Bariatric Patients and Supplements

This week, Jill answers a listener question about bariatric patients and the supplements they’re prescribed.

Jeff Sarris: Welcome back to the Kidney Stone Diet podcast, the show about reducing your kidney stone risk and living your best life. I’m your host and fellow student, Jeff Sarris.

Jill Harris: And I’m Jill Harris, your kidney stone nurse.

Jeff Sarris: Perfect. I just noticed the light behind me was flickering. I’m like “What is happening?”

Jill Harris: It does flicker, sometimes. So that’s my morning chair. I took away the Christmas tree. Everyone’s like, “Thank God. It’s June, girl.”

Jeff Sarris: It’s February 20. So, I mean, we’re sort of transitioning into spring-ish. I have my window here cracked open just a little bit. It’s not hot. It’s not warm, but it’s like you feel that that spring air just a little bit.

Jill Harris: It’s coming. So that’s now my reading chair where the tree was. So, in the morning when I’m looking at emails and stuff, it flickers. In the morning, I get up at like, 5:30-6:00. So, it’s flickering and I don’t love it. I’m not somebody who doesn’t believe in ghosts. I’m also somebody who does believe in ghosts. So I don’t know. But I don’t like light flickering for no reason. The light bulb is screwed on tightly. So, I don’t know. I’m up in the air about ghosts. So I don’t know what to tell you. So it makes me a little nervous.

Jeff Sarris: Yeah, so we both have a light on our right side that is going to flicker throughout this. So, we’ll see what happens.

Jill Harris: People are like, “Well, thank God I’m on Spotify and I don’t have to look at your damn lights and your trees, or whatever you got going on in your apartment.”

Jeff Sarris: Which, by the way, if you only listen on Spotify, Apple podcasts or wherever, thank you so much. If you want to watch the video, we’re also on YouTube. It’s just Kidney Stone Diet on YouTube. You can find it there. You know, obviously, find all the links that kidneystonediet.com and my camera’s going a little nuts now, too, so everything is a little funny.

Jill Harris: You have a ghost as well!

Jeff Sarris: I don’t know. The camera will move, but now–there, now it came back down to the right level. Okay. So, what do you say we go beyond the ghosts and we start the voicemail?

Jill Harris: Okay, let’s go!

Listener Voicemail: Hi, Jeff and Jill! This is Lauren from Aurora. I want to thank you guys so much for all your videos. I’ve learned a lot from your YouTube videos throughout the past year. Most of it, I get like bits and pieces that are related to me and so I wanted to call and get some more specific information for those people who have altered GI issues. Usually, like your information will say, “Oh, you can do this, you can do this, except if you have a GI issue.” So, I just wanted to get more specific about that. I specifically had a bypass. I know some other people have issues with oxalate related to other GI issues, but mine is specific to a bypass which I was doing fine with oxalate. I don’t have stones, but there was a time when after watching the documentary “Forks Over Knives,” I decided that I would do like a vegan diet and my staples were spinach, smoothies, almonds after workouts and unsweetened iced tea all day long.

So, unlike the kidney stone, there’s no like warning. There’s no wake-up call, just painless, silent kidney damage that you have no idea is going on. So, that’s all stopped now, but I do want to protect my kidneys moving forward. I don’t have stone issues, but definitely need to be aware of oxalate. So I just wanted to do maybe a little bit about things specific to that, like vitamin C. The bariatric multivitamins include vitamin C, and so I’m wondering, you know, at 200% of the normal daily value, should that be something that we should not take and then just not not take altogether, but do all the vitamins separately to not include C as opposed to the all in one multi?

Questions about collagen? I recently read that collagen peptides and collagen converts to oxalate. So I was surprised and, again, it felt like “Oh, there’s so much I’m finding out like after the fact.” Whey protein, is that different the way it’s metabolized than collagen? Collagen, is that fine for a supplemental protein shake? I know chocolate is not the way to go, but I wonder like, how is there a way to incorporate–

Jeff Sarris: And I think the voicemail cut off there. We have a wide-ranging question there. So, a few things to dive into.

First, let’s talk protein shakes

Jill Harris: Well, you know, first let me say before I forget, so Lauren from Aurora. I know exactly where Aurora is. Hello, Lauren! So, she said she had a bypass, I will assume, but I don’t know. So I’ve always been very honest. I’m assuming she meant a gastric bypass, I’m assuming, which is a bariatric surgery, but I don’t know, so let’s just put that out there. Now, we do have videos on bariatric surgery. We do have videos on this channel on collagen. And we do have videos on protein shakes. Although, she brings up a good point because she’s like, “Listen, old lady, I’m asking, specifically, about whey protein.” So we address protein shakes, in general, but I don’t, specifically, go into whey protein. So, basically, she’s saying, “Listen, girl, I know I have to worry about collagen converting over to oxalate, but what about whey?”

