Gastric Sleeve or Gastric Bypass: What’s the Difference?

Two commonly preformed weight-loss surgery procedures are the Roux-en-Y gastric bypass and the sleeve gastrectomy. Gary Korus, MD, FACS, bariatric surgeon at Penn Medicine, discusses the differences between these procedures.

Roux-en – Y Gastric Bypass

This laparoscopic procedure restricts food intake and shortens the digestive track by creating a small gastric pouch from the upper portion of the stomach. The intestine is surgically connected to this pouch, creating a small opening for food to pass through. The remaining larger portion of the stomach and part of the intestines are bypassed. The Roux-en-Y gastric bypass procedure limits the amount of food consumed and reduces the calories and nutrients absorbed from food.“The gastric bypass had been around for more than 25 years. Most people keep most of their weight off long-term,” says Dr. Korus. “It is also the only procedure that gives you feedback if you eat things you shouldn’t such as concentrated sweets.”

Sleeve Gastrectomy

During a sleeve gastrectomy, a sleeve-shaped tube is created from a small portion of the stomach and the majority of the stomach is removed. Food passes through the new stomach tube directly into the intestines. Nutrients and calories are absorbed from food normally, but patients feel full sooner and longer. Sleeve gastrectomy is performed laparoscopically and can be a permanent surgical solution to manage weight. Dr. Korus notes, “The gastric sleeve or sleeve gastrectomy provides an alternative for the patient that restricts what they eat without altering the route the food or beverages takes through the G.I. tract.”

Which Procedure is Better for Me?

How do you know which option is best for you? “The decision about what procedure is best for you can be made with your surgeon,” says Dr Korus. “Factors including your medical condition, medications, previous surgeries and dieting history will play a role in this decision.”

Lose Weight at Penn Medicine

Penn can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

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Your Daily Dose: Vitamin B12 Supplements after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the importance of the vitamin B12 supplements after weight loss surgery.

Vitamin B12 is the most common vitamin deficiency people experience after weight loss surgery. That is why it is important to supplement your diet with vitamin B12, especially after gastric bypass and sleeve gastrectomy.

Vitamin B12 is essential for proper nerve function, metabolism and red blood cell production. Deficiency can lead to B12 deficiency anemia, which causes fatigue, rapid heart rate, easy bruising and bleeding, stomach upset and diarrhea or constipation.

If the deficiency remains unaddressed, it can result in permanent nerve damage, including tingling or numbness in fingers and toes, difficulty walking, mood changes, memory loss and dementia.

Weight loss surgery reduces the acidity in the stomach, which makes absorption of vitamins and nutrients more difficult. That is why vitamin B12 deficiency is particularly common after surgery and supplementation is often required long after recovery.

Proper supplementation involves taking a daily form of vitamin B12 that dissolves under the tongue or getting a monthly injection, which is typically done by your primary care physician. 

To prevent vitamin B12 deficiency, follow the dietary recommendations for supplementation after weight loss surgery and get your blood work checked regularly by a primary care physician or bariatric care team.

If you experience the symptoms associated with B12 deficiency, please check with your health care team.

- Cara Stewart, RD, LDN

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Yo-Yo Dieter Takes Back Control

Lisa Harris of Clementon, NJ, was a self-proclaimed “yo-yo” dieter her whole life. Moved by her father’s dying request to get healthy, Harris had gastric bypass surgery at Penn Medicine with Alan Shuricht, MD, FACS.

In this blog post, she discusses her decision to have weight loss surgery at Penn, and how the Penn Metabolic and Bariatric Surgery Program team helped her lose 150 pounds (and counting!)

I’ve been a yo-yo dieter all my life. As a kid, I was overweight, but struggled to diet and lose weight from time to time. Kids were cruel, and at one point, my parents pulled me out of public school because I was teased about my weight so much.

When I graduated high school, I was heavy, but it wasn’t until June, 2010 I really paid attention to my weight and my health. My father was very ill, and told me he was worried about my health. Here he was, dying, and worried about the effect my weight was having on my health. It was like someone had snapped me in the back of my head. When he died two months later, I was ready to make a change.

Taking the first steps

I attended an information session about weight-loss surgery at Penn in Cherry Hill. It was there I met Dr. Schuricht, and I knew I was doing the right thing. When I made my first appointment that January, I was 357 pounds.

