Healthy Eating after Bariatric Surgery

Posted on May 13, 2012 by

Many questions arise as a patient contemplates bariatric surgery. What will life be life after surgery? What can I eat? How will my diet change? How much can I eat? These are all common questions. As you go through the process of preparing for surgery and recovering after surgery, many more questions will arise.

The surgery is just one step in your journey. Living a new healthy lifestyle after surgery will help you succeed in losing weight and becoming healthier for the long term. Your eating habits will absolutely need to change following surgery. You will not be able to eat the same types or amounts of foods as before surgery.

Immediately following surgery, the stomach will need time to heal and adjust to your new way of life. Your medical team will help you develop a diet that will work for you. Initially, it will take time to heal and become accustom to your smaller stomach. After surgery, you will start with a liquid diet bringing in some semisolid foods as you go. This can include broth, unsweetened juices, milk, cream soup and sugar-free gelatin. You will want to sip slowly, only taking in three to four ounces at a time.

As the medical team determines that you are able to keep these foods down, they will move you to soft foods. Foods like lean ground meats, beans, fish, egg whites, yogurt and soft fruits and veggies will be introduced. It will be important to keep these foods moist. Utilizing marinades, marinara sauces, low fat gravy, salsas, ketchup and broths will be helpful.

At your post-operative appointment with your registered dietitian (three to four weeks after surgery) you will be given the okay to slowly proceed eating solid foods. It is during this transition when you will initiate the behaviors that you worked on before surgery i.e. taking small bites; chewing well and pushing food away when you feel full. You will also have to make sure not to drink liquids with your meals.

‘Normal’ eating after bariatric surgery means making sure your meals are based around protein. Ideally you will be taking four bites of protein for every bite of a side dish. For example, for breakfast you could have a one-egg omelet with veggies, cheese and a slice of whole wheat toast. You would focus on the egg, cheese and vegetables and most likely only have one-quarter to one-half of the toast. As you move on to eating a more ‘normal’ diet, you will always need to be conscious of the types of foods you put into your body. Even within the months of following surgery, the body has a hard time digesting foods such as pasta, rice, popcorn, tough meats or breads. Highly fatty or sugary foods are not okay as the body will often reject these foods. Many doctors will discourage drinking caffeine drinks or alcohol.

Taking the appropriate steps to lose weight safety with bariatric surgery doesn’t end after the surgery is completed. The overall process is challenging and will change the way you view and eat foods the rest of your life.

If you would like to learn more about bariatric surgery and whether it is right for you, contact the Hallmark Health System’s Center for Weight Management and Weight Loss Surgery today.

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Extra Pounds Can Increase your Risk of Certain Diseases

Posted on May 10, 2012 by

As a person’s weight increases so does the risk of many serious diseases. Type 2 diabetes, coronary heart disease, certain types of cancers, hypertension, strokes, gallbladder disease; the list goes on and on. Unfortunately, as a person gains more weight, their desire to exercise decreases, this also contributes to the increase in diseases.

Most doctors evaluate a person’s weight problems by using a body mass index or BMI. This calculation is determined by several factors including your weight and height. A person is considered overweight when their BMI is over 25.0 and considered obese when their BMI is 30.0 or higher.

As your weight increases, so does your body fat. Additionally, exercise and healthy eating is typically not a priority. Many people can suffer from depression, lack of energy and joint pain due to the weight. For those who battle weight problems, your risk for the following diseases is higher and you should talk with your doctor about your risks and determine a plan that works for you.

  • Diabetes Type 2 is one of the more common diseases. Diabetes Type 2 is where the blood has too much blood sugar and the pancreas is unable to produce enough insulin to offset the glucose. Most diabetic patients are required to take insulin shots several times a day to help balance their blood sugar levels.
  • Coronary heart disease is also a common problem for many overweight patients. With a patient caring extra weight, the heart is working overtime. The heart enlarges and is unable to pump blood throughout the body effectively.
  • Excessive weight has also been shown to increase the risk of cancers such as endometrial, breast and colon cancer. Those with a family history of these cancers are at an even higher risk when weight is a factor.
  • With the reduction of exercise, the body is more likely to develop pulmonary embolism; which is blockage in an artery that can often result in death if not caught in time.
  • An overweight person often suffers from high blood pressure, which increases the likelihood of hypertension.
  • Gallbladder stones and gallbladder disease are common among people overweight. Often times, the gallbladder will need to be removed.

