Question about Nutritional/Vitamin Deficiencies Several Years Out

[Redsfan19 37]

Hi Everyone-

I've been reading a lot about potential complications, both anecdotally on these boards and in studies, as part of my pre-surgeon appointment research. I'm fairly young (31) compared to a lot of other people I see having WLS, and the surgery's long term impact is of particular interest to me. First, I fully recognize that if I have surgery, I will be taking my doctor's regimen of Vitamins and supplements daily and RELIGIOUSLY, as well as carefully watching my Protein intake in my diet.

So my question is...when I see things about people developing increasing anemia (particularly as i'm some ways from menopause), B12 deficiencies, etc, about 5 or so years out, does this appear to be somewhat inevitable? Some of the stats I see appear to make this look relatively inevitable, and it makes me wonder what this could mean for me 30 or so years down the line.

What are your thoughts on this, particularly those of you who may be a few years out from surgery and may or may not be experiencing this? If you are experiencing problems, do you feel your surgeon adequately explained those risks to you? I'm making a huge list of questions for the surgeon i'm seeing, but really appreciate the thoughts I've already gotten from this board on other questions I've asked.

Thanks so much!

[James Marusek 5,244]

There are different types of WLS. I had a RNY where they cut my stomach in two parts and rerouted it. As a result the part of my intestines that normally converts food into Vitamins has been bypassed. As a result, I need to take a Vitamin regime for the rest of my life. Failure to follow this regiment can result in very bad consequences.

On the plus side, I have been taking Vitamins almost all my life and a few more will not kill me. One of the great benefits of the surgery is that I no longer take prescription medicine to control my high blood pressure and diabetes.

As part of the preparation for the surgery I attended a one-day workshop just prior to the operation. This workshop goes into minute detail about the requirements. So I think I have been fairly well informed of the risks and requirements.

One of your questions is a little strange, but I will try and answer it the best I can. As a person ages, they reach a point where there bodies mimic some of the same effects as seen in RNY surgery (actually the other way around). This happens when they get in their 80's. They can eat and eat and lose weight. Their body does not manufacture vitamins as when they were younger and they can become malnourished. Generally their doctors recommend these individual supplement their meals with vitamins.

[Judyr 57]

I totally agree with James. I am almost a year out. I took Vitamins before WLS and now continue. But I no longer take 8 medications for diabetes, high blood pressure, high cholesterol , Migraines, arthritis and reflux. My blood work has never been this good. My kidneys have improved, they cannot be cured, but tests show improvement. This has been a wonderful experience. My daughter had the surgery over 6 years ago, she is 45. She sometimes forgets to take her Iron, but gets regular blood check ups. With a good primary car physician, who knows you, they will keep on top of your needs.

[Redsfan19 37]

I've been strongly leaning towards RNY myself, and i'm perfectly comfortable with the daily Vitamin regimen. Like @@judyr says, i'd rather be taking Vitamins than pharmaceutical meds!!

What I'm really asking is not about the general malabsorptive affects of surgeries like RNY, since I know that's part of the procedure, but complications I've heard about where post-surgical patients several years down the road appear to reach a point where supplements no longer do the trick, and they have to undertake things like monthly intravenous Iron infusions. One of the medical articles I was reading suggested that can happen in up to 50% of RNY patients long-term.

The possibility of this kind of dependency, say, ten years out scares me a little, although I realize i'd be balancing it with the risk of still being at this weight 10 years from now, which sets up its own kinds of risks!

[sassy14 178]

And then there are people like me. I had RNY 2/28/13 and lost 129 lbs. my body is very happy being normal weight. I have regular blood work because now my body--for the first time ever-- is absorbing Iron and B12 better! You have to have your regular bloodwork and make sure your doctor goes over all the results.

[James Marusek 5,244]

I am 17 months post-op RNY and haven't noticed anything yet. My surgeon will perform regular check-ups with me for many years to come and I will have regular bloodwork done to monitor my status. The bloodwork is pretty extensive, not your normal routine.

At around the year mark, they picked up that fact that I was low on Iron and directed that I take an Iron supplement in addition to the iron in the Flintstone chewables. I suspect that I was not adequately separating the time between Calcium and iron. I had started using milk as my Protein supplement and neglected to factor in the Calcium in milk. Anyways, I moved all my iron supplements to bedtime in addition to taking the iron supplement and that seemed to do the trick.

I have spoken to people who are many years out and I have not heard of conditions you describe. I suspect that several individuals have not been following the prescribed program and that can cause complications. But that is a guess.

[Redsfan19 37]

@@James Marusek, that's part of what I wasn't clear on, whether the people who were experiencing these more extreme absorption problems tended to have a history of not following the program or not, and what I also want to ask the surgeon. One thing I've found difficult to tell from my own pre-appointment research is how many complications tend to relate to a lack of close adhesion to plan rules vs. how many can just crop up as a result of the surgery. It's good to hear that some of you guys have yet to have any problems as you've worked closely with your doctors and taken your supplements as prescribed!

[James Marusek 5,244]

There may be 3 phases to RNY weight loss. In the first phase, you are consuming very few calories right after surgery (around 700) and the weight melts away very quickly. In my case, I lost 80 pounds after surgery in 7 months. The second phase is a Maintenance phase. It might be described as a Honeymoon phase. If one consumes within a caloric band, weight is maintained. For me this band is around (800-1500 calories per day). This is a happy state. I tend to go with the upper end of this caloric band. It gives me a lot of choices and freedom. But I am told there is a third phase. I will call this phase The Long Haul. This occurs around a year and a half, when the stomach heals and absorbs more calories. The stomach goes from 70% to 100% absorption. Since I am not quite at the year and a half mark, I haven't experienced this phase. If that is the case then I will need to reduce my caloric intake to adjust and that might be difficult. It's like a hidden trap and perhaps it is the reason why some people fail. There are some individuals that maintain a tight control during the Honeymoon phase on the lower side of the caloric band, and they should be fine. We will see how it affects me when I reach this phase.

[dc0520 263]

I have to say, all the research I did and my few personal friends that have had major long term complications were due to not following their regimen and/or neglected the mental aspects and developed other harmful addictions. I don't think it's such an issue if you are committed to the lifestyle change.

[Judyr 57]

I am in an online support group and the people who have had problems are the ones that don't get in the prescribed Protein, Water, and Vitamins. They also jump the gun on what they are eating. I had 3 wks of liquids, 3 wks puréed foods, 3 wks soft foods. It was quite a while before I could have salads. Still not eating Pasta and very little bread. Those who cheat are only hurting themselves. You have to make a commitment to follow all your doctors rules. My surgery was 11/19/13, so I am almost at my one year mark. I have had two blood tests and have more scheduled for the next month. My side effect has been low cholesterol. My back has had a hard time readjusting to my weight loss, but in time that should rectify itself. This was the best thing I have ever done for my health. I only wish I had done it sooner. I have stage 3 kidney disease from my medications, which is not unexpected at my age and has gotten better. Follow your Drs guidelines, don't rush adding back in foods, and lose weight before surgery as it really does help you.

[carolk36 142]

My sister had RNY in 2006 and continues to take her Vitamins as prescribed. She now gets all her Protein from food. She has maintained her weight loss and has had no deficiencies. Her blood tests always comes back in normal ranges and she takes no medications.

[Amyllf2 206]

My mom is 8 years out. She's very diligent about her Vitamins. She does have an Iron deficiency and does require treatment about once a year. That started after year 5. Her doctor said it was more age related rather than RNY related.