What are the odds these guys are measuring their OWN failures?

[DianaCox]

Failure to give appropriate nutritional and supplement advice?

People here 9+ years out - post your deficiencies, if any. I have none.


~~~~~
Obes Surg. 2017 Jul;27(7):1709-1718. doi: 10.1007/s11695-017-2560-6.
Nutrient Status 9 Years After Biliopancreatic Diversion with Duodenal Switch (BPD/DS): an Observational Study.
Strain GW1, Torghabeh MH2, Gagner M3, Ebel F2, Dakin GF2, Connolly D2, Goldenberg E2, Pomp A2.
Author information
1
Department of Surgery, Weill Cornell College of Medicine, 525 E 68th St, New York, NY, 10065, USA. [email protected].
2
Department of Surgery, Weill Cornell College of Medicine, 525 E 68th St, New York, NY, 10065, USA.
3
Department of Surgery, Hopital du Sacre Coeur, Montréal, Canada.
Abstract
BACKGROUND:
Since biliopancreatic diversion with duodenal switch (BPD/DS) produces hypoabsorption, evaluation of long-termnutrient changes is appropriate.

METHODS:
Measurements of micronutrients, trace elements, PTH, iron studies, and protein were completed for consented patients at baseline prior to surgery and at yearly intervals. The patients were advised and supplements were adjusted by blood studies with compliance checks. Independent t tests and ANOVAs compared changes between cross-sectional cohorts based on follow-up time from surgery. A p value of 0.05 was considered significant.

RESULTS:
Between 1999 and 2010, 284 patients had BPD/DS. At baseline, nutrient analysis was available for only 190 patients (70% women), age 42.7 ± 10.0 years, BMI 53.0 ± 11.9 kg/m2; at year 1, 189 were available; at year 3, 193; at year 5, 132; at year 7, 98; and at year 9, 68. Gender distribution was not significantly different between cohorts. Baseline vitamin D was low and PTH high. All of the patients took some supplements. Fat-soluble vitamins remained low. Protein deficiency appeared at year 3 and increased to 30% at year 9. Baseline zinc was normal, but at year 5, 45% were low. Over time, hematocrit was low for 40% and hemoglobin for 46%. Iron deficiency continued through year 9, more marked in males. Calcium deficiency increased from year 3 and remained steady. Half of the patients had abnormal PTH at baseline, and the percentage increased over time. Twenty percent had abnormal baseline magnesium values. Magnesium fluctuated during observation.

CONCLUSIONS:
Major deficits in nutrient status occurred and persisted after surgery although supplementation was prescribed. Interventions are mandated to avoid nutrient deficiency.

 

[harrietvane]

You mean taking some multivitamin gummis doesn't cut it?!

 

[Munchkin]

None here but it's not due to any doctor.

 

[Larra]

Don't forget those Flintstones! And the ADEK's!

Just kidding, but not so funny when we've seen over and over the crappy supplementation advice doled out. For me, I'm almost 12 years old, and I struggle with elevated PTH, so I keep taking more and more calcium citrate and hopefully the next labs will be going in the right direction. My D level is good so calcium seems to be the issue. But my D sure dropped like a stone the first year when I took ADEK's. Every other lab has been just fine.

 

[Marquis Mark]

To be fair, my copper plummeted after the DS despite taking up to 40 mg a day. Had a set of rare copper infusions a month ago which, according to the latest test, did little to elevate my level. Having another set of infusions next week. If those don't work, I would definitely chalk that up to a DS created problem as I am proactive, questioning, not intimidated by doctors and don't do gummy vites. And I had my copper tested right before surgery and it was fine.

My PTH is also up to 80 despite 150,000 day of Biotech dry D AND multiple D injections at Dr. K's. My D is at about 40. Hard to get it above that.

Iron could not be fixed with pills, but was fixed with infusions, so OK.

All else is good.

Too bad that study doesn't mention the types and amounts of supplementation. Without that, we're just left to speculate that everyone was taking Flinstones.

 

[juliebird4828]

"All of the patients took some supplements." Crap study that doesn't explain the supplementation used. Of course there are deficiencies!

