vitamin d3 malabsorbtion (sp?)

Hi All, This is where I am at with my blood work and I do not really have a doctor since we moved.  My GP is still with me (I would never leave him), but I hate my wls doctor!  What do you take?  I use the bariatric advantage multi (2 capsules, 3 times a day) and a sublingual B12 once a day. So far everything else seems good.  Guess I need to find a doctor here.  Any suggestions?  I am just outside Dover, DE. carrie

Carrie665: Hello, welcome and thanks for bringing up these issues (how to find a bariatrician doctor for lifelong follow up and supplements/labs postop).  So many of us suffer permanent damage due to lack of adequate follow-up! (B12 for instance if untreated can cause permanent and irreversible brain and nerve damage! And we all know that osteoporosis/metabolic bone disease can be deadly as well)I hope through education we can stop trading morbid obesity for malnutrition after WLS!

 

Are you vitamin D deficient? I am confused by the post title then reading your content?. You will find conflicting info for sure on this (and other topics r/t WLS) in the bariatric community, partially because there is limited research but sometimes due to lack of knowledge of what is currently available! * I am D deficient and have some good references on this. Most PCP's are not up to date on our lifelong needs, so do they even screen the correct labs? If they do can they manage the complexity of deficiencies we may face? I am not convinced. Luckily in my area we have many clinical nutrition DOCOTORS who are specialists with nutrition and bariatrics! One way to search would be this site:

 

 

 

http://www.asbs.org/html/about/membersearch2.html

 

or

 

http://asbp.org/locate_physician.php

 

 

 

of course hooking up with other WLSers in your area may yield + results as well (local support group perhaps? Or online Oh forum?)

 

 

 

Vitamins & supplements go on labs You will probably hear MANY different responses because each bariatric program has different guidelines, as well vit/minerals postop are individual based on a persons response to surgery and their pre-existing needs as well. This is why follow-up and labs are crucial...

 

Most need at least a Centrum type complete multivitamin, Calcium in the form of citrate for Rnyers to best absorb amount depends on labs/dexascan/comorbid conditions, and Sublingual B12. With that said some need more supplements like; *I have a whole document on why citrate is preferable with references if desired! Avoid taking carbonate and wasting bones, money and kidneys possibly with this form the risk kidney stones is higher in an already high risk population of post RNY-ERS! http://bariatrictimes.com/2007/09/10/urinary-calculi-and-bar iatric-surgery/  VIT A, D, E, K, ZINC, SELENIUM, COPPER, IRON *USUALLY FEROUS GLUCONATE OR FERROUS FUMARATE OR POLYSACCHARIDE IRON, IRON CHELTE OR CARBONYL IRON, KEEP FROM FERROUS SULFATE IT CAN BE MOST HARSH ON POUCH AND NOT AS READILY ABSORBED. (oops sorry cap loc****xtra magnesium, thiamin (B1), B6, folate, potassium etc. Preop have your levels been drawn? They are finding many Morbidly obese deficient preop now interestingly in things like Vit D especially.

 

 

 

TYPICAL LABS every 3-6-12 months postop depending on needs at least yearly for life after RNY! see below

 

IMHO FWIW there is no need to buy expensive vitamins UNLESS You find you do not absorb others, there is no 'bariatric vitamin' there can not be because we all respond differently to a bypass, yes we know certain typical deficiencies happen but our labs all differ slightly to greatly, so no manufacturer can formulate one for all patients, so save the cash do your on research on what works best for your body and pocketbook! Beware of gimmicks or providers pushing a product for they MAY be getting financial incentives to do so also....

 

 

 

 

 

COMPREHENSIVE METABOLIC PROFILE

 

LIPID PROFILE

 

GGT, LDH, Prealbumin

 

PHOSPHORUS – INORGANIC, URIC ACID

 

CBC w/ diff

 

B-12 & FOLATE, B-6 & Thiamine (B-1)

 

IRON, TIBC, % SAT, FERRITIN

 

VITAMIN A, E & D (25-hydroxy)

 

THYROID PANEL (T3, T4, TSH)*only initially unless suspect.

 

ZINC, MAGNESIUM, Selenium, Copper

 

SERUM INTACT PTH

 

Homocystine, MMA

 

HGB A1C (only if diabetic or suspected)

 

DEXA SCAN every 1-2 years depends on results!

 

Diagnosis:

 

579.3 post-surgical malabsorption

 

268   vitamin D deficiency

 

269.2 hypovitaminosis              

 

268.2 metabolic bone disease

 

244.9 hypothyroidism               

 

 

 

(I know repeating here!) As far as using a 'bariatricvitamin or other high profile/ESPEN$iVE VITAMIN" that is a choice but IMHO not necessary to pay for a name! There is NO way to make a bariatric vitamin because an INDIVIDUAL’S needs cannot be determined. We are not one size fits all so anyone who says take this and that is all you need is just not telling the truth and or doesn't know reality for most!

 

I buy a bottle of 300 multis (Centrum like Wal-Mart brand about $10 for a years worth! I need only 1 a day!) My iron is 300mg I do 1 day (ferrous gluconate) 100 tabs $6 Wal-Mart, upcalD 227 servings http://www.colonialmedical.com/product.php?productid=20018&cat=526&page=2

 

 $10.95 each + S&H lasts almost 4 months as I use 2 servings a day or citrical 180 tabs 500mg each for $9, 4 tabs = 2 doses day lasts me 45 days, vit C 500mg 500 tabs (lasts 1.5 yrs as I do one a day is $5!), b12 sublingual $6 bottle of 60 doses again Wal-Mart’s spring valley brand. Those are MY vits on my labs that I get q6 months.

