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Gastric Balloon Diet: Your Guide to Eating After a Gastric Balloon Procedure

Gastric Balloon Diet: Your Guide to Eating After a Gastric Balloon Procedure

If you have some weight to lose but you’re not ready—or don’t qualify—for bariatric surgery, an intragastric balloon might be just what you need. This is a nonsurgical, nonpermanent procedure that may help you eat less and lose weight.

Here’s how it works. First, you’ll be sedated. Then a bariatric surgeon will thread, with the help of a flexible camera called an endoscope, a catheter down your throat and into your stomach to deliver an uninflated balloon. Finally the balloon will be inflated with a saline solution and the endoscope removed.

Once inflated, the balloon takes up room in your stomach, leaving less room for food and helping you feel fuller, faster. This is an outpatient procedure that can be done in a bariatric surgeon’s office. Unlike many forms of bariatric surgery, the gastric balloon is not permanent—it will be removed in six months. The goal is to eat less and develop healthy nutritional habits that you follow after the balloon is removed.

Although the procedure itself is minor and nonpermanent, it requires a major shift in mindset and lifestyle to see continued success, especially after the balloon is removed. You’ll use the six months of the balloon in your stomach to develop a new way of eating and a new relationship with food.

Here’s what you can expect from your post-balloon diet, as well as some tips for making the most of your gastric balloon procedure.

Post-Balloon Diet: Week One

After your balloon is implanted, you’ll be on a heavily restricted liquid diet for about a week. This is to get your system used to having the balloon in your stomach.

For the first day or two, drink water only. Then you can expand to:

  • Broth or thin soup
  • Fruit or vegetable juice (diluted if you’re not making your own)
  • Nonfat milk
  • Protein or meal replacement shakes


  • Alcohol
  • Jell-O
  • Sugar
  • Full-fat dairy
  • Carbonated beverages

Post-Balloon Diet: Week Two

After a week of purely liquid nutrition, you may start adding solid foods back into your diet. Start slow and small, with soft foods. Eat small bites and chew thoroughly.

Foods to eat this week can include:

  • Lean meats, not fried
  • Cooked vegetables
  • Soft fruit
  • Jell-O
  • Yogurt
  • Oatmeal
  • Chunkier soups
  • Eggs or egg whites

Continue avoiding fried food and rough foods, such as certain raw fruits and vegetables (apples, carrots, etc.; anything crunchy) and tough cuts of steak.

Post-Balloon Diet: Beyond Week Two

After the second week post-procedure, you can resume eating so-called normal-textured food, but with a couple of big caveats. First, you’ll get ready to follow the diet plan you’ve discussed with a registered dietician (we have RDs on staff at Advanced Laparoscopic Associates), and that may (probably will) involve a change in eating habits. Second, you’re going to eat a lot less than before the balloon was implanted.

Regarding the first point, now is the time to start cleaning up your diet, if you haven’t already. That can mean a few things.

  • Avoid heavily processed foods and added sugar
  • Drink zero-calorie beverages: Water, black coffee, unsweetened tea
  • Eat lean meats, healthy fats and complex carbohydrates
  • Get plenty of fiber

Keep in mind that your stomach’s “storage capacity” is going to be a lot smaller with a balloon taking up space. That’s the point! Expect to eat no more than 1,200 calories per day. That’s not very much, but you’ll see rapid weight loss, and you won’t feel too hungry during that time thanks to your balloon.

After Balloon Removal

Now comes the important part: six months later, when your balloon is removed. By now you should have established eating patterns and a healthy lifestyle you’ve been following since your balloon procedure.

The tricky part can be keeping up with your new, healthy lifestyle once the balloon is removed. Six months should be enough for your new healthy habits to stick, but it can be easy to backslide. Be sure to take advantage of the nutritionists and weight loss experts at Advanced Laparoscopic Associates for help with your post-balloon life.

If you have 20 to 30 pounds to lose but don’t qualify for bariatric surgery, request an appointment at Advanced Laparoscopic Associates to see if the intragastric balloon is right for you.

The Connection Between Sleep and Weight Gain

The Connection Between Sleep and Weight Gain

Busy people in a busy modern society know that something has to give when it comes to juggling work, family, health, fun and everything else. Far too often, the result is compromised sleep. The truth is, sleep is one of the most important—and overlooked—aspects of health and quality of life.

