Blog - Advanced Laparoscopic Associates
Better Diabetes Care Advances Have Not Yielded Better Treatment Results

Better Diabetes Care Advances Have Not Yielded Better Treatment Results

Diabetes is a worldwide health problem affecting just under 10 percent of the United States population, according to the American Diabetes Association. Though there have been many advances in diabetes care over the past decade, these advances have failed to translate into more patients meeting treatment goals.

The Journal of the American Medical Association recently published a population-based study that suggests only one in four adults with diabetes achieved their treatment goals – a composite of various personal “targets.” The study demonstrated no significant improvement in any individual treatment targets being realized between 2005 and 2016.

Even with advances in insulin pump technology, medications, bariatric surgery and lifestyle modifications, diabetes care still has not meaningfully improved for diagnosed patients on a societal level. But individually, it doesn’t have to be like that. At Advanced Laparoscopic Associates, we aim to give our patients both the treatments and the tools they need to control or even beat their diabetes.

Barriers to Diabetes Management

Treatment and management of type 2 diabetes cannot be a one-size-fits-all approach. It’s more complicated than that, and it’s going to be different for each patient. But, similar barriers to successful diabetes management show up in the JAMA study and others. Here are two of the most common.

Cost of care. This factor plays a major role. According to JAMA, “Having health insurance was the strongest predictor of linkage to diabetes care.” This same predictor played out in other studies. Patients who lacked health insurance, drug insurance, or financial resources were unable to meet their treatment outcome targets. According the American Diabetes Association, in 2017, average medical expenses among people with diagnosed diabetes were 2.3 times higher than what their expenses would have been if they didn’t have diabetes.

Not only the cost of care comes in to play; the cost of a proper diet is also a barrier, and healthy foods required for diabetic management can be. Patients with obesity are particularly at risk for a cost of food barrier.

Patient self-management. Even with proper clinical support and advances in health care, patients bear the burden of managing their disease day-to-day. Optimal self-management is affected by a multitude of personal factors for each patient, including their access to care, their experience with medical care (positive versus negative), their financial status, the presence of co-morbidities and general health status, and other personal circumstances.

Patients’ adherence to their treatment plan, attitude, cultural and personal beliefs, and knowledge about their disease all may affect whether they meet their outcome targets. None of these factors are under the control of the treating clinician, who may be unaware of them.

Obesity and Diabetes

Obesity is the leading risk factor for developing type 2 diabetes, and over 90 percent of patients with diabetes are also overweight or obese. Both obesity and diabetes are also independent risk factors for the development of cardiovascular disease, which remains the leading cause of death for women in the United States.

Weight gain and obesity worsen insulin resistance. Losing weight slows the progression of diabetes complications. Though clinicians may provide options for counseling and behavioral management or referral to weight loss programs, these do not address some of the challenges obese patients face. Medication management becomes more complex and exercising is more difficult, or sometimes contraindicated, in obese patients. Additionally, options such as bariatric surgeries need to be examined, as their role in decreasing other health risks such as diabetes and depression are now starting to be realized.

We Can Help

At Advanced Laparoscopic Associates, we specialize in getting our patients down to a healthy weight through surgical or nonsurgical means. Bariatric surgery should be—and increasingly is—considered a first-line treatment for diabetes in addition to obesity.

If you have diabetes and a body mass index (BMI) of 35 or greater, you may be a candidate for bariatric surgery. If you don’t qualify, you still have options. We are dedicated to helping people live their best and healthiest lives, so request an appointment at ALA. Our bariatric experts will be with you every step of the way, from initial consultation to treatment, surgery, recovery and beyond.

Obesity and Mental Health: The Psychological Effects of Obesity

Obesity and Mental Health: The Psychological Effects of Obesity

Recent studies both in the U.S. and other countries show an alarming link between obesity and depression. Obesity and mental health effects, specifically depression, are associated with many health risks, including diabetes, cardiovascular disease, cancer and limitations on the ability to function in normal day-to-day activities. Not only does the research suggest higher rates of obesity in people with depression, but the converse is also true: People who are obese have a greater risk of depression.

Obesity and Depression: the Psychological Link

Being overweight or obese, and even the perception of being overweight, increases psychological distress in people. In both the United States and Europe, appearing as the socially defined version of “thin” is considered the ideal body image. Social acceptance and cultural factors play a role in the link between depression and obesity.

Being obese may increase dissatisfaction with body image and decrease self-esteem, both of which are risk factors for depression. These factors increase stress and anxiety. Eating disorders and disturbed eating patterns are also known to increase the risk of depression. In addition, the physical pain individuals suffer as a direct consequence of being obese adds to the risk of depression.

