After Bariatric Surgery Vitamin and Mineral Guide
By Dr Susan Mitchell
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Vitamin and mineral supplementation is a lifelong part of bariatric surgery. Supplements are one of those items that will be on your daily to-do list from now on. Call it a behavior modification, lifestyle change or a tweak to your daily routine. However you look at it, supplements are part of your new lifelong strategy for success
Why does bariatric surgery cause vitamin and mineral deficiencies?
Nutritional deficiencies are common after weight loss surgery and the type of surgery performed does make a difference. For example, vitamin and mineral deficiencies are more common after procedures such as Roux-en-Y gastric bypass or biliopancreatic diversion as compared to (LSG) sleeve gastrectomy and adjustable gastric banding (LAGB). That’s why you always hear me say to circle back with your health care team for clarity if you’re unsure about which supplements they recommend for your procedure.
Recommendations vary between surgical centers and even professionals groups so don’t be surprised if your supplements suggestions are different from someone else you know who’s had surgery.
Three important tips to keep in mind:
1. Vitamin & mineral supplementation usually begins shortly before surgery or when you go home from the hospital which is typically 2–4 days after surgery. So if you’ve had surgery and are home now, you should have started on supplements.
2. Your body has changed in it’s ability to absorb vitamins and minerals. How much it’s changed depends on the surgical procedure. When selecting your products, chewable or suckable pills, or liquids are a really good idea the first 3-6 months. Then if you choose and your health care provider doesn’t have you on any specific regimen, you can switch to capsules or tablets.
3. Routine vitamin and mineral screenings/lab tests should be part of your care from your health care team. How often and what they screen for will vary with your procedure.
For more information, listen to Bariatric Surgery Success EP 53 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery, Part 1 https://www.breakingdownnutrition.com/blog/53-6-must-have-vitamin-mineral-supplements-after-bariatric-surgery-part-1
What vitamin and mineral supplements do I need?
Take a “complete” multivitamin plus mineral supplement that is bariatric specific. Complete means it contains the typical A-Z formulation of vitamins and minerals similar to what you find in an adult supplement but in amounts recommended for bariatric surgery. Make sure it includes both vitamins and minerals and specifically check for vitamins A, D, E, K, folic acid and thiamin along with the minerals iron, zinc, selenium and copper. If it’s a good quality bariatric supplement it will contain all of these and more.
Here’s a need to know: you can find a multi both with and without iron. It’s fine to take your iron in the multi as long as you haven’t been put on a higher dose.
Vitamin B-12 aka cobalamin: the dose is 250-500 micrograms (ug) a day with most suggestions in the 350-500 microgram range daily or 1000 mcg every other day. The dose depends on your surgery, your lab results and the route of administration…meaning under the tongue, you swallow it, etc. Sometimes an intramuscular injection of B12 or a nasal spray will be ordered by your health care team. You can take B12 at any time or with any other supplements. It’s likely that your multi will have enough B-12 in it so check the label before you buy additional. Be sure and discuss your lab screenings with your health care team before you decide to take any extra.
The absorption of B-12 can be affected by bariatric surgery due to changes in acid production and reduced availability of what’s called the intrinsic factor. This intrinsic factor helps the B-12 to be absorbed and used by the body. When it’s not there or insufficient, B-12 doesn’t get absorbed and used as it should. You could experience neurological symptoms which include numbness and tingling of your arms, legs and skin plus feel like your coordination is off. This is a prime reason why routine screenings are so important and typically done every six months or so.
Iron: your multivitamin mineral supplement may be sufficient and you won’t need to purchase a separate one. You can find doses of iron in multis ranging from 18mg up to 36, 45, 60mg or even more but these are typical. Your dose will depend on your lab work, if you’re female and still have your period, hope to get pregnant or if you’re anemic whether male or female.
Here’s a smart strategy for you: take vitamin C or consume a vitamin C rich food at the same time as you take your iron to increase iron absorption. If both C and iron are in your multi, you’re good to go. If you’re eating an iron rich food such as black beans for example, also eating food containing vitamin C such as a tangerine will boost the iron absorption.
Don’t miss this tip: whether your multi contains iron which it usually does or you take it separately, be sure and take your calcium at a different time…about 2 hours later or the calcium will not be absorbed well by your body.
Speaking of calcium: calcium citrate is better absorbed than other types such as calcium carbonate. Recommended daily dose will be somewhere from 600 mg per day up to 1,200-1,500 mg per day.
Calcium is often sold in combination with vitamin D which helps increase the absorption of calcium from the intestine. You can take vitamin D with your calcium or get your vitamin D in your multi. How much Vitamin D do you need? The general recommendation is to take 3,000 International Units (IU) of Vitamin D3 per day. Your dose may be higher depending on your blood test.
Thiamin (vitamin B1): at least 12 mg should be included in your daily multi to prevent a deficiency so check the label before you purchase.
For more information, listen to Bariatric Surgery Success EP 53 6 Must-Have Vitamin & Mineral Supplements after Bariatric Surgery, Part 1 & Part 2
Try Free ProCare Health Samples
Vitamins can be tricky and everyone’s taste buds are different. Plus things change after surgery. Try a free sample pack of the once daily multivitamin in chewable and capsule form plus a few select other samples so you can feel confident in your purchase. These samples allow you to see how simple your vitamin routine could be with the ease of one multivitamin, once a day.