Gastric Bypass Benefits Outweigh Risks after Two Years?

| Posted in | Posted on 10:57 PM

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Deficiencies in iron, calcium and vitamin D were more common in the gastric bypass group....

A new international study found that two years post-surgery, those who had gastric bypass have better diabetes control, but they also had higher risks of infection and fractures.

Researchers recruited 120 obese patients with type 2 diabetes at three teaching hospitals in the U.S. and one in Taiwan between 2008 and 2011.

Participants, aged 30 to 67 years, were randomly divided into one of two groups, lifestyle and medical management ("lifestyle group") or lifestyle and medical management with gastric bypass ("bypass group").

Both groups were instructed to record their daily intake, increase their exercise goal of 325 minutes/week and weigh themselves while meeting regularly with a nurse or dietitian. They also met with an endocrinologist as needed to assess the need for medication management for glucose control, cholesterol and blood pressure. Weight-loss surgery was only within the bypass group.

Results of the Diabetes Surgery Study, which is still ongoing, found that 24 patients in the bypass group had lower HbA1c levels, lower LDL and lower BP two years post-surgery, compared to eight patients in the lifestyle group. Deficiencies in iron, calcium and vitamin D were more common in the bypass group. When comparing infections and fractures in both groups there were eight infections in the bypass group compared to four in the lifestyle group and five fractures in the bypass group compared to one in the comparison group.

"I assume nutritional deficiencies are likely to be an even greater problem in general practice," said Markku Peltonen of the National Institute for Health and Welfare in Finland in an accompanying editorial. Carefully taking nutritional supplements and maintaining physical activity reduces the risk of adverse events. “We are still not sure which are the best patients with diabetes to consider for gastric bypass or other bariatric surgery," he said.

Further research to identify which patients are the best candidates for surgery is necessary to minimize the risks of infection and bone fractures while also improving diabetes control.

Practice Pearls:
  • Infection and bone fractures are risks to consider in diabetic patients seeking gastric bypass for improvement in diabetes control.
  • Two years post-surgery, 24 patients in the bypass group achieved decreased HbA1c levels, LDL and BP compared to 8 in the lifestyle group.
  • Nutritional supplementation is important in the post-surgical monitoring diabetic patients undergoing bypass surgery.
 




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Benefits of Bariatric Surgery

| Posted in | Posted on 9:45 PM

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Severe Obesity: Why the Need for Surgical Intervention

Severe obesity is one of the most serious stages of obesity. You may often find yourself struggling with your weight and essentially feeling as if you’re trapped in a weight gain cycle. In addition, you most likely have attempted numerous diets – only in the end, to see your weight continue to increase.
More than a decade ago, The National Institutes of Health, better known as NIH, reported that individuals affected by severe obesity are resistant to maintaining weight loss achieved by conventional therapies, such as consuming fewer calories, increasing exercise, commercial weight-loss programs, etc.). The NIH recognized bariatric (weight-loss) surgery as the only effective treatment to combat severe obesity and maintain weight loss in the long term.

How Can Bariatric Surgery Help Me?

When combined with a comprehensive treatment plan, bariatric surgery may often act as an effective tool to provide you with long term weight-loss and help you increase your quality of health. Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and more. Frequently, individuals who improve their weight find themselves taking less and less medications to treat their obesity-related conditions.
Significant weight loss through bariatric surgery may also pave the way for many other exciting opportunities for you, your family, and most importantly – your health.

How Does Bariatric Surgery Work?

