Bariatric Advantage

Study Indicates That Calories, Not Protein, Lead to Increase in Body Fat

Tue, 3 Jan 2012 14:56:00 PST

Study Indicates That Calories, Not Protein, Lead to Increase in Body Fat

A study appearing in the the January 4, 2012 issue of JAMA indicates that when people increase the amount of food they eat, where the calories come from may significantly impact whether or not people gain fat when they gain weight.

Following 25 participants on tightly controlled diets, researchers at Pennington Biomedical Research Center in Louisiana found that when calories from protein were increased, while participants gained weight, they mostly gained lean body mass (muscle) and they ncreased thier resting energy expenditure. Those on a lower protein diet, gained body fat and lost muscle.

While controlling calories is obviously an important part of weight management, studies such as this lend insight to how the source of calories impacts critical factors like resting energy use and body composition - both of which have bearing on overall health.

Reference: JAMA. 2012;307[1]:47-55.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Health Benefits of Harder, Shorter Exercise

Mon, 12 Dec 2011 10:44:23 PST

Health Benefits of Harder, Shorter Exercise

Exercise has long been show to benefit those with Type-2 Diabetes. However, the American Diabetes Association current recommends 150 minutes per week of moderate to intense exercise. At just over 20 minutes per day, every day of the year, this recommendation is prohibitive for many.

A study published in the December 2011 issue of the Journal of Applied Physiology has supplied some new data suggesting that there may be other alternatives. Researchers at McMaster University assessed the benefits of of using 30 minutes per week of high-intensity exercise. They found significant benefits and improvements in key areas of diabetic health.

While the study was very small, and is really just a proof of concept, it is an indication that those with diabetes may be able to get substantial benefits from exercise without lengthy time commitments.

Reference:

Little JP, Gillen JB, Percival M, Safdar A, Tarnopolsky MA, Punthakee Z, Jung ME, Gibala MJ. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol. 2011 Aug 25. (epub, ahead of print)

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Hit the Trail

Sun, 20 Nov 2011 07:47:57 PST

Want to exercise outside but don't know where to start?

Staying physically active is an important part of good health and maintaining your weight. Some people love the gym, for others a great fitness DVD gets them going, but the outdoors also offers up many options for exercising while enjoying the natural environment.

If you are drawn to exercising outside, but often have thoughts like "it's going to take too long", "what if the trail is too hard for me" or simply "where do I go" then we have found a great app to help you on your way.

The AllTrails app (from AllTrails, inc) give you access to over 40,000 trail guides for everything from walking/hiking to snowshoeing. By accessing the GPS on your phone it lets you easily browse trails in your area by distance, length (shortest), and most popular. A simple to use map device will even give you directions from where you are. Once you choose a trail, you can access the trail map, read reviews by others who have been there, and more.

Because the app also gives you time estimates for completing an activity, you can also plan your outdoor time in a way that you know will work in your schedule.

This app is available both in the iTunes App Store and the Android Marketplace. It's free - so you don't lose anything by trying it out - but you may just discover something wonderful!

Happy trails!

http://alltrails.com/

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

"Eat Less and Exercise More" -- It's Not That Simple

Tue, 19 Jul 2011 16:29:06 PST

The study question: What effects do diet and lifestyle changes have on long-term weight gain? Most weight gain happens slowly over time, at the rate of roughly 1 pound a year, and few studies have previously examined what factors can affect weight gain over the long haul in healthy individuals.

This study investigated the relationship of several diet and lifestyle changes such as beverage choices and amount of sleep in nonobese men and women living in the United States. The study combined data from three different, long-term cohort studies—the Nurses' Health Study I and II, and the Health Professionals Follow-up Study—conducted from 1986 to 2006, with more than 280,000 participants. After people with chronic health problems were excluded, data from 120,877 participants were analyzed. Once participants reached age 65, they were excluded from further analysis to avoid confounding due to the loss of lean muscle mass that commonly occurs with age.

Changes in diet and lifestyle factors were measured at four-year intervals. Adjustments were made to take age, baseline body mass and lifestyle factors including physical activity, television watching, alcohol use, sleep duration, and cigarette smoking in account. Dietary factors examined included the amounts of fruits, vegetables, whole and refined grains, potatoes, nuts, dairy products, sweets and desserts, meats, fried foods, alcohol drinks, and trans fat. Several categories were broken down further: boiled and mashed potatoes, french fries, and potato chips; whole-fat and low-fat dairy products; processed and unprocessed meats; sugar-sweetened beverages, diet sodas, and 100% fruit juices; and different types of alcoholic drinks.The relationships between dietary choices and lifestyle factors were analyzed both separately and together.

The results: Small changes in individual behaviors make a big difference in long term weight. The average difference between those with the largest amount of weight gain over the study period and those with the smallest gain or actual weight loss was only 3.1 servings of vegetables per day and 25.3 metabolic equivalents of physical activity per week. Metabolic equivalents (METs) are a practical way to express the intensity of energy expended during various physical activities in a way that is comparable among different levels of physical activities performed by people of different weights. For example, brisk walking at 3 miles per hour, a moderate intensity activity, is roughly equal to 9-10 METs.

While eating more or less of any one food would change the number of calories consumed, the magnitude of weight gain was associated with specific foods and beverages. These show a strong positive association with increased weight gain. Per serving per day, potato chips resulted in a 1.69 pound gain and french fries resulted in 3.35 pounds gained. Refined grains (.39 lb) increased weight gain almost as much as sweets and desserts (.41 lb) per daily serving. Sugared sweetened beverages (1 lb), processed meats (.93 lb) and unprocessed red meats (.95 lb) all showed a similar pattern. The relationship between alcohol consumption and weight gain was not clear and requires more investigation. However, liquid carbohydrates, including alcohol, were associated with increased weight gain.

Less weight gain was robustly associated with increased consumption of other categories of foods. Per serving per day, vegetables resulted in -.22 lb, whole grains in -37 lb, fruits in -.49 lb, and nuts in -.57 lb. Dairy foods overall appear to be neutral. A surprising result was that a daily serving of yogurt was associated with -.82 lb. The authors speculate that the probiotic bacteria in yogurt may alter gut bacteria in such a way that influences weight. Increased consumption of these foods likely means less consumption of those foods associated with increased weight gain.

Physical activities such as sleep and television watching are also associated with long term weight. Weight gain was lowest among those who slept 6-8 hours a night, and was higher for those sleeping less than 6 or more than 8 hours a night. More hours of television watching appears to influence weight gain, and this may due to the opportunity for increased snacking and reduced physical activity. Smoking appears to result in a small initial weight gain, but little weight change afterwards, and the health benefits of smoking cessation far outweigh the associated risks of continuing to smoke as a means of weight management.

Is this study relevant to me? Yes. Anyone interested in maintaining a healthy weight as they age can benefit from the information contained in this study. Eating more nuts, fruits, vegetables, and yogurt appear to reduce weight gain over time, while consuming starches such as potatoes and processed foods high in fat and sugar can increase weight gain. A habitual imbalance of 50-100 calories a day may be enough to result in the gradual weight gain observed in most people.

Limitations of the study: Although this is one of the largest and most comprehensive studies to date on this issue, the study does have some limitations. Portion sizes and lifestyle behaviors were estimated, and could have resulted in some degree of error. The authors note that the true relationship with weight change is likely to be an underestimate. Participants in the study were largely white, educated adults in the United States, which may limit the generalizability of its findings to other populations.

Find this study in PubMed:
Changes in diet and lifestyle and long-term weight gain in women and men.
Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB.
N Engl J Med. 2011 Jun 23;364(25):2392-404.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is Bone Loss in Adolescents Following Bariatric Surgery Related to Weight Loss?

Wed, 8 Jun 2011 12:31:17 PST

The study question: To what extent is the bone loss that teenagers experience following Roux-en-Y gastric bypass surgery related to weight loss?

This study used a retrospective case review of the charts of 61 adolescent patients who all received the same gastric bypass surgery. Whole-body bone mineral content and density were measured using dual-energy radiograph absorptiometry (DEXA). Where possible, scores for these measures were taken prior to surgery and every three to six months following surgery, for a two year period. Scores for the measures were standardized to make them comparable. Data analysis was adjusted to take age, gender and height into account. All patients were told to take a multivitamin with 1000 mg of calcium and 800 IU of Vitamin D daily following their surgery.

The results: Patients’ weight, whole-body bone mineral content and bone mineral density decreased significantly over time following surgery, with boys losing more weight than girls. Weight loss was greatest during the first year after surgery, and then stabilized. Whole-body bone mineral content decreased by 7.4% over two years following surgery. Bone density scores at two years, however, were within the expected values for patients’ age and gender. Weight loss was significantly correlated with the bone loss, but accounted for only 14% of the decrease in bone mineral content in the first year after surgery.

The study raises a number of questions. While there are potential mechanisms to explain just how bone loss could occur after bariatric surgery, these metabolic and hormonal mechanisms need to be investigated in more detail. No one has studied the long-term consequences of weight loss surgery on bone health, so we don’t know whether adolescents who have weight loss surgery could have an increased risk of bone fractures as they age, or not.

Is this study relevant to me? Yes, if you are a teenager or parent of a teenager who has had or is considering weight loss surgery. While the results regarding bone density scores are somewhat reassuring, teenagers may be at a higher risk for nutritional deficiencies because they may be less compliant about dietary recommendations and taking supplements.

Limitations of the study: The study only included the charts of 61 patients out of the 102 that were eligible. Some patients were excluded because they exceeded the weight limit of the machine used to measure bone density, so those with extreme morbid obesity were not included. This may bias the study results. Not all of the study measures were taken at the same time, which can introduce error. Weight loss can also thicken tissue around bone, resulting in overestimates of bone density, and consequently underestimating the true amount of bone loss. There is also no way to know from studying the patients’ charts retrospectively whether they took the daily multivitamin as instructed.

Find this study in PubMed:

Kaulfers AM, Bean JA, Inge TH, Dolan LM, Kalkwarf HJ. Bone loss in adolescents after bariatric surgery. Pediatrics. 2011 Apr;127(4):e956-61. Epub 2011 Mar 28.

DOI: 10.1542/peds.2010-0785

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Another Reason to Avoid the Late-Night Drive Thru

Wed, 1 Jun 2011 10:52:21 PST

The study question: Is going to sleep later in the evening associated with other factors that promote weight gain, in and of itself?

This article examined the association between the timing of sleep, that is, what time people go to bed, and whether timing alone was linked to behaviors such as eating more fast food and fewer fruits and vegetables, a higher caloric intake, and having a higher BMI (body mass index), independent of how many hours people slept.

The study sample of 27 men and 25 women was drawn from the Chicago area using flyers and online advertisements. These participants were asked to wear a wrist actigraph, a small device worn on the wrist that records movement during sleep, for 7 days. Data collected from the actigraph was used to determine sleep and wake times, and the total duration of sleep. Participants used food logs to record every food or drink they consumed daily, along with the time, location, description, and quantity of each meal or snack. Fast food was defined as anything that can be purchased from a drive-through. The calorie content of all food and drink consumed was calculated using publically available nutrition information found at www.sparkpeople.com, in conjunction with restaurant and manufacturer websites.

The results: Participants were classified as having normal or late sleep times, and these two groups were compared to each other. Those with normal sleep times had the midpoint of their sleep earlier than 5:30am and those with late sleep time had the midpoint after 5:30 am.

Compared to the normal sleep timers, late sleep timers reported fewer calories consumed at breakfast and more calories at dinner, more calories consumed after 8pm, more fast food meals consumed, more sodas, and fewer fruits and vegetables. Late sleep timers also had shorter sleep duration (5 ½ hours versus 6 ½ hours) and a higher BMI (an average of 26.0, SD = 6.9), compared to normal sleep timers (an average of 23.7, SD = 3.2). Over the 7 days of the study, later sleep timers consumed an average of 248 calories a day more than the normal sleep timers. While this difference was not statistically significant, most of these calories were consumed at dinner and after 8pm, a behavior that was associated with having a higher BMI.

Is this study relevant to me? Yes, if you are trying to lose weight. The results of this study are consistent with previous research about weight loss, the timing of meals, and sleep. Eating after 8pm and going to sleep later in the evening may increase the risk of obesity.

Limitations of the study: The study used a convenience sample and the sample size is relatively small. The study relied on self-reported information by the participants about their dietary behavior and weight. The researchers did not measure objective metabolic and hormonal markers, so it does not address biological mechanisms that might help to explain the relationship between sleep timing or sleep duration to appetite and weight regulation. Showing an association between a behavior and an outcome alone, in and of itself, suggests but does not conclusively demonstrate a cause and effect relationship between the two.

Find this study in PubMed:
Baron KG, Reid KJ, Kern AS, Zee PC.
Role of Sleep Timing in Caloric Intake and BMI.
Obesity 2011 Apr 28.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Collagen supplements may support skin improvement

Tue, 31 May 2011 12:34:14 PST

The study question: Dietary supplements such as vitamins, micronutrients, and proteins have demonstrated beneficial effects on skin health. Can consuming collagen as a supplement do the same thing?

This article discusses basic science and clinical research about the effects of consuming collagen as a supplement to promote skin health and function. Gelatin is a highly digestible source of protein derived from collagen, the primary protein that makes up the body’s connective tissues such as skin, bone, fascia, tendons, and ligaments. Treating gelatin with enzymes to break its structure down further results in the substance collagen hydrolysate (CH). Clinical studies have found that collagen hydrolysate can reduce arthritis pain, and one study showed it plays a role in cartilage development.

Other basic science research discussed in the article shows that a derivative of collagen hydrolysate can be absorbed through the digestive tract, and appears to stimulate the synthesis of new collagen fibers. Proteins such as collagen are relatively large molecules that are too big to be absorbed directly through the skin when applied topically, so it is important to determine whether they can be absorbed through the intestinal wall and in what form, also known as bioavailablity. This body of research suggests that collagen hydrolysate supplements could be used to stimulate the growth of new collagen fibers in the skin.

Animal studies suggest that collagen consumption can increase the diameter of collagen fibers in connective tissue such as tendons, and that these results may also apply to skin. A Japanese study of 39 healthy female volunteers found that those who consumed a CH supplement had increased skin hydration, observed over a 60-day period. The sample in the Japanese study was small, however, and the difference between the group who consumed the CH and the control group was not statistically significant. Both the true and CH and placebo supplement contained a small amount of vitamin C, so the result of improved skin hydration occurred together with the vitamin C.

Based on the studies presented here, taking CH as a dietary supplement will definitely increase the amount of protein in your diet. It appears to be absorbed through the intestinal wall and metabolized by the cells of the skin. But more research is needed to determine whether and how it works to improve skin health and/or function. Any claims that CH will improve the health or function of your skin are premature at this point.

Is this study relevant to me? Yes, for anyone considering taking collagen supplements to improve skin health or appearance.

Limitations of the study: The research presented supports the idea that CH supplements have sufficient bioavailability, and the effects of CH on tissue repair are promising. But more clinical research with larger groups is needed to document the benefits of CH as a supplement, and to better understand how it might work.

Find this study in PubMed:

Zague, V. A new view concerning the effects of collagen hydrolysate intake on skin properties. Arch Dermatol Res (2008) 300:479–483.

DOI 10.1007/s00403-008-0888-4

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can Bariatric Surgery Help You Live Longer?

Fri, 27 May 2011 12:44:48 PST

The study question: What do we know about the current state of weight loss surgery?

This article is a position paper from the American Heart Association (AHA) that presents current thinking from the AHA about when bariatric surgery is appropriate, the different surgical options and complications related to surgery, and the subsequent benefits of bariatric surgery, including improvements in cardiovascular risk factors.

While more research is needed to determine which procedures work best for different groups of patients, bariatric surgery is the only effective long-term treatment option for those who are severely obese. There are two main types of surgical procedures. Restrictive operations, which reduce the size of the stomach, include the adjustable gastric band and the sleeve gastrectomy, which removes part of the stomach. Combination operations, such as the Roux-en-Y gastric bypass procedure, combine reducing the size of the stomach with reduced absorption of food by connecting part of the stomach directly to a lower part of the small intestine.

Like any kind of surgery, there are risks associated with bariatric surgery. These can include general complications such as blood loss, blood clots, infection, and death (also called mortality). Risks are much lower with laparoscopic surgery, which uses very small incisions in the abdomen, and when the surgery is performed by an experienced surgeon in a center where weight loss surgeries are performed more often. Higher mortality rates are associated with having a higher body mass index (BMI), being older, and also having sleep apnea or diabetes mellitus. Complications after surgery may develop from gastric bands slipping out of place and needing to be re-positioned; the stomach or intestines may become blocked by scar tissue and require more surgery.

Benefits of bariatric surgery include possible remission of diabetes mellitus. One large, long-term controlled study of people with established diabetes compared bariatric surgery to conventional medical therapy for obesity. After two years, 72% of the group who had bariatric surgery had reversed their diabetes, while only 21% of the conventional group did so. Markers of inflammation such as C-reactive protein were reduced; blood lipid profiles and liver function were improved. Gastric bypass surgery appears to be very effective at resolving systemic high blood pressure; in one study 80% of surgical patients maintained normal blood pressure over a 10-year follow-up period.

