Though you may think your bones are just a hard and dormant support structure for your body, they are actually  dynamic, growing tissue with new bone constantly replacing old bone. How can you keep your bones strong over time?   Feed them the right nutrients and engage in regular weight bearing physical activity.  Strong bones help protect your organs from injury, allow your body to move and support good posture. 

 Several vitamins and minerals are important for bone health. However, the top two that provide the most impact  are calcium and vitamin D. Calcium, the primary mineral found in bone, contributes to the strength and hardness of bone tissue. Over time, inadequate calcium intake can lead to weak, porous bones.

National survey data shows that many Americans are not getting enough calcium in their diet.  In women ages 19-30 and 31-50 only 28% and 33% are getting above the Recommended Dietary Intake (RDI) set for calcium. The best dietary sources of calcium are dairy foods and fortified nutritional foods such as protein shakes. Green leafy veggies also contain calcium but in very small quantities. For instance, 1 cup of broccoli contains only one-sixteenth of the recommended intake for the average adult aged 19-50!   So eat broccoli too, but be aware of the proportion of calcium coming from it versus other foods and take a calcium and vitamin D supplement if your doctor recommends it. Click here for an additional article about the benefits of calcium and vitamin D supplementation.

 Vitamin D helps your body absorb the calcium you consume. Most of us aren’t getting enough vitamin D either, which has set the stage for a vitamin D insufficiency and deficiency epidemic in this country. Few foods contain vitamin D. Most milk is fortified with it and it is also fortified in some brands of orange juice, yogurt and breakfast cereal. Egg yolks, liver and some types of fish naturally contain vitamin D. 

 In addition to eating a nutritious diet packed with calcium and vitamin D, everyone needs regular physical activity including resistance training (strength training) and weight bearing exercise. Lifting weights, rock climbing, gymnastics, running and walking are examples of activities that help build bone strength. If you choose to run or walk, be sure to lift weights for your upper body too so you build those bones as well.

 References:

Calcium and Bones. NIH.

What We Eat in America, NHANES 2005-2006.

Recently the updated clinical practice guidelines for bariatric surgery were released, cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery (ASMBS).  

For us practitioners it was a welcomed document since the last guidelines were published in 2008. In those five years, we have learned a lot more through research and we are always looking for the best practices and recommendations to treat weight loss surgery patients. There has been a lack of standards as you may know since recommendations vary between surgeons and practices. If you talk to friends or family who have had weight loss surgery at a different location than yourself, you know what I mean.

The new guidelines are somewhat lengthy and technical. I would like to point out the postoperative items of interest that I have shared with my patients. Many of these are not new, but have new research to substantiate the recommendation. (My comments follow.)

• Patients should adhere with principles of healthy eating, including 5 daily servings of fresh fruits and vegetables. (Eat your fruits and veggies before eating starchy carb foods.)
   
• Minimum protein intake should be 60 grams/day and up to 1.5 grams/kilogram ideal body weight per day. (Your RD can individualize your protein needs based on your age, weight, and gender.)
   
• Take your supplements daily. Your supplement needs depend on the type of surgery you had and your individual lab values. (Get your blood work done as ordered by your bariatric provider. Just because you feel good doesn't mean you don't have to take supplements. Supplements are not optional.)
   
• Fluids should be consumed slowly, preferably 30 minutes after a meal to prevent gastrointestinal symptoms and in sufficient amounts to maintain adequate hydration, more than 48 fluid ounces. (Water is always a good choice. Flavor it with slices of lemon, lime, or cucumber.)
   
• Exercise should include moderate aerobic activity of a minimum of 150 minutes per week and a goal of 300 minutes per week including strength training 2 to 3 times per week. (Do what you can, just get started. Any physical activity is better than no physical activity. You have got to do something and stick with it to maintain weight loss.) Read more on exercise after surgery
   
• All patients should be encouraged to join and attend support groups. Patients who regularly attend support group have better weight loss.  (Better yet, be a support group leader. Then you have made a commitment to attend group.)
   
• Regular postoperative dietary counseling with an RD means greater improvement in eating behaviors. (Your RD is important in your long-term success. Stay in contact with her/him.)
   
• If you have an adjustable gastric band, adherence with follow up visits is associated with greater weight loss. (The band doesn't work by itself. In order to keep it properly adjusted and stay in the "green zone" you need to attend your follow up appointments for tune- ups.)
   
• Out of control eating and grazing are associated with lower weight loss and weight regain. (Your pouch may not hold a lot of food at one time but if you eat every hour you can eat a lot of food over the course of a day. Ask yourself if you have physical signs of hunger or do you just want to eat.)
   
• Drinking alcohol after gastric bypass and gastric sleeve surgery results in accelerated alcohol absorption, higher blood alcohol levels, and longer times to eliminate the alcohol from your body. (If you decide to drink alcohol, be very cautious. These two surgeries are not good mixers with alcohol. NEVER DRINK AND DRIVE.)

Please keep in mind that these are guidelines and recommendations, not absolutes. Follow the guidelines provided by your bariatric team since they know you and are best suited to meet your individual needs.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

*Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient- 2013 Update: Cosponsored by American Association of Clinical Endrocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.

Spring has sprung! This hopefully means you’ll be outdoors more, walking, gardening, biking and all the things good weather and longer days bring.  Though your focus has turned to enjoying outdoor opportunities for healthy exercise and soaking in the spring sunshine, don’t forget about things like osteoporosis prevention, or management if you’ve already been diagnosed.  It's never too late to start getting adequate calcium and vitamin D, as well as strengthening bones with exercise.

Best form of Calcium?  Calcium Citrate
Calcium citrate has been shown to be the best form of calcium to supplement your intake. The citrate form absorbs faster and more thoroughly than calcium carbonate, and can be taken with, or without food, making compliance much easier. Look for one with 1000 mg of calcium and 1000 IU of vitamin D included in the formula. The combination aids your body’s use of calcium even further, which is all the better for your bones.

Vitamin D is also Important
Though we can manufacture vitamin D in our body when our skin is exposed to sunlight, many of us still don’t manufacture enough.  Sunscreen, darker skin, clothing and advanced age can all minimize how much vitamin D we produce.  That’s why it is important to ensure you are still getting enough vitamin D through food and/or supplements. The best form to take is vitamin D3, which is the form your body produces from sunlight.

Nutrient Rich Foods
What else can you do to ensure you are maintaining your bone mass?   Eat foods rich in soy.  Soy beans, tofu and soy protein shakes may all help build your bones.  You can also incorporate magnesium-rich foods in your diet.  Like calcium, magnesium is a mineral stored in bone tissue, and is important to maintaining bone strength.  Eating nuts, spinach, oatmeal, potatoes, beans, wheat germ and avocado are all great ways to boost your magnesium intake. 

