Re: Gastric bypass difficulty

[Guest guest]

:

We recommend Unjury protein powder, Met-Rx powder, EAS Whey powder, Premier

Nutrition protein drinks(ready-to-drink) for the first 3-4 months post-op, all

are tolerated well. Most people I see have been able to achieve their protein

needs through food at 6 months but if she is having difficulty with solid foods

a liquid may be needed or may allow for more variety in her diet. For gastric

bypass we recommend daily MVI + 500 mcg B12 + calcium (1200-1500 mg/day) + iron

for most, especially menstruating women; if she had lap-band surgery she should

be at least taking a MVI daily, we usually recommend calcium too. If she has

had excessive weight loss or vomiting vitamin deficiencies are likely, if she

has not been taking above vitamins, vitamin deficiency is likely. There is a

bariatric dietitian listserv on yahoo with extensive files of patient education

that you could access too!! All I see is bariatric surgery patients, let me

know if you need additional help. Best of luck.

Laschkewitsch RD

Laschkewitsch RD LD

Dietitian

Good Samaritan Weight Management Institute

Portland, OR

Gastric bypass difficulty

I will be seeing a patient for the first time tomorrow who is about 6 mo.

post-op from her surgery. She is having great difficulty getting appropriate

protein and food intake without feeling overly uncomfortable. She has lost

weight but I am unsure of the details about how much. She has seen an RD before

but I am not sure when...sounds like the traditional recommendations are not

working for this client.

What products are most easily tolerated? What about specific vit/min to include?

Any tips? I rarely see these types of clients in my practice. Thanks so much!

J. Sheerin, RD

Traverse City, MI

[Guest guest]

Thanks ! I just received additional information.....and I was slightly

wrong about what I had originally said....can you help??

" I am 10 years post-op from having a duodenal switch (Gastric bypass procedure).

Recently, I have been tentatively diagnosed with rickets and secondary

hyperparathyroidism. Clearly, I have absorption issues with vitamins and I am

also having protein absorption issues. In order for me not to swell up like a

puffer fish, I must maintain over 100 grams of protein per day. I have a

sensitivity to fake sugars rendering the majority of the protein shakes and bars

out of the question. Not to mention, I am at a point where I would need to drink

a shake while eating a meal to even think about getting an appropriate amount of

protein in. Being a gastric bypass patient, that's impossible to do since my

stomach is so small.

From my understanding, I would need to watch my phosphate levels with the high

PTH, yes? This means that I need to watch my intake of eggs and meat? Those are

my two main sources of protein. See my problems? "

Gastric bypass difficulty

I will be seeing a patient for the first time tomorrow who is about 6 mo.

post-op from her surgery. She is having great difficulty getting appropriate

protein and food intake without feeling overly uncomfortable. She has lost

weight but I am unsure of the details about how much. She has seen an RD before

but I am not sure when...sounds like the traditional recommendations are not

working for this client.

What products are most easily tolerated? What about specific vit/min to

include? Any tips? I rarely see these types of clients in my practice. Thanks so

much!

J. Sheerin, RD

Traverse City, MI

[Guest guest]

This type of surgery, with all these risks, seems like insanity! There

is no real health benefit:( Just lots of risks with terrible

consequences!

Sent from my iPhone

On Mar 21, 2011, at 3:58 PM, " Sheerin "

wrote:

> Thanks ! I just received additional information.....and I was

> slightly wrong about what I had originally said....can you help??

>

> " I am 10 years post-op from having a duodenal switch (Gastric bypass

> procedure). Recently, I have been tentatively diagnosed with rickets

> and secondary hyperparathyroidism. Clearly, I have absorption issues

> with vitamins and I am also having protein absorption issues. In

> order for me not to swell up like a puffer fish, I must maintain

> over 100 grams of protein per day. I have a sensitivity to fake

> sugars rendering the majority of the protein shakes and bars out of

> the question. Not to mention, I am at a point where I would need to

> drink a shake while eating a meal to even think about getting an

> appropriate amount of protein in. Being a gastric bypass patient,

> that's impossible to do since my stomach is so small.