Bariatric surgery, such as gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding, work by changing the anatomy of your gastrointestinal tract (stomach and digestive system) or by causing different physiologic changes in your body that change your energy balance and fat metabolism. Regardless of which bariatric surgery procedure you and your surgeon decide is best for you, it is important to remember that bariatric surgery is a “tool.” Weight loss success also depends on many other important factors, such as nutrition, exercise, behavior modification, and more.
By changing your gastrointestinal anatomy, certain bariatric procedures affect the production of intestinal hormones in a way that reduces hunger and appetite and increases feelings of fullness (satiety). The end result is reduction in the desire to eat and in the frequency of eating. Interestingly, these surgically-induced changes in hormones are opposite to those produced by dietary weight loss. Let’s take a closer look at the differences in hormonal changes between surgery and dietary weight loss:
  • Bariatric Surgery and Hormonal Changes
    Hormonal changes following bariatric surgery improve weight loss by maintaining or enhancing energy expenditure (calories burned). In fact, some surgeries even increase energy expenditure relative to changes in body size. Thus, unlike dietary weight loss, surgical weight loss has a higher chance of lasting because an appropriate energy balance is created.
  • Dieting and Hormonal Changes
    In dietary weight loss, energy expenditure is reduced to levels lower than would be predicted by weight loss and changes in body composition. This unbalanced change in energy can often lead to weight regain.
Significant weight loss is also associated with a number of other changes in your body that help to reduce defects in fat metabolism. With increased weight loss, you will find yourself engaging in more physical activity. Individuals who find themselves on a weight-loss trend often engage in physical activity, such as walking, biking, swimming, and more. Additionally, increased physical activity combined with weight loss may often improve your body’s ability to burn fat, lead to a positive personal attitude, and decrease stress levels. Massive weight loss, as a result of bariatric surgery, also reduces hormones such as insulin (used to regulate sugar levels) and cortisol (stress hormone) and improves the production of a number of other factors that reduce the uptake and storage of fat into fat storage depots. Physical activity is also a very important component of combating obesity.
Bariatric surgery may improve a number of conditions and biological actions (hormonal changes) to reverse the progression of obesity. Studies find that more than 90 percent of bariatric patients are able to maintain a long-term weight loss of 50 percent excess body weight or more.
Bariatric surgery can be a useful tool to help you break the vicious weight gain cycle and help you achieve long term weight loss and improve your overall quality of health and life.

Long Term Weight Loss Success

Bariatric surgeries result in long-term weight-loss success. Most studies demonstrate that more than 90 percent of individuals previously affected by severe obesity are successful in maintaining 50 percent or more of their excess weight loss following bariatric surgery. Among those affected by super severe obesity, more than 80 percent are able to maintain more than 50 percent excess body weight loss.

Improved Longevity

Several large population studies find that individuals affected by severe obesity who have had bariatric surgery have a lower risk of death than individuals affected by obesity who do not have surgery. One of these studies found up to an 89 percent greater reduction in mortality throughout a 5-year observation period for individuals who had bariatric surgery when compared to those who did not. Another large population study comparing mortality rates of bariatric and non-bariatric patients found a greater than 90 percent reduction in death associated with diabetes and a greater than 50 percent reduction in death from heart disease.
The mortality rate for bariatric surgery (3 out of 1000) is similar to that of a gallbladder removal and considerably less than that of a hip replacement. The exceptionally low mortality rate with bariatric surgery is quite remarkable considering that most patients affected by severe obesity are in poor health and have one or more life-threatening diseases at the time of their surgery. Therefore, as regards mortality, the benefits of surgery far exceed the risks.

Improvement/Resolution of Coexisting Diseases

The exceptionally high reduction in mortality rates with bariatric surgery are due to the highly significant improvement in those diseases that are caused or worsened by obesity.
Bariatric surgery is associated with massive weight-loss and improves, or even resolves (cures), obesity-related co-morbidities for the majority of patients. These co-morbidities include high blood pressure, sleep apnea, asthma and other obesity-related breathing disorders, arthritis, lipid (cholesterol) abnormalities, gastroesophageal reflux disease, fatty liver disease, venous stasis, urinary stress incontinence, pseudotumor cerebri, and more.
Bariatric surgeries also lead to improvement and remission of Type II diabetes mellitus (T2DM). In the past, diabetes was considered to be a progressive and incurable disease. Treatments include weight loss and lifestyle changes for those who are overweight or obese and antidiabetic medication, including insulin. These treatments help to control T2DM but rarely cause remission of the disease. However, there is now a large body of scientific evidence showing remission of T2DM following bariatric surgery. A large review of 621 studies involving 135,247 patients found that bariatric surgery causes improvement of diabetes in more than 85 percent of the diabetic population and remission of the disease in 78 percent. Remission of T2DM was highest for the bilio-pancreatic diversion with duodenal switch (BPD/DS) with a remission rate of 95 percent, followed by the Roux-en-Y gastric bypass (RYGB) with remission in 80 percent of patients, and the adjustable gastric band (AGB) with a remission rate of 60 percent. Other studies comparing remission of diabetes between surgeries found comparable rates between the laparoscopic sleeve gastrectomy (LSG) and RYGB, i.e. 80 percent.
Causes of improvement or remission of diabetes have not been completely identified. Improvement of T2DM with AGB is related to weight loss. However, with other surgeries, such as the LSG or RYGB, diabetes remission or improvement occurs early after surgery – well before there is significant weight reduction. In fact, some bariatric patients with T2DM leave the hospital with normal blood sugar and without the need for antidiabetic medication.

