Re: diet progression for sleeve gastrectomy

[Guest guest]

a,We are not currently doing banding as our surgeons were not liking the results from the patients who have had the procedure in the last year. We do laparoscopic and open RYGB. Our protocol:2 weeks prior to surgery = Optifast drinks1-2 days after surgery = clear liquidsDay 3 - patients usually go home and they go home on Puree for one week.After the one week on puree, progress to Mechanical soft/soft foods for 2-3 months - - then on to regular as tolerated. Patients pick their own protein supplements after surgery. Vitamin/minerals:Mega Multi for Women by 21st Century Pharmacist (2 per day)Vitamin D - 1000 IUCalcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin DMagnesium Oxide = 300-500 mg per dayFerrous Sulfate = 325 mg per dayWe also encourage an Omega 3 supplementTotal Vitamin D is 1800 IU per day - - we'd really like to see it higher, so will be pushing for that soon. Hope this helps. Bartholomay, LRDManager, Nutrition TherapyMeritCare Health Systems.Bartholomay@...(701) 234-6166Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer>>> <Humnut413@...> 9/29/2008 7:20 PM >>>Hi Everyone, I apologize if this has already been discussed, but I need to do what others are doing for the hospital stay for diet progression. My surgeon says he wants to progress faster the RYGB pts but not as quickly as the banding pts. Also, I have read some postings stating that supplementation should be the same as RYGB pts but wondering what others are doing. Thanks for your assistance with this. I am not able to access the archives for some reason.Sincerely,a Serafino-Cross, MS, RD, LDNBaystate Medical CenterSpringfield, MA Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators.

This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

[Guest guest]

Sorry - - I forgot the B12 supplement. We have them take this either sublingually, oral or by shot.>>> " Bartholomay" <.Bartholomay@...> 9/30/2008 9:26 AM >>>

a,

We are not currently doing banding as our surgeons were not liking the results from the patients who have had the procedure in the last year. We do laparoscopic and open RYGB.

Our protocol:

2 weeks prior to surgery = Optifast drinks

1-2 days after surgery = clear liquids

Day 3 - patients usually go home and they go home on Puree for one week.

After the one week on puree, progress to Mechanical soft/soft foods for 2-3 months - - then on to regular as tolerated.

Patients pick their own protein supplements after surgery.

Vitamin/minerals:

Mega Multi for Women by 21st Century Pharmacist (2 per day)

Vitamin D - 1000 IU

Calcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin D

Magnesium Oxide = 300-500 mg per day

Ferrous Sulfate = 325 mg per day

We also encourage an Omega 3 supplement

Total Vitamin D is 1800 IU per day - - we'd really like to see it higher, so will be pushing for that soon.

Hope this helps.

Bartholomay, LRDManager, Nutrition TherapyMeritCare Health Systems.Bartholomay@...(701) 234-6166Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer>>> <Humnut413@...> 9/29/2008 7:20 PM >>>

Hi Everyone,

I apologize if this has already been discussed, but I need to do what others are doing for the hospital stay for diet progression. My surgeon says he wants to progress faster the RYGB pts but not as quickly as the banding pts. Also, I have read some postings stating that supplementation should be the same as RYGB pts but wondering what others are doing. Thanks for your assistance with this. I am not able to access the archives for some reason.

Sincerely,

a Serafino-Cross, MS, RD, LDN

Baystate Medical Center

Springfield, MA

Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators.

This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

[Guest guest]

,

What level of vit D are you hoping to get to daily ?

Strathdee, RD, LD, LMHC

Genesis Medical Center, Davenport, IA

>>> " Bartholomay " <.Bartholomay@...> 09/30/2008 10:46 AM

>>>

Sorry - - I forgot the B12 supplement. We have them take this either

sublingually, oral or by shot.

>>> " Bartholomay " <.Bartholomay@...> 9/30/2008 9:26 AM >>>

a,

We are not currently doing banding as our surgeons were not liking the results

from the patients who have had the procedure in the last year. We do

laparoscopic and open RYGB.

