011 Jacqueline Jacques, ND Interview

by reeger on November 5, 2013

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Dr Jacqueline Jacques is a Naturopathic Doctor with more than 15 years of expertise in medical nutrition. She has spent much of her career in the dietary supplement industry as a formulator, speaker, writer and educator.  For most of the past 12 years she has been working in the area of obesity and bariatric surgery, and is considered to be an expert in the field. She is the author of a clinical guidebook called “Micronutrition for the Weight Loss Surgery Patient,” available through Matrix Medical Communications, which is often cited as “the Bible” on this topic. In addition, Dr Jacques serves on the boards of two non-profit organizations: the Obesity Action Coalition and the Samueli Center for Integrative Medicine at the University of California, Irvine. Professionally, she most enjoys anything that allows her to teach, create, and connect. Outside of her professional life, she is mom to two wonderful boys and makes her home by the beach in Southern California.

In this Interview Dr Jacques goes over important issues regarding vitamins and nutrition both pre- and post-WLS, including:

Why take vitamins? 

People, especially those who have had WLS, should take vitamins because vitamins keep people healthy. Most people who are candidates for WLS are at risk for nutritional deficiency, even before they have surgery. This is for a number of reasons including but not limited to: a life time of dieting, poor quality of foods consumed (calorie rich, nutritionally poor), natural aging processes, medications, diseases processes like diabetes, and extra adipose tissue all deplete a persons nutritional vitamin store.

The feel good phenomenon: When people feel good after surgery they can get tricked into thinking they dont need any medications, including vitamins, because they are not sick any longer. Their diseases associated with obesity are gone and they feel great. But taking vitamins is critical for reducing the risk of very real vitamin deficiencies after WLS. Dr Jacques recommends thinking of your vitamins as part of your wellness/diet plan that are needed forever after WLS.

How important is the quality of the vitamin consumed?

Quality is important regarding anything we put in our bodies. It is important to pay attention to quality and question the quality. Buy from trust worthy companies. Determining trust worthiness takes doing some homework.

How does one determine the quality of a vitamin?

One way to determine the quality is to ask your bariatric provider which companies they recommend. Another way to determine quality is to seek out companies that adhere to the U.S. Federal Drug Administrations (FDA) Good Manufacturing Practice (GMP) Guidelines. Companies that are selling over-the-counter (OTC) supplements must adhere to the GMP, to not do so is to break the law. When it comes to imported raw goods used to make supplements, these raw materials are closely monitored by the GMP laws and they must adhere to the same rules as non-imported OTC supplements. When it comes to the importing of finished supplements, Dr Jacques states that from her knowledge it can be harder to enforce regulations in this regard, but she is also quick to point out she has limited experience in the importation of finished supplements so she did not feel qualified to comment on the topic in greater detail.

If you want to determine your vitamin companies adherence to the GMP laws you can call them directly and ask them or you can go the FDA’s website to see if the vitamin company is in violation of the GMP.

The website is: http://www.fda.gov/food/dietarysupplements/

(I searched the FDA site and did not quickly find a link to “GMP compliance.” However, in the search bar at the top I did put in a number of different known vitamin companies and was able to easily find and read some letters from the FDA to the companies regarding some labeling and branding issues)

What are your thoughts on adults taking children chewable vitamins, just more of them?

This can be problematic: Children vitamins often don’t have a complete compliment of vitamins that adults need, especially not WLS adults. And/or the children’s one-a-day multivitamin might be heavily weighted in certain vitamins that growing children need, meeting 100% of recommended daily allowance (RDA) per pill. A WLS adult taking additional one-a-day children’s vitamins might be inadvertently getting too much of some vitamins and not enough of others. When it comes to vitamins, always be aware of not only too little but also too much!

There are numerous vitamins that the body needs, but only certain vitamins are really emphasized after WLS, like B12, Thiamin, Iron, folate, vitamin D, Calcium, etc. Why is this?

The easy answer is because these are the vitamins we see that cause the most deficiencies but the research is ever evolving and growing. The AACE/TOS/ASMBS Clinical practice guidelines are getting us closer to having defined Bariatric Dietary Allowance (BDA) and post-BDA but there is still work to do. The not so good news is that it takes time to do the research.The good news is that there is a lot of room for great research and many researchers are doing the work.

