When asked why they get a restrictive surgery, such as the sleeve, over a malabsorptive surgery such as RnY or a DS, many people point to the need to take vitamins and possible issues with malnutrition. Definitely, if you don't absorb everything you consume due to an intestinal bypass, your risks of problems caused by malnutrition go up. But that doesn't mean someone with a restrictive-only surgery has no chance of experiencing a problem brought on by not getting enough of certain nutrients.
In my own case, my issues have all been with protein.
My protein and albumin levels were adequate pre-op. Nothing to write home about, but at least within what is considered normal ranges. My protein was at 6.9 (the acceptable range is 6.4 to 8.2) and my albumin was 3.7 (3.2 to 4.7). I also had Vitamin D in the toilet at 32 (normal range is 45 to 100) and issues with calcium and potassium due to taking HCTZ for high blood pressure.
I have been able to solve my issues with calcium, potassium and Vitamin D by a combination of supplementation and getting off the HCTZ. But my protein levels have not been as cooperative.
Over the past 1.5 years, my albumin has ranged from a scary low of 2.9 to a "high" of 3.7. It seems to have settled into the 3.5-3.7 range at this point. And, yes, that is considered normal. But it's the low end of normal. I'd be happier to be in the middle of the range, especially if my protein is also at the lower end of normal.
Speaking of protein, mine dropped to 5.7 (!) at 7 weeks post-op, then climbed up to a whopping 6.1 at 3 months out and .... stayed there for over a year. This is while I was taking in 125 to 135 g of protein a day on average, I should note.
Also, I consume around 2000 calorie a day. So shouldn't I be getting pretty much all of the necessary nutrients from food? Yet my labs are good, but not fantastic. I am taking 2x the adult dose of a multivitamin every day and 1500 mg of calcium from supplements, 50,000 IU of Vitamin D3 every Monday, and .... my labs are okay. I had really hoped to cut down to 1000 mg of calcium a day and 1 multivitamin now that I'm eating the supposed daily average. But I don't see anything in my one year labs to justify dropping back on what I take.
The thing is: our bodies are made up of complex systems that interact on every level. You can't cut out part of an organ and not expect there to be consequences. With a smaller stomach, I now have less intrinsic factor than I used to and less stomach acid (especially since I'm on Prilosec). Also, my stomach empties slightly faster than normal. I also have much less ghrelin, aka the hunger hormone. While most of this is not going to cause big problems, it's not like it won't have any impact at all.
For me, having less ghrelin has been a blessing as has having less stomach acid. My GERD is mostly gone, easily controlled by taking a PPI, and my hunger is slightly under normal levels. But it appears that having a smaller stomach and faster stomach emptying means that I am not absorbing as many nutrients out of my food as I was pre-op, probably because the food is not as broken down when it hits my still intact intestines.
That means I have to keep taking all my supplements and it also means I have to be extra careful about my protein intake.
So, it's not just those with RnY and DS who have to worry about their labs and their nutrition. We all do.
We made it successfully between enrollments and we are now insured. All hell can now break loose. KIDDING. MORE THAN KIDDING.
I had missed my last blood work appointment, and bumped it to today. Here's to hoping I have some iron in my blood. It's been a long time since my last infusion - three months or so - so I may need another.
Last time we checked, I had low normal HCT and HGB and I had actually increased my Ferritin (iron stores) level to, I think, 11? (I am typically between 3 and 5, which is super low.)
If I don't need an infusion, I think I may start tanking up on oral iron supplements, there are so many I can try, and it might be a good time to give it a solid attempt with no metal dripping in an IV bag for a good long stretch. I never took anything repeatedly since starting infusions -- doctors had said NOT to -- to measure the effectiveness of the Ferrlecit and Dextran.
Here's to healthier blood.
Update - I'm not anemic. Woot. My hematocrit and hemoglobin were NORMAL.
My iron stores, ferritin, are still in the toilet at 7. The hematologist didn't even suggest a follow up. I guess this means, I'm going to attempt to take iron supplements, play doctor and work on getting my own iron stores up.
In fact, she was more concerned that my blood sugar was low during the draw. LOL. I didn't even know.
