Monday, July 30, 2007

WLS and Low Carb and Bipolar

I've been getting some flack in some recent emails. Seems the people who I've heard from wish I would just pick a category(WLS, Low Carb or Mental Health) and stick with it. Either focus on one but not all.

Well I can't do that. I am a whole person ---I am all of this and then some. So you might see anything that strikes my fancy on here. I use nutrition in all of these areas of my life---so there will probably be bunches of stuff about that. I also like to crochet so I may post some pics of some of my favorite projects or throw a pattern or two your way. I love to travel so who knows what virtual destination I may talk about. I'm a research fanatic---so you may see some obscure piece of info I find.

I will continue to post on areas of interest for those who might read this----but mainly this blog is for me.

Sunday, July 29, 2007

Fat Soluble Vitamins---Vitamin D---Part IV

This is the last in our ongoing discussion concerning Vitamin D. We'll focus on the research as it pertains to WLS. Check out the earlier posts (Part I, II, III).

First we look at this research concerning Vitamin D deficiency in those people even BEFORE they have WLS. As I posted in Part II, obesity is a risk factor for deficiency.

Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery:

BACKGROUND: Abnormalities in calcium and vitamin D metabolism have been reported after bariatric surgery. The purpose of this study was to evaluate vitamin D nutritional status among morbidly obese patients before gastric bypass surgery.
METHODS: We prospectively studied 279 morbidly obese patients seeking gastric bypass surgery for vitamin D nutritional status as assessed by serum 25-hydroxyvitamin D level. In addition, serum samples were analyzed for calcium, alkaline phosphatase (AP), intact parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D.
RESULTS: Mean patient age was 43 +/- 9 years; 87% of the study patients were women, and 72% were white. Serum calcium and AP levels were normal in 88% and 89% of the patients, respectively. Vitamin D depletion, defined as serum 25-hydroxyvitamin D level < .001). Vitamin D depletion was significantly more prevalent in the African-American patients than in the white patients (91% vs 48%; P < .001).
CONCLUSIONS: Before gastric bypass surgery, a majority of morbidly obese patients have vitamin D depletion and secondary hyperparathyroidism. Studies evaluating the effects of gastric bypass on vitamin D metabolism must consider preoperative vitamin D nutritional status.
So....this means I was probably deficient in Vitamin D before I ever had my WLS. With the added problem of malabsorption after WLS, I am more than likely to still be deficient. So what risks am I taking by continuing to ignore the nutritional science available.

Effect of gastric bypass surgery on vitamin D nutritional status.

BACKGROUND: We previously reported a 60% prevalence of vitamin D (VitD) depletion, defined as a 25-hydroxyvitamin D (25-OHD) level of < or ="20">
METHODS: We prospectively studied 108 morbidly obese patients who had undergone GB. Routine postoperative supplementation consisted of 800 IU VitD and 1500 mg calcium daily. Serum calcium, parathyroid hormone, and 25-OHD were measured before and 1 year after GB.
RESULTS: The mean patient age was 46 +/- 9 years, 93% were women, and 72% were white. Preoperatively and at 1 year postoperatively, the prevalence of VitD depletion and hyperparathyroidism (HPT) and the mean 25-OHD level was 53% and 44%, 47% and 39%, and 20 and 24 ng/mL, respectively. One year after GB, the percentage of excess weight loss was 67% and demonstrated significant correlations both positively with 25-OHD and inversely with parathyroid hormone. At both intervals, blacks had a greater incidence of VitD depletion than did whites, and, at 1 year after GB, HPT was more common in patients with VitD depletion (55% versus 26%, P = .002).
CONCLUSION: With customary supplementation, VitD nutrition is improved after GB, but VitD depletion persists in almost one half of patients, and blacks are at a significantly greater risk than whites. HPT did not improve, and those with VitD depletion had a significantly greater rate of HPT. Additional prospective studies are needed to determine how to optimize VitD nutrition and avoid potential long-term skeletal complications after GB.

The majority of the research on WLS and Vitamin D, focuses on it's relation to calcium. So it looks at the effects on your bones. As pointed out in the previous posts, Vitamin D plays a part in many aspects of the human body. So don't forget that either.

Bone and Gastric Bypass Surgery: Effects of Dietary Calcium and Vitamin D

Objective:To examine bone mass and metabolism in women who had previously undergone Roux-en-Y gastric bypass (RYGB) and determine the effect of supplementation with calcium (Ca) and vitamin D.
Research Methods and Procedures: Bone mineral density and bone mineral content (BMC) were examined in 44 RYGB women (>=3 years post-surgery; 31% weight loss; BMI, 34 kg/m2) and compared with age- and weight-matched control (CNT) women (n = 65). In a separate analysis, RYGB women who presented with low bone mass (n = 13) were supplemented to a total 1.2 g Ca/d and 8 µg vitamin D/d over 6 months and compared with an unsupplemented CNT group (n = 13). Bone mass and turnover and serum parathyroid hormone (PTH) and 25-hydroxyvitamin D were measured.
Results:Bone mass did not differ between premenopausal RYGB and CNT women (42 ± 5 years), whereas postmenopausal RYGB women (55 ± 7 years) had higher bone mineral density and BMC at the lumbar spine and lower BMC at the femoral neck. Before and after dietary supplementation, bone mass was similar, and serum PTH and markers of bone resorption were higher (p>0.001) in RYGB compared with CNT women and did not change significantly after supplementation.
DISCUSSION: Postmenopausal RYGB women show evidence of secondary hyperparathyroidism, elevated bone resorption, and patterns of bone loss (reduced femoral neck and higher lumbar spine) similar to other subjects with hyperparathyroidism. Although a modest increase in Ca or vitamin D does not suppress PTH or bone resorption, it is possible that greater dietary supplementation may be beneficial.

Metabolic bone disease after gastric bypass surgery for obesity.

BACKGROUND: The popularity of gastric bypass surgery for treatment of morbid obesity has been increasing in recent years. Osteomalacia and osteoporosis are commonly observed in patients who have had partial gastric resections for treatment of peptic ulcer disease. Recently, we encountered four patients with previous gastric bypass surgery who had metabolic bone disease similar to that reported in the older literature in patients who had partial gastrectomies.
METHODS: Review of clinical data of four patients who developed osteomalacia and osteoporosis 9 to 12 years after gastric bypass surgery for morbid obesity.
RESULTS: All subjects were women, 43 to 58 years old. Three had Roux-en-Y gastric bypass, and the other had a biliopancreatic diversion 9 to 12 years prior to presentation. Weight loss averaged 41.8 kg. Patients reported fatigue, myalgias, and arthralgias. They had symptoms for many months or years before the correct diagnosis was established. All were osteopenic or osteoporotic with hypocalcemia, very low or undetectable 25-hydroxyvitamin D levels, secondary hyperparathyroidism, increased 1,25-dihydroxyvitamin D levels, and increased serum alkaline phosphatase. CONCLUSIONS: Relatively little has been published in the general medical literature about this postoperative complication of bariatric surgery. Yet, nearly all patients after bariatric surgery will receive their long-term follow-up from a primary care physician. Physicians and patients need to be aware of this complication and take measures to identify and prevent it.