Bone Strengthening Exercise

Weight-bearing Exercises. Any exercises where your legs and feet support your weight qualify as weight-bearing.  These exercises work directly on the bones in your legs, hips and lower spine to slow mineral loss.  If you have osteoporosis, you should avoid high-impact activities such as running, jumping, or jogging.  For example:

• Walking
• Dancing
• Gardening
• Hiking
• Low-impact aerobics 

Resistance Exercises. Any activity that uses muscular strength to improve muscle mass, strengthen bones and reduce mineral loss is considered resistance exercise or strength training.  Compression fractures resulting from osteoporosis often lead to a stooped posture and increase pressure along your spine, resulting in even more compression fractures. Exercises that gently stretch your upper back, improve your posture and focus on strengthening the muscles between your shoulder blades can all help to reduce stress on your bones and maintain bone density.  Try these: 

• Free weights
• Weight machines
• Resistance bands
• Water exercises (water acts as the resistance) 

Flexibility Exercises. Stretching is always very important as part of an overall fitness program.  It’s important for joint and bone health by reducing pain and stiffness, and supporting good posture.  It is best to do stretching once your muscles are warmed up to prevent injury, at the end of your workout for example.  Always stretch slowly and gently, without bouncing.  

See where to get your next B-Vitamin Boost Here!

Feeling drained and lacking energy? Analyze your B vitamin intake.  Together, the group of B vitamins commonly referred to as the B-Complex group work together to produce energy in cells throughout your body.  Fall short of getting enough, and you may feel a lack of energy.

Though B vitamins are prevalent in a variety of foods, you may not be getting what you need if you cut out certain food groups from your diet, if you are on a low carb diet or don’t get enough variety in your diet.  There are also certain circumstances that deplete your body’s available B vitamins or that don’t allow for proper absorption, such as gastric bypass surgery, aging, alcohol consumption, excessive caffeine consumption and excessive stress.  Vegetarians and vegans typically do not get enough vitamin B12.  A B-Complex supplement is a great idea if you know you fall into dietary, circumstantial or malabsorptive reasons that your body may not be getting enough B’s.

• All B Vitamins – Fortified cereals.  Can’t go wrong here, just be sure to stay away from the sugary ones, most are good source of fiber too.
   
• Vitamin B1 (thiamin) –  Necessary for energy production.  Chronic alcoholics are most likely to be deficient in thiamin.   Top food choices: grains (cereal, bread, etc.), pork, beef, rice, nuts.
   
• Vitamin B2 (riboflavin), Vitamin B3 (niacin), and Pantothenic Acid – Deficiencies for these three B’s are not very common in the U.S.  If you consume an adequate amount of protein (vegetarian or vegans may not), you are most likely getting enough B3.
   
• Vitamin B6 (pyridoxine) – Like all B’s it helps to convert energy from the food you eat in to a usable form in your body, and it also contributes to red blood cell formation and is necessary to proper nervous system function.  A poor diet, some medications and conditions could cause a shortage of this vitamin.  Top Food Choices: chicken, pork, peanut butter, black beans, almonds.
   
• Biotin – Important to skin, hair and nails, energy conversion from food and nervous system function. Pregnant women, malnourished people and those who have lost a large amount of weight quickly can all be affected by a deficiency.  Top Food Choices: cooked eggs, wheat germ, peanuts, cottage cheese, and whole-wheat bread.
   
• Vitamin B12 – An outlier of the B vitamin group, B12 is the only one that can be stored in the body. Strict vegetarian/vegan diets run the risk of B12 deficiency since it can only be sourced from animal-based foods, as are those who have had certain kinds of gastric bypass surgery in which parts of the small intestine where B12 is absorbed have been removed.  Top Food Choices: liver, salmon, clams, trout, beef, yogurt, haddock, tuna, milk, and cheese.

What happens if you get B vitamins from food and from a supplement?  Can you get too much?

Because B vitamins are water soluble, what your body needs will be excreted, so there’s a low risk of getting too much. Look for a good liquid multivitamin or B-Complex supplement that contains at least 100% of the recommended daily intake for each vitamin. It’s the best way to insure you get all the essential vitamins and nutrients you need to stay healthy.

Congratulations!  You've just had bariatric surgery and you're excited to get started with your new life (or you are researching for after your surgery).  Part of that new life includes exercise.  If you want to keep the weight off, you need to make physical activity a regular part of your life.  It may be one of the most important lifestyle changes you make for long-term success. Where do you start?

Start with walking a little bit at a time...

• While you are in the hospital, the nursing staff will have you up and walking as soon as possible to help with your recovery. When you get home, you may be fatigued and that is normal. You've just had surgery! While you are at home recovering, the goal is to walk every day and every day walk just a little bit further. Maybe you can only walk to the end of the driveway and that's OK. As time goes on you will be able to walk further and longer. Just keep working at it.

Download your free Beginner Walking Chart Here!

• If you like to go to the gym or have exercise equipment at home, you will be fine on a treadmill or stationary bike right after surgery. You will want to avoid the cardio equipment that can put a strain on those recovering abdominal muscles, like a rowing machine and an elliptical if you use the arm attachments. You will want to get clearance from your surgeon for swimming or other pool exercise. Those incisions need to be healed and your surgeon will give you the go-ahead when he/she feels you are ready.
   
• Strengthening exercise is crucial to maintain muscle mass but you need to allow those core muscles to heal.  General recommendations for abdominal surgery are not to lift over 10 pounds (about the same as a gallon of milk) for two weeks. In the practice where I work we also recommend no abdominal exercises (crunches) for a month. Always check with your surgeon for clearance with any activity that involves lifting or putting a strain on those abdominal muscles.
   
• Just move!  Any exercise is better than no exercise. New recommendations from the American Society of Metabolic and Bariatric Surgery (ASMBS) include a minimum of 150 minutes a week of cardiovascular exercise with a goal of 300 minutes a week, plus strength training two to three times a week. Do what you can but do something. I have patients who are running half marathons a year out from surgery and would never have imagined that it was possible before their surgery. You may never run a half marathon but I am willing to bet you will be more active, walking further, and have more energy as you travel down the road of weight loss.

Be sure to take your supplements each and every day to help keep your energy levels up as well as getting enough protein.  B vitamins are especially helpful for energy and even help metabolism.  

