VITAMINS - MUST READ

I have had the chance this week to talk to several people this week who tell me they are not taking their vitamins or doing their protein . Most of us here where given a regimine to do for supplimenting protein and vitamins . Why would you NOT do this . This is a life or death matter . It pains me when I hear " No . I forget .. or they taste funny .. or protein taste funny ... All I can say is , find one that does not taste funny and if you can't then hold your nose ..LOL .. or get it from food sources . Below is somethings I hope you pre-ops will read and take note of . This is no joke .. nothing you should dismiss .. it is serious stuff . If you would like my entire lesson on this please email me, I Will be more than happy to send to you . Why protein supplementation? It's about Absorption Proteins form the body's main structural elements and are found in every cell and tissue. Take away the water, and about 75 percent of your weight is protein. Your body uses proteins: ● for growth ● to build and repair bone muscles hair connective tissue skin internal organs blood virtually every other body part or tissue Besides building cells and repairing tissue, proteins form antibodies to combat invading bacteria & viruses; they build nucleoproteins (RNA & DNA). They make up the enzymes that power many chemical reactions. They also carry oxygen throughout the body and participate in muscle activity. At least 10,000 different proteins make you what you are and keep you that way. Hormones, antibodies and enzymes that regulate the body's chemical reactions are all made of protein. Without the right proteins, blood won't clot properly and cuts won't heal. Each protein is a large complex molecule made up of a string of building blocks called amino acids. The 20 amino acids the body needs can be linked in thousands of different ways to form thousands of different proteins, each with a unique function in the body. Your body can't use food protein directly. So after protein is ingested, digestive enzymes break the protein into shorter amino acid chains, and then into individual amino acids. In the gastric bypass patient, this normal digestive process is bypassed. These digestive enzymes are not available until they meet with the food protein in the common channel of the small intestine, and then have only about 5 - 7 ½ ft (compared to 20 ft in a "normal" digestive tract) to do their job. The amino acids then enter the blood stream and travel to the cells where they are incorporated into proteins the body needs. Nine of the 20 amino acids required by human beings are considered "essential" because they come only from the diet; the other 11 are considered "nonessential" because the body can make them. AMINO ACIDS The average*** person (the "normal", NON-gastric bypass patient) needs 50-65 grams*** of protein each day. Considering malabsorption of at least 50%**, the RNY patient will need 100-140 grams per day minimum, which cannot be eaten as food because of the small size of the pouch. **Note: Depending on the length of bypass, the RNY patient may absorb as little as 25% or less. But it is normally agreed that even a short proximal will not absorb more than 50%. ***Note: Adults need a minimum of 1 gram of protein for every kilogram of body weight per day to keep from slowly breaking down their own tissues. That's about 8 grams of protein for every 20 lbs. Malnourished, septic, pregnant, injured or burned patients will require more protein, in the order of 1.5-2.0 g/kg daily. Extra protein is also required after surgical procedures and illness. According to Sally Myers, RD and regular contributor on nutritional issues to the WLS-related newsletter "Beyond Change": "How to determine grams of protein you need daily when not yet at ideal weight: Subtract 120 from your current weight. Multiply that answer by .25 and add it to 120. Base your protein needs on that number. Extra protein is not needed for fat mass." Around the world, millions of people don't get enough protein. This protein malnutrition leads to the condition known as kwashiorkor. Lack of protein can cause growth failure loss of muscle mass decreased immunity weakening of the heart and respiratory system death Specific vitamin and mineral deficiencies Vitamin/mineral Clinical manifestation Vitamin A Eyes Night blindness Xerosis (dry bulbar conjunctiva) Bitot's spots (conjunctiva plaques) Keratomalacia (corneal ulceration) Skin Hyperkeratosis Vitamin B12 Hematologic, neurologic systems Anemia Nonreversible loss of vibratory and position sense Paresthesia Gastrointestinal Diarrhea Vitamin C Skin Perifollicular papules (brittle hair) Perifollicular hemorrhages Gum bleeding Skin purpura, ecchymosis Vitamin D Bone Bone pain and softening Joint pain Rickets Proximal myopathy Vitamin K Bruising Bleeding Vitamin B6 (Pyridoxine) Skin Seborrheic dermatitis Cheilosis Glossitis Niacin Dermatitis Diarrhea Dementia Thiamine CVS CNS Congestive heart failure Wernicke's encephalopathy Wernicke-Korsakoff syndrome Zinc Skin Acrodermatitis enteropathica Alopecia Taste Hypogeusia Folate Hematologic, neurologic systems Anemia Reversible loss of position and vibratory sense CVS = cardiovascular system; CNS = central nervous system It is not uncommon