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	2/16/11	5/16/11	8/16/11
IRON	60	77	107
HEMOGLOBIN	13	13.6	14.1
HEMATOCRIT	39.5	40	41.6
FERRITIN	13	14	14
B12	320	501	1164
D HYDROXY	26	84	124
FOLATE	6.0	7.5	12.0
TOTAL PROTEIN	5.0	5.9	6.6
MAGNESIUM	1.6	1.8	1.8

7AM  ~CALCIUM AND PROTEIN
(1) Homemade Protein Shake- 71 mg protein
              (1) Package Sugar Free Carnation Instant Breakfast- 5 mg protein
           (1tsp) Now Foods Magnesium Citrate Powder - 600 mg
           (2scoops) Unflavored Whey Protein - 56g Protein
           (8oz) Over the moon higher protein milk- 10mg protein

(1) Bio Tech D3/50 - 50,000iu D3
(1) Calcet Creamy Bite (Lemon) - 500mg calcium citrate/400iu D3
(1) TwinLabs Methyl B12 sublingual – 5,000mcg B12


11 AM  ~IRON
(4) Vita-lady Tender Iron - 100mg elemental carbonyl iron
(1) Vitron C - 66mg elemental ferrous fumerate iron/250mg C 
(1) Spring Valley Chewable Tangy Orange Vitamin C - 500mg
(1) Opti Woman Multi Vitamin


3 PM   ~CALCIUM AND PROTEIN
(2) Bariatric Advantage Calcium/D Chews - 500mg calcium citrate/250iu D3
(1) IFlora Probiotic
(1) MegaRed Omega-3 Krill Oil
(1) ZONE chocolate almond raisin protein bar – 15g protein  


7 PM   ~IRON
(4) Vita-lady Tender Iron - 100mg elemental carbonyl iron
(1) Vitron C - 66mg elemental ferrous fumerate iron/250mg C 
(1) Spring Valley Chewable Tangy Orange Vitamin C - 500mg
(1) Opti Woman Multi Vitamin


10:00 PM ~CALCIUM & MEDS
(1) Calcet Creamy Bite (Lemon) - 500mg calcium citrate/400iu D3
(1) Peri-Colace - Stool softener & Laxative
(1) Atenolol - 50mg (for high blood pressure)
(2) Effexor - 150mg (for depression and anxiety)

blueberry reviva liquid....citrate with d and magnesium
http://www.amazon.com/Absorption-Calcium-Blueberry-Supplemen t-Magnesium/dp/B0046ZC15C

liquid calcium at wal mart...its from welleese....citrate with d
http://www.walmart.com/ip/Calcium-Vitamin-D3-Natural-Citrus- Flavor-Liquid-Dietary-Supplement/14654135


i LOVE LOVE calcet lemon creamy bites....citrate with d
http://www.bjsbariatrics.com/mm5/merchant.mvc?Screen=PROD&St ore_Code=bjb&Product_Code=celCalcCrmyLemon&Category_Code=new


Bariatric advantage Calcium citrate chews....citrate with d
(i chew a berry and a chocolate together, yum!!)

Of course I have to start with:

“The information below is strictly what I have learned and want to share, and it should not be used as medical advice. Always consult with your doctor first before changing your bypass/vitamin/medical routine ”

I am almost 8 years post op, and just learning what I should have known from the beginning. My labs are low and horrible, and my health is suffering. Take it from me....learn as much as you can as SOON as you can for optimum health.

OK….now that’s over with! Let’s get to the good stuff:

Here are a few basic things that are CRITICAL TO KNOW that I didn’t learn till I was 7 YEARS post op!!!  Yikes.

There are a few vitamins and minerals that all gastric bypass patients have to REALLY monitor: (Of course there are more, but the below are the “biggies” and the ones I am personally dealing with and learning about now.)