Okay, good question. So, I’ll address that now while I’m thinking it’s a good question. Whey protein: you guys can have it if it doesn’t bother you. Meaning, you know, you can have a little lactose in there. Some people can’t tolerate it, so if you want to use the whey protein shake, like she said anything–not chocolate– you can use it. Pay attention to the sodium and sugar in these products. Nowadays, protein powders don’t have any added sugar. We can thank Keto for that, mostly, but always check. Keto did definitely make us more aware of all the sugar we’re eating. So that is the one and only reason I like the Keto diet. Otherwise, I get a lot of kidney stone patients from the Keto diet, folks, just so you know.

But I will say this about protein shakes: I’ll hear people say, “Jill says no to protein shakes.” I do not say non protein shakes. I say, “Do not drink your meals. Do not drink your meals!” “But, Jill, I want to lose weight.” Well, what’s going to happen when you stop drinking that protein shake because you’re so friggin’ sick of it? All that weight you lost, you’re gonna regain. Why? Because you never learned how to eat. Because now you’re gonna go back to food and you still haven’t learned person control, portion control, and triggers and all that. We must learn how to eat. We must educate ourselves and we need to work through our obstacles on that. So that’s what I say. You want a protein whozee? Go ahead. Sip away, people, but don’t use them as meal replacements to lose weight.

You will gain it back. You probably have five times because everyone does. You can definitely have whey protein shakes. I don’t mind that at all. I use it an egg one. I use a casein whey blend in some of my baking stuff, but if I’m just having a protein shake, it is an egg protein that we always link in the bottom. I use Healthy & Fit. I like them. It is higher in sodium, so when I have that I pay attention to my sodium for the rest of the day. So, there’s that. You can have whey, Lauren.

Should bypass patients skip their supplements?

Now, she poses a very good question. “Jill, we as bypass patients–” and, again, I’m assuming it’s gastric bypass, especially since now she’s talking about the supplements “–we’re told to take supplements. Should I stop taking them because the kidney stones–” which, by the way, she’s never had. She said she had higher oxalate. I don’t know how she knows that because if she hasn’t had a kidney stone, I doubt she’s had a 24-hour urine collection. But, again, what do I know? I’m not sure of all these things. I’m throwing them out there, though. So I can answer at some point. Vitamins, supplements that bariatric patients have been told to take, we, me, Jeff, the internet folks, period, I’ll tell you right now, as a nurse, I never override a doctor’s order. You guys with a gastric bypass, intestinal issues, me with my surgeries I’ve had on my colon, we have special orders. We have special orders.

So how you handle this is just like this: “Dear doctor–” this is Lauren talking– “I’ve had higher oxalate–” how she knows this, I don’t know. Maybe she did do a urine collection. I doubt it because she hasn’t had a stone. But, anyway, if she’s talking to her gastric her GI doc who did her surgery, “Dear doctor, I’m petrified I’m gonna make kidney stones. I’ve eaten a lot of high oxalate food–” whether Lauren has malabsorption issues or not from her bypass, there’s a lot of information I don’t have on her. I would say to the GI, “I know you’re asking me to take vitamin C–” a lot of Gi doctors want bariatric patients to take calcium supplements and you will hear me all the time in the kidney stone world that says don’t take calcium supplements.

But if you have malabsorption issues, your doctor may want you to take them. You never stop taking supplements a doctor has asked you to take because of medical conditions. Just because of you’re worried about a kidney stone, you must talk to that doctor first because you could be making other things worse. Bariatric patients do not absorb calcium very well. They may need tons of it. These are questions for your doctor. I’m thrilled that she posed these questions so more people can hear this. They’re brilliant and I appreciate Lauren. But always go back to your doctor. Vitamin C, we know, if you take bigger doses of it, can convert to oxalate. But with bariatric patients, you may need it.

Now, how do you know if you’re having high oxalate from all these supplements? You should do a 24 hour urine collection. I don’t know if an insurance company is going to pay for that because the diagnosis wouldn’t be kidney stones and that’s what they look for when they pay. So this stuff, it’s not like you know, insurance pays. Insurance dictates our care, unfortunately. So there’s that.

Does collagen cause kidney stones?

Collagen–and like I said, there’s a video on it. Make sure you watch that. Too much collagen can convert over to oxalate. Now, as I’m getting older, I’ve seen how thin my hair is getting. Yeah, I got a lot of little bushy things up here, but it’s thinned out a lot as I’ve gotten older. And I know I’m working with patients my age, and they’re worried about their fingernails, and they’re worried about their thinning hair. When they want to take all these magical potions and pills that’s going to give them a head of hair. Listen, there is no good proof that collagen or any of those supplements increase your hair. So, you know, I’m gonna say this and I may get so many haters. We all know I don’t care. I am just stating my opinion. That’s all I’m stating. You are all grown. Please do what you feel is best for you.

