Posted on December 15, 2011 at 12:01 AM in Dr. Boyce In The Media, Nutrition
Bariatric Surgeon in Knoxville on Maintaining Nutrition Levels after Weight Loss Surgery
According to the latest study from the American Society for Metabolic and Bariatric Surgery (ASMBS), bariatric surgery may increase life expectancy for the morbidly obese by 89% and reduce the risk of premature death by 30 to 40% as compared to those who do not have surgery. Dr. Stephen Boyce, a bariatric surgeon in Knoxville, says that although weight loss surgery can offer the tools for effective relief of morbid obesity, patients must maintain a strict regimen of certain vitamins, minerals, and supplements to prevent nutritional deficiency.
Dr. Stephen Boyce of the New Life Center for Bariatric Surgery, a practice focused on weight loss surgery and nutrition bariatric supplements in Knoxville, says that while weight loss procedures can dramatically improve a person’s ability to lose weight and make healthy lifestyle changes, patients need to be aware of the effects of certain procedures on their nutrition. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), life expectancy may increase by 89% for patients whom undergo bariatric surgery. The ASMBS study also shows a reduction in the risk of premature death by 30 to 40% as compared to those who do not have surgery. However, Dr. Boyce says weight loss surgery procedures also reduce the intestine’s ability to absorb nutrients effectively, which can often cause deficiencies that result in poor hair, skin, and nail health. He adds that through vitamins and mineral supplements, patients are able to maintain their proper nutritional intake, preserving their well being, including hair, skin and nail health.
Because bariatric surgical procedures restrict food intake and can create malabsorption, the body cannot absorb as many nutrients through the gastrointestinal process as before. Therefore, weight loss surgery is often associated with hair loss, sagging skin, and poor nail health because of insufficient nutrient intake. Dr. Boyce says this insufficiency necessitates strict attention to dietary choices and vitamin and mineral supplementation. He says achieving safe and effective results following surgery depends on a patient’s ability to adhere to a daily regimen of nail, hair and skin vitamins and minerals. “If the patient wants to minimize their hair loss after weight loss surgery, they need to provide their body with the critical vitamins and minerals that it needs.”
Before undergoing a weight loss procedure, Dr. Boyce recommends patients find a bariatric surgical practice dedicated to providing post-surgery diet plans using a comprehensive range of nutritional vitamins, minerals, and supplements with continued nutritional education and follow up to minimize the risks of developing other serious medical complications associated with nutritional deficiency. He adds that patients should be sure to thoroughly research vitamin intake and their nutritional needs so as to achieve the safest and most effective results possible.
“It doesn’t make any sense to have weight loss surgery in order to cure diabetes, sleep apnea and hypertension only to develop serious medical conditions due to nutritional deficiencies. Patients who do not take adequate supplements are at risk for anemia, paralysis, osteoporosis, and fractures, as well as hair loss, excess skin and unhealthy nails. Hair health is known to rely on adequate iron, biotin, and high levels of Vitamin B and omega fatty acids. The New Life Hair Skin and Nails pack goes beyond the ASMBS’s recommendations in these vitamins and minerals in order to ensure optimal conditions for hair, skin and nail health.”
About Stephen G. Boyce, MD
Dr. Stephen Boyce graduated from Texas A&M University, obtaining his Bachelor of Science and Masters of Science, and received his medical degree at the University of Texas Southwestern Medical School. He completed a surgical residency at Parkland Memorial Hospital. Dr. Boyce has completed thousands of weight loss surgical procedures over the past twenty years and has received special training in advanced laparoscopic surgery. He is also a recipient of a Masters Certification in Bariatric Surgery and an Educator for Ethicon Endosurgery.
Located at 200 Ft. Sanders West Blvd MOB 1, Suite 200 in Knoxville, TN, The New Life Center for Bariatric Surgery can be reached at parkwestcwlc.com, newlifebariatricsupplements.com, or facebook.com/newlifecenterbariatricsurgery.
