Vitamin K1
April 08, 2015 7:16 pm
Vitamin K1 is a found in dark green leafy vegetables, asparagus, brussels sprouts, some grains, olive oil, prunes, soy bean oil, and canola oil. The body has limited storage capacity for Vitamin K and uses a recycle system to reuse it.
Vitamin K1 is a fat-soluble vitamin that after Duodenal Switch is not as easily absorbed due to the limiting contact of the food product with the bile until the common channel. Bile is needed to absorb fatty acids and fat-soluble vitamins.
Duodenal Switch patients in need of Vitamin K1 supplements should take “Dry” or water miscible type of Vitamin K1, such as Biotech brand. The patients laboratory studies will determine if a patient requires Vitamin K1 supplement. Duodenal Switch patients should have laboratory studies drawn and evaluated at least on a yearly basis. Vitamin K works in a delicate balance with other supplements and should be monitored by a physician, in at risk people.
Vitamin K1 is most know for it’s coagulation effect and the clotting cascade. Vitamin K1 works with calcium and proteins in order to accomplish coagulation synethesis. Care should be taken with Vitamin K supplementation and anti-coagulation (blood thinners) therapy. Please see your physician regarding any supplementation of Vitamin K and blood thinner medications.
A discovery of Vitamin K dependent proteins has led to research on Vitamin K1 in bone health. Bone matrix proteins, specifically osteocalcin, undergo gamma carboxylation with calcium much the way coagulation factors do; this process also requires Vitamin K. Osteocalcin is a Gla-protein that is regulated by Vitamin D. The calcium binding ability of osteocalcin requires several Vitamin K carboxylations to exert it’s effects on bone mineralization.
In adults, the causes of Vitamin K1 deficiency include the following :
Chronic illness
Malnutrition
Alcoholism
Multiple abdominal surgeries
Long-term parenteral nutrition
Malabsorption
Cholestatic disease
Parenchymal liver disease
Cystic fibrosis
Inflammatory bowel disease
Medications: Antibiotics (cephalosporin), cholestyramines, warfarin, salicylates, anticonvulsants, Cefamandole, cefoperazone, salicylates, hydantoins, rifampin, isoniazid, barbiturates, and certain sulfa drugs, higher Vitamin E can antagonized Vitamin K)
Massive transfusion
Disseminated intravascular coagulation (DIC) – Severe
Chronic kidney disease/hemodialysis
Additional information: https://lpi.oregonstate.edu/infocenter/vitamins/vitaminK/
Intake of Vitamin K1 and K2 and bone fracture risk
As always, discuss with your physicians and/or surgeon any changes in medications and supplements. This is not meant to be an all inclusive discussion of Vitamin K.
Vitamin B6 Toxicity
April 01, 2015 7:58 pm
In recent years, we have noticed a trend of increased Vitamin B6 (Pyroxidine) levels in post Duodenal Switch patients’ laboratory studies. Vitamin B6 is a water soluble vitamin, however, toxicity can happen with an increase in supplementation. The increased availability and amounts of Vitamin B6 in more supplements such as Calcium, multivitamins and B Complex supplements could be the cause of the trend post weight loss surgery. Please be sure to check the amounts of Vitamin B6 within your daily supplements.
Vitamin B6 Function:
Vitamin B6 is an important water soluble vitamin which functions as co-enzymes in a number of metabolic pathways including amino acids, fatty acids, glycogen, and steroid hormones (estrogen, cortisol, androgens and Vitamin D) metabolism. Other biological functions are hemoglobin synthesis, immune function and inflamation, neurotransmission and gene expression. B6 has been shown to improve carpal tunnel syndrome, PMS, AADHD, Alzheimer’s, acne, lung cancer, high homocysteine levels, asthma, kidney sones, and some cases of depression and arthritis. The U.S. Daily Recommended dose ins 1.2-2mg for adults.
Toxicity has most often happened from increased supplementation and rarely from food alone except for in a subset of people who may have increased sensitivity, gene mutations or other issues with Vitamin B6. In the average person, doses of 1000mg per day which is about 800 times the daily amount from food can cause neuropathy and neurotoxicity. There have been instances of toxicity issues at doses of 500mg daily. Other symptoms associated with high levels of B6 are skin rashes, nausea, vomiting, loss of appetite, increased liver function tests, sensitivity to sunlight. Nerve damage or numbness and tingling of the feet, legs and hand, if left untreated, can become irreversible. Stop taking B6 if you experience any of these symptoms. The daily U.S. no adverse effects dose is set at a max of 200mg daily. The daily recommend max limit is 100mg daily.
