Vitamin’s Physical State And Solubility are Two Different Things.
March 29, 2014 6:11 pm
Vitamins And Minerals
March 29, 2014 5:26 pm
|
Vitamins -Minerals |
Function |
Source |
Problems with deficiency |
|
B1 (Thiamine) |
Carbohydrate conversion, breaks down fats and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, immune system |
Pork, organ meats, whole grain and enriched cereals, brown rice, wheat germ, bran, brewer’s yeast, blackstrap molasses |
Heart, age-related cognitive decline, Alzheimer’s, fatigue |
|
B2 (Riboflavin) |
Metabolism, carbohydrate conversion, breaks down fat and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, antioxidant |
Brewer’s yeast, almonds, organ meats, whole grains, wheat germ, mushrooms, soy, dairy, eggs, green vegetables |
Anemia, decreased free radical protection, cataracts, poor thyroid function, B6 deficiency, fatigue, elevated homocysteine |
|
B3 (Niacin) |
Energy, digestion, nervous system, skin, hair, eyes, liver, eliminates toxins, sex/stress hormones, improves circulation |
Beets, brewer’s yeast, meat, poultry, organ meats, fish, seeds, and nuts |
Cracking, scaling skin, digestive problems, confusion, anxiety, fatigue |
|
B5 (Pantothenate) |
RBC production, sex and stress-related hormones, immune function, healthy digestion, helps use other vitamins |
Meat, vegetables, whole grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ, salmon |
Stress tolerance, wound healing, skin problems, fatigue |
|
B6 (Pyridoxine) |
Enzyme protein metabolism, RBC production, reduces homocysteine, nerve and muscle cells, DNA and RNA, B12 absorption, immune function |
Poultry, tuna, salmon, shrimp, beef liver, lentils, soybeans, seeds, nuts, avocados, bananas, carrots, brown rice, bran, wheat germ, whole grain flour |
Depression, sleep and skin problems, elevated homocysteine, increased heart disease risk |
|
B12 (Cobalamin) |
Healthy nerve cells, DNA/RNA, RBC production, iron function |
Fish, meat, poultry, eggs, milk and milk products |
Anemia, fatigue, constipation, loss of appetite, weight, numbness and tingling in the hands ad feet, depression, dementia, poor memory, oral soreness |
|
Biotin |
Carbs, fat, and amino acid metabolism (the building blocks of protein) |
Salmon, meats, vegetables, grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ |
Depression, nervous system, premature graying, hair, skin |
|
Folate |
Mental health, infant DNA/RNA, adolescence and pregnancy, with B12 to regulate RBC production, iron function, reduce homocysteine |
Supplementation, fortified grains, tomato juice, green vegetables, black-eyed peas, lentils, beans |
Anemia, immune function, fatigue, insomnia, hair, high homocysteine, heart disease |
|
Eyes, immune function, skin, essential cell growth and development |
Milk, eggs, liver, fortified cereals, orange or green vegetables and fruits |
Night blindness, immune function, zinc deficiency, fat malabsorption |
|
|
Calcium and phosphorus levels, calcium absorption, bone mineralization |
Sunlight, milk, egg yolk, liver, fish |
Osteoporosis, calcium absorption, thyroid |
|
|
Vitamin E |
Antioxidant, regulates oxidation reactions, stabilizes cell membrane, immune function, protects against cardiovascular disease, cataracts, macular degeneration |
Wheat germ, liver, eggs, nuts, seeds, cold pressed vegetable oils, dark leafy greens, sweet potatoes, avocado, asparagus |
Skin, hair, rupturing of red blood cells, anemia, bruising, PMS< hot flashes, eczema, psoriasis, cataracts, wound healing, muscle weakness, sterility |
|
Calcium |
Bones, teeth, helps heart, nerves, muscles, body systems work properly, needs other nutrients to function |
Dairy, wheat/soy flour, molasses, brewer’s yeast, Brazil nuts, broccoli, cabbage, dark leafy greens, hazelnuts, oysters, sardines, canned salmon |
Osteoporosis, osteomalacia, osteoarthritis, muscle cramps, irritability, acute anxiety, colon cancer risk |
|
Chromium |
Assists insulin function, increased fertility, carbohydrate/fat metabolism, essential for fetal growth/development |
Supplementation, brewer’s yeast, whole grains, seafood, green beans, broccoli, prunes, nuts, potatoes, meat |
Metabolic syndrome, insulin resistance decreased fertility |
|
Magnesium |
300 biochemical reactions, muscle/nerve function, heart rhythm, immune system, strong bones, regulates calcium, copper, zinc, potassium, vitamin D |
Green vegetables, beans & peas, nuts and seeds, whole unprocessed grain |
Appetite, nausea, vomiting, fatigue, numbness, tingling, cramps, seizures, personality changes, heart rhythm, heart spasms |
|
Selenium |
Antioxidant, works with vitamin E, immune function, prostaglandin production |
Brewer’s yeast, wheat germ, liver, butter, cold water fish, shellfish, garlic, whole grains, sunflower seeds, Brazil nuts |
Destruction to heart/pancreas, sore muscles, fragility of red blood cells, immune system |
|
Zinc |
Supports enzymes, immune system, wound healing, taste/smell, DNA synthesis, normal growth & development during pregnancy, childhood adolescence |