Though these are very serious diseases, you should also realize that a higher risk of fatty liver disease, erectile dysfunction, infertility, urinary incontinence, chronic renal failure and osteoarthritis are very common as well.

Many patients we see at Hallmark Health System’s Center for Weight Management and Weight Loss Surgery are extremely concerned about these risks and are ready to do something about it. For some patients, diet and exercise can’t always fix the problem long term. With bariatric surgery, patients see a dramatic change in not only their weight, but also their risk of these diseases drops dramatically, living a completely normal and healthy life for many, many years to come.

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Diabetes: What You Should Know about This Serious Disease

Posted on April 23, 2012 by

Diabetes is a serious problem throughout America. Over 25.8 million American children and adults are diabetic, which equates to 8.3 percent of our population. When doctors discuss diabetes, they are usually referring to one of two types of diabetes  – type 1 and type 2. Both can be dangerous and have real consequences if not diagnosed and properly treated.

Though type 1 diabetes can be diagnosed at any age, most often it is diagnosed in children, teens or young adults. The cause of type 1 diabetes is unknown, but doctors believe it is due to an autoimmune disorder and is passed down through families. The onset of type 1 diabetes is usually very quick and can endanger a person’s life if symptoms are not recognized quickly. For those diagnosed with type 1, the pancreas does not produce insulin or enough insulin to help the body process blood sugar (glucose) into energy.

A patient with type 1 diabetes will work with their doctor to monitor their blood sugar levels by testing the blood and taking insulin shots accordingly. Type 1 is very manageable with a doctor’s guidance, insulin injections, healthy diet and regular exercise. A person with type 1 diabetes can live a healthy life for many years to come.

Type 2 diabetes is the most common form of the disease and is estimated to affect 90 to 95 percent of those diagnosed with diabetes. With type 2, the body begins to resist insulin and is unable to use insulin properly.  This happens over time and happens most often to people who are overweight or obese and do not get regular exercise. With Type 2 diabetes, your fat, liver and muscle cells are insulin resistant, which means they are unable to correctly respond to insulin.

Fortunately, for type 2 diabetes there are proven ways to prevent or delay the onset. The CDC reports that lifestyle changes such as losing weight and increasing physically activity will reduce the development of type 2 diabetes by 58 percent. Bariatric surgery has also been show to help patients with type 2 diabetes. Two recently published studies in the New England Medical Journal have shown that type 2 diabetes patients who underwent weight loss surgery, such as gastric bypass or sleeve gastectomy, experienced remission from the disease. This is good news for those who have struggled with weight problems and diabetes.

Though recent research is good news for many, diabetes continues to be a very serious problem across the country. If diabetes is not treated or controlled, the complications of the disease are quite severe. Patients who resist taking care of themselves over a period of time can experience any of the following:

  • Heart disease and stroke
  • High blood pressure
  • Blindness
  • Kidney disease
  • Nervous system disease (neuropathy)
  • Amputation of a limb – usually foot or leg

If you are concerned about your risks of diabetes and struggled with your weight, don’t hesitate. Call Hallmark Health System’s Center of Weight Loss Management and Weight Loss Surgery at (781) 306-6166 or plan to attend one of our free monthly information seminars.

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Control the Craving

Posted on April 16, 2012 by

Craving: great or eager desire; yearning

Whether you are preparing for surgery or you are focusing on weight loss/maintenance after surgery, cravings can pose a challenge in your everyday life. Cravings can be the result of not eating the right foods or not following a proper meal schedule. They can also be the result of stress, boredom, your environment or bad habits. By following a regularly-scheduled meal pattern and tuning into your appetite signals, you can prevent and control cravings.

