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Iron
Calcium
Cobalamin (Vitamin B12)
Thiamine
Other Vitamins and Minerals
Iron
Gastric bypass surgery typically results in only a minor amount of malabsorption.
Iron is an especially important mineral supplement to follow after a gastric bypass since it is vital to the healthy exchange of oxygen from your lungs to your body. Iron atoms are incorporated in hemoglobin, the major oxygen carrying protein in the body, and account for the red color of blood. Iron is present in many foods and absorbed by the body. Without iron, the body cannot make healthy red blood cells, resulting in iron deficiency and a condition called anemia. Anemia, when severe, can cause fatigue.
Gastric bypass patients are prone to iron deficiency because after surgery food now bypasses the duodenum, the most efficient area of the intestine that absorbs iron. Also, iron is more readily absorbed in acidic environments, and there is very little acid produced in the small gastric pouch. Therefore, it is important to monitor iron and hemoglobin levels annually.
In the majority of people, multivitamin tablets contain an adequate amount of iron to prevent health issues. During follow-up testing, some people are noted to have the beginnings of iron deficiency despite taking their vitamins. In these people (about 15 percent of gastric bypass patients) it is necessary to take a separate iron pill. Premenopausal women and adolescent patients are most at risk for anemia.
One helpful hint is that iron absorbs better with vitamin C, so take your iron pill with your multivitamin. Iron absorption is blocked by calcium, so take your calcium tablets at least several hours after your iron or multivitamin pills. Although some evidence suggests that different formulations of iron (iron sulfate, FeoSol®, Slow-Fe®, iron gluconate, iron fumarate) result in different absorption, the real clinical differences are not known. Some people experience minor side effects to iron pills such as constipation, so if you are taking iron supplements, find the cheapest, tastiest formulation that doesn’t cause GI upset. Take these supplements as directed and follow up regularly with your bariatric program to ensure healthy iron levels in your body.
 Calcium
Calcium is an important mineral necessary for the development of strong bones. Calcium is best absorbed in the duodenum – although the rest of the intestines also absorb calcium. Since the duodenum is partially or completely bypassed after bariatric surgery, calcium deficiencies are possible.
After gastric bypass surgery patients should take between 1,000 and 1,500 mg a day of calcium to counteract the decreased absorption from foods. This can be in the form of calcium carbonate (such as TUMS®) or calcium citrate (Viactiv®). Calcium citrate has better absorption than calcium carbonate and may be especially good for people who have had kidney stones in the past. Foods with high calcium content include milk, cheese, cottage cheese, yogurt, broccoli, tofu, greens and eggs. On rare occasions patients may need vitamin D to enhance the calcium absorption.
Calcium deficiencies can cause osteoporosis, or weakening of the bones. After gastric bypass, decreased calcium absorption may result in a higher incidence of osteoporosis, developing only after years of decreased calcium absorption.
Bariatric surgery improves arthritis and joint pain by decreasing stresses across the joints. Attention to calcium supplementation is very important to maintain long-term weight loss success.
Cobalamin (vitamin B12)
Annual measurements of vitamin B12 levels and supplementation are also necessary, as it very important for formation of normal blood cells. Vitamin B12 can only be found in meats. Gastric bypass patients are at risk for B12 deficiency because little acid is produced in the new gastric pouch, and stomach acid is needed to break the vitamin B12 away from the meat. Vitamin B12 pills work for most people. Tablets that dissolve under the tongue bypass the entire system and get absorbed directly into the blood stream. Injections are needed only in very rare cases. Interestingly, vitamin B12 lasts in the body up to six months, and a deficiency takes years to develop. Reports suggest that vitamin B12 deficiency can occur in 12 to 33 percent of patients although deficiencies severe enough to cause symptoms are exceedingly rare.
Thiamine
Thiamine is one of the B vitamins, and is essential for metabolism of carbohydrates into the simple sugar glucose. Thiamine is found in whole-grain cereals, bread, red meat, egg yolks, green leafy vegetables, legumes, sweet corn, brown rice, berries, yeast, and the germ and husks of grains and nuts. Significant thiamine deficiencies are rare after gastric bypass, however it is recommended that patients take a multivitamin packed with B-vitamins.
Other Vitamins and Minerals
Other deficiencies are either extremely uncommon or of unclear significance. There are no reports of patients developing symptoms from or deficiencies in zinc, biotin, selenium, riboflavin, vitamin B6 or folic acid. There are extremely rare reports of copper deficiency. |
