In March 2020, the Federal Food and Drug Administration updated the food labeling requirements. Therefore clarifying the information. This was to simplify and improve the information provided to the consumer.

Added-Sugars-New-Nutrition-Facts-Label_1

Protein intake requirements change over time following weight loss surgery. This is based on the requirements imposed on our body by a number of variables. These include, activity level, muscle mass, over all health condition to name a few.

A very young muscular athletic male with a BMI or 30 will require much higher protein intake (and absorption) that an inactive older Female with the same BMI. The same young athletic male will require much higher protein intake is he is recovering from a surgery than his baseline.

As we have stated in the past, the protein intake, should be adequate and not excessive. High level of protein intake that are not accounted  for based on muscle mass and activity level, will eventually result in weight gain. The best measure of protein intake in a stable weight patient over 3-4 years post op  is their albumin and protein level. Following your yearly laboratory values at a minimum is an important part of weight loss surgery follow up care.

You also need to adjust protein intake when necessary. Protein needs increase depending on physical needs, infection, healing, pregnancy, surgery, age, injury, etc. Plastic surgery requires higher protein needs for appropriate healing.

Information on protein sources and quality here.

The basic formula for protein intake is 1gm/kg of ideal body weight. The calculator below will provide a guide for the protein into based on your stable weight in lbs.

A Parathyroid scan or Sestamibi scan may be needed if the typical weight loss surgical reasons for elevated PTH levels have been addressed. Sestamibi is a small protein which is labeled with the radio-pharmaceutical technetium-99. This very mild and safe radioactive agent is injected into the veins of a patient with overactive parathyroid and is absorbed by the overactive parathyroid gland. If the parathyroid is normal it will not absorb the agent. The scan below shows the uptake of the agent.

Calcium, Vitamin D and Parathyroid hormone are routinely measured on yearly follow up for most post weight loss surgical (WLS) patients. Elevated parathyroid hormone (PTH) may be caused by Vitamin D deficiency or calcium deficiency (most common in post WLS) or by over active parathyroid gland(s). In the latter case, if one of the four glands is overactive then this is knows as a parathyroid Adenoma. If all 4 are over active and are secreting too much PTH, this is known as hyperplasia. Ultrasound of the neck, may identify an enraged parathyroid gland (adenoma) which is located behind the thyroid gland. Given the large area where the parathyroid gland may be located, additional tests are needed to not only identify the location of the gland(s) but also to distinguish between single gland (adenoma) or multiple glands (hyperplasia) cause for the elevated PTH. It is important to investigate all avenues and testing in parathyroid hormone elevation and in some cases, not to rely on one test for your diagnosis. It is also imperative that weight loss surgical patients take their supplements routinely and consistently and have their laboratory studies followed at least yearly.

• Magnesium citrate or Magnesium Oxide can cause loose stool, gas bloating for some. Check your supplement labels for these types of Magnesium.  Magnesium Citrate is very common in Calcium supplements.
  Magnesium Glycinate is a more absorbable form of magnesium. Magnesium Information here.
• Too high of dietary fat intake. Fat Intake after Duodenal Switch here.
• Lactose (Milk Sugars)
• Milk or Milk products
• Artificial Sweeteners (Splenda, Aspartame (Equal), Acesulfame potassium (also known as Acesulfame K)),
• Sugar Alcohols (Usually found in sugar free items. List: https://www.diabetes.org/food-and-fi…)
• Sugar
• RTD shakes (many are whey concentrate which contains lactose)
• Preservatives
• Nitrates/Nitrites
• Additives
• Fruit
• Gluten from Bread products
• Flour (breading)
• Refried Beans
• Seasonings these may contain hidden or unknown gluten, MSG, etc.
• Meats (example: Pork causes some DSrs gas issues),
• Blend Protein Powders/Drinks (not whey isolate only, milk protein concentrate contains lactose)
• Cruciferous vegetables
• Legumes (Beans/peas/lentils)
• Refined or processed oils
• MSG

Things that help with the odor:

Things to help with trapped gas:

Supplements (which may help):

The importance of daily protein intake can not be over emphasized. The malabsorptive component of Duodenal Switch makes daily protein intake a lifetime necessity.  The amount of protein intake is dependent on individual needs and laboratory study results (which are also a necessity for life) however,  the minimum daily intake should be around 100+- gms per day.  Also hydration is of the utmost importance throughout the weight loss surgical journey. A minimum of 64 ounces daily for adequate hydration.  High hydration,  high protein, vitamins and minerals supplements, and low carb for life.  Fat will come with eating protein and is tolerate on an individuals basis based on age, common channel, alimentary channel, gut microbiome health, bowel motility, medications, etc.

Protein needs increase depending on physical needs, infection, healing, pregnancy, surgery, age, injury, etc. Plastic surgery requires higher protein needs for appropriate healing.

Whey isolate, low carb protein powders are the protein supplements of choice.

During the immediate post surgical period a good protein intake goal is:

1. 30 gms daily by 30 days post surgery
2. 60 gms daily by 60 days post surgery
3. 90 gms daily by 90 days post surgery, etc.

After healing, protein from real unprocessed food sources, such as meats, eggs, cheeses, dairy, seafood, nuts, any animal product is best.  Shakes are to fill in if you are unable to eat real food products.  Some people become lactose intolerant and may need to avoid items with lactose or take Lactaid.

