Patient questions & answers from Dr. Sosa – top rated bariatric and weight loss surgeon in Miami
Today the Sosa Clinic had our inspection by the Surgical Review Corporation to get our recertification as a Center of Excellence in bariatric surgery and I spent the morning talking to the inspector and then right around lunchtime we had to have the exit interview. She told us we passed, we’re recertified for another three years, that our program results are amazing, our processes are amazing. She toured the hospital, the Emergency Room, the Operating Room, the patient’s rooms as well. They talked to all the staff and told us the Sosa Clinic is good to be re-certified and compared to other bariatric programs, we’re doing great.
So we did have a few questions left over from last week.
If you are paying for surgery, depending on the program that you choose, you have a certain number of visits included in that price for follow up with Dr. Sosa. What happens after you have done all those visits or you need to come see him two or three years from now?
So anytime you have to come see him after your initial global period that you paid for with your surgery, the visits are $25. You pretty much cannot see a doctor for $25. So it’s pretty good. I mean I’ve had patients tell me, I didn’t have insurance so I haven’t come to see you. And I go, it’s just $25 a copay. It’s less than a copayment, it’s $25. If you don’t have insurance you are going to pay for the visit is $25 to see Dr. Sosa or to see the nurse practitioner.
We have tried to keep our prices the same throughout the 20 years. I think the only thing that we’ve increased, and we only increased it by $5 was the multivitamins and that’s because the supplier increased it to us. So the product to make it got more expensive, so we had to increase it a little. But even that, we always try to keep our prices low because we want the patients to be able to afford on the things that they’re going to need after surgery.
Compared to gas, we haven’t even increased with inflation. I mean most things are up 10%, 20%, 50%. Our price for surgery is not up. It’s not higher than it was three years, five years, or 10 years ago.
What about the nutritionist, the nutritionist price?
You can call or DM the office through our website at https://www.bariatricsurgeryspecialist.com
and our team can give you the prices. They vary depending on what you’re going in for. So there’s 30 minute appointments. There’s shorter appointments if you need to, and again, we can work with you on payment plans
The pricing is not that expensive. It’s $30 – $50. It’s not like $200-$300 to see a nutritionist. It’s very reasonable. Our goal is to keep it reasonable so you stay engaged in the journey to your success.
We had two questions on hair loss. That seems to be one of the most popular topics that we get is about hair loss.
Is it normal that they’re starting to experience hair loss after gastric bypass surgery? And they wanted to know is it normal?
It is common, but preventable. So what is hair? Hair is derived of protein. It’s pure protein. So are nails. It’s a derivative of protein. So when your body perceives, I do not have enough protein to maintain all the work that I need to do, the first thing your body does, it stops wasting protein. Nails and hair are kind of a waste of protein. So your body stops making new hair and your nails stop growing or grow much, much slower. Your hair falls out every day, it’s normal and it grows every day to replace it. If your hair continues to grow up and you stop replacing it, what happens? You look like you have hair loss, you get much thinner. What is the prevention protein? Protein supplements? Unfortunately it’s a significant amount of protein.
You need to have about 70, 80 grams of protein to maintain hair. In the beginning, the first 2, 3, 4 weeks, you are not drinking the protein yet. So you’re already in a little bit of a deficit and then later people will drink 20 grams, 30 grams. That’s not really enough to prevent the thinning, the falling out that people call it. It’s really thinning. So if you want to truly stop the thinning, you have to have 70, 80 grams a day. Every day for six months. People look at their hair and go, oh, mine’s not falling out. I’m doing great. I don’t need that protein. It doesn’t taste that good. Six weeks later, boom. Oh my god, what happened? And now to catch up, it’s going to take three months. It’s not like, okay, I’m going to start taking the protein tomorrow, I’ll start growing hair again.
So I take three to six months. The good news is when the hair loss is related to protein intake, it always grows back. Once you’re eating enough protein, once you’re six months, nine months a year, you’re eating steak, you’re eating burgers, you’re eating enough protein, your hair grows back. Now if you’re somebody like me that has a genetic male ball pattern, don’t think it’s going to grow back. A lot of people go, oh, 10 years ago I had hair and now I’m bald. I’m like, yeah, you were going to be bald because you have male pattern baldness, but if your hair is good and it starts to thin out, protein.