Sleep and Bariatric Surgery

Waking up well-rested makes you feel ready to tackle the day, but that’s far from the only benefit of getting enough sleep. People who have had bariatric surgery reap extra reward from a healthy sleep schedule, according to a study published in Obesity in September 2019.

Bariatric surgery is the most proven long-term weight loss method available. People who have had bariatric surgery regularly lose 50 percent or more of excess weight. Although many people keep most of it off in the long term, gaining some weight back is the norm.

How much weight is gained is partially determined by sleep quality, this study suggests. Researchers looked at body weight and body mass index (BMI) data from 14 people who had bariatric surgery: before surgery and at 1, 2, 6 and 9 years after surgery. The average amount of weight gain was 5.7 percent.

The study data suggests that the lower amount a person slept on average, the higher the BMI was at 6 and 9 years post-surgery. Also, across all categories (pre-surgery and all post-surgery follow-ups), longer sleep was associated with more weight lost.

Sleep and Obesity

This may be the first study that examined the effects of sleep on weight gain after bariatric surgery, but it is far from the first to explore the relationship between lack of sleep and weight gain. Data from the Nurses Health Study—a large-scale study involving more than 60,000 women over 16 years—suggest that study participants who slept fewer than five hours a night on average were 15 percent more likely to become obese compared to women who slept for more than seven hours a night.

Sleep can also influence eating patterns, with good sleep making a person more likely to eat better. A 2014 review published in American Journal of Lifestyle Medicine found that short sleep duration (less than six hours) was associated with:

  • Eating more food (about 200 calories more per day)
  • Eating more fat
  • Eating more in the morning
  • Having irregular meal times
  • Snacking between meals
  • Spending more money on eating out
  • Eating fewer vegetables

Getting Good Sleep

Sleep is one of the three pillars of good health, along with diet and exercise. If you want to boost your health and energy levels while watching the numbers on the scale get smaller, you need to get enough sleep. Here are some tips for getting better sleep.

  • Keep to a regular schedule. Go to bed and wake up at the same times each day (yes, even on weekends).
  • Keep your bedroom dark and quiet.
  • No phones, computers or tablets in the bedroom. Blue light from these devices can impair the production of melatonin, a hormone that’s needed for sleep and regulating your internal clock.
  • Avoid caffeine and large meals for at least two hours before bedtime.
  • Get plenty of exercise during the day to tire yourself out at night.

If you’re overweight or obese and want to make a change, request an appointment at Advanced Laparoscopic Associates. Our expert bariatric surgeons can tell you if you’re a candidate for weight loss surgery, describe your options and help you choose the best weight loss plan for you.

ALA Surgeons Teach and Learn at Prestigious International Conference

ALA Surgeons Teach and Learn at Prestigious International Conference

As yet another example of ALA surgeons’ commitment to providing the best patient care possible, two of our surgeons traveled more than 3,600 miles to learn from and teach their peers.

Dr. Hans Schmidt and Dr. Toghrul Talishinskiy attended the 24th International Federation of the Surgery for Obesity and Metabolic Disorders (IFSO) World Congress. The conference took place in Madrid, Spain in early September 2019.

The IFSO World Congress is one of the top conferences for bariatric surgeons. This year, some of the world’s best bariatric surgeons presented on a truly staggering array of topics.

A sampling included:

  • Preoperative preparation
  • Low BMI gastric bypass
  • Gastric sleeve in combination with other procedures
  • Hypoabsorption
  • Post-surgical complications
  • Cognitive changes after bariatric surgery

…and so much more.

Among the presenters were Dr. Schmidt and Dr. Talishinskiy, who had unique insights into a fascinating case from their patient files. They wanted to spread the lessons they’ve learned from working on the case to other surgeons from around the globe, and the IFSO World Congress was the perfect venue to do so.

At ALA, our surgeons are dedicated to staying at the top of their craft. Dr. Schmidt and Dr. Talishinskiy were able to learn new insights from other surgeons around the world, insights they took back to their colleagues at ALA and, ultimately, to their patients.

If you are considering bariatric surgery, request an appointment at Advanced Laparoscopic Associates. Our world-class surgeons will take the time to understand your needs, detail your options and help you choose a surgery or treatment plan that’s right for you.

Your Guide to Holiday Eating After Bariatric Surgery

Your Guide to Holiday Eating After Bariatric Surgery

The end of Halloween marks the unofficial start of the holiday season (is it getting earlier every year, or is it just us?). The holidays are a time for friends, family and—frequently—food. Having weight loss surgery can mean a drastic lifestyle shift and change to eating patterns. Bariatric surgery patients may worry that either they’ll slip into old, unhealthy habits, or they won’t be able to enjoy the holidays to their fullest.

