Expert: Jacqueline Jacques, ND - 1/2/2009

Question
I am 1 year post-op from gastric bypass surgery. I am 5'4 and on my surgery date I weighed 245. I am happy to say I have lost 110 pounds and everything has been going very well. My insurance ended a few weeks after surgery so I have only had one post-op check up since surgery. I now have health insurance and my question is, what tests should I ask my regular doctor about (he's not the doctor that performed the surgery) I cannot go back to the doctor that performed the surgery because he is out of my insurance network. I assume I should have my vitamin and iron levels checked, but what about any other tests? I have been taking all the vitamin supplements since surgery. I still experience "dumping" but I can pretty much identify what foods will cause it. Although I have experienced several severe episodes in which I have passed out. I know that anything high in sugar or carbs will cause me to "dump" so I really watch the sugar and carb content in foods. Another behavior I have noticed since the surgery is that I usually eat normally for 2-3 days and then I go for 2-3 days where I can't eat anything, like I'm so full of eating for 2 days I can't stand the thought or sight of food. This has gone on since the day of surgery. I still have to force myself to eat on those days. Any advice will be greatly appreciated thank you.

Answer
Dear Darlene,

First - congratulations on your success!  At 5'4" and 135 pounds you must look and feel great!

I am really a nutrition expert, so I can give you very good advice on what nutrients you should have tracked. But here is what I would suggest in general:

1) Call your surgeon's office and tell them exactly what you have told me.  Tell them you do not need an appointment, but need them to fax you a list of annual labs that you can give to your PCP.  I can't imagine any surgeon saying no to this - they likely have a standard panel they order and can just give you the list of what is on it.  If they don't want to fax it to you - ask them to fax it straight to your regular doctor.

2) If for some reason they say no, when you call to make an appointment with your regular PCP, ask if they will request it for you.  Have them do this before your first appointment so you don't waste your time having to go back twice.

3) As to nutrients, they should at least look at an iron panel (ferritin, serum iron and TIBC), B12, folic acid, PTH and vitamin D (as 25-OH-D) every year.  There are other nutrients that can become abnormal, but these are most common.  Additionally, your standard lab panel will have electrolytes (potassium, calcium, etc) and should have a measurement of protein such as albumin.  That covers a lot.  There are many deficiencies that are much less common such as zinc, copper, B1 and B6 - and I would not suggest checking these yearly, but only if something is wrong and the rest of your labs are normal.  You should also talk to your doctor about a bone density test - I don't know your age, but you are currently at a very good weight for this to be done.  The test you want is a DEXA.

4) As to your appetite, it's a bit unusual, but this may just be where you settle out.  Often people find that their appetites tend to continue to change for the first couple of years after surgery.  What you don't want is to be come undernourised, which is the biggest risk (and a real risk) of not eating enough.  If you really are not hungry, I would suggest using a meal replacement shake on those days.  You want something that is nutritionally fortified - not just straight protein.  Bariatric Eating used to do a sample kit with a bunch of products you could try - that might be a good resource for you.  It's best not be be consuming below about 800 calories a day unsupervised.  Gastric bypass patients can often get by on less, but as a health professional, I cannot advise that.  Most meal replacements have 140 to 200 calories - so you can do them a few times a day and get the nourishment you need.  Look for something that is high in protein and low in sugar so you don't dump!

I hope this is helpful for you.  Please let me know if you need anything else.

Happy New Year!

In Health,

Dr. Jacques