Education

Spatz Adjustable Gastric Balloon

The Spatz 3 adjustable gastric balloon was approved by the FDA in the United States in 2021. It is indicated for patients with a body mass index (BMI) of 35-40, or a BMI of 30-35 with an obesity related medical issue. Spatz 3 has been available outside the US for some time, and over 100,000 have been implanted.

What makes the Spatz unique is that it is the only adjustable balloon system. This is important for several reasons:

One of the most common complications for traditional saline-filled balloons is balloon interolerance. This means that a small percentage of patients will not tolerate their balloon and will have ongoing issues with vomiting and discomfort. In the past, if these issues persisted beyond a week or so then the balloon was typically removed early. With the Spatz however, some saline can be removed from the balloon which will usually cause these issues to resolve without balloon removal. This does require a repeat endoscopy, however.
Another issue with saline balloons in the past is that some patients will only lose weight for the first few months. These patients will either have a weight loss plateau or even weight gain. If this occurs with a Spatz, some additional saline can be added to the balloon which will usually lead to additional weight loss. This also requires a repeat endoscopy.

An additional benefit of the Spatz is that it can be left in the stomach for 8 months, as opposed to a maximum of 6 months for other saline gastric balloons that have been approved in the US.

These advantages have resulted in significantly better weight loss and long-term success for the Spatz balloon in their FDA trial than for any other gastric balloon, whether saline or gas-filled.

As can be seen in the above table comparing all gastric balloons with which we have experience, the Spatz has not only the best weight loss, but also the highest success rate.

Currently, only patients who are able to participate in the Spatz FDA Post-approval Study can have one of these balloons implanted. Click here if you’re interested to find out if you may be eligible!

Weight Loss Surgery And Hair Loss

by DrCurry Leave a Comment

A frequent question we get from surgical patients is “Will I lose a lot of hair?” This is a common concern, as some patients have heard isolated reports that they will experience hair loss after bariatric surgery. Although it can occur after surgery, maximizing your protein intake and taking the appropriate supplements can minimize this issue.

When hair loss does occur after weight loss surgery, it is typically a result of the body experiencing some degree of malnutrition as well as a stress reaction. Rapid weight loss plus major surgery both put stress on the body, and obviously bariatric procedures limit food intake by design and if the patient isn’t eating right, mild malnutrition can occur.

Protein intake is our primary focus after surgery for many reasons. One such reason is that adequate intake of protein is the best way to avoid significant post-op hair loss. Vitamin supplementation is important as well, to ensure proper nutrition to support all of the body’s functions, including hair health.

Biotin supplementation stimulates the regrowth of hair in some individuals. However, biotin will not prevent the actual loss so patients will still experience hair falling out without overall adequate nutrition.

Keeping all of your follow up appointments is key to maintaining good health and minimizing issues such as hair loss. Our providers and Registered Dietitians will monitor nutritional intake as well as lab values. Our team uses that information to help us to tailor a supplementation regimen appropriate for each patient!

Nutrients to Help Minimize/Prevent Hair Loss and Promote Hair Regrowth

Maintaining an adequate daily amount of protein (>80-100 grams), hydrolyzed collagen (2.5-15 gms), and fluid (>80 oz) may promote optimal hair regrowth and minimize hair loss. In addition, there are many vitamins and minerals, when consumed in a routine diet or taken in a daily supplement, which may also promote hair regrowth and may help reduce hair loss. These include:

Vitamin E (15 mg) – can block the erosion of your scalp tissues

Zinc (8-11 mg) – helps promote hair tissue growth and repair

Magnesium (320-420 mg) – helps to release hair follicles clogged by calcium

Vitamin C (65-90 mg) – helps build collagen

Vitamin A (700-900 mcg) – moisturizes the scalp

Vitamin B5 (5 mg) – helps by strengthening and nourishing hair follicle to promote healthy hair growth

Vitamin B12 (2.8 mcg) – promotes healthy hair growth by assisting in the production of oxygen-rich red blood cells which feed hair follicles

Biotin (30 mcg) – stimulates keratin production in hair and can increase the rate of follicle growth

Iron (18 mg) – prevents iron deficiency, which can cause anemia (a major cause of hair loss)

Vitamin D (600 IU) – stimulates hair follicles to grow

Maintaining a diet rich in eggs, seafood, leafy green vegetables, fruits, grains, nuts and seeds, as well as taking a comprehensive multivitamin will promote the opportunity to provide the necessary vitamins and minerals as outlined.

