Sufficiently Deficient

Rather than buy myself flowers or take a trip for my WLS birthday, I did what I've done for the last seven years: get a complete blood panel. And this year, like every year since my bowel obstruction in 2007, I find that I lack the necessary vitamins and minerals for good health and general wellness.

On the bright side, my levels are better this year than they were in 2008 when I last discussed them here. My lowest year ever was 2010, when my body was recovering from having Lily. Come to think of it, 2010 was one of my most challenging post-op years, marked by minimal communication simply because I had a hard enough time facing my deficiencies as an individual, much less in a public setting like this where readers can offer their two cents. At that time, my ferritin (stored iron) was -1 and my hemoglobin was 7.8. My B12 dipped dangerously close to 200. I was also seriously deficient in vitamins B1, B6 and D.

To put it lightly, I was miserable. I felt like I was wading through cobwebs. Simple conversations were exhausting because it took every ounce of my energy just to follow along. Exercise was out of the question because the lack of B12 caused coordination issues, and the anemia (caused by low iron and low B12) caused severe muscle cramping and general fatigue. Lacking B1 and B6 meant issues with memory, cognitive thought and mood. Getting out of bed was a feat in and of itself.

We aggressively tackled the deficiencies that year with iron infusions, B12 injections and fistfuls of pills. There were days when managing my health felt like my career. But looking over my most recent set of labs, it seems like the effort paid off.

By the Numbers
Before any of us gets too excited, let me reiterate that I am still deficient in many areas. The good news with this recent set of labs is that it appears that all levels are rising. I'll take whatever good news I can get. Here's where I am at as of Feb. 24, 2012 (date of the bloodwork; bold type indicates levels are within normal range):

• Hemoglobin -- 11.2 (Normal is 11.7-15.5)
• Ferritin -- 3 (Normal is 10-154)
• Total Iron -- 18 (Normal is 40-175)
• PTH -- 116 (Normal is 10-65)
• Vitamin B1 -- 73 (Normal is 87-280)
• Vitamin B6 -- 6 (Normal is 2.1-21.7)
• Vitamin B12 -- 330 (Normal is 200-1100)
• Vitamin D -- 67 (Normal is 18-72)

To clarify, anemia is defined by the amount of hemoglobin. Not enough hemoglobin mean not enough (or small) red blood cells, which means muscles and organs don't get the oxygen they need. Though I am still technically anemic, I'm considerably less so than I was two years ago. And this is the first time that my ferritin level has been a positive number.

PTH is an indicator of whether my body is leaching calcium from my bones. My level indicates I still haven't found the right oral supplement to prevent that from happening.

The B vitamins are all much higher than they were on my last round of labs, but B1 is still lacking. Also, I seem to be among the 10 percent who have brain/blood issues with a B12 level between 200 and 400.

Plan of Action
Lab results alone aren't enough to create a treatment plan, but they are a powerful tool. I will continue my high-dose B-complex oral supplements to boost B1, and I will start monthly B12 injections again to get that number closer to 1000. My Vitamin D level is the best news yet. It means I can go from taking my 50,000 IU supplement twice a week to once a month to maintain.

I have a referral to see a hematologist to discuss the best treatment for my lack of stored iron. He will be the best person to help me determine what's needed in that arena.

Seven Years -- No Itch

They say time flies when you're having fun, but I find it flies right by just when you're living life. At least, that's been my experience in the seven years since I had gastric-bypass surgery. My head spins when I think of all the changes I've gone through over the years. Though the physical changes are most noticeable, I think it's the emotional changes that have made the biggest difference.

I remember sitting at Kaiser South San Francisco during bariatric orientation with my first husband. Part of the program involved patients at various post-op stages describing their experiences. More than one mentioned being frustrated because they were treated differently at a new size. When I think on that now, I can't help but laugh. I am treated dramatically different than I was before, but I am not bitter about it. How can I be? I AM DIFFERENT. I think differently, talk differently and interact with the world differently than I did at 350 pounds.  I am truly half the person I used to be. I don't think it's possible to undergo that big of a physical change and not be internally affected.