Our protocol:

2 weeks prior to surgery = Optifast drinks

1-2 days after surgery = clear liquids

Day 3 - patients usually go home and they go home on Puree for one week.

After the one week on puree, progress to Mechanical soft/soft foods for 2-3

months - - then on to regular as tolerated.

Patients pick their own protein supplements after surgery.

Vitamin/minerals:

Mega Multi for Women by 21st Century Pharmacist (2 per day)

Vitamin D - 1000 IU

Calcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin D

Magnesium Oxide = 300-500 mg per day

Ferrous Sulfate = 325 mg per day

We also encourage an Omega 3 supplement

Total Vitamin D is 1800 IU per day - - we'd really like to see it higher, so

will be pushing for that soon.

Hope this helps.

Bartholomay, LRD

Manager, Nutrition Therapy

MeritCare Health Systems

.Bartholomay@...

(701) 234-6166

Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer

>>> <Humnut413@...> 9/29/2008 7:20 PM >>>

Hi Everyone,

I apologize if this has already been discussed, but I need to do what others

are doing for the hospital stay for diet progression. My surgeon says he wants

to progress faster the RYGB pts but not as quickly as the banding pts. Also, I

have read some postings stating that supplementation should be the same as RYGB

pts but wondering what others are doing. Thanks for your assistance with this.

I am not able to access the archives for some reason.

Sincerely,

a Serafino-Cross, MS, RD, LDN

Baystate Medical Center

Springfield, MA

Looking for simple solutions to your real-life financial challenges? Check out

WalletPop for the latest news and information, tips and calculators (

http://pr.atwola.com/promoclk/100000075x1209382257x1200540686/aol?redir=http://w\

ww.walletpop.com/?NCID=emlcntuswall00000001 ).

This e-mail message is intended only for the named recipient(s) above and is

covered by the Electronic Communications Privacy Act 18 U.S.C. Section

2510-2521. This e-mail is confidential and may contain information that is

privileged or exempt from disclosure under applicable law. If you have received

this message in error please immediately notify the sender by return e-mail and

delete this e-mail message from your computer.

This e-mail message is intended only for the named recipient(s) above and is

covered by the Electronic Communications Privacy Act 18 U.S.C. Section

2510-2521. This e-mail is confidential and may contain information that is

privileged or exempt from disclosure under applicable law. If you have received

this message in error please immediately notify the sender by return e-mail and

delete this e-mail message from your computer.

[Guest guest]

