Gastric Health Show

Looking to protect your bariatric gut during the holidays?  Check out our audio transcript for 10 tips.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, Registered Dietitian, and this week’s topic is 10 holiday tips to Maintain a healthy Gut after Bariatric surgery. We’re going to dive into kind of how to protect your gut through the holidays, and we’ve already survived two of the holidays this season with Halloween and Thanksgiving, but there’s still Christmas and New Year’s, so we need to stay strong and not let things get out of hand that by the end of the season that now you have gut dysbiosis and just a big imbalance that is created because things have been out of balance in your life for the whole holiday season. So first off, let’s talk about mindful eating amidst the festivities. So again, being present is truly an important task. Living in America, not always easy to do, we are rush, rush, go, go, and we tend to let things just take over our thoughts and we are not even present in the room mentally, and that’s what I want you to pay attention to.

(01:30):

So when your mind is somewhere else, then when you’re eating, you are less likely to get normal hunger cues, fullness and satiation cues, and it creates this great imbalance that is driven really by the stress of ruminating on things and not being present. Additionally, food is supposed to be fun, it’s supposed to be tasty, it’s supposed to be social. This is how we do community. So being mindful, put the food in your mouth, taste it, smell it, feel it, all the senses. You want to experience all the senses with food because it’s important. And when you bring yourself down to that, then you can have what I would call a positive relationship with food because in the end you need food, you can’t not eat, you don’t survive long without the fuel that your body needs and you feel pretty crummy additionally. So making sure you’re mindfully there and present at meals can help prevent overeating, especially after bariatric surgery.

(02:47):

It’s easy to not pay attention and because of the surgery, even taking one more bite can sometimes just tip you over to be miserable or having some nausea and vomiting, so not what you want. So be present, be mindful, enjoy the food that you are experiencing through this next month of December. And truly just don’t worry so much about numbers and your weight and all of that. It’s just truly being present and enjoying this season of time. Now I also want to talk about alcohol and its effects on your gut health because the holiday season is full of lots of festive drinks and this is something that I think having that awareness around that can really support you and keep you grounded in making good decisions. I don’t think there’s anything wrong with having alcohol after bariatric surgery. I think it’s a normal human thing, but do know that alcohol can become a problem for some and you don’t even have to have had alcohol problems prior to surgery for this to become a problem.

(04:12):

So always use wisdom, always know that you absorb alcohol very quickly and it gets metabolized quickly and can create a lot of problems for people if they don’t keep it in check. So on the flip side, I want you to also think about the impact that alcohol has on your gut bacteria and it can create dysbiosis in your gut because of the alcohol and it actually can lead to a condition we call small intestinal bacteria overgrowth growth or sibo. And this is something that alcohol is problematic in leading to. So anytime you’re consistently consuming alcoholic beverages on a regular basis, your gut health could be compromised. One trick I like to use is our multi-sport powder, which is the L-glutamine. We use a therapeutic dose and it can really help support a healthy gut lining and be protective against alcohol. So that’s one thing that I like to use if I’m drinking alcohol is to really support my gut lining and making sure that I keep it strong and healthy by utilizing that multi-sport powder.

(05:48):

Additionally, a lot of people think that blood sugar issues would be the opposite of what really happens with alcohol. Most people will think the alcohol will cause a rise in blood sugar, and in essence what it truly does is causes a low blood sugar or hypoglycemia. So this is something that you have to keep in mind and you have to kind of counterbalance in making sure that you’re having food with it. Ideally you would have alcohol during a meal when you’re having proteins and carbohydrates and fats and fiber and all of the properties that your body needs to kind of slow that absorption down so then it can have some blood sugar stability from the foods that you’re eating. It will help prevent the spikes and the drops that can occur from the alcohol. So using moderation, using awareness, setting some boundaries or all important to do.

(06:54):

Lastly, I want to say hydration. So when it comes to alcohol, not only does it lower your blood sugar and compromise your gut integrity, but it also dehydrates you. That is something that you have to keep in mind. So utilizing some type of electrolytes when you are drinking before the alcohol and after the alcohol, and really even during, if you’re having a few drinks, a few cocktails, few glasses of wine, maybe you have the electrolytes before and then after the first drink and then kind of in between the first and second drink if you’re having more than one. And then the next day making sure that you’re staying on top of that hydration as well because it will make a difference because again, alcohol dehydrates you and you need to replenish those electrolytes to help support adequate hydration levels. Now the next thing that I want you to think about is protein and how it can really support blood sugar stability during the holidays and really how to be smart about these festive meals that you’re going to maybe be partaking in how to make some good informed decisions and prioritizing protein is one piece of this and we know, I mean, as a bariatric patient, I feel like you guys are all already aware of this, the importance of protein.

(08:26):

The one thing that you probably have learned from your training prior to having surgery is the importance of protein. So having protein rich foods can help support healthy blood sugar levels compared to when consuming carbohydrates. When you put them together, that’s when you can prevent those spikes. So protein in combination with the carbohydrates can significantly improve how your body responds to that food. If you had carbohydrates all by themselves, you would likely get a spike and then a crash. If you had protein, then carbohydrates, you would get a spike because that’s normal for our blood sugars to go up with food. Ideally you want it to jump 15 to 20 points at most and not exceeding 30 point rise. Anything above a 30 point rise is telling us that your body is not managing or capable of managing that amount of carbohydrates or whatever it is that you have consumed.

(09:45):

It was not able to handle that well. And so we want to prevent those spikes. And having protein before you have the carbohydrates is a great way to kind of blunt that spike and prevent a crash, which is what would happen if you had carbohydrates by themselves. So making kind of balanced choices with protein, fiber and fat, those are really the key pieces to balanced blood sugars and it can make a huge difference during the holidays because there’s so many opportunities for lots of different foods and there’s nothing wrong with having those foods, but you got to do it kind of in the right combination where you’re having protein first, you get your protein in and then you partake in some of those other carbohydrate sourced type festive dishes. So it’s not that you don’t have them, it’s just you’ll be limited on the amount that you can have because your appetite is going to be controlled more from the protein.

(10:55):

So really just having an approach where you do a balanced plate with half of your plate being protein and then you kind of spread out the carbohydrates, the fibers, the fats, all of that is so important to include each time you are putting food on your plate. So making protein, the star of the plate can help support a healthy gut during the holiday season. Now how about choosing nutrient dense foods for your gut and hormone balance? So this is something that you’ve got to kind of think at a big picture level and your gut plays a role in your hunger and appetite and satiety hormones. So this is kind of a crucial piece because we want to optimize your fullness cues and we want you to also optimize those hunger cues because we need you to eat. We can’t have you eating so little food that you don’t even meet your metabolic needs.

(12:07):

So important piece to consider. How can consuming nourishing foods during this holiday season really help support your gut health? So first, it’s phytochemicals for your gut health. Phytochemicals are kind of this compound that is abundant and fruits and vegetables, and they do play a vital role in having a healthy gut, and they also have a role in digestion and gut integrity. Consuming foods that are rich in vital chemicals like berries, leafy greens, tomatoes, these food properties that are naturally in these types of foods, your fruits, your vegetables, your fiber filled carbohydrates, they all help enhance your gut barrier function and can really set you up for avoiding gut dysbiosis and small intestinal bacterial overgrowth, blood sugar imbalances, depression, anxiety, all of that stuff that impacts your brain can also be involved in this as well. But the big picture is consuming when you compare a consumption of the highly refined ultra processed foods compared to nourishing foods with fruits, vegetables, and whole grains.

(13:40):

Great big difference on how that translates into the health of your gut. So the more colors that you have on your plate, the more phytochemicals that are there to protect your gut health. So challenge yourself to build your plate, half of it, protein, and then see how many colors you can get on the other half of the plate to help support a healthy gut microbiome. Additionally, you want to think about antioxidants and the polyphenols. They play a role in butyrate production and again, berries, dark chocolate, nuts, certain spices, they truly do help boost your beneficial gut bacteria. And these compounds can really help increase the production of butyrate, which is just that short chain fatty acid that is essential for gut health and it is the primary energy source for your cells in your colon and that gut lining, and it does help lower inflammation in your digestive and really just help support healthy blood sugar balance.

(14:55):

So including again, those compounds from dark chocolate and the nuts and the seeds and just colorful fruits and vegetables will help fuel those gut bacteria to actually help support a healthy holiday season without creating a gut dysbiosis because you’ve consumed too many sugars and refined ultra processed foods. So take this time to actually cook some meals and cook some side dishes that can really support you during this holiday season. Now lastly, it also would play a role in your appetite hormones. So antioxidants and polyphenols really do influence those hormones like leptin and ghrelin, and it really can help dictate your fullness and hunger cues. So including those foods that are rich in polyphenols like the colorful foods that I mentioned with berries, cocoa, but then also green tea, olive oil, and any of the fruits and vegetables are always going to be key. They especially love cranberries, they especially love cherries and just those deep dark colored vegetables like beets, all of those are crucial to keeping your appetite hormones in check.

(16:31):

So by adding the other half of your plate full of colors and fibers and healthy fats is really the key to maintaining a healthy gut, but then also keeping those hunger cues in. Check next for managing the holidays, you have to think about hydration and staying well hydrated is key. So not only if we talked about it in the scope of alcohol, but just in general really keeping your water going, making sure that you are consuming half of your body weight in fluid ounces of water. That would be the key ideal scenario where you’re actually consuming half of your body weight in hydrating fluids. So you don’t want it to be caffeinated because that pulls fluid out of your body. So we want it to be fluids that can actually promote hydration, but then you also want to make sure you’re not missing some electrolytes. Most everybody needs a little bit of electrolytes to truly help support the fluid getting into your cells. So we need some potassium, magnesium, sodium, those type of transporters to get into the cells for the fluid to get into the cells. So making sure that you’re including that at times so that you get optimal hydration.

(18:12):

The next one is just kind of moderating your indulgences. So this is the holidays, this is the time when you’re going to be exposed to lots of opportunities and sometimes too many opportunities and you have to check yourself and say, am I partaking too often? I don’t think there’s anything wrong with enjoying these fun foods. They’re tasty, they are festive, and they just taste good. And it’s one of those things that depends on the person is dependent on how well you can incorporate these. I know my patients who have those genetic snips where they are more sugar loving or they are more have aversions to bitter foods and they really are drawn to those sugary things. It is tricky, and this is where I just say protein first, adequate fiber and healthy fats. Those are the three things you can’t compromise on and then fill in your plate with all of those bright, colorful fruits, vegetables and whole grains is a key piece to preventing you from going too crazy on all of the sweets and desserts and things that we should enjoy during the season.

(19:41):

You just have to determine what works for you. So everybody’s journey with their relationship with food is different and there may be times where you have to say, you know what? I’m just not in a place right now where this works, and that’s okay as you work on it and get better at not letting those thoughts take over. And you start dealing with some of maybe your past traumas and things that have contributed to you not having control around those foods and then maybe addressing some of the genetic pieces to help kind of mute those down and turn those genes off so that you do have better control and you don’t feel so drawn to them. So again, my best tip is if you truly want some sweet things, try to minimize as much of the sugar as possible so it doesn’t compromise your gut health.

(20:43):

So things with dark chocolate or the cocoa powder is a great way. Things with fruit, you’re cooking with fresh fruit that will help lower that blood sugar spike, will help prevent it impairing your gut lining and really kind of prevent those appetite regulation hormones and those cravings to take over being mindful about your sugar intake and carbohydrates for your blood sugar balance. So this is one thing that maintaining a stable blood sugar is really the biggest piece of this. It will help support healthy weight loss and maintenance, and it is really the key to stabilizing with stabilizing your blood sugar. This is where it can really help support a healthy weight in maintaining it. Long-term is just focusing on blood sugar balance. So this is where fiber filled carbohydrates are so important in making sure that you are consuming adequate fiber throughout the day so that you keep those blood sugar levels kind of in check.

(22:03):

That fiber helps slow the digestion down. Same with protein that can help slow that digestion down of carbohydrates and natural sugars. So anytime you are having sweets or higher carbohydrate meals, making sure there’s fiber included in it, make sure there’s protein included in it and some type of healthy fat and you might have to get creative. It might be that you throw on five or six olives to a meal that has a high carb number. There’s a lot of carbohydrates in a meal that you could kind of blunt that with some of those healthier fats and then making sure it’s full of vegetables to get that fiber in or you’re using a whole grain carbohydrate that has the fiber in it. Either way, you just want to make sure that you are preventing those big spikes and crashes. You also want to think about the liquid sugars.

(23:04):

So soft drinks, fruit juices, even the mixers and alcoholic beverages can all raise your blood sugar. And then if alcohol’s involved, then it’s going to definitely take you lower on your blood sugar numbers. So really being cognizant of what you are putting in your body and limiting that so that it doesn’t kind of get out of hand throughout the whole month of December. You could easily have that just from Halloween on. Could bring all that stuff back in with the sugars and the liquid sugars with soft drinks and coffee drinks and alcoholic drinks and fruit juices with mixers and all that stuff, easily bring it back in. You just have to get creative in doing maybe some sparkling water, some herbal teas, infused waters. All of those things can help prevent any blood sugar spike, but yet be tasty. So instead of drinking eight ounces of a juice, maybe you use one ounce and then you add sparkling water and cement leaves, or you do an ounce of juice with a green tea or just a chamomile tea or something and you add to top it off with a little sparkling water.

(24:28):

Little things like that can help limit the amount of sugars you’re getting and then prevent those blood sugar ups and downs. You definitely want to think about portion control, although I feel like most bariatric patients don’t have this issue. I do understand that at a genetic level, some people may, and that is okay if you still struggle with your hunger cues maybe being higher than what you expected after bariatric surgery. The key again is just making those three important things. The protein, the fat and the fiber, all of those things at every meal can really support healthy appetite regulation, healthy gut microbiome and healthy blood sugar levels. All of those can really help get you through the holidays when you focus to doing that at all of your meals. So when you’re building your plate, again, half of a protein and then the other half full of fiber colors and healthy fats is really the key.

(25:39):

Next thing to think about is just planning ahead. I mean, it’s easy to get out of sync with your routine and maybe meal prep or just cooking your meals in the evening. And it’s especially during this holiday season when you’re coming and going and you have lots of events that you should go see people and have fun. So plan ahead. If you’re going out to eat fine, you can still find protein, fiber, and fat at any restaurant. And my best tip is say you’re doing fast food. So do pick your protein. You want to get at least 30 grams of protein wherever you’re at. So you might have to get on the app or Google the restaurant and the nutrition facts for whatever food item or go to the restaurant and start searching what you like and then look at the facts of that meal and you want to get at least 30 grams of protein and then one carbohydrate.

(26:46):

So say it’s fast food and you want to have a burger. Have a burger and then you need to get a non carbohydrate side. So for some that might look like if you go to a Culver’s where they have broccoli or a cole slaw or maybe some restaurants you go to, you might have a potato salad instead. I would be fine with the potato salad only because it has resistant starch and it helps lower your blood sugar response and provides that resistant starch that enhances your gut microbiome. It produces short chain fatty acids. It really can help support a healthy gut. Again, pick one, maybe you do no bun, but then you do a cyto fries or you do fruit, however you can do it that you enjoy and find that balance that works for you if you want both. If you want, hey, I want a bun and I want the fries, okay, have them, but then go for a walk right after a 10 20 minute walk will help prevent that blood sugar spike and help lower that response.

(28:05):

So then your body is going to manage because you’re using up those sugars that you just consumed from the bun and the french fries. So being smart about how you are consuming these foods. I mean the big picture is you need to work with a dietitian to understand how many carbohydrates you need in a day or at each meal because you need some, the amount for each person is different based on your activity levels because some people need carbohydrates at all three meals because you are working out and you are building muscle and you are trying to recover those muscles. So again, don’t be afraid of the carbohydrates, just be smart about it and ask for advice. Find someone who can help give you insight into what works best for you.

(28:58):

Listen to your body when you are full. Learn to push away, process it and then determine five or 10 minutes later, do I need more? Do I want more? If you do have more, if you need more, don’t be afraid about having a second plate. If that’s what your body needs. Again, we’re all different and I don’t know what your activity activity level is or your health goals are and what all you’re working on. Sometimes you need more food than that initial plate may be provided. So again, it’s working with somebody that can really help break this down. And give you kind of a balanced approach that allows you to live your life, enjoy the foods you love and still be successful with weight loss and weight maintenance. I mean, I think that’s the key thing. And learning those hunger and appetite cues. So when you truly are full and to determine, okay, I physically can only eat this amount of food at a meal, but it’s not enough.

(30:08):

So that means I have to include snacks later so that again. That personalized attention needs to be developed with a registered dietitian to really help you understand. Your needs because you might not be losing weight because you are undereating. So it’s one of those things that you need someone. Kind of speaking into your life and helping you determine where your needs really are. So going through the holidays is no different. Listening to your body. You’re going to have so much food opportunity that you truly have to just learn to push away. And choose the things that you really want and move on. And just kind of know that it’s one day, it’s not every day and. Then the next day you just get right back on track and doing what you should be doing. The next is really just staying active and moving your body.

(31:14):

I mean, the more you move your body during the holiday season. The better chance you are at maintaining a normal weight throughout the whole holiday season. So just going for walks after meals. Trying to get some strength training with some weights as an amazing way. To use all the sugars that maybe you would be consuming from carbohydrates. Or the alcohols and the sweets and desserts that are available. Your muscle is your biggest consumer of glucose or sugar. And the more muscle you have, your body will continue to burn those calories at rest. So the more we can focus on increasing your muscle mass. The likelihood of you maintaining a healthy weight is there and. A healthy blood sugar balance and a healthy gut microbiome. It’s the whole package. It’s really just staying active and moving your bodies and moving your body and getting that muscle mass up.

(32:22):

And then lastly, don’t be afraid to ask for support. Get a buddy that you can kind of vent and. Talk through your feelings and talk through your plan. And just get a strategy with someone that you can feel confident in being vulnerable with. Because in the end you need that. You need someone who can be a sounding board. Who can maybe even have some tough conversations, give you some tough love when needed. You need those people in your life. So find your person, find your person that you can vent to If you’re like, oh my gosh. I want to eat pancakes and cookies and ice cream all day today. What is going on? So you have that support to say, you know what? It’s okay. Let’s go for a walk together. FaceTime, let’s do whatever so we can get you through and. Let’s talk through how can we maybe get some protein in instead. Before you have some of those foods and just talk you through it.

(33:29):

So get a support person that you truly can have those deep conversations. With that help get you through this a little faster. Because when you try to do it alone, things just go slower. When you do it together with other people, things just go way smoother and way faster. So seek that support. Don’t be afraid to ask for help. Hire a dietitian to help navigate through the holidays. To keep you accountable and making sure that you are one. Eating enough, two, getting adequate protein, fiber and healthy fats. We’re maintaining blood sugar stability.And you just have that accountability person. That can truly look through a different lens and support you on your journey. So let’s kind of wrap this up.

(34:24):

Navigating the holidays after bariatric surgery can be overwhelming in our thoughts, but truly it’s not. It can be so simple to just focus on a few key areas of one being mindful. Be present. Enjoy the food that you have. Don’t get too crazy on the alcohol. Make sure you’re protecting your gut by the protein foods. The polyphenols, the antioxidants, the phytonutrients, and just really supporting a healthy gut. Make sure you’re stabilizing your blood sugar at all your meals. So you have less opportunity for the spikes and. Valleys that can come because you’re not consuming enough protein or fiber or fat with your meals. And then be smart. Move your body. Try to keep active during this time. Keep your hydration in, check plan ahead. Listen to your body and seek support and find a buddy that you can be vulnerable

(35:36):

With to do the holiday season this last month of December. So I hope you guys have enjoyed this and hopefully. You’ve gotten some new tips to think about for implementing for the month of December. And excited to help any of you who are looking for someone to help give you that accountability and. Maybe dial in certain areas that you are struggling with to kind of help keep your weight in. Check during the holidays and keep that gut microbiome healthy and. No issues with gut integrity or shifting of your gut bacteria in a negative way. So I hope you guys had a fabulous. Thanksgiving and I hope that your December is just as awesome and reach out if you need anything. And you guys have a great week and we’ll see you next time. Bye-Bye.

The post 10 Holiday Tips To Protect A Bariatric Gut appeared first on Gastric Health.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, Registered Dietitian, and this week’s topic is on fermented food, the benefits for bariatric health. So this week I just really wanted to quickly cover some of the benefits of including fermented food in your diet. So I really like to, especially when I have someone who is struggling with digestive issues and we don’t really know what the driver is, I’d like to have them, especially if they’re not taking a probiotic. And this is an easy way to introduce those friendly gut bacteria that can really help support a lot of areas after bariatric surgery. I mean, it’s not a surprise really that digestive issues become a problem after Roux-en-y gastric bypass, sleeve gastrectomy, they’re very common to have digestive issues. Because of the nature of the surgery and how we are altering your anatomy, we are messing with your intestines that truly do impact your gut microbiome.

(01:27):

So adding fermented foods can help introduce those friendly bacteria so that you can kind of slowly do it and not have a lot of digestive upset. And then move into an actual probiotic is kind of how I like to do it. For some individuals, sometimes it’s the probiotic is first, but really to sustain long-term, to sustain your gut microbiome, you need fermented food. You need those good microbes coming into your daily diet. So if you have some digestive issues and we have the ability to kind of correct and resolve ’em and they’re no longer an issue, then adding the fermented food for some people, we’ll allow you to get away from taking a probiotic on a daily basis. For most, I would say for most bariatric patients, it’s going to be that you will probably need both. And you may find that’s the only way that you get the best support and that you can feel your best.

(02:46):

So what is fermentation and fermentation is just a naturally occurring process that involves breaking down food substances with the help of beneficial bacteria, yeast or even fungi. What happens is the microbes consume the sugars and other compounds in the food that results in the byproduct like organic acids, gases, and alcohol. And this process not only imparts kind of unique flavors, but it also preserves the food. So if you’ve listened to my podcast from the very beginning, I talked a lot about fermented food and how important it is and how it’s kind of a lost art in our today’s culture. And this is part of it. No one has fermentation crocs, or I shouldn’t say no one, but most of us don’t have fermentation crocs in our homes that we are continuously brewing some type of fermented food on a regular basis. And I remember in my grandparents’ basement them having crocs that they would ferment things in.

(04:04):

So again, it’s one of those things that we’ve just lost the art of, and with everything being so readily available that we really have little to do, to have access to food, whether it be really super nourishing or not, the food is there. So it’s one of those things that we know longer use those practices because someone else has done it for us. But what some of the benefits of fermentation are is that it enriches the food with the probiotics and digestive enzymes that can really support a healthy body after bariatric surgery. So just a few quick things, probiotics, these are the beneficial bacteria introduced or generated during fermentation. So these are the beneficial or the good bacteria that the byproducts from this setting, this food product out to ferment with some salt and water for like a sauerkraut, something so simple, there’s really nothing to it, and it produces these naturally occurring microbes that are already on the food.

(05:34):

And then enzymes, these are the proteins that kind of speed up the chemical reactions aiding in digestion and then preservation. The acidic or alcoholic environment created by fermentation kind of deters the spoilage so it deters the ability for the bad microbes to be taken over that food product. So let’s talk about some of the bariatric benefits of fermented food. One is gut health, and we all understand that bariatric surgery does disrupt this balance of bacteria in the gut. And fermented food can really help restore this balance, which is really essential for overall digestive health and can prevent issues like gas and bloating and irregular bowel movements. And the probiotics that are found in fermented food contribute to the big ecosystem that aids in digestion and nutrient absorption. Additionally, they also outcompete the harmful bacteria helping to maintain a balanced gut microbiome. So the more opportunities that you’re introducing these fermented foods into your diet regularly, and for me, I recommend at least once a day and I challenge you to go beyond yogurt as it’s great a great option and we’ll kind of go through some of these options shortly.

(07:08):

But I, tapping into the other type of microbes will give you a more balanced approach to keeping fermented foods and balancing out your gut. But essentially, if you really just continue to put these microbes in on a daily basis at least one time per day, that truly can make a huge difference with supporting a healthy gut microbiome after bariatric surgery. The next one is it aids in digestion, and this is because of the enzymes that this produces with the fermentation. So when you are fermenting foods, then it has the byproduct that is produced is all of these digestive enzymes, which can be super helpful in assisting you to break down food naturally with using this on a regular basis. And because you have altered digestion after bariatric surgery, these enzymes that the fermented foods produce can kind of ease the process and improve nutrient absorption and kind of reduce digestive discomfort.

(08:33):

The next one is immune support, and 70 to 80% of our immune system resides in our gut. And by enhancing your gut health with probiotics can play really a crucial role in fortifying your immune system. And several studies have shown that a healthy gut microbiome can help fend off pathogens and reduce the frequency of infections. So again, something so simple as one time a day, making sure that you’re consuming some type of fermented food is just a simple way to keep you healthier during the cold and flu season as well as throughout the year. It just ramps up that natural ability for your immune system to support your health better. The next one is anti-inflammatory properties. So not something that you really think about when it comes to fermented foods, but they do have properties that can help calm down inflammation that you could be experiencing any way that you can improve your body’s response to inflammation.

(09:50):

To me, it seems like a no-brainer because it’s easy for any person to get in a state where they have this low grade inflammation and sometimes during certain seasons of your life, like in menopause that you inflammatory response goes up naturally. That’s just part of the process with that estrogen and progesterone dropping and it creates this environment that inflammation is now at the core brewing and kind of spinning off all of these other problems that can occur because of inflammation. So again, including fermented foods is a great way to help keep inflammation kind of chilled out. Not all inflammation is going to be resolved with just eating a few fork fulls of fermented sauerkraut and a few containers of yogurt. That’s not going to solve your problem. Sometimes inflammation needs some higher hitting things, but think of it this way, if you’ve had bariatric surgery and you start incorporating these things early on, it can really help set the scene because the inflammation is all chilled out with bariatric surgery.

(11:16):

So the key is to keep that and to help keep that balance long-term, and that’s where the fermented foods really do come in to help support you and prevent that returning of the inflammation. So again, just a simple way to help calm out an inflammatory response. Another one is blood sugar regulation. And this is something that we see a lot with bariatric patients is bariatric surgery truly does magic in the world of blood sugar and it happens before you’ve even lost any weight. So we see as soon as the surgery is done with you’re still in the hospital, we see blood sugars for a lot, not a hundred percent of you, but for a lot of you become immediately normalized and no longer need insulin, no longer need metformin, no longer need these aids to help maintain a stable blood sugar. And again, you haven’t lost any weight.

(12:31):

So we know that there is a connection with your gut microbiome and the surgery that helps this occur. So we know that fermented food also plays a role because of the microbes that they provide. Those bacterias and fungi and yeast that are naturally occurring in the food products from this fermentation process, it really helps stabilize your blood sugar long-term. And I did a podcast and a blog post. You can go to gastric health.com and probably just type in blood sugar. And I did a whole post on this and it’s titled Why Bariatric Patients Should Care about Blood Sugar. And in this I talk about a study that shows it brought all the studies together explaining that blood sugar regulation is super improved immediately after surgery, but then as they reevaluate at year one and year five, the incidence of returning is it does become significant.

(13:50):

So they did find it year one for the Roux-en-y gastric bypass. It was 8.4% had a return of their diabetes and 11% for the sleeve gastrectomy. And then after five years, they found that 33% of the run white gastric bypass patients and 41% of the sleeve gastrectomy patients had a recurrence of their diabetes returning. So again, one of those things that you have to consider that it’s not magically gone forever if you’re not actively preventing it. This to me is a simple way to help support that is by adding the fermented food because you can help stabilize your blood sugar better by incorporating some type of fermented food on a daily basis. And the last one is mood enhancement. And we do know that there is a gut brain communication and we know that things that are occurring in your gut, occurring in your brain.

(15:01):

So if your gut is a mess, then you could have some brain inflammation which can really impact your mood. Anxiety, depression, all of that stuff is it really is driven out of having a gut dysbiosis or really just having bad gut health. Additionally, we know that the gut microbiome can impact neurotransmitters like dopamine and serotonin and really impact those mood regulating hormones and just incorporating and keeping that gut healthy can really help support your mood in a positive way. So let’s talk about the different types of fermented food. So what qualifies a food to be considered as fermented? Because you have to think about in this instance that you want these bacteria to be alive. You want them living. So say you look at a yogurt and it says No live cultures, you would want to put it back because you want it to have those lactobacillus species and it’ll have probably some bacillus or bifidobacteria species as well, but definitely the lactobacillus species, a bee, a dominant one in the yogurts and then kimchi.

(16:28):

So kimchi is just kind of a traditional Korean dish that’s made from fermented vegetables, mostly cabbage. They’ll use the Chinese cabbage with a bunch of different spices and seasonings and really turns into a little bit of a kick. A little spice with it is usually included, so it is tasty, it has a different unique flavor, but it is great to add to dishes to kind of enhance the flavor, but then also you get the byproduct of supporting your gut microbiome because of all the healthy good bacteria that are going to be alive in the kimchi. The next one is sauerkraut. So this one gets a little bit tricky because you can buy sauerkraut on the shelves and you can buy it in bags up by the deli. I want to tell you that none of those types of sauerkraut are fermented. They have vinegar in ’em, and you’re not looking for vinegar in any type of sauerkraut when it comes to fermentation.