Plenity Dosing For Surgical Weight Loss Patients

by DrCurry Leave a Comment

Plenity is a new weight loss treatment that expands after hydration to help patients feel full on smaller amounts of food. For more information on Plenity click here. Plenity has currently not been studied in surgical weight loss patients, however our practice has some experience with this and when closely supervised it can be done safely and effectively.

For patients with a normal stomach it is recommended to take 3 Plenity capsules, 20-30 minutes prior to lunch and dinner. For surgical weight loss patients however, it is very important if you are going to take Plenity to do it only under the supervision of your surgical weight loss team and to follow the dosing regimen outlined below.

For any patient who has had a gastric bypass, gastric band, gastric sleeve, SIPS, or gastric balloon, Plenity must be titrated. This means that you do not start off with the full 3 capsules. Rather, begin by just taking 1 capsule with 16 oz of a non-carbonated clear liquid 20-30 minutes prior to lunch or dinner. See how you feel with just 1 tablet. If you feel full on smaller portions, and have no symptoms of pain, bloating, or vomiting, then this will be your ongoing dosage moving forward.

If you feel minimal effect, as long as you have have no pain, bloating, or vomiting, then for your next meal you can try 2 tablets. Again, if you feel full on smaller portions and have no adverse symptoms, then this will be your ongoing dosage.

As before, if you feel minimal effect and have no adverse symptoms, you can try 3 capsules for your next meal.

Do not take more than 3 capsules at one dosing!

Importance of Post-op Labs!

by DrCurry Leave a Comment

With weight loss surgery it is important to follow the recommendations of your team and get your labs drawn promptly when ordered! If you are receiving this message, we have not yet received your lab results. If you have not gotten them drawn please do so as soon as possible! If you had them drawn, we have not received the results, so it would be helpful if you could contact the lab and ask them to fax them to us at 513-559-1235.

If you have any questions, please email our medical assistants at ma@curryweightloss.com, or call our office at 513-559-1222.

Sincerely,

JourneyLite Physicians

Mild Sleep Apnea and Weight Loss

by DrCurry Leave a Comment

Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important. The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.

In moderate or severe sleep apnea, the AHI is 15 or higher. These patients will need to be treated with CPAP or some other type of device prior to surgery. Patients who have an AHI of 10-15 have mild sleep apnea. Treatment in this range is based on the severity of symptoms. Weight loss is proven as an effective treatment for mild sleep apnea, therefore it is our protocol to not recommend a sleep appliance for patients with an AHI of 10-15 who are preparing to undergo weight loss surgery. If symptoms persist after losing weight, then a referral to a sleep specialist may be recommended.

If you are diagnosed with mild sleep apnea and end up not proceeding with a weight loss procedure, we recommend that you follow up with your primary care provider for further recommendations.

GERD After Weight Loss Surgery

by DrCurry Leave a Comment

By Dr. James Augusta

Gastroesophageal reflux disease (or GERD for short) is a common condition affecting overweight and obese patients. It is caused by irritation to the lining of the esophagus by gastric acid or bile. Many people have felt heartburn before, but GERD is a little different.

Symptoms can include:

Heartburn
Chest pain
Difficulty swallowing or food getting “stuck”
Cough
Pain felt behind your sternum or breast bone
Burning of the throat
Hot, sour or acidic taste in your mouth

These symptoms may be worsened by certain types of food, alcohol, smoking, or even bending over or lying flat particularly after eating a meal. Many factors are involved with severity of GERD including weight, and the presence of a hiatal hernia. A hiatal hernia is located where the esophagus crosses the diaphragm to enter the abdomen. When this opening becomes enlarged it distorts the normal anatomy and can lead to increased reflux symptoms. It can even cause some of the stomach to pull up into the chest.

In general, If hiatal hernias are moderate or large we will repair them during your weight loss surgery. If they are small sometimes they are best left alone as making the hiatus too tight can cause issues with swallowing meats and other hard foods.

The two most common options at JourneyLite for weight loss surgery include the gastric sleeve and the Roux-en-Y gastric bypass.

In our experience following a gastric sleeve procedure:

Roughly 1/3 of patients will develop GERD or their GERD symptoms will worsen.
Roughly 1/3 get better because:
- weight loss in general can improve GERD or
- the patient had a hiatal hernia that we fixed during the sleeve (see below).
1/3 have no change in their symptoms

In contrast, the gastric bypass is actually an increasingly-common surgical treatment for severe GERD. This is because we divert 80-90% of the acid production away from the esophagus with the creation of a small gastric pouch at the top of the stomach. If you do happen to develop severe GERD symptoms after a sleeve gastrectomy (and we are unable to control it with medications), we can convert this to a gastric bypass. In almost all cases this will resolve GERD symptoms, however this would require another surgical procedure and workup (including insurance approval if applicable).

