Role of a dietitian/ nutritionist in bariatric surgery set up

In Indian set up a dietitian is a person who advice no to many foods, particularly to the tasty foods which we enjoy in day today life and instead she stresses you to take only leaves and vegetables. She is very strict and never gives option to any indulging foods from the client’s aspect. Right? But, basically dietitian academic courses go in depth about the science behind the food and she learns all those basics and become an expert in her particular specialty after so many years as general dietitian. She knows what is good and bad for particular problem and she prescribes foods based on the clinical need of anyone.

In any bariatric set up, the success of the surgery starts preoperatively based the motivation and knowledge of the patient. As soon as the client walks in they meet the clinical and nutrition manager, who is in many bariatric set ups a dietitian starts with introduction, collection of history particularly the client’s food habits, medical condition, personal habits, likes and dislikes, sharing their issues with obesity in the family, friends and society. She tries to understand about the patient empathetically as she put herself in patient’s shoes and feels the same way as the patient feels. When this rapport is started, the patient is more transparent and flows like water without any inhibition about exploring themselves which is very much needed for any kind of therapy including surgery for both short term and long term benefits. In any bariatric set up a dietitian plays her multi-dimensional role connecting with the whole team which involves around the patient.

Any dietitian guides not only about diet but also your exercise habits, personal lifestyle changes, your stress, your sleep, your worries, your emotional eating habits, your favorite pass times, your friends, your pull downs etc. you can freely discuss with her and the burden to her and she will not judge you based on none of these. She can be your consoler and the scientific person at the same time throughout your bariatric lifetime journey.

Trust a dietitian/nutritionist  in the bariatric set up and she will take you to reach your  target weight loss goals by answering all your questions by getting solution in various ways from the surgeon to the nursing assistant to make you smile and lose weight by helping your day today problems regarding your life style and small physical complaints.

She functions very well with the surgeon and the whole team to find out the quest in bariatric nutrition in coming years.

Voice of an Accredited Dietitian

Cooking is an art the special feeling towards food is universal. We respond well to a good meal with a delight and our memories are still fresh about the food what our grandmother has given us when we were kids. 

In those days food is the medicine and medicine is the food but in this fast world everything has got changed and food is not an exemption to put our world in great distress. We go for easy cure which medicines does which is temporary instead if we change our lifestyle then permanent cure will be there for most of our illness.

I always think food can be used as an alternative for most the ailments since my school days where I understood biology is my sole interest during my high school and wonders about our food remedies as medicines for most of the ailments. Since childhood I am a healthy person and I have not taken any medicines from a doctor and always scared of injections and tablets and refuse to visit our family doctor with the agreement of no injection and tablet apart from syrups. Simultaneously I go for Holi basil (Thusli) and sweet basil  (thiruneetru pachai) for nose congestion and enjoyed the positive changes that makes inside my body. 

When I was in my higher secondary education I was not fancy about medicine as I am always scared about blood and allied health was my natural choice . I thought if I select physiotherapy I should treat patients physically and I denied; If I select biochemistry I have to deal with samples and I denied that too. If I select diet and nutrition there would be some distance and I should use my mouth with utmost care and can heal the patients and I decided dietetics is my favorite and ultimate destiny in my profession even though I was quite interested in psychology though.

My father advised me to get statistics so that I can settle in abroad with better life style and no need to fight for my increments and to fight with people who does not have proper education but are very well experienced in what they do. He was a great visionary of my future at my age of 17 and I truly miss him in my life decisions. I put application to nutrition, psychology and statistics and received invitation from all of these courses. My father said only my decision is final and I selected nutrition and dietetics course. 

While I started my dietetics course one of our relatives asked my father as why did you put her in a cooking course?  She can study that at home itself?? And my father explained  him dietetics is not only food but it teaches the way how to use the food in a wise way in our lives and my daughter decided to change people’s life in her perspective. I have done my bachelors in nutrition, FSM and dietetics and masters with the encouragement from my mother. When I was advised by my guide and head of the department to start my career as a tutor I denied that and with thousands of dream started my profession as a dietitian. 

The role of a dietitian has come a long way ever since early 1900s unfortunately our role is still unfamiliar to many though. We are the connection between the patient and the medical team or a doctor in assisting on complicating decisions making about nutrition care. For many years and to some extent even now there is no awareness about the importance of a dietitian in our country which should be amended.

The importance of a dietitian starts from home and extends to the society. Nature has gifted us with numerous food resources and we have to use them in the right way. When this changes, disorders and diseases occurs where a dietitian’s role comes. Dietitians help to change one’s food habits which are not suitable for their health and directing towards the betterment.

