Good Morning. Where did 30 grams of protein come from?

My dietitian says she watches our albumin and prealbumin even closer than our protein serum levels to judge protein nutrition.

Vitalady says protein serum level in the 7's, albumin in the 4's. I haven't seen her post what an optimal level for prealbumin is but I know mine are at the top of the range and she hasn't said a word.

--gina

The direct lab tests for prealbumin and albumin will run me over 100 dollars, so I figure unless there is a serious deficit for serum protein, then I will not worry about the nuances of it.  And can use that 100 dollars to pay for my 100 dollar a month protein powder habit.  :} 

Gina,
My surgeon doesn't run Protein but does Albumin and Prealbumin.  How do these numbers look?  I get in around 70-90 grms of protein a day.  I'm trying to up it over 100 but I have to do supplements to manage that.  Food just isn't enough, which is what my plan calls for.

Albumin - 3.3 to 4.7 -   I'm at 4.3
Prealbumin  18 to 41 - I'm at 22.4  which seems awfully close to the bottom line for me.

How much protein should I be getting at 147 pounds?

is it just protein that you arent' absorbing? What about iron, vitamin D, vitamin A, b12, k?  Have you been tested for celiac disease?  Or do you have any other digestive disorder that would cause malabsorbtion problems like IBD or chrohns?

Digestive enzymes should really have helped you absorb your food.    How is your kidney function?  Ingesting protein that high, can actually cause kidney stones which in fact causes you to lose protein through your urine which could be the cause for your low protein levels in the blood.  Just a thought. I just went through this.  I had terrrible swelling in my feet and ankles.  had blood tests done and in 2 weeks, my albumin went from 4.2 to 3.6.  I have kidney stones - had surgery in July for left side and am going in October for the right side.  I just ordered a test kit so I can try to find out why I am producing so many stones and so rapidly. I do consume alot of protein but nothing like you.

Protein was fine at 7 right before surgery.  A year after surgery was a point below low normal. Then back up to 6.8 with 3 shakes a day.  Ferritin was low after (but did not get it checked presurgery as a baseline), but D, A, B12, K, all fine.

No symptoms of any digestive disorders now or in the past.  BUN and creatinine are fine on tests, I have no symptoms that point to anything being a systemic issue for why the protein is low. No edema, no urinary issues, no random or unfounded pains, no pains really anywhere.  I have gotten sick once since surgery when folks were getting the flu and napped for a day and was fine! 

I have not seen a gastroenterologist in reference to the protein because I am a self pay for surgery, and get the full zillion vials drawn once a year at my "Annual Physical" but have serious reservations about being fully worked up about things that seem very pointedly due to the surgery because I do not need for insurance to start denying things and blaming the surgery for everything, you know?  I am incredibly blessed to *have* insurance, and unless something starts being life threatening, I do not see the point of pushing it.

I am so sorry for all of your troubles girlie! 

I thought the digestive enzymes would have been a bigger help also, but if the theory is that my food is shuttling through my stomach so fast that it does not have time to break down, then maybe there was not time for the enzymes to break down also?  I dunno.

All I know is with the digestive enzymes that I did not get morning breath or hormonal pit stink!  That was an amusing side effect! 

There are 2 other folks, who are fairly newish ops (one is not a year out, one is a yearish out) who are seeing their protein levels trend down and so are supplementing with shakes, so I dunno if we all are really not chewing?  Does our food shuttle through faster?  I do not know if folks are *really* LOOKING at their labs and their trends? 

I just do not know, but I was incredibly worried at first and cycled through everything I could to see what the problem could be, and decided that if the shakes were fixing what the issue was, then I was not going to worry.  I would definitely start to worry and push if I did have symptoms of protein malnutrition, or if even with the baseline 3 shakes a day  that my labs were trending down. 

Maybe its because I do not want to seem freaky and alone, but I really am not convinced many VSGers actually pay close attention to their labs until something goes awry. So many of their doctors tell them, and they will fight you to the death about, chewable children's vitamins, so, I just do not know. 