The Genetic Link Between Depression and Weight Gain

Research recently published in the International Journal of Epidemiology suggests that the psychological effects of obesity—not other obesity-associated illnesses such as diabetes—cause depression. To show this, the researchers used a genetic approach. The psychological aspect of being obese was separated from the impact of obesity-related health issues by using genes that predispose certain individuals to a higher body mass index (BMI), but a lower risk of diseases like diabetes.

The findings suggested that these genes were as strongly associated with the risk of developing depression as they were with a higher BMI and diabetes. This genetic component suggests that being overweight causes depression, whether the individual has obesity-related health problems or not, especially in women. Being overweight not only increases the risk of chronic diseases, but can also lead to depression.

Can Depression Cause Weight Gain and Vice Versa?

According to the Centers for Disease Control:

  • Research shows 43 percent of adults with depression being studied were obese.
  • Adults suffering from depression are also more prone to obesity than adults without depression.
  • As the severity of depressive symptoms increases in adults, the proportion of adults with obesity rises as well.
  • In all age groups, women suffering from depression are more likely to be obese than women without depression.
  • Race and ethnicity have an impact on the relationship between obesity and depression among women. Obesity rates are higher for white women of non-Hispanic ethnicity with depression compared with white women of non-Hispanic ethnicity without depression.
  • Obesity was present in fifty-five percent of adults with moderate to severe depressive symptoms who were also taking antidepressant medication.

According to the Journal of the American Medical Association (JAMA):

  • The overall association between obesity and depression is stronger among Americans; however, the mean adult BMI is higher in the United States compared with different European countries, which may account for this difference. The exact cause is unknown.
  • Being overweight is associated with depression in persons 20 years or older, but not in younger individuals.
  • A clinical interview is key to making the association between depression and obesity. The overall association is shown to be stronger when depression is assessed with a diagnostic clinical interview by a medical professional rather than when individuals provide a self-reported list of symptoms.
  • When persons experiencing depression are exposed to depression for a longer period (≥10 years), the risk of obesity increases. Studies showed obese persons had a 55 percent increased risk of developing depression over time, whereas individuals with depression experienced a 58 percent increased risk of developing obesity.
  • The association between depression and obesity is stronger than the association between depression and being overweight.
  • Time may play another role in the association between depression and obesity between men and women. Initial short-term research effects show the association only in women. However, when long-term data is examined, a reciprocal association between obesity and depression is found in both men and women.

Expert Help for Depression and Obesity

Seeking medical help as early as possible for either or both issues is key for patients. Understanding the relationship between depression and antidepressant usage and obesity is key for clinicians, as it may help them form the best treatment and prevention strategies for both conditions.

Time is of the essence in treatment and prevention for both patients and clinicians. The link between depression and obesity is reinforced by duration. The longer obesity or depression is experienced, the greater the risk of the developing the other. Clinicians of depressed patients must monitor them closely, as weight gain is shown to be a later consequence of depression. For the overweight or obese patients, mood must be closely monitored.

Awareness of this link by both patient and clinician can lead to prevention, early detection, and treatment for those who have already developed obesity and depression. For at risk patients, being cognizant and vigilant about medical follow-up care could ultimately reduce the burden of both conditions. Whether the clinician or the patient, the best strategy is speaking up and dealing with these conditions as early as possible.

If you are obese and ready for a change, request an appointment at Advanced Laparoscopic Associates. We can get you back on the road to health through many conservative and surgical treatments, including medically monitored weight loss and bariatric surgery.

Advanced Laparoscopic Associates Surgeons Named Jersey Choice Top Doctors

Advanced Laparoscopic Associates Surgeons Named Jersey Choice Top Doctors

Advanced Laparoscopic Associates congratulates our own Dr. Amit Trivedi and Dr. Sebastian Eid for their inclusion in New Jersey Monthly’s Jersey Choice Top Doctors award for 2019.

Dr. Trivedi has published numerous scholarly articles and textbook chapters, and is considered an expert in robotic surgery. He performed actress Rosie O’Donnell’s weight loss surgery, which she credits with losing more than 50 pounds and changing her life. Dr. Trivedi is Pascack Valley Medical Center’s 2019 Provider of the Year, and he even dabbles in beekeeping.

Dr. Eid is the author of more than a dozen journal articles and abstracts in such prestigious peer-reviewed journals as Surgery, Cancer and Advances in Nutrition. He gives presentations to expert audiences around the country and the globe. Included in his long list of awards over his career are multiple Jersey Choice Top Doctor awards.

