Archives: October 2025

Do I Have to Take Vitamins While I’m on GLP-1 Drugs?

“Just inject yourself once a week, and you’ll be fine!” – no, no, NO!

For any patient looking to lose weight, understanding their bodies and recognizing the importance of prioritizing protein intake, especially with more intense exercise, is a crucial part of their weight loss process. This is because they need to realize that rapid weight loss can also lead to muscle wasting and a loss of bone density.

Patients who understand this intuitively, without the oversight of a qualified medical professional, are few and far between. For most of us, it’s tough to jump on a strict diet and exercise regimen when we are losing weight so quickly and rapidly. Furthermore, with the lack of caloric intake, many patients on GLP-1 drugs might not have the energy to get out and about to the gym or go for a walk.

Due to a lack of hunger and a strong desire to lose weight rapidly, many patients on GLP-1 receptor agonists do not receive the nutrients they need to stay healthy. Problematic is an understatement. Improper nutrition can lead to a range of problems, including hair loss, skin issues, blood level abnormalities, and even organ dysfunction.

If you’re looking for obesity medical treatment, taking your supplements along with anti-obesity medications is very important. If certain supplements are hard to tolerate or afford, talk to your provider about options available. You may be able to take injections, oral tablets, or chew medications.

Speak with your doctor and get tested

If you are on an unsupervised GLP-1 drug regimen, you should consult your doctor about getting tested periodically to make sure you aren’t experiencing any nutritional deficiencies. This is a crucial part of follow-up care when someone is on weight loss medications and after bariatric surgery, as it helps prevent the numerous problems associated with nutritional deficits.

Unfortunately, medical guidelines have not caught up to the meteoric rise in GLP-1 popularity, and many patients taking the drugs may be inadvertently hurting themselves. Also know that compound pharmacies are subject to different regulatory requirements than large pharmaceutical manufacturers, which can result in variability in how compounded medications are produced.

What are some common vitamin supplements needed when taking GLP-1 drugs?

A lack of hunger while on GLP-1 meds means that we don’t eat what we did before, and therefore, we don’t receive the nutrients that our bodies may need and crave. There are a few nutrients that should be considered for supplementation while on GLP-1 medications. Many can be measured through a blood test, and you can certainly track others by closely monitoring your food intake.

If you are a bariatric patient, supplements are taken for life, and it’s very important to continue taking them even if you are two or 10 years from your surgery date.

Protein

Protein is one of the most essential parts of the weight loss process. Prioritizing proper protein intake is crucial to minimizing hair loss, muscle wasting, and bone density issues. It may be hard to get enough protein, in which case there’s nothing wrong with supplementing with an appropriate protein shake. Keep in mind that most protein shakes are full of less-than-desirable ingredients, so consider a bariatric shake from a specialized supplement company. It’s also better to eat your protein rather than drink it, so do your best to add it into your meals wherever you can.

Vitamin D

Vitamin D is usually synthesized by the skin through sun exposure and is a nutrient in which most people have a deficiency. Vitamin D plays a crucial role in the absorption of calcium, which is essential for maintaining healthy bones, teeth, and other bodily functions. Unfortunately, due to our mostly indoor lifestyles, we tend not to get enough vitamin D. Furthermore, vitamin D is not readily absorbed through eating food, so many patients require supplementation. A high-quality vitamin D supplement taken under the supervision of your doctor can start to show results within a week or two.

Calcium

Many patients may not get enough calcium, but supplementing with calcium, along with other essential nutrients such as vitamin D, can be very helpful in mineralizing bones throughout the body and mitigating the worst effects of osteopenia and osteoporosis. This is especially important for middle-aged, particularly female, and post-menopausal patients.

Iron

Iron, which is most abundant in animal meat, can be in short supply when you have limited ability to eat. A deficiency of iron, known as anemia, can cause systemic issues, including fatigue and other more significant problems. Iron supplementation can be challenging to balance, so please ensure you are under the guidance of a licensed nutritionist or dietitian, or a qualified weight loss practice.

Vitamin B12

Vitamin B12 is an essential vitamin that is often in short supply, even in patients who are not actively losing weight – but it’s particularly true for bariatric patients. Vitamin B12 regulates a number of bodily functions, not least of which is the nervous system. Along with most of the other nutrients on this list, B12 can be checked periodically through a complete blood panel with your primary care physician or weight loss practice.

