After bariatric surgery, you must take vitamins for the rest of your life. Serious illness can result from non-compliance with your vitamin and mineral guidelines. Mood, energy, and focus can also suffer from a lack of proper vitamins after bariatric surgery. Blood tests are required every three months for your first year after surgery and annually after that.
In this article:
- Why vitamins and minerals are essential after bariatric surgery.
- What types of vitamins and minerals are required by procedure?
- What to look for when buying vitamins and minerals.
- Signs and symptoms of vitamin and mineral deficiencies.
- How much you can expect to spend monthly.
Why Vitamin and Minerals Are Important
Bariatric surgery is all about improving your health, and a big part of improving your health is proper nutrition. Proper nutrition isn’t complicated. There are three things you need to think about; water, macronutrients, and micronutrients.
You’re probably already tracking your water intake and macronutrients; carbs, fats, and proteins. We recommend using an app like Baritastic to track. After surgery, you and your medical team will be monitoring your micronutrients, too.
Micronutrients are a ‘five-dollar’ word for vitamins and minerals. They’re called micronutrients, because, compared to carbohydrates, fats, and proteins, which you need in large quantities, the amount you need each day is exponentially less.
But they’re no less important, and that can present a challenge for those of us living the bariatric life. The fact is, it’s hard enough to get everything you need with a normal digestive system. After surgery, it’s even more difficult.
After gastric sleeve, gastric bypass, or biliopancreatic diversion (or it’s cousins like the single anastomosis duodenal-ileal bypass with sleeve (SADI-S) micronutrient absorption is abnormal.
If you’ve had gastric sleeve surgery, you don’t have the capacity in your surgically altered stomach to consume enough food to get adequate amounts of key micronutrients. Also, the part of your stomach that is surgically removed is an area that produces gastric acid and certain digestive enzymes, this impacts the way that micronutrients are absorbed. So even though the intestines remain the same after a sleeve gastrectomy there is still a change in the way that micronutrients are absorbed, and long-term micronutrient deficiency rates are similar between the gastric sleeve and gastric bypass.
If you’ve had gastric bypass surgery, you’ve got capacity issues, along with malabsorption. Because of the surgical changes to your digestive tract, your body can’t extract all the nutrients it needs from your meals. It’s even more important if you’ve had duodenal switch surgery, because more of the intestines are bypassed, limiting the body’s ability to absorb micronutrients.
To maximize absorption of micronutrients after surgery, you will likely need to take supplements a few times each day. There are more than two dozen micronutrients that your body needs to stay healthy. For most of these, you need only a trace amount. Others, such as B vitamins and minerals like iron and calcium, require more than that and, consequently, are more likely to come up short, particularly among bariatric patients.
Here are a few to look out for, no matter what stage of the bariatric journey you’re at.
Thiamin, aka vitamin B1, helps convert food into energy and contributes to healthy skin, hair, and liver. Early symptoms of a thiamin deficiency include fatigue, irritability, vomiting, uneven sleep, and abdominal discomfort, all of which are common enough as it is among people who have had a bariatric procedure, so they’re easy to write off as nothing serious. Ignored long enough, though, a thiamin deficiency can lead to permanent nerve damage.
Vitamin B12 helps the body manufacture new red blood cells and contributes to a healthy central nervous system, too. A small B12 deficiency can have no symptoms at all; untreated, though, it can lead to a general feeling of weakness, lightheadedness, muscle tingling and permanent nerve damage.
Iron deficiency is an astonishingly common condition in the United States, even more so among bariatric patients. Early signs of an iron deficiency present as dizziness, fatigue, or light-headedness, a fast heart rate or heart palpitations, or brittle nails. This is one of the most difficult deficiencies to treat post-operatively with oral iron supplementation and oftentimes a blood transfusion will be needed if you don’t get in enough iron every day.
Calcium and vitamin D go hand in hand because we get them both from dairy products. The sun is also a major source of vitamin D. If you’ve spent years covering yourself up because of a cold climate or body insecurities, shedding those clothes to get some sun isn’t something that always comes easily, and Greek yogurt isn’t going to do the job all by itself, either. A calcium deficiency is very difficult to detect, you often will feel no symptoms of it, and blood tests for calcium deficiency are not a good indicator. Often people do not realize they are not getting in enough calcium and / or vitamin D until they suffer from a broken bone – which does not occur until many years after surgery. Early signs of a vitamin D deficiency include bone pain and muscle weakness, also easily ignored by bariatric patients who are already dealing with similar conditions post-op.