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Liquid Supplements Bariatric Expert

Read Part One Here

As with all exercise programs, we need to consider the potential risk of injury or dropout. The main risk of HIIT training, as in any advanced training protocol, is the inherent mechanical stress that high intensity movements can create on the joints and connective tissues. In order to hit those higher intensities you will be performing some extreme movements like jumping, bounding, sprinting, burpees, mountain climbers and suicide push-ups. These moves may not be appropriate for everybody; in particular those with compromised joints. To minimize this risk you will need to prepare your body and progress into the program properly. If you plan on adding HIIT to your regime you will definitely want to build up and condition your speed and power muscle fibers—with HIIT Pre-Conditioning Exercises.

HIIT Pre-Conditioning Exercises

1. Regenerate your jump-ability
2. Train your turnover time
3. Clean up your core control

Regenerate Your JUMP- Ability

If you haven’t done any high impact or jumping for a while you may find that you have lost your ability to propel and descend your body properly. Women may also find that jarring causes the dreaded “ring around the crotch line”. So it may take some re-training to get your body mechanics and pelvic floor muscles back in order. One of the best preconditioning exercise is to simply stand with your hands on a wall or sturdy chair back and perform a set of heel drops (bounces). Concentrate on absorbing the shock with tall upright spinal alignment and a lifting contraction in the pelvic floor muscles. Keep you knees and hips slightly bent.

Once you are comfortable doing heel drops you can progress to low jumps where you bend through the ankles, knees and hips and spring up a small distance off the floor (extending the joints), then land with a shock-absorbing bend in the same three joints. Think about keeping the spine erect and pelvic floor muscles lifted. Progress this by either jumping higher, further (bounding) and /or in more rapid succession. These exercises should be practiced several times a week using 1 to 3 sets of 30 seconds.

 

Train Your Turnover

Turnover is the speed and agility of foot movement, or the number of times your feet strike the ground per minute. To train your turnover you need to keep track of the amount of footfalls you can complete in a 60 second period.  You can start with marching in place and work your way up to sprinting in place or running up and down on a platform.  Again you should practice this drill several times a week using 1 to 3 sets of 60 seconds.

 

Clean Up Your Core Control

Core control is your ability to move your limbs and body through space without compromising spinal alignment. As we perform high intensity whole body movements the core muscles (muscles surrounding your spine, shoulder girdle and pelvis) are taxed well beyond their normal function. Add speed and a little competition and you have the recipe for disaster in terms of form and execution.  Thus it will be important to condition your spinal support muscles prior to attempting the types of moves often used in HITT based workouts.  To do this start with holding wall planks for 30 to 60 seconds, then progress to hand and knee planks, forearm planks and planks with one or more limbs either lifted or moving. Vary the planks as well including front, rear and side positions. Practice this drill as many days a week as you can. Since the core muscles are an endurance group, you need to train them often with minimal external load (in most cases your body weight alone against gravity is plenty).

By pre-conditioning your jump, sprint and core control you will soon find that you have the strength and endurance needed to protect your joints as you challenge your system with these exciting and effective HIIT workouts. When in doubt, modify or opt out of any particular move you find too stressful! If you are not ready for them they can cause more pain than gain; and the last thing anyone wants from a new training program is to wake up the next day feeling like a dead duck rather than a spring chicken!

Don’t forget to feed your joints with the proper nutritional support to get the most out of your body over the long haul such as a liquid glucosamine and chondroitin supplement for healthy joint support.

HIIT is the hot, new workout concept of choice!

Over the past few years it has steadily grown in both popularity and purpose. Currently there are numerous HIIT based programs being taught, each with their own unique fitness twist and branding. Some of these include Tabata, R.I.P.P.E.D., Stacked, 4321 Fitness, PEAK 8, Jillian Michaels BODYSHRED, and the BEACHBODY INSANITY program. The list continues to expand while gaining huge consumer and club attention. Which is why it is more important than ever to understand not only what HIIT is, but also how to prepare and condition to perform it properly.

What is HIIT?

Let me start by defining HIIT, which is an acronym that stands for High Intensity Interval Training (or intermittent training). It is an exercise strategy that alternates short high intensity exercise (that makes you breathless) with less intense recovery periods (that brings your breathing back to a more normal rate).  If you have ever done wind sprints or Fartlek training you have a good idea of what these intervals feel like. 

What’s new about interval training?

Not much in principle but quite a bit in terms of the research and evidence that supports the many advantages HIIT can offer. This includes a long list of benefits from increasing metabolic rate (calories burned at rest) to reducing anxiety, staving off belly fat and improving insulin sensitivity.  Studies have show a traditional 60-minute workout can be whittled down to 20 minutes of HIIT, while yielding the same (or greater) calorie burn and weight loss results… Making HIIT the ultimate microwave workout.

Is there a down side to HIIT training?

As with all exercise programs, we need to consider the potential risk of injury or dropout. The main risk of HIIT training, as in any advanced training protocol, is the inherent mechanical stress that high intensity movements can create on the joints and connective tissues. In order to hit those higher intensities you will be performing some extreme movements like jumping, bounding, sprinting, burpees, mountain climbers and suicide push-ups. These moves may not be appropriate for everybody; in particular those with compromised joints. To minimize this risk you will need to prepare your body and progress into the program properly. If you plan on adding HIIT to your regime you will definitely want to build up and condition your speed and power muscle fibers—with HIIT Pre-Conditioning Exercises.

Read Part Two of our HIIT series on HIIT Pre-Conditioning Exercises

1. Regenerate your jump-ability
2. Train your turnover time
3. Clean up your core control

Remember to protect and nourish your joints no matter what kind of exercise you do especially when doing these kind of high impact exercises.  Glucosamine and chondroitin are not just for when you are having joint issues but are also good to use as a preventative.  Try a liquid glucosamine and chondroitin that is fast absorbing to keep joints flexible and to help maintain healthy cartilage.

Obesity can take a toll on the body, increasing a person’s risk for heart disease, certain types of cancer, fatty liver disease, osteoarthritis and many other diseases. And, to add insult to injury, obesity appears to launch an attack on the body’s defense network, the immune system. And, this attack appears to be multifaceted – there are several ways in which obesity may negatively affect the immune system, some of which haven’t been totally elucidated just yet.

Vitamin D Deficiency Link

• First, obesity is a contributing factor to vitamin D deficiency – a vitamin that has several effects on cells in the immune system. Vitamin D doesn’t just alter immune responses but a deficiency in this vitamin is associated with increased autoimmunity and an increased susceptibility to infection. Yet a recently published study found every 10% increase in BMI was associated with a 4.2% drop in vitamin D in the body. And therefore, monitoring vitamin D status in people who are overweight and obese may be critical for also maintaining a healthy immune system.
   
• Obesity also decreases the body’s production of specific immune system cells while altering the functioning of others. Is this due to vitamin D deficiency? This part of the picture isn’t quite clear. And, factors that can contribute to obesity – including over consumption of fat, sugar and calories can increase both inflammation in the body and oxidative damage to cell membranes (healthy cell membranes are critical because they are like gate keepers regulating what molecules can pass into and out of cells and therefore).

