Guest guest Posted May 18, 2005 Report Share Posted May 18, 2005 Trader Joe's has their own label of calcium citrate. We recommend calcium citrate as primary source, and just to keep confusion down for both surgeries. I heard GNC is going to be carrying the powdered UpCal with vitamin D, so also easier for patients to obtain and then hopefully comply. If they are totally non-compliant with the calcium citrate and are doing nothing, I suggest that they at least get in some calcium from Viactiv. I have however had a couple of pts get "hooked" on this like candy and have had them d/c. Joan Hultgren, RD LDN CDESaints Memorial Medical Center Lowell, MA Calcium Do you encourage your patients to take only calcium citrate? If so, what brands do you recommend. I have seen most typical supplement in the drug store are carbonate or a mixture with no % of which type calcium they contribute. I am curious what others are doing. TIA Gundermann RD, CDE Manager of Clinical Nutrition Services Good Samaritan Hospital Bon Secours Charity Health System (845) 368 - 5016 lgunderm@... The information in this communication is intended to be confidential to the individual(s) and/or entity to which it is addressed. It may contain information of a Privileged or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). Should this communication be received in error please notify the sender immediately either by response email or by phone at 845-368-5016, and permanently delete the original e-mail, attachments(s), and any copies. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2005 Report Share Posted May 18, 2005 Twin Labs also has a chewable calcium citrate. Runkle, MA, RD, LDN Building on Basics Nutrition Consulting Services, Inc. From: [mailto: ] On Behalf Of jeremiah elizondo Sent: Wednesday, May 18, 2005 8:56 AM Subject: Re: Calcium I recommend CitraCal or Bariatric Advantage calcium citrate for my bypass and just the store brand for my lap band patients. Jerry Elizondo RD LD " Gundermann, " <LGunderm@...> wrote: Do you encourage your patients to take only calcium citrate? If so, what brands do you recommend. I have seen most typical supplement in the drug store are carbonate or a mixture with no % of which type calcium they contribute. I am curious what others are doing. TIA Gundermann RD, CDE Manager of Clinical Nutrition Services Good Samaritan Hospital Bon Secours Charity Health System (845) 368 - 5016 lgunderm@... The information in this communication is intended to be confidential to the individual(s) and/or entity to which it is addressed. It may contain information of a Privileged or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). Should this communication be received in error please notify the sender immediately either by response email or by phone at 845-368-5016, and permanently delete the original e-mail, attachments(s), and any copies. Discover Find restaurants, movies, travel & more fun for the weekend. Check it out! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2005 Report Share Posted May 18, 2005 Will they also be carrying the other Global Health Products items (Upcal D Plus, Liquafiber, ProCel)? Runkle, MA, RD, LDN Building on Basics Nutrition Consulting Services, Inc. From: [mailto: ] On Behalf Of Joan M. Hultgren Sent: Wednesday, May 18, 2005 9:55 AM Subject: Re: Calcium Trader Joe's has their own label of calcium citrate. We recommend calcium citrate as primary source, and just to keep confusion down for both surgeries. I heard GNC is going to be carrying the powdered UpCal with vitamin D, so also easier for patients to obtain and then hopefully comply. If they are totally non-compliant with the calcium citrate and are doing nothing, I suggest that they at least get in some calcium from Viactiv. I have however had a couple of pts get " hooked " on this like candy and have had them d/c. Joan Hultgren, RD LDN CDE Saints Memorial Medical Center Lowell, MA Calcium Do you encourage your patients to take only calcium citrate? If so, what brands do you recommend. I have seen most typical supplement in the drug store are carbonate or a mixture with no % of which type calcium they contribute. I am curious what others are doing. TIA Gundermann RD, CDE Manager of Clinical Nutrition Services Good Samaritan Hospital Bon Secours Charity Health System (845) 368 - 5016 lgunderm@... The information in this communication is intended to be confidential to the individual(s) and/or entity to which it is addressed. It may contain information of a Privileged or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). Should this communication be received in error please notify the sender immediately either by response email or by phone at 845-368-5016, and permanently delete the original e-mail, attachments(s), and any copies. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2005 Report Share Posted May 18, 2005 The Twin Labs chewable citrate is difficult to find. I haven't found it yet at GNC's or other vitamin shops. We rec'd dissolving citracal in 4 oz of sugar free liquid. There's not taste. There's also UpCal Calcium packs and the one from Bariatric Advantage. Runkle <tarunkle@...> wrote: Twin Labs also has a chewable calcium citrate. Runkle, MA, RD, LDN Building on Basics Nutrition Consulting Services, Inc. From: [mailto: ] On Behalf Of jeremiah elizondoSent: Wednesday, May 18, 2005 8:56 AM Subject: Re: Calcium I recommend CitraCal or Bariatric Advantage calcium citrate for my bypass and just the store brand for my lap band patients. Jerry Elizondo RD LD "Gundermann, " <LGunderm@...