As you can see many things can come about because of the malabsorption associated with WLS. Vitamin D is just one of the major players. So get your levels checked properly and take heed of these docs advice.

Remember what I said in Part II---I'd also like to stress that when taking a Vitamin D supplement, you must look at what kind it is. D3 (cholecalciferol) is the preferred form. Vitamin D found in multivitamins and calcium/vitamin D combinations is D2(ergocalciferol) and useless. It is also more associated with Vitamin D toxicity. But as I pointed out in the Part I of this series, Vitamin D must be taken in an oiled base formula NOT pills.

This ends it for Vitamin D. Hope you take the info and use it. It is just too important not to listen to the science. Look for more posts coming about vitamins.

Fat Soluble Vitamins---Vitamin D---Part III

I have been focusing mainly on the WLS aspects of these posts on vitamin D (Part I, Part II). Now I want to address it from a mental health point of view.

Part of my "Wellness Toolbox", includes spending at least 30 minutes a day outside. Without the sunscreen, I might add. It is essential for my overall health.More important is the connection to what it can do for my mental health. The Vitamin D Council has a paper that addresses this: Vitamin D and Mental Illness

Does Vitamin D Affect The Brain?

Vitamin D rapidly increases the in‑vitro genetic expression of tyrosine hydroxylase (the rate‑limiting enzyme for the catecholamine biosynthesis) by threefold.

Summer sunlight increases brain serotonin levels twice as much as winter sunlight, a finding compatible with both bright light in the visible spectrum and vitamin D affecting mood.

Vitamin D is widely involved in brain function with nuclear receptors for vitamin D localized in neurons and glial cells. Genes encoding the enzymes involved in the metabolism of vitamin D are expressed in brain cells. The reported biological effects of vitamin D in the nervous system include the biosynthesis of neurotrophic factors, inhibition of the synthesis of inducible nitric oxide synthase and increased glutathione levels, suggesting a role for the hormone in brain detoxification pathways.

Evidence suggests that vitamin D may help mood but that evidence is not conclusive. (Remember, the way our medical literature system works, scientists often do not publish negative studies). The two positive studies above used vitamin D to treat seasonal affective disorder, not major depression. We were unable to find any studies in the literature in which patients with depression were treated with enough natural sunlight, artificial sunlight or plain old cholecalciferol to raise their levels to 35 ng/mL or higher. We all know how we feel after a week at the beach, but is that bright light, vitamin D, or something else?

Evidence exists that major depression is associated with low vitamin D levels and that depression has increased in the last century as vitamin D levels have surely fallen. Evidence exists that depression is associated with heart disease, hypertension, diabetes, rheumatoid arthritis, cancer and low bone mineral density, all illnesses thought to be caused, in part, by vitamin D deficiency. Finally, vitamin D has profound effects on the brain including the neurotransmitters involved in major depression.

Further Research Needed

Therefore, vitamin D may help major depression. It is too early to say. To know for sure, patients with severe major depression would have to have baseline 25(OH)D blood levels, be treated with doses of vitamin D adequate to raise their levels to at least 35 ng/mL for several months and be compared to a normal control group treated with placebo. No one has ever published such a study.

However, it is not to early to heed the following advice: If you suffer from depression, get your 25(OH)D level checked and, if it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment. If you are not depressed, get your 25(OH)D level checked anyway. If it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment.

To learn more about increasing rates of mental illness over the last 2.5 centuries I recommend the incredible book, The Invisible Plague: The Rise Of Mental Illness From 1750 To The Present, by E. Fuller Torrey—the scientist the Washington Post called "the most famous psychiatrist in America."

I have extreme difficulty with depression from around September until April. This is otherwise know as Seasonal Affective Disorder (SAD). I was prescribed "light therapy". It's this extremely expensive piece of equipment, measuring about 10"x13". It's the same concept behind a tanning bed.

Is depression associated with other conditions thought to be associated with vitamin D deficiency, such as heart disease, diabetes, hypertension, rheumatoid arthritis, cancer, or osteoporosis? For example, there is a strong association between heart disease and depression, and countless theories to explain it. The obvious one—that heart disease would cause anyone to get depressed—is incorrect. You see, depression often precedes the heart disease, suggesting a third factor causes both. Moreover, if depression were associated with heart disease, one would expect excess unexplained mortality in major depression, which is a well‑established finding.

Remember that association does not mean causation. If A is associated with B, then A could cause B, B could cause A, or a third factor(s), C, could cause both A and B. Therefore, if heart disease is associated with depression then the possibilities are depression caused the heart disease, heart disease caused the depression, or an unknown factor(s), perhaps vitamin D deficiency, caused some portion of both the depression and the heart disease. "Perhaps" being the key word. Remember, most of the serious errors in psychiatry (and medicine) are made when associations are confused with causation; or when subsequence is confused with consequence.

It is clearly a case of which came first, the chicken or the egg. It does you cause to want to look more closely at the available research. Well, it makes ME want to look more closely. Not everyone is as anal as I can be.

You can look anywhere online a find many opinions associated with the psych field. Some really blast the whole need for medications at all. They believe in using only a natural approach or don't believe in psychiatry to begin with. Then ther is the other end of the spectrum. Those who rely solely on their meds and firmly believe in them. I'm kinda in the middle. While I do rely on meds for my Bipolar Disorder, I firmly believe that the nutritional control of it plays a major role. As well as having therapy. I use a multifaceted approach, diet, exercise, meds, therapy, journaling, and connecting with others who have been through it.

The final post on Vitamin D will be focused solely on the research found as it pertains to WLS. So stay tuned for that.

Saturday, July 28, 2007

Fat Soluble Vitamins---Vitamin D---Part II

Let's get back to talking about vitamins, now that my rant is over.

I'm gonna focus on just how to make sure you get enough vitamin D. The best way for you to get vitamin D---Sunlight---Bet you're thinking--hey that's easy---just take a walk outside. You would think so wouldn't you. Let's find out shall we. This is from the Vitamin D Council:

Block the Sun, Block Vitamin D

Remember, our ancestors lived naked in the sun for several million years. Then 50,000 years ago, some of us migrated north and south to places with less sun. Then we put on clothes, started working inside and living in cities where buildings blocked the sun. Then we started traveling in cars instead of walking or riding horses and glass blocked even more of the UVB in the sunlight. Then, only a few years ago, we started actively avoiding the sun and putting on sunblock. All this time we humans have been steadily reducing the tissue levels of the most potent steroid hormone in our bodies, one with powerful anti-cancer properties.

The really significant reductions in sunlight exposure have occurred since the industrial revolution, just the time the "diseases of civilization," like cardiovascular disease, diabetes and cancer, seem to have greatly increased. Pretty frightening when you think about it.