Given the impact obesity has on the body’s defense network, it shouldn’t come as much of a surprise that research often shows obese hospitalized patients are more likely to develop secondary infections and complications.

If you have pounds to lose, don’t fret. Start by cutting down on sugary snacks, baked sweets and fried foods. Add vegetables to every lunch and dinner and fresh whole fruit to your breakfast. In addition, drink at least 8 glasses of calorie free fluid per day and get exercising. If you don’t exercise now, start by taking the steps instead of the elevator everywhere you go and take the long route when possible (park far from the store entrance for instance). Build up your exercise routine slowly (by 10% per week) to give your body time to adapt and minimize the likelihood of developing injuries.

If you have struggled with your weight for many years and still unable to lose the weight you need to for your health, consider weight loss surgery.  Talk with your healthcare professional about the options available to you.  Bariatric Weight Loss Surgery can be the needed tool for those who are obese and are unable to lose the necessary weight.  It can be a critical step towards a healthier, longer life.

Keep in mind that malnutrition and deficiencies can occur even if you are overweight, due to poor diet and/or inability to absorb enough nutrients from food.

For those that have already had bariatric surgery, be sure to always take your recommended bariatric vitamins and supplements for the rest of your life to protect against deficiencies such as vitamin D and calcium for immune and bone health.  Vitamin D is very important for the absorption of calcium for strong bones to prevent osteoporosis.  Make sure to get your blood levels tested regularly.  

References

PLOS Medicine 2013;10(2):1-13.

J Clin Invest 2003;112:1796-1808.

J Investig Med 2011;59:881-6.

Clin Exp Immunol 2006;146:39-46.

When I hear people say they need to get back on track or get refocused, my first recommendation is to start tracking food intake. But recording isn't just for those folks, it plays an important part in your diet progression right after surgery too.

There is so much research on the benefits of recording to prove it makes you more successful, and if you've kept an honest record, you know this to be true. Notice I said an honest record. I've had people tell me they don't record "the bad stuff".  It's not calorie-free because you didn't write it down or had selective amnesia.

1.  Track Protein Intake as well as Calories

Many people think the most important thing to track is calorie intake, and for some people, it is. But after bariatric surgery, it's equally important, if not more important, to track your protein intake. Recommendations vary depending on your surgeon, but typically the goal is 60-90 grams of protein a day. This can seem daunting in the early post-operative stages if you've had a gastric bypass or sleeve. This is a time when it is critical to track your protein intake. Further out from surgery, it might be more important for you to know where your calories are coming from: the distribution between protein, fat, and carbohydrates.

2. Use Easy Electronic Tools to Track

There are different tools to track your intake. Paper and pencil is better than nothing but to have any sort of meaningful analysis you have to look up your foods for their nutrient value. Let technology do the work for you. All you need to know is what did you eat and how much, and let technology figure out the rest. In a study presented at the American Heart Association meeting last year, a group of 210 obese adults tracked food and activity intake with either a handheld electronic device or a paper diary. Those who used an electronic device had significantly more weight loss than those using a paper record.

Most of us have cell phones and 15 percent of us have a health app for our Smartphone. There are also online programs like WebMd and Spark People and 27 percent of internet users track weight and fitness goals online. If you have looked at using an app or an online program you know there are a multitude of choices. So, how do you pick the best one for you?

3.  Know what you need to track

There are many free programs available or apps that are a minimal investment. You will need to know what is important for you to track. Are you good with the basics of calories, protein, fat, carbs, and exercise or do you want more detailed information to include fiber, sodium or other nutrients? Read the reviews, comments, and look at some sample pages. Most programs allow you to enter custom foods or labels, but a feature I find helpful is the one that allows me to enter a meal. For example, when I make a leafy salad I usually use the same veggies. I entered my salad into my meal program as Vicki's Salad. Now when I eat it, I can just enter Vicki's Salad rather than spend the time entering each salad component.

4.  Take the time to set it up right for most accurate tracking

It may take a while for you to be comfortable with the program or app you select. Initially you will be spending more time recording as you enter your custom foods. If you don't like the program after a few days or a week, it's easier to switch to another before you get too many of your custom foods entered. If you have a lot of time invested in setting up your database, you will be less likely to switch and if you don't like the program, you will be less likely to use it. Keeping track with technology isn't time consuming after you've got your custom foods and meals entered. You should be able to track your food and activity in less than five minutes a day. Recording as soon as you have eaten something makes it easier than trying to remember at the end of the day and you will less likely to forget what you ate.

It's also a great idea to track when you take your supplements especially those that you need to take more than once such as calcium.  
Set a reminder on your phone to help remember or use a post it note if you don't have a smartphone.  

Whichever program or app you settle on, just use it. Remember, research continues to show that people who record are more successful.

Eat Smart...

Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Nutrition Expert

Here are a few apps to try and most have fitness trackers as well:

Spark People Diet and Food Tracker

MyNetDiary Calorie Counter

MyFitnessPal

WebMD Tracker

Shroomies Nutrition Menu

www.MyFoodDiary.com

Resources:

Pew Research Center, Pew Internet & American Life Project. (2011). Half of adult cell phone owners have apps on their phones. Retrieved from www.pewinternet.org

Styn M. Et al. (2012, March). Overweight, obese adults use electronic device to stick to diet, exercise. Meeting report presented at American Heart Association scientific meeting.

Moveable joints, where bones come together and help us move, like our knees, hips and shoulders can become damaged over time due to wear and tear, disease, excess body weight and injuries. As a result, your joints may feel stiff, painful and become swollen. But, there are several steps you can take to prevent wear and tear on joint tissue.

STAY PHYSICALLY ACTIVE. Though some forms of physical activity – playing football in the NFL for years for instance, can add to wear and tear on joint tissue, normal levels of regular physical activity can help keep joints healthy by improving or maintaining bone density, muscle strength, joint flexibility and balance. Just be sure to protect your joints with protective pads when necessary and stop if they hurt more than tollerable discomfort from the exercise itself.  Swimming is great exercise and is particularly low-impact on joints. See more on joint-related exercise do's and don'ts here.

EAT HEALTHY.  Doing so will do more than just keep your weight within normal limits (being overweight puts stress on joints), but, it will also provide a variety of nutrients necessary for strong bones and muscles. In particular, adequate levels of vitamin D and calcium are necessary for bone health while protein is essential for building and maintaining muscle strength.  Having strong muscles around joints helps support the joint structure itself.

