Vitamin Requirements and Deficiencies

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Taking vitamins after bariatric surgery is an important commitment. Vitamin labels must be read, blood work drawn and vitamins adjusted. Timing is also important. Taking vitamins on an empty stomach will maximize absorption and taking calcium and iron two hours apart will improve the mineral’s effectiveness.You may have heard that eating the right diet makes vitamins unnecessary.  But, after bariatric surgery, the “right diet” may not be possible. Because of food intolerances and small meals, bariatric diets aren’t able to provide enough vitamins and minerals. Plus, many people who undergo bariatric surgery have a lifetime of learned poor eating habits and tend to choose low nutrient foods, furthering the need for healthy supplementation after surgery.A year or two after surgery some patients become bored or fed up and stop taking vitamins. In the short run, vitamin deficiencies may not develop until years after eating habits have changed. So it’s important to have lab work drawn every year after surgery to make sure deficiencies aren’t developing.

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B12 and Folate Deficiency
B12 and folate are like parents for your red blood cells. As the red blood cells grow, they need their parents to help them develop into normal red blood cells. Without B12 and folate, red blood cells develop in a way that prevents a smooth transfer of blood through the veins and limits oxygenation.

The B12 vitamin is found in animal foods such as beef, pork, and chicken. Although many people who have undergone gastric bypass eat plenty of animal-based foods, they’re still at an increased risk for B12 deficiency. This is because the smaller stomach doesn’t produce as much acid, which is needed to get B12 out of proteins. After the B12 is released, it still needs help to be absorbed, requiring an enzyme called Intrinsic Factor. And since a smaller stomach doesn’t make as much Intrinsic Factor, the efficiency of B12 absorption is reduced.

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Incidentally, B12 can be stored in the body up to five years. Therefore, a deficiency may not be discovered until years after a bariatric procedure. In fact, some studies show B12 deficiencies up to nine years post-op! This is why it’s important to continue to follow up with your doctor and have labs checked at least once a year.

Symptoms of a B12 deficiency include numbness in the hands and feet with results including permanent brain damage and in severe cases, delusions, hallucinations and even psychosis.

A supplement with 350-550 micrograms of B12 a day is plenty to prevent a deficiency. B12 is also available as a monthly shot or a weekly nasal spray.

Vitamin D and Calcium
These two vitamins depend on each other to absorb. When calcium intake is reduced, Vitamin D absorption decreases and visa versa. It’s common knowledge that calcium makes bones strong. But calcium’s most important job is to help muscles contract. Our heart is a muscle and it’s only job is to contract. Therefore, our bodies will always keep our heart pumping by pulling calcium from our bones when blood levels are low. Coincidentally, a lab test doesn’t really tell us if we have enough calcium because our blood will always show the right amount. Low calcium levels may never be noted until osteoporosis develops. By then, it’s often too late. A bone density test is the best to uncover the bone’s current state.

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Vitamin D deficiency is often found in people with high Body Mass Indexes. Before bariatric surgery, many already have low Vitamin D levels due to increased weight. Low vitamin D leads to low calcium absorption, which then causes increases in a hormone called calcitrol which causes our bodies store fat. This is an endless cycle: low levels of Vitamin D cause more fat accumulation, causing lower levels of Vitamin D.

Calcium and Vitamin D deficiencies increase risk for cancers of the colon, breast and prostate, as well as complicate disease such as diabetes, IBS, arthritis, and hypertension.

Calcium supplements should be taken in the form of calcium citrate as other forms are not absorbed well. The best supplement includes 500 mg of calcium citrate with Vitamin D, taken three times a day. Moderate exposure to sunlight can also increase Vitamin D levels. If you are outside long enough to tan, your body is making Vitamin D. Beware that carbonated drinks such as soda or tonic water decrease calcium absorption. And since Iron and Calcium complete for absorption, these supplements should be taken two-hours apart.

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Iron
Iron deficiency can occur after bariatric surgery because food spends less time in the small intestine, where it is absorbed. Iron deficiency occurs more frequent in those who do not tolerate meat. Since Vitamin C can help increase the absorption of iron, a salad with meat and mandarin oranges is a practical and tasty way to increase iron absorption.

Women of childbearing age should be particular about their iron supplementation as blood losses from menstruation increase the risk for Iron deficiency.

Low iron can also lead to decreased energy, preventing ability to exercise which promotes weight gain. Pica is a severe symptom of iron deficiency. Pica is a bizarre eating disorder where the sufferer is compelled to eat non-food items such as corn starch, chalk, paint, clay/dirt, or ice. Luckily this eating disorder can be reversed in a couple of months with iron treatment.

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Normally a multi-vitamin can provide all the iron our bodies need at around 36 mg a day. Note: those delicious gummy vitamins from the grocery store do not contain iron. The absorbable form of iron is not sable in gummy form. If your vitamin is a gummy, you'll need an extra iron supplement. 

Thiamin  (Vitamin B1)
A deficiency of Thiamin can occur in patients with frequent vomiting. If a deficiency goes undetected, it can lead to permanent muscular disorders and defects in learning and short term memory. Thiamin is a water soluble vitamin, meaning it isn’t stored in the body for very long. After only of couple of weeks of severe vomiting, a thiamin deficiency may develop. A multi-vitamin usually contains much more than 100% of the daily recommended value. For severe vomiting episodes, an extra B50 complex can be taken to ensure Thiamin and all other B vitamins are maintained.

So, what vitamin supplements  should you take? Many companies make vitamins specifically designed to meet the needs of bariatric patients. Bariatric Advantage, Celebrate Vitamins, Opurity Vitamins, and Nutrametrix Isotonic vitamins are recommended. Some insurance companies will pay for Nascobal prescription vitamins. This is a great deal; the vitamins are delivered to your door each month for only $25.00.

Bariatric Advantage Vitamins
Celebrate Vitamins
Opurity Vitamins
Nutrametrix Isotonix Vitamins
Nascobal Vitamins

As noted above, vitamin supplementation and follow up lab work is crucial to health after bariatric surgery.  And finally, it’s best to take vitamins in liquid or chewable form so digestion isn't required before vitamins are absorbed.