Don’t Forget Your Vitamins after Bariatric Surgery

Apart from diet and mild exercise, good supplementation would catalyse long-term weight and health success after Bariatric Surgery.

Patients after surgery may at times develop certain vitamin and mineral deficiencies in the long-run.

But, this risk can be very easily mitigated by following the supplementation plan as laid out by your surgeon.

One of the most common deficiencies is Vitamin B12 which is vital for the nervous system to function at an optimum.

The other key nutrients are Vitamin D and Calcium which are essential for good bone health and to prevent fractures and in the long haul osteoporosis.

Iron is another mineral which may be added to the list of requisite supplements.

Other vitamin supplements may or may not be added by doctors after an evaluation.

Patients often get complacent with taking the prescribed supplements on a daily basis with passage of time and due to early success of Bariatric surgery which is a magical experience for most patients.

A lifelong commitment to comply with your surgeon’s advice on supplementation will help you preserve and extend the success of surgery for life-time.

Bariatric Surgery a Cost-Effective Approach: Says A Recent Study

Its natural that patients consider many factors before deciding to opt for the bariatric surgery route for weight loss.

One key factor is financial.

Cost of surgery includes a package of surgeon fee, other clinician fees, consumables, OT charges, room rent, medications, supplements, time away from work recovery period of about a week etc.

Thus, the question begs itself – Is bariatric surgery a financially viable option?

And, the answer is a resounding – Yes!

A recent study* carried out, which is among many such studies, analysed the cost-effectiveness of bariatric surgery as compared to the conventional approach of managing obesity and its co-morbidities through medication and lifestyle management.

The study took into consideration the cost of surgery, nutritional supplements, follow-up care and costs arising from any surgical complications.

The study concluded that bariatric surgery resulted in savings of around Rs 7.5 lacs (9332 Euros) over a lifetime!

In addition, an analysis of the data showed that bariatric surgery patients had 5 more quality adjusted life-years (QALYs) as compared to patients treated through the conventional medical approach.

Thus, when looked at over a period of 10 years, bariatric surgery proved to be more cost-effective. Secondly when compared for a lifetime, it was dominantly a more financially wise decision.

It is also important to keep in mind that bariatric surgery leads to remission of diabetes in majority of the cases and also has a positive effect on blood pressure, cardiovascular health and other health issues.

These are all comorbidities associated with obesity and require medical intervention in the form of consultations, drugs, frequent hospitalization and treatment for life.

Bariatric surgery involves a one-time costly procedure but when compared with the lifetime annual medical expenses incurred for those suffering from Type-2 diabetes and other obesity-related comorbidities, it proves to be a more cost-effective approach.

Hence, what are you waiting for? For a detailed consultation to find if you qualify for Bariatric surgery, please call +91 98210 32169 and ask for an appointment with Dr Abhay Agrawal. Patients with a BMI of 30 and above will get a free consultation on phone for 15 minutes.

*https://www.tandfonline.com/doi/full/10.1080/13696998.2017.1419958

Bariatric Surgery in Adolescents with Type 2 Diabetes Brings Positive Outcomes Says Study by Joslin Diabetes Center

Over the last 30 years, number of obese adolescents suffering from type 2 diabetes has dramatically increased globally as well as in India- which has earned a sordid reputation as Diabetes Capital of the World.

Half of this cohort who are severely obese end up needing insulin injections within a year of diagnosis, says Dr Lori Laffel, MD, MPH, Chief Pediatric, Adolescent and Young Adult Section at Joslin Diabetes Center who is a coauthor of the study published in March 2018 issue of Journal of American Medical Association (JAMA).

This study shows how Bariatric surgery could be a potential option for very obese adolescents with type 2 diabetes in lowering blood glucose levels, improving weight loss and returning cholesterol and blood pressure levels to normal.

The study compared 30 severly obese teenagers treated with type 2 diabetes medication with 63 teenagers who underwent Bariatric Surgery.

In those who underwent surgery, HBAIc dropped from 6.8 to 5.5 in two years. Whereas in those who received only medication, HBA1c increased from 6.4 to 7.8 in the same period of two years.

In addition, those who underwent surgery weighed 30% less in two years and those who were only on medication weighed 3.7% more.

Also significant improvement in blood pressure, cholesterol levels and kidney function is seen in surgically treated teenagers in this study group but not in those treated with medication.

If you have any questions on this study or type 2 diabetes problem with an adolescent at home, please feel free to schedule a telephonic consultation with us. Text us on +91 98210 32169 for 15 minutes of free telephonic appointment with Dr Abhay Agrawal.

