Jag kan säga så här; inget av nedanstående information gavs 2004, eller 2008 eller 2012 eller 2016. Det sades bara: “du måsta äta kalcium och b12, livet ut”.
The duodenal switch (DS) procedure, also known as biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.
The restrictive portion of the surgery involves removing approximately 70% of the stomach along the greater curvature.
The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common channel. The shorter of the two pathways, the digestive loop, takes food from the stomach to the common channel. The much longer pathway, the biliopancreatic loop, carries bile from the liver to the common channel.
The common channel is the portion of small intestine, usually 75-150 centimeters long, in which the contents of the digestive path mix with the bile from the biliopancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. As a result, following surgery, these patients only absorb approximately 20% of the fat they intake.
The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of the normal population, as do patients having the RNY surgery. Commonly prescribed supplements include a daily multivitamin, calcium citrate, and the fat-soluble vitamins A, D, E and K.
-Jättekonstigt eftersom jag själv aldrig fått recept på dessa ens.
DS patients require lifelong and extensive blood tests to check for deficiencies in life critical vitamins and minerals. Without proper follow up tests and lifetime supplementation DS patients can become ill. This follow-up care is non-optional and must continue for as long as the patient lives.
Finns ingen som ansvarar för detta förutom jag själv som inte ens får ut mina recept och gnäll när jag söker kontroll av övriga vitaminer och mineraler än B12, D och Järn.
Longer term risks include the possibility of vitamin and mineral deficiency, hernia and bowel obstruction. There is little information as to the longer-term risks (greater than 15 years), as this procedure was very rarely performed prior to the year 2000.
Malnutrition is an uncommon and preventable risk after duodenal switch.
-Uncommond kanske men det finns!
Vitamin deficiencies are a big risk due to the malabsorbtive nature of the surgery, especially Vitamin A, Vitamin D, Vitamin E, Vitamin K, Iron, Calcium and Protein. This is the reason that so many bariatric vitamins and other medications are essential for DS patients. 6 Complications related to malnutrition are a serious concern.
Vitamin D – crucial for the absorption of calcium and maintenance of healthy bones and teeth. The most common vitamin deficiency seen in DS patients. In spite of some patients’ commitment to taking their supplements, they still develop a deficiency. I treat deficiencies of Vitamin D with a highly absorbable form called cholecalciferol (Vitamin D3). Dairy products are excellent sources of vitamin D.
Vitamin A – important for vision, healing, and healthy skin and nails. Deficiencies can manifest as nightblindness, brittle/dry hair & nails or slowly healing cuts/wounds. Good sources of Vitamin A include yellow/orange vegetables as well as dairy products.
Vitamin E – is primarily an anti-oxidant in the body, and deficiency is uncommon. Vitamin E is critical to the body’s ability to deal with super-oxides which can damage the cells. Tomatoes, carrots, sardines, herring and spinach are healthy natural sources of Vitamin E.
Vitamin K – plays a critical role in blood clotting pathways. Deficiencies of vitamin K generally manifest as bruising easily or prolonged bleeding ( from the gums or small cuts). Good natural sources of Vitamin K are green leafy vegetables.
Zinc – important for immune function and fetal development. Deficiencies in Zinc are quite common in DS patients. Good sources include oysters, red meat and poultry. Cereals and breads can decrease the absorption of Zinc.
Iron – important in the formation of red-blood cells. Deficiency may result in anemia, fatigue and confusion. Good sources include soybeans, chicken liver, red meat, oysters and clams. Taking 500-1000 mg of vitamin C with the iron can increase absorption
Risks of the procedure
BPD/DS reduces the absorption of essential vitamins and minerals and can result in serious, long-term complications. People who have BPD/DS may develop anemia, osteoporosis, or kidney stones.
In addition, people who have undergone BPD/DS are at high risk for calcium and iron deficiencies, as well as deficiencies in vitamins A, D, E, and K, the so-called fat soluble vitamins.
Although rare, a thiamine deficiency resulting in a condition called beriberi can occur after BPD/DS surgery. Beriberi can permanently damage the nervous system if untreated.
Up to 18% of people with a BPD/DS surgery also develop some element of protein-energy malnutrition. When severe, this conditions is known as kwashiorkor, a severe and potentially life-threatening form of malnutrition.
If you have BPD/DS surgery, you will need to take vitamin and mineral supplements and have regular blood testing for the rest of your life in order to prevent severe vitamin deficiencies and related complications. Even if you take the supplements as prescribed, you still may develop nutritional problems and require treatment.
After the procedure
The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends that doctors prescribe these daily supplements after BPD/DS weight-loss surgery to help prevent nutritional deficiencies:
- Vitamin A, starting 2 to 4 weeks after surgery
- Vitamin D, starting 2 to 4 weeks after surgery
- Vitamin K, starting 2 to 4 weeks after surgery
- Multivitamin with 200% of the daily values, starting the first day after discharge from the hospital
- Minimum of 18 mg to 27 mg of iron, and up to 50 mg to 100 mg a day for menstruating women or adolescents at risk for anemia, starting the first day after discharge
- Calcium supplements, usually taken as 3 doses to 4 doses of 500 mg to 600 mg doses, starting on the first day after your discharge or within the first month after surgery. Note: Don’t take these at the same time as iron supplements; wait a couple of hours.
- Vitamin B12 supplements containing 350 mcg to 500 mcg; some people will need to give themselves B12 injections
- Optional B-complex vitamin
- Up to 3 servings of calcium-rich dairy beverages
The ASMBS also recommends that you eat small but nutritious meals that are high in protein, along with fruits, vegetables, whole grains, and omega-3 fatty acids. You should avoid meals high in sugar.
It’s important to understand that following a healthy lifestyle is critical to maintaining weight loss after surgery. This includes eating a healthy diet and getting plenty of regular exercise. And it requires a lifelong commitment. For these reasons, BPD/DS surgery should not be considered a quick fix to lose weight.