The most striking finding discussed in this article is that bariatric surgery seems to help people live longer. At eight studies to date using different kinds of research designs have found that patients who have weight loss surgery consistently show reduced rates of mortality compared to those who do not, ranging from 25% to 89%

Is this study relevant to me? Yes, if you are considering the pros and cons of having weight loss surgery. Health care professionals who work with bariatric surgical candidates and patients will also find this article useful, based on its summaries of a large number of studies.

Limitations of the study: More research is needed to determine which surgical procedures offer the best outcomes for individual patients.

Find this study in PubMed:

Bariatric Surgery and Cardiovascular Risk Factors: A Scientific Statement From the American Heart Association.

Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA; on behalf of the American Heart Association Obesity Committee of the Council on Nutrition; Physical Activity, and Metabolism.

Circulation. 2011 Apr 19;123(15):1683-1701. Epub 2011 Mar 14.

DOI: 10.1161/CIR.0b013e3182149099

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

New Caramel Flavored Calcium Citrate Chewy Bite!

Tue, 5 Apr 2011 10:12:29 PST

Introducing the new Caramel flavored chewy bite from Bariatric Advantage -- providing 250mg of calcium citrate in a delicious soft chew. Pre-order yours today!

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Better Sleep, Less Stress, Lower Weight?

Tue, 29 Mar 2011 11:28:09 PST

A new study conducted at Kaiser Permanente in Portland, Oregon looked at the impact of lifestyle factors - sleep, stress, television watching, computer use and depression - on success with a weight loss program.

For approximately 500 patients trying to lose 10 pounds, getting adequate sleep (6 to 8 hours per night) and reducing stress, was associates with a much greater degree of success in achieving their goal. (Patients who lost 10 pounds in 6 months were admitted to the second phase of the study which will look at acupuncture and acupressure as a means of maintaining weight loss.) Individuals with the best sleep and lowest stress were twice as likely as those with poor sleep (under 6 hours) and high stress to move into phase 2 of the trial.

While the authors caution that this data may not apply to all individuals trying to lose weight, the question of how lifestyle may impact weight loss success is one that is important. Better sleep and lower stress have many health benefits, and unlike other kinds of interventions, do not come with unwanted side effects.

Reference:
C R Elder, C M Gullion, K L Funk, L L DeBar, N M Lindberg, V J Stevens
Impact of sleep, screen time, depression and stress on weight change in the intensive weight loss phase of the LIFE study
International Journal of Obesity (29 March 2011) doi:10.1038/ijo.2011.60

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Bone Loss in Teens After Gastric Bypass

Mon, 28 Mar 2011 13:30:12 PST

Bone Loss in Teens After Gastric Bypass
It has long been known that bone loss is a risk for adults who undergo weight loss surgery. In the first study to look at similar measures in adolescents, it appears that teens undergoing gastric bypass surgery are at risk for losing bone as well.

This study followed 61 teens who had undergone gastric bypass surgery for a full two years after surgery. Researchers found that bone mineral content decreased by 7.4%, and bone mineral density z scores also decreased, although they remained in the normal range for gender and age.

Because the study stopped at two years, it is still not known what the long-term impact might be. Unlike adults, teens are still building bone, and are in he process of developing what is called "peak bone mass" - the maximum bone density an individual develops in his/her life. Individuals with higher peak bone mass are at lower risk for osteoporosis later in life.

Reference:
Author: Kaulfers AD
Bone loss in adolescents after bariatric surgery
Pediatrics 2011; DOI: 10.1542/peds.2010-0785.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Vitamin A and Gastric Bypass

Wed, 15 Dec 2010 14:56:01 PST

Vitamin A Deficiency After Gastric Bypass - Underreported
Deficiencies of fat-soluble vitamins, with the exception of vitamin E, have not generally been considered to be a problem after gastric bypass. However, several recent studies have found vitamin A deficiency after gastric bypass, and this raises the concern that it is not being found because it is not being checked.

This new study from Beaumont Health found that at 1 year post-operatively, 18 percent of patients (n = 69) had low vitamin A status. Vitamin A is a very important nutrient for the health of the eye, and also supports health skin, mucosal membranes, and helps to maintain some elements of immune function.

Reference
Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication
Zalesin KC, Miller WM, et al.
J Obes. 2011; 2011: 760695. Published online 2010 September 14. doi: 10.1155/2011/760695.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

WLS Patients Presenting for Reconstructive Surgery Have Poor Nutrition

Wed, 15 Dec 2010 14:20:50 PST

WLS Patients Presenting for Reconstructive Surgery Have Poor Nutrition
In a study of 100 post-operative bariatric surgery patients presenting for reconstructive surgery (plastic surgery), may were found to have inadequate nutritional status.

Key findings included the following:

Eighteen percent had less than the recommended daily protein intake.
Hypoalbuminemia (low serum protein) was observed in 13.8 percent of subjects
Hypoprealbuminemia (low serum prealbumen) was found in 6.5 percent.
Forty percent of all patients had evidence of low iron, with ten percent of subjects having confirmed iron deficiency anemia.
Fourteen and a half percent had vitamin B12 deficiency.

Comments: Patients are often presenting for reconstructive surgery after they have stopped regular follow up with their bariatric surgery practice. These findings may be an indication of a drop off in nutritional compliance that happens in the long-term patient.

Reference:

Plastic & Reconstructive Surgery:

August 2010 - Volume 126 - Issue 2 - pp 602-610

doi: 10.1097/PRS.0b013e3181de2473

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

IOM Updates Vitamin D Recommendations

Wed, 15 Dec 2010 13:39:09 PST

New Recommendations for Vitamin D
in November of 2010, the Institute of Medicine issued new guidelines for vitamin D intake for the United States and Canada. These are the first new recommendations for vitamin D since 1997.

For vitamin D, the old recommendations were 200 international units for those under age 50, 400 IU for people 51-70 years old and 600 IU for those over 71. The new guidelines call for a modest increase to 600 international units (IUs) of vitamin D per day to maintain health, and to 800 IUs for those 71 and older.

Furthermore, they also increased the tolerable upper limit of safety (UL) to 4000 IU from the prior level of 2000 IU.

While this amounts to a substantial change for the IOM, many in the nutrition community were expecting a much greater change, thus there has been fairly high level of debate about what these numbers mean and whether they are the best recommendation.

Reference
http://iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Dieting Puts Vitamins and Minerals at Risk

Tue, 13 Jul 2010 13:09:37 PST

The results of the "A to Z" study from Stanford University, confirm that most popular weight loss diets put vitamins and minerals at risk. This trial look at people in four diet groups:

Atkins Diet (73 patients) - high protein, low carb
Zone Diet (73 patients) - low glycemic
LEARN - a low calorie diet
Ornish Plan - a vegetarian, very low fat diet

Researchers found that at 8 weeks, all dieters were wating about the same amount of calories, and each diet had unique nutrient deficiencies as follows:

Atkins - thiamine,folic acid, vitamin C, iron, and magnesium
LEARN - vitamin E, thiamine, and magnesium
Ornish - E and B-12 and zinc

By contrast, those on the Zone plan had a decrease in risk for deficiency of A, E, K, and C.

Reference
http://www.ajcn.org/cgi/content/abstract/ajcn.2010.29468v1
Am J Clin Nutr 2010 Jun 23. [Epub ahead of print]

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Gastric Bypass, Vitamin D and PTH

Fri, 9 Jul 2010 14:33:14 PST

Gastric Bypass, Vitamin D and PTH
A study conducted at Beaumont Hospital in Royal Oak, MI raises new questions about the relationship between vitamin D status and PTH in post-operative gastric bypass (RNY) patients.

Clinicians followed 123 patients checking baseline labs before surgery and comparing to one year post-operative data. They found that 86% of patients met the criteria for vitamin D deficiency prior to RNY. One year after surgery, mean vitamin D had increased (average supplemental level was 1200-2000 IU/day D3) 29 +/- 13 ng/mL. Despite that increase, and supplementation, 70% of patients remained deficient in D at 12 months. Also at 12 months, PTH was elevated in 33% of patients. Clinicians reported that "there was no correlation between vitamin D deficiency and levels of serum PTH at one year after" gastric bypass surgery.

Reference:
Signori C, Zalesin KC, Franklin B, Miller WL, McCullough PA. Effect of Gastric Bypass on Vitamin D and Secondary Hyperparathyroidism. Obes Surg Jul 2010.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Vitamin D Deficiency After Biliopancreatic Diversion (BPD)

Fri, 9 Jul 2010 13:40:03 PST

Vitamin D Deficiency After Biliopancreatic Diversion (BPD)
Vitamin D deficiency is common in morbid obesity as well as after bariatric surgery. Research is clear that this deficiency is a risk with bariatric surgery, but it is not entirely clear whether any given bariatric surgical procedure actually worsens deficiency - in fact evidence exists for weight loss improving vitamin D status.

Biliopancreatic Diversion (BPD) is a malabsorptive bariatric surgical procedure that has as a side effect a known impact on absorption of fats and fat-soluble vitamins. A new study, examined vitamin D levels in 219 BPD patients at an average time of three years post-operatively, and found that in patients with BPD, vitamin D levels decrease over time.

It is also worth noting that all patients in this study were asked to take 50,000 IU of vitamin D3 per day after surgery. While the authors admit that compliance was not evaluated, 72.3% of patients studied had vitamin D insufficiency, and 46.8% had a deficiency. This would either imply high rates of non-compliance or would suggest that for some percentage of BPD patients this level and/or method of prevention is not adequate.

Reference:
Khandavala BN, Hilbma PP, Fang X. Prevalence and Persistence of Vitamin D Deficiency in Piliopancreatic Diversion: A Retrospective Study. Obes Surg Jul 2010.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Proton Pump Inhibitors (PPIs) and Fracture Risk

Mon, 24 May 2010 11:27:05 PST

Proton Pump Inhibitors (PPIs) Increase Fracture Risk
Proton pump inhibitors (PPIs) are the most potent acid-blocking medications in use. They are known to inhibit calcium absorption, and also to increase fracture risk. A recent prospective, observational cohort study examined the fracture risk in long-term users of these medications (3 years or more).

Data came from over 130,000 women followed for an average of 7.8 years. While PPI use did not seem to significantly change bone mass density or increase specific risk for hip fracture, researchers did find increased risk for clinical spine fractures, wrist or forearm fractures, and overall total fractures.

It is not uncommon for bariatric surgery patients to take PPIs long-term after surgery. Surgery itself already increases the risk for fracture, calcium malabsorption, and bone loss. Thus clinicians would do well to be aware that PPI use might further contribute to this risk, and consider PPI use as one possible modifiable risk factor.

Reference
Arch Intern Med. 2010;170:747-748, 765-771.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Vitamin D May Be Better Absorbed With More Food

Fri, 7 May 2010 14:57:19 PST

Vitamin D May Be Better Absorbed With More Food
People often want to know if vitamins should be taken with or without food. New research indicates that for Vitamin D, administration with the largest meal of the day may substantially increase the absorption of Vitamin D supplements.

In a small study of 17 patients who had not been responding to vitamin D treatment, researchers at the Cleveland Clinic found that when instructed to take their Vitamin D with the largest meal of the day, vitamin D absorption was greatly improved and that over a 2-3 month period levels were raised on average by 50% from baseline.

Reference:
Mulligan, G. Journal of Bone and Mineral Research, April 2010; vol 25: pp 928-930.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Omega 3 For Bones?

Fri, 7 May 2010 10:19:12 PST

While there are many nutrients - calcium, vitamin D, vitamin K - that we know are important for bone health, there are still things that we are learning about the impact of other nutrients. A new study indicates that fish oils like DHA may also be important for healthy bone.

The study, conducted in rats, found that animals supplemented with DHA had healthier bone marrow and increased bone density.
It is not known if these findings would extend to humans, although a recent study commissioned by NASA found that astronauts supplemented with the Omega-3 EPA had less bone loss in space compared to unsupplemented astronauts.

References:
Yong Li, Mark F. Seifert, Sun-Young Lim, Norman Salem and Bruce A. Watkins Bone mineral content is positively correlated to n-3 fatty acids in the femur of growing rats. British Journal of Nutrition, Published online by Cambridge University Press 27 Apr 2010 doi:10.1017/S0007114510001133

Journal of Bone and Mineral Research
Published online ahead of print, doi: 10.1359/JBMR091041
"Capacity of Omega-3 Fatty Acids or Eicosapentaenoic Acid to Counteract Weightlessness-Induced Bone Loss by Inhibiting NF-κB Activation: From Cells to Bed Rest to Astronauts"
Authors: S.R. Zwart, D. Pierson, S. Mehta, S. Gonda, S.M. Smith

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Increased Serum Markers for Bone Loss After Gastric Bypass

Thu, 6 May 2010 15:23:18 PST

Increased Serum Markers for Bone Loss After Gastric Bypass
It is fairly well-understood that bone loss is a risk after gastric bypass surgery. Not all the factors contributing to this are understood. A new study published in January 2010 in the Journal of Clinical Endocrinology and Metabolism suggests a relationship to decreased leptin levels.

The study, which followed 10 men and 10 women found that at 6 and 18 months post op RNY serum osteocalcin, bone alkaline phosphatase and N-telopeptide (NTX) levels, and vitamin D levels were all increased and leptin levels were reduced. After regression analysis, the increase in markers of bone turnover, specifically NTX, were found to be predicted by reduced leptin.

While many factors related to bone loss are thought to be related to nutritional factors such as calcium and vitamin D, it is important to remember that there are other mechanisms including hormone changes, medication use, and central mechanisms of bone loss (such as changes in leptin and ghrelin levels). All of these factors are important to account for when managing risk for bone loss.

Reference:
http://jcem.endojournals.org/cgi/content/abstract/95/1/159
The Journal of Clinical Endocrinology & Metabolism Vol. 95, No. 1 159-166

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Abnormal GI Flora May Be Linked To Obesity

Thu, 6 May 2010 13:23:40 PST

Researchers from Cedars Sinai Hospital in Los Angeles, California, presented data at Digestive Disease Week (May 2010) showing that GI flora may be different in those with a higher BMI. They found specifically that individuals with higher BMIs have more methane-producing bacteria. The lead researcher in this study has proposed that higher methane levels in the gut may slow digestive motility and allow for absorption of more calories from a meal.

Reference:
LA Times, May 6, 2010

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Two New Studies on Gastric Balloons

Thu, 6 May 2010 13:13:43 PST

Two New Studies on Gastric Balloons
Two new studies presented at Digestive Disease Week in May 2010 have found that intragastric balloons might offer a save, less-invasive weight loss procedure for some people.

In the first study, researchers used a saline-filled balloon. They followed 81 patients, and found an average 20 pound weight loss in 5-7 months. This study included 14 patients who were overweight (BMI of 27.6 and 30) but not obese - and thus would not be candidates for bariatric surgery.

The second study used an air-filled gastric balloon. 19 patients were followed for 6 months and lost an average of 29 pounds.

Various forms of gastric balloons have been around since the 1980s, but none are currently approved as weight loss devices in the United States. Several clinical trials are currently looking at these devices to learn more about their safety and efficacy.

Reference:
WebMD News, May 6 2010
http://www.webmd.com/diet/weight-loss-surgery/news/20100506/gastric-balloons-may-aid-weight-loss

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Weight Loss With Adjustable Gastric Band Improves Functional Iron Status in Women

Mon, 5 Apr 2010 08:25:16 PST

Weight Loss With Adjustable Gastric Band Improves Functional Iron Status in Women

A study published in the January 2010 issue of Obesity found that functional iron status improved as women lost weight with an adjustable gastric band (AGB). The authors proposed that one cause of iron depletion in morbidly obese patients is inflammation leading to changes in hepcidin, an important regulator of iron homeostasis. The study found that as the women lost weight, both inflammatory markers and hepcidin declined, and this was associated with and improvement in iron profiles.

While this is a small study, many of the mechanisms for altered nutritional status in morbid obesity are still not well understood. As we improve our knowledge of these mechanisms, we are likely to become better at managing post-operative complications.

Reference:

Tussing-Humphreys LM, Nemeth E, Fantuzzi G, Freels S, Holterman AX, Galvani C, Ayloo S, Vitello J, Braunschweig C. Decreased Serum Hepcidin and Improved Functional Iron Status 6 Months After Restrictive Bariatric Surgery. Obesity (Silver Spring). 2010 Jan 14. (doi:10.1038/oby.2009.490)

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Preoperative Weight Loss improves Postoperative Outcomes

Thu, 1 Apr 2010 14:57:43 PST

Preoperative Weight Loss improves Postoperative Outcomes
A systematic review published in the November 2009 issue of SOARD indicated that the sum total of research to date is supportive of preoperative weight loss for improving postoperative outcomes. The authors included 15 studies with over 3400 patients in their analysis and found that preoperative weight loss was generally associated with better postoperative weight loss. They also noted that even modest weight loss of 10% (and in some studies less) of excess body weight improved other conditions that make surgery higher risk and can result in greater postoperative complications – these included sleep apnea, thromboembolism and elevated blood sugar. The analysis also showed that preoperative weight loss was positively associated with smaller livers, less intrabdominal, visceral and hepatic fat. These factors tend to decrease operative times and blood loss.

The authors concluded that mandating a 10% preoperative weight loss might also help to select for patient compliance – both to determine who might be most likely to comply with postoperative guidelines and also to help health professionals identify individuals who might need more education or support.

