November 2004 Newsletter Gastric Bypass

FHN Complementary Medicine Monthly Newsletter November 2004

Gastric Bypass Nutrition

The advent of the gastric bypass surgery for the treatment of obesity has brought about a whole new series of nutritional dilemmas. We are not going into the pros and cons of the procedures, but look at the type of things that need to be done post surgically.

There are several types of bypass surgeries currently being done, we are going to concentrate on the Roux-en-Y gastric bypass, as that is the procedure currently being performed here in Freeport.

In the Roux-en-Y gastric bypass - A small pouch is created to restrict food intake, and a Y shaped section of the intestine is attached to the pouch to allow food to bypass part of the intestine, (the duodenum and part of the jejunum). The bypass reduces the amounts of calories and nutrients the body is able to absorb.

In approximately 30% of patients a form of anemia develops. There are, however, other nutritional deficiencies that we need to consider. So let’s look at the function of some the areas we bypassed.

The small intestine consists of the duodenum, jejunum and ileum. The majority of carbohydrate and protein absorption takes place in the duodenum and jejunum. Fats and fat soluble vitamins, however are absorbed in the ileum. Bile salts are excreted from the liver into the duodenum; these are required for the absorption of long chain fatty acids and fat soluble vitamins in the ileum. Vitamin B12 binds to intrinsic factor (produced in the stomach) and is also absorbed in the terminal ileum.

Stomach absorbs 20% of the alcohol ingested, as well as some short-chain fatty acids.

Duodenum absorbs Vitamins A and B1, iron, calcium, glycerol, fatty acids, monoglycerides, amino acids, monosaccharides, and disaccharides.

Jejunum absorbs glucose, galactose, amino acids, glycerol and fatty acids, nonoglycerides, diglycerides, dipeptides, copper, zinc, potassium, calcium, magnesium, phosphorus, iodine, iron, fat-soluble Vitamins D, E, and K, most of the B complex, Vitamin C, and the rest of the alcohol.

The best-studied mechanisms of absorption are clearly for calcium and iron, deficiencies.

Active, transcellular absorption occurs only in the duodenum when calcium intake has been low. This process involves import of calcium into the enterocyte, transport across the cell, and export into extracellular fluid and blood. Calcium enters the intestinal epithelial cells through voltage-insensitive channels and is pumped out of the cell via a calcium-ATPase. So when we have bypassed this area this method of absorbtion no longer is viable.

Passive, paracellular absorption occurs in the jejunum and ileum, and, to a much lesser extent, in the colon when dietary calcium levels have been moderate or high. In this case, ionized calcium diffuses through tight junctions into the blood. Such transport depends on having HIGHER concentrations of free calcium in the intestinal lumen than in blood.

Iron is absorbed in the proximal duodenum. Efficient absorption requires an acidic environment, and antacids or other conditions that interfere with gastric acid secretion can interfere with iron absorption. Iron absorption seems to be enhanced by adequate vitamin C intake.

So with this in mind what do you do:

Take a good multiple vitamin to increase nutrient density.

Increase calcium to levels that will allow passive transport with an easily ionizable calcium ( ie calcitrate, gluconate, lactate….not carbonate)

Increase vitamin C to 500 mg /day

B1 and B12 are not going to absorb well so consider a sublingual source.

Vitamin A can improve hematological indicators and enhance the efficacy of iron supplementation.

A good organic source of iron.

Acidopholus Bacteria as the digestive bacteria (involving billions of cells) residing in the intestinal tract are an important source for several water-soluble vitamins, being renewed every four days.

EPA 3 Fish oils

These are the minimums that need to be done. Individually there may be other areas that may need to be addressed.

Sincerely

Dr. Glenn and Julie Smith

Complementary Medicine