Gastrectomy for cancer-supplement recommendations

Out of curiosity, I have been doing a bit of research on the wellbeing of post gastrectomy stomach cancer patients.  This is a little info on suggested supplements from surgeryencyclopedia.com:


Vitamin and mineral supplementation is necessary after gastrectomy to correct certain deficiencies, especially vitamin B ₁₂ , iron, and folate. Vitamin D and calcium are also needed to prevent and treat the bone problems that often occur. These include softening and bending of the bones, which can produce pain and osteoporosis, a loss of bone mass. According to one study, the risk for spinal fractures may be as high as 50% after gastrectomy.

There are other articles out there relating to the vitamin/supplement needs of the VSGer.  Foolishly, some think we don't need to follow this religiously - that is until they start passing out, have f'ed up labs, etc... We may not malabsorb food, still have the pyloric valve, etc.. but we are still missing most of a major organ and that organ played a part in how we function.

I have recently changed my vitamin/supplement routine and I am feeling a big difference. So there's lots to be said about taking our vites!

Thanks for the info.

 While I agree whole heartedly that we need supplements after VSG, I think it is important to point out that our anatomy post surgery really isn't comparable to a patient who had had stomach cancer.

Operations for stomach cancer are also partial (or total) gastrectomies, but do not involve a "sleeve" type resection as we have had. Either the distal (bottom) portion or the stomach, or the whole stomach is removed. This includes the pylorus, and necessitates some form of intestinal reconstruction (either with a roux-en-y or Billroth connection).

In other words, as far as nutritional deficiencies go- stomach cancer patients are more like bariatric patients who have had a Roux-en-Y gastric bypass.

 That's absolutely true in a lot of cases -- not all, I think.  With stomach cancer, I think what is removed varies depending on the cancer.  Sometimes the whole stomach is gone, other times just the area with the tumor.  I'm not sure how our sleeve absorbs food and nutrients.  The only thing I think most everyone agrees on is the B12, which I'm thinking is normally absorbed in the part they remove in us.(?)   My labs are good so far; I am trying to figure out the most likely path to keeping them good.  

 If it is truly for stomach cancer, there is always some type of reconstruction done (and hence the issues with malabsorption that go with that). Whether it is a partial gastrectomy or a total depends on the location of the tumor within the stomach, but sleeve or wedge resections are not done for cancer (they are done for some benign stomach tumors, or less aggressive things like a GIST).

This is a common misconception among VSG patients. Yes partial gastrectomy has been done safely for many years, but it is not the same operation we have. It is only the same in that a large portion of the stomach is removed. But the metabolic consequences for patients who have been operated on for stomach cancer are very different, because they also have some malabsorption due to the need to reconstruction the GI tract.

And, in case you are wondering, I do know what I am talking about. I am a surgeon. 

That does shed some light on the difference.  Thanks so much for weighing in on this - I defer to your expertise!    What is your take on our need for supplements (i.e., B-12, calcium, etc)?  I have seen conflicting advice, mostly by folks who appear to have an agenda. 

Iron deficiency anemia is also found in VSG people. Prior to surgery, I thought that this happened down the road, but within 2 months from surgery, I was diagnosed with anemia and have receiving treatment for it. Apparently, this is more common than most people think.

I think we do need supplementation, but the jury is out on exactly what. My surgeon recommends a multivitamin, B12 and calcium, then adjusting if needed based on your labs. I think that is reasonable. I will be starting iron as well, because my labs show my ferritin levels have trended down significantly. I'm thankfully not anemic yet, but I don't want to get there.

Some surgeons don't recommend anything, and I think that there is a real possibility for deficiencies, because we lose a large part of our stomach (which is hormonally active), and our diets change so drastically post op. 

 Thanks KM, appreciate your input.  That's kind of where I am as well (that whole calcium bone thing scares the bejeezus out of me)!  I think I tend to over-vitamin sometimes (I get the chewables and sometimes use them when I want a snack -- not good probably . . . )

Happy holidays to you and yours.  

Because our stomachs are smaller, we have less stomach acid and less IF. Both of these are involved in the absorption of certain minerals and that's why we need to supplement things like calcium (almost always) and sometimes iron and B12. The reason why you don't see 100% agreement on what to supplement is because (a) the surgery hasn't been done that long in this manner, (b) some programs treat everyone like they've had RnY, (c) there are certain minerals where only the minority have issues so some programs respond by making those supplements optional and some programs respond by making everyone supplement those things too "just in case."

There are probably other reasons for the differences (i.e., some surgeons are very ignorant about nutritional issues) but that gives you an idea.