Patients may be deficient or have a deficiency in several other vitamins as well, which is why it’s so important to have regular lab tests. Even if you don’t like needles, a good phlebotomist can make the procedure relatively painless and quick. On the other hand, not checking your blood regularly can increase the risk of serious vitamin deficiencies and subsequent physical and mental health problems.

What about a multivitamin?

Most patients will benefit from a multivitamin, especially as they reach middle age. A multivitamin tailored to the patient’s age and gender can be very helpful in supplementing commonly deficient nutrients. With that said, it’s essential to invest in a high-quality multivitamin from a reputable company to ensure the purity and quality of the nutrients being taken.

The bottom line

While a balanced diet is the best source of nutrients, this can be difficult to achieve after bariatric surgery or with reduced appetite from GLP-1 therapy. That’s why consistent vitamin supplementation is paramount. The body likes balance, and it’s vital that you routinely check your blood work to identify and correct any problematic values.

Many nutrients can be assessed directly through bloodwork, but protein is a little different. Tests to check it measure the body’s overall protein status rather than directly quantifying dietary intake. A total protein test evaluates components like albumin and globulin, which play key roles in fluid balance, immune function, and nutrient transport.

Remember that whether you’ve had bariatric surgery or you’re on GLP–1 medications, SAMPA is here for you. Our goal is to ensure that you lose weight safely and effectively, and most importantly, maintain that weight loss over the long term.

We look forward to being your partner in this fantastic process!

Three Reasons You Might Be Gaining Weight After Bariatric Surgery

Weight regain is a detour, not the end of the road. Together, we can get you back on the path toward the healthier life you worked so hard to achieve.

One of the best aspects of a well-built bariatric surgery program is the support patients receive before and after their procedure. With hundreds of thousands of bariatric operations performed across the U.S. each year, surgeons and their teams have basically “seen it all” and developed plans for most situations.

In the first several months to a couple of years after surgery, weight loss is usually dramatic. The scale moves quickly, motivation is high, and it’s easier to stick to the program. But the maintenance phase is quieter, less exciting—and sometimes harder. If you’re a few years out from surgery and notice the numbers creeping up, it’s important to understand why, so you can address it early.

As always, there’s no substitute for a direct conversation with your bariatric team. This article is educational, not medical advice, and is meant to help you walk into that visit more informed.

1. Your diet has slowly liberalized.

In the first year after surgery, your stomach is healing, your capacity is smaller, and you’re usually very motivated. However, over time:

• Your pouch or sleeve can tolerate larger portions even though it doesn’t increase in size.
• It’s easier to fall back into grazing, especially on slider foods (chips, sweets, soft breads, sugary drinks).
• “Special occasions” and going out to eat can quietly become daily habits.

Further, if you’ve had success in the past with very strict diets, it’s tempting to “crash diet” again every time the scale goes up. The farther you get from surgery, the less these short, aggressive diets tend to work, because your metabolism has already adapted, and your body is craving equilibrium. Plus, it’s worth noting they’re never healthy, no matter what phase of your post-op life you’re in.

2. Your anatomy has adapted by releasing ghrelin and making you feel hungrier.

Most bariatric patients in the last five to 10 years have had a sleeve gastrectomy. Early after surgery, many notice a dramatic drop in hunger. That’s largely because the upper, outer part of the stomach, the fundus, where much of the hunger hormone ghrelin is produced, is removed.

Over time, however, other areas of the body—including parts of the small intestine—can begin to secrete ghrelin and other appetite‑related signals. Hunger doesn’t go back to normal, but it often creeps back enough to throw you off track. This isn’t a lack of willpower. It’s a natural hormonal adaptation layered on top of environment and habits.

3. You’ve gotten into an exercise rut

Exercise is a critically important part of post-bariatric life. But all exercise is not the same. Yes, you will be walking from the day of your surgery, but eventually you will have to incorporate strength training as well. Walking and even higher intensity cardio can help you lose weight and certainly burn plenty of calories. It’s a critical part of early-days weight loss. However, you also need muscle-building activities to complement that long-term weight maintenance.

