Re: Fat soluble vitamin absorption-- and Chris

[Guest guest]

OK, guys.

Even though I'm Gagner's patient, why can't I follow the

supplementation recommendations of other surgeons? Would this be non-

compliant? I know; it's my own darn fault for not tasting these

things before surgery and then taking up the issue with the doctor.

I just can't handle the chewables. tell me exactly what

supplements you're taking. How are you doing with the water and

protein?

Thanks,

> >CHRIS HULL -- you would know this

> > technical stuff --- Are calcium and other trace minerals mainly

> absorbed in

> > the duodenum? What about protein? Are the fat-soluable vitamins

> (A, D, E,

> > K) absorbed in the common channel???

> >

>

> From what I have read, Vitamins B12 and some calcium are absorbed

in

> the duodenum, or at least they need the intrinsic factor that is

> produced in the duodenum. For this reason, RNY patients have need

> B12 supplimentation, but DS patients do not.

>

> Absorption of all fat soluble vitamins is affected by the BPD/DS.

It

> has not been documented (in any of the papers that I have read)

> exactly where the absorption occurs, but it is presumed to be

> primarilly in the common channel, with some absorption (possibly)

in

> the alimentary limb. Defeciancies of Vitamens D and Calcium are

the

> most serious, followed by Vitaman A. I have seen no documented

> issues with vitaman E & K. Interestingly, Dr. Anthone prescribes

> Allergy A & D vitamins plus a pre-natal multi-vitaman, and calcium.

He

> does not prescribe ADEK's, presumbably for the above stated reason.

>

> In addition, Iron absorption can be an issue (particularly with

> menstruating women). I think the duodenumm helps with iron

> absorption as well.

>

> Hull

[Guest guest]

,

don't toss em...in a week or two, they may actually taste better!

Seriously, or at least not gross!

Hugs,

Theresa

DS 11-19-01

Dr. Jossart

-13#s

> > >CHRIS HULL -- you would know this

> > > technical stuff --- Are calcium and other trace minerals mainly

> > absorbed in

> > > the duodenum? What about protein? Are the fat-soluable

vitamins

> > (A, D, E,

> > > K) absorbed in the common channel???

> > >

> >

> > From what I have read, Vitamins B12 and some calcium are absorbed

> in

> > the duodenum, or at least they need the intrinsic factor that is

> > produced in the duodenum. For this reason, RNY patients have

need

> > B12 supplimentation, but DS patients do not.

> >

> > Absorption of all fat soluble vitamins is affected by the

BPD/DS.

> It

> > has not been documented (in any of the papers that I have read)

> > exactly where the absorption occurs, but it is presumed to be

> > primarilly in the common channel, with some absorption (possibly)

> in

> > the alimentary limb. Defeciancies of Vitamens D and Calcium are

> the

> > most serious, followed by Vitaman A. I have seen no documented

> > issues with vitaman E & K. Interestingly, Dr. Anthone prescribes

> > Allergy A & D vitamins plus a pre-natal multi-vitaman, and

calcium.

> He

> > does not prescribe ADEK's, presumbably for the above stated

reason.

> >

> > In addition, Iron absorption can be an issue (particularly with

> > menstruating women). I think the duodenumm helps with iron

> > absorption as well.

> >

> > Hull

[Guest guest]

,

Yeah, you're right. I had planned on sticking it out for the three

weeks--that I can do. But after that? I WILL really explore these

issues when I see him on December 19. I let you know what I come up

with.

Here's something else that's been buggin' me. Our binder says to

take only three Citracals every day, but that's only 600 mg. of

calcium. Rabkin, Hess, and others say to take anywhere from 1500-

2000 mg. of calcium supplements. What do you think?

Also, is Chromagen Forte available with a Rx only? Gagner gave me a

Rx for use 3 weeks after surgery, but I thought the prescription

irons were only for those having problems.

Thanks again,

[Guest guest]

In a message dated 11/29/01 11:22:19 PM, duodenalswitch

writes:

<<

Here's something else that's been buggin' me. Our binder says to

take only three Citracals every day, but that's only 600 mg. of

calcium. Rabkin, Hess, and others say to take anywhere from 1500-

2000 mg. of calcium supplements. What do you think?>>>>>

Oh, I think that's supposed to be TWO pills THREE TIMES a day. But, you're

starting out with the citrical??? I thought they recommended the TUMS or

VIACTIVE in the first three weeks (The chewables). THose citricals are huge

buggers ... I suppose one could take them immediately post-op (perhaps many

have) but I just switched after three weeks b/c I liked having the chewables

at first....

Perhaps 3 a day is what they start you out on in the first three weeks... I

can't really remember clearly (I was on Viactiv and then Caltrate -- I took 1

viactiv or Caltrate three times a day -- the citrical is different -- it's

TWO pills three times a day but is supposedly better absorbed). Does anyone

post-op Mt. Sinai remember whether the dosage of the Citrical was the same in

the first three weeks and thereafter???

<<<<<<Also, is Chromagen Forte available with a Rx only? Gagner gave me a

Rx for use 3 weeks after surgery, but I thought the prescription

irons were only for those having problems.>>>>

The Chromagen Forte is presecription only, I think. There are other brands

-- like Niferex Forte but DON'T just get iron tablets over the counter... I

think they are NOT absorbable by post-op DS (Especially the 'slow action'

ones). I really like the Chromagen Forte -- It contains Vit C to maximize

absorption and is a liquid form in a soft capsule... I've never had problems

taking it on an empty stomach.