I would like 2000 IU at minimum, but seems that recent research points to even more than that. Our current plan provides 1800 IU total. See below:Obes Surg. 2008 Sep 16. Finding the Optimal Dose of Vitamin D Following Roux-en-Y Gastric Bypass: A Prospective, Randomized Pilot Clinical Trial.Goldner WS, Stoner JA, Lyden E, J, K, Larson L, kson J, McBride C.Section of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-3020, USA, wgoldner@....BACKGROUND: Vitamin D deficiency is common following bariatric surgery and is due to a combination of baseline deficiency and postoperative malabsorption. There are few prospective studies evaluating the appropriate dose of vitamin D to prevent and treat vitamin D deficiency following bariatric surgery. METHODS: We evaluated three doses of vitamin D3 (800, 2,000, and 5,000 IU/day) in a prospective, randomized pilot trial of 45 patients undergoing Roux-en-Y gastric bypass. Serum 25 hydroxy Vitamin D (25OHD), intact PTH (iPTH), calcium, and urine calcium/creatinine ratios were measured at 6, 12, and 24 months postoperatively. Due to a high dropout rate at 24 months, we focus on the 12-month data. RESULTS: At 12 months, the 800-, 2,000-, and 5,000-IU groups had a mean +/- SD increase in 25OHD of 27.5 +/- 40.0, 60.2 +/- 37.4, and 66.1 +/- 42.2 nmol/L, respectively (p = 0.09) with a maximum increase in each group of 87.4, 114.8, and 129.8 nmol/L. Forty-four percent, 78%, and 70% achieved 25OHD levels >/=75 nmol/L (p = 0.38). Results for the 6- and 24-month time points were similar to the 12-month results. Mean weight loss at 24 months of the study was not different among groups (p = 0.52). Serum calcium did not change significantly, and there were no cases of hypercalcemia or sustained hypercalciuria. CONCLUSIONS: Higher doses of vitamin D supplementation trend towards higher levels of 25OHD. Vitamin D replacement as high as 5,000 IU /day is safe and necessary in many patients to treat vitamin D deficiency following Roux-en-Y gastric bypass yet is still suboptimal in others. So - - it would be great to measure 25 OHD levels to ascertain the correct dosage for patients, but in reality, that probably won't be done consistently, so providing higher levels to start with for RYGB patients is probably a good thing. Especially in the North — we need more than those who live in the Southern states >>> " Strathdee" <strathdee@...> 9/30/2008 12:27 PM >>>,What level of vit D are you hoping to get to daily ? Strathdee, RD, LD, LMHCGenesis Medical Center, Davenport, IA>>> " Bartholomay" <.Bartholomaymeritcare> 09/30/2008 10:46 AM >>>Sorry - - I forgot the B12 supplement. We have them take this either sublingually, oral or by shot.>>> " Bartholomay" <.Bartholomaymeritcare> 9/30/2008 9:26 AM >>>a,We are not currently doing banding as our surgeons were not liking the results from the patients who have had the procedure in the last year. We do laparoscopic and open RYGB. Our protocol:2 weeks prior to surgery = Optifast drinks1-2 days after surgery = clear liquidsDay 3 - patients usually go home and they go home on Puree for one week.After the one week on puree, progress to Mechanical soft/soft foods for 2-3 months - - then on to regular as tolerated. Patients pick their own protein supplements after surgery.Vitamin/minerals:Mega Multi for Women by 21st Century Pharmacist (2 per day)Vitamin D - 1000 IUCalcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin DMagnesium Oxide = 300-500 mg per dayFerrous Sulfate = 325 mg per dayWe also encourage an Omega 3 supplementTotal Vitamin D is 1800 IU per day - - we'd really like to see it higher, so will be pushing for that soon.Hope this helps. Bartholomay, LRDManager, Nutrition TherapyMeritCare Health Systems.Bartholomaymeritcare (701) 234-6166Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer>>> <Humnut413aol> 9/29/2008 7:20 PM >>>Hi Everyone,I apologize if this has already been discussed, but I need to do what others are doing for the hospital stay for diet progression. My surgeon says he wants to progress faster the RYGB pts but not as quickly as the banding pts. Also, I have read some postings stating that supplementation should be the same as RYGB pts but wondering what others are doing. Thanks for your assistance with this. I am not able to access the archives for some reason.Sincerely,a Serafino-Cross, MS, RD, LDNBaystate Medical CenterSpringfield, MA Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators ( http://pr.atwola.com/promoclk/100000075x1209382257x1200540686/aol?redir=http://www.walletpop.com/?NCID=emlcntuswall00000001 ).This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer. This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

[Guest guest]

