Category: Supplements
Gas (Flatuence) GI upset
July 27, 2017 7:32 am
Following the Duodenal Switch operation, patients will have more frequent flatulence. The problem can get worse with specific dietary choices. A very simple way of looking at this would be that, in general, Carbohydrates contribute to gas and the fat contributes to causing loose bowel movements. Carbohydrate or gluten sensitivity can also increase stool production.There is a significant overlap of the effects of carbohydrates and fat intake and one has to remember that the symptoms of gas and loose stool can often accompany each other.
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.
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
Pregnancy And Weight Loss Surgery
November 21, 2015 5:34 pm
This is not a substitution for formal medical advise that should be given to any patient by their bariatric surgeon and and OB/GYN familiar and experienced in the care of female patients with history of weight loss surgery. This is information that we provide our patients when we are notified of their pregnancy.
We recommend and instruct to take all precautions to avoid getting pregnant within the first 18 to 24 months following weight loss surgery. There is a significant amount of information about preferable birth controls, those to avoid, and additional pertinent information on our website.
Women who become pregnant after Weight Loss Surgery (WLS) should receive specific attention from their obstetrician because of the high risk nature of their pregnancy. Please make sure that you share this information with your OB/GYN. Many patients have become pregnant and delivered health babies after Duodenal switch (DS) without difficulty, but you do need to be watched more closely. The scientific study favor patients getting pregnant after DS when their weight loss , and nutritional markers have stabilized (18 months or longer) and not before. You also need to make sure you are taking all necessary vitamins, minerals and protein.
The first trimester is a very important time in the development of the fetus. Most organs and structures of the fetus are formed in the first trimester and therefore it is imperative that you pay close attention to your nutrition and your nutritional supplements.
You should continue to take your general multivitamins, other vitamins, minerals and your calcium as you were taking prior to getting pregnant. In addition, you should also take what will be prescribed by your OB/GYN. Do not substitute your prenatal vitamin and any other supplements that you are prescribed by your OB/GYN with what you were prescribed by our office. Each patient’s situation is individualized and additional changes or supplementations may be needed based on the advice of your surgeon and OB/GYN. Multiple fetus pregnancies require additional vitamin, mineral and protein needs.
A good prenatal vitamin should contain these:
Vitamin C – is essential for tissue repair, wound and bone healing and increases the body’s resistance to infection. For mother and baby this vitamin is essential daily as it is the agent that holds newly formed cells together. Helps baby to grow and builds strong bones and teeth. It is also instrumental in the body’s ability to absorb iron.
Vitamin D – promotes general growth. It maintains proper levels of calcium and phosphorus thus helping to build baby’s bones and teeth.
B Vitamins (thiamine, vitamin B6, riboflavin) – Thiamine converts carbohydrates into energy for mother and baby and is essential for baby’s brain development. It also aids in normal functioning of the nervous system and heart. If deficient during pregnancy, a baby is at risk for beriberi, a serious heart ailment. Vitamin B6 is also vital to develop your baby’s brain and nervous system. Riboflavin helps the body to produce energy. It promotes growth, good vision and healthy skin for mom and is important for the development of the baby’s bone, muscle and nervous system.
Folic Acid – is one of the B Vitamins that is needed to produce red blood cells. It helps synthesize DNA, is conducive to normal brain functions and is a critical part of spinal fluid, thus making it one of the few nutrients known to prevent neural tube defects such as spina bifida.
Calcium – your developing baby needs this mineral to grow strong bones and teeth, healthy nerves and muscles and to develop normal heart rhythm and blood clotting.
Potassium – is a mineral that helps maintain fluid balance in the body. This mineral helps regulate blood pressure, nerve impulses and muscle contractions.
Vitamin A – is important for cell growth, healthy skin and mucous membranes, and resistance to infections. It benefits red blood cell production in both mother and baby. This vitamin is essential for postpartum tissue repair.
Copper – a trace mineral found in all plant and animal tissues; it’s essential for forming red blood cells-a key process during pregnancy, when your blood supply doubles. Copper also aids tissue growth, glucose metabolism, and growth of healthy hair. It also helps form a baby’s heart, skeletal and nervous systems, arteries, and blood vessels.
Pantothenic Acid – is a trace mineral that regulates the body’s adrenal activity, antibody production, and the growth and metabolism of protein and fats. If you are deficient in this vitamin during pregnancy your baby’s growth may be slowed. This trace mineral is required for many essential functions, including growth, appetite regulation, digestion, wound healing, and the maintenance of collagen and elastin which may explain why some doctors think it may also help prevent stretch marks, one of the banes of pregnancy.
Iron – makes red blood cells, supplies oxygen to cells for energy and growth and builds bones and teeth. In pregnancy this mineral is so crucial because the body must produce extra blood to support the growing baby. During pregnancy you will need double the recommended daily allowance of iron to insure your health and that of your baby’s.
