Bariatric surgery, such as gastric bypass or sleeve gastrectomy, can be an effective tool for weight loss and improvement of obesity-related health conditions. However, it's important for patients to understand that bariatric surgery can also lead to nutrient deficiencies, particularly in the first year after surgery when the stomach is still healing and adjusting to the changes. This is why it's important for patients to take vitamins and minerals after bariatric surgery to ensure that they are getting enough nutrients and to prevent deficiencies.
Which vitamins and minerals are impacted most after bariatric surgery?
Although many vitamins and minerals (micronutrients) can be impacted by bariatric surgery, some are more impacted by others and the risk for deficiencies may depend on the specific bariatric surgery. A 2017 review article published in the “Obesity Facts” journal reported the following vitamin and mineral deficiencies that are important to prevent, detect, and treat in bariatric surgery patients (where the “+” indicates frequency for each deficiency based on the specific procedure):
Busetto et al., Obesity Facts, 2017
Keep reading for more information on the micronutrients mentioned above.
Iron
One mineral that is especially important for bariatric surgery patients to pay attention to is iron. Iron deficiency anemia is a common complication after bariatric surgery, especially in women who have undergone gastric bypass surgery. This is because the bypassed portion of the small intestine is responsible for absorbing iron. Women are at an even higher risk of developing iron deficiency anemia when they are menstruating, because they lose iron in the blood that is lost each month.
To prevent iron deficiency anemia, it's important for bariatric surgery patients to take an iron supplement as directed by their healthcare provider. Iron is often included in oral multivitamin and mineral preparations that contain vitamin C, which helps promote iron absorption. One caveat is that iron supplements should not be taken with calcium supplements, as calcium can inhibit the absorption of iron. In addition to iron supplements, patients should also be sure to include iron-rich foods in their diet, such as red meat, poultry, beans, and leafy green vegetables.
Vitamin B12 (Cobalamin)
Another nutrient that is important for bariatric surgery patients to consider is vitamin B12, also known as cobalamin. Vitamin B12 is necessary for the proper functioning of the brain and nervous system, as well as the production of red blood cells. It is important for the metabolism of every cell in the body. Vitamin B12 is found naturally in animal products, such as meat, poultry, and dairy, but it can be difficult for bariatric surgery patients to get enough of it because the stomach is no longer able to absorb it effectively after surgery. Vitamin B12 stores are high in our bodies, so deficiency usually doesn’t happen within the first year, but slowly starts to increase with time as stores are depleted.
To ensure that they are getting enough vitamin B12, bariatric surgery patients should take a B12 supplement as directed by their healthcare provider. They may also need to receive B12 injections periodically, if indicated. It's important for patients to have their B12 levels checked regularly to ensure that they are getting enough of this vital nutrient.
Calcium
Calcium is a mineral that is important for bariatric surgery patients to supplement. Calcium is necessary for strong bones and teeth, as well as proper muscle function and blood clotting. However, bariatric surgery can lead to decreased absorption of calcium, which can increase the risk of osteoporosis and fractures.
To ensure that they are getting enough calcium, bariatric surgery patients should take a calcium supplement as directed by their healthcare provider and include calcium-rich foods in their diet, such as dairy products, leafy green vegetables, and calcium-fortified foods.
Fat-Soluble Vitamins
Vitamins A, D, E, and K are known as the fat-soluble vitamins and their absorption is reduced after bariatric surgeries that lead to lower fat absorption in the gut, like biliopancreatic diversion and the duodenal switch procedures. Deficiencies in these can lead to various problems like vision issues, anemia, peripheral neuropathy, and easy bleeding. Like those previously mentioned, these should also be supplemented if found to be low.
Final Remarks
In conclusion, it's important for bariatric surgery patients to take vitamins and minerals to prevent nutrient deficiencies and ensure that they are getting what is needed for their bodies to function properly. Fortunately, many of these are covered by adult multivitamin plus mineral supplements, and many bariatric surgeons have their own suggestions on how to ensure that patients are supplemented appropriately post-operatively. Some patients, however, may not receive adequate follow-up with their surgeon or may have received surgery in another country. That’s where Mochi Health may be able to help. At Mochi Health, you can speak with physicians who have expertise in weight loss methods who can provide more information about vitamin and mineral deficiencies, order labs to evaluate them, and provide treatment. Additionally, we have registered dietitians who can assess your diet and provide guidance so that you are getting all of the nutrients that your body needs. Visit us at joinmochi.com.
References:
- Busetto L, Dicker D, Azran C, et al. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts. 2017;10(6):597-632. doi:10.1159/000481825
