As many of you know, bariatric vitamin supplementation is very important following weight loss surgery in order to prevent micronutrient deficiencies. Gastric Bypass, Sleeve Gastrectomy and Adjustable Gastric Banding are the three most common procedures being performed in the United States and around the world. There are over 100,000 of these procedures being done annually in the USA alone. Due to malabsorption and decreased food intake with limited variety, the body has lost the ability to absorb crucial vitamins and minerals and the levels taken in through your diet are not nearly high enough. Continued education should be given pre and post operation concerning the importance of proper supplementation. Practitioners should keep in mind that overwhelming a patient with a difficult or expensive daily vitamin regimen will ultimately lead to decreased patient compliance and will lead to poor outcomes and an increase in complications.
Vitamin deficiencies commonly seen in the bariatric patient should be corrected before surgery as a decrease in food intake and food intolerances can exacerbate these deficiencies after surgery. Commonly seen post-operative symptoms such as nausea, vomiting, and diarrhea can also negatively affect vitamin and electrolyte imbalances.
Vitamin and mineral supplementation after weight loss surgery is critical to maintain proper health and nutritional intake. Micro-nutrient deficiency is the most common side effect from bariatric surgery and is more prevalent in gastric bypass due to the malabsorptive component of this procedure. This typically occurs in approximately 21% of patients. Sleeve Gastrectomy has considerably less malabsorption when compared to Gastric Bypass but absorption of some vitamins and minerals post-surgery are compromised. Malnutrition and poor dietary intake are the main factors that lead Adjustable Band patients to require significantly higher amounts key vitamins and minerals.
Frequently seen deficiencies after weight loss surgery include: Vitamin D, iron, B12, folate, thiamine, and calcium. These deficiencies can lead to side effects such as easy bruising, loss of hair, lack of energy, fatigue, weakness, depression, irritability, constipation, memory loss, etc… Patients should be made aware of these common signs and symptoms and encouraged to call their health care providers if any of these occur.
Taking a chewable multivitamin is the easiest and most effective way of reducing the risk of micronutrient deficiencies in the body after bariatric surgery. A chewable bariatric vitamin ensures successful absorption by beginning the digestive process in the mouth. Chewing breaks down the multivitamin to its most biologically available form and gives the digestive tract the distinct advantage of absorbing all the bariatric vitamins and minerals possible. In contrast, taking a capsule delays the absorption of supplements being taken. The shell of the capsule must be broken down in the digestive tract before absorption can occur. When and where this takes place cannot be determined with 100% accuracy.
Patients should find a bariatric vitamin and mineral formulation that is made specifically for those who have had weight loss surgery. This formulation should have dramatically higher percentages of fat soluble vitamins A,D, and E, B12, Folic Acid, iron, and Calcium. The supplement should also include chelated forms of minerals which increases and enhance absorption. Those patients taking anti-coagulants such as warfarin and coumadin must be sure to avoid formulations containing Vitamin K. Patients who suffer from migranes should consider a product that is sweetened with sucralose (Splenda) rather than aspartame. Blood work for early detection of underlying deficiencies should be checked on multiple times in the first year immediately following surgery and then on an annual basis for life.
Affordability, taste, and an easy daily regimen are the most important factors that influence if a patient will be compliant with proper supplementation after weight loss surgery. Expecting a patient to purchase multiple products and spend $60-$70/month realistically will not happen. Compliance is hindered further based on how many times during the day their vitamin must be taken. Frequently, patients present with associated comorbidities, including T2DM, polycystic ovarian disease, metabolic bone disease, lipid abnormalities, fatty liver, degenerative joint disease, hypertension, gastro esophageal reflux disease, and obstructive sleep apnea. These comorbidities often require pharmaceutical treatment and adding a difficult vitamin regimen will make compliance nearly impossible.