I do not know if because I lift weights that my muscle somehow eats up my protein, and some of the other folks I have asked who lift (but do not endurance sport, like Mac) one had had low protein the first 2 years, and the other one, well she does not answer my PMs or emails from here, and previously here on OH said her labs were fine, and when I have been pointed out her blog on another site - she says she has not had labs done in 8 years (although they do not know she has had surgery on that site either, so I am not sure if she thinks that having labs done will out her?) but all of that to say, I do not actually have any faith in what she might tell me now or at any point in the future, since her stories here and there are contradictory, so that's a bummer because she might have been a helpful reference in that respect.

Oh.. I have another friend who does lift and her protein has trended down since her PS, but I think she just had her yearlies done again recently and she has not let me know what her levels look like yet. 

So - maybe its just me not wanting to be a lone stranger, but I really am not under the impression that I am so terribly alone in this! 

Will you kit tell you, or have they told you what KIND of stones you are producing?  Will that help you change your diet to accommodate your body being such an avid pearl maker?

I am sorry you havent' been able to get the help you need.  I often  wonder about people that post one thing and then change there stories to fit the occasion.  You really do need to get to the bottom of this, it isn't normal to malabsorb protein after a VSG - there is something wrong somewhere and I cant' see insurance blaming your surgery when your surgery has nothing to due with malabsorbtion.

You should be able to get labs done also and paid for.  I had most of these labs done preop as long as your doctor gives you the proper diagnosis codes - that is the essential point. 

You can have malabsorbtion due to intestinal problems or due to pancreatic problems - hense the pancreatic enzymes - what type of enzymes did they give you and what dose?  I was on Pancrease 4200units - 3 with each meal and 2 with snacks. They actually caused me to absorb too well, I gained about 12 pounds in 3 weeks. I wanted to gain weight - had lost too much weight after multiple surgeries for complications but this was too much, too fast. Yes, I wanted to gain the 12 pounds but not in 3 weeks, if it had continued at that rate, I was afraid to see what would have happened.  So, there is a fine line with pancreatic enzymes - getting a dose that works but not too much to make you gain weight.

You might want to get a consult with a gastro doctor and possible colonoscopy - they can't blame that on your surgery.  That is what they are trying to do, scare you into not having things done.  These are necessary things to diagnose a condition.  Not everything we do in our lives after surgery are due to our surgery - they would like to blame it that way but it isn't the case.  Do you have diabetes?  Do you know how your blood sugars  are?  A pancreatic problem can either cause low or extremely high blood sugars as well as iron deficiency.  I had a CT scan and it showed that my pancrease was atrophied.  When the pancreas doesn't work properly, it doesn't produce the necessary insulin to control our sugar.  It also doesn't produce the enzymes necessary for us to absorb or digest our foods.

To know if you are getting malnurished - check your labs.  Look at your AST and ALT.  A high numbers means you have elevated liver enzymes due to liver involvement - fatty liver, use of cholesterol medications, PPI's and tylenol but a low levels usually means malnutrition.  My enzymes were always a bit high but not terribly - usually between 50 and 80. Then after my surgeries this winter, I had lost an excess 45 pounds in total - the weight kept falling off and couldnt stop it - they finally had to give me tube feedings of protein.  My AST and ALT got down to I believe 8 or 10.

I just got the kit today for the stone testing - it is from litholink.com - check the site out - it has tons of information on kidney stones and such - how to prevent them,what causes them, everything you would every want to know and more.  They sent me package with everything I need for the testing - 24hour urine and then I send it back to them via fed ex.  They then send my doctor a detailed report of what my stones are made of and recommendations of what to do to prevent them - both diet related and supplement related.  I checked out the site briefly and was amazed at how comprehensive they are.  My nephrologist said they have an amazing success rate of ridding them and stopping them from recurring.  I haven't had a great experience with them, so if they can get rid of them for good, I am willing to let them try. I also dont' have to deal with Quest this way.