At 357 pounds, I was not healthy. Two sleep studies revealed I had severe sleep apnea. I was on blood pressure medication and was borderline diabetic. I was only 43, but I felt tired all of the time.

And I wasn’t happy with the way I looked. I could only shop at Wal-Mart because I couldn’t fit into “normal” sized stores. I’d hide behind people if there was a photo being taken, and my body was hurting all of the time. It was no way to live.

I worked with the Penn Metabolic & Bariatric Surgery Program before surgery and lost 15 pounds. I joined a gym, even though I was very self-conscious. I was on my way.

Food is fuel

On the day of surgery, I was calm. Completely confident in Dr. Schuricht’s skilled hands, I was at ease. I was ready.

I had gastric bypass surgery, and when I got home from the hospital, I felt like a new woman. I began to lose weight, and started taking photos of myself each month to document the “shrinking woman” I was. Today, 12 months after surgery, I am down 151 pounds. I’ve gone from a size 28 pants to a size 16.

I don’t have to shop at Wal-Mart for clothing anymore – I can go to the mall and shop in any store I want.

But moreover, I feel healthy. I sleep better, am no longer borderline diabetic, and have gone off all of my blood pressure medications. I only wish my father was alive to see me. He would be so proud.

For me, food was an addiction. But for the first time in my life, I feel stronger than it. I don’t equate food with love; it’s fuel that gives me energy and helps me stay healthy.

Today, I am almost 45 years old, and my 19-year-old daughter struggles to keep up with me. How’s that for winning?

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you and attend a free information session about the Penn Metabolic and Bariatric Surgery Program.

At this free session, you will learn more about weight-loss surgery at Penn, and meet physicians and team members from the Penn Metabolic & Bariatric Surgery Program.

Register for this free event here.

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What is Bariatric Surgery?

Bariatric surgery is a type of weight-loss approach that uses surgical procedures to help patients lose weight, avoid or reverse some diseases such as type 2 diabetes and high blood pressure, and improve overall health.

Because every patient considering bariatric surgery is unique, the Penn Metabolic & Bariatric Surgery Program offers a full range of bariatric surgical options. This ensures that patients receive the bariatric surgery that will provide them with the best possible results.

Here are four types of bariatric surgery at Penn.

Sleeve Gastrectomy

Sleeve gastrectomy is typically considered for patients with a body mass index (BMI) of 50 or higher. During the surgery, a sleeve–shaped tube is created from a small portion of the stomach and the majority of the stomach is removed. The small intestine is not surgically altered. Sleeve gastrectomy may require a second operation like conversion to Roux-en-Y gastric bypass (see below) if even more weight loss is required to improve a patient's health.

Robotic-assisted Bariatric Surgery

All procedures performed by Penn bariatric surgeons are available using a minimally invasive approach called laparoscopic surgery. Laparoscopic surgery offers many benefits for patients including shorter recovery times and less post-operative pain. In addition, Penn performs robotic-assisted bariatric surgery for the adjustable gastric band and sleeve gastrectomy procedures. Penn's bariatric specialists are highly experienced in robotic-assisted surgery and have performed more than 500 robotic LAP-BAND® and sleeve gastrectomy procedures.

Roux-en-Y Gastric Bypass (RGB)

The most common type of bariatric surgery performed in the United States, during the Roux-en-Y procedure a Penn surgeon divides a small gastric pouch from the upper portion of the stomach and attaches it directly to the small intestine, completely bypassing the larger part of the stomach.

Adjustable Gastric Band

The adjustable gastric band does not divide or reattach any part of the gastrointestinal tract. During the procedure, a Penn surgeon places a band around the upper portion of the stomach creating a small pouch with a narrow opening to the lower stomach. The food eaten stays in the small pouch for more time, so the patient feels full longer. The band is adjustable, which means it can be tightened or loosened after surgery as needed.

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you and attend a free information session about the Penn Metabolic and Bariatric Surgery Program. 


At this free session, you will learn more about weight loss surgery at Penn, and meet physicians and team members from the Penn Metabolic & Bariatric Surgery Program.

Register for this free event here. 

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Drinking Alcohol after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate alcohol in a healthy diet after weight loss surgery.

People considering weight loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications. Here’s why:
       
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.

Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.

Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.

If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.

Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain. 

Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.

Guidelines for drinking:
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight loss surgery:

• Avoid alcohol for the first six months after bariatric surgery.
• When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. 
• Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar. 
• Never drink and drive, even after consuming only minimal alcohol. 
• Only drink with meals or while eating to help slow absorption of alcohol. 
• Be aware of the calorie content of alcohol.
• If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.