February 2005: Awaiting surgery.

I used to be a great observer. I think that's why I did so well in the newspaper field. I knew how to blend into the background (not easy when you're that big) until people forgot I was there. I watched. I listened. But I didn't participate. Ask anyone, that wallflower of years past is long gone. I won't lie. I think there are many people who miss her, but most have removed themselves from my present life. I grieved for the loss of some, but others are barely a memory as I have moved on. Those who are still present in my life get limited influence. I don't have the time, nor the energy, to live in the past.

Fall 2011: Almost seven years later.

I have no regrets, and there is nothing from my old life that I miss. I don't miss only being able to shop at Lane Bryant or Torrid for clothing. I don't miss my knees hurting every day. I don't miss the amount of time or effort it took me to move throughout the world. I don't even miss chocolate cream pie, which used to be my favorite dessert in the entire world. I love my life as it is right now. I love being a wife and mother. I love being an active volunteer. I love the fact that I have the energy necessary to do do all of those things and still run my own business.

When I think about it, there isn't much about my current reality that I don't relish. I feel fortunate that the tool of surgical weight loss gave me the freedom that I enjoy today. I am grateful for the changes it has forced me to make and maintain. Experts say any weight loss maintained after two years is a credit to the patient's hard work and commitment to permanent lifestyle change. If that's true, then I deserve a pat on the back. If it's not, then I owe a debt of gratitude to Kaiser, Dr. P. Legha, and the surgical team that made it all possible. Regardless, I have a deep sense of appreciation for the life I lead today, and the physical ease at which I live it.

36-Week Update

It's hard to believe that I'm in the home stretch of my pregnancy. It feels like just yesterday when I was bowled over by the news that I was expecting.

Brian and I have had a lot of fun over the past nine months, planning and preparing for our family to grow. Just married in March, we've celebrated a lot of firsts as a married couple and lasts as a childless couple. It's been a great time all around.

Now that I'm officially nine months pregnant, there's a collective sense of relief in our home. Though we both hope Baby Kubo holds out until his/her expected arrival date of Jan. 22, we know that s/he can safely enter the world at any point now.

Our twice-weekly doctor visits have been going well, with lots of visible movement and good variation of heart rate. We had a mild contraction during our last visit, according to the monitor. I didn't feel a thing, but the fetal monitor picked it up. If I could figure out how to make it through labor without noticing my contractions, I think I might have it made.

The most exciting thing for me, however, has been the improvement in my lab results. In just one month, my hemoglobin has jumped from 8.5 to 10.5 -- proof that my anemia was caused by both iron and B12 deficiencies.

It's amazing that it's taken almost five years after having gastric-bypass surgery for me to find a doctor willing to give me B12 injections, but I'm glad I have. Those weekly B12 shots have really turned things around for me, increasing my stamina and energy, in addition to raising my hemoglobin. Double-digit hemoglobin is important. Anemics aren't just at risk for pre-term labor, but many require blood transfusions after childbirth. Not a procedure I'm interested in if I can avoid it.

What is "Ready"?
People keep asking Brian and me if we're ready for the baby yet. We're definitely ready to meet the baby, to learn his/her personality and to have the reality of parenthood fully confront us. But I find that most people aren't really curious about the emotional side of parental readiness. When they ask that question, what they really want to know is whether the nursery is in order and if we have all the baby's stuff washed and ready for action.

The answer to that is short and sweet: Nope. Not even close.

There's a lot we'd love to do in the house before Baby Kubo makes his/her debut. There are a few things we'd still like to buy. But we also know that babies are very simple creatures with simple needs for the first few months of life. They don't need skillfully decorated nurseries or perfectly arranged outfits when they come home from the hospital. They need love, attention, food and warmth. That we have covered -- everything else is just icing on the cake, so to speak.

