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The stomach which is reduced through surgery absorbs less vitamins and minerals with less food. Supplementation is essential.
DEAR MAYO CLINIC: I had bariatric surgery 3.5 years ago and am doing well. I have been faithful in going to my follow-up appointments and take 200 milligrams of calcium with vitamin D daily. I broke my foot six months ago, and it hasn’t healed. What can I do to build back my bones?
ANSWER: Your situation is not uncommon after bariatric (weight-loss) surgery. Some investigation is necessary to determine why your foot hasn’t healed and to decide how best to treat the underlying cause. Perhaps you’re not getting enough vitamins and minerals to keep your bones strong. Other factors, however, also should be considered.
Bariatric surgery limits the amount of food a person can eat and digest. Three and one-half years ago, the most common bariatric operations were gastric banding (lap banding) and gastric bypass (Roux-en-Y). The kind of procedure you had is a factor in determining the amount of supplemental vitamins and minerals needed following surgery. Both types of surgery limit food intake, but only gastric bypass limits absorption of food, including vitamins and minerals.
During gastric banding, the surgeon places a band around the upper part of the stomach, creating a small gastric pouch to receive food. The band limits how much you can eat, and even a small amount of food leaves you feeling full.
In gastric bypass surgery, the surgeon creates a small pouch at the top of the stomach that’s sealed off from the rest of the stomach. The surgeon then connects the stomach pouch to the small intestine, which allows food to bypass most of the stomach and the first section of the small intestine. As a result, fewer calories are absorbed from the food ingested.
Gastric banding does not change the body’s ability to absorb vitamins and minerals. As a result, impaired bone healing is less likely to occur after that type of surgery. Gastric bypass surgery may affect your body’s ability to get enough calcium and vitamin D from food and from the supplements you’re taking to keep bones healthy.
In either case, first, you need a foot X-ray, which should help show why it isn’t healing. You may have a severe fracture that requires additional treatment to heal properly. Second, you should have a bone mineral density test to determine if you have bone loss or osteoporosis — a disease that makes bones thin and fragile, putting them at risk for fracture. Third, your physician should measure your calcium and vitamin D levels.
Calcium is important because it helps maintain strong bones. The richest sources of calcium are milk and dairy foods fortified with vitamin D. If dairy products cause diarrhea or other digestive problems after gastric bypass, calcium and vitamin D supplements can help ensure adequate intake.
You have to be careful what kind of calcium supplement you take, however. The most common supplement is calcium carbonate. To effectively be absorbed into the body, it must be broken down by stomach acid. After gastric bypass, what you eat doesn’t pass through as much stomach acid as usual during the digestion process. Most of that acid is made in the larger, bypassed part of the stomach. So you may not be absorbing as much calcium as you think. Instead, you may want to consider another type of calcium supplement, for example, calcium citrate, which can be absorbed even with reduced levels of stomach acid.
Vitamin D is important because it helps transport calcium from the gut into the bloodstream and then locks it into the bones, making them hard. Without enough vitamin D, bones won’t get adequate calcium.
Appropriately evaluating and treating a situation such as yours can be complicated. Your broken foot must be treated successfully. In addition, your physician must determine if underlying problems are increasing your risk of bone loss and bone fractures and must also ensure that you are getting needed vitamins and minerals.
To determine the appropriate treatment and follow-up care, I recommend you consult an endocrinologist or a physician-expert in nutrition who’s worked with bariatric surgery patients.
Detailed information about preventing bone loss and treating osteoporosis is available online from the National Osteoporosis Foundation (www.nof.org). — Daniel Hurley, M.D., Endocrinology, Mayo Clinic, Rochester, Minnesota
(Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To submit a question, write to: medicaledge@mayo.edu, or Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.)
