SAMMC Bariatric Clinic

Disclosure: This website is supplied for informational use, the Department of Defense, Department of the Air Force, Department of the Army and the managers of this website do not support or disclaim the views and products of the websites provided within. The use of these websites, and the products, items, materials and information within those sites, is at the patient's discretion. It is always best to consult your physician for information regarding your specific health needs.

Monday, February 28, 2011

Quotes & Sayings

Weight loss surgery is not an event with a finish line or a goal weight -- it is the beginning of a new way of life ~Susan Maria Leach

Friday, February 25, 2011

The Do's and Don'ts for a Successful Exercise Program

by Julia Karlstad, MEd, CSCS

Original content: http://www.obesityaction.org/magazine/ywm20/fitnessandwls.php

If you're considering weight-loss surgery or have already had weight-loss surgery, your commitment to adopting a physically active lifestyle along with sustaining healthy eating habits are critical to your long-term success.

Having worked with hundreds of weight-loss surgery clientele, I have seen some phenomenal success stories and I can say without hesitation that the successful weight-loss surgery patient has incorporated regular exercise into their daily lives. The important thing for you to recognize is how to exercise in order to compliment your weight-loss efforts and in turn sustain your fitness regimen injury free!

Combating Excess Body Weight

Excess body weight often restricts your ability to be physically active and it is important for you to understand how to work around these mobility limitations. The excess body weight as a whole is the biggest obstacle when determining an appropriate exercise program. Weight-loss will always be your number one objective initially since decreasing weight allows more mobility and puts less stress on your joints. Not to mention, the number one reason you had weight-loss surgery was to lose weight and increase your health, thus your exercise program should complement the effects of the surgery.

If you are an obese person or a fitness professional working with an obese client (body mass index greater than 30) follow these physical activity recommendations:

Increase daily activity. For example, wash the dishes by hand, clean the house, park further away, try using the stairs, etc.
Start slow and gradually progress until you're exercising 60 minutes a day, six days/week.
If your BMI is greater than 35, make every effort to avoid exercises that would create greater stress on your joints. Avoid activities such as jogging, jumping and competitive contact sports.
Do aerobic exercise that is low to moderate in intensity. This is best for weight-loss.
Emphasize duration over intensity in your exercise.
Select a modality of exercise that works around any physical or medical limitation.
Strength training should consist of two to three sets of 12-15 repetitions. Use light to moderately heavy weights. The goal is to maintain your lean muscle through the weight-loss phase, not to bulk up.
Focus on doing a total body strength training workout. Strength train anywhere from one to three times per week (a minimum of once per week), and be sure to leave at least 48 hours between strength training sessions.
Always remember that joint pain is not healthy pain. If the exercise causes pain, modify the exercise to alleviate the pain.
If you have major joint limitations in your lower extremities, try to perform most of your strength exercises from a seated position.
Always change up your exercise routine (i.e., flexibility, cardio and strength training) every four to six weeks.

Exercise Guidelines for Each Stage of Weight-loss Surgery

The best thing a weight-loss surgery candidate can do to prepare themselves for both before and after surgery is to increase their level of fitness. The better cardiovascular condition before surgery, the fewer complications they'll experience during and after surgery. The following guidelines should prove helpful:

Preoperative Stage

Make weight-loss a primary goal of your exercise program. Excess fat can make the weight-loss surgery operation itself more challenging. In fact, most surgeons require that their patient lose a certain amount of weight before they will operate.
Focus on cardiovascular exercise to improve heart health, decrease body weight and help lose body fat before surgery.
Follow the exercise guidelines discussed above.

Post-operative Stage

If there are any postoperative complications, that is physical problems following the weight-loss surgery, schedule an appointment with your bariatric surgeon and follow the surgeon's recommendations for an exercise program.
For the first four weeks after surgery, focus on flexibility exercises, deep breathing and getting back into performing normal daily activities.