The good news is all of these deficiencies can be easily avoided with supplements. It’s not a question of if you’ll take supplements, it’s which supplements you’ll take and how often. It just goes with the bariatric territory, and each of us must find our own path and our own way. The most common supplements post-op are multivitamins, vitamin D, calcium, iron and vitamin B12.
What Types of Vitamins Do I Need?
Bariatric specific supplements have been available from trustworthy brands for the last 20 years. While patients who had surgery long ago were told to buy their supplements over the counter, that is no longer the gold standard. As nutrition research has continued over the last few decades it is clear that the amount of vitamins and minerals your body needs after surgery is much higher than someone who hasn’t had bariatric surgery, therefor specialty supplements have been developed to help you get in all of those needed nutrients in as few of pills or chewable’s as possible. If you decide to purchase your vitamins over the counter, it is imperative that you check the labels and make sure you are getting enough of each individual vitamin or mineral listed below. Keep in mind you will need to purchase about 8-10 different bottles of supplements if you buy them at your local drugstore. If you purchase from a bariatric specific brand you will likely only need to purchase 2 or 3 bottles of supplements to meet your needs.
Let’s start with some guidelines of what not to take:
- No gummy vitamins.
- Avoid children’s and standard adult over the counter vitamins which are incomplete.
- Patches have not been proven to be effective at preventing deficiencies after surgery
Choosing a Multivitamin
- Depending on the brand and size of the vitamin you’ll need to take between 1 and 4 pills, or chewable tablets daily. Read the label to find out how many are required daily.
- The majority of patients need 45-60 mg of iron per day after surgery. Most bariatric specific multivitamins contain at least 45 mg of iron. If you choose a multivitamin without iron, you’ll need to take iron supplementation separately.
- Your surgeon or dietitian should provide guidance on how much iron you’ll need after surgery.
- It should contain at least 400 mcg of folic acid.
- At least 200% of the recommended daily intake for most, if not all, of the vitamins and minerals listed on the label.
- It contains at least 2mg of copper, and 16 mg of zinc.
- Should contain at least 12 mg of thiamin.
- At least 75 mcg (3,000 IU) of Vitamin D3.
Let’s take a look at the label below.
This is the label for Celebrate’s Bariatric Multivitamin in capsule form without iron. Almost all of the ingredients have over 200% of the daily recommended value. Vitamin D, Thiamin, Folate, Zinc, Selenium, and Copper all meet the requirements mentioned above. This is a high potency vitamin and 3 capsules are required daily. This is an excellent choice for a gastric bypass or gastric sleeve patient. If taking this vitamin, you’ll need to supplement with iron separately (again, speak to your dietitian or bariatric surgeon about your iron requirements). Celebrate has other options that contain iron as well.
Choosing Vitamin B12
- At least 500 mcg per day of Vitamin B12 (cobalamin or methylcobalamin).
- B-12 that dissolves (melts in your mouth) or chewable tablets are the most common choice for vitamin B-12 supplementation.
Some bariatric-specific multi-vitamins will contain enough B-12 where additional supplementation is not required. However, it’s very important to read the label. Some bariatric specific vitamins do not provide enough B12. The celebrate multivitamin shown in the first label does have 500 mcg of vitamin B12. If you’re taking the Celebrate multivitamin additional supplementation is not required unless your blood levels are low.
- 1,200 – 1,500 mg per day is recommended for VSG or RYGB. 1,800-2,400 mg is recommended for BPD-DS or more malabsorptive procedures.
- For best absorption take doses that range from 500-600 mg two to four times daily depending on your needs.
- It should not be taken within 2 hours of iron. Calcium inhibits iron absorption so separating these is necessary.
- Calcium Citrate is recommended. Absorption is better compared to calcium carbonate.
- If you’re taking a multivitamin without iron, you’ll need to take an additional iron supplement daily.
- Follow the guidelines recommended by your surgeon.
- Do not take iron and calcium at the same time. Separate iron and calcium by at least 2 hours.
