2nd try - lab help

OK, OK, OK, OK - I admit it. The vets are right. Don't listen to anything your surgeon's office says about nutrition post-op.  

Listed below are my pre and post-op labs and normal ranges. Anything out of range is in red. I bought the surgeon's office advice to start with their plan and adjust according to my labs. Now my labs have gone to **** and I'm not going to follow their advice anymore. Currently I am taking 3 Bariatric Advantage ADEK (1 pill 3 times a day); 2400 mg calcium (2 of Vitalady's calcium 4 times a day), 60 mg Vitalady iron (with 1000 mg generic C, once daily, by itself). My question - Should I switch to Vitalady's program or something more aggressive?  For nutrition I use 2 shakes (2 scoops each, total of 80-90 g protein) each day. The rest of the day I eat mostly eggs, cheese, meat, nuts and a few veggies. My total protein is usually about 120 g. Once in a while I'll eat a bit of bread or crackers, but I really try to limit the carbs. Should I add another shake? I'm 5 months out from surgery; DS surgery was 3/28. I've lost 71 lbs and have 54 lbs to go to goal.

	Reference Range			Pre-Op	Date	Post-Op	Date
	Low	High	Units	11/4/2010	3/8/2011	7/2/2011	8/26/2011
Metabolic Panel
Glucose	65	99	mg/dL	85	105	81	83
HA1c	6.5	% of hemo
Urea Nitrogen (BUN)	7	25	mg/dL	14	16	16	16
Creatinine	0.59	1.07	mg/dL	0.9	0.78	0.78	0.77
eGFR	>60		>60		89	91
sodium	135	146	mmol/L	138	137	139	139
potasium	3.5	5.3	mmol/L	3.9	3.9	3.4	3.7
chloride	98	110	mmol/L	103	104	106	107
carbon dioxide	21	33	mmol/L	24	29	23	26
calcium	8.6	10.2	mg/dL	9.5	9.8	8.9	8.9
calcium, ionized	4.8	5.6	mg/dL	5.1
PTH, intact	10	65	mg/dL	45			90
protein, total	6.2	8.3	g/dL	7.2		6.4	6.2
albumin	3.6	5.1	g/dL	4.5		4.1	4.1
globulin	2.2	3.9	g/dL	2.7		2.3	2.1
albumin/globulin ratio	1	2.1		1.7		1.8	2
bilirubin, total	0.2	1.2	mg/dL	0.6		0.6	0.8
bilirubin, direct

I give up on trying to paste in my spreadsheet. Here's the rest of my labs that are now out of range or changed a great deal:

lab                              range                 pre-op     post-op
vit D, 25 OH total  30-100           41          22
RBC                     3.8-5.1          4.01       3.17
hemoglobin           11.7-15.1      13.1        10.3
hematocrit             35-45           38.7        30.8
RDW                     11-15          11.5         15.4
cholesterol, total    125-200        162          94
HDL                      >45               66           42
LDL                      

There's the D. Oh yeah, too low. Definitely need to boost that D. Exercise should help with the HDL.

I don't see your vitamin levels. How is your D? Alkaline Phosphatase? Since your protein seems to be trending down, yeah, I would add another protein shake. PTH is high. So we need to see where your D is at. How much total elemental calcium are your taking a day? Are your taking magnesium citrate and K2? Those help with calcium absorption too.

Alk phosphatase is 60 (range 33-115). I'm getting 2400 mg calcium (divided into 4 doses). I'm not on magnesium citrate or K2, just those ADEKs.

Are those the chewble ADEK"s, thats more like a multivit you still need to supplement your D , A, k and E separately. A good place to start is with Vitalady's schedule.
Joan

ADEKs are inadequate for our needs. Check your supplements to make sure you are getting at least a 2:1 ratio of calcium:magnesium (preferably magnesium citrate). Vitamin K2 is important to make sure the calcium is going to your bones and not being deposited in your arteries or other soft tissue.

Bonnie.. you're going to find that it's going to take a little while to get your labs back up, I hope you are feeling more or less ok.

You mention supplimenting Iron, do you know what your hematocrit/hemoglobin is at?  If you're feeling tired and or cold a lot this could be part of the issue.  I take 3 60mg (it's 325mg, but only 60 is elemental) in the morning AND at night.  Taking it with vitamin C is good.  Also remember don't take it with any other medications or vitamins (except possibly copper) for an hour before/after you eat otherwise it won't be absorbed well at all.

It's good you're stepping up your suppliments, I was told 2 multivitamins and 4 tums a day by my surgeons office.  Wrong.

Justin

Edit: I see the rest of your labs now.  Get some 50k IU DRY D3 from Vitalady, I think she's got a summer sale ending soon on it.  People will tell you 40 is the bare minimum, but 80 is good. If you're at 22 chances are most of the calcium you're supplimenting isn't doing you much good.

 Justin I can not believe that surgeon saids 2 multi and Tums.  It is really hard to get labs up.  I wish you luck Bonnie.

 When the heck are surgeons going to figure out that we need more than an ADEK????   Grrrrrr.......then they stop doing the DS because of supposed deficiencies, when all they have to do is prescribe enough D from the get-go.    Did they test your zinc or your A?   We come up short on those, and they are all linked.    Get yourself on 50 k of dry D a day,  and that's for starters.     I can't help you much with the iron issues, as I am infused.

In my experience, my protein was pretty wonky for a while, then it righted.  My D and calcium issues though, do not seem to want to go away.