just has some general questions....

I'm 10mths post op and a little concerned....I'm 5'6" - starting weight 283lbs...current weight 121 lbs and still losing.  I have stopped exercising.  I think I'm losing too fast and too much.  I saw a post about all the supplements that everyone takes...I only take vitamins& calcium chews.  My labs always are fine.  My surgeon says I don't need B12 or anything else...but, I don't heal properly.  It takes forever for a scratch to heal.  I bruise so easily...I'm faint very often.  I only get in 600 calories aday.  I can't eat more than 5-6 bites of food.  I physically can't get anymore shoved into my pouch.  I've tested the limitations and anything past that 6th bite, I vomit.  I eat 5-6 times a day just to get in 50g of protein.  I know that's not enough protein! At 10 months out, I'm still losing 3-5lbs a week/week in a half.  I'm afraid that my body is taking from my muscles and organs.  I'm afraid that I'm going to have some big complications just down the road. What supplements should I be taking?  How can I slow the weight loss down?  Any suggestions would be very helpful... Thanks, Dawn

I'm not an RN or NUT but here's my take You didn't say anything about protein shakes.  You could drink them instead of your other fluids/liquids to up your calories and protein.  You would need to look for the ones with the most calories per scoop like body builders use. If you would use 2-3 of these a day that could add abother 300-600 calories and would help you to matain and not lose. GNC has a lot of different mixes to chose from. If you would use 2 scoops per drink that would give you another 220 calories and another 41 g of protein. They also have a Ready to drink that also has about the same values. There are also protien mixes and ready to drinks you can get at WalMart, and Sams if there isn't a GNS close to you.  Even if you added 2-3 Slim Fast High Protein shakes that would be a start.  As far as other supplements you could try the sublingula (SP) B12 and I don't think that would hurt.  How's your IRON?? if you are fainting and don't heal your iron might be low.  Each doc and everyone is different sometimes you just have to do what YOU think is best even if your doc doesn't say so.   Take all the info that is out here and do what is right for YOU it's your body and your life.  For an example my doc said that TUMS was ok to take for calcium and if you go to any wls board you know that is just WRONG!!!!!!!!! Good Luck,  Robin

If you are 5'6" and 121# - are you at goal? If so, it's time to start looking at a maintenance program.  This means you need to start increasing your calories.  it is very helpful to do this with the help of a dietitian - I strongly encourage you to get professional help from an RD who looks at your personal habits and history to find a program that works for you. I am concerned that you have stopped exercising.  Exercise has many long term benefits beside weight loss or maintenance.  You should be able to find a way to keep exercising and stop losing. For supplements - I'm not trying to bash doctors, but the evidence is clear that supplements for WLS patients are important and life-long.  You need B12 supplementation and other specific nutrients that your surgery causes you to malabsorb.  When you consult a dietitian for your calorie goals, also talk about supplements.  New research is coming out on this all the time - for increased vit C, D, Bs, and minerals like iron and calcium.  Do the research yourself as well!  The long term effects of deficiency can be devastating, and avoidable if you take care of it. BTW to the previous poster calcium carbonate is fine.  Calcium citrate is better absorbed, but calcium carbonate is cheaper.  I posted on this before.  You can meet your needs with Ca carbonate, just take a little more. I hope this gets you started!

Danielle Wrote: BTW to the previous poster calcium carbonate is fine.  Calcium citrate is better absorbed, but calcium carbonate is cheaper.  I posted on this before.  You can meet your needs with Ca carbonate, just take a little more. ----- I'm going to go find your post about calcium carbonate.  But my understanding is that calcium carbonate requires stomach acid, or an acid meal to begin breaking down.   Is that correct?  If so, then since we RNY'rs no longer have stomach acid and (especially at the beginning) don't eat highly acid foods then the carbonate doesn't have a chance to begin its absorption process until it reaches the Y where stomach acid is finally mixed with what we eat.   I've heard of way too many WLS folks who end up with osteporosis after years of taking carbonate. I've done a ton of research on this because I really don't want to have brittle bones or any further health problems that could be prevented now. People who develop osteoporosis have said that their blood tests come back fine for calcium levels, but that's  because carbonate is used mainly by the blood whereas citrate is used primarily by the bones.  Which is also a reason for us to have regular Dexascan bone density testing. I personally am taking UpCalD - powdered calcium - because I knew I would not be able to deal with taking 4 huge horse pills every day.  I had problems with big pills before surgery, so I knew I'd have issues post-op too.  I've found it so much easier to just add a scoop of calcium to whatever I eat and not worry about it again. Ok, off to search for your info about calcium. Pam

http://www.obesityhelp.com/forums/nutrition/a,messageboard/a ction,replies/board_id,5389/cat_id,4989/topic_id,3422493/pag e,1/#26667069 Here is the post I was referring to. I agree that it is important to be concerned about calcium - and this was not always the case in RNY post-op recommendations.  More doctors are on board now than before, which is good. The studies above reference RNY patients and their absorption of calcium.  The molecule calcium carbonate does not require acid to be broken.  Calcium carbonate is often used as an anti-acid because the molecule is able to pick up hydrogen atoms in the stomach thereby neutralizing the hydrochloric acid that is present there.  The molecule can break, freeing the calcium without acid - besides, the absorption cannot take place until it reaches the small intestine anyway.

Serum (blood) calcium levels are not a good indication of body calcium stores.  This is the case with most minerals that are measured in blood tests - they are not stored in the blood so the levels are not an indication of what's truly going on in the body.  Blood calcium levels will be normal (provided the carrier protein albumin is normal) because calcium will be leached from the bones to maintain serum levels.  The muscles are a big users of calcium as are neural tissue - levels of this ion are important for the body's function. It is also important to give the body a reason to support the bones - regular exercise, particularly weight bearing is an important factor in maximizing calcium absorption and maintaing bone mineralization.  There are other risk factors for osteoporosis already which can be compounded by the malabsorption of calcium in WLS.  I agree that DEXA scans are the "gold standard" in determining the porosity of bones.  But before osteoporosis can be visualized on a scan, it is important to approach the problem proactively and maintain good calcium levels and appropriate vit D to help with calcium absorption. Happy Thanksgiving!