More often than not, many expectant mothers find taking a prenatal vitamin increases nausea in early pregnancy and sometimes beyond. If this happens, ask your doctor or midwife to change your formula or it may help to change how and when you take your vitamin. It is sometimes helpful to take your prenatal vitamins before you go to bed at night. If swallowing a large pill is difficult, cut it in half. In any event just like your mother said all those years, don’t forget to take your vitamin.
The following are important vitamin and nutritional components throughout the pregnancy but in particular the first trimester.
- Folic Acid: one of the B vitamins has been found to prevent neural tube defects (NTD). Increased intake of folic acid reduces the risk of NTDs such as anencephaly and spina bifida (open spine) by as much as 50 to 70% if women take enough before conception and in the early months of pregnancy. Take your general multivitamin and prenatal vitamin every day.
- Vitamin A: important to prevent blindness in the fetus. Vitamin A levels should be drawn and monitored prior to becoming pregnant and during the pregnancy to ensure adequate intake. You may need to take additional Vitamin A in a Dry water-soluble form such as Biotech Vitamin A 25. Please contact your surgeons office if your Vitamin A levels are below normal, or have not been drawn recently.
- Vitamin D: important for bone growth and formation. Vitamin D levels should be drawn prior to becoming pregnant and during the pregnancy to ensure adequate intake. Dry water-soluble form of Vitamin D3 such as Biotech D3 50. There is some research that adequate Vitamin D levels help protect against pre-term labor and an increase in preeclampsia risk.
- Protein: necessary in all structural formation of the fetus and the mother needs to increase protein intake by a minimum of 30 grams daily. Protein is need in nearly all fetal tissue formation.
The second and third trimesters are important in the growth, development and formation of bone structure and the overall growth of the fetus. It is important at this point to continue taking a minimum of 1500 mg Calcium (or what was prescribed by your surgeon), increased protein intake, your multivitamin, prenatal vitamin and any other supplements prescribed by your OB/GYN or surgeon. You may also need to increase your calorie intake with nutritious foods included in a healthy, well balance diet.
If you have any questions please contact your surgeon or the OBGYN. Your surgeon should also be willing to discuss any concerns that you or your OB/GYN may have with them.
Here is an discussion about the outcome of pregnancy after weight loss surgery.
In general we also advice against certain types of birth control because of the associated weight gain reported by the manufacturers. This is a decision that needs to be made after considering all potential side effects including the potential weight related issues. Ease of use should not be the only variable.
As indicated at the beginning of this blog, the information provided here is not a substitute for your nutritional evaluation by your bariatric surgeon or an experienced OB/GYN.
Feeding Tube
April 20, 2015 11:43 am
Feeding tubes are catheters that are placed in the lumen of the gastrointestinal tract. They are used to provide or supplement the nutritional intake. The feeding tubes can be placed in the stomach (gastrostomy tube, G-tube) or the small bowel (jejunostomy tube J-tube). Patients who are having a revision of gastric bypass, VBG, or other weight loss surgical procedure that involves the stomach in our practice will have a feeding jejunostomy placed. The reasoning behind this is that in the unlikely event of a leak, or if the patient cannot tolerate adequate water or protein early on, this provides a way of getting hydration and nutrients. In the case of a patient with a small leak drained by the drainage tubes in place, a re-operation may be avoided if adequate nutrition can be provided to the patient by the feeding tube. Given that the J tube is placed in the small bowel, the patients usually require small, frequent feeding-hydration throughout the day.
The jejunostomy tubes are easily removed in the office.
Gastrostomy tubes are placed in the stomach. They can be placed endoscopically in an intact GI tract (they can not be placed in a gastric bypass patient without taking the patient to the operating room for a surgical approach). These tubes are easy to place, and large volumes of food and hydration can be administered simultaneously.
Additional information is also available here.
Different surgeons have different practice philosophies and approaches. After the revision of hundreds of failed gastric bypasses to the duodenal switch operation, It is my opinion that the benefits of a feeding jejunostomy far outweigh the short-term care issues associated with it.
Copper InformationExclusive Member Content
April 17, 2015 7:21 am
Vitamin K1
April 08, 2015 7:16 pm
Vitamin K1 is a found in dark green leafy vegetables, asparagus, brussels sprouts, some grains, olive oil, prunes, soy bean oil, and canola oil. The body has limited storage capacity for Vitamin K and uses a recycle system to reuse it.
Vitamin K1 is a fat-soluble vitamin that after Duodenal Switch is not as easily absorbed due to the limiting contact of the food product with the bile until the common channel. Bile is needed to absorb fatty acids and fat-soluble vitamins.