> wrote: Do you encourage your patients to take only calcium citrate? If so, what brands do you recommend. I have seen most typical supplement in the drug store are carbonate or a mixture with no % of which type calcium they contribute. I am curious what others are doing. TIA Gundermann RD, CDE Manager of Clinical Nutrition Services Good Samaritan Hospital Bon Secours Charity Health System (845) 368 - 5016 lgunderm@... The information in this communication is intended to be confidential to the individual(s) and/or entity to which it is addressed. It may contain information of a Privileged or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). Should this communication be received in error please notify the sender immediately either by response email or by phone at 845-368-5016, and permanently delete the original e-mail, attachments(s), and any copies. Discover Find restaurants, movies, travel & more fun for the weekend. Check it out! L. MacKechnie, RD Bariatric Dietitian New York, NY misook_27@... Mobile Take with you! Check email on your mobile phone. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2005 Report Share Posted May 18, 2005 There’s a Vitamin Shoppe near our office. They carry it, and will order just about anything that our patients request. Have you tried talking to a manager of one of the vitamin shops near your office? They can be great resources in getting your patients what they need. From: [mailto: ] On Behalf Of MacKechnie Sent: Wednesday, May 18, 2005 12:18 PM Subject: RE: Calcium The Twin Labs chewable citrate is difficult to find. I haven't found it yet at GNC's or other vitamin shops. We rec'd dissolving citracal in 4 oz of sugar free liquid. There's not taste. There's also UpCal Calcium packs and the one from Bariatric Advantage. Runkle <tarunkle@...> wrote: Twin Labs also has a chewable calcium citrate. Runkle, MA, RD, LDN Building on Basics Nutrition Consulting Services, Inc. From: [mailto: ] On Behalf Of jeremiah elizondo Sent: Wednesday, May 18, 2005 8:56 AM Subject: Re: Calcium I recommend CitraCal or Bariatric Advantage calcium citrate for my bypass and just the store brand for my lap band patients. Jerry Elizondo RD LD " Gundermann, " <LGunderm@...> wrote: Do you encourage your patients to take only calcium citrate? If so, what brands do you recommend. I have seen most typical supplement in the drug store are carbonate or a mixture with no % of which type calcium they contribute. I am curious what others are doing. TIA Gundermann RD, CDE Manager of Clinical Nutrition Services Good Samaritan Hospital Bon Secours Charity Health System (845) 368 - 5016 lgunderm@... The information in this communication is intended to be confidential to the individual(s) and/or entity to which it is addressed. It may contain information of a Privileged or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). Should this communication be received in error please notify the sender immediately either by response email or by phone at 845-368-5016, and permanently delete the original e-mail, attachments(s), and any copies. Discover Find restaurants, movies, travel & more fun for the weekend. Check it out! L. MacKechnie, RD Bariatric Dietitian New York, NY misook_27@... Mobile Take with you! Check email on your mobile phone. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2005 Report Share Posted May 18, 2005 I'm not sure. One of my pts told me that GNC is carrying the UpCal powder. I just need to check it out when I have a minute. Joan Hultgren RD LDN CDE Saints Memorial Medical Center Lowell, MA Calcium Do you encourage your patients to take only calcium citrate? If so, what brands do you recommend. I have seen most typical supplement in the drug store are carbonate or a mixture with no % of which type calcium they contribute. I am curious what others are doing. TIA Gundermann RD, CDE Manager of Clinical Nutrition Services Good Samaritan Hospital Bon Secours Charity Health System (845) 368 - 5016 lgunderm@... The information in this communication is intended to be confidential to the individual(s) and/or entity to which it is addressed. It may contain information of a Privileged or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). Should this communication be received in error please notify the sender immediately either by response email or by phone at 845-368-5016, and permanently delete the original e-mail, attachments(s), and any copies. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2005 Report Share Posted September 20, 2005 This may not be the correct forum for this question but since many on this list seem to know quite a bit about Ca, I thought I would try. Is any particular form of Ca better absorbed by person with celiac disease than any other? I have a pt with celiac who is convinced that coral shell is the best for her. I'm sure it's not but I don't have concrete evidence. TIA, Bev calcium has anyone ever heard of the form of calcium called tricalciumphosphate? Costco carries a chewable in this form, but I don't knowanything about its absorption after surgery. I usually recommend Cacitrate, but don't want to eliminate a readily available alternative ifit is appropriate.Thanks in advance. Simler, MS, RD, CDEValleyCare Health System******************* Internet e-mail Disclaimer **************************This message and any included attachments are from ValleyCare Health System and are intended only for the use of the individual named above, privilegesare not waived by virtue of this having been sent by e-mail. The informationcontained may include privileged or otherwise confidential information;unauthorized use, review,distribution, printing or copying is strictlyprohibited and may be unlawful.If you received this e-mail in error or havereason to believe you are not authorized to receive it, please promptlydelete this message and notify the sender by e-mail with a copy toSecurityOfficer@.... Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2006 Report Share Posted May 19, 2006 one thing i know is sometimes we take calcium and we just don't digest (?) absorb (?) it -- so it does help to take a good kind of calcium -- calcium citrate i know is good this is from both andrew weil and my good vitamin guy i go to felicity > (last post for tonight!) > > My grandmother is currently suffering from degenerative bone disease, > resulting from osteoporosis. She's really in a lot of pain and cannot > even feed herself. My mom had to put her in a nursing home (hopefully > temporarily) as she needs so much help. > > It was just a reminder to me to take that calcium and to continue > lifting. > > I did some quick research on calcium RDA's and could not get a > straight answer. Is 1200mg what is recommended? Do you count food > sources too? I always aim to take my two pills a day and regardless > of how much calcium-rich food I ate that day. > > I thought some one would know. > > Thanks. > > Candace > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2006 Report Share Posted July 20, 2006 I had also heard that calcium citrate was okay to take /c Fe and I found this on the National Osteoporosis Foundation website: “Calcium also interferes with iron absorption, so a calcium supplement should not be taken at the same time as an iron supplement. The exception to this is when the iron supplement is taken with vitamin C or calcium citrate. “ Dana Holland RD, LDN Clinical and Outpatient Dietitian Highland Park Hospital 847.480.2634 (office) 847.264.6485 (pager) Calcium Has anyone every heard that Calcium Citrate is the only form of calcium that does not interfere with iron absorption? Saw it yesterday on Twin Labs website. I had always heard that any form of calcium will interfere with the absorption of iron. I know Bariatric Advantage makes the iron seperate due to the absorption issue. Also, is anyone now recommending Magnesium along with the calcium in a (2-Ca:1-Mg) ratio as suggested in the most recent recommendations from ASBS? Unfortunately Citracal and Bariatric Advantage is minimal and the magnesium is no where near half the amount of calcium in these products. Any recommendations other than Twin Labs? Thanks in advance. Stuart, RD, LD  Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2006 Report Share Posted November 8, 2006 Because calcium from food is primarily absorbed in the duodenum, which is bypassed in RNY pts., supplements are recommended. Further, because many RNY pts. are lactose intolerant, and because they are told to limit sugar to <10 g per meal (even skim milk has 12 g per cup), we also prefer that they limit milk intake. Ava Lap RNY 4/21/04 The Ohio State Univ. Medical Ctr. > > 1500mg Ca citrate/day is what we are recommending, right? Does that > include high Ca foods or just supplements? If a post-op RNY drinks 3c > skim milk per day (900mg Ca)would they get by with adding 1 Ca > supplement per day? > Thanks, > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2006 Report Share Posted November 8, 2006 Our program aims for ~1800-2000 mg of Calcium daily with food sources and supplements. We require all of our patients take Calcium Citrate 600 mg BID and then aim for the rest of their calcium coming from food sources since our bodies absorb nutrients from food better than supplements. I don't have our patients neglect good calicum food sources b/c of natural sugar content. Only about 25-40% of my patients are lactose intolerant after surgery. We find that the patients who take in more calcium rich foods and compliant with vitamin regimen have less frequency of decrease bone density ~2 years out. The only limit I make is when I find patients are eating no sugar added, FF ice cream and puddings qd to get there calcium intake b/c they are leaning towards the ideas of sweets. I know not everyone likes milk and yogurt so i provide patients with a handout with calcium foods sources and recommend to aim for ~3 servings per day to help reach their goal. We clearly see elevated PTH levels in those patients who are non-compliant with supplements but also lack dairy in their diet and do not look for other calcium sources to substitute for their lactose intolerance or dislikes. If a patients drink 3 cups of low-fat or skim milk per day for 900 mg of calcium and can tolerate it then no problem still have them supplement with 1000-1200 mg of Ca Citrate. I will try to get the article from my surgeon which stated that RNY patients absorb ~50-60% of calcium intake. Beth Whelan, MS, RD, LD Re: Calcium Because calcium from food is primarily absorbed in the duodenum, which is bypassed in RNY pts., supplements are recommended. Further, because many RNY pts. are lactose intolerant, and because they are told to limit sugar to <10 g per meal (even skim milk has 12 g per cup), we also prefer that they limit milk intake. Ava Lap RNY 4/21/04 The Ohio State Univ. Medical Ctr. > > 1500mg Ca citrate/day is what we are recommending, right? Does that > include high Ca foods or just supplements? If a post-op RNY drinks 3c > skim milk per day (900mg Ca)would they get by with adding 1 Ca > supplement per day? > Thanks, > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2006 Report Share Posted November 8, 2006 Yes, if one has a normal digestive system. That would be great. I'll add it to our resources. See also April D. ; M. , Medication and Nutrient Administration Considerations After Bariatric Surgery, Am J Health-Syst Pharm. 2006;63(19):1852-1857. > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > that > > > include high Ca foods or just supplements? If a post-op RNY drinks > > 3c > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > supplement per day? > > > Thanks, > > > > > > > > > > > > > > > > > > > > > <!