The Jersey Choice Top Doctors award is the result of a rigorous screening process carried out on behalf of New Jersey Monthly magazine by Ringwood, New Jersey research firm Leflein Associates. The firm sends surveys to every doctor in New Jersey licensed for more than five years and asks them to recommend colleagues.

Dr. Trivedi and Dr. Eid have been selected by their peers for their dedication to learning and teaching, their compassion and bedside manner and, above all, their outstanding care provided to each of their patients. Advanced Laparoscopic Associates is proud of Dr. Trivedi, Dr. Eid and all of our exceptional clinical staff for making our practice one of the most successful in the state and best-loved by our patients.

If you have been considering bariatric or general surgery, request an appointment with Advanced Laparoscopic Associates. Our surgical team will sit down with you and together will come up with a personalized treatment plan that suits your situation, lifestyle and circumstances.

Drink More Water for Your Health and Weight

Drink More Water for Your Health and Weight

If you think you’re doing your body a favor by drinking a diet soda rather than its sugar-loaded version, think again.

It turns out artificially sweetened soft drinks may be just as lethal as the sugar-sweetened variety. A September 2019 study examined over 450,000 people from ten European countries. It turns out that while sugary soft drinks have long been associated with greater risk of death, so are artificially sweetened soft drinks.

So, if you’re going to hydrate, there’s one sure bet: make it water.

Why Drink Water?

We are water. Literally. That’s because the body is made up of about 60 percent water. And keeping a balance of body fluids is vital as it makes our “engine” run properly and efficiently.  Yet the majority of us—75 percent of Americans–don’t drink enough water.

Everything in our body runs on water. Hydration is important for tissues, and also helps cushion and brain and spinal cord. It works to maintain proper body temperature and blood pressure, and transports nutrients.

The health benefits of water are numerous. Here are a few of the specific benefits of drinking water.

Controls appetite

While water is not a magic weight loss tool, it can help fill you up as well as increase your metabolism. Certainly, drinking water instead of caloric beverages can be helpful. Drinking a glass of water a half hour before meals, “preloading” in a sense, can help you feel more full.

What’s more, the brain’s thirst mechanism is so weak that it is often mistaken for hunger. That midnight snack you’re craving might actually be a midnight sip. If you feel like raiding the fridge or the pantry, try the faucet instead and see if your urge to eat disappears.

Combats fatigue

Fatigue is a sign of dehydration. In fact, it turns out that people who seek treatment for fatigue are often dehydrated. The reverse may be true as well. Short on sleep? That can actually make you more than tired—it can also dehydrate you, according to a 2019 study published in Sleep. So, drinking water may help your fatigue, and getting enough sleep may help prevent dehydration.

Lubricates joints

Joints are composed of cartilage, which is made up of about 80 percent water. Drinking water helps that cartilage to do its job. In fact, long-term dehydration can lead to joint pain, due to the reduction in the joints’ ability to absorb shock.

Helps the bowels

Water helps soften stools and stimulate bowel movements. In fact, constipation is the result of dehydration because with insufficient fluids, the colon instead extracts the water from the stools. That is what causes constipation.

Prevents kidney stones

Kidneys serve to cleanse and rid the body of toxins. Water is vital for the kidneys to do that job. Water helps remove waste products, which the kidneys do by filtering about 30 to 40 gallons of fluid every day. Among its benefit for the kidneys, consuming sufficient water dilutes the minerals that cause stones.

Water Tips

It’s helpful to create and maintain a strategy for good hydration. You can do that with these water-drinking tips.

Choose water. Whether it’s at the gym or with meals, skip the soda, juice and other caloric options in favor of water.

Bring it with you. Carry water bottles for easy access, and also plant them, or a refillable water glass, at your desk or other commonly used locations.

Flavor or freeze. Freeze some water bottles to drink cold when thawed. To jazz up plain water, try flavoring it with a squeeze of lemon or lime, or some mint, or infuse water with fruit or cucumbers. 

Eat watery foods. Approximately 20 percent of daily fluid intake comes from our food. Think fruit and vegetables. Did you know a banana is 75 percent water and that broccoli is 90 percent water? Even a serving of oatmeal or beans has about a half cup of water.

Sip, don’t gulp. Try not to chug down water in large amounts, as it is not as well absorbed. Drinking large amounts at once causes the kidneys to simply expel the water, resulting in frequent trips to the bathroom and is a possible risk for hyponatremia (see below). Sipping water enables the body to more efficiently absorb in, which is indicated by fewer trips to the bathroom.

