Can Vitamin Deficiencies Affect Weight Loss after WLS?

I am just about beside myself.  I had the RNY in February of 2008 after having taken the six-month class and lost 10% of my weight to qualify.  I weighed 306 when I started, and got to 276 at my last class.  I was one of the few *****ached their goal weight, even though we all had the surgery.  I was the star pupil, TOTALLY motivated and EXCITED about the new me!  I was already excited at having lost the 30 pounds, and couldn't wait to lose the other 100, as my goal was about 180.

I lost 30 pounds in about three months - and then came to a screeching halt.  I meticulously charted my calories, my carbs, my fat content and weighed my food until I thought I'd go insane.  It was all I thought about.  It took over my life.

At 230 pounds . . . it made no sense . . . I could run -- RUN for 45 minutes without stopping!  I'd never done that in my life.  I could do 45 minutes of sustained step aerobics.  I took pictures of myself, measured and weighed myself every day -- which was something that was part of my denial in the past -- looking for something, ANYTHING to give me the fuel to keep going.  I no longer wanted to be denial.  I wanted to see me for how everybody else saw me, and I wanted that to be my motivation to keep going.

Weight loss is its own reward.  You are no longer rewarding yourself with food, so the reward you are getting from your denial is the physical results of how you look.  But I was no longer being rewarded for my efforts and I wanted to know why.  I was running out of steam and I just wanted results.  That's all I wanted.  I went through this for six months of the following:

I started going back to my surgeon, and went to see him at least six times, even once after my insurance would no longer cover seeing him.  He's WONDERFUL . . . but after the last visit with my husband, where I broke down & cried, not able to believe I'd had someone rearrange my insides and made it HARDER to lose weight, he told me, "It might be your metabolism."  WHAT?!  How can that be?!  No one told me that could happen!  What does that mean?  How can we fix it?  You mean NOW I have all the "want to" in the world, which I never had before,  I'm TRAPPED in obesity?!

Finally, after many other doctor visits, I went to see the head endo who approved my surgery, who is 45 minutes away.  He lacks severely in bedside manner, but he was my last choice, really.  Prior to me seeing him, I had done so much reading online and have hundreds of bookmarks trying to figure out why I stopped losing weight.  During this time, I had emailed my own doctor (who was out due to surgery herself and had a stand-in), and I told the stand-in what tests I wanted run.  He ran them, no questions asked. 

Fast forward several weeks later when I drive down to see the endo.  All those tests were now in the computer.  When he walked in, I was at my wit's end.  He asked me how I was.  I said, "That depends on this visit."  He said (and I quote), "I only have 20 minutes.  I have other patients to see."  Gee.  Thanks.

 

I tell him the truth: that I'm having trouble losing weight.  MIND YOU - never in my life have I ever said this to a doctor.  Ever.  It was stupid to make such a lame excuse and say something like that when you know yourself that the reason you can't lose weight is YOU, your OWN lack of self-discipline.  So up until this point, I'd never let those words escape my mouth, because before the surgery, it was a lie, and I knew I could lose it.  I just didn't do it.

But now . . . now I really couldn't, and I feared that he was going to take my complaint just as he takes everyone else's complaint -- an excuse.  And yet . . . you go to the doctor and you tell them what's wrong, don't you?  Anything other than the truth would be a lie.  So . . . why can't doctors hear what you're saying instead of making their own assumptions based upon what THEY think you're doing?

He critically and quietly views all my test results from all the tests -- that he didn't know I ordered.  Without even glancing way from the computer screen, he says (again, I quote), "Whoever your personal endocrinologist is, is an excellent endocrinologist."  !!!!!!!!  I look the man in the face and say, "I HAVE no other endocrinologist.  Those tests?  No doctor made the decision to run those tests.  Those tests are in the computer because I requested them to be run.  If nobody else cares why I had my insides rearranged and can't lose weight, I'M going to figure it out."  He was speechless.  One point for me.

At the end of the visit, he states he doesn't know why I can't lose weight.  He suggests that I'm depressed and suggests medication (to which I respond - "Let's fix the problem, not a symptom of the problem.  Fix the problem, and any sad feelings will go away.  Not the other way around.")  He also suggests that since he personally (but an out-of-state doctor) did not diagnose me with PCOS, he questions the diagnosis, and says that even if I don't have it, my lab results are normal, and it's not acting up, and it's not the reason for the difficulty.  He suggests an endoscopy (which I paid $150 for a few weeks later) to check the surgical connections, and says only if that shows a problem will I be able to get a revision.

Although I still cried all the way home, I had some solace in the fact that I wasn't crazy.  A board-certified endocrinologist for the Southern California region couldn't distinguish my orders from a real doctor's orders.  Little old me.  With a business degree.