>

> From my understanding, I would need to watch my phosphate levels

> with the high PTH, yes? This means that I need to watch my intake of

> eggs and meat? Those are my two main sources of protein. See my

> problems? "

>

>

>

> Gastric bypass difficulty

>

> I will be seeing a patient for the first time tomorrow who is about

> 6 mo. post-op from her surgery. She is having great difficulty

> getting appropriate protein and food intake without feeling overly

> uncomfortable. She has lost weight but I am unsure of the details

> about how much. She has seen an RD before but I am not sure

> when...sounds like the traditional recommendations are not working

> for this client.

>

> What products are most easily tolerated? What about specific vit/min

> to include? Any tips? I rarely see these types of clients in my

> practice. Thanks so much!

>

> J. Sheerin, RD

> Traverse City, MI

>

>

[Guest guest]

My friend who had this surgery sent this info: - she would never do it again

since she has had multiple medical problems. These are her exact words.

-------------------------------

" Her high PTH means she is sucking the calcium out of her bones for her

body. She needs to start taking calcium citrate. Many pills a day. She

needs buy DRY Vitamin D for the rickets. And take many of those a day. I

take mine every hour. My labs were fine after taking massive amounts of

calcium citrate and dry vitamin D.

When she poops rocks. She will know her calcium levels are normal.

She needs to have ALL of her Vitamin B's checked. My B-1 was low.

She will need to take a B-complex a day. Plus a separate B-1, B-2 and B-12

a day. This would bring her vitamin B's labs to normal ranges.

Bariatrics have to take massive amounts of vitamins just to have normal

ranges.

She most likely needs to take Dry Vitamin A, Vitamin E, and Vitamin K.

She should eat eggs, meat. High protein foods. Eat her meat first in a

meal.

Another case of her surgeon not telling her what exactly absorption means.

I hope this helps some.

My story is a mile long. "

On Mon, Mar 21, 2011 at 10:51 PM, Weaver wrote:

>

>

> This type of surgery, with all these risks, seems like insanity! There

> is no real health benefit:( Just lots of risks with terrible

> consequences!

>

> Sent from my iPhone

>

> On Mar 21, 2011, at 3:58 PM, " Sheerin "

> wrote:

>

> > Thanks ! I just received additional information.....and I was

> > slightly wrong about what I had originally said....can you help??

> >

> > " I am 10 years post-op from having a duodenal switch (Gastric bypass

> > procedure). Recently, I have been tentatively diagnosed with rickets

> > and secondary hyperparathyroidism. Clearly, I have absorption issues

> > with vitamins and I am also having protein absorption issues. In

> > order for me not to swell up like a puffer fish, I must maintain

> > over 100 grams of protein per day. I have a sensitivity to fake

> > sugars rendering the majority of the protein shakes and bars out of

> > the question. Not to mention, I am at a point where I would need to

> > drink a shake while eating a meal to even think about getting an

> > appropriate amount of protein in. Being a gastric bypass patient,

> > that's impossible to do since my stomach is so small.

> >

> > From my understanding, I would need to watch my phosphate levels

> > with the high PTH, yes? This means that I need to watch my intake of

> > eggs and meat? Those are my two main sources of protein. See my

> > problems? "

> >

> >

> >

> > Gastric bypass difficulty

> >

> > I will be seeing a patient for the first time tomorrow who is about

> > 6 mo. post-op from her surgery. She is having great difficulty

> > getting appropriate protein and food intake without feeling overly

> > uncomfortable. She has lost weight but I am unsure of the details

> > about how much. She has seen an RD before but I am not sure

> > when...sounds like the traditional recommendations are not working

> > for this client.

> >

> > What products are most easily tolerated? What about specific vit/min

> > to include? Any tips? I rarely see these types of clients in my

> > practice. Thanks so much!

> >

> > J. Sheerin, RD

> > Traverse City, MI

> >

> >

[Guest guest]

This type of surgical procedure should be forbidden if the stomach is there it

is because it is needed. Anyway, you can use Protein powder (I use protifar in

gastrectomized patients) in the 1st months to meet her protein needs, she should

also do a multivitamin, vitamin D and calcium supplements, and B12, B12 can't be

absorbed by the gut because it needs the activation factor produced by the

stomach to be absorbed, which isn't there anymore! So it is needed to be

administrated intramuscular. The best way to check vitamin B12 deficiency is not

the serum level of B12 because those can be falsely normal if folic acid levels

are normal or high. You should use metilmalonic acid.

