Malabsorbtion, Suppliments, long term lab results

This is not intended to be medical advice, but there seems to be a common theme on this forum where individuals recieve advice from nutritionist or their surgeons office and several years later, will find that they are vitamin deficient.

So here are some things to consider....just some food for thought:

1. Surgeons do 1 thing really well.....cut you open. Surgeons (at least most of them) are not well trained in nutrition. I'm not saying that about all doctors, but in "old style"medical training (this is changing) doctors get just get one or two classes in nutrition (if that).

2. Nutritionists sometimes give really really really good advice, and sometimes do not. I've seen it go both ways.

3. If you get a surgery that has malabsorbtion, it may be up to you to track your labs and figure out your suppliments. (Yes this is something you may need to do).

4. Suppliments cost MONEY. REAL MONEY...SOMETIMES LOTS OF MONEY. IF you cannot afford SUPPLIMENTS, do not get a surgery that has malabsorbtion (please please please do not). I spend about 100 dollars a month (give or take) on suppliments plus the cost of protein bars and shakes which I take for convince not because I need more protein.

5. You may need to take a dosage of suppliments that are considered "dangerous", depending on your level of malabsorption. I take 100K IUs of dry Vitamin A, and 150k IU of dry vitamin D. I remember telling the nutritionist at my doctor's office this a few years after surgery (they kept commenting how good my labs looked), that I took that much A and D and she turned a shade of purple. I guess I have the last laugh....I've been consistently in the mid-high range of average in A and D for 10 years.

6. Supplementation may need to change over time. I have added and taken away over the last 10 years...the basics stay the same, but I've added more zinc, taken away iron, then added it back in, took away B-12 then added it back in...etc. you will need to look at your labs..and see if there are any trends that need to be addressed.

7. You need to take suppliments everyday ....not once in a while. Suppliments are "forgiving"...I've missed a dose here and there, but pretty much I take them everyday...twice per day.

There is probably more to say about this...but the bottom line.....if you get a surgery that has malabsorbtion....you are going to need to make vitamins and tracking your labs part of your life for the rest of your life.

Scott

I had VSG (no malabsorption). The NUT at my surgeon's office has us on the same vitamin supplements as RNY patients for life.  Do you think that is necessary?

I recommend that you check out the ASBMS guidelines.  While I'm not saying that Scottie is an unreliable source, if you ever need an "official" source to cite, the ASMBS is the way to go.  

http://asmbs.org/resources/clinical-practice-guidelines-for- the-perioperative-nutritional-metabolic-and-nonsurgical-supp ort-of-the-bariatric-surgery-patient

If I took 3000 IUs of D (they say at least 3000 IUs) i'd be dead or have jello bones.




But you are right, as I started saying....my post is not to be taken as medical advice, but to make people aware that they are going to need to monitor their own health and labs and maybe take some doctors advice...and "file it"

Scott

That, plus you don't need to supplement calcium, either! This piece is why it's hard to take ASMBS's "recommendations" seriously, at least if you have something other than an RNY or lapband, which is a sad statement about the organization that is notionally looking out for us. It's embarrassing that they still have this piece posted on their site.

It's not unusual for surgeons or bariatric nuts to copy over RNY advice for other procedures our of convenience or sometimes outright ignorance of the differences (we have long been advised in our DS practice it ignore, or at least take with many kilos of salt, the advice of most hospital and bariatric dieticians as their experience is typically with the bypass which doesn't cut it with the DS.) For the VSG, the initial RNY based nutritional advice (extra calcium and B12 typically) is usually a bit of overkill but nothing particularly harmful other than maybe a bit more inconvenient, and should get squared away as labs dictate.

While you're probably not eating enough nutrition to sustain, you don't have malabsorption, so you may not need as much, or a RNY may need more than they recommend.  We DSers have suffered the single generic "wls" recommendations for decades, and along with several RNY patients that supplementation is never one-size-fits-all.

The only way to know is to read your labs.  Never take the vague statement that the nurse says when she calls and tells you that everything is "fine".  Few read the last labs to see if anything is trending up or down.  They're not hard to read, and the results usually give you what your target range should be.  Request a personal copy for yourself and get familiar.

You should be checking your labs. I'd start off with what they are recommending but ready to change as needed.

Scott

The surgeons office checked my labs at 3 months, then will do it at a year and every year thereafter. My PCP doesn't do labs with as wide a screening, but everything he did was in the normal range at my physical this week.  He noticed that my vitamin D was good now (had been low a year ago before surgery).

I just wondered if most people with VSG usually stayed on the same vitamin regimen.

I believe most eople with the vsg take vitsmins, and plan to do so for the rest of their lives. While you do not malabsorbtion, you have changed your digestive process by reducing the size of your stomach; in addition to that you should bit be able to eat as much; and long term some people have difficulties with certain foods...such as beef. It can (again this is my understanding and not medical advice) cause some deficiencies.

Honestly most people without any WLS should probably take bits. The American diet sucks and is full of processed foods with no nutritional value. Yet most doctors do not test for vitamin deficiencies unless there are specific symptoms.

I also had the vsg & my vitamin regimen has changed since surgery, but not by much. My vit B was going too high so I cut out taking that supplement along with the multivitamin to get the levels back down, but I had to take other vitamins to make up for what I wasn't getting in the multi vitamin anymore.

I'd suggest start keeping track of your labs & ask your pcp to start running tests. Usually they won't do anything until a problem develops which means that for months you could be deficient in something & not know it.

There is a range of what Drs consider to be good, you could be low on iron & be considered good, but you'll still be tired as hell.

We don't malabsorb but we might not get all our nutrients everyday at the right levels from just food, so keeping track of trends now gives you a baseline to work with & stay on top of.

I usually get blood work done a couple of times per year & share the info with all my Drs.