Would you recommend the same vit D dosis for Sleeve gastrectomy as well?VioletaEl 30/09/2008, a las 20:42, Bartholomay escribió: I would like 2000 IU at minimum, but seems that recent research points to even more than that. Our current plan provides 1800 IU total. See below: Obes Surg. 2008 Sep 16. Finding the Optimal Dose of Vitamin D Following Roux-en-Y Gastric Bypass: A Prospective, Randomized Pilot Clinical Trial.Goldner WS, Stoner JA, Lyden E, J, K, Larson L, kson J, McBride C.Section of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-3020, USA, wgoldner@....BACKGROUND: Vitamin D deficiency is common following bariatric surgery and is due to a combination of baseline deficiency and postoperative malabsorption. There are few prospective studies evaluating the appropriate dose of vitamin D to prevent and treat vitamin D deficiency following bariatric surgery. METHODS: We evaluated three doses of vitamin D3 (800, 2,000, and 5,000 IU/day) in a prospective, randomized pilot trial of 45 patients undergoing Roux-en-Y gastric bypass. Serum 25 hydroxy Vitamin D (25OHD), intact PTH (iPTH), calcium, and urine calcium/creatinine ratios were measured at 6, 12, and 24 months postoperatively. Due to a high dropout rate at 24 months, we focus on the 12-month data. RESULTS: At 12 months, the 800-, 2,000-, and 5,000-IU groups had a mean +/- SD increase in 25OHD of 27.5 +/- 40.0, 60.2 +/- 37.4, and 66.1 +/- 42.2 nmol/L, respectively (p = 0.09) with a maximum increase in each group of 87.4, 114.8, and 129.8 nmol/L. Forty-four percent, 78%, and 70% achieved 25OHD levels >/=75 nmol/L (p = 0.38). Results for the 6- and 24-month time points were similar to the 12-month results. Mean weight loss at 24 months of the study was not different among groups (p = 0.52). Serum calcium did not change significantly, and there were no cases of hypercalcemia or sustained hypercalciuria. CONCLUSIONS: Higher doses of vitamin D supplementation trend towards higher levels of 25OHD. Vitamin D replacement as high as 5,000 IU /day is safe and necessary in many patients to treat vitamin D deficiency following Roux-en-Y gastric bypass yet is still suboptimal in others. So - - it would be great to measure 25 OHD levels to ascertain the correct dosage for patients, but in reality, that probably won't be done consistently, so providing higher levels to start with for RYGB patients is probably a good thing. Especially in the North — we need more than those who live in the Southern states >>> " Strathdee" <strathdee@...> 9/30/2008 12:27 PM >>> ,What level of vit D are you hoping to get to daily ? Strathdee, RD, LD, LMHCGenesis Medical Center, Davenport, IA>>> " Bartholomay" <.Bartholomaymeritcare> 09/30/2008 10:46 AM >>>Sorry - - I forgot the B12 supplement. We have them take this either sublingually, oral or by shot.>>> " Bartholomay" <.Bartholomaymeritcare> 9/30/2008 9:26 AM >>>a,We are not currently doing banding as our surgeons were not liking the results from the patients who have had the procedure in the last year. We do laparoscopic and open RYGB. Our protocol:2 weeks prior to surgery = Optifast drinks1-2 days after surgery = clear liquidsDay 3 - patients usually go home and they go home on Puree for one week.After the one week on puree, progress to Mechanical soft/soft foods for 2-3 months - - then on to regular as tolerated. Patients pick their own protein supplements after surgery.Vitamin/minerals:Mega Multi for Women by 21st Century Pharmacist (2 per day)Vitamin D - 1000 IUCalcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin DMagnesium Oxide = 300-500 mg per dayFerrous Sulfate = 325 mg per dayWe also encourage an Omega 3 supplementTotal Vitamin D is 1800 IU per day - - we'd really like to see it higher, so will be pushing for that soon.Hope this helps. Bartholomay, LRDManager, Nutrition TherapyMeritCare Health Systems.Bartholomaymeritcare (701) 234-6166Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer>>> <Humnut413aol> 9/29/2008 7:20 PM >>>Hi Everyone,I apologize if this has already been discussed, but I need to do what others are doing for the hospital stay for diet progression. My surgeon says he wants to progress faster the RYGB pts but not as quickly as the banding pts. Also, I have read some postings stating that supplementation should be the same as RYGB pts but wondering what others are doing. Thanks for your assistance with this. I am not able to access the archives for some reason.Sincerely,a Serafino-Cross, MS, RD, LDNBaystate Medical CenterSpringfield, MA Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators ( http://pr.atwola.com/promoclk/100000075x1209382257x1200540686/aol?redir=http://www.walletpop.com/?NCID=emlcntuswall00000001 ).This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer. This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer. This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

