ASMBS suggested supplementation

On November 16, 2009, in General Nutrition, Vitamins, by Andrea

The American Society of Metabolic and Bariatric Surgeons has made a series of suggestions for postoperative vitamin supplementation prior to labs dictating otherwise.

- Adjustable Gastric Band/VSG: 100% of daily value
- RNY: 200% of daily value
- BPD/DS: 200% of daily value

  • Choose a multivitamin that is a high-potency vitamin containing 100% of daily value for at least 100% of daily value of 2/3 of nutrients
  • Begin with chewable or liquid
  • Progress to whole tablet/capsule as tolerated
  • Avoid time-released supplements
  • Avoid enteric coating
  • Choose a complete formula containing at least 18 mg iron, 400mcg folic acid, as well as selenium, and zinc in each serving
  • Avoid children’s formulas that are incomplete
  • May improve gastrointestinal tolerance when taken close to food intake
  • May separate dosage
  • Do not mix multivitamin containing iron with calcium supplement, take at least 2 hours apart
  • Individual brands should be reviewed for absorption rate and bioavailability
  • Specialized bariatric formulations are available

Additional cobalamin (B12)
- AGB/VSG: Not Applicable
- RNY: 350-500mcg if taken orally, 1000mcg / mo intramuscular injection

Additional elemental calcium
- AGB/VSG: 1500mg /day
- RNY: 1500-2000mg
- BPD/DS: 1800-2400mg

  • Choose a brand that contains calcium citrate and vitamin D3
  • Begin with chewable or liquid
  • Progress to whole tablet / capsule as tolerated
  • Split into 500-600 mg doses; be mindful of serving size on supplement label
  • Space doses evenly throughout day
  • Suggest a brand that contains magnesium, especially for BPD/DS
  • Do not combine calcium with iron containing supplements
  • Wait 2 or more hours after taking multivite or iron supplement to take
  • Wait 2 or more hours between doses
  • Promote intake of dairy beverages and/or foods that are significant sources of dietary calcium in addition to recommended supplements
  • Combined dietary and supplemental calcium intake greater than 1700 mg/day might be required to prevent bone loss during rapid weight loss

Additional elemental iron
- RNY: Minimum 18-27mg / day elemental
- BPD/DS: Minimum 18-27mg / day elemental

  • Recommended for menstruating women and those at risk of anemia
  • Begin with chewable or liquid
  • Progress to tablet as tolerated
  • Dosage may need to be adjusted based on biochemical markers
  • No enteric coating
  • Do not mix iron and calcium supplements, take at least 2 hours apart
  • Avoid excessive intake of tea due to tannin interaction
  • Encourage foods rich in heme iron
  • Vitamin C may enhance absorption of non-heme iron sources

Fat-soluble vitamins
- BPD/DS: 10,000 IU of vitamin A, 2000 IU of vitamin D, 300 mcg of vitamin K

  • With all procedures, higher maintenance doses may be required for those with a history of deficieincy
  • Water-soluble preparations of fat-soluble vitamins are available
  • Retinol sources of vitamin A should be used to calculate dosage
  • Most supplements contain a high percentage of beta carotene which does not contribute to vitamin A toxicity
  • Intake of 2000 IU vitamin D3 may be achieved with careful selection of multivitamin and calcium supplements
  • No toxic effect known for Vitamin K1, phytonadione (phyloquinone)
  • Vitamin K requirement varies with dietary sources and colonic production
  • Caution with vitamin K supplementation should be used for patients receiving coagulation therapy
  • Vitamin E deficiency is not prevalent in published studies

Optional B complex
- AGB / VSG: 1 per day
- RNY: 1 per day
- BPD/DS: 1 per day

  • B-50 dosage
  • Liquid form is available
  • Avoid time released tablets
  • No known risk of toxicity
  • May provide additional prophylaxis against B-vitamin deficiencies, including thiamin, especially for BPD/DS procedures as water-soluble vitamins are absorbed in the proximal jejunum
  • Note >1000mg of supplemental folic acid provided in combination with multivitamins could mask B12 deficiency

Calcium-rich foods

On November 16, 2009, in General Nutrition, Minerals, by Andrea

Tip:  Want to know how much calcium is in that thing you’re about to eat?  Take a gander at the nutrition label.  The percentage of calcium is based on a 1000mg being the daily value.  This means, you can add a zero to the percentage and this becomes the actual milligrams of calcium in the product.

Nutrition label

Nutrition label

In this instance, there would be 200mg of calcium in this product.

