more on vitamins

[Guest guest]

Hello again group,

Once again as I was surfing the web, I came across some

information. Now I know that you have some great advice for folks on

nutrition and vitamins , but I picked this up on the Alvarado site,

in an area marked for Doctors only. (Far be it from me to look only in

places they give me permission to look at). Anyway, I found this

interesting and wanted to share with you all.

Post-Operative Regimen

All of our patients undergo education in nutrition and physiology, and are

provided with extensive written instructions, in the form of an " Owners

Manual " for their surgery. Our basic instructions are quite simple:

* Eat 2 -3 meals per day, no more. Protein, in the form of lean meats

(chicken, turkey, fish), and other low-fat sources, should be eaten first,

and should comprise at least half the volume of the meal eaten. Foods

should be cooked without fat, seasoned to taste. Avoid sauces, gravies,

butter, margarine, mayonnaise, and junk foods.

* Never eat between meals - nothing. Do not drink flavored beverages, even

diet soda, between meals.

* Drink 2 -3 quarts, or more, of water each day. Water must be consumed

slowly, 1 -2 mouthfuls at a time, due to the restrictive effect of the

operation.

* Exercise aerobically every day, for 20 minutes at least (one mile brisk

walk, bike riding, stair climbing, etc.). We encourage weight/resistance

exercise 3 - 4 days per week.

Weight loss is often profound for 1 - 2 months, and then typically averages

2 - 3 lb per week over the following 8 - 18 months, depending upon the

amount of weight available to be lost.

Nutritional Considerations Following Gastric Bypass

The Gastric Bypass is primarily a restrictive operation, augmented by

physiological effects on the sense of satiety. It does not seriously affect

absorption of ingested nutrients. The bypassed gut includes the distal 90%

of stomach, and the duodenum. The remaining gut, comprised of the jejunum

and ileum, as well as the colon, accomplish most of the absorptive function

of the intact gastrointestinal tract.

Many physicians, when informed of the small amounts of food ingested after

gastric bypass, are moved to recommend frequent small feedings, to increase

nutrient intake, and to " avert starvation " . This is decidedly the wrong

approach. The rapid weight loss which follows Gastric Bypass is almost

entirely salutary, while long-term weight loss approximates 2 pounds per

week, implying a caloric deficit of approximately 1000 calories per day.

This is a healthful rate of loss, when accompanied by adequate intake of

protein and essential vitamins. Frequent feedings frustrate weight loss, and

more importantly encourage the most self-defeating habitual behavior that

the bypass patient can acquire: snacking and eating between meals.

The effects of the Gastric Bypass on nutrition reflect its restrictive

effect, and the exclusion of the duodenum from contact with the food stream:

Vitamin Availability

Multivitamins

The markedly reduced intake volume following Gastric Bypass implies that

ingestion of vitamins within food will be inadequate. Every patient is

therefore ordered to supplement dietary vitamin intake with a high-potency

multivitamin supplement. Presently, we recommend one of the following:

* Multigenics Intensive Care (Metagenics)

* Trader Joe's - The Women's Formula

* Vitox (IDN)

* Kirkland High Energy Pack (Price/Costco)

* Centrum

* Any well-formulated High-Potency Multivitamin Preparation.

Vitamin B-12

Impaired complexing of Vitamin B-12 in the proximal stomach may lead to

reduced absorption in the intestine. We recommend that this be replaced by

use of exogenous Vitamin B-12, either as a sub-lingual preparation, or by

periodic injection. The cost of empiric Vitamin B-12 dosage is far less than

that of regular testing of levels, let alone therapeutic repletion of

deficiency. Effective supplementation:

* Sub-Lingual Vitamin B-12 (Trader Joe's)

* Vitamin B-12 1000 mcg q 3 months sub-cutaneously.

Iron

Iron absorption occurs primarily in the duodenum, and is significantly

impaired following Gastric Bypass. Iron supplementation is recommended in

all menstruating females. The preferred formulation is Ferrous fumarate,

with Vitamin C, in a non-enteric coated tablet.

* Ferrancee HP

* Vitron C

* Ferrous Sulfate is very poorly absorbed, and is quite distressing to the

GI tract. It should not be used in Gastric Bypass patients.

Calcium

Calcium intake is likely to be inadequate in the bypassed patient, due to

reduced food intake, and the need to avoid milk ingestion. Calcium

absorption is not impaired. Patients should ingest 1000 - 1500 mgm of

Calcium daily. Suitable preparations are numerous.

Protein

We recommend that each meal contain approximately one-half of its volume as

protein-containing foods, such as eggs, chicken, turkey or fish, and we do

not require any detailed calculation of required protein intake. Other

potential sources include soy protein (tofu), beans, cottage cheese. For

those who prefer it, protein intake should approximate 1 - 1.5 gram per kgm

of ideal body weight -- adipose tissue is predominantly stored fat, and does

not require protein repletion.

Protein intake should be adequate with each meal, since the body's ability

to store protein or amino acids is very limited, and they are constantly

required for synthesis. Even more significant to the weight-loss process is

the very important inhibitory effect which protein has on the desire to

continue eating. We recommend that protein be eaten first, to ensure that it

is eaten, and to enhance the very important satiety response of the Gastric

Bypass, which seems to be most effectively stimulated by protein contact

with jejunum.

As always, take from it what works for you and realize that every program

and doctor has different ideas.

Sue in Las Vegas

500 lbs 10/26/98

181 now!

http://suebee420.homestead.com/Suebee2.html