“Expert” Opinions

On November 8, 2010, in General Nutrition, by Andrea

Sitting in the "Supplement Lecture," trying to find a way not to slit my wrists.

I’ve not been blogging.  This is my mistake, life has been in the way with my parents moving from Kentucky to North Carolina, some personal issues involved in that, their house being built apparently on an ancient VooDoo burial ground, and my inability to cope with it all.

Oh.  And my deciding, randomly, to take much of the information that I know about lab draws and tracking laboratory trends and writing a book.  9 days before the Houston OH event.  Yes, you saw that.  Nine.  1, 2, 3, 4, 5, 6, 7, 8, 9.  And I did it.  But that’s another blog post.  Coming.  And yes, they will be for sale.  Once I figure out how much to charge for shipping, etc.  Not the point, MOVING ON.

So, this weekend, the OH peeps were able to listen to the wonderful Connie Stapleton (who I REALLY think needs to do a segment on transfer addictions… PLEASE folks?  Please tell her this?  It’s a severe problem in our population with “current” numbers at 1 in 3 people being alcoholics and I think the number is VERY soft), the hilarious Mary Jo Rapini, and Bariatric Chef Dave Fouts (who, by the way, is ONE OF US).

But.  But.  But.

Then there was Dr. Garth Davis.  And his little friend Anessa Chumbley, a “Bariatric Dietician.”  And I know what you’re going to say.  “But ANDREA!!!  He’s on TV!  And! And!  And!  He’s a SURGEON!  He’s gone to medical school!  And she’s a DIETICAN!  Who are YOU?!?!”

Well, let’s go over the talks.

Dr. Davis has pretty much gone round the bend.  He’s now saying [sic] that the human body does not need as much protein as “once thought.”  And in speaking to his own patients, I can tell you that he has stopped advocating the use of, you know, meat.  He’s now also a strong advocate of “eating your vitamins” rather than taking a supplement.  Paraphrased here, “I told a patient to eat grapefruit to lower heart disease, they told me they couldn’t eat grapefruit with their heart disease medication.  Do they not see if they ate the grapefruit, they wouldn’t NEED the medication?”

This is all well and good.  EXCEPT?  In a body system that DOES NOT ABSORB VITAMINS FROM FOOD.  Period.  End of story.

Here is a reality check for you RNYers, and I’m sorry they did not put this in the brochure – the further out from surgery you are?  The more you will emulate a DS in terms of micronutrient malabsorption. Check that with a REAL bariatric dietician.  Or with some of the real life long term RNY patients.  I now massively malabsorb A, D, K.  Never did before.  Hrm, imagine that.  Surgeons and doctors will have you believing that the micronutrient absorbption gets better the further out you get.  They are lying.  And we simply do not, do not, do not, do not! absorb close to enough micronutrients from food.  Especially in the quantities that we eat to avoid weight gain, especially 18+ months out.  I do not know why Dr. Davis has lost his mind?  But he has turned whackadoodle and has lost any and all respect I have for him.

So turning to the “bariatric dietician” — Well.  Where do I start?

I went in with such great optimism.  Kaitlin Nelson did not.  But I had hope.

It died.  Quickly.  Within 2 minutes with the most asinine props imaginable.  I’d say they belonged in grade school, but that would be pushing it.  Pre-school, perhaps.  In fact?  One of the props was a size 2T pair of jeans (which I still can not remember the significance of.. so WAY TO GO ON THE PROPS!).

I DID take notes:

You can see at the top how calm and collected I was...

It only got worse.

So where should I start?

