Question

A 48 year old woman presented to your office for some nutritional support post-gastric bypass surgery. She saw her primary care doctor who ordered some labs which revealed the following: HA1c (5.3), Iron Total (16), % Saturation (4.3), Vitamin D 25-OH (27.6), Folate (15.8), Vitamin B12 (>1000). She currently gets vitamin B12 injections and has been taking a 50,000 IU vitamin D prescription once a week for the past two months. She is 9 months post-surgery. She is 5' 8", 181 lbs and is a non-smoker and does not drink alcohol. In addition, since her surgery she currently sees a personal trainer 2 days a week for 1 hour of personal training consisting of weight training and boot camp classes.

Make dietary and/or nutritional supplement recommendations (include dosing and length of initial support) for this client based upon the information above. Also, are there any additional labs or tests you would like to have performed?

Answer 1

Gastric bypass surgery refers to a surgical procedurein which the stomach is divided in to a small upper pouch and a much larger lower pouch and the small intestine is rearranged to connect to both. It is a lifesaving procedure. Nutritional deficiencies can occur after bariatric surgery. Vitamins and minerals are commonly deficient in the condition that includes vitamin b12, calcium, vitamin D, thiamine, folic acid, iron,zinc andmagnesium. The recommended diet for patients with post-gastric bypass surgery is high protein, low fat and low sugar. NUTRITIONAL SUPPLEMENT RECOMMENDATIONS: A) Mutivitamin (chewable with atleast 400IU of vitamin D to help with calcium absorption. This multivitamin also contains vitamin A,C, E and D, magnesium, potassium and other essential nutrients) B) Calcium citrate ( chewable or liquid form of calcium citrate 1,200 to 1,500mg daily and it should be taken separately from iron-containing supplements. C) B-Complex ( liquid or chewable with at least 100 mg of thiamine is recommended. It is essential for the conversion of carbohydrates in to energy). D) Vitamin B12 ( 1000mcg daily if the sublingual form. B12 metabolizes carbohydrate, protein and fat metabolism) E) Iron ( chewable is recommended after surgery. It helps in absorption) DIETARY GUIDELINES : a) choose lean meats. b) canned tuna and salmon can be used c) avoid spicy foods d) avoid whole milk e) eat nutrient dense foods . For instance, fruits, vegetables, meats and eggs f) shop healthy foods. Stay away from packaged foods and processed foods. ADDITIONAL LAB TESTS: Along with the above mentioned lab tests, these tests should be repeated once every 12months for monitoring purposes. A) Complete blood count B) Urea and electrolytes C) Ferritin D) Folate E) Calcium tests F) Parathyroid Hormone ( only if calcium levels are abnormal) G) Zinc and Copper