Malabsorption- What Do You Know?

I don't think we can expect to get all the vitamins/minerals we need primarily from supplements. These are typically artificial substitutes for what is found naturally in food. Food! Our arch-enemy/best-friend/nemesis/plague, but something we can't live without. Soo...here I go on my bandwagon again, we long termers have to understand what comprises good nutrition and how to get it. The fuel we put in our bodies has to meet the needs of our bodies or we "run" poorly. What works for Suzie doesn't necessarily work for Jane and we have to know that too. I'm not saying that we can't get some of what we need from the supplements, nor am I saying that we can get all that we need from food. But, we are more likely to absorb more of what we need by taking the artificial stuff REGULARLY and eating the good stuff--high quality proteins (I tend to think animal-based is superior for most people), darkly colored vegetables, bright fruits, high quality fats, and yes, some good carbs/fiber. I may simply have lucked out so far, but I seem to be absorbing very well--my blood work is excellent every time and I feel good. But I've working on this balance thing since the early part of my journey. That said, WLS is not a perfect science and some people's bodies will change in unexpected ways and indeed they may have long term problems with absorption issues. But, when we can, we need to take charge and become as knowledgeable as we can to stay healthy. It requires time and effort; we are not naturals at these things. I don't know where I'd be today if I hadn't dug deep to pay for a qualified nutritionist for 10 months. If anything is missing from most of our surgeon's post-op protocol, it is this element of learning and understanding. Just my thoughts. Ann

Ann, I don't think anyone here was saying only take supplements or get all your protein from drinks. I think what was being said was that even with a good diet AND supplements there are still malabsorption and malnutrition issues in some people. I agree with the philosophy that it is better to get nutrients from good foods, but I also know that it is quite possible to NOT get everything your body may need simply from food just because of how YOUR body, specifically, works. Since you obviously don't have these problems (and I am very happy for you that you don't), I think your viewpoint on this may be a little naive. Like Tek said, "just because it worked for you doesn't mean it worked for you". No flames intended, just wanted you to see that there are some people who truly do have issues unrelated to their diet. It's all a matter of how our bodies, individually, work. Linn

My WLS surgeon recently spoke to our support group and I had a specific question regarding malabsorption at over a year out. Mind you the direction of the conversation was in regards to the issue of it being a "tool" to us losing. As a surgeon who does "proximal", he said that he did not want us to get hung up on a number, say a 30% malabsorptive rate. As a general rule the purpose of the bypass, ergo the malabsorption, is to create an inability to absorb fat and sugar. In time, our body will correct this disturbance in our body and we will see that we can indeed tolerate more sugar and fat(uh, yeah!). We are perscribed a generous dosage of vitamins and supplements to correct any deficiency in this area. Only consienteous blood tests and followup will let us know that we are within the perameters. All that being said he did reiterate what many of you have mentioned. Every body is different coming into this surgery and everyone will react differently. There will always be the extreme case and/or reaction.

More random thoughts on this... I can't help but wonder how much of these issues weren't actually created by our (super) morbid obesity? Didn't we get our bodies used to having 2-3-4-5-10 times the amount of nutrients it needed for so many years, then suddenly we change the rules with WLS. It seriously has got to be hard NOT to get enough nutrients and trace elements when you are eating 5000 or more calories a day. Also, we are told that our bodies 'adjust' to the WLS. I accept this. After all, most of us have seen bodies adjust for many things, so this makes sense. BUT... Wouldn't it adjust based on what we are feeding it? If we are relying on Protein Drinks (or other suppliments), perhaps our bodies are adjusting wrong? As a purely FICTIONAL example, what if the same part (or adjustment mechanism) of our intestines that absorbs protein that absorb Protein absorbs Calcium. If we are overloading our system with Protein, that aspect of our system does not need to adjust, yet that adjustment would have been what was needed to absorb more calcium? OR... What if folks, in trying to lose weight during the "honeymoon period" are causing these future problems by causing their bodies to overcompensate in the 'adjustment'? Maybe my point is not clear, in which case I will be BLASTED for saying it wrong. Maybe focussing on 'life long habits' rather than 'losing weight' allows our bodies to adjust better? or worse? Its one bit The best we can do is what makes sense to us. I would hate to be the one to say "Do this" when "this" may turn out to be an early death sentence. Tek

Tek, I'm sure you know that each nutrient, amino acid, metal, etc. has it's own specific receptor. I agree that it may be a possibility that some of the receptors are in roughly the same place (I could find more out about this if I had my biochem/molecular bio text here at work - I've never really looked at that before) and that there may be some competition or turning on/off receptors based on concentrations of other things or hormones already bound (I know some of this happens, just don't know what may turn nutritional things off/on). You've got me curious now. I'll try to remember to get out my old text and see what I can find out. It would be great if you'd remind me. Linn