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Posted on November 17, 2011 at 4:01 PM in Bariatric Surgery, Nutrition, Weight Loss Surgery
Vitamins and minerals fall into a category called micronutrients. They function in our body as co-factors and enzymes that are necessary to complete every process in our bodies from our head to our toes. Unlike macronutrients (protein, carbohydrates and fats), they do not provide calories. Vitamins and minerals are necessary for healthy vision, cell growth and development, healthy skin, bones and teeth, immunity, wound healing, metabolism of nutrients, healthy brain and nerve function, normal heart rhythm and function, reproduction and much more! (1). Vitamins and minerals are found throughout all the food groups in a variety of foods and beverages. They are abundantly found in fruits and vegetables of all colors and sizes, protein sources like chicken, eggs and beans, dairy products like milk and cheese and in a variety of whole grains.
Vitamins and minerals play an important role in weight control and management! Micronutrients assist in many of the processes that regulate appetite and hunger hormones, metabolic rate, nutrient absorption and storage, glucose homeostasis and more! Therefor, adequate intake of vitamins and minerals is crucial for our body to appropriately use the nutrients we consume, a healthy and active metabolism, hunger control and ultimately optimal weight loss and long-term weight maintenance (1).
So how does vitamin and mineral supplementation affect the bariatric surgery patient? Before surgery vitamin and mineral supplementation is recommended to help boost your nutritional status. Your nutritional status prior to surgery is a good indicator of your healing process after surgery. The healthier you are prior to surgery the stronger your immune system and more efficient your wounds will heal and the shorter the recovery time (2).
After surgery, patients have an increased need for vitamin/mineral supplementation due to one of the three following procedural categories: restrictive, mal-absorptive or mixed procedures. Restrictive procedures limit the amount of food a person can consume. Mal-absorptive procedures limit the amount of calories you absorb and mixed procedures are a combination of both. All of the procedures restrict or limit food you consume and/or absorb and therefor restrict or limit the amount of micronutrients you consume and/or absorb. Patients who do not take their bariatric specific vitamins as prescribed will develop vitamin/mineral deficiencies. These deficiencies can lead to, but are not limited to, fatigue, weakness, headache, calf and leg pain, loss of night vision, dry skin and nails, seizures, cardiac arrhythmias, poor immune function, osteoporosis, neurological damage, neuropathy and even death (1).
In conclusion, patients who have bariatric surgery must take bariatric specific vitamins as prescribed before surgery and for the rest of their lives after surgery to promote health, healing, weight loss and weight maintenance and to prevent vitamin and/or mineral deficiencies.
Jennifer Jarrett Clark MS, RD, LDN
Registered Dietitian
Sources:
1. Source: Aills et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surgery for the Obesity and Related Diseases 8 (2008)
2. Source: Jacques, Jacqueline. Micronutrition for the Weight Loss Surgery Patient. Matrix Medical Communities :Edgmont, PA;1996
Posted on September 9, 2010 at 5:13 PM in Bariatric Surgery, Exercise, Nutrition, Weight Loss Surgery
How many times have you seen the doctor and have been told, you need to lose weight? How many times have you been told the other problems you are having are related to your weight, and if you lose weight, you can help fix these problems? How many times has the obesity been treated instead of the co-morbidity?
This is the question many doctors and patients are starting to ask. With obesity on the rise, even in our children, why aren’t more things being done to treat and prevent it? Also, why aren’t more insurance companies paying for the diagnosis? One of the answers I believe is the stigma associated with obesity. Another reason may be they don’t want to hurt a patient’s feelings. Obesity like other diseases has a genetic factor, you see families that are obese and are raising obese children. These same families also have diabetes, hypertension, sleep apnea, and heart disease to name a few comorbidities that most likely “run in the family.” These comorbidities and others all have medical interventions to treat the disease. Although we have medical interventions for obesity, they are not covered well by insurance the majority of the time, if they are covered at all. In our country we consider smoking, drug addiction, and alcohol addiction all diseases that are treatable. We don’t tell the person, you just need to stop using, and expect them to quit and be treated. So, why do we expect to do that to the obese? I know I have raised a lot of questions, probably more that even the experts can answer, but I am going to share my “perfect world” in which lies some, but not all of the answers.