Changes in Quality of Life and Psychological Status with Surgery

In addition to improvements in health and longevity, surgical weight-loss improves overall quality of life. Measures of quality of life that are positively affected by bariatric surgery include physical functions such as mobility, self-esteem, work, social interactions, and sexual function. Singlehood is significantly reduced, as is unemployment and disability. Furthermore, depression and anxiety are significantly reduced following bariatric surgery.





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7 Bariatric Surgery Benefits Besides Helping You Lose Weight

| Posted in | Posted on 11:39 AM

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You’d probably eat less if you felt full after eating a small amount of food. That’s exactly what bariatric surgery does and why it helps people lose weight.

Bariatric surgery enhances weight loss in obese people who have not achieved long-term success with other weight loss attempts. Bariatric surgery reduces the stomach’s storage capacity, which limits food intake and helps you feel full much sooner than normal.

But there’s more than one type of bariatric surgery. Options include gastric bypass, sleeve gastrectomy, gastric banding and gastric plication. Your physician can help determine if you’re a candidate and, if so, which option will work best for you.

“If you have a body mass index (BMI) of 35 or more, this means you likely need to lose over 65 pounds,” says bariatric surgery nurse Karen Schulz, MSN, CNS, CBN. Without making changes, you could develop serious health issues because of the excess weight. Almost all people with a BMI of 40 or more are candidates for the surgery.

Dietary adjustments after bariatric surgery

With their smaller stomachs, people who have had the surgery need to eat very slowly and take tiny bites. “One of the hardest adjustments for patients is that they cannot drink liquids while eating. Patients should drink their fluids at least 30 minutes before or 30 minutes after eating, but it doesn’t take long for most people to adjust,” Ms. Schulz says.

Those who have had the surgery also take vitamins and supplements recommended by a nutritionist who counsels patients after the procedure.

Weight loss only one health benefit of many

Bariatric surgery offers people significant and sustained weight loss.

“Most people who need to lose 65 or more pounds have tried multiple times to lose the weight on their own. While they may have some success at first, less than five percent of people keep the weight off for five years or more,” says bariatric surgeon and Director of Cleveland Clinic’s Bariatric and Metabolic Institute Philip Schauer, MD. In fact, he says they usually gain the weight back in less than a year.

