Sweets are a real problem for people who have undergone gastric bypass or lap-band weight loss surgery. Patients report feelings of loss for sweets and strong cravings. Yet patients know sweets pose several problems after weight loss surgery including dumping syndrome and weight gain. Patients who indulge in sweets not only get physically ill they also suffer feelings of failure and self-loathing for lack of will power.

According to Dr. David Katz in his book The Way to Eat a sweet tooth is not a matter of will power it is a matter of genetics. Early humans found sugar was a quick source of energy when they consumed it in the form of fruit, honey and sugar cane. So the tendency to like sweet is in our genetic code. But the difference today from then: sugar is now highly processed and in abundant supply.

Dieters consider sugar evil and blame sweets for weight gain. According to Dr. Katz “Sugary foods are often high-fat, calorie-dense foods as well; the pleasant taste of sugar stimulates high intake while the fat does much of the damage in terms of calories, weight gain and adverse health affects.”

I like that Dr. Katz’s attributes our genetic code for the sweet tooth – in my pre-WLS dieting life I considered myself a weak failure for having a sweet tooth. Unfortunately, my bariatric surgeon didn’t fix my genetic code for sweets. But what did happen during the early post-op and the weight loss phases is my interest in sweets waned. I believe once I was off the carb-fat-sugar roller coaster my body adapted to the more nutritional diet without processed sweets.

Limit Sugar For Health: General health guidelines indicate we should limit sugar intake, particularly processed sugar. Dr. Katz advises “Make some general commitment about the acceptable place of sweet foods in your diet.” He adds, “Such a commitment is only as good as your follow-through, of course. But making decisions about tempting foods at a time other than when you are tempted is a good strategy in general.”

For WLS people with gastric bypass that commitment is firm – most patients will get sick (dumping) if they consume sugary products. Lap-band patients don’t live with that fear, they need some personal resolve to limit or avoid sugar products. For all of us the desire to maintain our weight loss should be a good motivator.

Sugar Substitutes: So far we have two facts: 1- We are genetically coded to desire sweets and 2- We need to limit sugar intake for our health. Could two facts be more contradictory?

A variety of artificial sweeteners are available from the sugar alcohols (Sorbitol, Xylitol and Mannitol) that cause gas and bloating problems to the non-nutritive sweeteners such as Saccharine, Aspartame and Sucralose (Splenda). Dr. Andrew Weil, author of “The Healthy Kitchen” is concerned about the use of artificial sweeteners. In his book he says, “In the first place, there is no evidence that they help anyone lose weight, although that is why people use them…Second, most of them taste funny. And, most important, the highly popular ones may be harmful.” He sites studies that link Saccharin and Aspartamine to health problems.

Dr. Weil recommends sucralose, sold under the band name Splenda. He said, “It tastes better than aspartame and appears safer.”

Splenda, Sugar and WLS Diet: In general nutritionists working with WLS patients agree Splenda is an acceptable sweetener for patients when used in moderation. (Moderation – that word comes up a lot in our WLS food discussions!)

Many recipes can be adjusted to use all Splenda or a blend of Splenda and sugar. Using a blend of sugar and Splenda produces the best results for texture and moistness yet cuts half of the calories and carbohydrates. Using all Splenda eliminates all sugar calories, however, some consumers say using all Splenda results in an unpleasant after taste and unappealing texture. Using all sugar is not an acceptable option for WLS patients for reasons already noted.

Knowledge, Moderation, Occasion Ultimately, the key to including sweets in the WLS lifestyle is knowledge, moderation and occasion.

Know what is in the sweet product you are eating. Find sweets recipes that contain other nutritionally beneficial ingredients while eliminating or at least decreasing the sugar and fat.

Moderation: a small serving is fine. Scientific studies indicate a craving can be satiated with a modest portion eaten slowly and savored. I have found my occasional chocolate craving can be satiated with one Andes’ thin mint – think about it! One mint – 26 calories and 2.6 grams of sugar, 1.6 grams of fat.

Plan your occasions when you know you will indulge and then indulge wisely. Know the kind of sweetener used in your treat, know your serving size and know you will stop when that serving is consumed. At first it isn’t easy but with diligence planned occasional treats can be included in your WLS lifestyle.Love your new diet: Finally, rather than focusing on all the beloved lost foods spend time enjoying and loving your new way of eating. Dr. Katz said, “Even though you were born to like sugar, if your diet shifts, step-by-step to one richer in nutrient-dense, calorie-dilute, natural foods, there will simply be less place for processed sugar in your diet.”

Author: Kaye Bailey

Research has pointed to a possible benefit of using antibiotics for the treatment of some types of arthritis. This article discusses some of the data.

The role of antibiotic therapy for the treatment of arthritis is controversial. However there is at least some evidence for effectiveness in two examples. Minocycline, a member of the tetracycline family, appears to suppress enzymes involved in the inflammatory process. Doxycycline is an antibiotic that also belongs to the tetracycline group and has shown to have positive benefits in osteoarthritis.

Minocycline

In 1949, at the International Congress on Rheumatic Diseases, a possible relationship between mycoplasmas and joint disease was described.

Thomas McPherson Brown, M.D. and his colleagues at the National Institutes of Health reported the following year that rheumatoid arthritis may be caused by an immunologic reaction of antigen and antibody (with mycoplasma as the suspected antigen).

In 1955, Brown reported that mycoplasmas, unlike bacteria and viruses, could live in tissue cell cultures without destroying the tissue cells. In 1964 a high incidence of mycoplasma antibodies in the blood of rheumatoid arthritis patients was found, indicating current or previous infection. Also noted was a four-fold higher incidence of mycoplasma antibodies in females suggesting a correlation with the higher incidence of rheumatoid arthritis in females.

