How to avoid malnutrition – Tips and myths after bariatric surgery

Once you start to get informed about bariatric procedures, you might have some doubts related with the follow-up care after surgery. As a big recommendation, no matter which doctor or surgeon you choose, its crucial to follow his/her guidelines as prescribed; there’s a reason why they are providing you a special diet and instructions to follow, so every time you think about changing an element of your post-op care, please get in contact with you main physician or surgeon.

To talk about malnutrition, we need to establish what this is all about… This condition occurs due the lack of macronutrients (Calorie intake from protein, carbs or fat) and/or micronutrients (Vitamins and minerals). The effects of malnutrition range from unnoticeable to severe, affecting your weight loss goals and mostly important, your health.

Saying this, we share you the most common signs to identify malnutrition; fatigue, apathy, weakness, dry skin, losing hair, changes on your fingernails, dry eyes, bleeding gums or poor wound healing. (This may vary by the type of malnutrition)

Prevention – Malnutrition after weight loss surgery

Prevention is the key! You don’t have to wait for signs to start doing something about it; in fact you should take very serious your daily food and vitamin intake, especially during a major weight loss phase... First, stick to a diet rich in high nutrient foods, this means eating from 5-6 times a day, fruits, vegetables and ample lean protein, avoiding empty calories from processed food, sugar and beverages. (That you don’t feel hunger doesn’t mean that you don’t have to eat, your body needs enough energy to keep functioning properly).

Second, add supplements to your daily diet! These may be prescribed by your doctor, if not, get some extra help and visit a local pharmacy or shop where vitamins are sold, and choose a presentation that works better for you personal needs and lifestyle.

According to the American Society for Metabolic and Bariatric Surgery, supplements during the next month’s post-surgery should include:

• Vitamin B12
• 45-60 mg of Iron supplement
• 1-2 adult multivitamins with minerals containing iron, folic acid, and thiamine. 
• 1200 to 1500 mg of elemental calcium from the diet and supplements.  
• At least 3000 international units of vitamin D 

 

And third, but not least important; blood work! It’s very important to monitor your health and realize a blood/lab test every 6 months after bariatric surgery. This is in order to check your health and take better decisions to continue with a healthy weight loss and lifestyle.

In conclusion, having weight loss surgery is not going to cause a malnutrition problem to the patient… skipping meals, eating the wrong food and not taking vitamins its what can lead you to this health condition, even though you have or haven’t went trough bariatric surgery. Understanding the risk of malnutrition, taking steps to prevent and acting quickly when signs of malnutrition appears, can mean a substantial improvement on healthy and long-term weight loss.

If you have any more questions or doubts, please contact us at 1 888 349 4769

Long Term WLS – Weight loss surgery in Tijuana Mexico

Post Op Bariatric Surgery Diet! - General guidelines

The Long Term WLS / VSG Post-Op Diet is designed to bring about significant weight loss, and learning new eating habits helping to maintain this weight loss over time...

In general, the diet includes foods that are high in protein, and low in fat, fiber, calories, and sugar. Important vitamins and minerals are provided as supplements. It is also crucial to get enough protein right after surgery, to make sure that wounds heal properly and over the long term, to preserve muscle tissue. Too much fat delays emptying of the stomach and may cause reflux, nausea, stomach discomfort, or diarrhea. Sugary foods like candies, cookies, ice cream, milkshakes or soft drinks, sweetened juices, and most desserts are foods high in calories and fat, and they can promotes dumping syndrome in some patients with by-passed stomach.

The Long Term WLS / VSG Post-Op diet (basically, in gastric bypass or restrictive procedures) unfolds in 4 Phases:

•  The first phase of the restricted diet, after the operation, consists in clear liquids for 2-3 days.

•  And then followed by phase two a low-fat full liquid with high protein content (At least 60 g/day) for 2 to 4 weeks. Liquid yogurt based-diet, preferable with added protein or commercial products of enteral nutrition vs. formula-diet (as usual in the very low calorie-diet) are some of the alternatives at this period.

• Soft/blended diets are indicated 4-6 weeks after discharge (some patients may need to wait longer).

• The puree diet includes very soft, high-protein foods like egg, low-fat cheese, or blenderized lean meats like chicken, veal or pork and fish (red meats are usually less tolerated).