So from now on, when people ask if we're ready, I think my answer will be short and to the point. We're as ready as we'll ever be -- and we'll adjust as needed. Baby Kubo probably won't know the difference between ready and not, and I'm pretty sure s/he won't remember much about the first year. I think we can safely relax, knowing that as long as we cover the basic needs, we're doing everything Baby Kubo expects and requires.

Au Naturale: A New Kind of Supplement

One of the many perks of having a doula, or labor assistant, care for you before, during and after the birth of your child is that you become aware of options that exist outside of the mainstream.

Our first meeting with Dawn was a little on the daunting side. As a lay midwife, it’s her job to get a sense of my medical history in order to figure out the best way to support me in the birth experience of my choice and also to be prepared for potential complications that may arise.

I’m not sure if all of Dawn’s consultations are over two hours, but mine was. It took me a solid hour just to explain my medical history and laundry list of current ailments. I felt like one of those retirees who shares their trials and tribulations with anyone who shows the poor judgment of asking, “how are you today?” To her credit, though, Dawn did a great job of keeping a straight face.

We discussed my previous surgeries and the residual effects of each. I explained reactive hypoglycemia and my desire to labor at home for as long as possible because I’m concerned that the hospital’s protocol on limiting birthing women to ice chips and minimal clear liquids will put me at risk of an episode that could lead to an unnecessary C-section. We discussed my anemia, my vitamin D deficiency, my body’s tendency to retain water, my hospital anxiety stemming from my last surgical experience and just about everything in between.

We spent a lot of time discussing how I manage my hypoglycemia and which foods work at which stages. She encouraged us to make sure the fridge is stocked with all of those items by my third trimester so we can be prepared. She also gave us a variety of natural remedies to consider taking during the pregnancy to improve my outcome.

Chlorophyll for Anemia
For my anemia, she recommended liquid chlorophyll. Natural health experts believe chlorophyll to be molecularly identical to hemoglobin with the exception of the center atom. In hemoglobin, the center atom is iron; in chlorophyll, it’s magnesium. The thought is that this means chlorophyll can actually help do the job of hemoglobin (important for women like me who don’t have enough). The side effect of this is more energy and general well-being. Chlorophyll is also known to detoxify blood and increase the number of red blood cells in the body. It’s also known as a natural internal deodorant.

I found a moderately priced liquid chlorophyll supplement at Raley’s in the natural foods section over the weekend. I started taking it on Sunday and have faithfully drank two tablespoons a day ever since.

I expected it to taste similar to wheatgrass juice, which is known to be high in chlorophyll, iron and vitamin K. I like wheatgrass juice a lot, but jaunting to Jamba Juice every morning is neither practical nor cost effective. This bottled supplement from Raley’s seemed like a decent compromise.

I bought the “natural flavor” (mint is also available), and I also bought a bottle of acai juice as a chaser just in case it was dreadful. Initially, the chlorophyll is very sweet and finishes with a flavor I can only describe as “mud.” It’s like you just chowed down on some grass – dirt and all. You’re even left with bright-green lips as a reminder. The acai juice definitely helps afterward. All in all, though, it’s not the worst thing in the world. I have found it tastes better cold than at room temperature, and I’ve survived so far.

I have noticed increased energy during the day and possibly some reduced fluid retention. I feel different enough to continue taking it. We’ll see how my next set of labs come out to determine whether it’s truly effective in improving hemoglobin and red blood cell counts.

Red Raspberry Leaf Tea for Uterine Toning
Vitamin D deficiency is a side effect of the malabsorptive nature of the type of gastric-bypass surgery I had in 2005. Recently, scientists have linked vitamin D deficiency with an increased occurrence of emergency C-sections. Though no research has yet been done into why vitamin D deficiency can result in C-section births, the current hypothesis is that it’s due to muscle weakness.