(17:36):

So truly when you are fermenting sauerkraut, it is you are taking cabbage, you’re chopping up a whole head of cabbage into just fine textures. You can use a mandolin, but it is chopping it up and then you’re adding about one and a half tablespoons of salt, and what you’re doing is you’re just crushing the salt into the cabbage and the water then separates and comes out of the cabbage and then you put it in this jar. Now, when I do it at home, I would actually just kind of with my fist take the cabbage and pound down the cabbage in the jar and I would have a wide mouth jar that I could kind of punch it down and squish it down in there and the water would release. And then you put the whole head in this 32 ounce jar and you get the whole head in there and you just adding salt as you go, you’re adding salt, squishing it down, adding some more cabbage, then you add some more salt, and you just kind of do that until the whole head is in this jar.

(18:45):

And then there should be a little layer of water it comes to the top. Now usually I have to put a small jar with water in it and as a weight, and I just put that in the top of this jar and then put a coffee filter over top and put just a rubber band around the top to keep it sealed. And then you just let it sit out on the counter for a week, sometimes two weeks, depending on you just check as the days go by and you just watch it, you’ll start seeing bubbles rise to the top, and that’s showing you that the bacteria from the cabbage and that salt and water combo is allowing and creating that environment for those microbes to flourish. And so that is the type of fermented sauerkraut you’re looking for. So you will only find that pre-made in the coolers.

(19:46):

So if you don’t have an interest in making it for yourself, which there’s absolutely nothing wrong with that, but you would want to look in the coolers at your local grocery stores. Bubbies is a brand that I’ve used. Wild Brine is another one that’s pretty nationwide. I would say they’re shipped nationwide. That would be an option you could probably find in maybe a health food store if your area is more of like a food desert. So you might have to travel a little bit if you don’t have health food type stores that offer supplementation and stuff. So it just depends in your area. You can always ask your grocer if they can carry it, if they know you’re going to buy it, they can get it in. So if you’ve never had that available, talk to your grocer and see if they can get some in so you can have it available.

(20:43):

But again, that sauerkraut super simple, and I will tell you it’s great to use the liquid once all the cabbage you’ve eaten. All the cabbage, you can use the liquid to make salad dressings or other sauces. The key is though you’re not heating it, you wouldn’t want to put this with sausage like a traditional German dish where you’re putting it with some sausage and sauerkraut. You don’t want to heat it. You want this to be cold and chilled because the heat will kill those bacteria species and prevent you from getting the benefits of it. Then the yogurt, we’ve talked about that. The next one is kefir. So kefir is, think of it like a liquid yogurt and. It has 12 to 14 different strains and species of bacteria. And I tell my patients to just do little shots of it. Get like one of those kids’ medicine cups and do a shot of kier.

(21:44):

It’s a great way to get started with adding a whole bunch of good bacteria. Into your digestive tract if you’ve only just done yogurt. Because yogurt doesn’t have that many different species. Whereas Kifer does. It has a great way to add a whole bunch of bacteria into your digestive tract and give you the benefits. Tempe is another thing, it’s just a fermented soy product and is a complete protein. So something to consider if you’re also needing to boost your protein intake. Another one is miso paste. It’s really just a Japanese seasoning made from fermented soybeans and you can add it. They add it to soups and things. But you could add it to other vegetables as you’re cooking a great way. Again, to get that fermentation from something so simple. The next one is kombucha. My favorite and something I like to drink. It’s a fizzy drink, but it is made by fermenting. Sweetened tea with kind of this scoby is what it’s called.

(22:51):

A symbiotic culture of bacteria in yeast is what a SCOBY stands for. And it’s something that does have a little effervescent fizz to it. But not powerful in any way, but it is something that is super tasty. You just have to pay attention to the grams of sugar. Because some companies will add a lot of sugar after the fermentation process. There is sugar for it to ferment. But then the bacteria in the yeast actually consume that sugar to thrive and grow. And then if the manufacturers are adding additional sugars, then that’s what you want to avoid. You want to keep it to where the sugars are eight or less is. What I typically find 10 or less grams for sure. When you get into above 10, they’re adding sugar. They’re adding sugar after the fermentation process. And then the last one is pickles. So you can ferment pickles in really any vegetables on the counter, just like sauerkraut.

(23:57):

So you could do pickles, you could even do carrots, you could do beets. You could pickle them in a fermentation style. So there’s lots of options when it comes to that. And it’s literally just the brine water, salt and spices, and that allows it to ferment on the counter. So again, and if you check out the blog posts, there are a couple of recipes. The Greek yogurt veggie dip, and then we also did a kombucha vinegarette.Where we have that for you to consider. But just some simple ways for you to get some additional fermented foods in your diet regularly. So let’s wrap this up. I know this was a quick topic, but I really just wanted to keep this simple and keep it. So you have some thoughts when you’re at the grocery store of, okay. I’m going to challenge myself. How can I get fermented foods in my diet regularly?

(24:58):

Again, one time a day is efficient. And it is a great way for bariatric patients to keep that gut microbiome healthy. It’s a great way to keep those friendly bacteria winning inside. Your gut where you have adequate numbers of the good guys as you continue to consume those fermented foods. You’re adding to that army. So when any bad guy comes along that you get exposed to. Then your body’s able to fight it off because. You have enough of the good guys in your environment to fight all the bad guys. So it really prevents a lot of negative things that can occur when you have an imbalance in your gut. Just simple ways by adding kefir, kombucha, yogurts, sauerkraut, kimchi, any of these, you’re never going to go wrong. So I would say this week’s topic of fermented foods for bariatric health. My challenge to you is at the grocery. Find one fermented food that you’re willing to try and go through the list until you’ve tried them all. Especially if you’ve never done it. If you’ve never had some of these. Go through the list and try them and. Just have fun experimenting with different flavors of kombucha or different recipes. With the miso paste or kefir. How can I add this into my smoothies or maybe already into my yogurt or some type of oatmeal.

(26:42):

Just simple ways so that it’s really keeping this piece simple. And it’s providing all of those beneficial gut microbes. That can make a huge difference in your digestion and your immunity and. Your blood sugar and all of those benefits that you want to stay on top of. So I hope this has helped, and you guys have a great week and we’ll see you next time. Bye-Bye.

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The post Fermented Food, benefits for bariatric health appeared first on Gastric Health.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, Registered Dietitian, and this week’s topic is Postbiotics, the benefits of butyrate for Obesity. So we’re going to dig into this topic because I would say when I first started really researching probiotics and gut health and just really understanding and learning all about this gut microbiome, this, we didn’t understand this, we did not understand the benefits of postbiotics.

(00:41):

But in general, I think this is a great topic to kind of explore. So as you are diving into making informed choices about probiotics, this is something to consider. So let’s get started. We all know that obesity is more than just a calories in, calories out problem. It is a metabolic problem that is complex and it takes a combination of things and strategies and approaches to really align everything for an individual and what aligned for one may not align for another.

(01:22):

So what I’m saying is just because your friend did great on a certain diet and exercise routine and taking a specific probiotic or taking a supplement or a medication doesn’t guarantee you will get the same results. We have shown in studies that postbiotics, especially butyrate, and we’ll get into the details of the different types of postbiotics, which is a short chain fatty acid, can help in preventing obesity. We’re going to kind of explore postbiotics more specifically butyrate, the short chain fatty acid butyrate and how they can counter obesity. So what is postbiotics? We know that our digestive system is home to trillions of microorganisms, bacteria, viruses, fungi, yeast, and archaea. All of these have resident in our gut and throughout our body and have the ability to impact our health positively or negatively. They interact with our immune system, they consume and produce nutrients.

(02:47):

And when bacteria break down, some of those molecules are released, which others remain bound to the bacteria. And these molecules known as postbiotics can actually be helpful for us and they influence our body’s activities and functions in a good way. So a simple way to think of this is that postbiotics are the helpful leftovers from the activities of all these microorganisms. They include a range of substances like short chain fatty acids, peptides, enzymes, and vitamins, and butyrate in particularly, is a powerful short chain fatty acid post biotic that helps maintain your gut health and influences several physiological processes in your body that help in contributing to obesity.

(03:43):

So let’s dig into short-chain fatty acids. And I know I have spoken on short-chain fatty acids frequently, but I’ll kind of recap if you’re new and make sure that you have a full understanding. But short-chain fatty acids are the byproducts of what your gut produces after they consume the non-digestible carbohydrates or so. When you consume fiber filled carbohydrates, the gut bacteria consume all that and they spit out this short chain fatty acid of butyrate, which is a post biotic. The most prominent short chain fatty acids are

(04:27):

Acetate, propionate and butyrate. These compounds are known for their abundance in both the plasma and the intestines. However, butyrate and propionate rather than acetate, are reported to have significant obesity fighting effects. And one way that this occurs is through appetite regulation. So butyrate and propionate have the ability to stimulate gut hormones and reduce your food intake. And several studies have shown that short chain fatty acids help curb overeating by influencing hormones such as leptin, which signals fullness.

(05:07):

Additionally, butyrate and propionate also inhibit fat storage. They can reduce the absorption of dietary fat and downregulate fatty acid synthesis in the liver, which hinders fat creation and then acetate facilitates fat sense of this. So it’s all about having an appropriate balance between all three of these short-chain fatty acids. Now, the short-chain fatty acids also influence blood sugar regulation and your fat cells. So butyrate is associated with genes that control gluconeogenesis, which is what regulates blood glucose levels.

(05:49):

And these postbiotics may activate the intestinal gluconeogenesis through a of different mechanisms that can lead to a rejection in body weight and adiposity. One study looked at the role of postbiotics in diet induced metabolic disorders. And according to this study, butyrate improves insulin sensitivity and glucose metabolism. However, it is unclear whether butyrate can reduce glucose levels in patients with metabolic syndrome therapeutically. So we don’t really know if just giving someone like a butyrate supplement or a post biotic supplement with butyrate using majority of butyrate and propionate if that would truly influence in humans.

(06:47):

Now we also have to think about thermogenesis with short-chain fatty acids. So to kind of explain this, we have a few different types of fat tissues in our bodies. The two main types are the white adipose tissue and the brown adipose tissue. The white tissue stores excess energy as fat, and then the brown helps burn the energy to keep us warm, and it’s kind of our body’s natural way of staying lean.

(07:17):

There’s also a third type called the beige fat, which can develop in response to certain triggers and act like the brown adipose tissue, so more in benefit and burning fat. Some recent studies have shown that the potential of acetate to enhance the activity of the brown adipose tissue or promote browning of the white adipose tissue in animal models. So we don’t have the evidence yet in humans, but they are finding that acetate can enhance this brown adipose tissue in helping and burn burning of the fat cells.

(08:03):

As a result, short-chain fatty acids may promote thermogenesis, which is essential to weight management. Additionally, there is another study where they use Clostridium, a microorganism that produces butyrate and it was found to be beneficial for treating obesity and other diseases. And according to the study, this certain form of Clostridium strain alleviated obesity by increasing energy expenditure and activating the thermogenic genes in the brown adipose tissue.

(08:38):

So let’s talk about the gut microbiome connection, right? Because the balance of all of these bacteria and Fila in the gut are really the vital part in you producing short chain fatty acids. And we know that the more diverse of bacteria that you have in your gut, the healthier your gut is and the more normal weight you are. So we know that you have fewer species and strains with obesity. So our goal is to have a variety of microorganisms and a good number of each of them so that it is robust and you have strength in diversity.

(09:46):

We know that bacteroidetes are known to produce acetate and propionate while the firmicutes are associated with the butyrate production. We know that butyrate as a postbiotic plays a crucial role in kind of shaping that whole gut microbiome and it fuels the colon cells and promotes the growth of beneficial gut bacteria.

(09:59):

And this balance between the good and the bad gut bacteria is essential for maintaining a healthy metabolism. So what are the anti-obesity effects of butyrate? 1. Appetite regulation. 2. Fat storage inhibition. 3. Gut barrier integrity. 4. Improved insulin sensitivity. 5. Inflammation reduction. 6. balanced immune response.

(10:29):

And 7. Metabolic health enhancements. So with appetite regulation, we know that butyrate stimulates the release of those appetite regulating hormones like leptin and helps us feel full faster. So as long as you’re consuming those fiber field carbohydrates feeding your gut microbiome, they will produce this byproduct of butyrate that is a post biotic. And then when it comes to the fat storage, it will limit the fat accumulation in your adipose tissue, and butyrate can reduce the absorption of dietary fat. So it is a part, think of it this way, your gut bacteria can influence how many calories you absorb from food, which is why having adequate amounts of short chain fatty acids is important to your metabolic health and your overall weight.

(11:33):

Now, when it comes to your gut barrier integrity, so think of that gut lining and how we need that to be strong so you don’t get leaky gut. That is one thing that butyrate does. It strengthens and keeps that intestinal lining strong and robust and preventing things from slipping through that we don’t want to get into our bloodstream because then our body gets confused and thinks that it’s a foreign substance that maybe we should attack.

(12:09):

So it’s important to make sure that if you want to prevent having autoimmune issues, then this is part of it. Fueling your body with fiber field carbohydrates is super important. It is one piece of this puzzle that maintains your overall health. Now, when it comes to insulin sensitivity, butyrate helps reduce insulin resistance and type two diabetes by improving and making you more insulin sensitive, which is good. And that is we want our bodies to quickly shuttle the sugar from your blood into the cells so it can energize your life and make you feel great and keep your blood glucose numbers in check.

(13:04):

But when insulin is bombarded and it has too much sugar, it becomes resistant to unlocking those cells and shuttling the sugar into the cells. So now it remains in your bloodstream. Then your body thinks, oh, we have too much sugar, we need more insulin. And now it’s no longer capable of doing its job. It’s resistant to unlocking the cells, and it kind of shuts off that ability to tap into your fat stores.

(13:38):

So if your insulin levels are too high, then guess what? You are not going to be tapping into your fat cells to burn and allowing you to lose weight if needed because your insulin is blocking that, your insulin prevents that from occurring. Then we think of short chain fatty acids and reducing inflammation, which is totally correlated with obesity and just your overall body weight. So low grade chronic inflammation is directly associated with obesity, and this is something that kind of goes together.

(14:20):

So as you transition to maintaining a healthy weight, it has to include those fiber filled carbohydrates. Because of this, your gut bacteria need this fuel source, these non-digestible fibers for it to fuel off of and to be strong and robust without them, they start breaking down your mucus layer, which is protective, and it then takes your proteins and fats that you consume in your diet and converts those to fuel off of. And the negative is when you do that, it creates the wrong environment and it produces an environment that is correlating with disease.

(15:12):

So it is the wrong fuel source. It’s kind of like if you had a Ferrari, would you put 87 octane in it? No, you wouldn’t. So again, it’s understanding how your body works and understanding this concept of you know what? I have to be able to fuel my body appropriately and I have to feed these microorganisms and they all work together, and if I don’t give it the right fuel source and I’m eliminating a whole food group, then I’m missing out on this property long-term.

(15:50):

You have to think about the connection with your immune response. When it comes to short chain fatty acids, butyrate is known to play a role in regulating the immune system. And it’s important for obesity prevention because chronic inflammation and metabolic dysfunction can result from an imbalanced immune response. And then the last one is your metabolic health enhancement. So butyrate helps prevent harmful substances from entering the bloodstream through the gut barrier, just as I kind of described. And it can have a positive effect on your metabolic health, the stronger that gut integrity is.

(16:31):

Researchers have demonstrated that postbiotics are beneficial for managing metabolic disorders through several effects. This is anti-inflammatory properties. They’re antibacterial immune modulatory, anticarcinogenic, they’re an antioxidant and hypocholesterolemia. All of these effects enhance both the immune system and improve your intestinal barrier by acting directly on the intestinal epithelium as well as various organs and tissues.

(17:05):

So you can see that the big picture of metabolic health, which translates to having a healthy weight or struggling with overweight or obesity, it’s the package deal. We can’t leave out this piece because let’s say even if you went on a strict calorie deficit diet and you were not consuming many calories, whether you just did this yourself or you did it with a medication, or you did it with surgery or whatever way you did this,

(17:45):

That you suppressed your chloric intake, you lost the weight, you lost a significant amount of weight, but yet you weren’t fueling your body with these fiber filled carbohydrates. So what happens when you change what you’re doing with your caloric intake or as that increases? What changes? It’s highly likely that you can regain this weight because we missed this piece of fueling or taking care of these microorganisms and fueling them appropriately.

(18:24):

So while butyrate is a promising post biotic to help against obesity, it is essential to remember there’s no magic bullet. And when it comes to weight management, you can’t just pop a post biotic supplement or a specifically one that says butyrate and expect the pounds to just melt away. That does not exist. So again, you have to frame this in the right way. It’s the package deal. So are there ways that we can get your body back in alignment so that it can do the things you’re supposed to do? Absolutely. It’s a process and none of that happens in a month, and none of that happens in three months. It’ll likely take 12 months to rebuild recondition, repair, repopulate that whole environment. So it’s a long play. When you are utilizing these strategies that I provide most of them, it’s one puzzle piece, and you got to put all these puzzle pieces together so that it adds up to the big picture of maintaining a healthy weight.

(19:48):

And that’s where you have to, you just start going. You just start rolling through and adding and adding and adding until you get everything in alignment so that now your body is efficient, it is fueling, it is receiving everything that it needs. So now your metabolism is strong. Your metabolism is capable of having and caring for a robust immune system, a healthy weight, and just overall healthy life because everything’s in alignment, if that makes sense. So when it comes to postbiotics like butyrate, it works best when complimented by supporting your whole gut health.

(20:40):

So this approach should incorporate a balanced diet that is full of prebiotic fibers. Think of the fiber field, carbohydrates, probiotic, rich foods, and postbiotics. So it’s a combination of all of these things. So prebiotics, probiotics, postbiotics do not compete with each other in any way. Instead, they actually worked harmoniously and kind of provide you the whole picture for having a healthy metabolism.

(21:13):

So when it comes to prebiotics, you can think of foods that contain fiber that are found in fruits, vegetables and whole grains. Probiotics, these are beneficial microorganisms. So these are live bacteria and they can come from food and from supplements. And then the postbiotics, they are a byproduct of your short-chain fatty acids, butyrate and propionate producing these postbiotics from consuming those fiber filled carbohydrates and those prebiotics. So essentially it’s a teamwork approach and each playing a different role in maintaining your overall health and preventing obesity.

(22:03):

Prebiotics, fuel the good bacteria, probiotics, balance the gut microbiome and postbiotics are the silent mediators of your metabolic health. So let’s wrap this up. This relationship between the prebiotic butyrate and its anti-obesity effects is really being uncovered in research. And they are showing that having this property of postbiotics, whether it is created naturally from the short chain fatty acid production because you’re consuming fiber filled carbohydrates or you are consuming a butyrate supplement, they are finding benefit with this and they’re finding that it can help support a healthy metabolism and help in preventing metabolic diseases. But remember, just taking a pill is not going to solve all the problems.

(23:05):

They work in synergy with your other probiotics and prebiotics to round it all out to make them work efficiently. So taking one without adding the others is not going to provide the same benefit as just taking a post biotic. So hopefully all of this makes sense and you have enjoyed learning about postbiotics, that powerful butyrate and propionate that really do have anti-obesity effects and can help benefit you long-term. And I’ll say

(23:45):

I occasionally do use butyrate supplements with some of my clients, and I definitely use probiotics. And our gastric health line has some really great options with our ultimate Gut Restore probably being our most popular. And then the WLS formulated probiotic is also a second best because it is just a lower dose. But have had great results for a number of years using this product on thousands of people. So again, I think A, it’s a no-brainer. And the more that you can dial in your diet to include adequate amounts of prebiotic fibers. With taking a probiotic and then allowing your body to create those postbiotics naturally, or you take a probiotic and you take a butyrate supplement and you combine that with consuming prebiotic fibers and it’s kind of the magic combo to make sure you have it all available so that your body can optimize your metabolic health. So I hope you enjoyed this topic on Postbiotics and hope you guys have a great week, and we will see you next time. bye-bye.

Listen, Learn, Enjoy

The post Postbiotics: Benefits of Butyrate for Obesity appeared first on Gastric Health.

To learn more about the importance of Vitamin B1 after gastric bypass & sleeve, check out our audio transcript.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxall, Registered Dietitian. Today we are going to dive into the topic of vitamin B1, the importance of vitamin B1 after gastric bypass and sleeve. And we are going to kind of get to the minute details of why it matters after you’ve had bariatric surgery and how it impacts really a big piece of your health after weight loss surgery. So a lot of people are familiar with vitamin B12, but not a lot on vitamin B1. And I’ll say while doing bariatric surgery or being involved in bariatric surgery since 1995 in some way, shape or form, it has been an interesting experience. And I will say way before the surgeons I worked with were doing ruin y gastric bypass, we were not doing that. We were already seeing vitamin deficiencies without even bypassing the part of your intestines where you absorb nutrients, where you absorb all the vitamins and minerals.

(01:29):

So we were already seen those come to life and already was addressing this piece way back in the mid to late nineties and making sure that our patients were receiving adequate vitamin B1 and a huge difference when we implemented this and just making sure that you get an adequate amount and we were really aggressive, probably too aggressive with the milligram dosage, but it did make a huge difference when we did implement that. So let’s get into the basics. The foundation of vitamin B1, vitamin B1, it’s also called thiamine. Some people call it thiamine. So however you have heard it, vitamin B1 is thiamine and it is one of the B vitamins in the complex family and it is involved in converting food into energy. So it is playing a role in just like vitamin B 12 in how well you feel energized.

(02:49):

It plays a role just not as significant in the energy category, maybe as much as vitamin B 12, but it performs a lot of functions in your body. So it plays a role in your metabolism, your nerve function, your brain health, and like all B vitamins, it is water-soluble and it has to be replenished through your diet or supplements. So your body does not make this vitamin. You have to be diligent about getting, and I’m going to go through some areas that can rob your vitamin B1. So maybe you are even consuming adequate amounts of vitamin B1 in your diet and in your multivitamin, or maybe you’re even taking a B-vitamin or B complex, you’re like, I’m good, I’ve got adequate amounts, I’m hitting the numbers that it has been recommended, but yet you have some symptoms. You can identify some of these symptoms that are showing you have a deficiency.

(03:56):

So this is where testing is so important in making sure that you are getting and absorbing what your body is actually needing. This is where working with your bariatric team, working with a skilled practitioner who understands the interpretation and the actual lab to order. If your bariatric team should be drawing a whole blood thiamine and it should not say vitamin B1, it would say whole blood thiamine. So make sure that they are testing the right one. And even I know there are some really great family doctors and who are super open to managing the nutrition piece after weight loss surgery and that’s amazing, but not all of them are, and some of them just don’t have the experience, so they may not understand the interpretation of how to look at it. So again, making sure that the right blood test is drawn will give you a better picture of your true status of your actual B1.

(05:13):

So keep in mind, having gastric bypass or sleeve surgery does just put you at a higher risk. We are altering your anatomy, we are altering your ability to digest and absorb nutrition. So this matters. This makes a difference on the outcome of what is available for your body to use. And I know that you may be thinking, okay, how would a sleeve, how would that impact? And with a sleeve, you have to think about the lower amount of stomach acid that you would be having. That in essence really impacts the big picture of how it’s actually available to absorb. So because you’re not without adequate stomach acid, you’re not going to be able to break down the food to appropriate molecules and to be delivered appropriately, if that makes sense. So again, staying on top of this actual level and testing your blood annually as a bariatric patient is key.

(06:26):

So vitamin B1, it plays a central role in the production of your mitochondrial ATP, which is kind of the powerhouse. The mitochondria are the powerhouse of energy. So you want this little piece. All of these vitamins and minerals, micronutrients and phytochemicals have a role and without them your body will be lacking and they are learning more and more about the mitochondria and how important it truly is. And in a lot of chronic disease states, the mitochondria have been impacted. So we know that vitamin B1 plays a role in the production of mitochondrial ATP, which is your energy, and this is why you want to make sure you are getting optimal amounts. It is also essential in rate limiting co-factor in many processes, particularly at the entry points of the glucose fatty acid and amino acid pathways. So it’s impacting fats or carbohydrates, fats and proteins.

(07:42):

So all of these are energy, the food, the energy from our food sources are going to be impacted because B1 plays a role in this process. So it plays a role in fueling the body by converting the food into energy and then also maintaining your proper nervous system function and generating DNA and RNA gastric bypass and gastric sleeve patients because of your anatomy being altered. Again, this is impacting nutrient absorption. This is where you have to be diligent about intake and monitoring. So those are the two pieces. Doing your part with the food, doing your part with the supplements, and then doing your part with getting those annual blood draws. That’s the biggest thing for prevention and protection. So that’s how you prevent problems that I’m about to cover. The consequences, the risks, the symptoms, all those things that come with having a vitamin B1 because of bariatric surgery.

(08:59):

Now I will say probably 20, the 2016 or 2019 A-S-M-B-S guidelines for nutrition. I can’t remember which year it was that they came out and it was like someone had dug into the B1 thiam and the whole document was just massive on the amount of information on vitamin B1 thiamine. It was a huge difference from the previous guidelines and it really made an impact in how programs were addressing this. And I know that if we have a patient that is coming in with dehydration and they just need IV fluids, they would get a banana bag and it has B1 thiamin in it. So that is something that’s super important to make sure when you’re rehydrating that you are getting the vitamin B1 as well. But again, this is where it began to be questioned. Are bariatric patients getting enough? And it was in that timeframe when the AS SMBS guidelines for nutrition came out.

(10:24):

Again, I don’t remember the exact year, I want to say 2016 was maybe the first time that it really blew up and made a significant impact on the document, on how they were reporting about it. Prior to that, it had very little recognition and in all honesty, it was very interesting. At the center that I worked at, it was already a priority to us. We were already utilizing high doses of this on all of our patients. Didn’t matter which surgery you had because interestingly enough, so we did lap bands and so the adjustable bands were done, we phased those out. We didn’t see the success with them, but we did see B1 thiamine deficiencies with even the adjustable band. So again, if you’ve had a band or history of having a band and then maybe you’ve had some revisions from that, making sure that you are still monitoring and getting adequate intake is super important.

(11:36):

So again, B1, it turned the corner and kind of exploded in the bariatric world, it seemed 2016, 2019, don’t quote me on the year, but I do remember all of the dieticians in the office. We were like, wow, what happened with B1 Thim and why are they all just now coming to this conclusion? How important it’s, and we’re like, we’ve been used to this for 15, 20 years already. So it was just interesting. It was interesting. But nevertheless, several studies have shown that post-surgery patients are at risk for thiamine deficiency despite supplementation. So again, like I said earlier, just because you take a supplement does not guarantee that your body is capable of utilizing all of that. Some individuals may need additional support, which is one that I would say probably is not as familiar in the conventional world. So I would tend to, if I have somebody who’s really struggling with their vitamin B1, we just try an over the counter thiamine and it really doesn’t go anywhere.

(12:55):

I would be recommending the Benfotiamine and this is a fat soluble form of thiamine and it is going to be better absorbed than the water soluble. But I’ll get into more details of that in a little bit. I have some studies on that as well. But in order to maintain optimal vitamin B1 patients and their bariatric team should recognize the importance of the symptoms and what can help maintain an optimal level. I would love to say that we could give a dose for every single person, which honestly is what we would do. Everyone had the same dose, but we would adjust it, or at least I did as a dietician when I would be evaluating blood work, I’d be like, okay, this person’s B1 is high, there’s no need to be at this a hundred milligrams, we need to drop it, so let’s drop it down to 50 or 25.

(13:52):

Let’s go a little lower because they obviously are getting more in their diet and absorbing it well. So optimizing that and personalizing it is what I would say. So making sure that you are being guided by that lab draw. And I will say this is a plug of getting your annual labs drawn, and I would say this is probably the hardest thing for bariatric patients is continuing that care, that level of care that you truly need because your anatomy is no longer the same and it’s permanent for life. So you’ll always need these annual labs drawn nutrition labs that no family doctor is routinely checking. So at most I have seen B 12 and vitamin D on more primary

(14:50):

Care doctor lab draws, which is awesome because they have really solid standing with people. But for a bariatric patient, that list grows. So your nutrition indicators grow. You have a whole list of vitamins that should be checked because bariatric surgery is in the business of malnutrition. So we are altering how you absorb nutrition. So this is why I’m putting that plug in for making sure that you get those annual labs drawn. Don’t skip it, don’t wait five years or don’t get it your first year and then never again invest in yourself because these foundational things, so whether you realize it or not, vitamins and minerals, phytonutrients, polyphenols, antioxidants, all of these things is what protects us from diseases. And if we are not absorbing well because of bariatric surgery, then you are at risk for more chronic diseases. So it’s just another little push schedule that appointment, get those labs drawn, and you will have the ability to keep yourself in a prevention mode, keep yourself out of the doctor and out of the hospital more.