The regular diet starts about 12 weeks or later after bariatric surgery... It is important to start with high-protein foods, like white eggs, lean meats, cheese or milk, at every meal. Each meal should take between 20-30 min, in much smaller amounts (50-100 g), and chewing carefully. Fluids should be consumed on a near-constant basis; sip slowing but only in between meals. It will be necessary to contact to a dietician for advice on planning an individualized regular diet pattern, and management of lifestyle changes.

Remember to follow the meal to make sure that you lose more weight and also to create a better eating habit, once you learn to eat better and healthier you will feel better and prevent future digestive problems.

Nutrition after weight loss surgery - Frequently asked questions

Its pretty common to have doubts and concerns before and after weight loss surgery, so we asked to our patients their most frequent concerns related with surgery..
For more doubts or questions, contact us! 1 888 349 4769

• Why have I been requested to lose weight prior to surgery?

A: It’s not that you have to lose weight the pre-op diet that we provide is focused to reduce your liver size and prevent any risk during surgery, also it helps you to have a better and faster recovery.

• How long will I be in the hospital?

A: The hospitalization is typically 3 days and 2 night stay.  The recovery period varies, but some patients return to work within a few weeks after the operation. Their only restriction is no heavy lifting for six weeks after the operation.

• How often will I come back for checkups?   

A: Unless you live close by every six months if not do general blood test every six months just to check that your levels are normal.

We also recommend patients stay as connected to the program as possible by attending support groups regularly. So stay in touch on our Facebook group.

• What should I do if I am feeling nauseous?  

A: First look at your eating behavior. You may be eating too much and/or too fast. It is also very important to keep food records to see if this is related to certain foods. Also contact us or our nutritionist if issue continues.

• Why is protein so important?

A: Protein is essential after surgery to help the healing process, and preserve your lean body mass (muscles). Meeting your protein goals is essential, and you also want to EAT YOUR PROTEIN FIRST!

• What if I am vomiting?

A: Vomiting is not an uncommon occurrence, however it can be controlled. If you are vomiting, there are some things you should be looking out for:

- Are you eating your food too quickly?

- Note the texture of the food. Is it too dry? Most often you will find meats difficult to tolerate. Make sure your meat is moist. If you are still not tolerating them, you can make substitutions for these foods. Leave them out of your diet for a few weeks and try them again at a later date.

- Are you chewing your food well? Enjoy, feel, and taste every bite.

- Remember to drink fluids separately.

- Do not eat and drink at the same time. Wait approximately 30 minutes before and after a meal to drink liquids. Most often liquids fill you up and may cause distress, making you feel like you need to vomit.

- Alcohol and coffee create an acid environment in your stomach and can produce vomit.

- Dinner after 7 pm also is important to be aware of.

• Why is fluid important?  

A: It is important to maintain fluids intake of about 64 ounces or more per day. This will help maintain the appropriate body levels of fluids and replace the losses from weight loss. You need to take small slow sips of fluids throughout the day.

Fluids should have minimum calories, no caffeine and no carbonation. To help meet both nutrition and fluid goals you need to keep fluids separate from meals by at least 30 minutes.

• What is the size of my new stomach or pouch?

A: About 1 ounce, which is approximately the size of a small shot glass

• Will I experience some hair loss?  

A: This happens on rare occasions it's more common on the gastric bypass. Sometimes after surgery patient will complain of hair loss. It can be related to not getting enough protein or vitamins in your diet. This is often the body’s response to rapid weight loss. Hair loss is usually not permanent and re-growth typically occurs 3-6 months after it starts falling out.  Talk to your dietitian if you are experiencing this.

• What should I do if I am having a problem with constipation?

A: You may need to increase your fiber and fluid intake. Food records will help you quantify how much you are actually drinking. Adding a fiber supplement may help. If increasing fiber doesn’t help, you may try milk of magnesia, prune juice or stool softener.

• What do I do if I have gas and bloating? What if I have some diarrhea?

A: Some patients may experience these symptoms due to sugar found in milk products called lactose.  If you are intolerant to lactose, it may cause cramping, gas bloating, and/or diarrhea. Switch to lactic products or soy products.   

Also make sure you are not eating too much or too fast. Slow down your eating, take small bites and chew well... If you get a severe dehydration you need and IV, got to the ER to have it applied by a nurse or a doctor.