TAKE SUPPLEMENTS. And finally, the dietary supplements glucosamine and chondroitin sulfate can reduce moderate to severe knee pain in some people. Chondroitin helps absorb water in cartilage and both chondroitin sulfate and glucosamine block the enzymes that break down cartilage and some studies suggest they may also help build new cartilage tissue. Click the "recipe" link to read about a great recipe for a fun, refreshing way to take this supplement!

Remember those crazy April Fool’s Day jokes you used to play on your siblings or your parents when you were a kid?  Maybe you are still a prankster even in adulthood – if so, it could be to your benefit!

April is National Stress Awareness Month, and a report from the Society for Vascular Surgery shows filling your month with laughter can be very beneficial for your vascular health.

“Laughter increases blood flow and improves the function of blood vessels.  Reducing stress is especially beneficial for persons who have hypertension (high blood pressure).” Dr. Vivienne Halpern, from the Society for Vascular Surgery said in a press release.

Stress and high blood pressure can have detrimental effects on the body. The combination of pressure at work, financial issues, and personal or relationship problems can all raise blood pressure and cause hypertension, and even contribute to cardiovascular disease.

So to add a little fun to your April Fool’s Day, fake your family out with these fun and funny trick foods! 

Get your meat-loving family to go unexpectedly meatless for a meal – replace all their favorites with all vegetarian faux-meat options and see if they’ll even notice.  Joke’s on them if they can’t tell and love the meal!

Make a Meatloaf Cake (meatloaf that looks just like carrot cake? That’ll fool `em!)

Roll some Mock Sushi – rice crispies and fruit roll ups, marshmallows and twizlers in the middle, could scare your kids into not eating candy!

Even the Academy of Dietetics and Nutrition is getting in on the fun with these cute tricks for your kids:

Un-Drinkable Drink - Prepare a tall glass with sugar-free gelatin mix. Put a straw in it and place in the refrigerator. When it's ready to serve to your kids, watch them try to drink their beverage before offering a spoon.

Rotten Apple - Use a corer to cut a small hole in the side of an apple. Put a gummy worm in the hole!

As a dietitian you might think I never have to battle with my weight. You would be wrong.

I have lost 25 to 30 pounds and regained it four times. I have lost 20 pounds in the last 6 months, 17 of those in the first four months, and I now weigh what I weighed in 1991. That was a long time ago and I was a lot younger. People keep asking me for my secret or what diet did I use. I have been working with weight loss surgery patients for the past 10 years and I am walking the talk. Here is the "secret."

"Secret #1"- I know from patients that boredom eating is the biggest emotional eating issue. I keep myself busy. Often too busy. Evening TV is not my friend. The TV and the sofa are not a good combination for me. I have a list of things to do in the evening that don't involve being a couch potato.

"Secret #2"- I eat very few meals out, maybe 1 to 2 times a month. I pack my lunch to work every day. I eat my dinner at home. I do not eat fast food. When I do eat out, I dine. I focus on the company, conversation, and atmosphere. The food has become secondary.

"Secret #3"- I do not keep problem foods in the house. Yes, I have my "difficult to control foods" and if I eat them, it's in a controlled situation with a controlled portion. If I have those foods in the house, they call my name and earplugs don't always work. If you don't buy it, you can't eat it. The first line of defense is in the grocery store.

"Secret #4"- I eat mostly the same foods. I drink a protein shake for breakfast six days a week. I eat a salad with a protein food on top for lunch six days a week. I eat a protein food and veggies for dinner. I eat Greek yogurt, fruit, and veggies for snacks. Sundays I break from the routine but I still stick to healthy food choices. I do not eat the food that comes into the breakroom at work since most of it is empty calories.

Now I have had people tell me that I don't enjoy my food....wrong. I eat foods that I like but that don't tempt me to overeat. I'm not going to waste my calories on food I don't like. People have told me that I have taken the "fun" out of eating. Food is not entertainment. Please tell me what is fun about diabetes, sleep apnea, hypertension, heart disease, gout, back pain, knees that need to be replaced, etc. Fortunately, I don't have these health problems but I work with people every day who do and I see the pain, agony, and expense they cause.

"Secret #5"- I go to bed early and usually get 7 to 8 hours of sleep a night. Remember, I keep myself busy from Secret #1 so I am  pretty tired when I climb into bed. If  you don't get enough sleep you have a greater release of the hormone that says, "I'm hungry." And that hormone is hungry for high calorie foods, not carrots.

"Secret #6"- This is the kicker....I exercise six days a week. I thought about all the times I regained the weight lost and realized every single time it was when my exercise slacked off. Research shows that in order to sustain weight loss you have to be physically active 30 to 60 minutes most days of the week. I walk  briskly 30 to 45 minutes six, sometimes seven, days a week. I do strength training three days a week. I go to Tai Chi two times a week. I climb the stairs at work every day. I get up from my desk every 45 minutes and walk up and down the hall. I park at the far end of the parking garage. I wear a pedometer to make sure I get my 10,000 steps a day. I look at my work schedule for the week and write my exercise time in my planner just like an appointment. Do I work out like I did in 1991 when I was at my fittest? Not even close, but I do something and that is the key. I have arthritis in my lower back and although the exercise causes discomfort, without it I have pain. Anything is better than nothing when it comes to physical activity. Just get up and move. Our bodies are not meant to sit all day and it is killing us.

Am I perfect? No, but I am on track about 95% of the time with my food choices and 99% of the time with my exercise. I am still working on eating slower and that is a constant effort.

So, all these "secrets" come down to eating healthy and moving more. Use your weight loss surgery to help you manage your eating. It is a tool but you have to do the work. Work on focusing on eating to live rather than living to eat. The more you practice the easier it gets.

Eat Smart...

Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

All of us know people, or are people that spend too many hours seated in front of a computer screen in our offices.  Whether you operate in a home office or corporate setting, exercises do exist that can help retain muscle tone and help battle the forced sedentary day to day work life that can be detrimental to your health and waistline. 

HANDS AND ARMS

Arm Pump.  Be a cheer section for 1-2 minutes!  Raise your arms straight over your head and then elbows out fists toward your shoulders in a pumping motion…it’ll get your heart rate going and help keep your arms and shoulders loose.  Do this exercise with a full water bottle in each hand for additional strength training.

Tricep dips. Put your arms behind your back, gripping each side of your chair firmly at the sides – slowly raise and lower yourself using just your arm strength.  Note:  This is rather dangerous on a chair with wheels; make sure you have a chair with rubber grips on the bottom and no wheels!

Shadow Box. Also known as a great, healthy and constructive way to relieve frustration!  Stand up and take a couple jabs at the air, til you feel better.

FEET AND LEGS

Toe Raises.  Lift your toes, but keep your heels planted firmly on the ground.  This one can be done sitting or standing, and you can really feel it in your shins and calves!