(16:15):

So let’s talk about vitamin B1 deficiency symptoms. What would someone experience if they are having an actual vitamin B1 deficiency? So one is fatigue and weakness. Vitamin B1 can lead to fatigue like we talked about your mitochondrial ATP. So this is your powerhouse of energy. This is where all of your energy is derived from. So if you feel tired and weak all the time, then again, if you haven’t had your whole blood thiamine drawn, this is where you need to make sure you’re checking them. Number two is nerve damage. So this one gets confusing for bariatric patients who also have diabetes. So a lot of those patients will say, oh, I have some nerve damage from my diabetes, which may be very true, but if I have someone who wasn’t experiencing it and now they are experiencing it after bariatric surgery, I am going to make sure that that whole blood thiamine is within optimal ranges and making sure we’re covering all the bases to make sure that hey, thiamine is not the problem here.

(17:36):

So that’s in essence really though, and you’ll see in a minute that B1 thiamine actually plays a role in glucose metabolism. It does impact your blood sugar and helping it perform optimally. So if you have some nerve damage, these are things like numbness, tingling, even pain, so particularly on your hands and your feet, but this is where you have to kind of know how you’re doing with your diabetes. If you’ve been diagnosed with diabetes, you always have diabetes, but it’s either in remission or not. So staying on top of this lab indicator is a good thing. So even if you’re at your primary care doctor and he’s managing your diabetes, maybe you have or haven’t been to your bariatric team and getting those annual labs drawn, you could ask if you’re having some nerve pain or tingling or numbness, those types of things.

(18:38):

Ask your primary doctor to check a whole blood thiamine just to make sure that your bases are covered. Number three is memory and cognition. So vitamin B1 deficiency can cause memory problems, poor concentration and brain fog. So this mental health piece is important. And I will say it does get confusing again here because the majority of bariatric patients are females between the forties and sixties, and guess what? Forties and sixties is perimenopause and menopause. So guess what? You have more memory problems, poor concentration and brain fog. Then you throw in the group of people who come into bariatric surgery with hypothyroidism or Hashimoto’s where they have issues already with their thyroid functioning appropriately. Again, checking these levels, making sure that you’re checking those boxes that nope, this isn’t the issue. So if you’ve really noticed that, hey, my memory, my concentration, just a foggy brain more chronically, then ask your doctor to check a whole blood thiamine and just say, let’s check this box off and make sure that it is at optimal levels.

(20:13):

Because I’ve had bariatric surgery, I mean to me that should be a no-brainer. Number four is gastrointestinal disorders. This one is very interesting. So we will find that individuals who have a lot of GI distress is very common to have thiam and deficiency. So we do know that GI issues do come with bariatric surgery, constipation, diarrhea, bloating, gas, all of those things are very common and having GI problems is a symptom of a B1 deficiency number five is cardiovascular problems. Thiamin plays an integral part of cardiovascular health and having a deficiency in B1 thiamine can increase your heart rate cause shortness of breath and lead to heart complications. So if you are realizing that, hey, you know what, I’m going up this flight of steps and I do feel like I’m huffing and puffing a whole lot more. I’m walking to my car and it feels harder.

(21:28):

Or maybe your doctor’s office is saying your heart rate is higher or you are noticing it physically, you can feel it again. Checking that whole blood thiamine is important. Number six is muscle wasting. So insufficient thiamine levels can cause muscle wasting in bariatric patients affecting their overall strength and health, and we know that your grip strength is an indicator of longevity. So if you have good grip strength and don’t quote me on any of the numbers and stuff like that for it, I would encourage you to read the book Outlive by Dr. Peter Atia and it’s a really good book. I listen to it on audible, so I go through it pretty quickly and at a faster speed is what I usually do, but he does talk about this. We know that sarcopenia is an issue as we age, we lose muscle and perimenopause and menopausal females lose more muscle rapidly, and this is where that muscle wasting or sarcopenia becomes a problem.

(22:43):

B1 thiamine is involved in this process. So again, if you are a bariatric patient, and even if you’re not, I would say if you have family members or friends that are having issues with this and they haven’t ever tested their whole blood thim, it would be a good thing to evaluate or just actually just work with the dietician who could do that and make sure that they’re evaluating these levels appropriately. Number seven is psychological symptoms. So vitamin B1 deficiency can cause psychological symptoms like anxiety, depression and making it super difficult to manage your mood and your motivation be because of this side effect. So this is where if you do struggle with anxiety and depression and you’ve had bariatric surgery and maybe you’re a number years out from bariatric surgery and maybe your anxiety and depression has ramped up. Maybe usually I like to look at a timeline of events.

(24:02):

So when I have my patients that are working with me, I have them fill out this long assessment form and it gives me that snapshot in time of when things started happening and it gives me that picture of saying, Hey, okay, anxiety and depression became a problem at this time or this season and this was six months prior to when all the problems started and now they’re working with me. So again, you just kind of back it up and say, okay, we need the full panel. We need to look at the big picture of what you are actually absorbing. So again, all of these things play off of each other because I could even say the same thing about perimenopause and menopause. You have more anxiety, more depression. So again, it’s getting with a practitioner who understands all of this and can look at that 30,000 foot view picture and say, Hey, okay, we have bariatric surgery so we know that these vitamins, minerals are going to an issue we have to pay attention to and start putting all of these pieces together.

(25:22):

So yes, do I want you to have relief if you’re having anxiety and depression? Absolutely, but does that mean you have to go on anxiety medication or an anti-depression and anti-depression medicine immediately? Maybe not. I mean maybe if we just get your micro minerals and all your vitamins and minerals kind of addressed and replenished that restores all of these problems and makes them go away. So again, you have to, again, working with someone who understands this really can help speed up the process and making sure that you are not missing any piece. Let’s look at the big picture of B1 thiam in’s role in your overall health. So we can think about blood sugar regulation. So thiamine plays a role in maintaining a stable blood sugar and how your body metabolizes carbohydrates and post-bariatric patients, especially those with diabetes or pre-diabetes, have to really pay attention to their vitamin B1 intake because this is going to impair because you’ve had bariatric surgery or you had diabetes.

(26:49):

This is going to impair your body’s ability to maintain a normal level. Next is Alzheimer’s disease. There is some evidence showing that thiamine might protect against neurodegenerative diseases like Alzheimer’s, and so it’s super important to make sure that your thiamine intake after bariatric surgery is monitored to make sure that you don’t dip low chronically because in the end it could impact your brain health. So the next one is Barry Berry. Barry Berry have totally seen this in the bariatric world, Barry Berry, and the next one is Warnick course, ofoff syndrome. So both of those have been seen at least where I have worked, I have seen this with patients and I would say the one thing that we were really good at all the dieticians that I worked with, we were really good at monitoring symptoms. So every visit that you would come in, we’d go through a list of symptoms of vitamin deficiency symptoms.

(28:03):

So we are covering all of those things. We’re vitamin minerals, proteins, fats. We’re asking all these questions because we have that knowledge to know that hey, this symptom is a direct correlation to a low vitamin A or a low vitamin B1 or a low B 12, and then when we start getting multiple symptoms like two or three, a few of these symptoms listed, it really pulls it all together for me to show that, hey, this person has a high likelihood of saying, Hey, this vitamin could be low because they have all of these symptoms. So then that’s when I would order blood work and make sure that we are testing those vitamins or anything that correlates with those symptoms I would be addressing. Berry, berry is where it has progressed to a higher level deficiency. So your hands and feet are swelling, they tingle or have a burning sensation, you feel confused breathing problems due to lungs being filled with fluid and then uncontrolled eye movements.

(29:24):

So your eyes will kind of go back and forth without you even knowing or doing it. So again, those are important things to ask yourself, am I experiencing these symptoms regularly? Not just occasionally, but regularly Are we seeing this occur? So that again, that’s usually when it’s progressed further, if you are staying connected with your bariatric team, again, this is another plug for getting those annual labs drawn, but they should be assessing you for this. These are the important pieces that we need to put with these levels. So for me personally, I’m going to ask you all of those questions about vitamin and mineral deficiencies, protein adequacy, and I am going to match that with your blood work. So when your labs come in, I’m going back to that last visit note and I’m looking, what symptoms do you have and what are these numbers telling me?

(30:38):

I’m going to take those numbers and I’m going to say, are they in the normal reference range? Fix all the ones that are abnormal out of the normal reference range? Those are the obvious ones. Then the ones that are within the normal reference range but maybe are suboptimal. Maybe they’re low normal or high normal or just maybe not optimal for you. Yes, they are reference ranges and there is a range that we could all fall within, but we’re also different. It doesn’t mean that just because your body even needs higher or lower amounts of something that’s not wrong either. So as a practitioner, I should look at the data, but hear what you’re saying, listen to what you’re saying and assess on treating you appropriately providing the best care possible because again, we’re all different. So that doesn’t mean that the reference range that is established for the bariatric community, I mean, just think about that.

(31:51):

You can have somebody that’s six five and someone that’s four 10, and we use the same parameters, guidelines, reference ranges for all of us doesn’t make sense. That’s where you have to have somebody personalizing it, putting these puzzle pieces together to actually make all this make sense. So if someone progressed to Barry Berry one, either the patient did not follow through on their end and get the blood work in that case or two, or maybe there were skipped appointments or just not adequately scheduled appointments or whatever, but not enough touch points that something was able to be seen, right? You weren’t seeing the right providers that could acknowledge this type of disorder because for me, I would’ve caught thiamine deficiency prior. If I have all the symptoms, if I’m checking these symptoms on every visit, then to me, I would’ve had some red flags if you would’ve said, Hey, my hands and feet are swelling, okay, we’re checking your whole blood thiamine, we’re checking your protein, the pre albumin, we’re going to check C-B-C, C-M-P, we’re going to check all of these indicators because not normal and because you can have a burning sensation with berry, berry, I’m also going to test copper and zinc because copper can give you a burning sensation in your feet too when it’s low.

(33:33):

So again, all of these things can cross lines and give similar symptoms. That’s where you have to be educated in knowing the difference. So again, I would test all of those because of those symptoms, and this is where you have to take care of yourself. You have to advocate and say, I want these drawn. Yes, it’s an investment. I know labs are not always cheap and they are expensive at times, but there are options. I had a patient for a number of years, she would email me every year and she had no coverage for labs and to do our full panel out of pocket is like $2,000 and she’s like, I can’t afford that. So every year she would email me and say, I’m ready for my labs. And we would use a direct to consumer lab service and she would say, this is how much, this is my budget.

(34:36):

I have $400 this year and this is all I can spend. So I would pick, we’d go through her symptoms, we would go through all the notes and kind of evaluate where she’s at with her body and how she’s feeling and taking everything. Has she been good at taking consistently? Has she missed a lot of doses of any one thing? And I would base that on what labs we drew that year, and some of ’em I drew every year. I wouldn’t slack. I would make sure that every year they’re drawn, but some of them, they were not done every year and we would just kind of alternate and maybe do them every other year, but really I just personalized it to her and what she truly needed. Now the next one is the warnick Korsakoff syndrome, and this is, again, we’re worsening, we’re getting worse.

(35:31):

We’re not addressing the issue. So this is why whenever you start having chronic problems, you need to get into your bariatric team because they need to address the nutrition piece that the other providers are not thinking about. That is not their wheelhouse, that is not how their brains work. They’re thinking other things. They’re thinking of all the other stuff and covering those bases. Your bariatric team is the one that is going to cover these, the malnutrition deficiencies that occur after bariatric surgery. Those are the things that your bariatric team is likely the one that would catch, not typically, I’m not going to say always, but you can go to a neurologist and that would be their wheelhouse. But again, for some people, your symptoms are so vague and not extreme that you can float through different appointments and it gets dismissed and it really turns into something bigger because you are able to tolerate so much more than maybe someone else that it really gets dismissed unintentionally.

(36:50):

And it’s not that they were trying to be dismissive, it’s just because that was not the forethoughts of where their brain goes for those types of symptoms. So this is the Wernikes Disease. It plays a role in your nerve endings and actually causes damage can cause something called foot drop. And the foot drop is where it’s kind of like curved, it curves, and when you walk, that is a sign of the wernikes disease. And again, also it’s having the jerky eye movements and just walking difficulties, breathing difficulties again because we’re damaging the nerves and your whole nervous system is being impacted. It’s definitely something that can be seen in the world of alcoholism. So if you truly have a bariatric patient who is also struggling with alcoholism, this could really be an issue. So this is where you have to make sure that getting your vitamin B1 in, if you have alcohol use disorder or you are consuming alcohol frequently, then that would be something to keep as a top priority.

(38:20):

And then also the memory and mood problems that come with the corset cough syndrome and turning this around high doses of thiamine can improve that muscle coordination and that memory loss that can come from progressing to these more severe forms of vitamin B1 deficiency. Additionally, something that’s interesting is cataracts. So there’s several nutrients that can reduce the development of cataracts, and thiamine is one of them. So having a diet rich in vitamin A, B1, B two, B three and protein does reduce your risk of developing cataracts. And then additionally, getting enough vitamin C, E and B complex vitamins and even flic acid can prevent cataracts from developing. But they definitely know that more research is needed in this, but they do see benefits in those vitamins. So B1 included that can help in the prevention phase of cataracts. So what does the A-S-M-B-S guidelines say? How are we supposed to assess a bariatric patient for vitamin B1 deficiency? So here are kind of the parameters that are given.

(39:53):

People that have a higher risk of vitamin B1 deficiency are females, black individuals, people who are skipping their checkups, so bariatric patients who are not doing those annual labs, any bariatric patient that is experiencing stomach or intestinal issues or just digestive problems or having severe nausea, vomiting, or even constipation, people with heart issues who take medications like furosemide, those with small intestinal bacterial overgrowth or sibo. So again, this is so common in bariatric patients to develop sibo, 40 to 80% of bariatric patients can develop sibo and guess what? It consumes those vitamin B1 and does not leave enough for you. And then also losing weight to rapidly or using alcohol, all of those would be red flags that, hey, you are in a higher risk category and we need to monitor this level consistently. So thiamine and supplementation. So how do you prevent it?

(41:23):

How much should you be consuming? The A-S-M-B-S guidelines are 12 milligrams of thiamine a day, but preferably 50 to a hundred milligrams daily. And I will tell you in my experience, a hundred milligrams right out of the gate is great. So maybe the first three to six months use a hundred milligrams. We typically saw that B1 thiamine would be elevated when that dose was consistent and we were very comfortable and confident in dropping that to 25 to 50 grams. Honestly, we never fully relied on just the multivitamin. 12 milligrams never seemed to be sufficient, but 25, 35 to 50, that definitely was a better match for our patients. And it’s just that most multi bariatric multivitamins don’t contain, nor do regular multivitamins contain high doses of that typically. But if you are diagnosed with a deficiency, you are going to have to take a hundred milligrams, and typically you can do that two to three times a day until you start feeling better having, again, hydration with like if you’re getting IV fluids and they’re not including a banana bag that can deplete thiamine.

(42:54):

So making sure that they are doing a banana bag that has thiamine in it is important as well if it has progressed. So say someone is presenting and they are really, really low and they could do through a vein or through an IV where they replenish it more quickly and that’s going to be more in the 200 to 500 milligrams three times a day for three to five days, and then they’ll lower the dose and then they’ll do it for another three to five days. Again, we’re just rapidly increasing the body with these doses so that you can replenish it quickly. Some damage can be permanent when it comes to B1 thi, which is why I would say we were so aggressive. So we know that when you progress to some of the wernickes and the Korsakoff, those sometimes can’t be reversed.

(43:55):

We can’t correct some of that damage and that nerve damage that occurs and you’re walking or your gait. Even with the foot drop and things, sometimes we can’t fix it. So that’s why out of the gate we always wanted to be more aggressive. So if somebody right after surgery was having nausea, vomiting, diarrhea and they couldn’t catch up, they were getting depleted quickly because they were losing all of this food that they’re consuming and not really getting much nutrition, then that’s where that would help protect us. That would help protect and prevent a rapid depletion of those levels. We also have to think about refeeding syndrome, and this is where that if you replenish someone too quickly with nutrients like with food and fluids even, so making sure it’s packaged together with magnesium, potassium, phosphorus will help prevent the complications of refeeding syndrome. And then continuous monitoring and SIBO considerations.

(45:14):

So again, checking your thiamine levels and then also evaluating symptoms. If someone is saying, Hey, I have constipation and diarrhea kind of go back and forth, or one extreme or the other, and they’re also having bloating and they just seem to be reacting to food and their stomach just hurts all the time, they don’t feel great, then we could assess them for sibo and that could be the driver of their vitamin B1 deficiency. And I will say that I did have a patient for years that I worked with, and she truly did struggle with sibo, and we struggled to get that resolved because the practitioners she worked with didn’t seem to have belief in SIBO or really the knowledge to treat it. So we kept running into roadblocks because she had to use her insurance and couldn’t really do cash pay on anything. So she kind of got trapped in the system and was really difficult to treat because they just would not prescribe her the medications, and she really didn’t have the resources to purchase the antimicrobial forms to do it a different way.

(46:38):

And she chronically was low in thiamine, I mean chronically. And we would give high doses like always, and it would never replenish. She could never get it replenished and she’d had IV thiamine a few times. So again, just another way to assess kind that lab. Look, I’ve talked about vitamin BB 12 and RBC folate. B 12 can be low, but also B1 could be low. But RBC folate B high being a lab look for sibo. And again, this is where having a skilled practitioner who understands this connection is important. Because they can put the puzzle together and get you better faster. So the Benfotiamine is the fat-soluble form of B1, and this is something that. I would like to use with patients when they are struggling. Kind of like that example of my patient who unfortunately did not have the resources to purchase this product because it is something that you get from a supplement company, but her insurance wasn’t going to cover it and she didn’t have the resources to purchase otherwise.

(48:05):

So again, it became this issue. But this Benfotiamine is the fat-soluble form. So it’s more highly absorbable and more readily available for absorption. Some of the studies have shown has enhanced bioavailability because of it being fat soluble. It’s more effective at absorbing and tissue penetration than water soluble supplements. So again, in some studies they did show a fivefold improvement in bioavailability, also has anti-inflammatory properties and Benfotiamine has been demonstrate to inhibit active signaling pathways that participate in the inflammatory process. And it can help really treat with chronic illness associated with underlying inflammation. So think about obesity, that low grade inflammation that is occurring. So if you’re struggling with your weight being stuck, addressing the inflammation piece is part of it. We have to get the inflammation down for you to be successful with weight loss. Benfotiamine also provides some neuroprotection and it promotes nerve regeneration and health, making it a great therapy for anyone who is having neuropathy pain.

(49:37):

It can also help with diabetics who experience problems with glucose metabolism and their nerve function. So utilizing this form of vitamin B1 is important, especially if you have diabetes. And Benfotiamine is also going to be beneficial for neuropathy management, cardiovascular health, mental health, Alzheimer’s disease. All of those including the diabetes and improved blood sugar control. All of those are going to perform better with using the fat soluble form or the Benfotiamine as opposed to a water-soluble form. So what are some of the B1 food sources? Asparagus, brown rice, cantaloupe, salmon, the wild caught salmon, flax seeds, green peas, lentils, milk, orange and pecans. All of those have significant sources of vitamin B1 in them that can give additional input of this vitamin to your body. So this is where getting a variety of foods in your diet is so important. Because it can provide you with a different vitamins, minerals, phytonutrients, antioxidants that you won’t get otherwise.

(51:03):

So let’s wrap this up. So vitamin B1, thiamine is a crucial element of post-bariatric nutrition and health. And research suggests that benfotiamine the fat soluble form of vitamin B1 could be helpful. Because thiamine deficiency can affect blood sugar, mental health, heart health, and might be link to Alzheimer’s disease. So maintaining a varied diet where you’re getting a variety of different foods that contain thiamine is important. As well as taking your supplementation as recommended by your bariatric team. And then most importantly, getting those annual labs draw and making sure that. You’re staying on top of those levels, that it never drops too low. So I hope this has helped and you’ve enjoyed learning a little bit about vitamin B1 thiamine. And its role in your success after weight loss surgery. So you guys have a great week and we will see you next time. Bye-Bye.

Listen, Learn, Enjoy

The post The Importance of Vitamin B1 after Gastric Bypass & Sleeve appeared first on Gastric Health.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, a Registered Dietitian, and today we are going to discuss the benefits of olive oil after bariatric surgery. And I really just want to talk about this food item and the property that is in olive oil that can be so beneficial to your health overall. So there’s lots of gut benefits, but then also some other comorbidity factors that it could actually benefit. So let’s kind of, I guess, give you the insight to why you should include olive oil in your diet daily and how utilizing this one food ingredient on a regular basis can set you up for success with your health and your success with bariatric surgery. In general, olive oil is just one of those things that you can easily do, and I’ve brought up the use of olive oil in regards to GLP-1 hormone release and how it can help suppress your appetite in a natural way.

(01:22):

And that is where utilizing the olive oil regularly can be beneficial for that one property. But it also has a whole list of other beneficial attributes that I think warrant some recognition and giving you the insight to This can really help you make informed decisions with your food choices on a daily basis. And I try to teach all of my clients the importance of really just packaging their meals to give them sustainability to the next meal. And I get it, sometimes you can’t get any more food in and it does require snacking, and that’s okay too. But learning how to package your meal with appropriate protein, appropriate fiber and appropriate fats can make a huge difference in your appetite regulation. But then on the flip side, it also makes a huge impact on how your health is impacted. So I want to dig into olive oil and just kind of give you some important highlights and then explain all the benefits that you can attain by including this in your daily diet.

(02:45):

So olive oil is just a liquid fat that is extracted from olives and how it’s extracted kind of matters, and that’s where it gets different names and the differences in what properties it provides. So probably the most important one is extra virgin olive oil. And when I have talked about olive oil in regards to GLP-1, and I did come across studies showing that having just straight olive oil compared to extra virgin olive oil does have differences. So making sure that you purchase extra virgin olive oil as opposed to a bottle that just says olive oil is important because there are additional benefits that you attain from extra virgin olive oil and it is considered really the highest quality of olive oil, and it is kind of pressed, it’s like cold pressed so there’s no heating involved. And when the bottle says cold pressed and when it says first cold pressed, that’s even a higher quality.

(04:01):

So when you’re looking on bottles and there’s lots of brands, and I really do try to purchase brands that have a harvest date on them and that you just look on the back of the label and you can find if there’s a harvest date, if it doesn’t mention it, then I would put it down and continue looking until you find one that does have it. And the extra virgin olive oil, if it says ideally first cold pressed, second cold pressed, you just don’t want it to be heat extracted is the key point. So the extra virgin olive oil is going to have this first pressed and that is going to significantly improve the amount of polyphenols that are in it and the natural antioxidants that are overall providing the benefits to your health. So a higher, extra virgin olive oil is a higher quality olive oil that provides more polyphenols and more beneficial effects to your health.

(05:13):

Now one that says virgin olive oil, it’s similar but has a higher acidity level and same great flavor and aroma, but fewer polyphenols than the extra virgin olive oil. And then it can be like a refined olive oil. Years ago I dug into healthy fats. How can I support my patients with educating them on healthy fats? And I had no idea the controversy of olive oil and how shady the manufacturers of olive oil were and that it was a big, again, I had absolutely no idea. So there is lots of, what do you want to call it, I guess, fraud when it comes to olive oil and that it’s not a hundred percent olive oil that are in some bottles. There’s some loose labeling laws and I think some ability that allows the manufacturers to get away with not being a hundred percent transparent in what is in the bottle.

(06:35):

And I think that’s what led to all this controversy, and this has probably been a decade ago that I dug into this, but again, looking for the harvest date is your way of knowing that hey, at least I know it’s been harvested and when, and knowing that you’re getting a pure product, whereas when they don’t have the harvest date, you don’t know what and when and how old it is or what it’s mixed with because of the labeling laws, allowing or being so loose and allowing many things to be included in that bottle. So refined one is really not going to have as many polyphenols and have the benefits. So a bottle that just says olive oil is not guaranteed be guaranteed to be just olive oil. Again, it’s one of those things that seems to me wrong and it doesn’t make sense that some of this stuff has been allowed.

(07:42):

But in the end, I think it’s not surprising with the food industry and how do they maintain profitability when if you think about it to some degree, it’s not their fault because they are following the influence, they’re following the health influence. And decades ago it was fat was enemy, so they pulled fat out of all the food and then they jacked up the carbohydrates in it. Now we’re saying the carbs are the enemy and everything’s low carb and they’re just trying to make money and to be profitable. And so they’re following the health trends right or wrong, but because that’s what people vote with their purchasing dollars. So by you making a purchase of an extra virgin olive oil over just a straight olive oil is telling those manufacturers, this is of importance and we need more of this. So that’s where staying educated on food and just understanding the benefits and really choosing keeping your diet as close to whole real foods as possible.

(09:07):

The majority of the time where you don’t feel restricted in any way, but yet you feel empowered to make healthier choices. So again, when you’re purchasing olive oil, go for the extra virgin olive oil if you can get it first cold pressed, awesome. If not, go for pressed olive oil where it’s extracted by compressing the olives down to squeeze out all of the olive oil and there’s no heat and there’s no chemical added that has to be burned off. So that’s kind of the big picture of it. So how much should you consume? And again, I talked about this with the GLP-1. So for optimal health benefits, most studies show 10 to 20 grams or two and a quarter teaspoons to four and a half teaspoons per day. And even some of the studies go up to 30 grams, which is as high as six and three-fourths of a teaspoon.

(10:15):

So that’s a lot. That’s like two tablespoons and three-fourths of a teaspoon a day. But I will say the research is very compelling and very interesting in how getting that amount in daily can really truly be beneficial. So anywhere from two teaspoons to three tablespoons, think of it that way. So I would again, start small, start adding it to things, and it’s an easy way to get in a healthy fat, a polyphenol, some appetite suppression, a great way to include it in your diet for just those simple things that you have to deal with. You can make salad dressings with it. You can dip things in it, you can drizzle it on things, you can mix it with things to spread over foods. So again, easy ways is just mixing it with things so that you have the purest property of it. Some believe that you can’t cook with it or you shouldn’t cook with it. You lose some of the benefits and the oxidation that occurs in the heating process and they find that that is what is the negative piece. Some of the studies that I’ve seen is if

(11:52):

You don’t heat it above 350 degrees. So I try to opt for if I’m cooking, I am using avocado oil. If I am making salad dressings, if I’m drizzling on my cottage cheese or putting it in a smoothie or making some type of marinade, I am using the olive oil more in those fresh states where it’s not going to be. So what are the benefits of extra virgin olive oil after bariatric surgery? So you can think of extra virgin olive oil as a healthy monounsaturated fat, and it is oleic acid, which is a monounsaturated fat, is a significant component of extra virgin olive oil. And these healthy fats help support your health and your blood lipid levels and reducing the chances of cardiovascular complications that are associated with obesity and post bariatric surgery patients. So again, this type of fat, this oleic acid or this monounsaturated fat is what extra virgin olive oil is composed of.

(13:08):

So it’s important to include these in your diet regularly. It also has anti-inflammatory properties and the polyphenols that are found in the extra virgin olive oil have been shown to have strong anti-inflammatory properties. So if you have a lot of joint pain achy, you know that your CRP or your C-reactive protein, which is a blood marker of your inflammatory response in your body if it is above one. So you want that to be one or less, or really you want it to be less than one, like 0.9 or lower, but definitely you don’t want it to be greater than one. If you know that that is elevated, then that is a great opportunity to start adding extra virgin olive oil to your meals to help support that anti-inflammatory property. The next one is gut health. It can really help support a healthy gut. The polyphenols are what help grow that good bacteria and inhibit the overgrowth of the harmful bacteria.

(14:23):

And I’ll go in a little deeper here in just a little bit on how gut health is truly impacted with extra virgin olive oil. The next one is the blood pressure regulation. And studies have shown that extra virgin olive oil reduces hypertension related complication by stabilizing your blood pressure. So something so simple as adding olive oil to your meals can help with the big picture of keeping your blood pressure in check. The next is blood sugar control, which it kind of goes back to that package of protein, healthy fats and fiber and really packaging your meals in this way, in this manner where you’re getting those healthy components. And that is what provides that blood sugar stability. But insulin sensitivity is often improved after a bariatric surgery, but blood sugar fluctuations can still occur. And as a result, extra virgin olive oil, the monounsaturated fatty acids, insulin sensitivity and glucose metabolism are enhanced just from the extra virgin olive oil or that oleic acid because of it’s a monounsaturated fatty acid resulting in better control of your blood sugar levels.

(15:42):

So again, you’re providing that healthy fat. It also provides the satiation and helps you get to that next meal better. The next one is weight management. Even though olive oil has more calories, it can still be part of a balanced diet. So I know that many people get so confused when it comes to calories, how many calories should I be doing? What should I be focusing on? How low should I be? How high should I be? And there’s a lot of factors that play into a person’s actual calorie needs. Meeting your metabolic needs is important. And even though extra virgin olive oil is going to be higher in calories compared to a carbohydrate or a protein, it’s still part of making a balanced diet. So don’t be afraid because of the calorie component, don’t be afraid to add it to your meals. And then it also has some cardioprotective effects.

