How to Know When You Are Nutrient Deficient

How to Know When You Are Nutrient Deficient by Katie Jay   Traveling around the country meeting weight loss surgery (WLS) patients has been one of the best parts of my job.   I enjoy a lot of email correspondence, but there is nothing like looking into the eyes of another survivor -- another person who has taken the plunge into the radically new way of life offered to us with WLS.   Most of the time, it is a purely silly exchange of stories about slips falling off in public and shopping misfires, like trying on clothes that look too small only to find they hang like drapes on a now-small frame.   Every time I meet with a group of WLS patients, however, I encounter at least one person who looks almost desperate. I hear the signs of deficiencies, like:   "I feel obsessed with chewing. I can't stop eating ice."   "When does the energy come back? I am two years out and I still feel horrible."   "I feel so foggy and my memory is shot. My boss is getting fed up with me."   The anxious faces are heartbreaking, because I know that the most likely reason for these problems is nutritional deficiency.    Correct Knowledge Is Power    While most surgeons educate their patients about the nutritional aspect of their surgery, the information can be misunderstood, lacking, or outdated. And for laypeople there is often no way for them to assess the quality of the information they are receiving.   The potential for misunderstanding or misinformation is why it is critical for all WLS patients to take responsibility for and completely understand their nutritional, vitamin, and supplement needs.    It's All About the Lab Work    Ideally, a WLS patient will get every possible, relevant type of lab work done before surgery. Doing this allows you to have a baseline, partly so that you can correct any deficiencies before you even have surgery.    After WLS the Lab Work Becomes Essential    Don't assume that just because your lab numbers are in the normal range that you are okay. Be aware that for most people, shortages will not show up immediately.   A downward trend in a lab value can be in the normal range so that you don't even realize you're slipping.    You Have to Compare Results   Many times I have heard people say to me, "I don't need all that stuff [meaning supplements]. I feel good and my labs are fine."   Your iron can drop 30 points and still be in the normal range. Your B12 can drop 100s of points and still be in the normal range.   The trend in your lab work is where you need to focus.   Many people use an excel spreadsheet to track their lab work. It's simple to do, and will allow you to identify a negative trend before you become dangerously depleted and get permanent damage.    Some Common Deficiencies   Protein, iron, calcium, zinc, B1 (Thiamin), B12 and the vitamins A, D, and E, commonly show a downward trend in lab work.   People are starting to report other deficiencies as well, so staying current on research about weight loss surgery is critical.   It's far better to assume you have deficiencies and look for them before they become critical.    Deficiencies Will Vary According to Surgery Type    Those who have had the lapband procedure are less likely to have A and D deficiencies, for example, but should still be tested.   For those who have Roux-en-Y gastric bypass and bileo-pancreatic diversions with or without the duodenal switch, nutritional deficiencies can vary depending on how short the Y-shaped part of their intestine is.   If it's really short, there's a lot less absorption and you need more supplementation of almost all vitamins.   The bottom line is nutritional needs vary from surgery type to surgery type and from person to person. Never just assume you're okay, no matter what type of surgery you have had.    Vitamins and Supplements Require a Strategy    Go over your schedule of nutrients with your surgeon or dietitian to make sure you are optimizing what you take.   For example, when you take iron with calcium, vitamins, minerals, medicines, dairy, caffeine, eggs, or whole grains, you can lower your iron absorption.   Sometimes, the type of supplement will influence your absorption. Calcium is best taken in citrate form, otherwise you increase the risk of kidney stones and other problems.   Sometimes how you take a supplement makes a difference. For example, B12 has to be sublingual (under the tongue), or by injection. And don't assume you don't need B12 if your procedure is merely restrictive.    Check with Your Surgeon or WLS Nutritionist, But Don't Blindly Surrender to Them    As always, please check with your surgeon or nutritionist before adding to or changing your vitamin and supplement regimen. And be sure to get your labs done, learn how to read them, and advocate for yourself.   Finally, general practitioners do the follow up care for many WLS patients, and that's okay, but they do not have training in this specialized area and often do not stay up on the latest literature. You must be educated and in turn educate your general practitioner, if necessary.    Always Advocate for Yourself    Never let a strong-willed doctor or surgeon, WLS specialist or not, pronounce that you are okay when you either feel poorly, or see a downward trend in your labs.    Note: NAWLS has a dietitian available to answer members' questions. Sally Myers, RD, CPT, has worked with WLS patients for more than a decade and is co-author of the book, "Caring for the Surgical Weight Loss Patient," which can be purchased from Amazon.  From Small Bites, the email newsletter for the National Association for Weight Loss Surgery. Subscribe today and get your F'REE report, The 10 Most Common Mistakes Weight Loss Surgery Patients Make at www.10WLSmistakes.com. (c) 2007  National Association for Weight Loss Surgery, Inc. All rights reserved.

I know my surgeon & nutritionist do a lot with keeping up with the trends & new info on deficienses.  I was really great about following research in the beginning but not so much lately.  Definitely a little kick here to update my knowledge & make sure my info, labs & surgeon are up to date also.  Thanks Jill!!!

Thanks Jill for posting this was real good information for us all. :)

This IS good stuff... Thanks Jill!

Hey....no prob. How ya feeling????

What labs are you getting checked and how often?  I am about 10 mo out and will get labs at 1 yr...my last labs were at 6 mo.