for the patient to think the toilet is malfunctioning because several flushings are needed to remove the stool. A greasy character and truly rancid odor are indicative of increased stool fat, but are often absent until late. These complaints are often readily passed over by the busy physician. At such time, physical findings are usually absent, but hyperactive bowel sounds may be noted, especially in small intestinal disease. If symptoms are intermittent or if they progress slowly over many years, patients may exhibit vague, seemingly unrelated symptoms such as chronic fatigue and depression, long before the physician considers the possibility of serious organic disease. Vitamins: Sources, Amounts and Important Issues The Food and Nutrition Board of the National Academy of Sciences is the governing body in charge of setting the minimum vitamin levels in order to prevent deficiencies in healthy adults also known as the RDA (recommended daily amounts). We now know that vitamins are important for maintaining health and preventing disease. No one knows what the RDA is for a gastric bypass patient due to altered anatomy and a low calorie post-operative diet. We have seen vitamin deficiencies before surgery despite adequate calorie intake but likely due to poor eating habits. For bypass patients, in order to maintain good nutritional status, we have learned from measuring blood levels that a vitamin supplement that exceeds the RDA can provide adequate serum levels. Vitamin A Vitamin A is a fat-soluble vitamin also known as retinol (fat soluble-animal source) and beta-carotene (water soluble-plant source). It functions in the body; to aid in tissue growth and repair; to improve and maintain normal vision, to maintain healthy skin and mucous membranes, and to fight against infection and boost immunity. If you are deficient in vitamin A possible symptoms could include night blindness, skin type eczema, weight loss, poor bone growth and diarrhea. Toxicity is rare, but if taken in excess, you could experience headaches, hair loss and have anorexia. Common food sources of vitamin A: cod liver oil, beef, liver, eggs, any dark green, red, or orange vegetables like sweet potatoes, pumpkins, broccoli and apricots. For Bypass Patients it is Important to Know Alcohol can decrease vitamin A stores. Drugs that affect the liver such as steroids and Dilantin may affect vitamin A stores. Low vitamin A levels when protein intake is low can correlate with poor nutritional status. Vitamin A stores can be maintained within normal limits if a vitamin supplement is taken. Some deficiencies have been seen if there are excessive fatty stools or te vitamins aren't taken. Vitamin A levels can decrease transiently after an operation but return to normal after recovery and supplementation. Vitamin A can be lost from foods during cooking, preparation and storage. Olestra can lower vitamin A levels due to fat malabsorption. Vitamin B-1 (Thiamin) Needed for: Normal function of the heart, nerves, muscle tissue and digestive system; aids in carbohydrate metabolism and energy production. Their function include maintaining normal function of the central nervous system, muscles and heart, promoting normal growth and development, and is a co-factor in carbohydrate metabolism (by releasing energy). If you are deficient in vitamin B1, you may experience visual changes, an unsteady gait, a loss of appetite, have fatigue or nausea and perhaps some mental confusion. Ingestion of high amounts of thiamine may cause drowsiness. Common food sources of B1 are liver, beans (like navy and black eye peas), peanuts, raisins and whole grain products. For Bypass Patients it is Important to Know Supplementation is suggested since the post-operative diet is low in calories. Antibiotics and oral contraceptive agents can decrease B1 levels. Avoid over cooking meals, since B1 can be destroyed by heat. Excess alcohol increases risk for B1 deficiency. Large amounts of raw fish and shellfish can increase your risk for a B1 deficiency. Eating an excess amount of refined carbohydrates and not taking your vitamin can potentially lead to a sub-therapeutic level of B1 and produce deficiency symptoms. Vitamin B-2 (Riboflavin) Needed for: Energy production, immune system function, healthy skin. Vitamin B-3 (Niacin) Needed for: Energy production, healthy skin, and digestive system function. The body can manufacture niacin from the amino acid tryptophan. Vitamin B6 (Pyrodoxine) Needed for: Energy production, red blood cell formation, immunity, nervous system and hormone function. Vitamin B-12 Needed for: Energy production, red blood cell production, utilization of folic acid, nervous system function. Vitamin B12 is also known as cobalamin. Cyanocobalamin is the synthetic form. B12 has many functions with the most important being the nerve function. B12 and folate are metabolically interrelated. B12 converts folate to an active form. B12 is responsible for the manufacturing and normal functioning of red blood cells. It also helps metabolize carbohydrates and fats and synthesize proteins. B12 binds to Intrinsic factor, produced in the stomach. This no longer happens in the pouch, which is left after gastric bypass, causing B-12 deficiency in many patients. Deficiency