Drug interactions with high doses of B6 levels are phenobarbital, phenytoin and L-Dopa and cause decrease effectiveness. B6 deficiency is a side effect of oral contraceptives, isoniazid, cycloserine, pencil amine, methylxanthines, and long term NSAIDs use due to impaired Vitamin B6 metabolism.
Once B6 levels are elevated it is important to to try to decrease intake as much as possible and levels will usually drop in weeks to months. Read your labels of drinks, energy drinks, multi-vitamin, cold supplements, high B6 foods, protein supplements, and other sources. These are items that typically have added high levels of B6 supplement. You can also avoid group Vitamin B supplements and go to individual B vitamins that are needed.
Additional information on Vitamin B6. Please have your surgeon or your primary care physician review your laboratory studies. Seek medical attention if you are experiencing any of the above symptoms or any other unusual symptoms.
September 3, 2014 Group Meeting & Webinar Laboratory Studies and Vitamin K2Exclusive Member Content
September 06, 2014 8:03 pm
Vitamin D Metabolism, Deficiency and Treatment
August 23, 2014 4:17 am
Vitamin D and Weight Loss Surgery
Patch or Spray Vitamins
August 15, 2014 10:37 pm
At the last group meeting, there were several questions whether vitamin D and other vitamins would be absorbed via patch (transdermal) and spray (buccal/sublingual) routes. After reviewing several resources, the only article I could find was for transdermal Vitamin D absorption. However, if we look at the mechanism for each route we can make an educated assumption.
Transdermal route of absorption (without additional absorption enhancers) (ref) requires a molecular mass less than 500 g/mole, high lipophilicity (affinity to fat or lipids), and low required daily dose (less than 2mg). The fat-soluble vitamins are definitely lipophilic, all of them have molecular weights less than 500 g/mole and daily dose is under 2mg. It seems that hydrophilic medications (that have an affinity to water) may have less ability to be absorbed with this route unless a chemical enhancer is added to the product. Most vitamins and minerals have lower molecular weights except Vitamin B12 which has too high of a molecular weight unless an enhancer is added. The transdermal route has slower absorption than buccal (oral mucosa) but faster than usual tablet oral route. The down side to transdermal route is possible skin issues due to medication, adhesives, and also different rates of absorption due to skin thickness and condition.
Buccal/sublingual route of absorption is dependent on lipid solubility, oil to water partition coeffincient, saliva pH, small to moderate molecular weight, and oral mucosa thickness. The mechanism of action is osmosis, which means items that readily dissolve in water are easily absorbed. Unlike orally ingested medicates, that take time to absorb and need to be filtered and/or processed in the liver, sublingual route is fast absorbing and the liver is bypassed. The down side to this route is it disrupts eating and drinking and is not efficient with smoking due to vasoconstriction.
An e-mail was sent to the companies inquiring about the outcomes of their products with people with malabsorption issues. No response was received from the spray vitamin companies.A request was also sent to obtain any research articles they may have but a response has not been received at this time. The following is the response I received from the maker of Patch MD.
“I am the president and founder of Patch MD. We design Patch MD to help people that have digestive issues and malabsorption. Our whole premise is to avoid the digestive track, by doing so we avoid dealing with conditions such as short bowel syndrome, acid reflux, and bariatric surgery to name a few. People also with Crohn’s disease and iliac disease are challenged with digestion and absorption every day of their life. Our patches are designed specifically to pass nutrition through the skin into the bloodstream. We get letters every day from people that have had bariatric surgery and were unable to get vitamin D, calcium, the B’s and Vitamin A and K, our product works because we use the skin as our delivery system, absorption is through the skin, avoiding all digestive potential issues. The only problem that we may have is we tell our customers to use no lotions or cream in the patch application area, as you may understand it will prevent absorption. We are going to be at a national convention this weekend in Manhattan Beach California to take part and display our products at the ObesityHelp conference. They ask us to take part as they were getting great reviews from their members that are using the patch. All were improving their blood work after taking Patch MD patches.”
