Question:
Are shots/sublingual neccessary?
I've tried to find an answer to this, and haven't been able to find the answer to this particular slant. I log on to fitday.com, take my vites, and as a pre-op, I am taking in plenty of B12, according to the nutritional analysis, in fact, more than is needed. Now, I know, post op, I certainly won't be eating this way, although I am careful, and will most likely be taking additional nutritional supplements, but after a 3-4 month period, is it neccessary to continue with the additional B12 shots/sublingual, or will a balanced diet provide the needed B12? The only thing I can't seem to reach the mark on a daily basis is Vit. K. Any insight would be most appreciative! — track (posted on October 10, 2003)
October 9, 2003
The difference is you currently have a normal functioning stomach with
intrinsic factor present. This allows the B-12 to be absorbed. However,
after surgery, assuming an RNY, you will not longer produce any intrinsic
factor and therefore any b-12 you consume will not be absorbed etc. Taking
it as a sublingual, under the tongue, will allow the mucous (sp?) membranes
to absorb it and get it into your body. The shot accomplishes the same
thing. If you take a pill it is not absorbed because it does not have
intrinsic factor to help absorb it.
<p>So PLEASE take you b-12 after surgery. The results of not doing
it will not sure up for probably 2 years and then it will be too late!
— zoedogcbr
October 9, 2003
Wellllllll, your two basic multis should cover the K well. We do absorb a
lil K all along the intestine (not just up front) and even in the colon.
BUT there is an ADEK product, if you want to feel covered. The main
elements we need to cover supplmentally are: protein, iron + C, calcium
citrate, dry form A, D, E
zinc and B12. Some need to tweak magnesium and/or potassium, but by labs,
not by guess. That's in addition to two multis
— vitalady
October 9, 2003
It seems some people require B12 for years after surgery, while others may
never need it at all. That's why post-op blood work check ups are
important. Your doctor will probably play it by ear...and when and if you
need it, you'll have it. My doctor says unless a problem occurs, my
Flintstones vitamins (double dose) should keep me very well. Wish you the
best~~~~~~~~~~~~~ Renee pre-op surgery Nov. 11th 2003 (32 days and
counting)
— Renee B.
October 10, 2003
My surgeon/nutritionist do not require additional B12 unless your labs
indicate a need. Ask your health care team.
— Leslie R.
October 10, 2003
I started out getting a B-12 shot each month, never felt any different,
and then decided to stop the shots to see how my labs were. That was at
about 6 mo post op and at 20 months post-op my labs for B-12 are fine. I
asked the surgeon about it and he said some need extra B-12 and others
don't. I'm still not sure why this is if he has some patients that require
it and others of us that don't and we are all bypassed a similar
length....I also do not take any additional iron other than my multi's and
my iron levels are fine too....
— Cindy R.
October 10, 2003
Just a comment on the value of post-op lab work. I have taken a sublingual
B-12 supplement ever since surgery. My doc wanted me to take 1000 mcg a
day, so I have. For the first 2 years my labs repeatedly showed my B-12 to
be double the upper limit of normal. I was beginning to think 1000 mcg was
overkill and considered changing to 500 mcg instead until my last labs, 3
months ago. Suddenly my B-12 had dropped by half, still in the normal
range, but it convinced me not to lower my dose of B-12!
— LLinderman
October 10, 2003
Leslie and Cindi, your responses scare me. I don't want to be someone who
runs around yelling the sky is falling or anything, but.... A post op
friend told me her doctor said that since a few years ago they have
discovered that to not take B12 was not a matter of if, but WHEN, you'd
suffer neurological damage. I'll tell you what, that was enough
information for me to decide I'd be more careful to remember my B12
sublingual. Here's the deal with those things: They're small, they don't
taste much but are certainly not unpleasant, they're not overly expensive,
etc. Basically it's a nonissue. Now if they can possibly prevent
something really awful from happening to you, and they're not bad, then why
not just take it? It's like the the citrate and carbonate debate in
calcium. Maybe you don't have to have citrate, but if you're taking
calcium anyway, why not take the one so many people think is the right one?
Better safe than sorry in both instances I say. Everyone has to decide
for themselves, but those are my thoughts on the matter. Good for you for
trying to figure this all out and do the right thing. S
— sherry hedgecock
October 10, 2003
I would not stop the B12 unless your labs say they are too high. We
malabsorb B-12 so it's best to take the supplement.