(16:53):

It has been shown to lower your LDL cholesterol, your triglycerides, and it can increase your good cholesterol. The HDL. One study showed the extra virgin olive oil had beneficial effects on cardiovascular health, reducing inflammation and oxidative stress, which we can think of oxidative stress as the human equivalent of rusting. It’s like your joints are resting from the oxidative stress showing that it improves cholesterol and glucose metabolism. So the study indicated that the extra virgin olive oil may be a useful dietary intervention of chronic kidney disease patients as well. It allows you some versatility in cooking and provides a nice flavor and a great way to easily get in some healthy fats that provide the additional benefits to your body outside of just that satiation factor. And then the last one is even cognitive function. Extra virgin olive oil has been shown to improve cognition in several ways.

(18:04):

For example, can improve the brain blood flow, protect nerve cells and reduce inflammation. One study found that people who consumed extra virgin olive oil reduced their risk of Alzheimer’s and enhanced brain connectivity than those who consumed other types of fat. So think about butter and lard and bacon, fat, those types of fats. It’s not the monounsaturated fatty acids. So you’re getting more saturated fats so you get better cognition with the extra virgin olive oil. Another study found that extra virgin olive oil improved memory and cognitive function in older adults. So extra virgin olive oil may be beneficial for people with mild cognitive impairment. And this is characterized by mild problems with memory and your thinking, that type of thing. But they do find that people with those problems are more likely to develop Alzheimer’s disease. A study of people with the mild cognitive impairment found that those who consumed extra virgin olive oil had improved cognitive function and brain connectivity compared to those who consumed refined oil.

(19:30):

So how does olive oil affect the gut microbiota composition? So this is important. Bariatric surgery changes your gut microbiome in positive ways, but we know that it doesn’t fully rescue a gut that is out of balance. And we know. So back up a smidge, we know that obesity being obese, calm with having gut dysbiosis. So it’s a contributor. Which comes first? Is it the chicken or the egg? I think it’s a combination of both. I mean, I think one leads to the other and it just gets you in a vicious cycle where you become more efficient at the absorption of calories because certain bacteria having more of certain bacteria can increase the amount of calories that you actually extract from food. So this is an important piece when it comes to weight maintenance. If your gut is out of balance, you have to make sure that you have the right types of gut bacteria there to support a healthy microbiome so that you don’t more calories from your food.

(20:49):

And I think after bariatric surgery, I think this is a piece of it. I think prior to surgery, you come in with gut dysbiosis because this is a known thing. Obesity has, you have gut dysbiosis. We know through studies showing that bariatric surgery improves that significantly, but it doesn’t fully reverse it or fully correct it. So we still have some gut dysbiosis. That’s why it’s important to make sure that you address it and correct that full gut dysbiosis and repair that whole gut environment after you’ve had bariatric surgery. Because otherwise, if you don’t, then the ability for that to return is there because you’re never going to get full resolution and the amount of calories that you could be extracting from food could continue to rise. So the bacterial composition in your gut is really referring to the type and the amount of bacteria in your digestive tract.

(21:56):

And the goal is to have a gut that is diverse. You want a lot of different types of bacteria in your gut and in the right amount. You don’t want way too much of one and way too little or none of another. So it’s all about balance. They’re all supposed to live harmoniously in your gut, all the good and the bad guys. And the more that you have those good quality gut bacteria, then you have the ability to fight off the bad guys when they show up. So say you get exposed with some bad food or some food that’s maybe sat out a little too long and there’s now some bacteria growing that could be harmful. The more you have of the good guys, your body’s ability to fight that off is there and the easier for you as long as it’s not too crazy high.

(22:56):

So food poisoning a whole new ball game, but think of the things that we get exposed to every day that we are around. It’s all over everything in our life. It’s on the shopping cart handles, it’s on packages that other people and everyone is touched. I mean, there’s microbes in everywhere, there’s bacteria, there’s pathogens, there’s viruses, there’s all kinds of different bacteria living in and around us that we could easily, when you don’t have enough of the good guys, then that’s when they could easily take over. So again, like we’re saying, bariatric surgery changes this positively, but it doesn’t fully correct. So moving through and correcting it fully is important and making sure that you set yourself up for success. And there’s been studies showing that with the ruin white gastric bypass, it reduces the richness and diversity of the gut microbiome. So that means you have fewer varieties of different bacteria and there’s less population of each of them.

(24:16):

So you have fewer of the good guys and they’re not very hearty. So again, the surgery shifts that and it’s important to fix. Studies have also shown that the sleeve gastrectomy can enhance the diversity of the gut flora in the first year following surgery, increasing the levels of harmful bacteria which can cause inflammation and infection. Now additionally, we know that the sleeve gastrectomy can enhance the diversity of your gut flora in the first year following surgery. So we don’t know enough past that. I think more studies are being done that we can understand this better. But in a nutshell, Roux-en-y gastric bypass sleeve gastrectomy are the two most popular surgeries. And we know that there are positives and negatives in the gut shifts that occur. And the key is continuing the work. The surgery does some of the work for you and shifts things in a positive way.

(25:27):

I just encourage you to continue that work after surgery so that you set yourself up for success long-term. According to one study, they show that the polyphenols and the extra virgin olive oil act as prebiotics and can help modulate the gut microbiome after bariatric surgery. And think of the prebiotics as food for the bacteria. So that is what your gut bacteria fuel off of is the prebiotic fibers. So that’s why it’s important to make sure you’re consuming those types of foods in your diet regularly. And olive oil has the polyphenols which can provide that fuel source for your gut bacteria. Additionally, the polyphenols can help inhibit pathogenic bacteria like enterobacter and Clostridium. So that’s a great thing that you’re supporting yourself in protection just by adding extra virgin olive oil can help suppress that overgrowth or that ability for bacteria to easily take over. Now, how does olive oil affect the gut microbiota function?

(26:45):

So we talked about the composition, but what about the function of your gut microbiome? The gut microbiome can produce short chain fatty acids. And I talk about short chain fatty acids all the time, showing the importance of having adequate amounts of short-chain fatty acids of butyrate, acetate, propionate. All three of those short-chain fatty acids are super beneficial to the whole ecosystem of your gut and helps keep a nice thick mucus layer for them to protect the tight junctions in your gut lining so that you don’t get issues with intestinal permeability or what you will know it as leaky gut. So again, this is something that is important to have occurring in your gut and they feed off of those fiber filled carbohydrates. So you and prebiotic fibers and resistant starch, those are the foods that your gut bacteria fuel off of that then produce the short chain fatty acid.

(28:00):

It has been shown that the Roux-en-y gastric bypass can enhance the expression of genes involved in glucose and insulin metabolism by the gut microbiome. Proteins encoded by these genes play a vital role in controlling blood sugar levels and in preventing the development of diabetes. And it has been demonstrated that the sleeve gastrectomy decreases the short chain fatty acid production by the gut microbiome and enhances inflammation and oxidative stress in gene expression. So I think there’s more data needed for that. I think we need to understand more fully why they find this occurring. And is this something to be concerned about? Should this help in making informed choices of which surgery to have? Again, you want short chain fatty acid production. Everyone needs short chain fatty acid production. Without it, it’s chronic disease, your body will not be without disease. So it’s a property that your body is producing from your gut bacteria, consuming the fiber field carbohydrates and resistant starch and polyphenols and all of those things that it can fuel off of.

(29:25):

And the prebiotics that it then creates this byproduct that is very supportive in your overall health and allowing you to maintain a healthy weight and allowing you to have a remission in diabetes and blood pressure and all of those things. Extra virgin olive oil can modulate the gut microbiome after bariatric surgery by providing the polyphenols that your gut need and they act as antioxidants and anti-inflammatory agents. Additionally, they reduce oxidative stress by scavenging the free radicals, which are bad. Now, how does olive oil impact blood pressure? So blood pressure basically is just a measure of how much pressure the blood exerts on the walls of your arteries. And a normal blood pressure is 1 20 80, and it has been proven that high blood pressure has a higher risk of health related issues. So hypertension, and despite its benefits of reducing body weight and. Heart strain, bariatric surgery can be related with fluctuations in your blood pressure.

(30:39):

Not everyone gets to come off a blood pressure medication after bariatric surgery. Some of this is genetically driven. So this is something that you may have to be super efficient at and. Do extra things just to maintain normal blood pressure levels. And this is where monounsaturated fatty acids can help. So extra virgin olive oil can lower blood pressure after bariatric surgery by relaxing the arteries. Reducing inflammation and modulating blood pressure regulating hormones. And according to a few studies. Olive oil can lower blood pressure in hypertensive individuals making it a valuable component. A postoperative diet for hypertensive patients. Now, what is the role of the polyphenols in olive oil and extra virgin olive oil contains abundant polyphenols. So we know that buying an extra virgin olive oil over just an olive oil, you get more polyphenols. So that is one compound that you want to have in your diet, polyphenols. And they act as powerful antioxidants, anti-inflammatory agents and. Studies have shown the positive benefits of polyphenols in metabolic health and weight management.

(32:04):

So the ability of polyphenols to promote gut health is one of their key benefits. So we know that polyphenols really do help support akkermansia, which is the bacteria that can influence GLP-1 release. And we know that it’s very common when akkermansia is low or undetectable in one’s stool test. That it is typically difficult for them to lose weight. Several studies have shown that polyphenols in olive oil support beneficial gut bacterial growth and inhibit harmful ones. So how can you start including more extra virgin olive oil in your diet? And the easiest answer is really mimicking more of a Mediterranean diet. Now, it’s going to be different for every person. But a Mediterranean diet is one that is going to have olive oil consumption higher. As well as plenty of fresh vegetables, whole grains, lean proteins, and healthy fats. So just slowly incorporating more beans and lentils and vegetables, lots of leafy greens and. Including those regularly in your diet can be super beneficial.

(33:33):

And one study found the Mediterranean diet had a number of health benefits for people with obesity. And obesity related disorders like weight loss and maintenance, reduced risk of cardiovascular disease. Improved blood sugar control, reduced inflammation and improved gut health. The study also found that the Mediterranean diet is a safe and sustainable dietary pattern for people of all ages. And this Mediterranean style of eating includes extra virgin olive oil. And this can help be a part of a healthy plan for your health strategy after bariatric surgery. So let’s wrap this up. So even though there is never one magic food that’s going to fix all of your problems. Especially after bariatric surgery, the goal is to have a balanced approach. Where you’re prioritizing proteins, healthy fats, plenty of fiber filled carbohydrates. And lots of color on your plate. And extra virgin olive oil can be a part of this healthful diet. So that it sets you up for success. So if you are looking to improve your blood pressure, your blood sugar, your gut microbiome. Or just really help support a healthy weight start, including extra virgin olive oil. Which I know in your brain sounds weird because you’re getting more calories from this food item. But again, you have to look past sometimes. The numbers and you have to look at what it provides for you. And you can easily still consume a moderate calorie diet that meets. All of your needs without being restrictive and not including extra virgin olive oil. So I hope

(35:37):

Has helped, and I really hope that you will check out extra virgin olive oil. At the store and make sure. You’re buying the right type of olive oil, that it has a harvest date. And you’re looking for the right properties of olive oil when you go to the store. I’d love to have any questions. Let me know your thoughts and. I’d love to connect with you if you need support in choosing better foods and. Just knowing how to apply it to your life. So you guys have a great day. Bye-Bye bye.

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The post Benefits of Olive Oil After Bariatric Surgery appeared first on Gastric Health.

Is your vitamin B12 abnormal due to your genetics and microbes?  Check out out audio transcript to learn more.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, a Registered Dietitian, and this week’s topic is vitamin B-12, a nutrient shaped by genetics and microbiome. So we are going to dig in a little bit deeper, well, I guess I would say a lot deeper into vitamin B-12 and what influences the actual level that you see on your blood work. And this is where I would say can really get complicated and really make someone really have to have a good understanding of their body to truly make informed decisions. So if you are struggling with a B-12 deficiency or having high levels of vitamin B-12, these can give us insights into truly maybe some other underlying drivers like your genetics or your gut microbiome playing a factor in that outcome. So we did talk about a couple weeks ago we talked about why is vitamin B-12 so important after bariatric surgery?

(01:19):

We’re going to, this is kind of an extension to that, but if you want to go back to that one first, you’ll really kind of understand the intricacies of just vitamin B-12 and how it’s absorbed, what impacts it, what labs that you check, and not relying just on one serum vitamin B-12 level as your way to make a decision. So let’s dig into the genetics and the gut microbiome connection so that you can fully make informed decisions. So what is vitamin B-12 and why do we need it? We know that the human body does not produce vitamin B-12, so we have to get it extrinsically. We have to get it from outside sources. And this is where animal products are so important for this to occur because you cannot get vitamin B-12 from plants. So this is where having a balanced diet, and I would say in my experience to keep life simple, it is better to add in animal protein in some way, shape or form.

(02:37):

And that may mean that yes, you’re a vegetarian, but maybe you include some dairy products or maybe you include some eggs, whatever you feel comfortable with. Vegans, I would say the job is hard and you have to supplement. It’s unlikely going to work out well. I would guess you could think about the genetics and the gut microbiome really influencing that. But in most, I would say the majority of cases, if you are following a vegan diet, you will need to supplement with some additional vitamin B-12. Otherwise a vegetarian may or may not. Someone who actually consumes animal products regularly may or may not after bariatric surgery. It is typically for most people a must to take some vitamin B-12 supplementation. I do find occasionally that there are gaps in this, but I would say for the most part, most all of my bariatric patients truly do need a vitamin B-12 supplementation, and I’ll get into that in a minute.

(03:58):

So we know that your body cannot produce vitamin B-12. It has to come from exogenous sources from your diet, and some people may require more or less vitamin B-12 depending on their age, their health status, lifestyle, genetic makeup, medications. There’s a variety of things that can really influence how well you absorb, utilize and transport vitamin B-12. So vitamin B-12 plays a significant role in a lot of biochemical reactions. One important one which impacts your cardiometabolic health is homocysteine and it influences homocysteine metabolism, and homocysteine is just an amino acid, but when this level is elevated, it can damage your blood vessels if it is left at high levels for periods of time. Now vitamin B-12 helps convert homocysteine to methionine. It’s a component of protein synthesis and cellular function. It also plays a role in red blood cell production, D N a synthesis and nerve function.

(05:15):

All of that is dependent upon your vitamin B-12 level. So that is super important and really can impact your health positively or negatively. How do genetic variations affect vitamin B-12 levels? Let’s dig into these genes and there are six genes that I’m going to talk about and they all play a role in how your body transports utilizes metabolizes vitamin B-12. So if you have any of these genetic variations or a combination of these. So it could be that you have multiple. You could have all six of these genetic variations. You could have half of them. So the weighting of the impact is dependent on that. So if you have a very high impact gene of one of these genetic SNPs, then the likelihood of you struggling with your vitamin B-12 level regardless of your diet, including animal protein, and regardless of taking vitamin B-12 supplementation, all of that can play a significant role in your actual B-12 level.

(06:38):

So the first one is the FUT2, F-U-T-two FUT2 encodes an enzyme that adds sugar molecules to intestinal cells. And this sugar molecule acts as a receptor for intrinsic factor which binds vitamin B-12 and facilitates its absorption in the small intestines. And we talked about that last week. Intrinsic factor is a protein in the lower portion of your stomach that gets stapled off or removed with bariatric surgery. So it gets stapled off with the roid gastric bypass and it gets removed with the gastric sleeve. So either one of those is going to cause problems with intrinsic factor. That’s why for one bariatric surgery truly does influence the whole picture of B-12 and this is part of that picture. So now you throw on not only maybe does a patient have bariatric surgery that they also have this genetic SNP, this influences intrinsic factor which then impacts their vitamin B-12 level.

(07:55):

So those with the variant FUT2 are called non-secretors as their intestinal cells don’t secrete sugar molecules and non-secretors have lower intrinsic factor and vitamin B-12 absorption levels than actual secrets. Non-secretors have lower intrinsic factor and vitamin B-12 absorption levels than secretors who have normal enzyme activity. And a study found that non-secretors had 25% lower serum vitamin B-12 than the secretor. Now the second one is TCN2, and this is the transcobalamin II. And we did lightly talk about this a couple weeks ago when we were digging into vitamin B-12 after bariatric surgery and this protein transports vitamin B-12 from the intestine into the bloodstream and delivers it to the cells. So this piece is pretty important and people who have variants in this TCN2 that reduce the amount or function of the transcobalamin II have lower levels of circulating vitamin B-12.

(09:13):

Then people with normal TCN2 in one study, people with the TCN2 variant had 31% lower serum vitamin B-12 levels. So having this genetic SNP sets you up for lower vitamin B-12 levels regardless of bariatric surgery. But it would be interesting to see a study with bariatric patients who have this genetic SNP to see if that percentage rises. The next one is MTHFR, and this one is very well known and a lot of people have this genetic ssn. So this gene encodes an enzyme which converts folate to its active form and the active form converts homocysteine to methionine, which requires vitamin B-12 as a co-factor. A person with the variant of the MTHFR will have a higher level of homocysteine and a lower level of the active form. And this can impair the methylation cycle and affect the availability of vitamin B-12 for other metabolic pathways.

(10:25):

And if you recall, if you’ve listened to any of my other podcasts, I talk about methylation being the safety. So your genes load the gun methylation is the safety that gets released, and then your diet and lifestyle or your epigenetics are what pull the trigger. According to one study, people with the MTHFR variant had 16% lower serum vitamin B-12 levels than those without the variant. The next one is MTR this gene encodes an enzyme known as methionine synthase, MTR, which converts homocysteine to methionine by using the active form of the 5-MTF and vitamin B-12. So those with this MTR variant that reduce the enzyme activity have higher homocysteine levels and lower methionine levels than those with normal MTR. And this can also affect the methylation cycle in the demand for vitamin B-12. So that means your needs of vitamin B-12 may go up.

(11:40):

One study found that people with MTR variant had 14% lower serum vitamin B-12 levels than people without the variant. However, in another study, the MTR variant was not associated with serum levels of vitamin B-12. So there’s a lot to still learn about how MTR variants affect vitamin B-12 levels. The next one is MTRR, and this gene encodes methionine syntase reductase MTRR. An enzyme responsible for restoring vitamin B-12’s active form in MTR. And a person with a variant of that reduces enzyme activity has lower levels of MTR activity and higher levels of homocysteine than the individual with a normal MTRR. As a result, vitamin B-12 may become more necessary as the methylation cycle is impaired. So one study found that people with an MTRR variant had 18% lower serum vitamin B-12 levels than people without the variant. And then the last one is NBPF3, and this gene encodes neuroblastoma breakpoint family member three. And it is a DNA repair and chromatin remodeling component.

(13:10):

And a person with the NBPF3 variant that increases the gene’s expression has higher levels of the DNA damage and lower levels of vitamin B-12. Than someone who doesn’t have this genetic snp. And as a result, the genome stability and integrity of the cell’s functionality may be affected. So it’s important to understand that it’s not just take a vitamin B-12 supplement because if you have some of these genetic SNPs or a combination of these, your ability to utilize what’s available is impacted. And it doesn’t mean that all forms are going to work equally, we do find that the individuals that have these genetic SNPs typically do need more of the methylated forms of vitamin B-12 or of the B vitamins. So it even includes like B-6 and folate. So it’s not just B-12, you need the methyl forms of these.

(14:30):

And when it comes to B-12 in general, there are different forms of vitamin B-12, most over the counter vitamin B twelves that you purchase, whether it be a sublingual or liquid or a tablet or even the pills, which I don’t recommend for bariatric patients because you’re not going to absorb those well at all. Whereas the sublingual forms where you put it underneath your tongue, whether it’s a dissolvable tablet or if it’s a liquid dropper that you just put a few drops under and it dissolves underneath your tongue and gets right into the bloodstream, those are great ways as well. You’re kind of bypassing the gut and I’m not opposed to those, but some people need the methylated forms, so they need to find instead of the cyanocobalamin, you need the methylcobalamin. There’s also adenalsylcobalamine and hydroxycobalamin. So there’s different forms and having these genetic SNPs can really influence which type of B-12 or cobalamin that you actually will absorb better.

(15:44):

And sometimes I use a blend, it’s called Tricobalamin that I utilize their product and it is just a mix of all of those methylated forms and we find that some people that have different other genetic SNPs, they maybe need, they over methylate and they have high levels. So we need to address that as well and look at the whole picture on how your body is functioning. So that’s why it’s important to really, if you are struggling with your energy, you’re having some anemia issues and you haven’t felt well for a while, this could be part of the puzzle. And really understanding this, having those genetics to really dig into can really make a difference in utilizing the right product and the right timing and the delivery, whether you do a sublingual, whether you do an injection, whether we work on your gut, all of that stuff matters for the outcome.

(17:04):

Now let’s talk about how does the gut microbiome affect vitamin B-12 levels and several microorganisms can actually produce vitamin B-12 which your body or the bacteria in your body will absorb. So dependent on lots of factors is dependent on what is happening with that. However, there are differences in the amount of vitamin B-12 produced by different gut bacteria. So certain gut bacteria can produce more than others as well as they can produce different forms of vitamin B-12, such as pseudo B-12, which is not biologically active in humans. Now approximately 20% of gut bacteria can produce vitamin B-12 and more than 80% of gut bacteria require vitamin B-12 for metabolic reactions. So you can see how important it is to include vitamin B-12 rich foods in your diet because your gut bacteria need them for jobs that they do.

(18:21):

Competition between the gut microbes and your body and the microbes to microbes, so microbes to your body and then microbes to microbes create the risk of vitamin shortage and the intestines if you don’t consume enough by diet, if your diet is lacking in vitamin B-12 rich food, then your gut bacteria are going to utilize whatever they can get from your diet and then potentially leaving you with less available for your body. Now, small intestinal bacteria overgrowth also cause megaloblastic anemia, which results from vitamin B-12 deficiency and binding of vitamin B-12 to bacteria in the upper small intestines can prevent absorption of the vitamin in the ileum. So when you have typically kind of a look on labs, so when you’re trying to figure out if someone has small intestinal bacteria overgrowth, a very common lab look is they’ll have a high RBC folate and a low vitamin B-12. serum vitamin B-12.

(19:39):

Now I would of course be checking the methylmalonic acid, I’d be checking at homocysteine, I would be looking at that full picture because I would want to I guess have more evidence kind of build the case that hey, we might have small intestinal bacterial overgrowth or SIBO present and we might need to do some gut work. So I will say that although it’s not conclusive, having a high RBC folate and a low B-12 is not conclusive of SIBO. A breath test is really your only guaranteed way of knowing. Some of the stool tests can give you insights. The blood tests can give you insights, symptoms can give you insight, food tolerance and intolerance. Certain foods can give you insights and it really depends on the practitioner as to how they approach SIBO. And I’ve worked with multiple GI docs and some of them just don’t have a lot of faith in the breath tests and they will end up treating empirically. I’ve worked with several bariatric surgeons and they kind of approach it the same way.

(21:05):

There are some questions when it comes to the breath test for bariatric patients in the accuracy because transit time is different and you’re looking at time, you’re looking at time on this breath test and it matters to a certain minute level. And once you get past that, then we assume you’re in the colon and we don’t want that information, we just want the information from your small intestines. So you want to interpret it correctly. And so you have to look at the timing. Well, bariatric surgery transit through your small intestines is different than a normal anatomy person. You can’t always derive the same information, but you have to look at it through the lens of, hey, this, you should be getting into your colon faster with this breath test because of bariatric surgery. So those alterations specifically. Especially a Roux-en-y gastric bypass is really one that. You would have to look at the big picture of timing and just really looking at the detail of, hey, is this truly accurate when it comes to the interpretation? So factors affecting your gut microbiome which end up shaping the B-12 landscape. So we know that your gut microbes fuel off of this. We know that certain gut microbes produce vitamin B-12. So what influences how vitamin B-12 looks for you in the human body, your diet, antibiotic probiotics and infections diseases? Of course your genetics can influence your gut microbiome and its composition and these factors can affect how much and what type of vitamin B-12 the gut microbes produce and how available it is for the host.

(23:15):

So in my eyes, this is where it’s important to have a healthy gut and making sure that you are addressing any gut imbalances and gut dysbiosis, small intestinal bacteria overgrowth and really truly resolving this to move this out as a problem because ignoring this or just living with the symptoms, although not pleasant, you can still live with them. So you might have more constipation, you might have constipation, diarrhea, you might have a lot of bloating and discomfort after food. Again, the livable things, but it’s what it’s doing on the backside. When I start seeing all of these levels being impacted and how it’s truly impacting your overall health, what is it contributing to on the flip side, what is it doing on the other side that it’s prohibiting you from getting resolution to some of those comorbidities because we’re not dealing with these basic things that are truly driving it.

(24:26):

That gut microbiome is really for a lot of people at the root of a lot of their disease and we can’t get resolution until we kind of repair, rebalance and repopulate and just really recondition that whole gut and get it to a better place. So you have to think about vegan diets that exclude animal products can reduce vitamin B-12 intake from outside sources. So being a vegan is something that we really have to pay attention to and how it’s not just impacting your overall B-12 level per se, but it’s also impacting your gut health, your gut microbiome, the positive. I would say one of the positives, if you’re doing a vegan diet correctly, again, how does your vegan diet look? Is it full of quinoa and amaranth and tofu and lots of cruciferous vegetables and lots of fruits and just tons of plants and really getting in a diversity of plant foods, whole new ballgame.

(25:48):

But if you’re relying on tortilla chips with guacamole and box mac and cheese and vegan chicken nuggets or meatless beyond meat, all of those things, whole different outcome to what’s happening in your body. So that’s why it’s important to work with a Registered Dietitian when it comes to a vegan diet after bariatric surgery because it is complicated and it is something that you have to truly, you have to kind of track and know what you’re doing to see if you’re even hitting your protein goals and to make sure that you are getting all the vitamins and minerals that your body needs. Now another big one is antibiotics, which is not a surprise that antibiotics would kill or inhibit beneficial and harmful bacteria in the gut. So I would say with the exception of xifaxin… Xifaxan is an antibiotic, but it is very unique. It is not a systemic antibiotic where it kills the good and the bad throughout your whole body.

(27:06):

It is literally localized to your small intestines. So it’s very unique. So when I talk about antibiotics, I’m talking about the ones that are systemic and they do kill the good and the bad in the gut. And at times sometimes you just have to have antibiotics and that’s just okay and the best thing you can do is just really support your body during that treatment. With taking good probiotics, I like to do a blend where like our ultimate gut restore with our sacchromyces boulardii that has beneficial yeast plus 50 billion CFUs and a good mix of different lactobacillus and bifidobacterium strains and species that can truly help support. So you don’t lose all of the good guys to keep your immune system active and vibrant. And then not only do you think about just taking probiotics, then you’ve really got to fuel it with the prebiotics. And I really like to use food in this case, and you could even just blend some up in a smoothie and really taking those prebiotic foods to a new level.

(28:22):

Of course you can buy powdered prebiotics, but again, food first one, it’s going to be way cheaper. And two, it is providing you with nutrients that that isolated nutrient of a prebiotic is not. So that’s the difference. That’s why it’s food first is really going to provide you the best outcome, but I’m also real and realize that sometimes it’s overwhelming and it’s just too much and sometimes you just need a prebiotic powder to throw in your protein shake and you don’t have to think about it and there’s nothing wrong with that. I just try to encourage you and teach you how to do it with food so that you get the best outcomes and you feel the best when it’s over. Now you may be thinking, could you take a probiotic to help increase your vitamin B-12? So one study found that a daily probiotic treatment of lactobacillus performed a beneficial effect on both bacterial overgrowth and vitamin B-12 absorption, suggesting that the probiotic treatment might improve the vitamin B-12 deficiency via inhibiting the vitamin B-12 consuming bacteria overgrowth.

(29:48):

So what that is saying is the bacteria that is overgrown in your small intestines are consumers of vitamin B-12. They gobble up all of the B-12 so that your body does not have any to utilize creating a vitamin B-12 deficiency. And what they’re saying is taking a probiotic that has lactobacillus species in it can help prevent an overgrowth of bacteria in your small intestines. So you’re stopping it before it occurs is really what it’s coming down to. And in all of the studies that I shouldn’t say all of the studies, but in a lot of studies that I reviewed on bariatric surgery and bacterial overgrowth a lot found that taking a probiotic can prohibit this from occurring. So taking probiotics can help prevent SIBO from becoming a problem. So I think to me, I would say that is one thing that I really encourage people to be consistent with.

(31:07):

Taking a probiotic, we would always have our patients take a probiotic beginning on day one of preop their pre-op consultation. So they come in for the very first time and meet the surgeon, meet the staff, get introduced to everyone, and as well as get to hear and talk to the surgeon and learn more about the different surgeries and what that surgeon does. And at that first visit is when we send them home with, okay, it’s time to start taking vitamins and probiotics was one of them and we wanted them during those beginning phases because some insurance companies required three months or six months worth of dietitian, doctor visits, and sometimes you do psych evals and they need some additional time or they have some additional work to do. We want them working on their gut and we want to optimize all those vitamin levels prior to them going into bariatric surgery.