Sites with information on protein:

https://www.dsfacts.com/protein.php

Dr. Keshishian’s blog on protein: https://www.dssurgery.com/blog/protein

Other protein powder recommendations:

Isopure Zero Carb Unflavored or flavored Whey Isolate: https://www.amazon.com/Natures-Best-Perfect-Isopure-Vanilla/dp/B000E95HP0

Unjury many flavors and chicken soup. https://www.unjury.com

Jay Robb Whey Isolate: https://www.jayrobb.com/protein/whey-protein-unflavored-80-oz.asp

Optinumu Nutriton Whey Isolate: https://www.amazon.com/Optimum-Nutrition-Standard-Extreme-Chocolate/dp/B002DYIZHG/ref=sr_1_1?ie=UTF8&qid=1423600951&sr=8-1&keywords=on+protein+isolate+2+lb

List of Ready to Drink Protein Products:

Isopure clear protein drink comes in several flavors:

Vitamin Shoppe’s Isotech protein drink comes in several flavors

Lift protein drink (Atkin’s) https://www.amazon.com/s/?ie=UTF8&keywords=lift+protein+drink&tag=googhydr-20&index=aps&hvadid=89316918974&hvpos=1t2&hvnetw=g&hvrand=3955536375689546811&hvpone=&hvptwo=&hvqmt=e&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9031137&hvtargid=kwd-152082169968&ref=pd_sl_94bo1om6xz_e

Premier protein is a combination protein and contains lactose which some people do not tolerate. https://www.premierprotein.com

Smaller bottles of Isopure clear whey isolate drink: https://www.amazon.com/Isopure-Protein-Alpine-6-Count-Bottles/dp/B001M0NJOQ

Cystosport clear whey isolate drink: https://www.cytosport.com/products/whey-isolate/?tab=flavors

This does not constitute medical advice, diagnosis or prescribing.  It is simply a compiled list of gathered information and not meant to be all inclusive.  If you are in doubt or have questions please contact our office for further assistance. 

The following documents are in the workbook section of our website.  We have decided to add them here also for those that need to reference it in the future.  The documents are a compiled list of the top tips to help you your first weeks at home following WLS.  This is not meant to be an all inclusive list and if you should have any questions, concerns, or comments please do not hesitate to contact our office either by calling or e-mail. 818-812-7222 or contact@dssurgery.com

Duodenal Switch Top Tips For Your First Weeks At Home [Download not found]

Sleeve Gastrectomy Top Tips for Your First Weeks At Home [Download not found]

During the hot summer months and even year around, hydration can be

difficult for weight loss surgical patients due to limited amount of intake and bypassed small intestines.  Staying hydrated can be a full time activity that takes consistency and diligence.  There are many commercial products in both liquid and powder form (mix with fluids) that can provide hydration and electrolytes.  We have a previous webinar on the subject of Fluids and Electrolytes and their importance and role in bodily functions. Please read the labels of some of the powder products available as several are high in Vitamin B6, which if taken in high doses of a long period of time can cause toxicity issues for some people.  It is also best to look at your other supplements for the amount of Vitamin B6 also. Here is a previous blog on Vitamin B6 toxicity.

There are also many infused water recipes that you can make yourself.  It is usually best to add a vegetable or fruit to an herb and a citrus.  If you would like, stevia can be added to sweeten infused waters or leave it unsweetened for a more savory flavor. You can also freeze these and make popsicles or ice cubes.

There are many combination that you can become creative with. Some great combinations for infused waters are:

• Lemon, rosemary, celery

  

• Lemon, blueberry, mint
• Lemon, cucumber, basil
• Lemon, raspberry, mint
• Apple, cinnamon stick, parsley
• Lime, raspberry, parsley

Using a natural type salt can also give you additional electrolytes as well as a salt substitutes that also have potassium.  You can add these to your foods or water.  There are also some beverages available that offer hydration, electrolytes and probiotics.

We have also found a few drinks, drink mixes and water enhancers that are sweetened with Stevia that are great for on the go.  Stur, Crystal Light Pure, Real Lemon and Bai are just a few.

The recommended daily fluid intake is a minimum of 64 ounces of fluids daily after weight loss .  You may have higher fluid intake requirements based on increased fluids lost through drainage, liquid stools, time of year (summer months), fever, illness, vomiting, exercise, or increased sweating. Any type of fluids, preferable low carb fluids count toward your daily goal. If you vomit that fluid should not be counted toward your daily goal. Staying hydrated will take continuous sipping.

If you have any of the following symptoms it is time to call your surgeon/physician.  It is extremely difficult to overcome dehydration once you get into the cycle of dehydration causing nausea causing more dehydration. Intravenous hydration is the best way to overcome dehydration at this point. Untreated dehydration increases chances of heart arrhythmias, heart attack, blood clots, brain swelling, kidney failure, seizures, heat injury, coma and death.

• Nausea
• Increased thirst
• Dry mouth and swollen tongue
• Weakness
• Tiredness
• Sleepiness
• General malaise
• Dizziness
• Lightheadedness
• Low blood pressure
• High heart rate
• Palpitations (feeling that the heart is jumping or pounding)
• Confusion
• Sluggishness
• Fainting
• Inability to sweat
• Decreased urine output
• Dark urine color may indicate dehydration. If urine is concentrated and deeply yellow or amber, you may be dehydrated. (not necessarily true if taking vitamins, vitamins make urine darker)
• Increased or constant vomiting for more than a day
• Fever over 101°F
• Diarrhea for more than 2 days
• Weight loss
• Decreased urine production
• Confusion
• Weakness
• Lack of tear production

Take the person to the hospital’s emergency department or call 911 if any these situations occur:

• Fever higher than 103°F
• Confusion
• Sluggishness (lethargy)
• Headache
• Seizures
• Difficulty breathing
• Chest or abdominal pains
• Pain in calf or leg
• Fainting
• No urine in the last 8 hours