new ASMBS guidelines

the ASMBS has published some new guidelines!  Check them out here http://www.meltingmama.net/files/asmbstos2013guidelines.pdf and ask your surgeon and dietician if they've read them (if they haven't offer to send them the link, or print them out and give them a copy).

I've just skimmed through them rather quickly, but noticed a few important things:

• they now recommend bone density scans - one pre op for a baseline and one at two years post op
• they now advise against any use of NSAIDS due to the risk of ulcers
• they report zinc deficiency is quite common in WLS patients and recommend checking your zinc level when you get labs done
• they mention that very high doses of D3 are sometimes required, sometimes as much as 50,000 IU daily (which we all knew already, right?  but it's nice that they included it, in case our docs don't know it yet)
• they advise checking selenium levels in patients with "unexplained" fatigue or diarrhea

Thanks Kelly.  I'm definately taking this with me to the doctor.

I recently watched a video on the connection between high iron and zinc levels and Alzheimer's.  As I am 60, I think I am not going to add iron supplements other than what is in my multivitamin and not adding extra zinc.

Thank you for the update!

As long as you get your iron and zinc levels checked regularly, you'll know if you need to add more or not.  I wouldn't take either if my labs didn't show I needed them.  However, most RNY people do need extra iron, since we no longer absorb iron from our diet well.

Well thank goodness about the vitamin D thing. I'm going to send this to my surgeon. I take 50k IU a day outside his advice because that's the only way it won't tank (and when it tanks I get PAINFUL muscle spasms).

What causes us to "tank"         is it when we do not take enough of the vitamin?

I had horrible muscle spasms also when mine tanked.  

I think my "absorber" is different - I was taking 20,000 D3 a day and my last D reading was 180!!!  I have cut back to 10,000 and will see how that goes.  My B12 was 1800 so I have cut that back too.  I think I have started absorbing everything now!!!

I don't really think you are any different than most of us.  You didnt say what your B12 dose is, but my B12 was also high on two 5000mcg doses a week, so I dropped back to one dose, and the level is fine.  Several people here have mentioned getting injections of 1000 MONTHLY).

You are also taking a REALLY high dose of D3.  20,000 per day is 140,000 a week.  Compare that to the 400 unit daily dose (28,000 per week) that is the recommended daily amount! (I think it is just a matter of perspective... If you weren't taking a dose WAY above the 400 per day, I am sure you would be deficient.)  I was taking 50,000 units twice a week and was at about 70, so I increased it to three times a week (150,000 per week... about what you were taking) and mine was too high at 138, so I dropped back to two doses (PCP wanted me to drop to one but I was not willing to do that because it was so hard to get my D up from the 9 (yes, 9) that it was at my first labs,a me I know 50,000 a  week is too little).

Lora

Thanks for posting this, Kelly.

I am glad to see that they are added the guidelines on the bone scan.  It was something my surgeon did not mention, and one of the things I learned about here on OH. (I also first learned about the issue with serum calcium not really representing adequate calcium intake here, so the bone scans certainly seem necessary to me!)  I didn't have a baseline one, but had one at 2+ years out that was "normal", so I guess that is close enough.  I plan to repeat it this year (since I will have reached my $3000 out of pocket max (ouch!) for my insurance after this knee replacement surgery).

I get my D checked again next week (after lowering it when my normally calm and reasonable PCP freaked out at my dosage and level of 138), so I will go out and give him the link to this.  He completely understands the need for the D to be up at 80, and he even routinely does Vit D checks on his patients because so many are deficient, but the 50,000 unit doses freaked him out.

i guess I need to ask him to add selenium to my next set of labs.

Lora