Vitamin and Mineral Supplementation after Bariatric Surgery

Vitamins and minerals are critically important to the normal functioning of the body and nutritional deficiencies can cause a number of physical and psychological consequences. When caloric intake is significantly reduced, such as after bariatric procedure, it becomes imperative for the patient remains healthy, in part with balanced vitamin mineral intake period

The extent to which a patient is prone to nutritional deficiencies will depend on their unique circumstance. For example, some patients have difficulty absorbing certain vitamins – most commonly vitamin D3 and vitamin B12. Others may not consume the needed quantities due to diet and lifestyle considerations. Potential vitamin deficiencies may also be influenced by the procedure itself. Malabsorptive procedures such as the gastric bypass and duodenal switch carry a greater risk of nutritional deficiencies than purely restrictive procedures such as the gastric sleeve, the gastric band or the balloon.

In order to ward off any potential nutritional deficiencies, we perform bloodwork at regular intervals after surgery to ensure all important vitamin and mineral levels are adequate.

Common Deficiencies and Supplementation

From the start, patients need protein supplementation as well as a multivitamin vitamin for the rest of their lives. Taking additional protein makes up for lower protein levels at meal time simply because patients are not physically able to eat enough after surgery. Taking a multivitamin is a low-risk way to ensure broad levels of supplementation with no significant side effects.

Patients will also be at risk of vitamin 12 deficiency. When the stomach is removed during surgery, this is especially true for gastric sleeve patients, the body produces less intrinsic factor. Intrinsic factor is critical to proper absorption of vitamin B 12 and lack thereof can lead to deficiency. Sublingual vitamin B12 supplementation is effective for some patients, while others may require periodic injections.

Vitamin D3 is also a common deficiency after surgery. The primary form of absorption of vitamin D3 is via sunlight. D3 deficiencies are widespread in United States, mostly due to changes in lifestyle – people stay inside more often than ever before. Further, some patients do not synthesize vitamin D3 effectively through sunlight alone. Oral Vitamin D3 is sufficient to normalize levels.

Because of the restrictions in the bariatric diet, Calcium deficiency it is not uncommon. Further, the body requires vitamin D3 to produce usable calcium – therefore if the patient has Vitamin D3 deficiency, they are a greater risk of a calcium deficiency which can lead to osteoporosis and brittle bones. Patients who are being treated for poorly controlled acid reflux using proton pump inhibitors or PPIs may also be a greater risk of bone density issues.

Some patients, especially women, will experience low iron levels. The post bariatric surgery diet promotes foods rich in iron such as dark leafy greens, . However red meat, . Iron deficiencies are easily managed with a supplement to avoid anemia. However, patient should only take iron supplements of the supervision of their doctor as too much iron, especially in women, can be dangerous.

Patients may also experience deficiencies in other vitamins and nutrients are unrelated to their bariatric procedure. For this reason, it is very important for patients to work with their primary care physician or specialist to ensure balanced nutritional levels. Genetic, hormonal and medicine related nutritional deficiencies should be addressed by an appropriate specialist.

There is a fine balance between losing weight and ensuring the health of each of our patients. Our dietitians and nurses work with each patient to ensure a balanced post-op diet. Following guidelines provided after surgery is the best way to ensure proper vitamins levels. Further, sticking to our regular follow-up schedule and attending support groups monthly, typically addresses any nutritional imbalances before they become problematic.