I accept my fictional example may have been way off, but I think there may be something to the concept to our bodies adjusting and by our habits we could cause them to adjust wrong. Do they really have it all pinned down on where each thing is absorbed? I ask because there is so much debate about what actually is absorbed and not absorbed as a result of WLS that it seems very much guesswork. Also, since Calcium and Iron are believed to conflict with each other, and Vitamin D helps calcium absorbtion, that it isn't so cut and dried at best? There MUST be similar interactions happenning all over the place that simply aren't known or documented, no? Even going with the Calcium/Iron conflict, which I have no reason to doubt, could it be that while Calcium/Iron conflict in absorbtion, causing less of each to be absorbed, but not zero... that BOTH of them being present may help other necessary nutrients to be absorbed? Or may prevent too much of something else from being absorbed? That by seperating their consumption, we are UNDOING something else? I guess the crux of my conjectures is that maybe we are making big changes to the puzzle based on how one or two pieces fit together. Of course, the ultimate manifestation of this is having WLS Tek

I'll send you an e-mail with the info I find out. Who knows I may post it, but I generally don't do that. I do know that a lot has been done on where in the body certain things are absorbed, but like we both said, that doesn't mean it's exactly the same for everyone, and likely doesn't account for the physical changes from WLS. I'll see what I can discover. Linn

I haven't become deficient in anything, but my labs did show decreases, heading out of the normal range, for iron (at about 2 years out) and B-12 (about 7 months out). My dexascan also showed a ten percent reduction in bone density between roughly year 1 and year 2 post-op (though by year three post-op, it was pretty stable). I've taken prescription iron, Trinsicon, with Vit C. and a multi, every day since my WLS in '02. I'm a proximal RNY, 75 cm. bypassed. Even with doing that faithfully (and not taking the iron within 4 hours of calcium, either), my ferritin kept dropping and dropping, so I added a second dose of prescription iron at about 2 years post-op and it seems to have stabilized. I'm one of the lucky ones for whom B-12 sublinguals worked and still work, so that problem was easily addressed. I didn't take 'em until the B-12 started tanking, though, because my surgeon seems to have thought the Trinsicon alone would provide my B-12 needs (it didn't). Regarding calcium, I took a total of 1500 mg. of calcium a day, spread out in three 500 mg. doses, along with Vit. D and magnesium, most every day for the first couple of years post-op. Then I learned I wasn't really taking 1500 mg. of elemental calcium, but rather, 1500 mg. of calcium citrate along with some fillers 'n stuff (that's the case with some brands of calcium citrate, I'm told -- many provide calcium citrate, but don't break down how much of the 500 mg. dose you're getting is actually "elemental calcium citrate"). To reach the goal of 1500 mg. of elemental calcium per day, I had to triple my intake of the particular brand of calcium citrate I was using. After a year of doing that, the dexascan didn't show a big drop in bone density (sure, it showed a little, but I'm gettin' old here fercdryinoutloud). I guess that means I'm supplementing at the right level now, but who knows really? . . . Like most of us, I dunno why these things happened and can't prove for sure that anything I've done (or not done) either caused it or helped correct it. I just keep an eye on the labs and try to adjust according to what they suggest is happening.

My last labs showed my Vitamin A and Zinc levels were just a tad low. My surgeon added 50 mg Zinc 3X/day and 8000 i.u. Vitamin A 3x/day to my daily regimine. Here I was worried about calcium, iron, and B-12 and came up with vit. A and zinc deficiencies instead. Someone asked me what that would mean if it continued to be low and I told them I figured I'd be thin, blind (lack of Vit. A) and bald (lack of zinc). So, I'm going to take the extra supplements and see what happens with the next round of bloodwork. I did have a bone density test run a couple weeks ago for a baseline and my bones are way at the top of a "young woman's" range. All my other bloodwork is great. And it's hard to say if this is long range from being 26 months post-op or short term from being 8 months post-op. DeeDee

Dx, I am not sure what problems I had before surgery....its weird now I am very conscious of what I am taking, what my blood work says, testing and such and I pay attention now...but before I had WLS I didn't! I could not even tell you if I had any issues. Not good but its the truth. My dexascan came back I am on low side but normal in the spine....so a good question would have been was I like this before surgery or did this appear as a result of malabsorption...this body will never know! But since I know this information now I pay attention. I have kept copies of tests and will do my own comparisons! Yes I am taking control over my body for a change! It feels good too! Debbie