Hi all, I thought I would add my two pennies to the pGBP / BF discussion and a few journal links that should help.
I have read a study (which I recently looked for to add to my list below, but couldn't find. I will keep looking) which showed pGBP milk had 50% less fat. (This could explain the FTT.) What I don't remember is how far post op the lactating mom(s) were. I know that in time the new "pouch" does stretch and hyperplasia does occur so in time the pGBP person is able to eat and absorb more. (hence, the common 3-5 yr po 15% wt regain average.)
However, since the duodenum and the proximal jejunum are bypassed (no part of the intestine is removed as a standard part of the operation) where Mg, Ca, Fe, and water soluble vitamins are absorbed--the patient needs to work closely with a qualified RD to ensure that they meet their new nutritional needs. A component of the surgery is malabsorption (roux-en-Y, Duodenal switch etc. NOT Lap band) Therefore, absorption of nutrients mentioned above is dependent upon passive absorption. Consequently, particular care needs to be taken to teach the patient about nutrient interactions that would bind the needed nutritents and hinder absorption through the passive process. (please note the use of tannins and Fe binding in the article below). This needs to occur in conjunction with proper bioavailable supplementation. As with any surgery, long term compliance is an issue. The biggest obstacle (IMHO) is inadequate/inconsistent information from the health care providers these patients look to
for guidance. Consequently, many turn to fellow pGBP patients for (mis)information, which only worsens the problem.
IMHO, Refering the mom to a qualified/knowledgable RD/MD to ensure diet, milk composition, and maternal labs are where they should be, would be the best TEAM approach for a new pGBP mom/baby dyad. Attempting to offer Nutrition advice at the time of consult from an undereducated source adds to the problem and doesn't assist the dyad. Instead, referal and follow up to ensure the mom has been to a qualified RD/MD would be a better route (IMHO).
Here are some of the Journal Aritcles I have in my extensive collection on the subject that I found helpful/informative. Some are about pregnancy and MO, some are about pregnancy and pGBP, and the elusive one I am still searching for is about breasmilk composisiton pGBP. I hope this helps those who are reading this and those who refer back to this.
1) In Obstetrics and Gynecology: Pregnancy following Gastric Bypass Surgery for Morbid Obesity by Edith D. Gurewitsch, MD; Michelle Smith-Levitin, MD; and Judith Mack RD
2) In Obesity Surgery: Pregnancy Following Gastric Bypass for Morbid Obesity by Alan C. Wittgrove MD, FACS; Leslie Jester CRNP; Perri Wittgrove MD, FACS; G. Wesley Clark MD
3) In Am. Surg 1982 Aug;48(8):363-5: Pregnancy following gastric bypass for the treatment of morbid obesity by Printen KJ, Scott D.
4) Obstet Gynecol 1998 Jan;91(1): 97-102: Pregnancy outcome and weight gain recommendations for the morbidly obese woman
5) J reprod med 1987 Mar; 32(3): 172-6: Pregnancy after gastric bypass for morbid obesity by Richards DS, Miller DK, Goodman GN
Lora Williams
Nutritionist, Lactation Consultant Intern
Pharmanex Independent Distributor
ID# US0744039
1115 Toro St. Ste F
San Luis Obispo, CA 93401
805) 215-0363
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