We need to start with our school children, for the first time the current younger generation have a lower life expectancy than their parents. Adolescents are on blood pressure medication and diagnosed with Type 2 or adult onset diabetes. To help this we need more fruit and vegetables to be available in student cafeterias. Less soda pop, high carbohydrate juices, and chips and candy should be available. We need to teach our children to play outside, and go with them and do it. I swung on a swing and went off a diving board for the first time in close to 20 years a couple weeks ago, and I had fun, we as adults need to play more. We need to encourage schools to have gym class, not cut out recess to have gym, but have both. This need continues into high school as well. I had great physical education classes in high school (gymnastics, circus stunts, and self defense) and I still broke a sweat but had fun doing it. I know these things may not have funding, but remember this is my Perfect World.
After high school comes college and the freshman 15, or 20 or 30, depending on lifestyle, of course. This is when it gets challenging because parents have no control, and this age group is very self conscientious. By diagnosing overweight and obesity, more can be done to help at this age level. Also, by learning in younger years the proper way to eat, and by staying active we can decrease or eliminate that extra weight the first years away from home bring on. It is difficult when you go from a situation where limited foods are available to one where there are many different types of food available in abundance. This is also a time where gym is no longer a necessity to graduate; and those that were athletes in high school may not be in college. All these bring on the extra pounds, and to prevent it, it comes again to watching what you eat and increasing activity.
Now on to adulthood, this is where the circle ends and begins. Many people I run into have very different obesity stories. Some have been obese all their lives, some became overweight during college and then obese after marriage and children. Some were normal weight their whole lives and then became obese later in life. No matter the story the outcome becomes the same, co morbid conditions, difficulty with activity, low self esteem, depression, and this can go on. It is important for us to understand that nothing can be fixed overnight, no one goes to bed one day normal weight and wakes up the next obese, so it can not come off that quickly either. Having surgery to fix the obesity is not the end all, be all, it takes dedication to lifestyle change to be successful as well. I believe this is why it is difficult to diagnose obesity as a disease. Many other problems we have medication for, but even those you still have to have a lifestyle change to make it last. A newly diagnosed diabetic may have good control with one oral medication, but eventually it goes to two or three or even to insulin use if the person does not adapt good dietary and exercise habits. But with obesity, there are not many medications that have long term results, you can not build on them, if they are not working you stop the medication, and any weight the person might have lost comes back on. To properly lose weight, you need dietary and exercise counseling, but for the majority of people, these are not covered services and most people can not pay out of pocket for them as well. There is also the downside to diet and exercise counseling, it is normally not successful long term for the morbidly obese population, and surgery for weight loss is the only proven successful long term treatment for morbidly obese. So to properly use diet and exercise counseling it needs to be done when a pt is overweight, not wait until the patient is morbidly obese and has co morbid conditions. By treating at a lower weight, there is a higher chance of being successful and thus a lower chance of advancing to obesity or morbid obesity. By treating obesity in adulthood, even with surgery your goal needs to be to teach the younger generations how to eat properly, how you eat after surgery, not how you ate prior to surgery. I hear many times how patients make 2 suppers, one for them and one for their family, because their spouses or children just won’t eat what they eat. By passing on healthy eating information now, you will help prevent complications later.
So, in my perfect world there is less “junk food,” more affordable fruits and vegetables, more activity and family play time, and generalized good health. Primary care physicians will sit down and have a discussion with patients when they are slightly overweight and not obese with co morbid conditions. If a patient is obese, doctors will diagnose obesity as a disease and insurance companies will pay for treatment for obesity. Treatment can be diet and exercise counseling alone or combined with surgical or pharmaceutical intervention. I know these ideas are not perfect, nor complete. It is just some ideas to get you started. Remember in the end, it is up to each individual to determine their commitment. If you choose us or have chosen us to help you, we will commit with you (a spin off of one of Dr Boyce’s favorite sayings.) Take time out to play each day, it really is as fun as the kids make it look, and you will burn calories while doing it.
Hope everyone is having a great start to the new school year, a new beginning for some, a re-commitment for others.
Posted on August 2, 2010 at 12:38 PM in Bariatric Surgery, Nutrition
Protein is an essential nutrient that the body needs in order to grow, repair and form new tissue and cells, which includes muscles, blood, skin, hair, nails and internal organs. Protein also aids in wound healing (important after surgery), maintains lean body mass (which increases metabolism) and is necessary to prevent protein malnutrition. Protein is one of the three energy-producing nutrients, which provides 4 calories per gram of protein. High-protein foods slow the movement of food from the stomach to the intestine, which means you feel full longer. The body also uses more energy to digest protein than it does to digest carbohydrate or fat.
