Baby

Bariatric surgery may improve pregnancy outcomes – mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest – which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

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My post bariatric surgery baby – my smallest birthweight baby.

 

New York Times

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM –

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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WHO-proposed sugar recommendation comes to less than a soda per day

WHO-proposed sugar recommendation comes to less than a soda per day

WHO’s current recommendation, from 2002, is that sugars should make up less than 10% of total energy intake per day. The new draft guideline also proposes that sugars should be less than 10% of total energy intake per day. It further suggests that a reduction to below 5% of total energy intake per day would have additional benefits. Five per cent of total energy intake is equivalent to around 25 grams (around 6 teaspoons) of sugar per day for an adult of normal Body Mass Index (BMI).

The suggested limits on intake of sugars in the draft guideline apply to all monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) that are added to food by the manufacturer, the cook or the consumer, as well as sugars that are naturally present in honey, syrups, fruit juices and fruit concentrates.

Much of the sugars consumed today are “hidden” in processed foods that are not usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4 grams (around 1 teaspoon) of sugars. A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of sugar.

The draft guideline was formulated based on analyses of all published scientific studies on the consumption of sugars and how that relates to excess weight gain and tooth decay in adults and children.

Read the draft guideline and submit your comments

http://www.who.int/mediacentre/news/notes/2014/consultation-sugar-guideline/en/

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Recommended Carbohydrate Levels After Gastric Bypass

Via Bariatric Times

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After you read this study, let's discuss:  

  • Did your nutritionist give YOU guidance in regards to carbohydrate intake after your roux en y gastric bypass surgery?
  • Background: Exact carbohydrate levels needed for the bariatric patient population have not yet been defined. The aim of this study was to correlate carbohydrate intake to percent excess weight loss for the bariatric patient population based on a cross-sectional study. The author also aimed to review the related literature.
  • Materials and Methods: A cross-sectional study was conducted, along with a review of the literature, about patients who underwent Roux-en-Y gastric bypass at least 1 year previously. Patients had their percentage of excess weight loss calculated and energy intake was examined based on data collected with a four-day food recall. Patients were divided into two groups: 1) patients who consumed 130g/day or more of carbohydrates and 2) patients who consumed less than 130g/day of carbohydrates. 
  • Limitations: The literature review was limited to papers published since 1993. 
  • Results: Patients who consumed 130g/day or more of carbohydrates presented a lower percent excess weight loss than the other group (p= 0.038). In the review of the literature, the author found that six months after surgery patients can ingest about 850kcal/day of carbohydrates, 30 percent being ingested as lipids. A protein diet with at least 60g/day is needed. On this basis, patients should consume about 90g/day of carbohydrates. After the first postoperative year, energy intake is about 1,300kcal/day and protein consumption should be increased. We can, therefore, establish nearly 130g/day of carbohydrates (40% of their energy intake) 
  • Conclusions: Based on these studies, the author recommends that 90g/day is adequate for patients who are six months post Roux-en-Y gastric bypass and less than 130g/day is adequate for patients who are one year or more post surgery. 
  • The author concludes that maintaining carbohydrate consumption to moderate quantities and adequate protein intake seems to be fundamental to ensure the benefits from bariatric surgery.



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http://bariatrictimes.com/recommended-levels-of-carbohydrate-after-bariatric-surgery/

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Cleveland Clinic study shows RNY bariatric surgery restores pancreatic function by targeting belly fat

Just to keep you on your toes, a couple days ago I shared the study that stated that WLS doesn't save you money in the long run.

Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.

We already knew this.

Thanks, pancreas!  *thumbs up for working so well!*

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*Waves to all the post bariatric reactive non-diabetic hypoglycemics*

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Cleveland Clinic study shows bariatric surgery restores pancreatic function by targeting belly fat

2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.

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Nutrition for Reactive Hypoglycemia

 

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Many post weight loss surgical patients deal with blood sugar fluctuations, particularly those of us whom have had roux en y gastric bypass.  Aside from dumping, we often have a blood sugar reaction after dumping — and sometimes without — called reactive hypoglycemia.  

 


Nutrition for Reactive Hypoglycemia –

via http://www.mckinley.illinois.edu/Handouts/hypoglycemia_nutrition_reactive.html

What is reactive hypoglycemia?

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A blood sugar meter that tracks your patterns? The OneTouch Verio

 

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Niiiiiice.  

This post is absolutely copied from PR for OneTouch, but I am super intrigued by this product.  I want one and I want to play with it.

 A meter that tracks your blood-sugar trends and gives you feedback on predicted lows — highs.  I can see the potential use of this for those of us who have hypoglycemia issues after weight loss surgery.  If I were more aware of my lows or potential lows, perhaps I wouldn't pre-treat so often.  (My pre-treating?  EATING TO AVOID LOWS.  LOL.)  I wonder.

Via Diabetes Health

LifeScan has introduced the OneTouch® VerioTM IQ, a meter that not only tracks and displays blood sugar patterns, but also announces them with messages, such as "Looks like your blood sugar has been running LOW around this time."

The meter, which incorporates what LifeScan calls "PatternAlertTMTechnology," is specifically designed fordiabetes patients who take insulin. LifeScan's reasoning is that insulin users are at greater risk of hypoglycemia than non-insulin users and must monitor their blood sugar throughout the day to adjust for meals and physical activity.

"All meters will tell you your blood sugar level at a particular moment in time, but this is the only one to compare your current result with your previous results and proactively alert you to important patterns you might not even be aware exist," says Michael Pfeifer, chief medical officer at LifeScan, Inc.

The PatternAlert Technology reflects the recommendation by diabetes experts that patients identify patterns of highs and lows that last at least two or three days in a row.

A "High Glucose Pattern" consists of three before-meal highs within the same three-hour window over the past five days. High (before meal) results are preset to 130 mg/dL or above to match current American Diabetes Association guidelines, but can be personalized to any result at or above 100 to 160 mg/dL.

A "Low Glucose Pattern" consists of two lows within the same three-hour window over the past five days. Low results are preset to 70 mg/dL or below to match current ADA guidelines, but can be personalized to any result at or below 90 to 50 mg/dL.

When the meter finds a pattern, a message appears, such as "Heads up. Your before-meal glucose has been running HIGH around this time." Patients may choose to view additional information about each test result in the pattern, such as the blood sugar value, day, time, and type of result (before or after a meal, for example).

A companion OneTouch® VerioTM IQ Pattern Guide is available to patients from healthcare professionals or by contacting OneTouch directly at 888-567-3003. The guide offers possible causes and potential solutions for high and low patterns, based on guidance from leading diabetes experts.

Watch for the OneTouch Verio release on Twitter.

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Hypoglycemia Prevention Program

This just hit my email, coinciding with my blood sugar on a rollercoaster today — because I CHOSE to eat half a cup of soft pretzel nuggets for lunch.

I've been in a carb-coma for most of the afternoon, a walking zombie.  I'd go to bed for the night right now if I could.

Thud.

It's for patients of the Joslin Clinic (who are typically diabetic, I am not… I am a post roux en y gastric bypass patient with reactive hypoglycemia issues) in Boston, Massachusetts, but Right Now?  It looks about right.

But, I figure, there's got to be a FEW Diabetic Boston Area Patients in my readership —

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