From my practice with cancer patients:

- don't give food high sugar because they usually have high osmolarity and can

cause dumping syndrome

- fish is a lot easier to digest than meat

- They don't tolerate lactose in the 1st couple of months so I use lactose free

milk or soy milk

- I recommend them to do several snack along the day high in protein (you can

give an high protein drink for example)

- Avoid gas forming foods because usually they cause more discomfort in the 1st

6 mo.

Here are some good references to read:

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digesti\

ve-health/nutrition-support-team/copy_of_nutritionarticles/practicalgastrofeb04.\

pdf

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digesti\

ve-health/nutrition-support-team/copy_of_nutritionarticles/ODonnellArticle.pdf

http://www.obesityhelp.com/forums/rny/nutritional-guidelines-after-roux-en-y-gas\

tric-bypass-surgery.html

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digesti\

ve-health/nutrition-support-team/copy_of_nutritionarticles/index-to-nutrition-ar\

ticles-in-practical.html

>

> I will be seeing a patient for the first time tomorrow who is about 6 mo.

post-op from her surgery. She is having great difficulty getting appropriate

protein and food intake without feeling overly uncomfortable. She has lost

weight but I am unsure of the details about how much. She has seen an RD before

but I am not sure when...sounds like the traditional recommendations are not

working for this client.

>

> What products are most easily tolerated? What about specific vit/min to

include? Any tips? I rarely see these types of clients in my practice. Thanks

so much!

>

> J. Sheerin, RD

> Traverse City, MI

>

>

[Guest guest]

Yes, and these are physicians (surgeons) who took the Hippocratic

oath, " First, do no harm " .

Sent from my iPhone

> This type of surgical procedure should be forbidden if the stomach

> is there it is because it is needed. Anyway, you can use Protein

> powder (I use protifar in gastrectomized patients) in the 1st months

> to meet her protein needs, she should also do a multivitamin,

> vitamin D and calcium supplements, and B12, B12 can't be absorbed by

> the gut because it needs the activation factor produced by the

> stomach to be absorbed, which isn't there anymore! So it is needed

> to be administrated intramuscular. The best way to check vitamin B12

> deficiency is not the serum level of B12 because those can be

> falsely normal if folic acid levels are normal or high. You should

> use metilmalonic acid.

>

> From my practice with cancer patients:

> - don't give food high sugar because they usually have high

> osmolarity and can cause dumping syndrome

> - fish is a lot easier to digest than meat

> - They don't tolerate lactose in the 1st couple of months so I use

> lactose free milk or soy milk

> - I recommend them to do several snack along the day high in protein

> (you can give an high protein drink for example)

> - Avoid gas forming foods because usually they cause more discomfort

> in the 1st 6 mo.

>

> Here are some good references to read:

>

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digesti\

ve-health/nutrition-support-team/copy_of_nutritionarticles/practicalgastrofeb04.\

pdf

>

>

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digesti\

ve-health/nutrition-support-team/copy_of_nutritionarticles/ODonnellArticle.pdf

>

>

http://www.obesityhelp.com/forums/rny/nutritional-guidelines-after-roux-en-y-gas\

tric-bypass-surgery.html

>

>

http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digesti\

ve-health/nutrition-support-team/copy_of_nutritionarticles/index-to-nutrition-ar\

ticles-in-practical.html

>

>

> >

> > I will be seeing a patient for the first time tomorrow who is

> about 6 mo. post-op from her surgery. She is having great difficulty

> getting appropriate protein and food intake without feeling overly

> uncomfortable. She has lost weight but I am unsure of the details

> about how much. She has seen an RD before but I am not sure

> when...sounds like the traditional recommendations are not working

> for this client.

> >

> > What products are most easily tolerated? What about specific vit/

> min to include? Any tips? I rarely see these types of clients in my

> practice. Thanks so much!

> >

> > J. Sheerin, RD

> > Traverse City, MI

> >

> >