Okay Vets-need your excellent knowledge-lab results

Got my 1 year lab results back yesterday:

my out of range were

albumin 3.4 g/dl 

calcium 8.3 mg/dl

vitamin A 37 mcg/dl

vitamin D 28 mg/dl

hdl 34 mg/dl

iron 27 ug/dl

vitamin b12 >2000

pth 87.3 pg/dl

So I knew that I needed to prob up my protein, I had been getting my protein from food since I can eat enough (wasn't re-sleeved with my DS last year). I am getting around 100-120 grams a day but will add in at least one shake and possibly a protein soup or 2.

vitamin D, calcium, Pth--- since surgery I have been taking 1200 mg of calcium citrate in 3 divided does per day and 50000 iu of vitamin D per day. I was going to up the vitamin d to 100000 iu/day, any recommendations on the calcium? Does that sound good for the vitamin D?

vitamin A- I take 100000 iu/day in 3 divided doses already-recommendations?

I will prob cut back on b12 to 2 or 3 times per week?

Iron- I take 3-60mg vitalady tender iron (along with vitamin c) per day. The dr prescribed Integra F for me to take. It says it has equivalent to about 125 mg of elemental iron). Has anyone used and had luck with this prescription? Should I switch to it only? Maybe take it and 1 tender iron? Suggestions? Or is there something better I can ask him to prescribe?

The NP at the surgeon's office said that iron was well absorbed for their 'bariatric' patients. I don't trust her as far as I can throw her. She prescribed a vitamin D gel capsule 50000iu/once a week (which I won't be getting filled), and was flabbergasted when I told her that I already take 50000 iu /day of dry D. I think she really didn't believe me and repeated it several times.  Her suggestion was 'What multivitamin are you taking." And when I told her centrum, she said I needed to switch to a bariatric multivitamin because that would help me because I will better absorb it! Ugh  The recommendations with the lab work also recommend me to have 60g of protein/day. Eat beef, fish, poultry, pork, eggs, and low fat cheese each meal.  

It's just scary that people that don't know to research on their own would think these things can help them. This is the same office that the NUT Told me prior to surgery to just take a multivitamin and calcium and we would handle deficiencies that came up when we did labwork because she didn't want me taking things that weren't needed. I would hate to think what shape I would be in right now if I had followed that advice. I have taken vitalady's DS regimen from the start and still have issues.

Thank you everyone in advance for your priceless advice!! You guys are the best!

your nut really is a nut.  The most important issues are your bone health and your protein status.  Where is your pre-albumin?  Increase your protein.   You need to up your calcium citrate, I would suggest 3,150 mg citracal max./day divided in 5 doses.  your vit d is very low, yes increase to 100K, forget the vitd2 they gave as a RX we cant absorb that form.

Two- three.. things I noted.

. the vitamin A can become toxic..it is oil based and your body stores it.

B vitamins are water based and your body can not store it, and gastric juices destroy them. To get by this easiest , I use a sublingual b-complex..2cc a day.This will help you build and keep your iron levels up...

I also use buffalo liver capsules 3-4 a day to build and maintain Iron...I could not take any other type except the prescribed foltrin, which has all factors to absorb the iron in it...It hurts my stomach, as well sometimes...so the liver capsules is my substitute and they don't cramp me.

also I would increase the calcium and make sure your magnesium,zinc, selenium... and other bone minerals are "up to par"... you don't want to get 15 years down the road and loose all your teeth like I have done...

I am 20 yrs post op... a hybrid by pass procedure that is not done any more.(a Rny + other procedures, have the DS symptoms..)still would have it again.

You can get thru this, you are pro active and you must be, with the responses you have recorded..

My thoughts.

Some of this is hard to tell since you didn't publish the ranges for your labs. For instance calcium on my lans is 8.5 - 10.5 for part of a normal range. If you are just into the low category I would up my calcium to around 2000 mg a day from 1200 and see where that takes you. If you did 4 does of citrical max that would take you to approx 2400mg.

Try taking the D on an empty stomach but go ahead and increase to two a day.

In my experience if Hemoglobin and hematocrit are still normal the Docs usually don't want to do too much. I would try the prescription with two of the tender irons. That would be an additional 60mg or so elemental iron.

What kind of Vitamin A are you taking. I can't quite remember I think from palmitate is the best. I take 1 biotech 25k a day.

As far as the iron absorption goes I think they were right. Some people just don't absorb iron well even before the DS and the DS doesn't change that.

Keep at it.

Pete