Breads, grains, & cereals

TOTAL Protein cereal, 1/2 c     100mg
Instant Oatmeal (1 pkt) made with 1/2c milk     216mg
TOTAL Corn Flakes cereal, 1/2c     384mg
Cream of Wheat cereal (1/2c) made with 1/2c milk     227mg
Whole Wheat Bread (1 slice)     25mg

Milk and Dairy

Milk (8oz)     300mg
Soy Milk Calcium Fortified (8oz)     300mg
Lite Yogurt (6oz)     200mg
Powdered Nonfat Milk (1 TBSP)     100mg
American Cheese (1oz)     160mg
Ricotta Cheese (1/4c)     167mg
Cheddar Cheese (1oz)     200mg
Cottage Cheese (1/2c)     50mg
Mozzarella Cheese, String Cheese (1oz)     150mg

Meat & Meat Substitutes

Salmon, canned with bones (1oz)     56mg
Soybeans, cooked (1/4c)     65mg
Almonds (24nuts or 1oz)     75mg
Tofu, calcium-fortified (4oz)     140-250mg
Kidney, Lima, or Navy Beans (1/2c)     25mg
Eggs (1)     25mg


Orange (1 medium)     50mg
Calcium-fortified orange juice (6oz)     200mg


Turnip Greens (1/2c)     75mg
V-8 Juice Bone Health (8oz)     300mg
Spinach, cooked (1/2c)     150mg
Broccoli, cooked (1/2c)     25mg
Carrots, raw (1/4c)     25mg

Important note about calcium-fortified foods from the National Dairy Council:

Calcium Bioavailability. The bioavailability of calcium from calcium-fortified foods is another consideration. In general, calcium absorption is most efficient when consumed in doses of 500mg or less (5,50). Some well-known brands of cereal are fortified with calcium levels as high as 600 and 1,000mg/cup. A serving of these cereals with 1/2 cup of milk provides either 750 or 1,100mg of calcium. Calcium absorption from this high intake consumed at a single time islikely to be lower than multiple calcium intakes of 500mg or less.

A variety of calcium salts are used to fortify foods and beverages. Although the bioavailability of calcium from various salts is similar to that from milk (23,51), calcium bioavailability from calcium-fortified foods may differ from that expected. For example, calcium-fortified soy beverage is not comparable to cow’s milk as a source of calcium, according to a recent study (52). Becauses soy beverages naturally contain very little calcium (i.e., about 10mgper serving), they are often fortified with calcium, although the amountis not regulated and levels can vary from 80 to 500mg calcium per serving(52). In a study of 16 healthy men, the calcium from soy beverage was absorbed at only 75% the efficiency of calcium from cow’s milk. Sixtypercent more calcium (i.e., 500mg per serving) was needed in soy beverages for calcium absorptionto be comparable to that from cow’s milk (i.e., 300mg per serving) (52).

The bioavailability of calcium in calcium-fortified foods may be influenced by the presence of inhibitors such as phytic acid in certain foods (23,53). Phytic acidcan significantly reduce calcium bioavailability in calcium-fortified breads and cereals.

CNN gives the DS a shoutout

On November 16, 2009, in Uncategorized, by Andrea


In a quick Q&A, a doc answers a question about resolution of diabetes with weight loss surgery:

Does roux-en-Y gastric bypass cure diabetes?

Asked by Rick Shetron, Troy, New York

“60 Minutes” had a story several months ago about a type of weight-loss surgery that seemed to also cure type 2 diabetes in many people. Has more research been done on this? Do you need the full bypass of about one-third of the small intestine or just the duodenum and jejunum? My weight problem came about with/after diabetes, not before.

Expert answer

Hi, Rick. I’m not a surgeon, so to answer your question more thoroughly, I consulted with a very well-respected bariatric surgeon in San Francisco, John Rabkin, M.D. He explained that the roux-en-Y gastric bypass (RGB) improves type 2 diabetes via at least three different mechanisms:

1. The surgery decreases caloric intake immediately after the procedure because food intake is restricted by the small volume of the created stomach pouch, which holds only 1 ounce. The decrease in food intake, particularly refined carbohydrates, which are not well-tolerated after this procedure, can help stabilize blood sugar levels and immediately improves control of diabetes.

2. The significant amount of weight loss that results from the surgery improves insulin resistance over time.

3. There are changes in hormones and caloric processing because the food ingested bypasses the segment of the small intestine closest to where it attaches to the stomach (the duodenum and proximal jejunum), but not quite as much as you mentioned (not one-third of the small intestine). Because of the anatomical changes resulting from the surgery, it appears that these hormonal changes are greater than would be seen with weight loss via diet and exercise, but no research has yet to compare the two directly and evaluate hormonal changes.

The overall outcome is complete resolution of type 2 diabetes in greater than 70 percent of patients with diabetes before the procedure.

Unfortunately, as many RGB patients regain weight over time, the durability of the cure isn’t as high as with a newer procedure called the duodenal switch.