Reference:
Does weight loss immediately before bariatric surgery improve outcomes: a systematic review
Surgery for Obesity and Related Diseases, Volume 5, Issue 6, Pages 713-721
M. Livhits, C. Mercado, I. Yermilov, J. Parikh, E. Dutson, A. Mehran, C. Ko, M. Gibbons

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Whey Protein Improves Satiety and Blood Sugar

Thu, 1 Apr 2010 14:55:11 PST

When used before a meal, a dose of 10 to 40 grams of whey protein may decrease food consumption and improve post-meal blood sugar and insulin levels.

Researchers studying the impact of dairy proteins on satiety, found that giving whey protein in advance of an "all you can eat" meal, caused young adult subjects to eat less, feel more satisfied and have healthier blood sugar and insulin levels.

Reference:
Effect of premeal consumption of whey protein and its hydrolysate on food intake and postmeal glycemia and insulin responses in young adults
Am J Clin Nutr 91: 966-975, 2010
http://www.ajcn.org/cgi/content/abstract/91/4/966

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Vitamin A (Retinol) Deficiency After Gastric Bypass

Thu, 18 Mar 2010 14:13:16 PST

Despite the fact that several studies reported in journals in the past several years have found some incidence of retinol deficiency in gastric bypass, it has been given minimal attention as a deficiency of concern in these patients. Procedures with a higher degree of malabsorption (BPD, BPD-DS) are known to produce a substantial risk for vitamin A deficiency and associated eye disease, but many have believed that with lesser malabsorption, RNY would not produce this problem. A study conducted at the Madigan Army Medical Center in Tacoma, Washington, both sheds new light on vitamin A deficiency after gastric bypass and raises new concerns about monitoring and prevention.

Low Vitamin A levels were identified in 7 of 64 RYBG patients (11%). Ocular xerosis (extremly dry eyes) was present in 18 patients (27%) with night vision changes reported in 45 (68%). Visual disturbances occurred in 7 patients (11%) found to have low Vitamin A, with hypovitaminosis A present in 22% of patients with xerosis. The researchers concluded that “low Vitamin A levels and frequent ocular complaints that may be associated with decreased Vitamin A, are common findings in the post-RYBG patient population. Further study is needed to assess the role of routine vitamin A screening and replacement in the post-bariatric surgery patient.”

Vitamin A deficiency can cause very serious problems: most notably eye disease and blindness, but also impaired immunity, skin disease, thyroid dysfunction, and birth defect/deformity.

Reference:
Eckert, M.J., Perry, J.T., Sohn, V.Y., Boden, J., Martin, M.J.,
Rush, R.M., Steele, S.R., The Incidence of Low Vitamin A Levels and Ocular Symptoms
after Roux-en Y Gastric Bypass, Surgery for Obesity and Related Diseases (2009), doi:
10.1016/j.soard.2010.02.044.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Adjustable gastric banding better than diet for obese teens.

Tue, 9 Feb 2010 14:52:14 PST

An Australian study published in JAMA on February 9, 2010 looked at the outcomes of gastric banding versus diet therapy in obese teens (ages 14-18). In the study 25 teens were given a gastric band and the other 25 were placed in a lifestyle intervention group. 84% in the gastric banding group lost more than 50% of excess weight compared to 12% in the lifestyle group. The gastric banding group also showed significant improvements in obesity-related health conditions such as hypertension and metabolic syndrome.

Reference:
O'Brien P, et al "Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial" JAMA 2010; 303: 519-26.

The full text of this study is available here:
http://jama.ama-assn.org/cgi/content/full/303/6/519

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

2 Case reports of birth defect associated with deficiency in bariatric surgery patients

Tue, 9 Feb 2010 10:44:33 PST

The January 2010 issue of SOARD reports on 2 cases of birth defect that appear to have resulted from severe maternal vitamin deficiency after malabsorptive bariatric surgery. The first case was of a baby born at 33 weeks to a 27 year old mother 16 months post-op from a biliopancreatic diversion (BPD). The mother was deficient in vitamin A, D, K, protein, selenium and zinc. The infant was delivered prematurely with multiple defects including bone malformation, cleft palate, facial hypoplasia, and respiratory insufficiency. The baby died at 3 months of age. The second case was of a full-term infant born to a 26 year old mother 11 months post-op from a roux-en-y gastric bypass. The infant was born with multiple defects of bone and cartilage as well as hearing loss which were attributed primarily to maternal vitamin K deficiency. While most of the recent reports of pregnancy after weight loss surgery have been positive in terms of both fetal and maternal health, these cases should remind us that nutritional deficiency in pregnancy can lead to grave results. Both of these patients had been counseled about waiting 18 months to 2 years before becoming pregnant, one even having signed a consent form prior to bariatric surgery. Because of the significant impact that massive weight loss can have on fertility, it is likely that more young, obese women will opt for bariatric surgery to not only improve their overall health, but also to assist with pregnancy. Clinicians and patients alike need to be made aware of the problems that can arise when women who are not adequately nourished become pregnant.

Reference: Kang L , Marty D, Pauli RM, Mendelsohn NJ, Prachand V, Waggoner D. Chondrodysplasia punctata associated with malabsorption from bariatric procedures. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):99-101. Epub 2009 May 23.

Abstract: Click Here

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

A Case of B1 Deficiency in a RNY Patient After Plastic Surgery

Tue, 9 Feb 2010 10:40:54 PST

The January 2010 issue of Surgery for Obesity and Related Diseases (SOARD) reports on a case of acute thiamine (B1) deficiency after plastic surgery in a patient with a history of gastric bypass. The patient underwent multiple, successful procedures including panniculectomy, face lift and brachioplasty (arm lift), however she developed symptoms of neurological deficit during recovery. For several days her medical team pursued a cause for the symptoms without success. On day 3, empiric therapy with intravenous thiamine was tried, providing for significant symptomatic improvement within hours. Over the next 48 hours, with continued “aggressive thiamine therapy” the patient made a full recovery.

Cosmetic surgery, which often involves large incisions, can be taxing on the nutritional stores of the body. Many nutrients are required for wound healing – such as protein, zinc and vitamin C – however many more are conditionally essential meaning that a patient might have normal/borderline levels that are simply inadequate to meet the demands of surgery. While thiamine is not often thought of as a wound healing nutrient, the body stores very little and deficiency can be induced by administration of glucose. Doctors in this case suspect that deficiency may have been brought about by a combination of marginal levels in the patient coupled with the administration of a glucose-containing IV over the many hours of a lengthy set of procedures.

Reference: Sebastian JL, Michaels JM, Tang LW, Rubin JP. Thiamine deficiency in a gastric bypass patient leading to acute neurologic compromise after plastic surgery. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):105-6. Epub 2009 May 18.

Abstract: Click Here

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Study Looks at Issues of Compliance

Thu, 4 Feb 2010 14:14:13 PST

A new study released online January 27, 2010 demonstrates that compliance with nutrition is a challenge for many bariatric surgery patients. The study, titled Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient, looked at bariatric patients admitted to a single hospital years after their bariatric procedures (admissions for other causes). Researchers evaluated what they were doing for supplementation at the time of admission and compared this to current ASMBS guidelines (available here: http://www.asmbs.org/Newsite07/resources/asmbs_items.htm). Most of the patients were 3-7 years post-op, 87% were roux-en-Y gastric bypass. On admission only 33% were taking a multivitamin and only 5% were taking B12 . Problems were also noted with iron, calcium, folic acid and vitamin D supplementation. In addition, researchers found numerous medication errors, the primary problem being the use of slow releasing medication forms in patients with malabsorptive procedures. Overall, this study points to the continued need for both bariatric surgery patients and healthcare professionals to be better educated on appropriate nutrition and medication protocols.

Reference:
Lizer MH, Papageorgeon H, Glembot TM. Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient.
Obes Surg. 2010 Jan 27. [Epub ahead of print]

Link to abstract: Click Here

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What are the ingredients in ProJoe?

Thu, 28 Jan 2010 09:48:19 PST

What are the ingredients in ProJoe?

Mocha: INGREDIENTS: Brewed Arabica coffee (coffee and water), EasyGest protein blend (milk protein concentrate and whole grain brown rice protein), carageenan, dipotassium phosphate, natural and artificial flavors, calcium hydroxide, caffeine, Ace-K, sucralose, niacin, pantothenic acid, cyanocobalamin, pyridoxine HCL.

Chai: INGREDIENTS: Brewed tea (tea and water), EasyGest protein blend (milk protein concentrate and whole grain brown rice protein), carageenan, natural flavors, dipotassium phosphate, calcium hydroxide, caffeine, Ace-K, sucralose, niacin, pantothenic acid, cyanocobalamin, pyroxide HCL.

Nillaccino: INGREDIENTS: Brewed Arabica coffee (coffee and water), EasyGest protein blend (milk protein concentrate and whole grain brown rice protein), carageenan, dipotassium phosphate, natural and artificial flavors, calcium hydroxide, caffeine, Ace-K, sucralose, niacin, pantothenic acid, cyanocobalamin, pyroxide HCL.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

I have had past reactions to Niacin, can I still take your vitamins?

Mon, 25 Jan 2010 15:32:09 PST

I have had past reactions to Niacin, can I still take your vitamins?
The most common type of reaction to niacin is called a "niacin flush", which is not caused by all forms of niacin. Crystalline niacin (the acid form) is found in some vitamin formulas and prescription drugs and is used to lower cholesterol. In some people it causes a very uncomfortable reaction called a niacin flush. This is not usually harmful, but it can be scary and very uncomfortable. People who have had niacin flushing may think they have an allergy.

The kind of niacin most commonly found in multivitamins is the amide form, also called niacin, but technically it is niacinamide (or nicotinamide). The amide form does not lower cholesterol and cannot cause flushing. This is the only form Bariatric Advantage uses in any of our products.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Study Shows More Benefits of Preoperative Weight Loss

Mon, 25 Jan 2010 14:31:50 PST

Study Shows More Benefits of Preoperative Weight Loss
A study published in the December 2009 in the Archives of Surgery shows that the weight loss prior to gastric bypass surgery is significantly associated with a reduction in post-operative complications.

The study, conducted at the Geisinger Medical Center in Danville, Pennsylvania, examined the detailed records from 881 patients who had bariatric surgery at the facility between 2002 and 2006. All patients in the study had either open or laparoscopic gastric bypass surgery and all participated in a 6-month standardized pre-operative program. As part of this program, patients are advised (but not required) to lose 10% of their excess body weight (EBW). Of the 881 patients included in the study, some gained weight and some lost weight. The authors of the study categorized patients by the amount of weight gained or lost in the preoperative period and compared this to postoperative complications in the same groups.

A loss of 6-10% EBW was associated with the lowest incidence of 30-day postoperative complications for both open and laparoscopic procedures. Those losing greater than 10% EBW also had significantly lower complication rates as compared to those who gained weight or only lost 0-5% excess weight.

This data supports prior data from the Geisinger Center which showed that patients with 10% (or higher) preoperative EWL had shorter postoperative hospital stays, indicating that the likely reason is the reduced rate of complications found in the current analysis.

While the authors stop short of suggesting that all patients undergoing bariatric surgery should be required to undergo preoperative weight loss, the do call for prospective, controlled trials to support their findings.

Reference: Arch Surg. 2009;144:1150-1155, 1155-1156.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

New study - Benefits of calcium and vitamin D for fracture prevention

Mon, 25 Jan 2010 14:26:31 PST

New study shows benefits of calcium and vitamin D for fracture prevention
A new review the looked at data from 70,000 adults in the US and Europe has found that the combination of calcium and vitamin D lowers fracture risk. The findings that pooled results from several studies found that an average of 1000mg calcium and 800 IU reduced overall fracture risk by 8 per cent, and hip fractures specifically by 16 per cent. Vitamin D alone did not show protective effects for fracture.

Reference: Abrahamsen B, et al "Patient level pooled analysis of 68,500 patients from seven major vitamin D fracture trials in U.S. and Europe" BMJ 2010; DOI: 10.1136/bmj.b5463.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Study Shows More Benefits of Preoperative Weight Loss

Tue, 12 Jan 2010 12:26:07 PST

Study Shows More Benefits of Preoperative Weight Loss
A study published in the December 2009 in the Archives of Surgery shows that weight loss prior to gastric bypass surgery is significantly associated with a reduction in post-operative complications.

The study, conducted at the Geisinger Medical Center in Danville, Pennsylvania, examined the detailed records from 881 patients who had bariatric surgery at the facility between 2002 and 2006. All patients in the study had either open or laparoscopic gastric bypass surgery and all participated in a 6-month standardized pre-operative program. As part of this program, patients are advised (but not required) to lose 10% of their excess body weight (EBW). Of the 881 patients included in the study, some gained weight and some lost weight. The authors of the study categorized patients by the amount of weight gained or lost in the preoperative period and compared this to postoperative complications in the same groups.

A loss of 6-10% EBW was associated with the lowest incidence of 30-day postoperative complications for both open and laparoscopic procedures. Those losing greater than 10% EBW also had significantly lower complication rates as compared to those who gained weight or only lost 0-5% excess weight.

This data supports prior data from the Geisinger Center which showed that patients with 10% (or higher) preoperative EWL had shorter postoperative hospital stays, indicating that the likely reason is the reduced rate of complications found in the current analysis.

While the authors stop short of suggesting that all patients undergoing bariatric surgery should be required to undergo preoperative weight loss, the do call for prospective, controlled trials to support their findings.

Reference: Arch Surg. 2009;144:1150-1155, 1155-1156.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the difference in formulation between the old unflavored Calcium Crystals and the new unflavored Calcium Crystals?

Thu, 12 Nov 2009 12:22:04 PST

We revised the calcium crystal formula to fix a problem with clumping in cold water. We also removed the sucralose, so this is now an unsweetened product.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is the liquid Vitamin D designed to only be taken straight from the dropper or can it be mixed into other foods as an option?

Thu, 12 Nov 2009 12:19:30 PST

The Liquid Vitamin D can be taken straight or mixed into a soft food or liquid.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the difference between a Prebiotic and a Probiotic?

Thu, 12 Nov 2009 12:17:14 PST

A prebioitc is a non-digestible food, such as a fiber, that stimulates the growth and/or activity of bacteria in the digestive system which are beneficial to the health of the body. In essence, prebiotics are food for probiotics.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is a “Bariatric Vitamin”?

Thu, 5 Nov 2009 13:36:07 PST

After bariatric surgery, people lose weight because they eating less and (depending on the surgery) have malabsorption. These procedures are wonderful for weight loss, but create nutritional change in dietary intake and absorption that can be a challenge. Many studies over the past twenty years have identified nutrient deficiencies that bariatric surgery patients are at higher risk of than the general population – in fact, research is still being done and there continues to be better science looking at these issues over longer periods of time.

A “bariatric vitamin” is one that is formulated with the idea of providing the levels of nutrition that can support the health of bariatric surgery patients and using the forms of nutrients that are preferred based on the surgical alteration of the digestive system. You can think of this a similar concept to prenatal vitamin that provides the amounts and types of nutrients that are needed for the support of a healthy pregnancy.

A bariatric vitamin or vitamin system should help patients, at a minimum, to meet the guidelines established by the American Society of Metabolic and Bariatric Surgeons (ASMBS) and/or the joint committee of the American Academy of Clinical Endocrinologists, The Obesity Society, and the ASMBS.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is a Probiotic?

Tue, 3 Nov 2009 09:43:38 PST

The human digestive system is normally home to several kinds of healthful bacteria or "flora" that play a role in bowel health and regularity, immunity, carbohydrate fermantation, absorption and more. It is sometimes possible for this flora to become altered due to medications (such as antibiotics or acid blockers), illnesses, or surgical procedures.

Probiotics are healthful bacteria that can be supplemented in a tablet, capsule, or food (like yogurt). According to the currently adopted definition by the World Health Organization, probiotics are: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host". Probiotics generally support the health of the digestive system by helping to maintain a good balance of beneficial bacteria. The most common strains of probiotics are Lactobacillus acidophilus and Bifidobacterium Lactis, though many other strains exist.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Iron, B12 and Folate after Sleeve Gastrectomy

Fri, 23 Oct 2009 13:58:37 PST

A new study has shown that there is a risk of B12 and folate deficiency, and a lesser risk of iron deficiency one year after vertical sleeve gastrectomy. 151 patients who underwent the vertical sleeve gastrectomy procedure in Saudia Arabia, had their labs followed for one year. The incidence of B12 deficiency increased from 8.1% pre-operatively to 26.2% post-operatively. Folate deficiency developed in 9.8% of patients and iron deficiency developed in 4.9% of patients. These findings suggest that vertical sleeve gastrectomy patients are at nutritional risk based on their procedure and should be monitored for deficiency after surgery.

Hakaem HA, O’Regan PJ, Salem AM, Bamehriz FY, Eldali AM. Impact of Laparoscopic Sleeve Gastrectomy on Iron Indices: 1 Year Follow-Up. Obes Surg. 2009 Jul 15.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why do the new meal replacements have more sodium and potassium?

Tue, 29 Sep 2009 10:53:59 PST

When we reformulated our meal replacements we went to a higher-grade whey protein isolate. Because highly purified isolates are bitter, sodium and potassium are added to neutralize the taste (by adjusting the pH). This is actually a benefit in longer-term use for weight loss, where there can be issues with electrolyte balance. For short-term use, it really should not matter.

