Blood Work Question .... RNY vs VSG

Thank you Donna! I appreciate your response. I'll ask my surgeon's office if they can order a DEXA scan, and will see what insurance says. I'm in my 60s anyway, so it is not a bad idea regardless. I live in California where there is plenty of sunshine, nevertheless once in the past few years my D was low enough to require supplementation. Also a good idea to have it checked. It was good about a year ago, I know.

My PCP just had some blood tests done, checking for RA/inflammation due to pain issues... got a call the other day that my Vitamin D level was low, so I have to increase to 3000mg(?) /day. When I see her next week I'll ask for a copy of the results so I'll be able to see what tests were done. Then I'll do a search here to check out what should be done. I know that question has been asked and answered before.

Tx.

Try to get a copy every time, and track the results. Usually docs are fine as long as everything is in the "normal" range, but tracking will let you see trends so that you can address them before they become abnormal - if D is trending lower each time, adjust the diet and/or supplements before it gets too low. My PCP is fine with it being 50ish normal (and it's stable) but the bariatric doc prefers it to be 70ish - he has a better feel for what works best for bariatric patients than the PCP does. The bariatric practice started checking D pre-op some years ago when they realized that they had little idea how much of the post-op D deficiency they were seeing was the WLS (primarily DS, where D is a known malabsorbed vitamin) and how much was intrinsic in the incoming population.

In principle, the VSG shouldn't need extensive testing as its' inherent absorption properties aren't all that different from normies, but I agree with Grim in that given the poor diet of the general population, its good to understand where your body chemistry lies. And, since many WLS people are susceptible to various high deficiency fad diets (you name it - Atkins, Paleo, keto, etc.) that's all the more reason to treat everyone as if they had a malabsorbing WLS procedure. Even without the fad diets, as we advance in age we are often struck with the need to adopt certain restrictive diets to address various maladies that crop up.

That's actually somewhat of a misnomer regarding fad diets. Keto isn't prone to vitamin deficiencies, as 1) vitamins are stored in fat, and 2) you need less of certain vitamins whilst in ketosis. For instance, the need for vitamin C is drastically reduced in ketosis, as you are no longer utilizing the citric acid cycle/krebs cycle as the predominate source of ATP generation. Meat and fat are also both high in the vitamins WLS patients are often deficient in. In fact, often they are higher than plant sources, so I'm naturally curious how they could be responsible for vitamin deficiencies. I suppose if all you eat was packaged plastic low-carb foods, then yes, you'd be getting poor nutrition. If you are eating primarily meat and animal fat, though, biochemically you should not be having deficiencies unless it is highly processed. Unless there's some aspect to biochemistry I'm missing, which may be the case!

Of course, I'd also argue they aren't necessarily fad-like, depending. Arguably, it's healthier to eat primarily meat and low-sugar plant materials and skip most grains, physiology and genetics depending. It's also, arguably, better to keep serum insulin low, because even if blood glucose is low, higher serum insulin is what causes many of the diseases of western civilization. Then, staying in a state of ketosis is more beneficial for cognitive function, as well as autophagy, which in turn reduces, again, many symptoms we attribute to age.

Of course, I regularly eat organ meat and most people do not (beef heart tonight!) so I am atypical, myself.