In this procedure, there is a much larger pouch created (4 to 5 ounces), and the complete stomach anatomy is preserved, which helps preserve more normal stomach function. In this procedure, the rearrangement of the intestines leads not only to some restriction of food, but also causes your body to absorb significantly fewer calories, which has a more lasting effect.

Rabkin, a leader in this procedure, reports that he has had a 96 percent cure of type 2 diabetes at one year after surgery, which has persisted for five and 10 years post -op and seems to be similarly durable out past 15 years post-op.

Hope this helps. I strongly recommend spending a considerable amount of time with your surgeon if you are considering either of these procedures, as both have important lifestyle-related issues that should be discussed to determine the best procedure for you for the long term.

Answered by Dr. Melina Jampolis Physician Nutrition Specialist

Bout time this is really hitting the mainstream.  I would take some exception with the assumption that all RNY’ers regain their weight, but many do.  I get that.  I only wish they had qualified this a bit better, but glad the DS got some mainstream attention.

Believe Italian Cappuccino

On November 15, 2009, in Protein, Reviews, by Andrea

Disclaimer – I got this from the OH Atlanta convention.  Theresa from Bariatric Eating was handing these out, along with the Calcet creamy bites (which might be where I got mine, I’m not certain..)  BE doesn’t know I’m doing this review — in fact, I’m not certain Theresa knows who I am, and she certainly didn’t know I was going to be blogging about the product when she handed it to me.  Actually, neither did I.  It took Beth several conversations over the course of the weekend to convince me to do so.  So basically, again, no product endorsement was asked for, implied, or anything else.

Italian Cappuccino

Italian Cappuccino

Italian Cappuccino, is a Splenda-sweetened espresso latte, with 20 grams of protein, a blast of natural energy and a hint of caramel goodness.

You have never tasted anything quite as delicious as Believe, our new ready-to-drink sensation. Smooth and delicious coffee lattes filled with healing protein & natural energy – packed in premium glass bottles, they’re a pleasure to sip.

Believe is perfect for a busy morning or afternoon break – these deliciously bold coffee protein beverages invigorate the body and mind with pure natural energy. Bliss in a bottle that’s actually good for you!

We’ve infused the finest coffee with natural flavorings and 20 grams of protein, making Believe a smart alternative to skipping a meal or eating fast food. Enjoy a bottle either chilled or over ice; wherever you are it’s pure perfection.

So I’ll be honest — I opened this expecting it to be exactly like the Buxx drinks in the same containers.  I’m not certain why, given that this is good for me and those, well, aren’t.  But my mind saw the bottle, the packaging and thought “mmm.. creamy coffee goodness..”

Well, not quite.

It’s thinner, much much thinner.  It’s sweeter, to me, than the Buxx drinks, and this comes from an admitted Splenda whore.  To me, it leaves an aftertaste — kind of a gritty aftertaste on my tongue, like a dry taste, but not horrible.  This might just be me because I handed it to the hubs, who does not like diet anything and he said it tasted much like the Buxx drinks to him.  So maybe my tongue may be broken, or overly-sensitive, or something else.  It is nowhere near as strong as Click is, so if Click is too much for you but you like your coffee, then this might be a good alternative to try.

The statistics are really good for the drink:

Italian Cappuccino Stats

Italian Cappuccino Stats

So would I drink this again?  Yes.  In fact, since I have one in my fridge, I will be drinking it again.  It’s not as strong as the Click, which might be great for people who aren’t into the massive espresso need like I am.  It’s definately something I would drink, and would consider buying again.  And let’s face it, the stats are super.

Available at Bariatric Eating.

A tattoo that tells blood sugars?

On November 14, 2009, in General Nutrition, by Andrea

It may be on it’s way…

Source: MSNBC

Scientists are starting to test a kind of sensor that changes color with rising blood sugar levels. The high-tech tattoo, which is about the size of the clicker on the end of a ballpoint pen, is made up of tiny spheres that are injected into the outermost layer of skin. These nanospheres contain a special kind of ink that reacts with glucose, explains the tattoo’s inventor, Heather Clark, a biomedical engineer at Draper Laboratory in Cambridge, Mass.

What would be cool is if this could be used for those of us that are severely hypoglycemic rather than diabetic.  Some of us don’t even begin to get symptomatic until comatose levels — quite recently, I remember a reading of 28 on my glucometer — a number that would have many people unconscious and drooling on the floor.  If I had this implantable mood ring of sorts, I could save myself some of the misery that I encounter at such low numbers and try to head off the hours it takes to gradually get those numbers normal without doing a massive yo-yo of reactive-ness (yes, I am now making up my own words).

A girl can dream, right?

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