(32:13):

So we set them up for success. So if you have not had bariatric surgery yet. I would strongly encourage you to start taking a probiotic. So that you can prohibit that overgrowth of bacteria in your small intestines. Which is not where the bacteria should be growing. Another study suggested that an addition of the or B-12 increases the generation of short chain fatty acids. Especially butyrate and proprionic acid. And I talk about short chain fatty acids all the time. How it’s truly beneficial to the integrity of your gut lining helps build that mucus layer which is your protection. And helping prevent intestinal permeability issues. Autoimmunity. So there’s a lot of benefit for having a short chain fatty acid production and. It’s a positive that taking cobalamine, especially in food form is a great way to optimize your gut health. Now I also want to just throw in here a few other factors that can influence your vitamin B-12 levels we talked about even last week or two weeks ago, I should say age, the amount of stomach acid and intrinsic factor decreases with age.

(33:44):

And this is necessary for your body to break down the food and cleve off the vitamin B-12 from the food. And when that doesn’t occur because there isn’t enough stomach acid, then you’re missing that. So you’re putting in the effort and you’re not getting the benefit from it. Age also plays a role in that intrinsic factor production and the transcobalamin II. Which is what transports it to your cells through your bloodstream and into your organs and all that. It’s the transporter. And then also you got to think about medications, chronic disease, all of those may influence it as well. Then sunlight exposure, skin synthesizes vitamin D. And so we get sunshine on our skin and our body synthesizes vitamin D. Which is additionally important for your bone and immune health. But vitamin D also regulates the expression of genes related to vitamin B-12.

(34:54):

Metabolism. Such as the TCN2 and the MTHFR low vitamin D levels may impair these genes function. And affect vitamin B-12 status. So it’s kind of all of these vitamins and minerals work synergistically and. They work off of each other and they impact the total outcome of the whole picture of what you’re experiencing. So they’ve even done some studies on osteoporosis and the connection with vitamin B-12. They have yet to have a full understanding if the B vitamin family really plays a role in developing osteoporosis. But they do show that it can influence it in small ways. So making sure that you understand your genetics. But do the basics, get some sun, 15 minutes, no sunscreen at noon is your optimal time for getting vitamin D and. You have to expose your arms and your preferably your arms and your legs, your face, all of that.

(36:15):

Personally, I’m going to wear sunscreen on my face and neck and I’m going to expose my arms and legs. So guess what? Winter months I’m not really getting vitamin D from the sun. Yes, I’m a snow skier and yes. I am out and about, but I am wearing sunscreen. So I’m not getting a great amount when I’m skiing. I do take a vitamin D supplement vitamin D three, and that is important to consider. If that influences your ability to maintain a stable B-12. I would make sure that you check your vitamin D level as well so that you know for sure if you are optimal on your level. The next one is smoking. So smoking increases oxidative stress and inflammation damaging the cells and tissues that regulate vitamin B-12. It also reduces vitamin B-12 absorption from food and increases it excretion in urine.

(37:18):

Studies have shown smokers may require more vitamin B-12 than non-smokers and maintain just to maintain adequate levels. And then physical activity can influence vitamin B-12 levels by influencing homocysteine clearance. And a high level of homocysteine can cause cardiovascular problems like we’ve discussed. But vitamin B-12 is necessary to convert homocysteine into methionine, which is essential for cellular function and protein synthesis. Moderate physical exercise increases blood flow and oxygen delivery to the tissues which can lower your homocysteine level. However, excessive physical activity can increase homocysteine through muscle breakdown and tissue damage. So people who exercise regularly must balance their vitamin B-12 intake with their physical activity level. And again, it’s just really paying attention. Attention to your lab work and making sure that all of these things are in check. So that homocysteine level, although again. Your bariatric team may not love checking that asking your primary care provider. Or whoever you see for normal blood work on an annual basis. Asking them to check this homocysteine level is a really good thing.

(38:51):

And that again, it’s just giving you insight. Your bariatric team should already be checking your serum B-12 and a methylmalonic acid or the MMA. And that will give them the full picture of. Hey, is my B-12 actually normal? And that will help you make decisions paired with your movement and understanding. Are you training for things? you doing a marathon or a bunch of five Ks? Are you using weights a lot? What is occurring and what is driving that homocysteine level up out inappropriate ranges? So let’s wrap this up. So vitamin B-12, as you can see, really is complicated. And it has a complex deepness to it when it comes to genetics. And your gut microbiome that can truly influence the outcome of what you see on your blood work. So is it your gut that’s driving it? Are the gut microbes causing this elevation?

(40:02):

Are the gut microbes causing a deficiency? Is it you have a genetic SNP that is really influencing your ability to utilize the B-12 that you get? All of that matters. So it’s more than just take a vitamin B-12 pill and check your serum B-12. It is more than that because it truly does impact other vitamins and minerals and. Truly does impact disease state your cardiovascular health, your immune health methylation that turns genes on and turns genes off. All of that determines your health outcomes. So I hope this has made a little dent in your understanding of the importance of vitamin B-12. And getting it from your food, taking a supplement in most cases, but then considering. Hey, let me work on improving my gut. Let’s recondition your gut, let’s get it healthier so that you can utilize. You’re already doing the things you need to do to optimize and have a good level. It’s just your gut isn’t capable of taking that

(41:33):

And turning it into adequate B-12 for your body. So hopefully this has given you that insight and maybe some additional questions to have with your primary care team. Or your bariatric team so that you really can get the outcomes that you desire. Because we know that vitamin B-12 truly does impact how well you feel physically and mentally. So don’t discount something so simple as vitamin B-12. You guys have a great week and we will see you next time. Bye-bye.

Listen, Learn, Enjoy

The post Vitamin B12: A Nutrient Shaped by Genetics and Microbes appeared first on Gastric Health.

Dawn, RD (00:00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell and I have the privilege today to introduce to you Kim, and she is a Registered Dietitian and is going to have a good conversation today on signs that you are under fueling your workouts after bariatric surgery. So welcome, Kim.

Kim, RD (00:00:22):

Thank you. I’m so happy to be here.

Dawn, RD (00:00:24):

Yeah, why don’t you share a little bit about yourself so people kind of know your background and what you focus most on.

Kim, RD (00:00:33):

Sure. So I’m a bariatric dietitian, but I actually specialize in active individuals that have had bariatric surgery and now are wanting to change their nutrition to optimize their fitness levels. And how I got into that, I was always an athlete growing up and I was always interested in sports nutrition, but once I became a dietitian, I went into clinical and my first floor that I ever covered was actually the surgical floor that did the bariatric surgeries. And so my first position for the first three years of being a dietitian, and I’ve been a dietitian for 16 years now, was working with bariatric patients in that immediate, basically the discharge phase where they came to me, they’d have their surgery, I’d go in, I’d review their discharge menu, that kind of thing, how they’re going to be fueling and eating after the bariatric surgery. And really just stayed with that for quite a long time.

(00:01:23):

I really enjoyed that. And then again, being interested in sports nutrition, I actually was a division one of sports dietitian for a university here where I’m at Fresno State University for about seven years. And still during that time I worked with bariatric patients. And then in my last position, I worked in a surgical center for the last 10 years in a bariatric surgical center here where I’m at and really worked in both the pre-op and the post-op phases of bariatric surgery. And what I found the missing kind of gap or lack of information was someone that’s had bariatric surgery and now is wanting to have all these exciting new fitness goals. Maybe they want to increase their muscle masks, they want to start training for a half marathon or a cycling event, and there just wasn’t a lot of information out there.

Dawn, RD (00:02:12):

So

Kim, RD (00:02:12):

Having had the sports nutrition background, I could apply the sports nutrition guidelines, but basically had to kind of overlap that with the bariatric nutrition guidelines and how those interacted with each other, how I helped folks. And so in the last two years, I actually left my full-time clinical position and opened up my own private practice, which is called Active Bariatric Nutrition, and I work one-on-one with individuals who have those fitness goals after bariatric surgery.

Dawn, RD (00:02:40):

Awesome. That’s exciting because that is such a needed area because so many individuals do get excited about moving their body. They feel so much better, but yet they don’t know how to fuel it appropriately. Sometimes it is confusing when you have a very small pouch, how do you get enough energy in when you’re burning it on the backside with all the activity? So that’s amazing that you’ve combined those two and serve the bariatric population because there probably aren’t many sports dietitians that have actually been helpful in the bariatric community. So this is great.

Kim, RD (00:03:26):

It’s definitely a unique kind of niche area and I can’t tell you the number of the folks that are like, yeah, I didn’t know who to turn to. There’s just not a lot of information or education out there for active bariatric individuals. So yeah, it’s been great. I’ve really enjoyed it.

Dawn, RD (00:03:40):

Yeah. Well, I’m excited to dig into this topic. I do feel like I see this with a lot of patients now. I’m definitely not a sports dietitian, so I don’t have that background and knowledge, but I feel like a lot of the patients that are active, they lack in the energy requirements. And so that’s why I really wanted to dig into this topic because any way that we can show them that it’s okay to have more calories, it’s okay to have more protein or carbs, I think is helpful and we’re just keeping that line less blurred and less confusing when it comes down to fueling their body. So I want to get into our first question and just what are some maybe physical or mental or just signs that someone would have a clue that, hey, maybe I’m not fueling my body appropriately?

Kim, RD (00:04:44):

Yeah, it’s such a great question because certainly after we have bariatric surgery and we’re thinking about keeping our overall energy intake low really for life, right? Because that’s kind of the message that is out there. We start doing that, we’re maybe increasing exercise and then maybe you start having these signs and symptoms and you think, is this related to just my exercise? AM something else going on? And so there are definite signs and symptoms that can be identified that indicate some low energy availability. One being persistent fatigue. So if you’re just chronically tired all the time, just have low energy levels throughout the day, that can certainly be a symptom of low energy availability, muscle weakness or loss of power and strength in your workouts. If you’re noticing that you really just don’t feel like you have the power to be moving the weights that you had been doing.

(00:05:34):

Or for example, in the clients that I work with, if they’re not seeing any gains, they’ve been doing resistance training for some time and they’re just not seeing any increase in muscle mass, that can be an indication too that overall energy needs are not being met for those types of goals mentally. Some mood disturbances, so irritability, irritability, confusion or that brain fog, some depression, anxiety, lack of concentration, those can all be symptoms that again, overall energy intake is inadequate and then increased some GI issues even. So these can sometimes be confused for some of the things that can be experienced after bariatric surgery, but another sign of low energy intake can be some GI issues like bloating, cramping, nausea. Those can also be an issue that maybe your gut microbiome is off, and that can be due to chronic levels of stress from low energy availability, higher levels of cortisol.

(00:06:30):

So that can be a problem for ladies if you’re having missed periods. So think of usually what we hear, which is exciting, is that sometimes there’s menstrual dysfunction before you have bariatric surgery, especially if ladies have PCOS, polycystic ovarian syndrome. But if after surgery you regain normal functioning with that weight loss and everything’s going well, but then all of a sudden we’re starting to have maybe irregular or missed periods, that absolutely can be a sign of inadequate energy intake. And so we definitely want to address that before it really worsens. And then just a few other ones, reduced sleep quality, increased incidences of illnesses. If you’re chronically having upper respiratory tract infections, you get over it and then you’re just sick. Again, that tells us that you’re not taking an adequate calories protein to create those antibodies to fight off infection. And then just incidents of injuries.

(00:07:22):

So we see increased risk of stress fractures, especially if you’re having bone density issues due to overall low energy intake and then inability to recover from your training sessions. So for example, if you work out, and typically if we start a new workout session or a workout program, you’re going to be sore in the beginning, but if you’ve been training and you just feel like you don’t recover, well, it’s 3, 4, 5 days and you’re sore all the time again indicating we need to look at what we’re taking into our body in terms of calories, carbohydrates, protein, et cetera.

Dawn, RD (00:07:54):

Yeah, yeah, yeah, I think that’s good because I think it can be confusing, especially the early post-op. A lot of these symptoms can be normal after bariatric surgery. And I know as a bariatric dietitian for so many years, you do promote, Hey, let’s move your body. Let’s get that routine, develop that behavior right out of the gate because you have that reinforcement of weight loss that you’re seeing, and when you get that behavior connected, you can develop that longer term when you’re motivated and motivation is the highest right after. So yet you have maybe some symptoms that you’re like, okay,

Kim, RD (00:08:47):

Well

Dawn, RD (00:08:47):

I’m not really eating, but a few ounces of food, so how much exercise can I really do realistically and not have these side effects? So if we broke down the beginning after surgery, when do you see these pre-op patients? When do you see them at a stable state to move past just general walking and pretty mild and low intensity workouts? Is it several months or do you require certain amount of food for them to be consuming, or what do you do in that scenario?

Kim, RD (00:09:30):

Yeah, typically really the first six months, you’re really still going through those. I mean, of course the first three months is really that post-op diet phase where you’re progressing through the different phases, but really I see in the years that I’ve been working with bariatric patients that usually around six months we’re tolerating a little bit wider variety of food. Our intake is increasing gradually, and then even beyond that nine months to 12 months where we might start doing more than just walking. And it’s not that people don’t start some resistance training earlier on around that six month mark or so, but typically the energy intake is not even nearly sufficient enough to really get a lot out of those workouts in that first six month period. So typically, and everyone’s different, these are general, but I typically see people starting to feel a little bit better having more energy after six months. And then from there, it’s going to be highly dependent upon what type of surgery you had, how you’re feeling, what foods you tolerate, and how much timing, all those things play a role in fueling properly. And it takes some time. And I’ve had patients that were like, it really took me after a year before I really had a good consistent eating pattern where I could really start to push myself a little bit. And so again, it’s just going to be independent on how you are feel and everyone’s so unique.

Dawn, RD (00:10:49):

Yeah, yeah, agreed. Yeah, and I think that as they kind of dive into movement, I mean for a lot of people it’s new to ’em. They’ve not been into this area for maybe a period of time or ever. They’ve never adopted these types of behaviors, which is totally fine, but as you’re experimenting and finding fun things that you enjoy, do you think it’s bad to right out of the gate, say just walking like say 30, 45 minutes, all that’s great, even though your calorie intake is maybe 500 800 calories at that time, maybe we’re getting to a thousand if we’re having a lucky day, what would be the negatives of doing more than walking? Or can you do yoga? Could you do Pilates? Could you do those types of workouts and not compromise your energy availability and have more fatigue and more problems by doing something more intense?

Kim, RD (00:11:55):

Yeah. I have a podcast that I’ve had on where I’ve had physical therapists come on and in listening to them and in their areas of expertise, talking about really giving your body that chance to, again, the rapid weight loss phase kind of changes how our body moves itself. And so typically what I have relied on is their recommendations, which is really the first three months of walking is such a great, you’re moving your body, you’re relearning the balance of your body in its new shape as you lose weight. And that changes throughout that first year and even beyond. And so typically after about the three month mark, I have had people start doing some very low weight resistance training or band work just to start moving their body in a new way. And typically that’s tolerated well with the intake that they’re focusing on as long as they’re getting in their protein and they’re taking their daily bariatric vitamins and minerals, the meeting their fluid goals, et cetera.

(00:12:52):

Beyond that, if we start increasing intensity level, frequency, duration of workouts, maybe moving more into longer duration and endurance activity or aerobic activity, that’s where we start needing now more carbohydrate to be able to fuel those workouts. So because specifically the first three to six months is really primarily is you’re really trying to meet your protein goals because you’re in such a low energy intake state, you will notice more fatigue if you start trying to right out of the gate increased intensity level and duration and frequency because you’d need carbohydrate to do that type of activity. Now your body can utilize fat as an energy source, but at low to moderate levels, once we get moderate to higher intensity, carbohydrate is the energy source that our body needs to fuel our muscles. And so without that, you’re not going to be able to push yourself because you’re going to fatigue. That’s the way it will happen if we don’t have those muscle glycogen stores to fuel the workout. So I would say really you have to get through those initial phases of, like I said, at least three to six months before you’re starting to push yourself past just generally walking or lower intensity activity.

Dawn, RD (00:14:03):

Yeah, and that makes sense to me. I mean, keeping it just beginning things and finding joy and going on a hike and a bike ride and not an intense bike ride, but tool around the neighborhood or a walk, those, to me, those seem doable for their intake.

Kim, RD (00:14:23):

Absolutely. And always when I work with my clients, I teach ’em kind of a hierarchy and the low level on the hierarchy is meeting your bariatric nutrition basics. We can’t layer on sports nutrition guidelines to fuel high intensity workouts if we aren’t even just doing the basics of meeting our daily protein goals, taking inadequate fluids, taking our bariatric vitamins and minerals. If we can’t even do those things first, we don’t even want to go to the next tier up until we can hit those. So that is kind of what I hammer home to start with. And then we layer on additional strategies to fuel exercise sessions or movement sessions.

Dawn, RD (00:14:59):

Yeah, no, that’s great. I think that’s valuable information that they can always just lay that good foundation. I mean, really that’s where everything begins, get the foundation, and then as you build, then everything just moves easier and it’s just flows so much better for how you feel and your results.

Kim, RD (00:15:24):

Totally. Absolutely.

Dawn, RD (00:15:25):

Yeah. Have you had clients that come to you and they’re doing pretty intense workouts for a pretty low intake of calories?

Kim, RD (00:15:38):

Yes, and honestly, typically when I have someone that’s less than six months post-op in terms of working one-on-one with me to optimize their nutrition, I usually say we need to get through that phase first. You’re not even at an energy level intake that we can even really manipulate or optimize much because we’re just focused on meeting our bare, bare minimum needs, which is your protein goals, your fluids, your vitamins, et cetera. So in those phases, I will tell folks, Hey, let’s just work on that first. Let’s just get that daily movement going your base. Let’s get those things established first. Then as you increase activity, then we do need to look at how to optimize the fueling strategies for that. And again, people have to be at a place where they’re able to tolerate carbohydrate foods. Do they have enough room in their pouch after they eat their protein to incorporate those yet if we’re not even at that phase yet, then we need to look at what we’re doing for exercise, what the demands of exercise are asking or your movement goals, whatever that might be, your fitness goals, and are you able to even tolerate that much nutrition yet?

(00:16:39):

And so there’s got to be a balance there as to what you’re expending and what you’re able to take in, especially in those early phases. So I try not to get into the fitness guidelines outside of just, Hey, we need to be able to fuel what the movement is that you’re doing, and you need to address your movement goals with what you can take in at this point.

Dawn, RD (00:17:04):

Good. So let’s go over what are some of the lab tests that someone could look at or their bariatric center may already be doing or they could ask to have done to give them insight? Maybe someone’s listening today and they’re like, okay, I’m past six months. I am doing workouts. I’m not sure I’m fueling myself appropriately. What kind of lab data would give me insight into knowing more about my current state?

Kim, RD (00:17:38):

So the labs that I’m going to review. So first I would just say the labs that I’m going to review. There are many reasons as to why these labs may be high or low, that could be unrelated to low energy availability, so need to be interpreted by your doctor. But some labs that have been shown to kind of indicate or maybe correlated with overall lower energy availability. So if you have a C B C done, which most of the time is a very easy panel that are run in almost all panels that are done by doctors, a C B C, which is your complete blood count can be run, and basically any abnormalities in your red blood cell count, your hemoglobin and hermatocrit levels, it can indicate anemia, which we need to look at. Of course an iron panel as well, but that can be associated with low energy availability.

(00:18:20):

So in connection to that, an iron profile, so low levels of serum iron ferritin transparent saturation can also suggest an iron deficiency. And I always just kind of relate this to, as you increase your exercise, your need for red blood cells are increased because red blood cells are what carry the oxygen are on there, and they carry that oxygen containing energy to the muscle cells for energy and for chemical reactions to occur. And so as our red blood cell need increases with exercise, then that means we need to either making sure that we’re taking our bariatric vitamins and minerals, but also overall energy intake from red meats and other iron containing foods is important to help maintain our iron levels and again, early out as well as with just bariatric surgery in general, we know that you’re already at an increased risk of an iron deficiency due to the surgery itself.

(00:19:11):

That also can be something to take a look at. Certainly thyroid function tests are another big one that are associated with overall low energy intake. For example, you might want to have your T-3, T-4 and T S H, which is thyroid stimulating hormone, a full panel run. So any abnormalities there might indicate some endocrine issues that could be related to overall low energy intake. Another one just for ladies, so luteinizing hormone as well as follicle stimulating hormone. Those two, again, if those are abnormal, that can indicate hormonal disturbances due to overall low energy intake and those are really important. So definitely ladies, if you’re, again, just having a lot of these signs and symptoms, you’ve been increasing your exercise over time, those are two that you can ask to have run as well. And then I’ll just a couple other ones. Cortisol can be elevated when we’re in a chronic stress state, and that can be due to inadequate energy intake insulin like growth factor low IGF one levels can be indicate impaired growth and recovery due to energy deficits. So those are some. And then I’ll just lastly finish with bone turnover markers. Those really are due to long-term low energy intake. Now we have hormonal imbalances, and so you can have some tests run that look at vitamin D level bone specific alkaline phosphatase, which is known as BAP or cross-linked C telopeptide, which is C T X. Those can indicate bone marker turnover rate that if they’re abnormal, we want to take a look at what’s happening with our nutrition,

Dawn, RD (00:20:50):

Which is great because you think of the population of the bariatric community being so heavy in females and the high risk of osteoporosis with females in general. I mean anyone but especially females because of the estrogen loss, our bone health changes with menopause. So now you throw in I’m improperly fueling my body. So now, and I recently, I’ve had three patients come to me with osteoporosis,

Kim, RD (00:21:29):

And

Dawn, RD (00:21:29):

So it’s on my four thoughts right now of supporting them in a way that maybe if we had worked together sooner, we could have changed the outcome of them already being in osteoporosis. But in the end, I think being aggressive in how you approach this prevention phase is super important. So the more you can advocate for yourself and ask for those lab tests, I think is critical.

Kim, RD (00:22:02):

And I’ll just add to that, just your typical bariatric panel that should be run annually for life. I want to reiterate that paired with taking your vitamins and minerals every day, because as you just mentioned, if someone’s, of course, low energy intake is going to impact these micronutrients, but also remember that bariatric surgery is already increasing your risk of deficiency in things like calcium and vitamin D and iron and B 12. So those are critical to be taking. And then paired with the fact now that you’re moving more, those are also very important for energy metabolism and for bone density and things like that and neuromuscular contractions, things like that. So there’s so many layers that when you’ve had your bariatric surgery, your overall intake is lower, now you’re exercising more. The demand for these micronutrients are even more critical that you’re meeting those through your supplements and through your intake.

Dawn, RD (00:22:53):

Yeah. Do you find that it’s hard for active bariatric patients to actually meet that intake demand because their pouch is so small?

Kim, RD (00:23:07):

So what I run into is I’ll get folks that come to me and they’re like, Hey, I start working out at the gym and my personal trainer wants me to be eating some really high number from where they’re at. Okay, I eat right now 12 to 1400, but my trainer said I have to be at 3000. Well, here’s the thing that may be the case based on if we did indirect calorimetry and we look at someone’s resting metabolic rate and then we factor an activity factor, absolutely. The calories are your day-to-day needs are going to be higher than usually, especially in those first few years, not able to take that much in. And so where I kind of come in is, listen, we have to start with where we’re at, but we want to work gradually towards increasing your intake because you are going to need that based on whatever your movement goals are to meet the demand of what you’re asking your body to do.

(00:23:55):

And so my strategies with clients is really to do it in an incremental stepwise fashion. We gradually increase and it takes time because they have to work on that. And maybe it might mean we have to implement a snack, pre post-workout snacks, maybe an additional snack. It just depends because again, everyone will be different with how much they can take in at one time. And then how do we meet the goals in a day by distributing those calories in multiple settings? That’s typically what I try to focus on with my folks. And we look at of course, timing of protein and carbohydrates around workouts and being consistent with that, but it is very challenging. And so there is that gap with what your body really needs, but what you’re able to tolerate are two different things. And so I always just recommend doing it in a very incremental way.

Dawn, RD (00:24:42):

So let’s talk about some of those pre and post-workout fuelings that someone could tap into. So how do they know they need them? Should everyone do a pre-workout snack or do you do it fasted? Is it bad to do a fasted workout or not?

Kim, RD (00:25:03):

Yeah, so there’s debatable research out there on fasting and utilizing fat stores and all these things. And really at the end of the day, what it really comes down to is how you feel in your workout, your performance goals, et cetera. And what we know as fact is that carbohydrate does help improve performance. It helps decrease your time to fatigue meaning, or I should say increase time to fatigue, meaning you can work out harder longer before that kind of fatigue sets in where we’re having to slow down. Carbohydrates are king for that. And so in my practice with my active individuals, I really hone in on strategizing timing of meals and to really optimize the workout because again, we’re overall limited in our intake. We want to strategize with the timing. So I do recommend if someone can try to get in about 15 to 30 grams of carbohydrate in the one to two hours pre-workout, and that can be something as simple as just a half banana or for my runners, they do an applesauce pouch, they squeeze in.

(00:26:02):

Or for those that have a little bit more time and they have time to do a little bit of toast or maybe some oats or things like that, they have a little bit more time. Or if it’s like a lunch meal and they’re going to work out at three hours later, they can have a more well-balanced meal that incorporate both carbohydrates and proteins. That’s fine. Now to answer your question about fasting, I don’t see it beneficial there already. Overall intake is low and to just be putting yourself in a more prolonged state of no energy intake is not going to help with your workouts, how you feel. But also in the long-term with recovery with muscle protein synthesis and muscle gains going long periods without eating is not helping you to build it is actually helping you to break down because your body is having to just use its stored energy if it’s not getting any from the intake. And so I really recommend trying to get something in pre-workout and then post-workout, trying to fuel as quickly as you can with carbohydrates and protein because both are necessary to begin that muscle glycogen restoration. So putting the carbohydrates back into the muscles and then also taking in amino acids so that our muscle protein synthesis can begin, it can heal, we can grow and hopefully over time increase our muscle mass,

Dawn, RD (00:27:15):

Which I think is so important for them to understand the priority of that muscle that’s like their metabolic power. That is the thing that we have to preserve and in some instances really rebuild because I feel like that first three months is so depleting when it comes to their muscle mass that it’s like we got to rebuild this

Kim, RD (00:27:45):

A hundred percent. And I would just add even many surgical centers require a weight loss prior to even their surgery. So patients have already been on a somewhat low caloric intake prior to surgery. Then we go into this really rapid weight loss phase of really low energy and take that first three to six months or longer. And so again, you’re losing in that both fat loss as well as muscle loss in that rapid weight loss phase. And as you just mentioned, I totally agree with you, muscle is that driver of our metabolism and long-term, it’s going to help with functionality and mobility and strength, and we want to maintain that as long as possible. So the sooner that folks, people that are listening if you’re exercising, fueling, really helps with all of these things and taking in carbohydrates and then carbohydrates and protein post-workout as well as at your meals consistently really help with just preventing future losses of muscle, but also in that gaining and then stimulating metabolism.

Dawn, RD (00:28:44):

How many minutes before a workout or hours or what’s the timeframe for, say you have a banana before you go, if you did it 10 minutes before, is that bad or does it need to be 30 minutes or an hour?

Kim, RD (00:29:03):

So everyone’s different. No, so perfect time, but what I always teach my individual athletes is, so if you have a long period of time, so if you have three to four hours before a workout, let’s say you’re working out in the afternoon or evening, you’re going to eat your regular eating pattern. But in that three to four hour meal, it can contain more whole grains or slower to digest carbohydrates that are going to provide energy for our muscles in three to four hours. That’s okay. And that’s where you’re going to keep having your protein. You can have some fruit. It’s a more well-balanced plate because we have more time to digest that. But as you get closer to the start of your workout, the priority is going to focus on mostly just carbohydrates, more rapidly available. Carbohydrates are easier to digest, but we want to reduce our overall intake of fat and fiber because those do take longer to digest And remember, the key is we want energy available to the muscles when they need it.

(00:29:52):

And so if we’re eating things that are high on fat and fiber, it’s not going to empty out and be available in time. And also you can start having some GI issues if you have something like a high fat or high fiber meal in a workout point is if you’re getting closer, what I usually say is if we’re within an hour or so, you want to be focused on just basically carbohydrate rich beverage or food, small volume so that it is able to be digested and absorbed and ready for the muscles to use once you start moving.

Dawn, RD (00:30:20):

Yeah, okay. I think that’s good because I have some patients who are morning workout people, and so they get up and they go work out and they’re fasted. So it’s kind of like, okay, let’s throw in a small snack. And then they’re like, okay, well, I take my thyroid medicine, so how do I balance all of these moving pieces to fuel myself before the workout?

Kim, RD (00:30:49):

Yes. So I literally had a session yesterday with one of my clients who also takes thyroid medication. And so in her case, she backed it up just 30 minutes, basically backed it up, and that gave her that time to wait the minimum of 30 to an hour before she can start eating. And so she just, again, just something small. And even if you can’t tolerate something, what I always tell folks is you can train your body to get used to that having some fuel because I can tell you the number of folks that I have that are like, I cannot have anything. And so there’s two trains of thought to that. So basically if you are doing a great job at your meals throughout the day, you’re incorporating carbohydrates at every meal. Most bariatric patients as you get farther out are typically can consume at least about 30 grams, maybe 45, maybe more grams per meal of carbohydrate, just depends on where you’re at and what type of surgery you had. But if you’re doing a good job of taking in overall carbohydrates, that’s a good thing that can help you. But I still recommend, even if it’s just a small sip, if it’s just one squirt, anything would be beneficial to prolonging your time to fatigue and giving your muscles a little bit of an energy source to rely upon. So it is a beneficial strategy. I’m not a big fan of fasting because again, it’s just not helping you with recovery and in the long-term with muscle protein synthesis and growth.

