Malnutrition and the sleeve

Via MacMadame -

When asked why they get a restrictive surgery, such as the sleeve, over a malabsorptive surgery such as RnY or a DS, many people point to the need to take vitamins and possible issues with malnutrition. Definitely, if you don't absorb everything you consume due to an intestinal bypass, your risks of problems caused by malnutrition go up. But that doesn't mean someone with a restrictive-only surgery has no chance of experiencing a problem brought on by not getting enough of certain nutrients.

In my own case, my issues have all been with protein.

My protein and albumin levels were adequate pre-op. Nothing to write home about, but at least within what is considered normal ranges. My protein was at 6.9 (the acceptable range is 6.4 to 8.2) and my albumin was 3.7 (3.2 to 4.7). I also had Vitamin D in the toilet at 32 (normal range is 45 to 100) and issues with calcium and potassium due to taking HCTZ for high blood pressure.

I have been able to solve my issues with calcium, potassium and Vitamin D by a combination of supplementation and getting off the HCTZ. But my protein levels have not been as cooperative.

Over the past 1.5 years, my albumin has ranged from a scary low of 2.9 to a "high" of 3.7. It seems to have settled into the 3.5-3.7 range at this point. And, yes, that is considered normal. But it's the low end of normal. I'd be happier to be in the middle of the range, especially if my protein is also at the lower end of normal.

Speaking of protein, mine dropped to 5.7 (!) at 7 weeks post-op, then climbed up to a whopping 6.1 at 3 months out and .... stayed there for over a year. This is while I was taking in 125 to 135 g of protein a day on average, I should note.

Also, I consume around 2000 calorie a day. So shouldn't I be getting pretty much all of the necessary nutrients from food? Yet my labs are good, but not fantastic. I am taking 2x the adult dose of a multivitamin every day and 1500 mg of calcium from supplements, 50,000 IU of Vitamin D3 every Monday, and .... my labs are okay. I had really hoped to cut down to 1000 mg of calcium a day and 1 multivitamin now that I'm eating the supposed daily average. But I don't see anything in my one year labs to justify dropping back on what I take.

The thing is: our bodies are made up of complex systems that interact on every level. You can't cut out part of an organ and not expect there to be consequences. With a smaller stomach, I now have less intrinsic factor than I used to and less stomach acid (especially since I'm on Prilosec). Also, my stomach empties slightly faster than normal. I also have much less ghrelin, aka the hunger hormone. While most of this is not going to cause big problems, it's not like it won't have any impact at all.

For me, having less ghrelin has been a blessing as has having less stomach acid. My GERD is mostly gone, easily controlled by taking a PPI, and my hunger is slightly under normal levels. But it appears that having a smaller stomach and faster stomach emptying means that I am not absorbing as many nutrients out of my food as I was pre-op, probably because the food is not as broken down when it hits my still intact intestines. 

That means I have to keep taking all my supplements and it also means I have to be extra careful about my protein intake.

So, it's not just those with RnY and DS who have to worry about their labs and their nutrition. We all do.