Bariatric sleeve surgery is a weight-loss surgery technique that involves removing a portion of the stomach. As a result, you have a smaller stomach that cannot tolerate eating a large amount of food. While eating less food will help you to lose weight, you will be getting fewer nutrients in your daily diet. To compensate for this, your physician may recommend taking certain vitamins. Before taking them, however, you should check with your physician. The first supplement you will likely take after bariatric sleeve surgery is a multivitamin. Immediately after surgery, you may need to take chewable or liquid vitamins because you may have trouble swallowing tablets. Bariatric multivitamins are available and typically contain vitamins A, D, and E. You also need iron and folate. In the first six months after your bariatric surgery, your physician may recommend taking two multivitamins per day because you will not be able to eat a significant amount of food as your stomach heals. While your multivitamin may contain some calcium, it may not be enough to compensate for calcium losses in your daily diet.
Because you need calcium for healthy bones and teeth, you may need to take a calcium supplement that contains 1,000 to 1,500 mg of calcium. Look for calcium citrate, which is better absorbed after gastric sleeve surgery. Your body can only absorb about 500 mg of calcium at a time, so you may wish to separate your supplements into three servings over the course of your day. Vitamin D is required to help you absorb calcium in your body. This vitamin is difficult to get in your daily diet and even more difficult following bariatric sleeve surgery. Take at least a 1,000 IU vitamin D supplement each day to ensure you get enough of this vitamin. Vitamin B-12 is necessary for brain functioning and building red blood cells. This vitamin binds to intrinsic factor, which is secreted by the stomach, for absorption. During laparoscopic gastric bypass, the portion of the stomach responsible for making intrinsic factor is bypassed. The lack of intrinsic factor decreases the amount the body is able to absorb vitamin B-12 after gastric bypass and to a lesser extent after gastric sleeve surgery.
As such, you should take a vitamin B-12 supplement that is either liquid or dissolves on the tongue. Take at least 500 micrograms of vitamin B-12 per day to ensure you get enough vitamin B-12 in your diet. Iron is needed to build healthy red blood cells in your body. Without enough, you can feel weak and fatigued. Taking iron supplements can upset your stomach. For this reason, you should choose iron supplements that contain ferrous fumarate, ferrous sulfate or ferrous gluconate, which your body better absorbs. Because iron can affect calcium supplementation, take these supplements two hours apart. A Pre-Op Diet for the Gastric Sleeve Diet & Exercise Program for Gastric Sleeve Patients Carbonated Drinks After a Gastric Bypass Meals for Gastric Bypass Patients How to Eat After a Gastric Sleeve Pre-Operative Liquid Diet Before Having Bariatric Surgery Expected Monthly Weight Loss With the Gastric Sleeve How to Build Muscle After Gastric Bypass
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Somewhere along the way, your bariatric surgeon, or the dietitian in the office, probably gave you a list of the vitamins you needed to take after surgery based on your procedure. Also, if your doctor looked at your labs, you might have been given some very specific recommendations just for you. Either way, this is where you should start. If you have not seen your bariatric surgeon in many years, it is also wise to call the office and find out what the current recommendations are – knowledge about nutrition has changed a lot in recent years and they might have new recommendations that you were not given. Generally speaking, taking supplements after surgery is for three reasons: The most common types of supplements taken after surgery are multivitamins, calcium, vitamin B12 and iron. When you have bariatric surgery, no matter which procedure you have, one primary reason you lose weight is that you eat less. When people eat less, getting the vitamins and minerals they need each and every day is hard to do – the truth is that most people can’t do this even when they can eat as much as they want.
A study done in 2008 followed 210 post-operative patients for two years and compared the nutrition in what they ate to the Dietary Reference Intakes (DRI’s). They found that even though patients tended to eat better after surgery, not one was able to eat even the minimum requirement for Vitamin A, Vitamin C, calcium, iron, B1, B3, B6, Folate, biotin or pantothenic acid (B5) (1). The kind of multivitamin you need to take may vary by procedure, but most often patients are asked to look for something with 100 percent of the Daily Value (DV) for all the vitamins and the trace minerals. A multivitamin is very unlikely to have the DV for minerals such as calcium, magnesium or potassium. Products calling themselves “complete” may not actually provide all the vitamins and minerals, so carefully read labels. Doctors from the Mayo clinic recently looked at 97 patients from the past 20 years who had bariatric surgery (2). They found that 21 of these patients had suffered a total of 31 fractures – this is more than twice the fracture risk of the general population.
Most fractures occurred an average of seven years after surgery, with the primary locations being in the hands and feet. Other sites of fractures were the hip, spine and upper arm. Bone loss is a risk after all types of bariatric surgery and getting adequate calcium is one important part of helping to prevent bone loss. The American Society for Metabolic and Bariatric Surgery recommended intakes for calcium after bariatric surgery are as follows: The stomach is very important for B12 absorption. This is because stomach acid helps to release B12 from food, and another substance that is made by the stomach – Intrinsic Factor –is essential for B12 absorption. Some bariatric surgery procedures, such as gastric bypass and vertical sleeve gastrectomy, make B12 absorption more difficult for these reasons. Often people who have these procedures will be required to take additional B12 as an injection, intranasal spray or sublingual tablet. Low iron or iron deficiency anemia can be a complication of bariatric surgery, but is especially common after gastric bypass.
Iron levels are harder to maintain after gastric bypass because the primary area where iron is absorbed (the duodenum) is bypassed. Many doctors will recommend that patients take iron preventively to protect against developing a deficiency. Depending on your nutritional labs or on the specific concerns of your programs, you may be asked to take other nutrients. Some common nutrients include Vitamin D, Thiamine (B1) and protein supplements, but there may be others. Again, your doctor’s advice should be primary. One final piece of advice: if you don’t take your vitamins, they won’t work. Many people become overly concerned about what they should take, but don’t necessarily do a great job at taking the nutrients they need on a daily basis. It’s also not uncommon for people to do a great job taking their vitamins for a year or two after surgery, but they may stop taking them over time. Most nutritional deficiencies are easier to prevent than to treat, and once you have had surgery, your risk for developing a problem never goes away.