Dawn, RD (00:32:08):

Yeah, I think that all the intermittent fasting and ketogenic diets, I feel like it creates so much confusion for people and they feel like, okay, I’m supposed to fast. I’m not supposed to eat to lunch, and so now let’s do my workouts. I have to do my workouts in the morning or they’ll never do ’em. And so now they’re like, well, that doesn’t work for fasting. So it’s like, and if I’m hearing you correctly, and I a hundred percent agree with this, you can’t be on this low calorie diet and fast too. Your body, that’s too many stressors. Your cortisol is going to be through the roof

Kim, RD (00:32:50):

And

Dawn, RD (00:32:52):

Guess what? You’re going to put on body fat and it’s going to stop your ability to lose weight, it’s going to increase your insulin, it’s going to do the total opposite of what you want to occur.

Kim, RD (00:33:06):

Yeah, I totally agree with you. And that is exactly what I will remind my folks too, is that we want to break down that catabolic state. We want to stop that catabolic state. We want to fuel on a consistent schedule so that again, you’re providing your muscles the fuel when it needs it. And so it’s really important both pre and post-workout to come into your workout well fueled, because again, as you just mentioned, we’re already at a low overall intake and then layering on these other dietary restrictions just makes it even more challenging to meet your needs. And so I always just tell folks when they’re like, Hey, I’m going to do fastening your chemo. I’m like, well, but you have the bariatric surgery tool in place. We have that tool to use. Let’s maximize that tool. We don’t need these other strategies because as long as we’re fueling properly and utilizing the tool and listening to our body when it tells us we’re hungry or when we’re full, that’s our one tool. And it doesn’t mean that there aren’t other tools that can help, but those dietary restrictions just kind of make it worse for you to meet your needs. And it’s just a lot more challenging if you’re trying to be active.

Dawn, RD (00:34:05):

Yeah, yeah, exactly. And don’t misinterpret and say, okay, well then I’m not going to work out. So that I

Kim, RD (00:34:13):

No, that’s helpful. That’s a helpful tool to do as long as you are then putting the nutrition back in that your body needs to move your body.

Dawn, RD (00:34:20):

Right. Yeah, I read, it was some research article I have every day. I have emails that come from PubMed on different topics and one came in on muscle mass and it just really struck me as, wow, the whole purpose of weight loss has all been about fat loss and maybe we’ve looked at it wrong and maybe it should be focused more on muscle mass loss, that that’s the driver of why so many people have issues with an increase in body fat. So we should focus more on increasing our muscle mass and less on the body fat, and you would get the results you actually wanted. So it’s very interesting because probably you and I both were trained that the calories in calories out model was how you lost weight. But being in bariatrics, we understand that it’s definitely more than just a calories and calories out model. We’re not math equations that you plug in these numbers and you automatically lose weight. It doesn’t. Absolutely.

Kim, RD (00:35:37):

The hormonal influences alone are a whole nother layer that impact how much you’ll lose after bariatric surgery. And I would argue too that I think moving forward, I’m really, it seems like we’re moving in this direction, it feels like it, but moving away from body mass index, meaning just looking at the weight on the scale and your height and judging that as your measure of outcome or success after bariatric surgery versus body composition and really looking at what is actually changing in our body? What are the compartments that we are increasing or decreasing because it is not ideal to be losing muscle mass. So when you hear that 60 to 80 grams of protein a day, it’s because the research that had been done looked at that’s like the bare minimum that people need to consume to prevent muscle wasting during a low energy intake state.

(00:36:23):

And so I would argue that hopefully moving forward, we utilize more body composition measurements, trends, things like that as an indicator of how things are going. And like you just mentioned, minimizing muscle loss, which drives our metabolism. So then the long-term, if you’re wanting to change your body composition and you want to gain more muscle and be stronger and all those things, it’s going to come from taking an adequate protein, adequate calories to maintain muscle, and the fat loss will come as well if you’re striving to increase your muscle and you’re moving your body and you’re taking an adequate nutrition. So I’m hoping that as we move forward, that that’s kind of the direction that the big surgical centers and our research will look at as an outcome measure.

Dawn, RD (00:37:03):

So let’s talk about body composition. I mean, what type of tools do you recommend for people to utilize to monitor that? Do you like some of the BIAs? Are you against them or what’s your thoughts on ’em?

Kim, RD (00:37:21):

Yeah, I’m totally for BIA bioelectrical impedance, I think there are good way that our available right there are of course more highly technical and more maybe accurate ways to do it, but it requires a laboratory setting or a hospital setting, and that’s not going to be easily accessible to the masses to understand what’s happening in my body. So BIA you can find these types of the InBody scans, and SECA is really a worldwide company that looks at body composition, but their scales and BIA are very accurate. They’re just typically found in medical offices, but you can certainly ask your primary care or your surgical center to incorporate those. But I think that it’s the best way to go about it in terms of understanding how things are happening after surgery. Because as we know, and I actually just talked about this in my podcast, there are so many things that impact our scale day to day that have nothing to do with calories and calories out.

(00:38:19):

It can be a high salt intake. It can be you worked out really hard and your body’s retaining fluid to help with healing. It can be that you increased your carbohydrates. So now when we store carbohydrate in the muscles, we draw water in, there’s just so many things menstruation with, we gain weight as we come into when we’re going to have our period. There’s so many things that impact the day-to-day scale, and I just find that it’s so frustrating because folks, we’ve been kind of ingrained to use the scale and it doesn’t give us the accurate picture as to what’s happening. So to go back to your original question, I am a big fan of body composition measurements, and I would recommend those as more of a tool to measure your progress.

Dawn, RD (00:39:00):

Yeah, I love it. I think, and they are, I mean, some gyms have it for free access. I, and I know my doctor’s office, they offer it. And so I free twice a year I can get a done and monitor how my body is changing and know where I’m lacking or weak or need to improve.

Kim, RD (00:39:27):

Absolutely.

Dawn, RD (00:39:27):

Yeah,

Kim, RD (00:39:28):

Because if you’re getting having B I H and you’re okay, my weight went down, but it’s coming from muscle, that means we want to look at a nutrition strategy. We want to change what you’re eating. We want to increase your protein intake. Maybe we need to increase your overall intake to fuel what you’re doing for this movement goals that you have. And so I think that’s a much better indicator because it tells us, oops, that’s a nutrition intervention point. We need to look at how we can optimize the nutrition so that we’re not losing muscle mass as we lose weight or lose body fat.

Dawn, RD (00:39:59):

Do you use at my doctor’s office, they use the InBody, I think seven 70 is the one they use. And I’ve seen some other dietitians comment that they don’t think that the basal metabolic rate that is provided is very accurate on at least the InBody I’ve seen commented frequently. Do you feel in general, because if somebody goes and gets CYS done, they’re going to see this B M R basal metabolic rate there, which is kind of the calories you’re going to see a calorie number. So do you feel they’re accurate? Do you feel like it’s a good place to even hover around for making informed decisions?

Kim, RD (00:40:50):

All testing methods are going to have some inborn error. And what I usually go off with folks is none of these tests are a hundred percent accurate. None of ’em are. And so they’re all going to have some error. So I usually will recommend is just looking at them as trends, utilizing the numbers as which direction are we heading? That’ll give us a better overall picture than saying, this is my B M R right now. Because again, I’ll be honest, I really don’t know how does bariatric surgery though impact outside of, generally we know that after bariatric surgery because muscle goes down, our overall B M R can decrease because we have less muscle mass. So that can impact that reading. But in terms of accuracy and utilizing that is kind of the end all be all in terms of what we should be aiming for.

(00:41:37):

I would say that’s why working with a healthcare professional, like a Registered Dietitian who can use also calculations to estimate your basal metabolic rate plus activity factor so that we get an overall energy expenditure picture, that’s what you really want to use as kind of a better overall understanding of what you should be aiming for. Because again, then we layer in the fact that, great, well, this says I should be at 1600, but I literally cannot eat any more than X, whatever that might be at your phase that you’re in. And so again, it might be a good number to start working towards, but I always just recommend working with a Registered Dietitian because he or her can help you to really understand what your needs are and how to get there,

Dawn, RD (00:42:19):

Which is good because I just had a patient that had an InBody and saw the number and they were eating under that, and I’m like, okay, we at least got to get you to that number and then we’re going to go higher. We’re going to need you to go higher because that’s not even enough. And they’re like, how am I ever going to lose weight if I’m eating more than this number? And I’m just like, okay.

Kim, RD (00:42:46):

Yeah, and that’s such a great question because it’s like I had this surgery and I am losing all this weight. I want to keep losing, and I’ve been kind of educated on this really low calorie level or the 60, 80 grams of protein a day for life is what’s been out there across most surgical centers. But how I try to present it to folks is, okay, again, this is why I work with people. Usually once they’re past that kind of rapid weight loss phase, I’ll say, okay, we’ve gotten through the majority of that rapid weight loss phase. Now we’re starting to fine tune body composition. And to do that, we have to kind of re-strategize with our nutrition. And that might mean we’re going to start slowly increasing your caloric intake, your protein, your carbohydrates, your fats, et cetera to help stimulate metabolism because we’re going to help with muscle growing, and that is what you want because long term, it’s going to mean a better overall metabolism, a better all energy strategy in terms of meeting your adequate needs so that you can do all this movement that you’re wanting to do and feel good doing it.

(00:43:50):

No purpose in doing all these things. If you have all these signs and symptoms that we talked about earlier, that can start really having some real serious physiological repercussions. So I try to just represent it as, Hey, we’ve gotten through that rapid weight loss phase. Let’s now look at how are we going to optimize your body composition. Let’s focus on that and see what we can do with your nutrition.

Dawn, RD (00:44:10):

Yeah, I think diet culture has just taken over in everyone’s mind in thinking less is more and have created such confusion in really understanding even how their body works to know how to support it. So I think it’s like you’re saying, work with a dietitian, start learning how to fuel your body, especially after bariatric surgery because this is such a crucial timeframe that you are going through so many changes. So if you don’t get that care, you really can compromise your results because your intake is so low,

Kim, RD (00:44:58):

Right? Absolutely. And it’s okay to start making slow incremental increases. That’s okay. That’s a good thing. And I always remind folks, over time, you are going to be able to tolerate more overall nutrition. That’s a great thing. And if we can strategize with those calories and carbs and proteins and the timing and all these things, it’s going to help you to get to what your ultimate goal is, which is whatever that might be. Body composition goal is to train for these different events or whatever, and that’s okay. And that’s having a healthful eating pattern is to take in the amount that your body needs to do all these great things. And so that’s kind of a reframe to look at it after your bariatric surgery is we’re developing this new healthful strategy for life that can really help us to move our bodies in a great way.

Dawn, RD (00:45:44):

Agreed. Now, timing of the fuel, we kind of touched a little bit on this, but do you feel like you have some more to add that you could share with the audience and how to fuel your body with the protein, carbs and enough calories during and before workouts? What other tools do you have for them?

Kim, RD (00:46:10):

Yeah, so timing is really important as we mentioned earlier. So number one, overall, if you are trying to increase your muscle mass, the number one most important factor is meeting your overall calorie and protein goals in a day. The second most important factor now is the timing and to put the nutrients in when your body needs them. And so what I teach my folks is we talk a little bit about the branch chain amino acids, leucine being the prime driver of muscle protein synthesis. And just to kind of put that in layman’s turn, it’s an essential amino acid that you basically need to get in from the diet, and it is the main driver that helps us with building protein in our body, building muscle. And so to do that, the timing of protein plays a role. We want to be getting in about three to four grams of leucine at each meal, and that usually requires anywhere between about 30 to 40 grams of protein per meal to really help with stimulating muscle protein synthesis and taking us out of that catabolic state.

(00:47:07):

That can happen when we have our overall energy intake is low, or we’ve had a stressful workout, for example. So what I teach my folks is eating on a consistent pattern is key, and what that means is going to be different for you and for someone else. Their pattern’s going to be different, but trying to eat about three to four hours trying to get in at least that 30 to 40 grams of protein per meal. And again, when you’re earlier out, that’s going to be challenging. I understand that that’s kind of what we want to work towards. As you increase your exercise, that’s going to be a critical goal. And then also incorporating more carbohydrates, again, incrementally as you increase your exercise frequency, duration and intensity level, your need for carbohydrate increases. And so again, without getting into grams, per kilograms and all these things, what I teach folks is let’s start with where we’re at.

(00:47:53):

Let’s say right now you’re eating 30 grams of carbohydrate per meal. Okay? So I’ll give you an example. One banana is 30 carbs, okay, half banana is 15, or if we’re looking at a half cup of oats is 15 grams. So if we’re going to a whole cup that’s 30 grams. So point is most of the time folks are usually, once they’re out of the initial stages, they’re getting around the 30 carbs and maybe a little bit more. And what I’ll tell folks is, so again, in that immediate post-op phase or post-workout, excuse me phase, try to eat as soon as you can. And again, if we can try to again in protein, if we can bump it up to that 30 grams, that’s awesome. That’s going to help with that muscle protein synthesis. And then I also encourage folks to try to get in about at least 30 grams of carbohydrate as well to help with that muscle glycogen restoration process. And then we’re fueling every couple hours thereafter, because again, when our overall volume is reduced due to bariatric surgery, the frequency can help us to meet our needs. And so I want to just highlight this that I see very frequently with my clients, which is skipping around workouts or not eating breakfast or anything, and then putting all their calories at nighttime or in the evenings.

Dawn, RD (00:49:02):

And

Kim, RD (00:49:03):

That also keeps us in that prolonged kind of catabolic state because we aren’t providing our body nutrients to halt that and be able to grow and build. We’re going these long periods without putting those nutrients in, and we need to not do that right. We want to try to get that fuel in as soon as we can so our body can utilize it. So really to answer your question, I am a big fan of, if you can pre-workout, we’re trying to get in about 15 to 30 grams of carbohydrate in that one to two hours. You can take in some protein, but carbs are going to be more important. And then post-workout window as soon as you can, we’re trying to get up to at least that 30 grams of protein and ideally about 30 grams of carbohydrate to begin the recovery process. And then we’re fueling every several hours thereafter, every maybe three to four hours thereafter.

Dawn, RD (00:49:47):

Do you find that a lot of bariatric patients need to utilize the protein supplements more or do you try to gear them towards just using whole real food as their post-workout quote, meal or pre-workout food? Do you find that one works better than the other or performance is different with shakes and bars or?

Kim, RD (00:50:14):

Yeah, no, it’s a great question. Typically, I always promote food first just because that’s going to increase the variety of nutrients that you’re getting in your diet, reduce constipation because a lot of shakes and bars are very concentrated, and so that can, for some folks lead to some bloating, sometimes some constipation issues from those types of products. If you’re overusing them, meaning you’re taking in several bars a day, several shakes, what I usually say is that because we have increased demand due to increased movement, those types of products have a role and they can play an important role in meeting our needs. Again, they’re secondary to trying to eat balanced plates of real food, and then when we need to increase, we need an extra blast. That’s a great way to do it. I just don’t recommend relying on them as your sole way to meet your protein goals. For example, I wouldn’t be like, yeah, you should be drinking two shakes a day and then one meal of food. No, no, no. We’re trying to eat three meals of food and then we’re incorporating a shake or a bar here or there as needed based on our demands.

Dawn, RD (00:51:16):

Yeah, that’s awesome. Yeah, I agree. I think that’s common to see that they want to use that shake as a meal, and it’s totally not enough fuel. The majority,

Kim, RD (00:51:31):

A hundred percent. And the majority of the time, most protein shakes are low in carbohydrate. And so I always remind my folks, if you’re going to have a protein shake, you need to pair that with some source of carbohydrate as well. So again, half bananas, 15 grams of carb right there. Or if you have the shake and you’re going to have a meal an hour later or something like that, that’s going to incorporate carbohydrates, that’s fine. But again, I want to reiterate it is important, try to get in those protein and carbs as soon as you can after your workout.

Dawn, RD (00:51:58):

So if we go back to the leucine, what are some food sources of leucine that they could actually get that three to four grams when they finish their workout?

Kim, RD (00:52:08):

Yeah, primarily your animal-based proteins are going to be a better source of the branch chains and leucine whey protein powder, casein protein powder, and even soy-based protein powder has the branch chains, but in a lower amount. And also the availability. The absorbability of it in plant-based proteins are going to be less as well as lower overall. So your best sources are going to be coming from your animal-based proteins. Milk egg is another good protein source that you can have, and soy. Soy is also a good source.

Dawn, RD (00:52:41):

But

Kim, RD (00:52:41):

Again, as we get into more of the plant-based proteins, then the concentration of the branch chains are much less, especially leucine. And so then you have to eat a variety of different plant-based proteins in order to get all essential amino acids in. And I want to highlight too, I’ve gotten this question a lot. Can I just take branch chains as a supplement? And the research out there says, yes, we know that leucine plays a critical role in muscle protein synthesis, but you need all nine of the essential amino acids to really gain muscle mass. So you can’t just take those three and be like, that’s all I need, just these branch chains, powder, whatever. You have to get in all the nine essential amino acids from your dietary intake as a whole. So don’t be fooled into just thinking you only need the branch chains. Whey protein is going to have all nine. So is casein, so is soy, and it’s going to have the branch chains as well. So I usually tend to recommend those products over just a straight B, c, a type of supplement as well as of course, eating your animal-based proteins or a wide variety of plant-based proteins.

Dawn, RD (00:53:46):

Yeah. Now, we didn’t talk about this prior, but I’ve been learning more about creatine because of my season of life I’m in and how valuable it’s in menopausal females. I’m like, my mind is blown that the benefit, even with bone health, it’s like I’m really intrigued by utilizing this product even for myself. So how do you feel about creatine for the female population and even males, because we have males too that are bariatric patients that listen. So

Kim, RD (00:54:27):

Creatine, I’m a big fan of it. So creatine monohydrate is the most studied sports nutrition supplement out there. Okay. There is a robust amount of research on creatine monohydrate for its efficacy, its safety, and really they’re looking at creatine in all parts of the lifespan from children all the way up to the elderly and how it impacts not only increasing muscle strength, power size, but also bone health, brain health. So they’re doing more cognitive research on how creatine impacts the brain function, bone density in women, but creatines. So to kind of give a quick exercise, physiology recap, creatine is the first energy system that our body uses when we move at a high intensity level for about up to 180 seconds or so. So it’s an anaerobic system. So if you and I got up right now and started doing squat jumps for the next 30 seconds, our body is using our stores of creatine in the muscle to fuel that movement to provide a t p to the muscle to move our body.

(00:55:28):

So creatine is that first energy system that is used. And so it’s important that we have it. And what I think folks kind of misunderstand or the old myths that were out there with, it caused cramping and it causes weight gain and all these things and whatever. I would say, of course, first, make sure you speak to your doctor before beginning creatine, especially if you have any history of kidney or renal dysfunction. You do want to talk to your doctor before beginning creatine. But back to why it’s important is if we don’t have that energy source to draw upon, you can’t produce that energy force at a high rate for a long period of time for someone that’s resistance training, that’s doing weightlifting.

(00:56:07):

Every extra rep you can get in to move that you’re pushing is helping your body to break down as well as rebuild that muscle. So creatine allows you to basically go harder longer. So the people that really benefit, number one, men and women benefit from creatine as well as vegetarians and vegans, why they’re not eating animal-based products. And that is where creatine is found in the diet, is from our animal-based products, just like humans, animals make it as well. So when we eat animal protein, animal foods, we get that creatine. So we do take it in through our diet, but what we have found is that the dietary intake of creatine versus what we use in movement oftentimes either wash each other out, meaning we’re kind of at a net zero. And so the supplementation of it is helpful to saturate and keep the creatine stores in our muscles elevated. So vegetarians and vegans who are not eating it really see typically a good response to creatine monohydrate supplementation because they’re not taking it into their diet. And so to really just summarize this, I’m a huge fan. I actually had Dr. Darren Kow on my podcast recently. He’s one of the world’s leading researchers in creatine, and he has just talking about the explosion of more creatine research in different areas outside of just muscle gaining and the benefits across the lifespan. So highly recommend folks to look into it, speak to your doctor first, but it can certainly help with increasing muscle mass, power size, and then we have the bone in the brain benefits as well.

Dawn, RD (00:57:35):

That’s amazing. Yeah, I think it’s so interesting how over the year, I mean, I’ve been a dietitian for almost 30 years, so how it was perceived when I was becoming a dietitian completely different as it is today. So yeah, so cool to see what research can give us the information that it can give us and how important it is. Especially like we were talking earlier, we need more research on activities with bariatric patients. We need that data so we can understand their needs better. So yeah, I think the more that we can tune into our community with bariatric patients, it’s going to only help them in the future.

Kim, RD (00:58:25):

Absolutely. And to go off of the creatine thing, especially for bariatric folks, of course, overall calor intake, protein intake, all those things are going to be really important for increasing muscle mass. But creatine is an ergogenic aid, meaning it’s a supplement that helps to round out or boost what your body needs. And so I always tell folks, listen, supplements are at the tip of the iceberg. We don’t even touch that until we get the basic dietary strategies in place. There is no supplement that can cover up a poor diet or poor intake. And so to reiterate, with bariatric folks, I would say creatine can absolutely be a very helpful supplement as long as you are doing resistance training and you are eating the optimal amount of calories and protein and carbohydrates, et cetera, to fuel the movements that you’re doing, like your weightlifting or whatever. But it definitely can be a helpful supplement. Talk to your doctor first. Of course.

Dawn, RD (00:59:14):

Yeah, I think that’s a good point to make, that they’ve got to get that foundation first before you start more supplements to maybe not even really help you in that scenario.

Kim, RD (00:59:29):

Totally. Yeah, I agree.

Dawn, RD (00:59:30):

Yeah, that’s awesome. Okay. This has been awesome. So any last thing that you would love to share with the audience that maybe you didn’t get to finish the full thought on or just something that you feel like would be important to them to hear?

Kim, RD (00:59:48):

I would just say it’s exciting that after you have had bariatric surgery and you’re changing, you’re changing your life, you’re changing your body composition, you’re starting these new exciting goals, nutrition plays such a critical role in that process, and really to feel good doing it to meet the goals that you’re striving for. It takes a little bit of focus and some practice, but you can meet those goals through increasing and improving your nutrition over time. Nothing to be afraid of with gradually increasing overall calories, carbohydrates, proteins, fats, all those rules out there about no carbs, especially with my more active folks, I’ll just say there’s a time and place and they play a very critical role in your overall ability to do all these new exciting goals that you have in terms of fitness. So I always just remind folks it can be done. Working with a healthcare professional, like a Registered Dietitian can really help you to sort out the what do I need to take in, how much and when and how’s that going to meet my unique needs as a bariatric individual that now have all these fitness goals. I just want to recommend, always try to find a professional. It’s just really helpful. It saves you time, confusion, all those things that you don’t want to have to be focused on. So I just really appreciate being on today. I thank you so much for having me.

Dawn, RD (01:01:02):

Yes. Awesome. How can people find you, share where your website and maybe all your social media, where can they find you to maybe work with you or learn more about what you talk about?

Kim, RD (01:01:16):

Sure. Yeah. So my business is Active Bariatric Nutrition. I have an Instagram account, my social media, my handle is at Active Bariatric on Instagram. I have a TikTok page, which is Active Bariatric Nutrition. I have a YouTube channel that hosts all of my podcast episodes. So I do have a weekly podcast that’s called the Active Bariatric Nutrition Podcast. And I bring on both bariatric individuals that have fitness goals to kind of help with motivation, inspiration, learning from each other. I bring on professionals, other dietitians and doctors and exercise experts to talk all about this area. And so you can see all the videos of the podcast on my YouTube channel, and you can go and listen anywhere that you listen to your podcast for the Active Bariatric Nutrition podcast. And then I do have a Facebook community. So if you’re wanting to come inside my Facebook community, just search the active Bariatric Nutrition community, and it is a private community. So I will let you in, but we just talk day to day about different topics and questions that you might have. And then lastly, my website, which is www.activebariatricnutrition.com. If you’re ever interested in scheduling a discovery call, you can go there and we can learn more about each other through that call.

Dawn, RD (01:02:27):

That’s amazing. I love it. Thank you so much, Kim. This has been very helpful and I know the audience will love all this information that you’ve provided. You definitely are a wealth of knowledge when it comes to the sports nutrition piece that bariatric patients really do need when they’re so active.

Kim, RD (01:02:49):

Thank you so much. I appreciate it, and thanks for having me on today.

Dawn, RD (01:02:51):

Yeah, awesome.

Kim, RD (01:02:52):

Thank you. You too.

Dawn, RD (01:02:53):

Yeah.

The post Signs you’re under fueling your workout after bariatric surgery appeared first on Gastric Health.

Have you ever wondered why vitamin B12 is so important after bariatric surgery?  Check out our audio transcript to learn more.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, a Registered Dietitian, and I am excited to talk to you today about why vitamin B 12 is so important after bariatric surgery. So we are going to dive into the importance of having adequate vitamin B 12, and I do feel like a lot of bariatric patients are aware of this, but I do see that over time a lot of patients gets taken off of their supplements for various reasons or quit taking them or have just not gotten a good routine of taking it consistently. And so here I want you to understand the why of its importance. I feel like when you know the why, it’s easier to do it. You prioritize the doing and because we all know that knowing and doing are two different things, but when you understand that it’s impacting your mood and it’s impacting your energy level, it’s easier to prioritize it because you know that you’re going to feel pretty crummy if you don’t.

(01:14):

So let’s dig into B 12 so that you have a good understanding and you can support yourself well with understanding how this impacts your life overall. So vitamin B 12, or we also call it cobalamin. It is a water-soluble vitamin. And years ago we would really think not too much about the dosing of vitamin B 12 because it is water soluble and it was kind of believed that, hey, if you’re just going to pee out what you don’t need. But really essentially it does matter the dosing. So you don’t want to go too crazy, but there are a lot of factors that kind of determine the appropriate dose for you. So vitamin B 12 plays really a variety of roles in your body. It is mostly found in animal foods and can be found in lots of fortified foods as well. However, many people do not absorb vitamin B 12 properly due to really multiple factors like medications, disease, age, genetics, food choices, all of that plays a role in your ability to absorb. So just because you maybe take a supplement doesn’t mean that you’re absorbing all of it appropriately. So how is B 12 absorbed? I don’t want to get too technical, but really the foundation of it is the stomach acid and pepsin that breakdown food. It kind of breaks off the B 12 from the food. And then we have a protein, it’s a binder protein,

(03:01):

And in the small intestines the pancreatic enzymes break down transcobalamine and freeze up B 12 again. So your stomach, it binds your small intestines, it gets broken off from that binding, and then from that release it gets bound with intrinsic factor, which is actually something that comes from your stomach into your small intestines. And then it is absorbed in the cells in your part of your intestines called the ilium. And then from there, that’s where it gets bound to transco ballin two, which is really what transports B 12 into the bloodstream and delivers it to your organs and your tissues. So that process, any glitch in any of those processes can impact your ability to have normal B 12 levels. So what interferes with the absorption of B 12? We can think of medications, disease, your diet, age and genetics, all of those play a role in your ability to actually absorb adequate amounts of vitamin B 12.

(04:24):

So medication metformin is one. This is a very popular diabetes medication, proton pump inhibitors, PPIs, and then also H two blockers. So those acid, think of all those acid blockers, acid reflux medications, they are widely used in bariatric surgery and it is something that you want to challenge your practitioners on in trying to get off of them and not maintaining on them long-term. Next is birth control pills. They are known to deplete vitamin B 12 or just interfere with that absorption of, so then you have lower levels of B 12 and then certain antibiotics and anti-convulsants, all of those impact how you can absorb vitamin B 12. The next is certain disease states. So anything that’s going to inflame or damage your stomach or intestinal lining would definitely be a risk factor for having low absorption of B 12. So think of things like gastritis, which is really just an inflammation of the stomach celiac disease, Crohn’s disease atrophic or atrophic gastritis or pernicious anemia, which is autoimmune disorders that destroy the stomach cells.

(05:55):

So those are things that in the big picture really do prevent you from having normal B 12 levels. Next is your diet. So if you consume a diet that is low in animal proteins, then you’re not going to be getting adequate amounts of B 12 in your diet. So think about vegans and vegetarians mostly in this case, or if you’re a bariatric patient that has a difficult time with solid dense meats that could contribute. But if you do well with eggs and cheese and dairy type stuff, that could make up for it. If you’re strong in those but maybe weaker in the solid dense meats, you might be fine potentially. It just really depends. You got to look at all these factors that’s going to interfere. So if you have some of those medications that you’re taking or maybe some of those disease states, you can’t just rely on that alone.

