Question:
How great is the threat of vitamin deficiency with the proximal RNY?

I was reading through some old posts this morning when I came across some information on vitamin deficiencies in RNY postops. I read about long-term concerns over iron, B12, calcium and vitamin D. When I had my proximal done it was my understanding that I was at less of a risk for deficiencies because very little of my intestine was bypassed (as compared to malabsorptive procedures). Now Im reading that its not the bypassed intestine that leads to deficiency problems but bypassed lower stomach. In fact one study quoted that 40% of RNY postops experienced vitamin B12 deficiencies (see post Surgery Types - Comparison - Complications of RNY and BPD/DS). Even though Im doing well Im starting to second guess myself and wonder if I should have gotten the DS (which is still a possibility since I have all my parts). On the other hand, I dont want to expose myself to unnecessary risk. Ive been reading up on the DS procedure and it does have its appeal but, as a malabsorptive procedure, doesnt that pose risks of vitamin deficiencies as well? One of the most mentioned benefits of having the DS is that you wont have a problem with dumping and can eat any foods you want but I already CAN eat any foods I want: dairy, sugar, most meats (limiting the fatty red meats) and my weight loss seems to be holding up. My main concern is the long-term dangers. Should I be worried?    — Rita O. (posted on April 3, 2000)

April 3, 2000
Gastric bypass with Roux-y results in ingested food bypassing the gastric fundus, body, antrum, duodenum and a variable length of proximal jejunum. In consequence, these patients are at risk to develop iron deficiency secondary to lack of contact of food iron with gastric acid and consequent reduced conversion of iron from the relatively insoluble ferrous to the more absorbable ferric form. In addition, vitamin B12 deficiency may result in consequence of food no longer coming in contact with gastric intrinsic factor. Vitamin D and calcium absorption may also be reduced since the duodenum and proximal jejunum, which are the preferential sites of absorption, are bypassed by this procedure. Life long supplements of multivitamins, vitamin B12 and calcium are mandatory following this procedure. A corollary of this is the need for long term follow up for physical, nutritional and metabolic evaluation and counseling: NOTE: My surgeon as well as countless others suggest a good multi vitamin (I use Flintstones Complete with Iron) and a calcium Supplement (tums or Viactiv)I asked about B-12 and he said there is enough B-12 stored in our liver to last 5 years. Regular check ups with full blood work every 6 months is standard protocol. Michelle C. had Distal I'll ask her to post on what she was recommended and takes. Also Fran G. might enlighten you on DS requirements or I can look that up..
   — Victoria B.

April 3, 2000
The dangers are real. I do RNY bypasses, and I start getting folate, vit b12, and iron levels at one year, I make all the patients take a vitamin supplement, and other surgeons are even more paranoid than I. If you have an unrecognized vit b12 deficiency you can get permanent nerve damage.
   — Bruce B.