 Preventing a potential craving

  •  Do not skip meals! If you skip a planned meal or snack you are putting yourself at risk for experiencing extreme hunger later on. With extreme hunger usually comes cravings and unhealthy food choices. Give your body what it needs before you lose control.
  •  Plan ahead. Make sure you plan your day out and always carry a nutrient-dense snack with you in case of a “food emergency.” For example, reduced fat cheese and whole grain crackers, a small handful of nuts and a small piece of fruit, etc.
  •  Make sure to stay hydrated. Drink at least 64 oz of fluid daily. Sometimes dehydration can make you feel hungry and cause cravings.
  •  Don’t forget balance. Although protein remains the priority, it is important to include some healthy carbohydrates (fruit and whole grains), vegetables, and healthy fats (nuts, olive oil, peanut butter, etc.) in your diet. Note: take into consideration your current dietary stage.
  •  When you are trying to establish a regular meal pattern, you may need to rely on eating by the clock more versus eating according to hunger. Even if you do not feel hungry for a meal, make sure that you eat something anyways. This ensures that you remain in control of your hunger.

Focus on mindful eating

  •  If you feel hungry between a planned meal or snack, ask yourself a few questions.
  •  Am I really hungry?
  • Or do I feel hungry because I am sad/mad/frustrated or stressed?
  • Am I bored?
  • Do I want to give into a stressful social situation?
  • If you are not truly hungry and you are experiencing a craving, do not give in! You are in control.
  • Find an activity or activities to engage in other than eating. You will find it becomes easier to cope with cravings as time passes.
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New Research Shows Patients Experience Diabetes Remission after Bariatric Surgery

Posted on April 3, 2012 by

Last week, the New England Journal published research showing many Type 2 Diabetic patients experience remission after bariatric surgery. Two separate studies tracked patients over two years to identify the effects of bariatric surgery on diabetes. For some time, doctors have seen a dramatic reduction in diabetes following surgery, but did not have specific research data to prove it.

The studies were conducted at two institutions – The Cleveland Clinic and Catholic University of Rome. The Cleveland Clinic study evaluated 150 patients that had body mass index’s (BMI) of 27 to 43 and received either gastric bypass or sleeve gastrectomy surgery. The results indicated that 42 percent of bypass patients experienced diabetic remission versus 37 percent of sleeve patients.

Catholic University of Rome study included 60 patients with BMI’s between 30 between 60 who either received gastric bypass or biliopancreatic surgery. (Biliopancreatic surgery is not offered in the U.S.) Those patients who received the bypass surgery experienced 75 percent remission rate.

Though the research is good news for those suffering from Type 2 Diabetes, both research studies were smaller in scope. A related article appeared in the NY Times.
Bariatric surgery has also been shown to help lower blood pressure and cholesterol in overweight patients. If you’re interested in learning more about bariatric surgery, join us on April 11 for our informational seminar.

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Caffeine Interferes with Absorbing Nutrients After Bariatric Surgery

Posted on April 2, 2012 by

It is the position of the American Medical Association that “moderate tea or coffee drinkers need have no concern for their health relative to their consumption provided lifestyle habits (diet, alcohol consumption) are moderate as well.” Moderate caffeine consumption is considered to be about 300mg, which could be equal to about three, eight oz. cups of coffee, depending who is making the coffee. How much caffeine are you getting in your drinks? The Caffeine Awareness website can help you determine the amount of caffeine in your drinks.

Gastric bypass surgery alters the anatomy of your digestive system. After gastric bypass surgery, you process and absorb things differently than an average person. Patients with Lapband surgery should also be wary and use caffeine in moderation. There is little research on caffeine and bariatric surgery. But as you read on, you may wish to rethink that cup of mojo. Remember, our recommendation is no more than eight oz. coffee/tea per day.

After gastric bypass, you don’t absorb all of your nutrients. Caffeine may further decrease calcium absorption, which in turn may lead to osteoporosis and increased risk for fractures. Therefore calcium should not be taken with caffeine. Caffeine may also decrease iron absorption. Plan your caffeine and food intake carefully. (And remember; don’t take calcium supplement with dairy. You can only absorb a certain amount of calcium at once.)

Caffeine may cause:
• nausea/vomiting
• GI distress
• Dyspepsia
• increase in gastric acid secretion, leading to gastroesophageal reflux and diarrhea

Caffeine is not recommended with peptic ulcer, GERD, or irritable bowel. It may cause ulcers in some people. Caffeine belongs to a family of drugs that are heart and muscle stimulants, cerebral vasoconstrictors and diuretics. Caffeine may cause anorexia in high doses and may increase hunger in some people.