Source: http://www.joslin.org/news/Obesity-Surgery-Linked-To-Positive-Outcomes-In-Very-Obese-Teens-With-Diabetes.html

Magic Potion for Weight Loss!

Have you heard of the magic potion for weight loss? It is colourless, odourless and tasteless and as far as our health goes, it is priceless. Yes, you guessed it. It is, quite simply, water!

Various studies have shown that reducing water intake leads to increased fat deposits whereas drinking more water helps mobilize stored fat. Enough cannot be said about the power of water for patients who have undergone gastric bypass surgery.

But, the reduced stomach capacity post-surgery makes it difficult for patients to stay on top of their fluid intake goals and dehydration is one of the main reasons for patients’ readmission to hospitals.

Your doctor has advised you on your required daily fluid intake. And, it is now up to you to ensure that you manage to meet that target. How do you that?

Simply, drinking water when you “feel” thirsty may not be enough. It is important to monitor your fluid consumption.

A recent study from Greenwhich Hospital USA showed that monitoring the quantity of water being consumed by patients helped more than double the quantity of water they were drinking.

Download an App on your phone to keep a tally of the number of glasses of water you are drinking. You can also download an App to remind you to drink water periodically through the day. Or, make sure you keep water bottles at hand all the time to serve you as a reminder to drink up.

Avoid carbonated and caffenaited drinks. Instead, add slices of lemon and a few sprigs of mint leaves to your water bottle. It will provide a refreshing flavour through the day and make you reach out for your water bottle.

Don’t drink too much fluid during meals. Restrict a large part of fluid consumption to between meals. Besides ensuring that you stay hydrated, it will give you a feeling of fullness and stop you from reaching for unhealthy snacks.

Don’t undermine the power of H2O in your recovery and continued weight loss post-surgery.


About Dr Abhay Agrawal:

Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.

Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.

He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.

Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai.

For appointments, call on +91 22 2888 6666

Obesity and Cancer

There are many diseases that are associated with obesity – high blood sugar, high blood pressure, infertility and arthritis to name a few.

The reason these red flags are spotted pretty quickly is because they are easy to detect – either due to symptoms or with routine tests.  But, there is another grave side-effect, one that takes longer to surface and is more complex to tackle – Cancer.

Obesity often leads to chronic inflammation of organs and tissues which over time damages the DNA which leads to cancer. Also, fat tissue produces excessive amounts of estrogen which is known to be associated with cancer of the breast, ovaries, etc and the increased secretion of insulin in diabetics may also be attributed to cancer of the liver, colon, kidney and other organs.

According to the data collected, obesity is linked to two of the most common cancers – breast and bowel and three of the cancers that are most difficult to treat – gall bladder, pancreas and oesophagus

One study assessed the increase in new cases of 18 types of cancers based on the prevalence of diabetes and high BMI in 175 countries between 1980 and 2002.

While liver cancer and endometrial cancer make for the largest number of cases whose causes can be traced to high BMI and diabetes, latest research shows that cancer of the kidney, oesophagus, myeloma and bladder can also be linked to diabetes and obesity.

These findings stress on the importance of tackling obesity and there by diabetes to stem the rise in the cancer cases attributable to them.

Bariatric surgery has an established track record in successfully tackling many obesity-related co morbidities besides weight-loss and transforming the health of the patients post surgery to lead a disease-free and stress-free life.


About Dr Abhay Agrawal:

Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.

Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.

He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.

Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai.

For appointments, call on +91 22 2888 6666

Freedom at Midnight!

The Birds dispersed after the secret meeting at midnight. Their plan to escape the zoo was taking shape. Owl had planned every detail. Freedom was a month away.

‘Party-time!’ quaked Duck, digging into some chips and chocolate.

‘What is this?’ asked Kingfisher, peering into the packet of chips.  ‘I haven’t seen anything like this before!’

‘Chips!’ smiled Duck, slurping some Cola. ‘You don’t know what you’re missing!’

‘That doesn’t look like food to me!’ shrieked Parrot. ‘Why not celebrate with nuts?’ she asked, offering some she had stashed away.

‘I have some delicious fish!’ Kingfisher announced.

‘Trr Trr’ Babbler flew in. ‘Here…some chana from the little boy who visits daily.’

‘Yuck!’ shrieked Duck. ‘You can eat your boring chana!  And nuts and fish!  I have more exciting things to eat!’ she said, pushing away their offerings.

The Birds enjoyed their midnight feast, dreaming of their flight into freedom.

