary,  I recommend that Duodenal Switch patients who have had surgery with our practice have a high protein balanced diet. I do not recommend avoiding fat, or going on a low fat diet.  I am not sure if there a reason to consume excessive amount of fat, which may in fact have unexpected metabolic and nutrient consequences.

Every patient, as their weight stabilizes, will find what works and what does not work for them. Some patients will tolerate a higher fat intake and other will not be able to tolerate higher fat intake.

Optimizing Pre-operative Health Status

November 12, 2014 1:23 pm

The outcome of any weight loss surgery is dependent not only on the operation but also the extend and depth of preparation before surgery and adherence to the post operative recommendation. The operation should be considered a planned injury to the body. We should enter the operating room in the best physical and mental condition possible to secure the best possible outcome. Optimizing your Pre-operative health status is the best plan for going into surgery in the best shape possible. Here are some basic steps to maximize the odds for a good outcome. Physical preparation:
  • Maintaining a healthy diet
  • Cessation of ALL tobacco and alcohol use
  • Do not use NSAIDS prior to surgery or after surgery until cleared by surgeon
  • Getting plenty of rest
  • Staying Hydrated
  • Pulmonary embolus prevention exercises such as ankle circles and point and flex toes
  • Maintaining or starting a regular activity level. Any amount of increase in activity will benefit you after surgery. Walking, squats, lifting weights with arms
  • Full laboratory blood studies and vitamin levels as ordered by the surgeon
  • Start and optimize your vitamins, calcium and other mineral and supplements. Vitamin D deficiency increases surgical complications. (Another Vitamin D article)
  • Manage preexisting health conditions (diabetes, sleep apnea, high blood pressure etc..) Follow instruction in regards to what medication to stop or continue before surgery i.e. Aspirin, blood thinners, medications that interfere/interact with anesthesia, etc.
  • Two forms of Birth Control if indicated.

Mental preparation:

  • Have a clear understanding of the procedure
  • Study all information provided to you regarding your surgery
  • Remember that surgery is one of many tools to assist in weight loss and improved health. It does not fix other issues.
  • Realistic expectation of the outcome of surgery
  • The role of family involvement for support
  • Be prepared with all the purchases for the post operative diet, vitamin and mineral supplements.
  • There is also a number of other variables that will improve the long term outcome of the weight loss surgery:
  • Investigate Protein Supplements for the highest bioavailability
  • Try and eat whole, unprocessed foods
  • Read labels on all food items
  • Look for high protein recipes
  • Network with supportive people who will provide a positive influence
  • Long term success also depends on:
  • Maintain daily protein requirements
  • Maintain daily vitamins, calcium, minerals and other supplements
  • Routine follow up with your bariatric surgeon.
  • Routine laboratory studies to surveil vitamin and mineral levels.
  • Get your medical advice from your surgeon.
  • Get suggestions from other patients. Do not confuse this with medical advice.
Weight loss surgical procedures are not an easy way out. On the contrary, weight loss surgical procedures are complex operations, from technical, metabolic, nutritional and psychologic perspective. A patient has to be prepared to deal with all aspect of the surgery for the best possible longterm outcome.

Prebiotic Potential Of Almond

July 01, 2008 7:07 pm

Almonds, as well as being high in vitamin E and other minerals, are also thought to have other health benefits, such as reducing cholesterol. Recently published work by the Institute of Food Research has identified potential prebiotic properties of almonds that could help improve our digestive health by increasing levels of beneficial gut bacteria.

Our digestive system maintains large population of bacteria that live in the colon. Prebiotics are non-digestible parts of foods that these bacteria can use to fuel their growth and activity. These ‘good’ bacteria form part of our body’s defense against harmful bacteria and play a role in the development of body’s immune system. The prebiotics work by stimulating the growth of these bacteria. However, in order to get to where they are needed prebiotics must be able to get through the upper part of the intestine without being digested or absorbed by the body.

Funded by the Almond Board of California, IFR scientists first used the Model Gut, a physical and biochemical simulator of the gastro-intestinal tract, to subject almonds to the same conditions experienced in the stomach and small intestine. They then added the digested almonds to an in vitro batch system to mimic the bacterial fermentation in the large intestine and monitored its effect on the populations of intestinal bacteria.

The study, published in Applied and Environmental Microbiology, found that finely ground almonds significantly increased the levels of certain beneficial gut bacteria. This effect was not seen when the fat content was removed from the almond preparation, suggesting that the beneficial bacteria use the almond lipid for growth, and this is the basis for the prebiotic effect of almonds.