- Cara Stewart

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Healthy Bites for People on the Go: Meal and Snack Bars

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the nutritional value of meal and snack bars and provides a guide for making healthy selections. 

It can be hard to fit healthy eating into a busy lifestyle. Between work, family, social obligations and more, sometimes it feels like there’s not enough time to prepare or sit down for a healthy, balanced or home-cooked meal.

But a shortage of time does not mean you have to sacrifice your commitment to healthy eating!

In fact, snack and meal replacement bars are perfect items to stock up on for those moments when you’re strapped for time and need a healthy bite to eat. They are easy, convenient, portable and if you make smart choices, they can be healthy, too.

From breakfast bars to granola bars to energy bars and protein bars, it’s hard to know which variety is the best, most healthful choice. The wide variety of bars on the market can make selection overwhelming and it doesn’t help that many bars masquerade as healthy despite being packed with sugar and fat.

Use this guide to find a healthy snack or meal replacement bar for the next time your stomach is grumbling but you’re on the way out the door.

Meal Replacement Bars
These bars are ideal when you’re in a rush and otherwise would skip a meal. Look for the following nutritional requirements per serving when making a selection:

• 200 to 300 calories
• At least 15 grams of protein
• At least 5 grams of fiber
• Less than 20 grams of sugar (Less than 10 grams of sugar for people who had gastric bypass surgery)
• Less than 10 grams of total fat
• Less than 2.5 grams of saturated fat

Snack Bars
Snack bars are great for quenching hunger between meals or as fuel before a workout. Make sure that your snack bar contains the following nutritional requirements per serving:

• 150 to 200 calories
• At least 5 grams of protein
• At least 3 grams of fiber
• Less than 15 grams of sugar
• Less than 7 grams of total fat
• Less than 2 grams of saturated fat

These general considerations are helpful to keep in mind when deciding which meal or snack bars to purchase:

• Bars that are low in carbohydrates are generally low in fiber or high in fat, especially saturated fat. Be careful that you’re not trading one unhealthy nutrient for another.
• Some bars, especially those that are low in sugar and carbohydrates, contain sugar alcohols, which can cause bloating, gas and diarrhea.  
• Bars that contain fruit naturally have more sugar. With fruit bars, you can be more flexible with the sugar content per serving.
• Pay attention to flavor and consistency. Make sure that you actually enjoy the taste of the bar!

Snack and meal bars made specifically for people who have had bariatric surgery are available on the following websites:

• BariatricAdvantage.com
• BariatricChoice.com
• BariatricEating.com
• DoctorsBestWeightLoss.com

- Cara Stewart, RD, LDN

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Does milk give you problems? A guide for choosing milk alternatives

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides a list of healthy milk alternatives.  

Milk is not the beverage of choice for everyone. Despite its nutritional benefits and popularity as a complement for everyday foods like coffee and cereal, cow’s milk is actually problematic for many people, especially those suffering from lactose intolerance or milk allergies and those who are vegans.

In fact, some patients become lactose intolerant after gastric bypass or sleeve gastrectomy surgery.

But the good news is that there are more lactose-free milk options available today than ever before. Follow this guide to choose the best milk alternative for you.

Lactose-free Milk - Lactase enzyme is added to regular cow’s milk to break the lactose down into a simpler sugar.

• Protein per cup: 8 grams
• Flavor: Slightly sweeter than regular milk.
• Where to purchase: Grocery store refrigerated section; available in low-fat, conventional and organic varieties; refrigerated cartons.

Goat and Sheep Milks - Milk from other animals contains lactose with a high degree of cross-reactivity, meaning that people with an allergy to cow’s milk have a high chance of reacting to these milk varieties as well.

• Protein per cup: Goat milk - 9 grams; Sheep milk - 14 grams
• Flavor: Sweeter than cow’s milk; grassy undertones.
• Where to purchase: Whole Foods or local farm market; refrigerated cartons.

Soy Milk - Made from cooking and pressing soybeans.

• Protein per cup: 7 grams
• Flavor: Nutty, beany flavor with thick consistency.
• Where to purchase: Grocery store; shelf stable and refrigerated cartons in variety of flavors.