• What if my weight loss slows down?

A: Your weight loss may seem like a staircase. You are also going to experience “plateaus” and this is normal. Everyone will lose weight at a different rate, so please do not compare yourself to other people. If you hit a plateau (not losing weight for longer than 2 weeks), continue to keep food records and track your exercise. You may need to adjust your diet or exercise to help with your weight loss. If a plateau last longer than 4 weeks call your dietitian.    

• What is the Honeymoon period?  

A: Often you may experience a lack of appetite after surgery. In turn this often causes patients to skip meals, depriving themselves of the nutritional needs. You will need to plan to have 4-6 small meals per day to meet your nutrition goals and have a successful weight loss.  

• What is dumping?  

A: Almost flu-like symptoms (nausea, vomiting, sweating, bloating, diarrhea, etc.) that usually occur after high-fat or high sugary foods.

The symptoms typically last about ½ hour. However, not everyone experiences dumping. To avoid these symptoms, you should select foods that have 14 grams of sugar or less per serving and 3-5 grams of fat or less per serving.

• Why should I take vitamins?

A: Being compliant with your vitamins is key for your health, meeting your nutrition goals, and preventing deficiencies. We will test your labs periodically to help prevent and/or treat any deficiencies you may develop.

• Will I be able to take my prescribed medications after surgery?

A: Small pills or capsules can be taken as before. Larger medications may be broken or crushed, or alternate medications may be prescribed. Check with the medical team or your prescribing physician's.  

• What could be causing me to feel a tight feeling in the middle of my chest while I am eating or right after I eat?

A: A tight feeling when eating is usually a warning sign that there is something about your eating behavior or food consistency that is not right. You may be overeating or eating too fast. Time yourself when you sit down to a meal. Remember it should take about 10 minutes to eat 1 oz food. Make sure that your food preparation methods and food consistencies are appropriate for your diet stages.  

• When am I allowed to drive after my surgery?

A: You are allowed to drive when you are no longer taking narcotics and have enough mobility to drive safe.

• When can I return to work?

A: You may return to work as soon as you feel able as long as you are not required to do heavy lifting as part of your job. Typically 2-6 weeks for most desk jobs, and 6-8 weeks for manual labor jobs. 

Genetics and Obesity are related!

Today we are going to talk about how your genetics are sometimes against you and your weight, but why?... Well Obesity and genetics a directly related and combines with some environmental influences they are 70% responsible for your body’s weight.

And here at Long Term WLS / VSG we understand that bariatric surgery may be the only way to effectively alter these genetically predetermined body processes.

But why my genes are causing me obesity?

Evolution yeah that’s it evolution is one of the main reasons. We are designed to survive and that’s how our bodies has been adapting itself going through survival requirements have coincided with environmental factors over the course of human history.

Let’s stop the history lesson for a moment and go back to what happens internally and let’s talk about hunger. Your genetics determine the amount of hunger-causing hormones that are secreted by your body into your bloodstream and how your brain interacts with those hormones.

Three types of internal body secretions have been found to regulate hunger:

• Hormones from the digestive system, including ghrelin, peptide YY and GLP-1, let your brain know when more nutrients are “needed” based on your body’s requirements.
• Hormones from fat cells (“adipocytes”) such as leptin keep your brain informed about your body’s level of energy deposits (fat cells).
• Neuropeptides in the brain regulate food intake by responding to signals from hormones secreted by the body.

Ghrelin is the first of three hormones sited most frequently in conjunction with obesity. When your stomach is empty, ghrelin is secreted into your blood stream by your stomach. After you eat, the amount of secreted ghrelin drops, then slowly rises until your next meal. Lower ghrelin means less hunger.

Neuropeptide Y neurons in the brain are activated by ghrelin. When your blood carries more ghrelin to the brain, your neuropeptides create “hunger signals” leading you to feel hungry and eat.

The third most commonly-referenced hormone associated with obesity is leptin, which is secreted by fat cells!

If dieting has not worked for you, ghrelin, peptide YY and leptin are likely to be a few of the main culprits because as you diet…

• The amount of ghrelin your stomach secretes increases, causing your brain to receive more hunger signals.
• The amount of peptide YY your digestive system secretes decreases, causing you to feel hungrier.
• As your leptin-secreting fat deposits dissolve, less leptin is released into your blood causing your brain to want to eat more in order to restore its fat deposits.

