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B12 and Other Nutritional Requirements
May 2, 2011
11:57 am
Greenfield, WI
Forum Posts: 13
Member Since:
December 2, 2010
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Could Donna Walsh provide some information, or direct us to specific websites with information, about what is required to maintain our nutritional and good health needs; vis-a-vis, why B12 injections are required, what other vitamin/mineral/food supplements may be needed (and in what form), what other bio-chemical processes need to be monitored regularly?

Thank you!


May 6, 2011
3:20 pm
Forum Posts: 3
Member Since:
December 23, 2010
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Hi Donna - Check under the Gastric Cancer tab on the home page for information about nutrition and special concerns.  Under the Gastric Cancer  tab, go to the Life Without a Stomach and then the Basic Principles of Nutriton After a Gastrectomy and Special Concerns tabs.  This section is still partially under construction but you can get information about healthy diet guidelines, fat malabsorption, and lactose intolerance there.  There are some other biochemical processes that are also affected by a total gastrectomy.   These include nutritional anemias and metabolic bone disease.   I am still developing these guidelines but they will soon be included under the Special Concerns  tab.  I have outlined the basic concerns below.



Nutritional anemia resulting from a vitamin B12, folate or iron deficiency are common in people who have had a gastrectomy.  Anemia may not occur until close to a year or more after surgery but it is important for your health care provider to monitor levels of these nutrients.  

B12 Deficiency

B12 is a water soluble vitamin necessary for normal neurological function and formation of red blood cells.  Normal B12 levels vary with the laboratory used but are usually in the range of 200-800 pg/ml.  The absorption of naturally occurring B12 is complex and depends upon several factors produced in the stomach including hydrochloric acid and intrinsic factor.  A total or partial gastrectomy may result in damage or removal of the cells that produce hydrochloric acid and intrinsic factor, markedly decreasing absorption of naturally occurring vitamin B12.  People who have had a complete gastrectomy will need to monitor their B12 levels and supplement their diet with synthetic oral vitamin B12 or intramuscular injections of vitamin B12.   

Folate Deficiency

The absorption of folate may also be impaired after gastric surgery.  This may be due to malabsorption and impaired digestion.  Red blood cell (RBC) folate levels should be monitored instead of serum folate as serum folate is affected by recent folate intake.  It is important to note that folic acid supplementation can mask a B12 deficiency, therefore B12 levels should be checked before taking a folic acid supplement.

Iron Deficiency

Iron deficiency due to changes in digestion and absorption is common in patients who have had a total or partial gastrectomy. The primary site of absorption of iron is in the duodenum or first part of the small intestine.  Rapid transit through the intestine as well as decreased acid combines to decrease the absorption of iron.  Ferritin levels are an accurate indicator of iron stores over time and should be monitored.  

Bone Disease

Bone disease such as osteoporosis, osteopenia and osteomalacia is common in people who have had a gastrectomy.  People who have had a gastrectomy frequently consumea diet with that is inadequate in calcium, vitamin D and lactose-containing foods.  This, combined with altered absorption and metabolism contribute to bone disease in patients who have had a gastrectomy.  Monitoring 25-hydroxy vitamin D levels and bone mineral density via DEXA (dual energy x-ray absorptiometry) scans are recommended. Additional calcium and vitamin D supplements may be indicated.

I hope this helps.  More to come.


Donna Walsh, MS, RD, CSO


May 7, 2011
2:32 pm
Greenfield, WI
Forum Posts: 13
Member Since:
December 2, 2010
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Thank you!  This is exactly what I was looking for.  I had been to the other sections of the website you mention, but they didn't specify which vitamins/minerals/enzymes are affected by the TG.  I'm glad to know you will be including them soon.

Also, for those who may be having difficulty finding the kinds of foods we need (like me), here is a link to the Stanford Cancer Center website with recipes from their nutrition department:  http://cancer.stanford.edu/pat.....ipes/ Yea!!

Finally, I was talking with Karen the other day about the intramuscular vs. subcutaneous injections for the B12.  I am the first in my family to have the intramuscular injection (ouch!).  Everyone else is able to do their own shots at home using the subcutaneous method.  I'm looking forward to hearing what (if any) benefits there are for one method over another.

Thanks again for the information.



January 25, 2012
5:51 am
Gretchen Borzi
Massachusetts, USA
Forum Posts: 39
Member Since:
October 6, 2010
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Hi everyone. I realize you were discussing this some time ago, but I'm just reading it now and wanted to share my experience with B12 supplements. I had my TG on July 26 last year and my surgeon suggested that I try taking an oral B12 supplement after surgery instead of going for a shot every 6 weeks. He had learned that some absorption can occur in the mouth and small intestine. So I tried it, taking a sublingual pill (it dissolves slowly in your mouth) daily. It is 1000 micrograms of B12. After having my levels checked in late September, I learned that everything was normal. And now, 6 months post-op, I still feel that I'm fine, although I haven't checked my levels again since Sept.

If there is one thing I've learned is that everyone has a different reaction to surgery, but if this is working for me, it could work for others. I hope you find this helpful.

all the best,

January 26, 2012
1:33 am
Karen Chelcun Schreiber
Madison, WI
Forum Posts: 120
Member Since:
August 11, 2010
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You're right about that Gretchen...we certainly are all different.

I find that shots work well for me.  I don't have to go anywhere for them, I do them myself at home.  It costs me about $18 (without insurance) for the B12 vials and syringes (I give myself a shot every 4 to 6 weeks.

I take so much daily (orally) in terms of supplements that I personallyl like the once a month shot.  I wish I could take everything else that way.

Currently I take each day: multi-vitamin, vitamin E, Coromega 3 gel, 3 calcium chews, Florajen acidophylis (sp?), iron every two days or so...so you can see why I like having one less thing to take each day :-)

But I know many others who are happy with the oral B12.

Whatever works!

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