Vitamin D is known to promote muscle strength. The uterus is one giant muscle that must contract repeatedly in order to bring a baby into the world the ol’ fashioned way. If a woman doesn’t have enough vitamin D, it’s possible she won’t have the uterine strength or stamina to birth a baby naturally.

Red raspberry leaf (commonly consumed as a tea) is known to strengthen the uterus. It’s often found as a primary ingredient in herbal teas marketed to expectant women. I found a box of 24 tea bags at the Vitamin Shoppe for $4.99 – lower than what prenatal teas typically cost (about $6 for 14-16 tea bags). I now drink a mug of red raspberry leaf tea each morning. It doesn’t taste bad, but I wouldn’t call it delectable either. It is what it is.

Dandelion Tea for Liver Health
Detoxifying one’s body is always a good idea, but when you’re pregnant, your body has to handle a lot of extra waste until the baby develops organs stronger enough to supports its own systems. That’s one reason pregnant women retain excess fluid.

Dandelion tea is known to be a strong detoxifier, particularly for the liver. I’m now drinking a cup a day of this (right after the raspberry leaf tea) as well. It’s not pleasant, but I’ve survived so far. I can’t describe the taste other than to say it’s not good. But I found it at the Vitamin Shoppe for an affordable price, and if it truly works, I would say it’s worthwhile.

So far, that’s the extent of the supplements I’ve tried. Dawn also recommended alfalfa, garlic and fish oil, but I can only take so many pills a day before I’m not longer able to fit food in my tummy. And the available pill space is currently taken up by my prenatal vitamins and iron supplements. So we’ll see how the next few weeks go, and then proceed from there.

21 Weeks and Counting

5 months

4 months

3 months

It's hard to believe I'm halfway through my pregnancy already. Seems like only yesterday that I was staring at a digital pregnancy test in disbelief, waiting for "NOT" to appear in front of the word "Pregnant."

Now we're halfway through and talking baby registry, home repairs, childbirth education and everything else under the sun that is baby-related.

I had my 5-month check-up Monday, and the baby seems to be perfectly normal (at least until he/she is born and takes on personality traits from his/her parents -- at least we know we're weird). The baby's heartbeat is strong, and he/she appears to be growing at a perfectly normal weight.

I, on the other hand, have a few pregnancy-related challenges that I'm working to overcome. My doctor is diligent is monitoring my vitamin levels. I'm still deficient in Vitamin D, but my anemia has become more aggressive.

It's funny. Between WLS and the bowel obstruction, I've learned a lot about reading doctors. There's a definite difference between getting a call from the doc's nurse who reports, "Umm...looks like your iron is a little low," and getting a call from the doc herself saying, "Uhh...yeah...I just received your lab results and your iron is quite low. Did you run out of vitamins?"

The silence on the other end of the line was deafening when I said that no, I had plenty of vitamins, was still taking them and didn't realize there was a problem.

So now, I'm on an even bigger cocktail of supplements. I'm combining chewable and tablet prenatal supplements, and combining my SeVate with a standard ferrous sulfate supplement. I'm learning to disperse my doses throughout the day to avoid stomach upset and to improve the opportunity for absorption, but it's a work in progress.

Brian is a great helper when it comes to reminding me. This "prego brain" phenomenon I keep hearing about makes it easy for me to lose track of which pills to take and when. But I'm getting better.

My other no-so-fun pregnancy side effect is water retention. My legs, ankles and feet are swelling to the size of tree trunks! Despite a dear friend's assurances that tree trunks are considered sexy in some countries, it's disturbing to watch one's formerly cute feet get bloated and distorted by excess fluid.

The doctor assures me there is nothing to worry about. My blood pressure is steady around 110/67 so preeclampsia isn't a concern. She says that this is just how my body is reacting to its newest resident. That's the upside. The downside is that there isn't much that can be done about it. Reducing sodium during pregnancy has been proven detrimental to expectant mothers so that's out. Mint Bliss lotion helps the swelling subside overnight, but it never goes away completely.