Then we have this from the Linus Pauling Institute:

Sunlight exposure provides most people with their entire vitamin D requirement. Children and young adults who spend a short time outside two or three times a week will generally synthesize all the vitamin D they need. The elderly have diminished capacity to synthesize vitamin D from sunlight exposure and frequently use sunscreen or protective clothing in order to prevent skin cancer and sun damage. The application of sunscreen with an SPF factor of 8 reduces production of vitamin D by 95%. In latitudes around 40 degrees north or 40 degrees south (Boston is 42 degrees north), there is insufficient UVB radiation available for vitamin D synthesis from November to early March. Ten degrees farther north or south (Edmonton, Canada) this “vitamin D winter” extends from mid October to mid March. According to Dr. Michael Holick, as little as 5-10 minutes of sun exposure on arms and legs or face and arms three times weekly between 11:00 am and 2:00 pm during the spring, summer, and fall at 42 degrees latitude should provide a light-skinned individual with adequate vitamin D and allow for storage of any excess for use during the winter with minimal risk of skin damage.
My point here is sunlight is good for you--but you have to be EXPOSED to the UVB to do any good. How many of y'all out there wear sunscreen? Well I do. Simply because many of the psych meds I take make you photosensitive.
So that means I'm not being exposed to the UVB as I should be. Which in turn means I'm not making enough Vitamin D. Which then means I need a supplement. But having had WLS, I don't absorb Vitamin D very well. Sheesh, my head is spinning just from typing all that. So now what am I suppose to do?

You can get Vitamin D from the food you eat.

Vitamin D is found naturally in very few foods. Foods containing vitamin D include some fatty fish (mackerel, salmon, sardines), fish liver oils, and eggs from hens that have been fed vitamin D. In the U.S., milk and infant formula are fortified with vitamin D so that they contain 400 IU (10 mcg) per quart. However, other dairy products such as cheese and yogurt are not always fortified with vitamin D. Some cereals and breads are also fortified with vitamin D. Recently, orange juice fortified with vitamin D has been made available in the U.S. Accurate estimates of average dietary intakes of vitamin D are difficult because of the high variability of the vitamin D content of fortified foods. Vitamin D contents of some vitamin D-rich foods are listed in the table below in both international units (IU) and micrograms (mcg). For more information on the nutrient content of foods you eat frequently, search the USDA food composition database.

Food Serving Vitamin D (IU) Vitamin D (mcg)
Pink salmon, canned 3 ounces 530 13.3
Sardines, canned 3 ounces 231 5.8
Mackerel, canned 3 ounces 214 5.4
Quaker Nutrition for Women Instant Oatmeal 1 packet 140 3.5
Cow's milk, fortified with vitamin D 8 ounces 100 2.5
Orange juice, fortified with vitamin D 8 ounces 100 2.5
Cereal, fortified 1 serving (usually 1 cup) 40-50 1.0-1.3
Egg yolk 1 medium 25 0.63

Y'all already know I live a low carb life so I recommend the fish, fish oils or eggs. You don't need all that fortified food---in my opinion. But there is no way to get all the Vitamin D you need just from food. Dr Davis from the HeartScan blog has this to say.

You'll note that the only naturally-occurring food sources of vitamin D are the modest quantities in fish, egg yolks, and liver. All the other vitamin D-containing foods like cereal, milk, and other dairy products have vitamin D only because humans add it.

It takes me (personally) 6000 units of vitamin D per day to bring my blood level to an acceptable 50 ng/ml. To obtain this from eating salmon, I would have to eat 58 ounces, or 3 1/2 pounds of salmon--every day. Or, I could eat 30 cans of tuna fish.

If I didn't want to eat loads of fish every day, I could drink 60 glasses of milk every day. After I recovered from the diarrhea, my vitamin D might be adequate, provided the milk indeed contained the amount stated on the label (which it often does not when scrutinized by the USDA).
If vitamin D is a vitamin, how are humans supposed to get sufficient quantities? I don't know anybody who can eat 3 1/2 lbs of salmon per day, nor drink 60 glasses of milk per day. But aren't vitamins supposed to come from food?

The problem is that vitamin D is not really a vitamin, it's a hormone. If your thyroid hormone level was low, you'd gain 20, 30, or more pounds in weight, your blood pressure would skyrocket, you'd lose your hair, become constipated, develop blood clots, be terribly fatigued. In other words, you'd suffer profound changes. Likewise, if thyroid hormone levels are corrected by giving you thyroid hormone, you'd experience profound correction of these phenomena.

That's what I'm seeing with vitamin D: restoration of this hormone to normal blood levels (25-OH-vitamin D3 50 ng/ml) yields profound changes in the body.
There are many risk factors that contribute to Vitamin D deficiency. Having WLS is just one of them.
  • Exclusively breast fed infants: Infants who are exclusively breast fed and do not receive vitamin D supplementation are at high risk of vitamin D deficiency, particularly if they have dark skin and/or receive little sun exposure. Human milk generally provides 25 IU of vitamin D per liter, which is not enough for an infant if it is the sole source of vitamin D. Older infants and toddlers exclusively fed milk substitutes and weaning foods that are not vitamin D fortified are also at risk of vitamin D deficiency. The American Academy of Pediatrics recommends that all infants that are not consuming at least 500 ml (16 ounces) of vitamin D fortified formula or milk be given a vitamin D supplement of 200 IU/day.
  • Dark skin: People with dark skin synthesize less vitamin D on exposure to sunlight than those with light skin. The risk of vitamin D deficiency is particularly high in dark-skinned people who live far from the equator. In the U.S., 42% of African American women between 15 and 49 years of age were vitamin D deficient compared to 4% of White women.
  • Aging: The elderly have reduced capacity to synthesize vitamin D in the skin when exposed to UVB radiation, and are more likely to stay indoors or use sunscreen. Institutionalized adults are at extremely high risk of vitamin D deficiency without supplementation.
  • Covering all exposed skin or using sunscreen whenever outside: Osteomalacia has been documented in women who cover all of their skin whenever they are outside for religious or cultural reasons. The application of sunscreen with an SPF factor of 8 reduces production of vitamin D by 95% .
  • Fat malabsorption syndromes: Cystic fibrosis and cholestatic liver disease impair the absorption of dietary vitamin D. (add WLS here)
  • Inflammatory bowel disease: People with inflammatory bowel disease like Crohn’s disease appear to be at increased risk of vitamin D deficiency, especially those who have had small bowel resections.
  • Obesity: Obesity increases the risk of vitamin D deficiency. Once vitamin D is synthesized in the skin or ingested, it is deposited in body fat stores, making it less bioavailable to people with large stores of body fat.

So how do you know when you are taking enough. Vitamin D can go both ways. It can be bad if you get too little or too much. According to research Vitamin D toxicity is extremely rare, but deficiency is very common.