Hip Flexions.  While sitting in your chair, lift your foot a few inches off the floor while keeping your knee bent at a 90 degree angle.  Hold for as long as you can, and repeat with the other foot/leg.

Football Feet.  Football players warm up and practice rapidly tapping their feet in place as fast as they can, stimulating a run.  This is great while stuck at a desk; try it for 30 seconds at a go, and see how quickly your heart gets pumping!

TORSO

Butt Squeeze.  This is a self-explanatory one….squeeze and hold your rear-end muscles for a count of ten, then release.  Do as many reps as you can.

Side Twists. To help keep your back flexible and aligned, side stretches are excellent.  Whittle your waist by engaging your core and side torso muscles by raising your arms over your head, or planting hands on hips, lean gently over to each side as far as you can safely go (without falling out of your chair!) A few times on each side and you should be able to feel it, and keep the benefits going by doing this exercise at least 2-3 times throughout the day.

Don’t worry about looking silly, and see if you can get your coworkers to participate too.  That way you can cheer, bend, leg-lift and run in place along with everyone else looking for a little extra healthy balance in their long office day!

What is bariatric weight loss surgery?

Bariatric surgery is a term that covers a wide range of weight loss procedures. A bariatric surgery is an option for people who have tried many traditional ways to lose weight with no success. National Institute of Health recommends bariatric surgeries for obese people with a BMI (body mass index) of at least 40 or for people with a BMI of 35 with serious medical conditions such as diabetes, high cholesterol and others. Those procedures consist of reducing the size of the stomach with a gastric band or even removing a part of the stomach   which is called gastric sleeve or by rerouting the small intestines to a small stomach pouch which is called gastric bypass surgery. A few possible advantages of bariatric surgery are significant weight loss in the long run, improvement of cardiovascular risks and recovery from diabetes (actual results vary from person to person).  However, bariatric surgery won’t make you lose weight without a healthy nutrition and an exercise plan.

Nutrition after a bariatric procedure

After bariatric surgery it is very important to adapt your lifestyle to achieve maximum results and facilitate weight reduction. A very good tip is to change your diet even before you have bariatric surgery so you can be prepared. You won’t be able to eat the same foods you ate before, at least not for a few months, depending on your recuperation and type of surgery.

Stage 1:  Liquids

Right after the surgery,  in the hospital, you will receive a clear liquid, sugar free diet. Do not use a straw to drink the liquids, using a straw can increase your gas problems and make you uncomfortable. The first few sips is normal to be hard to swallow but it will get better with time.  The portions may be regular size, but normally you will be able to consume about 4 ounces every waking hour, remember, your stomach is a lot smaller now. As soon as you will be able to tolerate it, your surgeon will decide if you can move to the next step, full liquids, which includes fat free cream soup, pudding, sugar free yogurt (no fruits) etc. You might be sent home after you tolerate a stage 1 diet, but this depends for every hospital and surgeon.

Stage 2:  Pureed or mushy  foods

This diet will go on for about 4 to 6 weeks and may vary by surgeon and the bariatric surgery type. It is very important to eat about 500-700 calories a day and at least 60 grams of protein as the proteins take an important role in your recovery. You should eat small and frequent meals;  your new stomach can only hold about an ounce at a time. It is also very important to drink enough fluids to prevent dehydration.

A Few Extra Tips:

• Eat your meals and sip your liquids very slowly
• Make sure you chew food very thoroughly
• Protein is very important during your recovery from surgery, make sure you eat at least 60 grams of protein every day
• Drink at least 7-8 cups of water or any other sugar free liquid between your meals every day to keep you hydrated
• It is important to drink only between meals
• Don’t eat high fat foods

Stage 3: Soft and healthy foods

After about 6 to 8 weeks you may introduce into your diet soft solid foods, it is important to continue to eat 4 to 6 small meals every day. Focus on high protein foods and avoid foods that are high in fat, sugar and fiber.  You may start to introduce one solid food per meal every day depends how you can tolerate it and remember to chew well so the food will be nearly pureed by the time you swallow. Some examples of food items for this stage are:  eggs, light yogurt, soft fish, lentil dishes and soup.

Stage 4: Solid foods

Eventually you will probably be able to eat most foods, just in smaller portions;  however, you should be making healthy food choices including lean meat or vegetable protein incorporating fruits and vegetables as you can and avoiding junk foods. The volume you can eat will always be limited so choose foods wisely.

A few more tips that you will have to take into consideration permanently

• Do not drink with a straw because it will overfill your stomach with fluid and air
• Avoid alcohol or drink wisely, you will feel the effect of alcohol more severely and it’s a source of unwanted calories
• Avoid carbonated beverages because it will fill your stomach with air and will make you feel uncomfortable
• Drink less caffeine, it can affect your iron absorption and lead to dehydration
• Eat slowly and be aware when you’re full and stop eating or you will develop chest pain and may vomit (dumping)
• Take your supplements EVERY DAY!  Because you are not able to absorb as much nutrients from food, it is very important to take your supplements every day such as calcium and vitamin D, multivitamin, iron (if recommended/needed), B-Complex and or B-12. 
• Exercise daily
• Join a support group both online and in person

Guest post by Dr. Jeremy Korman, M.D. at L.A Bariatrics within Marina Del Rey Hospital, a bariatric surgery center of excellence.

Successful post-op starts before surgery.

I love my job as a bariatric dietitian. One of the most rewarding parts of my job is seeing the post-op patients who have lost weight to become healthy and have a much improved quality of life. And a successful post-op starts with the work and commitment before surgery. Your program dietitian is part of the team at your surgeon's practice.

Working with your team from start through your years of follow-up means you are more likely to successfully maintain your weight loss by adhering to your lifestyle changes.

First – Nutrition Evaluation and “Training Camp”

One of the requirements prior to surgery is a nutrition evaluation. This visit will help educate you for lifestyle changes that need to happen and provide you with realistic expectations from the surgery. Working one-on-one with you, your dietitian can evaluate your needs and help with problem-solving. This time gives you a chance to practice the "mechanics of eating", as I call them and work on the recommendations recommended by your dietitian. She/he can be your guide, or coach, through the preoperative phase. I tell my patients that this pre-op stage is like the athletes' training camp. Athletes practice and practice some more before their season starts. This is your time to practice and practice some more because after surgery it is "game on."

