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Obesitycliniclondon.co.uk

DISCHARGE ADVICE FOLLOWING SLEEVE GASTRECTOMY
Lifestyle Measures after Bariatric Surgery:

We recommend the following general dietary advice – otherwise patients are likely to
regain weight:
1. Patients should restrict themselves to eating three small meals and take regular exercise of at least 30 minute sessions 3-4 times a week. 2. Patients should separate solids from liquids during their meals by at least half an 3. Patients should eat one small mouthful a minute and chew it well 4. Patients should eat 3 meals including breakfast a day - their meals should consist of a maximum of 20 to 30 mouthfuls and taken over 20 to 30 minutes at least. 5. Patients must avoid consuming high energy foods or drinks (like fast food, crisps, chocolate, fruit juice, fizzy drinks or alcohol). 6. Patients must stop eating as soon as they feel full and not eat if they are not 7. Patients may find it difficult to take tablets or capsules – hence it is advisable that all oral medications are dispersible, liquid or crushed. 8. Patients may find it difficult to swallow bread, meat or other stringy food. 9. I also recommend that you attend our Bariatric Support Group evenings in order to help you remember lifestyle changes required for long term weight control.
Nutritional Deficiency after Sleeve Gastrectomy:
Please note that laparoscopic sleeve gastrectomy patients are prone to nutrient
deficiency,
in particular to vitamin B12, Folic Acid, iron, calcium, vitamin B1 and
sometimes other micronutrients like zinc, magnesium, copper, selenium, vitamin C
etc.
Patients can suffer from neurological, immunological, cardiovascular and other
sequelae unless regular monitoring is performed and supplements prescribed. Hence, I
would strongly recommend that patients’ GP monitor their iron, calcium and vitamin
levels on a six-monthly basis.

Nutritional Supplements after Sleeve Gastrectomy:
There are 3 nutrients that are of particular concern following sleeve gastrectomy.
1. Absorption of iron is compromised by decreased food intake (especially red
meat) and lack of gastric acid. Menstruating women will be at higher in risk of deficiency. The incidence of deficiency is between 25-52%. It is recommended that a total of 50mg of elemental iron is taken a day. 2. The lack of gastric acid and the smaller food intake also compromises
absorption of calcium and vitamin D. The incidence of deficiency is between
10-50%. 1000-1500mg / day of calcium are required.
3. Vitamin B12 levels are also compromised due to decreased gastric acid, a lack
of intrinsic factor and decreased red meat intake. The incidence of deficiency is 37%. It is most efficiently used in the body if given intramuscularly. Therefore I would recommend that your GP prescribes the following products and monitors your blood levels: Calcium supplements- 1000mg calcium / day. Liquid or effervescent
tablets
Ferrous Sulphate/ ferrous fumarate or sodium feredetate – drops, syrup or
sugar free elixir. 50mg of iron/day
Hydroxocobalamin Vitamin B12 injections – 1mg every 3 months
Multivitamins containing the vitamins (A, D, E, K, B1, B2, B6) mentioned
previously – Forceval, Sanatogen gold, Centrum and Well Kid Chewable
contain these vitamins.


You can also find more information on my websites www.obesitycliniclondon.co.uk and
www.cebls.com.


Source: http://www.obesitycliniclondon.co.uk/pdf/bariatric-discharge-advice-following-sleeve-gastrectomy.pdf

Case study matrix3-pdf.xls

A-D Nutraceuticals -- Case Study Matrix Notes All patients entering therapy were diagnosed as terminal or at the end of Stage IV. Only patients surviving longer than ninety days from beginning of MSQ treatment have been included in the matrix. Virtually all patients had preexisting or extenuating conditions. Most were unable to continue with additional interventions due to:* Chemotherapy - t

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CONVENIO RELATIVO A LA OBLIGACIÓN DE DILIGENCIA POR PARTE DE LOS ESTABLECIMIENTOS BANCARIOS y DE AHORRO DE ANDORRA 9 DE ABRIL DE 1990 INTRODUCCIÓN, PREÁMBULO Los Bancos establecidos en el Principado de Andorra han adaptado hasta la fecha sus actividades a las normas habituales de la banca comercial, siguiendo los tradicionales usos y costumbres de los Bancos comerciales europeos. D

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