CALCIUM
VITAMIN D
IRON
B12
PROTEIN

We need Calcium Supplements. Not all calcium is the same.  We cannot absorb calcium carbonate…so check your labels, and throw away those Tums! We must take in at least 1500 mg of calcium citrate a day…and it should be taken with vitamin D3 to be properly absorbed. Also our body can’t absorb more than 500mg of calcium citrate at once, so take it spread out over 3 times a day.

We need iron Supplements. The amount you need will depend on your labs, usually 100mg of ELEMENTAL iron a day will keep your iron and ferritin (iron stores) up.  Read the label carefully and see how much ELEMENTAL iron your supplement has…not just “iron”….”elemental iron”.  Your iron must be taken with vitamin C….as we have no acid in our pouches, and iron needs acid to be absorbed. Vitamin c provides this acid.

We can NOT take iron and calcium within 3 hours of each other, as calcium blocks the absorption of iron. You must be careful if your daily vitamin has calcium, or your protein shake has calcium. Your iron and C intake is better off taken alone~ away from anything else~ all by itself.

We should have around 100mg of protein a day and whey protein isolate is the best absorbed. Wal mart has a cheap 14.00 tub of WHEY protein powder that tastes pretty good and will work just fine. 1 shake, 2 scoops has 50 grams of protein. The body can only absorb around 50mg protein at a time, so you need to spread it out over 2x during the day.  We don’t need expensive powder with all kinds of added stuff in it. Our protein  shake should be used for protein purposes ONLY….don’t count the vitamins or calcium or other things in the shake towards your daily total...just consider them a bonus.

Gastric bypass patients have issues absorbing B12. We can NOT absorb it from our tummies AT ALL, as we have no intrinisic factor...which B12 needs to be absorbed.  B12 MUST be taken by a sublingual (under the tongue), the patch, nasal spray, or the shot.  All that B12 that you are swallowing in your daily vitamin or protein shake or the liver you eat? Useless!  I gagged down liver 3 times a week for 4 years thinking I was helping my low b12 and iron levels, and come to find out, it was all for nothing. Well, I got the protein, but NO b12 or iron!!

Listed RDA amounts for vitamins are a JOKE in the United States. They are way too low...again my personal opinion. Especially for us bypass people. If some amounts I recommend seem too high, it’s because we NEED it that high. If you have any questions, please ask your doctor…but to be honest, MY doctor knows less about vitamins than the people on this board!! Also remember, it is very hard to get TO MANY VITAMINS or “overdose”…...you are more likely at risk of NOT GETTING ENOUGH.

Also, lab results that show a range for NORMAL are usually too low for gastric bypass patients, and the levels set for NORMAL are a joke to begin with.   For example: They say that 200-500 range for b12 is “normal range”. No way, not for us. Our b12 should be up over  900 for optimum health. You will learn all this as time goes by. Just take your correct daily vitamins at the correct times~faithfully every day. Then get your labs done every 3 months, yes, 3 months, don’t let it go to long when you are a new patient… something critical could be missing.  Get your labs….then tweak your vitamins as needed.   My b12 came back 300…and that is critically low for a gastric patient, and my general doctor wouldn’t give me shots because she said I was in the normal range! Uhhh, right.

We do not absorb some micronutrients and vitamins from food. Yes, once again, we do NOT absorb some vitamins from food. They took out the part of the intestine that breaks down certain micronutrients and vitamins from food. (This is SO important to know) Example: If you eat yogurt, you get the protein, but get no calcium. If you drink milk, you get the protein but DON’T get the calcium. If you eat steak, you get the protein, but you DON’T get the iron and b12. You will not get some of the vitamins you critically need FROM SOME FOOD.  

Why? That part of the intestine that breaks them down was "BYPASSED" during our surgery.

SO…. How do we get these vitamins? We must count our daily vitamins and protein from pills and shakes, as the vitamins in these items are already broken down and the body can absorb them.  I don’t count any vitamins or protein from FOOD in my daily totals.  I just consider what I get from food as a “bonus”.