-- > > #ygrp-mlmsg {font-size:13px;font-family:arial,helvetica,clean,sans- serif;} > #ygrp-mlmsg table {font-size:inherit;font:100%;} > #ygrp-mlmsg select, input, textarea {font:99% arial,helvetica,clean,sans-serif;} > #ygrp-mlmsg pre, code {font:115% monospace;} > #ygrp-mlmsg * {line-height:1.22em;} > #ygrp-text{ > font-family:Georgia; > } > #ygrp-text p{ > margin:0 0 1em 0; > } > #ygrp-tpmsgs{ > font-family:Arial; > clear:both; > } > #ygrp-vitnav{ > padding-top:10px; > font-family:Verdana; > font-size:77%; > margin:0; > } > #ygrp-vitnav a{ > padding:0 1px; > } > #ygrp-actbar{ > clear:both; > margin:25px 0; > white-space:nowrap; > color:#666; > text-align:right; > } > #ygrp-actbar .left{ > float:left; > white-space:nowrap; > } > .bld{font-weight:bold;} > #ygrp-grft{ > font-family:Verdana; > font-size:77%; > padding:15px 0; > } > #ygrp-ft{ > font-family:verdana; > font-size:77%; > border-top:1px solid #666; > padding:5px 0; > } > #ygrp-mlmsg #logo{ > padding-bottom:10px; > } > > #ygrp-vital{ > background-color:#e0ecee; > margin-bottom:20px; > padding:2px 0 8px 8px; > } > #ygrp-vital #vithd{ > font-size:77%; > font-family:Verdana; > font-weight:bold; > color:#333; > text-transform:uppercase; > } > #ygrp-vital ul{ > padding:0; > margin:2px 0; > } > #ygrp-vital ul li{ > list-style-type:none; > clear:both; > border:1px solid #e0ecee; > } > #ygrp-vital ul li .ct{ > font-weight:bold; > color:#ff7900; > float:right; > width:2em; > text-align:right; > padding-right:.5em; > } > #ygrp-vital ul li .cat{ > font-weight:bold; > } > #ygrp-vital a { > text-decoration:none; > } > > #ygrp-vital a:hover{ > text-decoration:underline; > } > > #ygrp-sponsor #hd{ > color:#999; > font-size:77%; > } > #ygrp-sponsor #ov{ > padding:6px 13px; > background-color:#e0ecee; > margin-bottom:20px; > } > #ygrp-sponsor #ov ul{ > padding:0 0 0 8px; > margin:0; > } > #ygrp-sponsor #ov li{ > list-style-type:square; > padding:6px 0; > font-size:77%; > } > #ygrp-sponsor #ov li a{ > text-decoration:none; > font-size:130%; > } > #ygrp-sponsor #nc { > background-color:#eee; > margin-bottom:20px; > padding:0 8px; > } > #ygrp-sponsor .ad{ > padding:8px 0; > } > #ygrp-sponsor .ad #hd1{ > font-family:Arial; > font-weight:bold; > color:#628c2a; > font-size:100%; > line-height:122%; > } > #ygrp-sponsor .ad a{ > text-decoration:none; > } > #ygrp-sponsor .ad a:hover{ > text-decoration:underline; > } > #ygrp-sponsor .ad p{ > margin:0; > } > o {font-size:0;} > .MsoNormal { > margin:0 0 0 0; > } > #ygrp-text tt{ > font-size:120%; > } > blockquote{margin:0 0 0 4px;} > .replbq {margin:4;} > --> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2006 Report Share Posted November 9, 2006 What is the rational for limiting natural sugars(milk sugar)? People still need to eat carbohydrates even though they are post bariatric patients. Milk is high protein food+ rich in calcium . In addition, people may add carnation instant breakfast and dry milk powder and it will be ~20 g protein=high pro drink. Bariatric patients will not have dumping after drinking milk because it has natural sugar and protein. If patients become lactose intolerant, I recommend Lactaid milk, Soy milk +Ca or Lactaid pills. Why do you ristrict milk? Anybody else restricting milk? Fruit? WHY? i suggest additional Calcium supplements even though they drink 3 cups of milk a day. Thank you! > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > that > > include high Ca foods or just supplements? If a post-op RNY drinks > 3c > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > supplement per day? > > Thanks, > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2006 Report Share Posted November 9, 2006 Does anyone have recommendations for a good calcium citrate chewable without a lot of sugar. Janette RD, LD Mercy Center for Weight Reduction 603 E 12th st Des Moines, IA 50309 P 515-643-0532 F 515-643-0939 E jhoward@... From: [mailto: ] On Behalf Of Beth Whelan Sent: Wednesday, November 08, 2006 10:10 PM Subject: Re: Re: Calcium Our program aims for ~1800-2000 mg of Calcium daily with food sources and supplements. We require all of our patients take Calcium Citrate 600 mg BID and then aim for the rest of their calcium coming from food sources since our bodies absorb nutrients from food better than supplements. I don't have our patients neglect good calicum food sources b/c of natural sugar content. Only about 25-40% of my patients are lactose intolerant after surgery. We find that the patients who take in more calcium rich foods and compliant with vitamin regimen have less frequency of decrease bone density ~2 years out. The only limit I make is when I find patients are eating no sugar added, FF ice cream and puddings qd to get there calcium intake b/c they are leaning towards the ideas of sweets. I know not everyone likes milk and yogurt so i provide patients with a handout with calcium foods sources and recommend to aim for ~3 servings per day to help reach their goal. We clearly see elevated PTH levels in those patients who are non-compliant with supplements but also lack dairy in their diet and do not look for other calcium sources to substitute for their lactose intolerance or dislikes. If a patients drink 3 cups of low-fat or skim milk per day for 900 mg of calcium and can tolerate it then no problem still have them supplement with 1000-1200 mg of Ca Citrate. I will try to get the article from my surgeon which stated that RNY patients absorb ~50-60% of calcium intake. Beth Whelan, MS, RD, LD Re: Calcium Because calcium from food is primarily absorbed in the duodenum, which is bypassed in RNY pts., supplements are recommended. Further, because many RNY pts. are lactose intolerant, and because they are told to limit sugar to <10 g per meal (even skim milk has 12 g per cup), we also prefer that they limit milk intake. Ava Lap RNY 4/21/04 The Ohio State Univ. Medical Ctr. > > 1500mg Ca citrate/day is what we are recommending, right? Does that > include high Ca foods or just supplements? If a post-op RNY drinks 3c > skim milk per day (900mg Ca)would they get by with adding 1 Ca > supplement per day? > Thanks, > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2006 Report Share Posted November 9, 2006 I explain it as liquid calories - 3 cups of skim milk = 270 calories per day, 1890 calories per week and 98280 calories per year or about 28 pounds a year worth of liquid calories. I have no problems with fruit and promote them as part of their healthy diet. Just my input Jerry saleva25 <saleva25@...