*Please Note: The OAC Blog is not a substitute for medical advice. If you have any questions regarding the information in this blog series, please be sure to speak with a healthcare professional regarding your concerns.
The decision to have bariatric surgery is a life-changing one. After surgery, there are many adjustments that have to be made to support health and success long term. Some of these adjustments will always be nutritional, such as new portions, new foods, more protein, less sugar, etc. All of these and more will become a routine part of life for those who have chosen surgery to treat obesity.
Using dietary supplements – vitamins and minerals (and sometimes protein or others) – to guard against low nutrient levels is usually recommended to some degree after all bariatric surgery procedures. This blog series will cover some of the basic recommendations by procedure. However, if you have had or are considering bariatric surgery, it is important that you follow the specific recommendations given to you by your program doctor or dietitian.
Adjustable Gastric Banding (LAGB)
Because the LAGB is only restrictive, people may think they do not need to supplement. However, it is still recommended for the following reasons:
- It is common for individuals to have low levels of some vitamins and minerals before surgery.
- After surgery, you are eating a lot less, so it is harder to get all the nutrition you need from your food alone.
For these reasons, the most recent recommendations on nutrition after LAGB are to take a daily adult multivitamin with minerals that has iron, folic acid and thiamine (B1). They also recommend Calcium (citrate) 1200 to 1500 milligrams daily and vitamin D at a level of at least 3000 IU per day. For vitamin D it is important that a doctor check your levels and make sure you are in a healthy range.
Sleeve Gastrectomy (VSG) and Gastric Bypass (RNY)
In a sleeve gastrectomy, a large portion of the stomach is removed leaving a thin, tube-like stomach. In a gastric bypass the stomach is made much smaller and the top portion of the intestines are bypassed (meaning food does not go through that part anymore). Because more of the digestive system is changed with these surgeries, there is more of a risk for problems with nutrition.
While the procedures are different, current information would indicate that the nutritional problems that can occur are fairly similar. The recommendations include 2 adult multivitamins plus minerals (each containing iron, folic acid, and thiamine), 1200 to 1500 milligrams of calcium as calcium citrate, 45-60 milligrams of elemental iron (total from multivitamin and other supplements), enough vitamin B12 to maintain normal levels and vitamin D at a level of at least 3000 IU per day. For both B12 and vitamin D it is important that a doctor check your levels and make sure you are in a healthy range. It is also important to note that levels of iron above 45mg per day are above the upper limit of safety for adults – so you should not take more than a total of 45mg per day unless your doctor as told you to and is supervising your treatment. It is also typically recommended that VSG and RNY patients start with a chewable (or liquid or powder) product for at least six months.
If you walk into a health food store or drug store, you will literally find hundreds of kinds and forms of vitamins and minerals. Because some will be ok for bariatric surgery patients and some are not, it is best to ask your surgeon or dietitian for their recommendations (most will give them to you before or soon after your surgery). If you decide to change what you are taking (more, less, different products), it is important to tell your surgeon or dietitian what you are doing so that they have the right information to monitor your health.
If you have trouble taking vitamins for any reason, you should also get help with this – nutritional deficiencies can take a while to appear, but they can be serious when they do, so prevention is important. And finally – make sure you get in for your regular lab work. Deficiencies can happen even in those doing everything “right.” If we find deficiencies early, they tend to be easy to treat – but if we find them late, there can be serious problems. So testing is almost as important as taking your vitamins for your long-term health.
About the Author
Dr. Jacques, a frequent author in the OAC’s quarterly publication, Your Weight Matters Magazine, is a Naturopathic Doctor with more than a decade of expertise in medical nutrition. She is the Chief Science Officer for Bariatric Advantage (a Division of Metagenics, Inc) a company dedicated to providing the best of nutritional care to weight-loss surgery patients. Her greatest love is empowering patients to better their own health. Dr. Jacques is a member of the OAC National Board of Directors.