So he said a little tidbit that I want to just from my personal experience, he said, eventually you’ll eat enough protein. But honestly, even without the surgery, I don’t eat enough protein. So I need to take a protein supplement. I’m taking a drink that has about 30 grams, so I’m adding 30 grams to what I’m getting from my food and I’m trying to be very mindful about how many grams of protein I’m getting from my food. You can get there on your own. You just have to pay attention to what you’re eating and maybe do a few swaps. There’s a few things that you can swap out and replace them with healthier alternatives that are going to help with your protein intake. We’re actually working, I’m working with our head nutritionist, Rosa. She’s making a handout specifically about protein because this is one of our most common questions that we get. So I asked her to make a handout, she’s already made it. So we got to print them and we’re going to have them for you guys. We’ll post it on our social media as well so that you can easily see four ounces of chicken has this much protein, two eggs has this much protein. So you can quickly glance at this handout and kind of like go, okay, today if I did this, this and this, this is how much protein I would have.
The name of the drink is Fair Life. I just had one because after I work out I have a protein because you want to be building muscle, so you need extra protein. So I just had one. It tastes amazing.
So just as a warning, they have different sizes and different drinks. Please make sure to read the label. So when we have is the lowest calorie one. So we are always comparing how much protein to how many calories. So the one that we drink is 150 calories and I think it only has one sugar and then it has 30 grams of protein. So that one is very Good when taking protein supplements, be it liquid, be it a shake that you make, be it a bar, go high protein, low sugar, low calorie, that’s the best one. Sometimes people go, oh, this is amazing. It’s got 300 calories and 10 of protein and 12 of sugar. That’s not a protein bar, that’s a snack bar. So high protein, low sugar and carbs, relatively low calorie. That’s the best protein supplement.
So just a little aside on something that I’ve been doing, it’s something that I preach to the patients. So I’m practicing what I preach. I am a firm, firm believer in journaling, food journaling, either when you’re not feeling well or when you’re not losing weight or you’ve gained some weight. So I had gained a few pounds over the last few weeks. I’ve probably gained three or four pounds and I am building muscle, but I know that some of it was not muscle. So I started journaling again. So come Sunday I got my lunch, I mean breakfast, what I ate, how many calories and how many grams of protein because my goal is to stay a calorie deficit, which is go under the calories that I need for the day and increase my protein intake. Very similar goal to what many of you should have. So I am counting my calories and I am counting my protein. I’m not counting anything else, but I always do try to stay low in my fat count, but I’m specifically counting my calories and my carbohydrates. I’m writing it down, reading my labels. If you need help, the nutritionists also have, if you want to make an appointment with them to do a class to learn how to read labels, you can do that as well.
Do you have an app for your food journal?
We have some journals in the office that we sell, and I personally like to write it down. There is an app, it’s called MyFitnessPal, and there’s a bariatric one called Bariatric Pal. MyFitnessPal has been around for a really long time. That’s an app that you download and you can even search foods and it’ll tell you the calories and the requirements of each of those foods and they even have a lot of restaurants listed on there. So I used to use MyFitnessPal. I personally do better with writing it down. Not only am I writing it down, I’m looking at it, it helps me remember, that’s just my form of learning is I like to write things down. So I’m using a pen and paper. It’s best to use what works for you and what you can keep. If you hate doing something, you’re not getting in the habit or if it’s something you like. She likes journaling. I personally have the best food journal. I have an AI that I tell I want to eat 600 calories with a lot of protein and the AI tells me what I need to eat. So it’s awesome. But if you don’t have an ai, there are apps and everything you can use the goal. We’ll talk another day more about what I call big D, little D. Big D is a diet. Little D is your diet. So one thing is a diet. You’re going to go on a diet to accomplish something. If it’s body melding, you’re going to go on a high protein diet, etc
If you need to lose weight, you’re going to go on a restricted calorie diet and we can talk about what are good diets, what are bad diets, what diets work for what and what. And then there’s the small, the diet that we eat every day, which is the diet that you should have. High protein, low sugar, low carbs, good polyunsaturated fats that should be part of your diet. Grains, nuts, healthy proteins, whole foods, whole foods. That is the best healthiest diet. Now sometimes when you’re a big D diet, you don’t worry about the healthy small D diet. You let go certain things like fruits, like certain high calorie vegetables because you’re on a diet to accomplish a goal, lose weight and that might be a very restrictive diet like paleo, like atkins. So those diets, the point to use them is to accomplish a goal.
Your regular diet once you get there or it has to be something that you can continue that you can enjoy. But with the goals of low sugar, low calorie, high protein and polyunsaturated fats, good fats, not bad fats.
So what are polyunsaturated fats?
I’m not going to go into the chemical stuff, but polyunsaturated fats are fats that are much easier to digest and have no tendency to cause cardiovascular disease, artery disease, etc. Unsaturated fats are the thicker fats, the animal fat. Some of the lard that most restaurants, that deep fry they recently tastes so good is the deep frying what we call lard, which is really very saturated type of fat. So what you want to do is stick to the polyunsaturated fats. They’re healthier fats. Now mind you, fat is essential to your health. You cannot live and survive without fats that we need them in the body.
