Minerals and Vitamins
Einstein Bariatrics - Resources
Other Vitamins and Minerals
The 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.
Iron 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 and a condition called iron deficiency anemia results. This 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. So, annual monitoring of iron and hemoglobin levels is important.
In the majority of people, multivitamin tablets contain an adequate amount of iron to prevent problems. 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: 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 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.
Patients after gastric bypass surgery should take between 1,000 mg 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. Rare patients may need vitamin D to enhance the calcium absorption.
Calcium deficiencies can cause osteoporosis - or weakening of the bones. After the gastric bypass, decreased calcium absorption may result in a higher incidence of osteoporosis. Osteoporosis develops only after years of decreased calcium absorption.
Bariatric surgery improves arthritis and joint pains by decreasing stresses across the joints. Attention to calcium supplementation is very important to maintain long-term weight loss success.
Annual measurements of vitamin B12 levels and supplementation are necessary. Vitamin B12 is a very important factor in the formation of normal blood cells and can only be found in meats. The reason that gastric bypass patients are at risk for B12 deficiency is that 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 in a pill works in most people who need post surgery. Vitamin B12 tablets that dissolve under the tongue bypass the entire system and get absorbed directly into the blood stream. Vitamin B12 injections are needed only in very rare cases. Interestingly, vitamin B12 lasts in the body of 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. Annual blood tests and long-term follow-up should be sufficient.
Thiamine is one of the B-vitamins. Thiamine is essential for the metabolism of carbohydrates into the simple sugar glucose. Significant thiamine deficiencies are rare after a gastric bypass. In general, patients with severe thiamine deficiencies have had a prolonged course of nausea and vomiting. Potential symptoms of thiamine deficiency include changes in sensation of the toes and feet, irritability and fatigue. In very severe cases, changes in mental alertness and heart disease may result. The thiamine stores are very short lived and deficiencies can occur in just a few months. This is why it is recommended that patients after a gastric bypass take a multivitamin that is usually packed with B-vitamins. 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.
Other deficiencies are either extremely uncommon or of unclear significant. 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.
This page last updated on 2007-09-14 15:51:15