Know Your Water Needs

It would seem simple: the body will tell you when you need fluids; drink when you’re thirsty. But by the time you get thirsty, you are probably already on the way to being dehydrated, having lost from one to two percent of your body’s water content.

From exercise to medications that require water consumption, it is important to understand your water needs. While the hard-and-fast rule has been established as “eight glasses a day” (referred to as 8 x 8=eight eight-ounce glasses), that one-size-fits-all is not true for everyone. For general guidelines on your needs, check out a water intake calculator.

A variety of customized apps can also help with hydration. They feature reminders to drink water and keep track of what you’ve consumed, and can match your water needs based on your personal use.

Keeping track of your water intake is important for many reasons. However, in all of this discussion of drinking more, it is also important to understand there is too much of a good thing, and that you can also overhydrate. That phenomenon is called hyponatremia, or water intoxication, which can lead to some serious consequences.

So, raise a glass of water, and drink to your health!

If you’d like to get healthy, request an appointment at Advanced Laparoscopic Associates. Our bariatric surgery experts and our nutrition team can help you come up with a plan to control your weight and cut your risk of disease.

Bariatric Surgery Cuts Heart Risk in People with Diabetes

Bariatric Surgery Cuts Heart Risk in People with Diabetes

You have a lot on your mind when you have diabetes. How’s my blood sugar? Will this banana spike it too much? Is that ulcer on my foot serious? How’s my heart health?

That last is especially important because heart disease—already the top cause of death in the US—is even more of a concern for people with diabetes. But there’s new hope: A huge study published in September 2019 suggests bariatric surgery can reduce the risk of heart disease in those with diabetes.

Bariatric Surgery: First Line Treatment?

Bariatric surgery is any procedure used on the gastrointestinal system to facilitate weight loss. Bariatric surgery also may be referred to as metabolic surgery because it influences a patient’s metabolism by inducing weight loss and altering the physiology of the gastrointestinal system.

This distinction is important for patients suffering from both obesity and type 2 diabetes. In these cases, bariatric surgery is not just a weight loss solution, but a metabolic surgery, as it has a positive impact as a treatment for type 2 diabetes.

Research Suggests Bariatric Surgery Helps Heart

The Journal of the American Medical Association (JAMA) has published a large and important retrospective study linking metabolic surgery with a decreased risk of adverse cardiovascular events, such as heart attack or stroke or death, in patients with type 2 diabetes and obesity.

The authors reviewed and compared the outcomes in 287,438 patients receiving both metabolic surgical procedures and traditional non-surgical treatment at The Cleveland Clinic from 1997 to 2017, with follow-up through December of 2018. The study concluded that bariatric surgery has a positive impact on type 2 diabetic patients, both in reducing obesity and as a proven treatment for type 2 diabetes.

Other studies have shown that when patients have both type 2 diabetes and obesity, long-term health goals are harder to achieve using medications and lifestyle modifications, such as diet and exercise. In this specific patient set, cardiovascular disease is the major cause of poor health and risk of death.

What Is the Link Between Heart Disease and Diabetes?

If you have diabetes, you are more likely to develop heart disease, increasing your chances of a heart attack or stroke. In fact, heart disease and stroke are the most common causes of death in adults with diabetes. The risk of dying from heart disease or stroke is doubled in adult patients with diabetes, and they also develop heart disease at a younger age than adults without diabetes.

When you have diabetes, you must manage your blood sugar (or blood glucose) to protect your heart. When high blood glucose is left untreated, it can damage not only your blood vessels, but also the nerves that control your blood vessels and heart. The longer you have untreated diabetes, the higher the risk of developing heart disease.

When you are overweight or obese, your ability to manage your diabetes becomes harder, and your risk for other health problems increases. Even if you are not overweight, excess belly fat around your waist can raise your chances of developing heart disease.

What Causes Heart Disease?

The cause of heart disease varies depending upon the type of heart disease. Coronary artery disease or coronary heart disease is the most common form of heart disease and is caused by atherosclerosis.

Atherosclerosis is a buildup of fatty plaques in the arteries that thickens and stiffens the artery walls. These plaque buildups can break off from the artery walls (a process called rupturing). Clots form around them, and if the clot travels through the arteries, it can block blood flow to the heart (a heart attack), the brain (a stroke) or the lungs (pulmonary embolism), starving them of oxygen and destroying tissue. Atherosclerosis often develops due to correctable lifestyle factors, such lack of exercise, poor diet and smoking.

When you have diabetes, high blood sugar damages blood vessels over time. This makes the vessels more susceptible to rupture, which is why people with diabetes have increased risk of heart attack and stroke.