Dietitians more importantly play the disease prevention role which requires discipline, exercise and more effort in the kitchen.  If everyone gets access to a dietitian it saves our economy in the sense, the overall costs we spend on tax, medicines, surgery etc. to manage the diseases like diabetes and heart diseases especially coronary heart disease which are as a result of poor eating choices over many years.

In my words, medicine should be used as complementary but I do agree as only the medical world is saving our dear and near ones in critical condition and I would like to say, if we set the base in the appropriate way through lifestyle mostly through food since childhood most of the health issues will be gone in no time. 

At this point, I would like to stress at this point that to select an appropriate dietitian who has done their proper education and not to go with any certification done and so called nutritionist or a dietitian in this world for the sake of your betterment. 

So I would say, each one of us should be aware of the importance of an Accredited Dietitian and to approach them for the prevention and cure THROUGH FOOD mostly ……..and " not to the so called Dietitian"

Academic Credential , Certificate & License

Health Professionals Council, UK registered as a Dietitian

Was a very lengthy process and was very happy when I got this first registration done. 

Anti-Anemia Diet

What is anemia?

Anemia occurs when the body has less than the normal number of red blood cells in the blood or when the red blood cells in the blood do not have enough hemoglobin

Hemoglobin is a protein which gives the red color to the blood

Its main work is to carry oxygen from the lungs to all parts of the body. Without oxygen organs and tissues cannot work

What are the causes of anemia?

Anemia happens when,

The body loses too much blood (heavy periods, certain diseases and trauma) or

The body has problems making red blood cells or

Red blood cells break down or die faster than the body can replace them with new ones or

More than one of those problems happens at the same time

What are the types of anemia?

Iron deficiency anemia

Iron deficiency anemia is the most common type of anemia

This happens when enough iron is not in the body. Eating low iron foods can also cause iron deficiency anemia

To make hemoglobin the body needs iron. It can occur due to heavy and long periods, child birth, uterine fibroids, ulcers, colon polyps or colon cancer, regular use of aspiring and other drugs for pain, infections, severe injury and surgery

Some people have enough iron in the diet but due to absorption problems due to diseases such as crohn’s disease and celic diseases or because of diet. Also pregnancy can cause IDA

Vitamin deficiency anemia or megaloblastic anemia –

Indicates low levels of vitamin B12 or folate are the most common causes of this anemia

This happens due to lack of vitamin B12 in the body to make red blood cells to keep nervous system function normally

This can happen due to intestinal problems or poor absorption because of an autoimmune disorder

The symptoms are numbness in legs and feet, walking problems, memory loss, and problems in seeing

Folate deficiency anemia

Folate (folic acid) is also needed to make red blood cells. If enough folate is not consumed this anemia happens. It may also occur during the third trimester of pregnancy, when the body needs extra folate

Anemais caused by underlying diseases

Kidney diseases and dialysis, inherited blood disease – sickle cell anemia , thalassemiaa,and aplastic anemia

What are the symptoms of anemia?

Anemia takes some time to develop. In the beginning there may not be any signs or they may be mild.

But as it gets worse the symptoms are fatigue, weakness (which are very common), dizziness, headache, numbness or coldness in hands and feet, low body temperature, pale skin, rapid or irregular heartbeat, shortness of breath, chest pain, irritability and not doing well in general.

All these symptoms can occur because the heart has to work harder to pump more oxygen-rich blood through the body

What is the treatment of anemia?

Dietary changes and dietary supplements, medications, blood transfusion or surgery

What will happen if anemia goes untreated?

May be life threatening if not diagnosed and treated. It can harm the heart and lead to heart attack

How to prevent anemia?

Eat iron rich foods such as liver, legumes and beans, green leafy vegetables such as spinach, red meat (lean only), fish, dried fruits such as raisins, prunes, apricots, tofu

Eat and drink foods that help body to absorb iron like orange, limejuice, straw berries, broccoli or other citrus fruits and vegetables with vitamin C

Do not drink coffee and tea with meals which interferes with iron absorption

Calcium can hurt absorption of iron. If it is hard time getting enough iron makes sure to get the best way to get enough calcium as well

Make balanced food choices. Fad diets and dieting can lead to anemia

What are the food sources for anemia?

