After reading the post by Steve101 on this subject a month ago, I was so intrigued that I decided to seek a medical opinion. Like many people who have had an oesophagectomy, I sometimes suffer from fatigue and a general lack of energy.
I forwarded the post to the Chairman of our local Upper GI Network Cancer Group, on which I am a patient representative. He forwarded it on to the Upper GI Dietitian at Watford General. Here is her response. I have edited it slightly and, therefore, take full responsibility for any errors.
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“I read the post with great interest and in answer to your question is this true? Well, mostly yes!
Anyone having undergone upper GI surgery has multiple reasons for developing nutritional deficiencies, e.g. poor food intake, post-op therapy, surgical stress, etc. As regards magnesium, it has many roles in the body and I would agree that many people are deficient, particularly those who have had bowel surgery. Gastro-intestinal absorption is indeed poor and hence we supplement it intravenously. As for the ‘uselessness’ of serum measures, I don’t know the answer to this, but can say that we frequently check and correct patient levels and the serum levels respond quickly to intervention. In addition, I am not convinced of the absorption through the skin and it’s certainly new to the rest of the team. However, magnesium has a very low toxicity, so I wouldn’t worry about its safe use by patients.
B12, again like most wonderful nutrients, has multiple roles in the body. Those proven to be at risk are gastrectomy patients, due to the lack of intrinsic factor, and all gastrectomy patients’ GPs are specifically advised to give B12 injections at 3-6 month intervals, but any upper GI patient is also nutritionally at risk as mentioned above. Again, it can be safely supplemented and can be taken orally.
In answer to your question about how we manage these issues locally, I personally recommend (by letter) to all upper GI patients’ GPs that a broad set of micronutrients are checked annually (i.e. full blood count with haematinic markers (ferritin, B12 and folate), liver function tests, parathyroid hormone level, zinc and selenium levels) and I also suggest a daily multivitamin. I do not give more specific advice to patients for a couple of reasons: 1) many patients cannot absorb this level of information and there is really a limitless quantity that they could read; and 2) unfortunately the scientific evidence for micronutrients in this patient group is lacking. There is a huge amount of theory, but demonstrating deficiency in large numbers is inherently difficult. My recommendation of a multivitamin is preventative, based on recent research by dietitian Stephanie Wakefield at St. Mary’s Hospital in London.
In summary, I would definitely agree that this patient group is at risk, but would add that it is not just Mg and B12, but probably other micronutrients as well, and a daily broad spectrum multivitamin should cover all bases. Most nutrients will be absorbed well, but you will get some benefit even from those that are poorly absorbed. “
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Some of you may have attended, as I did, the excellent lecture that Stephanie Wakefield gave to the London Branch of the OPA a few years ago on the prevalence of micronutrient deficiencies in upper gastro-intestinal cancer patients after treatment. In summary, the recommendations are to get a broad set of micronutrients checked annually by your GP and take a daily broad spectrum multivitamin supplement.
Hope this is useful.
G
