It’s important to understand Vitamin D metabolism and deficiency potential following weight loss surgery Vitamins after DS need to be followed via laboratory blood studies. There are basic vitamin needs but individual needs should be based on medical history, genetics, alimentary limb length, common channel length and other surgical and physiologic determinations. Vitamins after DS are a life long commitment as well as protein needs and hydration. Duodenal Switch is a malabsorptive procedure which requires at least yearly laboratory blood studies, daily vitamins/minerals, daily high protein and daily hydration intake. There is not an all in one vitamin that is adequate for a DS patient or tailored to your individual needs. (example: you may need more Vitamin D and less Vitamin A if you are taking a all-in-one vitamin you can’t get more of one and less of another vitamin)

DS patients are recommended to take Dry forms (water miscible form) of Vitamin A, D3, E, K due to the fat malabsorption after DS. Dry formulations by Biotech are processed so they can be absorbed by a water soluble method after the DS procedure. Vitamin D seems to be the vitamin that can become deficient the easiest, followed by Vitamin A. Take these vitamins away from dietary fat.

In some cases, patients may need injectable Vitamin A or D to improve vitamin levels.

Click the links to view the information below and within the comments of this file:
Vitamin D3 50 by Biotech:  Amazon
directly from BioTech:

Many DS surgeon’s do not recommend Children’s vitamins or chewable vitamins unless there is a specific reason or need for them.
DS Surgeon Blog on Vitamin D:
Webinar on Vitamin D metabolism:
Medications that effect Bone health:
This does not constitute medical advice, diagnosis or prescribing. It is simply a compiled list of gathered information. If you are in doubt or have questions please contact your medical healthcare professional.

Recently I had a short live presentation on the subject of osteoporosis, osteoporosis medications, and the treatment options of this deteriorating bone condition. A patient who has had a bone scan may be diagnosed with Osteopenia and/or Osteoporosis. This information is usually conveyed by the forms of a Low T score. Both of these indicated demineralization of the bones, and the end result is  worsening of the bone structure. This leads to weaker bones and higher chance of fracture due to stress or trauma.

Treatment options should be approached is a global and systemic fashion. It is critical that the nutritional status is at its best possible and optimized for important healthy bone vitamins and minerals. Low protein needs to be corrected. Special attention should be given to nutrients, minerals and vitamins. These include Protein, Calcium, Magnesium, Vitamin D, and Vitamin K1/K2to name a few.

Healthy bones require ongoing and routine force in the form of exercise to remain health. Just as exercise improves muscle strength, it also improves bone health. Exercise is also critical in improving bone structure and density. Ideally, exercise should be weight bearing and resistance.  Examples include: hiking, walking, jogging, climbing stairs, playing tennis, and dancing. Resistance type exercise is weight lifting and resistance bands.  These exercise work by creating a pull or force on the bone either by gravity, movement or weight.  Always check with your physician before beginning an exercise routine, start slowly and building up to longer periods of time.  The ideal goal would be at least 30 minutes a day, every day, if you are able.

We frequently see patients immediately started on osteoporosis medications without checking or improving some of the nutritional markers noted above or without looking at exercise history. In some case, the medication recommended are contraindicated due to nutritional status.

The medications can be grouped in to those  that help with new bone formation (Anabolic agents) or those that help by suppressing the bone breakdown phase (Antiresorptive agents).

 

National Osteoporosis Foundation has an exhaustive list (below) of medications for treatment of Osteoporosis.

The table below outlines the side effects and mechanism of the actions of the common medications used for treatment of  osteoporosis which was published by the University Health News Publication on August of 2014.

 

With all this information, the few points to remember is that the most important factors in healthy bone structure are the nutritional status Protein, Calcium, Magnesium, Vitamin D, and Vitamin K1 levels.

This is an animation of normal bone Metabolism. It shows how bone structures is taken down and rebuilt continuously. This allows for a healthy bone maintainence as we age. The key is the balance of breakdown (osteoclast) and the build up (osteoblast) activity is regulated. Osteoporosis develops when there is more breakdown that build up.

With permission of Dr. Susan Ott of University of Washington.

Additional information available on her site.

Past blogs on Bone Health.

The topic for the Glendale group meeting and webinar on September 3, 2014 was Vitamin K2, laboratory studies and their significance.

The webinar video is on our website.

There was an online question regarding night hunger.  In order to abate this, it is best to eat frequent small volume of high protein meals.  Also if possible, a solid piece of protein such as meat, egg, cheese as close to bedtime as tolerable may be better that a protein shake in liquid form.  This will decrease ghrelin production, give the satisfaction of satiety and normalize blood sugar level throughout the night.  Frequent small protein meals, snacks and hydration throughout the day is also necessary to alleviate this feeling.  It is not unusual to need to have something in your stomach every 2-3 hours during the rapid weight loss phase and some people even yeas out.

Protein

Another question asked if staying on limited types of protein was adequate.  The recommendation is to rotate types of protein in food form and supplement form as tolerated to avoid loss of absorptive capacity and development of allergies.  There have been several incidences of people developing an allergy to whey protein after several years when there had not been a history of the allergy previously.

Vitamin K2

Lastly, there was a questions regarding  Vitamin K2.  Vitamin K is a fat soluble vitamin that has two forms, K1 and K2. It has long been thought that the majority of Vitamin K2 was synthesized by the microflora in the gut. But research is revealing that it may involve more processes and is more significant than was previously thought.

Vitamin K 1 and Vitamin K2 are separate vitamins. Vitamin K 1 is found in dark leafy vegetables and plays more of a role in blood coagulation. Vitamin K2 is found in hard cheeses, egg yolk, soft cheeses, natto, chicken liver, other organ meats, ground beef, salami and grass fed beef butter.

Vitamin K2 has a much broader function in directing calcium, via Human matrix Gla protein, to appropriate places to deposit such as bone and teeth and preventing it from depositing in arteries and possibly forming kidney stones.  It is also a antioxidant which has shown to reduce cancer risk and encourage healthy nerve growth and protection. Vitamin K2, however, seems to be another vitamin, similar to vitamin D3,  that is going to be going through a great deal of research in the near future with changing recommendations and knowledge base.

Vitamin K2 controls osteocalcin, which is a calcium regulating protein. Osteocalcin binds to the mineral portion of the bone but in the absences of Vitamin K 2 the result is calcium reabsorption from the bone and osteoporosis develops.  Vitamin K2 is a fat soluble vitamin that comes in several  bacterial menaquinones MK4-MK10. However the majority of research is based on MK4 and MK7.  While both have bone protective properties, MK4 also has the cardiovascular protective attributes and colon cancer growth inhibitory effects.  MK7 is said to have a higher bioavailability and longer half life. Article on MK7 and bone health.

Most of the studies regarding bone health and vitamin K2 the patients were treated in conjunction with Vitamin D and calcium supplements.  For a Duodenal Switch patient, the supplement of choice would probably be a combination of Vitamin K 2 with MK4 and MK7. Again, there is ongoing research regarding Vitamin K2 which may reveal new daily allowances, mechanism of function and recommendations in the future.

Here is an article regarding Vitamin K2.

The recipes for the evening snack.

Pumpkin smoothie was the following protein shake with an addition of a scoop of unflavored protein powder.

Paleo black pepper crackers with goat cheese and walnut crusted cheddar ball.

Bacon wrapped chicken wings.