All posts by Dee Anne Agonis

Bariatric Health Kansas City – Cortisol and Weight

Bariatric Health Kansas City - ProjectAWARE

Almost 10 years ago, Tiffany Spudich, PharmD, wrote an article about Cortisol and Weight that is still relevant today (you can view the article here). After reading the article, we would like to summarize how it relates to our “Bariatric Health Kansas City” series.

For some time, there has been a question about stress and weight. Does stress affect weight at all? Does it affect eating? Does it affect where the fat is deposited in our bodies? We do know that our bodies make cortisol to help us with stress. When stress goes up, cortisol levels go up as well. Studies have shown that obese people have levels of cortisol that are higher than average.

According to Tiffany, cortisol is “a hormone in a group of steroids commonly referred to as glucocorticoids. Cortisol is a hormone produced by the adrenal gland as a part of your daily hormonal cycle.” It is made when our stress levels go up. It’s the result of our natural “fight or flight” response when stressed. Our pupils dilate, we breath in more oxygen, our body shuts down our digestive system, and our appetite is suppressed. When the stress is over, the cortisol increases our appetite to replenish our bodies with the carbohydrates, thinking we just ran away from a lion, so to speak.

We are modern creatures who at times, have a sustained amount of stress in our lives. We aren’t running away from lions. We are often sitting at our desk or in traffic. According to the authors of The Cortisol Connection, we are tired from the stress, overeat to comfort ourselves, and gain inches around the waistline as a result. This is a dangerous place to gain weight, as it can lead to diabetes and heart disease.

Bariatric Health Kansas City – Cortisol Conclusion

By accepting the possibility that chronic stress and high cortisol levels may be factors in gaining the weight, what are our options for controlling our weight? First we must cut out the stress, or become resistant to it altogether. Walks and regular exercise are excellent examples to promote weight loss by burning calories and neutralizing stress levels. Second is meditation, yoga, and breathing exercises. Controlling the stress by relaxing helps us battle our hectic lifestyles. Third, seeing our stress from a different point of view could eliminate it all together. It is all in how we perceive it.

For weight loss support, we offer support groups that meet twice a month and our own specially formulated bariatric health supplements. Feel free to read our blog as we update with articles to keep you informed.



Kansas City Bariatric Surgery – Hair Loss

Why does my hair fall out after Bariatric Surgery?

A common fear and complaint of Kansas City Bariatric Surgery patients is hair loss after the operation. While our hair is an important part of our body image, it is not very important to our bodies. For this reason, nutrition can have a great impact on hair health because when forced to make a choice, the body will shift nutritional stores to vital organs like your brain and heart and away from your hair.

Hair loss has many causes. The most common type of hair loss after weight-loss surgery is a diffuse loss known medically as telogen effluvium, which can have both nutritional and non-nutritional causes.

Whether you are aware of it or not, for most of your life you are always in the process of both growing and losing hair. Human hair follicles have two states; anagen, a growth phase, and telogen, a dormant or resting phase. All hairs begin their life in the anagen phase, grow for some period of time, and then shift into the telogen phase which lasts for about 100 to 120 days. Following this, the hair will fall out.

Specific types of stress can result in a shift of a much greater percentage of hairs into the telogen phase. The stressors known to result in this shift, or telogen effluvium, include:

  • High fever
  • Severe infection
  • Major surgery
  • Acute physical trauma
  • Chronic debilitating illness (such as cancer or end-stage liver disease)
  • Hormonal disruption (such as pregnancy, childbirth or discontinuation of estrogen therapy)
  • Acute weight-loss
  • Crash dieting
  • Anorexia
  • Low protein intake
  • Iron or zinc deficiency
  • Heavy metal toxicity
  • Some medications (such as beta-blockers, anticoagulants, retinoids and immunizations)

Weight-loss Surgery and Hair Loss
Nutritional issues aside, Kansas City bariatric surgery patients already have two big risks: major surgery and rapid weight-loss. These alone are likely to account for much of the hair loss seen after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into the telogen phase have fallen out. There is no way of switching them back to the anagen phase.

Hair loss rarely lasts for more than six months in the absence of a dietary cause. Because hair follicles are not damaged in telogen effluvium, hair should then regrow. For this reason, most doctors can assure their weight-loss surgery patients that with time and patience, and keeping up good nutritional intake, their hair will grow back. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. One would be more suspicious of a nutritional contribution to post-bariatric surgery hair loss if:

  • Hair loss continued more than one year after surgery
  • Hair loss started more than six months after surgery
  • Patient has had difficulty eating and/or has not complied with supplementation
  • Patient has demonstrated low values of ferritin, zinc or protein
  • Patient has had more rapid than expected weight-loss
  • Other symptoms of deficiency are present


What can I do?