The Daily Value (%DV) for sodium is 2400mg – even at 5 serving/day someone will only be at 1500mg with this product. A low sodium diet is generally defined as one not going over 2000mg/day – which is still higher than the amount in 5 servings. Just for a point of reference, 3 ounces of tuna, 2 medium apples, or 2 cups of milk would give about the same amount of sodium as are found in one serving of the High Protein Meal Replacement. Those who have been advised to restrict sodium or potassium or both, such as individuals on medications for high blood pressure or those on dialysis, should discuss the use of this product with their health professional.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why are Vitamins A, E and D measured in IU rather than grams, mg, or mcg?

Wed, 26 Aug 2009 08:57:52 PST

Some vitamins – specifically A, E and D – are expressed as a unit of biological activity (IU, International Units), rather than as weight such as grams, milligrams or micrograms. Occasionally, it is helpful to know the weight of a nutrient expressed this way.

Here are some of the common conversions:

Vitamin A
1 IU = 0.3 mcg all-trans retinal = 0.3 mcg retinol = 0.344 mcg retinyl acetate = 0.55 mcg retinyl palmitate = 3.6 mcg Beta-Carotene
1 mcg Retinol = 3.34 IU of vitamin A activity
1 mg of all-trans Beta-Carotene = 1667 IU of Vitamin A activity
1 mcg Beta-Carotene = 1.67 IU of Vitamin A activity
1 mcg dietary Beta-Carotene = 0.167 mcg retinal

Retinol Equivalents (RE) = the Vitamin A activity in foods 1 RE = 1 mcg all-trans retinal = 1 mcg retinal = 3.33 IU Retinol 1 RE = 6 mcg all-trans Beta-Carotene = 6 mcg Beta-Carotene 1 RE = 12 mcg other provitamin A carotenoids

Vitamin E
1 IU = 0.67 mg of d-alpha-tocopherol or 0.45 dl-alpha-tocopherol
1 mg = 1.49 IU d-alpha-tocopherol (natural vitamin E; RRR-alpha-tocopherol)
1 mg = 1.10 dl-alpha-tocopherol (synthetic vitamin E; all-rac-alpha-tocopherol)

Vitamin D
1 IU = 0.025 mcg of cholecalciferol (Vitamin D3)
1 mcg Vitamin D (cholecalciferol) = 40 IU

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

New research Supports Calcium Citrate Over Carbonate After RNY Gastric Bypass.

Wed, 26 Aug 2009 08:45:46 PST

New research conducted at the University of Texas Southwestern Medical Center supports the use of calcium citrate over calcium carbonate after gastric bypass surgery. Calcium absorption is impaired after gastric bypass surgery as there is significantly less stomach acid as well as malabsorption from bypassing the duodenum. This study was a double-blind crossover study to compare the absorption of calcium citrate to calcium carbonate after gastric bypass. This is important as bone loss is a serious risk after surgery. Patients are asked to take large amounts of supplemental calcium after surgery, and these are the commonly supplemented forms. This study showed not only better absorption of calcium as calcium citrate, but also a greater decline in serum PTH levels in response to calcium citrate.

Source: Tondapu P, Provost D, Adams-Huet B, Sims T, Chang C, Sakhaee K. Comparison of the Absorption of Calcium Carbonate and Calcium Citrate after Roux-en-Y Gastric Bypass. Obes Surg. 2009 Sep;19(9):1256-61. Epub 2009 May 13. Click Here to view the source article.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Are water miscible vitamins still fat-soluble?

Wed, 26 Aug 2009 08:32:17 PST

A water miscible fat-soluble vitamin is one that has been prepared so it can mix or dissolve in water. This may assist with absorption in someone who has fat malabsorption. In the body, the vitamin itself does not become a water-soluble vitamin like vitamin C and the B-vitamins. A, D, E and K remain fat-soluble vitamins in the body.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the difference between Omega-3, Omega-6, and Omega-9?

Thu, 13 Aug 2009 11:03:11 PST

There many kinds of fatty acids found in the human diet. The two essential fatty acids are the omega 3 and omega 6 groups.

The important omega 3s include α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), all of which are polyunsaturated. Dietary sources include flax, hemp, walnuts, and fatty fish. Most research indicates that our modern diets do not contain sufficient omega 3 fatty acids for good health, and for this reason it can be health-supportive to supplement them from a source like fish oil.

Omega 6 fatty acids that are important include linoleic acid (LA) and arachadonic acid (AA). Dietary sources include almost all animal products, and common sources like palm and soybean oils. Most research indicates that the modern American diet is abundant in these fats, and that relative to our omega 3 fatty acids, we have a very high % of omega 6 in what we eat. Excess omega 6 fats interfere with the health benefits of omega 3 fats; in part because they compete for the same rate-limiting enzymes. Most people, therefore do not need to supplement these fatty acids.

Omega 9 fatty acids are non-essential fatty acids that primarily come from sources such as nuts, avocados, olive oil and animal fats. They are fairly plentiful in the American diet and as they are non-essential, they are usually not supplemented.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do my vitamins need to be taken with or without food?

Wed, 12 Aug 2009 11:31:16 PST

Many of the common nutrients found in a multivitamin are better absorbed when taken with some food.

Calcium can usually be taken on an empty stomach if desired. Your dietitian will likely give you guidance on the best way to take your vitamins each day.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Sublingual B12: How long do I have to let the tablet sit under my tongue?

Wed, 12 Aug 2009 11:28:41 PST

You should keep the B12 in your mouth until it completely dissolves.

If it is hard to keep it under your tongue, place it between your cheek and gum on the side of your mouth. You can also crack the tablet in half with your teeth to help it dissolve a bit more quickly.

Chewing and swallowing the tablet is not advised.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the difference between Calcium Citrate and Calcium Carbonate?

Wed, 12 Aug 2009 11:25:15 PST

Calcium citrate and calcium carbonate are different chemical compounds with different properties.

Calcium citrate has been shown to be better absorbed by close to 30% when there is low stomach acid such as after a gastric bypass, or in those taking medication that reduces stomach acid.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Calcium Crystals: Can I use more or less water than what is recommended on the back of the label?

Wed, 12 Aug 2009 11:21:58 PST

It is okay to use more liquid with the calcium crystals. However if you use less, the crystals may not completely dissolve.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Omega 3: is there a daily value for this product?

Wed, 12 Aug 2009 11:18:43 PST

There is currently no formal recommended intake level for Omega3 fatty acids. This is likely to change in the future and Bariatric Advantage will update the product information when it does.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Are Bariatric Advantage products Only for a Bariatric patient?

Wed, 12 Aug 2009 11:14:32 PST

Our products are specifically designed with the bariatric surgery patient in mind, however many would be fine for those who have not had surgery. It is always best to talk to a qualified health professional before starting any new nutritional product, especially if you have a health concern.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the Recommended Daily Intake of Protein for a Person Who Has Had Bariatric Surgery?

Wed, 12 Aug 2009 11:09:49 PST

There is not an exact amount of protein that is recommended after bariatric surgery; however both the American Society of Metabolic and Bariatric Surgeons (ASMBS), and the joint committee of the ASMBS/American Academy of Clinical Endocrinologists/The Obesity Society have offered some guidance. ASMBS advises that for a gastric bypass patient a range of 60 to 80 grams per day is a common recommendation. They advise that a higher average intake of 90 grams/day would be good for DS patients. The ASMBS/AACE/TOS committee advises a range of 60-120 grams of protein per day after all surgeries. Because protein needs vary somewhat by size, gender and procedure, it is a good idea to ask your doctor or dietitian what is right for you.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Probiotics and Gastric Bypass

Wed, 22 Jul 2009 11:18:45 PST

John Morton, MD at Stanford University has been conducting ongoing research into the use of probiotics in post-operative gastric bypass patients. The study, stared in 2006, has followed 44 patients. Half the patients were instructed to take a daily probiotic, the other half took nothing. The initial outcome that Morton and his team were looking for was improved Quality of Life (QoL) markers, especially fewer digestive complaints. While they did find benefits for general GI complaints, the surprising results were improved weight loss and higher B12 levels. At six months, had a 7% greater excess weight loss compared to the control and higher B12 levels. While the weight loss was considered “not-significant” by statistical measures, it is certainly interesting enough to beg more research into the influence of probiotics on weight.

Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg 2009 Jul;13(7):1198-1204.
study: doi 10.1007/s11605-009-0891-x

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Omega-3 Fatty Acids and Obesity

Wed, 22 Jul 2009 11:15:08 PST

New research published in the British Journal of Nutrition has shown that people with lower body mass indexes (BMI) have higher blood levels of essential fatty acids such as EPA and DHA. The researchers looked at 124 subjects and classified them by BMI as normal weight, overweight, or obese. Obese people had omega-3 levels of 4.53 per cent, compared to 5.25 per cent in their healthy-weight peers. Researchers do not yet know whether essential fatty acids play any role in helping people to lose weight or to maintain weight loss. It is not clear from the results of this study if the link is causal or a simple correlation, however researchers are hopeful that future studies will help to answer these questions. Essential fatty acids are known to support other areas of health such as brain, eye and cardiovascular health.

Source: British Journal of Nutrition
Published online ahead of print, doi: 10.1017/S0007114509382173
"Plasma n-3 polyunsaturated fatty acids are negatively associated with obesity"
Authors: M. Micallef, I. Munro, M. Phang, M. Garg

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Water Miscible, Water Soluble, and Dry.

Thu, 25 Jun 2009 10:20:00 PST

The fat-soluble vitamins A, E, D and K are typically found in oil preparations. This is because in their natural states, they are oily substances that disperse or dissolve well in a fat such as soybean oil.

In some situations, such as when compressing a tablet or providing nutrition to a person who malabsorbs fat, it is advantageous to use a form of a fat-soluble that is designed to either dissolve or disperse in water.
These preparations give several advantages:

They are more stable than the oil-soluble compounds.
They are free-flowing and can be used as a powder or compressed in a tablet.
They do not have to be emulsified by bile so that they can be more easily absorbed by those who have impaired fat digestion and absorption.

We sometimes call these preparations “dry” because they are in a powder form versus a “wet” oil. They are also referred to as water-miscible or cold water-soluble (CWS).

The most common preparation for water-miscible, fat-soluble vitamins is some form of microencapsulation. This is the enrobing of extremely fine particles of the vitamin and is a water-soluble matrix such as acaciamat it using the toolbar.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do we have IF in our Sublingual B12?

Tue, 2 Jun 2009 07:43:01 PST

Bariatric Advantage does not have IF (intrinsic factor) in the sublingual B12 product. While IF is an issue of B12 if swallowed, when it is absorbed in the lining of the mouth or nose, IF is not needed. The reason IF is not needed is the binding sites in the GI tract that require a B12-IF complex for absorption are not involved. For this reason we really encourage people to allow the tablet to dissolve in the mouth (We suggest between the cheek and gum) rather than to chew it up and swallow it. If chewed and swallowed, most people will only absorb 1% - 3% of the B12. Bariatric Advantage encourages people not to swallow the pill, to best assure that they get the B12 they need.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Should vitamins be taken with food?

Thu, 28 May 2009 07:36:10 PST

Generally, it is best to take vitamins with food. This is not only because it is easier on the stomach, but also because we were designed to absorb nutrition from our food.

For this reason, almost all nutrients that we would put into a vitamin are better absorbed when taken with food. This is sort of like tricking the body into thinking the vitamins are still in the food and not in a pill. For some nutrients this makes a BIG difference. For example, taken with food, vitamin E is 5 times better absorbed than when taken alone in a pill.

Another thing to keep in mind is that if we are talking about iron, it shouldn't be taken with a dairy (milk, cheese, yogurt, etc). You can improve the absorption of iron if taken with some sort of meat or a vitamin C containing food such as fruit.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is PDCAAS?

Tue, 26 May 2009 07:50:28 PST

Protein Digestibility Corrected Amino Acid Score (PDCAAS)

A PDCAAS value of 1 is the highest, and 0 the lowest as the table demonstrates the ratings of common foods below.

Food	Serving size	Grams Protein	Calories	BV	PDCAAS
Chicken breast, boneless, cooked	3 oz. (85 g)	27	128	79	.91
Ground Beef, lean, cooked (15% fat)	3 oz (85 g)	24	197	80	.91
Tuna, canned in water	3 oz (85 g)	23	99	83	0.90
Egg, hardboiled	1 large	6	78	93.7	0.97
Milk (1%)	1 cup/8 oz (244 g)	8	102	84.5	0.94
Yogurt, low-fat, plain	1 cup/8 oz (227 g)	12	143	84	0.95
Tofu	3 oz (85 g)	13.5	123	64	0.93
Salmon, baked	3 oz (85 g)	18.8	175	76	1.0
Rice	1 cup (158 g)	4.3	205	64	0.47
Peanut butter, chunky, unsweetened	2 Tbsp (32 g)	7.7	188	83	0.52
Corn (cooked kernels)	½ cup (82 g)	2.6	72	60	0.42
Peas (cooked)	½ cup (82 g)	4.1	62	76	0.73
Oatmeal, cooked	1 cup (234 g)	13	129	55	0.57
Whey Protein (isolate)	1 oz (28 g)	24	100	159	1.0
Whey Protein (concentrate)	1 oz (28 g)	22	113	104	1.0
Soy Protein	1 oz (28 g)	23	100	74	0.96

Sources:

Health Canada, Nutrient Value of Some Common Foods (1999)
Tufts University School of Medicine; Harvard University
USDA National Nutrient Data Bank

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much Caffeine is in Click Protein drink?

Wed, 8 Apr 2009 14:37:19 PST

Per, the manufacturer of the product: The caffeine in Click! Is naturally occurring in the coffee so it may vary a bit. It is approximately equal to 180 mg or what you would find in 2 cups of coffee.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Blood thinners and multivitamins.

Wed, 8 Apr 2009 14:35:48 PST

The only Bariatric Advantage products that have Vitamin K are the Tropical Multi Formula Vitamin, Bariatric Advantage Meal Replacements, and the Calcium Carbonate Chewy Bites – all the others are free of K. For calcium, the crystals and the citrate chewy bites have no vitamin K. If you are on blood thinners, you should always consult your physician about what you can and cannot safely take.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Adding Unflavored Protien and Meal Replacements to food.

Wed, 8 Apr 2009 14:13:24 PST

Unflavored meal replacements can be added to almost anything – yogurt, oatmeal, flavored drinks, blended with fresh fruit/sugar free flavorings, added to soups after cooking. Some unflavored proteins (AnyWhey) can actually be used in cooking, however the meal replacements cannot be cooked.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do BA products contain Allergens?

Wed, 8 Apr 2009 14:07:48 PST

Part of the labeling requirements since 2005 has been the meticulous disclosure of allergens in our products. The allergens that must be disclosed BY LAW are any component or derivative of any of eight allergenic foods: milk; eggs; fish such as bass, flounder, and cod; crustacean shellfish such as crab, lobster, and shrimp; tree nuts such as almonds, walnuts, and pecans; peanuts; wheat; and soybeans. The law also identifies as a major food allergen any ingredient that contains protein derived from any of these eight foods. We have some dairy ingredients (whey protein in our meal replacements), a couple of soy ingredients, and one fish-derived ingredient. These are clearly disclosed in the allergen warning which is on the left panel of our labels (when you look at the front of the bottle the part to the left of the product name). The one thing we are not required to disclose that could cause an allergy is flavor agents. We use almost all natural flavor agents.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What are benefits in taking Acidophilus?

Wed, 1 Apr 2009 06:31:17 PST

Acidophilus is a strain of bacteria that is normally found in the healthy digestive system. Levels of this healthy bacteria are often damaged after taking antibiotics or having surgery on the digestive system. Replacement can help to restore levels in the digestive system. This can support normal digestion and local immunity in the digestive system, help to maintain bowel regularity, and may benefit nutrient absorption.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do your products have an NDC code?

Tue, 8 Jul 2008 07:56:46 PST

Do your products have an NDC code?

As a dietary supplement company the CDER will not allow us to apply for NDC numbers. NDC numbers are only given to OTC and prescription drugs, and dietary supplements are not either of these. We track all products by UPC codes and by lot numbers.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Calcium Lactate Gluconate Absorption

Thu, 3 Jul 2008 10:10:36 PST

When it comes to calcium so long as you can dissolve and ionize it, the absorption is all the same. The acid soluble forms of calcium - carbonate, phosphate, diphosphate, triphosphate, calcium-protein complexes (like those in milk) - are thus not acceptable because you must have acid to ionize them and make them bioavailable. For example, calcium carbonate has to undergo a chemical reaction with HCl to calcium chloride which then freely ionizes in the small intestine making it easy to absorb. This cannot happen without acid. For forms such as citrate or lactate-gluconate, they freely ionize at neutral and even basic pH. The crystals actually ionize when they are put in water making them readily available for absorption. As the chemical properties are very similar otherwise to citrate, this would make it a very acceptable form. There has really only been one trial of calcium citrate in RNY patients - and it was pretty small. Most of what people rely on for the recommendation is the pharmacology above.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Soy in BA High Protein Meal Reaplcements

Tue, 29 Apr 2008 10:10:32 PST

The Bariatric Advantage High Protein Meal Replacements provide 27 grams of protein from high quality whey protein isolate. The allergen statement on the left panel of the label discloses soy because of lecithin, an ingredient used to mask aftertaste. There is no soy protein in this product.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Pregnancy outcomes after gastric bypass.

