1.  Physical Stress

Different types of stresses on the body can cause hair loss.  Stressors can include:  high fever, severe infection, major surgery, acute physical trauma, chronic debilitating hair loss, acute weight loss, crash dieting, anorexia, low protein intake, medications (beta-blockers, anti-coagulants, retinoids, immunizations), hormonal disruption, iron or zinc deficiency.  Surgery-related hair loss should not last for more than six months and hair should re-grow after that period of loss.  If the hair loss is diet-related, it may last for longer.

2.  Nutrient Deficiency

Here are some common signs that your hair loss may be nutrient-related:

• Your hair loss started more than six months after surgery.
• Your hair loss lasts more than 1 year.
• You have low energy levels or other physical signs of fatigue and malnourishment.

If you have these diet-related symptoms, you may need to change something about your diet.  Ask yourself if you are getting at least 60 grams of protein if you’re a female or 80 grams of protein if you’re a male.  If you are not, you should start increasing your protein intake immediately.  Be sure to go with food first.  Getting a majority of your protein from supplements may enable you to reach your protein goal, but you may be missing out on nutrients from real foods that your body needs.

3.  Vitamins/Minerals Deficiency

Are you following your vitamin regimen closely?  If not, start immediately.  Iron is the single most important nutrient when it comes to preventable hair loss.  Zinc deficiency has also been seen in correlation with hair loss.  Biotin is commonly believed to help prevent hair loss but has not been confirmed through research involving humans.  Other possibilities for deficiency include Vitamin A, Folate and B6.  Taking your multivitamin daily is key.  If you have a history of anemia or are a female of menstruating age, you may have to take an additional Iron supplement.  Omega-3 Fatty acids are also good for hair health and are found in walnuts, avocado and flax seed.

4.  Emotional Stress

Are you stressed for any reason?  Stress can cause hair loss.  Try to incorporate even as little as 10 minutes of quiet time into your day.  Sit in silence for some deep breathing, go for a walk or do some reading to decrease your stress levels.  If you have recently stopped smoking, this may also cause you to feel stressed.  If so, hang in there!  You will feel better and be glad you quit soon.

If you don’t think any of the above reasons are causing your hair loss, make an appointment to see your doctor.  There may be an underlying metabolic issue that could be the cause.

Why is protein so important?

• It forms the structure of cells such as hair, skin and nails.
• It keeps the body’s metabolism running at its best by regulating thousands of chemical reactions in the body.
• It helps give your body energy.
• It also helps your body fight infections by building up the immune system.
• It maintains and rebuilds lean body muscle mass.  Unlike fat cells, muscle cells are constantly burning calories.  The more muscle you have, the more calories you are burning all day long.

How much protein do I need with the Gastric Band or Gastric Bypass?

• In general, for both lap-band and bypass patients, women need 60 to 80 grams of protein per day while men need 70 to 90 grams per day.
• For bypass patients, getting enough protein is especially important because you are at higher risk for protein deficiencies.
• Foods such as meats are not only high in protein but also high in Vitamin B12, Iron, Folate and Copper.  These are vitamins and minerals that all weight loss surgery patients, especially bypass patients, are at risk for deficiencies.
• High protein levels can dehydrate you quickly.  Drink at least 73 to 100 ounces of fluid daily, mostly water.
• If you are weightlifting on a regular basis or have become an avid endurance athlete, you should aim for even higher levels of protein.  Talk to your dietician about a more specific protein goal for you.

What are some signs/symptoms of protein deficiency?

• Brittle, easily breakable hair; hair loss
• Brittle nails, unhealthy looking skin
• Delayed wound healing
• Low energy levels; muscle weakness
• Edema (water retention)
• Difficulty losing weight despite a positive change in eating habits and exercise

What foods are high in protein?

• Meats, fish and meat substitutes
• Dairy products
• Beans, nuts and seeds
• Protein supplements

What  types of foods should you eat after having weight loss surgery?

1. Protein Foods – Eat the protein on your plate first.  Meats, fish, beans, nuts, dairy products, eggs, and meat substitutes are all sources of protein.  Choose meats that are leaner such as poultry and fish to eat more often than red meat or fatty pork.  Use healthy preparation methods such as baking or grilling instead of deep-frying.  Also, be sure to choose low-fat or fat-free dairy products.

 

2. Vegetables – After you have eaten 2 to 4 ounces of protein at your meal, eat the vegetables on your plate next.  Salads or any other non-starchy vegetable can taste good without butter or salt.  Experiment with various seasonings.

 

3. Starch – If you have eaten the protein and vegetables on your plate, have a very small serving of starchy foods such as potatoes, rice, toast, crackers or pasta.  Remember that whole grains are always best to make you feel full, keep your bowel movements regular, lower your cholesterol and help you control your blood sugars.

 

4. Fruits - Fruits are a great food group to include with breakfast or as a dessert with lunch or dinner.  However, keep your priority on the protein foods first.