> wrote: What is the rational for limiting natural sugars(milk sugar)? People still need to eat carbohydrates even though they are post bariatric patients.Milk is high protein food+ rich in calcium . In addition, people may add carnation instant breakfast and dry milk powder and it will be ~20 g protein=high pro drink.Bariatric patients will not have dumping after drinking milk because it has natural sugar and protein.If patients become lactose intolerant, I recommend Lactaid milk, Soy milk +Ca or Lactaid pills.Why do you ristrict milk?Anybody else restricting milk? Fruit? WHY?i suggest additional Calcium supplements even though they drink 3 cups of milk a day.Thank you!> >> > 1500mg Ca citrate/day is what we are recommending, right? Does > that > > include high Ca foods or just supplements? If a post-op RNY drinks > 3c > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > supplement per day?> > Thanks,> > > >> Everyone is raving about the all-new beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2006 Report Share Posted November 9, 2006 Even though it is liquid calories as long as they count their milk intake as a meal or snack (good source of CHo and Pro) these calories are actually very minimal compare to the types of foods which are consumed as snacks (cheetos, chips, crackers, sweets, low fiber intake, high fat, nuts, peanut butter, etc). There are many benefits to milk; helps promote sleep (Calcium) if drank before bed, 3 servings of yogurt and milk on a low-calorie diet showed more weight loss compared to a low-calorie meal plan with a low calcium intake, help lower BP (DASH diet). When did our profession stop believing the 3-A-Day compaign and the benefits of calcium in our diet? I know some people keep saying that since they don't have a normal digestive track the calcium in milk will not be absorb anymore but how will the calcium supplments be absorbed if food isn't being absorbed............it appears to be the same prespective as how can patients regain weight. I guess I an in awe that RD's are recommending patients to avoid milk. Beth Re: Re: Calcium I explain it as liquid calories - 3 cups of skim milk = 270 calories per day, 1890 calories per week and 98280 calories per year or about 28 pounds a year worth of liquid calories. I have no problems with fruit and promote them as part of their healthy diet. Just my input Jerry saleva25 <saleva25 (DOT) com> wrote: What is the rational for limiting natural sugars(milk sugar)? People still need to eat carbohydrates even though they are post bariatric patients.Milk is high protein food+ rich in calcium . In addition, people may add carnation instant breakfast and dry milk powder and it will be ~20 g protein=high pro drink.Bariatric patients will not have dumping after drinking milk because it has natural sugar and protein.If patients become lactose intolerant, I recommend Lactaid milk, Soy milk +Ca or Lactaid pills.Why do you ristrict milk?Anybody else restricting milk? Fruit? WHY?i suggest additional Calcium supplements even though they drink 3 cups of milk a day.Thank you!> >> > 1500mg Ca citrate/day is what we are recommending, right? Does > that > > include high Ca foods or just supplements? If a post-op RNY drinks > 3c > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > supplement per day?> > Thanks,> > > >> Everyone is raving about the all-new beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2006 Report Share Posted November 9, 2006 First, the calcium and protein in milk is malabsorbed in RNY pts. Second, if RNY pts. are advised to restrict sugar (natural or otherwise) to <10g per meal, milk products may not be the best choice to get the protein and calcium they need. Regarding Carnation Instant Breakfast, the label tells the story. When it's made as instructed on the package, a serving of the Carb Conscious Rich Milk Chocolate flavor has 150 calories, ONLY 12 g of protein, but TWICE that many grams of carbs, of which 7 g are lactose. By comparison, one scoop of the Pure Whey Stack protein powder, Chocolate flavor, is 130 calories, 23 g of protein, 4 g of carbs, of which 2 are sugars. If an RNY pt. uses 1.5 scoops per serving, they get approximately 30 g of protein, which is generally accepted as the maximum amount they can absorb at one time. This comparison does not even address the bioavailability of the protein. Predigested whey-based protein is much more readily absorbed than the form found in Carnation Instant Breakfast. And yes, some RNY pts. do dump after consuming milk. I'm one of them who had no problem pre-op. Low-glycemic fruits should be included. Ava Lap RNY 4/21/04 The Ohio State Univ. Medical Ctr. > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > that > > > include high Ca foods or just supplements? If a post-op RNY > drinks > > 3c > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > supplement per day? > > > Thanks, > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2006 Report Share Posted November 9, 2006 But the protein powder doesn't provide potassium and calcium. Carnation provides additional multivitamins. Are you saying that bariatric patients should get protein only from whey protein supplement for the rest of their life? How does Calcium is absorbed from supplements not from the milk? I don't understand how can you dump (hypoglycemia)after drinking milk which contains almost 10 g protein? It doesn't fit the definition of the dumping. Did you had the symptoms of the dumping syndrome the same as after eating concentrated sweets? It is suprising that you would dump after drinking CHO + CARB, but you don't have dumping after eating fruits-sugar only? Or maybe you just had dairy intolerance? How do you meet min 100 CHO a day? Are you a Registered Dietitian? Thank you! -- In , " Ava " <marchjo@...