Thu, 31 Jan 2008 15:16:36 PST

There a continued questions about the safety of pregnancy following bariatric surgery. Researchers at Allegheny General Hospital in Pittsburgh, Pennsylvania compared the perinatal outcomes of 26 bariatric surgery patients to both obese and non-obese controls. They found that postoperative patients had a rate of pregnancy complications similar to non-obese controls and statistically less than morbidly obese controls.

Patel JA, Patel NA, Thomas RL, Nelms JK, Colella JJ. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008 Jan-Feb;4(1):39-45.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Dietary Fish Oil and Weight Gain

Mon, 31 Dec 2007 10:47:43 PST

A study published in December 2007 in the Journal of Nutrition compared two groups of mice on high fat diets. In one group, 8% of the fat calories came form fish oils high in Omega-3 fatty acids, in the other it did not. The high fish oil group gained less weight and metabolised more fat than the control. The high fish oil diet was further found to improve fat metabolism-related enzyme activity, including fatty acid beta-oxidation, omega-oxidation, and malic enzyme activities in the small intestine.

Mori T, Kondo H, Hase T, Tokimitsu I, Murase T. Dietary fish oil upregulates intestinal lipid metabolism and reduces body weight gain in C57BL/6J mice. J Nutr. 2007 Dec;137(12):2629-34.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Childhood Obesity and Coronary Artery Disease

Mon, 31 Dec 2007 09:17:10 PST

A study appearing the the December 6, 2007 issue of the New England Journal of Medicine significantly connects childhood weight to adult risk of coronary artery disease. Danish researchers looked at 277,000 children born from 1930 to 1976 and found that those with higher BMIs were significantly more likely to have heart disease as adults. Researchers further predicted that with the global rates of childhood obesity rising, that this will lead to a potentially epidemic rise in adult coronary disease in the next 3 decades.

Baker JL, Olsen LW, Sørensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007 Dec 6;357(23):2329-37.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Amount of folate in a pre-natal (prenatal) vitamin

Fri, 28 Dec 2007 13:43:58 PST

Folic Acid (folate) is a very important nutrient in pregnancy. Most pre-natal (prenatal) vitamins provide 600 to 1000 micrograms of folic acid per day. All Bariatric Advantage multivitamins provide 800 micrograms of folic acid. To reach the level of 1000 micrograms (1mg) the addition of our B12 with folate adds another 200 micrograms.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Amount of iron in a pre-natal (prenatal) vitamin

Fri, 28 Dec 2007 13:40:29 PST

The RDA for iron in pregnancy is 27mg. Most pre-natal vitamins provide between 27 and 60 milligrams of iron per day. This is 1 to 2 of the Bariatric Advantage Passion Fruit Iron or 2 to 3 of the Strawberry Iron.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why is there copper in the Zinc-50?

Fri, 28 Dec 2007 12:19:33 PST

The Zinc-50 capsules contain a small amount of copper. The copper is there to help guard against zinc-induced copper deficiency which can happen if you take enough zinc for a long period of time. If you are taking a high dose of zinc for a long time, your doctor should also be monitoring your copper levels.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Ferronyl® Carbonyl Iron Powder

Wed, 26 Dec 2007 11:05:08 PST

Document Source - International Specialty Products (ISP)

Ferronyl® Carbonyl Iron Powder: A Safer Choice For Iron Supplements
Information for Bariatric Surgery Physicians & Patients

Introduction
Each year accidental iron overdose accounts for a significant number of emergency room visits and too many cases of childhood death. In developing effective products for iron supplementation, care must be taken not to increase the incidences of toxic exposure. Thus, one must consider not only bioavailability, but also toxicity when selecting an iron source for a supplement product.

Ferronyl® carbonyl iron powder (CIP) is elemental iron (Fe) with > 98% iron content. A key physical property of Ferronyl is its fine spherical particle size (5 µm) which is considerably smaller than the 10-100 µm of other forms of elemental iron (e.g., reduced, electrolytic and atomized). As a result, Ferronyl has higher human bioavailability than these other forms. The net absorption per unit dose of Ferronyl is also greater than that of any of the currently used ferrous (Fe 2+ ) salts (Fe 2+ sulfate, Fe 2+ fumarate, Fe 2+ gluconate, etc.). While the latter may have a higher relative biological availability than elemental iron, their iron content is only 12 - 32% of Ferronyl.

The primary reason Ferronyl is offered as an alternative to ferrous salts is the inherent safety (30 - 150 fold reduction in toxicity) that results from the rate limiting conversion of elemental iron to ferrous ion via gastric acid. As a result of the slow gastrointestinal oxidation, toxic effects resulting from accidental overdose of carbonyl iron take longer to materialize; a window of time allowing clinical intervention. Both historic and more recently expanded acute oral toxicity studies in several animal models support these claims. In addition, statistics compiled by the American Association of Poison Control Centers show both fewer and less severe incidences of toxic exposure resulting from accidental overdose of carbonyl iron powder versus ferrous salts. This inherently safe material is one effective and demonstrable way iron supplementation does not become iron overdose and death.

Further details on product properties (specifications, regulatory status, tableting, stability) can be found in the ISP Ferronyl Technical Profile brochure.

Bioavailability
The amount of iron absorbed by the body per unit dosage from a particular iron source is a function of several factors - particle size, surface area, ionic charge, iron content. The first three of these factors contribute to the relative biological value (RBV) of the iron source - a measure of how quickly the iron enters the blood stream. The iron content is a function of molecular structure, i.e. elemental iron versus ferrous salts like FeSO4 and is a measure of the percentage of iron in a unit dose. Multiplying the RBV by the iron content produces the iron absorption per unit dosage. Table 1 shows that the high iron absorption from Ferronyl results from its small particle size which contributes to a higher RBV than other forms of elemental iron and its high iron content relative to ferrous sulfate.

Table 1. The small particle size of Ferronyl contributes to its high RBV, which together with its high iron content leads to high absorption per unit dose.

Iron Source	Particle Size	µm RBV, %	Iron Content, %	Absorption, %
FeSO₄	N/A	100	20	20
Reduced Iron	10 - 20	34	96	33
Electrolytic Iron	10 - 20	48	97	47
Ferronyl	4 - 6	70	98	69

In a study of iron-deficient rats, Sacks and Houchin (1978 a,b) concluded that, for similar iron dosage levels, carbonyl iron powder was as effective as ferrous sulfate and more so than ferrous pyrophosphate in restoring normal hematocrit levels (Table 2). Due to its finer particle size, carbonyl iron powder was also found to be more efficacious than the other forms of elemental iron (e.g., electrolytic and reduced).

Table 2. Effect of various iron supplements on rat hematocrit levels.

Iron Source	Supplement Dose (mg/kg)	Iron Dose (mg/kg)	Increase in Hematocrit with 2 weeks Supplementation
Control (Basal Diet)	0	0	-2
FeSO₄	30	6	4
FeSO₄	60	12	11
FeSO₄	120	24	22
CIP	12	12	6
CIP	24	24	15

Toxicity
Poison Control Statistics
In recent statistics compiled through the American Association of Poison Control Centers' Toxic Exposure Surveillance System (AAPCC TESS) carbonyl iron powder had substantially fewer and less severe signs and symptoms of toxicity then ferrous salts both on an absolute basis and relative to the total number of reported incidences (Table 3). In fact, CIP has never been documented to cause a major side effect or death. Furthermore, the same AAPCC TESS database shows that CIP is significantly safer than ibuprofen, a common over the counter drug not subject to the packaging and labeling requirements of iron supplements. Another finding from these data is that the AAPCC documented the length of time these overdose signs and symptoms persisted in the ferrous salt and carbonyl iron powder overdose situations. With iron salt overdoses, the majority of the symptoms for both moderate and severe effects lasted over 24 hours and some as long as one month. In the two reported cases of carbonyl iron powder overdoses there was complete recovery within 8 hours.

Table 3. Carbonyl iron powder caused fewer and less severe incidences of toxicity than ferrous salts or ibuprofen.

	Iron Salts (1995)	Iron Salts (1996)	Ibuprofen (1995)	Ibuprofen (1996)	CIP (1995)	CIP (1996)
Moderate Effect	155	117	17	29	1	1
Major Effect	14	5	1	2	0	0
Death	2	2	0	0	0	0
Total	171	124	18	31	1	1
Reported Exposures	21,643	22,382	18,333	21,970	1527	1252
≥ Moderate Effect	0.79%	0.55%	0.10%	0.14%	0.06%	0.08%

Moderate effects include hemetemesis, acidosis, hyperglycemia, vomiting, diarrhea, and electrolyte abnormalities.
Major effects include seizures, respiratory depression, and tachycardia.

Animal Toxicity Studies
The relative safety advantage of carbonyl iron powder over ferrous sulfate has been known for over fifty years. Acute oral toxicity studies done in several different laboratory species show that for the same iron dosage CIP is 30-150 times safer (Table 4).

Table 4. For the same iron dosage, CIP is significantly safer than ferrous sulfate.

Study	Species	FeSO ₄ LD ₅₀ (mg/kg)	Fe ²⁺ LD ₅₀ (mg /kg)	CIP LD ₅₀ (mg/kg)
Shelanski, 1950; Boyd & Shanas, 1963	Rat	1490-5000	298-1000	30,000
Shelanski, 1950; Boyd & Shanas, 1963	Guinea Pig	1500-1750	300-350	20,000
GAF, 1990	Dog	800	160	>25,000
ISP, 1997a	Young Rat	950	190	19,000

In the 1997 study on young rats (ISP 1997a,b), the research also looked at the time to expiration for animals given a toxic iron dose. When treated with 1000 mg/kg ferrous ion, 60% of the animals expired within 2 hours and the remainder within 4 hours. For animals treated with 100 times more Ferronyl; all lived at least 4 hours, half lived at least 24 hours and some lived for as long as 5 days (Table 5). This time differential is directly related to the rise in free plasma iron and suggests that the oxidation of Ferronyl to ferrous ion and subsequent movement of the ion across the mucosal cell is significantly slower than the simple transport of the ferrous ion derived from ferrous sulfate. The slower increase in toxicity provides time for clinical intervention in the case of accidental Ferronyl overdose that is not available in the event of iron salt overdose.

Table 5. The toxic effects of iron overdose from Ferronyl take longer to develop than those of ferrous salts despite the higher dosage.

Time (Hours)	Mortalities / Treated (100,000 mg Ferronyl/kg)	Mortalities / Treated (1000 mg Fe ²⁺ LD ₅₀ (mg /kg)
1	0 / 10	1 / 10
2	0 / 10	6 / 10
4	0 / 10	10 / 10
24	5 / 10	---
48	8 / 10	---
72	9 /10	---
120	10 / 10	---
T₅₀	24.57	1.4

In rats given a LD₉₀ dose of iron (ISP 1997c), Ferronyl treated animals had lower plasma iron after 1 hour and no visibly detected gastrointestinal tract erythema, despite 100 (males) and 290 (females) times higher dosages of iron than the ferrous sulfate treated animals (Table 6). This corroborates the previous finding that Ferronyl entered the vascular space more slowly than ferrous ion.

Table 6. The low toxicity of Ferronyl results from the controlled release of iron into the blood stream.

Iron Source	Iron Dose (mg/kg)	Plasma Iron (µg / dl)	1 Hour Post-Dosing	Stomach & Intestine; Gross Pathological Examination
FeSO₄	240 (1200 FeSO 4 ) Male; 220 (1100 FeSO 4 ) Female	993 ± 638	Erythema	"slight - pronounced"
Ferronyl	23,000 Male; 64,000 Female	438 ± 22	No Erythema	black granular [test] material"

In a study of young swine (ISP 1998), all of the animals lived, but the physiologic response to a noxious insult (vomiting and diarrhea) was less severe for the highest dose of Ferronyl than the lowest dose of FeSO 4 (a 750-fold difference in iron content) (Table 7).

Table 7. Despite significantly lower dosages, the reaction to Ferronyl in young swine was significantly less severe than to ferrous sulfate.

Iron Source	Dose of Test Substance (mg/kg)	Dose of Iron (mg Fe/kg)	Mortalities	Vomiting	Diarrhea
FeSO₄	100	20	None	Severe	Severe
FeSO₄	250	50	None	Severe	Severe
FeSO₄	500	100	None	Severe	Severe
Ferronyl	500	500	None	None	Moderate
Ferronyl	5,000	5,000	None	Minimal	Moderate
Ferronyl	15,000	15,000	None	Minimal	Moderate

Plasma iron levels increased for all FeSO 4 and Ferronyl treatment groups. The plasma iron levels for swine receiving the highest dose of Ferronyl (15,000 mg/kg) were comparable to those that received the lowest dose of FeSO 4 (20 mg Fe 2+ /kg). These findings, like those of the previously mentioned rat study, suggest that although iron crosses the wall of the GI tract, there is a barrier to the movement of large amounts of Ferronyl into the blood stream in a short period of time. Histopathological staining of key organs for iron deposits reinforced this observation. Again the amounts found in the lowest doses of ferrous sulfate were comparable to the amounts of iron found with the highest doses of carbonyl iron powder. A 14-day recovery period indicated that iron stores in liver and spleen returned to normal in Ferronyl treated animals vs. those that received FeSO 4 .

References

Boyd & Shanas, The Acute Oral Toxicity of Reduced Iron, Canad. Med. Assn. J. 89, 171-175, 1963.
Crosby, W. H., Prescribing Iron? Think Safety. Arch. Intern. Med., 138, 766-767, 1978.
GAF. Acute Oral Toxicity in the Dog: Carbonyl Iron vs. Ferrous Sulfate, GAF Unpublished data, 1990.
ISP, Single Dose Oral Toxicity in Rats / LD50 in Rats; Carbonyl Iron Powder, ISP Unpublished data, 1997a.
ISP, Single Dose Oral Toxicity in Rats / LD50 in Rats; Ferrous Sulfate (Iron II) Sulfate, ISP Unpublished data, 1997b.
ISP, Single Dose (LD90) Oral Toxicity in Rats; Carbonyl Iron Powder and Ferrous Sulfate (Iron II) Sulfate, ISP Unpublished data, 1997c.
ISP, Food Additive Safety Study with Carbonyl Iron and Ferrous Sulfate in Young Swine, ISP Unpublished data, 1998.
Sacks, P. V. and D. N. Houchin, Comparative Bioavailability of Elemental Iron Powders for Repair of Iron Deficiency Anemia in Rats. Studies of Efficacy and Toxicity of Carbonyl Iron, Am. Jrnl. Clin. Nutrition, 31(4), 566-571, 1978a.
Sacks, P. V. and D. N. Houchin, Elemental Iron Powders for Food Enrichment. Acid Solubility as a Predictor of Bioavailability, Am. Jrnl. Clin. Nutrition, 31(4), 571-576, 1978b.
Shelanski, H. A. Acute and Chronic Toxicity Tests on Carbonyl Iron Powder, GAF Unpublished data, 1950.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Multivitamins May Support Healthy Weight Loss

Fri, 21 Dec 2007 13:12:01 PST

November 2007 - Two studies published in late November the British Journal of Nutrition indicate that taking a multivitamin and mineral supplement may assist in weight management. The first study reported on a survey of survey of 267 men and 320 women aged 20 to 65. The survey found that in men regularly taking a dietary supplement weighed less, had less body fat, and lower BMI than those who did not. Women reported similar results, as well as generally reduced appetite.

In the second study, obese patients were placed on a low calorie diet and either given a multivitamin or placebo. While both group lost weight equally, those taking the multivitamin reported significantly reduced hunger both between and after meals.

G.C. Major, E. Doucet, M. Jacqmain, M. St-Onge, C. Bouchard, and A. Tremblay. Multivitamin and dietary supplements, body weight and appetite: results from a cross-sectional and a randomised double-blind placebo-controlled study. Br J Nutr. 2007 Nov 1;:1-11

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Follow Up is Important to Success

Fri, 21 Dec 2007 12:41:47 PST

Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass

December 2007 - A new study confirms what many people have long felt to be true: that patients who take their follow-up care the most seriously have the best results after gastric bypass surgery. The study compared patients who came to all follow-up visits for three years, to those who stopped after one year, to those who stopped before one year. Those who came to all scheduled appointments had the greatest weight loss at three years.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Sclerotherapy as possible treatment for dilation

Fri, 21 Dec 2007 11:23:24 PST

One possible cause of weight gain in post-operative gastric bypass patients is the dilation of the gastojejunostomy. 32 cases of patients who underwent sclerotherapy (an injection of sodium morrhuate to sclerose or scar local tissue) between 1999 and 2006 were reviewed. 75 percent of the treated patients lost weight while the remaining 25 percent had weight stabilization after this procedure.

Long-term Results of Sclerotherapy for Dilated Gastrojejunostomy After Gastric Baypss

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

ASMBS Position on Sleeve Gastrectomy

Fri, 21 Dec 2007 11:08:00 PST

December 2007 - Following a review of 15 published peer-reviewed studies on the short-term outcomes of the sleeve gastrectomy procedure, the American Society of Metabolic and Bariatric Surgery has adopted an initial position statement. Based on the current body of evidence, the ASMBS has stated that this procedure "may be an option for carefully selected patients, particularly those who are high risk or super-super-obese." They further recommend that doctors collect and report data on these cases, and encourage surgeons to inform patients of the limited data on this procedure while assuring they understand the better-studied surgical options.

Sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007 Nov-Dec;3(6):573-6.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is a chelate?

Thu, 20 Dec 2007 15:00:41 PST

Most simply, chelate means 'claw or grab.' A chelated mineral is one that has been bound to or �clawed to� another substance � usually an amino acid or an organic acid such as citrate, malate, succinate or aspartate. Sometimes other substances are used as chelators such as gluconate (gluconic acid, an oxidation product of glucose) or picolinate (a derivative of tryptophan). The form of chelate that will be best absorbed depends on the mineral, and varies. Some, like selenium, are best-absorbed bound to an amino acid (selenomethionine), others like calcium, when bound to one or more organic acids (such as citrate or citrate-malate). Overall, chelates are better absorbed that inorganic mineral salts such as oxides and sulfates. These forms are less expensive and occupy less space than chelates, however, so are used by many manufacturers of dietary supplements for all or part of their mineral content.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Will insurance pay for supplements?

Thu, 20 Dec 2007 14:59:13 PST

Will insurance pay for supplements?

Unfortunately, the answer is usually no. Still sometimes people find that can get coverage with a specific written prescription from their doctor. Since vitamins are considered a requirement after gastric bypass and related procedures, many doctors are happy to write a prescription and let patients try to receive reimbursement. One can also look into medical savings accounts or "cafeteria plans" (ask your insurer or your bank), which may provide some tax relief.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can anyone take Bariatric Advantage products?

Thu, 20 Dec 2007 14:57:30 PST

While our products were developed for weight loss surgery patients, almost anyone could use them for general health.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Labs frequency after surgery

Thu, 20 Dec 2007 14:55:40 PST

How often should I have lab work after surgery?

Your doctor will recommend a regular schedule of lab work for you after surgery to make sure you are stating healthy. This is often done several times in the first year, and then yearly.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Calcium Citrate May Not Cause Kidney Stones

Thu, 20 Dec 2007 13:06:16 PST

DALLAS—Calcium citrate supplementation alone or in combination with potassium citrate does not increase the risk of kidney stones in healthy postmenopausal women, according to a study published in the September issue of The Journal of Urology (172, 3:958-61, 2004).

In the randomized clinical trial of four two-week phases, 18 postmenopausal women without stones received twice-daily supplementation with 400 mg calcium citrate, 20 mEq potassium citrate, calcium citrate and potassium citrate (at same doses) or placebo. During the last two days of each phase, urine samples were obtained in 24-hour pools and analyzed for stone risk. Compared to placebo, calcium citrate increased urinary calcium and citrate, decreased urinary oxalate and phosphate and did not affect urinary saturation of calcium oxalate, brushite and undissociated uric acid.

Potassium citrate decreased urinary calcium, increased urinary citrate and pH, decreased urinary saturation of calcium oxalate and undissociated uric acid, and did not change the saturation of brushite. When calcium citrate was combined with potassium citrate, urinary pH increased, saturation of brushite increased, levels of urinary undissociated uric acid decreased, levels of urinary calcium remained elevated, urinary citrate levels increased, and urinary oxalate levels decreased, thereby slightly decreasing the urinary saturation of calcium oxalate.

The researchers concluded calcium citrate supplementation does not increase the risk of stone formation in healthy postmenopausal women, and the co-administered potassium citrate may provide additional protection against formation of uric acid and calcium oxalate stones.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Dairy Calcium May Help Slim Adolescent Girls

Thu, 20 Dec 2007 13:00:53 PST

MANOA, Hawaii -- Scientists at the University of Hawaii have linked dairy calcium intake with lower iliac skinfold thickness (a measure of body fat) and body weight, according to a study published in the August 2004 issue of the Journal of Nutrition (134, 8:1905-09, 2004).

The study examined the body fat and weight of 323 Pacific Islander and Asian girls, aged 9 to 14 years, in relation to age, ethnicity and physical activity. Subjects were surveyed for mean age, calcium intake, weight and iliac skinfold thickness.

Calcium intake, age and physical activity were found to have significantly negative associations with iliac skinfold thickness, whereas height, Tanner breast stage and Pacific Islander ethnicity were found to have significantly positive associations. One mg of total and dairy calcium was significantly associated with lower iliac skinfold thickness and one milk serving was associated with 0.78 mm iliac skinfold thickness. Nondairy calcium was not associated with weight or iliac skinfold thickness. In addition, soda intake was significantly positively associated with weight in both models.

The researchers concluded decreasing soda intake and increasing dairy consumption among Asians may help maintain body fat and weight during adolescence.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Low Vitamin A Paves Road to Iron Deficiency

Thu, 20 Dec 2007 11:43:17 PST

DAVIS, Calif.--According to a study published in the January issue of The Journal of Nutrition (135:27-32, 2005) low maternal levels of vitamin A may leave breastfed offspring at risk for iron deficiency. University of California researchers hypothesized low vitamin A intake during lactation elicits differential effects on mammary gland and liver iron transport and storage proteins, thus affecting the iron concentration in milk, but not maternal iron status.

A positive correlation between maternal iron status and iron levels in milk were observed in lactating women supplemented with both vitamin A and iron, but not with iron alone. The scientists fed rats either a control diet or a marginal vitamin A diet--containing one-tenth of the vitamin A given in the control diet--through mid-lactation. Effects on plasma, milk, liver and mammary gland iron and vitamin A concentrations, and divalent metal transporter-1 (DMT1), ferroportin (FPN), ferritin, and transferrin receptor (TfR) expression were determined. The rats fed the vitamin A diet were not vitamin A or iron deficient at the onset of the study.

Milk and liver vitamin A and iron levels, as well as mammary gland iron concentrations were lower, liver TfR expression was higher, and mammary gland TfR expression was lower in rats fed the vitamin A diet compared with rats fed the control diet. Liver Ft was unaffected, yet mammary gland ferritin was lower in the vitamin A fed rats compared with those on the control diet. Liver and mammary gland DMT1 and FPN protein levels were lower in the vitamin A rats compared with the control.

The researchers concluded the mammary gland and the liver respond differently to marginal vitamin A intake during lactation, causing iron levels in milk to become significantly decreased due to effects on mammary gland iron transporters, thereby putting the nursing offspring at risk for iron deficiency.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Effectiveness of selenium supplements

Thu, 20 Dec 2007 11:31:10 PST

Yiming Xia, Kristina E Hill, Daniel W Byrne, Jiayuan Xu and Raymond F Burk

Background: Selenium is an essential micronutrient with a recommended dietary allowance for adults of 55 µg/d. It functions as an essential constituent of selenoproteins. Although there is no evidence of selenium deficiency in the United States, people in many other areas of the world are selenium deficient, with the consequence that they are unable to express their selenoproteins fully.

Objective: We carried out a supplementation trial in a selenium-deficient population in China to assess the requirement for selenium as selenite and as selenomethionine.

Design: One hundred twenty subjects with an average selenium intake of 10 µg/d were randomly assigned and administered tablets containing no selenium or amounts as high as 66 µg Se/d for 20 wk. Plasma was sampled before supplementation and at 4-wk intervals during supplementation and was assayed for the 2 plasma selenoproteins, glutathione peroxidase and selenoprotein P.

Results: Full expression of glutathione peroxidase was achieved with 37 µg Se/d as selenomethionine and with 66 µg/d as selenite. Full expression of selenoprotein P was not achieved at the highest doses of either form.

Conclusions: Full expression of selenoprotein P requires a greater selenium intake than does full expression of plasma glutathione peroxidase. This suggests that selenoprotein P is a better indicator of selenium nutritional status than is glutathione peroxidase and that the recommended dietary allowance of selenium, which was set with the use of glutathione peroxidase as the index of selenium status, should be revised. Selenium as selenomethionine had nearly twice the bioavailability of selenium as selenite.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

A controlled study of peripheral neuropathy

Thu, 20 Dec 2007 11:19:29 PST

A controlled study of peripheral neuropathy after bariatric surgery.

U.S. National Library of Medicine Neurology. 2004 Oct 26;63(8):1462-70. Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG, Norell JE, Dyck PJ.

BACKGROUND: Although peripheral neuropathy (PN) occurs after bariatric surgery (BS), a causal association has not been established.

OBJECTIVES: To ascertain whether PN occurs more frequently following BS vs another abdominal surgery, to characterize the clinical patterns of PN, to identify risk factors for PN, and to assess if nerve biopsy provides pathophysiologic insight.

METHODS: Retrospective review identified patients with PN after BS. The frequency of PN was compared with that of an age- and gender-matched, retrospectively evaluated cohort of obese patients undergoing cholecystectomy.

RESULTS: Of 435 patients who had BS, 71 (16%) developed PN. Patients developed PN more often after BS than after cholecystectomy (4/126; 3%) (p < 0.001). The clinical patterns of PN were polyneuropathy (n = 27), mononeuropathy (n = 39), and radiculoplexus neuropathy (n = 5). Risk factors included rate and absolute amount of weight loss, prolonged gastrointestinal symptoms, not attending a nutritional clinic after BS, reduced serum albumin and transferrin after BS, postoperative surgical complications requiring hospitalization, and having jejunoileal bypass. Most risk factors were associated with the polyneuropathy group. Sural nerve biopsies showed prominent axonal degeneration and perivascular inflammation.

CONCLUSIONS: Peripheral neuropathy (PN) occurs more frequently after bariatric surgery (BS) than after another abdominal surgery. The three clinical patterns of PN after BS are sensory-predominant polyneuropathy, mononeuropathy, and radiculoplexus neuropathy. Malnutrition may be the most important risk factor, and patients should attend nutritional clinics. Inflammation and altered immunity may play a role in the pathogenesis, but further study is needed.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Gluten in Bariatric Advantage Products

Mon, 17 Dec 2007 06:57:18 PST

Gluten is a component of wheat and other grains that can be an allergen in some people. All of the Bariatric Advantage vitamins are wheat and gluten free.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is BA chewbale iron gluten free?

Tue, 10 Jul 2007 14:07:44 PST

Bariatric Advantage chewable iron products are gluten free.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is folate deficiency a risk after WLS?

Sun, 8 Jul 2007 18:22:06 PST

Folate Intake Still Inconsistent Among Women (From Natural Products Marketplace 7/3/07)

AUSTIN, Texas-A majority of women are still not supplementing with folic acid, despite encouragement from federal agencies to do so, with greater numbers of obese and non-white women failing to fight neural tube defects with the B vitamin. Up to 70 percent of neural tube defects of the brain and spinal cord can be prevented by consumption of folic acid by women before and early during pregnancy.

A new study from the Texas Department of State Health Services compared folic acid supplementation rates among obese, overweight and normal-weight women (J Obstet Gynecol Neonatal Nurs. 2007 Jul-Aug; 36(4)335-41). Among 6,835 study participants, 35 percent reported daily folic acid supplementation. Obese women were less likely to supplement, even after adjustment for other factors.

Similar findings were recently reported by the Centers for Disease Control and Prevention (CDC), which analyzed nutrient intake data reported by 1,685 nonpregnant women aged 15 to 49 years who participated in the 2001-2002 National Health and Nutritional Examination Survey (Am J Clin Nutr. 2007 May; 85(5):1409-16). Only 8 percent of nonpregnant women reported consuming at least 400 mcg/d of folic acid from fortified foods; among non-Hispanic black women, the percentage fell to 5 percent, compared to 6.8 percent of Hispanic women and 8.9 percent of non-Hispanic white women. A smaller percentage of non-Hispanic black (19.1 percent) and Hispanic (21 percent) women than non-Hispanic white women (40.5 percent) consumed at least 400 mcg/d folic acid from fortified foods, supplements or both, in addition to food folate.

Commentary

This recent data suggests that in the general population we still aren't doing enough to make sure that women of childbearing years get the nutrition they need to have a healthy pregnancy and healthy babies. This may be a particular concern with weight loss surgery. Why? Several reasons.

The majority of folate in the diet comes from folate-fortified foods such as bread and pasta. Most post-surgery diets eliminate or restrict these foods. Most patients still don't comply with a multivitamin long-term. In the absence of supplementation, bariatric surgery patients have been shown to have low folate and high homocysteine. For example:

Gasteyger et al recently reported a 41% decline in folate levels in Lap-Band patients 24 months post-op. (Obesity Surgery, 16, 243-250) This is often the time at which surgeons are giving patients the green light to get pregnant.

Madan et al found frank folate deficiency in 11% of RNYGB patients one year post-op. (Obesity Surgery, 16, 603-6)

Fertility can return rapidly in women who have been infertile due to obesity and/or insulin resistance. Despite being counseled to avoid pregnancy for 18 to 24 months, and to undergo nutritional counseling prior to pregnancy, women still become pregnant. Many bariatric surgery programs do not check folate status or homocysteine status.

We know that one great benefit of weight loss surgery is increased fertility. It is very important that women be advised of the potential consequences of becoming pregnant with inadequate nutritional status. Additionally, bariatric surgery programs should consider testing for folate status, at least in women who plan to become pregnant.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What type of protein is in Profect?

Wed, 27 Jun 2007 12:06:29 PST

Profect contains of blend of protein coming from hydrolyzed collagen isolate, whey protein isolate and casein protein isolate.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why does the calcium have vitamin K?

Thu, 19 Apr 2007 10:32:28 PST

Vitamin K is an important nutrient for bone health. Many people do not get adequate vitamin K and deficiency has been shown to contribute to bone loss. Vitamin K can not only increase bone mineral density in osteoporotic people but also actually reduce fracture rates. Additionally, increasing evidence suggests that vitamins D and K are synergistic, and work better for bone health when used together. If you are supposed to avoid vitamin K, please consult with your doctor before trying products with vitamin K.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is there vitamin K in the multivitamins?

Thu, 19 Apr 2007 10:25:42 PST

Blood thinners such as coumadin are fairly common medications used by bariatric patients. For this reason, three of our multivitamin are made without vitamin K - the Orange Chewable, the Capsules and VitaBand. If you need to avoid vitamin K, you should not take the Tropical Multivitamin.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is vitamin A safe?

Mon, 26 Mar 2007 14:39:59 PST

Vitamin A has two basic forms that are found in supplements. Retinol, often called pre-formed vitamin A, can be toxic if you take too much. The Institute of Medicine set the tolerable upper limit (UL) at 10,000 IU per day for adults. However, sometimes patients with deficiency or malabsorption need more - you should ask your doctor if you are concerned. The other form of vitamin A is beta-carotene, sometimes called "pro-vitamin A." Beta-carotene is non-toxic even at very high doses and does not have an upper limit for this reason.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What are bioflavonoids?

Mon, 26 Mar 2007 14:31:57 PST

Bioflavonoids are colorful molecules found in the skins of many fruits and vegetables. Scientists have become increasingly interested in the potential for various dietary flavonoids to explain some of the health benefits associated with fruit and vegetable-rich diets. They also help to support the uptake and use of vitamin C.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is Chromium picolinate?

Mon, 26 Mar 2007 14:28:34 PST

Chromium picolinate is a specialized form of the essential trace mineral chromium, bound to picolinic acid. Chromium picolinate has been well-studied for the support of balanced blood sugar.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can Devrom help with bad breath?

Mon, 26 Mar 2007 11:44:42 PST

Devrom is an FDA approved medication for stool odor and flatulence, it is not designed to help with bad breath. Most bad breath after weight loss surgery is due to ketosis, when your body burns fat as energy.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is Devrom?

Mon, 26 Mar 2007 11:40:31 PST

Devrom® is an internal deodorant used to effectively neutralize odor from stool and flatulence. A trusted product for over 40 years and no prescription required, Devrom® is an over-the-counter drug that safely and effectively neutralizes offensive odor. FDA approved Devrom® comes in a chewable tablet form so it is easy to take. The active ingredient is bismuth subgallate.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Are the soups the same as the shakes?

Mon, 26 Mar 2007 11:35:57 PST

If you are using the OptiFast 800 program, the soups are an excellent alternative to the shakes and can be used interchangably.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can I use OptiFast 800 after surgery as a meal replacement?

Mon, 26 Mar 2007 11:33:39 PST

This depends on your doctor and your procedure. If you have had a gastric bypass, your doctor may prefer that you use a product like OpitFast HP that has more protein and less carbohydrate. If you are unsure about what kinds of products your doctor has approved for you use, you should ask.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do the OptiFast bars have the same nutrition as the shakes?

Mon, 26 Mar 2007 11:30:43 PST

The OptiFast 800 bars and shakes are somewhat different. The bars are lower in protein, higher in fat and carbohydrate, and a little different nutritionally. You can compare the Nutrition Facts on our website at www.bariatricadvantage.com. If you are wanting to use bars over shakes, you should discuss this with your doctor.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How are the powders and Ready-to-Drinks different?

Mon, 26 Mar 2007 11:27:21 PST

The OptiFast 800 powders are very similar to the ready-to-drink product, and are interchangable if you are doing the OptiFast 800 program. The biggest reasons people often choose the ready-to-drink are for convenience and portability.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why do I need to take OptiFast before surgery?

Mon, 26 Mar 2007 11:18:09 PST

OptiFast is a medical weight management system that physicians may request you to use prior to surgery. This is usually for one of two reasons - either because your insurer requires medical weight management for approval for surgery, or because your surgeon wants you to lose some weight. If your surgeon is asking you to lose some weight before surgery, this is usually to reduce the size of your liver to make your surgery safer and easier.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why does my doctor want me to lose weight before surgery?