If you’ve had bariatric surgery, you don’t have to worry about the holidays. Having a plan and some rough guidelines going into a Thanksgiving or end-of-year holiday meal can mean the difference between overeating and sticking to the program.

Here are our best tips for healthy holiday fun.

Avoid the Eggnog

Bariatric surgery alters how your body processes alcoholOne of the easiest ways to stay on track this holiday season is to drink only water. At Advanced Laparoscopic Associates, we counsel our bariatric patients to stick to water year-round, but it is especially important during the holidays. You’ll be surrounded by rich, heavy foods, so even if you indulge a bit, you’ll be saving calories by skipping the hot chocolate.

Additionally, an important point to remember is that some types of bariatric surgery—gastric bypass especially—change the way your body processes alcohol. It might be because liquids empty from the gastric pouch quickly, or that bypassing the stomach means alcohol is absorbed into the bloodstream faster.

Studies suggest that alcohol gets processed faster, becomes more concentrated in the bloodstream and leaves the body slower in people who have had gastric bypass surgeries. Add on all the empty calories in alcoholic drinks and you’ve got plenty of reasons to stay away from it this holiday season.

Practice Mindful Eating

After you’ve had bariatric surgery, you need to be more aware of what you put in your body. Portion control is one of the most important aspects of post-bariatric-surgery life. It is just so easy to overeat during big family dinners, though.

Here are some tricks to help you be mindful:

  • Stay away from the buffet—If you’re standing up by where the food’s laid out, you may be more prone to mindlessly snacking. Grab a plate and sit down instead.
  • Say no to seconds—Take enough on the first plate to keep you full. Start with protein, then fill most of the rest of your plate up with veggies. Protein and fiber will help you feel sated so you’re not as tempted to go back for seconds. If you do want seconds, give it 20 minutes or so; since it takes about that long for your brain to get the message that your stomach is full.
  • Make time to eat—Just like standing too close to the buffet, socializing and snacking can cause you to overeat. Sitting at a table can help you focus on food and be mindful of what you’re putting into your mouth.

Keep Consistent Eating Patterns

You may be tempted to “save up” some calories by not eating all day. This is a mistake. You don’t want to go completely crazy just because it is a holiday meal. You should eat normally throughout the day of your holiday celebration, and keep tracking your intake.

It is ok to indulge a little at the feast, but be mindful of how many calories you’ve already consumed. Also, be realistic: Don’t try to lose weight during the holiday season, but instead try to maintain weight (i.e., try not to gain).

The one caveat to keeping your eating patterns consistent is this: It might be wise to eat a little something before you go to your party. That way you might be less hungry and less inclined to overeat.

The holidays can be a time of fellowship and togetherness. People bond over food; they always have. There’s no reason for that to change for you after you’ve had bariatric surgery. Weight loss surgery is a massively positive change in your life, but it is a change nonetheless. Remember that your needs are different now, follow our tips and have a happy, healthy holiday season.

Don’t Overindulge

Some bariatric surgery procedures are restrictive, so you can't eat too much without feeling poorlyIt is tempting to pile on the food from the buffet or the dessert table, but for people who have had certain weight loss procedures, that can get downright uncomfortable. Remember that if you’ve had a gastric bypass or gastric sleeve, your stomach has been modified to handle less food.

With a gastric band, eating too much risks dumping syndrome. That’s when too much food enters your small intestines at the same time. It can cause:

  • Diarrhea
  • Dizziness
  • Nausea
  • Sweating
  • Vomiting

Similar symptoms can happen if you overeat when you have an adjustable gastric band. If you eat too much, too fast or don’t chew enough, food can get stuck near the band opening. To prevent that, chew slowly and thoroughly, at least 20 times per bite, and take about 30 minutes to finish your meal.

One of the benefits of having a gastric sleeve is that it physically prevents you from eating a lot. What happens when you try anyway? You risk your stomach stretching out, which negates one of the main purposes of the gastric sleeve. Since you’ll produce less ghrelin, a hormone that tells your brain that your stomach is empty, you’ll feel full faster, so it is important to listen to your body.

If you need help managing your holiday eating after bariatric surgery, request an appointment at Advanced Laparoscopic Associates. Our Registered Dieticians can help you plan for a healthy, enjoyable holiday that won’t pack on the pounds.

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.