After – Monitor and Support and a “Tune Up”

After surgery you may experience food intolerances, difficulties with the diet progression, meeting protein goals, taking your required supplements, and/or following the guidelines from your surgical practice. Your dietitian can access and monitor your nutritional adequacy and help prevent nutritional deficiencies. Someone before you has been down this road and working with your bariatric team can help you over the bumps in the road. Most often, your dietitian can a great support for you since she/he was working together with you from the beginning. All the changes to be made can seem overwhelming and your dietitian can help you make smaller, achievable goals to build upon. I also encourage patients who are doing well to come in for a motivational "tune up."

Help With Setbacks to “Get Back On Track”

Even long-term successful patients can run into trouble with slipping back into old habits. A crisis arises and it is easy to go back to using food for dealing with the stress, depression, or other emotional issues. Sometimes weight regain can keep you from keeping your follow up appointments. When you know you are in trouble, that is the time an experienced helping hand can work with you to get you back track to maintain success.

Support Groups Recommended to “Stay on Track”

Don't underestimate the power of support groups. You may have a great support system at home, but unless your family has had weight loss surgery, they may not fully understand the process and changes you need to go through. Ten studies totaling 735 patients reported on social support and weight loss outcomes and all found a positive association between post-op support groups and weight loss. I co-facilitate four support groups a month and those patients who remain involved are doing a good job of maintaining weight loss. For those I see in clinic who are struggling, attending a support group is one of my top recommendations.

Remember, your dietitian is the nutrition expert and support groups will keep you in contact with people who "have been there, done that." We all get by with a little help from our friends.

Eat Smart...
Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.

Ever want to do yoga but not sure which format is right for you?

Today there are many styles of yoga, all of which date back to a practice established in ancient India many thousands of years ago. In the earliest times it was used as a spiritual practice to help control both the mind and body for a greater purpose of meditation, concentration and self-enlightenment. In Hinduism, Buddhism and Jainism the word yoga means "spiritual discipline".

As the practice expanded it was influenced by various gurus leading to the many different styles of yoga we see today.

Yoga Benefits

In the West, the term "yoga" is typically associated with Hatha yoga and its asanas or postures. Hatha yoga focuses on the physical and is more typically used as form of exercise rather than a spiritual practice. Since the late 90s, the popularity of yoga in the USA has been on the constant rise. The number of people who practice some form of yoga has grown from 4 million (in 2000) to over 20 million (in 2013). It is no wonder that the practice of yoga has swelled in the fitness capitals of the world with claims of physical benefits such as reductions in heart disease, high blood pressure, chronic joint pain and back fatigue as well as mental benefits such as improvements in mood disorders, stress reduction and substance abuse. (1- 4)

Practice Yoga with Care

With that said there are some important things to be aware of when it comes to yoga safety and effectiveness. I have some concern with the growth and popularity of yoga programs in the general health club setting. Many of the traditional yoga poses and sequences involve mastery of movement and may take years to perfect to the end range positions (for example a full plow, headstand or cobra). If a novice comes into a class and these poses are being practiced it may be tempting for him or her to try them. Some poses can actually cause or irritate existing injuries in the spine (or other compromised joints) if not practiced and progressed properly. An extensive survey of yoga practitioners in Australia showed that about 20% had suffered some physical injury while practicing yoga. Headstands, shoulder stands, lotus and half lotus (seated cross-legged position), forward bends, backward bends, and handstands produced the greatest number of injuries.(5.)

Look for a Experienced Yoga Instructor

There are modifications for all yoga poses. This is where a well-versed and engaged instructor can make a huge difference. It will be important for the instructor to recognize the individual limitations within the group and offer appropriate modifications. It will also be important for the students to accept and respond to those cues and recommendations. It is also a good idea to have various levels of yoga classes available on the schedule. That way if a person is entering a beginning level class they can be confident that the instructor will not be offering or demonstrating advanced variations. Thus the most important thing to do to ensure a safe and effective yoga experience is to match your level of experience to the class. Gentle, restorative or beginning yoga would be best for the novice exercisers. The more advanced classes would and should be labeled as advanced or may be titled things like power, strong, Bikram(hot) or Ashtanga yoga. And most importantly students must learn to listen to their body and joints throughout any class.  If a move or pose or stretch causes joint pain, it is not appropriate and should be modified or discontinued immediately.  If a pose is so difficult that you feel the need to hold your breath, it is probably too advanced and should also be modified.  Most moves or poses can be easily modified by simply reducing the range of motion or by adding support (i.e. a hand support to thigh or yoga block)

Visit the following link to take a fun yoga quiz that can help you better define the type of yoga class you might like best.  www.proprofs.com/quiz-school/story.php?title=what-type-yoga-may-best-suit-you

1. Streeter, Chris C. et al. "Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study." Journal of Alternative & Complementary Medicine. Nov 2010, Volume 16 Issue 11, p1145-115
2. Yoga could be good for heart disease. Simultaneous focus on body, breathing, and mind may be just what the doctor ordered. (2010). Harvard Heart Letter: From Harvard Medical School, 21(3), 5.
3. Tilbrook Helen E et al. (2011). "Yoga for Chronic Low Back Pain: A Randomized Trial". Ann. Intern. Med. 155 (9): 569–578.
4. "Siginificant benefits of yoga in people with rheumatoid arthritis, study shows". Sciencedaily.com. 2011-05-28. Retrieved 2012-11-28.Chuang, Ling-Hsiang et al. (2012). "A Pragmatic Multicentered Randomized Controlled Trial of Yoga for Chronic Low Back Pain: Economic Evaluation". Spine 37 (18): 1593–1601. doi:10.1097/BRS.0b013e318254593
5.  Penman, Stephen; Marc Cohen, Philip Stevens, and Sue Jackson (2012). "Yoga in Australia: Results of a national survey". IJOY, International Journal of Yoga 5 (2): 92–101. doi:10.4103/0973-6131.98217

We’re all at different spots ~ the way we view, make choices about and manage our health is as varied as each individual person.  So where does social media fit into how you perceive and make choices about your health?

Do you use social media to motivate others and absorb motivation from others? From gluten-free lifestyle blogs, to weight loss surgery boards, to fitness videos on Pinterest, there’s something for every age and stage.  All the fun motivational quotes, personal success stories and variety of categories of health to choose from can lead to stumbling on the one thing, or many things, that you truly take to heart and use to make change in your life. Motivation is key to keeping up a healthy lifestyle ~ in the immortal words of Zig Ziglar:

 “People often say motivation doesn’t last. Well, neither does bathing, which is why we recommend it daily.”

What about a sense of community, commitment and accountability?  Facebook and health/wellness boards where people connect and come together in specific groups for support, encouragement and information exchange are a great way to engage through social media.  These communities can often make the difference for someone who would normally not have any positive healthy support in their lives.

