Bariatric Advantage

Adjustable gastric banding better than diet for obese teens.

Tue, 9 Feb 2010 14:52:14 CST

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 CST

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

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

Tue, 9 Feb 2010 10:40:54 CST

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

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Study Looks at Issues of Compliance

Thu, 4 Feb 2010 14:14:13 CST

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

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What are the ingredients in ProJoe?

Thu, 28 Jan 2010 09:48:19 CST

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

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

Mon, 25 Jan 2010 15:32:09 CST

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

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Study Shows More Benefits of Preoperative Weight Loss

Mon, 25 Jan 2010 14:31:50 CST

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

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

Mon, 25 Jan 2010 14:26:31 CST

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

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Study Shows More Benefits of Preoperative Weight Loss

Tue, 12 Jan 2010 12:26:07 CST

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

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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 CST

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

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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 CST

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

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What is the difference between a Prebiotic and a Probiotic?

Thu, 12 Nov 2009 12:17:14 CST

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

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What is a â€œBariatric Vitaminâ€?

Thu, 5 Nov 2009 13:36:07 CST

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

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What is a Probiotic?

Tue, 3 Nov 2009 09:43:38 CST

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

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Iron, B12 and Folate after Sleeve Gastrectomy

Fri, 23 Oct 2009 13:58:37 CST

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

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

Tue, 29 Sep 2009 10:53:59 CST

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

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

Wed, 26 Aug 2009 08:57:52 CST

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

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

Wed, 26 Aug 2009 08:45:46 CST

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

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Are water miscible vitamins still fat-soluble?

Wed, 26 Aug 2009 08:32:17 CST

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

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

Thu, 13 Aug 2009 11:03:11 CST

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

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

Wed, 12 Aug 2009 11:31:16 CST

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

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

Wed, 12 Aug 2009 11:28:41 CST

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

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What is the difference between Calcium Citrate and Calcium Carbonate?

Wed, 12 Aug 2009 11:25:15 CST

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

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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 CST

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

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

Wed, 12 Aug 2009 11:18:43 CST

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

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Are Bariatric Advantage products Only for a Bariatric patient?

Wed, 12 Aug 2009 11:14:32 CST

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

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

Wed, 12 Aug 2009 11:09:49 CST

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

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Probiotics and Gastric Bypass

Wed, 22 Jul 2009 11:18:45 CST

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

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Omega-3 Fatty Acids and Obesity

Wed, 22 Jul 2009 11:15:08 CST

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

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Water Miscible, Water Soluble, and Dry.

Thu, 25 Jun 2009 10:20:00 CST

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

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Do we have IF in our Sublingual B12?

Tue, 2 Jun 2009 07:43:01 CST

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 CST

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 CST

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 CST

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 CST

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 CST

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 CST

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 CST

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.

Soy in BA High Protein Meal Reaplcements

Tue, 29 Apr 2008 10:10:32 CST

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 CST

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.

Bariatric Advantage

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 â€œBariatric Vitaminâ€?

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?

Soy in BA High Protein Meal Reaplcements

Pregnancy outcomes after gastric bypass.

What is a â€œBariatric Vitaminâ€?