Efforts to demonstrate the effectiveness of tetracycline therapy were initiated and first reported by Dr. Brown shortly thereafter. In 1989, NIH initiated controlled clinical trials of tetracycline therapy for rheumatoid arthritis. The preliminary results of the clinical trials, known now as MIRA or Minocycline in Rheumatoid Arthritis, were promising.

The result of the MIRA clinical trial were: “Patients who suffer from mild to moderate RA now have the choice of another therapeutic agent. Not only did the antibiotic significantly reduce symptoms, but side effects were minimal and less severe than observed for most other common rheumatoid treatments”.

Despite these findings, many rheumatologists remain skeptical. Other studies have failed to demonstrate clinically significant improvement.

According to the American College of Rheumatology, “Minocycline is prescribed for patients with symptoms of mild rheumatoid arthritis. It is sometimes combined with other medications to treat patients with persistent symptoms of this form of arthritis.”

Their formal position is stated in this fact sheet for patients:

…There is evidence minocycline may slow the progression of joint damage in arthritis and prevent disability like other drugs in the class known as DMARDs (disease-modifying antirheumatic drugs).

Minocycline is prescribed for patients with symptoms of mild rheumatoid arthritis, sometimes in combination with other medications to treat patients with persistent symptoms of this form of arthritis.

…Minocycline decreases the production of substances causing inflammation, such as prostaglandins and leukotrienes, while increasing production of interleukin-10, a substance that reduces inflammation.

Minocycline usually is given as a 100 milligram (mg) capsule twice a day. It may be taken with food, although it should not be taken with other medications such as antacids or iron tablets.
It may take 2 to 3 months before any improvement in arthritis symptoms is experienced and up to a year before maximum benefits are realized.

The most common side effects from this medicine are gastrointestinal symptoms, dizziness and skin rash. Some women who take minocycline develop vaginal yeast infections. While this can occur with other antibiotics, it seems more prevalent with minocycline and other tetracyclines. It is thought minocycline kills bacteria normally present in the body which protect against yeast infections.

Minocycline may increase sensitivity to sunlight, resulting in more frequent sunburns or the development of rashes following sun exposure. It is recommended patients apply sunscreen (SPF 15 or greater) before outdoor activities or avoid prolonged exposure to the sun while taking minocycline.

More rarely, minocycline can affect the kidneys or liver. Doctors may recommend periodic blood tests for long-term users to check liver and kidney function. In equally rare cases, minocycline can induce lupus, but this condition usually improves after stopping the medication.

Minocyline use during pregnancy can slow the growth of teeth or bones in infants after birth as well as cause discoloration of the newborn’s teeth when taken during the last half of pregnancy. Minocycline may decrease the effectiveness of some birth control pills.

Minocycline is passed into breast milk, so mothers should avoid breast-feeding to prevent delayed development of teeth and bones in their infants. Minocycline can increase a nursing infant’s risk of fungal infections or dizziness in the newborn. Because minocycline may cause discoloration of teeth and problems with bone growth in young children, it is recommended that those younger than 8 years old not take this medication. This is not a problem in older children and adults.

Possible interactions with minocycline may occur when taking warfarin (Coumadin), antacids containing calcium, aluminum or magnesium (such as Tums, Rolaids, Maalox, or Mylanta), iron tablets and oral contraceptives (birth control pills).

To highlight one of the potential side effects of minocycline, a small study reported in the June 2006 issue of the Journal of Rheumatology indicated that skin discoloration (hyperpigmentation) appears to be a very common side effect of minocycline use. The study involved 27 patients. Forty-one percent (11 patients) reported developing skin discoloration after using minocycline for approximately one year. Four of the 11 patients stopped using minocycline because of hyperpigmentation (two had skin discoloration on their face and two had skin discoloration on their arms).

The use of minocycline for rheumatoid arthritis is rare nowadays because of the proliferation of newer biologic therapies. Nonetheless, it remains a viable option for the rare individual with extremely mild disease.

Doxycycline

Doxycycline, another tetracycline derivative, has been used to treat osteoarthritis. Study results reported in Arthritis & Rheumatism (July 2005 issue) suggest that treatment with the antibiotic doxycycline may slow the progression of this disease.

Researchers compared the use of doxycycline to placebo, using about 400 obese women with knee arthritis as study participants. Researchers analyzed the impact of doxycycline on the joint space of the affected knee.

The study participants were randomized into two groups, receiving either 100 mgs of doxycycline two times a day or placebo for up to two and a half years.

Following 16 months of treatment, results indicated that the average loss of joint space in the affected knee was 40% less among participants taking doxycycline than those who took placebo.

At the end of the two and a half year period, the loss of joint space was 33% less in the group who took doxycyline than in the group who took placebo.

Doxycycline treated patients also reported having marginally less joint pain.

Researchers said that this was the first major study of doxycycline as a potential treatment for osteoarthritis. More studies will be needed to confirm these results.

While the study did not clearly show that oral doxycycline was effective in reducing pain, there was evidence that there was less progression of osteoarthrits (i.e. less cartilage loss) in patients on the antibiotic. The authors felt doxycycline works through anti-inflammatory effect and not due to an anti-bacterial effect.

Based on this study, it is difficult to recommend long term doxycyline for relief of symptoms. On the other hand, it is possible that patients taking the antibiotic may be less likely to require joint replacement in the future due to a decrease in joint damage on radiograph.

Obviously, longer term studies are required. The problem, as it exists today, is that we have no other drugs with significant disease-modifying effects for osteoarthritis.