> wrote: > > First, the calcium and protein in milk is malabsorbed in RNY pts. > > Second, if RNY pts. are advised to restrict sugar (natural or > otherwise) to <10g per meal, milk products may not be the best choice > to get the protein and calcium they need. > > Regarding Carnation Instant Breakfast, the label tells the story. When > it's made as instructed on the package, a serving of the Carb > Conscious Rich Milk Chocolate flavor has 150 calories, ONLY 12 > g of protein, but TWICE that many grams of carbs, of which 7 g are > lactose. > > By comparison, one scoop of the Pure Whey Stack protein powder, > Chocolate flavor, is 130 calories, 23 g of protein, 4 g of carbs, of > which 2 are sugars. If an RNY pt. uses 1.5 scoops per serving, they > get approximately 30 g of protein, which is generally accepted as > the maximum amount they can absorb at one time. > > This comparison does not even address the bioavailability of the > protein. Predigested whey-based protein is much more readily absorbed > than the form found in Carnation Instant Breakfast. > > And yes, some RNY pts. do dump after consuming milk. I'm one of them > who had no problem pre-op. > > Low-glycemic fruits should be included. > > Ava > Lap RNY 4/21/04 > The Ohio State Univ. Medical Ctr. > > > > > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > > that > > > > include high Ca foods or just supplements? If a post-op RNY > > drinks > > > 3c > > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > > supplement per day? > > > > Thanks, > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 Is there any research that states Ca and protein from milk is malabsorbed? Some of my pt's can only tolerate milk proteins early post-op. I don't want to cause malnutrition by giving the wrong advice. RD Re: Calcium First, the calcium and protein in milk is malabsorbed in RNY pts. Second, if RNY pts. are advised to restrict sugar (natural or otherwise) to <10g per meal, milk products may not be the best choice to get the protein and calcium they need. Regarding Carnation Instant Breakfast, the label tells the story. When it's made as instructed on the package, a serving of the Carb Conscious Rich Milk Chocolate flavor has 150 calories, ONLY 12 g of protein, but TWICE that many grams of carbs, of which 7 g are lactose. By comparison, one scoop of the Pure Whey Stack protein powder, Chocolate flavor, is 130 calories, 23 g of protein, 4 g of carbs, of which 2 are sugars. If an RNY pt. uses 1.5 scoops per serving, they get approximately 30 g of protein, which is generally accepted as the maximum amount they can absorb at one time. This comparison does not even address the bioavailability of the protein. Predigested whey-based protein is much more readily absorbed than the form found in Carnation Instant Breakfast. And yes, some RNY pts. do dump after consuming milk. I'm one of them who had no problem pre-op. Low-glycemic fruits should be included. Ava Lap RNY 4/21/04 The Ohio State Univ. Medical Ctr. > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > that > > > include high Ca foods or just supplements? If a post-op RNY > drinks > > 3c > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > supplement per day? > > > Thanks, > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 , You are not giving wrong advice. Drinking milk is totally appropriate for protein, as is eating yogurt and cheese. I encourage patients to drink Carnation or Glucerna because it's a complete supplement where so many of the protein drinks or powders are only protein and nothing else. I suggest they add whey/soy powder or non-fat dry milk to get in extra protein. Griehs, MS, RD, LDN Clinical Dietitian Specialist Bariatric Surgery Program Hospital of the University of Pennsylvania Phone: 215-614-0993 Fax: 215-662-3148 E-mail: rachel.griehs@... From: [mailto: ] On Behalf Of Sent: Friday, November 10, 2006 8:46 AM Subject: RE: Re: Calcium Is there any research that states Ca and protein from milk ismalabsorbed? Some of my pt's can only tolerate milk proteins earlypost-op. I don't want to cause malnutrition by giving the wrong advice. RD -----Original Message-----From: [mailto: ] On Behalf Of AvaSent: Thursday, November 09, 2006 10:42 PM Subject: Re: CalciumFirst, the calcium and protein in milk is malabsorbed in RNY pts. Second, if RNY pts. are advised to restrict sugar (natural orotherwise) to <10g per meal, milk products may not be the best choice toget the protein and calcium they need.Regarding Carnation Instant Breakfast, the label tells the story. Whenit's made as instructed on the package, a serving of the Carb ConsciousRich Milk Chocolate flavor has 150 calories, ONLY 12 g of protein, butTWICE that many grams of carbs, of which 7 g are lactose.By comparison, one scoop of the Pure Whey Stack protein powder,Chocolate flavor, is 130 calories, 23 g of protein, 4 g of carbs, ofwhich 2 are sugars. If an RNY pt. uses 1.5 scoops per serving, they getapproximately 30 g of protein, which is generally accepted as themaximum amount they can absorb at one time.This comparison does not even address the bioavailability of theprotein. Predigested whey-based protein is much more readily absorbedthan the form found in Carnation Instant Breakfast.And yes, some RNY pts. do dump after consuming milk. I'm one of them whohad no problem pre-op.Low-glycemic fruits should be included.AvaLap RNY 4/21/04The Ohio State Univ. Medical Ctr.> > >> > > 1500mg Ca citrate/day is what we are recommending, right? Does> > that> > > include high Ca foods or just supplements? If a post-op RNY> drinks> > 3c> > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > supplement per day?