Losing the weight and gaining it back does nothing to mitigate the potential health problems associated with obesity. You must keep the weight off for a minimum of five years to consider the loss a success and one that can result in a happier, healthier you.
Benefits of sustained weight loss through bariatric surgery include:
  1. Long-term remission for type 2 diabetes. “A recent Cleveland Clinic study suggests that bariatric surgery causes long-term remission of difficult-to-control type 2 diabetes. The results of this study show the procedure is highly effective for obese patients with type 2 diabetes, allowing almost all patients to remain free of insulin and adjunct medications for at least three years post surgery,” says Dr. Schauer.
  2. Improved cardiovascular health. Weight loss surgery decreases a person’s risk of coronary heart disease, stroke and peripheral heart disease. “Blood pressure and cholesterol levels can return to normal, or near normal after surgery, reducing these risks and improving overall well-being,” Ms. Schulz says.
  3. Relief of depression. Many obese people feel depressed because of poor body image and social stigma. Even younger people who carry significant excess weight find it difficult to participate in activities they might otherwise enjoy, leading to social isolation and depression. Losing this excess weight can improve emotional health in these patients.
  4. Eliminate obstructive sleep apnea. Achieving and sustaining a normal weight range often allows people with sleep apnea to stop using a CPAP machine at bedtime.
  5. Joint pain relief. Carrying around excessive weight puts a lot of stress on your weight-bearing joints, often causing chronic pain and joint damage. “The significant and sustained weight loss that occurs after bariatric surgery relieves the stress on joints and often allows people to stop using pain medications and enjoy much more mobility,” Dr. Schauer says.
  6. Improve fertility. Weight loss surgery can also improve fertility during childbearing years.
  7. Alleviate other medical conditions. Weight loss surgery can alleviate metabolic syndrome, pregnancy complications, gallbladder disease and more.
With obesity and its associated health complications rising at an alarming rate in America, bariatric surgery certainly represents a powerful tool for providing sustained relief for overweight people.
Dr. Schauer warns that it’s important to choose a facility with extensive experience in performing these procedures. “Bariatric surgery is very safe and, when performed by a knowledgeable and experienced team, comes with no more risk than a knee or gall bladder surgery,” he says.

The best facilities have a team of experts to help guide people through pre-surgery counseling and give ongoing support afterward.

“Patients have the best chance of success when supported by an experienced medical team that includes surgeons, bariatric medical physicians, nurses, psychologists, endocrinologists, and dietitians,” says Ms. Schulz.





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Protein is one of the most important nutrients for your body

| Posted in | Posted on 10:03 PM

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Protein is one of the most important nutrients for your body, and you need a lot of it in order to stay healthy… up to 80 grams a day.

With your old stomach, this was no problem. But now that your stomach is down to the size of a golf ball, 80 grams is a big percentage of the available space.

Your body’s going to do all it can to get the adequate amount of protein, so if you’re not eating enough your body will begin to break down muscle. This can cause you to feel nauseous, irritable, weak and tired. If lack of protein intake goes on too long it can ultimately cause general swelling, hair loss and skin problems, worsen your immune system and increase your risk of infection.

So eat your protein first.

It can be found in many foods, including meat, fish, soy and dairy products, legumes and nuts. When you’re picking your protein, be mindful of fat content as many protein sources contain ample amounts of it. Always opt for the lean or low-fat option.

If you’re having a tough time getting enough, it may be necessary to supplement your bariatric diet either every day or as needed. For example, a daily supplement can be taken in the form of a pill or powder, or you can make yourself a protein shake at the end of a low-protein day.




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Long-term Bariatric Diet - What NOT to Eat

| Posted in | Posted on 9:52 PM

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First, let’s talk about what not to eat.

You’ll notice the term “trigger foods” throughout our site. This refers to foods that upset your digestive system (cause digestive issues such as difficulty swallowing, vomiting, diarrhea or constipation).

As you transition into your long-term bariatric diet, certain foods will need to be put on the back burner until your stomach is ready for them while others may upset your stomach forever. You may be able to avoid the trigger by reducing their amounts, but there is also the chance you will need to give the food up altogether.

According to the American Society for Metabolic and Bariatric Surgery1, following are the foods may or may not be okay depending on your body and the type of surgery you choose…

Carbonated beverages
Soft “doughy” bread
Pasta
Rice
Tough, dry, red meat
Nuts
Popcorn
Other fibrous foods
Caffeine in moderation
Alcohol in moderation

The following foods should be eliminated from your diet forever…

Sugar, sugar-containing foods and concentrated sweets
Fruit juice
High-saturated fat
Fried foods

So, what should you eat?

Eat healthy

Healthy bariatric eating has two angles… what you eat and how you eat. Here we focus on what you eat. We’ll get into the “how” further down the page.