The doc's best advice? Elevate whenever possible. Lie down whenever possible. Drink lots of fluid. Avoid long car rides or any activity that requires sitting for prolonged periods of time.

Eventually, the swelling is likely to impede mobility, so we're already planning for my medical leave to take place in early December instead of early January.

I'm trying to look at the extra time off as an early Christmas present -- more time to plan/prepare for Baby Kubo's arrival. I imagine by that time, I'll probably relish the break and the excuse to loaf about all day.

We shall see.

Vitamins, vitamins and more vitamins

The top priority for any women when trying to conceive or upon discovering she is pregnant is to get on a high-quality vitamin program to ensure her growing baby has all of the nutrients necessary for development. Normally, doctors prescribe a brand they prefer. Some docs are OK with patients taking over-the-counter vitamins, but my experience has shown a strong preference for prescription vitamins during pregnancy.

Since my bowel obstruction, I have struggled with ingesting and process pills and tablets. Even though, it's been four years since I had gastric-bypass, my digestive system has retained many sensitivities since the emergency surgery I had in 2007. For that reason, my doctor and I chose to augment my current vitamin routine to ensure I'm getting the necessary amounts of vitamins and minerals without overdosing on any one nutrient.

Here's what I'm taking daily right now:

• 2 Bariatric Advantage high-potency (extra A, D, E, K) chewable multivitamins -- Before pregnancy, I took 1 daily
• 10 Bariatric Advantage Calcium Chewy Bites (250 mg of calcium citrate each) -- Before pregnancy, I took 5 daily
• 1 Bariatric Advantage sublingual B-12 tablet -- Before pregnancy, I took 2 per week
• 1 Se-Vate iron supplement with succinic acid and B12 (generic for Repliva, which has since been taken off the market) -- This is the only tablet I swallow daily.

Obviously, my vitamin expenses have increased during pregnancy. But I figure it's better to be safe than sorry. My doctor's main concern is that I get at least 800 mcg of folic acid daily and that we keep my existing nutrient levels as high as possible. My vitamin D has been very low lately and my iron still runs on the low side of normal.

I have to admit, though, that the daily B12 has really helped with my energy levels.

We're closely monitoring my nutrient levels, but it appears that so far, what we are doing works. The proof, however, will come when I deliver a healthy baby in a few months.

The Human Pin Cushion Speaks Again

My latest set of lab results just came in, and the news is mostly good.

After three rounds of iron therapy with Repliva, my hemoglobin has risen to 10.2 -- a small increase, but we're taking it as a good sign and continuing my current dosage of 150mg.

My B-12 levels are on the low side of normal at 232 with normal being considered any amount over 200. Doc isn't worried yet.

Parathyroid hormone (PTH) is elevated to 87 instead of being below 65, which -- combined with normal calcium levels -- indicates hyperparathyroidism. Don't you just love big words? Long story short, I'm not absorbing the calcium I'm taking in. I'm switching to UpCal D, which is a powdered form of calcium that mixes easily in liquid. I have a few friends who credit it with rapidly decreasing their PTH levels. I found it online for about $20 for a 16-oz canister. If you know of a cheaper source, e-mail me.

With my body having a difficult time still recovering from last year's bowel obstruction, my doctor has recommended keeping close tabs on my labs this year. We'll retest iron, B-12 and PTH in two months to see if my modifications have improved matters at all.

Pumping Iron

I'm just wrapping up week three of my Repliva regimen. A word of warning to anyone interested in the prescription iron supplement: The pills are HUGE! The Web site, I think, makes the pills appear to be the size of birth control pills when in reality, they are the size of prenatal vitamins.

I wish I could say I feel differently now than before I started Repliva, but I don't. It still takes me 30 to 45 minutes to get out of bed in the morning. I still feel as if I'm walking underwater as I go about my day. Every little thing feels like it requires great effort. To say I'm dragging is a bit of an understatement.

