Dear Friends and Family of Laparoscopic Associates of San Francisco,

Welcome to our January Newsletter. In this issue you will find information on sugar alcohols, obesity in the news, a patient success story, recipes, and insurance updates. Please feel free to submit your tips or your success story with pictures to

We wish you a very happy, healthy, and prosperous 2006!

Statistics & New Surgery Sites

In 2005, the Doctors of Laparoscopic Associates of San Francisco have performed ~450 bariatric surgeries without a single mortality.

Also, the LAPSF doctors are performing surgeries at 2 other facilities!

Lap-Band patients can have their surgery at the Greenbrae Surgery Center in Marin. This is now a brief outpatient procedure with patients being discharged the same day or next day.

Bariatric surgeries are also being performed at Good Samaritan Hospital in San Jose.

Insurance Updates

Reminder: New patients should check with their insurance company regarding weight loss surgery benefits.

Blue Cross is still in the process of establishing their Centers of Excellence, therefore many patients are seeing delays in the authorization process.

Blue Shield will now approve the Duodenal Switch and potentially the Vertical Gastrectomy.

If you have questions regarding insurance or billing, please call Marsha or Marilyn in our billing office at: 415.331.8390 ext. 13 or 14; or toll free 800.704.0028

Guest Speaker- San Luis Obispo
Laparoscopic Associates- Dr. John Feng, will be the guest speaker at the Sierra Vista Regional Medical Center in San Luis Obispo on March 11th at noon.

Sugar Alcohols- What are they?


sugar alcohols, also known as polyols, are ingredients used as sweeteners and bulking agents. They occur naturally in foods and come from plant products such as fruits and berries. But don’t be confused. Sugar alcohols are neither sugars nor alcohols. They are carbohydrates that partially resemble sugar and partially resemble alcohol, but they don’t contain ethanol as alcoholic beverages do.

Common sugar alcohols are mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol, and hydrogenated starch hydrosylates (HSH). Unfortunately, there are some negative effects associated with sugar alcohols. The most common side effect is the possibility of bloating and diarrhea when sugar alcohols are eaten in excessive amounts. There is also some evidence that sugar alcohols, much like fructose in fruit and fruit juice can cause a "laxative effect". Weight gain has been seen when these products are overeaten.

Food products labeled "sugar-free," including hard candies, cookies, chewing gums, soft drinks and throat lozenges often consist of sugar alcohols. Beware- there is often the misconception that all sugar alcohol-containing products are "free foods." Some of these products may still contain significant amounts of carbohydrates. It's important to check the food label for total carbohydrate contained in the product.

If a manufacturer uses the term "sugar free" or "no sugar added," they must list the grams of sugar alcohols. If more than one sugar alcohol is used in a product, the "Nutrition Facts" panel will list the amount of sugar alcohol it contains under the "total carbohydrate." If just one sugar alcohol is used, the label will list its specific name, for example, "mannitol" or "sorbitol."

Sugar alcohols and artificial sweeteners, such as saccharin and aspartame, are not one and the same. One difference between the two types of sugar substitutes is that the artificial sweeteners contain zero calories whereas sugar alcohols contain about 2.6 calories per gram. Another difference is that artificial sweeteners do not contain carbohydrates so they do not cause blood sugar to elevate, whereas, sugar alcohols have some effect on blood sugar. Overall, both can be useful in the management of diabetes when used properly.

Obesity in the News

Physical Inactivity Worsens GI Symptoms in Obese People
Source: Clinical Gastroenterology and Hepatology
Date: 2005-10-03

Bethesda, MD - According to a recent study published in the October journal of Clinical Gastroenterology and Hepatology, physical activity may help reduce gastrointestinal (GI) symptoms. Researchers found that a high body mass index (BMI) and lack of physical activity were associated with an increase in GI symptoms such as stomach pain, diarrhea, constipation, and irritable bowel syndrome.

Researchers from the University of Washington and University of Minnesota found that obese people who incorporated some form of physical activity into their routine suffered less from GI symptoms than others who were inactive. According to Ronda L. Levy, PhD, University of Washington professor and lead study author,"It is well-documented that maintaining a healthy diet and regular physical activity can benefit GI health.""Our study is the first to show the benefit of maintaining these healthy habits and staving off the occurrence of GI symptoms in obese people. These findings have future implications for the treatment of both obesity and various GI disorders and symptoms that are more prevalent in this population."

During the last 20 years, the average body weight of Americans has increased by approximately 10 percent, with more than half of the adult population being overweight and nearly one in every three adults diagnosed as obese. A diet rich in fruits and vegetables and increasing physical activity are great ways to control weight and lead a healthier lifestyle.

2006 Support Group Dates & Locations- Please make note of the changes to the East Bay and Honolulu dates.
Here is the most recent and up-to-date list of Support Groups. **The February Support Group for Hawaii is now on Saturday, February 11th- not on February 4th.**

LAPSF Support Group Locations 2006

SAN JOSE: We meet on the third Wednesday of the month at 6pm for pre-ops and 7pm for post-ops. All meetings are at Good Samaritan Hospital- 2425 Samaritan Dr., Conference room 4 in the basement.

SACRAMENTO: Our support group meeting is on the 4th Saturday of the month at 9am. Located at the Doubletree Hotel- 2001 Point West Way in Sacramento near Arden Fair.

STOCKTON: The Stockton Support Group is held the 1st Saturday of the month at the Radisson Hotel Stockton- 2323 Grand Canal Blvd. Seminar form 9-10am & Support Group from 10-11am.