Gradually incorporate low-intensity aerobic exercise (i.e. walking, biking or swimming).
If the surgery was laparoscopic, it is generally safe to start exercising up to your pain threshold two weeks after surgery, but it is best to consult with your surgeon before starting any exercise program.
If the surgery was "open," it may take a few more weeks to recover. Here are some tips for those that underwent "open" procedures:

During the first six weeks after surgery, do not lift any more than 15 lbs; otherwise, exercise up to pain threshold.
Avoid abdominal exercises for the first eight to 12 weeks (allow the incision to heal). This helps alleviate abdominal hernias near or around the incision.
Significantly reduce caloric intake. During the first few weeks to months after surgery, patients should consume less than 500 calories a day (the surgeon will give specific instructions). This significant decrease in calories may initially cause some fatigue. Therefore, do not perform high-intensity exercise. As weight is lost and the level of fitness is improved, you will be able to take in a few more calories as well as exercise at higher levels of intensity. Follow the surgeon's dietary recommendations.

Caloric Intake

The bariatric surgeon may increase the caloric intake to 1,200-1,400 calories six to 12 months after surgery, particularly if their patient has lost a large percentage of their excess weight. Follow the surgeon's and/or dietitian's recommendations on food intake. Regularly monitor and assess your exercise program to ensure continued compliance and continued weight-loss which ultimately leads to weight maintenance.

Conclusion

A lifelong exercise program is critical to a weight-loss surgery patient's long-term success. Bariatric surgery is a valuable tool for rapid weight-loss; however, in two to three years, if a physically active lifestyle has not been adopted, the weight returns.

Exercise is insurance for long-term weight-loss. If you can stick to this advice, you'll be at a healthy weight and in good physical condition for years after your weight-loss surgery.

About the Author:
Julia Karlstad, MEd, CSCS, is the president of JKFITNESS, LLC. Julia has worked in the fitness industry and specifically the medical wellness community for several years. Previous to owning her own business, Julia personally developed and directed an exercise physiology program that consisted of two bariatric hospitals and three medically supervised weight-loss clinics. For more information on Julia, please visit www.juliakarlstad.com or www.jk-fit.com.

Thursday, February 24, 2011

Foods to avoid after surgery

The following foods should be carefully limited or eliminated for the rest of your life:

Cakes Candy Bars Candy Chewing gum Cookies

Custard Granola Honey Ice Cream Jam and Jelly

Molasses Pastries Pies Sugar Sweet Rolls

Sugar coated cereals Syrup Sweetened Fruit

Sweetened Condensed Milk

Severely restrict:

Regular soft drinks regular fruit drinks sweetened seltzer water Ensure

Ultra Slim Fast or any sweetened beverages (unless sweetened with saccharin

NutraSweet acesulfame-K or Splenda (surcalose) aspartame

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

Wednesday, February 23, 2011

WHMC Bariatric Weight Loss Surgery (WLS) Program

Step 1: Referral from Primary Care Manager (PCM)

Step 2: Attend Initial Informational Briefing

Step 3: Attend Surgery Specific Briefing-enrollment in program

Step 4: Complete Pre Surgery Checklist

Step 5: Notify clinic checklist complete @ 292-4303

Step 6: Pre-Operative Appointment

Step 7: Surgery

Step 8: Follow up appointments

Tuesday, February 22, 2011

Protein powder

The following recipes can be found at the original link http://www.unjury.com/using/weight_loss_surgery_protein.shtml

Quick Ways to Use Each UNJURY Flavor

Chocolate

Mix in 8 oz. skim milk or soy milk. Customers say, "Tastes like chocolate milk!"
Mix in 8 oz. warm coffee (about 130○ F, not hotter). Makes a mocha!

Vanilla

Mix in 8 oz. skim milk or soy milk. For an old fashioned custard taste
Mix in 8 oz. warm coffee (about 130○ F , not hotter) Rich creamier taste
Mix in 8 oz. orange beverage (example Crystal Light). Makes a dreamsicle!

Strawberry Sorbet

Mix in 8 oz. cold water. Fresh light strawberry taste
Mix in 8 oz. sugar free lemonade. Strawberry lemonade!