Regardless, I'm still confident the Repliva will work in time, and I have yet to miss a dose.

Annual Lab Results: The Human Pin Cushion Speaks

It's that time of year again. You post-ops all know what time I'm referring to. The time when we head to the doctor a leave with a handy-dandy lab request form in hand that has more boxes marked on it than unmarked, leaving us to wonder whether it would have just been easier for the doctor to write a note saying, "Check for everything but ... "

My lab results weren't that great last year. Both my blood sugar and iron levels were low. But with my employer changing insurance providers and then me taking a new job that offered other types of insurance plans, I had a hard time keeping track of things.

I met my PCP last week and instantly liked him. Merced may have a shortage of physicians, but so far, I think the ones we do have are top notch. He ordered a full course of lab tests for me and referred me to a nutritionist to discuss my hypoglycemia.

At the lab, I struggled not fall asleep as the technician drew eight vials of blood. I made a bee-line from the lab to a food source when it was all said and done.

My results came in early this week. I wish I could say I was surprised by them, but they only served to confirm what I already knew: I'm a bit out of whack.

First the good news: My cholesterol is 167. My risk level for cholesterol-related heart disease is 0.67. Average risk is 2.34-4.13. My doc is very happy. The nutritionist says I can eat all the cheese I want. Must be why I like her so much ;-)

Now for the not-so-good news: I have mytocytic anemia, most commonly referred to as iron-deficiency anemia. Most common, most easy to treat. The main concern is that I've been supplementing daily yet my iron levels are half of what they were a year ago, and my organs are not getting the oxygen they need. This is why I'm so tired and why I can't sustain physical activity for very long.

Here are my results for perspective:
Ferritin -- 1 (normal is 10-154)
Total Iron -- 22 (normal is 40-175)
Hemoglobin --- 10 (normal is 12-15)

Thought my ferritin level is in the toilet, the nutritionist I saw today said she doesn't recommend infusion therapy unless total iron is 10 or less, or hemoglobin is 7 or less. It's her opinion (she's also a family practitioner) that I can afford to try a higher dose of oral therapy for six weeks to see if that improves my levels. If it doesn't, then she'll combine oral therapy with weekly injections. Transfusion will be her last course of action. We will continue to monitor my iron levels every six weeks until I get in the normal range.

I've been taking 20mg of chewable iron daily. She's prescribing a new type of iron supplement that's supposed to be really good for women in general, but has also shown great results in bariatric patients. It's called Repliva. It's set up like birth control pills, where you take one active pill a day for 21 days and then an inactive pill for 7 days. Apparently, the body absorbs iron better when it gets a little break in between supplement cycles. Repliva is said to be more bioavailable than other forms of iron, because it contains B12, Vitamin C and Succinic Acid, which all act as binders to improve absorption. So, in theory, my body will absorb all 150mg of my daily dose. It's available by prescription only, and there is a chance that my insurance company won't cover it. But if it's not covered, I will figure something out. I can't afford not to supplement my iron intake. I'm not the type of person to cut corners when it comes to my health.

I really like my nutritionist. She gave me a glucometer so I can test my blood sugar levels daily and also gave me a plan of action on how to better control my hypoglycemia. I feel like she really took her time explaining reactive hypoglycemia to me and giving me additional tools to manage it. For instance, she told me that reactive hypoglycemia is much more common in the morning, which explains why I have such issues after breakfast that can lead to me ping-ponging all day to achieve balance. The solution may be as easy as eating only protein for breakfast. Following the same logic, that would mean that if I do want to indulge in a carbohydrate, dinner is the best time to do so.

Aside from logging my meals and testing regularly to find patterns, my immediate goal is to figure out how much carbohydrate my body can handle at one time and then ensuring I get a steady dose of that level throughout the day. This should alleviate my problems with fluid retention and bloating. I'm starting with 100 grams of carbs a day, split equally (20g) through my five meals. She prepared me for the need to juggle as my glucose monitoring reveals a pattern. For example, she said I might find that I have to limit my morning meals to only 10 grams of carbs but can boost my afternoon and evening meals to 30 grams.

