Dr. Champion proudly presents the Bariatric Reunion for 2010 given by Northside Atlanta, Forsyth and Cherokee Hospitals.

Northside Hospitals of Atlanta, Forsyth and Cherokee, has opened up the Event to ALL of OUR Patients.

We are very pleased and look forward to seeing ALL of our Patients coming to the Reunion! There will be Dinner, Dancing, Silent Auction, Accessory Sale, Raffles & More…

For new patients this is a glamorous evening presented by  Northside Hospitals for all Bariatric Weight Loss patients of Dr. Champion’s. You will get a chance to meet Dr. Champion’s, his lovely wife, the wonderful staff and many post Bariatric patients!

This evening will start off with cocktails and great opportunities to socializing with many of our other post-op patients.  You will meet many from  our local support groups, exercise classes, annual bariatric events and our traveling post-ops you normal only see on our online support groups. Take this as an opportunity to dress up and mingle with Dr. Champion and all of his wonderful staff.

We will be taking pictures, but please bring your camera’s! We are hoping to showcase some of the pictures on the site and Dr. Champion’s growing facebook page.(please click to join)

INVITATION:

Saturday, August 21. 2010
Cocktails 6-7 pm, Dinner & Dancing 7-10 pm
Intercontinental Buckhead
3315 Peachtree Road NE, Atlanta

Attire – Cocktail/After Five

Fee – Complimentary for Patient, $20 for Guest

RSVP: Patricia Daniel – Northside Hospital Foundation

Phone: (404) 851-8389 or

E-Mail: foundation.rsvp@northside.com
***Space is Limited***

Click to view the invitation

Bariatric Reunion

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2009

Questions about Dealing with Weight Regain after Bariatric Surgery

1.What are the keys to patients succeeding after Bariatric Weight Loss Surgery?

2.What are the causes of patients failing Bariatric Weight Loss surgery?

3.What can patients do to deal with post-op weight regain?

Keys to success After Bariatric Weight Loss Surgery and NOT Regaining Weight

1. Healthy food choices (reduce carbohydrates in diet to 50% or less with 35-40% protein and 10-15% fat, concentrate on meats, colored veggies and fruit, limit simple carbs such as bread, potatoes, rice and pasta to 2 days a week and never twice on the same day, no high calorie liquids such as soda, fruit juices, smoothies or protein supplements, no ice cream, no cream soups, no sugar free snacks, no junk food such as chips and nuts or candy, limit alcohol consumption to 2 drinks per week

2. Increased activity and exercise ( 45 minutes of aerobic activity three times a week: that means patients sweat and increase their hear rate) take the stairs, park in the back of the parking lot, get a pedometer and walk 6 miles per day

3. Behavioral changes (eat every 4 hours by the clock, no snacking between meals, don’t skip meals, don’t drink with meals and for 30 minutes afterwards, Slow down eating and chew food well, stop eating when full, eat protein first and then veggies or fruit, practice portion control with small plates, don’t utilize food to deal with emotions: anger, boredom, sadness, stress)

4. Stay connected with your Bariatric Weight Loss Surgery Support groups! Being active and connected with a Bariatric Support group also you to connect with others like you and with that in in various stages of Weight Loss surgery connected, informed and accountable is a key for many peoples successes. Bariatric Weight Loss Surgery is not only a tool for weight loss but it is a life style. People may slip but those that reconnect and have support are faster at getting back up and staying on the right path.

note: Dr. Champion has Bariatric Weight Loss Surgery Support groups in Atlanta, Georgia satellite Bariatric Support groups in Valdosta, Macon, Winder, Savannah, North Carolina and online. Please check our page dedicated to our Bariatric  Support Group to find the most convenient one for you.

Causes of failure after bariatric surgery

A. Behavioral Noncompliance with recommendations

Maladaptive eating or eating around the operation, (snacking, drinking high calorie liquids, eating sweets, high carbohydrate diets), lack of exercise, unresolved emotional issues

The surgery requires significant changes in a patients’ behavior towards food and eating and physical activity; it is not a magical procedure that changes their metabolism and allows them to eat whatever they want and still lose weight. Their metabolism only requires around 1200 calories per day and if they eat 1600 calories they will regain 6 pounds per year. The changes they adopt the first 12 months after surgery must continue the rest of their life. Some patients think they only have to comply with the guidelines the first 12-15 months until their reach their target weight and then they can go back to eating their old way and the result is they regain weight.