Nut Milk - Made by soaking and grinding nuts into pulp, then straining the creamy liquid. Almond milk is the most readily available, but there are other nut milks including hazelnut and cashew as well.

• Protein per cup: 1 gram
• Flavor: Nutty with thin consistency.
• Where to purchase: Grocery store; shelf stable and refrigerated cartons in a variety of flavors.

Hemp Milk - Made from the seeds of cannabis plants, hemp milk does not contain psychoactive substances. It is a good source of omega-3 and -6 fatty acids.

• Protein per cup: 2 grams
• Flavor: Nutty, earthy flavor with thick texture.
• Where to purchase: Natural foods store, Whole Foods; shelf stable cartons.

Grain Milks - Made from cooked grains such as oats or barley.

• Protein per cup: 4 grams
• Flavor: Mild, grainy and nutty.
• Where to purchase: Whole Foods or natural foods store; shelf stable cartons.

Rice Milk - Made from cooked rice.

• Protein per cup: 1 gram
• Flavor: Sweet with watery consistency.
• Where to purchase: Grocery store; shelf stable cartons.

Coconut Milk - Made from coconut meat and the water inside the coconut.

• Protein per cup: 4 grams
• Flavor: Slight coconut flavor; creamy texture.
• Where to purchase: Grocery store; refrigerated cartons.

- Cara Stewart, RD, LDN

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Having a Baby After Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, and Monica A. Mainigi, MD, fertility specialist at Penn Fertility Care, provide important information for women trying to become pregnant and maintain a healthy pregnancy after weight loss surgery.

Many women struggle with fertility as a result of their weight. In fact, obesity puts women at greater risk for ovulation dysfunction and menstrual irregularity, both of which can interfere with fertility. In addition, obesity can lead to an increased risk of miscarriage and decreased success with fertility treatments. For overweight women who are having a hard time conceiving, weight loss surgery may be an option to consider.

For women considering pregnancy after they have had bariatric surgery, it is important to keep the following information in mind.


Fertility boost
Obesity can interfere with hormone production, making it more difficult to get pregnant.  Weight loss after bariatric surgery can lead to regular cycles and ovulation, and improved fertility. In fact, a 2005 study published in the Journal of Clinical Endocrinology and Metabolism found that surgical weight loss for women with PCOS often resolved their reproductive and metabolic abnormalities. 

Healthier pregnancy, healthier baby
After weight loss surgery, medical conditions such as high blood pressure and diabetes are significantly improved or resolved leading to a lowered risk of developing serious complications during pregnancy or delivering a baby born with complications.  Many women are still obese after weight loss surgery which places them at a higher risk for gestational diabetes and preeclampsia, but the risk is far less than before surgery.  Pregnant women who have had bariatric surgery should see a high-risk obstetrician to best manage prenatal care.

Give it time
It is important to wait at least 18 months after surgery to start trying to get pregnant. In the period immediately following gastric bypass or sleeve gastrectomy, rapid weight loss causes stress on the body, including diminished nutrition intake, which can cause complications for an expecting mother and growing baby. Effective contraception is absolutely critical for women pursuing weight loss surgery.  For women with an adjustable gastric band, fluid may be removed from the band during pregnancy to accommodate the need to eat more calories.

Keep supplementing
Good nutrition is especially important for women trying to conceive.  After weight loss surgery, patients are at a higher risk for deficiencies of certain nutrients, including vitamin B12, folic acid, calcium, iron, and vitamin D. It essential to continue taking vitamin and mineral supplements as recommended by the bariatric team.

Be ready for weight gain
After having weight loss surgery, it can be difficult to accept that pregnancy is a time when it is normal, healthy and necessary to gain weight.  Healthy weight gain during pregnancy is important to nourish a growing baby, but work with the program dietitians to avoid unhealthy weight gain during pregnancy.

The Penn Metabolic and Bariatric Surgery Program offers lifelong follow-up care and nutritional support for patients who have had weight loss surgery. Women considering pregnancy after weight loss surgery should discuss their plans with the bariatric surgery team.

For more information on fertility services at Penn Medicine, visit the Penn Fertility Care website.

- Cara Stewart, RD, LDN and Monica Mainigi, MD

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Tips for Healthy Holiday Eating After Weight Loss Surgery

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for managing your post-surgical diet during the holidays.

There is no getting around it. Food is a central part of the holiday season. Whether you’re enjoying holiday food with friends and family or inundated with unhealthy treats at the office, it is hard to maintain your healthy eating goals over the holiday season, but it is possible.