(07:04):

You also have to think about your age as we age, we have less intrinsic factor and stomach acid, which that impairs your ability to actually absorb vitamin B 12. And then we have to think about genetics. So various gene variants can affect your ability to metabolize and transport vitamin B 12. For example, people with mutations in the gene that code for the transco ballin two, that protein that we talked about that actually gets it into your bloodstream, transports it into your bloodstream, that goes to your tissues and your organs and stuff. If there is a mutation in that gene or its receptors, you may have lower levels of circulating vitamin B 12. So it’s how you were made, it’s the genes you were given and it just is impacting your ability to have a normal B 12 level. So how can bariatric surgery impact B 12 absorption?

(08:13):

So this is where you got to think a little critically on this because bariatric surgery reduces your stomach acid, it reduces intrinsic factor and it reduces the pancreatic enzymes in some cases. So if we talk about your stomach acid, this across the board, at least in all the research that I have dug into when it comes to bariatric surgery and especially with ruin white gastric bypass, but even with gastric sleeve, we see lower amounts of stomach acid and it can be tricky with a sleeve because some people with the sleeve have a lot of heartburn and reflux, which may be more from the pressure as opposed to just excess acid. And that pressure is creating that sphincter from that lower esophageal sphincter, the flap at the bottom of your esophagus to not be tight and sealed, but then also having adequate stomach acid plays a role in that too.

(09:32):

If you don’t have adequate stomach acid, it’s not going to have a tight seal. So it matters. Your stomach acid matters and you’ve got to have, whether you’ve had a sleeve or you’ve had a roid gastric bypass, the amount of stomach acid that you have is not appropriate. So supporting that, and that’s where the digestive enzymes really do help and help set you up for success in having adequate amounts of stomach acid and supporting it. And that’s why I really love our W L S formulated digestive enzymes. It really does support you in this way. The next one is the reduced intrinsic factor, and this is because of where intrinsic factor is made in your body and it is in the lower portion of your stomach, which is either removed with a gastric sleeve or it is stapled off with a ruin wide gastric bypass.

(10:33):

So you are reducing that availability of intrinsic factor and that’s what your body needs. Like we talked about, the intrinsic factor plays a role, it’s part of the process for you to absorb and it’s important to have adequate amounts. So you’re lacking that with bariatric surgery. And then pancreatic enzymes, and this isn’t for every person, but this is where the exocrine pancreatic insufficiency comes into play or E P i, certain people after bariatric surgery will develop E P I where you aren’t going to have enough pancreatic enzymes. And then you think about if an you’re having low levels of pancreatic enzymes released. That is, remember when we went through the process when those pancreatic enzymes are not sufficient, that’s what breaks that binding apart so that it can go to the next binder when we are going through the steps of absorption. So the pancreatic enzymes break down the transcobalamine and freeze up the B 12 again, and then now the B 12 gets bound to intrinsic factor.

(11:54):

So if you don’t have that adequate pancreatic enzymes to break down or break apart that transcobalamin and free up the B 12, then it’s not going to get attached or bound to that intrinsic factor. So that’s why it matters. That’s why you have to pay attention to all of these pieces. And are there signs that maybe you aren’t releasing enough of the pancreatic enzymes? Are there digestive issues? So again, working with someone is critical in making sure that you cover all of these pieces to really get down to what’s driving it. So how can vitamin B 12 deficiency be diagnosed? Personally, I still look at a serum B 12. Now this is definitely not a conclusive lab test, this is not your end all be all to determine adequacy of vitamin B 12 that you are adequately getting in enough B 12 and absorbing it.

(13:10):

It is really showing you more of what you’re taking in with your food and your supplements as opposed to telling me what’s in the cell. What you need to determine if you have enough in the cell is methylmalonic acid or M M A. And this test measures a byproduct of the metabolic process that requires vitamin B 12 as a co-factor and the body accumulates M M A when vitamin B 12 levels are low. And so whenever your M M A is elevated, it means that you have a vitamin B 12 deficiency. So I like looking at both. Someone can give me their vitamin B 12 level if it’s within that normal, I like it above 600 if it’s a high or if it’s low, I really like to have an M M A as well. But if somebody within that reference range, it’s like 200 to 900 or a thousand depending on the lab.

(14:19):

If that serum B 12 is within those reference ranges, but it’s at least around 600 or a little more than 600, I’m probably not going to get too worried if I have an M M A to look at, unless the person is saying I’m tired, I have numbness and tingling, I have all these symptoms, then I’m going to want an M M A for sure. But again, it’s information. So if we need more data with the M M A, we need to do it. And then the last one is homocysteine. So homocysteine, this measures the amount of homocysteine, which is just an amino acid that kind of participates in that metabolic pathway requiring vitamin B 12 and folate. So it’s not a full picture of just B 12, but it’s what they do together. Folate and B 12 work together and homocysteine accumulates in the blood when vitamin B 12 or folate levels are low.

(15:23):

So having a high level of homocysteine indicate vitamin B 12 or a folate deficiency and then to really determine if it’s B 12, you would need the M M A to really get to the full answer. I don’t know that a lot of surgery centers really do test for homocysteine. We did at the very, very beginning and then our doctors just feel uncomfortable with it because it’s also a cardiac marker. It’s utilized in that way as well. So when those levels are elevated, it can be saying, Hey, there’s maybe some cardiac issues. So again, that’s where some programs probably aren’t going to be testing that, but it is information if we need to dig deeper that a homocysteine could be drawn on. The last one is the holo TC or the holo transcobalamine test. This is not used often more in research as opposed to in a clinical setting, but it measures the level of the holo tc, which is the active form of B 12, bound to transcobalamine two, the transcobalamin two, and delivered to the tissues.

(16:48):

As a result, low levels of holo TC indicate vitamin B 12 deficiency. So again, probably not something that you are going to have drawn in a clinical setting per se, but if your doctor is aware of this test and wants to really doesn’t feel like he’s getting the data he needs with these other available tests, then he could totally do that. The next is why is vitamin B 12 so essential after bariatric surgery? So why would someone’s body need vitamin B 12? So one, it prevents anemia. Two, it supports nerve function. Three, it enhances your cognitive function. Four, it protects cardiovascular health. Five, it supports your metabolism. And six, it supports D N a synthesis. So when it comes to research has shown that vitamin B 12 is crucial for the production of red blood cells, which that’s what transport red blood cells are, what transport oxygen through the body.

(18:01):

An anemia can cause fatigue, weakness, shortness of breath, pale skin, and an increased heart rate. So if you have anemia and you have these symptoms, you feel tired all the time, but you’re also kind of short of breath walking up steps or not even going up and down steps, but maybe just walking two things, you are more tired and you feel like your heart rate can erasing a lot. Those could all be signs of anemia because you don’t have enough of the red blood cells to transport the oxygen through your body. So super important. But B 12 plays a role in this process, support your nerve function. So think of this as your ability to have healthy nerves. So you have myelin sheath that protect or encapsulate these nerve fibers and low levels of vitamin B 12 can damage myelin sheath or those protectors around the nerves and then end up causing nerve problems, which is the numbness, the tingling, burning or just pain in general.

(19:22):

And it can progress further if left undiagnosed going to the cognitive function. So B 12 plays a vital role in the cognitive function and plays a role in neurotransmitters such as serotonin and dopamine, which regulate your mood, your memory, your learning. And low B 12 levels really do contribute to depression and confusion and dementia and Alzheimer’s. All of those pieces is information. So if you’re really struggling with your brain, like your foggy thoughts and you just feel down all the time and confused, maybe part of this is your B 12 cardiovascular health.  B 12 regulates homocysteine, which we kind of talked about works with folate. So folate and B 12 work together to lower homocysteine levels and homocysteine can damage blood vessels and contribute to cardiovascular disease and stroke. Having a high level of homocysteine can inhibit the function of nitric oxide. And this nitric oxide is a molecule that relaxes and dilates the blood vessels to improve blood flow.

(20:55):

So this is a positive thing. We want adequate amounts of nitric oxide. So anything that can impair that from functioning appropriately or having adequate amounts is not a positive thing. And high levels of homocysteine will inhibit this nitric oxide function. So that’s where it can lead to damages with cardiovascular events. D N A, oh, let’s see here, support your metabolism. So vitamin B 12 is a co-factor in many enzymes involved in energy production and fat metabolism. When we say energy, we mean calories. So when vitamin B 12 levels are low carbs, fats and proteins are not properly converted into energy, which can result in weight gain, low energy and poor appetite. It’s part of the package deal. We need all of these things in your body working correctly for you to get the end result of a healthy metabolism. So you can’t ignore some of these and use a different pill to treat your or symptoms when it’s B 12.

(22:24):

That’s the problem D N A synthesis. So vitamin B 12 facilitates D N A synthesis ensuring that your cells can replicate and grow properly. So our cells turnover and become new frequently. I think it’s like every seven years all of our cells throughout our body have been replated and restored and brand new. So it’s important to make sure that you think about B 12 because it’s a helper that ensures that our cells can make new D n a. So it’s part of how our body functions and grows. Now how much vitamin B 12 should bariatric patients take or how much do you need as a bariatric patient? How much vitamin B 12 do you need? Typically when it comes to supplements, you’re talking 500 to a thousand micrograms a day, and this is in the form of sublingual, which means underneath your tongue a nasal spray or an injection.

(23:37):

I would not recommend a swallowable B 12 pill because of all of the things we just talked about. We’re not going to have enough stomach acid to break that off so that you can utilize it efficiently. Food, you can get it from food like we’re talking about animal proteins have a good source of vitamin B 12. So think of clams, beef, liver, trout, salmon, tuna, milk, yogurt, cheese, eggs and chicken. All of those have a good quality of vitamin B 12 available that you can absorb and you can also get it from some fortified cereal. But remember that all of those fortified foods or those ultra processed foods are not going to be absorbed equally like an animal based B 12. So you get better absorption of the whole real food form compared to a synthetic fortified form from ultra processed foods. So hopefully that makes sense that you whole real food is really going to outperform an ultra processed food that has been fortified or refortified with vitamin B 12.

(25:07):

So it’s important to get those animal sources in and make sure that you are getting it in consistently. So let’s wrap this up.  Bariatric surgery really does put a person in need of maintaining normal. Vitamin B 12 levels because we are altering how your body breaks down and absorbs nutrients. So bariatric surgery is all about malnutrition. So we are trying to prevent malnutrition, and that is where we have to make sure you’re absorbing adequately of these nutrients so that you don’t have problems and symptoms that you are thinking is something way completely different. Proper monitoring, at least annual labs, you should be getting a serum B 12 and methylmalonic acid or M M A drawn from either your bariatric team or whoever does your annual labs with all the nutrition indicators that is necessary. Also making sure that you’re supplementing. And I find frequently that a lot of bariatric patients will be taken off of B 12 supplements because their serum B 12 is elevated.

(26:37):

And remember how I said that serum B 12 is really just an indicator of what you’re taking in from your food. And your supplements and something I’ll be talking about next time on. I have another continued topic on B 12 where we’re dialing more of the genetics and. The gut microbiome because gut bacteria actually produce vitamin B 12. So you have to think about those pieces as well because it’s going to influence how your body is utilizing all of it. So it matters. And I want you to make sure that you are supplementing appropriately and. Not allowing a primary care provider to take you off because of an elevated serum B 12 that is sometimes dangerous. And I’ve seen it frequently that they’re like, yeah, my doctor said I don’t need to take that anymore. My level was good. Well, your level was good because you were taking it and you don’t have. Your surgery has created this environment that you are not going to have the ability to absorb enough from your diet.

(28:04):

So don’t go off of it and make sure that you are testing, you’re getting those labs test every year. And if they’re abnormal, then you test them every three months until you get ’em normal and. Making sure that you’re correcting those low levels. So it’s important to work with a provider like myself who is skilled in interpreting this data. Just gathering this data. I find it interesting that the lens in which we look through things. I find that an md, a pa, an np, an RN might look at it one way and say. Oh, that looks fine to me. But a dietician might look at it and say, oh no, that’s not high enough. If I have somebody that has a serum B 12 that’s 400, I want it higher, I want it above 600. If I have somebody that’s at 1200, I want a methylmalonic acid drawn. And if that is elevated, then I’m going to get concern or. I don’t want to say concerned, but I’m going to start digging a little deeper. I’m going to start thinking, Hey, what’s happening in their gut? Do we need to do some gut work? And that’s why, because their gut microbiome is now. Or those gut bacteria are now producing excessive amounts of vitamin B 12 that are not going to be utilize. And so it’s creating this wrong environment. So again, we’ll get in deeper with the gut microbiome and your genetics next

(29:41):

Time when I talk about B 12, so that you have that to process on as well. So I hope this has helped and I hope you guys have learned something and. Maybe this will make you be a little more efficient with taking your B 12 supplements. And making sure that you’re taking it regularly like you’re suppose to after bariatric surgery because it is super important. It is something that does matter and can impact how you feel. So you guys have a great week and we will see you next time. Bye-bye.

Listen, Learn, Enjoy

The post Why is vitamin B12 so important after bariatric surgery? appeared first on Gastric Health.

Do you question why you feel hungry all the time?  Check out our audio transcript to learn more.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, a Registered Dietitian. And this week’s topic is Why do I feel hungry all the time? And we are going to dig into this kind of complex topic of hunger and hopefully give you some deeper understanding of why maybe you have dysregulated hunger cues. I think that’s kind of the big picture that I want you to understand is that hunger is normal and everyone should have hunger. So it’s not bad to feel hungry, but it’s not uncommon. Or it can be kind of an understanding of why some people experience dysregulated hunger. But essentially it’s important to learn from this cue. This cue of hunger is your body’s way of saying, Hey, I need fuel. And whether it’s accurate or just confused by hormones or genes or other biological or even psychological causes, it’s still your body’s communication system to you to say, Hey, I need something.

(01:30):

So this is where I want to challenge you and I want you to really evaluate as we go through this. I always like to present it in the way that if your hunger is dysregulated, it could be because something in your life is out of balance and that’s what you have to focus to correct. And this could be a wide variety of causes, and that’s what we’re going to dig into. What is physical hunger? And really physical hunger is just an actual cue that your body is sending when it genuinely needs food. It is hungry for a reason because it needs the fuel source to keep your brain thinking, your lungs expanding, your food digesting, and just everything flowing like it’s supposed to. It’s very smart. Your body is very smart. And when your stomach stretches or expands, it begins the communication between that gut and brain for satiation and hunger hormones to be released.

(02:53):

So you can think of the ghrelin and the leptin in this case, but additionally, your blood sugar, it kind of plays a role in prompting those hunger cues as well. Now, what is psychological hunger? And this is not triggered by really a physical need, but it’s more of an emotional, environmental or stressful trigger that really prompted you to go digging in the pantry. So this type of hunger really is complex and it does have deep roots in some instances. But I also want you to know that this type of hunger is not abnormal. So it’s not bad if you have psychological hunger or what you may think of it as like a head hunger. It’s not bad to have that. It’s normal for human beings to experience this and learning these cues and the differences is where there’s power to be found. And in reality in some studies, it did show that 38 to 75% of adults admit to having psychological hunger.

(04:14):

So again, you should never feel shame or guilt for having hunger. And I will say with all of the GLP-1 medications, this has been brought to the forefront to my attention at least, that I feel like people are confused, that you shouldn’t be hungry and hunger is bad and it really isn’t. And I want you to understand that it’s good to have hunger cues and it’s good to learn from them and expand in that understanding on what you should do. If your hunger cues seem dysregulated and inappropriate for maybe you just had a meal recently, then it’s time to explore maybe what’s driving that, what’s triggered you to want to go back to the kitchen after you just ate a full meal an hour ago. So let’s dig into these together and hopefully this will help you get a bigger understanding. So some biological causes of hunger.

(05:35):

(06:43):

So if you have some genes that are turned on and are really driving this appetite hunger dysregulation, then we have to kind of go upstream and turn it off and block it so that you are not struggling with dysregulated hunger. So the next one is blood sugar and insulin dysregulation. And I would say to me this is foundation one, you have to get your blood sugar and your insulin within normal reference ranges. You can’t have pre-diabetic numbers and insulin resistant numbers and not feel hunger all the time, and especially even cravings. I’m not really going to mix those in, but really they are connected. You will have more cravings and increased appetite and hunger regulation with dysregulated blood sugar and insulin levels. So you have to get those imbalance first, and that’s where learning how to eat, how to package your meals, the timing of your meals, all of that matters in making your appetite and hunger cues in balance.

(08:06):

And I would say maybe not in balance, but in a way that seems appropriate so you don’t feel like, Hey, I just had a full meal, I need to eat in an hour. No, when we get those imbalance, you can go a normal four to five hours without having these cues to have to eat. 3. The gut dysbiosis. So we know that certain gut bacteria play a role in driving hunger for certain foods. Low diversity makes you more susceptible to bacterial messaging. So what does low diversity mean? So diversity is the different varieties of bacteria are living in your gut. And what we know is that obesity in general always presents, and this has been study after study after study, this is not something new. Low diversity. So you have very few species and strains of bacteria and that is correlated to that bacteria having more control of the communication and messaging.

(09:25):

And this is where things can get hung up and really get you in a bad place where you feel like you have no willpower and you are relying on willpower is really a better way to think of it. So you want a high diverse range of bacterial species and strains in your gut. That is the ultimate goal. And if you follow me long enough, you probably know this answer, but you need fiber filled carbohydrates to accomplish this. So that is one piece of it because that’s what’s going to grow it. So probiotics with some prebiotics, but those fiber filled carbohydrates are going to give you the prebiotics and then also fermented foods. Those will also provide some good beneficial bacteria that will add. And actually when you combine those altogether, that’s when you get the magic. That’s when you can increase that short chain fatty acid production.

(10:31):

That’s when you’re providing that or setting that right environment in your gut so that you can have a healthy gut microbiome and you can have normal hunger cues. If this is what’s driving it, and I want to preface it, I guess I should have said this first, but it’s probably not just one thing. Driving hunger dysregulation for most people, it’s probably a combination of some of these or probably two or three or one or two of these is really contributing to this dysregulated hunger. So that’s where start with the lowest hanging fruit. Start with the one that makes the most sense to you that you feel like, Hey, I’m ready to tackle this. I feel like I can do something about this. I want to work on my gut. Or I’m ready to work on my blood sugar and my insulin. I’m ready to make those changes and strategize and plan and act on it.

(11:38):

So whichever one makes the most sense, that’s where you start. But it’s likely going to take a combination of one or more of these to correct to get your hunger in the right place. So some other things about gut dysbiosis. So we know that the more opportunistic bacteria that are in your gut or think of those as the bad guys that it creates the environment for disease. We want more commensals, more good guys in your gut or just a balance of good and bad. All of us will have opportunistic and commensals. We need the good and the bad guys and they live harmoniously in our gut. So we don’t want to wipe out all the bad guys. You need some of them to create balance and you don’t want to have way too many of the good guys that creates imbalance as well.

(12:36):

So it’s all about finding this harmonious balance with all of them living together. But some things about certain species and strains of bacteria that drive hunger for certain foods. So we know that bacteroidetes prefer certain types of fat. We know that Prevotella grows better in a carbohydrate source. We know that bifidobacterium outcompete others in the presence of dietary fiber. And then lactobacillus and bifidobacterium grow from foods rich in polyphenols. So again, this is giving us guidance. This is giving us the ability to shift the microbiome. So if you have gut dysbiosis where it’s you don’t have enough good bacteria or you have too much bad bacteria or you have an imbalance of bacteria in the wrong location or all of those or a combination of those, then that could be why you have hunger dysregulation and it seems out of place and you feel hungry all the time.

(13:52):

So this is where we work on improving your gut health and really just shifting that environment and get it to a better place. Okay, the next one is the stress and cortisol. In the short term, excess stress hormones can actually lower or suppress appetite, but it’s when it becomes chronic is when that shifts and triggers an increase in your appetite. So that’s where learning how to manage your stress and keeping your cortisol level in check and making sure that it’s not elevated chronically, that you’re not in that sympathetic state or fight or flight state all the time, which is causing that dysregulated hunger. The next one are hormones. So think about ghrelin. You can think about leptin, GLP-1, GIP. Ghrelin is your hunger hormone. And whereas the GLP-1 and GIP and leptin are more satiation hormones and these hormones when they are out of balance is when you can have dysregulated hunger.

(15:15):

So that’s where if you feel hungry all the time, that’s where if you learn to increase that GLP-1 naturally by your food choices. And I have a whole YouTube, podcast and blog post on GLP-1s, increasing GLP-1s naturally, and I just spoke on this at the Bariatric Symposium, and really increasing this hormone can help balance out your hunger hormones in a way that can be sustainable. So again, feel free to check those out on our website at gastric health to get those details of that information on GLP-1s. But it’s important to understand that I think it’s the combination of these five things, the genetics, your blood sugar, insulin dysregulation, gut dysbiosis stress or cortisol imbalances, and then hormones. What about these are driving those desires or need to eat more than is appropriate? Again, remember, that is not bad to have hunger and you should honor your hunger.

(16:35):

You should eat when you feel hungry, but when your hunger is inappropriate and that you need to eat so frequently and that you never feel satisfied, look at these biological causes and decide, is this part of the puzzle? Is this what I need to focus on to get this imbalance or get this in a more acceptable state that I don’t think about food all the time? Next is psychological causes of hunger. And so this area is complicated and really can get deep and it’s really multifactorial and can really, I want to say, go into a place that you might find that you need a lot of head work, mindset talk, maybe even some therapy to really get into what is driving this piece for you. So four causes of psychological hunger, one, hedonic hunger, two, unprocessed trauma. Three, you’re stuck in fight, flight or freeze.

(17:54):

Four, you have a poor relationship with food. So let’s go to the hedonic hunger. And this is considered, you can think of this as like head hunger, but essentially you are eating for pleasure, not for a physical reason. It’s more there’s a connection and you need this. You can even think of a dopamine boost or something in that area because you are seeking pleasure. So maybe there’s negative things going on or there’s a trigger that has occurred that stimulated this and that is why you are desiring to eat a certain food. But hedonic hunger is linked to food addiction and obesity. And one study found after bariatric surgery, and this was a small study with 120 participants and they did a very low calorie diet or bariatric surgery and both experienced a 10 to 15% weight loss and a reduction in head hunger. But they found that the bariatric surgery results in greater changes in head hunger and food rewards than the very low calorie diet did, which totally makes sense if you have a smaller stomach, it’s a lot easier to manage the hunger between meals compared to somebody consuming 800 calories, 500 to 800 calories a day to get in that very low calorie range to maintain that and not feel hunger.

(19:43):

So to me, that makes sense. So again, it just shows the benefits of bariatric surgery when you really do struggle with appetite and hunger dysregulation, causes of hedonic hunger, sleep disturbances, genetics or your hungry genes and obesity, and first off sleep disturbances. Insufficient and poor quality sleep disrupt your hunger regulating hormones. This is where getting a good night’s sleep is so important and why we find that paying attention to sleep matters when it comes to hunger. And we know that a lack of sleep increases your ghrelin and decreases your leptin. A 2018 study showed a lack of sleep, increase your desire for high fat, sweet food and changed behavior towards sweet and savory. A 2019 study show having a reduced sleep by 33% had increased hunger, tiredness, sleepiness, portion sizes, and food reward. So everyone has had a bad night of sleep and definitely can impact you when they go night after night after night. Another 2018 study found increasing total sleep by 21 to 177 minutes, decreased your overall appetite, desire for sweet and salty and desire for dairy-free, sugar-free food. So this is the flip of that showing that just increasing your sleep by 21 minutes per night can have a beneficial effect on your appetite and hunger regulation. So that’s why it’s important to prioritize getting a good night’s sleep and just really focusing on how can I improve my sleep in every way so that each night I am just getting good deep quality sleep.

(22:15):

Okay, so let’s go into genetics, the hungry genes. And I will tell you, this really blew my mind when I started learning about genetics and the whole connection with your appetite and hunger regulation and how this truly does influence your ability to have hunger, how you experience fullness and hunger. It’s genetically driven. So some of us have more of those genes that set us up for having stronger hunger cues just in general. So that would be, think of those individuals who have battled their weight their whole life and likely have some of these hungry genes that really make it difficult to control hunger. Not impossible, because I will tell you there are things that you can do to get this gene back in place and get you to where hunger and appetite is in a good solid place, that it’s not dysregulate, it’s not in a place that you really struggle.

(23:39):

So we really have to focus on all those biological pieces and making sure that we’re getting all of that dialed in and just optimized. Same with the sleep. We have to get those pieces working for you so that you can keep those genes silence or kept in a place that you are not bothered by it. So let’s talk briefly about some of these genes. MC4R have weaker satiety signals and increased calorie intake. The FTO gene have a decreased responsiveness to satiety. The APOA2 have increased ghrelin and food intake. The FAAH have an increased reward with sugar, and TAS2R38 has an aversion to bitter food. So you will likely lean more towards those sweeter things because you don’t enjoy or you really have an aversion or a negative correlation with bitter foods.

(24:59):

And SLC2A2 have increased sugar intake, and then the DRD2, which is your dopamine receptors, they have increased binge eating and then the CLOCK genes changes in your eating behavior, especially if you don’t get adequate sleep. So again, all of these hungry genes or genes that really influence food intake can really drive one to have dysregulated hunger and really feel hungry all the time. So again, don’t get confused in that, oh, I’ve just been given awful genes and I have nothing I can do about it. No, I know I say this anytime I talk about genes, but your genes only load the gun. Methylation pulls off the safety and your epigenetics or your diet and your lifestyle pull the trigger. So it just means that there are ways to change this. We have the ability to shift these hungry genes to a place that is more sustainable, that will benefit your health and keep you healthier longer because they’re going to be in check.

(26:20):

They’re not going to be dysregulate and out of balance in a way that you can’t make it from meal to meal without starving. Okay, so then obesity and having the disease of obesity additionally adds to this hunger dysregulation because our fat cells are their own endocrine system and that can influence your appetite. One study found that the genes ANKK1 and DRD2, which we just talked about, the DRD2, the dopamine receptor genes. These two SNPs contribute to obesity, overweight and hedonic hunger in women. So again, it’s just showing you that, hey, maybe you were given some crappy genes. Maybe your genes are stacked against you, but I promise you there are things that you can do to put the odds in your favor that you’ll have better appetite and hunger control without feeling like you’re going to pull your hair out and that you have to be hungry, that you have to have this hunger… deal with this hunger all the time.

(27:36):

No, there are things we can do. We go back up to those biological things and some of these that are driven by poor sleep and we work on them. We really work on that genetic signaling and really putting the odds in your favor to have more control in your hunger. Then we kind of go, so these four things of psychological causes of hunger. Number two is unprocessed trauma. And this is something that if you have never read the book, The Body Keeps the Score. I would highly encourage you to listen to it if you or read it. I listened to it on Audible. It is a very long book. I think it’s like 17 hours on Audible or maybe even more, but I’m pretty sure it was like 16, 17 hours on Audible. But oh my gosh, I was glued. I just couldn’t stop listening to the book and I was just like, this makes so much sense.

(28:41):

So unprocessed trauma is something that you have to explore. If this hunger is dysregulate and we’re checking the boxes, we’re getting your blood sugar imbalance, we’re fixing your gut imbalances, insulin is not out of whack and we’re getting your stress, we’re managing it better, your sleep is better. We’re getting all of these things working for you, but you are still struggling. Then this is when you have to enlist a therapist. This is when you need to get into counseling and dig into maybe what is keeping me stuck in this from my past. So again, unprocessed trauma is something that can be a contributor to dysregulated hunger. The third one is stuck in fight, flight or freeze. Again, that goes back to stress management, maybe some unprocessed trauma, lifestyle behavior routines. You maybe say yes when you should be saying no or you’re just, this is season of life is just full of events, life events.

(30:07):

So if you’re stuck in that, that could be why. So the last thing you need if you are stuck in fight, flight or freeze is to one, really be focusing on the biological piece. I would really be focusing on the psychological pieces and working with a good therapist. So that you can work through this piece of it. And the fourth one is a poor relationship with food. That comes with that fear and guilt that drive this. And when you really are afraid to eat and you really are. You think that it’s a badge of honor to have excessive hunger all the time and restricting the food more and just white knuckle it out as the way to do it. I think it’s time to look through a different lens when it comes to food and working with a therapist, working with a dietitian, and really challenging this piece, move through this negative food piece where you’re feeling fear and guilt for consuming certain foods and shame.

(31:38):

So I do want to say something when it comes to this because. I will say there are times when certain diets are necessary in an easy example for me is a celiac patient. If I have somebody who has celiac’s disease, they can’t have gluten. I mean one milli bowl of gluten. So one crumb of gluten can really impact their ability to manage their disease. So there’s a time and a place for certain diets. And the goal for all dietitians, we want you to be able to eat a wide variety of foods and not be stuck in a restrictive state. No dietitian wants that for you, but you have to layer in that there are some people. They really can’t have certain foods for the rest of their lives, and that’s okay. But that doesn’t mean that just because you can’t have that food that it doesn’t mean. You can’t have some other foods that are just like that, that doesn’t contain maybe that one ingredient that gluten.

(33:00):

So you think of food allergies, you think of celiac disease, inflammatory bowel disease. I have other patients that there are times. When we’re in healing that we can’t have certain foods and it’s for a season. Same thing with people who struggle with some of the FODMAPs. There is a period of time where you really can’t have certain foods at very high amounts. So again, it’s a fine line that you work through. But your ultimate goal is you shouldn’t feel shame or guilt or fear for eating food. Food is fuel. No matter if it’s good or bad food. It still provides fuel and it still provides some type of nourishing property. Whether it’s maybe the best for you or not. Again, it’s finding a way to really not look at the food as or demonize one food or one food group. I think we could easily talk about carbohydrates here.