Growing awareness that vitamin D insufficiency has serious health consequences beyond rickets and osteomalacia highlights the need for accurate assessment of vitamin D nutritional status. Although there is general agreement that the serum 25(OH)D level is the best indicator of vitamin D deficiency and sufficiency, the cutoff values have not been clearly defined. While laboratory reference ranges for serum 25(OH)D levels are often based on average values from populations of healthy individuals, recent research suggests that health-based cutoff values aimed at preventing secondary hyperparathyroidism and bone loss should be considerably higher. In general, serum 25(OH)D values less than 20-25 nmol/L indicate severe deficiency associated with rickets and osteomalacia. Although 50 nmol/L has been suggested as the low end of the normal range, more recent research suggests that PTH levels and calcium absorption are not optimized until serum 25(OH)D levels reach approximately 80 nmol/L . Thus, at least one vitamin D expert has argued that serum 25(OH)D values less than 80 nmol/L should be considered deficient, while another suggests that a healthy serum 25(OH)D value is between 75 nmol/L and 125 nmol/L. Data from supplementation studies indicates that vitamin D intakes of at least 800-1,000 IU/day are required by adults living in temperate latitudes to achieve serum 25(OH)D levels of at least 80 nmol/L.
Vitamin D plays a major role in disease prevention. Which to me is the most important role of all. You can ward off so many things like Osteoporosis, Cancer of many types (Colorectal Cancer, Breast Cancer, Prostate Cancer), Autoimmune Diseases, and Hypertension (High Blood Pressure). It also plays a major role in the brain--which I will discuss in a future post.

I'd also like to stress that when taking a Vitamin D supplement, you must look at what kind it is. D3 (cholecalciferol) is the preferred form. Vitamin D found in multivitamins and calcium/vitamin D combinations is D2(ergocalciferol) and useless. It is also more associated with Vitamin D toxicity. But as I pointed out in the Part I of this series, Vitamin D must be taken in an oiled base formula NOT pills.

In closing, I want to again stress the importance of being proactive in your own health care. That goes for anyone. Most docs do not know or they just fail to do these essential blood levels.

Kimkins Saga---Revisited

As anyone knows in the low carb community, these past weeks have been a storm of controversy. It has taken time to come full circle. I was upset by much of the info being thrown around. My biggest problem was the unhealthy approach to weight loss the Kimkins supposedly "diet" represents. Very low calorie diets are just not healthy. Plus the constant equation to gastric bypass was a bone of contention with me too.

Another reason it upset me so, was the whole-hearted endorsement by Jimmy Moore. Someone who I greatly admired. When I first began doing great research on low carb eating, after my WLS. I looked to Jimmy's blog as a point of reference. I frequently posted links to important research found at his to the WLS forums I frequent. I was a daily reader of his blog. He spent a great amount of time and effort to get good positive info out about living a low carb life. I feel he let me and many others in the low carb community down with his insistence that Kimkins should be an option for people. After finally looking into the concerns of many in the low carb community, he has "seen the light". Check out his post for yourself.

Jimmy Moore's Livin' La Vida Low-Carb™ Blog: From The Bottom Of My Heart, I'm Sorry

As for the very low calorie diet pushed by Kimkins---it is just bad news. that is not a healthy way to approach weight loss. You screw up your entire body. Making it impossible to sustain any weight loss in the long run. Check out this post. Carol did really did her research and I'm all for that.

Kudos For Low Carb (And High Expectations): How Much Body Fat Can You Really Lose In A Week?

All this being said--I want to now address my WLS friends. I love each of you dearly, but I see so many of you caught up in the low calorie, low fat hype. The majority of you had this surgery to become healthier. Continuing to force your body to live on a very low calorie diet will only make sustained weight loss impossible. Take the time to read Carols enlightening post. Take the time to listen to the SCIENCE. Yes there is contradictory info out there. Yes you still have many who push the "carbs are essential" nonsense. You have to look at their motivation. As the saying goes---follow the money.

I see so many of you still spouting the "whole grain" is good for you ideas. We have enough time getting the proper nutrition due to our surgery without taking in food that can do nothing for our body but cause a rise in insulin. Which only leads to further hunger and need of more carbs. You would be much better off if you would add fat to your eating plan and give up the whole grains.

I know, many of you have a problem with dumping when you eat fatty foods. But what are you eating alone with it. My guess is the whole grains AKA fiber. Fiber is another thing the body really does not need. I've got a post coming up that will address this in further detail. Let's just say this---leave off the fiber and carbs and up your fat---especially saturated fat---and there will be no more dumping. Plus you will benefit from being able to absorb your vitamins more readily.

Well I'll get down off my soapbox now. This rant is over. I would like to say I hope the Kimkins saga will be history---but as long as the site still stands---the saga will continue. I'll continue to stand behind my fellow bloggers to get the real truth out there.

Friday, July 27, 2007

Some Good Reads

Once again I've come across some interesting things to read. You can never stop expanding your horizons.

ScienceDaily: Weight Gain or Weight Loss Can Affect Unborn Baby

Scientific review confirms superiority of carbohydrate control | Dr Briffa’s Blog

Gaining Weight? Blame Your Friends - World of Psychology

Junkfood Science: Oh what a tangled web we weave — Sir Walter Scott (1771-1832)
Talks about the same study as the post above, but from an entirely different perspective---good read always from Junkfood Science.

Diabetes Update: Type 2s: Understanding False Hypos
This is the best blog out there about diabetes---check it out.

ScienceDaily: Antibiotic Resistance: Doctors' Antibiotic Prescribing Practices Still Contributing To Problem

Psychology Today: The Decline and Fall of the Private Self

Once upon a time, people kept secrets. Today's tell-all bloggers and MySpace denizens have made the notion of a guarded personal life feel obsolete. What effect does such exposure have on the psyche?

Psychology Today: Seven Deadly Sentiments
Evolutionary psychology helps us understand why we are ashamed of having forbidden thoughts that make us feel like lousy people. It tells us that these shameful feelings are hardwired—strategies that led to success on the Pleistocene savanna.

I'll keep scouring the net for some more tidbits of info to share.

Have a good day everyone.....

Thursday, July 26, 2007

Fat Soluble Vitamins---Vitamin D---Part I

This is one of the most forgotten and most important of the vitamins I've been researching. Fair warning---this will end up being multiple posts. I have found too many things to share, to try and put it all in one post.

Vitamins A, D, E and K are all classified as fat soluble vitamins - since they are soluble in fat and are absorbed by the body from the intestinal tract. They follow the same path of absorption as fat and any condition interfering with the absorption of fats would result in poor absorption of these vitamins as well. This class of vitamin can be stored in the body to some extent, mostly in the liver, and because of this, short term deficiencies are less likely to manifest themselves slower than the water-soluble vitamins.

Vitamin D is another one of the many deficiencies seen after WLS. Many post-ops just take this supplement combined in their calcium. Is that enough? Or better yet, is it the correct type? In doing this research, I've found that most of these supplements come in varying forms. It DOES matter which form you take. I'm not talking about pills vs liquids here. I'm talking about the variety of different types of the same vitamin.

First I'll give the role of Vitamin D in the body. Then we'll see how it applies to WLS.

