Bariatric Dietitian Elizabeth Anderson explains why feeling sunshiney is the perfect reason to keep visiting your local phlebotomist.

New Year, new calendar, time to enter in to your digital devices all those reminders and important events for 2017.

Birthdays, anniversaries, car inspection and for bariatric post-ops…don’t forget your LAB WORK!

I know this is one of the first things that gets forgotten in the avalanche of to-do’s in the first year after weight loss surgery.

As a bariatric dietitian, I try to make it easier for my clients by sending reminder emails and letters to them and their PCPs.

Many of my clients will say, “Elizabeth, I’m healthier than I’ve ever been; I feel great! Why waste time and co-pays on lab work?”

Short answer? It’s critically important—no matter which procedure you had done.

The American Society of Metabolic and Bariatric Surgery (ASMBS) recommends lab work after bariatric surgery at 3 months, 6-9 months and 12 and 18 months. After that, an annual work-up is usually sufficient.

Here’s why:

Vitamins and minerals play many key roles in weight management. If you don’t get adequate amounts, you’re compromising your health

and

slowing down your weight loss.

Gastric Sleeve, Gastric Bypass and BPD surgeries ALL change your metabolism. This means the digestion and absorption of nutrients, vitamins and minerals can be negatively affected.

Some nutritional deficiencies lead to severe consequences--some irreversible and at least one, fatal.

Nutritional deficiencies continue to occur after surgery—some as far as 20 years post-op.

a. Iron deficiency is most commonly seen 4+ years

after

surgery!

b. Dietitians in Boston, MA report that in one group of post-ops—

43%

were B12 deficient 15 months after surgery.

Many patients are deficient in key vitamins

before

surgery.

a. One study showed 48% of WLS patients had at least one nutritional deficiency before surgery! (1)

b. Another study showed more than 50% of all WLS patients are low in Vitamin D preoperatively. (2)

It’s safe to say those pre-op deficiencies don’t improve with weight loss, reduced calories and smaller meals.

I send my patients to their doctors and NPs with this list of recommended labs:

ü Thiamine

ü Folate

ü Vitamin D

ü Vitamin B12

ü Vitamin B6

ü complete protein

ü complete metabolic panel (CMP)

ü complete blood count (CBC)

ü Lipid panel

ü Liver function tests

ü Parathyroid hormone (PTH)

ü Bone density test or (DXA) every 2 years.

More often than I like, providers will pick and choose from the list. They too, wonder if all the tests are truly necessary.

I gently push back with the research data and thankfully, more labs are ordered.

When the labs come back, make sure your bariatric dietitian or some member of your bariatric team reviews them.

Many healthcare providers aren’t well-versed in the nutritional concerns after WLS and might miss an important trend.

I know regular labs are one more thing on the to-do list, but remember, you made a life-changing investment in yourself and your health when you had bariatric surgery.

Consider all those vials of blood just part of your insurance policy protecting that investment!

-Elizabeth Anderson MA, RDN, LD

References:

1. Ernst B et al. Obes. Surg 2009;19(1):66-73.

2. Gehrer S et al. Obes. Surg 2010;20(4):447-53.

I realize that testing hormone levels via blood tests are kind of hit and miss, but as a guy, I can tell you it was really critical. Pre-surgery my testosterone level's were really low. So I was receiving supplementation, the first few months following surgery the T levels spiked during the hormone dump (rapid fat loss led to everything stored in the fat cells to bounce into the blood stream). Now everything has leveled off. If I had just done a "one and done" blood test we would have missed this. And too much T can cause blood clots, and actually make it difficult to do aerobic exercise. If you don't have insurance, check online, there are places where you can get the blood work done affordably, and you can take the results to your doc and NUT.

You might want to add Vit C, zinc. I've had problems with those and part of the reason why is the Vitamins I get. Vitamin K was an issue for years too.

I didn't have a DS either ... that should tell you something.

Fantastic article. Thank you for writing and posting this.