[Guest guest]

Yes, since vitamin D deficiency is common in obese patients to start (pre-surgery), it makes sense that they would need more as well. >>> Violeta Moizé Arcone <violetamoize@...> 9/30/2008 2:36 PM >>>Would you recommend the same vit D dosis for Sleeve gastrectomy as well?VioletaEl 30/09/2008, a las 20:42, Bartholomay escribió:I would like 2000 IU at minimum, but seems that recent research points to even more than that. Our current plan provides 1800 IU total. See below:Obes Surg. 2008 Sep 16. Finding the Optimal Dose of Vitamin D Following Roux-en-Y Gastric Bypass: A Prospective, Randomized Pilot Clinical Trial.Goldner WS, Stoner JA, Lyden E, J, K, Larson L, kson J, McBride C.Section of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-3020, USA, wgoldnerunmc (DOT) edu.BACKGROUND: Vitamin D deficiency is common following bariatric surgery and is due to a combination of baseline deficiency and postoperative malabsorption. There are few prospective studies evaluating the appropriate dose of vitamin D to prevent and treat vitamin D deficiency following bariatric surgery. METHODS: We evaluated three doses of vitamin D3 (800, 2,000, and 5,000 IU/day) in a prospective, randomized pilot trial of 45 patients undergoing Roux-en-Y gastric bypass. Serum 25 hydroxy Vitamin D (25OHD), intact PTH (iPTH), calcium, and urine calcium/creatinine ratios were measured at 6, 12, and 24 months postoperatively. Due to a high dropout rate at 24 months, we focus on the 12-month data. RESULTS: At 12 months, the 800-, 2,000-, and 5,000-IU groups had a mean +/- SD increase in 25OHD of 27.5 +/- 40.0, 60.2 +/- 37.4, and 66.1 +/- 42.2 nmol/L, respectively (p = 0.09) with a maximum increase in each group of 87.4, 114.8, and 129.8 nmol/L. Forty-four percent, 78%, and 70% achieved 25OHD levels >/=75 nmol/L (p = 0.38). Results for the 6- and 24-month time points were similar to the 12-month results. Mean weight loss at 24 months of the study was not different among groups (p = 0.52). Serum calcium did not change significantly, and there were no cases of hypercalcemia or sustained hypercalciuria. CONCLUSIONS: Higher doses of vitamin D supplementation trend towards higher levels of 25OHD. Vitamin D replacement as high as 5,000 IU /day is safe and necessary in many patients to treat vitamin D deficiency following Roux-en-Y gastric bypass yet is still suboptimal in others. So - - it would be great to measure 25 OHD levels to ascertain the correct dosage for patients, but in reality, that probably won't be done consistently, so providing higher levels to start with for RYGB patients is probably a good thing. Especially in the North — we need more than those who live in the Southern states >>> " Strathdee" <strathdeegenesishealth> 9/30/2008 12:27 PM >>>,What level of vit D are you hoping to get to daily ? Strathdee, RD, LD, LMHCGenesis Medical Center, Davenport, IA>>> " Bartholomay" <.Bartholomaymeritcare> 09/30/2008 10:46 AM >>>Sorry - - I forgot the B12 supplement. We have them take this either sublingually, oral or by shot.>>> " Bartholomay" <.Bartholomaymeritcare> 9/30/2008 9:26 AM >>>a,We are not currently doing banding as our surgeons were not liking the results from the patients who have had the procedure in the last year. We do laparoscopic and open RYGB. Our protocol:2 weeks prior to surgery = Optifast drinks1-2 days after surgery = clear liquidsDay 3 - patients usually go home and they go home on Puree for one week.After the one week on puree, progress to Mechanical soft/soft foods for 2-3 months - - then on to regular as tolerated. Patients pick their own protein supplements after surgery.Vitamin/minerals:Mega Multi for Women by 21st Century Pharmacist (2 per day)Vitamin D - 1000 IUCalcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin DMagnesium Oxide = 300-500 mg per dayFerrous Sulfate = 325 mg per dayWe also encourage an Omega 3 supplementTotal Vitamin D is 1800 IU per day - - we'd really like to see it higher, so will be pushing for that soon.Hope this helps. Bartholomay, LRDManager, Nutrition TherapyMeritCare Health Systems.Bartholomaymeritcare (701) 234-6166Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer>>> <Humnut413aol> 9/29/2008 7:20 PM >>>Hi Everyone,I apologize if this has already been discussed, but I need to do what others are doing for the hospital stay for diet progression. My surgeon says he wants to progress faster the RYGB pts but not as quickly as the banding pts. Also, I have read some postings stating that supplementation should be the same as RYGB pts but wondering what others are doing. Thanks for your assistance with this. I am not able to access the archives for some reason.Sincerely,a Serafino-Cross, MS, RD, LDNBaystate Medical CenterSpringfield, MA Looking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators ( http://pr.atwola.com/promoclk/100000075x1209382257x1200540686/aol?redir=http://www.walletpop.com/?NCID=emlcntuswall00000001 ).This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer. This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