Dehydration is commonly seen after gastric bypass surgeries. Obese patients require greater amounts of fluid to maintain normal fluid balance. Caffeine causes increased urine output, which can increase the risk for dehydration, particularly during rapid weight loss. Caffeine should only be added when adequate hydration is achieved and there are no symptoms of nausea. Fluid needs vary depending on your weight and exercise expenditure. Fluid goal is approximately 64 oz. per day.

So, if you have surgery to improve your health, why would you risk getting ulcers, osteoporosis or other complications?

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Weight Management is a Day-to-Day Effort – Start Today!

Posted on March 26, 2012 by

Starting a weight management program can feel overwhelming, especially if you haven’t exercised in many months or even years. For an overweight individual, tackling even the littlest activity can be exhausting.

Rather than continuing to promise yourself that you will get started the next day or the day after, it is vital for your health to get started today. “But, how?” you might ask.

Start your new weight management program by accessing and recording your abilities in a workout diary or journal. This will give you a baseline as to where you started and you can track your progress. It may not feel like you can run a 5k today, but looking forward you will see a vast improvement if you continue your efforts every day.

We recommend accessing the following:

  • Your body mass index (BMI) – there is many easy-to-use online calculators to help you with determining your BMI
  • Waist circumference – while standing straight measure your abdomen just above your hipbones
  • Time it takes to walk one mile
  • The number of sit ups and push-ups you can complete at one time

Once you have an idea of what you can do today, you can build goals for yourself. These goals should be included in your journal, reminding you daily of what you are trying to accomplish.

Exercising consistently every day is important to reach your goals, but with that said, it is also important not to burn yourself out. We recommend you select a variety of activities, alternating between activities. By alternating your activities from day to day, this will help reduce the chance of getting bored, but also allow the proper rest period for your body.

These activities might include walking, hiking or running, riding a bike or stationary bike, yoga or exercise class like Tae Bo or Zumba, weight training at the gym, and so on and so forth. There are many activities you can do to help you get into shape. To ensure you don’t get hurt, start slowly and build up, doing a bit more every day. Be sure to write down you daily activities in your journal. This will help you keep track and push yourself a bit more the next time you do that activity.

Don’t forget to monitor your progress throughout and don’t get down if you miss a day here or there. Recalculate your access points from day one every four to six weeks making notes in your journal. As you see improvements, this will help keep you motivated.

At Hallmark Health, we feel it is important to combine a healthy diet and an exercise program to manage your weight. In addition to this program, be sure you pack your meals with lean protein and a rainbow of veggies.  Drink lots of water to ensure you stay hydrated.

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Weight Management Starts with Breaking Old Habits

Posted on March 19, 2012 by

Everyone has developed habits with their diets, some good and some bad. It is important to start breaking your bad habits around food in order to have a successful weight loss journey. Whether the habit is eating too quickly, drinking with your meals or grazing throughout the day, breaking these habits is one of the first steps towards successful weight loss.

Psychologists say that it takes 21 days to make or break a habit. The first step to breaking a bad habit is to understand what it is doing to your life. Then it becomes a matter of starting each day by re-committing yourself to a new way of life.

8 Steps to breaking free from a bad habit

  1. Realize why it is important. Decide how serious you are. If a habit seems to bother everyone but you, it may be hard to break. You must have motivation. Listen to your intuition. Write down the negativity that this habit is bringing into your life. For example, smoking is harmful to your health.
  1. Identify the times, situations and your emotional state when you perform the behavior. Habits can be automatic. Conscious awareness is critical. If you can anticipate that you are about to perform the behavior, before you actually do, you are more likely to be able to stop it.
  1. Set short-term goals. Be realistic when setting short-term goals that will help you reach your long-term goals. Goals should be written down, specific, measurable and realistic. Create deadlines for your goals. Substitute better behaviors. For example, by Feb 1, I will have cut down to one small cup of coffee, by replacing coffee with water.
  1. Set yourself up for success. Develop a plan that can work for you. Identify another behavior that you can do to avoid the problem behavior. For example, if you know that you should stop buying candy bars at the vending machine on your way to meetings, change your route so that you don’t pass the vending machine and if the route is a little longer, embrace the additional steps!
  1. Our mind is often more motivated by pictures and visualization, than words or written exercises. Draw, cut out pictures or take photographs of what you want in your life. Put pictures on your refrigerator, bathroom mirror or anyplace that will remind your subconscious of your desires to reinforce your goal.
  1. Develop confidence in yourself and your abilities. Listen to motivational CD’s and tapes in your car while commuting. Control your self-talk. Focus on your strengths, not your weakness. Develop a determination to follow through on your goals regardless of obstacles, circumstances or criticism. Have persistence. Live in the moment, pay attention to the beauty in the world and look for the good in people. Help someone each day. Don’t allow yourself to become distracted with excuses about why things can’t be done.
  1. Praise, social support and material rewards can reinforce successful attempts.
  1. Commit to exercise. Exercise is an instant confidence booster – blood starts to flow and you feel better. Even if you only do 10 minutes a day, every morning for the rest of your life, it would perpetuate other positive actions throughout your day.
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Alcohol Consumption After Bariatric Surgery

