MM - BBGC - Life After WLS

Long-Term Health Problems Linked to Bariatric Surgery: Copper Deficiency

Iron Deficiency? Proferrin.

Andrea, are you pleased?  (Andrea, from WLS Vitagarten, has been suggesting Proferrin for-ever.  MM with IV iron pokes every few months, will g'head and take it now.)

Proferrin 11mg Heme Iron (30Tablets)

Malnutrition and the sleeve

Via MacMadame -

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.

Not anemic!

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.

Weight-Loss Surgery Brings Risk of Iron Deficiency - ABC News

Nothing new here, just a very straight-forward article:

Weight-Loss Surgery Brings Risk of Iron Deficiency - ABC News 

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 Nutrition.

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 severe obesity.

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.

The 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 before surgery.

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.