Fat malabsorption

[AZhiker 2,251]

I am not absorbing fat, and this has driven my Vitamin D levels to the lowest they have ever been. Has anyone else struggled with this? Any tricks for increasing absorption? I am on 50,000 units twice a week now. I take Vit D with a meal that contains fat (nuts, peanut butter) and I really don't know what else to do. I am a bit concerned for my bone health as I already have osteopenia. Do pancreatic enzymes help?

[summerset 5,261]

How did you take your Vitamin D in the past? Did it come in an oily form or in a dry form? And how low are your levels? What suggestions did your dietician make?

[AZhiker 2,251]

19 minutes ago, summerset said:

How did you take your Vitamin D in the past? Did it come in an oily form or in a dry form? And how low are your levels? What suggestions did your dietician make?

My vit D has been in tablet form that I dissolve in my mouth before swallowing. The 50,000 units I take now are the little dark green capsules. My dietician is not very helpful. I'm working more with my PCP. I asked the pharmacist and she said to take it with food and oil, which I have always done. I am outside all the time - I garden, tend to livestock, hike, and bike. I do not use sunscreen except on my face. The D levels were a bit low before surgery, which is common in obesity. But afterward, they have continued to drop. Level last week was a whopping 15.1. YIKES! I thought for sure, after losing all the weight, my D would be good, but the malabsorption from the surgery has really taken it down. I've had steatorrhea ever since surgery - stools are loose, frequent (up to 10 times a day), urgent, light colored, gassy, and floatie, so it is pretty clear that I am not absorbing fat. I am going to ask about pancreatic enzymes. My PTH is fine, Calcium levels are within normal limits, although toward the low end.

[summerset 5,261]

Calcium levels in your blood says nothing about bone health. It just means that your PTH is doing what it's supposed to do: keep calcium at adequate levels in your blood stream and that there most likely doesn't seem to be a calcium malabsorption. Or do you talk about a DEXA scan?

DS patients have to deal with fat malabsorption and can have problems with absorbing fat soluble Vitamins. I think they take Vitamin D in dry form though I don't know for sure. Maybe it's a good idea to ask on the DS board for advice?

[2Bsmaller18 435]

I would ask if they feel like this could be temporary and that at 2-3 years out from surgery will your body naturally increase fat and thus Vit D absorption. I know that doesn't help now but at least maybe you only need to fix the issue in the short term. I would assume there's a max you can absorb from the sun. You probably wouldn't want to start using a tanning bed since you already have a lot of sun exposure. Can you research if Vit D can be injected or a compound pharmacy mix it into a cream you apply to absorb it through the skin? I have no idea if that's possible. Does Vit D absorb better if it is mixed with another Vitamin? This is the only thing I came across.

Vitamin D comes in two forms: D2 and D3. D2, also called ergocalciferol, comes from plants. D3, also called cholecalciferol, comes from animals. You need a prescription to get D2. D3, however, is available over the counter. It is more easily absorbed than D2 and lasts longer in the body dose-for-dose. Work with your doctor to find out if you need to take a vitamin supplement and how much to take if it is needed.

[RickM 1,747]

The DS folks are old hands at this, as that specifically malabsorbs fats; while the bypass isn't specifically known for it, there no doubt is some fat malabsorption going on there as there is some commonality in the sections of intestine that are bypassed. There are some D supplements that are Water soluble (strangely referred to as "dry" form) that are commonly available from the usual Vitamin Shoppe/GNC type places, or online.

You may also need to adjust the dosage; within the DS crowd, some, like my wife, only need one of those 50k pills every week or two (she varies depending on her labs) while others need one or two per day. Go figure - but that kind of individual variation is not uncommon.

[catwoman7 10,874]

yes - DS patients have that issue - they have to take the dry form. Maybe you'll need to try that as well? I take a dry sublingual D.