Many patients either never start their strength training or begin tapering off after a year or two of seeing results. We get it. It’s hard to go to the gym three times a week. However, there are plenty of resistance training exercises you can do at home if the gym is not an option, or if you enjoy the gym, redouble your efforts to make it out there, even if you know it’s not going to be a great lifting day. It’s also important to know you don’t have to exercise like you’re training for the Ironman.

And, especially for any of our female patients, if you’re worried about bulking up, don’t be. Yes, you will build muscle tone, but it is largely down to your genetics. That will ultimately decide how big your muscles can get. Typically, these worries are overblown, and most patients will see pleasing results from their strength training.

Bonus: Mental Health, Stress, and Emotional Eating

Weight regain after bariatric surgery is almost never just about food or exercise. In the U.S., anxiety, depression, chronic stress, and burnout are common, and they influence eating, movement, and sleep. Stress can drive emotional eating, “mindless” grazing, late‑night snacking, and skipping workouts because “there’s too much going on.”

There is nothing weak about saying, “I’m struggling.” In fact, it’s one of the most important parts of a successful post‑bariatric lifestyle.

Your bariatric practice can connect you with mental health resources, if necessary, and help you rebuild structure when you’ve hit a rough patch. Patients who periodically step back and honestly assess their state of mind often find it’s the missing piece that helps them get back on track.

The key takeaway:

Weight regain is not inevitable, but after 2–3 years, you usually have to be a bit more intentional. Practical steps to stay on track include:

• Get tracking again for a few weeks using whichever calorie‑tracking app you’d like. Don’t aim for perfection, but awareness.
• Prioritize lean protein at each meal, then non‑starchy vegetables, then complex carbs.
• Watch out for liquid calories, as specialty coffees, juices, alcohol, and even “healthy” smoothies can add hundreds of calories per day.
• Revisit your program materials.

We can’t stress enough how common these little blips on the radar may be. Every patient deals with them, and most worry too much, which can lead to a downward spiral. Treat this like a “reset,” not a failure. Get the help you need, and we know you’ll get back on track!

How Quickly Can You Get Rid of Hemorrhoids?

Hemorrhoids are simply an expansion and bulging of veins around the anus. We all have external and internal hemorrhoids, but modern dietary and bathroom habits have made inflamed hemorrhoids more common.

Most people will know they have hemorrhoids because of chronic (sometimes intense) itching back there. Some patients with more severe hemorrhoids may feel pain, sometimes bad enough that they can’t sit properly. Other patients may see blood in the toilet after a bowel movement, at which point visiting a colorectal specialist is necessary to rule out anal fissures, cancers, and other significant concerns.

With that said, many patients wonder whether hemorrhoids can go away on their own and what the best way of treating them might be. Let’s dive right in.

Treat early

If you are experiencing itching or pain in the anal area, it’s a good indication that you should get checked out by a qualified colorectal specialist. Of course, not everyone takes this opportunity to see their doctor immediately, so using appropriate over-the-counter creams, such as Preparation H, can help minimize discomfort. However, this will not treat the root cause. Treating hemorrhoids early reduces progression and leads to faster resolution, with a higher likelihood of success.

Is urgent care enough? The vast majority of cases will indeed end up being hemorrhoids or other benign conditions, such as an anal fissure, or simply some irritation from G.I. issues. However, on occasion, the symptoms of hemorrhoids can overlap with colorectal cancer. As such, it’s important to maintain your periodic colorectal screenings and see an appropriate specialist whenever something feels off.

Change Your Bathroom Habits

Getting back to baseline with hemorrhoids requires better bathroom habits. You may have a habit of pushing or straining during bowel movements. This is one of the most common causes of hemorrhoids. Even sitting on the toilet for an extended period can increase the risk. Try not to bring any reading material into the bathroom with you or any other distractions.

Getting More Fit

Your physical health plays a crucial role in reducing the risk of hemorrhoids. Patients who have obesity or carry a significant amount of excess weight may find that hemorrhoids are more common and take longer to resolve. Similarly, patients with metabolic disorders may require more intensive treatment. Ultimately, maintaining a metabolically healthy lifestyle makes a significant difference.

Will Hemorrhoids Go Away On Their Own?