Chicken Soup flavor

Mix in 8 oz. warm water (about 130○ F, not hotter). Tastes like cup-of-soup!

Unflavored

Mix in 8 oz. Crystal Light – Fruit Flavored such as Orange or Raspberry or Fruit Punch.

Tips and Tricks

Grab-and-Go: Mix up your favorite UNJURY drink the night before and leave in the fridge. Grab it on your way out the door for a healthy breakfast.
Eating Out: Have a packet with you when you go out to eat. Order your beverage – milk, cold water, iced coffee – and an extra glass for mixing.
Know your Microwave for Chicken Soup flavor: See how many seconds it takes your microwave to get water up to 130○ F. Then you know the time to get the water just right.
Lunch at Work: Faster than a trip to the lunch counter, and probably more protein. Keep UNJURY handy, and there's always time for lunch.
Milk Ice Cubes: For richer frosty-cold drink, substitute frozen skim milk ice cubes (from milk ice cubes frozen in your ice cube tray) for some of the milk. For example, use ½ cup of frozen cubes and ½ cup milk in your recipe. Blend in blender until smooth.

Friday, February 18, 2011

Support Group Daytime today

Come out and join us for the Daytime Support Group
At the General Surgery/Bariatric Clinic (WHMC) on Lackland AFB

11:30am to12:30pm (1130-1230)

No appointment needed - just show up!

No need to check in at counter, just have a seat in the waiting room and one the Clinic Nurse/Technicians will come out and call attendees to the conference room at 11:30.
**Reminder each patient must attend one meeting before surgery

Bariatric Surgeons will be there
Topic is selected and presented by the clinic Nurses'

Questions call (210) 292-4303 during duty hours

Thursday, February 17, 2011

Gastric Bypass Post Operative Complaints

Complaint	First Try	Then…
Nausea	Eating different foods, eat slower, a little fluid with bites of food, luke warm fluids instead of very hot or very cold foods, look at the food label and make sure the carbohydrate content is not too high, smaller bites of food	See physician or dietitian (bring food log)
Vomiting	Eat slower, smaller bites, smaller more frequent meals, practice good food sanitation, go back to a Stage 1 or 2 for a few days	See the physician about a swallow study
Dumping Syndrome (Nausea, Vomiting, Cramping)	Don't eat "problem causing" foods, eat less carbohydrate and fat	See dietitian or physician if this becomes a problem
Diarrhea	Eat enough fiber (use supplement if necessary-see below)	If it lasts for longer than 3 days and is causing discomfort, see the physician
Constipation	Increase fluid intake, increase fiber with Citrucel or Benefiber—Metamucil can cause gas	Increase exercise if possible, increase Citrucel or Benefiber as directed by a dietitian or physician
Lethargy (feeling tired)	Increase exercise, take a multivitamin, protein powder and enough fluid	Get vitamin B₁₂ and iron studies, possibly pre-albumin
Hair Falling Out	Increase protein intake. Take a multivitamin, may need gel cap vitamin	Get tocopheral, retinol, zinc studies. May need additional supplementation as appropriate
"Food Caught in Chest" Feeling	Drink a little fluid with food to wash it down	Consider swallowing study
Blood in Vomit or Stool	Call physician immediately	----------------------------
Fever	Call physician immediately	----------------------------
Lactose Intolerance	Use Lactaid, soy milk, and/or lactase pills	----------------------------
Gas	Try Beano, Gas-X or Simethicone drops	Begin a lactose free diet, see lactose intolerance above.

