Bellevue Bariatric

Program

February 2019

Lactose Intolerance and Sensitivity after

Bariatric Surgery by Kat Cozza , PA-C

Patients who have had bariatric surgery may experience a varie-

ty of gastrointestinal changes. In particular, some bariatric by-

pass patients may experience GI symptoms due to an intoler-

ance or sensitivity to lactose found in dairy products, such as

whey protein shakes, milk, cheese, and yogurt.

Symptoms of lactose intolerance can include:

abdominal pain

diarrhea

flatulence

bloating

The severity of symptoms differs, often depending on the

amount of lactase (lactose digestive enzyme) remaining in the

body and how much lactose has been consumed.

Dumping Syndrome vs. Lactose Intolerance

Dumping Syndrome is difference as it is a whole-body re-

sponse: rapid heart rate, sweating, nausea and then the diarrhea

& cramping occurs. The most common cause is eating or drink-

ing high sugar foods or beverages. Lactose intolerance symp-

toms show up in the lower GI system with bloating, cramping

and flatulence when certain dairy products are consumed.

Continued on page 2 & 3

February Issue:

Taming Your Tummy

Lactose Intolerance ………......1-3

Healthy Pizza ……..……….....4-5

Daily Vitamins …………….......6

Apps for Healthy Habits ……….6

Support Group locations……….7

Clinic contact Info ….....……....8

Bariatric Team …………......….8

Food for Thought:

Get out of bed

Workout

Improve everyday

Be kind to yourself

Explore new things

& just get out of bed.

2

What is Lactose?

Lactose is a natural sugar found in dairy products and digested in the small intestine by an enzyme called lactase.

When a person with a normal stomach eats or drinks dairy products the lactose accumulates in the stomach and is re-

leased slowly into the small intestine where the digestive enzyme lactase is located.

The stomach will release the lactose slowly into the intestine to allow enough transit time for lactase to do its digestive

work before it reaches the colon.

In the post gastric bypass population, the stomach has been modified and is much smaller which

allows milk and dairy products to transit quite rapidly into the small bowel.

The dairy can overwhelm the available lactase enzyme resulting in intolerance symptoms because

the undigested lactose reaches the colon before being fully digested. Similar symptoms can occur if

you have had a sleeve gastrectomy but not at as high of a frequency.

Are dairy products still an option after surgery?

It’s important to know the amount of lactose in the foods and beverages you are consuming to help

avoid developing GI symptoms. The table on the next page provides a few examples of foods containing lactose and

how much lactose is in these foods.

You may notice that you do not tolerate high lactose containing foods, but you do tolerate lower lactose containing

foods. Use your food records to track the foods that may be causing symptoms and reduce your intake to a level where

the symptoms resolve.

Another strategy is to eat and drink lactose containing foods slowly, choose thicker products such as yogurt or cheese

rather than liquid dairy products such as milk or dairy based protein shake.

• The transit time from pouch to intestine will be much slower.

• If you find you have symptoms with several dairy products you may be one of the estimated 30—50

million American adults who lack the lactase enzyme and have difficulty digesting lactose.

GI symptoms with dairy may have been present prior to surgery. If you had symptoms prior to surgery or find that

you are sensitive to several dairy products after surgery consider eating and drinking dairy alternative products such as

whey protein isolate, plant-based sources, lactaid or plant-based milk sources.

Regardless of dietary tolerance to dairy it’s important that all bariatric patients take a calcium supplement, if you are

unable to eat or drink any dairy products because of intolerance you may need a little extra calcium supplementation,

talk with your provider and dietitian before changing your vitamins.

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Amount of Lactose in Milk & Dairy Products

Lactose grams Milk & Other Dairy Products Quantity

20 Sweetened, condense milk ½ cup

12.5 Whole, 2%, 1%, skim, or chocolate milk 1 cup

12 Evaporated milk ½ cup

12 Yogurt, plain ¾ cup

10.8 Goat milk ½ cup

10 Buttermilk 1 cup

9 Ice milk, vanilla ½ cup

8 Kefir ¾ cup

5 - 6 Ice cream, vanilla ½ cup

3 Yogurt with probiotics ¾ cup

2 Cottage cheese, creamed ½ cup

2 Sherbet, orange ½ cup

1.5 Cream cheese & swiss cheese 1.5 oz

1.2 Bleu & Colby cheese 1.5 oz

1.1 Mozzarella cheese 1.5 oz

.9 Gouda cheese 1.5 oz

.8 Cheddar and processed cheese 1.5 oz

.6 Half & half cream & light cream 1 Tbsp.