Another condition known as bile reflux can also cause GERD after a gastric sleeve. This is a condition where bile (produced by the liver) comes backwards into the stomach and potentially up the esophagus causing reflux symptoms. Most patients with pre-existing bile reflux will have worsening symptoms after a sleeve. The gastric bypass is also a surgical cure for bile reflux.

For patients with GERD symptoms an EGD (esophagogastroduodenoscopy-an endoscopic camera down the esophagus and stomach) can help you and your surgeon confirm which procedure is best for you. During your consultation, discuss your symptoms and your surgeon can decide if an EGD is warranted. Additionally, if you have already had an EGD done you can request the records be sent to our office for your surgeon to review.

In summary, when considering which procedure is best for you, having a discussion with your surgeon about GERD symptoms is crucial to making the right choice. An EGD can be a good starting point for the surgeon to give recommendations about procedure selection. If you’ve had an EGD done before, you can request the records to be faxed to our office at 513-559-1235. This may save you time and help get your procedure completed sooner. Sometimes it simply comes down to a tradeoff between a gastric bypass with a lower risk of post-op GERD, or gastric sleeve with a higher risk of GERD but a much lower overall long-term risk.

Potassium

by DrCurry Leave a Comment

Potassium

Function: Promotes growth, maintains water balance, and helps regulate muscular activity.

Deficiency: Rare

Toxicity: Rarely occurs, except in kidney failure

Recommended Daily intake of Potassium is:

MEN AND WOMEN AGE 19+ YEARS = 4.7 GM/D

FOOD SOURCES	AMOUNT	# of MG

VEGETABLES
Swiss chard, boiled	1 cup	961
Lima beans, cooked	1 cup	955
Yam, cubed, cooked	1 cup	911
Winter squash, baked, cubed	1 cup	896
Spinach, boiled	1 cup	839
Crimini mushrooms, raw	5 oz-wt	635
Beets, boiled	1 cup	519
Potato, baked, with skin	1 cup	510
Broccoli, steamed	1 cup	505
Brussel sprouts, coiled	1 cup	495
Collard greens, boiled	1 cup	494
Green peas, boiled	1 cup	434
Tomato, ripe	1 cup	400
Carrots, raw	1 cup	394
Green beans, boiled	1 cup	374
Fennel, raw, sliced	1 cup	360
Summer squash, cooked, slices	1 cup	346
Celery, raw	1 cup	344
Romaine lettuce	2 cups	325
Sweet potato, with skin	1 each	306
Kale, boiled	1 cup	296
Turnip greens, cooked	1 cup	292
Asparagus, boiled	1 cup	288
Mustard greens, boiled	1 cup	282
Onions, raw	1 cup	251
Eggplant, cooked, cubes	1 cup	246
Cauliflower, boiled	1 cup	176
Bell peppers, red, raw, slices	1 cup	163
Cabbage, shredded, boiled	1 cup	146

FOOD SOURCES	AMOUNT	# of MG

NUTS/SEEDS/BEANS
Soybeans, cooked	1 cup	886
Pinto beans, cooked	1 cup	800
Lentils, cooked	1 cup	730
Kidney beans, cooked	1 cup	713
Split peas, cooked	1 cup	710

FOOD SOURCES	AMOUNT	# of MG

FRUITS
Avocado, slices	1 cup	875
Papaya	1 each	781
Figs, fresh	8 oz-wt	526
Cantaloupe, cubes	1 cup	494
Banana	1 each	467
Prunes	¼ cup	317
Kiwifruit	1 each	252
Strawberries	1 cup	239
Oranges	1 each	237
Watermelon, diced	1 cup	176
Grapes	1 cup	176
Grapefruit	½ each	159
Plum	1 each	114
Apricots	1 each	104

FOOD SOURCES	AMOUNT	# of MG

MEATS
Halibut, baked/broiled	4 oz-wt	653
Tuna, yellowfin, baked/broiled	4 oz-wt	645
Snapper, baked/broiled	4 oz-wt	592
Cod, baked/broiled	4 oz-wt	586
Scallops, baked/broiled	4 oz-wt	444

FOOD SOURCES	AMOUNT	# of MG

DAIRY PRODUCTS
Yogurt, low fat	1 cup	573
Goat’s milk	1 cup	499
Cow’s milk, 2%	1 cup	377

Calcium

by DrCurry Leave a Comment

Calcium

Function: Builds bone and teeth, needed for muscle contraction/relaxation, blood clotting, and normal heart rhythm.

Deficiency: Decreased growth, osteoporosis, and rickets.