Now to complete the cycle you have to know that your weight also has an important role here. Each of our bodies has a set weight that it “wants” to maintain. If your body weight goes above your set point, your metabolism will speed up in an attempt to burn off the excess weight. If your weight falls below your set point, your metabolism will slow down to allow more fat accumulation.

Now we that we know how genetics affect let’s talk about how weight loss surgery helps. Let’s keep it in two ways:

1.       Hormones and weight loss: surgery impacts the hormones that affect hunger

2.       Metabolism and weight loss: surgery increases the body’s fat-burning metabolism

Surgeries that bypass or remove part of the stomach, including gastric bypass surgery, gastric sleeve surgery and duodenal switch surgery may reduce feelings of hunger by…

• Reducing the level of ghrelin secreted into the blood stream by the stomach
• Increasing the level of peptide YY secreted into the blood stream by the lower digestive system

Ghrelin and peptide YY plasma (blood) levels are unchanged after lap band surgery (gastric banding) and vertical banded Gastroplasty surgery.

Therefore, it could be suggested that the procedures that remove or bypass part of the stomach (i.e. gastric bypass, gastric sleeve and duodenal switch) could aid in long-term weight loss by causing patients to feel less hungry. At a minimum, sustained weight loss should feel easier to achieve after these procedures due to fewer hunger signals reaching the brain.

Also bariatric surgery has been shown to increase glucose metabolism causing the body to burn energy (fat) more quickly. Increased metabolism is the result of and directly proportionate to the amount of fat lost after weight loss surgery...

For the meat lovers ♥

Red meat contains large amounts of iron, creatine, minerals such as zinc and phosphorus, and B-vitamins: (niacin, vitamin B12, thiamin and riboflavin). Red meat is the richest source of lipoic acid, a powerful antioxidant.

Red meat also contains small amounts of vitamin D. The liver contains much higher quantities than other parts of the animal. And it’s also well known for being a great source of protein.

Now we have to make choices on witch type of cut are more beneficial for a healthier meal. The tastiest cuts of beef are often the ones with more fat. But when you're concerned about your health or you're trying to watch your weight, you want the leanest cuts of beef. 

But which ones are the leanest cuts?

The U.S. Department of Agriculture (USDA) regulates whether cuts of beef can be labeled as "lean" or "extra lean" based on their fat and cholesterol content. So the best way to get the leanest cut is to check labels...

To make sure you are having a lean cut a 3.5-ounce serving (about 100 grams) that contains less than:

·         10 grams total fat

·         4.5 grams saturated fat

·         95 milligrams cholesterol

Now in order to get an extra lean cut make sure that in a 3.5-ounce serving (about 100 grams) that contains less than:

·         5 grams total fat

·         2 grams saturated fat

·         95 milligrams cholesterol

The following ones are considered a great choice for extra lean cuts:

·         Eye of round roast or steak

·         Sirloin tip side steak

·         Top round roast and steak

·         Bottom round roast and steak

·         Top sirloin steak

If you still have questions about which cuts of beef are lean or extra lean, ask your butcher or grocer. If you're dining out, ask the restaurant server or chef for recommendations for lower fat options. But keep in mind that the same cuts of beef can have different names. For example, a boneless top loin steak may also be called a strip steak, club sirloin steak or N.Y. strip steak.

Other tips when choosing cuts of beef:

·         Choose cuts that are graded "Choice" or "Select" instead of "Prime," which usually has more fat.

·         Choose cuts with the least amount of visible fat (marbling).

·         When selecting ground beef, opt for the lowest percentage of fat.

·         Limit consumption of beef organs, such as liver, to about 3 ounces (85 grams) a month since organ meat is high in cholesterol.

Even the leanest cuts of beef can become high-fat diet busters if you prepare them in unhealthy ways. Here are a few simple methods to control the fat:

• ·         Trim it. Cut off any visible, solid fat from meat before preparing, and then remove any remaining visible fat before eating.
• ·         Drain it. After cooking ground meat, put it into a strainer or colander and drain the fat. Then rinse the meat with hot water. Blot the meat with a paper towel to remove the water.
• ·         Chill it. After cooking, chill beef juices so that you can skim off and discard the hardened fat. Then add the juice to stews, soups and gravy.
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Now that you know how to choose your meat, eat healthy and stay healthy!

www.longtermvsg.com

Long Term VSG - Weight loss surgery promotional price:

• Gastric Sleeve surgery staring at $2999 USD
• Revision surgery starting at $4499 USD

Vitamins! Why are they so important after wls...

