Life afterBariatric Surgery

Pouya Shafipour, MDWellesley MedicalLos Angeles, CA

First the Good News! At the end of this presentation you will have a

clear understanding of the following:

You will lose excess weight in a healthy way and

reach your ideal weight fairly rapidly post-op

You will feel better than you have in a long time

You can do this through safe and effective

dietary changes

You will learn how to maintain your weight

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In this talk we will cover:

The Problem

The Causes

The Solution

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An example of the Good news!

• TJ 40 y/o F

• 5’ 2”

• 130 pounds overweight

• Size 18

• Frequent Headaches

• Nausea

• Insomnia

• Chronic Fatigue

• Diabetic

•6 months later

• 70 pounds loss

•Size 8

•headaches gone

•nausea gone

•Dizzy spells gone

•Diabetes cured

•Great sleep

•Lots of energy!

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Now the Bad News!

• When it comes to Dieting and Weight loss in the US, We are confused

• Our current weight problem is not a result of lack of effort by the American Public.

• With over 6000 diets available and the contradictory “scientific evidence”, it would be a miracle if Americans were not confused

• Following the wrong plan, no matter how hard you try, will get poor results.

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The ProblemAmerica is Overweight and Obese

According to the CDC 1 out of 4 people

Are either Pre-Diabetic or Diabetic?

Oct 2010 CDC Estimates

By 2050 up to a third of the population diabetic

57 Million Americans Pre-Diabetic.

24 Million Americans Diabetic.

7th cause of Death in 2007

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More Statistics

Over 400,000 Deaths from Obesity year.

74% of Adult Americans are

Overweight/Obese

Since 1980 number of Overweight

Americans has doubled

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The Epidemic

Over the next 24 hours

2200 diabetics will be diagnosed

512 diabetics will die

66 diabetics will go blind

77 diabetics will develop end stage kidney

disease

153 will have diabetes related amputations

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Overweight and Obesity

Cancer Stats in U.S.

90,000 Cancer Deaths

14% of all Male Cancer

20% of Female Cancers

American Cancer Society*

*estimates excess weight

contributes to 33-50% of

women!

Heart Disease in

U.S.

Since 1984 more female deaths,

than male.

512,000 female Deaths

447,000 male Deaths

10,000 women under 50

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Health Effects of Being Overweight/Obese

• Type II Diabetes

• Heart disease

• High B.P., Heart Attack

• Stroke, Arthritis

• Pancreatitis

• Infertility, Birth Defects

• Carpal T.S., Low Back Pain

• Impaired Immune Response

• Impaired Resp. Disorders

• Fatigue, Fatigue and more...

• Gall Bladder D., Gout

• Menstrual disorders

• Menopausal hot flashes

• Insomnia, Sleep Apnea

• Depression, Reflux

• Surgical Complications

• Pain, Urinary Incontinence

• Chronic Ven. Insufficiency

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Cancers and Obesity

Esophagus

Pancreas

Colon and rectum

Breast (after menopause)

Endometrium (lining of the uterus)

Kidney

Thyroid

Gallbladder

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These Statistics Represent:

Quantity & Quality of Human Life Severely

Diminished by this one condition

Meaning Quantity in Years Lost

Quality of Life 24 hours, 7 days a week

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Why is There an Epidemic of

Diabetes and Obesity?

Falsehoods Exposed

“Its in my genes – I am doomed to get it”

“It is out of my control”.

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Causes of Diabetes & Obesity

• Unhealthy Eating Habits

• Excessive Weight (Abdominal Fat)

• Lack of Adequate Nutrients

• Lack of Exercise

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Changes in Our Eating Habits

Sugar intake 1900, 2-4 lbs. of

Sugar/person/year

Sugar intake 1999, 158 lbs./person/year

Refined Grain intake from late 1970’s thru

2000 has increased by 60 lbs. per year

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French vs American Diet

Late 20th Century French Diet was

higher in fat, had equal amounts of

meat and fish, 4X's as much butter

and cheese, and they had 60% less

Heart Disease than the US.

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More About Fats

From the mid 1980’s to mid 1990’s, the % of daily calories from Fat in the American Diet, decreased from 40% to 33%, while obesity in increased significantly

From 1910 to 1970, Heart Disease escalated from almost non-existent to # 1 cause of death. During this time the intake of Animal & Butter fat significantly decreased, dietary cholesterol did not increase, while sugar intake increased dramatically

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How do we Gain FAT?

Let’s look at the common scenario of fat

gaining that takes place, slowly but surely

over time, from too many carbs, too many

“empty calories”.

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When blood sugar exceeds a certain level

the body converts it to fat and stores it.

High Carb

Meal

Fat

Storage

Fat

Storage

Fat

Storage

Fat

Storage

Low Blood sugar

Symptoms

Next Carb Fix

Next Carb Fix

Next Carb Fix Next Carb Fix

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Insulin and GlucagonInsulin

• lowers elevated blood sugar.

• shifts our metabolism into storage mode

• removes dietary fat from blood and transports it into fat cells.

• Increases body's production of cholesterol

• causes the kidneys to retain fluid

• stimulates the release of eicosanoids. (proinflammatorySignaling Molecules)

Glucagon

• shifts metabolism into burning

mode

• turns fat into blood sugar for

energy use.

• Decreases body’s production

of cholesterol

• causes the kidneys to release

excess fluid.

