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Bill Klaproth (Host): Protein and vitamins after bariatric weightloss surgery go hand in hand. Here to talk with us more about the importance of protein and vitamins is Wynnie Hoodis, a Registered Dietician at Garden State Bariatrics and Wellness Center. Wynnie thank you for your time. Always a pleasure to talk with you. So, let’s dig into protein first. Why is protein important for patients after bariatric surgery?

Wynnie Hoodis, MS, RDN (Guest): Hi Bill. Thanks for having me. Protein is important for patients because it’s important for them to maintain their lean muscle mass as they lose weight. And many patients don’t realize that protein has many different jobs in our bodies related to muscle and tissue repair, chemicals, hormones and immune function. And when our patients have bariatric surgery and they don’t get enough protein; they may have slow healing, low energy levels. They may lose muscle and they could potentially maybe lose some hair. Now saying this, the key is to aim for enough protein, but not to go overboard with too much protein.

Host: Interesting. Alright so how can a patient meet their protein needs after bariatric surgery?

Wynnie: Good question. So, what we do or what I do is I work with patients on how to pick different protein shakes. So, right after bariatric surgery, patients primarily get their protein by drinking protein shakes throughout the days. In our nutrition appointments, we talk about what constitutes a good protein shake. How many grams of protein they need to get per day and then we always – or protein powder if they want to like make their own. So, we always give patients like a number of different options so that they can meet their protein needs right after surgery.

Host: And what about food? You are just talking about liquid protein choices. Are there good protein food choices after bariatric surgery?

Wynnie: There are. So, as weeks and months progress, patients are encouraged to start consuming food certainly. And they are encouraged to start with eating soft proteins like fish, it could be like white fish or salmon, ground meats, soft chicken like a shredded chicken. They are encouraged to consume a variety of different kinds of beans or lentils, tofu, edamame, Greek yogurt and eggs. Those are all great sources of protein.

Host: So, is there a protein goal or are there guidelines on how much protein to consume each day?

Wynnie: There are. And it depends on the type of bariatric surgery that you are having and that’s something that we always talk about in our appointments. So, typically, our patients are getting anywhere between for like let’s say a gastric sleeve or bypass, somewhere between 50 and 70 grams of protein per day and if they are having the duodenal switch, it’s a little higher 70 to 90 grams of protein per day. So, that’s something that we help our patients sort of figure out so that they can plan ahead. And that’s throughout the day. So, it’s not – they have to be consuming protein breakfast, lunch, dinner.

Host: Really good information. So, let’s turn to vitamins. Why are vitamins important for patients after bariatric surgery?

Wynnie: So, a great question. And we often talk about vitamins in my office. A lot of times, patients should really be on a multivitamin prior to surgery taking place, especially if they are not eating a diet made up of sort of those healthy vegetables, fruits, lean meats, dairy and whole grains. And then some patients don’t realize that sometimes their medications can interfere with the proper absorption of vitamins from our food. But after bariatric surgery, because of the significant changes that are going on, just the size of their stomach is changing typically, sometimes their gastrointestinal system has been altered; it’s even more important that those patients get nutrients from vitamins because they are just not eating a whole lot and I always like to tell patients that we have to remember that vitamins do play a major role in helping our bodies function well. Vitamins help in turning our food into energy, they aid in brain and nerve function, keeping our eyes, skin, bones and teeth healthy. They help us fight infections and heal from injuries. So, typically, our patients aren’t quite consuming a variety of different foods after surgery, so they really do need to be consuming vitamins after to meet those needs.

Host: So, Wynnie are there special vitamins for bariatric patients?

Wynnie: There are. There are. I always recommend bariatric vitamins and, in our office visits we talk about all the different options. There are different vitamins specific for the different types of bariatric surgeries that patients are going to have. So, there are different - these vitamins have just a little more content of the different breakdown of vitamins and minerals in them versus an over-the-counter option. So, we always, especially if somebody is coming in and having surgery for the first time; I always steer them towards those bariatric vitamins.

Host: So, how do you know what vitamins to take? I know you were just talking about the bariatric vitamins but are there other ones you should be taking in conjunction with the bariatric vitamins? And how do you know which vitamins those would be?

Wynnie: Yeah, so, really you can meet – from a bariatric surgery perspective, you can meet – you can get your multivitamin that has iron in it, a bariatric multivitamin that has iron in it and they are typically also recommended to be taking a calcium citrate that has vitamin D. Some of our patients have to take additional vitamin D depending on their nutrient levels and then we are always monitoring other things like B12, to see if they might need additional B12 or any of the other supplements. Sometimes our patients are really diligent about taking the vitamins that we recommended to them; but then we find just in their yearly appointments that maybe they are a little low in iron and they need to take an additional iron or a little low in something else and so we can supplement that way. But separate from the bariatric vitamins, they typically don’t have to take anything separate from that unless we notice something in their blood work.

Host: Okay, that makes sense. So….

Wynnie: And just to say the bariatric vitamin is a multivitamin, multimineral. So, it’s – it has everything in it. It has all your fat-soluble vitamins like vitamin A, D, E and K. it has your B vitamins. It has all the different minerals. So, it’s a complete vitamin that they are taking in addition to the others that I mentioned.

Host: Oh, well that’s good to know. So, someone might be thinking to themselves vitamins, expensive. Are the bariatric vitamins expensive?

Wynnie: So, I will say just in research or just looking at all the – there are many different companies that make and sell bariatric vitamins. They do tend to cost a little bit more than over-the-counter brands. But not always. And there are – sometimes they can be covered by private health insurance. In most cases, they are not covered by Medicare or private health insurance. But that’s always perhaps an option. But here’s the thing. Vitamins even if there is a cost associated to them; they really are important after bariatric surgery. So, I always sort of stress that to my patients that they have to look at this as for their overall health that the cost of those vitamins, it might be just a little bit more than the over-the-counter brand; but it’s well worth it.

Host: So, I’m thinking about vitamins and I’m thinking kind of out of sight, out of mind so, what can patients do to remember to take their vitamins?

Wynnie: Yeah and that’s the thing. A lot of patients come in and they say oh I forgot to take them, or it just seems like – because you can’t take your calcium at the same time you take your multivitamin so, it’s not like you can take all your vitamins at one time. So, what I always tell my patients to do is they can set an alarm on their phone, they can lay out their vitamins in the morning. They can get one of those day of the week pill boxes and sort of fill those up so they kind of know like oops, I haven’t taken my vitamins yet today. We also have an app that we encourage our patients to download. It’s Baritastic app and that app has reminders as well. So, there are different ways of getting our patients to take them. But we just have to come up with something that really works for them.

Host: Well those are good suggestions. Put an alarm on your phone, great idea. Lay them out before bed. And then obviously, some people do use the pill boxes, and did you call it the Baritastic app?

Wynnie: Yeah, the Baritastic app.

Host: I love that.

Wynnie: Yeah, it’s a good app. So, we always encourage all of our patients to download it. It’s a free app and they can connect with our clinic with a specific code. And it’s a way for them to – they can not only monitor their vitamin intake, but they can also monitor their food intake, there is information about support groups, information about the different types of bariatric surgery, nutrition info in there, recipes. So, we really encourage all of our patients to download that app and connect with us.

Host: So, useful, beneficial, and a cool name. The Baritastic app. I love it. Alright Wynnie well thank you so much for your time. We appreciate it. For more information please visit the Garden State Bariatrics and Wellness website at www.gsbwc.com, that’s www.gsbwc.com. This is Winning Through Losing, a Weightloss Surgery Podcast with Garden State Bariatrics. I’m Bill Klaproth. Thanks for listening.