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

Wednesday, February 16, 2011

San Angelo : Support Group

Tuesday, February 15, 2011

After surgery in the hospital

You will go to the recovery room. Where you will be monitored and every effort will be made to make you comfortable. You will have oxygen and air stockings on to prevent blood clots. You will then go to the medical-surgical floor. You will be oriented to your room and family may visit. You will be given pain medication. It is important you do breathing exercises with the incentive spirometer 10x an hour while awake. You must get up and walk in the hallway the day of surgery. This is important to reduce the risk of blood clots forming in your legs, going to your heart leading to death. With Gastric Bypass and Sleeve you will not be allowed to having nothing to eat or drink till the following day after a Swallow Study. Medications will be provided. You will have a clear liquid diet provided to you. When you tolerate this you will be advanced to a full liquid diet. This is the diet you will stay on till your 2 week follow up appointment with your surgeon.

Plan to stay 2-3 days in hospital after surgery

--Hospital stay length varies with each patient

--Lap band: same day surgery or 1 overnight

--Sleeve: 2 overnights

--Gastric Bypass: 2-3 overnights

Monday, February 14, 2011

How to get your vitamins? EAT THEM!

By: Susan Maria Leach
Original article http://www.wlslifestyles.com/articles/wls-lifestyles-spring-2010/wls-lifestyles-spring-2010-feature-articles/20100519706/how-to-get-your-vitamins-eat-them-.php

Excerpts from article…

In his book, Eat This and Live, Don Colbert, MD, doesn't pull any punches in his plea for us to recognize the seriousness of the consequences of eating processed foods.

Living foods – fruits, vegetables, grains, seeds, and nuts – exist in a raw or close to raw state and are beautifully packaged in divinely created wrappers called skins and peels. Living foods look robust, healthy, and alive. They have not been bleached, refined, or chemically enhanced and preserved. Living foods are plucked, harvested, and squeezed – not processed, packaged, and put on a shelf. Living foods are recognizable as food.

Dead foods are the opposite. They have been altered in every imaginable way to make them last as long as possible and be as addictive as possible. That usually means the manufacturer adds considerable amounts of sugar and man-made fats that involve taking various oils and heating them to dangerously high temperatures so that the nutrients die and become reborn as something completely different – a deadly, sludgy substance that is toxic to our bodies.

Life breeds life. Death breeds death. When you eat living foods, they flow into your system in their natural state. Dead foods hit your body like a foreign intruder. Chemicals, including preservatives, food additives, and bleaching agents, place a strain on the liver. Toxic man-made fats begin to form in your cell membranes, they become stored as fat in your body and form plaque in your arteries. Your body does its best to harvest the tiny traces of good from these deadly foods, but in the end you are undernourished, overfed, and overweight.

Every day we all make important decisions to eat either healthy living foods or unhealthy dead foods! Nothing fuels our body as effectively as beautiful whole foods. Plants and real foods have hundreds of compounds that may provide us with benefits we don't even know of. I know long-term post-ops that have severe nutrient deficiencies who won't touch a sweet potato, because they believe it has too many carbohydrates. They cannot grasp that the nutrition is crucial for their well-being. If a single tomato and four saltines have the same number of carbs – eat the tomato - it sweeps amazing micronutrients into your body and those few carbs are worth sacrificing.

I rely on vitamin C from broccoli, red bell pepper, Brussels sprouts, and ripe papaya; vitamin E from chilled unsweetened almond milk, unsweetened peanut butter, and sunflower seeds; beta carotene flows into my body from carrots and sweet potato; my folate and B6 are from garbanzo beans, black beans, and lentils; my B12 levels are boosted by my love of wild salmon, organic beef, and farm raised trout filets.

After this awakening, I now look at every bite as an opportunity to fuel my body for a healthy future. I finally have the balance and perspective in this journey that I have lacked for so long. Have an apple, some carrots or sweet potato – EAT your vitamins!

Susan Maria Leach is the author of Before & After – Living & Eating Well After Weight Loss Surgery (HarperCollins Publishers 2007), both a memoir and a cookbook – an intimate account of Leach's own transformation, as well as a guide for those who have undergone or are considering the procedure. As Susan Maria has learned in the more than nine years since her own RNY procedure, weight loss surgery is not an event with a finish line or a goal weight – it is the beginning of a new way of life. She maintains a loss of almost half of her heaviest body weight. Susan Maria owns BariatricEating.com and BE, Inc., which has both warehouses and an onsite store in Pompano Beach, Florida – and is an officer for the corporate council of the American Society for Metabolic & Bariatric Surgery.