— mrsmyranow
October 10, 2003
Too much of something can be just as bad as not enough. Since everyone's
body functions differently, you may not need to take B-12 after surgery. I
did not take any, and also use fitday and found that post-op I was taking
in enough and the results of my 6-month blood work showed I was right in
the middle of the range. I take a pre-natal vitamin and an iron pill
everyday. I was anemic pre-op, but since surgery my hemoglobin is now 12.7,
higher than I have even known it to be. So obviously I am able to absorb
pills, and I have also taken capsules and the medication worked. So follow
your doctors advice and do not just go on your own and take extra
supplements.
— Sarahlicious
October 10, 2003
Sherry, thanks for the concern, however, just because a friend tells you
that her doc said, etc, etc, does not mean that is the definitive answer.
There is alot of well documented evidence on citrate vs. carbonate, at
least there are alot of post-ops suffering forms of osteoporosis from
taking carbonate or not enough calcium, and thats enough to make me err on
the side of citrate and to have annual bone scans to monitor. However, I
don't hear the same about not taking B-12. I don't know of or have heard of
even 1 case of neurological problems in post-op WLS'ers. I'd be interested
in hearing of any, though. There are several surgeons here who say you
don't need it, mine included, and lab work shows that to be the case so
far. I'm not a believer in taking more drugs or vitamins than necessary.
I may post this over at the OSG grad board to get some opinions there and
provoke a little discourse...
— Cindy R.
October 10, 2003
I just recently found myself not getting enough Vitamin K, so I switched my
multi-vitamin to One-a-day Maximum. Since I take 2 of them a day, I get
62% of my daily requirement from them.
— joeandteri
October 10, 2003
Cindy,
I have a friend who, post-wls, was struck with serious neurological damage
due to not enough b12 for an extended period of time (three months!!) She
now has no feeling at all in her left leg below the knee, no feeling in her
right foot and no feeling in either of her hands.... well, not entirely NO
feeling... she has that constant pain-tingle of a limb gone to sleep. She
can no longer do for herself at all.
I have minor nerve damage from lack of b12... nothing near as severe as
hers, but alarming and frustrating none-the-less. While I don't think it is
necessary for everyone to take b12, I DO think it is necessary for everyone
to get it checked frequently after wls!
BTW -- I am not jumping on you... you said in a post that you would be
interested to hear about post wls nerve damage... :~)
Sharon
— Sharon m. B.
October 10, 2003
The other thing you asked was about vit K. Some do the ADEK vitamins. But
usually the 2 multis covers it pretty well. It is one of the very few
things absorbed all along the small intestine AND in the colon, amazingly.
So, if you are getting green leafies AND your multis, that should give you
plenty. If it worries you, ask for labs to check it every 3months until you
are satisfied that you can meet it. I've not yet seen vit K OTC, only by
Rx. Doesn't mean it isn't out there, but I have not seen it.
— vitalady
October 10, 2003
Cindy, Sharon:
It's not just a B12 issue. It's a protein issue. If your protein numbers
get really low, 6 is critical and they like you to be over 20, you can
develop a condition called peripheral neuropathy. It causes numbness in
the extremities as well, and a rushing sound in your head. It is very
serious, and if you aren't eating your protein first, and then other
things, you are probably deficient.
The neuropathy takes a long time to "cure", and there is no
medication to speak of. You have to get more protein in. See your doctor
asap, this could really be serious for you.
— Gail N.
October 11, 2003
assuming you are having the rny procedure, you will need B-12 suppliments
for the rest of your life. The B-12 found in foods is attached to protiens
and the vitamin needs to be broken away from the protiens in order to be
absorbed. The intrinsic factor that a poster referred to earlier is
something in the stomach acid that will do that. Because the majority of
your stomach has been bypasses the food you eat does not come into contact
with enough of the stomach acid to be able to separate the vitamin. This
is why you will require suppliments for the rest of your life. Suppliments
that are either injected or absorbed in some way other than digestion.
Taken directley from the insert in my B-12 vial prescribed by my doctor.
"Vitamin B-12 deficience that is allowed to progress for longer than 3
months may produce permanent degenerative lesions of te spinal cord."
"Patients with pernicious anemia should be informed that they will
require monthly injections of vitamin B-12 for the remainder of thier
lives. Faliure to do so will result in return of the anemia and in
development of incapacitatioin and irreversible damage to the nerves of the
spinal cord." ~~~ It's your choice. But for 18 dollars I got a 3
year supply of B-12. I think it was worth it. :)
— RebeccaP
October 11, 2003
This may be helpful
http://www.nlm.nih.gov/medlineplus/ency/article/000569.htm
— RebeccaP
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