Diet and Healthy Hair

A healthy diet can help your hair stay strong and shiny. What you eat can also keep you from losing your locks. If you’re not getting certain nutrients from food, you might see the effects in your hair.

Essential fatty acids, especially omega-3s, play a key role in the health of your skin, hair, and nails. You should eat some of these foods, which are rich in omega-3, every day:

  • Salmon, tuna, mackerel, and other fatty fish
  • Flaxseed oil
  • Walnuts and almonds

Vitamins B6, B12, and folic acid are also important to your hair. Vegetarians and vegans often don’t get enough of them.

Foods with B-6 include bananas, potatoes (both white and sweet), and spinach. Major sources of B12 include meat, poultry, fish, and dairy products.

You can get folic acid with plenty of fresh fruits and vegetables, especially citrus fruits and tomatoes. Whole grain and fortified-grain products, beans, and lentils also have it.

Protein is also critical for keeping your hair healthy. Lean meats like fish and chicken, eggs, and soy products are good sources.

Bariatric Vitamins contain many of the essential vitamins and minerals to add to your healthy diet, continue taking your vitamins and calcium!

The right foods can be really good for your ‘do, but hair loss has many causes. Sometimes genetic factors like male or female pattern baldness can play a role. 


Hair loss can be distressing to Kansas City bariatric surgery patients and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is mostly likely caused by surgery and rapid weight-loss.

Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Thyroid disease, anemia, autoimmune diseases, and hormone issues may also cause changes or loss of hair.   If your hair loss lasts more than 6 months after surgery make an appointment with your doctor to evaluate for other causes.


  1. Rushton DH. Clin Exp Dermatol. 2002 Jul;27(5):396-404.
  2. Neve H, Bhatti W, Soulsby C, Kincey J, Taylor T. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg. 1996 Feb, 6(1):63-65.
  3. Updegraff TA, Neufeld NJ. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981;78(2):135–140
  4. Segal A, Kinoshita Kussunoki D, Larino MA. Postsurgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14(3):353–360.
  5. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity.
  6. Dig Dis Sci. 1994 Feb;39(2):315-20.
  7. Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–28.
  8. Mock DM. Biotin. In: Shils M, Olson JA, Shike M, Ross AC, eds. Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkins; 1999:459-466.
  9. WebMD Feature: “Eat Right for Your Hair.”American Academy of Dermatology: “Hair Loss.”KidsHealth: “Your Hair.”National Institute of Arthritis and Musculoskeletal and Skin Disease.
  10. Jacqueline Jacques, ND:”Weight-loss Surgery, Nutrition and Hair Loss” –

June 2, 2016 – Hair Loss

Bariatric Support Group Date: June 2, 2106 / Facilitator: Chris Bovos, RN, CBN /

Chris reviewed how hair grows, why you go through a period of hair thinning about 3 – 4 months after surgery, and what things you can do if it doesn’t start growing back after that happens.

All hair goes through 3 phases of growth, as shown in the slides (available online).  90% of your hair is in the growth phase for anywhere from a few months to years, like the hair on your head.  When your body goes through a major stressor, such as major surgery, weight loss, severe infection, childbirth, etc., the nutrition you are taking in is used to heal your body and therefore your hair doesn’t get any nutrition.  That pushes it into a state call telogen effluvium, which is excessive shedding, and your hair moves from the growth phase to the telogen stage. This stage lasts about 3 -4 months, and then the hair falls out.  This stage lasts about 100 – 120 days, and then regrowth begins as long as the hair follicles have not been damaged.

Hair thinning that goes beyond 6 months to a year after surgery is usually due to some nutritional deficiency.  It is important to get enough protein, iron, zinc in your diet in order to regrow your hair.  One of the biggest causes of chronic hair thinning beyond the 6 months is a deficiency in iron.  This is measured by have a “ferritin” level drawn.  This is a measure of your iron stores.  Anything below 40 micrograms means your iron stores may be low, and you either need to take more iron, or you may require an iron infusion if you don’t absorb enough iron.

Protein is another nutrient needed to regrow hair.  You need to eating 60 – 75 gms of protein a day in order to regrow your hair and keep your muscles strong.  The protein you eat needs to be high quality protein.    Zinc is another element that has been tied to hair thinning, but too much zinc can be toxic.  You do not want more than 40 mg of zinc a day, and if you are taking Journey Vitamins, they provide 15 mg in each capsule.

