Wednesday, December 10, 2008

Vitamin D Substitution after Roux-en-Y Gastric Bypass

Vitamin D 

Vitamin D

Earlier this week, I visited Drs. Jeffery Genaw and Arthur Carlin, bariatric surgeons, at the Henry Ford Hospital in Detroit, MI. I would not only like to thank them for their great hospitality and allowing us to see their new bariatric surgical unit but would also like to take the time to highlight a piece of recent research done by Carlin and colleagues, just published in SOARD.

As some readers of this blog may be aware, vitamin D (VidtD) depletion is a common finding (up to 60%) in patients with morbid obesity presenting for surgery. Currently, despite recommended daily supplementation with 800 IU VitD and 1500 mg calcium after Roux-en-Y gastric bypass (RYGB), VitD depletion persists in almost one half (44%) of patients.

Carlin and colleagues now performed a randomized controlled study in 60 VitD-depleted morbidly obese women who were given conventional supplementation or an additional 50,000 IU of VitD weekly after RYGB.

At 1 year after RYGB, only 14% in the high-dose VitD group showed VitD depletion compared to 85% in the regular dose group. The high-dose group also showed a significant 33% retardation in hip bone mineral density decline and a significantly greater resolution of hypertension (75% versus 32%).

No significant adverse effects were encountered from pharmacologic VitD therapy.

The authors conclude that 50,000 IU of VitD weekly after RYGB safely corrects VitD depletion in most women, attenuates cortical bone loss, and improves resolution of hypertension.

I am particularly intrigued by the observation that high-dose VitD improved hypertension, as failure of hypertension resolution after bypass surgery has been a puzzling finding of the SOS trial. Perhaps VitD status is the answer? Certainly an observation that warrants further study.

AMS
Baton Rouge, LA

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5 Responses to “Vitamin D Substitution after Roux-en-Y Gastric Bypass”

  1. Nana says:

    Thanks Arya,
    I will make sure our recommendations to patients are updated in light of this information. One of our graduate students in the Nutrition and Health Sciences program just finished a study in which high dose Vitamin D decreased blood pressure in patients with hypertension. Vitamin D treatment for hypertension is definitely showing some promise!
    nana

  2. Hanafy says:

    *Applause* This is an excellent posting of a study that is addressing a very important topic. Vitamin D and bone health issues in obesity and bariatric surgery have been addressed mostly by a relatively smaller number of physicians and surgeons who have particular interest in the area. It amazes me how many patients, who think that they are doing well after gastric bypass, are skipping on the vitamin D (and calcium) supplementation. Low vitamin D was, in another study, found to be an independant risk factor for hip fractures (http://www.annals.org/cgi/content/full/149/4/I-42). Thumbs up!

  3. g.a. says:

    question for Nana: what dose of Vitamin D did your grad student use to decrease blood pressure? I have some patients on the ABCD drugs for hypertension and still not well controlled and yes they have seen the nephrologist and had all tests done! Perhaps this is the missing answer. Were there any negative side effects to the treatment?

  4. Phyllis VanOverschelde says:

    My laproscopic roux-en-y surgery was Aug. 2004. After 2 yrs. I had lost 120#, but in the last 1 1/2yrs. I have gained back 45 #. I’m now counting calories again, after spending $30,00 for the surgery & am very discouraged. I’ve visited with several Dr’s-
    one said it was all in my head. I’m still on vitamins- B-6, B-12. Vit C, 2 sugar free multi-vitamins, vit E, magnesium, chromiun phosphate,6 Tums a day, & iron pills.
    Should I take vit-D or any other vitamins. Dr.’s around here just aren’t knowledgeable
    & my gastric by-pass surgeon only wants to deal with future patients & not long term follow-up patients. I’m having extreme problems with eating meats ( no beef), spicy, fried, no breads, etc. Mainly have to stick to a bland & soft diet. Any suggestions?

  5. Melissa Laws says:

    My mother had the Roux-en-Y Gastric Bypass about a 18 months ago. She has been very successful in her weightloss. Whe went from 390lbs to 170lbs. He vitamin D was extreamyl low though. The bariatric doctor that performed the surgery does not see her long term. Unfortuanely the regular doctors don’t know much about her situation. The lab doesn’t even know the proper way to draw her blood to check her values. Her memory is terrible and she doesn’t feel right. I think bariatric doctors need to keep seeing the patients yearly or regular doctors need to make it a point to educate themselves in the care of a bariatric patient. She has to take special vitamins she orders on line. I wonder if there is liquit vit. D or is she can get shots or something. Taking the special oral vitamins doesn’t seem to be working.

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