  • “Carbonation is bad” – no.
  • Iron’s job description: “Carries oxygen to every cell” – NO.  Hemoglobin, which, yes, is made up of iron in part, carries oxygen to every cell.  But iron itself does not.
  • “Heme iron likes acid.” – no.
  • “Next time you eat some red meat, eat a few orange slices with it.”  – no.
  • “All iron, unless you get it naturally, will hurt your ‘tummy’ ” – NO.  Heme and carbonyl are the gentlest and help the most people with this.
  • “Iron should not be taken with ANY calcium.”  – no.  There are tolerances – ionic iron can be taken with 300mgs of calcium and heme up to 600mgs.  So SIPS OF MILK are fine, dammit.
  • “We should take our calcium after food because that is when there is the most acid in the stomach.  We don’t take TUMS (aka carbonate) because it is an ANTACID.” – FUCKING HELL NO.  We take calcium citrate because our guts don’t HAVE acid in them, regardless of food ingestion and the citrate portion of the molecule adds enough acid to properly absorb the calcium.  We do not take calcium carbonate because it requires a high amount of stomach acid to break the carbonate apart from the calcium because it is rock.  Not having that amount of acid means it goes directly to the kidneys, which also means it tends to cause kidney stones in many people (especially those who do not drink enough water).
  • “We get lots of calcium from foods.”  – no.  Calcium fortified foods are high in calcium phosphate, which also requires a high amount of stomach acid to break down.  These are also fairly useless to us.
  • “There is absolutely no Intrinsic Factor in the pouch.”  – no.  The body still makes IF.  Period.  In fact, the recent research shows the problem isn’t in a LACK of IF, it’s a lack of tolerance of foods high in B12 (ie red meat) that is a cause of pernicious anemia.
  • “There is no absorption outside of the stomach of B12.”  – NO.  There is passive absorption, without IF, of 1-3% depending on the person.  BTW, B12 isn’t absorbed in the stomach.  Very little is.
  • “Thiamin covers nerves.” – NO.  Myelin does, which is a fatty substance.  Thiamin IS important for nerves, but not because it covers the nerve sheaths.
  • “No such thing as water soluble toxicity.”  Which she then contradicted herself during the Q&A part.  Great.  There IS, by the way.  Some water solubles are VERY toxic in high range levels, others not so much, and others it takes a long time to get to toxic range.
  • Metaphors using trucks, and 2T jeans, and cheerios trying to emulate hypochromic anemia (which, btw, she used the wrong terminology for?)
  • “We should eat lots of orange fruits and veggies to get our vitamin A in the form of beta-carotene.” – NO nonononono.  Beta-carotene requires a very acidic environment to absorb, a high fat concentration eaten WITH the food to absorb, and is only converted to retinol in the duodenum.  Last time I checked, these are problems for 3 of 4 major surgery types.  Additionally, as we age, our pH acidity becomes more neutral — so you older AGBers are fucked, too.  Sorry.  Also?  You need a ton of BC to get enough vitamin A.  14 units of dietary beta-carotene make 1 unit of retinol.  Lovely conversion rate, there.
  • “Centrum is not the best vitamin out there.” – No, in fact almost all general multis take Centrum as a template.  Sorry, try again.
  • “You should buy vitamins from companies you trust.  Opurity is good because they are China free.”  – Please kill me now.  I mean, seriously, I’m in New Orleans right now?  Come find me and KILL ME because I know 3 people who moved from BA or Celebrate to Opurity and their labs TANKED.

So.  yeah.  That was informative.  On how to completely fuck up your life post surgery.  Follow Dr. Garth’s “become a vegetarian, don’t do protein!” life and listen to the well-coiffed and beautiful but idiotic dietician who doesn’t know squat about supplementation post-WLS and get blood as thin as water.

The sad part is that people thought she was very informative.  This really hurts my head.

And I’ll be the one to have to fix them.  How do I charge for labs without getting in trouble?

But yet I don’t have letters behind my name and can only prove the above with medical studies, research, and long-term patients and labs to prove it.  So.. I’m just an idiot.

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17 Responses to ““Expert” Opinions”

  1. Pam Tremble says:

    Andrea – thank you for writing about this. After hearing Dr. Garth in Ohio and all the notes I took on his vewpoint… I just couldn’t bring myself to waste my breath (or energy) trying to correct his poor advice from his session at the conference. I’ve had several of the Davis patients come to me asking if they should really stop eating meat. It’s sad that he’s giving such hogwash advice to his patients. Eventually his stats will tank and his patients will start taking it to court and then maybe he’ll come to his senses. I didn’t get to hear Anessa’s presentation in Ohio, so I didn’t realize how bad she was too. It all just makes me shake my head and wonder how bad things have to get before they come to their senses.

    Thanks again!
    Pam

  2. Halina says:

    ((( HUGS ))) One self-learner to another… I have your back..
    BTW: let’s do on like nutritional program to get “paper” Then we can tell people as “professionals” …lol. I think these programs start at $600?

  3. Dee/ says:

    I don’t agree with your self description but…. you’re OUR idiot! The one we know we can depend on for the truth, the one that ONLY has our best interest at heart. I hope you do understand how much we all depend on you and how grateful we are to have you watching our backs.