NEW YORK (Reuters Health) - Weight loss surgery can help you lose
weight, but it's also likely to leave you unable to absorb iron, a new
study suggests: Iron deficiency is a common problem after stomach
bypass surgery to treat severe obesity -- and standard iron supplements
may not be enough to prevent it in some patients.
Researchers found that among 67 Chilean women who had undergone
the most common form of weight-loss surgery, 39 percent developed low
blood counts, also known as anemia, within 18 months of surgery. That
anemia was most often due to a deficiency in iron, which the body needs
to produce healthy red blood cells that carry oxygen.
In contrast, less than two percent of the women had been anemic before
surgery, the researchers report in the American Journal of Clinical
It's well known that nutritional deficiencies are a risk after the type
of surgery examined in the trial, known as Roux-en-Y gastric bypass,
the most common and most effective form of weight- loss surgery for
The procedure involves stapling off the upper portion of the stomach to
create a small pouch that restricts the amount of food a person can eat
at one time. The surgeon also makes a bypass from the pouch that skirts
around the rest of the stomach and a portion of the small intestine,
limiting the body's absorption of nutrients.
new findings suggest that impaired iron absorption, rather than reduced
iron intake, is the major cause of long-term deficiency after gastric
bypass, according to the researchers.
Tests done six months after surgery showed that, on average, women
were absorbing just one-third of the iron from food that they had
What's more, their absorption of iron from supplements showed nearly as
great a decline. And many women became deficient in iron despite taking
supplements after surgery, according to the researchers, led by Manuel
Ruz of the University of Chile in Santiago.
All of the women in the study were put on vitamin and mineral
supplements after surgery, though not all took iron pills. Those who
did were prescribed 18 milligrams per day -- the standard recommended
iron intake for women younger than 50.
That amount, Ruz and his colleagues write, appears "largely insufficient to prevent iron deficiency and iron deficiency anemia."
The researchers say that some patients may need to take newer, more
readily absorbed iron formulations, or receive infusions of the mineral
rather than pills, to prevent a deficiency.
According to the American Society for Metabolic & Bariatric
Surgery, about 220,000 Americans had some form of weight-loss surgery
in 2008, with gastric bypass accounting for the majority.
SOURCE: American Journal of Clinical Nutrition, September 2009.
Evaluation of Short-term Nutritional Regimens Following Bariatric Surgery
NAAC Review Published: September 15, 2009
The two types of bariatric procedures most often performed in
Europe are adjustable gastric banding (AGB) and gastric bypass (GBP).
The use of bariatric surgery has demonstrated long-term effectiveness
on weight loss and comorbidities, including three recent studies, which
used restrictive and malabsorption procedures, with findings of
decreased mortality several years following the bariatric procedures.
Gastric bypass, an irreversible restrictive and mildly malabsorptive
procedure, is more efficient than AGB, a purely restrictive and
reversible procedure, on weight loss and comorbidities. However, GBP
potentially induces more nutritional deficits, compared to adjustable
gastric binding. Adverse effects of bariatric surgery are not uncommon,
but less is known about nutritional complications of bariatric surgery.
In the present study, the authors prospectively compared the prevalence
of nutritional deficiencies after AGB and GBP procedures.
I haven't felt right lately, I've been super-forgetful, clumsy and generally feeling stoopid. Enough so that I felt it necessary to get an urgent visit with the PCP this morning. (Many of those symptoms point to a medication problem, I don't want to mess around.) I was already having memory and cognitive problems, I have for a long time, but it's increased.
I didn't call, I just walked in to see if they had any available appointments, and they squeezed me in. (Although, I have to mention, that any time that's ever happened, that I have been "squeezed in" -- the offices are empty. But I do appreciate it.)
The doctor sent me to get blood drawn, she's checking my current state of anemia, metabolic panel, vitamin levels, thyroid and my seizure med level. I told her that SOMETHING is not right. Something is out of balance. I am off kilter, more than my usual. Here's to hoping something IS off kilter, or you can set me up in that special Alzheimer's Unit now.
No seriously, you don't get it. I walked in to drop off the baby at school today and a former co-worker of Mr's was there. She said, "Hi! How are you?" I HAD NO IDEA WHO SHE WAS. She's been IN MY HOUSE. Mr. has only been in the new job for what, a month? I knew that I recognized her, but I could not place her. She likely thought I had lost it.