Make sure you are careful with your iron and B12 - you do still need to be careful with those as  a VSG patient.  Do you get copies of your labs?  Just because your doctor says all is normal, doesn't mean this is true.  You could be at the very bottom of normal and been at the top of normal the time before and they will tell you all is fine.  They dont' compare - all they see is in range  - all good.  They dont' look for optimal either.  This is why we all get copies and post them here for Vets to check over and make recommendations. If you ever need any help or suggestions, feel free to PM me.

good luck
randi

Mac had the protein weirdness for a long time too, hers seems to be adjusting itself now.

I definitely do get my labs in hand and track them so I can watch for trends!! 

Enzymes, there was no they, just me.  I took Vitamin Shoppe Multi-Enzymes, I took 3 tablets with every protein dense meal.  I also took hcl at every meal, I returned those after the month of them not working, so I do not have the dose off the top of my head. 

No diabetes. Blood glucose was 90, so midrange. 

AST 29 with ranges being 5 to 43
ALT 22 with ranges being 7 to 56. 

I do get the big chunk of labs drawn at my yearly, which I do not think is unreasonable for them to pay for, but the stuff that needs recheking midyear - I go to directlabs.com and have the local Quest folks do the draw. 

I learned about not trusting "normal" not just from everyone here posting, but also because when I had my year labs drawn and was a point below low normal, nobody bothered to say anything and I only found out that it was low and my ferritin was crap because I had the labs sent to me!

Thanks for all of your help!

I am excited for your hopeful finding out what your stones are made of and getting rid of them!  I know when I had guinea pigs who were insane stone producers (not the same, I know :} ) that diet made all the difference in the world, but only after we knew what they were made of!  .

I am going to peek at litholink and watch for you in case you post stuff about your stones when you find out! 

I hate the fact that we have to learn about all this stuff because somebody has to suffer, but I am glad to be able to glean from anyone who is willing to share! 

Thank you again!

One more thing = I just compared your digestive enzymes with my prescription enzymes and I now know why yours didnt' work.

Yours - Pancreatin - Protease 100USP units, Amylase 100USP units and Lipase 8 USP Units  - these are the porcine like the prescription from a pig but the dosage is miniscule then it lists below, an additional 200 of Amylase, 200 of Protease and 50 of Lipase but I am not sure what the difference is plus several other things not sure the significance.

In the prescription stuff I took Pancreaze - 4200 USP of Lipase, 10,000 USP of Protease and 17,500 of Amylase.  Protease is what helps you absorb protein, then amylase and lipase - one is for carbs and one is for fats - can't remember which right now.  That is quite a difference in dosing.  To buy something in a vitamin shoppe, they can't sell full strength plus they aren't regulated so there isnt' even a guarantee that is has what it says it has.

So, if you really want to give pancreatic enzymes a try, ask your doctor for a prescription. Just be careful to watch your weight.  I think I just took to many of them since I eat like 7 or 8 times per day - trying to gain weight and was eating high calorie foods, so if taking something to make me absorb these high calorie foods, it makes sense that I would gain.  Since stopping them, I am doing better - no gain but no loss either and the diarhea is much better too.

Urrrg!  I think you kind of unsold me at diarrhea and weight gain, mz Randi!  :} 

I eat 5 or 6 times a day too, especially since I wake up so danged early.  And I do not have one of those "cant eat solid food until noon" stomachs either! 

Sorry, you misunderstood part of it - I took it partly to stop constant diarhea - it didnt' cause the diarhea.  But, I agree if you can keep your protein levels up with the shakes then go for the shakes but it is just something to keep as a reference in case you ever need it.  I dont' think the weight gain would be as much of an issue for you as it was for me since I had just lost an enourmous amount of weight so all of sudden absorbing the high amount of calories - my body didnt' know what to with all so up went the scale.  So, now I am just enjoying eating without the pills and doing okay.
good luck and I am signing off for now. If you every have  questions or concerns feel free to PM me