 

 

 

 

 

Multi less than $1/month

 

B12 $3/month

 

Calcium *I do a combo:

 

UpcalD 2 doses a day (1,000mg total)+60 doses=1/4 can= $3/month

 

Citrical 4 pills a day (1,00mg total)=120 tabs=(~ 2 bottles for 3 months)=$6/mo

 

Iron 1 tab day=30 month (3+mo in bottle)=$2/month

 

Vit C 500mg tabs 1 day=30 month=30 cents or so/mo!!!

 

______________________________________

 

$15.30 /mo in vits x 12 months= $183.60 yearly

 

Some articles: *I have more that are PDF if you want email me at [email protected] I will send! (what a pcp should know etc) 

 

Other good articles: 'Dear Gastric Bypass Patient' http://www.bbvitamins.com/Research.aspx 

 

by: Cynthia Buffington PHD (*well known/published bariatric researcher)

 

 

 

http://www.uspharmacist.com/index.asp?show=article&page=8_14 38.htm Vol. No: 30:02 Posted: 2/22/05 The Skinny on Gastric Bypass What Pharmacists Need to Know Sarah A. Fussy, PharmD Candidate, BS Pharm Sci, minor Nutrition Sci, North Dakota State University Status: post Lap Roux-En-Y 6/03/03US Pharm. 2005;2:HS-3-HS-12.

 

 

 

The Long-term Effects of Gastric Bypass on Vitamin D MetabolismJason M. Johnson, DO; James W. Maher, MD; Eric J. DeMaria, MD; Robert W. Downs, MD; Luke G. Wolfe, BS; John M. Kellum, MD Ann Surg.  2006;243(5):701-705.  ©2006 Lippincott Williams & Wilkins Posted 05/11/2006 http://www.medscape.com/viewarticle/531684_print  you have to register it is free though

 

 

 

http://jcem.endojournals.org/cgi/content/full/91/11/4223

 

Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status  Meena Shah, Vinaya Simha and Abhimanyu Garg  Division of Nutrition and Metabolic Diseases (M.S., V.S., A.G.), Department of Internal Medicine (V.S., A.G.), and Center for Human Nutrition (M.S., V.S., A.G.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-9052; and Department of Kinesiology (M.S.), Texas Christian University, Fort Worth, Texas 76129

 

 

 

http://www.bariatrictimes.com/obesity-medical-books.cfm Micronutrition for the Weight Loss Surgery Patient  Description: Price: $49.95 (plus $5.00 shipping and handling) Written by Jacqueline Jacques, ND Softbound, 148 pages. Nutritional medicine is really a specialty unto itself, and few physicians today are properly prepared to manage complex cases such as those that may present in the weight loss surgery patient. Unmonitored nutritional deficiencies can leave weight loss surgery patients vulnerable to both acute and chronic conditions with variably reversible to permanent physical damage. This book is intended to offer a practical manual for prevention, diagnosis, and treatment for surgeons, primary care physicians, dietitians, and others caring for weight loss surgery patients. Clinicians using this book should ultimately find themselves better equipped to make educated decisions regarding nutritional management of their weight loss surgery patients.

 

 

 

Chain Reaction: Vitamin Deficiency

 

http://www.vitamins-nutrition.org/vitamins-course/vitamin-de ficiency.html

 

 

Hi! Thanks for your reply!  You sent a huge amount of information and I will go through it gladly!  I have just begun to go onto the forums, it seems that they are a vast network of support and information that isnt "out there" as one giant source. Ignorantly, I thought that once the surgery was over, once the weight loss was over 100lbs, that it was nearly over.  However, it seems like there are always other doors to open and explore.  One of the biggest conflicts I have had to face is insurance companies.  So that you are not confused:  I have tested twice on Vit D difficiency.  The first time was through my surgeon and he did nothing.  The next time through my family doctor and he sent me lab slips to have my blood and urine tested in 3 months with an order for me to take 50,000mgs of Vit d supplements once per week.  I am totally duh about where to get that, or what brand to choose etc.....I do have a pharmacist I know that may help and I most deffinately need to talk to my doctor. So, are you really a cat lady?  Single?  No children?  I say that jokingly as I have 4 cats and have been accused by my kids...........They are the purrrrfect pet arent they? Thanks for all the info!  Wish me luck finding a good dr in my new state! Carrie

Hi, the Vit D is by prescription go to the pharmacy they will fill it for you! You can not buy this amount of D over the counter! I am married with 5 furbabies no kids! Yes they are wonderful, best of luck keep in touch! Knowledge is power! If you want more info let me know offline [email protected]

Thank you so very much!  I am currently getting my family dr to give me Rx.  Still looking for a bariatric dr. here. Hubby is still living (ha ha) but kids are gone!  Just steps away from being a real cat lady! I will let you know what I end up with. Thanks! Carrie

OK!

I take vitamin D3 capsules in 50,000 doses.  I do not need a prescription for this.   I buy from http://www.bio-tech-pharm.com  This place is very popular with distals, because I think they may be the only one's offering high dose vitamin D supplements.  I have a 100 cc common channel (very short) - so I malabsorb the maximum amount.  I take two 50,000 capsules - every day - for 6 days every week.  This puts my D3 -O 25 at 64. Amy

Hi Amy: Thank you for the site, I went there and see no prices? http://www.bio-tech-pharm.com/products/d35.html how much is a bottle? I know many order this from Vitalady www.vitalady.com http://www.vitalady.com/cgi-bin/commerce.cgi?preadd=action&k ey=1070 it is $24.99 for same thing (trying to bargan shop!) I have been getting my Vit D (I am a proximal 100cm bypass making my CC probably more like 400cm+!) by RX 4 caps are $6!!!