Oysters, red meat, poultry, beans, nuts, seafood, whole grains, fortified breakfast cereals, and dairy |
Growth retardation, hair loss, diarrhea, impotence, eye & skin lesions, loss of appetite, taste, weight loss, wound healing, mental lethargy |
|
COQ10 |
Powerful antioxidant, stops oxidation of LDL cholesterol, energy production, important to heart, liver, and kidneys |
Oily fish, organ meats, and whole grains |
Congestive heart failure, high blood pressure, angina, mitral valve prolapsed, fatigue, gingivitis, immune system stroke, cardiac arrhythmias |
|
Carnitine |
Energy, heart function, oxidize amino acids for energy, metabolize ketones |
Red meat, dairy, fish, poultry, (fermented soybeans), wheat, asparagus, avocados, peanut butter |
Elevated cholesterol, liver function, muscle weakness, reduced energy, impaired glucose control |
|
N-Acetyl Cystein (NAC) & Glutathione |
Glutathione production, lowers homocysteine, lipoprotein, heal lungs, inflammation, decrease muscle fatigue, liver detoxification, immune function |
Meats, ricotta, cottage cheese, yogurt, wheat germ, granola, and oat flakes |
Free radical overload, elevated homocysteine, cancer risk, cataracts, macular degeneration, immune function, toxin elimination |
|
Alpha Lipoic Acid |
Energy, blood flow to nerves, glutathione levels in brain, insulin sensitivity, effectiveness of vitamins C, E, antioxidants |
Supplementation, spinach, broccoli, beef, brewer’s yeast, some organ meats |
Diabetic neuropathy, reduced muscle mass, atherosclerosis, Alzheimer’s, failure to thrive, brain atrophy, high lactic acid |
What does elevated Alkaline Phosphatase level mean?
March 18, 2014 2:17 am
There are laboratory studies that can distinguish between 2 primary sources of the ALP. The two “isoenzymes” are bone ALP and liver ALP.
Endoscopy Procedures and Duodenal Switch
February 27, 2014 6:58 pm
Upper Endoscopy (Esophagogastroduodenoscopy- EGD)
Gastrointestinal endoscopic procedures can be done in patients after the duodenal switch operation.
An upper endoscopy in an intact anatomy, involves examination of the esophagus, stomach, pyloric valve, and the duodenum including the ampulla of vater. This is where the biliopancreatic secretions are added into the GI track for absorption of the nutrients.
The upper endoscopy examination is limited after the duodenal switch operation to the first part of the three parts of the Duodenum. So the ampulla of vater can not be examined. This is also why an ERCP cannot be performed in patients after the duodenal switch operation.
Lower Endoscopy (Colonoscopy)
Duodenal switch operation does not change the anatomy of the large intestine. The colonoscopy examination can be done as with a patient who has not had the duodenal switch operation. The only consideration should be the bowel preparation. It has been noted that the patients after the duodenal switch operation require a longer than usual time for the bower prep. We recommend patients going on a liquid diet for 4-5 days before the planned procedure. I know it sounds unexpected that we recommend patients after the duodenal switch to be on liquid diet. You may also want the physician doing the colonoscopy be aware that you may need more aggressive and longer bowel prep.
Please see examples of the upper endoscopy here.
Fancy Drinks and Iced Teas
February 27, 2014 3:00 am
Most of you may have heard me emphasize the importance of adequate hydration after surgery. At the same time I would be the first one to admit that drinking plain water gets old very quickly. I also do not recommend carbonated drinks (diet or regular). Most commercial products such as Crystal light also contain artificial sweeteners which in my opinion are to be avoided. Please note that there is extensive information here on my website on this topic.
One of the most benign looking drinks may be the refreshers that are available at Starbucks. An example of it is Very Berry Hibiscus Starbucks Refreshers™ Beverage. It contains 21 g of sugar and 100 calories in a 24 ounce serving size. Note that it also contains 70-85mg of caffeine.
Having some of these drinks on occasion will do no harm. However I would not recommend these drinks to replace water as means of hydration. High content of Caffeine can result in oxalate crystal formation. This predisposes a post weight loss surgical patient to much higher chance of kidney stone formations.
“Depo” Shot and Weight Gain
September 16, 2013 4:14 pm
Female patients having weight loss surgery should use two forms of Birth control for 18 months after weight loss surgery. Depo shots are suppose to prevent ovulation for a prolonged period of time. An attractive aspect of it is once a patient get the injection, there is not need to worry about birth control till the next injection is due.
There have been a number of studies that have associated Depo shots with weight gain.
Below are three citations from pubmed and the ACOG website.