Two months later, I go back to him with the endoscopy.  But this time I bring my husband.  The doctor walks in, SHAKES our hands, and proceeds with a 45 minute visit that we can barely get him to stop talking!  He was a different person at this visit.  The diagnosis . . . ?  "It's your PCOS," he states.  This is the same man who told me two months before that he questioned whether I had it, and even if I did, it WASN'T the reason for my difficulty.  Does he even know what he's talking about???

 

Since that time, I've all but given up.  I have several times started to lose weight, I start losing for a few weeks, and the same thing happens.  Everything stops.  In mid-March I started back up again and lost 10 pounds in three weeks.  Five weeks after that?  I was still where I was after three weeks.  I was doing the same thing but getting no results.  I had obviously been doing something right to lose the 10 pounds, so when the results stopped coming, it wasn't because I wasn't doing things right, but that my body stopped responding.  It's like being chained to a tree!  You can run all you want, but if you're chained a tree - you're going nowhere fast.

I have gained some of my weight back, and it makes me ill.  The weight gain is no one else's fault but my own, but I had no reward for continuing.  Deprivation and a new lifestyle is supposed to have rewards.  There were none for me.  Why continue to run if you're chained to a tree?  And when you DO ask for help, no one believes you?  What do you do with that?  I have so many marks and goals on my calendars and various charts I've made to pull myself up by my bootstraps and start yet again.  Now, every week, I watch myself miss goal after goal after goal, even when I'm continuing to do what allowed me to lose weight before.  I'm doing what I need to do to reach my goal.  My body isn't.

But this time . . . dealing with weight gain is very different from the old me prior to surgery.  Before surgery, I would have just bought bigger clothes, and that would have made me feel pretty when other clothes got too small.  That would soothe the pain of having gained weight, and I'd just forget all about the sadness I felt about the tight dress that no longer fit.

Now?  I don't allow myself to do that anymore.  I no longer buy bigger clothes.  Instead, I LET myself feel the pain and the frustration of getting dressed for church and putting on things that don't fit.  I face it.  I let myself feel ugly.  I intentionally box myself into a decision: be miserable or change.  The old Sheryl never would have done that.  That's how I got to 306 pounds - I kept making allowances.  I don't do that anymore.  I let myself feel the discomfort so that I'll be uncomfortable enough to DO something about it!

But what do you do when YOU'RE doing right . . . but your body isn't?  At this point, I'm ready to pay the $$$ and go outside of my PPO to go see someone who specializes in minerals and hormones.  I don't even know where to start with that.  But something's wrong.  I've had my thyroid checked a million times.  The blood tests all say everything is normal.

Now I pray every time I go to the mall or to the store that I don't run into anyone from my class.  I already feel like I failed -- even though I know it wasn't me but my body -- and couldn't stand for someone to pass even more judgment on me.

The only thing that's been consistently off in my blood tests is my Vitamin D.  My surgeon said that has nothing to do with my inability to lose weight.  But, by the same token, I had an RN, who herself had the surgery, tell me (and I quote): "I do know this.  If you're deficient in anything, you won't lose."  But yet I know people who have had the DS who are seriously anemic who lose!  I don't understand it.

So I say all that to say this . . . if anyone has any knowledge or help in the area of vitamins and/or minerals or hormones that could be an issue for me, or the type of doctor I need to go see . . . I've spent hundreds of dollars already and have all kinds of food journals, et cetera.  When you do what you've always done and you don't get any results, it's time to do something you've never done.  And that, for me, means going a different route with a different kind of doctor.

Hi Sheryl,

     Find a doctor who specializes in bio-identical hormone replacement.  You want someone who has you do  a saliva test. They look at all your hormones, and replace based on what you're deficient in... Usually it's the anti-aging doctors who do this. I see one in my area who is a chiropractor. She has me send  the saliva samples to the lab, we look at the results together, and she replaces them accordingly. She also does more specific tests for my thyroid and blood work. My vitamin D was very low.
     After these simple tests and replacing what needed to be replaced, I feel like a million dollars. I'm not saying this is your problem, but sounds like you've tried everything else, and at least it's worth a shot.

Good Luck.

Vitamins. That'd be me.

Did you want to fix that pesky D? Anyone working on your iron?

Yes, if you remain deficient, it can damage your ability to lose. You may have cravings for the oddest things, like cough drops!

Can you email me privately? I'm kinda behind, but I'm more behind with PM's. My email is [email protected]

You're outside the 2 year calorie malabsorption RNY window.  With RNY the intestinal villi adapt after 2 years and you absorb 100% of your calories, so you've done pretty well considering you're nearly 3.5 years out.

This is a reason why some RNYers revise to the DS.

Thanks so much for your reply!  I've looked into the DS, but honestly . . . I don't even know that I have the energy to go through the red tape to get my insurance company to cover it.  I mean, what do I tell them?  "I had the RNY and I can't lose weight"?  I've already had more than one doctor stare at me with jaw open in incredulousness when I said that.