In normal weight people it takes 30 minutes for the hunger control switch to be activated after beginning a meal. By slowing down, everyone will eat less by allowing the body’s natural control process to “catch up”. This is particularly important in patients attempting to lose weight from diets or surgery. Patients must choose coarse dense foods high in protein and low in carbohydrate which will stay in their pouch for 30 minutes after meals (meats and colored veggies) to control their appetite for the next 4 hours. The small gastric pouch controls hunger by filling with dense food and staying in the pouch for 30 minutes to stimulate the Vagus nerve to produce satiety, replacing Leptin (a hormone produced in fat cells) as the hunger control. If patients drink with a meal it washes the pouch out and hunger will return in about 45 minutes. If the meal is high in carbs the blood sugar will raise causing insulin to be released and again hunger will return quickly. A high protein diet causes the blood sugar to be level and not get the wide swings which cause increased hunger. Patients must eat by the clock every 4 hours and not skip meals or go too long between meals. Eating every 4 hours and not skipping meals keeps the body’s metabolism level; otherwise the body will slow the metabolism and make it harder to lose weight, or regain weight eating the same amount of calories. Skipping meals will result in overeating at the next meal and extra calories get stored as fat, or it results in snacking due to hunger. A healthy afternoon snack is scheduled to break up the interval between lunch and supper if it is going to be more than 4 hours between meals.

B. Mechanical or physical problems with the surgery

(see also Bariatric Weight Loss Surgery Revisions)

Gastro-gastric fistula, staple line breakdown, tubing or balloon leak, pouch or stoma dilatation, poorly constructed bypass with short limb or poor pouch construction, bariatric surgery intolerance (chronic nausea and vomiting, acid reflux, difficulty swallowing chronic abdominal pain, or excessive weight loss), poor initial choice of operation for the patient.

These are potentially correctable problems, but may require additional surgery for a Bariatric Weight Loss Revision or conversion to another operation and carry additional operative risk compared to the first operation. These problems will require an evaluation and testing to identify. Approximately 50% of Lap-band patients and around 10% of Gastric Bypass patients won’t lose sufficient weight or will be dissatisfied with their initial procedure. Recent studies and our own experience indicate around 25% of Lap-band patients will have their band removed due to weight loss failure or band problems.

What can you do to deal with post-op weight regain?

1.Go back to the basics!

2.Exercise 3 times weekly for 45 minutes. Aerobic exercise with sweating and increased heart rate over 110. Walking, Shopping, Gardening, House cleaning, Playing with the kids, etc is not aerobic exercise.

3.Restrict carbs and re-institute the rules for eating post-op.

4.Get counseling if you’re eating to deal with emotions.

POST OP DIET TO IMPROVE WEIGHT LOSS

Reduce “simple” carbohydrates to two days per week. (Like Tuesday and Saturday). Simple carbs cause a rise in blood sugar and hunger in 45 minutes after eating. If extra calories are absorbed in a meal with simple carbs the calories will be immediately converted to fat cells and either weight gain or a slowing of weight loss.

Simple carbs are any food in the BREAD, RICE, POTATOES or PASTA family. These food groups are usually white but it doesn’t matter if they are white or brown or any color.

Concentrate on eating meats, fruits and colored vegetables. Colored vegetables are complex carbohydrates and the body must burn calories to digest them so it takes longer to absorb and doesn’t cause increases in blood sugar, late dumping syndrome, and “craving” or hunger after 45 minutes.

Your surgery works by filling your pouch with coarse foods like meat, green beans, and carrots etc which stay in the pouch for at least 30 minutes. This sends a signal to the brain you’re full and will control your hunger for 3-4 hours and then you will be hungry again. This is why we have you eat every 4 hours and don’t drink with meals which will wash the pouch out and make you hungry again in 45 minutes. Soft mushy foods like mashed potatoes, yogurt, and soups slide right through the pouch and do nothing to control your appetite and may actually make you hungrier.

Remember

1.Eat 3 meals per day and a healthy afternoon snack: something every 4 hours.

2.Use a small plate to limit portion size and slow down. It takes 30 minutes to feel satisfied, and stop when you’re full: don’t clean your plate!

3.Limit simple carbs to 2 days per week.

4.Don’t skip meals: you lose less weight by slowing your metabolism.

5.Eat your protein first and then any veggies or fruit.

6.Nuts are a terrible snack.

7.All liquids must be low calorie and no liquid protein supplements after 6 weeks post-op.

8.NO DRINKING WITH MEALS!!