How does a person address the logistical challenges of getting their vitamins in, especially when it comes to scheduling when to take vitamins and what vitamins should be taken separately, etc. 

Set yourself up for success. Ideally vitamins are taken throughout the day for optimal absorption including taking iron and calcium separately. However, for some people this does not work. If a person always remembers to take vitamins at one time of day but never remembers to take additional vitamins at a different time of day, then the advice is to take the vitamins all at once. At least the person will have a chance of absorption taking them all at once verses no chance of absorption from the vitamins the person forgets.

Also Tips: Set reminders on your phone, carry vitamins with you, and have vitamins in different locations you frequent.

Why is calcium so unpalatable?

Calcium Citrate is acidic and can be challenging from a flavor standout because it can be bitter, but the science around making calcium more palatable continues to come a long way. Additionally people go on flavor “jags” followed by “flavor fatigue” where they love a flavor and then get tired of it. In those cases it’s time to move on to another flavor or brand.

Iron: 

Ferrous Fumerate is traditionally the recommended form of Iron after WLS but there are more forms of iron on the market than ever before. Often it takes trial and error to determine which Ferrous form a person will both tolerate and hematologically benefit from. When in doubt, IV Iron infusions may be needed for a subset of patients who do not respond to oral iron supplements.

Vitamin D:

It is still the darling of nutritional studies. The research has demonstrated all the different ways that Vitamin D plays important nutritional roles, beyond helping with bone health. Dr Jacques believes the research supports Vitamin D deficiency as a co-morbidity for obesity before surgery.

Current Clinical Pracitice Guidelines recommends taking oral D3, approx 3,000iu D3 daily and the treatment goal is >30ng/ml by lab value.

Protein: 

On a vegetarian diet, it is possible to obtain enough protein but it takes more work. People who have had WLS that are vegetarian need to have more education on what they need and how to obtain the needed non-animal based nutrients to meet their protein metabolic requirements. Dr Jacque mentioned that India is a country where many people are vegetarian and, interestingly, in the case of WLS in India, the practitioners do not see many cases of protein malnutrition. This is thought to be because the Indian diet has greater variety of legumes (aka Pulses) compared to the standard US vegetarian diet.

Caffeine:

Can be problematic in some people post-WLS. People who have had gastric ulcers should avoid coffee. Vitamins should not be taken with coffee because absorption can be reduced, especially B vitamins. One 8oz or 236ml cup of coffee a day for people who are otherwise diligent with their nutrition are probably going to be ok. However, problems can arise from heavy (>1 cup) coffee or other caffeine sources due to nutrient depletion, dehydration (caffeine is a diuretic, aka makes you urinate), and can be an empty calorie trap.

Hair loss: 

Post WLS hair loss can happen in two phases, in the early post-op phase and/or late post-op. The causes for early verses late hair loss are different. Early post-op hair loss (telogen effluvium) is usually temporary and situational, caused by physiologic and nutritional stress after surgery. The hair loss usually peaks 3-6 months after surgery then starts growing back (people dont go bald from having WLS). Late post-WLS hair loss usually is caused by nutritional problems (iron, Vitamin A, zinc, protein deficiency can all be the culprits) or hormonal imbalances and need to be investigated.

Conclusion:

There is no one way or trick for anyone who has had WLS to stay on track and do what they need to do to maintain health after WLS, including taking vitamins, but we know for sure we need to keep talking about all aspects of health after WLS, keep building a community, and keep giving education and support.

If you would like to purchase Dr Jacques book, “Micronutrition for the Weight Loss Surgery Patient,” you can find it here (I could not find a link via Matrix Medical Communications):

http://www.amazon.com/Micronutrition-Weight-Loss-Surgery-Patient/dp/0976852624

 

In health and with connection,

Reeger Cortell, FNP-C

 

 

{ 2 comments… read them below or add one }

Judy Mohr November 24, 2015 at 4:16 am

Thank you Reeger! My friend turned me on to your podcast. I listen while I walk and it is fabulous.

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reeger December 6, 2015 at 6:12 pm

Hi Judy! Thanks for letting me know and great to have you!! Reeger

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