Weight Gain
Vitamin D And A -Dry (Water soluble) Formulary
August 24, 2013 7:57 pm
Vitamin A and D are fat soluble vitamins. This means that in order for them to be absorbed by the GI track, them need to be absorbed by fat globules (chylomicrons). These are then taken up by the lymphatics of the GI track and taken to the blood stream. With the anatomical changes of the Duodenal Switch, the fat absorption capacity is significantly reduced. This results in excellent weight loss. It also results in much diminished absorption of the Fat soluble vitamins A, D, E and K. It is essential to use Dry Water Soluble forms of Vitamins A, D, E, and K. Bio-Tech is a brand that is formulated in this manner.
The Biotech D3-50 has 50,000IU of Vitamin D.
We recommend specific dosages of dry (water soluble) Vitamin A and D. These are not available at most pharmacies. In fact when our recommendations are presented at most pharmacies they are incorrectly dispensed with the fat soluble variety with is worth less becasue it is not absorbed by the duodenal switch patients. It is also important to not that this type of vitamin should not be taken with any dietary fat. Fat can inhibit the absorption of this type of vitamin. When ordering online, please make sure that the “Dry” or “Water Soluble” formulary is ordered.
Injectable Vitamin A and Vitamin D
June 20, 2013 11:24 pm
Injectable Vitamin A and Vitamin D can improve vitamin status post weight loss surgery. One of the common side effect of all weight loss surgical procedures is nutritional and/or mineral deficiencies. Patients undergoing weight loss surgical procedures are always instructed to supplement their diet with multivitamin, calcium, iron, vitamin D and other supplements or minerals. If you do not take your supplements regularly you can become deficient. The symptoms associated with vitamin A deficiency is night blindness. Chronic vitamin D deficiency may result in low calcium, osteoporosis and other health-related issues.
Vitamin A and vitamin D, both fat-soluble vitamins, are absorbed by duodenal switch patients only if taken and a dry formulation. An alternative to oral supplement, would be injectable form of these two vitamins. Both of these vitamins can be formulated and purchased from compounding pharmacies that are equipped and experienced with the interpretation of injectable vitamins and minerals. Your primary care WILL need to contact the pharmacy of their choice for the recommendations and be willing to make the injections available to you.
We will gladly be able to provide injectable Vitamin A and Vitamin D for patients whose data laboratory studies are available to us and see us in the office.Please be aware that these are compounded and are not covered by insurance.
We will not be able to provide prescriptions for injectable vitamins to be sent to your primary care or other physicians to provide the injections.
Vitamin D supplement has been discussed previously in my Blog .
The common dosing for the vitamin D is 600,000 IU, deep IM every 6 months till the levels are normalized. The patient then can take the oral supplements only.
Vitamin A supplements was also discussed in my Blog.
The common dosing for the vitamin D is 100,000 IU, deep IM every 2-6 months till the levels are normalized. The patient then can take the oral supplements only.
Vitamin A supplements was also discussed in my Blog.
The common dosing for injectable vitamin A is 50,000 IU, deep IM every 6 months till the blood levels are corrected, and the patient symptoms are resolved.
Just as a reminder, we have no financial interest in any of the vendors that are recommended on our website. Also, note that this is not in any form or fashion a substitute for an evaluation by your primary care physician or your surgeon. This is for information only, and is not to be taken as a recommendation for any particular patients’ condition.
Gastro-gastric fistula after gastric bypass operation
May 10, 2013 9:09 pm
One of the complications of gastric bypass is a gastro gastric fistula. This happens when a connection between the gastric bypass pouch develops to the remnant stomach. In a gastric bypass operation, a very small pouch is created from the stomach, and connected to a segment of the small bowel.
The purpose of this operation is to decrease over 95% of the volume of the stomach. In theory, the benefits of this is to reduce the volume of food that can be consumed. Over time, the size of the stomach pouch, and/or size of the gastro-jejunostomy anastomosis might stretch. This result in weight regain that is very commonly seen in about 3 years after a gastric bypass operation.
One of the complications of gastric bypass is a gastro gastric fistula. This happens when a connection between the gastric bypass pouch develops to the remnant stomach. In a gastric bypass operation, a very small pouch is created from the stomach, and connected to a segment of the small bowel.
The purpose of this operation is to decrease over 95% of the volume of the stomach. In theory, the benefits of this is to reduce the volume of food that can be consumed. Over time, the size of the stomach pouch, and/or size of the gastro-jejunostomy anastomosis might stretch. This result in weight regain that is very commonly seen in about 3 years after a gastric bypass operation.
Another possible explanation for weight regain may be an abnormal connection that may develop over time between the bypassed stomach and the small pouch that was created. This abnormal connection is known as a gastro-gastric fistula. In a patient who may have a gastro-gastric fistula, the food can travel down the gastric bypass path or enter the bypassed stomach and go down the path of a normal anatomy.
In these cases, the physiological effect of a gastric bypass procedure becomes ineffective.
The treatment that I favor most for correcting the complication of the gastro-gastric fistula is is to revise the gastric bypass to the duodenal switch operation.
“Normal” Lap Band placement!
April 23, 2013 9:39 pm
One of the most common problems that we see are patients who have been told that their band is in correct placement, and yet they are still having nausea, vomiting, reflux etc. These patients are frequently blamed for their symptoms as if properly placed band completely eliminates the problems being associated with the band.