Toxicity: Kidney stones and calcium deposits in soft tissues.

Recommended Daily intake of Calcium is:

MEN AND WOMEN: AGE 19-50 = 1000 MG/D – AGE 51+ = 1200 MG/D

FOOD SOURCES	AMOUNT	# of MG

DAIRY PRODUCTS
Ricotta Cheese, part skim	1 cup	669
Yogurt, nonfat plain	1 cup	452
Yogurt, low-fat plain	1 cup	415
Yogurt, low-fat with fruit	1 cup	313
Skim Milk	1 cup	303
Low-Fat milk/1% milk	1 cup	296
Buttermilk	1 cup	285
Soy milk	1 cup	284
Whole Milk	1 cup	291
Swiss Cheese	1 ounce	272
Cottage Cheese	1 cup	226
Cheddar Cheese	1 ounce	205
Ice Cream	1 cup	200
American Cheese	1 ounce	174
Ice Cream, soft serve	½ cup	137
Yogurt, frozen/plain	½ cup	89

PROTEIN FOODS	AMOUNT	# of MG
Tofu, with calcium sulfate	½ cup	434
Salmon, broiled/baked	3 ½ ounces	354
Sardines, canned w/bones	3 ounces	324
Quiche Lorraine	½ cup	211
Mackerel, canned w/bones	3 ounces	205
Salmon, canned w/bones	3 ounces	203
Tofu, no calcium sulfate	½ cup	130
Perch, baked	3 ounces	117
Shrimp, canned	3 ounces	98
Almonds	¼ cup	94
Soybean	½ cup	88
Chickpeas, cooked	1 cup	80
White beans	½ cup	65
Brazil Nuts	4 medium	28
Caviar	1 teaspoon	28
Sesame Seeds	2 ounces	68

VEGETABLES	AMOUNT	# of MG
Turnip greens, cooked	½ cup	184
Mustard greens, cooked	½ cup	183
Chinese cabbage, cooked	½ cup	158
Collard greens, cooked	½ cup	152
Kale, cooked	½ cup	134
Broccoli, cooked	½ cup	88
Okra, frozen, cooked	½ cup	88

FRUITS	AMOUNT	# of MG
Figs, dried	5 each	134
Rhubarb	3/8 cup	78
Prunes	4 large	57
Orange	1 each	52

Iron

by DrCurry Leave a Comment

Iron

Function: Carrier of oxygen and helps prevent anemia.

Deficiency: Anemia, fatigue, sore mouth/tongue, and weight loss.

Toxicity: Severe vomiting, diarrhea, abdominal pain

Recommended Daily intake of Iron is:

MEN AGE 19-70 = 8 MG/D

WOMEN:AGE 19-50 = 18 MG/D

AGE 50+ = 8 MG/D

FOOD SOURCES	AMOUNT	# of MG

DAIRY PRODUCTS
Eggs	2 each	2

PROTEIN FOODS
Clams, raw	3 ounces	12
Liver, beef	2 ounces	5
Sardines, canned	3 ounces	5
Beans, lima, dry/cooked	½ cup	3
Beef, variety	3 ounces	3
Pork, variety (not ham)	3 ounces	3
Turkey, variety	3 ounces	3
Dry beans, split peas	½ cup	2
Soybeans, boiled	½ cup	2
Black-eyed peas, boiled	½ cup	2
Chicken, variety (no skins)	3 ounces	1
Garbanzos beans, canned	½ cup	1
Peanut Butter	1 Tablespoon	1

BREADS/CEREALS
Bulgar flour	3 ounces	21
Wheat bran, crude	3 ounces	15
Bran flakes	¾ cup	8
Corn flakes, fortified	¾ cup	8
Cream of wheat	½ cup	8
Malt-o-meal	½ cup	8
All Bran	1/3 cup	5
Waffle	1 each	3
Corn tortilla	1 each	3
Corn meal, enriched	3 ounces	3
Bread, white	1 slice	2
Rice, white, enriched raw	1 cup	2
Rice, brown, cooked	1 cup	1
Oatmeal, cooked	¾ cup	1
Enriched bread	1 slice	1
Whole grain bread	1 slice	1

FOOD SOURCES	AMOUNT	# of MG

FRUITS
Peaches, dried	3 ounces	4
Prune juice	½ cup	2
Apricots	2 each	1
Prunes, dried	2 each	1

FOOD SOURCES	AMOUNT	# of MG

VEGETABLES
Spinach, boiled	½ cup	3
Potato, with skin	6 ½ ounces/1 medium	3
Avocado	1 medium	2
Leafy greens, raw	1 cup	2
Asparagus	¾ cup cooked	2
Leafy greens, raw	¾ cup	2

Vitamin B9 (Folic Acid)

by DrCurry Leave a Comment

Vitamin B-9 (Folic Acid)

Function: Part of blood cells, necessary for cell division, and important in increasing the number of blood cells.