Pinterest is a great way to regenerate interest in healthy lifestyle choices.  From WOD (workout of the day) posts, so you have a new fresh lineup to keep you from getting bored, to new ways to exercise muscle groups you may never have heard of, to the most amazing “skinny-version” recipe you always wanted but could never find.  Variety is its own form of motivation!

So whether you’re actively exchanging stories, recipes and information on multiple social media outlets, or you’re brand new to online activities, take a look at Facebook, Pinterest, community boards and blogs in the areas of healthy living that interest you most. It might surprise you!

There are 8 different vitamins in the B-Complex family. Though each has it’s own functions within the body, all help your body convert the food you consume into usable energy. In addition, the B vitamins work together as a team.

1. Thiamine or B1 - helps in the conversion of carbohydrates into energy reserves
2. Riboflavin or B2 - precursor to coenzymes involved in the growth and repair of skin and tissues lining the gastro-intestinal tract, as well as the synthesis of amino acids
3. Niacin - necessary for normal breakdown of fats and fatty acids, and energy release from carbohydrates
4. Vitamin B6 - converted into the main enzyme responsible for amino acids & protein metabolism
5. Folic Acid - essential especially for pregnant women for baby's development
6. Vitamin B12 - plays a role in entire nervous system, promotes energy metabolism and support healthy heart function
7. Biotin or B7 - supports the metabolism of carbohydrates, fats and proteins for energy and often associated with hair, skin and nail health
8. Pantothenic Acid or B5 - converts to Coenzyme A in the body, which is important for many reactions involving energy metabolism

B vitamins from Diet

B vitamins are found in a wide range of foods from dairy products and eggs to meat, grains, vegetables and beans; therefore, a deficiency in any B vitamin is rare. However, some individuals may consume lower amounts of specific B vitamins than they need for optimal health. In particular, those who are dieting or cutting out specific food groups, individuals with a limited food intake such as those who have had bariatric surgery, vegetarians, vegans, gluten free, alcohol-dependent individuals and those with malabsorption issues all have an increased risk of falling short on their nutrient needs.

Vitamin B-12 Deficiency More Common

One of the more common B vitamin deficiencies is B-12, which affects from 1.5 – 15% of the population. Some of the symptoms of B12 deficiency include weakness, fatigue, constipation, appetite loss, weight loss and tingling in the hands and feet. Those most at risk for B12 deficiency include older adults, people with gastrointestinal disorders such as celiac disease or Crohn’s disease, individuals who have had weight loss surgery and vegans.  B12 becomes increasingly important with age with risk of decreased absorption which can lead to deficiencies in both B12 and Folic Acid.

Vitamin B12 is involved with energy metabolism, heart health and nervous system function. 

B Vitamins for Energy

B vitamins work together in the body to convert food into energy metabolism, support mental focus and reduce the effects of stress. Because they are water soluble and not stored in the body, they must be replenished daily to maintain optimal health.  Many energy drinks on the market contain B vitamins for the energy they provide.  However, most energy drinks also contain sugar and/or caffeine so are not considered a good source.

Vitamin B Supplements - Do you need them?

If you are deficient in one or more B vitamins or your intake is suboptimal, it is possible to improve your overall health if you consume more foods rich in B vitamins or take a dietary supplement. But, always talk to your health care professional first prior to taking any new supplement.

References:

JAMA. 2002 Jun 19;287(23):3116-26.

Dietary Supplement Fact Sheet: Vitamin B12. Office of Dietary Supplements, NIH.

It is well known that obesity is a risk for poor cardiovascular health. Hypertension, hyperlipidemia, diabetes, congestive heart failure, and stroke are common problems associated with obesity. Carrying excess body weight makes the heart work harder and this can cause structural changes and enlarge the heart.

Standard recommended treatment for poor heart health includes medications and weight loss. We know the weight loss can reduce blood pressure and cholesterol levels but how does bariatric weight loss surgery compare with traditional treatment to decrease cardiovascular risks?

Effects of Weight Loss Surgery on Heart Health – A Review

A review of the literature produced several studies and results from systematic reviews involving the effect of weight loss surgery and heart disease risk factors. Although several of the studies involved a small number of people, the results all point to a decrease in risk factors after bariatric surgery.

The Swedish Obese Subjects (SOS) study followed 2010 obese subjects who underwent bariatric surgery and 2037 matched obese controls who received the usual care. Surgery patients included gastric bypass, banding, and vertical banded gastroplasty. At 10 years after surgery, improvements were still noted for blood pressure, blood triglycerides, and diabetes. There were fewer cardiovascular deaths in the surgery group compared to the control group, 28 vs. 49 deaths. This study concluded that compared with usual care, bariatric surgery was associated with a reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

Research has shown that Bariatric surgery can significantly reduce risk factors

Cleveland Clinic researchers conducted a systematic review involving almost 20,000 patients who had weight loss surgery and examined 73 bariatric surgery and cardiovascular risk factors. Prior to surgery about 44 percent had hypertension, 44 percent had high cholesterol, and 24 percent had diabetes. After surgery 63 percent had improved blood pressure, 65 percent saw a decrease in cholesterol levels, and 73 percent had improvement in their diabetes at a mean of almost 5 years after surgery. In addition, the heart remodeled, or became healthier. Researchers in this study concluded that bariatric surgery can significantly reduce several risk factors for cardiovascular disease and can improve the structure and function of the heart in much less time than standard weight loss and/or medications.

The American Heart Association (AHA) made a statement in 2011 concerning bariatric surgery and cardiovascular risk factors.  Read Here http://circ.ahajournals.org/content/123/15/1683.long#sec-23

Bariatric surgery is not without risks but the benefits to reducing cardiovascular risk factors warrants a discussion with your physician about possible surgery.

Eat Smart...

Vicki Bovee, MS, RD

Resources:

Ashrafian H, Et al. Effects of Bariatric Surgery on Cardiovascular Function. Circulation. 2008;118:2091-2102.

Cleveland Clinic. Weight Loss Surgery Should Be Considered Life-Saving Procedure for Overweight and Obese Patients with Cardiovascular Risk Factors. Retrieved from http://my.clevelandclinic.org/media_relations/library/2012/2012-10-18-cleveland-clinic-study-finds-bariatric-surgery-reduces-heart-disease-risk-factors-and-improves-heart-function.aspx

Sjöström L, Et al. Bariatric Surgery and Long-term Cardiovascular Events. JAMA. 2012;307: 56-65.

Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association.2011 Apr 19;123(15):1683-701. doi: 10.1161/CIR.0b013e3182149099. Epub 2011 Mar 14.Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA; American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism.

The research studies presented here are summarized from credible, peer-reviewed journals. Conclusive evidence about the effectiveness of any treatment is rarely found in a single, individual study. Anyone who is considering starting or changing a medical treatment should consult with their doctor.

.