Previous studies have shown that the amount of available lipid is reduced if the almonds are not processed, for example by grinding as in this study or by chewing. The length of time the almond spends in the digestive system also affects the amount of available lipids and proteins. More detailed studies on the digestibility of almonds are now required, and the prebiotic effect of almond lipids needs to be tested in human volunteers.

Health benefits of taking probiotics

Bacteria have a reputation for causing disease, so the idea of tossing down a few billion a day for your health might seem — literally and figuratively — hard to swallow. But a growing body of scientific evidence suggests that you can treat and even prevent some illnesses with foods and supplements containing certain kinds of live bacteria. Northern Europeans consume a lot of these beneficial microorganisms, called probiotics (from pro and biota, meaning “for life”), because of their tradition of eating foods fermented with bacteria, such as yogurt. Probiotic-laced beverages are also big business in Japan.

Enthusiasm for such foods has lagged in the United States, but interest in probiotic supplements is on the rise. Some digestive disease specialists are recommending them for disorders that frustrate conventional medicine, such as irritable bowel syndrome. Since the mid-1990s, clinical studies have established that probiotic therapy can help treat several gastrointestinal ills, delay the development of allergies in children, and treat and prevent vaginal and urinary infections in women.

Self-dosing with bacteria isn’t as outlandish as it might seem. An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. These microorganisms (or microflora) generally don’t make us sick; most are helpful. Gut-dwelling bacteria keep pathogens (harmful microorganisms) in check, aid digestion and nutrient absorption, and contribute to immune function.

The best case for probiotic therapy has been in the treatment of diarrhea. Controlled trials have shown that Lactobacillus GG can shorten the course of infectious diarrhea in infants and children (but not adults). Although studies are limited and data are inconsistent, two large reviews, taken together, suggest that probiotics reduce antibiotic-associated diarrhea by 60%, when compared with a placebo.

Probiotic is a nondigestible supplement. a dietary supplement in the form onondigestible carbohydrate that fthe growth of desirablemicroflora in the large bowel.
Probiotic is a substance containing beneficial microorganisms: a substance containing live microorganisms that claims to be beneficial to humans and animals, e.g. by restoring the balance of microflora in the digestive tract.

Probiotic therapy may also help people with Crohn’s disease and irritable bowel syndrome. Clinical trial results are mixed, but several small studies suggest that certain probiotics may help maintain remission of ulcerative colitis and prevent relapse of Crohn’s disease and the recurrence of pouchitis (a complication of surgery to treat ulcerative colitis). Because these disorders are so frustrating to treat, many people are giving probiotics a try before all the evidence is in for the particular strains they’re using. More research is needed to find out which strains work best for what conditions.

Probiotics may also be of use in maintaining urogenital health. Like the intestinal tract, the vagina is a finely balanced ecosystem. The dominant Lactobacilli strains normally make it too acidic for harmful microorganisms to survive. But the system can be thrown out of balance by a number of factors, including antibiotics, spermicides, and birth control pills. Probiotic treatment that restores the balance of microflora may be helpful for such common female urogenital problems as bacterial vaginosis, yeast infection, and urinary tract infection.

Many women eat yogurt or insert it into the vagina to treat recurring yeast infections, a “folk” remedy for which medical science offers limited support. Oral and vaginal administration of Lactobacilli may help in the treatment of bacterial vaginosis, although there isn’t enough evidence yet to recommend it over conventional approaches. (Vaginosis must be treated because it creates a risk for pregnancy-related complications and pelvic inflammatory disease.) Probiotic treatment of urinary tract infections is under study.

Probiotics are generally considered safe — they’re already present in a normal digestive system — although there’s a theoretical risk for people with impaired immune function. Be sure the ingredients are clearly marked on the label and familiar to you or your health provider. There’s no way to judge the safety of unidentified mixtures.

In the United States, most probiotics are sold as dietary supplements, which do not undergo the testing and approval process that drugs do. Manufacturers are responsible for making sure they’re safe before they’re marketed and that any claims made on the label are true. But there’s no guarantee that the types of bacteria listed on a label are effective for the condition you’re taking them for. Health benefits are strain-specific, and not all strains are necessarily useful, so you may want to consult a practitioner familiar with probiotics to discuss your options. As always, let your primary care provider know what you’re doing,