General Fear

I'm in my 5th post op week and doing well. I'm having no problems with liquids and tolerating all foods. I'm happy with my weight loss so far. But, I'm scared and I want to journal a bit about it here because I can't talk to my husband about my fears. I thought I researched well before having this surgery, but I think I only read what I wanted to read.

I'm scared of:

1. Micronutrient deficiency - One study showed that after five years, vitamin and mineral deficiencies with VSG were the same as those with gastric bypass despite regular vitamin supplementation. (https://www.ncbi.nlm.nih.gov/pubmed/23438491) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021197/)
2. Anemia due to PPI use and lack of intrinsic factor
3. Stomach Ulcers and Barrett's esophagus due to high stomach acid
4. Osteoporosis due to PPI use and calcium/Vit D deficiency
5. Having a damaging amount of stomach acid but not having heartburn so not treating the acid
6. Starting out pregnancy with vitamin deficiencies or excesses, especially too much Vit A (as seen in most bariatric vits) which can cause birth defects.

I feel like I have always been a hearty and healthy person with a great immune system and no health problems (aside from pcos) - and now I'm scared I might become a tired anemic person with brittle bones and looming health concerns.

I know my fears are largely irrational. I fully plan to eat a healthy diet, get adequate hydration, and take vitamin supplements for the rest of my life. I'm taking omeprazole daily for at least another month before I try to figure out whether I have too much acid or not.

Thanks for listening :)

In regards to deficiencies-- as a bariatric patient, you will have regular bloodwork done to keep tabs on that. At first, it may be every month or two, then every six months to a year afterwards. You can keep track of your values in a spreadsheet and watch the trends over time to see if your vitamin regimen needs to be adjusted. A good doctor will help you correct any issues early, before you run into things like osteoporosis or anemia.

You'll also want to have your bloodwork done before becoming pregnant, that way you can get the greenlight from your surgeon to go off birth control. It's smart to see both your OGBYN and surgeon during pregnancy and they can help make sure you stay healthy.

A bariatric vitamin will likely have about 200% RDA of vitamin A, which isn't nearly enough to cause birth defects; research shows that you'd probably need to consistently take in 400% RDA or more.

I got pregnant 13 months post-op and had a super easy pregnancy, thanks to losing weight after my VSG. I'm happy to answer any questions about having a baby after WLS, feel free to PM any time.

I do plan to get regular bloodwork, but I had surgery in Mexico so I'm not getting follow-up surgeon visits. My surgeon told me that annual bloodwork is fine, but I plan to get it at 6 months as well just to be safe.

Also, from the link you posted - the correlation was seen at 10000 IU of Vitamin A which is 200 RDA and what is in most of the bariatric vits I have seen.

Hmm. Mayo Clinic says RDA of vitamin A for women is 2,300 IU; 10,000 IU would be 430% of that. That's where I got my numbers from.

You'll find quite a lot of variation in bariatric vitamins; this one, for example, has 7,500 IU of vitamin A.

Many folks, myself included, don't rely on bariatric-specific vitamins after the early post-op period. You can meet ASMBS guidelines perfectly well using a general multivitamin, albeit a higher-than-normal dose.

Thank you! Can I ask what your personal vitamin regimen is?

Sure! I take:

• Kroger generic of One-a-Day Women, two daily (one in morning, one at bedtime)
• Feosol complete iron, 1 daily
• Citracal 1,200mg + Vitamin D

I've taken extra vitamin D and B12 in the past, but my history shows that I don't need those extra supplements anymore.

If you don't have a copy yet, here's a handy reference guide to vitamin requirements.

All of these fears are definitely reasonable. But they are also things that you can keep yourself aware of and prevent/manage if they happen. I think the key is just to stay on top of your healthcare and lab work. For the lab work, make sure that YOU get a copy of your results and that you plug them into a spreadsheet so you can track trends. Do not trust your PCP to do this for you.

Your fears are totally rational, albeit controllable, for the most part. Nutritionally, talk with your PCP about adding nutritional labs to your annual physical schedule so you can make sure you're in good shape. The VSG has you absorbing nutrients just as your body always has, unlike the RNY and DS, so you need to eat strategically and take vitamins, tweeking according to what your labs tell you.

Your fears are not irrational. These are good things to be afraid of.

Fear can be a good thing. It keeps us vigilant. As others said, get regular lab work and checkups, and you should be fine.

Many of the people who run into problems with deficiencies just stop getting checkups after a year or two. They stop taking supplements, because, hey, so far so good, right? And anyway, they had VSG, so they don't need all that stuff, right?

Start off with the ASMBS recommendations for supplements. Get labs, and adjust up or down accordingly.