There has been renewed interest by the medical community recently in the role of Vitamin D in the maintenance of good health that needs to be shared with our patients. Let me first begin by stating that Vitamin D absorption from the diet is not affected by weight loss surgery, however, over 50% of the entire population of the United States has a vitamin D deficiency. This article will review facts about vitamin D; including how we get it, what happens to our body when it gets low, and how do we prevent and treat vitamin D deficiency.

Vitamins are organic substances which are essential for normal metabolism, growth and development of the body. We get vitamin D in our diet and from exposure to sunlight. It is present in milk, fatty fish such as salmon, tuna and cod, and eggs, butter, and dietary supplements.

Vitamin D’s principal function is related to our body being able to use calcium and phosphorous, which are the minerals which make up our bones. Vitamin D is essential for the normal absorption of calcium and phosphorous from our GI tract. In addition, vitamin D is necessary for normal muscle function, cardiovascular health and the function of our immune system. Deficiency of vitamin D is best known for its effect on our bone strength or bone density and can cause osteoporosis which leads to fractures of the hip and spine as we grow older. These fractures heal poorly in thin bone and are very painful. At present 50% of women and 20% of men will develop osteoporosis by age 50 (this is in patients who haven’t undergone bariatric surgery) and experience a fracture related to their poor bone density in their lifetime. Low vitamin D also results in an increase in autoimmune disorders like type 1 diabetes, multiple sclerosis and Chron’s disease and can interfere with our body’s defense against bacterial or viral infections. Deficiencies also increase the risk of some cancers (prostate, pancreas, colon, ovary and breast) and can lead to higher rates of hypertension and cardiovascular disease. Chronic muscle pain and fibromyalgia has been reported to resolve in up to 90% of patients when their vitamin D deficiency is corrected. We are just coming to understand the role of vitamin D which was rarely tested in the past. Current testing has revealed that 50% of the current population has a vitamin D deficiency. A major reason testing is not done more frequently is the current cost of the lab exam which can run from $160-400, and is rarely covered by insurance.

Vitamin D can be obtained in our diet, but requires we eat a fatty fish such as salmon 2-3 times weekly. Other foods such as milk and diary products which contain vitamin D are actually fortified artificially with the addition of vitamin D by the supplier of the product. It was previously thought that we needed only 400 units of vitamin D daily along with 800 mg of calcium, and many of the over the counter supplements contain this quantity in 2 tablets daily. We have since learned this isn’t enough and the government has suggested 800 units of vitamin D and 1500 mg of calcium daily. Even this amount may not be enough and we often have to prescribe a super strength vitamin D with 50,000 units which is taken either weekly or every other week.

It has been documented that patients who undergo gastric bypass surgery are at higher risk of metabolic bone disease such as osteoporosis due to reduced absorption of calcium, however, we have monitored our patients with bone density testing yearly in the office and our incidence of osteoporosis has decreased after surgery due to our insistence our patients take the calcium and vitamin D supplements and be monitored closely. Patients who don’t return to our office for follow up should ask their family physician to order a bone density study yearly to insure adequate calcium replacement. Blood tests which measure calcium are not adequate to monitor calcium supplements. Routine vitamin D blood test can be reserved for patients with demonstrated abnormal bone density tests or known vitamin D deficiency due to the cost of the test at this time.

We are just beginning to understand the importance of vitamin D for good health in all people. Remember: it’s extremely important for our patients to take their calcium supplements with vitamin D and have routine testing done yearly to insure adequate replacement of nutrients in their diet.

I must confess, I have only recently started working out regularly so the aforementioned weight loss would probably be greater had I not been sedentary.  The good news is, I recently joined a fitness club and am doing 45 minutes of intense cardio 4-5 days a week.  I will soon be incorporating strength training 3 days a week into the mix to help with muscle tone. I can’t begin to tell you how much better I feel.  Especially my energy level!

Lately, I think my brain is finally syncing up with my revised stomach.  That was the hardest thing at first.  I am now able to distinguish between true hunger and the hunger in my head.  I can definitely feel the difference without Grehlin.  I don’t feel ravenous or deprived anymore.  My stomach sort of growls like it used to if I’m truly hungry but I don’t feel the need to eat everything but the kitchen sink.  I feel like I have advanced past the experimental phase with food.  I am naturally making better choices, no sweets except fruit.  I am sticking to 3 meals a day and no grazing especially now that the holidays are over.  I don’t miss the old eating days anymore.  I did at first though.  My relationship with food has changed dramatically.