Other major controllable contributors to heart disease include:

  • High blood pressure
  • High cholesterol
  • Obesity – Body mass index (BMI) greater than 30 kg/m2 (you can check your BMI with the calculator on our home page)
  • Morbid obesity –BMI of 40 or greater, or BMI 35 or greater with coexisting obesity-related health conditions, such as high blood pressure or diabetes

How Can Bariatric Surgery Help Reduce the Risk of Heart Disease in People with Diabetes?

According to the JAMA study and other research:

  • Use of noninsulin diabetes medications, insulin, renin-angiotensin system blockers, other antihypertensive medications, lipid-lowering therapies, and aspirin were significantly lower after metabolic surgery compared with traditional non-surgical treatment.
  • Metabolic surgery was associated with significantly lower risk of death over 8 years.
  • Metabolic surgery is associated with improvements in glucose levels and blood pressure control, contributing to a significant reduction in the risk of heart failure.
  • A significantly lower incidence of diabetic nephropathy was observed in the surgical patients compared with nonsurgical patients. Prior studies have also suggested this same result.
  • Metabolic surgery can improve insulin sensitivity by two to three times within days after surgery, before any noticeable weight loss even occurs. A complete resolution of diabetes occurred in 76.8 percent of surgical patients in a JAMA systematic review and meta-analysis.

Smaller clinical trials have consistently shown a significant effect of metabolic surgery on obesity and improvements in diabetes control. Due to its success in treating and even resolving type 2 diabetes and the associated health benefits, bariatric surgery is now being used on patients who are less obese than prior requirements for surgery.

If you have diabetes and are ready to take control of your health, request an appointment at Advanced Laparoscopic Associates. Our expert surgeons can tell you if you meet the criteria for weight loss surgery and which bariatric procedure is right for you.

Weight Loss Surgery for Teenagers And Adolescents

Weight Loss Surgery for Teenagers And Adolescents

It is no secret that obesity is an epidemic in the United States. More than 93 million Americans—that’s nearly 40 percent—were overweight or obese in 2015 and 2016, according to the Centers for Disease Control and Prevention.

And, if you think children and teens are immune to obesity, think again. One in five teens between the ages of 12 and 19 are obese.

Obesity is the top cause of preventable death, resulting in more life-years lost than even smoking. It increases the risks of a host of diseases—some deadly—including:

  • Heart disease
  • Diabetes
  • Obstructive sleep apnea
  • Some cancers
  • Osteoarthritis
  • Fatty liver disease
  • Kidney disease

…and more.

If you are overweight or obese, it is never too late to start getting healthy…or too early.

Bariatric Surgery for Teens and Adolescents

There are multiple guidelines for bariatric surgery in teens and adolescents. Patient selection is one of the most important parts, and most teens must meet fairly rigorous criteria to be considered for bariatric surgery. Some of these include:

  • A high body mass index (BMI) of 40 or more
  • Fully grown or nearly so
  • Failed at least six months of conservative weight loss attempts
  • Pass a psychological screen
  • Have an obesity-related condition such as type 2 diabetes, hypertension or obstructive sleep apnea

The US Preventive Services Task Force recommends screening for obesity in children and adolescents.

In 2018 American Society for Metabolic and Bariatric Surgery published guidelines in pediatric weight loss surgery and concluded that metabolic and bariatric surgery is a proven, effective treatment for severe obesity disease in teenagers and adolescents and should be considered standard of care.

Pediatricians and primary care providers should recognize that children with severe obesity should be referred to a center with advanced treatments and support as soon as possible.

Healthy Weight for Teens

Bariatric surgery is the most effective method for long-term weight loss, but there are many other tactics people can use to lose weight if they do not want or do not qualify for weight loss surgery. Candidates for bariatric surgery must generally meet one of the following requirements:

  • A BMI of 40 or more
  • A BMI of 35 or more, plus an obesity-related health condition such as high cholesterol, high blood pressure, type 2 diabetes or obstructive sleep apnea

BMI is a ratio of height to weight. Use the BMI calculator on our home page to determine yours. Calculating BMI is different for children and teenagers, but teenagers with a BMI greater than 30 are likely obese.

Teens who want to lose weight or maintain a healthy weight should start in much the same way as adults: getting plenty of activity and moderating food intake. The CDC recommends a minimum of 150 minutes of moderate exercise per week. A food diary or app such as MyFitnessPal can help teens estimate and limit the number of calories they consume every day.

If you or a loved one wants to lose weight and may be a candidate for bariatric surgery, request an appointment at Advanced Laparoscopic Associates today.

Can Exercise Cut the Risk of Dementia?