• stimulates the release of

eicosanoids. (antiinflammatory

signaling molecules)

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The Eicosanoids

Insulin• Promotes platelet

aggregation

• Promotes vasoconstriction

• Depresses Immune Response

• Is Pro-Inflammatory

• Increases Pain Transmission

Glucagon• Inhibits platelet

aggregation

• Promotes vessel opening

• Stimulates Immune Response

• is Anti-Inflammatory

• Decreases Pain Transmission

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Where Does the Sugar come From?

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Think about the foods you love?Are they healthy choices?

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Refined Sugar

Sodium

Saturated Fat

Minerals,

Vitamins,

& anti-oxidants

Probiotics

Omega-3

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Out of Control Portion Size

Hamburger 2.8oz – 4.30oz 50% inc in calories

French Fries 2.4oz – 7.00oz, 10x inc in calories

Chocolate Bar 2.0oz – 7.00oz, 3x inc in calories

Coca Cola 6.5oz – 16.0oz, 2x inc in calories

Popcorn 3cups – 21cups, 10x inc in calories

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“If there is one thing that could bankrupt America, it’s health care.

And it’s out of control!”

David Walker, GAO – Presidential Forum on Aging

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The Status Quo

Not

Sustainable.

33% Diabetic - CDC!

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So, How do We

Solve this Problem?

The Bad News is:

There is No Magic Pill to solve

this problem.

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What Does not Work• Natural Stimulants”, i.e. Ephedra and the

many other “Fat Blockers”, “Carb Blockers”, “sleep your way to weight Loss, dont change your lifestyle” products.

• Prescription Medications for Weight Loss, remember Fen, Phen?

• Lastly,“it is not the fault of your Genes”. When we take care of the body in the way it is designed to be cared for, it performs wonderfully and loses weight steadily.

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Really Good News

Gastric Bypass Cures Diabetes and most

diseases associated with Obesity

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This Challenge is:

Following a plan that focuses on:

Fat Loss

Preservation and increase in muscle mass

Long-term sustainable weight loss and

avoids weight regain.

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It is not about a Diet

It is about a system!

A System Structured for

Success

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What a typical diet lacks:

Proper nutrients.

Proper protein content.

Adequate unsaturated “good” fat

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Long term Post-op Program

• Abdominal Fat Loss

• Develop Healthy Food Habits

• Nutritional Deficiencies Supported

• Exercise

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Abdominal Fat Reversal

Establish a Bio-chemical State to Target:

ABDOMINAL FAT

Abdominal Fat = Development of Insulin Resistance & Tumor Formation

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Abdominal Fat Study

Excess body weight in combination with

physical inactivity is a major determinant

for the development of insulin resistance

with associated hyperglycaemia and

hyperinsulinaemia and further leads to

tumour development.”

Arch Physiol Biochem. 2009 May;115(2):86-96. Obesity related hyperinsulinaemia and hyperglycaemia and cancer development. Becker S, Dossus L, Kaaks R.

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Healthy Food Habits• Understand Food Habit Impact on Blood

Sugar

• Make the 20/80 Flip

• Minimize Foods that Induce Allergies/Sensitivities

• Ensure Adequate Intake of Protein with Meals (60 grams/day minimum)

• Maintain 3 Meals a Day – Never Miss Breakfast

• Healthy Snack Between Meals

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Nutritional Deficiencies

• Typical post-op Mineral and Vitamin

Deficiencies

• Chromium, Magnesium, Zinc, EFA,

Selenium, CoQ-10, alpha lipoic

acid, calcium with vitamin D, iron

and vitamin B12

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Exercise

• Daily 30 minutes of movement for Heart Health

• 60 minutes of exercise for weight maintenance

• Family Exercise very important to prevent childhood obesity

• Non-Exercise Activity Thermogenesis(NEAT)

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Summary

• Gastric Bypass is an effective procedure to

cure diabetes and cause dramatic weight

loss.

• Caloric intake, nutritional deficiencies and

Protein intake need to be monitored post-

operatively and for the rest of one’s life.

• 60-80 grams of Protein/day is necessary to

avoid muscle loss and maintain one’s weight.

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Conclusion

Have 4-6 small meals a day. You can

not eat large amounts of food and

your meals will not last as long as they

did before, so eat more frequently.

Drink at least 64 ounces of water daily.

Drink at least 30 minutes before eating.

This "water loading" will make you feel

fuller before you eat.

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Simple Action Steps

Chew your food very well- 20 times before swallowing. It

slows down your eating and also breaks down the food to

allow the food to go down easier

Keep a food diary and plan your meals. If you fail to plan,

you plan to fail.

Don't rely on what is nearby for food. Fast food will slow

you down. Never skip breakfast. Eat like a queen for

breakfast, princess for lunch and pauper for dinner.

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Simple Actions

Avoid foods high in sugar (more than 20

grams per serving) or high in fat (more 30%).

Bread does not grow on Trees! So Avoid Carbohydrates as much as possible

Be careful with liquids like juices, smoothies, or lattes. These

have calories and you will not have the feedback or solids

telling you that you are full.

Avoid snacking. Grazing on food will add weight. Stick to your

set meal times.

Concluding Remarks

Don't give up. Weight loss and weight maintenance is a life long process. If you over indulge one day, make up for it the next day. Keep working to make yourself better each in every day in each and every way.

Find time for yourself. If you are stressed at work or home your body will know it and not like it. Take care of yourself or you can't take care of others.

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For more information please visit us at

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Or Call us at (310) 400-5565