.5 Sour cream 1 Tbsp.

.5 Dry curd cottage cheese ½ cup

.4 Whipping cream, unwhipped 1 Tbsp.

.2 Parmesan cheese, grated 1 Tbsp.

.2 Camembert or limburger cheese 1.5 oz.

.1 Lactaid milk 1 cup

Source: Manual of Dietetics, 6th Edition, American Dietetic Association and Dietitians of Canada, 2000.

The lactose content t may vary depending upon the brands and amounts of milk solids added.

2

February 9 National Pizza Day

Traditional pizza is not bariatric patient friendly but that doesn’t mean you

have to give up pizza forever. With a few substitutions, you can eat a pizza

that is healthy, easy on your new stomach and still delicious!

Chicken Pizza Crust

Ingredients

1 lb. ground chicken breast

3 oz shredded mozzarella cheese

2 large eggs

salt and pepper to taste

pinch of Italian seasoning (optional)

Directions:

1. Pre-heat the oven to 400F.

2. Line a sheet pan (18x13 in) with parchment paper.

3. Add the ground chicken, cheese, eggs, salt & pepper to a bowl. Mix thoroughly

with your hands.

4. Dump the mixture on parchment paper lined pan and spread into a pizza shape

about 1/2 inch thick.

5. Place the pizza crust and the parchment paper directly on the oven rack. Bake

for 20 minutes

6. Remove from the oven and add your favorite pizza toppings.

7. Bake for an additional 10 minutes.

8. Remove from the oven and cool slightly. Slice and serve.

Cauliflower Pizza Crust

Ingredients

1 head cauliflower, stem removed

2 eggs, lightly beaten

¼ cup shredded mozzarella

¼ cup grated Parmesan

½ tsp dried oregano

¼ teaspoon garlic powder

pinch salt or to taste

Directions

1. Preheat the oven to 400 degrees F. Line a baking sheet with parchment paper.

2. Cut cauliflower into small florets and Steam in a steamer basket and drain well.

3. Pulse in a food processor until fine. Let cool.

4. In a bowl, combine the cauliflower with the mozzarella, Parmesan, oregano,

salt, garlic powder and eggs. Transfer to the center of the baking sheet and

spread into a circle, resembling a pizza crust. Bake for 20 minutes.

3

Suggested Pizza Toppings

Sauces: tomato or low sugar BBQ sauce

Leaner meats: chicken sausage (sweet or hot Italian), grilled chicken, turkey bacon

bits, lean ground beef, Canadian bacon

Veggies: artichokes, arugula, basil, black or Greek olives, broccoli, cilantro, garlic,

green or red peppers, jalapenos, onions, pepper, mushrooms, pineapple, spinach,

tomatoes

Cheeses: asiago, bleu cheese, feta, goat, gorgonzola, mozzarella, parmesan, ricotta

Low Sugar BBQ Sauce Ingredients

1 Tbsp olive oil

1 large minced onion

2-3 cloves garlic, minced

2 beef bouillon cubes

½ cup hot water

3 (6 ounce) cans tomato paste

1 cup granular sucralose sweetener (i.e. Splenda®)

¾ cup Worcestershire sauce

¾ cup Dijon mustard

3 Tbsp hickory-flavored liquid smoke

1 tsp salt

1/3 cup cider vinegar

Hot pepper sauce to taste

Directions

1. Heat the oil in a large saucepan over medium heat, and cook and stir until the onion is translu-

cent, about 5 minutes.

2. Add water and beef bouillon cubes into saucepan and stir to dissolve the cubes.

3. Mix in the tomato paste, sucralose sweetener, Worcestershire sauce, Dijon mustard, liquid

smoke flavoring, salt, cider vinegar, and hot pepper sauce.