Posted on March 13, 2012 by

The weather is warmer, BBQ season is here and social gatherings are taking place. This means that alcohol is more abundant and the opportunity to consume it is all around. Is it okay to have a drink? What should you drink? How much is safe?

Why alcohol is a concern post-surgery?

  • After the gastric bypass procedure, a large portion of the stomach and the upper gut is bypassed. The alcohol quickly moves to the small intestine and absorption rapidly occurs. Since the stomach pouch is smaller after gastric bypass surgery, the enzyme that breaks down alcohol (alcohol dehydrogenase) is not as abundant. This alters the body’s ability to metabolize alcohol and increases its effect on the body.
  • Patients who have had gastric bypass surgery are at a higher risk of becoming deficient in Iron, B12, folate and thiamin. Alcohol is also known to cause malabsorption of Vitamin B12, folic acid and thiamin.
  • In the early postoperative period, calorie and carbohydrate intake is reduced and the body’s metabolism is altered. This increases the risk of developing low blood sugar (hypoglycemia) with the use of alcohol.
  • Many people who opt for bariatric surgery have struggled with food addiction throughout their lives. The surgery offers a healing tool for food addiction. However, some people experience what is called Addiction Transfer, where an addiction to a new substance such as alcohol is more easily acquired.
  • With both the gastric bypass and the lap band procedure your daily calorie intake is reduced. Ideally, you want to choose nutrient and protein dense foods to ensure adequate nutrition despite your reduced calorie intake. Alcohol falls under the category of “empty calories”. It provides calories with no real nutritional benefit. In addition, a calorie-restricted diet might cause you to “feel” the effects of alcohol more rapidly and intensely.

How to make smart choices

  • Alcohol should not be considered until you have fully advanced to solid foods and are tolerating your diet well.
  • If you decide to have a drink, make sure that you sip very slowly and pay attention to how it makes you feel.
  • Avoid beer and other carbonated beverages.
  • Be extremely cautious with liquor since it has a high alcohol concentration.
  • Stay in control during and after alcohol consumption – do not give into a temptation to snack on empty calories.
  • If you have a glass of wine, pour it into a small 4 oz juice glass to make sure you are not over indulging.
  • If you choose to have a cocktail, avoid any high sugar juice mixers.
  • Make a small glass of alcohol a compliment to your social experience and not a highlight of it. Enjoy the company, conversation and weather. Be thankful for a healthier you.
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Welcome from Hallmark Health System’s Center for Weight Management and Weight Loss Surgery

Posted on March 6, 2012 by

Welcome!

As the Director of Hallmark Health System’s Center for Weight Management and Weight Loss Surgery, I would like to take this opportunity to welcome you to our new blog. Our Center is designated by the American Society of Metabolic and Bariatric Surgery as a Bariatric Surgery Center of Excellence. This special designation places our Center among an elite group of select hospitals in Massachusetts and throughout the country that have completed a stringent review process and met the high standards set forth to be designated a Center of Excellence. In the United States, there are fewer than 250 hospitals with this designation. The mission of our Center is to provide world-class weight management services to our community in a kind, caring and welcoming environment.

Our Facebook page, Twitter account and blog were developed for modern, social media savvy individuals. Click the ‘Like’ button on Facebook and ‘Follow’ us on Twitter and you will be alerted to our important events. We will keep you posted about important trends and news about medical and surgical weight management. And, if you have any questions or need help in managing your weight, please call us for an appointment at (781) 306-6166.

Andras Sandor, MD, F.A.C.S., F.A.S.M.B.S.

Director of Hallmark Health System’s Center for Weight Management and Weight Loss Surgery

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