Long story short, she did a lot to make me feel that all is not lost. That my hypoglycemia can be managed. And though it will take patience and discipline, I feel like she's willing to partner with me in figuring out my specific needs.

Vitamin Shoppe

I was shopping in Modesto on Saturday when I discovered a Vitamin Shoppe store on Pelandale in the same shopping center as Cost Plus World Market. I had heard from other bariatric patients that Vitamin Shoppe had a great selection of bariatric-friendly products and knowledgeable staff.

I had a little time to kill so I ducked in. It proved to be everything I heard of and more. When I walked into the spacious store, the selection of supplements was almost overwhelming. I was glancing over the events calendar, which features product tastings and events hosted with local gyms when the manager greeted me. I told her I was a gastric-bypass patient and that I was just looking to compare the store's prices with my favorite supplier. She handed me a flier the store has for bariatric patients that lists all the WLS-friendly products they have and a $5 off coupon.

Not only did the store have many of my favorites -- such as Micellar Milk, Zero-Carb Isopure and PowerCrunch bars -- but it also carried some of the products I've been wanting to try but haven't got around to ordering -- such as Oh Yeah! protein wafers and PowerCrunch's new cinnamon bun flavored bars. And to top it off, the store's products were priced about a $1 less than my favorite online supplier, and there's no shipping to worry about if you have a store nearby.

They didn't have all of my favorites, though. The manager said AchievOne RTDs aren't even offered as an option from her supplier. Revival soy chips and Snack & Slim pudding were also MIA. However, the store sells a sugar-free instant protein pudding that the manager mixed up for me to try. I was impressed; it was chocolately and tasty.

While looking over the various supplements, I found out one of the clerks had gastric bypass three years ago. She told me this was her first job since having surgery. She looked great, and she told me she feels great, too. We discussed our experiences with surgery while I looked over digestive supplements. The store carries a wide variety of vegan and vegetarian probiotics and digestive enzymes.

Probiotics can come in handy for people who've taken lots of antibiotics, because they replace the good bacteria in the digestive tract. Digestive enzymes work to break down undigested food in the intestinal tract. This is an important aid for WLS patients. Our new anatomical design means our food doesn't benefit from the chemical and mechanical digestion that typically takes place in the stomach. That's why we have to chew our food to baby-food consistency and stick with foods that chew down easily. Food that isn't chewed well enough can get stuck or irritate the intestines. Depending on the brand selected, digestive enzymes break down protein, fat, fiber and dairy and other foods.

Before I realized it, I had spent two hours at the Vitamin Shoppe and was late for my shopping date. I left in a rush, but I promise to be back.

Product Review: Tropical Oasis Liquid B-Complex

Tropical Oasis Liquid B-Complex Supplement-$23 for about 32 ounces

I was excited to try this vitamin b-complex supplement. I use Tropical Oasis' liquid calcium supplement, and I love it. It's tasty and provides a large amount of calcium in a small dose.
I wish I had similar praise for the B-Complex supplement. Unfortunately, the liquid vitamin B supplement is icky. It contains all B vitamins, so I hold each dose under my tongue for a minute to allow my body to absorb the B-12 before swallowing it. That may be why I think it tastes so terrible. Most liquid vitamins are only in your mouth for a moment, but when you're letting a dose sit in your mouth for a minute, the nasty flavors are more noticeable.

In talking with some fellow post-ops, I've discovered that all liquid B-complex supplements are gross. The consensus among my friends is that one of the B vitamins (everyone's assumption was that it's B1, or thiamine.) has a disgusting flavor that cannot be masked.

Most gastric-bypass patients don't need a B-complex supplement. Those who are diligent will get all needed vitamins and minerals by taking a specialized multivitamin, about 2,000 mg of calcium, iron and a weekly B-12 supplement (monthly if injected). However, there are increasing numbers of post-ops who have become deficient in thiamine. And supplements such as this one are an unfortunate necessity for those people.