Can Exercise Cut the Risk of Dementia?

Humans were made to move. Exercise is so good for the body that the Centers for Disease Control and Prevention (CDC) recommends everyone get 150 minutes per week of moderate exercise. Regular exercise reduces the risk of a long list of diseases and risk factors, including:

  • Diabetes
  • Obesity
  • High blood pressure
  • High cholesterol
  • Stroke
  • Certain cancers

…and even death from any cause. And, Alzheimer’s disease may soon be added to that list.

What Is Alzheimer’s Disease?

Alzheimer’s disease, the sixth-leading cause of death in the United States, is the most common and best-known form of dementia. Dementia is an umbrella term for a number of diseases that cause degeneration of mental processes that can result in wholesale memory loss, drastic personality changes and a breakdown in cognition.

Much remains unknown about how and why Alzheimer’s takes hold and progresses, but prevailing theories revolve around abnormal brain structures known as amyloid-beta plaques and tau tangles. Plaques are protein snippets that build up between brain cells (neurons), whereas tangles are misfolded proteins that form within the neurons themselves.

A healthy brain clears these structures on a regular basis. A brain with Alzheimer’s cannot do so, and plaques and tangles accumulate. It is thought that plaques and tangles contribute to the destruction of neurons over time.

Brains with Alzheimers have abnormal protein structures

Alzheimer’s is both progressive and incurable. Symptoms start subtly and progress slowly. Some memory loss is a natural part of aging. It crosses into the territory of mild cognitive impairment (MCI)—a precursor to dementia—when it begins to affect daily life. On average, people with Alzheimer’s disease live between 3 and 11 years after diagnosis.

Exercise and Alzheimer’s: How It May Help

Exercise is good not just for the lungs, heart and other muscles, but evidence is mounting that exercise may have both a protective effect against Alzheimer’s and may mitigate its effects.

A 2017 review in The Lancet examined a number of studies on the benefits of exercise for people with mild-to-moderate dementia. While it found few well-designed studies on exercise and Alzheimer’s, most of the studies included in the review showed improvements in cognition for those who exercised compared to control groups. According to one of the studies, higher intensity exercise (greater than 70 percent of the maximum heart rate) produced stronger results.

The authors stated that, “Exercise programmes [sic] for people with mild-to-moderate dementia are feasible and well-tolerated, and exercise offers positive small effects on function for people with dementia, but whether it helps cognition is unclear.”

More recently, a study published in JAMA Neurology in July 2019 looked at data from more than 180 people. The results suggest that higher levels of physical activity are associated with slower amyloid beta-related cognitive decline, as well as a slower rate of brain matter loss. Additionally, it suggests that healthier blood vessels—one of the benefits of regular exercise—was also associated with slower cognitive decline.

Finally, an ongoing clinical trial called the EXERT study is attempting to quantify the effects of exercise on the prevention of Alzheimer’s disease. Participants are adults aged 65 to 89 who are physically inactive and showing signs of MCI. The goal of the study is to see if exercise can slow the progression of cognitive decline.

Obesity has recently passed smoking as the top preventable cause of life-years lost. If you are committed to getting to a healthy body mass index, request an appointment with Advanced Laparoscopic Associates. We can determine if you qualify for weight loss surgery, as well as help you decide which procedure is right for you.

The Gastric Sleeve Diet: How to Eat Before and After Your Gastric Sleeve Surgery

The Gastric Sleeve Diet: How to Eat Before and After Your Gastric Sleeve Surgery

Bariatric surgery is the most proven way to lose weight and keep it off long-term, but it’s only the beginning. A surgery like the gastric sleeve—the most popular weight loss surgery in the United States—requires a fundamental lifestyle shift, including how you eat.

Getting weight loss surgery is a big change, but that doesn’t mean it has to be difficult. At Advanced Laparoscopic Associates, we specialize in setting our patients up for success. That’s why we’ve put together this gastric sleeve diet guide. By following a sensible diet before and after gastric sleeve surgery, you won’t have to let your weight or your health hold you back from the life you deserve.

The Importance of Nutrition for Gastric Sleeve Surgery

The gastric sleeve procedure (also known as vertical gastric sleeve and sleeve gastrectomy) is a restrictive weight loss procedure. It works by removing approximately 80 percent of the stomach, leaving it roughly the size and shape of a banana.

A smaller stomach can hold less food, but what makes the sleeve gastrectomy different from another procedure, such as a gastric bypass or gastric band, is what gets removed during a sleeve gastrectomy. The true benefit to a gastric sleeve is the removal of cells that produce a hormone called ghrelin.