Protein in the diet can be found in mostly animal products, but there are non-meat sources of protein as well. Excellent sources of protein include meat, poultry, fish, eggs, dairy products (milk, cheese, yogurt), beans and nuts. To reduce fat intake choose lean cuts of meat, remove any skin and visible fat and pick low, reduced-fat or fat-free dairy products. Choose healthy protein sources like skinless white meat chicken and turkey, fish and shellfish (cod, flounder, tuna, trout, crab, lobster, shrimp, salmon), lean pork (fresh ham, Canadian bacon, tenderloin, center loin chop), and lean beef (ground round and sirloin).
Carbohydrate is the second energy providing nutrient, which provides 4 calories per gram of carbohydrate like protein. All carbohydrates are broken down to its simplest form, glucose. Glucose is utilized immediately for fuel by the brain and central nervous system. Carbohydrates provide all the cells of the body with the energy they need for everyday tasks and physical activity. Glucose may be converted to glycogen for later energy use.
Carbohydrates can be found naturally in a variety of foods which include milk, fruit, fruit juice, beans, starchy vegetables (peas, corn, potato, sweet potato, winter squash) and other starches (bread, cereals, grains, crackers, ect). You should avoid sweets, desserts and candies which are usually high in fat and calories and low in protein. When picking carbohydrate sources choose foods high in nutrients, low in fat and added sugars. For example, fruits, 100% fruit juices (must be diluted) and low-fat milk will provide carbohydrates, vitamins, minerals and water. Whole grains and starchy vegetables are a good source of fiber as well, but remember you may not have these starches until phase 4.
Fat is the third energy providing nutrient, which provides 9 calories of energy per gram of fat. Dietary fat is stored as adipose (fat) cells in the body, which is used for structural purposes to hold the body organs and nerves in position and protect them against traumatic injury and shock. Fat is also used as a cushion to surround your bones and protect them from mechanical pressure. Fat insulates your body, preserving body heat and maintains body temperature. Dietary fat is essential for the digestion, absorption, and transport of fat-soluble vitamins (Vitamins A, D, E and K).
Remember, fat has more than twice the amount of a calories per gram compared to protein and carbohydrates. Excess fat intake as well as excess carbohydrates will be stored in the body as adipose fat. Consuming high amounts of fat in the diet may cause a person to exceed their calorie requirements, which will lead to weight gain. Also, high fat intake can lead to elevated blood cholesterol, which is a major risk factor for cardiovascular disease.
Remember to avoid foods high in fat such as cakes, cookies, ice cream, whole milk, cream, oils, margarine, butters, mayonnaise, sour cream, fast foods and high-fat meats (hot dogs, sausage, bologna).
Remember, foods do not have to be bland. Try using spices, herbs, garlic, mustard, fat-free mayonnaise, broths, fat-free gravies, cooking sprays or sugar-free jellies to add flavor to your foods.
Jennifer Clark MS, RD, LDN
Posted on April 13, 2010 at 8:26 PM in Bariatric Surgery, Nutrition, Uncategorized, Weight Loss Surgery
I have often been asked by patients how much protein is adequate for bariatric surgery. Our post-op resource guide details our recommendations, but I am often faced with the question, “How much protein do I need?” and “What protein shake should I drink?” The answer is you don’t have to drink any, but you will likely feel and progress better if you manage to take in a certain amount of protein.
How much protein do I need? The amount depends on the type of weight loss surgery that you have had. Our restructure patients (lap bands and sleeve gastrectomy) require a little less protein around 6 grams daily. They will absorb protein better and therefore require a little less. Our Gastric Bypass patients will generally need 60 to 80 grams daily because there is a malabsorptive component to this mixed procedure. Our Billary Pancreatic Diversion patients (BPD) will generally need 80 to 100 grams daily because this procedure involves a higher degree of malabsorption.