But the best fats to eat are the polyunsaturated fats and you’ve heard about them all along. Fish fats, omega threes, olive oil. You should be a little educated on what’s a good fat and you have to incorporate good fats into your diet. My personal bias it is better to have more fat and less refined carbs in a healthy diet, little D diet, what you’re going to eat all your life all along. It is much better to go with some stuff that is more fatty, especially if it’s polyunsaturated, but minimize the sugar, the carbs decrease the sweet stuff because that tends to lead much more to obesity, much more to depositing extra calories, adipose tissue fat that then kills you long term. It tastes really good and people go all the time to me, but you have to have sugar to live. Actually you don’t. There is no sugar in nature. What is in nature is polysaccharides are complex sugars, monosaccharides, glucose, what we call sugar table sugar, that white refined sugar we invented. It doesn’t exist in nature. In nature, whether it’s a fruit or a sweetie vegetable, that sugar in there is a complex sugar. Your body has to break it down. The amount of calories it gets out of it is lower because of the complex digestive. We then invented refined sugar, monosaccharide it taste because it tastes good. It deliver a lot of calories at a time in history where calories were awesome because we as hunter calories didn’t get enough calories.
But how do we invent sugar? The sugar cane we invented to take the cane, squeeze it, crystallize it, and get sugar out of it. That’s a human invention. There’s no sugar cane in history. You go to a sugar cane and it doesn’t drop white sugar. It doesn’t. Sugar is also made out of beets. Beets are kind of sweetie, but you don’t squeeze a beet and get grains of sugar. We invent the sugar. So sugar is not necessary for a healthy diet to live complex sugars. Polysaccharides. We are going to find those in nature, in grains, in fruits, et cetera.
I mean I think for everybody, I know you say it in the office all the time, you’re always telling the patients, specifically the sleep patients. You’re a sleep patient. You’ve heard him say this. No sugar, no sugar, no sugar, no sugar. Sugar free
Sugar is the enemy of most big diets, big D diets and most little D diets because if you put a lot of sugar in your daily diet, you’re not going to be able to be at a normal weight and a good metabolism. Sugar is the enemy. We don’t need sugar, we need polysaccharides, complex sugar, fruits, et cetera. Our body then makes the sugar, glucose that our organs and our cells use. You don’t need to eat glucose to live perfectly normal.
Lesson. Polyunsaturated Fats. So now we know low calorie, high protein, low sugar, right? Right.
Got Right And the good fats.I’m not going to use the fancy word. I’m just going to say the good fats versus the bad Fats. We have a little time, so I’ll do the big D, the diet. You’re going to go on a diet. What’s the best diet? What are you trying to accomplish? What you’re trying to accomplish is weight loss decreasing the amount of fat of adipose tissue in your body. The best diets are very high protein, pretty high fat, minimal or no carbs or low sugar. People call him by a bunch of names. The truth of the matter is that the one that really came up with this was Dr. Atkins. And for a long time everybody criticized them. They told him your diets are crazy. Yet what all the studies showed was his diet was not crazy. His diet was actually fairly healthy because what he did is it got you to lose adipose tissue, got you to lose fat. So if you’re trying to accomplish losing fat, losing weight, the best diet is Atkins, the new fancy term paleo, bottom line, high protein, pretty high fat, minimal carbs, minimal sugar.
Why is that diet so good for losing weight? It provides satiety. When you eat a high protein, high fat meal with very low carbs, you stay unhungry, you have satiety for a long time. Volume wise, a big piece of food, be it a steak, a chicken, eggs, ham, that food is a big bolus of food that’s going to stay in there. Takes a long time to digest before you get hungry. So volume wise, you’re going to eat a lot more for much fewer calories versus a cinnamon roll, which is small, it’s going to give you twice as much calories as a protein meal. But the worst part is all that sugar is going to cause an insulin spike, the insulin is going to spike, it’s going to drive up down your blood sugar and then you’re going to get really hungry again. So high carb diet, high sugar diet A, you can eat less for the same calories.
So it’s hard to be in calorie deficit. Also they don’t provide satiety. It’s a very hard diet not to be hungry thoough people go can a cookie diet work? Absolutely a cookie diet can work, but the amount of cookies that you can eat to match what in a steak is two cookies and then you’re going to be really hungry. Now, if you only eat the two cookies per meal, you’re going to lose weight. But no one does that. Everybody eat the two cookies and then another cookie. And so that’s why those crazy carb diets don’t really work because they provide a lot of hunger. Whereas the high protein, high fat diets provide a lot of satiety. Now is that a great diet for little D the rest of your life? A steak, two eggs and cheese every meal? No, but those diets are to accomplish a goal to get kind of close to your BMI to your fat level that you need. Then you need to shift from the big D diet into the little D diet where you begin to incorporate healthy things.