> > > Thanks,> > > > > >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 When patients do not tolerate milk they develop a lactose intolerance due to decrease of lastase enzyme to help with the digestion process (this displays what majority of humans develop as they get older since humans are the only species who can tolerate milk). They experience gas, cramping, bloating, and diarrhea. The symptoms with lactose intolerance are closely related to dumping syndrome but they are DIFFERENT. Dumping syndrome is due to the high intake of concentrated sweets or fats or sugar alcohol secondary to a change in osmality of the environment in the stomach and digestive tract which creates this negative side effects when consumed in large doses (as seen in a Billroth II). Only ~50% of my patients will experience this these side effects with these poor food choices but not all will and can lead to going back to old eating habits and weight regain. Many patients mistake dumping syndrome for a lactose intolerance.Do you have any studies showing calcium and protein in milk are 100% malabsorbed? I've work with bariatric surgery for >5 years now and never heard of this theory. Re: Calcium First, the calcium and protein in milk is malabsorbed in RNY pts. Second, if RNY pts. are advised to restrict sugar (natural or otherwise) to <10g per meal, milk products may not be the best choice to get the protein and calcium they need. Regarding Carnation Instant Breakfast, the label tells the story. When it's made as instructed on the package, a serving of the Carb Conscious Rich Milk Chocolate flavor has 150 calories, ONLY 12 g of protein, but TWICE that many grams of carbs, of which 7 g are lactose. By comparison, one scoop of the Pure Whey Stack protein powder, Chocolate flavor, is 130 calories, 23 g of protein, 4 g of carbs, of which 2 are sugars. If an RNY pt. uses 1.5 scoops per serving, they get approximately 30 g of protein, which is generally accepted as the maximum amount they can absorb at one time. This comparison does not even address the bioavailability of the protein. Predigested whey-based protein is much more readily absorbed than the form found in Carnation Instant Breakfast. And yes, some RNY pts. do dump after consuming milk. I'm one of them who had no problem pre-op. Low-glycemic fruits should be included. Ava Lap RNY 4/21/04 The Ohio State Univ. Medical Ctr. > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > that > > > include high Ca foods or just supplements? If a post-op RNY > drinks > > 3c > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > supplement per day? > > > Thanks, > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 RNY pts. malabsorb Ca and protein not just from milk but from most foods. You'll find this discussed in hundreds of journal articles. See, for example: , A.D. and , K.M. (2006). Medication and nutrient administration considerations after bariatric surgery. Am J Health-Syst Pharm, Vol 63. The reason we advise " limiting " milk is due to its sugar content and form of protein (not as bioavailable). Ava > > > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > > that > > > > include high Ca foods or just supplements? If a post-op RNY > > drinks > > > 3c > > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > > supplement per day? > > > > Thanks, > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 Since when is milk's protein not as bioavailable? Casein and whey?Ava <marchjo@...> wrote: RNY pts. malabsorb Ca and protein not just from milk but from mostfoods. You'll find this discussed in hundreds of journal articles.See, for example: , A.D. and , K.M. (2006). Medication and nutrientadministration considerations after bariatric surgery. Am JHealth-Syst Pharm, Vol 63.The reason we advise "limiting" milk is due to its sugar content andform of protein (not as bioavailable). Ava> > > >> > > > 1500mg Ca citrate/day is what we are recommending, right? Does> > > that> > > > include high Ca foods or just supplements? If a post-op RNY> > drinks> > > 3c> > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > > supplement per day?> > > > Thanks,> > > > > > > >> > >> >> > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 Protein from *all* sources, including milk, is malabsorbed following RNY, DS, and BPD (see below). That's why I prefer to recommend a more bioavailable form of protein (*predigested* whey) with less SUGAR, but all bariatric practices have their own preferences. This is from an NPR broadcast on July 29, 2006, which featured Dr. Ernsberger, Assoc Prof of Nutrition, Case Western Medical School and Dr. Flum and Dr. Marc Bessler, two WLS surgeons: Dr. Ernsberger: " . . . we have to look into the biology of the digestive process. So food, as you know, comes down the esophagus and enters into the stomach. There in the stomach, many important things happen. First of all, it's very acidic. It's as acid as battery acid. This is important for a number of reasons. One, it kills all of the germs and viruses that come in. It dissolves the minerals so that they can be absorbed. And the process of protein digestion starts. Also, the stomach is in constant chemical communication with the rest of the GI tract, and the very precise increments of food are let out of the stomach into the initial portion of the small intestine, where most of the vital nutrients are absorbed. " Now what happens after a gastric bypass? Food now goes from the esophagus through a very tiny, golf-ball-sized portion of the stomach. It's not acidified. There's no protein digestion. Instead of staying in the stomach for half an hour to four hours, it stays in for seconds. " And now, instead of going to the initial part of the small intestine, the duodenum, it goes deep into the intestine, past the point where many of the important vitamins and minerals are absorbed. So there's a great diminution in the absorption of protein, calcium, magnesium, iron and the B vitamins. " --------------------------- See also: Obes Surg. 2005; 15(2):145-54 (ISSN: 0960-8923) Nutritional deficiencies following bariatric surgery: what have we