Taking a chewable multivitamin is the easiest and most effective way of reducing the risk of micro-nutrient deficiencies in the body after gastric bypass surgery.  A chewable vitamin ensures adequate absorption by beginning the digestive process in the mouth.  Chewing breaks down the multivitamin to its most biologically available form and gives your digestive tract a distinct advantage of absorbing all the vitamins and minerals possible.  Taking a capsule delays the absorption of supplements being taken.  The shell of the capsule must be broken down in the digestive tract before absorption can occur.  When and where this takes place cannot be determined with 100% accuracy. 

 
            You must find a vitamin and mineral formulation that is made specifically for patients who have had gastric bypass surgery.  This formulation should have dramatically higher percentages of vitamins A through E, B12, folic acid, and calcium.  It must also include iron and chelated forms of minerals which increase your chance of absorption. 

 
            Those patients taking anti-coagulants such as warfarin and coumadin must be sure to avoid formulations containing Vitamin K.  Patients who suffer from migraines should consider a product that is sweetened with sucralose (Splenda) rather then aspartame.  Be sure that your surgeon or primary doctor routinely checks your blood work for early detection of any underlying deficiencies.

Whole grains include the bran, germ and endosperm which all contain nutrients.

• The bran is the outer layer of the seed which is rich in niacin, thiamin, riboflavin, magnesium, phosphorus, iron and zinc. The bran also contains most of the seed's fiber.
• The germ is the part from which a new plant sprouts. Niacin, thiamin, riboflavin, vitamin E, magnesium, phosphorus, iron and zinc can be found in the germ. The germ also contains protein and some fat.
• The endosperm or the kernel makes up the most of the seed. It contains mostly protein and carbohydrates and has small amounts of vitamins and minerals.

  Whole grains vs. refined grains

  Whole grains contain the bran, germ, and endosperm. Refined grains have the bran and germ removed by milling. Since whole grains still have the bran and germ they are better sources of fiber and other nutrients (as above). Refined grains have vitamins and minerals added back in after the milling process, but they still do not have as many nutrients or as much fiber as whole grains do.

   

  Whole grains	Refined grains
  Amaranth Bulgur (cracked wheat) Barley Brown rice Buckwheat Bulgur (cracked wheat) Millet Oatmeal Popcorn Quinoa Rye Spelt Whole-wheat bread, pasta or crackers Wild rice	Corn flakes Couscous Enriched macaroni or spaghetti Grits Pretzels Saltines White bread White rice

   

Added sugars are found in many foods and not just in the form of sucrose a.k.a. table sugar. Added sugar is often disguised with many different names. These added sugars may include cane sugar and evaporated cane juice, brown sugar, beet sugar or any other ingredient ending in sugar, as well as syrups (or syrup solids) such as maple, corn or cane.

The Nutrition Facts panel tells you the number of grams of sugars in a serving, but because it lumps together all sugars, it does not differentiate between natural and added sugars. Therefore you need to read the ingredients list. If added sugar is one of the first three ingredients, it is recommended that the food item not be consumed.

Below is a list of various added sugars:

**Please refrain from using fiber supplements unless instruted by the office.

**Please refrain from using fiber supplements unless instruted by the office.

1.  Exercise: Just do it!

The hardest part of exercise is getting started. Once you find something that you like to do – whether it is walking, running, biking, swimming or lifting weights – the rest is easy. You don’t need to join a gym – just find something that you like to do and commit to doing it. If you like the gym atmosphere-, which can provide a sense of structure and variety, then go with that. Many gastric bypass patients thrive at Synergy Health and Fitness thanks to the constant encouragement from our trainers and the camaraderie of others.

The benefits of exercise are well documented and cannot be ignored. We all know that exercise helps keep us healthy by promoting weight loss, preventing cardiovascular disease and diabetes, as well as strengthens our muscles. But did you know exercise also helps make our bones stronger, reduces stress and depression, helps us sleep better, and has even been shown to reduce hot flashes in menopausal women? It is hard to argue with the benefits of something that good for our bodies yet, we all resist it.

Get moving – find the exercise you like and do it every day!

The “Prescription for Exercise” that I give so many patients is to start exercising every day for 15 minutes over 2 weeks. Then, increase that exercise to 20 minutes a day for 2 weeks. After that, increase to 30 minutes a day and keep it going 7 days a week. You can add other activities onto that “routine exercise” but not in place of it. Your body needs to have your heart rate increased on a daily basis for at least 20-30 minutes to truly reap the benefits of exercise.

• Go for extra points – be more active!

• Take the stairs – who wants to wait for the elevator any way?

• Park your car further away in the parking lot– you can reduce door dings also!

• Go for a walk during lunch – fresh air and sunshine can brighten your day!

• Do yard work – this is a great workout plus improves the curb appeal of your home!

• Go for a bike ride, go for a swim, go for a walk – whatever you do, just go, go, go!!

Patients who start exercising and keep active seem to be more successful with their weight loss as well as improving their health. In the long run, exercise can benefit you more than just with weight loss  - It can help add years to your life!!

We are bringing in a new surgeon who is completing his fellowship this summer in laparoscopic bariatric surgery, including gastric bypass and gastric banding.    

We hope all patients in need of or desirous of our services can become our patients.

While the surgeon is a critical component of “excellent” care, a Bariatric Surgery Center of Excellence involves the coordinated efforts of a multidisciplinary team including registered dietitians, exercise physiologists, nurses, psychologists, a compassionate office staff and more.  To read more about how this program got started and what Centers must do to earn this distinction, click here. This link will take you to the Obesity Action Coalition website.  Click on “Resources” and select “OAC News”, page 15. 

Taken from OAC News Volume 1 Issue 2.  January 2006.