Sources of iron – meat(lean mutton and liver), poultry, fish, eggs, dairy products, , legumes like beans and soy beans,  spinach and green leafy vegetables or iron fortified cereals, dried fruit

Sources of folate - Folate is a B vitamin found in green leafy vegetables, citrus fruits and juices, bananas, dried beans and peas, legumes, and fortified cereals

Sources of vitamin B6 – meat (chicken, lamb, turkey and pork), fish, vegetables like spinach, bell peppers, yams, broccoli, green peas), peanuts, cashews, sunflower seeds, hazelnuts, chick peas, soybeans and other legumes

Sources of vitamin B12 – mutton and liver, fish, poultry, eggs, milk and other dairy products

Sources of vitamin C – citrus fruits like grapes and oranges and juices, red and green pepper, broccoli, melons and berries, musk melon, fresh tomatoes helps increase iron absorption

High Fibre Diet

                                            HIGH FIBRE DIET

What is fibre?

v  Fibre is the indigestible part of plant foods also known as roughage

v  It  eases bowel movements and to helps keep the digestive system healthy

What are the benefits of fibre?

v  Stabilizes blood sugar, Manages blood pressure, Lowers blood cholesterol

v  Increases the feeling of being full and aids in weight loss

v  Regulates bowel movement and reduces the risk of digestive and bowel diseases

v  Prevents heart diseases and weight gain

What are the types of fibre?

v  There are two types of fibre: soluble and insoluble

v  Both types of fibre are present in all plant foods, but rarely in equal proportions

v  Animal foods such as meats, fish, eggs and dairy products have no fibre

Soluble Fibre

v  Dissolves in water and form gel which slows down digestion. It delays emptying stomach and makes to feel full which helps in weight control

v  Soluble fibre helps soften the stools and make them easier to pass and to have a healthier colon by increasing the amount of healthy bacteria

v  Slows stomach emptying and have a beneficial effect on insulin sensitivity, which may help control  and prevent diabetes

v  Soluble fibre can also help lower LDL(bad) cholesterol by interfering with the absorption of dietary cholesterol

v  Food sources – Oat bran or oat meal, barley, rye, legumes like dried peas ,beans, soybeans, chick peas, black eyed peas, citrus fruits , apple, ripe banana, pears, plums, straw berries, avocado, cucumbers, celery, broccoli, root vegetables such as carrots, potatoes, sweet potatoes, almonds, flax seeds

Insoluble Fibre

v  They are gut-healthy fibre because  they have a laxative effect helps prevent constipation and other digestive disorders like diverticulosis and irritable bowel syndrome and colorectal cancer

v  Does not dissolves in water, so they pass through gut without being broken down and helps other foods move through the digestive system more easily

v  Food sources –Whole grains like whole wheat, brown rice, wheat and corn bran, maize, oats, all millets, cabbage, broccoli, onions, skin of tomato, carrots, green beans, dark leafy vegetables, grapes, unripe banana, fruits and root vegetable skins, nuts and seeds

Tips to increase fibre

v  Eat more whole fruits instead of fruit juice

v  Snack on raw vegetables and fruits and eat the skins and seeds of vegetables and fruits

v  Replace refined wheat flour (maida) products with whole grain products [ e.g parota Vs tenai dosai / varau idly (or) white rice Vs kuthiraivali rice)

v  Have a small handful of almonds or other nuts instead avoid potato chips, bakery products, sweets and  deep fried snacks

Note:

v  Increase the amount of fibre slowly and drink plenty of fluids to avoid discomfort and gas

v  Constipation can occur if insufficient fluid is consumed with a high fibre diet

Fibre content of some foods

Food	Fibre in gms/100gms
Kuthiraivali (Bainyard)  -raw	10.0
Varagu (Kodo Millet) - raw	9.0
Tenai (Foxtail Millet) - raw	8.0
Samai - raw	7.6
Oat meal - raw	7.0
Barley - raw	3.9
Ragi - raw	3.6
Organic hand pounded parboiled rice- raw	2.5
Whole wheat flour - raw	1.9
Pomegranate (medium)	11.3
Pears (medium)	5.5
Apple (medium)	4.4
Orange / Banana (medium)	3.1
Cooked channa (1/2 cup = 100 g)	7.6
Cooked peas (1/2 cup=100g)	4.4
Cooked cabbage (1 cup = 145g))	3.0
Cooked spinach ½ cup=100g)	2.5
Almonds (one ounce = 23 nuts)	3.5
Fenugreek seeds ( 1tbsp)	3.0
Pistachio nuts (one ounce = 49 nuts)	2.9
Flax seeds (1 tbsp)	1.9