learned? Bloomberg RD ; Fleishman A ; Nalle JE ; Herron DM ; Kini S Deficiencies in vitamins and other nutrients are common following the Roux-en-Y gastric bypass (RYGBP), biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPDDS), and may become clinically significant if not recognized and treated with supplementation. This paper presents a review of the current literature and evidence of the most commonly deficient vitamins and minerals following weight loss surgery, including protein, iron, vitamin B12, folate, calcium, the fat-soluble vitamins (A, D, E, K), and other micronutrients. The deficiencies appear to be more substantial following malabsorptive procedures such as BPD, but occur with restrictive procedures as well. The review suggests that further studies are needed to evaluate the clinical significance of the nutritional deficiencies, and to determine guidelines for supplementation. Am J Med Sci. 2006 Apr;331(4):219-25. Nutritional and metabolic complications of bariatric surgery. Malinowski SS. Bariatric surgery is an effective treatment for patients with clinically severe obesity. In addition to significant weight loss, it is also associated with improvements in comorbidities. Unfortunately, bariatric surgery also has the potential to cause a variety of nutritional and metabolic complications. These complications are mostly due to the extensive surgically induced anatomical changes incurred by the patient's gastrointestinal tract, particularly with roux-en-Y gastric bypass and biliopancreatic diversion. Complications associated with vertical banded gastroplasty are mostly due to decreased intake amounts of specific nutrients. Macronutrient deficiencies can include severe protein- calorie malnutrition and fat malabsorption. The most common micronutrient deficiencies are of vitamin B12, iron, calcium, and vitamin D. Other micronutrient deficiencies that can lead to serious complications include thiamine, folate, and the fat-soluble vitamins. Counseling, monitoring, and nutrient and mineral supplementation are essential for the treatment and prevention of nutritional and metabolic complications after bariatric surgery. > > Since when is milk's protein not as bioavailable? Casein and whey? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 Beth, I'm not aware of ANY foods or vites that are 100% malabsorbed, and I've never made that statement. Please reread my original post below. What I HAVE said is that the protein and calcium in milk is malabsorbed (i.e., not fully absorbed), just as protein and calcium and iron, etc., are malabsorbed in ALL foods following RNY. Because milk contains 12 g or sugar per cup, and because the calcium and protein are malabsorbed, we feel there are better choices for protein and calcium intake. So we advise pts. to restrict--not completely avoid--milk intake. > > > > > > > > > > 1500mg Ca citrate/day is what we are recommending, right? Does > > > > that > > > > > include high Ca foods or just supplements? If a post-op RNY > > > drinks > > > > 3c > > > > > skim milk per day (900mg Ca)would they get by with adding 1 Ca > > > > > supplement per day? > > > > > Thanks, > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > <!-- > > #ygrp-mlmsg {font-size:13px;font-family:arial,helvetica,clean,sans-serif;} > #ygrp-mlmsg table {font-size:inherit;font:100%;} > #ygrp-mlmsg select, input, textarea {font:99% arial,helvetica,clean,sans-serif;} > #ygrp-mlmsg pre, code {font:115% monospace;} > #ygrp-mlmsg * {line-height:1.22em;} > #ygrp-text{ > font-family:Georgia; > } > #ygrp-text p{ > margin:0 0 1em 0; > } > #ygrp-tpmsgs{ > font-family:Arial; > clear:both; > } > #ygrp-vitnav{ > padding-top:10px; > font-family:Verdana; > font-size:77%; > margin:0; > } > #ygrp-vitnav a{ > padding:0 1px; > } > #ygrp-actbar{ > clear:both; > margin:25px 0; > white-space:nowrap; > color:#666; > text-align:right; > } > #ygrp-actbar .left{ > float:left; > white-space:nowrap; > } > .bld{font-weight:bold;} > #ygrp-grft{ > font-family:Verdana; > font-size:77%; > padding:15px 0; > } > #ygrp-ft{ > font-family:verdana; > font-size:77%; > border-top:1px solid #666; > padding:5px 0; > } > #ygrp-mlmsg #logo{ > padding-bottom:10px; > } > > #ygrp-vital{ > background-color:#e0ecee; > margin-bottom:20px; > padding:2px 0 8px 8px; > } > #ygrp-vital #vithd{ > font-size:77%; > font-family:Verdana; > font-weight:bold; > color:#333; > text-transform:uppercase; > } > #ygrp-vital ul{ > padding:0; > margin:2px 0; > } > #ygrp-vital ul li{ > list-style-type:none; > clear:both; > border:1px solid #e0ecee; > } > #ygrp-vital ul li .ct{ > font-weight:bold; > color:#ff7900; > float:right; > width:2em; > text-align:right; > padding-right:.5em; > } > #ygrp-vital ul li .cat{ > font-weight:bold; > } > #ygrp-vital a { > text-decoration:none; > } > > #ygrp-vital a:hover{ > text-decoration:underline; > } > > #ygrp-sponsor #hd{ > color:#999; > font-size:77%; > } > #ygrp-sponsor #ov{ > padding:6px 13px; > background-color:#e0ecee; > margin-bottom:20px; > } > #ygrp-sponsor #ov ul{ > padding:0 0 0 8px; > margin:0; > } > #ygrp-sponsor #ov li{ > list-style-type:square; > padding:6px 0; > font-size:77%; > } > #ygrp-sponsor #ov li a{ > text-decoration:none; > font-size:130%; > } > #ygrp-sponsor #nc { > background-color:#eee; > margin-bottom:20px; > padding:0 8px; > } > #ygrp-sponsor .ad{ > padding:8px 0; > } > #ygrp-sponsor .ad #hd1{ > font-family:Arial; > font-weight:bold; > color:#628c2a; > font-size:100%; > line-height:122%; > } > #ygrp-sponsor .ad a{ > text-decoration:none; > } > #ygrp-sponsor .ad a:hover{ > text-decoration:underline; > } > #ygrp-sponsor .ad p{ > margin:0; > } > o {font-size:0;} > .MsoNormal { > margin:0 0 0 0; > } > #ygrp-text tt{ > font-size:120%; > } > blockquote{margin:0 0 0 4px;} > .replbq {margin:4;} > --> > Quote Link to comment Share on other sites More sharing options...
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