Deficiency: The symptoms of Folic Acid deficiency include: oral lesions, swollen tongue, and anemia

Toxicity: Large doses of Folic Acid may damage the kidneys and may mask a B-12 deficiency.

Recommended Daily intake of Folic Acid is:

MEN AND WOMEN AGE 14+ YEARS = 400 MCG/D

FOOD SOURCES	AMOUNT	# of MCG

VEGETABLES
Asparagus, boiled	1 cup	263
Spinach, boiled	1 cup	262
Collard greens, boiled	1 cup	177
Turnip greens, boiled	1 cup	171
Lima beans, boiled	1 cup	156
Romaine lettuce	2 cup	152
Beets, boiled	1 cup	136
Split peas, cooked	1 cup	127
Mustard greens, boiled	1 cup	103
Green peas, boiled	1 cup	101
Broccoli, steamed	1 cup	94
Brussel Sprouts, boiled	1 cup	94
Corn, yellow, cooked	1 cup	76
Winter squash, baked, cubed	1 cup	57
Green beans, boiled	1 cup	42
Summer squash, cooked, slices	1 cup	36
Kelp (sea vegetable)	¼ cup	36
Celery, raw	1 cup	34
Onions, raw	1 cup	30
Cabbage, shredded, boiled	1 cup	30
Tomato, ripe	1 cup	27
Fennel, raw, sliced	1 cup	24
Bell peppers, red, raw, slices	1 cup	20
Crimini mushrooms, raw	5 oz-wt	20
Kale, boiled	1 cup	17
Carrots, raw	1 cup	17
Swiss chard, boiled	1 cup	15
Eggplant, cooked, cubed	1 cup	14
Cucumbers, slices, with peel	1 cup	14
Leeks, boiled	1 cup	13

FOOD SOURCES	AMOUNT	# of MCG

MEATS
Calves liver, braised	4 oz-wt	861

FOOD SOURCES	AMOUNT	# of MG

NUTS/SEEDS/BEANS/LENTILS
Lentils	1 cup	358
Pinto beans, cooked	1 cup	294
Garbanzo beans, cooked	1 cup	256
Black beans, cooked	1 cup	256
Navy beans, cooked	1 cup	254
Kidney beans, cooked	1 cup	229
Peanuts, raw	¼ cup	88
Sunflower seeds, raw	¼ cup	82

FOOD SOURCES	AMOUNT	# of IU

FRUITS
Papaya	1 each	116
Avocado, slices	1 cup	90
Oranges	1 each	40
Raspberries	1 cup	32
Cantaloupe, cubes	1 cup	27
Strawberries	1 cup	25
Grapefruit	½ each	15

Education

Potassium

Recommended Daily intake of Potassium is:

MEN AND WOMEN AGE 19+ YEARS = 4.7 GM/D

FOOD SOURCES

AMOUNT

VEGETABLES

FOOD SOURCES

AMOUNT

NUTS/SEEDS/BEANS

FOOD SOURCES

AMOUNT

FRUITS

FOOD SOURCES

AMOUNT

MEATS

FOOD SOURCES

AMOUNT

DAIRY PRODUCTS

Calcium

Recommended Daily intake of Calcium is:

MEN AND WOMEN: AGE 19-50 = 1000 MG/D – AGE 51+ = 1200 MG/D

FOOD SOURCES

AMOUNT

DAIRY PRODUCTS

PROTEIN FOODS

AMOUNT

VEGETABLES

AMOUNT

FRUITS

AMOUNT

Iron

Recommended Daily intake of Iron is:

MEN AGE 19-70 = 8 MG/D

FOOD SOURCES

AMOUNT

DAIRY PRODUCTS

PROTEIN FOODS

BREADS/CEREALS

FOOD SOURCES

AMOUNT

FRUITS

FOOD SOURCES

AMOUNT

VEGETABLES

Vitamin B-9 (Folic Acid)

Recommended Daily intake of Folic Acid is:

MEN AND WOMEN AGE 14+ YEARS = 400 MCG/D

FOOD SOURCES

AMOUNT

VEGETABLES

FOOD SOURCES

AMOUNT

MEATS

FOOD SOURCES

AMOUNT

NUTS/SEEDS/BEANS/LENTILS

FOOD SOURCES

AMOUNT

FRUITS