Do what is best for you, but my take on all these supplements and pills that are going to make our nails stronger. You know, what are we doing? Rock climbing? I don’t know, how strong do you need your nails? I mean, I don’t know, I’m asking you. Number one, I would say before you start taking a supplement, you might want some blood tests run. Is this indicative of, like, thyroid disease? Do you have something else going on? So figure that out. That’s another question for the doctor. As far as collagen and giving you a full head of hair, at some point, don’t we just need to embrace that we’re getting older? I get it. It’s not for the faint of heart getting older. I see myself I’m like “Wow!”

But, at the same time, because of my stage four cancer stuff, I’m like, I just feel really grateful that I have a breath. I mean, so what? Maybe I’m going a little bald. Okay, so? Maybe, eventually, I’ll lose a lot more hair, but I have a breath. And I’m gonna watch my son grow up, I’m hoping to God, and, maybe, hopefully a little grandbaby. No pressure, Nate! But, what I’m saying is, I don’t know. I’m just gonna push back a little. That’s all. I’m gonna want us to think about that a little. Only because there’s so much more to life. When we’re on our deathbed, I don’t think we’re going to be thinking “Does my hair look good?” No, no. We’re going to be thinking about things like love and time. Did we spend enough time with those people we love? I can’t really think of anything else, much more that we would think about. It’s not going to be our hair.

Now, if I’m making you feel less than because you’re like, “Shit, I’m worried about my hair.” That’s what I’m saying. You, please, take care of it. Collagen ain’t gonna bring it back. There’s no good research that says that, but you must do what you want to do. The things I talk about, as far as kidney stone disease, it’s all based upon science. Some of these life little things, I just add them in here because–and I do this with my Kidney Stone Prevention course students in the accountability calls–these are the kinds of things we think about as we’re navigating diet, and lifestyle, and the obstacles that get in the way of maintaining lifestyle and diet. So we talk about these things.

And at the end of the day, when people say to me, “Well, I hate my hips.” I’m like, “You’re not going to be thinking about them when you’re dying. You just won’t. I promise you.” Because I’ve been at a very scary place in my life with my cancer. I just know that the those are not things you’re going to be worried about. You’re going to only be thinking about things of the heart, not your head, not your hair, and not your hips. None of the H’s, just your heart. That’s the only “H” you’re going to be thinking about. I want you to just love yourself the best you can. And that takes practice. You’re not going to do it overnight, but I don’t want you to worry so much about your hair. And you take the supplements that have the timer now on the clearance rack at Marshall’s because it’s a fad.

So those are just my thoughts. You don’t have to listen to them. You don’t have to believe them. You can certainly do what you want to do. I’m just telling you, maybe or asking you maybe to think about this in a different way. And, as a woman and an older woman, I know what it’s like to look at your hair and go “What the hell?!” I get it, but you’ve gotta laugh at it and just say, “Well, this is who I am. It’s who I am.” And that’s okay. You know, it’s part of the process, and that we get to age. Does anybody know what we’re talking about? I think somebody called Lauren, did she call in? So, collagen, go look at that video. The supplements and bariatric surgery, you may very well need those supplements, please do not stop them. Talk to your GI doctor about it, please.

Now, one more thing, no more life lessons, I promise. I would just want to close it with this. I will ask you to push back on this, bariatric patients, specifically. I noticed in my practice that when–I deal with a lot of bariatric patients because they do get kidney stones because they have lower citrate. They have lower urine volume. They have higher oxalate. They have lower pH because their malabsorption issues. So, they’ve got things going on. But I have noticed this in my practice, I noticed that–and I don’t know–but are all of you on five calcium supplements a day? Are you all on the same citrate? Is it a generic order that all bariatric patients are told to take supplements? Are they all told to take this much vitamin C, this much calcium? Could it be that it needs to be tailored more for each person?

Should they be doing 24 hour urine collections or whatever tests needed to see if–? Is this a generic order we’re giving you guys? Not me because I don’t I don’t give supplement orders. But you know what I’m saying? I don’t know, because a lot of patients that talked to me about what their doctors said, it seems like it’s kind of like all bariatric patients take this much vitamin C, this much calcium, and just you can ask the doctor, “Is this based upon me? Based upon just bariatric people in general?” Because maybe you don’t need as much as they’re suggesting. Does that make sense? I hope it does. Does that make sense, Jeff?

