Vitamin and Mineral Intake Recommendations After Bariatric Surgery
Bariatric surgery requires lifelong adherence to behavior modification including mineral and vitamin supplementation. While some weight loss procedures pose a greater risk of nutritional deficiencies postoperatively than others, none provide 100% immunity. Decreased portion sizes, difficulty tolerating certain foods and food groups, and malabsorption are the main reasons for vitamin-mineral supplementation. Nutritional deficiencies after bariatric surgery are commonly reported; however, most of these can be prevented with patient compliance to proper supplementation. The type and frequency of nutritional deficiency is associated with the type of weight loss surgery performed. Restrictive procedures such as the adjustable gastric band have the least risk of deficiency due to complete absorption of all nutrients. The duodenal switch and gastric bypass procedures have higher risks of deficiency because parts of the digestive tract are bypassed which may cause malabsorption of some nutrients.
The following are the most current vitamin and mineral recommendations from the American Society for Metabolic and Bariatric Surgery following weight loss procedures. These recommendations are starting points. As you progress through your weight loss journey, your medical team will conduct labs and more supplements may be added based on your individual values.
Adjustable Gastric Banding
The adjustable gastric band poses the least risk of nutritional deficiencies, but patients still need to consume a multivitamin that contains 100% of nutrient daily values. The percent of daily values will be shown on the supplement label. 1500 mg daily of calcium citrate with vitamin D3 is also recommended. The calcium supplement should be split into 500-600 mg doses and distributed evenly throughout the day. Do not consume the calcium supplement with a multivitamin that contains iron. Calcium and iron will bind together and not be utilized beneficially in the body.
Biliopancreatic Diversion with Duodenal Switch
Due to the restrictive and malabsorptive aspects of this procedure, a multivitamin that contains 200% of daily values should be consumed daily. Calcium citrate with Vitamin D3 should be consumed in the dose of 1800-2400 mg daily. As with the gastric band, 500-600 mg doses should be consumed evenly throughout the day. In addition to the iron in the multivitamin, an additional 18-27 mg of elemental iron is needed daily. Due to limited fat absorption, this procedure has a higher risk of fat-soluble vitamin deficiency. Patients will need to obtain 10,000 IU of Vitamin A, 2000 IU of vitamin D, and 300 mg of Vitamin K daily. In most cases, additional supplementation will be needed because large amounts of these vitamins are rarely found in a multivitamin.
Gastric Bypass
(roux-en-Y)Similar to the duodenal switch procedure, gastric bypass patients need a multivitamin that meets 200% daily values and an additional 18-27 mg daily of elemental iron. Due to malabsorption and bypassed areas of the stomach, B12 supplementation is also needed and can be obtained through a monthly injection of 1000 mg or daily tablets that contain 350-500 mg. Calcium citrate and vitamin D3 supplementation is needed at the total dose of 1500-2000 mg daily but separated into 500-600 mg doses.
Sleeve Gastrectomy
Since this is the newest weight loss surgery, research is inconclusive of specific guidelines to follow after sleeve gastrectomy surgery. Experts agree that until further post operative nutritional deficiency studies have been conducted, patients should follow gastric bypass vitamin-mineral supplement recommendations.
B complex vitamins that contain thiamin, riboflavin, niacin, and other B vitamins are recommended as optional for all weight loss surgical procedures. There is no known risk of toxicity with B complex supplementation. Chewable or liquid supplement forms are the safest following all types of weight loss surgery, but some patients can gradually increase to a tablet or capsule (as tolerated). Recently, many multivitamins and supplements specifically tailored to weight loss surgery have been made available. These products are usually chewable and potent which may reduce the total number of pills taken daily.
Vitamins and minerals are important to overall health, well being, continued weight loss, and longevity. Overall, if you follow the supplement guidelines and postoperative follow up care recommended by your bariatric team, your risk of nutritional deficiency will be minimal.
Note: This article is not intended to be used for medical advice. Please follow the supplementation guidelines outlined by your specific bariatric program
Sources:
- www.asmbs.org
- www.lapband.com
- http://www.akrongeneral.org/obesity/lapband.htm
- http://www.healthsystem.virginia.edu/uvahealth/adult_cardiac/obgasbyp.cfm