Copyright © 2009, Tribune Media Services
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Health Benefits of Selenium
(THP) Selenium is an antioxidant (scavengers of free-radicals) and a component of several essential enzymes. Health benefits of selenium are partly explained by its antioxidant effect. Selenium may delay or prevent the onset of cancer and have anti-aging effects. Selenium is also an important mineral needed for proper thyroid function. Additionally, selenium also promotes a healthy immune system.
Selenium deficiency is associated with reduced immune cell counts and higher risk of death for HIV patients.
Selenium Toxicity
If selenium is consumed in overdose, it may have toxicity effects. The upper intake level recommended for selenium (by the Institute of Medicine of the National Academy of Sciences) is 45 micrograms for infants and 400 micrograms for adults.
Some of the symptoms of selenium toxicity are fatigue, hair loss, and white blotchy nails.
Natural Food Sources of Selenium
Natural food sources high in selenium include cereals (eg. corn, wheat, and rice), nuts (Brazilian nuts and walnuts), legumes (soybeans), animal products (beef, chicken, egg, cheese), and seafood (tuna). Other selenium rich foods are oats, cod and turkey. Brazilian nuts are among the very rich sources of selenium. In fact, it is advised to exercise caution with consumption of Brazilian nuts, as the selenium intake may reach a toxic level.
9 A Day Plus Vitamins are a natural source of selenium.
Nine A Day Plus is a multi-nutrient, all natural whole food vitamin supplement, that contains an excellent source of selenium. All the ingredients in 9 A Day Plus Vitamins are derived from natural organic food, which enables the body to assimilate a pure source of necessary nutrients for optimal function. To learn more click here>>
Table: List of foods high in selenium content.
Selenium food sources Selenium content (µg/ 100 g food)
Nuts, brazilnuts, dried, unblanched 1917.11
Nuts, mixed nuts, oil roasted, with peanuts, with salt added 421.16
Fish, roughy, orange, cooked, dry heat 88.35
Fish, tuna, light, canned in water, drained solids 80.35
Fish, tuna, light, canned in oil, drained solids 75.96
Wheat flour, whole-grain 70.67
Mollusks, oyster, eastern, cooked, breaded and fried 66.47
Fish, tuna, white, canned in water, drained solids 65.65
Mollusks, oyster, eastern, wild, raw 63.69
Fish, swordfish, cooked, dry heat 61.70
Fish, swordfish, cooked, dry heat 61.65
Chicken, broilers or fryers, giblets, cooked, simmered 59.59
Fish, herring, Atlantic, pickled 58.55
Fish, flatfish (flounder and sole species), cooked, dry heat 58.24
Fish, flatfish (flounder and sole species), cooked, dry heat 58.19
Braunschweiger (a liver sausage), pork 58.02
Turkey, all classes, giblets, cooked, simmered, some giblet fat 57.93
Fish, ocean perch, Atlantic, cooked, dry heat 55.53
Fish, sardine, Atlantic, canned in oil, drained solids with bone 52.67
Pork, fresh, leg (ham), whole, separable lean only, cooked, roasted 49.88
Bread stuffing, bread, dry mix, prepared 49.80
Mollusks, clam, mixed species, canned, drained solids 48.59
Fast foods, fish sandwich, with tartar sauce and cheese 48.42
Crustaceans, shrimp, mixed species, canned 47.50
Fish, tuna, yellowfin, fresh, cooked, dry heat 46.82
Fish, cod, Pacific, cooked, dry heat 46.82
Fish, halibut, Atlantic and Pacific, cooked, dry heat 46.82
Fish, rockfish, Pacific, mixed species, cooked, dry heat 46.82
Fish, halibut, Atlantic and Pacific, cooked, dry heat 46.79
