Thursday, February 05, 2009

Bad Advice from Experts

I'm still seething - 3 days later - from such bad advice given by a so-called expert in the bariatric field. In fact, Dr. M was a favorite of mine. His knowledge about WLS, nutrition and how the body works has always been something I admired. He tends to ramble and get caught up on tangents when he speaks to a crowd... but his information is usually solid and trustworthy. But on Monday night he disappointed me greatly.
His discussion was centered around nutrition, supplements and common deficiencies after RNY. His chief complaint is that Americans tend to over-vitaminize themselves and that we should rely more on food sources for the nutrients we need for the body to function. Yes... that's a great idea in theory. A great idea for people with normal stomachs and normal digestive tracts and normal absorption. But when we have our guts rearranged, it's a totally different story for us.
Here are a few of his points that I disagreed with:
  • Iron -- "if you just eat some red meat, your iron should be fine."
  • Calcium -- "keep your Vitamin D levels up high enough and you don't need to worry about calcium."
  • Calcium -- "eeh... calcium carbonate, calcium citrate - who cares, it doesn't matter. Drink milk, you'll be fine."
  • Bypass Amount -- "only the first 3 feet of intestines are bypassed, you still have plenty of other space to absorb nutrients."

During his talk, I raised my hand and asked a question: "So are you saying we don't need to take calcium anymore?" His response was: "Yes, still take your calcium, but you don't need to worry about it so much if your Vitamin D is OK."

Shall I take each point and disect it based on what I know?

Iron -- I eat more red meat now, post-op, than I ever did before surgery. Before surgery I lived on grilled chicken breasts and fish for 2 solid years trying to lose weight. Only after surgery, and being bypassed, did I start to see a drop in my iron levels. I don't menstrate, so that's not my issue. My issue is that I'm not absorbing the iron nutrients from the food I eat because the point of absorption has been cut away and food does not pass that point anymore.

Calcium -- You all know that I preach about calcium. My mom is suffering from osteoporosis (5.5 years post-RNY) because she didn't take calcium and when she did, it was the wrong kind of calcium (carbonate). Her Vitamin D levels never showed deficient until just this past year. There are two spots in the small intestine where calcium is absorbed from food -- both spots are bypassed.

Calcium Citrate -- After RNY we have achlorhydria - no stomach acid - and it's a well documented fact that calcium carbonate requires high amounts of acid to even dissolve the pill. Calcium citrate is water soluble and easily dissolves in a pH neutral pouch (or even a glass of water that we can then drink if we can't take large pills). Obviously Dr. M doesn't think we need to worry about calcium either way ... but we all know (from my preaching) that we DO need calcium. And it's one of the most important supplements we need.

Bypass Amount & Nutrients from Food -- The typical bypass amount is 100-150cm which is about 3.3-feet to 5-feet. The duodenum is 1-foot long, the julunum is 8-feet long (and just for referencs sake, the ileun is 12-feet long and the large intestine is 5-feet long). So I know that my surgeon has a standard bypass amount of 150cm - or 5-feet and I believe all the other surgeons in the practice uses the same length of bypass. Dr. M works with these surgeons, so he should know this information, right? Basically all of the duodenum and half of the julunum is gone after RNY at my bariatric center.

Take a look at this diagram of the digestive tract. Each section of intestine has a very specific job of which nutrients are absorbed where -- once a section is bypassed, the rest of the intestinal tract can't grow back those absorption spots. These absorption spots indicate where the body would normally get nutrients from food. Since it can't get it from food any longer, we have to supply those specific vitamins and mineral in the form of supplements in order to give the body what it needs. There's no two ways about it... supplements are the only way we can get what we need because the body can't extract them from food.

I know all this to be true. So many of the patients in that presentation know all this to be true as well. I saw many, many post-ops looking at each other, shaking their heads and looking quizically at Dr. M throughout his presentation. Us old-timers knew he was off his rocker that night. I'm scared that the newbies will never get the right information ... especially when "experts" are giving such bad advice. It makes me sad. It makes me angry.


1 comment:

  1. I'm shocked! I thought Dr. M was the best after the things he said in my pre-admissions testing. Maybe not so now...


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