What protein shakes should I get? There are many protein shakes that would be adequate for our post bariatric patients; there are so many brands that it is impossible to list them all in this context. In general, it is important to look at the nutrition label, make sure that aren’t too many calories, carbohydrates, or fat grams per serving. It usually recommends less than 120 calories, less than 5grams of fat, and less than 8 grams of carbohydrates, also to be affective it should have at least 12 grams of protein. In Summary, shakes are not absolutely necessary, but they do facilitate healthy weight loss in both bariatricand non-bariatric patients. Protein is vital for all body functions; including maintenance of muscle mass. In my early years of bariatric surgery 2004-2005, I worked in a bariatric program that forbade all protein shakes. Now our program activity encourages protein shakes, I can honestly say, the patients feel and progress better.
Dr. K. Robert Williams
Posted on January 13, 2010 at 4:14 PM in Bariatric Surgery, From the Desk of Dr. Boyce, LapBand, Nutrition, Weight Loss Surgery
“Weight regain after surgery. Why does it happen?”
I often get asked by patients and their families at the pre-op visit “Why do people regain weight after surgery”? So, why does this happen? While observing a few older patients (some from our practice and some from others), I have noticed several poor dietary behaviors develop, such as eating in between meals, overeating, and eating wrong combinations of foods. It is never a good practice to snack in between meals. This will lead to a great amount of calories. Also, I would find that patients would choose high carbohydrate snacks, such as starches and simple sugars. Both of these lead to a lack of satiety and increased hunger as they are quickly digested and burned. High carbohydrate snacks also lead to hypoglycemia in the bypass patient with nausea, sweats, and dumping like symptoms a couple of hours later. If the calorie load is higher than the need, then the remainder is stored as fat. Folks tend to snack for a variety of reasons. Examples could be stress, loneliness, and boredom. For those who cannot seem to understand why they overeat, I recommend psychological counseling. A licensed psychologist can take a closer look into the causes behind the overeating and help the person find other alternate forms of stress relief. For those where boredom is an issue, I recommend taking up a new hobby. If loneliness is an issue, try joining a support group, working out at a fitness center, chatting online or volunteering time and services. All of these things will expose one to many different and interesting people and will help foster friendships.
Overeating at meal times is another cause of weight regain. Several things can lead to this, but I will only name a few. To avoid overeating at restaurants, half the portion served and immediately ask the server for a box. Not only will one be cutting portion sizes to a normal size, there will be leftovers for another meal. If an extended time is spent socializing, get refills on non-caloric beverages such as decaffeinated tea, coffee, and lemon water instead of opting for more high caloric drinks such as cocoas, smoothies, and alcoholic beverages. When dining at home, fill your plate from the stove. Research has shown that people are less likely to overeat if extra food is kept in cooking ware and not served at the table. Finally, if taking too much time to eat is a problem, set a timer for 20-30 minutes for each meal. This is sufficient time to allow one to eat and prevents excessive intake.
Finally, proper food combinations are essential to weight loss, weight stability, and satiety. Many patients have heard our dietitian say, “There are no wrong foods, just wrong combinations of them.” For each meal, make sure that 50-70% is protein. Research has shown that a higher protein diet promotes weight loss. Because proteins make us feel satisfied longer. Proteins come from a variety of sources: low fat dairy products, eggs, lean meats, seafood, legumes, nuts, seeds. In addition to protein, choose low fat and low carbohydrate sides such as dairy products, fruits, vegetables, whole grain snacks, and whole grain pastas. Limit starchy vegetables such as potatoes, corn, and peas. Many empty calories and fat grams come from some of the things we use to prepare our foods such as butter, dressings, sauces, and condiments. A few suggestions would be using spritzers instead of dressings for salads, opting for light sour cream in place of butter for a potato. One may also want to consider diluting marinades or asking for sauces on the side if eating out.
Let’s get the new year off to a good start with good eating behaviors and lifestyle choices!
Kristine Vanhoose, FNP-BC
Posted on December 14, 2009 at 1:34 PM in Bariatric Surgery, Nutrition, Weight Loss Surgery
THE IMPORTANCE OF PROTEIN AND WATER BEFORE AND AFTER SKIN REDUCTION SURGERY
After successful weight loss, many of our patients inquire about body contouring and what to expect afterwards. You may read about the different types of procedures performed by our surgeons on this website; however, I’d like to make a specific reference to something you can do to facilitate the healing process after surgery. There are always some variables which affect the rate and ability of our bodies to heal such as age, certain disease processes, condition of the skin related to smoking and sun damage, and personal hygiene. However you can play a significant role in improving your outcome by maintaining a proper, nutritionally sound diet to aid in your healing process relating both to the speed and overall satisfaction of your recovery.
