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Have you had a Gastrectomy?

If you have you may be deficient in VITAMIN B12 and HYDROCHLORIC ACID 

One of the issues arising out of surgery is something called post-gastrectomy syndrome. It shows as anemia due to low levels of vitamin B12 ,iron and higher risk of osteoporosis.  These problems generally occur months or even years after gastric surgery.  

Vitamin B12 malabsorption occurs when a protein known as intrinsic factor is either not produced by the stomach (this is a condition called pernicious anemia) or when the the portion of the stomach that produces intrinsic factor has been removed.  Under normal circumstances intrinsic factor binds to vitamin B12  and assists with the absorption of this vitamin in the lower portion of the small bowel.  When vitamin B12 is poorly absorbed, anemia and, in some cases, poor nerve function can occur.  This generally does not happen for several years because vitamin B12 is stored in large amounts in the liver. 

Iron deficiency anemia develops because removal of the stomach often leads to a marked decrease in the production of gastric acid.  This acid is necessary to convert dietary iron to a form that is more readily absorbed in the duodenum.  Anemia usually does not occur for a few years after gastric surgery because iron is stored in moderately large amounts in the bone marrow, where red blood cells are produced.

Osteoporosis develops as a result of poor calcium absorption, another problem that occurs after gastric surgery.  Under normal circumstances, calcium absorption, which occurs in the duodenum and proximal small bowel, is modest at best, with large amounts being lost in the bowel movement.  Following gastric surgery, calcium absorption is even less efficient as a result of rapid emptying of the stomach.  Calcium also binds tightly to unabsorbed dietary fat which further interferes with its absorption.  Symptoms of osteoporosis may develop ten or more years after gastric surgery because of the large amount of calcium that is normally stored in bone. 

So it is important to adjust your diet to allow for these factors.

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