Some products that patients have reported helping are Biotin, Omega-3 fatty acids, the product “Hair, Skin & Nails,”  hair care products from Nioxin, Keranique, and supplements with Saw Palmetto in them.  Hair Essentials is on the internet with good reviews, but that is unverified.  The most important thing to do is to eat enough protein, take your vitamins as prescribed, and be patient. Hair thinning is temporary!

May 21, 2016 – HIIT Exercise Training

Bariatric Support Group Date: May 21, 2016 / Facilitator: Greg Justice, M.ED.

Greg talked to the group about metabolism, how to boost it, and the importance of mixing strength and resistance training into your routine.

Greg started by explaining that metabolism is the total sum of all the chemical reactions that take place in your body. The four components of metabolism are:

  • Resting Metabolic Rate (RMR) – what your body burns due to normal breathing, heart pumping, resting activity – accounts for 70% of your daily metabolism
  • Physical Activity Level (PAL) – what you burn when you exercise – accounts for 20%
  • Thermic Effect of Feeding (TEF) – what you burn digesting food – accounts for 5%
  • Non-Exercise Activity Thermogensis (NEAT) – based on genetics – accounts for 5%

The only one you cannot control is NEAT – your genetics.  All the rest you can influence.

Metabolic Training is a way to maximize calories burned and increased your metabolic rate not only while you exercise, but also after your workout.  After you work out, there is something called the Excess Post-Exercise Oxygen Consumption (EPOC) or “After burn.”  EPOC is the increase in your metabolism and calories burned following exercise.  Resistance training (using the weight of your own body as resistance) and High Intensity Interval Training (HIIT) or circuit training, give you a higher EPOC than cardio training, where you do one type of exercise for 30 -60 minutes. Metabolic training takes much shorter period of time, and give you a much higher EPOC.  All exercise is good for you, but when trying to lose weight, the metabolic training is the best.  A couple of patients demonstrated the typical resistance training workout circuit for everyone, and Greg told everyone to go online to You-tube and there are tons of workout videos.  You can also work out with Greg at one of the classes for bariatric surgery patients and learn how to do it.  All classes are $10 each, and information on the classes is available from Chris at

To view the video of Greg’s presentation, go to:

May 5, 2016 – Weight Loss Process & Expectations

Bariatric Support Group Date: May 5, 2016 

The presentation began with a discussion about what happens in the body when you lose weight and reviewing what we know about energy.  Energy is measured in calories, and calories are composed of Proteins, Fats, Carbohydrates and Alcohol.  The energy you burn, or Total Energy Expenditure (TEE) is made up of several components:

  • Basal metabolic rate (BMR) – accounts for a about 60% of daily energy out
  • Thermic Effect of Food (TEF) – this is the energy you use to digest food when you eat, and accounts for about 10-15% of energy output
  • Non-Exercise Activity Thermogensis (NEAT) – this is the energy your burn throughout the day that isn’t the result of exercise or sleeping, and accounts for about 15% of output – you can control this and improve it by just becoming more active and sitting less
  • Adaptive Thermogenesis – the energy you burn when you exercise, which changes as you lose weight and your body begins to adapt to the new weight and your body works more efficiently – you can also control this

After surgery, your intake is dramatically reduced, to about 400 – 600 calories a day, and then gradually to 800 calories a day.  That’s why you begin losing weight right away.   As you begin to get more active and then exercise more, you can gradually increase your activity to maximize the energy burned and lose the most weight in that first year.

A lot of the medications we take either cause increased weight gain or prevent weight loss, such as insulin and some of the antidepressants.  It is important to review every medication you are on with your primary care doctor and switch those that sabotage weight loss to a different drug that doesn’t.

We then discussed weight loss expectations.  We viewed a chart with 2 patients, one who had sleeve gastrectomy and one that had gastric bypass.  It showed that initially their weight loss was close to the same, but by 8 weeks, the patient with the gastric bypass began to have more weight loss during the course of the first 12 months.  They both started at 350 lbs., and the patient with the sleeve lost about 120 lbs. in a year, and the patient with the bypass lost about 170 lbs., which is as expected.

The sleeve patient lost 34% of their total body weight and the bypass patient lost 48%.

We discussed that ideal body weight varies from person to person, and that when you lose even 10% of your body weight, you improve your health dramatically.  After 6 – 12 months, the Ghrelin, your hunger hormone, can begin to come back and make people hungry again.  There are medications that can be used to help with that in order to main the weight loss long term.