 

How much of these foods should you eat?

In general, about a cup to no more than two cups of food should fill you up at each meal and keep you full until your next one.

By the end of your day, you should have had all the food groups listed above.  As you can see by the diagram, most of what you eat should come from protein first, then vegetables, and starch and fruits in the smallest amounts.  Talk to your dietician for more specific amounts of each food group you should eat based on your calorie intake.

If you missed our support group meeting this month, have no fear! Here is what you missed: With new diets, new recommendations, and new products on the market almost every day, it is important to your health and weight loss success to learn how you can tell what information is believable and what is simply just fiction (or just wanting your money). Follow these steps to determine what/who you can trust for nutrition information:

1) Find the source of the information. There are three sources of information: primary, secondary, and tertiary. A primary source of information is the actual document where the information you are seeking was originally written. For example, a paper written by a clinical researcher on the benefits of red wine intake on the prevention of cardiovascular disease, is a primary source. The people who wrote that document were the ones who followed  a tightly-regulated scientific process to publish that information.

A secondary source of information is a source that summarizes/re-hashes the information that was originally presented in the primary source. For example, an article in a magazine could be written about a research study that was recently published. The article may even mention that the study was performed by researchers at Harvard. However, is this article believable? Not necessarily. The article can choose to leave out some really important information, such as how many people were involved in the study or whether the study was performed on humans or mice. Both of those pieces of information are necessary when it comes to whether a study/piece of information is believable. Therefore, always try to find the primary source that the article mentions and read it for yourself. Do not trust the reporter/writer to determine what information you do and do not need to know. A tertiary source of information is a compilation of primary and secondary sources. Once again, determine what the primary sources are and try to read them for yourself.

2) Determine if that source is credentialed in nutrition. Not all primary sources are believable. Trustworthy experts are educated and credentialed. Someone who was not trained in a science could claim that they have the credibility to publish material, but in reality, they do not. For nutrition information, believable professionals include:

• Registered Dietitian (RD): an individual who possesses at least a bachelor’s degree and some additional studies and experience in nutrition and dietetics. This person has also passed the Registration Exam for Dietitians.
• Licensed Nutritionist: depending on what state you live in,  a Registered Dietitian could be called a Licensed Nutritionist. Generally, they are the same thing. However, the RD is a national title. Be sure this person has still maintained their RD status.
• Professional with a Master’s degree or Doctoral degree (M.S., M.A., or Ph.D.): Many people have taken the study of nutrition beyond the bachelor degree level, including many Registered Dietitians. However, be aware, anyone who is not a Registered Dietitian is legally not capable to provide clinical dietary counseling or treatment for individuals with illnesses or diseases. Be sure their Master’s or Doctoral degrees are in Nutrition/Dietetics. Just because someone has an MS or a PhD, does not mean they actually studied humans or know anything about nutrition and health!
• A Medical Doctor (M.D.) is trained to practice medicine in the U.S. This individual typically has limited training in the field of nutrition. Chances are a physician will refer you to a Registered Dietitian if you require a dietary plan to meet some specific needs you have.
• Professional Organizations of professionals with these credentials often publish secondary or tertiary materials to help the public. Examples of believable organizations include but are not limited to: The American Dietetic Association, The American Society for Nutrition, The Society for Nutrition Education, and The American College of Sports Medicine.

In summary, certain people have the training to publish believable primary sources of information. Make sure the information you are reading was written by one of these professionals!

3) Is it a Government Source? There are several federal and international agencies and departments that have come together to fund and publish very important and very large research studies on health and nutrition-related issues.

• The Centers for Disease Control (CDC) is often regarded as the leading federal agency that protects the health and safety of humans. The CDC is involved in health promotion, disease prevention and disease control. You can trust that nutrition-related materials published by the CDC were written by experts in that topic.
• The National Institutes of Health (NIH) is the world’s leading medical research center, which is a part of the Department of Health and Human Services (DHHS) and it aims to make scientific research on health and disease topics easily accessible and well-known in the public.
• The Food and Drug Administration and the United States Department of Agriculture are branches of the government that also aim to make disease prevention and related health information their top priority.

4) Is it selling something or is it too good to be true? Then take that information with a grain of salt. Instead, look up what some of the professional organizations or government sources listed above have to say on the topic. Or ask a Registered Dietitian!

Next time you cannot decide whether nutrition information is believable or not, ask for the source and analyze who that source is. Are the credentialed? Are they experts? Or do they just want your money?

Regardless of which bariatric procedure that a patient undergoes, they will be on a planned diet as part of the recovery process. One of the most important things to remember is to follow your diet plan designed by our nutritionist and the team at North Florida Regional Medical Center. The post-surgery diet consists of four “phases” of foods. Following the plan, phase by phase, facilitates the healing process and allows the body to acclimate to its new condition.

