To D or Not to D, That Is the Question

World Wide Web | To D or Not to D, That Is the Question | What relevance are Vitamin D and Calcium following weight loss surgery?Vitamin D is absorbed in the first part of our gut (the ileum and the jejunum). It is a fat soluble vitamin and is stored in our body's fat cells.In the UK, it is estimated 25% of the population are vitamin D deficient (DoH 2012) and vitamin D is reportedly the most common vitamin deficiency of the northern hemisphere. Reduced hours of exposure to sunshine, covering our bodies and limited nutritional intake are all contributory factors.

Those who have a BMI of >40 would arguably have high stores of fat and, theoretically, more stored Vitamin D. Yet Aills et al 2008 found that between 60-70% of preoperative bariatric patients are deficient in Vitamin D.

Following weightloss surgery during the rapid weightloss phase. Vitamin D is released from the fat cells and levels reportedly rise by approximately 30% before stabilising.

What has calcium got to do with Vitamin D? It is a case of, 'you can't have one without the other', the nutritional Tom and Jerry, Fred and Ginger partnership.

Bone is a living tissue being absorbed and continually replaced and calcium is essential to this process. Without Vitamin D, calcium has little ability to be directed to the bone. Absorption of calcium is dependent on Vitamin D, and with inadequate absorption, the bone becomes soft, unable to repair and to regenerate itself. Diseases such as rickets and osteomalacia can result.

Loss of bone comes slowly, silently and without pain, leaving degenerative disease and potential increased risk of fractures. Long-term bone loss has been a significant concern following bariatric procedures. A recent epidemiological study (Rochester USA) indicates that seven years post malabsorptive surgery (e.g. gastric bypass) individuals are twice as likely to experience a fracture than the general population.

To simply 'take any old calcium tablets' is not ideal for WLS individuals as there will be issues of absorption. Stomach acid plays an essential part in the pathway of calcium absorption but for those with sleeve gastrectomy or gastric bypass, the stomach acid content is reduced by the surgery itself. 

Calcium citrate, however, does not require high gastric acidity for absorption. It is therefore the preferred option in such cases.

For some, flying south to Sardinian sunshine will certainly increase vitamin D stores and calcium intake will be satisfied with delicious local fresh foods. For weightloss surgery patients this, alone, will not be adequate and prescribed supplementation is key in disease prevention. It is essential to understand the importance and reasoning behind this, accepting that such levels of supplementation will be needed life long.

Vitamin D & Calcium Supplements 

Daily vitamin D and calcium supplements. Multivitamins, even those containing calcium citrate and vitamin D may not provide enough protection for bone health. Calcium citrate at 1500 mg/d (gastric banding), 1500-2000 mg (gastric bypass) and 2400 mg/d (after BPD/DS) combined with vitamin D3 are recommended in divided doses 3 - 4 times / day.

This should be additional to, not instead of, foods and drinks that are high in calcium.

Calcium supplements should not be taken at the same time as iron containing supplements as they will not be well absorbed - wait over 2 hours.Oral vitamin D supplementation if a deficiency is detected. Your doctor may prescribe 50,000 IU of vitamin D2 taken orally once a week for eight weeks.

Article Source: EzineArticles