The creative packaging in the supermarket can make it difficult to distinguish between the healthy and unhealthy foods. In general, your bariatric diet should only consist of FOG foods…

Farm – The food is raised on a farm (i.e. chicken, turkey, eggs, dairy products)
Ocean – It comes from the ocean (i.e. fish)
Ground – It is grown in the ground (i.e. fruits, vegetables, nuts, whole grains) (click here for a great resource about starting a garden and organic gardening)
When possible, avoid anything that was modified by humans in any way. A good rule of thumb can be applied by reading the label… if there are more than 3 to 5 ingredients or if there are any ingredients that you can’t pronounce, don’t buy it.

How you prepare your food is as important as what you buy…

When cooking, bake, grill, poach or broil…don’t fry.
Use skim milk instead of whole milk.
Use chicken or vegetable broth instead of oil.
Replace oil in recipes with applesauce or yogurt.
Add spices or lemon juice to add flavor instead of olive oil or butter.
We know, we know… how boring, right?

Give it a shot. Not only will you eventually get used to the change, you will probably start to be turned off by not eating this way.

Many patients have said that after a while they actually became repulsed at the thought of unhealthy food because of how it made them feel compared to their new bariatric diet.

In addition, many patients’ taste for unhealthy food changes after surgery.

Here is a list of good diet books for Post Surgery Patients:

http://amzn.to/1AkVrpz

Losing 650 Pounds, and Preparing to Shed a Reminder of That Weight

| Posted in | Posted on 11:24 PM

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ORANGE, Mass. — Once weighing 980 pounds and a contender for the dismaying title of world’s fattest man, Paul Mason lost an astonishing 650 pounds after gastric bypass surgery five years ago. But he was left with a cruel, perpetual reminder of the person he had once been: 100 or so pounds of loose skin that enveloped him like a living shroud.
It is still everywhere: hanging from his arms, draping in folds over his midsection, encircling his thighs, frequently becoming infected, and so cumbersome that it puts him in a wheelchair most of the time. “It’s like carrying around a couple of children,” Mr. Mason said.
Mr. Mason, who is 54, could not find a doctor willing to remove the extra skin in England, where he lived until recently. But through a combination of strong will, good fortune, leaps of faith and the kindness of many strangers, he is now living here deep in the Massachusetts countryside and preparing for the first of a series of skin-removal surgeries in New York City.
See more here





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Diet recommendations after gastric bypass surgery

| Posted in | Posted on 8:55 PM

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Diet details

Diet recommendations after gastric bypass surgery vary depending on where the surgery is performed and your individual situation.
A gastric bypass diet typically follows a staged approach to help you ease back into eating solid foods as you recover. How quickly you move from one step to the next depends on how fast your body heals and adjusts to the change in eating patterns. You can usually start eating regular foods about three months after surgery.
After gastric bypass surgery, you must be careful to drink enough fluids to avoid dehydration, and to pay extra attention to signs that you feel hungry or full.

Liquids

For the first day or so after surgery, you'll only be allowed to drink clear liquids. Sip slowly and drink only 2 to 3 ounces (59 to 89 milliliters) at a time. Once you're handling clear liquids, you can start having other liquids, such as skim or low-fat milk.
Liquids you can have during stage 1:
  • Broth
  • Unsweetened juice
  • Decaffeinated tea or coffee
  • Milk (skim or 1 percent)
  • Strained cream soup
  • Sugar-free gelatin or popsicles

Pureed foods

Once you're able to tolerate liquids for a few days, you can begin to eat strained and pureed (mashed up) foods. During this phase, you can only eat foods that have the consistency of a smooth paste or a thick liquid, without any solid pieces of food in the mixture.
To puree your foods, choose foods that will blend well, such as:
  • Lean ground meats
  • Beans
  • Fish
  • Eggs
  • Soft fruits and cooked vegetables
  • Cottage cheese
Blend solid foods with a liquid, such as:
  • Water
  • Skim milk
  • Juice with no sugar added
  • Broth
It's important that you don't eat and drink at the same time. Wait about 30 minutes after a meal to drink anything. Also keep in mind that your digestive system might still be sensitive to spicy foods or dairy products. If you'd like to eat these foods during this phase, add them into your diet slowly and in small amounts.