This e-mail message is intended only for the named recipient(s) above and is covered by the Electronic Communications Privacy Act 18 U.S.C. Section 2510-2521. This e-mail is confidential and may contain information that is privileged or exempt from disclosure under applicable law. If you have received this message in error please immediately notify the sender by return e-mail and delete this e-mail message from your computer.

[Guest guest]

Thanks, . I plan to share this with our team.

Strathdee

>>> " Bartholomay " <.Bartholomay@...> 09/30/2008 01:42 PM

>>>

I would like 2000 IU at minimum, but seems that recent research points to even

more than that. Our current plan provides 1800 IU total. See below:

Obes Surg. 2008 Sep 16.

Finding the Optimal Dose of Vitamin D Following Roux-en-Y Gastric Bypass: A

Prospective, Randomized Pilot Clinical Trial.

Goldner WS, Stoner JA, Lyden E, J, K, Larson L, kson J,

McBride C.

Section of Diabetes, Endocrinology, and Metabolism, Department of Internal

Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-3020, USA,

wgoldner@....

BACKGROUND: Vitamin D deficiency is common following bariatric surgery and is

due to a combination of baseline deficiency and postoperative malabsorption.

There are few prospective studies evaluating the appropriate dose of vitamin D

to prevent and treat vitamin D deficiency following bariatric surgery.

METHODS: We evaluated three doses of vitamin D3 (800, 2,000, and 5,000 IU/day)

in a prospective, randomized pilot trial of 45 patients undergoing Roux-en-Y

gastric bypass. Serum 25 hydroxy Vitamin D (25OHD), intact PTH (iPTH), calcium,

and urine calcium/creatinine ratios were measured at 6, 12, and 24 months

postoperatively. Due to a high dropout rate at 24 months, we focus on the

12-month data.

RESULTS: At 12 months, the 800-, 2,000-, and 5,000-IU groups had a mean +/- SD

increase in 25OHD of 27.5 +/- 40.0, 60.2 +/- 37.4, and 66.1 +/- 42.2 nmol/L,

respectively (p = 0.09) with a maximum increase in each group of 87.4, 114.8,

and 129.8 nmol/L. Forty-four percent, 78%, and 70% achieved 25OHD levels >/=75

nmol/L (p = 0.38). Results for the 6- and 24-month time points were similar to

the 12-month results. Mean weight loss at 24 months of the study was not

different among groups (p = 0.52). Serum calcium did not change significantly,

and there were no cases of hypercalcemia or sustained hypercalciuria.

CONCLUSIONS: Higher doses of vitamin D supplementation trend towards higher

levels of 25OHD. Vitamin D replacement as high as 5,000 IU /day is safe and

necessary in many patients to treat vitamin D deficiency following Roux-en-Y

gastric bypass yet is still suboptimal in others.