These tips can help you stay on track with your post-surgical diet and lifestyle changes while still allowing you to enjoy the holiday festivities.

Don’t skip meals
Always make time for breakfast, lunch and dinner. Going long stretches without eating can lead to eating too much or too quickly and cause nausea or vomiting in people who have had weight loss surgery. It can also result in unhealthy food choices due to overwhelming hunger.

Be selective about food choice
Resist the temptation to try foods that are high in sugar and fat. After gastric bypass surgery, fatty and sugary foods can cause “dumping syndrome,” resulting in severe abdominal pain and cramping, diarrhea, nausea and vomiting. Instead, choose low-calorie party foods such as raw vegetables, fruit with yogurt dip or boiled shrimp with lemon or cocktail sauce.

Stay well hydrated
Stay hydrated by drinking water and low-calorie beverages. Avoid alcoholic beverages and try to separate eating and drinking by 30 minutes.

Keep a food diary
Research* shows that recording what you eat helps you stay on track during the holidays. It also helps you meet your protein and fluid goals. Take a minute each night to record your food and fluid intake for the day.

Click here for more healthy eating tips for you and your family.

- Karen Buzby, RD, LDN


*Cornett R, Akers J, Salva J, Zoellner J, Davy B. Daily self-monitoring during the winter holiday period: a feasible strategy for holiday weight maintenance. SCAN’s PULSE. Fall 2011, Vol 5, No 4: 1 – 6.

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Bariatric Surgery's Halo Effect: Weight Loss for the Whole Family

Bariatric surgery improves the health and well-being of those who undergo surgery, but a recent study at Stanford University School of Medicine shows the positive impact actually extends to the entire immediate family. 

Researchers found that one year after a family member's gastric bypass surgery, other obese adults in the family lost an average of eight pounds and obese children had a lower body mass index than expected for their growth curve. The family members and children that participated in the study accompanied the bariatric patient to all pre- and post-operative clinic visits, including diet and lifestyle counseling. 

Adult family members reported improved eating habits with less uncontrollable eating, emotional eating and alcohol consumption. Both adults and children reported a significant increase in their activity levels. 

The results of this study come as no surprise to members of the Penn Metabolic and Bariatric Surgery team who have witnessed this pattern many times. After bariatric surgery, patients often report that their pursuit of a healthier lifestyle spurred changes for their whole family, including kitchen cabinet makeovers, healthier home-cooked meals and family fun nights that involve physical activity.

Family members and friends are always welcome to attend Penn Metabolic and Bariatric Surgery Program information sessions and support groups to help their family members and to help themselves as well. 

Note: The study was published on Oct. 17, 2011 in the Archives of Surgery. 

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Taking Vitamin and Mineral Supplements: Make time even if you feel fine!

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, outlines the important vitamin and mineral supplements to take after weight loss surgery.

After weight loss surgery, you need to commit to taking a regimen of vitamin and mineral supplements for the rest of your life. Eating smaller amounts of food means your body receives fewer nutrients. In addition, after gastric bypass or sleeve gastrectomy surgery, your system does not absorb some vitamins and minerals as well.

This table highlights the functions of several key nutrients and the symptoms of their deficiency. The damage to your body from many of the deficiencies is permanent, so be sure to follow your dietician’s instructions for taking supplements and have your lab values checked routinely with your primary care physician.

NUTRIENT	WHAT IT DOES	DEFICIENCY
Vitamin B1 (thiamine)	Helps all cells of the body produce energy from carbohydrates	Fatigue, weak muscles, nerve damage
Vitamin B12	Works with folate to make red blood cells Vital part of every cell Helps body use fatty acids and some amino acids	Anemia, fatigue Permanent nerve damage including tingling or numbness in hands and feet
Folate (folic acid)	Plays essential role in making new body cells Works with B12 to form hemoglobin in red blood cells Helps reduce risk of neural tube defects (spina bifida) in developing fetus	Anemia caused by malformed blood cells that won’t carry as much oxygen Increased risk of neural tube defects in developing fetus
Vitamin A	Promotes normal vision, helps eyes see normally in the dark Promotes growth and health of all cells Keeps tissues healthy to prevent infection Works as an antioxidant	Night blindness Dry, scaly skin Reproductive problems
Vitamin D	Promotes absorption of calcium and phosphorus Regulates amount of calcium in blood	Osteoporosis (loss of bone mass) Osteomalacia: softening of bones
Calcium (**NOTE: Supplements are still needed even if blood levels are normal)	Helps bones remain strong by slowing rate of bone loss with age Helps muscles contract and heart beat Promotes normal nerve function	Osteoporosis
Iron	Essential part of hemoglobin that carries oxygen in blood Supports healthy immune system	Iron deficiency anemia Fatigue Infections