Tue, 20 Mar 2007 11:13:41 PST

The most common reason doctors ask their patients to lose some weight (usually 5 to 10% of your weight) before surgery is to reduce the size of the liver. If your liver is in the way during surgery, it can make the surgery longer and potentially more dangerous. If you have a very high BMI or central obesity, this is more common.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How long can I use meal replacements after surgery?

Tue, 20 Mar 2007 11:10:28 PST

There is really no rule for this. Some programs recommend them for extra nutrition while you are transitioning back to solid food, others recommend them long-term, still others do not recommend them at all. It is best to know what your surgeon wants you to do.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why are meal replacements used before surgery?

Tue, 20 Mar 2007 11:08:23 PST

Some doctors recommend meal replacements for weight loss before surgery. This may be to make the surgery safer and easier by shrinking the liver. In some cases, your insurance may also require this.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why does B12 have to be sublingual?

Fri, 16 Mar 2007 14:50:15 PST

After some forms of weight loss surgery like gastric bypass, it becomes much harder to absorb B12. Without some of the functions of the stomach, only about 1 to 2 percent of B12 can be absorbed in the intestines. Thus, a sub-lingual B12 that dissolves in the mouth is often preferred. Other good choices are shots or nasal preparations.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can I open the capsules?

Fri, 16 Mar 2007 14:47:18 PST

Any of the capsules can be open and mixed into a liquid or soft food.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What B vitamins can become deficient with WLS?

Fri, 16 Mar 2007 14:45:59 PST

The most common B-vitamins that can become deficient with weight loss surgery are B12, folate and B1 (thiamine). Others include B6 and B2 (riboflavin).

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why does B-complex make my urine bright yellow?

Fri, 16 Mar 2007 14:44:10 PST

This is caused by the riboflavin (vitamin B2), which has an intense yellow color. This is a natural process and no cause for alarm.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the best time to take B vitamins?

Fri, 16 Mar 2007 14:32:30 PST

It is generally best to take your B-vitamins with a meal. Some small percentage of people find that if they take B-vitamins too late in the day they have more trouble sleeping. If you find you have trouble sleeping after taking B-vitamins, you may want to take them with breakfast or lunch.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How often should I take my B12?

Fri, 16 Mar 2007 14:30:39 PST

Your doctor should tell you how often they want you to take B12. Usually it is taken between once a week and once a day.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is 1000mcg of B12 too much?

Fri, 16 Mar 2007 14:29:13 PST

Though it sounds high, 1000 micrograms (mcg) is only one 1 milligram. This is a very commonly recommended dose of vitamin B12, even as a daily dose.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is Biotin for?

Fri, 16 Mar 2007 14:18:23 PST

Biotin is a member of the B-vitamin family. It plays a role in the metabolism of protein, fat and carbohydrate. It may help to maintain the health of nails and hair.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do I need B-complex if I am taking a multivitamin?

Fri, 16 Mar 2007 14:17:13 PST

A good multivitamin should provide you with a comprehensive B-complex. Some doctors like their patients to take more. Your doctor should tell you if they want you to take an additional B-complex.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Should I take Thiamine?

Fri, 16 Mar 2007 14:07:10 PST

Thiamine deficiency can occur before or after weight loss surgery. A good multivitamin should provide thiamine, and this is enough for most people. However, if you have a deficiency, your doctor may instruct you to take more. If you are concerned about whether you get enough thiamine, you should discuss this with your doctor.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Will calcium give me kidney stones?

Fri, 16 Mar 2007 14:04:42 PST

Doctors used to tell people with kidney stones to avoid calcium. Recent studies have shown that a diet with normal amounts of calcium is probably best. Over a period of five years, scientists studied people with kidney stones and found that those who had normal calcium levels in their diet were less likely to form new stones than those who were on a low-calcium diet. If you have a history of kidney stones and are concerned about calcium, you should discuss it with your doctor.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much calcium is in a serving of Tropical Oasis?

Fri, 16 Mar 2007 13:58:13 PST

A serving (1 Tablespoon) of Tropical Oasis Liquid Calcium Magnesium has 252 milligrams of elemental calcium.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can I take calcium with my multivitamin?

Fri, 16 Mar 2007 13:56:47 PST

You can take calcium together with your multivitamin. If, however, you rely on your multivitamin for iron, you may want to try to separate them by a couple of hours.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What kind of calcium do I need if I have a Band?

Fri, 16 Mar 2007 13:51:46 PST

If you have an adjustable gastric band such as a Lap Band, you can take almost any form of calcium. However, if you take medication to suppress stomach acid, you should talk to your doctor about calcium citrate.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do you make a calcium tablet or capsule?

Fri, 16 Mar 2007 13:50:09 PST

We do not currently make a calcium citrate capsule. This is because it would take 6 to 8 capsules to make an average dose of calcium.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can I chew the calcium lozenges?

Fri, 16 Mar 2007 13:48:41 PST

You can chew the calcium citrate lozenges. However, you will get a better texture and flavor if you suck on them for a few minutes until they get soft.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How are calcium citrate and carbonate different?

Fri, 16 Mar 2007 13:47:14 PST

Calcium citrate and calcium carbonate are both calcium, but are bound to different substances. Calcium carbonate, the form most commonly found in dietary supplements, requires stomach acid to be optimally digested and absorbed. It is therefore not the best choice for those who have had gastric bypass or people who regularly use medication to suppress stomach acid. Calcium citrate can be digested even by those with little or no stomach acid.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can I take my iron with other vitamins and minerals?

Tue, 13 Mar 2007 13:12:59 PST

Iron can interfere with other nutrients. The most important nutrient that it competes with is calcium. Taking iron with calcium supplements or with high calcium foods can reduce the amount of iron you absorb. The amount of calcium in a multivitamin is usually not a problem. If you are taking high doses of iron (for example to treat an anemia), then you may need to worry about iron depleting other minerals like zinc and copper. Your doctor or dietitian should be able to tell you if this is a concern.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much iron should I take each day?

Tue, 13 Mar 2007 12:26:21 PST

The RDA for iron is 8mg for men and 18mg for women. Iron deficiency can occur after weight loss surgery, and your doctor probably checks your levels with your regular blood work. If you need more iron, your doctor should let you know. Since iron can be toxic, you should not take more than your doctor has advised.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

If my iron gets sticky is that OK?

Tue, 13 Mar 2007 12:23:48 PST

Your iron is still fine if it gets sticky. This can happen if it gets exposed to too much moisture or humidity. To minimize this, keep the cotton and the dessiccant (the little "pillow") in the bottle, and store it in a cool, dry location.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do you make a chewable potassium?

Tue, 13 Mar 2007 12:00:11 PST

We do not make a chewable potassium supplement at this time.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Should I take extra vitamin A?

Tue, 13 Mar 2007 11:59:20 PST

Fat malabsorption can occur with some forms of weight loss surgery and this can also mean that some fat-soluble vitamins like vitamin A are not well absorbed. If you are concerned about your vitamin A levels, they can be checked through a simple blood test. Vitamin A can be toxic when taken in excess. so it is best to know if you need more than the level in your multivitamin before taking it on your own.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do I need extra vitamin D?

Tue, 13 Mar 2007 11:56:50 PST

Vitamin D deficiency is relatively common in people with obesity and in those who have had weight loss surgery. The only way to really know if you need more vitamin D is to have lab tests done to check for the levels in your body. Your doctor can provide you with information about this kind of testing.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much vitamin D do I need?

Tue, 13 Mar 2007 11:54:41 PST

The Recommended Daily Allowance (RDA) for vitamin D is 200 IU for adults up to age 50, 400 IU for adults ages 51 to 70 and 600 IU for adults over 70 years of age. However, there is currently a lot of debate about whether this is enough. Vitamin D is a common deficiency with obesity and with weight loss surgery. Your doctor should be able to tell from your labs if you are getting enough vitamin D and advise you as to how much you need to maintian healthy levels.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How is D3 different from D2?

Tue, 13 Mar 2007 11:50:51 PST

Vitamin D2 (ergocalciferol) is differenet from vitamin D3 (cholecalciferol). D2 is the most common commercial form because it can be readily prepared from plant materials that contain the compound ergosterol. Vitamin D3, cholecalciferol, is the form that animals (including humans) synthesize from cholesterol, and is considered to be the natural form of the vitamin. D3 is estimated to be 3 times more potent than vitamin D2

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can my vitamins be taken with my medication?

Tue, 13 Mar 2007 11:42:50 PST

There are interactions that can occur between vitamins, minerals and prescription drugs. It is best to ask your doctor or pharmacist about possible interactions.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Should I take vitamins before my surgery?

Tue, 13 Mar 2007 11:41:20 PST

This is something you should discuss with your surgeon. There is some strong evidence of nutritional deficiencies occurring in obesity, and in pre-op weight loss surgery patients. Some programs recommend vitamins before surgery, others do not. Conversely, there are some nutrients that you may need to stop taking prior to surgery - your doctor should be able to tell you what these are.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do BA products use "dry" or fat soluble vitamins?

Tue, 13 Mar 2007 11:39:31 PST

Yes. Bariatric Advantage products only use the water-miscible (also called water-dispersible, water-soluble, or dry) forms of vitamins A, D, E and K.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How can I tell if my vitamins and minerals are absorbed?

Tue, 6 Mar 2007 12:22:31 PST

While there is intensive medical testing that can be done to answer this question, it is expensive and invasive and in really never done outside of scientific experiments. The easiest way to know how you are responding to the nutrition you are taking is to go to your doctor for regular lab work. Your bariatric surgery program is likely to be testing for all the critical nutrients that you need to worry about after surgery.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Are liquid vitamins better absorbed?

Tue, 6 Mar 2007 12:21:36 PST

No. Liquid vitamin manufacturers sometimes make surprising claims for their products like “100% absorbable” – this is never true. You never absorb 100% of a nutrient. The things that makes the biggest difference in how well you will absorb a nutrient is how well it breaks down and whether the form itself is well-absorbed.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can’t I get all my nutrition from food?

Tue, 6 Mar 2007 12:20:04 PST

Probably not. Most Americans, even those who have not had weight loss surgery, do not get even their basic nutritional requirements met through food. After surgery, you cannot eat as much and you may have malabsorption (depending on your procedure), so taking nutritional supplements helps to make up for what you cannot get from your diet.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is there a best time of day to take vitamins?

Tue, 6 Mar 2007 12:19:14 PST

There is no proven best time to take vitamins, however some people find that if they take a multivitamin or B-complex too late in the day it may keep them up at night.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Should I take my vitamins with food?

Tue, 6 Mar 2007 12:18:36 PST

Most vitamins are actually best tolerated and better absorbed if taken with food. Some, like calcium citrate, can be taken either way.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Why are there so many pills?

Tue, 6 Mar 2007 12:17:22 PST

Often times the better forms of vitamins and minerals take up more space. For example, calcium citrate takes up two to three times the space as calcium carbonate. Additionally, some nutrients like calcium and iron are best taken separately so they require separate tablets.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the most I can take of a vitamin or mineral?

Tue, 6 Mar 2007 10:13:22 PST

For almost all nutrients there is something called the Tolerable Upper Limit (or UL for short). This number is set by the Institute of Medicine as a guide for safety. It is different for all nutrients. Some nutrients like iron or vitamin A can be very toxic in large doses. If you are concerned that you may be getting too much of a particular nutrient, you should discuss this with your doctor or dietitian.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the DV (Daily Value)?

Tue, 6 Mar 2007 10:12:18 PST

The Daily Value or DV is the recommended amount of a nutrient (a vitamin, mineral, protein, fat, fiber or carbohydrate) that you should get each day. The Percent Daily Value (% DV) is the amount of that nutrient you should get based on assumed calorie intake. The FDA (Food and Drug Administration) generally assumes intake of 2000 calories for an average adult.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Do I need to take a chewable vitamin?

Tue, 6 Mar 2007 10:11:00 PST

It is usually recommended to take a chewable vitamin for somewhere between 3 and 12 months after surgery. You need to ask your surgeon or dietitian (RD), when your program will allow you to stop chewable vitamins if you want to do so. Many weight loss surgery patients prefer to keep taking chewable vitamins because they are more comfortable with this form than with swallowing a pill. There is no harm in continuing a chewable vitamin if you are not comfortable swallowing or if you prefer them for some other reason.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

I take a children’s chewable vitamin, are yours different?

Tue, 6 Mar 2007 10:08:42 PST

Children’s vitamins are generally designed for healthy small children, to supplement their diet. They are not designed for adults, and they are really not designed for adults who have undergone weight loss surgery. Many children’s vitamins are missing some key nutrients (it is common to not have essential nutrients like selenium or chromium), and use nutrient forms that are less bioavailable (not as easy to absorb). This is even true in some products that say they are “complete.” It is also common for children’s products contain many “other” ingredients – coloring agents, preservatives, starches, fats and more.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the best protein?

Tue, 6 Mar 2007 09:46:40 PST

There is really no one best protein – most dietary experts would tell you that variety is beneficial, and that it is best to get multiple sources. In terms of protein quality, animal proteins always rate higher than vegetable (soy, pea, rice). Egg, whey and casein tend to be the top rated proteins for amino acid content, bioavailability and quality. However, all animal proteins - fish, chicken, lamb, beef, etc - rate very high.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much protein can I take at one time?

Tue, 6 Mar 2007 09:45:42 PST

Many sources say that 20 grams of protein is the maximum that one should take in at a sitting. However, scientific literature is very conflicted on this issue – some studies point to much higher numbers. Most nutrition experts agree it is best to try to divide the total amount of protein you need in a day into several servings.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is liquid protein made of?

Tue, 6 Mar 2007 09:43:21 PST

Liquid proteins are typically made of hydrolyzed collagen with some added amino acids.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much protein is in a serving of Nectar?

Tue, 6 Mar 2007 09:42:25 PST

There are 23 grams of protein in each serving of Nectar.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Does the Nectar Lemon Tea have caffeine?

Tue, 6 Mar 2007 09:41:38 PST

Yes. It has approximately 50 to 80 mg. of caffeine per serving.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Does whey protein have lactose?

Tue, 6 Mar 2007 09:40:14 PST

Some whey proteins do have lactose and some don’t. Most of the time if they don’t, they will say so on the label. A good way to tell is to look at the ingredient list. Concentrates usually have lactose, whereas isolates tend to have very little or none. Ion-exchange whey protein is usually the very lowest.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can Any Whey be heated or cooked?

Tue, 6 Mar 2007 09:38:43 PST

Absolutely. 100% Any Whey is a virtually flavorless whey protein that can be added to almost any food or drink, hot or cold. It is also optimized for baking. For more information on cooking with Any Whey, you can visit the Optimum Nutrition website : http://www.optimumnutrition.com/anywhey/default.html

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How are BA multis different from Centrum?

Tue, 26 Dec 2006 11:44:29 PST

Our multis all contain on average 200 to 400% of the RDA for each of the B-vitamins in a daily dose – which is 2-4 times the levels in Centrum. So generally patients should not require additional Bs unless they have a deficiency. The exception is B12 which is absorbed very differently from the other B vitamins. I recommend a sublingual or an injection with RNY.

Just an additional note on Centrum – they lack selenium and chromium (essential elements) and include many ingredients that we simply won’t use either because the form is inappropriate for RNY patients (dibasic calcium, magnesium oxide, etc) or because they are unnecessary (gums, preservatives, 4-5 sweeteners, colorants, lactose). Here is their ingredient list:

Sucrose, Dibasic Calcium Phosphate, Mannitol, Calcium Carbonate, Stearic Acid, Magnesium Oxide, Ascorbic Acid (Vit C), Pregelatinized Starch, Microcrystalline Cellulose, dl-Alpha Tocopherol Acetate (Vit E), Contains <2% of: Acacia, Aspartame, Beta Carotene**, Biotin, BHT, Calcium Pantothenate, Carbonyl Iron, Carrageenan, Chromic Chloride, Citric Acid, Cupric Oxide, Cyanocobalamin (Vit B12), Dextrose, Ergocalciferol (Vit D), FD&C Yellow 6 Aluminum Lake, Folic Acid, Gelatin, Glucose, Guar Gum, Lactose, Magnesium Stearate, Malic Acid, Manganese Sulfate, Mono and DiGlycerides, Natural & Artificial Flavors, Niacinamide, Phytonadione (Vit K), Potassium Iodide, Potassium Sorbate, Purified Water, Pyridoxine Hydrochloride (Vit B6), Riboflavin (Vit B2), Silicon Dioxide, Sodium Ascorbate, Sodium Benzoate, Sodium Citrate, Sodium Molybdate, Sodium Silicoaluminate, Sorbic Acid, Starch, Thiamine Mononitrate (Vit B1), Tocopherol, Tribasic Calcium Phosphate, Vanillin, Vitamin A Acetate (Vit A), Zinc Oxide, May Also Contain: Fructose, Maltodextin.