Jeff Sarris: Yeah, it absolutely does. And and that is the thing we don’t know what we don’t know. So right going in and having these specific questions to ask I think is helpful in itself. I mean, you might not have an answer because you that’s not your your area, but knowing to ask the doctor these things is helpful.

Jill Harris: Right, because when I go to the doctor, I know they’re like take 3000 IUs of vitamin D. “Well, where did you get back from? We need to do the blood test yet.” “Oh, well, we will do the blood test–” and that so I’m just saying from my own care, and I have top A+ care– I’m dealing with thousands and thousands of patients a year. They tell me a lot of things. And so they’ll be like, “My doctor told me to take–” What? What? Based upon what? “Well, I don’t know, to tell you the truth.” So, we, as patients, I come to my students and patients way more with a patient point of view than I do with a nursing point of view. Because I know, as a patient, what we’re told and how it’s all kind of, like, you know, just kind of generically thrown at us just like the oxalate lists are generically thrown at us or this list, this list.

You can even do a urine collection today! Do you have high oxalate? Are they even making calcium oxalate stones? I mean, right? So, you know, it’s tough. We need to get specific help for each of us. And that’s why that’s what I do for a living. So, if she called me in at a private consult, I’m going to be very specific with her. I’m not going to give her generic advice. I have to listen to her. Her likes, her dislikes, her other medical conditions, and then we formulate a plan of action for her. So that’s Lauren and then when I talk to Sammy next, totally different phone call. And that’s how healthcare should be, but that’s why I don’t work in a hospital anymore because there’s no time for that. So, we owning our own business here, Jeff, we can do whatever we want, and spend as much time as we want. So we do, because that’s how we should be. But that’s just not it’s not cost effective, obviously, right?

Jeff Sarris: Yeah, it’s just a different system. The system we’ve built, the little universe, if you will, that we built here is what you have seen from the inside, from the patient side, from being a nurse and just seeing where you can add in a way that’s really needed. So that’s why all of this exists.

Jill Harris: Yes, absolutely. I think I got to all of her questions. I think that’s it.

Jeff Sarris: Yeah, which is really good. And, yeah, we really appreciate the question, even though some of it is directing to other videos, it’s very helpful because we are in the hundreds, 130ish episodes now? A lot of people will jump in at any point and to know that, “Oh, yeah, we touched on this.” Maybe it’s 50 episodes ago, maybe it’s 100 episodes ago, but there’s different things that we can reiterate, we can send you elsewhere, and just we have a a large and growing breadth of information, podcast episodes, the website, kidneystonediet.com, and all these things that we just want to direct you to whatever can help you along on your journey.

Jill Harris: And let me say this because a lot of people my age–which that’s why I’m working with every day–when you’re on this YouTube channel, look for the little magnifying glass right by the title and you can search for what you–put “collagen.” Lauren, go up there, press collagen, so you’re not scrolling, scrolling, scrolling, and the collagen video will come up so you can see it. I’ve always used that magnifying glass. It’s super helpful to find what you need, okay? If you just put it “oxalate,” you’ll just get all the oxalate videos. If you put in salt, if you get you know, whatever, it’s a lot easier to manage it that way, too. That’s what I do when people are searching. They’re like, “Jill, what about collagen in the Facebook group?” So then I go and I put in the magnifying glass and you know, I get collagen. So search that way through the channel, people.

Jeff Sarris: Yeah, you can search on YouTube. You can search on the website, if you just click the little menu, it’ll pop out. You’ll have a search box there. It’ll go through everything on–

Jill Harris: Or even Google!

Jeff Sarris: Yeah, plenty of information out there and as long as you’re coming through Kidney Stone Diet, you know that it’s 100% backed in science. So, yeah, thanks again, for your question, Laura. And if you if you’re out there with a question, the number is 773-789-8763. And we would love to feature you on a future episode. If you want to dive deeper, again, the website is kidneystonediet.com. You can find that prevention course, the meal plans, all the free information and resources. All those links are down below in the show notes in the description wherever you’re listening or watching right now. And we–

Jill Harris: Oh, Jeff, wait! People signed up for Patreon! So, go ahead, take that away!

Jeff Sarris: Yeah, you’ll find the link to the Patreon down below. People have asked how they can support. This is purely just if you wanted a different way to support the channel, what we’re doing Kidney Stone Diet, the platform, in general. It’s patreon.com/kidneystonediet. And we just wanted to shout out Allen, who is a new patron this month, and we wanted to thank him and everyone else for their contributions and their help to help us reach more people. If you’re out there listening, watching, just give it a thumbs up, share it, subscribe. All of those things help us reach more people.

Jill Harris: Thank you, Alan!

Jeff Sarris: And, with that, we will wrap and see you next week!

Jill Harris: Thanks Lauren, bye! Thanks, Alan!