Wednesday, February 9, 2011

Fill ‘Er Up – A Look at Gastric Banding Fills

by Lloyd Stegemann, MD, FASMBS

Original content: http://www.obesityaction.org/magazine/ywm22/bandfills.php

A very popular weight-loss surgery operation in the United States right now is an adjustable gastric band. Known more commonly by its trademark LAP-BAND® or REALIZE Band®, an adjustable gastric band is a silastic belt that is surgically placed around the upper portion of the stomach. This creates a small pouch of stomach above the band with the majority of stomach below the band (pictured right).

On the inside of the band, is a balloon. The balloon is connected by a tube to a port that sits underneath the skin on the abdominal wall. By injecting saline into the port, the surgeon, or assistant, can begin to blow up the balloon on the inside of the band. This procedure, known as a fill, is needed to get the adjustable gastric band to work properly in controlling hunger and food portions which will help band patients lose weight. But, how does one know when they need a fill?

Fill Protocols
There are no widely established fill protocols that have been shown conclusively to lead to better or more sustained weight-loss in band patients. What we do know is that if you don't fill the band, it's unlikely to work and if you overfill the band you will likely create significant complications. Between these two extremes, most surgeons make up their own fill protocol (sorry, but it is true). In my experience, most band patients will need somewhere between three to five fills in the first year after surgery and two fills a year after the first year in order to keep the band "tuned."

Do I need a fill?
When I see a band patient, here are the things I consider when deciding if the patient needs to have a band fill:

Hunger Control
I think hunger control is paramount to achieve weight-loss. Hunger is a primal driving force in mankind and if people are hungry, they will eat. I ask each of my patients, "How many times a day do you get hungry?" Good hunger control, in my opinion, is when someone gets hungry two to three times a day and they aren't searching for food between meals. Most band patients will get hungry somewhere between 10 am to noon and again somewhere between 5 pm to 7 pm. Hunger will vary from day to day, but my main concern is that people can get through the day without constantly thinking about food.

The next question I usually ask my patients is, "How many times a day do you eat?" This may seem silly to you, but these are two very different questions. It is essential that all weight-loss surgery patients begin to separate physical hunger from "head" hunger (emotional hunger). Tightening the band (or filling it) can help control physical hunger, but it won't help with "head" hunger.

Portion Control
The band works by doing two things – controlling hunger and limiting portion size. To assess portion control, I ask patients to write down common foods they eat.

The first thing I look at is what type of foods are on the list. Are they all soft foods? This might indicate that solid foods are causing them pain because their band is too tight. Is there a wide variety of foods on the list or are there only three because those are the only three foods that will go down comfortably? If there is a solid protein listed, then I ask about the amount they can eat comfortably. Most band patients should be able to eat three to four ounces of solid protein without discomfort.

They should also be able to get in some vegetables or salad with their solid protein. In general, a band patient should be able to eat roughly 25 to 50 percent of the volume of food they could eat in one sitting prior to weight-loss surgery.

Weight-loss
A band patient who is "doing everything right" should lose approximately one to two pounds a week. Remember, with a band, it is definitely "slow and steady wins the race." This can be a challenge for band patients as they need to be very patient as they are unlikely to reach their lowest weight until 18-24 months after weight-loss surgery.

Snacking between meals, consuming liquid calories and not exercising are common problems I often find when one of my band patients is not losing weight at a rate I would expect. For this patient, a fill is not going to help them and may lead to unintended complications.

Danger Signs
I ask each post-op patient I see, "So, how many times have you thrown up since the last time I saw you?" Generally, they'll start laughing and say something like, "I didn't, was I supposed to?" And the answer is…vomiting is never normal after weight-loss surgery! If a band patient (or any weight-loss surgery patient for that matter) is vomiting on a regular basis, then something is wrong and needs to be evaluated.