Bariatric Advantage™ Chewables vs. Centrum® Chewables

Nutrient	BA Orange per serving Amount %DV		BA Tropical per serving (2 Tablets) Amount %DV		BA VitaBand per serving Amount %DV		Centrum Chewables per serving Amount %DV
A	7500 IU (100% carotene)	150%	10,000 IU (50-50 carotene-retinol)	200%	5000 IU (100% carotene)	100%	3500 IU (29% carotene)	70%
C	120mg	200%	120mg	200%	120mg	200%	60mg	100%
D3	100 IU	25%	600 IU	25%	600 IU	150%	400 IU (as D2)	100%
E	30 IU (natural)	100%	500 IU (natural)	100%	30 IU (natural)	100%	30 IU (synthetic)^¹	100%
K	0	0 %	120mcg	150%	0	0%	10mcg	13%
B1	6mg	400%	6mg	400%	3mg	200%	1.5mg	100%
B2	3.4mg	200%	3.4mg	200%	3.4mg	200%	1.7mg	100%
Niacin	50mg	250%	50mg	250%	50mg	250%	20mg	100%
B6	4mg	200%	4mg	200%	4mg	200%	2mg	100%
Folate	800mcg	200%	800mcg	200%	800mcg	200%	400mcg	100%
B12	100mcg	1666%	100mcg	1666%	50mcg	833%	6mcg	100%
Biotin	300mcg	100%	300mcg	100%	300mcg	100%	45mcg	15%
Pantothenic Acid	10mg	100%	10mg	100%	10mg	100%	10mg	100%
Calcium	200mg (citrate)	20%	100mg (citrate)	20%	600mg (citrate-carbonate blend)	60%	108mg^²	20%
Magnesium	50mg (citrate)	12%	50mg (citrate)	12%	50mg	12%	40mg^³	10%
Iron^⁴	0	0%	0	0%	18mg	100%	18mg	100%
Phosphorus^⁵	0	0%	0	0%	0	0%	50mg	5%
Iodine^⁶	0	0%			0	0%	150mcg	100%
Zinc	15mg (citrate)	100%	15mg (citrate)	100%	15mg	100%	12mg^⁷	80%
Selenium^⁸	100mcg (selenomethionine)	143%	134mcg (selenomethionine)	192%	55mcg	79%	0	0%
Copper	1mg (citrate)	50%	1mg (citrate)	50%	2mg	100%	2mg^⁹	100%
Manganese	2mg	100%	2mg	100%	2	100%	1mg	50%
Chromium	100mcg	84%	100mcg	84%	120mcg	100%	20mcg	17%
Molybdenum	75mcg	100%	75mcg	100%	75mcg	100%	20mcg	27%
Choline	2.35mg	>1%	2mg	>1%	5mg	1%	0mg^¹⁰	0%
Flavonoids	12.5mg		12.5mg		0		0
Inositol	5mg		5mg		5mg		0
Vanadium	25mcg		25mcg		25mcg		0
Other ingredients	Invetek base, stearic acid USP, natural orange flavor, natural creamsicle flavor, citrus flavor blend, magnesium citrate NF/FCC, sucralose		Invetek base, lemon flavor, stearic acid USP, citrus blend flavor, natural pineapple flavor, magnesium citrate NF/FCC, sucralose				Sucrose, mannitol (wheat)^¹¹, stearic acid, pregelatinized starch, microcrystalline cellulose, acacia, aspartame, BHT, carrageenan, citric acid, dextrose, FD&C yellow #6, gelatin, glucose, guar gum, lactose (milk)^¹², magnesium stearate, malic acid, maltodextrin, mono and di-glycerides, natural and artificial flavors, potassium sorbate, purified water, silicone dioxide, sodium benzoate, sodium citrate, silicoaluminate^¹³, sorbic acid, starch, vanillin^¹⁴.

1 Synthetic vitamin E is significantly less (about 1/3) bioactive than natural vitamin E. The estimate of relative activity is as follows:

RRR-alpha-tocopherol (natural or d-alpha-tocopherol):

IU x 0.67 = mg RRR-alpha-tocopherol.
Example: 100 IU = 67 mg

all-rac-alpha-tocopherol (synthetic or dl-alpha-tocopherol):

IU x 0.45 = mg RRR-alpha-tocopherol.
Example: 100 IU = 45 mg

2 From Dibasic Calcium Phosphate, Tribasic Calcium Phosphate and Calcium Carbonate. These are poorly soluble forms for those with malabsorption and low stomach acid.

3 From Magnesium Oxide. This form has poor solubility for those with malabsorptive procedures and l;ow stomach acid.

4 We omit iron form our multivitamins that are intended for malabsorption so that it can be easily separated from competitive minerals like calcium and to allow for flexible dosing.

5 Phosphorus is not necessary in dietary supplements as it is ample in food. There is phosphorus in Flintstones because it is present in the calcium form, Dibasic Calcium Phosphate.

6 Iodine is the only allergen to a nutrient that occurs relatively commonly. It is also frequently prohibited in those with thyroid disease.

7 100% from Zinc Oxide – a poorly soluble form for those with malabsorption

8 Centrum lacks the essential nutrient selenium. Selenium has been found to be deficient in obesity and after weight loss surgery.

9 100% from Cupric Oxide– a poorly soluble form for those with malabsorption

10 Centrum lacks choline, an essential nutrient for cell membranes and nerve health

11 Wheat/gluten intolerance occurs in approximately 1 in 300 adults of European heritage.

12 Lactose intolerance is a common problem

13 An anticaking agent that is also used as a commercial pesticide.

14 Centrum actually contains 24 nutrients and 31 excipients.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much iron is in Ferrous Gluconate 324?

Tue, 26 Dec 2006 11:39:38 PST

One tablet of Ferrous Gluconate 324 contains 37.5mg of elemental iron. Someone wishing to take BA iron could most easily accomplish this with 2 18mg strawberry iron tablets.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Optifast 800 vs Optifast HP

Fri, 13 Oct 2006 12:35:15 PST

We sometimes get questions about which Optifast product is best for which patient at which time. For RNY, either Optifast 800 or Optifast HP can be used as a pre-operative weight loss program. The 800 program gives a much greater selection, including the RTDs, so it is often the preferred choice. The HP program is definitely a better choice for post-op patients as it has 26 grams of protein and only 10 grams of carbohydrate.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Difference between a Meal Replacement and Protein Powder

Tue, 10 Oct 2006 10:20:00 PST

Patients who have undergone weight loss surgery often desire or are requested to utilize protein supplements or meal replacement products to augment their diets. A protein supplement is simply a protein - sometimes sweetened or flavored - but without other added nutritional content. Common protein supplements include whey protein or soy protein. A meal replacement is a product that is designed to nutritionally be exchangable for a food-based meal. They may be found as powders, ready-to-drink liquids, bars, cereals, and in other forms. They contain protein, carbohydrate and usually some fat as well as a specified quantity of vitamis and minerals.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can B12 be chewed

Mon, 9 Oct 2006 17:10:56 PST

Vitamin B12 is normally very dependent on the stomach for digestion and absorption. When B12 is swallowed, at best, 1 to 3% is available for absorption. B12 can be absorbed in a few other places such as the mucosa of the nose or mouth. To absorb B12 in the mouth, it needs to stay in contact with the mouth for several minutes under the tongue or on the side of the mouth (between cheek and gum). If it is chewed and swallowed, the advantage of absorption in the mouth is lost.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Pre-natal (prenatal) nutrition

Mon, 9 Oct 2006 16:57:03 PST

Women who are pregnant or nursing have specialized nutritional needs. It is of foremost importance that a WLS patient who is pregnant or desires to become pregnant discuss her nutritional needs with her physician. Generally, there are increased needs for iron, calcium, protein and folic acid.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Sweeteners in vitamins

Mon, 9 Oct 2006 16:52:48 PST

Bariatric Advantage products are designed to be either extremely low sugar/low glycemic or sugar free. Most are sugar free. We use the following sweeting agents either alone or in combination: xylitol, sorbitol, sucralose (Splenda), and fructose.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

VitaBand for other procedures

Fri, 6 Oct 2006 20:20:36 PST

We have had numerous questions about the use of VitaBand for those with other procedures such as RNY or DS. Some health professionals may prefer it based on simplicity and price, however, it is not nearly as good as the other products (Orange, Tropical, or Capsules) for these other procedures. The primary reason is the use of calcium carbonate, which is fine for Lap-Band patients who still have adequate stomach acid. Additionally, in the VitaBand formula, iron and B12 are included. It is really best for RNY and DS patients to take iron separately from calcium, and to use B12 as a sublingual or an injection.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Pre-natal (prenatal) vitamins

Wed, 4 Oct 2006 13:16:13 PST

Pre-natal vitamins are a common recommendation after weight loss surgery. They are often suggested for the higher iron content relative to standard vitamin preparations. Studies have shown, however, that several key nutrients - particularly iron and to a lesser degree folic acid - are less bioavailable in pre-natal products than when taken alone. This is thought to be due to competitive absorption, but may also be due to some nutrients not being well released from the complex matrix.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Can capsules be opened?

Tue, 3 Oct 2006 11:00:56 PST

Sometime customes wish to open capsules into a liquid or soft food rather than swallow them. For all Bariatric Advantage products, this is fine. Customers should note that products designed to be swallowed in capsules are not sweetened or flavored in any way, thus they will have a very strong flavor of the nutrients they contain. This is generally better masked in a soft food (apple sauce is a very good choice) rather than in a liquid, but either is fine.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

B12 and moisture

Fri, 29 Sep 2006 09:05:48 PST

Our B12 tablets are designed as sublingual dissolvable tablets. As such, they easily take on moisture from the atmosphere. This may be especially evident if people live in humid climates. To decrese this effect, we place a dessicant pack in each bottle. This should be left in by the customer after the product is opened. Product should additionally be stored in a cool, dry location. The refrigerator, which is generally quite moist, is not a good place to store vitamins. The best locations tend to be kitchen cupboards. It should also be noted, that the B12 is not harmed by taking on some moisture like this.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What is the best way to take the Calcium Citrate Lozenges?

Thu, 28 Sep 2006 13:55:00 PST

The calcium citrate lozenges were designed, ideally, to be dissolved in the mouth. This gives the best flavor and the best texture for the product, as well as may produce better absorption of vitamin D. However, they can be chewed if people prefer to do so. It is best to take them in divided doses (more than one time per day) as doses of calcium over 500 mg are not as effectively abosrbed as smaller doses. Unlike calcium carbonate, calcium citrate can be taken either with or without food.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Is there iodine in the multivitamins?

Thu, 28 Sep 2006 13:37:48 PST

Bariatric Advantage multivitamins including Orange, Tropical, Vita-Band and Capsule products are are free of iodine and shellfish derrivatives, making them safe for those with iodine sensitivity or those needing to avoid iodine for other reasons.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Tropical Multi Label

Thu, 21 Sep 2006 08:20:47 PST

The Tropical multi can be taken in two ways - as 2 tablets/day for RNY patients or as 3 tablets/day for DS patients. The label on this product (Supplement Facts Box) shows the amount of nutrition is one tablet because of the different dosing possibilities. The Orange Multi is intended to be taken in only one way - as 2 tablets daily. The Supplement Facts Box for this product reflects the Total Daily Dose - or the amount of nutrition in two tablets. This can confuse people who are not careful label readers.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How can I tell if my protein product is lactose-free?

Wed, 20 Sep 2006 11:34:05 PST

Dairy-derived proteins such as whey, casein, or milk protein isolate are common both as stand-alone proteins and in meal replacements. Many bariatric patients are concerned about lactose content because they may become sensitive to lactose after surgery. Most-often, if a product is lactose free, this will be stated on the product label. If not, products that are labeled "isolates" are much more like to have minimal or no lactose versus those that are "concentrates". The lowest lactose content is in products that are ion-exchange.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

How much protein do I need after surgery?

Wed, 20 Sep 2006 11:11:48 PST

The most common recommendation for protein intake after bariatric surgery is 50 to 60 grams per day, taken in divided doses throughout the day. Some programs will calculate protein needs off of ideal or lean body mass. If this is done, the basic calculation is 0.8 to 1.2 grams of protein per kilogram of lean body mass. In general, it is best to take no more than 20 to 30 grams of protein at one sitting.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

What essential fatty acid products do we carry

Mon, 18 Sep 2006 15:42:38 PST

Bariatric Advantage Omega-3 Berry flavored Chewy Bites (60 chews per bag), Bariatric Advantage Opti-EPA High-Potency Fish Oil (60 count soft gels), and CorOmega - fish oil emulsion.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Are Essential Fats good for weight loss surgery patients

Mon, 18 Sep 2006 15:39:29 PST

Yes. Essential fats, also called omega-3 fats, are important for everyone. There is some evidence that they are malabsorbed after surgery, but more importantly they are critical to health and very few people have adequate dietary sources. Marine (fish) sources are the best-studied for health. These fats support the health of the heart, brain, skin, joints, eye and hormone balance.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Daily Dose

Tue, 5 Sep 2006 14:23:04 PST

All multivitamins should be taken according to the labeled instructions unless a customer has been directed to take more or less by their physician.

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage

Have a question for Dr. Jacques!? Submit it here.

Bariatric Advantage

Study Indicates That Calories, Not Protein, Lead to Increase in Body Fat

Health Benefits of Harder, Shorter Exercise

Hit the Trail

"Eat Less and Exercise More" -- It&#39;s Not That Simple

Is Bone Loss in Adolescents Following Bariatric Surgery Related to Weight Loss?

Another Reason to Avoid the Late-Night Drive Thru

Collagen supplements may support skin improvement

Can Bariatric Surgery Help You Live Longer?

New Caramel Flavored Calcium Citrate Chewy Bite!

Better Sleep, Less Stress, Lower Weight?

Bone Loss in Teens After Gastric Bypass

Vitamin A and Gastric Bypass

WLS Patients Presenting for Reconstructive Surgery Have Poor Nutrition

IOM Updates Vitamin D Recommendations

Dieting Puts Vitamins and Minerals at Risk

Gastric Bypass, Vitamin D and PTH

Vitamin D Deficiency After Biliopancreatic Diversion (BPD)

Proton Pump Inhibitors (PPIs) and Fracture Risk

Vitamin D May Be Better Absorbed With More Food

Omega 3 For Bones?

Increased Serum Markers for Bone Loss After Gastric Bypass

Abnormal GI Flora May Be Linked To Obesity

Two New Studies on Gastric Balloons

Weight Loss With Adjustable Gastric Band Improves Functional Iron Status in Women

Preoperative Weight Loss improves Postoperative Outcomes

Whey Protein Improves Satiety and Blood Sugar

Vitamin A (Retinol) Deficiency After Gastric Bypass

Adjustable gastric banding better than diet for obese teens.

2 Case reports of birth defect associated with deficiency in bariatric surgery patients

A Case of B1 Deficiency in a RNY Patient After Plastic Surgery

Study Looks at Issues of Compliance

What are the ingredients in ProJoe?

I have had past reactions to Niacin, can I still take your vitamins?

Study Shows More Benefits of Preoperative Weight Loss

New study - Benefits of calcium and vitamin D for fracture prevention

Study Shows More Benefits of Preoperative Weight Loss

What is the difference in formulation between the old unflavored Calcium Crystals and the new unflavored Calcium Crystals?

Is the liquid Vitamin D designed to only be taken straight from the dropper or can it be mixed into other foods as an option?

What is the difference between a Prebiotic and a Probiotic?

What is a &ldquo;Bariatric Vitamin&rdquo;?

What is a Probiotic?

Iron, B12 and Folate after Sleeve Gastrectomy

Why do the new meal replacements have more sodium and potassium?

Why are Vitamins A, E and D measured in IU rather than grams, mg, or mcg?

New research Supports Calcium Citrate Over Carbonate After RNY Gastric Bypass.

Are water miscible vitamins still fat-soluble?

What is the difference between Omega-3, Omega-6, and Omega-9?

Do my vitamins need to be taken with or without food?

Sublingual B12: How long do I have to let the tablet sit under my tongue?

What is the difference between Calcium Citrate and Calcium Carbonate?

Calcium Crystals: Can I use more or less water than what is recommended on the back of the label?

Omega 3: is there a daily value for this product?

Are Bariatric Advantage products Only for a Bariatric patient?

What is the Recommended Daily Intake of Protein for a Person Who Has Had Bariatric Surgery?

Probiotics and Gastric Bypass

Omega-3 Fatty Acids and Obesity

Water Miscible, Water Soluble, and Dry.

Do we have IF in our Sublingual B12?

Should vitamins be taken with food?

What is PDCAAS?

How much Caffeine is in Click Protein drink?

Blood thinners and multivitamins.

Adding Unflavored Protien and Meal Replacements to food.

Do BA products contain Allergens?

What are benefits in taking Acidophilus?

Do your products have an NDC code?

Calcium Lactate Gluconate Absorption

Soy in BA High Protein Meal Reaplcements

Pregnancy outcomes after gastric bypass.

Dietary Fish Oil and Weight Gain

Childhood Obesity and Coronary Artery Disease

Amount of folate in a pre-natal (prenatal) vitamin

Amount of iron in a pre-natal (prenatal) vitamin

Why is there copper in the Zinc-50?

Ferronyl&reg; Carbonyl Iron Powder

Multivitamins May Support Healthy Weight Loss

Follow Up is Important to Success

Sclerotherapy as possible treatment for dilation

ASMBS Position on Sleeve Gastrectomy

"Eat Less and Exercise More" -- It's Not That Simple

What is a “Bariatric Vitamin”?

Ferronyl® Carbonyl Iron Powder

Can’t I get all my nutrition from food?

I take a children’s chewable vitamin, are yours different?