Vitamin D is a fat-soluble vitamin that is essential for maintaining normal calcium metabolism. Vitamin D3 (cholecalciferol) can be synthesized by humans in the skin upon exposure to ultraviolet-B (UVB) radiation from sunlight, or it can be obtained from the diet. Plants synthesize vitamin D2 (ergocalciferol), which also has vitamin D activity in humans. When exposure to UVB radiation is insufficient for the synthesis of adequate amounts of vitamin D3 in the skin, adequate intake of vitamin D from the diet is essential for health.

Vitamin D has many functions in the body, Calcium Balance, Cell Differentiation, Immunity, Insulin Secretion, and Blood Pressure Regulation. It has to ACTIVATED first to do anything.

Vitamin D itself is biologically inactive, and it must be metabolized to its biologically active forms. After it is consumed in the diet or synthesized in the skin, vitamin D enters the circulation and is transported to the liver. In the liver, vitamin D is hydroxylated to form 25-hydroxyvitamin D [25(OH)D], the major circulating form of vitamin D. Increased exposure to sunlight or increased intake of vitamin D increases serum levels of 25(OH)D, making the serum 25(OH)D concentration a useful indicator of vitamin D nutritional status. In the kidney and other tissues, the 25(OH)D3-1-hydroxylase enzyme catalyzes a second hydroxylation of 25(OH)D, resulting in the formation of 1alpha,25-dihydroxyvitamin D [1,25(OH)2D]—the most potent form of vitamin D. Most of the physiological effects of vitamin D in the body are related to the activity of 1,25(OH)2D.

Your doc can check your levels. Be specific---you need (25-OH-vitamin D3) level done. While I'm at it---Vitamin D is not really a vitamin---it is a steroid hormone precursor. I found this info in an article on The Heart Scan Blog. John Cannell on Vitamin D

The active form of vitamin D is a steroid (actually a seco-steroid) in the same way that testosterone is a steroid and vitamin D is a hormone in the same way that growth hormone is a hormone. Steroid hormones are substances made from cholesterol, which circulate in the body, and work at distant sites by "setting in motion" genetic protein transcription. That is, both vitamin D and testosterone regulate your genome, the stuff of life. While testosterone is a sex steroid hormone, vitamin D is a pleomorphic (multiple function) steroid hormone.

Now that we have it activated in the body. What is the body gonna do with it? Why is it so important? Let's find out, shall we.

Calcium Balance

Maintenance of serum calcium levels within a narrow range is vital for normal functioning of the nervous system, as well as for bone growth, and maintenance of bone density. Vitamin D is essential for the efficient utilization of calcium by the body (1). The parathyroid glands sense serum calcium levels, and secrete parathyroid hormone (PTH) if calcium levels drop too low. Elevations in PTH increase the activity of 25(OH)D3-1-hydroxylase enzyme in the kidney, resulting in increased production of 1,25(OH)2D. Increasing 1,25(OH)2D production results in changes in gene expression that normalize serum calcium by 1) increasing the intestinal absorption of dietary calcium, 2) increasing the reabsorption of calcium filtered by the kidneys and 3) mobilizing calcium from bone when there is insufficient dietary calcium to maintain normal serum calcium levels. Parathyroid hormone and 1,25(OH)2D are required for the latter two effects

Now we know as post op WLSers, calcium absorption is a real biggy. It is SOP(standard operating procedure) for anyone having WLS to be on a calcium supplement twice a day for the rest of your our lives. Period. Not just any form of calcium either---it must be calcium citrate only, as I pointed out in this post here.
I'll discuss later how calcium and Vitamin D play such an important role in WLS.

Cell Differentiation

Cells that are dividing rapidly are said to be proliferating. Differentiation results in the specialization of cells for specific functions. In general, differentiation of cells leads to a decrease in proliferation. While cellular proliferation is essential for growth and wound healing, uncontrolled proliferation of cells with certain mutations may lead to diseases like cancer. The active form of vitamin D, 1,25(OH)2D, inhibits proliferation and stimulates the differentiation of cells.
In layman's terms it can help put a stop to cancer.


Vitamin D in the form of 1,25(OH)2D is a potent immune system modulator. The VDR is expressed by most cells of the immune system, including T cells and antigen-presenting cells, such as dendritic cells and macrophages (6). Macrophages also produce the 25(OH)D3-1-hydroxylase enzyme that converts 25(OH)D to 1,25(OH)2D (7). There is considerable scientific evidence that 1,25(OH)2D has a variety of effects on immune system function that may enhance innate immunity and inhibit the development of autoimmunity.
Here we have another example of a vitamin helping with the immune system. How many of you out there in WLSland stay sick about half the time? Are you getting enough of your vitamins???

Insulin Secretion

The VDR is expressed by insulin secreting cells of the pancreas, and the results of animal studies suggest that 1,25(OH)2D plays a role in insulin secretion under conditions of increased insulin demand (9). Limited data in humans suggests that insufficient vitamin D levels may have an adverse effect on insulin secretion and glucose tolerance in type 2 diabetes (noninsulin-dependent diabetes mellitus; NIDDM).
I don't worry too much about this from my personal standpoint. The low carb/ketogenic diet I follow helps me with my insulin resistance.

Blood Pressure Regulation

The renin-angiotensin system plays an important role in the regulation of blood pressure (13). Renin is an enzyme that catalyzes the cleavage (splitting) of a small peptide (Angiotensin I) from a larger protein (angiotensinogen) produced in the liver. Angiotensin converting enzyme (ACE) catalyzes the cleavage of angiotensin I to form angiotensin II, a peptide that can increase blood pressure by inducing the constriction of small arteries and increasing sodium and water retention. The rate of angiotensin II synthesis is dependent on renin (14). Recent research in mice lacking the gene encoding the VDR, indicates that 1,25(OH)2D decreases the expression of the gene encoding renin through its interaction with the VDR (15). Since inappropriate activation of the renin-angiotensin system is thought to play a role in some forms of human hypertension, adequate vitamin D levels may be important for decreasing the risk of high blood pressure.
In short, Vitamin D plays a round about role in helping keep your blood pressure under control. To quote Martha "it's a good thing".

To answer the questions I posed at the beginning of this post,no we probably don't get enough. Hey it's a fat soluble vitamin--we never get enough. Most people don't.

One Billion People Don't Get Enough Vitamin D

In the July 19 issue of the New England Journal of Medicine, Michael Holick, director of the General Clinical Research Center at Boston University School of Medicine and director of the Bone Healthcare Clinic at Boston Medical Center, published an overview of his work on vitamin D.

According to Holick, it has been estimated that one billion people in the world are vitamin D deficient or insufficient...

~ Washington Post

Also most of you just take your calcium/Vitamin D combo. First off most of these forms are the wrong type of calcium--calcium carbonate. Secondly, it is the wrong type of Vitamin D. Vitamin D Must Be Oil Based form. Tablets do not work. You can get Vitamin D from sunlight also.