I take one Women’s Ultra Mega vitamin from GNC daily.  I still need to get in more protein.  It’s hard as I’m single and on the go.  I also need to get in more water than I should.  It’s hard because I can’t chug-a-lug anymore.  Especially after a workout!  Although I can never finish a whole can in a given day, I do have a vice and that’s sipping on diet Coke at work.  I know!…  It’s bad!  I’m working on it and trying to replace it with crystal light but I miss the carbonation.

I plan to get a physical once I find a good PCP here so I can get some blood tests and see how those look.  When I do, I will have them forwarded to your office.

I am also still smoke free and have been since Last August.  I smell better, look better, and most importantly, I feel better!  And I owe it all to Dr. Champion and his wonderful staff!  You have all given me a new lease on life and I will be forever grateful!  I have absolutely no regrets on the surgeon or the procedure I chose.

I’m so sorry for the lengthy e-mail.  I just figured since you only have a couple sleeve patients, my feedback would be helpful to you.  There is so much to talk about!

Thanks again for everything and I will keep you posted from up here in Massachusetts!

Take care for now.  Warmest regards,

Val C.

Recent studies have demonstrated that 50% of the US population has a vitamin “D” deficiency and 50% of women will develop osteoporosis by age 50 in patients who haven’t undergone weight reduction surgery. While Vitamin D absorption isn’t affected by weight loss surgery, our lack of adequate intake in modern diets requires everyone to take a calcium supplement of at least 1500 mg daily with at least 800 units of vitamin D for good health.

Your calcium supplements with vitamin D may all be taken together at the same time. It doesn’t have to be taken in multiple doses, and you can’t absorb more than 1500 mg daily, so increasing your dose won’t improve your bone strength beyond the 1500 mg recommended. There is no real difference in bone strength between the different calcium preparations, so chose the one you like best. A Vitamin D in a prescription strength of 50,000 units may be required if patients have a severe D deficiency or bone thinning (osteoporosis or osteopenia) on a bone density study.

Calcium shouldn’t be taken at the same time as iron, or it will block the absorption of iron. We recommend taking your multi-vitamin and iron together and then take your calcium at least 4 hours later. Iron is usually better tolerated with food, and may cause nausea if taken on an empty stomach. Constipation sometimes occurs with iron and can be treated by taking 2 stool softeners daily, like Colace of Miralax.

Some patients may require additional Vitamin B-12. We test blood levels before prescribing additional B-12, since not everyone will require additional supplements. B-12 may be given by injection, nasal spray, or orally by tablet. We recommend 1000 ug oral vitamin B-12 for patients preferring the oral tablet method.

The answer is no!

Patients who undergo a Lap- Band procedure will not have any of the small intestines bypassed, so they shouldn’t worry about medication absorption. Many will ask why we place them on supplemental vitamins and calcium if the upper portion of the small bowel is not bypassed like after the Roux-en-Y Gastric Bypass. The answer to that question is many patients don’t eat a balanced diet which is high in iron such as green leafy vegetables, or avoid some food groups such as milk products which are high in calcium. About one out of every three patients is found to have low iron, calcium or “B” vitamins before surgery. In addition 50% of women over age 50, who haven’t had weight loss surgery, will develop osteoporosis in their lifetime or have vitamin D deficiency, so taking supplements is a good idea.

Gastric Bypass patients do have around 20% of the small bowel bypassed along with the portion just beyond the stomach called the duodenum. This will decrease the absorption of iron, calcium and “B” vitamins, so they must take supplements to remain healthy. This bypassed intestine only represents around 20% of the bowel, so medications can be absorbed normally in the remaining 80% of the distal bowel. No medications, vitamins, or nutrients are absorbed in the stomach; it simply serves as a mixer to grind up the food particles into smaller pieces. This is why you must chew your food until it is almost liquid to make up for the bypassed stomach.

We are not aware of any medications that are absorbed better or worse after Gastric Bypass Surgery. We occasionally see a reduction in thyroid medication, but we believe this is due to a change in the patient’s metabolism and weight loss, not a change in absorption. Requirements for other medications like for diabetes, high blood pressure or cholesterol may also decrease after Gastric Bypass due to weight loss and changes in the body’s metabolism, but it is not due to a change in absorption. Birth control pills are absorbed normally as far as we are aware, but must be taken as prescribed. Fertility often increases with weight loss, so remember to be diligent with birth control methods the first 18 months. All methods of birth control including the pill have a known failure rate of at least 1%.

So remember, take your medication as prescribed and do not make adjustments or changes without clearance from either your Primary Care Provider or Dr. Champion. Please call our office at 770-425-5525 if you have any questions.