Soft foods

After a few weeks of pureed foods, and with your doctor's OK, you can add soft foods — in the form of small, tender, easily chewed pieces — to your diet.
During this stage, your diet can include:
  • Ground or finely diced meats
  • Canned or soft fresh fruit (without seeds or skin)
  • Cooked vegetables (without skin)

Solid foods

After about eight weeks on the gastric bypass diet, you can gradually return to eating firmer foods. But foods must still be chopped or diced. Start slowly with regular foods to see what foods you can tolerate. You may find that you still have difficulty eating spicier foods or foods with crunchy textures.
Even at this stage, there are foods you should avoid because they may cause gastrointestinal symptoms, such as nausea, pain or vomiting.
Foods to avoid:
  • Nuts and seeds
  • Popcorn
  • Dried fruits
  • Carbonated beverages
  • Granola
  • Stringy or fibrous vegetables, such as celery, broccoli, corn or cabbage
  • Tough meats or meats with gristle
  • Fried foods
  • Breads
Over time, you may be able to try some of these foods again, with the guidance of your doctor.

A new healthy diet

Three to four months after weight-loss surgery, you may be able to start eating a normal healthy diet, depending on your situation and any foods you may not be able to tolerate. It's possible that foods that initially irritated your stomach after surgery may become more tolerable as your stomach continues to heal.

Throughout the diet

To ensure that you get enough vitamins and minerals and keep your weight-loss goals on track, at each stage of the gastric bypass diet, you should:
  • Eat and drink slowly. Eating or drinking too quickly may cause dumping syndrome — when foods and liquids enter your small intestine rapidly and in larger amounts than normal, causing nausea, vomiting, dizziness, sweating and eventually diarrhea. To prevent dumping syndrome, choose foods and liquids low in fat and sugar, eat and drink slowly, and wait 30 to 45 minutes before or after each meal to drink liquids. Take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup (237 milliliters) of liquid.
  • Keep meals small. During the diet progression, you should eat several small meals a day and sip liquids slowly throughout the day (not with meals). You might first start with six small meals a day, then move to four meals and finally, when following a regular diet, decrease to three meals a day. Each meal should include about a half-cup to a cup of food. Make sure you eat only the recommended amounts and stop eating before you feel full
  • Drink liquids between meals. Expect to drink at least 6 to 8 cups (48 to 64 ounces, or 1.4 to 1.9 liters) of fluids a day to prevent dehydration. Drinking liquids with your meals can cause pain, nausea and vomiting as well as dumping syndrome. Also, drinking too much liquid at or around mealtime can leave you feeling overly full and prevent you from eating enough nutrient-rich food.
  • Chew food thoroughly. The new opening that leads from your stomach into your intestine is very small, and larger pieces of food can block the opening. Blockages prevent food from leaving your stomach and can cause vomiting, nausea and abdominal pain. Take small bites of food and chew them to a pureed consistency before swallowing. If you can't chew the food thoroughly, don't swallow it.
  • Focus on high-protein foods. Immediately after your surgery, eating high-protein foods can help you heal. High-protein, low-fat choices remain a good long-term diet option after your surgery, as well. Try adding lean cuts of beef, chicken, pork, fish or beans to your diet. Low-fat cheese, cottage cheese and yogurts also are good protein sources.
  • Avoid foods that are high in fat and sugar. After your surgery, it may be difficult for your digestive system to tolerate foods that are high in fat or added sugars. Avoid foods that are high in fat (such as fried foods, ice cream and candy bars). Look for sugar-free options of soft drinks and dairy products.
  • Try new foods one at a time. After surgery, certain foods may cause nausea, pain and vomiting or may block the opening of the stomach. The ability to tolerate foods varies from person to person. Try one new food at a time and chew thoroughly before swallowing. If a food causes discomfort, don't eat it. As time passes, you may be able to eat this food. Foods and liquids that commonly cause discomfort include meat, bread, raw vegetables, fried foods and carbonated beverages.
  • Take recommended vitamin and mineral supplements.Because a portion of your small intestine is bypassed after surgery, your body won't be able to absorb enough nutrients from your food. You'll likely need to take a multivitamin supplement every day for the rest of your life. Talk to your doctor about what type of multivitamin might be right for you and whether you might need to take additional supplements, such as calcium.





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