Phase1: Liquid Diet (Days 1-10)

Immediately after surgery, patients are put on a liquid diet which consists of mild sources of nutrients for the healing stomach. It has two stages: clear liquids and full liquids.

• Clear Liquids (Days 1-4 for Gastric Bypass; Days 1-2 for Adjustable Gastric Band)- The substance of the diet is clear to nearly clear liquids. The liquids cannot have any solid pieces in them; this includes small pieces of pulp in juice. Liquids are to be sugar free and non-carbonated. The patient will sip them slowly. The goal is to build up to consuming 48-64 ounces a day without drinking so quickly that the patient feels nauseas. This limit applies to both Gastric Bypass and Adjustable Lap Band procedures.
• Full Liquids (Days 4-10 for Gastric Bypass; Days 3-10 for Adjustable Gastric Band) – After the body can handle clear liquids without a problem, the patient should switch to “full liquids”. These liquids can have some solid pieces in them, but it is important to make them as fluid as possible. Supplement shakes and even well cooked cereals (oatmeal or grits) can be eaten. The limit is 64 ounces of liquid per day for Gastric Bypass procedures and 78 ounces a day for Adjustable Lap Band patients. Low fat, low sugar food sources that are high in protein are the ideal choices.

Phase 2: Pureed Foods (Weeks 2-5 for Gastric Bypass; Weeks 2-3 for Adjustable Lap Band)

Once the healing process is finishing up and the patient’s body is adjusting to its new stomach, some more traditional foods can be included in the diet. 64 ounces of water should be drunk a day for Gastric Bypass patients while Adjustable Lap Band Patients should consume 72 ounces per day Keep in mind that it should be consumed in between meals. Drinking with a meal will cause the stomach to be full faster and reduce the amount of food that can be eaten. All food must be naturally soft or pureed so that any large pieces are broken down. Patients must avoid food choices that are hard to digest. For Gastric Bypass patients weeks 2 and 3 will be entirely pureed foods, in weeks 4 and 5 the patient can start to have some foods that are soft. For patients who undergo an Adjustable Lap Band procedure, pureed foods are eaten for 5 days and the rest of the phase can consist of soft foods. Remember to eat slowly so as to not over do it. The following food groups (with suggestions) are the basis of the pureed food diet and are listed in order of importance.

• Protein (The most important part of your diet) – Protein is the anchor of the diet and should be eaten first before the patient is full. Soft food choices are important and it is recommended that meals be pureed in a food processor. We suggest:

• Baby Food
• Scrambled Eggs
• Low Fat Yogurt
• Hummus
• Broiled fish (weeks 4 and 5)
• Tofu

• Fruits- Even though fruits are generally soft they should be mashed. All skin must be removed.

• Ripe bananas
• Unsweetened Applesauce
• Sugar free jams/jellies
• Strawberries

• Vegetables- Vegetables provide necessary vitamins. As with fruits, remove all skin and do not choose fibrous vegetables like celery. Remember green vegetables are the best.

• Mashed Potatoes (Not sweet potatoes)
• Boiled Carrots
• Well Done Spinach

• Grains- Grains must mostly be in pureed form as well. Many hot cereals are good choices. Use low fat milk when they are prepared to add protein.

• Grits
• Oatmeal

• Cream of Wheat
• Whole wheat toast (weeks 4 and 5)

Phase 3: Soft Foods (Weeks 6-8 This additional time with soft foods is only for Gastric Bypass patients. Adjustable Lap Band recipients move on to their permanent diet at week 4 or as instructed by their physician. The food suggestions here can be consumed during the second stage of Phase 2 for those who undergo Adjustable Lap Band procedures.)

The third phase does not require that any food be pureed. The diet consists of the soft foods that were eaten along with pureed foods at the end of the previous stage. Remember that patients should not drink within 30 minutes of a meal. They should chew food thoroughly, at least 20 times before swallowing. No fibrous foods are allowed, only soft easily digestible choices. Try:

• Protein- Beef is not allowed nor are cuts of poultry unless they are pureed.

• Fish
• Soy Burgers
• Tofu

• Fruits- Fibrous fruits and skins are still not allowed.
  • Mangoes
  • Berries
• Vegetables- Vegetables are to be cooked well until they are soft. Avoid raw vegetables and fibrous choices like asparagus.
  • Collard Greens
  • Carrots
• Grains- Toasting bread is still necessary as it makes it easier to digest. Enjoying hot cereals is still a great idea but do not add nuts, raisins or anything else.

For Gastric Bypass patients there is a fourth stage that includes the hard foods that can be eaten for the remainder of the patient’s life. This is to be discussed at a different time. Above all, heed the warnings in each dietary stage. Cooking foods well and following the steps precisely will produce the best results for the body.

For more information on bariatric procedures please contact North Florida Regional Medical Center. Visit our bariatric page online or call 1-800-342-6057.