Here are some other symptoms that might mean your band is too tight or that there may be a problem with the band (slip, concentric dilation, etc):

- Significant and recurrent heartburn or reflux, especially at night

- Waking up at night coughing

- Pain when eating solid foods

- Pain or redness at your port sight

- Sudden loss of hunger or volume control

- Vomiting on a regular basis

Conclusion
I believe it is important for band patients to keep in mind that a band that is working well will only do two things:

Control hunger
Control portion size

By controlling these two key areas, band patients can begin to work on the challenging lifestyle changes they need to make to give them their best chance at creating long-term success after weight-loss surgery.

About the Author:
Lloyd Stegemann, MD, FASMBS, is a private practice bariatric surgeon with New Dimensions Weight Loss Surgery in San Antonio, TX. He is the driving force behind the Texas Weight Loss Surgery Summit and the formation of the Texas Asso ciation of Bariatric Surgeons. Dr. Stegemann is a member of the American Society for Metabolic and Bariatric Surgery and the OAC National Board of Directors.

Tuesday, February 8, 2011

Self Sabotage- Are you Guilty?

(Cher Ewing, CC)
By: Cher Ewing

Original content: http://www.wlslifestyles.com/all-blogs/cher-ewing/20090211466/self-sabotage--are-you-guilty.php

I hear this from my clients all the time, they are "Self Sabotaging" themselves and don't know why. I know I was guilty of doing this in year two and didn't even realize I was doing it. For me I fell into a comfort zone, I liked the new clothes I was wearing, my new found self assured attitude, and my life focus had shifted. I believe we all have different reasons as to why we sabotage our weight loss efforts. Being successful brings a whole new "Spotlight" on us and that scares the hell out of us. With success brings responsibility, commitment, and life change. Who wants to take all of that on, I know I didn't. Or we are afraid of the new found attention we are going to receive; attention from the opposite sex, our boss will have higher expectations from us, our friends and family want more from us.
We can make excuses all day long as to why we do what we do, bottom line is you signed up for a "Life Changing" surgery. Are you going to continue to make excuses or are you going to embrace the life you signed up for and commit to the change? If you want to continue to make excuses then I'm sure you have heard the old saying "If you continue to do what you have always done, expect to receive the same results". Nothing is going to change until you are ready to change. If you have agreed to commit to change then there are some things you can start doing today to help ensure you achieve success like never before.

Pre-Surgery- Remember back to your pre-surgery week, you were ready to take on the world. Bring that sense of excitement back into your life and watch yourself soar.
Remove unrealistic goals- Dr. Vuong says it best "Don't commit to run the Boston Marathon if you don't even own a pair of running shoes" You don't have to take on the world in a day. Set realistic goals for yourself, write those goals down and follow through.
The Buddy System- Let others help you; you don't have to take this journey alone. We need to be accountable to someone, find someone who is taking the same journey you are. Commit your goals to them and allow them to do the same. When we have others accountable to us, it's so much easier to be accountable to ourselves.
Food- Create a food diary and keep track what you are eating. Dr. Terry Simpson has a great tip: Using your cell phone take pictures of everything you eat throughout the day, take a picture of your meal before you eat it then another after your done. This will give you clarity as to what you are really consuming throughout the day.
Exercise- If you have not already committed to an exercise program, and then you are not going to achieve the results you want from your "WLS" journey. Find something you love and yes I mean love. If you choose an exercise program you dread, guess what is going to happen, you are going to make excuses as to why you can't do it. By finding something you love you will be excited to do it.
Self Care- We always want to take care of everyone else first, we always put ourselves on the back burner. Honestly would you treat your children, friends and family the way you treat yourself? I'm guessing no. We want to give our best to our children, friends and family. But guess what by placing ourselves on the back burner we are not giving them our best. Take some time to enjoy the things you like to do. Go to the movies with your girlfriends, go play a round of golf, reconnect with an old hobby, just find something that gives back to you.
Purge the negative- If you have something or someone who is bringing negative energy into your life; purge it. We have so much going on in our lives we don't need any negative outsiders bringing us down. Negativity just drains you and sucks up your energy, make a decision it's going to stop.
Celebrate the positive- Look at all you have accomplished to date. You have made changes, you've lost weight, went down a size or two or three. Remember how good you felt when you accomplished small milestones; think how good you are going to feel when you accomplish big milestones.
Follow up- If it has been a while since you have seen your surgeon, make an appointment. Don't give me the excuse he/she is going to yell at you because you have gained weight. Go in with the mind set you are coming clean and you are ready to commit to the process. Your surgeon works for you, you are paying them to "Care" for you so go get the care you need.
Coaching- If you still think this overwhelming contact me to set up a complementary coaching session. I know it can be overwhelming; but with a game plan in place you can turn this around. I can help you find out what is blocking you from the success you need and deserve.

