Beneficial Bacteria: All About Probiotics

Danielle Rosenfeld, MS, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses probiotics, a “buzz word” in the food industry.

Beneficial Bacteria

Probiotics are “good” bacteria similar to organisms that occur naturally in the digestive tract. The digestive tract needs a healthy balance between good and bad bacteria for optimal health. Believe it or not, there are more than 100 trillion good bacteria living in the human body, many of which reside in the digestive tract. There are numerous strands of probiotics that have been linked to a variety of health benefits when administered in large enough amounts.

Why Take Probiotics

A study conducted at Stanford University School of Medicine examined the effect of probiotics in post-operative Roux-en-Y gastric bypass surgery patients. After three months, the participants who had taken a daily probiotic supplement had higher average weight loss and enhanced absorption of vitamin B12. In addition to these findings, probiotics, particularly lactobacillus acidophilus, may facilitate lactose digestion in lactose-intolerant individuals, a common problem for post bariatric patients.

Food Sources of Probiotics vs Supplements

Probiotics are found in cultured dairy foods such as yogurt and kefir. The number of active cultures found in foods varies greatly, depending on the type of bacteria and food processing. Certain processes to prolong shelf life, such as pasteurization in yogurt, can kill off some of these beneficial bacteria. Look for yogurts that have a “Live and Active Cultures” seal, as these contain approximately 22 million active cultures in a typical 8-oz serving. Additional food sources include pickled vegetables, sauerkraut and dark chocolate.

Supplements generally contain a much more concentrated supply of probiotics, providing 100 million to 1 trillion active cultures per dose. When shopping for probiotic supplements, look for one with many species of lactobacillus, such as L. acidophilus or bifidobacteria, as strains of these probiotics have been shown to improve digestion and have an extensive safety record for use in the generally healthy population. There is no specific dose recommendation and products should be used according to the manufacturers’ recommendations.

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Preventing Bone Loss After Weight-Loss Surgery

Danielle Rosenfeld, MS, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses bone loss, and how to prevent it while losing weight.

Bariatric surgery can result in excess body weight loss between 40 to 70%. It can also impact bone health, making the need for supplementation vital.

Recent studies are finding that significant and rapid weight loss is associated with increased bone damage. A 10% weight decline has been linked with a measured 1 to 2% bone loss at various sites. Bariatric surgical procedures can further heighten this bone turnover and associated bone loss.

What does this mean? Bariatric surgery patients are at increased risk for osteoporosis and bone fracture. Postmenopausal, lactose intolerant and vegetarian patients may be at even greater risk for osteoporosis. Why significant weight loss impairs bone health is not fully understood and likely involves numerous factors.

Preventing Bone Loss with Calcium and Supplements

Appropriate vitamin/mineral supplementation is essential in preventing bone loss.

Calcium, the most abundant mineral in the body, is stored in the bones and teeth where it supports bone structure by making them strong and dense. After bariatric surgery, calcium absorption is less efficient and supplementation with calcium citrate + vitamin D is essential in order to keep bones strong and healthy. Proper supplementation includes 1500 to 2000 mg daily with no more than 600 mg at a time. Dietary calcium intake is also very important and patients should aim to consume low fat dairy foods and beverages in addition to supplements, up to 3 servings daily.

Taking a complete multivitamin/mineral supplement daily is also required after bariatric surgery as there are many other micronutrients, such as magnesium and vitamin D, which play important roles in bone health. Your surgeon might ask that you take additional vitamin D if your labs indicate you have a deficiency.

A recent study examined bone health at 18 months post gastric bypass surgery and found that there was prolonged bone turnover, which indicates that supplementation needs to be lifelong and not just in the immediate postoperative period.

Bottom Line

• Bariatric surgery patients need to be increasingly aware of bone health and take measures to prevent bone loss associated with rapid weight decline
• Combined dietary and supplemental calcium intake may be required to prevent bone loss during rapid weight loss
• Choose calcium citrate rather than calcium carbonate- this is the form that post-op bariatric patients can absorb
• Consume a diet rich in calcium
• 1 cup milk, 1 cup yogurt, and 2 oz cheese contain at least 300 mg calcium
• 3 oz canned salmon or sardines contain at least 200 mg calcium
• 1/2 cup cooked greens (kale, spinach, collards), ½ cup soybeans, broccoli, white beans contain 50 to 100 mg calcium.

• Follow vitamin/mineral supplementation regimen prescribed by bariatric team

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Study Shows Weight Loss Supplements Are No Magic Pill for Weight Loss

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a recent study about the safety and effectiveness of weight loss supplements.

Supplements that promise quick, easy and permanent weight loss can be tempting, but a new study published in the International Journal of Sport Nutrition and Exercise Metabolism proves the old adage: “If it sounds too good to be true, it probably is.” It turns out that weight loss supplements are no exception.

A recent study showed that there is no evidence of a link between supplements and significant weight loss. In fact, some products produce detrimental side effects, such as increasing the risk of stroke or heart problems.

Led by researchers at Oregon State University, the study looked at hundreds of weight loss supplements, including chitosan, caffeine, conjugated linoleic acid and soluble fiber. They found no direct link between these products and significant weight loss. They did find that a few products, including green tea, fiber and low-fat dairy supplements, showed modest weight loss of three to four pounds, but only when combined with a reduced-calorie diet.

The bottom line is that there is no magic pill for successful and sustained weight loss. If you have had weight loss surgery, and even of you haven’t, the key to losing weight and keeping it off is a healthy diet and regular exercise program.

- Cara Stewart, RD, LDN

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Feeling Tired or Sluggish? The Culprit Could be Iron

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses the impact bariatric surgery has on iron levels and provides tips for iron supplements.

Your body uses iron to produce red blood cells. Insufficient iron in your diet may put you at higher risk for developing iron deficiency or iron deficiency anemia. Iron deficiency is a condition in which the body does not produce enough normal red blood cells for optimal health. Symptoms of iron deficiency include:

• Tiredness
• Shortness of breath
• Decreased physical performance
• Learning problems in children and adults
• Increased risk for infection

People who have had bariatric surgery are more prone to iron deficiency because of their reduced intake of iron-rich foods, such as red meat, seafood, and poultry. In addition, gastric bypass and sleeve gastrectomy patients produce less stomach acid, which can interfere with iron absorption. Maintaining an optimal iron level is particularly challenging for people who have had gastric bypass, as the surgery circumvents the primary site of iron absorption.

While some people with bariatric surgery are still able to obtain adequate iron from food, others rely on iron supplements to maintain a healthy iron level. For those who require iron supplements, the following tips can help maximize iron absorption while minimizing any unpleasant side effects.

• Take 250 mg of vitamin C or consume foods rich in vitamin C when taking an iron supplement. Examples of good sources of vitamin C include:

- Bell Pepper
- Broccoli
- Brussel sprouts
- Citrus fruits
- Cantaloupe
- Cauliflower
- Kale
- Parsley
- Strawberries

• Take iron supplements with food to prevent nausea or abdominal discomfort.

• Prevent constipation by consuming adequate fiber through your diet and supplements, drinking enough fluids and exercising regularly.

• Avoid calcium supplements and dairy when taking an iron supplement or consuming iron-rich food. Calcium can inhibit the absorption of iron. Separate consumption of calcium and iron by at least two hours.

• Avoid tea, cola, coffee, red wine, pomegranates and berries when taking an iron supplement or eating iron-rich food. These foods and beverages contain tannins, which can inhibit iron absorption.

Make sure to check with your healthcare team to determine whether an iron supplement might be helpful for you.

- Cara Stewart, RD, LDN

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