Most patients are aware of “dumping syndrome” which may occur in patients who consume sweets or desserts after gastric bypass surgery. Dumping syndrome actually occurs in 2 different forms: Early and Late.

Early dumping syndrome is due to eating sweets which are high in sugar. This occurs usually immediately after eating something like ice cream and results in nausea, vomiting, diarrhea, and possibly lightheadedness or feeling faint. Early dumping is due to a large sugar load hitting the intestine all at once, so the bowel pulls in water from your blood stream to try and dilute the sugar. As you rapidly lose water from your blood your blood pressure drops so you feel faint and sweaty. As the GI tract fills with water and distends the bowel you begin to cramp, become nauseated, vomit, or have diarrhea. It will last 1-2 hours then go away on its own. You only think you’re going to die. This will occur in around 90% of patients after gastric bypass. Unfortunately it’s not in everyone, and some patients can eat sweets after surgery. The treatment is to not eat sweets again.

Late dumping begins to occur about 12-18 months after gastric bypass surgery, and it is due to a low blood sugar. The GI tract and intestine are very sensitive to carbohydrates after weight loss surgery. If you eat a meal which is high in simple carbs like mashed potatoes, and especially if you drink fluids with the meal, you may experience adverse symptoms. Typically about 45 minutes after a meal you feel sweaty, lightheaded and nauseated. This is due to the carbohydrates making your blood sugar increase rapidly after a meal and extra insulin is produced in response to the meal. The insulin then makes the blood sugar drop too low and causes the symptoms. Treatment is to drink a small amount of orange juice or eat a couple of lifesavers to raise the sugar slightly. The long term solution is to eat a diet which is high protein and low carbohydrate and avoid all simple carbs which are white foods (potatoes, rice, bread, pasta) and don’t drink fluids with the meal. The symptoms almost always go away with time by year 2 or 3 post-op.

There is a literal internet war going on over opinions regarding the best calcium supplements. Let me settle it for you. There is no “best calcium supplement”. The two most common calcium products in the United States are calcium carbonate and calcium citrate. You can chose either and feel good about your choice. We routinely recommend at least 1500 mg of calcium with 800 units of extra vitamin D for patients who have had bariatric surgery. Vitamin D absorption isn’t decreased by bariatric surgery, but we now know 50% of the US population is vitamin D deficient and Vitamin D helps with absorption of calcium in the diet. .

Kidney stones aren’t more common in bariatric surgery patients and calcium supplements don’t cause kidney stones in most patients. Most kidney stones are calcium oxalate stones, but it is the oxalate which is the problem. Poor hydration or excessive amounts of foods high in oxalate such as ice tea will lead to kidney stones. Any post-op patient who has a kidney stone needs to try and have the stone analyized by a professional lab so we can determine what chemicals are in it. Your kidney doctor will know how to do this. There are rare cases where the stones are pure calcium and the patient is absorbing too much calcium, and in that case we would stop the calcium supplements.

Calcium carbonate with extra Vitamin D is in Viactive and Caltrate. It is the most common and most popular calcium product. It is inexpensive and more concentrated than calcium citrate so the pill is usually smaller, which is nice if you have a small stomach outlet. It is better absorbed with food, so take it with meals.

Calcium citrate which is in Citracal can be absorbed without food so it can be taken anytime. It has been reported to be better absorbed than calcium carbonate, but no one has shown any difference in bone density, so it doesn’t appear to matter. Calcium citrate has been reported to cause more intestinal gas and bloating, so avoid it if this is an issue.

Calcium of any type interferes with iron absorption, so take the iron and calcium at different times at least an hour apart. The calcium supplements can be taken all at once and doesn’t need to be divided into multiple doses over the course of the day.

A low dose of aspirin (81mg or a baby aspirin) has been suggested to reduce the risk of heart disease. It appears to be effective in men but it definitely increases the risk of bleeding or ulcers after gastric bypass surgery. Aspirin in women under the age of 65 has not been shown to prevent heart disease, so there is no cardiac reason to take it. About one in four patients who take aspirin or plavix after gastric bypass surgery will have an episode of bleeding from the GI tract or stomach. Aspirin can also cause Lap-band or VBG patients to have a band erosion and the band will need to be removed. Antacids medications called proton pump inhibitors such as Nexium, Prilosec or Prevacid may reduce the risk. In summary we recommend low dose aspirin after bariatric surgery only in patients who have a proven need for it such as having had a heart attack, coronary bypass or stent placed, and then they must take medication to protect the stomach.