    Alphabet soup behind your name or not…..I trust you above them all.

  4. Laurie says:

    O.M.G. I am sitting here in utter shock. Maybe OH needs to be addressed on who they are picking to hold these conference sessions. Did you throw stuff at them during the Q&A time? How did that go over? I am just flabbergasted.

    I really hope a conference comes close to me again. It looks like you all had a great time!!!

  5. Renae says:

    Tell us how you REALLY feel, surgery sister :P No, seriously, that woman has NO clue what she was talking about and I MISSED her “lecture”. Yeah, I think those of us who live it every day are more knowledgeable than the one with the degree, in this case. Oh, girl, they need to let YOU do the Vitamin/Supplement talk next time. I vote for it!

  6. Jen Stockinger says:

    Wow, there are no words. I knew Dr. Garth was on this meatless kick for himself, did not realized he was actually discouraging his patients from eating protein. Glad I missed it, he didn’t get on that kick in NY. At least not to the same degree. Thanks for all that you do, it’s very much appreciated. Can’t wait for the book!

  7. Krys says:

    Also interested in knowing if you tripped them up during the Q&A part. With your headaches :( though, I hope they didn’t have you reduced to sitting in a corner whimpering.

    Cheerios? 2T pants? Erk.

    {{hugs}} {{hugs}} When it comes time to get the letters after your name, you will have a cult following to prove your point. I’ll volunteer to be one of your vita-pigs (guinea pigs for vitamins) for your studies. :D

  8. Sharyn says:

    Don’t stop, Andrea.

  9. Terry says:

    Glad we have you around to keep it real Andrea! Continue to write and post the truth.

  10. MsBatt says:

    Go GET that piece of paper!!! You’re far more qualified that most of the people who have the credentials, and you deserve to get paid for your time and effort.

  11. Christina Moctezuma says:

    Sad thing is, because he has the ‘M.D.’ behind his name, his word (and anyone he brings with him) will be taken as gospel to most.

    In my opinion (and countless others) I would rather hear your take on the vitamin situation, because you have been there. Has he had surgery, or had malnutrition induced illness? NOPE!

    I can’t wait for your book. I will order it the first day available.

    Chris

  12. Jackie E says:

    Andrea:
    Thank you so much for posting this…How very, very sad that even though more WLS are being done than ever, the “snake oil men” come out, and even WORSE is that “celebrity M.D’s” spread false information.

    Andrea, and all the others who have ADVOCATED for us, who have done the hard work…Thank you! ((((hugs)))) I am so glad that SOMEONE is keeping up with the times, researching and challenging (old) information to keep us healthy!

    There is no reason that we should not be advocates for our own lives. We are fortunate to have those (Like Andrea, and many others!) who have taken the time to truly study how vitamins interact with WLS patients.

    Thank you, from a WLS patient who has GREAT labs thanks to your wisdom! Please know, despite your “detractors” and “nay-sayers” that YOU are saving lives. That is some great Karma and we are grateful!
    Warmly,
    Jackie

  13. Debbie says:

    Andrea,

    As usual, you provide invaluable advice to us post-ops. Very thankful for your research, understanding and willingness to share. Oh, and I plan to purchase your lab workbook.

    Deb

  14. Paula says:

    Actually, start calling yourself a journalist. A muckraker. I think you have the chops!

  15. MacMadame says:

    Well, I never respected Dr. Davis so I guess I can’t lose respect for him.

    And Centrum isn’t the best vitamin? HA! I looked into about 10 different vitamins when picking my multi and that’s the one I picked. I’ve been offered a couple of new ones since then but when I compare them to my Centrum, they don’t measure up. Now, there may be better ones out there that I just didn’t find, but it’s a pretty decent multi and hard to beat.

    It’s interesting that some surgeons are now telling their patients that they eventually absorb vitamins again. Someone posted that on OH and I said it wasn’t true, but I assumed they had just misunderstood what their doctor told them. The thing is: the intestines that remain can grow more villi, sure, but the part that isn’t in the food path any more isn’t there. How can it absorb stuff 3 years down the line *if it isn’t there*? 3×0 is still 0.

  16. MacMadame says:

    Ooh, just say Paula’s post. Yeah, call yourself a Health Writer. That’s a real title people use all the time.

  17. Mary says:

    Wow… you are amazing Andrea. Amazing!

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