Bariatric Vitamins After Bariatric Surgery.
Bariatric vitamins are essential after weight loss surgery. You’ll need to commit to taking vitamins forever to maintain optimum health and prevent deficiencies.
But which should you take after bariatric surgery? And should someone with a gastric sleeve take different vitamins than someone with a lap band?
This article will dive into all the details of how the different types of bariatric surgery impact your nutritional needs, why supplements are so important postoperatively, and exactly which vitamins and minerals are recommended.
You’ll also find a downloadable pdf of the most popular bariatric multivitamins.
Why Vitamins Are Important After Surgery
Your vitamin regimen will be based on the type of surgery you have, any nutrient deficiencies found before or after your procedure, and what nutritional issues you may be at a higher risk for facing as a result.
Following your surgery – no matter which bariatric procedure you have – you will be eating less than you normally would. Especially in the early weeks and months, your stomach will be adjusting to its new size and the reduced amount of food it can tolerate in one sitting. Your anatomy and physiology have changed, and your nutritional needs will need to adjust accordingly.
Research shows that the prevalence of nutrient deficiencies after bariatric surgery is increasing. Some of the main reasons for this include:
- Eating too many foods that are high in calories and low in other nutrients
- Limited absorption of certain nutrients from foods
- Inflammation that can negatively affect metabolism of minerals like iron and zinc
- Small intestinal bacterial overgrowth that can lead to vitamin deficiencies.
Types of Bariatric Surgery and How They Impact Nutritional Needs
There are a number of bariatric surgery procedures available and they can all impact your post-surgery nutritional needs a little differently. Here are some of the basics of what to expect, to better understand why nutrient needs change so drastically postoperatively.
Gastric Bypass or Roux-en-Y Gastric Bypass (RYGB). This is considered the standard weight loss surgery. It creates a small pouch that divides the top of your stomach from the rest of it. Part of your small intestine is then divided and rerouted, changing the path of food. RYGB reduces the amount of food you can eat, as well as the amount of calories and nutrients absorbed. It requires lifelong diet and supplement compliance.
Sleeve Gastrectomy (SG). This procedure removes 80% of your stomach, leaving a pouch that is shaped like a banana. SG is not reversible and comes with a high risk for vitamin deficiencies, again making it imperative to follow your regimen closely.
Adjustable Gastric Band (AGB). This procedure involves placing an inflatable band around the top portion of your stomach, separating a small pouch from the rest of your stomach. It reduces hunger and ultimately the amount of food eaten. The band can be adjusted. AGB requires strict adherence to dietary and supplement regimens.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS). As the name indicates, this is actually two steps. First, part of your stomach is removed, leaving a small portion. Then, a big part of your small intestine is bypassed. This procedure has a high risk for long-term vitamin deficiencies and requires strict adherence to supplements and diet.
Common Bariatric Vitamins and Minerals Prescribed After Surgery
When it comes to the best vitamins and mineral regimens after bariatric surgery, there are a number of things to consider. Supplements come in many different forms, doses, and brands. The right one for you may not be the right one for someone else. Below are some of the most common supplements available, and some pros and cons to weigh when considering what vitamins to take after gastric bypass and other bariatric surgeries.
All-in-One Multivitamins in Capsule or Chewable Form
Many vitamin companies such as Bariatric Advantage, Celebrate, Bariatric Fusion, and BariatricPal are beginning to offer an all-in-one option for their multivitamin. This can make it easier to remember to get all your nutrients in. If you do choose to take these multivitamins there are a couple things to keep in mind.
First, you may need to still take more than one tablet or capsule a day. Each vitamin has different directions so it’s important to look at the directions and ask your doctor what is right for you. Second, most of the all-in-one options do not contain calcium. You’ll still need to take calcium separately. This is because calcium may interfere with iron absorption.
With that being said, there are companies such as Bariatric Fusion and BariLife that offer an all-in-one option for their multivitamin that contain, both, iron and calcium. There is controversy with this method since the calcium and iron may compete with one another for absorption when taken at the same time. Another thing to keep in mind with these vitamins is you need to take at least 4-6 tablets a day, which may be a lot for some people.
To help make things easy for you, I’ve created a multivitamin spreadsheet that compares sixteen different options for you. This spreadsheet identifies which nutrients are in each vitamin, dosage, cost, and additional notes about which additional vitamins/minerals you may need.
