WLS and Labs....(not the four-legged kind.)

[Elizabeth Anderson RD 669]

If you'd rather vacation in a desert greenhouse this summer than get your bloodwork done, you're obviously not a fan of WLS labs. Are all those labs really necessary? Bariatric Dietitian Elizabeth Anderson helps you decide if it's time to fast or pack the sunscreen.

“Do you think I should keep taking my sublingual B12, Elizabeth?” Roxanne* is 3 years post op from her gastric sleeve and is wondering if the expense of the meltable supplement is worth it.

“I’m not sure, what does your latest B12 lab show?” I respond.

“Uh…..I haven’t had labs done in, well...years,” Roxanne admits.

And she’s not alone. Scores and scores of WLS clients intend to keep up with the required post op labs but life gets in the way.

People, I am here to tell you, if it has been a long, LONG since you’ve had your specific bariatric lab work done, run, don’t walk, to your nearest phlebotomist.

Every few years, the Obesity Society (TOS), the American Society of Metabolic and Bariatric Surgery (ASMBS) and the American Association of Clinical Endocrinologists (AACE) update medical guidelines for bariatric surgery patients. They have a list of labs that need to be done at 3 and 6 months and those that need to be done annually. Yes, every-single-year, after surgery.

Why? Believe it or not, Vitamin and mineral deficiencies increase over time—regardless of your WLS procedure.

I know many PCPs push back against ordering these regular labs--whether it’s the cost to their practice, the patient or both, many providers don’t understand the necessity for the work-up.

What concerns me the most is that the damage from some vitamin and mineral deficiencies cannot be undone or corrected. The damage is permanent.

A psychiatrist speaker at a recent convention I attended, talked about patients he’s seen that were 6-10 years post op that were suffering from mental health issues--sometimes incapacitating problems.

When he looked at their lab work, he was shocked to see that for some patients, vitamin and mineral deficiencies were the sole cause.

If your provider pushes back against these labs, I’m happy to provide you with the link to the scientific paper citing which labs need to be done and when. You can share this with your provider and insurer.

Roxanne is off having her B12 checked as we speak. Armed with those results, we’ll be able to determine the most affordable and healthful path forward, specifically for her.

You deserve the same so make that appointment today. I thank you.

*names of clients have been changed

[Cervidae 2,389]

I'm getting my one year post op labs done tomorrow! And one of the things I love so much about my bariatric center is they encourage and expect you to be patients there for life. They schedule annual follow-ups every year following surgery for as long as the patient will show up. The surgery and lifestyle change is for life, so the checkups should be too!

[Christinamo7 4,042]

yup the practice where I had my surgery also has follow up and labs at 3,6 9 months and at one year, and yearly after that. it's good to keep an eye on things!

[Djmohr 6,965]

This is an excellent article. I happen to be a person who moved states following bariartric surgery and because I am post op, my new PCP handles everything.

She is great and I really like her for general things but I feel like I am teaching her. I come prepared with the list of labs they did at my one year post op in Minnesota and tell her exactly what needs to be pulled.

The scary part is, most PCPs simply are not trained on what to look for and as a patient I don't know what I don't know.

I happen to be one of those people who does a ton of reasearch and I pay close attention to my body mostly because I have always had a lot of medical issues.

I wish general physicians were better trained if they have a post Bariatric patient. I am constantly teaching or questioning other non Bariatric specialists as well.

I for one, would love that link.

[Elizabeth Anderson RD 669]

Here's the link for you: https://asmbs.org/wp/uploads/2014/05/AACE_TOS_ASMBS_Clinical_Practice_Guidlines_3.2013.pdf

[Alex Brecher 10,515]

@Elizabeth Anderson RD,

Thanks for this article! It is so important to get bloodwork done regularly, and so easy to overlook or conveniently forget. A lot of us might naturally think about Iron deficiency anemia as an example and figure all nutrient deficiencies are similar: that you’ll feel the symptoms (such as fatigue from Iron deficiency), and that you can reverse them when you start to take your supplement. But that’s not always true.

As you said, some complications from deficiencies are irreversible. You’ll never be able to gain back all of your bone mass if you’re low in Calcium for a long time. You can’t overcome certain types of nerve damage from Vitamin B12 deficiency.

Also, it’s important to remember that you won’t always see and feel symptoms until it’s too late. For example, you won’t know that your Vitamin D is too low even though you could be losing bone mass. Or women may not have any idea that they’re low in folate until it comes up in a pregnancy screening.

Another reason to get bloodwork done is that you can actually get too much of certain Vitamins and minerals. B Vitamins are generally safe, but you don’t want to take high amounts of iron for too long without getting your blood levels tested because iron overload can lead to liver problems.

Thanks for the article! Oh, and one other reminder: even if you have a whole long laundry list of nutrients to test and you need to fill a bunch of vials of blood, you still only need to go to the lab and get your arm pricked once!