Nutritional supplementation is a lifelong necessity following bariatric surgery. The reduced amount of food consumption and absorption that occurs after surgery not only promotes weight loss, but it can lead to nutritional deficiencies as well. Since the body will not get all the nutrients it needs to function properly from food sources, it is important for bariatric patients to take vitamin and mineral supplements to prevent adverse health conditions.

Nutritional supplementation
is a lifelong necessity
following bariaric surgery.

Bariatric surgery promotes weight loss by either restricting food intake or altering food absorption. In either case, it affects the amount of nutrients absorbed by the body. Although the recommended supplementation will vary between bariatric procedure and patients, all bariatric patients will need to take some level of vitamin and mineral supplementation for the rest of their lives following bariatric surgery.

Supplementation vs Type of Procedure

The restrictive weight loss procedures reduce the amount of calories consumed, while the malabsorptive weight loss procedures alter digestion and reduce the amount of food that is absorbed by the body. The malabsorptive procedures are more likely to cause nutritional deficiencies since the intestines have been cut and rerouted to minimize the amount of food absorption. Although the risk of developing deficiencies is less with restrictive procedures than with malabsorptive procedures, the overall amount of food intake is reduced which in turn can contribute to nutritional deficiencies.

Laparoscopic Adjustable Gastric Banding

Laparoscopic Adjustable Gastric Banding (LAGB) is a restrictive method of bariatric surgery. The two approved procedures in the United States are the LAP-BAND System and the REALIZE Band. With these procedures, the food passes through the normal digestive tract, thus there is no malabsorption. With reduced food intake, however, nutritional deficiencies may still occur.

• It is generally recommended that LAGB patients take at least a complete multivitamin daily. Calcium and iron supplements may be advised as well.

Gastric Bypass Surgery

Roux-en-Y Gastric Bypass Surgery is a combination restrictive and malabsorptive procedure. Weight loss occurs primarily by restricting food intake, but it also involves a malabsorption component. The food bypasses the entire duodenum (first portion of the small intestine) and a short portion of the jejunum (second portion of the small intestine), which results in mild fat and protein malabsorption. The digestive tract changes also reduce the absorption of calcium, iron, and B-complex vitamins.

To provide the body with adequate nutrients, gastric bypass patients must emphasize protein food sources in the diet, as well as take vitamin and mineral supplementation daily for the rest of their lives.

• The supplements that are generally required following gastric bypass surgery are a multi-vitamin, multi- mineral, calcium, B-complex vitamins, and iron.

Duodenal Switch Procedure

The duodenal switch is primarily a malabsorptive weight loss procedure combined with a minimal restrictive component. The surgery reroutes the digestive tract so that approximately 60% of the small intestine is bypassed. The result is that less calories and nutrients, particularly protein and fat, are absorbed by the body. Maintaining healthy levels of certain nutrients is very challenging after duodenal switch surgery due to the high amount of malabsorption. Specifically, there can be deficiencies in protein, calcium, iron, and the fat-soluble vitamins A, D, E, and K.

• It is essential for duodenal switch patients to consume a protein and nutrient-rich diet, supplemented with a multi-vitamin, specially formulated vitamins (A, D, E, and K in water-soluble form), calcium, and iron.

Monitoring for Nutritional Deficiencies

Bariatric patients, especially gastric bypass and duodenal switch patients, require lifelong nutrient supplementation and monitoring to prevent nutritional deficiencies and adverse health conditions. Since the body is not able to absorb all the nutrients it needs from food, it will be necessary to take daily vitamin and mineral supplements.

Your bariatric surgeon will advise you as to the necessary supplements, which generally includes at least a good multi-vitamin, calcium, and iron. It is important to follow the guidelines of your bariatric surgeon and nutritional advisor and to consult with them before making any changes in diet or vitamins.

Blood tests will be required on a regular basis to check for deficiencies in life critical vitamins and minerals, including protein malnutrition, iron deficiency (anemia), calcium deficiency (bone disease), coagulation function, electrolytes, liver function, thyroid function, and cholesterol. If nutrient levels are not maintained, life-threatening health conditions can occur.

Your bariatric surgeon will continue to monitor you on a regular basis to make sure you are maintaining a healthy level of vitamins and minerals, as nutritional deficiencies may occur over time following bariatric surgery.

How Nutrient Levels Aid Weight Loss

The body uses vitamins and minerals for numerous biological processes, including those that regulate body size. They include appetite, hunger, nutrient absorption, metabolic rate, fat and sugar metabolism, thyroid and adrenal function, energy storage, and others. Maintaining sufficient nutrient levels in the body is not only important for good health, but for maximizing weight loss results and long-term weight maintenance.

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