Please check out this link below….it is a diagram that is very important to know. Between the red lines is what part of the intestine we had removed, and the vitamins we cannot break down and absorb from FOOD.

http://pamtremble.blogspot.com/2008/05/where-are-nutrients-absorbed.html

Also, We have trouble absorbing "fat soluble vitamins" (A, D, E, K) due to not having a denodium even in pill/supplement
form. It would be in our better interest to take “water solubilized” versions of these vitamins. This means that in the laboratory they were created to be absorbed better through the intestinal wall.

You don’t have to break the bank buying your vitamins and protein powder. You can get most stuff you need at Wal-Mart or rite aid or cvs… Then as you get more experienced you can start tweaking things around and combining things and checking out other vitamin options on the internet.

Most  doctors (well at least MINE!) don’t go into detail of WHY  for the rest of your life you must take vitamins and protein on a schedule all day long, or HOW to take them or WHEN to take them…..and it is so very very important to our health.

They sent me away from surgery and said “Take 2 Flintstones chewables a day, get iron and calcium…bye”. 

Wow, I knew nothing, they told me nothing, and I blindly trusted them.   Gastric bypass was new back then…and no one I knew had had one. There was hardly ANY info on the internet, and general doctors were basically clueless in bypass nutrition. Now my labs are horrible, and its 7 years later. I am learning what I should have known 7 years ago. I commend you for investigating. If i could go back in time, i would have done A LOT of things differently.

GINNY

[email protected]

I have been taking my blood pressure daily at the same time for the last 7 days.
NORMAL RANGE!!!!!!!....im so excited!!!!!
for the past 5 years i have been in "pre hypertension" range even on meds.
I have had every test known to man to find out why...but no one ever tested my blood/vitamins.
can vitamins actually make that much of a difference?
was it my low D? Ferritin? Iron? B12? Protein?....
maybe i can talk to my doc about eventually coming off my high blood pressure meds.
im over the moon happy.

ISOPURE SMOOTHIES 32 GRAMS OF PROTEIN
http://www.gnc.com/product/index.jsp?productId=4014930

7AM
(1) Homemade Protein/Calcium Shake: 71g Protein/500mg Calcium/500iu D3
      (1) Boost Glucose Protein Shake – 15g protein
      (1tsp) Now Foods Magnesium Citrate Powder - 600 mg
      (1tbs) Wellesse Calcium/D Liquid – 500mg calcium citrate/500ui D3
      (2scoop) Unflavored Whey Protein - 56g Protein
      (8oz) Water

(1) Opti Woman Multi Vitamin
(1) IFlora Probiotic
(1) TwinLabs Methyl B12 sublingual – 5,000mcg

11 AM
(6) Vita-lady Tender Iron - 150mg elemental iron
(2) Spring Valley Chewable Tangy Orange Vitamin C - 1000mg  

3 PM
(2) Bariatric Advantage Calcium/D Chews - 500mg calcium citrate/250iu D3
(1) Bio Tech D3/50 - 50,000iu D3 (till i get crummy labs up)

7 PM
(2) Vitron C - 122mg elemental iron/250mg C
(1) Genesis Acai with C Chew - 250mg C
(1) Opti Woman Multi Vitamin

11:00 PM
(1) Calcet Creamy Bite (Lemon) - 500mg calcium citrate/400iu D3
(1) Peri-Colace - Stool softener & Laxative


 

My first post...I am so glad I found this site

8 years ago on 7/3/03 I had an open gastric bypass (I couldn’t have laparoscopic due to internal issues…I have a scar from chest to belly button to prove it, yuck) and lost 200 pounds~ and have kept it off. But not without a lot of physical problems, mistakes, and learning along the way!  Would I do it again? Well, to be honest, if I could go back~ I think I would have gotten the adjustable band instead....yup.

Back then all this bypass stuff was sort of new. I knew no one who had one, and there wasnt much info on the internet, no groups in my area...nothing. I felt sort of alone and in the dark.  It is so different now.  post op i was in bed for a month. i ate cream of wheat and sugar free jello for over 4 weeks, and didnt eat real food for almost 4 months!...things seem to be so much faster and different now. Eating meat within a month? wow!!....it took me 6 months for my doctor to approve meat!!