Add that to the general feeling of askew in my body? Good times.
It could be worse.
Alongside me, a woman my age, being escorted out of a van with full head protection on.
Study suggests the womb may be key to breaking cycle of fat, diabetes
"Obese women who manage to shed excess pounds before becoming pregnant may be able to break the cycle of inherited weight problems and pass along better health to their children, a new study shows.
found that children were less likely to become obese if their mothers
lost significant weight through obesity surgery before becoming
pregnant, according to an upcoming study in the Journal of Clinical
Endocrinology & Metabolism. The children with the surgically
slimmed mothers also looked to have a lower risk of heart disease and diabetes.
shown that when the mother loses weight prior to becoming pregnant, the
kid does not become obese,” said Dr. John Kral, study co-author and a
professor of surgery and medicine at the State University of New York
Downstate Medical Center in Brooklyn.
Other studies have shown that obese moms are more likely than slim women to have obese children, Kral said.
the health risks associated with obesity are well-documented for both
moms and babies, said Dr. Dominic Marchiano, an assistant professor of
obstetrics and gynecology at Pennsylvania Hospital in Philadelphia.
But until now, it was unclear exactly how to break the cycle.
Steeped in sugary womb The
new results shift some of the blame for childhood obesity from genes
and the home environment to the conditions a fetus encounters as it
matures in the womb.
Factors in the uterus
might affect how a kid’s genes function later on, Kral said. For
example, obese mothers often have blood sugar levels that are too high.
“And that can leave the kid marinating in
sugar as he develops,” Kral said “But it’s not only that. There are
many other substances in the amniotic fluid of an obese woman that can
affect the developing offspring.”
and his colleagues studied 111 children from Quebec City, some of whom
were conceived before and some after their moms had weight-loss
surgery. The kids ranged in age from 2 to 26.
The 49 moms in the study had a procedure called biliopancreatic diversion, or BPD.
surgery directs food to bypass part of the small intestine and also
makes the stomach a little smaller. The resulting weight loss is mainly
due to the fact that people absorb fewer calories, Kral said, adding
that studies have shown that people with BPD continue to eat
significantly more than people who are naturally lean. This suggests
that what the moms ate later on, during their babies’ childhoods,
wasn’t the difference; instead, it was likely their actual weight loss.
The women in the study had lost an average
of 36 percent of their body weight and had kept the weight off for
about 12 years. They also had experienced improvement in their
cholesterol and blood sugar levels.
and his colleagues counseled the women to hold off on conceiving until
they had achieved their desired body weight. When the women did become
pregnant, they were given supplements to make sure that their babies
didn’t miss any important nutrients, Kral said.
Healthier babies When
the researchers compared children conceived before and after a mom’s
weight loss surgery, they found startling results: post-surgery babies
were smaller, though not underweight, and they were three times less
likely to become severely obese as they grew up.
children born to thinner moms also appeared to be healthier overall,
with lower insulin resistance and cholesterol levels, signs of a
reduced risk of diabetes and heart disease.
these results were the same when the researchers limited their analysis
to children who were siblings: 25 of the 49 moms had children born both
before and after their surgeries.
What was most striking, Kral said, was that you could break a family’s cycle of obesity by getting the mom to lose weight.
Kral said, it really doesn’t matter how the moms drop the pounds. The
results are expected to be the same if a mom loses weight through
dieting instead of surgery.
results may give those contemplating pregnancy another incentive to
slim down, Marchiano said. “We always recommend that women lose weight
prior to conception — but not while they are pregnant,” he added. “This
may help with motivation as women think about the weight destiny of
I especially like the visual of the fetus marinating in sugar.
I'm actually an experiment in progress, with three pre-WLS babies and one post WLS baby.
Does the post WLS kid stand a better chance of not becoming obese? Environment be damned, will she be better off than the first three? I do wonder sometimes.
My post WLS child didn't marinate in sugar, in fact, I was seriously hypoglycemic throughout her development. I actually wondered if she would be negatively effected due to my health post WLS. For a while, I thought she might be born with some type of abnormality, either from the constant hypoglycemia, anemia or another vitamin issue. She, of course, is now nearly three and fine, but I did wonder!