PETALUMA: Our Petaluma support group meets the third Saturday of the month at Groverman Hall at Petaluma Valley Hospital on North McDowell in Petaluma at 10:30am. New patient seminar at 9am.

EUREKA: Our Eureka support group meets at 7pm on the Thursday evening that our doctors are seeing patients in Eureka. It will be held at the Redlion Hotel- 1929 4th St. (5 blocks from downtown) in Eureka.

EAST BAY: Our East Bay support group meets at 7 pm on the second Tuesday of the month at the Mt. Diablo Regional YMCA in Pleasant Hill at 350 Civic Drive in the Lion's Den Room.

SAN FRANCISCO: Our SF support group normally meets the last Thursday of the month at 6pm at the Cathedral Hill Hotel in San Francisco, at the corner of Van Ness and Geary. Parking is validated.

HONOLULU: The group meets the 1st Saturday of the month at the Diamond head room at 10 am at Kapi'olani Med Center at Pali Momi. 98-1079 Moanalua Rd, Aiea, on Oahu in Hawaii. Call 808.486.6000 for directions.

Pan Sauteed Tilapia with Salsa
4 ounce WLS portion: Calories 235, fat 12 gr, carbs 1 gr, protein 28 gr
Serves 4

4 small tilapia filets, about 4-5 ounces each
Flour for dusting
1 tablespoon olive oil
One jar of your favorite salsa
Lime wedges as a garnish, optional

Rinse fish filets and dry using paper towels. Dust each filet on both sides with a small amount of flour and pat to remove excess. Heat olive oil in a nonstick skillet over medium high heat and saut©filets until golden on one side, about 3 minutes; carefully turn and continue cooking until done, about 3 additional minutes. Transfer to serving plates. Add about one cup salsa to the hot skillet, swirl pan while mixture sizzles, and spoon a little over each filet. Copyright©2005 by Susan Maria Leach, HarperCollins Publishers Inc. all rights reserved.

Creamy Shrimp Chowder
4 oz (1/2 cup) WLS portion: Calories- 130, Fat- 1.5g, Carbs- 10g, Protein- 22g. Makes 4 servings.

1 cup cauliflower, coarsely cut
cooking spray
1/4 cup medium onion, chopped
1 tsp garlic, chopped
1 oz low-fat ham, finely diced
1/4 tsp lemon-pepper
1- 8oz bottle clam juice
1 cup evaporated fat-free milk
1/2 lb large shrimp, shelled, deveined, and quartered
salt & pepper to taste

Steam cauliflower on stove or microwave until very soft. Coat the bottom of a large saucepan with cooking spray and cook onions and garlic over medium heat until soft, about 2 minutes.

Stir in ham and lemon-pepper, then add clam juice and evaporated milk. Cook, stirring occasionally for 10 minutes (it should be slightly thinkened.)

Puree 1/2 of the cauliflower and add to soup, stir well, and simmer for 5 minutes. Coarsely chop remaining cauliflower and add to soup.

Stir in shriimp and cook for 30 seconds to 1 minute until all shrimpe pieces turn pink. (Entire soup may be pureed for an excellent shrimp bisque!)

Ambrosia Salad
Makes twelve,1/4cup servings
Calories 61, Fat 4gr, Carbs 3gr, Protein 3gr

One, 20-ounce can Libby's Splenda Sweetened Pineapple Tidbits or Dole in natural juice
4 ounces whipped cream cheese
4 ounces reduced fat sour cream
4 ounces part skim milk ricotta cheese
2 teaspoons sugar free vanilla Jell-O Instant Pudding powder
1/4 cup Smuckers Sugar Free Orange Marmalade
Freshly grated zest of one orange
1/4 cup Splenda Granular

Drain pineapple tidbits and place on folded paper towels to absorb excess juice. Whisk together cream cheese, sour cream and ricotta until smooth. Slowly add pudding mix while whisking and blend until creamy. Beat in marmalade, orange rind, and Splenda; then fold in drained pineapple. Cover and chill until serving time. Copyright©2005 by Susan Maria Leach, HarperCollins Pub. Inc. all rights reserved.

Don't Forget to Get Your Yearly Lab Work Done Early!
Image We are busy gathering yearly lab statistics from our patients. Believe it or not, the lab where you get your lab work done takes 3-4 weeks to get us the results of your complicated one year labs. This means that you should schedule your one year lab tests at least one month before your one year appointment. Don't forget to stop taking your vitamins 3 days before your annual lab tests. Please see our website or the link below for an annual lab form. If you cannot download it, call our offices and speak to Michelle. We appreciate you getting your labs done on time!

Click here for your annual lab form.

Image Do you have questions specific to your type of surgery? Or want to meet other patients who have had a similar surgery? Then sign up for the LAPSF Yahoo Group...there's a specific group for each type of surgery. Just log on & request to join!

click here for the main LAPSF Yahoo Group

Thank you for your support to date, see you at the next support group meeting!


Dr. Gregg Jossart ~ Dr. Paul Cirangle ~ Dr. John Husted
Khristi Autajay, RD
Laparoscopic Associates of San Francisco
2100 Webster Street, Suite 518
San Francisco, CA 94115
866-957-3627/(415) 561-1713 fax

You are receiving this message because you ar a past patient or you have contacted us about weight loss surgery. If you no longer wish to receive these emails, please reply to this message with "Unsubscribe" in the subject line or simply click on the following link: Unsubscribe