Posted on May 10, 2011 in Gastric Bypass Surgery, Lap Band, Pregnancy, nutritional suppiements
Pregnancy after Weight Loss Surgery
Infertility is a common problem in morbidly obese patients due to the fat cells destroying the female hormone, estrogen. Infertility can also be an indication for weight loss surgery in couples who wish to have children. However, patients who have had a gastric bypass for weight loss should not become pregnant for at least 18 months after surgery due to the risk of damage to the unborn baby from inadequate nutrition. The loop of intestine used to bypass the distal stomach (ROUX limb) does not absorb nutrients the first 12-14 months. By 18 months the bowel thickens and undergoes changes which allow it to begin re-absorbing nutrients which can be vital to a growing fetus.
While morbidly obese women have an increased risk of infertility, miscarriages and birth defects, this risk reverts to normal with significant weight loss. A large study from California followed over 150 women who became pregnant after gastric bypass and there was no increased incidence of problems as long as they waited 18 months after surgery.
Vitamins and especially FOLATE are critical to the formation of nerve tissue such as the brain in a fetus, therefore it is important any women considering pregnancy should be diligent about taking their vitamins and have their folate, iron and B-12 level checked before they become pregnant.
All post-op female patients should utilize birth control for the 18 month period even if they have experienced infertility and been told “you can’t have children”. Several of our patients have become pregnant prior to the 18 month safe period and our policy is to inform them they are at extremely high risk of having a child with significant birth defects and we urge them to consider a therapeutic abortion out of medical necessity.
Pregnancy is possible at an earlier time if patients undergo a VBG or Lap-band, but adequate vitamin levels and supplements are equally important. The pregnancy will interrupt the weight loss process and therefore it is best to wait at least one year after these two procedures.
Posted on May 3, 2011 in Nutrition, Post Op Diet, Vitamins and Supplements, Weight loss Support Group, nutritional suppiements
ATLANTA BARIATRIC SUPPORT GROUP
J K CHAMPION MD
POST-OP NUTRITIONAL SUPPLEMENTS AND MONITORING
Problems with nutrition or malnutrition can develop after surgery for morbid obesity. The absorption or intake of vitamins, minerals, and nutrients may be reduced enough to adversely effect your health. These problems can usually be corrected with supplements if detected early. This is why we emphasize periodic nutritional monitoring with blood tests for life, so deficiencies can be addressed. Occasionally (1/200) nutritional problems fail to respond to supplements and a reversal of weight loss surgery is indicated, although there is increased operative risk with subsequent surgery.
The purpose of this newsletter is to emphasize the importance of taking vitamin and calcium supplements after surgery and having routinely yearly blood monitoring by our office to try and avoid complications. We are seeing a lot of patients not taking supplements and refusing to keep follow-up appointments, or be monitored by their local physician, despite everyone signing a contract to comply. Permanent irreversible damage to your health, or even death can result from failure to follow post-op instructions.
Lets review our recommendations for nutritional supplements and monitoring:
Vitamins:
Vitamins are organic chemicals needed in small amounts to assist in normal metabolism that cannot be manufactured in the body. They must come from outside. They assist our body to function normally and severe irreversible damage can occur from deficiencies
Examples
B vitamins; thiamine B1, riboflavin B2, niacin B3, pyridoxine B6, cobalamin B12
These are needed for metabolism and effect cardiovascular and nervous system function. Deficiences can cause permanent nerve damage, which is irreversible, anemia, cardiovascular disease and heart failure, and birth defects in pregnant women.
Folic acid; needed to form genes and promote growth
Vitamin C; antioxidant
Vitamin A; important in vision and skin, also antioxidant
Vitamin D; needed for calcium absorption
Vitamin E; antioxidant and important for fertility and muscle function
Minerals:
Minerals are non-organic chemicals we need to function normally
Examples:
Iron; required to form red blood cells which transport oxygen in our body
Calcium; for bone formation and chemical messenger in heart and nerve tissue. Deficiencies cause osteoporosis
Phosphorus; important for cell activity as energy source
Magnesium; required to assist other proteins to work
These vitamins and minerals can be obtained in a good multivitamin with iron such as the Flintstones chewable we provided in the office. Other examples of good vitamins include one-a-day, Centrum, Theragram. All should include additional iron. Calcium supplements are required with 1000 mg per day. Examples are 3 Tums, os-cal , caltrate, and viactiv. These may include additional vitamin D to aide absorption.
The problems we usually encounter after weight loss surgery are with B vitamins, iron and calcium deficiencies. We monitor a complete blood count (CBC), comprehensive chemistry, iron and B12 level at 6 months, 12 months and then yearly to assess nutritional needs and make adjustments to maintain good health.
DO NOT FAIL TO TAKE YOUR SUPPLEMENTS AND BE MONITORED ON A YEARLY BASIS, OR PERMANENT IRREVERSIBLE DAMAGE COULD OCCUR!
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