Cher Ewing, CC Certified Health & Wellness Coach www.bandedtogether.net cher@bandedtogether.net

Monday, February 7, 2011

Weight-loss Surgery, Nutrition and Hair Loss

by Jacqueline Jacques, ND

Original content: http://www.obesityaction.org/magazine/ywm22/wlsandhairloss.php

Typically, about 90 percent of hairs are anagen (in a growth phase) and 10 percent are telogen (in a dormant or resting phase) at any given time, meaning you are usually losing a lot less hair than you are growing so you don't have noticeable hair loss. But sometimes this can change.

A common fear and complaint of bariatric surgery patients is post-operative hair loss. While for most of us as people, our hair is an important part of our self-image and body image, it is not very important to our bodies. For this reason, nutrition can have a great impact on hair health because when forced to make a choice, the body will shift nutritional stores to vital organs like your brain and heart and away from your hair.

Hair loss has many causes. The most common type of hair loss after weight-loss surgery is a diffuse loss known medically as telogen effluvium, which can have both nutritional and non-nutritional causes.

Growing and Losing Hair
Whether you are aware of it or not, for most of your life you are always in the process of both growing and losing hair. Human hair follicles have two states; anagen, a growth phase, and telogen, a dormant or resting phase. All hairs begin their life in the anagen phase, grow for some period of time, and then shift into the telogen phase which lasts for about 100 to 120 days. Following this, the hair will fall out.

Specific types of stress can result in a shift of a much greater percentage of hairs into the telogen phase. The stressors known to result in this shift, or telogen effluvium, include:

High fever
Severe infection
Major surgery
Acute physical trauma
Chronic debilitating illness (such as cancer or end-stage liver disease)
Hormonal disruption (such as pregnancy, childbirth or discontinuation of estrogen therapy)
Acute weight-loss
Crash dieting
Anorexia
Low protein intake
Iron or zinc deficiency
Heavy metal toxicity
Some medications (such as beta-blockers, anticoagulants, retinoids and immunizations)

Weight-loss Surgery and Hair Loss
Nutritional issues aside, bariatric surgery patients already have two major risks of major surgery and rapid weight-loss. These alone are likely to account for much of the hair loss seen after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into the telogen phase have fallen out. There is no way of switching them back to the anagen phase.

Hair loss rarely lasts for more than six months in the absence of a dietary cause. Because hair follicles are not damaged in telogen effluvium, hair should then regrow. For this reason, most doctors can assure their weight-loss surgery patients that with time and patience, and keeping up good nutritional intake, their hair will grow back. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. One would be more suspicious of a nutritional contribution to post-bariatric surgery hair loss if:

Hair loss continued more than one year after surgery
Hair loss started more than six months after surgery
Patient has had difficulty eating and/or has not complied with supplementation
Patient has demonstrated low values of ferritin, zinc or protein
Patient has had more rapid than expected weight-loss
Other symptoms of deficiency are present

Nutrition Iron
Iron is the single nutrient most highly correlated with hair loss. The correlation between non-anemic iron deficiency and hair loss was first described in the early 1960s, although little to no follow-up research was conducted until this decade. While new research is conflicted as to the significance of ferritin as a diagnostic tool in hair loss, it has still been found that a significant number of people with telogen effluvium respond to iron therapy.