Vitamin D, Sunshine, and Your Health

  • If you totally avoid the sun, recent research indicates you need about 4,000 units of vitamin D a day! Which means you can't get enough vitamin D from milk (unless you drink 40 glasses a day) or from a multivitamin (unless you take about 10 tablets a day), neither of which is recommended.
  • Most of us make about 20,000 units of vitamin D after about 20 minutes of summer sun. This is about 100 times more vitamin D than the government says you need every day.
  • The only way to be sure you have adequate levels of vitamin D in your blood is to regularly go into the sun, use a sun bed (avoiding sunburn), or have your physician administer a 25‑hydroxyvitamin D test. Optimal levels are around 50 ng/mL (125 nM/L).
  • If you don't get vitamin D the way Mother Nature intended, from sunshine, you need to take supplemental vitamin D3 cholecalciferol. Since most of us get a lot more vitamin D from sunshine than we realize, most of us need about 2,000 units a day extra.

Well that does it for today. There is still alot of info to go on Vitamin D alone---so stay tuned.

Wednesday, July 25, 2007

Urgent Action Alert: Sponsors Needed for the ADA Restoration Act

From: Bazelon Center for Mental Health Law

Support Needed Now to Restore ADA Rights

July 23, 2007--This Thursday, July 26, on the 17th anniversary of enactment of the Americans with Disabilities Act, House Majority Leader Steny Hoyer (D-MD) and Congressman James Sensenbrenner (R-WI) will introduce the ADA Restoration Act of 2007.

Court decisions have seriously eroded the rights of people with disabilities under the ADA, creating a Catch-22 that allows employers to say a person is "too disabled" to do the job but "not disabled enough" to be protected by the law.

People with conditions like mental illness, epilepsy, diabetes, HIV, cancer and hearing loss who manage their disabilities with medication, prosthetics, hearing aids, etc. - or "mitigating measures" - are viewed as "too functional" to have a disability and are denied the ADA's protection from employment discrimination.

People who are turned down for a job or fired because an employer mistakenly believes they cannot perform the job - or because the employer does not want "people like that" in the workplace - are also denied the ADA's protection from employment discrimination.

This Is Wrong!

Congress should correct this to ensure that the courts will interpret the ADA fairly, and as Congress intended.

Many voices are needed now to help Congressmen Hoyer and Sensenbrenner gather as many original co-sponsors as possible to show strength and support for this effort.

Please Act Now!

  • Call your Representative immediately at 202-224-3121 and ask him or her to become an original co-sponsor of the ADA Restoration Act of 2007. (You can also get a direct phone number at
  • Ask your Representative (or the staff member you speak to) to contact Representative Hoyer's (ext. 5-3130) or Sensenbrenner's (ext. 5-5101) office today to sign on as an original co-sponsor.
  • Forward this Action Alert to your network to get as many people as possible people to call their House member immediately with the same message.

What if you miss Thursday's deadline? Not to worry! Co-sponsors will still be needed after July 27th, so do call your Representative's office.

Here are talking points on the ADA Restoration Act and, below, a sample telephone message for seeking original cosponsors:

"Hi. My name is_______ and I live in ________. I would like Representative______ to be an original cosponsor of the ADA Restoration Act of 2007. A Dear Colleague letter was just sent to you on Friday, July 20 from Representatives Hoyer and Sensenbrenner to let you know that they will be introducing the ADA Restoration Act this Thursday, July 26, the 17th anniversary of the original enactment of the ADA.

"People with disabilities are still too often treated unfairly in the workplace. When they go to court with a claim of discrimination, they are treated unfairly again, often by a court that says they do not even have disability and are not eligible for coverage under the Americans with Disabilities Act - even when they have been fired or refused employment because of their disability! The ADA needs to cover the people the U.S. Congress originally intended it to cover when it was passed in 1990, people with mental illnesses, epilepsy, diabetes, multiple sclerosis, intellectual and developmental disabilities or cancer. But that is not what is happening now.

"Please solve this problem by becoming an original cosponsor of the ADA Restoration Act of 2007."

* * *

If you find our Action Alerts and Reporters useful, please consider making a contribution in support of the Bazelon Center's advocacy for people with mental disabilities. You can donate safely online at

I urge everyone to get involved. This is important.

Monday, July 23, 2007

Fat Soluble Vitamins---Vitamin A and WLS

Vitamins A, D, E and K are all classified as fat soluble vitamins - since they are soluble in fat and are absorbed by the body from the intestinal tract. They follow the same path of absorption as fat and any condition interfering with the absorption of fats would result in poor absorption of these vitamins as well. This class of vitamin can be stored in the body to some extent, mostly in the liver, and because of this, short term deficiencies are less likely to manifest themselves slower than the water-soluble vitamins.

All this being said, Vitamin A deficiency can occur years later in those who have WLS. It's the nature of the beast, so to speak, as I wrote about in this post. Due to the malabsortive properties of the RNY procedure of WLS, many vitamins depend on just where and how they are absorbed to be effective. Fat soluble vitamins are particularly difficult. This is from Linus Pauling Institute of Oregon State University:

Vitamin A is a generic term for a large number of related compounds. Retinol (an alcohol) and retinal (an aldehyde) are often referred to as preformed vitamin A. Retinal can be converted by the body to retinoic acid, the form of vitamin A known to affect gene transcription. Retinol, retinal, retinoic acid, and related compounds are known as retinoids. Beta-carotene and other carotenoids that can be converted by the body into retinol are referred to as pro vitamin A carotenoids. Hundreds of different carotenoids are synthesized by plants, but only about 10 % of them are pro vitamin A carotenoids

Vitamin A plays a major role in many bodily functions Vision, Regulation of gene expression, Immunity, Growth and development, Red blood cell production, and Nutrient interactions (works with zinc and iron). In vision retinol plays a major role in night vision.


Retinoic acid (RA) and its isomers act as hormones to affect gene expression and thereby influence numerous physiological processes.

Regulation of gene expression

Through the stimulation and inhibition of transcription of specific genes, retinoic acid plays a major role in cellular differentiation, the specialization of cells for highly specific physiological roles. Most of the physiological effects attributed to vitamin A appear to result from its role in cellular differentiation.


Vitamin A is commonly known as the anti-infective vitamin, because it is required for normal functioning of the immune system. The skin and mucosal cells (cells that line the airways, digestive tract, and urinary tract) function as a barrier and form the body's first line of defense against infection. Retinol and its metabolites are required to maintain the integrity and function of these cells. Vitamin A and retinoic acid (RA) play a central role in the development and differentiation of white blood cells, such as lymphocytes that play critical roles in the immune response. Activation of T-lymphocytes, the major regulatory cells of the immune system, appears to require all-trans RA binding of RAR.

Growth and development

Both vitamin A excess and deficiency are known to cause birth defects. Retinol and retinoic acid (RA) are essential for embryonic development. During fetal development, RA functions in limb development and formation of the heart, eyes, and ears. Additionally, RA has been found to regulate expression of the gene for growth hormone.

