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To all J-Pouchers, how is your absorption of water and vitamins after the j-pouch surgery? I understand the colon observes a lot of water and some vitamins. So, do you feel you are getting the same (or similar at least) absorption after the j-pouch surgery? Are you able to play sports? Do you get dehydration or any nutritional deficiencies?

Thanks!
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Your small intestine does the absorbing of the nutrients. You can play sports and do all the things you did before but you have to be extra conscious about staying hydrated. I'm really bad about it....I really should drink more water.

The only puzzleing thing I have going on is that it's been two years since my surgery and I'm still anemic. I take iron supplements 2x a day and my hemoglobin doesn't want to creep past 9.5. So to me it doesn't seem like I'm absorbing iron. My doc can't give an answer as to why. If its not better soon, I will be going for iron infusions.
I struggled with symptoms of dehydration and low sodium following my first of the 3 step surgery. 7 years post takedown finally went onto home IV fluids. It means I no longer get admitted for fluids and when things are in balance I feel so much better. Its a fine balance as when I get a bad flare of pouchitis or the weather is too hot my levels quickly drop and I need extra fluids. Also monitored for B12 with injections as needed.
It does vary and in fact you may find that over time, your body adapts, in that you may need more water in the beginning but less as time goes on. Our bodies are pretty resilient and can become more efficient at maximizing water absorption with time. I'm now approaching 7 years without my colon and I probably drink less now than I did immediately after my colectomy (though a lot of that was probably out of fear--I was told to drink drink drink and that I did, at first. I also peed peed peed and after a while I realized I probably didn't need to drink--or pee--quite so much so I cut it back.). I always have water with me now, but I don't guzzle it constantly. Truth be told, I probably should be drinking more now than I do, but I'm pretty active and I generally let my thirst guide me. That said, I tend to make sure I do include a lot of foods high in potassium since low potassium has been an issue for me in the past. I drink a low sodium vegetable cocktail every day with lunch to keep my potassium levels up. I did have nutrient absorption problems initially after my colectomy, but my overall health was so poor at the time that I think it was a combination of everything going on, not just being without my colon.
I am 7 months post reversal and my experience was that I needed to lots more fluid in the first couple of months since reversal and it has gradually improved over time. I would recommend that you take rehydration drinks (sold in pharmacies) initially. I suffered horrible dehydration after my first op when I had the temp stoma and ended up being readmitted about 5 times becuase I was being sick. It took the docs a while to figure out it was actually dehydration that was causing the sickness and scarily the next stage is fitting followed by a coma. So... make sure you take hydration seriously. I drank lots and lots of water and it didn't help (can in fact make things worse as it dilutes the amount of salt in your body) - the rehydration salts were crucial in my case. I'm sure for some people lots of salty food and water would do the trick - everyone is different afterall!

In the case of vitamins and nutrients it isn't true that the small bowel absorbs everything. I think it differs per person but I have been told that up to 15-20% of absorption can happen in the colon. This explains why some people (me) struggle to gain weight after the j pouch op. Now, it's still early days and I do think things will improve as my body learns (the water is definitely absorbed better now) but I take vitamin supplements and eat ALOT (much to my friends envy!)to maintain my weight. I have met other j pouchers who say the same...

Hope this helps.
Im a pretty good authority on water so will give some points below. As always though, these are just my thoughts and everyone should consult their G.P. Surgeon or GI disclaimer disclaimer disclaimer etc etc etc…. so….

This will be long but if you read it all I think it will help not only in giving good advice, but explaining all the details behind how water works with our bio chemistry. I will do a summary at the bottom though for those that want to skip the details Smiler

Firstly, Hydralyte is sold in chemists is really good for rehydration. So if your struggling, head for that.

I DON’T recommend people to drink tap water. It has alot of heavy metals, chlorine, fluoride and devoid of any mineral content.

Boiling tap water helps remove heavy metals, chlorine etc which is good, but you end up with “pure H2o” or “distilled water”. The problem with this is your body won't absorb pure H2o very well. It needs a variety of minerals present to absorb the H2o, so if you drink pure H2o the only way your body can get those minerals is to leech them from your bones and teeth, leading to tooth decay and osteoporosis! This was shown in a 12 year study at the university of newcastle, where cities around the world which had their water distilled showed increased reports from dentists and doctors to the World Health Organisation for massive increases in osteoporosis and tooth decay, and it was in people very young to typically get it!

So no tap water, no boiled water, no bottled water that is marketed as "pure". As its going to cause tooth and bone issues and wont really provide optimal hydration anyway.

GETTING HYDRATED
To get maximum hydration (i.e water carry over into your cells) you need a high level of total dissolved solids (known as TDS), or mineral content. When you sweat how does it taste? SALTY! Your cells and your body are approximately 70% water, and that water is SALTY. It is in fact as salty as the ocean! So drinking tap water or bottled water which is VERY different to whats in your cells WILL NOT hydrate you. The cell wall is very protective in its design so unless what is on the outside is very similar to what is on the inside it won't let it cross over. Make sense?