symptoms can be manifested as anemia, nerve damage, fatigue, dementia and even coronary artery disease. There have been no reported toxic effects with high does of B12. Vitamin B12 for Bypass Patients Heat and moisture may change the action of the vitamin. Store in a cool dry place. High intake of vitamin B6 reduces B12 absorption. Smoking decreases vitamin B12 metabolism. For improved absorption, take B12 one hour before meals. Colchicine reduces absorption of B12. Folic Acid Needed for: Energy production, red blood cell formation and growth. This is essential for prevention of certain birth defects. Pantothenic Acid Needed for: Carbohydrate, fat, energy and protein metabolism. Biotin Needed for: Energy production, fatty acid synthesis and the breakdown of certain amino acids. Vitamin C (Ascorbid Acid) Needed for: Normal growth, wound healing, disease and infection resistance, bone and teeth formation, more efficient iron absorption. The best and most common sources of vitamin C are fruits and vegetables. Vitamin C is a water-soluble vitamin, that is important if formation of collagen (a protein that gives structure to bones, cartilage, and muscle). It maintains the capillaries and aids in the absorption of iron. Vitamin C is a known antioxidant that prevents cell damage. Eating a variety of fruits and vegetables ensures appropriate intake of the vitamin. If you are deficient in vitamin C, you may experience muscle weakness, loss of teeth, easy bruising, nosebleeds and frequent infections. Vitamin C assists in calcium absorption and can increase iron absorption. Smoking increases requirements for vitamin C. Vitamin D Needed for: Normal growth; healthy bones, teeth and nails; proper absorption of calcium and phosphorus. Vitamin E (tocopherol) Needed for: Cell membrane integrity and protection. Folate Folate and Folic Acid are interchangeable terms. Folic acid is the synthetic form of folate, which is found naturally in some foods. Folate is primarily known for preventing neural tube defects, a form of spinal cord deformity in newborns, preventable by taking folate. Folate is essential for the synthesis of RNA and DNA, the genetic material of cells. It plays a vital role in growth and development of cells. Folic acid is necessary for aiding in protein metabolism. It also may be protective against heart disease by lowering homocysteine levels. Folic acid is absorbed from the small intestine. Of all vitamins, a folate deficiency is most common due to a diet poor in vegetables, primarily dark green leafy vegetables, increased alcohol consumption, and also contributing is folate-increased sensitivity to heat and light. Symptoms of folate deficiency include loss of appetite, inflamed tongue and diarrhea. A folate acid deficiency can damage the lining of the gut and lead to further malnutrition. Folate for Bypass Patients NSAIDS (Motrin, Advil and Aleve) and anticonvulsants elevate folate requirements. Excess alcohol intake can lead to a deficiency. Of vitamins are not taken daily and increased risks for a deficiency exists. Taking additional B vitamins in a daily supplement form rather than through food only ensures proper micronutrient nutritional status. If you are of childbearing age, please take a folic acid supplement to prevent neutral tube defect. Prenatal vitamins contain twice the RDA for folate. Vitamin K Needed for: Production of proteins required for normal blood clotting. Note: In addition to their other roles, vitamins C, E and beta-carotene (which the body converts into vitamin A) are known as "antioxidants." Certain minerals and other substances also act as antioxidants. Antioxidants can offset the damage caused by free radicals, the unstable, highly reactive molecules formed during the metabolism of glucose and fatty acids to provide energy. Free radicals are also produced in the body by pollutants, ultraviolet light from the sun and drinking alcohol. Free radicals react with and damage many components of tissues, including cellular DNA, or genetic material. Damage from free radicals may lead to conditions such as cataracts, cancer, heart disease and even aging. Minerals The minerals we need in our body are those found in rocks, metals, soil and water, though they may be in slightly different forms. While each mineral plays a unique role, collectively they support the body's enzyme systems and keep blood and other body fluids balanced and healthy. Minerals, the major components of bones, also help regulate blood pressure and heart muscle contraction, heal wounds and conduct nerve impulses. The minerals needed in relatively large amounts are: calcium, phosphorus, magnesium, sodium, potassium, chloride and sulfur. Other minerals needed in smaller amounts, called "trace elements," consist of iron, copper, fluorine, iodine, selenium, zinc, chromium, cobalt, manganese and molybdenum. Although the body can't produce any minerals of its own, minerals are found in a large variety of fruits, vegetables, beans and grains. Calcium Needed for: Healthy bones, nails, muscle tissue; assists in blood clotting and heart and nerve functions. Chromium Needed for: Normal release of energy from glucose. Copper Needed for: Enzyme reactions, iron metabolism Fluoride Needed for: Healthy bones and