Fish, rockfish, Pacific, mixed species, cooked, dry heat 46.78
Waffles, plain, prepared from recipe 46.27
Pork, fresh, leg (ham), whole, separable lean and fat, cooked, roasted 45.29
Oat bran, raw 45.21
Pork, fresh, loin, center loin (chops), bone-in, separable lean and fat, cooked, broiled 44.35
Fish, pollock, walleye, cooked, dry heat 43.41
Pork, fresh, loin, center rib (roasts), bone-in, separable lean only, cooked, roasted 43.18
Beef, cured, corned beef, canned 42.92
Crustaceans, lobster, northern, cooked, moist heat 42.71
Fast foods, shrimp, breaded and fried 41.71
Crustaceans, shrimp, mixed species, cooked, breaded and fried 41.65
Fish, tuna salad 41.22
Pork, fresh, loin, center rib (roasts), bone-in, separable lean and fat, cooked, roasted 41.06
Turkey, all classes, dark meat, cooked, roasted 40.95
Fish, haddock, cooked, dry heat 40.53
Fish, haddock, cooked, dry heat 40.47
Crustaceans, crab, blue, cooked, moist heat 40.24
Crustaceans, crab, alaska king, cooked, moist heat 40.00
Wheat flour, white, bread, enriched 39.71
Pork, fresh, loin, country-style ribs, separable lean and fat, cooked, braised 39.65
Pork, fresh, backribs, separable lean and fat, cooked, roasted 39.29
Pork, fresh, loin, center loin (chops), bone-in, separable lean and fat, cooked, pan-fried 39.06
Fish, cod, Atlantic, canned, solids and liquid 38.12
Fish, salmon, sockeye, cooked, dry heat 37.81
Fish, salmon, sockeye, cooked, dry heat 37.76
Barley, pearled, raw 37.70
Turkey, all classes, meat only, cooked, roasted 36.79
Turkey, all classes, neck, meat only, cooked, simmered 36.18
Wheat flour, white, all-purpose, self-rising, enriched 34.40
Wheat flour, white, all-purpose, enriched, bleached 33.92
Crustaceans, crab, blue, canned 31.78
Chicken, broilers or fryers, breast, meat and skin, cooked, fried, batter 28.00
Couscous, cooked 27.52
Macaroni, cooked, enriched 26.43
Spaghetti, cooked, enriched, without added salt 26.43
Spaghetti, whole-wheat, cooked 25.93
Chicken, stewing, meat only, cooked, stewed 25.21
Mushrooms, shiitake, cooked, without salt 24.83
Fast foods, english muffin, with egg, cheese, and canadian bacon 24.82
Rice, white, long-grain, parboiled, enriched, dry 23.89
Noodles, egg, cooked, enriched 23.88
Fast foods, submarine sandwich, with tuna salad 23.52
Duck, domesticated, meat only, cooked, roasted 22.40
Fast foods, chicken fillet sandwich, plain 22.20
Noodles, egg, spinach, cooked, enriched 21.81
Fast foods, cheeseburger, regular, double patty and bun, plain 21.31
Pie crust, standard-type, prepared from recipe, baked 21.11
Fast foods, hamburger, regular, double patty, with condiments 20.88
Fast foods, cheeseburger, regular, double patty, plain 20.71
Fast Foods, biscuit, with egg and sausage 19.00
Fast foods, chili con carne 17.39
Fast foods, cheeseburger, large, single patty, with condiments and vegetables 17.08
Sandwiches and burgers, cheeseburger, large, single meat patty, with bacon and condiments 16.92
Cheese, ricotta, part skim milk 16.71
Sandwiches and burgers, hamburger, large, single meat patty, with condiments and vegetables 15.41
Milk, canned, condensed, sweetened 14.80
Cheese, ricotta, whole milk 14.51
Fast foods, taco 13.69
Spaghetti with meat sauce, frozen entree 11.91
Data source:
USDA National Nutrient Database for Standard Reference, release 18.
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True Healthy Products, LLC
915 N Courtenay Parkway
Merritt Island, FL 32953
USA
Email: support@truehealthyproducts.com
Toll Free: 888-400-2920
Fax: 321-821-1310
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