food intake in women two years or more after bariatric surgery meets adequate intake requirements - supplements and what that data is based on? I mean some of these places do market to us, do we really need it?

I admit I am overwhelmed in info but didn't it say that women who lost the highest excess weight percentages were most prone to deficiency?

What I think about is how little I eat however I don't eat junk food. I have known people who don't really eat veggies and live on Cereal, burgers and fries kind of intake. Seems like even with their high intake of food they would still be deficient. Is one impact of the sleeve micronutrients malabsorbtion??

It's EXTREMELY important to take Vitamins and supplements. I was 23 when I was sleeved and I didn't take any of it seriously, vitamins wise. I have deficiencies in everything now and I bruise easily too. I still get light headed all the time, have my sluggish days, my period takes a lot out of me for 4 days, and when I catch a cold, I'm in be for at least a week.

Sure, I'm still alive and energetic, my doctors say that a 20-something year old won't feel it it now but later. And it's so hard to catch back up.

Wish I would have listened instead of thinking I knew it all...

Yes it did. Explains me. LOL.

There has been discussion of malnourishment being overweight. They've seen it with things like Vitamin D. I don't eat junk either, maybe now and then, but its salads (you can sprinkle Vega Protein berry or tropical, which is also good in applesauce) and chicken or turkey, eggs, etc.

I have seen fellow WLS'ers eat donuts and/or Protein Bars and I grab a banana. Those protein bars are the ones that have sugar, etc. in them.

Most but not all of my levels in terms of Vitamins and Minerals are in the normal range. That means only that it is in that range, not that it is the range I can be healthy in.

They have never fleshed it out in the medical literature, there is question that because the stomach reservoir is not there, food does move differently down to the intestines and there are changes. I think that is an academic discussion at this point, not a proven or studied one.

I admit I am overwhelmed in info but didn't it say that women who lost the highest excess weight percentages were most prone to deficiency?

What I think about is how little I eat however I don't eat junk food. I have known people who don't really eat veggies and live on cereal, burgers and fries kind of intake. Seems like even with their high intake of food they would still be deficient. Is one impact of the sleeve micronutrients malabsorbtion??

What if people are getting what they need from Vitamins and supplements? I think it works two ways: what are people eating, how much of it are they eating, and do all of us need to supplement? Supplement with what? If I have someone 400 pounds who is now 200, maybe still obese, stretched the pouch some, but healthy and feeling good, do they need all the supplements or vitamins that someone 110 pounds who isn't healthy does?

In the research above, calories were gotten in but not certain minerals/vitamins. If we supplemented with that, do you think that would suffice? Again, what I'm talking about is that the surgical community is doing a one size fits all with the vitamins, one size fits all with BMI, and there is nothing to suggest that that one size fits all answer works for everyone.

What if people take Protein powders, things like Vega? Some people cant do the pills, some need more of it than others. That's where I think there needs to be better aftercare.

Lets face it - if people gain back a fair amount of weight, they're getting in more calories and nutrients than they need. If not, they need to cut back on what they are getting too much of (calories) and concentrate on eating those nutrients they aren't.

There are more people who gain back than struggle with malnutrition.

It's EXTREMELY important to take vitamins and supplements. I was 23 when I was sleeved and I didn't take any of it seriously, vitamins wise. I have deficiencies in everything now and I bruise easily too. I still get light headed all the time, have my sluggish days, my period takes a lot out of me for 4 days, and when I catch a cold, I'm in be for at least a week.

Sure, I'm still alive and energetic, my doctors say that a 20-something year old won't feel it it now but later. And it's so hard to catch back up.

Wish I would have listened instead of thinking I knew it all...

I did most of my preop research regarding deficiencies by looking at studies conducted on cancer and ulcer gastrectomy patients. Gastrectomy surgery has been around for a hundred years (just not for weight loss). There are numerous studies conducted 10, 20, 30 + years after patients had part or all of their stomachs removed for medical reasons. It actually took decades for some of the deficiencies to show up.

But since we are all individuals and we all eat and metabolize differently, I think our best bet is you get our blood tests and adjust our diets or supplementation accordingly. At least that's what I'm doing.

It bothers me how little people check into this stuff. Its heart warming to see those who did.