So when you drink bottled water or tap water, its very different to the water in your cells, so the cell does not let the water cross over very well. This is what we call “EXTRA-CELLULAR” hydration. Means you have a lot of water in your body, but not in your cells. When this occurs your body eventually flushes the excess water out, so you pee a lot, sound familiar? Drink a lot of water, pee all the time! Thats NOT hydrating the cells of body. Thats just flushing water through your system and making your kidneys work overtime.

To get “INTRA-CELLULAR” hydration you need H2o, (without chlorine, fluoride and heavy metals), and it needs to have over 300TDS in mineral content. How do you do this? EASY. There are a few options….

1. Boil tap water for a good 10 minutes. This destroys all the chlorine and leaves pure H2o.
2. Alternatively, go buy a VERY GOOD water filter. A double reverse osmosis one is the best. This also gives you pure H2o
3. Go buy water from the shops that is branded as “pure H2o”.

So we want to START with pure H2o, without the metals, chlorine etc…

Now go to your local Health shop. Not your big chain commercial food supplier but the little health shop on the corner and ask for: RAW, CELTIC SEA SALT. You want to get one that is a FINE GRAIN, and it should be unbleached, unprocessed. It will look grey and a bit dirty almost. This is REAL salt taken straight from the ocean. If its pure white, it has been processed, bleached and is NOT goodyou’re your health. So inspect your salt!

Now you put a pinch of this per litre into your pure H2o. (note, if you can taste it, you put way too much!). So its only a pinch, but this adds the mineral content to the H2o that the body needs to assist in absorbing the water. There are hundreds of minerals on the planet. Celtic Sea salt has 78 specific minerals. Now if I was to take your blood plasma, and pull it apart and analysed the mineral content, you also have 78, and it’s THE SAME 78 as found in celtic sea salt. THAT is how you hydrate the body. That’s no coincidence, that’s mother nature, or god, whatever you want to belive in, designing us to survive on this planet. When we try to be intelligent and bring in plastic bottles with chlorine, and fluoride and devoid all the mineral content just so a big company can make money, you don’t get hydrated that way! That’s not how the body works!

You will find by adding a pinch of the salt this makes the water you drink almost identical to the fluid inside your cells, allowing the water to get absorbed into the cells, giving you maximum hydration… and the best side effect, much less peeing! I typically drink 1.5 litres before lunchtime, and normally don’t pee until atleast 200pm when im getting closer to my 2litre mark for the day.

BOTTLES
A few points on bottled water. Your other alternative is to buy water that already has all the right stuff in it ready to go, the brands I am aware of that are global are: FIJI and EVIAN. Both have TDS above 300, bottled at the source so no heavy metals are picked up in pipelines and no chlorine or fluoride added. So it’s a very good quality. However, only use the bottle once, never refill plastic water bottles. There are oodles of studies showing chemicals, particularly estrogen and phytoestrogens found in plastic bottles and if used over and over these chemicals leech into your water. For a male, this is very problematic as it really can be detrimental to your hormonal system, thyroid and adrenal glands. Also, the softer the plastic, the worse it is and the more it leeches. I recommend buying stainless steel drinking bottles that have proven to have BPA free testing as well as 100% zero leeching of metals. These are basically 100% clean bottles to drink from. I get mine from http://green-canteen.com.au/ or www.cheeki.net.au/


HOW MUCH TO DRINK?
Really varies person to person. A simple guide is this:

Multiply your body weight in Kg’s by 0.03.

So a 70kg person needs about 2litres, a 100kg person is 3 litres.
Also for every hour of strenuous exercise add another litre
If you live in a very hot climate add more as well.

A 100kg male, living in a hot climate who does an hour of exercise really should be up around 5-6 litres to stay optimally hydrated!

So in summary:

• Hydralyte is a good option if your really struggling
• No tap water
• No bottled water unless its FIJI or EVIAN
• Drinking boiled water removes nasties but causes bone and teeth issues
• All water filters remove nasties but again causes tooth and bone issues
• Add a pinch of celtic sea salt to your boiled water, reverse osmosis water or Pure H2o water purchased from the shop to get the needed mineral content to increase hydration and prevent bone or tooth issues
• FIJI and EVIAN are ok, just don’t re-use the bottles.
• Drink out of stainless steel bottles for decreased toxin exposure

I personally buy Pure H2o from the shops in large casks (10 litre cask – I get 6 at a time so 60 litres!). Then I fill up my 1 litre bottles and add a pinch of my celtic sea salt to it every morning and away I go. Fast, effective and easy to do. Clean water, optimal mineral content, maximum cellular absorption.

Hope this helps!

JH
I've read that B12 absorption occurs at the end of the small intestine, and depending on how the surgery goes, some j-pouchers end up unable to get enough B12 from their diet. I asked my surgeon about this, and he said I will be able to absorb it, but I'm still skeptical because it wouldn't be the only thing he's told me just to comfort me that turned out to be false. Next time a go to the doctor, I plan to find out if I'm lacking B12 or any other nutrients.

To anyone who knows the answer to this question: How long does a B12 injection supply B12 to the body before another one is needed?
I am getting close to my first of 2-step surgery myself and am glad to see this thread. As a follow-on question- does drinking enough to not be dehydrated basically also mean putting up with more bowel movements, jn comparison with drinking more modestly, Or is that correlation more in the beginning before the small intestine and j-pouch "learn" to absord water better?

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