Earl Hailey, President Patch MD
In light of the review of data, it would seem that the transdermal route would be beneficial to people who are having issues maintaining blood levels of fat-soluble vitamin levels. The other vitamins also have a good prospect of absorption via transdermal route. Buccal or sublingual (sprays) would seem to have a better outcome for water-soluble vitamins unless there is an additive added to the product to increase the solubility of the fat-soluble vitamins and make them water miscible. We must realize that there is no data for Duodenal Switch patients and very little data regarding these routes of absorption with vitamins specifically. If you are going to try these types of vitamins you should be extremely diligent in following your laboratory studies for vitamin levels with greater frequency until it is determined they are maintaining your blood levels.
Also, it should be noted that water miscible (dry) Vitamin A, D, E, K are the only type of these vitamins a DS patients should be taking. Over the counter Vitamin A, D, E, K are fat-soluble and due to the fat malabsorption after DS these type of vitamins are not appropriate to maintain blood levels. Water miscible (dry) vitamins should NOT be taken with fatty or oily foods and should also be taken 30 minutes prior or 30 minutes after eating. The water miscibility makes them water soluble and therefore will not have optimal absorption if taken with fat. Fat also increases the rate of digestion through the small bowel after DS and decreases the amount of time the vitamin has in the bowel and therefore, decreases absorption. They are best absorbed when taken on their own.
The good news patches and spray routes of administering medications and supplements is an up and coming area of research. There are several ongoing research studies and new developments on the horizon for increasing absorbability of transdermal route with different types of additives and techniques.
Injectable Vitamin D Information and Research Articles
July 11, 2014 1:06 am
Injectable Vitamin D may be needed in some cases of Vitamin D deficiency or inability to increase Vitamin D level with oral supplements. Vitamin D is a fat soluble vitamin. It plays an important role in bone metabolism and structure. It has also been found to affect the immune regulation, control off- inflammatory reactions, and also be involved in a number of broad cellular functions throughout the body. Until a few years ago, very little attention was given to vitamin D levels. More recently, we have realized that due to a number of factors, there is a tendency for vitamin D deficiency to be present in the U.S. adult population. This finding is even more pronounced and severe in overweight patients.
The recommended dose for vitamin D supplements is much larger today than it was a few years ago. For example, it is not too uncommon to recommend an average dose of a 50,000 (IU) international unit of vitamin D by mouth on a daily basis after the duodenal switch operation.
Since vitamin D is a fat soluble vitamin, it is important that the appropriate type be utilized. Dry formulation of vitamin D is needed to ensure adequate absorption. There are a number of manufacturers that produce these. When searching for Dry Vitamin D the type a patient should be looking for is “Dry” D3-50. Some larger supplement manufacturer’s carry these products. The links to these manufacturers is located here. The “Dry” type of Vitamin D should NOT be taken with fatty or oily foods. Also to optimizes absorption they should be taken either 30 minutes prior to eating food or 30 minutes after eating.
If you are deficient in Vitamin D after trying “Dry” or water miscible Vitamin D then intramuscular Vitamin D injections might be an effective way to normalize your Vitamin D levels. Vitamin D can be formulated and purchased from any compounding pharmacies that are equipped and experienced in the interpretation of injectable vitamins and minerals. Your primary care WILL need to contact the compounding pharmacy of their choose for the recommendations and be willing to make the injections available to you. UNLESS you have been told to stop taking your daily “Dry” Vitamin D tablet supplement you should continue taking it after the injection.
We are supplying the following so that your PCP will understand the research behind injectable Vitamin D and to hopefully ensure that every patient is armed with this knowledge. Vitamin D deficiencies are becoming more common place in society due to the use of sunscreen and sun shielding clothing and hats, not only Duodenal Switch patients.
This is a research paper out of Finland that discusses injectable Vitamin D for the aged. The information can translate to anyone who finds themselves in a Vitamin D deficit state. https://www.gwern.net/docs/nootropics/1992-heikinheimo.pdf
This research paper is out of Australia where despite then sun drenched climate they are experiencing a large amount of people with Vitamin D deficiencies due to sunscreen, veiling, malabsorption, etc.
https://www.direct-ms.org/pdf/VitDGenScience/Vit%20D%20deficiency%20Australia%20art%20and%20ed.pdf
Below find the order sheet with the Injectable Vitamin D concentration listed. 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.
Finally, this is an except from an another Australian research paper describing the use of Megadoses of injectable Vitamin D in patients after Biliopancreatic Diversion which has a malabsorptive component similar to Duodenal Switch.
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 |
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.
Vitamin D supplements
August 01, 2011 1:12 am