The smartest thing any post-op can do is take all required vitamins daily to avoid ever getting deficient so yucky supplemetns are a requirement.

Hit or Miss? Miss this one, unless you truly are deficient in one of the B vitamins.

Importance of Vitamins and Minerals after Gastric Bypass Surgery

Led by Dr. Monica Ganz
People who’ve had malabsorptive procedures (Roux En Y and duodenal switch) are in danger of vitamin and mineral deficiencies because certain vitamins and minerals cannot be absorbed by the new digestive tract through ingestion.

Vitamins are essential for the release of energy from carbohydrates, fats and proteins. B-12, for example, is a vitamin that can’t be replenished once a person has become truly deficient in it.

Minerals don’t furnish energy but are vital in many other physiologic functions. The body stores and reuses minerals so deficiencies aren’t easily detected.

Many post-ops become deficient in iron and calcium.

Iron
Iron deficiency occurs because the pouch empties too quickly for iron to be absorbed and because RNY and DDS patients have their duodenum – where 50% of iron absorption takes place – bypassed. Symptoms of iron deficiency include fatigue, feeling cold, pica (compulsive eating of non-food items), tongue fissuring and pagophagia (compulsive eating of ice).

Supplements should be in the form of 18mg of ferrous fumerate or amino-iron, which is most absorbable. Taking iron with vitamin C (such as diluted orange juice or even a chewable vitamin C) to help its absorption. Food sources of iron include liver, oysters, shellfish, organ meats, lean meats, poultry and fish (best meat sources), dried beans and vegetables (best plant sources), egg yolk, dried fruits, dark molasses, whole grains and enriched breads and cereals.

Calcium
Calcium deficiency occurs because post-ops can’t eat enough of calcium-rich foods, and the mineral is absorbed in the duodenum. Symptoms of calcium deficiency include fragile bones and hypertension.Supplements should include 1200mg of calcium citrate (plus vitamin D) per day, four servings of dairy products per day. For each missed serving of dairy products, supplement with an additional 500mg of calcium citrate. This is why many post-ops are encouraged to take up to 2400mg per day.Another problem is that calcium deficiency is hard to detect because the body will leach the necessary calcium from the bones. Dexa bone-density tests are the best way to find out whether a post-op’s body is leaching calcium from the bones. Some people also notice teeth problems, such as a loss of enamel.

Vitamins most commonly found deficient in post-ops are vitamin B1 (Thiamin), vitamin B-12 and folic acid.

Thiamin
Thiamin is necessary for the breakdown of glucose for energy, nerve function, good digestion, normal appetite and good mental outlook. Deficiency is rare in the U.S., except in alcoholics. Symptoms include beri beri, fatigue, poor appetite, constipation, depression, etc. Supplementation is as easy as taking a chewable multivitamin (Bariatric Advantage, Optisource, etc.).

Vitamin B-12
Vitamin B-12 aids in the formation of mature red blood cells, synthesis of DNA, stimulates appetite, promotes growth and releases energy. Food sources include liver, kidney, dairy products, fish, clams, oysters, salmon and sardines.Gastric bypass post-ops MUST supplement with B-12 because the pouch doesn’t supply the intrinsic factor required for absorption. Signs of deficiency include pernicious anemia, tiredness and neurological disorders.Supplements can be by mouth, injection or nasal spray. Monthly injections are the safest best.

Folic acid
Folic acid is necessary for formation of red blood cells. Deficiency happens because of poor dietary intake, low iron and alcoholism. Symptoms of deficiency include rapid heartbeat, fatigue, anorexia, pale skin, paranoia, or sore, inflamed tongue. Food sources include soy, leafy greens, organ meats, mushrooms, oatmeal, red beans and wheat. Supplementation is usually as easy as taking a good multivitamin.