- Cara Stewart, RD, LDN

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Low-calorie but not a Freebie: Get the Scoop on Sugar Alcohol

Sugar alcohols, or polyols, are carbohydrates that get their name from their chemical structure. Adding sweetness and texture to foods like sugar-free candy, gum and desserts, sugar alcohols contain fewer calories than regular sugar -- 2.6 calories versus 4 calories per gram – and do not contribute to tooth decay.

The body absorbs sugar alcohols slowly and incompletely, reducing their effect on blood sugar. This can be helpful for people with diabetes or those who are limiting caloric intake. Sugar alcohols do not cause dumping syndrome for people with gastric bypass, although their abnormal absorption can cause cramping, bloating and diarrhea when consumed in large quantities. Studies indicate that people can tolerate 10 to 15 grams of sugar alcohols per day without gastrointestinal distress, although some individuals can experience side effects from less.

It is important to remember that sugar alcohols are typically used in foods that have little nutritional benefit but still contain calories, such as desserts and snacks. Therefore, portion control remains very important for long-term, sustained weight loss.

Products containing sugar alcohols list the grams per serving on the nutrition fact label. The sugar alcohol content can also be found by looking for ingredients ending in “-tol,” such as sorbitol, mannitol and xylitol.

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Give Your Heart a Gift

February is American Heart Month: a time to raise awareness about cardiovascular disease, the number one cause of death in the United States. The risk of cardiovascular disease is increased for people with severe obesity. Obesity can cause structural changes in the heart including excess heart muscle and ventricle inflammation that can lead to heart failure.

It is no secret that weight loss reduces cardiovascular risks, but a recent study published in the Journal of the American College of Cardiology suggests that bariatric surgery can also help reduce the risk of heart disease.

Researchers found that gastric bypass surgery can lead to a “remodeling” of the heart as well as significant weight loss. The study compared a group of more than 400 severely obese people with gastric bypass surgery to a group of 300 severely obese people who did not have surgery.

Two years later, echocardiograms showed a reduction in left ventricular mass and right ventricular cavity area among the surgical patients. The improved cardiac function and appearance suggests less stress on the heart and reduced overall cardiovascular risk.

For more information on how bariatric surgery can reduce your cardiovascular risk, please contact the Penn Metabolic & Bariatric Surgery team at 800.789.PENN.

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Avoiding Added Sugar

Added sugar can derail any diet, but it can be especially harmful for patients who have had bariatric surgery.

Many prepared foods contain added sugar, including yogurts, cereals, granola bars, jams, canned fruit, and sweetened beverages. Natural sugar occurs in healthy and unprocessed foods, including milk, fruit and vegetables. Added sugar is introduced into food in the processing or preparation stage and lacks nutritional value. High intake of added sugar is linked to increased risk for obesity, high blood pressure, high triglycerides, heart disease and stroke.

After bariatric surgery, it is essential to limit intake of added sugars for continued and maintained weight loss. The best option is to avoid food and beverages that are high in added sugar, or consume only small portions.

In addition, for people who had gastric bypass surgery, consuming too much added sugar can also lead to dumping syndrome.

Added sugar is often disguised under a variety of names. It is important to carefully review the nutrition facts of food and beverage products before consuming them. If any of the following ingredients appears near the beginning of the nutrition facts, the food or beverage may be high in added sugar:

• Beet sugar
• Brown sugar
• Brown rice syrup
• Cane sugar
• Cane juice or evaporated cane juice
• Confectioner's sugar
• Corn syrup or high fructose corn syrup
• Corn syrup solids
• Crystallized cane juice
• Fruit juice concentrate
• Honey
• Ingredients ending in "ose" including dextrose, glucose, maltose and sucrose
• Invert sugar
• Maltodextrin or dextrin
• Maple syrup
• Molasses
• Palm sugar
• Raw sugar
• Turbinado

To find the added sugar content in many common foods, visit the U.S. Department of Agriculture’s Database for the Added Sugars Content of Selected Foods.

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