Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be...

http://meltingmama.typepad.com/wls/2008/05/nutritional-def.html

Bottom line? A study just published in the May issue of the American Journal of Clinical Nutrition shows that the majority of gastric bypass patients cannot maintain their nutritional health on a basic multivitamin supplement. The study followed 137 gastric bypass patients for two years. By the end of year one, 59% of the participants required additional supplements and by the end of year two, this number had increased to 98%. The most common additional supplements needed were B12, folic acid, calcium, iron and vitamin D. Much less commonly, they identified deficiency of thiamine, zinc, magnesium and B6. The authors concluded that basic multivitamins are not effective at preventing deficiency in gastric bypass, and typical supplementation to keep a gastric bypass patient health averages about $420.00/year when additional nutrients are accounted for. They also encouraged further study and the use of routine post-operative labs to assess nutritional status.

Source:  American Journal of Clinical Nutrition, Vol. 87, No. 5, 1128-1133, May 2008 © 2008 American Society for Nutrition

Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation^1,2

Christoph Gasteyger¹, Michel Suter¹, Rolf C Gaillard¹ and Vittorio Giusti¹

¹ From the Division of Endocrinology, Diabetology, and Metabolism (CG, RCG, and VG) and the Department of Visceral Surgery (MS), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Background: Despite the increasing use of Roux-en-Y gastric bypass (RYGBP) in the treatment of morbid obesity, data about postoperative nutritional deficiencies and their treatment remain scarce. 

Objective: The aim of this study was to evaluate the efficacy of a standard multivitamin preparation in the prevention and treatment of nutritional deficiencies in obese patients after RYGBP. 

Design: This was a retrospective study of 2 y of follow-up of obese patients after RYGBP surgery. Between the first and the sixth postoperative months, a standardized multivitamin preparation was prescribed for all patients. Specific requirements for additional substitutive treatments were systematically assessed by a biologic workup at 3, 6, 9, 12, 18, and 24 mo. 

Results: A total of 137 morbidly obese patients (110 women and 27 men) were included. The mean (±SD) age at the time of surgery was 39.9 ± 10.0 y, and the body mass index (in kg/m²) was 46.7 ± 6.5. Three months after RYGBP, 34% of these patients required at least one specific supplement in addition to the multivitamin preparation. At 6 and 24 mo, this proportion increased to 59% and 98%, respectively. Two years after RYGBP, a mean amount of 2.9 ± 1.4 specific supplements had been prescribed for each patient, including vitamin B-12, iron, calcium + vitamin D, and folic acid. At that time, the mean monthly cost of the substitutive treatment was $34.83. 

Conclusion: Nutritional deficiencies are very common after RYGBP and occur despite supplementation with the standard multivitamin preparation. Therefore, careful postoperative follow-up is indicated to detect and treat those deficiencies.

so true. too bad a million surgeries later is what they find out.

we were started on:
2 multi
dry forms A&D (too low dose, but right stuff)
iron & C (right dose, wrong iron)
calcium (low dose, wrong calcium)
dry E
zinc

no B12

but lots of supplemental protein, back in the 90's. only reason my dh & are still healthy is because i read about this stuff 24/7. Our docs are still not as far up on this as I am, but we have periodic lil chats. But we're by far the exception to the rule of 1990's ppl.

even today, if ppl are covered beyond the multi, it's often the wrong product are ridiculously low dose, like out of some school book written 20 yrs ago. No help to us with today's info at our finger tipes.

That's better than we were started on and I'm only talking about September of last year! 2 x multivitamins 100mcg B12 1500mg calcium carbonate No iron, no A, C, D or zinc.

Surprise, surprise!  Guess who had to come running to you for help!

Hugs and blessings to you Michelle.

Is that the face that goes with the voice?

COOL!

And I had to be in Utah to see you? LOL

Well, am anxiously awaiting your next labs. And an email saying you feel human again!

Yep! The Brit. from the base of Mt.Rainier! LOL I won't send you an email Michelle - you can read it here - I'M FEELING GREAT! Took a few weeks before I noticed an improvement but I no longer feel like a zombie. Next bloodwork is in September.  Trust me - you'll get a copy.

My doc told me up front that I would need a B12 supplement (sublingual 2x/week.)  I tested as slightly anemic and do take a daily iron.  Nothing in this report comes as a great shock to me. Do you think that the reported percentages are really higher than the general population or is it beause we are tested more then non-WLSers?  Perhaps if everyone were as rigorously tested and monitored we would see that our numbers are comparable.  I know plenty of non-WLS people who need more than just a daily multi-vitamin.   Hmmmm.... J

Nothing comes as a great shock to me either, but then again, I knew that I was dealing with possible malabsorption from the start.

thanks for the 'food for thought.'

b

Hmmmmmph.... Well...that 'splains things!  That and my not taking my vitamins (AND then some) every single day...like I do now! (And thinking I eat enough healthy foods for my vits!  Yeah...NOT!)  Very interesting...I'm so glad I take it seriously now and bug people to get religious about vits and supps EVERY chance I can....so thanks for this...Now I don't feel like such a pain in the arse about it!  Of course, now I'll never shut up! (Like that could happen anyway!) Thanks for posting this!

I may consider carrying links around to articles, because, everyone brushes me off when I say, "You know, I think we could have prevented this, " as I'm dropping into a seizure.