The short answer is that, with time and proper lifestyle changes, the hemorrhoids will likely resolve on their own if you can manage the discomfort in the meantime. In that case, the interventions and lifestyle changes outlined above may help you eliminate hemorrhoids even more quickly, with some patients achieving significant relief within a matter of weeks. However, if your symptoms are particularly severe or you are not seeing any improvement after a week or so, you should be evaluated.

The Bottom Line

Be sure to manage your hemorrhoids early by combining medical advice from a colorectal specialist with improvements in your bathroom habits, diet, and exercise. Doing so will reduce the likelihood of worsening symptoms and speed up your recovery from this very annoying and sometimes debilitating concern. If you have any questions or need assistance from a colorectal specialist, please don’t hesitate to contact us.

When Your Sleeve Needs a Second Act: Exploring Revision and Conversion Options

The gastric sleeve is the most popular bariatric operation in the United States, a status it has maintained for over a decade. Its popularity stems from being a practical procedure that combines mechanical restriction with hormonal changes, helping patients lose an average of 60-70% of their excess body weight. Particularly focused and dedicated patients may even lose up to 100% of their excess weight.

However, while the gastric sleeve is a straightforward procedure, it remains a delicate operation. A well-formed sleeve can be the difference between excellent long-term weight loss and possible complications.

One of the most common concerns that sleeve patients experience is the development of new or worsening reflux after the procedure. This is often due to a poorly formed gastric pouch, a condition that Dr. Ringold at SAMPA has been at the forefront of researching. Indeed, his latest research has shown the new single-cut sleeve technology known as the Titan stapler can significantly reduce the risk of reflux. (Learn more about the Titan stapler here.)

To that end, whether your gastric sleeve requires a revision or a conversion will depend on a personalized assessment with your surgeon.

Revision of a Gastric Sleeve

A gastric sleeve revision is usually recommended when the original sleeve isn’t small enough. Typically, about 25% of the stomach remains after a sleeve procedure.

However, despite its popularity, there is no universally accepted guideline for performing the sleeve, leading to variability in results between surgeons. If the sleeve was not sufficiently reduced during the initial procedure, has stretched over time due to patient noncompliance, or has an irregular staple line, a revision may be indicated. A revision removes additional stomach tissue to enhance the sleeve’s restrictive effect.

Patients more than two years out from surgery may begin to lose some of the hormonal benefits of the original sleeve. While the stomach’s fundus does not return or regrow, ghrelin, the hunger hormone, can start being produced in the small intestine, leading to renewed hunger pangs.

Conversion of a Gastric Sleeve

Far more often, bariatric surgeons convert a gastric sleeve to another procedure. The most common reason for this is gastroesophageal reflux disease (GERD). By reducing the stomach to a smaller pouch, the sleeve increases pressure in an otherwise low-pressure system, which can worsen or trigger reflux. This is one of the reasons why we tend to steer patients toward a gastric bypass if they have severe reflux as one of their initial comorbidities. Gastric bypass surgery is very effective at restoring reflux.

A gastric sleeve can be converted into a gastric bypass by trimming more of the stomach and rerouting part of the small intestine. Conversion to a Duodenal Switch or SADI is also an option, as the gastric sleeve is the first part of each of these procedures.

Risk and Considerations of Gastric Sleeve Conversion

The first and most crucial consideration when converting a gastric sleeve is recognizing that any conversion is a major operation – and with that comes additional risks beyond those of the primary procedure. An experienced bariatric surgeon can mitigate many of these risks, but we don’t move forward with a conversion or revision without first addressing other key factors. This includes evaluating dietary and exercise habits to identify areas for improvement. In some cases, a GLP-1 receptor agonist regimen can also be used to reduce hunger and kickstart a new round of weight loss.

When other options have been exhausted, patients may be recommended for a revision, which insurance may cover on a case-by-case basis.

Ultimately, a consultation with your bariatric surgeon will determine the most appropriate approach to converting or revising a gastric sleeve. Keep in mind, many of the same challenges you faced after your primary surgery can arise again. A conversion is not a simple procedure, so it’s important to work closely with your surgeon on lifestyle and behavioral improvements to maximize the success of your secondary surgery.

If you’re experiencing reflux, weight regain, or other challenges after a gastric sleeve, our expert team at SAMPA can help determine whether a revision or conversion is right for you. Schedule a personalized consultation today and explore the safest and most effective path to achieving your weight-loss goals.