Article By: Rachel Brooks, Dietetic Intern
Co-Author: Rachel Ignomirello, MS, RDN, CSOWM, LDN
Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.
As a dietetic intern, I am learning something new related to nutrition and health each and every day. Over the past two weeks, I have been a dietetic intern at a bariatric clinic and have been following Rachel, a registered dietitian and board certified specialist in obesity and weight management. I have learned so much from this experience! While I could write pages about everything I found intriguing, I have narrowed down a list to the four things that I found most surprising about bariatrics.
1) There's a big difference between bariatric multivitamins and adult multivitamins. People who have undergone bariatric surgery have unique nutritional demands compared to those who have not. This is because bariatric surgery changes the anatomy of the gastrointestinal tract and alters how well the body can absorb vitamins and minerals. For example, bariatric surgery patients must supplement with vitamin B12 because the amount of acid produced in the smaller stomach pouch is not enough to release this vitamin from protein foods. Without the correct supplements, there is a higher risk of deficiencies, which can be dangerous.
I was so surprised when I read the label of a bariatric multivitamin and compared it to an over-the-counter women's multivitamin. The concentration of vitamins and minerals is significantly higher in bariatric vitamins. One bariatric multivitamin I looked at had 375% of the daily dose of vitamin D, while the women’s multivitamin only had 125%.
2) Nicotine use can be life-threatening after bariatric surgery by increasing the risk of peptic and anastomotic ulcers. I was surprised to learn how dangerous it is for bariatric patients to use nicotine products, including cigarettes, cigars, nicotine vapes, patches, dip, and gum. Where I am interning, the guidelines require patients to practice cessation and completely quit at least 6 weeks prior to surgery. It is already common knowledge that smoking is not good for our health, but I never knew until now that smoking increases the risk of peptic and anastomotic ulcers. This is especially true in bariatric surgery patients because nicotine increases stomach acid in the smaller pouch while also breaking down the protective, mucosal lining of the stomach. This is the perfect mix for an ulcer to develop. It is very dangerous because these ulcers may not be detected until the point of a life-threatening rupture.
When I first asked my preceptor about the risks of using nicotine after surgery, she informed me of a devastating incident that occurred years ago. A patient had initially quit smoking prior to surgery and passed the required pre-op nicotine test. At some point after surgery, the patient began using nicotine again and did not inform their doctor or any other staff. Unfortunately, they developed a peptic ulcer that ultimately ruptured and resulted in death. From this situation, I learned how important it is for patients to be open with their doctor if they are having trouble quitting (it really can be a matter of life or death)!
3) Health parameters can improve quickly after bariatric surgery. I already knew that a 3-5% reduction in body weight alone has been shown to improve health parameters such as blood pressure, cholesterol and lipid panels, blood glucose, insulin sensitivity, and more. From what I have experienced while interning at other clinical sites, losing weight can take a long period of time and so the health benefits are not immediately seen. What I did not know about bariatric surgery is that with the correct lifestyle and behavior modifications, patients can see drastic improvements in health within weeks of surgery.
4) Protein, protein, protein. Before starting this rotation, I had a very limited idea of what kinds of products are available for increasing protein intake. My initial thought of products that are high in protein were those protein bars with added sugar, either vanilla or chocolate flavored protein powder, or pre-mixed shakes that tasted a little chalky. I found out quickly that I was completely wrong on my first day when I got to try a high-protein hot chocolate, mixed with hot water, that tasted amazing and had zero sugar.
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