One of the roles of ghrelin, sometimes known as the hunger hormone, is signaling to your brain that your stomach is empty. In addition to causing feelings of hunger, it also promotes fat storage.

Losing ghrelin can make sticking to a diet easier, but because you’ll very likely be eating less, eating the right foods become all the more important. A small 2011 study found that up to 48 percent in the study were at risk for certain vitamin imbalances. Deficiencies included:

  • Anemia
  • Folic acid
  • Vitamin B12
  • Vitamin D

Getting and staying healthy, both before and after gastric sleeve surgery, means eating right. We’ll show you how.

Gastric Sleeve Pre-op Diet

Your pre-surgery weight and body mass index (BMI) may influence your gastric sleeve’s success, according to a 2015 study published in Bariatric Surgical Practice and Patient Care. Researchers found that patients who had a BMI of less than 50 had kept more excess weight off at one year after a gastric sleeve procedure.

If you are obese, you should focus on losing as much as you can before you get to the operating room. Weight loss is a simple—though not easy—equation of calories in, calories out: If you burn more calories than you consume, you’ll lose weight. That usually means a combination of diet to reduce the number of calories you consume and exercise to increase the number of calories you burn. At Advanced Laparoscopic Associates, we have a team of nutritionists who can make sure your weight loss efforts are safe and effective.

Post-op Diet Phases

It can be helpful to think of a post-gastric sleeve diet in stages or phases based on the amount of time that has passed since the surgery. Although the number of stages differs from source to source, a good rule of thumb is four phases, lasting from immediately after the surgery until about a month later.

Phase One Diet

Phase one diet will begin in the hospital and last for approximately a week. It is a clear liquid diet plan that takes into account the possible effects of anesthesia and the discomfort that’s possible after abdominal surgery.

A clear liquid diet can include:

  • Broth
  • Decaf tea or coffee
  • Jello
  • Sugar-free popsicles

Alcohol, caffeine and excessive sugar should be avoided, as should any food that requires chewing.

Phase Two Diet

Most people are not hungry immediately after gastric sleeve surgery. When they do become hungry—about a week after surgery for most people—phase two begins. Phase two consists mostly of liquids with some very soft foods as well.

Protein is extremely important to the healing process. People in phase two should aim for between 60 and 80 grams of protein per day.

Foods to eat in phase two include:

  • Protein shakes
  • Thin soups
  • Soft noodles in soup
  • Diluted juice
  • Applesauce
  • Greek yogurt
  • Mashed potatoes
  • Pureed chicken or tuna
  • Baby food
  • Thin oatmeal
  • Fat-free, sugar-free ice cream or frozen yogurt

Phase Three Diet

Phase three begins the transition to solid foods. All foods from phases one and two are safe to eat. Protein continues to be important, so keep drinking your protein shakes.

New additions include:

  • Eggs
  • Soft vegetables
  • Heartier soups
  • Cheese
  • Soft fish
  • Deli meat

Phase Four Diet

Four to six weeks after surgery, most patients are ready to return to their (new) normal eating patterns. Solid food is safe by now, but to achieve the success you want from your gastric sleeve surgery, you should avoid:

  • White bread
  • Fried food
  • Soda
  • Sweets
  • Processed food
  • High-fat, -sugar and -calorie foods

Eat Right for Results

The four-phase gastric sleeve diet will have you well on your way to meeting your goals. It takes discipline and commitment, but you don’t have to do it alone.

Advanced Laparoscopic Associates surgeons are pioneers in the field of laparoscopic weight loss surgery. We will be by your side every step of the way, from initial consultation to recovery and beyond. Our team of clinicians and nutritionists are always available to answer questions and make sure your weight loss is effective, safe and sustainable. Request an appointment today.

Dr. Schmidt Shares Expertise at GERD Symposium

Dr. Schmidt Shares Expertise at GERD Symposium

Advanced Laparoscopic Associates congratulates our own Dr. Hans Schmidt for a job well done. Dr. Schmidt was an invited lecturer at the 2019 GERD Symposium, which took place on June 9 at Hackensack University Medical Center in Hackensack, NJ.

Dr. Schmidt is an acknowledged expert on the surgical management of gastroesophageal reflux disease (GERD). At the symposium, he spoke to a large group of medical professionals about current surgical treatment options for the condition.

The annual symposium focuses on diagnostic and treatment protocols for GERD. Of special emphasis was minimally invasive surgical management, which Dr. Schmidt and Advanced Laparoscopic Associates specialize in.

GERD affects millions of people each year, leading to a lower quality of life and raising the risk of esophageal cancer. Advanced Laparoscopic Associates is one of the only practices in New Jersey that performs the LINX procedure, a safe option for the management for GERD.