So - - it would be great to measure 25 OHD levels to ascertain the correct

dosage for patients, but in reality, that probably won't be done consistently,

so providing higher levels to start with for RYGB patients is probably a good

thing. Especially in the North * we need more than those who live in the

Southern states

>>> " Strathdee " <strathdee@...> 9/30/2008 12:27 PM >>>

,

What level of vit D are you hoping to get to daily ?

Strathdee, RD, LD, LMHC

Genesis Medical Center, Davenport, IA

>>> " Bartholomay " <.Bartholomay@...> 09/30/2008 10:46 AM

>>>

Sorry - - I forgot the B12 supplement. We have them take this either

sublingually, oral or by shot.

>>> " Bartholomay " <.Bartholomay@...> 9/30/2008 9:26 AM >>>

a,

We are not currently doing banding as our surgeons were not liking the results

from the patients who have had the procedure in the last year. We do

laparoscopic and open RYGB.

Our protocol:

2 weeks prior to surgery = Optifast drinks

1-2 days after surgery = clear liquids

Day 3 - patients usually go home and they go home on Puree for one week.

After the one week on puree, progress to Mechanical soft/soft foods for 2-3

months - - then on to regular as tolerated.

Patients pick their own protein supplements after surgery.

Vitamin/minerals:

Mega Multi for Women by 21st Century Pharmacist (2 per day)

Vitamin D - 1000 IU

Calcium citrate with Vitamin D = 600 mg Calcium + 400 IU Vitamin D

Magnesium Oxide = 300-500 mg per day

Ferrous Sulfate = 325 mg per day

We also encourage an Omega 3 supplement

Total Vitamin D is 1800 IU per day - - we'd really like to see it higher, so

will be pushing for that soon.

Hope this helps.

Bartholomay, LRD

Manager, Nutrition Therapy

MeritCare Health Systems

.Bartholomay@...

(701) 234-6166

Strengths: Arranger, Ideation, Adaptability, Empathy, Maximizer

>>> <Humnut413@...> 9/29/2008 7:20 PM >>>

Hi Everyone,

I apologize if this has already been discussed, but I need to do what others are

doing for the hospital stay for diet progression. My surgeon says he wants to

progress faster the RYGB pts but not as quickly as the banding pts. Also, I have

read some postings stating that supplementation should be the same as RYGB pts

but wondering what others are doing. Thanks for your assistance with this. I am

not able to access the archives for some reason.

Sincerely,

a Serafino-Cross, MS, RD, LDN

Baystate Medical Center

Springfield, MA

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[Guest guest]

Due to nausea and some vomiting we progress our sleeve patients similar to

gastric bypass

progression. Clear liquids for 1 week, full for 1 week then to soft and then to

regular foods

with beef, pork and ham at 6 months

Ciara Halpin RD,LD

- In , Humnut413@... wrote:

>

> Hi Everyone,

> I apologize if this has already been discussed, but I need to do what

> others are doing for the hospital stay for diet progression. My surgeon says

he

> wants to progress faster the RYGB pts but not as quickly as the banding pts.

> Also, I have read some postings stating that supplementation should be the

> same as RYGB pts but wondering what others are doing. Thanks for your

> assistance with this. I am not able to access the archives for some reason.

> Sincerely,

> a Serafino-Cross, MS, RD, LDN

> Baystate Medical Center

> Springfield, MA

>

>

>

> **************Looking for simple solutions to your real-life financial

> challenges? Check out WalletPop for the latest news and information, tips and

> calculators. (http://www.walletpop.com/?NCID=emlcntuswall00000001)

>

[Guest guest]

Thanks, . This is very helpful. So your facility is no longer doing the Sleeve Gastrectomy? I wonder about other facilities.

a Serafino-Cross, MS, RDLooking for simple solutions to your real-life financial challenges? Check out WalletPop for the latest news and information, tips and calculators.