 

[KathrynK]

I am a patient in this practice. The nutritionist is very good. The compliance of patients is poor. This is a good bariatric group and she has given me extensive counseling about nutrition and tested me regularly. They are now hesitant to offer DS to people who can’t be compliant with a procedure that requires a lot of work and cost. They have told me about patients who live on macaroni and cheese, who say they can’t afford the vitamins, and who end up in a bad place. These professionals aren’t the problem. The patients are. Too many patients don’t come back annually and they don’t follow through with lifelong commitment. People who go to websites like this one are the cream of the crop. We are unaware of a percentage of people who don’t take this lifelong responsibility seriously. Even the best of us need to be realistic about the long term knowledge about this procedure. No matter how good we are, the most compliant of us, we are are guinea pigs in long term nutritional outcomes. I am not sure, despite all the vitamins and proteins in we take, that it is enough to make up for our new anatomy. DS must be reserved for people who are smart enough and frankly, who have the insurance, intellect, and financial ability to manage the daily issues with this. In the future, short limb DS may not be available to people like us because of the incompetent patients who have wasted this opportunity. I know these professionals are impressed with how successful DS is and I know they are concerned about long term nutrition. Don’t assume the people here are the average patient.

 

[juliebird4828]

I get that. It’s really important that these studies continue and supplementation is well documented and investigated. When all we have is the experience of veterans to help us, the medical community needs to acknowledge that and do more work in that area. I am in health care, I know patients are a part of the problem- hence the long laundry list of health care conditions affected by social determinants of health. (Can only afford pasta- or that’s what is at the local food pantry) We have to do more- better investigation into what is effective and what is not. And the patients abilities need to be a part of that.

I am a patient in this practice. The nutritionist is very good. The compliance of patients is poor. This is a good bariatric group and she has given me extensive counseling about nutrition and tested me regularly. They are now hesitant to offer DS to people who can’t be compliant with a procedure that requires a lot of work and cost. They have told me about patients who live on macaroni and cheese, who say they can’t afford the vitamins, and who end up in a bad place. These professionals aren’t the problem. The patients are. Too many patients don’t come back annually and they don’t follow through with lifelong commitment. People who go to websites like this one are the cream of the crop. We are unaware of a percentage of people who don’t take this lifelong responsibility seriously. Even the best of us need to be realistic about the long term knowledge about this procedure. No matter how good we are, the most compliant of us, we are are guinea pigs in long term nutritional outcomes. I am not sure, despite all the vitamins and proteins in we take, that it is enough to make up for our new anatomy. DS must be reserved for people who are smart enough and frankly, who have the insurance, intellect, and financial ability to manage the daily issues with this. In the future, short limb DS may not be available to people like us because of the incompetent patients who have wasted this opportunity. I know these professionals are impressed with how successful DS is and I know they are concerned about long term nutrition. Don’t assume the people here are the average patient.

f they don’t document the su

 

[bearmom]

At 10 years out, I struggle to get my D above 40, and most levels are good right now, but things that have shown up in past labs that needed adjusting at times have been zinc, copper, calcium (mainly for kidney stones) iron, D. I've added things to assist D absorptions, that aren't tested (strontium, K2 and silica), and probiotics that no one talked about when I had surgery.

My surgeon originally gave me a sheet after surgery that said tums and gummies were fine. When I pushed back on that information, they then said "we meant just immediately post op, then you can do the list you brought (it was an early version similar to vitalady suggested vites that I'd brought with me). But that is not what any of their printed stuff stuff said, and I had a binder full of it. After multiple arguments they did finally concede their info was for RNY patients. That list wouldn't have been good for an RNY either. That surgeon was so gung ho on making obesity and weight loss surgery understood and training surgeons on that side of the globe, and opening new bariatric wings in hospitals to accommodate large WLS patients so I was extra interested in them having decent nutritional info. The nuts have not been open to hearing anything else, and I quit updating them with my stellar labs and supplement list (the list that is the very reason for such stellar labs) a few years ago.

 

[Duckman]

My surgeon originally gave me a sheet after surgery that said tums and gummies were fine. When I pushed back on that information, they then said "we meant just immediately post op, then you can do the list you brought (it was an early version similar to vitalady suggested vites that I'd brought with me). But that is not what any of their printed stuff stuff said, and I had a binder full of it. After multiple arguments they did finally concede their info was for RNY patients. That list wouldn't have been good for an RNY either.

Srikanth/Howard are super into adjusting everything based on very detailed labs. I have come to appreciate this as I read (on the other forum where I'm active) people trying to guess what they need for supplements instead of using labs.