Perhaps if I'd given myself a break and realized two years ago that the issue wasn't with ME but with the surgery, I might have been in the frame of mind and had the energy to push in that direction.  But when everyone's telling you the problem is with you, you start believing it.  After all . . . it's my fault that I'm obese in the first place, right?  It's been all my fault up until now, so why wouldn't everything else associated with it just continue to be my fault?

So, I kept pushing ahead on my own, alone, and without support, and tried to beat myself into changing a million different things to get results.  So, now?  I am weary.  I almost feel sick to my stomach to think about trying to go through the red tape of all that, after all the hoops I had to jump through for my first one. . . .  And then, there's the imminent fear--even if I DID have the energy to fight, who's going to believe me, anyway?  It's not just a matter of stating the truth and having someone believe me.

At this point, I feel like I'd be fighting a losing battle.  After all, when all the doctors told me it was my fault that I wasn't losing, I wasn't campaigning for a new surgery - I was asking for HELP for why my CURRENT surgery didn't work and what I needed to do to GET it to work.  The word "revision" never escaped my lips during that time.  So, if they reacted like that when all I wanted was answers and help with my RNY, Lord knows what they're going to do if I mention a revision!

As for the malabsorption, I was taught by my surgeon and by the nurses who oversaw my six month health class prior to surgery that with the RNY, we have always absorbed 100 percent of our calories--it's just the vitamins we didn't absorb, thus the need for the vitamins.  I hear differing opinions on this . . . and I think, actually, it depends upon how much intestine they bypass.  But, this is what my surgeon told me.

I have a boatload of vitamins right now, and I look at that stack of stuff every day and get weary of taking them, often feeling like since I didn't lose, I'm not worth the effort.  I didn't lose the weight, so why am I taking vitamins, anyhow?  To take care of an obese body?!  Maybe my mind is warped, but I guess along the way I have felt that it was only worth it to take the vitamins if or while I lost the weight.  THEN I'd be worth taking care of.  But, now that I can't?  I often look at those labels and think, "Why bother?"

You have to take vitamins when you've had your intestines re-routed... it's VERY important!!!  You don't want to get a deficiency as that can kill you more quickly than excess weight.

You do malabsorb calories initially with RNY as just making you malabsorb nutrients would be pointless!

Don't feel bad, your surgery failed you not the other way around.  WRT it being our fault for being overweight in the first place I say yes and no.  Many DSers joke that they got WLS coz they couldn't get brain surgery, but in all honesty who knows what hunger each person is really feeling.  Plus food is better than many other coping mechanisms like drugs or alcohol (the lesser of several evils IMHO).

You're not alone, there are plenty of RNYers seeking revisions, checkout the board here http://www.obesityhelp.com/forums/revision

Vitalady *****plied to your email herself got ERNY (more intestine bypassed, whilst it's simpler revision and it increases the amount of calories not absorbed it comes with its own complications, so you'd have to really look into it if you went that route).  With ERNY you keep the same pouch and if you dump that'll continue.

With DS/ERNY vitamins are even more critical than just RNY (that's no excuse for you not taking them now though - they're still extremely important), so unless you are prepared to be diligent with them I wouldn't recommend DS (or ERNY).

I hope you find something that works for you and please stop beating yourself up, you're not alone by any stretch.

((Hugs))

TJP

BTW I just saw in Vitalady's signature she had RNY distal, but I think that's the same thing, as I said you'd have to look into that more if you were interested as I don't know too much about that (not ever planning on getting RNY, so not fully up to speed on the details of RNY revision).

Please see beemerbeeper's link here for further details http://www.obesityhelp.com/forums/failed_wls_second_time_aro und/4389195/Please-dont-blame-yourself-if-your-RnY-failed-yo u/

And finally to reply to the question the subject, I've read that vitamin deficiencies can affect weight loss in normies (ie people without WLS), so if that's the case then it'd affect people with nutrient malabsorption worse.

BTW a doc telling your lab results are 'normal' isn't always normal for someone with intestinal re-routing.  I know on the DS board some people post their labs and others review them and give them feedback.  Maybe they do something similar on the RNY board.

I'd get in touch with Michelle/Vitalady and see how she can help, as she's really helped a lot DSers and is very loved on that forum.

Our local drug store will test for vitamin/mineral and hormone deficiencies. It is a silava test. They mail it off and then give you the results. There may be some kits available online if your drug store does not do this. btw/ you have to ask for it. It is not advertised. Also, concerning your thyroid...There are many other tests besides testing your TSH levels. That may not be something to write off right away. Trust me. I had a thyroidectomy. There is a whole gammet of issues that can go on with that little gland. Good Luck