[AZhiker 2,251]

3 hours ago, summerset said:

Calcium levels in your blood says nothing about bone health. It just means that your PTH is doing what it's supposed to do: keep Calcium at adequate levels in your blood stream and that there most likely doesn't seem to be a calcium malabsorption. Or do you talk about a DEXA scan?

DS patients have to deal with fat malabsorption and can have problems with absorbing fat soluble Vitamins. I think they take Vitamin D in dry form though I don't know for sure. Maybe it's a good idea to ask on the DS board for advice?

I did not have DS. My dexa scan shows mild osteopenia, a change from a perfectly normal scan 2 years ago.

[AZhiker 2,251]

1 hour ago, catwoman7 said:

yes - DS patients have that issue - they have to take the dry form. Maybe you'll need to try that as well? I take a dry sublingual D.

I did not have DS. I was wondering if other gastric bypass patients have dealt with this and what helped minimize the fat malabsorption. All my other Vitamins are great.

[catwoman7 10,874]

44 minutes ago, AZhiker said:

I did not have DS. I was wondering if other gastric bypass patients have dealt with this and what helped minimize the fat malabsorption. All my other Vitamins are great.

I know - I was agreeing with the poster above me (RickM) who said he knew that was an issue with DS people, so maybe they could respond since they were "old hands" at this.

[Ling82 21]

You need Vitamin K to absorb vitamin D.

[Darktowerdream 419]

My Vitamin d was low for A long time. I had my gallbladder removed during surgery due to chronic inflammation and perhaps my low functioning gallbladder contributed to my low vitamin D.

Low vitamin d can be symptom of an underlying illness and supplementing with high dose vitamin d can make it worse. Plus I don’t feel that the prescribed doses or form are utilized by the body very well. It needs to be in a form that’s bioavailble K2 MK7 with D3. I personally think Multivitamins and any Vitamins should be Whole Foods based and in chewable or sublingual or liquid when possible.

i Buy this for my mom. It’s also a good value

https://www.vitacost.com/pioneer-chewable-d3-k2-gluten-free-spearmint

personally I was taking garden of life my kind organic whole food based (prenatal) Gummy multivitamins, along with a Calcium + D3 supplement and my vitamin D levels returned to normal for the first time in a long time and they were low years before I had surgery. I like the natures way alive calcium plus D3 gummies although I have been taking a tablet for the past two months. I did switch up my multivitamins for now, because I needed a three month supply but the my kind are the best.

[AZhiker 2,251]

7 hours ago, 2Bsmaller18 said:

I would ask if they feel like this could be temporary and that at 2-3 years out from surgery will your body naturally increase fat and thus Vit D absorption. I know that doesn't help now but at least maybe you only need to fix the issue in the short term. I would assume there's a max you can absorb from the sun. You probably wouldn't want to start using a tanning bed since you already have a lot of sun exposure. Can you research if Vit D can be injected or a compound pharmacy mix it into a cream you apply to absorb it through the skin? I have no idea if that's possible. Does Vit D absorb better if it is mixed with another Vitamin? This is the only thing I came across.

Vitamin D comes in two forms: D2 and D3. D2, also called ergocalciferol, comes from plants. D3, also called cholecalciferol, comes from animals. You need a prescription to get D2. D3, however, is available over the counter. It is more easily absorbed than D2 and lasts longer in the body dose-for-dose. Work with your doctor to find out if you need to take a Vitamin supplement and how much to take if it is needed.

I did not know the difference between D2 and D3. I knew D3 was more easily absorbed and I wondered why my PCP prescribed D2. But knowing I am vegan would make sense. Thanks for the info.

[AZhiker 2,251]

3 hours ago, catwoman7 said:

I know - I was agreeing with the poster above me (RickM) who said he knew that was an issue with DS people, so maybe they could respond since they were "old hands" at this.

Thanks. I was reading most recent and did not catch Rick's post right away. I'll check in with the DS folks.

[AZhiker 2,251]

3 hours ago, Ling82 said:

You need Vitamin K to absorb Vitamin D.

Hmmmmmm..... I'll have to check this out.