- For any person who has had VSG, RYGB, BPD-DS, the recommendation based on bariatric published guidelines is to take 45-60 mg per day, regardless of gender.
- Studies show that iron deficiency risk is extremely high years after you’ve had surgery, indicating that upwards of one out of two patients will develop iron deficiency 5 years out from their procedure.
- Keeping normal iron levels in the blood is so important as it’s very difficult to return to normal levels once they decline. It’s much easier for your body to prevent this deficiency, than correct it if it develops.
It is helpful to find a vitamin supplement that is easy for you to remember to take, and one that you enjoy taking. Research shows that the number of pills, or chewable tablets, you need to take in a day may play a role in the likelihood of you remembering to take them. What this means is that if you have the option of taking five pills per day versus ten pills per day, you are more likely to stick to your plan with the fewest number of pills. This is why bariatric specific vitamins are the vitamins of choice after surgery, because they provide you with the necessary nutrients to help prevent vitamin deficiencies. All bariatric specialty vitamins vary in what they provide. Below are the main nutrients to pay attention to when selecting your vitamin, this one from Bariatric Advantage provides everything listed below.
- A Bariatric Multivitamin that contains at least:
- 45mg of iron
- 12 mg thiamin
- 75 mcg (3,000 IU) vitamin D
- 1,500-3,000 mcg RAE Vitamin A (5,000 – 10,000 IU)
- at least 90 mcg vitamin K
- at least 15 mcg vitamin E
- at least 350 mcg of B-12
- 400-800 mcg folic acid
- 16 mg zinc and 2 mg copper
- 200% DV of other B vitamins
- Provides magnesium
- Calcium Citrate 1,200-2,400 mg per day.
What to Look For When Buying Vitamins and Minerals
When choosing a vitamin and mineral supplement after bariatric surgery, you’ll want to consider the following:
Does this vitamin meet my needs?
There are a lot of different formulations and options when it comes to choosing a vitamin and mineral supplement. Understanding how to read the nutrition label is important along with knowing which minerals and vitamins and what quantities are needed. Re-read the section above if you are having trouble identifying if a vitamin or mineral will meet your needs.
How many do I need to take?
Taking 2-3 multivitamins spaced throughout the day and then taking 2-3 more calcium chews (or chewables or tablets) is a lot. Remembering to take these consistently can be difficult. Fortunately, there are several options to fit your personality. If you are consistent and detail oriented, you will probably do well with a multivitamin that requires 2 or more pills throughout the day.
If remembering to take pills is difficult, you may want to choose a one-pill-per day option. One pill per day options are typically bigger in size and they may cause nausea since they pack so many nutrients into one pill or tablet. If you have a sensitive stomach, you will likely do better with a multivitamin that you take 2 or 3 times daily. .
Can I swallow pills or do I need a chewable?
Swallowing pills shortly after surgery can be difficult. Many bariatric programs recommend starting with a chewable vitamin and mineral and then switching to a capsule or pill. For patients that prefer to never swallow pills, a quality chewable multivitamin is fine to take daily lifelong.
Is this a brand that I trust?
Unlike medicines and food, the FDA (Food and Drug Administration) does not have to approve vitamins and minerals before they are sold in the United States. Look for brands that follow current Good Manufacturing Practices (cGMP) and regularly test their products to ensure that what’s on the label is actually inside of the bottle. Some of the more reputable bariatric specific brands include Bariatric Advantage, Barimelts, and Celebrate Vitamins.
Can I afford to take these for the rest of my life?
A typical multivitamin and calcium monthly regimen will usually cost up to $70 per month. It’s not cheap but money well spent to ensure you stay healthy, happy, and active. Research has shown that the cost of treating a micronutrient deficiency is far greater than the cost of your monthly vitamin and mineral supplements. Preventing deficiencies is the key to maintaining health after surgery!
Thankfully, people who have had bariatric surgery, have an entire range of products and solutions to choose from. You’ve undergone a major procedure to get healthy, it’s important to invest in yourself to stay healthy.
We recommend choosing a bariatric specific vitamin that follows the ASMBS guidelines to ensure your micronutrient needs are met. Figuring out your schedule, sticking to it, and finding a vitamin that works for you is key to success. Post-op, micronutrients must be part of your daily routine for the rest of your life. Work closely with your surgeon and your dietitian to figure out exactly what you need and how to get it.