It's really bad out there. Unfortunately the nutritionist Srikanth sent me to is not up to speed on DS stuff. Nice lady, though.

 

[Marquis Mark]

At 10 years out, I struggle to get my D above 40, and most levels are good right now, but things that have shown up in past labs that needed adjusting at times have been zinc, copper, calcium (mainly for kidney stones) iron, D. I've added things to assist D absorptions, that aren't tested (strontium, K2 and silica), and probiotics that no one talked about when I had surgery.

My surgeon originally gave me a sheet after surgery that said tums and gummies were fine. When I pushed back on that information, they then said "we meant just immediately post op, then you can do the list you brought (it was an early version similar to vitalady suggested vites that I'd brought with me). But that is not what any of their printed stuff stuff said, and I had a binder full of it. After multiple arguments they did finally concede their info was for RNY patients. That list wouldn't have been good for an RNY either. That surgeon was so gung ho on making obesity and weight loss surgery understood and training surgeons on that side of the globe, and opening new bariatric wings in hospitals to accommodate large WLS patients so I was extra interested in them having decent nutritional info. The nuts have not been open to hearing anything else, and I quit updating them with my stellar labs and supplement list (the list that is the very reason for such stellar labs) a few years ago.

I'm in the same boat as you regarding trying to get my D above 40. Despite 200K/day dry D and occasional Vitamin D shots it's hard. Dr. K and a Nutritionist MD at UCLA both told me MK-7 is not really proven to help. Is there anything you've tried which has? My PTH is about 80 and I'd like to get it down.

 

[bearmom]

Srikanth/Howard are super into adjusting everything based on very detailed labs. I have come to appreciate this as I read (on the other forum where I'm active) people trying to guess what they need for supplements instead of using labs.

It's really bad out there. Unfortunately the nutritionist Srikanth sent me to is not up to speed on DS stuff. Nice lady, though.

When I was first looking at WLS in WA, Srikanth wasn't on my radar (but another seattle surgeon was, that did several types of RNY). I've heard good things about Srikanth, and wish he was better known a little earlier, as I might have opted to stay in the states.

There are some FB groups where people just post saying "i have XXX happening. What do I need to take for that." Ugh.

 

[bearmom]

I'm in the same boat as you regarding trying to get my D above 40. Despite 200K/day dry D and occasional Vitamin D shots it's hard. Dr. K and a Nutritionist MD at UCLA both told me MK-7 is not really proven to help. Is there anything you've tried which has? My PTH is about 80 and I'd like to get it down.

I'd prefer an actual study (or 2 or 5) that show that K2 actually helps, but there are plenty of things we've taken without definitive proof before we had much beside anecdotal data. Silica is one that is worth reading about for calcium. I also take more calcium that many, because of kidney stones, but am careful to take it with everything I eat. I also take about twice the amount of magnesium than most here do (many take magnesium at 50/100 ratio of their calcium, but I take even amounts.

At this moment, my calcium, bone density, pth (vitamin D if 40 counts as OK) and even kidney stones all seem to be doing OK, so specifically which of those things it is, I'm not sure, but going to continue with every one of them and not rock the apple cart.

Once upon a time, I found some liquid D at costco. You drank it, and it was a fruity, water based drink. I didn't really follow the dosing of however many teaspoons, and would just take a chug out of the bottle. I still took my usual dry D, but that was the best my D had ever been, and I quit because it was pretty expensive the way I was just chugging it. I don't see it anymore, and wish I could find it and give it another try, and follow the dosing to make tracking easier.

 

[DonRobbie]

I'm preop, so please don't hurt me. I take gummy vitamins for my daily multivitamin. I've seen a lot of passing comments on gummy vitamins here. Are they generally bad or does the post DS malabsorbtion 'break' them?

 

[southernlady]

I'm preop, so please don't hurt me. I take gummy vitamins for my daily multivitamin. I've seen a lot of passing comments on gummy vitamins here. Are they generally bad or does the post DS malabsorbtion 'break' them?

Generally bad. But compare yours to Centrum. If it’s the same it’s fine for now. What breaks them after the DS is all the sugar or sugar alcohols in them, esp since many of us double or triple our dose of multi. I take three multi’s every day. So does my dh. A 500 count of Costco Kirkland Daily is $13.99 for a cost of .08 cents a day per person. We go thru a 500 count in +/- 3 months.