My bypass procedure was called a “Silastic Ring Roux-en-Y Gastric Bypass”.

My ring/band has developed ulcers and scar tissue all around it and my stoma is basically scared almost closed. In medical terms it’s called Stomal Stenosis. I have EXTREME trouble getting food and large pills down. (larger than a tylenol is a "no go").  I developed stoma stenosis "ulcers" by taking NSAID'S for almost a year post op..ibuprofen for my back aches and head aches. No one told me not to...sigh.

CURRENT LABS:

Iron: 77  
B12: 320  
Ferritin: 14  
Vitamin D 25 hydroxy: 26  
Total serum protein: 5.9  
Glucose: 96  
Magnesium: 1.8 

Yucky, huh? Well, I never knew they were....as I never got them and read them before.  I figured if i had an issue, the doctors would contact me...right? NOPE.... no doctor has ever called me and said there was a problem. I trusted them. I put my health in their hands. Maybe i shouldnt have...maybe i should have gotten those labs and questioned them before. I didnt know.  humpfffffff.

After my surgery I was told "Go home, chew a  flinstones with iron twice a day and make sure to get B12 and Calcium".

OK. So I did.   I was never told WHY..or HOW....or WHEN.....and I didnt question it. No one I knew back then had a gastric bypass.....I was a pioneer baby!!  There was no info out there, and it was so new,  I am an old timer.  I just trusted the docs and went on my merry ignorant little way.  I chewed calcium carbonate (OOPS), swallowed b12 (OOPS), and ate plenty of liver to make sure i was getting my iron (OOPS). All for nothing. I didnt know we cant absorb calcium carbonate, i didnt know we dont absorb b12 by swallowing it, i didnt know we dont absorb most vitamins from food...wow.

I have had a few endoscopies done since I have gotten things stuck in my stoma, but other than that, I have not seen the doc except for my yearly blood tests.

WOW....For the past 7 years I have been SOOOO in the dark and mis-informed. And, I have been so DARN worried about my "STOMA STENOSIS & NAUGHTY POUCH & ULCERS" and how I cant "eat enough food to get good vitamins and minerals" that I didnt even THINK about the part of the intestine that the surgeon took out (the duodenom) and what that means to my body. Even if I could eat the food, my bypassed intestine wont absorb most major vitamins and minerals from food anyways!!  OMG...... I had no clue.

Also...did my surgeon take out MORE than the Duodenom (first part of the intestine)? Did he take out part of my Jejunum (second part of the intestine) like some bypass doctors do? I need to find out, as the more intestine they took out, the less vitamins and minerals will be absorbed. 

Click HERE to see a diagram of our intestinal tract….and the vitamins and minerals us bypass patients DO NOT ABSORB from food. It almost blew me away.

For the past year or so I took 1 vitron c  3-4 times a week, plus what was in my daily multi. Oops. Not enough iron.

I also didn’t know that taking your calcium with your iron is a no no….and was taking my iron pill with my calcium rich protein shake. Oops.

Oh, did I say Calcium rich? Well not for me it wasnt. I didnt know we need at LEAST 1500mg of Calcium a day....and cant absorb Calcium Carbonate. Oops.

I had no clue that I needed more vitamin D than the little amount that was in my Calcium CARBONATE rich shake. Ooops. And I thought I was being EXTRA good popping a TUMS now and again!

Also, I thought the B12 in my daily multi was enough. I didn’t know we absorb NONE by swallowing it. Oops.

Thank the lord I happened upon this board while surfing around the internet. I started looking around...and LEARNING! It has taught me more than any person OR doctor EVER has…thank you.

So, in light of all this new, wonderful information I have received....please scroll UP see my new vitamin routine/daily routine blog called "MY ROUTINE"  :-)

I would love to hear from you

[email protected]