Red blood cell production

Red blood cells, like all blood cells, are derived from precursor cells called stem cells. These stem cells are dependent on retinoids for normal differentiation into red blood cells. Additionally, vitamin A appears to facilitate the mobilization of iron from storage sites to the developing red blood cell for incorporation into hemoglobin, the oxygen carrier in red blood cells.

Nutrient interactions
  • Zinc
Zinc deficiency is thought to interfere with vitamin A metabolism in several ways: 1) Zinc deficiency results in decreased synthesis of retinol binding protein (RBP), which transports retinol through the circulation to tissues (e.g., the retina). 2) Zinc deficiency results in decreased activity of the enzyme that releases retinol from its storage form, retinyl palmitate, in the liver. 3) Zinc is required for the enzyme that converts retinol into retinal. At present, the health consequences of zinc deficiency on vitamin A nutritional status in humans are unclear.

  • Iron
Vitamin A deficiency may exacerbate iron deficiency anemia. Vitamin A supplementation has been shown to have beneficial effects on iron deficiency anemia and improve iron nutritional status among children and pregnant women. The combination of vitamin A and iron seems to reduce anemia more effectively than either iron or vitamin A alone.

As you can see from this---Vitamin A is just one of the keys to good health for anyone---but as it pertains to those of us who have undergone WLS---it is so much more than that. Because we have difficulty tolerating fat. Well some of you do, I don't. Also I've found some interesting research about this whole fat tolerance. But that is for another post.

The thing is---because of the bypass of the upper portion of the small intestine in the RNY surgery---we don't absorb fat as easily. Hence we don't absorb fat soluble vitamins as easily---ergo we are very susceptible to Vitamin A deficiency. The main points as far as deficiency go as related to WLS have to do with the role it plays with iron and zinc as stated above. Here are 2 additional key points about this deficiency.

Vitamin A deficiency and vision

Vitamin A deficiency among children in developing nations is the leading preventable cause of blindness. The earliest evidence of vitamin A deficiency is impaired dark adaptation or night blindness. Mild vitamin A deficiency may result in changes in the conjunctiva (corner of the eye) called Bitot's spots. Severe or prolonged vitamin A deficiency causes a condition called xeropthalmia (dry eye), characterized by changes in the cells of the cornea (clear covering of the eye) that ultimately result in corneal ulcers, scarring, and blindness.

This has been shown to happen even years after WLS. Sometimes leading to BLINDNESS. Yep, that's right. You can go completely blind from not having enough absorption of Vitamin A. Check this out: Vitamin A Deficiency Related to GI Surgery Can Occur Years Later You will have to register to be able to access the info. Here are some highlights:

Intestinal surgery may result in malabsorption of vitamin A, with ocular symptoms manifesting years or even decades after surgery, especially when other comorbidities are present, ophthalmologists report.

Drs. Chae and Foroozan, of the Baylor College of Medicine in Houston, reviewed the records of patients diagnosed with vitamin A deficiency from January through December 2005. The researchers detected four cases related to GI surgery; one patient developed ocular symptoms within months of gastric bypass surgery, while the other three did not have visual symptoms until at least 18 years after intestinal surgery.

The first was a 69-year-old man who reported 4 months of night blindness. He had undergone intestinal bypass surgery 20 years earlier.

The second patient was an 80-year old man presenting with 4 months of decreased vision in the right eye that was worse in dim light. Thirty-six years earlier he had undergone partial small and large bowel resection for ruptured ileum related to Crohn's disease.

The third patient reported several months of decreased vision in both eyes that was worse at night. Her medical history included "multiple abdominal surgeries 18 to 20 years earlier as a result of complications from a cholecystectomy.

In a related editorial, Dr. W. B. Lee and Dr. I. R. Schwab point out that other investigators have reported severe visual complications, including blindness, that followed gastric bypass surgery resulting in malabsorption of vitamin A.

I don't know about y'all, but that scares the begeezes out of me. The fact that even years after having this surgery I may go through this. :shudders:
Here's some more of that article:

The two male patients were treated with intramuscular injection of vitamin A, and both reported improvements in vision in both eyes within the first week. The woman refused further treatment and was lost to follow-up.

Dr. Chae and Dr. Foroozan recommend that "vitamin A deficiency should be suspected in patients with unexplained decreased vision and a history of intestinal surgery, regardless of the timing of the surgical procedure."

Well at least there is some hope for reversal of the symptoms. That is good to know.
Vitamin A also plays a role in the immune system. I don't know about y'all, but I don't like being sick. Hell, I don't know of too many people who actually enjoy being sick.

Vitamin A deficiency and infectious disease

Vitamin A deficiency can be considered a nutritionally acquired immunodeficiency disease. Even children who are only mildly deficient in vitamin A have a higher incidence of respiratory disease and diarrhea, as well as a higher rate of mortality from infectious disease, than children who consume sufficient vitamin A. Supplementation of vitamin A has been found to decrease the severity of and deaths from diarrhea and measles in developing countries, where vitamin A deficiency is common.

This is what the RDA recommends for Vitamin A supplementation:

Recommended Dietary Allowance (RDA) for Vitamin A as Preformed Vitamin A (Retinol)
Life Stage Age Males: mcg/day (IU/day) Females: mcg/day (IU/day)
Infants 0-6 months 400 (1333 IU) 400 (1333 IU)
Infants 7-12 months 500 (1667 IU) 500 (1667 IU)
Children 1-3 years 300 (1000 IU) 300 (1000 IU)
Children 4-8 years 400 (1333 IU) 400 (1333 IU)
Children 9-13 years 600 (2000 IU) 600 (2000 IU)
Adolescents 14-18 years 900 (3000 IU) 700 (2333 IU)
Adults 19 years and older 900 (3000 IU) 700 (2333 IU)
Pregnancy 18 years and younger - 750 (2500 IU)
Pregnancy 19-years and older - 770 (2567 IU)
Breastfeeding 18 years and younger - 1,200 (4000 IU)
Breastfeeding 19-years and older - 1,300 (4333 IU

Now this is for NORMAL people. As someone who has had WLS, you are never NORMAL again. Your whole entire life is different. That again is something for another post. Anyway back to the topic at hand.

As far as vitamins go most people think if 1 tab is good than 2 is twice as good. That you can never get enough of a good thing. That is not always the case. There can be major problems associated with getting too much Vitamin A. But how much is too much??? First let's talk about what having too much can do to your body.

It is important to note that treatment with high doses of natural or synthetic retinoids overrides the body's own control mechanisms, and therefore carries with it risks of side effects and toxicity. Additionally, all of these compounds have been found to cause birth defects. Women who have a chance of becoming pregnant should avoid treatment with these medications. Retinoids tend to be very long acting; side effects and birth defects have been reported to occur months after discontinuing retinoid therapy.


