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Bariatric surgery leads to significant changes in your body's ability to digest food and absorb nutrients from the gut.

Some key points on why vitamin supplementation is so critical:
  • Metabolic changes reduce vitamin and mineral absorption - After procedures like gastric bypass or sleeve gastrectomy, parts of the small intestine that are most efficient at absorbing nutrients are bypassed or removed. This leaves less surface area for absorption and can lead to deficiencies without proper supplementation.
  • Higher risk of both short and long-term deficiencies - Low nutrient levels early on can cause symptoms like fatigue, dizziness, and confusion. Prolonged deficiencies over years often have more serious effects on bone density, blood cells, and nerve function.
  • Supplement needs are lifelong post-surgery - The anatomical changes from bariatric surgery are permanent, so vitamin supplementation has to be life-long as well. Maintaining adequate nutrition is important even after the rapid weight loss phase.
Consequences of going unsupplemented vary by the vitamin and can include:
  • Neurological issues from vitamin B deficiency like confusion, weakness, numbness in hands/feet
  • Increased fracture risk and bone loss without enough calcium and vitamin D
  • Iron deficiency anemia causing symptoms like rapid heart rate, shortness of breath, dizziness
  • Problems with wound healing, infections, loss of hair and dry skin due to zinc, protein or vitamin C deficiency

Daily Bariatric Vitamins You Will Need Post-Surgery​

After bariatric surgery, most patients will need to take 2-4 supplements daily for life. Some of the essential bariatric vitamins include:

Multivitamin​

Calcium Citrate​

  • 1200-1500mg daily needed post-surgery
  • More readily absorbed form than calcium carbonate
  • Take in divided doses throughout the day

Vitamin B12​

  • Crucial for nerve health and energy levels
  • Sublingual tablets or liquid supplements best as intrinsic factor needed for B12 absorption is reduced
  • Daily dose around 350-500mcg

Vitamin D​

  • Needed for calcium absorption and bone metabolism
  • Around 3000 IU daily required after bariatric procedures
  • Can choose oral supplements or prescribe high dose versions
Other Key Supplements

Many patients need additional vitamins including:
  • Biotin - for hair, skin and nail health
  • Thiamine - improves energy and neurological function
  • Magnesium - prevents muscle cramps and weakness
  • Zinc - supports wound healing and immunity
  • Iron - prevents anemia for those with heavier periods
Speak with a bariatric dietitian to determine your specific supplementation regimen based on your individual nutritional needs and gaps. Routinely monitoring vitamin levels through bloodwork is also essential.

Key Nutrients To Pay Special Attention To​

While all vitamins and minerals are important for overall health, there are some that warrant extra attention and monitoring for those who have undergone bariatric surgery.

Protein
  • Vital for preserving lean muscle mass as rapid weight loss occurs
  • Recommended daily intake is 70-100 grams protein post-bariatric surgery
  • Include high protein foods like Greek yogurt, eggs, bariatric-friendly protein shakes, chicken, fish and lean red meat
Iron
  • Crucial for oxygen transport in red blood cells
  • Higher risk for iron deficiency anemia due to low stomach acid production and monthly periods
  • Food sources include red meat, eggs, spinach, lentils; may need supplemental iron
Calcium
  • Critical for bone health and density long-term
  • Absorption is hampered after gastric bypass surgery
  • Supplementation around 1200-1500 mg/day is typically advised
Vitamin B12
  • Required for red blood cell formation and neurological function
  • Can be deficient over time since intrinsic factor to help absorb B12 is reduced
  • Need 350-500 mcg daily of sublingual or liquid B12 supplement
Vitamin D
  • Important in calcium absorption and bone metabolism
  • Deficiency leads to osteoporosis risk over time
  • High dose supplements around 3000 IU per day recommended
Routine lab testing helps gauge if you need additional supplementation for any deficiencies that develop after surgery. Tracking any symptoms you experience can also indicate if vitamins may be too low.

Vitamin and Mineral Deficiencies To Watch Out For​

As the small intestine is bypassed or shortened during bariatric procedures, patients have an increased risk of developing nutritional deficiencies over time. Some common ones to be aware of include:

Iron Deficiency Anemia
  • Most common deficiency seen
  • Symptoms like fatigue, dizziness, rapid heartbeat
  • More prevalent in menstruating women
  • May require supplemental iron long-term
Vitamin B12 Deficiency
  • Can cause neurological issues like numbness and tingling in hands/feet
  • Contributes to fatigue and weakness when chronic
  • Need lab monitoring and supplemental B12 intake
Vitamin D Deficiency
  • Leads to bone loss and increased fracture risk long-term
  • Causes muscle weakness, bone/joint pains early on
  • High doses around 3000+ IU vitamin D needed daily
Calcium Deficiency
  • Sets stage for osteoporosis later in life
  • Can trigger symptoms like cramps, spasms when severe
  • Citrated forms better absorbed than carbonate forms
Zinc Deficiency
  • Associated with hair loss, skin issues, poor wound healing
  • Can impair taste sensation and appetite
  • Might require additional zinc supplementation if deficient
Routine screening bloodwork allows monitoring levels and guiding appropriate repletion to prevent prolonged deficiencies. Tracking your energy, menstrual symptoms, and gastrointestinal function can also provide clues on any low vitamins that need addressing. Speak with your bariatric team on concerning symptoms.

Food Sources To Incorporate For Vitamins​

While daily supplementation is necessary post-bariatric surgery, eating vitamin and mineral-rich foods can also assist in meeting nutritional needs long-term.

High Protein Foods
  • Greek yogurt
  • Eggs
  • Cottage cheese
  • Skinless chicken and turkey
  • Tofu or edamame
  • Fish like tuna, salmon, tilapia
  • Protein shakes or powders
Produce For Vitamin C
  • Citrus fruits
  • Tomatoes
  • Strawberries
  • Brussels sprouts
  • Red/green peppers
Iron-Rich Foods
  • White beans
  • Lentils
  • Spinach
  • Pumpkin seeds
  • Grass-fed red meat
Calcium Sources
  • Low fat milk and yogurt
  • Kale
  • Canned sardines with soft bones
  • Soy milk and tofu
  • Some orange juices fortified with calcium
Healthy Fats For Vitamin Absorption
  • Nuts like almonds
  • Avocados
  • Olives
  • Nut butters
  • Olive, canola or flaxseed oil
Be mindful of portion sizes, chewing thoroughly and avoiding excess added sugars as malabsorption risks remain high after surgery even when eating vitamin-rich foods. Focus on nutrient density within your post-op diet plan.

Key Takeaways​

  • Take a complete multivitamin, calcium citrate, vitamins B12 and D daily along with other supplements tailored to your needs
  • Ensure adequate intake of protein, iron, calcium, B12 and vitamin D specifically through foods and supplements
  • Monitor for common deficiencies like anemia, osteoporosis risk, neuropathies through lab testing
  • Incorporate vitamin-rich foods like yogurt, eggs, leafy greens within your post-op diet
  • Work closely with your bariatric dietitian to develop a nutrition plan and vitamin regimen specific to your surgery, health status and needs
Lifelong adherence to vitamin supplements and focusing on nutrient density within your meals and snacks is crucial to experience the full benefits in health and weight loss that bariatric surgery offers. With close monitoring and supplementation compliance, deficiencies can be avoided successfully.
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