Optimal iron levels for hair health have not been established, although there is some good evidence that a ferritin level below 40ug/L is highly associated with hair loss in women.1 It is worth noting that this is well above the level that is considered to be anemia, so doctors would not be expected to see this as a deficiency.

Zinc
Zinc deficiency has been tied to hair loss in both animal studies and human cases. There is data linking zinc deficiency in humans to both telogen effluvium and immune-mediated hair loss. Zinc deficiency is a well-recognized problem after bileopancreatic diversion/duodenal switch, and there is some indication that it may occur with other procedures such as gastric bypass and adjustable gastric banding.

In 1996, a group of researchers chose to study high dose zinc supplementation as a therapeutic agent for related hair loss2 in patients with vertical banded gastroplasty. The study administered 200 mg of zinc sulfate (45mg elemental zinc) three times daily to post-operative patients with hair loss. This was in addition to the multivitamin and iron supplements that patients were already taking. No labs for zinc or other nutrients were conducted.

Researchers found that in patients taking the zinc, 100 percent had cessation of hair loss after six months. They then stopped the zinc. In five patients, hair loss resumed after zinc was stopped, and was arrested again with renewed supplementation. It is important to note that in telogen effluvium of non-nutritional origin, hair loss would be expected to stop normally within six months. Since the researchers conducted no laboratory studies, and there was no control group, the only patients of interest here are those who began to lose hair again after stopping zinc. Thus we cannot say that zinc would prevent hair loss after weight-loss surgery, and further study would definitely be needed to make this connection.

A further note: The Tolerable Upper Intake Level (UL) for zinc is set at 40mg in adults. This study utilized a daily dose of more than three times that level. Not only can these levels cause gastrointestinal distress, but chronic toxicity (mostly associated with copper depletion) can start at levels of 60 mg/day. Information related to this study has made its way to many a support group and chat room – even to doctor's offices – with the message of "high dose zinc will prevent hair loss after weight-loss surgery." Patients should be advised that high dose zinc therapy is unproven and should only be done under supervision due to the associated risks of toxicity. A lab test to check for zinc deficiency would be best before giving a high dose such as this.

Protein
Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen or prealbumen. Limited studies suggest that patients with the most rapid or greatest amounts of weight-loss are at greatest risk.3

With surgical reduction of the stomach, hydrochloric acid,4 pepsinogen5 and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion, rather than malabsorption, is responsible for most cases. Some studies have also implicated low protein intake.6

Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2 grams of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.1

Many individuals believe that supplementing with or topically applying the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.7

Other
Other nutrients associated with hair health include vitamin A, inositol, folate, B-6 and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS) and is influenced by genetics.

Conclusion
Hair loss can be distressing to bariatric surgery patients and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is mostly likely caused by surgery and rapid weight-loss.

Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value.

About the Author:
Jacqueline Jacques, ND, is a Naturopathic Doctor with more than a decade of expertise in medical nutrition. She is the Chief Science Officer for Catalina Lifesciences LLC, a company dedicated to providing the best of nutritional care to weight-loss surgery patients. Her greatest love is empowering patients to better their own health. Dr. Jacques is a member of the OAC National Board of Directors.

Wednesday, February 2, 2011

Evening Support Group

Please keep safety in mind for weather conditions if you should attend evening support group 3 Feb 2011.

If an announcement is made that Lackland AFB is closed for non-essential personal then support group is canceled 3 Feb 2011.

Please call the Bariatric Clinic during duty hours to confirm if support group will be held or canceled @ 210-292-4303.

Bariatric Surgery is a tool

Surgery is a Tool in weight loss. It is essential to have a combination of healthy eating and exercise with surgery to equal successful weight loss and maintance of weight loss. This may also led to the reduction of obesity related diseases. Bariatric Surgery is not a quick fix. It's a life-long commitment. You are the key to your success!