Yes, that is dead on - some of us need different types of supplementation. Having a dairy issue, and a few other things, I need something different than what some of the others I've seen get. The problem comes in the ability to get doctors to test per person and not just some standard lab panel, not just the regular stuff.

I've had high copper levels before and borderline high. That would make 0 sense given my eating. Deficiencies are common but not high ones. That's why testing and supplementation should truly be unique and not blanket.

As the above shows, I think people can get in their food but again, its WHAT they get in that makes a difference. I eat more fresh veggies, fruit, and lean Proteins than the vegetarians I know. However, the large combo of problems and the specific problems I have gives me a greater risk for some things.

The other item that hasn't been thrown out here is our athletic endeavors. Now that I'm sidelined, I don't need to eat certain things, do certain things, because of that. Those who do, need extra help.

That article was written about people who have had RNY. There is malabsorption with that surgery. We do malabsorb some, but not to the extent that the people who have had RNY/gastric bypass.

Edited June 1, 201412 yr by Oregondaisy

I have constantly been told that VSG's do not have malabsorption. The problem is that we don't know where some people do and some people don't. Since there is altered motility of the GI track with the VSG, it is a guess as to who gets what. There can be other factors that affect that issue.

I am 2.5 years out and having a costly detail nutrition analysis done. I have heard that even without surgery and decent eating you can have imbalances due to digestive or absorption issues. I figure it will be good to know!

This is true and glad you have found someone to take care of you. I'm really paying the price for the lack of after care, so it is comforting to know a few people are getting it. I have another couple of people I'm talking to that the aftercare isn't there.

Very concerning. Something I preach about - asking your doctor about aftercare.

I worry about folks who think that healthy eating and having VSG rather than RNY will protect them from deficiencies. I consider my intake to be very healthy, AND I take good quality bariatric Vitamins, and still ended up with deficiencies. Maybe it's just marketing hoo-ha, but I'm willing to believe it matters which brand of vitamins you take, because the source of the nutrients differs, and some are more readily absorbed than others. We were all told to take Calcium CITRATE, not CARBONATE, right? So it makes sense to me that other nutrients in a multi-Vitamin may also differ. I'm willing to pay more to take a Multivitamin that's formulated for post-ops. And while it's true that we don't have the same risks of deficiencies as RNY post-ops, we still have smaller stomachs, and many of us are on PPIs long-term, impacting absorption of nutrients that require an acidic environment. I'm vigilant, but I still ended up extremely low in thiamine and Iron. I keep up with my tests, and I focus particularly on calcium, since I can't check that with a blood test. I had a bone density scan done along with a DEXA scan a couple of years ago, but since most women in their early 40s don't have bone density scans done, my PCP tells me there's not good data to compare my results to. I'll test again in a couple of years so I can compare to my prior results.

Posted on this in another area but you can still get problems even with supplementation. You're exactly 100% correct.

Still shouldn't be on PPI's long term. Like HRT, they were never meant to be a forever thing.

As for calcium, there are several ways of testing that. Blood serum, ionized, and then urine calcium. The combination can actually tell you a LOT about whether or not you are utilizing the bones or not. I'm around your age and I have DEXA scans every year now. Not only do I have every risk on the planet for it, but my female members ALL are or were on biophos. and they're bigger, taller, etc. than I am.

On top of that, my last DEXA scan showed a significant drop in one hip and a drop in the other that wasn't significant.

Well, I'd like not to be on a PPI long-term, but short of a miracle cure, I don't see getting off it any time soon. And having lost my mother to esophageal cancer a few years ago, I think I'd prefer to deal with nutritional deficiencies than the dangers of untreated / insufficiently managed GERD.

Would you like to be in my shoes? Untreated malnutrition goes to neurological damage, eventual eye surgery for cataracts, sight problems, vein issues ... the list goes on.

No, I don't meant to make light of the risks of untreated nutrient deficiencies, which is why I'm vigilant about taking my supplements and having blood work done regularly to catch issues early and address them. But I don't see that I have much of a choice about staying on a PPI, either. It could be worse, at least the PPI works for me, most of the time.

The info on calcium tests is helpful - I'll make a note to review with my PCP when I'm in next. (My surgeon has moved to Florida, so I no longer have routine visits with a bariatric practice).