If you are experiencing GERD and have tried more conservative treatment measures without success, request an appointment at Advanced Laparoscopic Associates to see if surgical management is right for you.

Body Shape: Why it Matters

Body Shape: Why it Matters

A July 2019 study has put a spin on the finding that body shape matters—despite one’s overall body size. We know that a pear-shaped body is better than an apple-shaped body in terms of health risks. That’s because the fat in the abdominal area (the apple shape) is mostly visceral fat, the most dangerous kind. And while it’s customarily been the case that this is true of only overweight people, the study contends that it doesn’t matter if you’re overweight or normal weight: Carrying fat around the middle is a significant mortality risk.

The study, detailed in the July 24, 2019 issue of the JAMA Network Open, included 156,624 postmenopausal U.S. women who are enrolled in the famed Women’s Health Initiative study. The authors state that while current public health guidelines for obesity focus on body mass index (BMI, which is determined by weight-to-height ratio), those guidelines do not sufficiently stress what is termed as central obesity, which is measured by waist circumference and reflected in the apple-shaped body.

Central (waist) obesity was highlighted in a 2010 JAMA Internal Medicine study of almost 105,000 people, which found that both men and women with bigger waistlines (apple-shaped) were twice as likely to die as those with smaller waistlines (pear-shaped). Those with bigger waists also had a greater risk for type 2 diabetes, cholesterol problems and coronary heart disease.  The study pointed out that it is the body shape, i.e. where a person carries body fat, is what matters most when it comes to health.

The body size in the 2010 study included apple-shaped participants who had waistlines of more than 47 inches for men and 43 inches for women. Yet the new study findings show that even women of normal weight can carry the same health risks if they have central obesity. In fact, it found that those normal weight (as defined by BMI) post-menopausal women studied who had central obesity had a 30 percent increased risk of mortality over normal weight subjects without central obesity.

Types of Fat

Colors of fat

Although the term “body fat” is widely used, not all body fat is alike. There are several types, and each serves a physiological purpose. Fat is divided into various types and by its color shades. To simplify, there are three basic colors of body fat:

  • Brown: Brown fat is considered healthy, but is only present in small amounts in adults. It is mostly a feature of newborn babies. Brown fat helps keep us warm, so it is known as “fat-burning” fat.
  • White: White fat, on the other hand, comprises a majority of the body and increases with age. In excess amounts, white fat can be harmful for our bodies.
  • Beige: Beige fat is a combination: it is similar to brown fat in that it is energy-burning, but it has its own unique cell type and is embedded (mixed in) in white fat.

Essential fat

Essential fat is necessary for life and health. It is found in the heart, lungs, liver, brain, nerves, intestines, bone marrow, muscles and tissues of the central nervous system. It helps to regulate body temperature, hormones (fertility hormones in women) and cell structure. This is the type of fat you should not lose, as its loss compromises health.

Subcutaneous fat

Subcutaneous fat is fat stored under the skin and is a combination of brown, white and beige fat cells. This fat is partially energy-storing, it helps regulate body temperature, is padding to protect muscles and bones and is part of helping nerves and blood vessels to travel between skin and muscles.

However, too much subcutaneous fat can be accumulated due to genetics or lifestyle, such as overeating and being sedentary. Too much of this fat can lead to heart disease and stroke as well as high blood pressure, type 2 diabetes, kidney and liver disease and some cancers.

Visceral fat

Visceral fat, also known as “belly fat”, is sometimes also called “active fat” as it can actively increase the risk of various serious health conditions. Visceral fat is white fat, and it is located within the abdominal cavity and surrounds organs such as the heart, liver, pancreas and intestines.

Some belly fat is not necessarily visceral fat; it can be subcutaneous fat, the type of fat found in the arms and legs. But visceral fat increases the risk of heart disease and heart attacks, stroke, type 2 diabetes, and breast and colorectal cancer. It is also associated with an increased risk of Alzheimer’s disease. 


It is well-established that obesity is connected to a number of health risks. It is also well-established by significant research and the length of time it has been available that bariatric surgery is one of the safest and most effective ways to address obesity. This includes, in particular, the health risks related to obesity, which have been shown to dramatically decrease with the weight loss that occurs as a result of this surgery.

Explore bariatric surgery with one of our experts at Advanced Laparoscopic Associates by requesting an appointment today. We can determine if bariatric surgery is right for you and give you the options for the form of surgery most appropriate for you. We’ll care for you every step of the way, from consultation to postoperative follow-up and beyond.