(34:15):

Before it used to be fats, now it’s carbohydrates. And you just have to learn that there’s no one magic diet that’s going to work for everyone. This is where personalized nutrition, which is going to be the future. And it is going to be where we can dial this in more to your genes and. Really help support you at a genetic level that can really help support getting a good variety of foods without the fear or guilt of having them. So again, I think you just have to evaluate, Hey, why am I experiencing hunger? Why am I removing this food? And now I’m hungry because I don’t have any carbohydrates and I am working out all the time? And guess what? Your body needs carbohydrates. If you’re working out, you need carbohydrates. You can choose fiber filled carbohydrates to get your optimal results. But again, I think it’s that relationship with food that gets messy and. Gets people in a place that they think. I shouldn’t and I couldn’t have these things.

(35:34):

When in reality you can. You just have to determine what makes sense for your body and run with it. So that’s where you really, just working with somebody can help if they’re train in… especially a dietitian. I would say really a register dietitian is your best bet because. That’s where you’re going to get the best guidance in improving that relationship with food. As well as providing you what your body needs without being restrictive and crazy about food choices. So let’s wrap this up. Hunger really is a complex combination of biological and psychological driven causes. And this is why it’s important to work with a license healthcare professional. That is train in really helping you peel back the different layers that maybe are contributing to this dysregulate hunger. And I would love to work with anyone who is really struggling with their hunger. I love to do the genetic test and work with you through this.

(36:49):

I know that not everyone can do this. But I will tell you, even without having a genetic test. Sometimes we can make some really good educated guesses and. Assume that some of the genes that you do have are turned on. We can work through changing that. So if you feel like that’s you, that, hey, my hunger is dysregulated. I’m hungry all the time. No matter what I do, I try to do what they say online, and I’m confused. I just don’t know what to do. And that’s where I’d love for you to reach out. I’d love to help you, and. I’d love to help give you good solid evidence-backed guidance to help support you in a way. That can help turn this around and get your hunger in a place that is appropriate. You have appropriate hunger cues and you feel balanced and satisfied in life. Because you’re not jumping from diet to diet. You have some food freedom, and you have no shame or guilt around your food choices. And you really do enjoy the food that you eat. You get to enjoy it with the people that you love. So I hope this topic has given you some insight because. I really want you, if you, one, are hungry all the time, start working through these biological. And psychological causes and see if you can’t get things to turn around. And I think you’ll find a different.

(38:36):

Once you get that in a different place, you’ll be surprised how quickly that you can feel that fullness from just eating the foods that you enjoy. So I hope this helps you guys. Have a great week and we’ll see you next time. Bye-bye.

Listen, Learn, Enjoy

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Taş, F., & Gezer, C. (2022). The relationship of hedonic hunger with food addiction and obesity in university students. Eating and Weight Disorders-Studies on Anorexia, Bulimia, and Obesity, 27(7), 2835-2843.

Cifuentes, L., & Acosta, A. (2022). Homeostatic regulation of food intake. Clinics and research in hepatology and gastroenterology, 46(2), 101794.

Grannell, A., Fallon, F., Al Najim, W., & le Roux, C. (2021). Obesity and responsibility: Is it time to rethink agency? Obesity Reviews, 22(8), e13270.

Aliasghari, F., Nazm, S. A., Yasari, S., Mahdavi, R., & Bonyadi, M. (2021). Associations of the ANKK1 and DRD2 gene polymorphisms with overweight, obesity, and hedonic hunger among women from the Northwest of Iran. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 26, 305-312.

Aukan, M. I., Brandsæter, I. Ø., Skårvold, S., Finlayson, G., Nymo, S., Coutinho, S., & Martins, C. (2022). Changes in hedonic hunger and food reward after a similar weight loss induced by a very low energy diet or bariatric surgery. Obesity, 30(10), 1963-1972.

The post Why do I feel hungry all the time? appeared first on Gastric Health.

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, and today I have the pleasure of introducing you to Sheila. She is one of my clients that has been working with me for the last seven months, and I got the privilege of interpreting her genetic results, and I just wanted to share her with you today and let her give you a little insight to what the experience was like for her and why it was important for her to get this information. So, Sheila, welcome.

Sheila (00:37):

Hi. Thank you. Thanks for having me.

Dawn (00:40):

Yeah, absolutely appreciate you being willing to share with everyone else, one, what this experience is like, but two, just kind of the mindset into what drove you to this point of wanting this information. But first off, I would love if you would just give us a little backstory of what got you to the point that you had bariatric surgery, and just give us those details that most bariatric patients want to know. Where did you start? How did you get there? And then how did it go? Were you successful with that and what were the results?

Sheila (01:23):

Great. Yeah, so probably a lot of people, the older I got, the more challenged I became with my weight and it just kept adding and adding and adding. And every time I would try something, I might be successful losing 10 pounds, but then all of a sudden I found myself gaining 20. So it just kept increasing, increasing and no matter what I did, it seemed like I was on the geral wheel.

Sheila (01:54):

I just kept spinning my wheels and finally got to the point where I was at a number that I really, really wasn’t happy with and started really affecting my overall health. I had high blood pressure that couldn’t be controlled. I was think on four or five high blood pressure medications and it was continuing to spike. And so thought time for something more drastic, it felt at the time, very drastic. Now, in retrospect, it really wasn’t at all drastic, but, and

Dawn (02:31):

Then tell ’em what surgery type of bariatric surgery you did have.

Sheila (02:36):

Yeah. So I ended up choosing the sleeve I needed to lose. I was at 2 89 and my goal was to get below 200. So after discussions with my surgeon, he thought that was the best choice for me, and I agreed that that was probably a good choice for me.

Dawn (02:57):

Yeah, and you did great because you lost how much weight with doing that.

Sheila (03:03):

Yeah. To date, I’ve lost over 90 pounds. So yeah, I’ve been really, really happy with the results. The whole process was, I feel very lucky. I know a lot of people struggle with various aspects of it, but I did not. I was very successful, followed all the rules. I am a bit of a rule follower, so I think that did help for sure. But yeah, ended up being very successful with my overall loss.

Dawn (03:35):

I think that’s amazing to lose 90 pounds with a sleeve, and I think that has served you well.

Sheila (03:43):

Yeah, for sure. It really has changed my life drastically.

Dawn (03:48):

Yeah. Yeah, agreed. So then about March timeframe, you reached out to me and we began this journey of genetic testing and exploring this piece for you. So tell us the backstory of what was your thinking, what was your thought process of why you would want that information of your genetic roadmap?

Sheila (04:22):

So at my year anniversary, I was so excited for my journey thus far. It was really very successful. But then after exploring different information, I found that regain was real. It’s really a challenge for a lot of people to keep it off. And I was bound and determined after working so hard during that year that wasn’t going to happen to me. So I just started exploring various options. And honestly, Dawn, I don’t know how I came upon you. I think it was through one of the bariatric Facebook groups that I belong to.

Sheila (05:01):

Somebody had mentioned your name and started looking into your social media and really following you and what you were saying just really resonated with me. It made so much sense. Your stories about not every diet works for every person and why do some diets work for some people? And it just made sense that it had to be tied to genetics. It had to be something about my body makeup would be very successful, and maybe that’s why I was so successful with the gastric surgery even could it be my genetics? And of course after getting the results, it just made sense. My whole life made perfect sense.

Dawn (05:46):

It does. Yeah. I would say that’s the cool thing about the genetic test because you could literally not meet an individual, interpret the test and then go to them and present them the results, and you could tell them what they’ve experienced their whole life, and maybe if they gave you the symptoms that they’re currently experiencing, you could tell them what’s probably driving it and what we need to do to move through and out of that. So I guess mind blowing that it’s so spot on when every genetic test that I do, it’s like crazy. The amount of ability that it really can tell us your history and what we need to do to fix anything moving forward. It shows us where you get hung up, where your body is likely to get hung up and stuck

Sheila (06:53):

And possibly could have easily slipped back because some of the things that you Dawn’t realize really affect your health and wellbeing can easily be seep back into your life in ways that are unintentional. It’s not necessarily just the overeating or overindulging or I eat more, I Dawn’t want to say junk, but more I in my mind, couldn’t eat chocolate. I thought that was a bad thing. Well, my genetic results say, actually it’s a good thing and I should be eating chocolate every day. And that was like, oh,

Dawn (07:32):

I can do this. Yeah, exactly. Exactly. You learn. Well, especially with kind of a food forward approach, it really does bring to light the foods that are beneficial to your health and not all foods are equal. So it’s like you learn how to utilize the foods to your advantage.

Sheila (07:58):

For sure.

Dawn (07:59):

So maybe if you can remember, give an example of how the test was when you got the test kit in the mail. What was it like to complete the test and send it in?

Sheila (08:17):

It was super easy. I think it was just a mouth swab and stick it in the mail and drop it in the mailbox. And that was that.

Dawn (08:26):

Correct. It’s like two minutes and you’re Dawne.

Sheila (08:29):

Exactly.

Dawn (08:30):

It’s so painless. And they make it very simple. They have all the instructions and

Sheila (08:37):

Everything you need.

Dawn (08:38):

Everything you need is in this little cylinder and you’re Dawne. Literally, you do the cheek swab for a minute or two, you put it in the thing and you ship it off. Yeah. And a

Sheila (08:52):

Paid self-addressed envelope even, you Dawn’t even have to go to the post office,

Dawn (08:58):

Right? Yeah. It’s just stick it in your mailbox and it’s taken care of. And it does take anywhere from three to four weeks to get that interpretation in. So that I’m sure that anticipation in that month’s time is not always enjoyable, but it’s

Sheila (09:16):

Hard waiting but worth it at the end. For sure.

Dawn (09:19):

Yeah, exactly. And once I got the results in, I messaged you and said, I have ’em. And I’m like, okay. And it was literally within three or four days we were interpreting it, if I remember. I think we were like, okay, I have this time available to you. Let’s do this day. And it was like three or four days later and you did

Sheila (09:43):

A lot of work. So I was pretty amazed that you were able to get that Dawne in that short of

Dawn (09:48):

Period. Yeah, it took us pretty close to two hours to interpret your results. Yeah. Yeah. It’s a long report. But again, the goal is that when you go through this, you have at least a good enough understanding of the information that is contained in those test results.

Sheila (10:11):

And that meeting with you was so helpful the way you broke it down and the way you shared the results. Because I think if I had just looked at that by myself, I think I would’ve been really confused by a lot of the information.

Dawn (10:26):

Agreed. And I will say with the 3×4 genetic test, they do direct to consumers so anyone can purchase this test for themselves and get the interpretation. It’s just not necessarily laid out to understand it super easy in a way by just looking at the test result. So that’s where having a practitioner interpret it for you and kind of break it down. I mean, I think your presentation, because I do a whole slideshow, oh gosh, I think it’s like 50 or 60 pages long. I mean, I can’t remember how many pages, but it’s very thorough, each area and each area. So we really get to dig into all the details moving forward. You could use that information and then we give you the results and you could move on and never work with me again.

Dawn (11:39):

And you would still have everything you needed to tap into in the future if something came up, because I try to make it so that you have those resources to refer back to when things pop up in life, because stressful things happen, accidents happen. You unintentionally do things that trigger things. So you can find yourself back in a position that some genes are maybe triggered or switched back on that you really wouldn’t have expected. But here you are. So now you go back to the foundation and you say, what can I do to get these back to a less expressive state to where they’re not in a state where I feel all of these symptoms and feel bad or have the side effects that I’m having

Sheila (12:40):

Put them back to bed.

Dawn (12:41):

Yes, exactly. Yes. Get rid of them for now, not rid of them. And

Sheila (12:47):

I find myself sometimes, even now, just out of curiosity, just reading, just peeking at it and just looking at it and thinking

Dawn (12:56):

Back. Yeah.

Sheila (12:57):

And just again, changing up my diet a little bit. Thinking, oh, what could I maybe try differently if I want to just lose five more pounds or whatever. So I definitely reflect on it.

Dawn (13:13):

Yeah. Now, when we started this process, your health goals I, I’m looking at the interpretation report and I had put together your health goals and I had put on there, understand what impacts your ability to maintain a healthy weight, manage your cravings and understand your disease risk. Those were your three main areas that you wanted more information on. So if we look at those, do you feel like after the interpretation you really have a good understanding of how you can maintain a healthy weight?

Sheila (13:57):

Absolutely. I mean, everything in that report helped me realize I need more green leafy vegetables, so how can I add those into my diet on a regular basis? I would often eat a spinach salad for lunch, but getting them in, I think I need five cups a day. That’s a real challenge, especially with the sleeve, because back in the day, I could probably eat a salad with three cups of spinach or something like that, but now I’m lucky if I can get two cups and dirt for a salad. So looking at how can I add those? And you had suggested the smoothies, and now that’s my favorite go-to in the morning. It’s so easy. So another cup of green leafies is so easy and so delicious.

Dawn (14:59):

It makes it simple.

Sheila (15:00):

Yeah. Caffeine was such an interesting one to me because I knew I did not feel great with caffeine, and I really do think it contributed to my blood pressure being high. I’m not on any blood pressure medication, but would sometimes get heart palpitations or something if I drank a little too much espresso, which I love. So just really coming off that altogether. Every now and then I’ll have a cup if I’m feeling really tired or hardly ever anymore. And so that’s really interesting.

Dawn (15:40):

Yeah, you were a slow metabolizer of caffeine, meaning that you’re it, it’s going to take a while for that to get out of your system. And typically caffeine in general, it takes about eight hours for a normal processor. So not necessarily a fast metabolizer, but just normal processing. It takes eight hours. So if you slowly process that, it could take you 10 or 12. So you can see how easily for someone, if you were drinking caffeine in the afternoon, how that could negatively impact your sleep and how that could impact your heart palpitations throughout the day, especially if you’re drinking it in the morning and throughout the afternoon.

Sheila (16:22):

And when I was working, sometimes you’re just in meeting after meeting after meeting, and everybody’s serving you coffee and you’re just, next thing you know you’ve had way too much coffee,

Dawn (16:32):

Right? Yeah, absolutely. So easy

Sheila (16:35):

To, it’s really feeling awful,

Dawn (16:37):

But you’re not correlating necessarily that it’s the coffee or the caffeine that’s doing it. But now you understand that you would have to make different choices if you weren’t prepared or willing to experience those symptoms.

Sheila (16:53):

Yeah,

Dawn (16:55):

Which is good. How about the cravings? Do you feel like that you have tools to manage cravings? And do you struggle with cravings anymore? Yeah, it’s

Sheila (17:05):

The strangest thing. Every now and then I’ll crave something, but now I find I’ll have it. I’ll have a bite or two of what I want and go about my day and not think, oh, that’s a bad food, or I can’t have that. But chocolate was always my biggest craving. I was always craving chocolate. And now that I’ve figured out how to get healthy chocolate into my life every day, it really helps. Tremendously thing. Now are these, have you seen, I love to cook. So dates with you stuff them with peanut butter and roll them in chocolate and roll them in peanuts. They’re like little snicker spars.

Dawn (17:52):

No, I have not Dawn that. I’ve wrapped them in bacon, but I have no,

Sheila (17:56):

Skip the bacon.

Dawn (17:58):

That sounds delicious. If

Sheila (18:00):

You have a sweet tooth, they are just like snicker spars. Yeah. So I use the Lily’s chocolates, which have no sugar, the dark chocolate. They are so yummy. So yeah, just figuring out how to combat your craving with a healthy version of that I think is what I’m really focused on now.

Dawn (18:19):

Yeah.

Sheila (18:20):

But again, last night I wanted a french fry, so I had a french fry. I had two or three french fries. But then I’m like, I feel like hell. And I think that’s the other thing I’ve really learned to do is listen to how my body reacts to food and really correlate that with, I feel lousy. I love ice cream. If I have more than a bite or two of ice cream, I feel like bloody hell. So I know if I want an ice cream, I will steal a bite or two of one of my daughters or the ice cream, but I won’t order a hole on myself.

Dawn (18:58):

But that works. That’s balance. That is a way to manage your health in a sustainable way, because having a few bites of ice cream is not going to mess anything up and not having chocolate when you truly enjoy it. Now, I think, if I remember right, you were already one that enjoyed dark chocolate.

Sheila (19:26):

Yes. So I was lucky that way.

Dawn (19:29):

So that was easy for you. You came to me already when you choose chocolate, it was already dark chocolate. So it wasn’t like we were shifting you from milk chocolate to dark chocolate to be able to do that sustainably and in a beneficial way. And whereas ones that’s full of sugar maybe isn’t a good idea to do every day, but in the approach that you’re taking it, being in more antioxidant form and polyphenol form is beneficial to your health. And the benefits far outweigh any risks that your chocolate is giving you, which

Sheila (20:11):

Is a good thing for me.

Dawn (20:13):

It is a great thing. Yeah. I love dark chocolate myself. I probably have one to three squares, I would say four, five nights a week. I mean, I make sure we keep our dark chocolate bars at home. And I’ll say, when I did your test, I was, and I think I remember telling you this, that you had the most protective jeans that I had interpreted to date. And I think you had, let me see here. 3, 6, 9, 11, you had 11. Oh no.

Dawn (20:49):

You had nine protective genes and you even had three of them in the weight gain weight loss resistance category. So, interesting. Isn’t it? It’s so interesting. It is. So when we got to the appetite, well really the weight loss and weight loss resistance genes, when we interpreted those, it was showing us that you are likely to respond to weight management interventions. You can be successful, your genes can set you up to be successful in those weight loss modalities.

(21:31):

But the one thing we realized was all the strategies that you had really tried prior to having a sleeve surgery was not the same that your pathways was telling us from your genetic tests. You had a lot of detoxification issues, and you even had those, we break ’em down into pop stars. And those are ones that, there’s usually a couple of pop stars that may show up on people, and they have a really big impact. And your detoxification genes really had a big impact on your ability to manage the fat in a healthy way. And your body wasn’t capable of managing any excess fat cells, and it was very efficient at growing fat cells.

(22:29):

It liked to produce fat cells, and then they would become inflamed, and then your body would not, you wouldn’t be able to tap into it. So I think the sleeve surgery really kind of shifted those genes for you and allowed all of that stuff to become to a neutral place that now you have the tools, it’s kind of reset all of your genes in a healthy way that now you have the tools moving forward to know that, hey, okay, I just need to evaluate what I’m doing, what I’m exposed to, make sure I’m not getting some type of toxin in a way that I’m unaware.

(23:18):

Or I’ve started drinking alcohol several times a day or several times a week that your body’s having to pause on detoxifying naturally, everything that it produces, all the toxins it produces, now it’s having to detoxify the alcohol first, and that’s when things can kind of get backed up. But for I think the detoxification and the blood sugar and insulin, were the bigger ones for you for managing a healthy weight.

Sheila (23:58):

And then with that toxicity, I get to enjoy Epsom salt baths and saunas and all those things that I found out are so good for my health that I have to have a massage.

Dawn (24:11):

Yeah, exactly. And for you in the exercise, and that is one thing that you have Dawne fabulous at, tell them what you do for movement. You are so active

Sheila (24:28):

Right now. I’m on a bit of a hiatus as I just got my knee replaced. But prior to that, I’m very fortunate too. I also retired during this timeframe, so found myself with a lot of free time, which I had never in my life had. So with that free time and with my new body, I decided I really wanted to explore some new fun things and also moved to a new town, so wanted to meet new people. So I joined a pickleball group that plays every morning from seven 30 to 10. I think they play. I just went back for my first time Monday, so I’m so excited.

Dawn (25:11):

Oh, that’s amazing.

Sheila (25:12):

Getting back in. Yeah. That’s amazing. Eight weeks. That’s

Dawn (25:16):

Amazing. You did great.

Sheila (25:20):

But they’re just a great group of people. We have so much fun, so many laughs. So that’s more fun than exercise, really. And I have a bike and live it, a town that it’s very convenient to ride my bike to the library. I can ride my bike to pickleball, I can ride my bike to the beach. So I try to use my bike as transportation as much as possible just to build that in every day. And my all time favorite thing is to walk the beach. So I was walking about three miles a day on the beach, and that just clears. That’s more for my mind and soul more than anything else. I wasn’t trying to break any world records,

(26:11):

But it really helped ground me. And then I found you and I had talked about strength training and really the importance of strength training, especially for someone my age, post-menopausal women, those muscles just deteriorate so quickly. I found an amazing program that, it’s called Be one Fitness. It’s just a local woman who started this practice and it is a form of Pilates, not really Pilates, but it uses that machine, that Pilates machine, and really focuses on core all the different muscle areas. And again, it’s 10 women in a room with lot loud music and just lots of laughs and fun. So it doesn’t even feel like I’m working out. So those are the things that I really focus on in my life to move my body,

Dawn (27:14):

Which you’ve done great with. You’ve always been active since you’ve had surgery?

Sheila (27:21):

Since I’ve had surgery, it’s been a little more challenge since I had my second surgery. My knee replacement surgery, your

Dawn (27:27):

Knee replacement.

Sheila (27:29):

I’m up to walking a mile now, which I’m happy to do, but it takes me, I used to walk a mile and maybe 20 minutes, now it’s 30 minutes. So still a little slow, but

Dawn (27:41):

Great.

Sheila (27:42):

Still. I just got cleared to start riding my bike, so I’m going to try maybe to go out today and take a little bike ride and see how that goes. Cleared to try pick a ball. So I tried that the other day. Again, slow. But,

Dawn (27:57):

But all of that is, it’s like even having those eight weeks of not being able to do the things that one, clear your mind, set your mindset and community, your socializing with lots of women and enjoying yourself. That was kind of, oh, that’s

Sheila (28:16):

The other thing I forgot. Did we have a Nordic walking group? So I joined the Nordic walking group, and those are great. Again, usually a group of 10 to 15 women all chopping through the woods with our Nordic walking poles.

Dawn (28:33):

Yeah. So yeah, even with taking eight weeks off with knee replacement surgery, you were able, once released, after doing all your physical therapy you did, you were able to go back and get right back in the rhythm of doing all those as quickly as they allowed you to, which is great. It wasn’t like you took the eight weeks off and then you’ve struggled to get back in that routine. You haven’t jumped right back in. It’s

Sheila (29:06):

Great to get back in. I know how know how good I feel when I do it. I know how, I think I talked to you our last session that I feel like my muscle is just melting off my body, and I know how hard I work to put it on my body, so I just can’t wait to, it feels so strong. And especially, I’m a single woman in the twilight of my life. So to feel strong and powerful and to be able to do hard things with my body at this age, it’s really, it’s powerful.

Dawn (29:43):

It is absolutely. So that you know, have everything you need to care for yourself and in your eighties and beyond. I mean, you could easily, you’re setting yourself up for longevity. And I can’t remember if some of your genes were, any of the beneficial ones were for longevity or not. I Dawn’t remember. Well,

Sheila (30:12):

The thing I’m most worried about that we talked about is my mom has dementia. Really warding that off.

Dawn (30:20):

And that was a high impact for you as well. The memory and mood piece. That was one. But we did discover you Dawn’t have that a p o four gene that really sets people up for Alzheimer’s and dementia. You did not have that. You have some of the other genes that can lead to memory and cognition problems. But if you set your lifestyle and your add the things into your diet to keep the blood sugar and insulin controlled.

Dawn (30:58):

And you keep your liver flowing and working efficiently with detoxification, you will do well with supporting that. So yeah, you were able to see that yes, those are there. They’re not active right now. And you have some tools that we can tap into if needed, if they start arriving or you start noticing changes. And I think we gave you some goals of, oh gosh, to work on coordination things. And let me see if I can find, because

Sheila (31:44):

I learning new skills, I think. Yeah.

Dawn (31:46):

Can I, coordination Mahjong

Sheila (31:49):

Just learned how to play mahjong, things like that. Exactly,

Dawn (31:52):

Yeah. To work on those. And

Sheila (31:55):

The pickleball is the hand-eye coordination. That’s the, yeah,

Dawn (31:58):

Exactly. And when you started with me, had you just started with pickleball, I feel like?

Sheila (32:05):

Yes. Yeah.

Dawn (32:06):

Yeah. That was all new. And so we were like, okay, all new. Yeah, great. You’ll have that piece with that. And then we’re work on brain games and different things that can help challenge your brain and learn a new language or do something that uses your brain in a different way to help keep that memory and cognition sharp. So yeah, you have a lot of the tools necessary. And I think a big thing that really isn’t going to be recognized on a genetic test, but is super important for everyone’s wellbeing is just that sense of community and having those connections with other people.

Dawn (32:52):

You have lots of touchpoints. You have lots of people that you have as a resource, even with your knee surgery. You had friends that came in and cared for you, cooked for you, and something we haven’t mentioned. But you have celiac’s disease and the genetic pest did show that she was a medium impact for a gluten problem and that she had a likelihood of developing celiac’s disease. So again, another way to see how powerful the test really is and how spot on it is. You’ve been diagnosed with celiac disease for 20, 30 years, wasn’t it?

Sheila (33:39):

Yes, it was when my third child was born, so she’s 28 going to soon be 29. And I think I had told you that when I was diagnosed that long ago. They didn’t do the same testing that they do now, so I was never 100% sure that I was a full-blown celiac. So it wasn’t good to know. But it is good to know that I have been following this lifestyle for 28 years for

Dawn (34:11):

A good reason. Good reason. Yep, exactly. A valid, very valid reason. Agreed. Yeah. What would you say to someone who’s on the fence about completing a genetic test?

Sheila (34:24):

It’s funny. I just had this conversation with my son, actually. It’s expensive. It’s very expensive, but so is being overweight. To me, it was just a priceless piece of information, knowing again, that I can set myself up for longevity. I just had my first grandchild. I just found out I have a second on the way. Oh, that’s exciting. Being there for their lives is so important to me. So what can I do to live my best life going forward? And why wouldn’t I invest in that? I think especially as women, we spend so much of our lives taking care of others and making sure others are all set and making sure that others have the best of everything. And we forget about ourselves.

Sheila (35:14):

And I think that is a mistake I learned. That’s how I got obese in the first place, is I was too focused on making sure my kids were at their sporting practices and had the best skates and I wasn’t taking good care of myself. So when I retired, that was my goal was now it’s about me. My kids are all settled, they’re all where they need to be, and now I’m really going to take good care of myself. And I think the genetic test gave me all of the information I need in order to do that in perpetuity, for I know now I can live a healthy lifestyle for as long as I choose to.

Dawn (35:59):

Exactly.

Sheila (36:00):

And that will make sure I’m here to take care of those littles and to make sure I get to enjoy life to the fullest.

Dawn (36:08):

Yeah. Yeah. Even with your first grandchild, we were working together and you got to do some of the overnights and help get up with the baby, and

Sheila (36:19):

Now I’m taking care of her two days a week now. So Tuesdays and Thursdays is Yaya day. I’m Yaa.

Dawn (36:25):

That’s amazing. I love that. So again, you’ve set yourself up to be capable of to do the things you want to do, and you Dawn’t have to feel held back in any way.

Sheila (36:40):

And 90 pounds ago, I Dawn’t know physically if I would be able to take care of a little, it’s a lot of physical work. It is. Again, I can’t wait to get back to strength training to hold that. She’s 18 pounds now.

Dawn (36:57):

Oh my gosh. Yeah.

Sheila (36:58):

That’s a lot of extra weight to carry around.

Dawn (37:01):

Yeah. No, that’s amazing. Is there any last things that you would say to anyone or that you want to kind of leave it with?

Sheila (37:15):

Honestly, I think we talked at our last session. This is the best thing I feel like I’ve ever done for my what maybe second best? The best was definitely the sleeve surgery. That to me, just set me on course that made it, I don’t want to say easier. Again, it was hard work, but it set me on a course where I felt like I could make a drastic change in my life and be successful doing it. And then to have you come in and all of the knowledge and everything I’ve learned from you has just helped me so much in my trajectory of having a really healthy life.

Dawn (37:59):

Yeah, that’s awesome. And

Sheila (38:01):

Just being able to enjoy life to the fullest, which again, I feel like I have not enjoyed life this much in a long, long time. So now I have a new knee, so now I’m going to start paddle boarding and kayaking. I can’t wait.

Dawn (38:17):

That’s awesome. Yeah. Heck, why not? Yeah, exactly. The things that maybe you desired to do when your kids were young and you were so busy taking care of them that you now it’s like, let’s do the fun things. Go

Sheila (38:33):

Play.

Dawn (38:34):

Yeah. You have the body that is available to do these hard things that can take you anywhere you want to go. Yeah.

Sheila (38:46):

It’s a good life.

Dawn (38:47):

It is. That is amazing. So awesome. Thank you so much, Sheila, for sharing your story and explaining kind of the process of doing a genetic test and what type of information you get from it and what you can do with that information. So thank you.

Sheila (39:07):

Thank you, Dawn, for everything too. I really, I appreciate you so much and everything you’ve given me.

Dawn (39:13):

Awesome. Very good.

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