Proteins are essential in wound healing and tissue regeneration. If the body’s cells aren’t properly nourished, they lack the ability to adequately regenerate (recreate lost or damaged tissues). Increasing your consumption of high quality protein in the weeks before and after surgery will help your body do the repair work it needs to do more effectively and quickly. Ensure an adequate intake of lean protein found in lean beef, chicken, fish, seafood, eggs, low-fat dairy and soy products. When time is an issue and you need a quick source of protein, take advantage of the protein supplements available on our website in the forms of shakes, bars and liquid additives in preparing yourself for your surgical recovery.
Another important ingredient to proper healing is water, water, and more water. Making sure your body is well hydrated will make you more comfortable during the time when you can have nothing by mouth in the hours before surgery. Most importantly however, it will help you move the anesthesia and other surgery drugs more quickly out of your body after surgery. Increase your water consumption to 10-12 glasses of water per day in the weeks before surgery, as well as after, to facilitate your healing process. This will also help reduce water retention which can make you feel uncomfortable after surgery. Water helps to keep your skin turgor at its best while your body is adjusting to its new form.
Be proactive in your health and put yourself as a priority in living your “New Life” to the fullest!
Robin Saunders, RN, BSN
Posted on November 25, 2009 at 4:40 PM in Bariatric Surgery, Nutrition, Weight Loss Surgery
Happy Thanksgiving, Merry Christmas and soon to be New Year. With the holidays comes the “the holiday weight gain” and then of course those New Year Resolutions. We all think of ways to better our life and accomplish goals with our resolutions, but I feel we always forget one thing when looking at our health in the New Year, Vitamins. As we make our resolutions to eat healthier and exercise more, we forget to include vitamins to the list. Many of us are deficient in a vitamin or mineral, whether it is Iron, Vitamin D, or a B vitamin, and we most likely don’t even know it. As we start to exercise and eat better we forget to add in a multivitamin which can help us maintain or achieve the proper vitamin levels, and thus make us more energetic and healthier. The two deficiencies we see most commonly are Vitamin D and Iron.
Vitamin D is very important in our calcium absorption and a great reason to get out into the sunshine. Studies show that up to 1/3 of adults and 2/3 of those under 18 are deficient in this vitamin, those are staggering numbers. D helps us in many ways, mostly for us to stay healthy, not only for our bones but our immune system as well. Because one of the best ways to get D is by sunlight it is estimated that the number of those with deficiencies rise in the wintertime when many people are not out in the sun due to the weather. So what can you do? Take supplements…Vitamin D3 to be exact. This can benefit you not only if you have had surgery but after surgery as well.
Iron: many of us feel fatigued and run down at times, especially with all the holiday running! But, for some of us it could be an iron deficiency, which is the most common nutritional deficiency worldwide and here in the United States. Taking an iron supplement can help boost those numbers and help your overall well-being.
Now don’t get me wrong I am not saying everyone has a deficiency, but some of us might, and it is always a good idea to be on a supplement. After you have surgery it is a MUST, but prior to surgery it is HIGHLY recommended (wink, wink.) So what can you do? Begin taking a good multivitamin with iron (unless you have a medical condition and have been instructed not to take iron – then get on a good multivitamin without iron.) We have a few here in the office. We have our Perfect Pak II for Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy patients and our Perfect Pak Plus for Bilio-Pancreatic Diversion with Duodenal Switch patients. We also offer a chewable vitamin that is a complete multivitamin appropriate for any patient at any stage of their process. The number of chewable vitamins you would take each day is dependent on whether you are pre-op or post-op and on what surgery you’ve had.
We are always looking for ways to help improve your health and to do it in a way to fit your needs. Remember, no matter where you are in the process, in the famous words of Dr. Boyce “We are ready to commit if you are.” So to end this I wish all of you and yours a Merry Christmas, a Happy Hanukkah, a Happy Kwanza, and a Wonderful New Year!
Sarah Grimes RN, CBN
