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Bariatric surgery is a restrictive method of weight loss and depending upon the procedure, can also change the absorption of food. This means that the weight loss is achieved due to the procedure that will either decrease stomach size causing you to eat less, or cause food to bypass certain areas of digestion and thereby not all calories are absorbed.

The restricted intake of food, or the decrease in absorption, means the Bariatric patient must take recommended vitamins and minerals to meet micronutrient needs.

After Bariatric surgery, patients must take vitamin and mineral supplements for the rest of their lives. Shortly after surgery, patients begin with a chewable/liquid version of these vitamins and minerals. Eventually, about 1 month later, they progress to supplement tablets if tolerated or preferred.

The common daily regimen for most patients after surgery includes:

  • Multivitamin
  • Vitamin B12
  • Calcium citrate with Vitamin D (2x/day)

But that’s not the whole story. Here’s a bit more on vitamins and minerals pre and post-surgery…

Correcting Vitamin Deficiencies Prior to Your Bariatric Surgery

The bariatric team here at ORMC recommends that you take you vitamins and minerals prior to surgery. Obesity in itself can be a form of malnutrition because many deficiencies are commonly seen within this population. Research also has shown that up to 51% of patients undergoing sleeve gastrectomy had below normal levels of at least one micronutrient1, such as:

  • Iron
  • Potassium
  • Folate
  • Vitamins B6 and B12
  • Vitamin D

This is why bloodwork is done prior to your surgery. The goal is to improve, as much as possible, or correct these deficiencies before the surgery, so it may not be exacerbated afterwards.

Avoid The Risks of Nutritional Deficiencies Post-Surgery

Research has shown that patients who undergo sleeve gastrectomy are at risk for nutritional deficiencies in iron, folate, and vitamins B12 and D.2-4 This is due to the fact that the sleeve decreases acid production in the stomach, which may affect iron and B12 absorption. Vitamin B1 (Thiamin) deficiency could lead to Wernicke-Korsakoff syndrome, a type of neurological disorder. Despite universal supplementation, the prevalence of vitamin D deficiency was the most commonly observed deficiency five years postoperatively in sleeve gastrectomy patients.

Research also has shown that most bariatric patients do not adhere to their vitamin/mineral recommended protocol. We encourage you take your vitamins and minerals as recommended by your surgeon and doctors, and continue to get your annual checkups with your surgeon’s office in order to monitor for micronutrient deficiencies.

  • Consider a bariatric brand of vitamins/minerals, which may be more expensive, but will meet your needs post-surgery. (Remember, you will be saving a lot on your grocery bills after surgery which gives you some leeway to purchase a more appropriate and better quality vitamin/mineral.)
  • Set an alarm on your phone to remind you when to take your supplements
  • Continue with chewable/liquids if better tolerated or preferred
  • Take supplements after consuming a meal to decrease nausea and improve vitamin absorption
  • Consider a bariatric powdered vitamin/mineral supplement you can add to water

Note: Transdermal delivery of vitamins/minerals via patch is in the process of clinical trials, but has not been resulted for post-op bariatric surgery patients and cannot prevent all nutrient deficiencies. Numerous factors can influence the body’s ability to absorb nutrients from the skin including the molecular size of the nutrient and an individual’s skin conditions.

Until clinical trial research is completed, the ORMC Bariatric surgery program recommends continued use of oral supplements only, as current oral micronutrient supplement guidelines have been established by numerous professional societies.


References:
1. Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881-889.
2. Hakeam HA, O’Regan PJ, Salem AM, Bamehriz FY, Eldali AM. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19(11):1491-1496.
3. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic roux-y-gastric bypass (LRYGB): a prospective study. Obes Surg. 2010;20(4):447-453.
4. Capoccia D, Coccia F, Paradiso F, et al. Laparoscopic gastric sleeve and micronutrients supplementation: our experience. J Obes. 2012;2012:672162.
5. Aarts EO, Janssen IM, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21(2):207-211.
6. Bos JD, Meinardi MM. the 500 Dalton rule for the skin penetration of chemical compounds and drugs. Exp Dermatol. 2000;9(3):165-9.
7. Parrot J, Frank L, Rabena R, et al. ASBMS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient – 2016 Update: Micronutrients. Surgery for Obesity and Related Diseases. 2016:12:955-959.
8. NCT02686905 https://clinicaltrials.gov/ct2/show/NCTO2686905?term=transdermal+vitami…, 2017).2(4)NCT02174718

All content presented are provided for informational and educational purposes only, and are not intended to approximate or replace professional medical advice, diagnosis, or treatment.  Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.  Never disregard or delay seeking professional medical advice because of something you have read within the website content.  If you think you may have a medical emergency, call 911 immediately.

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