teeth those are resistant to decay. Iodine Needed for: Regulation of body temperature, thyroid hormone synthesis, metabolic rate, reproduction, growth and nerve and muscle function. Iron Needed for: Formation of healthy red blood cells and prevention of anemia; helps carry oxygen to cells. The recommended iron intake is higher for women between the ages of 11 and 50 to compensate for iron loss during menstruation. Magnesium Needed for: Energy production, normal heart and nerve function and prevention of muscle cramps Phosphorus Needed for: Growth; maintain bone density; assists in energy production; and regulates blood chemistry Potassium Needed for: Regulation and balance of body fluids, promotes normal heart rhythm; prevents muscle cramping Selenium Needed for: Antioxidant properties protect vitamin E and polyunsaturated fats in the body Sodium Needed for: Regulation of body fluids and maintenance of acid-base balance; aids in nerve transmission and muscle contraction Zinc Needed for: Normal appetite and taste, wound healing, healthy skin and normal growth The Bottom Line: Vitamin and mineral supplementation is a life long commitment for gastric bypass patients. Knowledge is your best armor. Eating a balanced diet and taking your supplements provides the best route to fulfilling your nutritional requirements. Did you know that dietary supplements are taken by more than half of the USA adult population? Sales are going up but which supplements are best and more importantly, are they safe for us to take? The Federal Trade Commission (FTC) regulates the advertising of supplements. The Food and Drug Administration (FDA) has set up DSHA or Dietary Supplements Health and Education Act along with the National Institute of Health (NIH) a framework for supplement regulation and research. Additionally, there is an independently appointed commission who provides reports for the claims for the use of supplements (i.e. vitamins, minerals, herbs, etc.). Dietary supplements have to meet certain criteria. Since March of 1999, manufacturers are required to provide an informative dietary supplement panel on the label, which indicates the following information. · A statement of identity (i.e. Vitamin C · Net quantity of contents (i.e. 90 tablets) · Structure-function claim like "Calcium builds strong bones" and the statement "This statement has been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease." · Directions for use · Supplement fact panel (lists serving size, amount and active ingredients) · Other ingredients in order of predominance · Name and place of business of manufacturer, packer or distributor along with the address to write for more product information What are vitamins? Vitamins are nutrients that are essential for maintenance of normal metabolic functions. Vitamins are supplements both synthetic and natural and come in many forms. The water-soluble vitamins are Thiamine (B1), Riboflavin (B2), Niacin (B3), Panethanic Acid (B5), Pyridoxine (B6), Biotin, Cobalamin (B12), Folic Acid, and ascorbic acid (Vitamin C). The fat-soluble vitamins are vitamin A, D, E and K. The water-soluble vitamins are not significantly stored by the body and need to be replaced daily by food or supplement to maintain adequate levels. These vitamins can be rapidly depleted in conditions interfering with intake or absorption. The fat-soluble vitamins are better stored in the body, and if not excreted, toxic levels could occur. For the gastric bypass patient, who malabsorbs fat, fat-soluble vitamins cannot be digested properly, and are excreted without doing their job. Vitamins in dry form only are therefore suggested. If your vitamins are in an oil base, they are doing you no good. Bottom Line ... YOU MUST DO IT ... OR YOU CAN DIE ...

Thanks so much for all of this valuable info. The bariattris coordinator at tmy surgeon's office is getting my packet together right now for insurance approval. So hopefully in about 2 weeks, I'll have my approval and be on my way to USING all of your insightful info. Robin

What is sad is that some of those who get sick over and over are those who do not take in adequate protein, and stopped taking vitamins long ago. Heed Nat's plea, folks! Lois

Natalie, thanks for the kick in the but. I got away from drinking shakes because I thought I got enough protein in my food. Once I started having this Ulcer, I gavitated toward stuff that didn't hurt my pouch, namely carbs. I started drinking some protein again, but thanks to you, I will remind myself just how important it is. As for vits, I never forget. One of my big pet peeves is post-ops who take Viactiv instead of Calcium Citrate. I hear "But my Doctor Says it's ok", "Well Honey, your doctor is WRONG!" . We can't even absorb Calcium Carbonate anymore because we don't make stomach acid anymore. That's needed to absorb it into the body, Citrate doesn't need acid. I guess when those ladies loose a couple of inches in height and have osteoperosis 5years down the road, I can say "See, I told you so!." Hugs, Jane BTW, Got your text message. I'm off to the Plastic surgeon for my Pre-op appointment!

OK, Hon, lecture recived and heeded...vitamins and protein will be taken every day....sorry I was so lacking in it...love ya bunches..Betsy