Journey Bariatric Supplements – KC Bariatric Surgery Patients

Kansas City Weight Loss SupplementsThe Bariatric Center of Kansas City is pleased to announce that our specially formulated “Journey” bariatric nutritional supplements are now available for online purchase!  Patients can select the large yellow “Journey Bariatric Supplements” button found in the middle of our website homepage to be redirected to the Journey online ordering site.  You will also find a Journey page tab at the top of our homepage and a Journey Logo at the bottom of our homepage, which when selected will also route you to the Journey website.  Or you may get to the Journey website directly by entering in your web browser.

Buy Now
Journey Supplements

Why Journey Bariatric Supplements
for bariatric surgery patients?

Journey Bariatric Multivitamins and Protein have a UNIQUE formulation of vitamins, minerals, and probiotics especially designed for the weight loss surgery patient.

Journey bariatric supplements have been developed exclusively by our experienced Kansas City Bariatric Surgeons to meet your individual nutrition needs before and after surgery. Our formulation has been designed to ease digestibility, using ingredients that are highly absorbable to prevent deficiencies. Patient supplementation compliance is often a common concern among our Kansas City Bariatric Surgeons. For this reason, our bariatric nutrition regimen has been simplified and improved to provide ease in daily supplementation.

Journey Bariatric Supplements - Kansas City Bariatric Surgery Patients
Journey Bariatric Supplements – Bariatric Surgery Patients

Nutrition is the primary environmental trigger to a healthy weight. Vitamins and minerals are essential factors in many biological processes that regulate appetite, hunger, nutrient absorption, metabolic rate, fat and carbohydrate metabolism, energy storage, and glucose balance. After weight loss surgery (see types of Weight Loss Surgery), there is a high risk of vitamin and mineral deficiency due to malabsorption and/or incomplete digestion of foods related to small amounts of gastric acid produced (see Gastric Bypass Kansas City) and dietary intake. Journey Bariatric supplements are designed to ensure complete and balanced nutritional health for the bariatric patient.

Healthy bacteria that reside inside your gastrointestinal system are affected by antibiotics taken after weight loss surgery. These organisms influence many processes in your body, including fat burning and storage. The addition of good bacteria (probiotics) helps with healthy weight and metabolism by extracting energy and calories from the foods you eat, aiding in weight loss and maintenance (see our section on support for Weight Loss Surgery). On the other hand, insufficient or imbalanced bacteria caused by the use of antibiotics, poor nutrition, and/or environmental toxins can affect weight loss efforts and lead to weight gain.  Journey Multivitamins include probiotics that help provide additional health benefits to the bariatric patient’s health regimen.

We believe you’ll agree JOURNEY is the most advanced nutrition supplement brand for bariatric surgery patients!  
*** Sign up for a monthly auto-ship supplement package and receive free shipping! ***

April 7, 2016 – Meditation for Inner Peace

Bariatric Support Group
Date: April 7, 2016
Facilitator: Rosie Dominguez and Chris Bovos, RN, CBN

Chris introduced Rosie Dominguez, who is a spiritual and wellness coach.  Rosie shared her story of how she used to have a very stress filled job for many years, and then with the illness of her mother, began a shift that led her to a number of big changes that helped her to reconnect with her true inner self and began living from her heart.  She began using a healing technique called Emotional Freedom Technique, or EFT “tapping,” that helps a person to move away from “feeling unlovable”   to a place of self-love.

She also discussed the practice of meditation as a way to deal with the everyday stress in our lives rather than seeking comfort in food.  Meditation has been used for thousands of years in other cultures as a form of prayer or way to clear the mind and refocus our lives on what is most important to us.  She led us through a short guided meditation, which began with getting into a comfortable position either on the floor, sitting in a chair, or even lying down.  Then we took 3 slow, cleansing breaths, and then she spoke quietly and softly about relaxing every part of our body, breathing into those areas that may be painful, and ended with meditating to music.  Silent meditation takes a lot of practice and she discussed how when you are trying to quiet your mind, thoughts will continually come into your mind. The best way to deal with those is to simply acknowledge them and then return to focus on your breathing.  Some people use a word or a phrase to focus on (sometimes called a mantra) to help them focus by repeating it while they are meditating.

By meditating on a daily basis, usually twice a day for 10 to 20 minutes, you can begin to find you are more able to deal with life’s stresses and challenges as they arise.  Rosie suggested that you set a timer so that you know when you are finished.  There are many CD’s that can be used for meditation, but Rosie emphasized that the voice of the person speaking in the CD is crucial.  If the voice does not “suit” you, you won’t be able to relax and meditate listening to it, so you may need to try a few different CD’s.

Our next support group will be April 21st, from 3 – 4 pm, and Chris & Laura will be here to lead small group discussions.