A month passed and the day of escape arrived. The sun set and the last visitors exited the zoo. The zookeepers locked up the enclosures and made their way out. Signalling to them all, Owl led the forward march toward the southern wall where Owl and Kite, had worked very hard over several months, to tear a small hole into the wire-mesh wall.

One by one, the Birds emerged from the caged enclosure. Kingfisher Babbler Parrot and all. They flew out into freedom. Entering a whole new world where no cages bound them.

‘We’re free!’ they all danced, thanking Kite and Owl.

‘Wait! Duck isn’t out yet!’ hooted Owl, as he encouraged Duck to press himself through the little opening.

‘I’m too large for this!’ Duck rued, as he struggled to squeeze through.

‘I told you not to drink those colas and eat those chips!’ muttered Parrot. ‘Now look how huge you have become!’

Duck nodded. ‘I’m stuck now!’ he cried. ‘Please help me! I promise I will never have chips and colas again!’

The Birds felt sorry for Duck. ‘Wait! I have an idea!’ chirped Babbler. ‘Maybe that boy who feeds me chana everyday can help!’

The Birds flew to the home of the little boy across the street and created a din to wake him up. They led the boy to the wall of the enclosure and he understood the problem immediately. Tugging at the wire-mesh, the boy made more space for Duck to hop out.

A cheer went across as the Birds danced around Duck, as he hobbled out of the zoo, in relief.

Deeply grateful, Duck made a vow to eat nothing other than his food again. The sight of chips and cola reminded him only of the dreadful life he had left behind. A life trapped in a cage.

Eat Healthy. Not Junk.

Chips and Cola can trap you in a cage you cannot escape!


About Dr Abhay Agrawal:

Dr Abhay Agrawal is a world-class expert in all types of Bariatric and Diabetes surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery). He is highly skilled with vast experience in advanced laparoscopic surgery. One of the few in India to offer 3D laparoscopic Surgery.

Dr Agrawal is among World’s first and few to be certified as International Surgeon of Excellence from the non-profit accreditation organisation from USA, Surgical Review Corporation (SRC).

He has treated more than 4000 patients with Bariatric and Diabetes Surgeries. His Bariatric and Diabetes Surgery program is well known for consistent and high quality results in long term weight loss and permanent cure for Type 2 Diabetes.  He personally treats every patient with out delegating it to juniors.

Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; Apollo Spectra Hospital Tardeo, at Mumbai; and once a month at Kalda Hospital Raipur, India.

For appointments: Call or What’s app on +91 98210 32169 or Email at drabhay@gmail.com

Positives of Multi-Location Practice

Sometime people ask why do I practice from many locations. Am I hedging my risk?

No. Actual reasons might sound counter-intuitive.

First, our patients can choose a location they want for their consultation, surgery and post-operative care.

Second, it preserves our autonomy to take the best clinical decision every time. As surgeons we are outcome driven whereas hospitals are process driven. Being attached to many hospitals provides us with the flexibility to match a patient condition with the center that is best suited to achieve the outcome.

Whereas if we are tied full-time to one hospital, all our decisions will have to be within the boundaries and rules and regulations of that hospital.

There is a constraint too. Bariatric and other advanced Laparoscopic surgeries that we perform need advanced equipments, state-of-the art operating theaters and well trained staff. Hence we need to be selective about Hospitals that we operate at.

All these efforts are worthwhile because there is nothing more satisfying than to cure a patient by pooling the best of the facilities, people with our skills. Its the least we could do in return of the trust and faith our patients place in us.

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Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.

Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.

He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.

Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai.

For appointments, call on +91 22 2888 6666

Weight Gain After Bariatric Surgery: Everything You Wanted to Know

Average weight regain after 5 years from Bariatric Surgery ranges from 0 to 10%, depending on on two key factors: 1) The procedure chosen and 2) Patient behavior.

However, several non-surgical measures exist to prevent or reverse weight regain.

First lets see which procedures cause how much long-term weight loss and average weight regain from our Center’s experience and various studies published in medical journals:

Highest long-term weight loss with little to no weight regain:

Duodenal switch: 70%+ excess weight loss (EWL) after 3 years with little or no weight-gain

Duodenal switch is a procedure where the first part of our small intestine called Duodenum is partially removed and replaced with a graft of the last part of our small intestine called Ileum.

We are the most experienced Center in India in Duodenal Switch Surgery which can also be used in non-obese type 2 diabetes patients for permanently resolving Diabetes. In fact we were the first in India to offer Duodenal Switch Surgery since 2010.