4. Stir until the sweetener has dissolved.

5. Bring the sauce to a simmer, reduce heat, and simmer until the flavors have blended, 25 to 30

minutes. Stir frequently. 6. For best flavor, cover and refrigerate overnight. Store in refrigerator up to 1 week.

Daily Vitamins for the Bariatric Patient

You need to take these vitamins DAILY and for the REST OF YOUR LIFE.

• Bellevue Pharmacy is now carrying Bariatric Advantage & Celebrate Vitamins.

• Buy them at your convenience after the Bariatric Education class or your follow up visits!

• They’re also available online.

• Bariatric Advantage has a special offer for Kaiser patients. Receive Kaiser member pricing of roughly 20% discount & free shipping with validation code: KAISER.

• For a full list of our recommended vitamins: https://wa.kaiserpermanente.org/static/pdf/public/bariatric/meds.pdf

For more information on brand recommendations, please refer to the Bariatric Vitamins: Recommended Brands & Daily Requirements Handouts

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Gastric Bypass (RNY) & Sleeve Gastrectomy

Vitamins & Supplements Servings per Day*

Bariatric formulated multivitamin-mineral with

18 - 60 mg iron and 500 mcg Vitamin B12 1 serving

Vitamin B complex (with 50 mg thiamin) 1 serving

Calcium Citrate with Vitamin D3

(total 1200 - 1500 mg daily)

2 servings of 600 mg per serving

3 servings of 400 or 500 mg per serving

Probiotic 1 serving

*Serving sizes vary with different brands, READ THE LABEL

Apps for Healthy Habits

• Baritastic

• Waterlogged

• Fooducate • My Diet Coach • Happy Scale • Watch Me Eat

Bariatric Support Group Locations

Bellevue

Kaiser Permanente Bellevue Medical Clinic, Room E101/105

Held quarterly, the 3rd Wednesday of the month

January, April, July & October, 6:00 - 8:00 pm

March 20th at 6:00 pm

Please call 425-502-3454 for more information.

Overlake Bariatric Support Group

Held twice monthly: 2nd Thursday; 6:00 - 8:00 pm and 4th Saturday; 10:00 - 12:00 pm

Overlake Medical Center - PACCAR Education Center

Insight Conference Room

1035 116th Ave. NE, Bellevue, WA 98004

Please call (425) 467-3957 for more information.

Tacoma

MultiCare Center for Weight Loss and Wellness in Tacoma

Held on the 4th Monday of every month, 5:30 - 6:30 pm

2202 S Cedar St. Suite 300 Tacoma WA 98405

Please call (253) 301-5280 for more information.

Sumner (led by MultiCare Center WLW staff)

YMCA in Sumner

Held on the 2nd Wednesday of every month, 5:30 - 6:30 pm

16101 64th St E Sumner WA 98390

Please call (253) 301-5280 for more information.

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Contact Us

Nurse: 425-502-3454

Listen to the Prompts.

Press 3.

Routine Appointments:

425-502-3454

Listen to the Prompts.

Press 1

Consulting Nurse:

1-800-297-6877

*Call the Consulting Nurse line if

after 4:00 and weekends, with any

symptoms/concerns.

Bariatric Team Email:

bariatricpatients@kp.org

*For specific questions regarding your health, please email us through Kaiser’s MyChart to ensure privacy.

Bariatric Team

Bariatric Surgeon:

• Dr. Gupta MD, FRCSC,FACS,FASMBS

Diplomate, American Board of Surgery

Diplomate, American Board of Obesity Medicine

Kaiser Permanente Bellevue Bariatric

Program Director

Bariatric PAs:

• Kat Cozza, PA-C

• Lynda Crescenzi, PA-C

• Travis Sears, PA-C

• Heather Vincent, PA-C

• William Young, PA-C

Bariatric Nurse Practitioner :

• Lori Gokee, ARNP

Bariatric Nurse:

• Sarah Chan, BSN, RN

• Elizabeth Puckett, RN

Bariatric Dietitian:

• Lisa Stariha, RDN

Medical Assistant:

• Karen Kucera, MA-C

Clinical Operation Manager:

• Liam Malpass, RN

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We want to hear from YOU!

• What do you want included in the monthly newsletter?

• Send us your ideas to:

bariatricpatients@kp.org