Yes, the iron is supposed to be taken only at 3 weeks post-op. I think this

is to save an already tender-tummy from having a bad reaction (especially b/c

this must be taken on an empty stomach). I think Dr. G routinely prescribes

iron for menustrating women... Not sure if it's different for menopausal

women or not. I think that iron is malapsorbed so that's why it is

*commonly* taken by many post-ops (at least post-op women of childbearing

age). You do NOT want to become anemic and/or require iron injections,

etc.... This is a very real possibility if you don't take iron post-op. I

think Hull mentioned that iron is absorbed in the duodenum and, since

we only have a few inches of it (compared to pre-op), there's a real

possibility that a post-op can develop this kind of deficiency.

Now, I'm sure there are post-ops who DON'T take iron (even if they are women

of child-bearing age). I'm sure if your iron levels are high they will want

you to reduce or stop the supplements. I've heard of this happening with

some women -- they don't need the iron. My iron level was always ok

pre-op... I wasn't anemic or anything. And, I'm taking Chromagen Forte twice

a day.

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 201 lbs/size sweet 16

[Guest guest]

Dory---doing what you just did...thanks so much for the update....I will show

this to Dr. Rabkin and ask his opinion....hope to see you at the December

meeting...we have changed the format to offer postop patients more

support....stay in touch we us and I look forward to knowing you more in your

postop course!! Barb

[Guest guest]

In a message dated 11/30/01 11:12:08 AM, duodenalswitch

writes:

<< Thanks for the information. You must be right about the Citracal in

that the dose should be 2 pills, three times a day. Still, that's

only 1200 mg., and considering that Gagner's so conservative about

all the other supplements (to the point of overkill, MAYBE) why run

short on the one, single supplement that is MOST crucial for us???

Hess, Rabkin (others?) recommend 1500--2000 mg. in calcium

supplementation.>>>>>>

Oh, you're most welcome, . Now, two of the citrates have 500

mg/calcium... so taken three times a day that would be 1500 gm (similar to

other DS docs suggestions). Do you have the Citrical citrate pills? Those

are 500 gm/two pills. NOt sure if another brand may have less???

<<<<<Glad to hear that the Chromagen is a gel capsule thingy. Does your

insurance pay for this?>>>>>

Strangely, my old Oxford policy did, but at a percentage (a regular script

would cost me 15 but the chromagen cost 25. BEtter than over 50 without any

coverage!). THen, my dh got a new job and we still had Oxford but they NO

LONGER covered this as a supplement! Oxford generally does NOT cover

nutritional supplements but has some exceptions. Guess I don't have any of

those anymore!

<<<<<<Clarification: I AM taking Viactiv for the first three weeks; the

Citracal comes later. Same with the iron--haven't started taking it

yet, but was given the prescription to fill.>>>>>

I started out on the Viactiv but got so sick of chewing and really didn't

like the chocolate taste! That was a big surprise to me! I switched to

Caltrates. They have a really nice, fruity flavor. I really liked those,

but decided to switch to Citrical when I was three weeks post-op b/c I heard

it was absorbed better...

I'm still not sure what type of citrical you have but I would think they

would be pretty standard... 500 mg/two pills... I know they have different

formulas. I like the Citrical Plus (it also has Vit D but minerals, etc.).

all the best,

lap ds with gallbladder removal

January 25, 2001

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 200 lbs (ok ------ will I be celebrating this weekend? I hope

so!!!)/size sweet 16

[Guest guest]

,

Thanks for the information. You must be right about the Citracal in

that the dose should be 2 pills, three times a day. Still, that's

only 1200 mg., and considering that Gagner's so conservative about

all the other supplements (to the point of overkill, MAYBE) why run

short on the one, single supplement that is MOST crucial for us???

Hess, Rabkin (others?) recommend 1500--2000 mg. in calcium

supplementation.

Glad to hear that the Chromagen is a gel capsule thingy. Does your

insurance pay for this?

Clarification: I AM taking Viactiv for the first three weeks; the

Citracal comes later. Same with the iron--haven't started taking it

yet, but was given the prescription to fill.

Best,

[Guest guest]

, as I told you in my most recent e-mail, I started, a few

days ago at my 3 week mark, taking Calcium Citrate instead of the

Tums Ultra I was taking twice daily before. I bought the ones with

the most mgs. and that's 315 each. I take 2 three times a day so am

getting nearly 1900mg. daily. The nutritionist at NYU says to shoot

for 1800, so I've got that covered! By the way, not to worry, they

are not chewable(I know how much you love those!), but they ARE horse

pills!

At the check-up, I was given a prescription for Iron too. Though my

iron count was very good pre-op, I think Dr. Ren(and most doctors)

like pre-menopausal women to be on it, regardless.

Hope you're feeling better!

~ D.

> ,

>

> Thanks for the information. You must be right about the Citracal

in

> that the dose should be 2 pills, three times a day. Still, that's

> only 1200 mg., and considering that Gagner's so conservative about

> all the other supplements (to the point of overkill, MAYBE) why run

> short on the one, single supplement that is MOST crucial for us???

> Hess, Rabkin (others?) recommend 1500--2000 mg. in calcium

> supplementation.

>

> Glad to hear that the Chromagen is a gel capsule thingy. Does your

> insurance pay for this?

>

> Clarification: I AM taking Viactiv for the first three weeks; the

> Citracal comes later. Same with the iron--haven't started taking

it

> yet, but was given the prescription to fill.

>

> Best,

>