tooth health post RNY

Question
Hi Dr Jacques:
I have had my procedure done on July 11 this year and after that besides lots of diarrhea,nausea, ended up with colonoscopy which was negative for twist and put on b12 along with elemental iron, due to low iron and B12 and now am totally constipated even with using lots fibre ,fruit,etc but now am having trouble with my teeth -lost 1 last evening so with all of this mal-absorption have you heard of tooth problems as well?
I was told that the calcium citrate and ferrous sulphate together can cause severe constipation so am now on feromax instead of the ferrous sulphate.
Sorry I realise that I have digressed  but both issues have been a problem.
Any recommendations would be appreciated
Thanking you in advance, Denise

Answer
Hi Denise,

Regarding the constipation. Best to be off ferrous sulfate - almost any other form is better. Calcium carbonate is associated with constipation but citrate is not, so you are ok there.  Water, fiber, probiotics and movement all help, but if you are still struggling, talk to your doctor about what else you can do.

Hopefully you are also taking a multivitamin daily?

Dental problems don't get talked about enough after bariatric surgery. Probably this early on they are not nutritional in nature (things like long term calcium and vitamins D deficiency can increase tooth decay and loss). Reflux is one possible issue as is the increase in use of soft foods, and possibly use of chewable vitamins. Some tips: brush and floss more often, rinse your mouth with water after using chewable vitamins, use a xylitol-sweetened sugarless gum after meals (seriously, I saw a dentist from England present on this at a bariatric meeting), and get in for a dental clenaing and perhaps a fluoride treatment. Talk to your doctor and see if you need to be evaluated for reflux. Also, if you have a history of diabetes, make sure that your blood sugars are normal.

I hope this helps!

In Health,

Dr Jacques

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