High long-term weight loss, with 8 to 10% weight regain:

Gastric sleeve: 60% EWL after 3 years

Gastric bypass:  60% EWL after 3 years

Lap-Band: 55% EWL after 3 years, but highly variable from patient to patient

Moderate short-term weight loss, with 100% weight regain possibility if a secondary procedure is not done:

Gastric balloon: 30% EWL in 6 months, then must be removed. If the patient does not receive another gastric balloon after their first one is removed or does not undergo one of the more interventional procedures listed above, 100% weight regain is likely.

The key to preventing weight regain after Bariatric surgery depends on these 4 actions:

  1. Lose as much weight as possible before Surgery:

Studies show that your BMI before surgery directly correlates to how much weight you will lose and keep off after surgery. Hence we put patients on a liquid diet two weeks before surgery so that much weight is gone as you get operated, and the procedure would accelerate loss of remaining excess weight.

  1. Follow Bariatric Diet:

The right bariatric diet addresses “What” to eat. It includes:

  • High-protein, low-carb diet, and no cheating before surgery
  • Slow transition from clear liquids to solid foods after surgery
  • Healthy foods, proteins first
  • Lots of sugar-free liquids, but never around meals
  • Minimal snacking
  • Small portion sizes, chew thoroughly
  • Adhering to prescribed vitamin regimen
  • Avoiding “trigger” foods and alcohol

 

Our Center has well experienced Dietician to help you with this part.

  1. Bariatric Eating:

The right bariatric eating is about “How” to eat what you have chosen to eat.

These techniques help prevent complications, weight regain, and malnutrition. They include:

  • Preparing your food properly
  • Controlling portion sizes
  • Eating slowly and chewing thoroughly
  • No drinking before, during, or after meals
  • Being mindful of warning signs

 

We guide all our patients through this process in detail.

  1. Moderate Exercise

 A reputed study by UCLA (University of California, Los Angeles) in the US reveals that those who moderately exercised after Bariatric Surgery had 4.2% lower BMI than those who didn’t exercise.

Another study from University of Virginia found that patients who maintained 2 ½ hours per week exercise routine showed significantly greater long-term weight loss vs patients who didn’t exercise.

2 ½  hours as you realise is just 30 minutes exercise for 5 days a week.

I am sure you can find this much time and motivation however busy or uncharacteristic of physical activities you are.

Why does moderate exercise matter so much for long term weight-loss success?

The reason is counter-intuitive.

Moderate exercise by itself may burn as little as 200 calories per session. These many calories can be gained back in 5 minutes by eating two gulab jamuns or a small piece of black forest cake.

The more important reason a 30 minute moderate exercise works is by boosting your metabolism, which is especially important considering your body’s natural tendency to slow down your metabolism as you lose weight.

A higher basal metabolic rate means that your body will automatically burn calories at a faster rate even while you are resting, thus leading to additional weight loss.

Key is to start slowly and build endurance at your pace.

The best exercise for bariatric surgery patients achieves a balance of Flexibility, Strength and Endurance.

For more details on exercise plans, please do connect with us for a detailed discussions. If you have any chronic pain, our highly experienced physiotherapists will be able to help.

If you wish to learn more about any of the points shared above, please feel free to call us at +91 22 2888 6666 for an appointment with Dr Abhay Agrawal or his Dietician or Physiotherapist.

Dr Abhay Agrawal is also available at Apollo Spectra Hospital Tardeo, Seven Hills Hospital Andheri East and Thunga Hospital Malad West on prior appointment so that you can meet him at a convenient location to you.

How Bariatric Surgery combats premature aging and adds eight years of life to patients

Weight loss through bariatric surgery can help you effectively combat premature aging and add about eight years of extra life, as per a recent study conducted in Vienna.

The researchers collected blood samples before surgery and one and two years afterwards.

They compared the levels of premature aging markers called Telomeres in the blood before and after surgery.

Telomeres are the internal clock of each cell. Telomeres get shorter when a cell divides or when oxidative stress causes them to break.

When the telomeres get very short the cell can no longer divide and is replenished or stays in the body as an aged cell.

Previous studies have shown that obese women had shorter telomeres compared to women with a healthy weight, which amounted to an added eight years of life.

Vienna study found that two years after surgery, patients had 80% longer telomeres than they had before the procedure and could reverse the premature aging in obese patients.

The study included 76 patients who were 40 years old on average; and the average BMI was 44.5 kg/m2. All patients had been unable to lose weight through lifestyle changes and were referred for bariatric surgery.