Approach with a balanced meal. Now looking at not only the macronutrients but the micronutrients, what’s a healthier diet? More nuts, more vegetables, legumes, but still maintaining more protein, more polyunsaturated fats, minimizing carbs as you stabilize in a long-term diet. I will tell people a diet that disgust you, cauliflower rice, you’re not going to do. So don’t waste your time doing a cauliflower rice diet. Okay, so why does he say that? Okay, so once upon a time, he’s already mentioned his name a couple of times, he’s a huge fan of the Atkins diet. He’s always been a huge fan of the Atkins diet. So what did I want to do? I went and bought the book. I bought the book, I started reading, I started getting the recipes and he came home and I was like, I cooked dinner and it’s from the Atkins recipe book was a cauliflower potatoes recipe. The most disgusting thing you’ve ever tasted on earth probably as bad. What are those little things that greet stuff that people try to make me eat? Brussels sprout. Oh my god, who eats that? A piece of steak or a fried egg with some cheese that’s at least palatable. It’s the same thing. It’s high protein, but brussels sprouts, and cauliflower mashed potato, I’m not going to do that diet. So don’t put me into a diet that will not work. So you have to find what you can do, what you can handle to achieve the calorie deficit, high protein, high polyunsaturated fat. We’ve become successful. When we found the balance, first of all, one of the things that we do is many times we don’t eat the same thing. We don’t like the same thing for lunch, we’ll usually eat the same thing, but for dinner, many times we do not eat the same thing. We don’t like the same thing. So that’s one of the things that we’ve incorporated is we each have what we like. And the second thing is to count our calories and our protein around the foods we like learn within the foods that we like what is viable for our goal. So it’s not like we’re going to go, I did it once. It didn’t work. We’re not going to go buy a whole grocery full of vegetables, not our thing. We’ll eat a few, not a lot. That’s bad. We know we know, but this is what works for us. This is what’s, we’ve made it work, how we’ve made it work.
Fish is amazing, but if you hate fish, don’t incorporate fish into your diet, you’re not going to eat it. So you got to match, counter your taste to what’s good. High protein, polyunsaturated fats, low carb.
What kind of credit check is run for bariatric surgery if you are applying for financing?
One of our coordinators, if you leave your information, they will reach out to you. You can complete the application with them over the phone and it’s a soft credit check so it will not affect your credit. Call 786-559-0803 or complete the contact form
We’re talking polyunsaturated fats an amazing snack. You’re hungry and the afternoon dinner’s not for two or three hours. Multigrain bread, which multigrain bread is very good because it has multiple complex grains. Then you take some olive oil, polyunsaturated fat, drizzle it, you get a slice of avocado, polyunsaturated fats, good healthy fats, you put it on the bread and you sprinkle some garlic salt. Garlic is very good for you and salt is not that bad in moderation and that makes an amazing tasty snack that is high on polyunsaturated fats, not too many calories and very good for you and it will fill you three, four hours until it’s dinnertime. So I love that snack. We often don’t have what we need to make it, but when I remember and I have it is an amazing snack in the mid afternoon, an avocado sandwich, multigrain bread, olive oil, garlic salt.
This is one of my favorite snacks. That’s actually good for you. Way better than reaching for a bag of chips. That’s pure carbs, pure sugar.
A hundred calories of a pack of almonds or nuts with cranberries, it’s a hundred calories. Now if a hundred calories is not enough, you can do two packs and it’s 200 calories. You’re not breaking the bank with 200 calories and it’s high protein and it fills you. Almonds, nuts, an amazing snack. You can’t have the whole bag, but if you have a limited amount of calories, it will fill you and it’s very healthy snack. Way better than most of the carb based snacks like chips or I won’t say brand names, but all that crunchy stuff that is pure sugar.
He talked about getting something from a big bag. If you are going to be eating something that is in a big bag, you need to look at the serving size and you need to serve yourself either in a cup, a bowl in a Ziploc bag, the serving size, put away the big bag and have the serving size. We try to buy things that come in single servings just so that your mind doesn’t play that trick on you. And so you know that what you need to eat is just that one little bag. But if you are having food that’s more than one serving size and it’s very important to serve it and then put the big bag away, be very mindful of serving, size serving. Many times they’re tricky.
All right guys, thank you for joining us.