The condition caused by vitamin A toxicity is called hypervitaminosis A. It is caused by overconsumption of preformed vitamin A, not carotenoids. Preformed vitamin A is rapidly absorbed and slowly cleared from the body, so toxicity may result acutely from high-dose exposure over a short period of time, or chronically from much lower intake. Vitamin A toxicity is relatively rare. Symptoms include nausea, headache, fatigue, loss of appetite, dizziness, and dry skin. Signs of chronic toxicity include, dry itchy skin, loss of appetite, headache, and bone and joint pain. Severe cases of hypervitaminosis A may result in liver damage, hemorrhage, and coma. Generally, signs of toxicity are associated with long-term consumption of vitamin A in excess of 10 times the RDA (8,000 to 10,000 mcg/day or 25,000 to 33,000 IU/day). However, there is evidence that some populations may be more susceptible to toxicity at lower doses, including the elderly, chronic alcohol users, and some people with a genetic predisposition to high cholesterol (9). In January 2001, the Food and Nutrition Board (FNB) of the Institute of Medicine set the tolerable upper level (UL) of vitamin A intake for adults at 3,000 mcg (10,000 IU)/day of preformed vitamin A.

Tolerable Upper Level of Intake (UL) for Preformed Vitamin A (Retinol)
Age Group UL in mcg/day (IU/day)
Infants 0-12 months 600 (2,000 IU)
Children 1-3 years 600 (2,000 IU)
Children 4-8 years 900 (3,000 IU)
Children 9-13 years 1,700 (5,667 IU)
Adolescents 14-18 years 2,800 (9,333 IU)
Adults 19 years and older 3,000 (10,000 IU)

So since our absorption of vitamin is remarkably decreased for several reasons, we really should be taking the maximum allowed without fear of toxicity. It would be safe to state, that 10,000 IU would be our recommended dose.

But where do you get Vitamin A from? Can you take it in a pill?? Can you get it from eating whole foods alone??? This is what I have found.

Retinol activity equivalency (RAE)

Different dietary sources of vitamin A have different potencies. For example, beta-carotene is less easily absorbed than retinol and must be converted to retinal and retinol by the body. The most recent international standard of measure for vitamin A is retinol activity equivalency (RAE), which represents vitamin A activity as retinol. Two micrograms (mcg) of beta-carotene in oil provided as a supplement can be converted by the body to 1 mcg of retinol giving it an RAE ratio of 2:1. However, 12 mcg of beta-carotene from foods are required to provide the body with 1 mcg of retinol, giving dietary beta-carotene an RAE ratio of 12:1. Other provitamin A carotenoids in foods are less easily absorbed than beta-carotene, resulting in RAE ratios of 24:1. The RAE ratios for beta-carotene and other provitamin A carotenoids are shown in the table below. An older international standard, still commonly used, is the international unit (IU). One IU is equivalent to 0.3 mcg of retinol.

Retinol activity equivalency (RAE) ratios for beta-carotene and other provitamin A carotenoids
Quantity Consumed Quantity Bioconverted to Retinol RAE ratio
1 mcg of dietary or supplemental vitamin A 1 mcg of retinol* 1:1
2 mcg of supplemental beta-carotene 1 mcg of retinol 2:1
12 mcg of dietary beta-carotene 1 mcg of retinol 12:1
24 mcg of dietary alpha-carotene 1 mcg of retinol 24:1
24 mcg of dietary beta-cryptoxanthin 1 mcg of retinol 24:1

*One IU is equivalent to 0.3 mcg of retinol, and one mcg of retinol is equivalent to 3.33 IU of retinol.

Food sources

Free retinol is not generally found in foods. Retinyl palmitate, a precursor and storage form of retinol, is found in foods from animals. Plants contain carotenoids, some of which are precursors for vitamin A (e.g., alpha-carotene and beta-carotene). Yellow and orange vegetables contain significant quantities of carotenoids. Green vegetables also contain carotenoids, though the pigment is masked by the green pigment of chlorophyll (1). A number of good food sources of vitamin A are listed in the table below along with their vitamin A content in retinol activity equivalents (mcg RAE). In those foods where retinol activity comes mainly from provitamin A carotenoids, the carotenoid content and the retinol activity equivalents are presented. You may use the USDA food composition database to check foods for their content of several different carotenoids, including lycopene, lutein and zeaxanthin.

Food Serving Vitamin A, RAE
Vitamin A, IU Retinol, mcg Retinol, IU
Cod liver oil 1 teaspoon 1,350 mcg 4,500 IU 1,350 mcg 4,500 IU
Fortified breakfast cereals 1 serving 150-230 mcg 500-767 IU 150-230 mcg 500-767 IU
Egg 1 large 91 mcg 303 IU 89 mcg 296 IU
Butter 1 tablespoon 97 mcg 323 IU 95 mcg 317 IU
Whole milk 1 cup (8 fl ounces) 68 mcg 227 IU 68 mcg 227 IU
2% fat milk (vitamin A added) 1 cup (8 fl ounces) 134 mcg 447 IU 134 mcg 447 IU
Nonfat milk (vitamin A added) 1 cup (8 fl ounces) 149 mcg 500 IU 149 mcg 500 IU
Sweet potato 1/2 cup, mashed 959 mcg 3,196 IU 0 0
Carrot (raw) 1/2 cup, chopped 385 mcg 1,283 IU 0 0
Cantaloupe 1/2 medium melon 466 mcg 1,555 IU 0 0
Spinach 1/2 cup, cooked 472 mcg 1,572 IU 0 0
Squash, butternut 1/2 cup, cooked 572 mcg 1,906 IU 0 0


The principal forms of preformed vitamin A (retinol) in supplements are retinyl palmitate and retinyl acetate. Beta-carotene is also a common source of vitamin A in supplements, and many supplements provide a combination of retinol and beta-carotene. If a percentage of the total vitamin A content of a supplement comes from beta-carotene, this information is included in the Supplement Facts label under vitamin A. Most multivitamin supplements available in the U.S. provide 1,500 mcg (5,000 IU) of vitamin A, substantially more than the current RDA for vitamin A. This is due to the fact that the Daily Values (DV) used by the FDA for supplement labeling are based on the RDAs established in 1968 rather than the most recent RDAs, and multivitamin supplements typically provide 100% of the DV for most nutrients. Because retinol intakes of 5,000 IU/day have recently been associated with an increased risk of osteoporosis in older adults, some companies have reduced the retinol content in their multivitamin supplements to 750 mcg (2,500 IU).

So there you have it y'all. Everything you always wanted to know about Vitamin A. Hey it's probably more than you want to know. But you definitely NEED to know.

WLS is not a "quick fix" for obesity. It is not the "easy way out" so many seem to think it is. This is --everything changes for the rest of your life--surgery, not to be taken lightly.

My advice to anyone who has had WLS or is thinking about it---know what is needed to maintain proper health now that we are no longer NORMAL. Eat good sound whole foods---not food products. Take your supplements religiously. Have your doc do routine blood work that includes checking your Vitamin A levels.

Hey, it is NOT standard procedure to have this test done. So don't even think you are "peachy keen" if your doc states your "labs" look great. Ask for a print out of them. Know exactly what tests they have done. Don't just blindly accept or assume this was one value they checked.

Every health consumer---not just those having WLS--- should be proactive in their own care.

Stay tuned for many more posts dealing with supplements after WLS.