One year after surgery BMI had significantly dropped to an average of 27.5 kg/m2, which amounts to a 38% reduction.

Something Stealing your Sleep?

A character from a French folk tale lends her name to a sleep disorder that many suffer from without even knowing it.

It is called Ondine’s Curse or in medical terms Central Hypo-ventilation Syndrome.

Ondine was a celestial nymph who fell in love with Palemon, a mortal, who promised to love her with every waking breath he takes. Ondine is overwhelmed and comes down to the earth to join her lover, giving up her Celestial home and Immortality forever. But the love story is soon to take a dramatic twist.

One day, Ondine finds her lover asleep in the bedchamber in the arms of another woman.

Seething in anger, Ondine barges into the room and curses Palemon. ‘So long as you are awake, you shall breathe. But should you ever fall into sleep, your breath will desert you!’

With that curse, Palemon is doomed to stay awake forever. For he knows that the moment he goes to sleep, he will be dead.

Interesting story?

Borrowing its name from this tale, Ondine’s curse is a disorder where a person stops breathing during sleep.

More than 10 million people in India are said to be suffering from it.

The condition is also called Sleep Apnea. It is a potentially serious condition in which breathing stops and starts repeatedly during sleep.

Due to the stoppage in breathing, the brain and other parts of the body are not supplied with adequate oxygen.

One of the most common forms of Sleep Apnea is called Obstructive Sleep Apnea and it is caused by the blockage of the airway when the soft tissue at the back of the throat collapses during sleep.

This happens involuntarily. So often, those suffering from Sleep Apnea do not know it.

They wonder why they feel groggy, sleepy and unrested in the mornings. Or often, they doze off to sleep during the day. The reason in many cases, is not having enough restful sleep at night.

One of the most common causes of Sleep Apnea is Obesity.

Excess fat accumulation around the throat, air passages and lungs can cause the condition.

Males above 40 who are over-weight are in the highest risk category.

Obesity is not just the weight on your body. It is also the weight on your lungs and air passages. Increased fat around the throat can cause breathing difficulties and disorders like Sleep Apnea.

Obesity is determined by calculating the BMI or Body Mass Index of the person.

Eg :  if one’s height is 175 cm and weight is 70 kg, the BMI would be calculated as follows :-

BMI = 70 / (1.75 * 1.75) = 22.86

 

When one’s BMI is 30 or more, one is said to be Obese.

People use many ways to tackle obesity including diet and exercise. However, often such attempts end up being futile because root cause of obesity such as over-eating and excess absorption of food by the intestines is not easy to win over with just diet and exercise.

Bariatric Surgery is a scientifically proven, tried and tested alternate method for weight loss and obesity with much higher success rate compared to conventional methods.

Known also as Weight Loss or Obesity Surgery, it is a procedure to induce weight loss amongst people who suffer from Obesity. Particularly amongst those for whom other weight loss measures have not worked.

Bariatric surgery involves reducing the active size of the patient’s stomach with the help of a gastric band also known as a lap-band. Alternatively, a part of the stomach is surgically removed. In one more type of surgery, food pathway is rerouted.

All these three options in Bariatric surgery result in reduction of food intake or less absorption of fat and sugars or both, to help long term weight loss. Your Doctor will advise which of these three options are best for you.

Post the bariatric procedure, one is required to have small frequent meals. As the stomach size is reduced, one tends to feel full with smaller quantities. The food intake will thereby reduce on its own.

The impact of bariatric surgery becomes apparent within the first few weeks of surgery.

The procedure is performed through laparoscopy i.e. through the key-hole method. This involves miniature incisions. As a result, there will be no major scars of surgery and recovery is painless and quick compared to open surgery.

Bariatric Surgery involves risk just like any other surgery. But it is important to understand that as with any other surgery, the surgeon’s skill and expertise reduce the risk involved.

The success of a surgery and the patient’s experience depends mostly on the experience, skill and expertise of the surgeon. It is therefore necessary that one approaches a top bariatric centre with vast experience in performing bariatric and laparoscopic surgeries.

Apart from Sleep Apnea, Obesity is associated with increased risk of several physical health disorders including diabetes, high blood pressure, stroke, cancer, arthritis, infertility, heart disease and thyroid amongst others.

It is also a major cause of mental and psychological problems like Depression, Anxiety, etc. caused due to social seclusion and isolation.

Bariatric Surgery may be the answer to end your battle with Obesity and the multifarious problems that come along with it.

 

Want to learn more? Call us for a consultation on: +91 98210 32169.