Duodenal Switch patients in need of Vitamin K1 supplements should take “Dry” or water miscible type of Vitamin K1, such as Biotech brand. The patients laboratory studies will determine if a patient requires Vitamin K1 supplement. Duodenal Switch patients should have laboratory studies drawn and evaluated at least on a yearly basis. Vitamin K works in a delicate balance with other supplements and should be monitored by a physician, in at risk people.
Vitamin K1 is most know for it’s coagulation effect and the clotting cascade. Vitamin K1 works with calcium and proteins in order to accomplish coagulation synethesis. Care should be taken with Vitamin K supplementation and anti-coagulation (blood thinners) therapy. Please see your physician regarding any supplementation of Vitamin K and blood thinner medications.
A discovery of Vitamin K dependent proteins has led to research on Vitamin K1 in bone health. Bone matrix proteins, specifically osteocalcin, undergo gamma carboxylation with calcium much the way coagulation factors do; this process also requires Vitamin K. Osteocalcin is a Gla-protein that is regulated by Vitamin D. The calcium binding ability of osteocalcin requires several Vitamin K carboxylations to exert it’s effects on bone mineralization.
In adults, the causes of Vitamin K1 deficiency include the following :
Chronic illness
Malnutrition
Alcoholism
Multiple abdominal surgeries
Long-term parenteral nutrition
Malabsorption
Cholestatic disease
Parenchymal liver disease
Cystic fibrosis
Inflammatory bowel disease
Medications: Antibiotics (cephalosporin), cholestyramines, warfarin, salicylates, anticonvulsants, Cefamandole, cefoperazone, salicylates, hydantoins, rifampin, isoniazid, barbiturates, and certain sulfa drugs, higher Vitamin E can antagonized Vitamin K)
Massive transfusion
Disseminated intravascular coagulation (DIC) – Severe
Chronic kidney disease/hemodialysis
Additional information: https://lpi.oregonstate.edu/infocenter/vitamins/vitaminK/
Intake of Vitamin K1 and K2 and bone fracture risk
As always, discuss with your physicians and/or surgeon any changes in medications and supplements. This is not meant to be an all inclusive discussion of Vitamin K.
Telogen Effluvium: Hair Loss After WLS (Weight Loss Surgery)
September 14, 2014 12:56 pm
Telogen Effluvium is the premature pushing of the hair root into a resting state and can be chronic or acute. It is usually brought on by a shock to your body such as high fevers, childbirth, severe infections, severe chronic illness, severe psychological stress, major surgery or illnesses, over or under active thyroid gland, crash diets with inadequate protein, and a variety of medications. Most hair loss from medications, is this type of hair loss, and the related medications include retinoids, beta blockers, calcium channel blockers, antidepressants, and NSAIDS (including ibuprofen). Supplements that can also cause or increase telogen effluvium are higher doses of iron and Vitamin A.
The hair begins to fall out in differing amounts and can start weeks to months after the initial shock to the body or medication initiation. The hair loss can continue up to 6 weeks and typically slows at 8 weeks after the start of the hair loss.
Weight loss surgical patients experience this due to the stress of surgery and the low protein state directly after surgery. Although there is no specific treatment for Telogen Effluvium, there are steps that can be taken to potentially slow the hair loss and help support the new hair growth.
The most important steps to take are to maintain your protein supplementation at a minimum of 80-100 grams of protein daily and hydration (at least 64 ounces daily) after weight loss surgery.
Protein, particularly L-lysine, are the building blocks of hair and nails, without adequate protein your body will forgo making hair and nails to maintain critical muscle mass. Also hydration is important to flush the body of toxins, due to fat breakdown in the liver during the rapid weight loss phase, that will prevent further new hair growth.
Vitamin B6 and B12 deficits can also contribute to hair loss. Multivitamin supplementation is essential to maintaining the required levels of these vitamins. The recommended multivitamin supplementation is two multivitamins daily that are equivalent to Centrum brand multivitamin.
Some people add Zinc supplements to increase hair production. However, if you are adding Zinc it is advised to also add a Copper supplement as they compete with each other for absorption. Copper is important for red blood cell production and a copper deficiency can exacerbate iron deficiency anemia. Inactivity can also decrease zinc levels, therefore exercise/activity will naturally maintain zinc levels.
Biotin is also a B vitamin that can be helpful in new hair growth.
Folicure is a supplement tablet that contains many vitamins and minerals that some people find helpful for hair re-growth. They also manufacture a shampoo that can be used.
There are many shampoos and topical treatments that people use and report satisfaction in their results. However, it is important to note that a topical treatment may make your hair appear thicker but the hair regrowth will only be supported by internal nutritional maintenance. Minoxidil is a liquid vasodilator medication applied to the scalp that is the exception to this rule and can help with hair regrowth. However, Minoxidil will not work to it’s optimal level in the absence of adequate nutritional status.
We always go back to our basics after weight loss surgery of hydration, protein and exercise to maintain health of body and hair.