Vitamins and minerals are essential to our lives and they help us to have a healthier body, now that you have gone through a WLS they are more important so you can continue to be healthy and stay that way...

But why are they important?

Let’s put it this way, your body needs the right amount of the right vitamins and minerals to work at its full potential not just to keep you healthy, and also it can relate to a better weight loss.

Vitamins do regulate core processes such as:

• ·         Appetite and hunger

• ·         Brain activity

• ·         Nutrient absorption

• ·         Metabolic rate

• ·         Fat and sugar metabolism

• ·         Thyroid and adrenal function

• ·         Energy Storage

Food is the best way to get the vitamins and minerals that your body needs, but sometimes we aren’t able to get the amount that we need from our everyday diet, that’s where the supplement comes in...

Here comes the best part after what you as a WLS patientneed to know...! After a bariatric surgery your body is more vulnerable to vitamin deficiencies (depending on the procedure), that’s because the procedures normally reduces the body’s ability to absorb vitamins (malabsorptive procedures), another one is that it doesn’t allow your body to hold as much food from which to draw vitamins (restrictive procedures) or it can go both ways.

In addition, as many as 80% of bariatric surgery patients don’t get enough vitamins before surgery, so the right bariatric diet and bariatric vitamins are that much more important following surgery.

Primarily Malabsorptive:

• ·         Duodenal Switch

• ·         Laparoscopic Gastric Bypass Surgery

• ·        Mini GastricBypass Surgery

Primarily Restrictive:

• ·         Adjustable Gastric Banding (Lap Band Surgery)

• ·         Gastric Sleeve Surgery

• ·         Vertical Banded Gastroplasty

Making sure your body has the right amount of each vitamin will keep you healthy, help you lose weight and help your body keep the weight off!

Now let’s talk about gastric sleeve and which vitamins I have to be aware of as we all know a GS is a restrictive surgery so there is possibility on deficiency on some vitamins such as:

• ·         Thiamin (Vitamin B1)

• ·         Folate

• ·         Vitamin A

...So just be aware and try to find more resources of food to get the amount that is needed.

What happens when you don’t take the vitamins that you need?

Not having regular checkups (blood test) or ignoring the doctors or nutritionist guidelines can have severe problems on a long run. Some of these problems can be caused:

• ·         Calcium deficiencies (Can lead to osteoporosis)

• ·         Iron deficiencies ( Can cause anemia (when your body does not have enough red blood cells to carry oxygen throughout the body), increased feelings of fatigue and hair loss)

• ·         Folate (Folic Acid) deficiency (Can also lead to anemia)

• ·         Protein Deficiency (protein is one of the most important components of your body as it makes up most of your major organs. Not getting enough can lead to a myriad of problems, including muscle deterioration, organ failure, gallstones and even death)

• ·         Thiamin (Vitamin B1) deficiency (affects the heart, digestive system and nervous system. If not caught and treated quickly, learning and memory could be permanently affected. Ultimately, coma and death could be the result)

• ·         Vitamin A deficiency (Can lead to night blindness and increases the risk of disease and death from severe infections. During pregnancy after weight loss surgery, it increases the risk of night blindness and child mortality)

• ·         Vitamin B12 (can cause fatigue and tingling in the hands and can eventually lead to anemia and neurological disorders)

• ·         Vitamin D deficiency (can lead to liver and kidney disorders and bone softening diseases)

• ·         Vitamin E deficiency (causes neurological problems, anemia and can cause wounds to heal more slowly0

• ·         Vitamin K deficiency (increases the risk of osteoporosis and heart disease and can cause you to bruise more easily)

• ·         Zinc deficiency (will give you brittle nails and can lead to hair loss)

The only way to be aware if you have a deficiency in any vitamin is through a blood test. Symptoms that start to appear are often confused with other bariatric surgery side effects and aren’t often diagnosed by a physical exam.

In short, take bariatric vitamins very seriously. If you’re not prepared stick to a strict regimen forever, don’t move forward with surgery.

www.longtermvsg.com