Multivitamin chews have become a popular option after weight loss surgery. They have a good texture and are less chalky than chewable multivitamins. They are usually more expensive than the chewable multivitamins. In addition, they often lack iron, calcium and copper and need to be taken multiple times throughout the day so it is important to look at the label. You’ll likely need to take additional supplements if you choose this route.
These are a great option for those that don’t like the texture or flavor of the chewable multivitamins. These are also included in the vitamin comparison schart.
One popular option in the WLS community is the patch vitamin, which is pretty much exactly what it sounds like. Patch vitamins are made to be placed externally on the skin and slowly released into your body. The problem is that not all vitamins can easily be absorbed through the skin.
A 2019 study among 44 bariatric patients found that users of multivitamin patches were much more likely to be deficient in vitamin D and have lower levels of other vitamins and minerals in their blood, when compared to those who took multivitamins in oral pill form. In fact, vitamin D deficiency was found in 81% of patch users, and only 36% of pill users.
As such, I don’t recommend patch vitamins post bariatric surgery due to the overall limited research on their absorption as well as long-term health effects.
Individual Vitamins and Minerals
Instead of taking a multivitamin with minerals, you can also opt for taking individual nutrients. Some of the most important and frequently prescribed vitamins and minerals to take post bariatric surgery are listed below.
Calcium is an essential mineral for keeping your bones, nerves, and muscles strong and functioning normally. In combination with vitamin D, calcium works to prevent bone loss.
Unfortunately, bariatric surgeries can lead to impaired ability of your intestines to absorb calcium and vitamin D, putting you at high risk for bone problems. As such, all bariatric patients should take a calcium supplement.
Most individuals need to take a calcium supplement in addition to their multivitamin because most multivitamins don’t contain it.
Individual calcium supplements can come in the form of either calcium citrate or calcium carbonate. Calcium may also be included in all-in-one multivitamin supplements. I recommend calcium citrate, as it has better bioavailability and depends less on stomach acid for absorption.
Folate, or vitamin B9, is a water-soluble vitamin found in dark leafy greens and some fortified foods. It’s an essential cofactor in many bodily reactions, like the metabolism of amino acids, cell division, and the formation of DNA.
Folate deficiency is reported in up to 65% of people who undergo bariatric surgery, making it incredibly important to get enough from food and supplements. This is especially a concern among women of childbearing age, as folate plays a crucial role in normal fetal and placental development.
Vitamin B9 can be found as folate (the active form of the vitamin) in whole foods and as folic acid (the synthetic form of the vitamin) in fortified foods and dietary supplements
Alternatively, some supplements are found as methylfolate (5-methyl-THF). This form may be better suited for people who cannot convert folic acid to folate, such as people who have the MTHFR genetic mutation. However, these supplements tend to be more expensive.
Vitamin D can be made by your skin through sunlight exposure, and is found in some foods, but also comes in supplemental form. It’s involved in calcium absorption, bone health, immune function, and reducing inflammation.
Vitamin D after gastric bypass and other bariatric surgeries is one of the most important supplements often recommended to patients. This is because Vitamin D deficiency is among the most common nutritional concerns after bariatric surgery. In fact, research shows that this deficiency is reported in up to 100% of patients after gastric bypass or other procedures.
As supplements, vitamin D can be found as vitamin D2 or vitamin D3. Vitamin D3 is recommended, because it tends to be more effective in preventing and treating deficiencies.
Vitamin B12 is an important nutrient for energy production, immune response, and cognitive function.
Vitamin B12 after gastric bypass and other bariatric surgeries is commonly recommended, The reduction of stomach size makes it more difficult for your stomach to release B12 adequately during the digestion process. In turn, this puts you at a higher risk for B12 deficiency.
The prevalence of vitamin B12 deficiency in people at 2-5 years after bariatric surgery is around 20% for gastric bypass and 4-20% for gastric sleeve. That’s up to approximately one out of every five people.
Iron is an essential component of hemoglobin in your red blood cells. It helps transport oxygen throughout your body, which is why one of the most common symptoms of iron deficiency is fatigue.
Iron deficiency is a common nutritional concern for people who undergo bariatric surgery.
The prevalence of iron deficiency between 3 months and 10 years post procedure is reported to be 14% for AGB,18% for SG, 20-55% for RYGB, 13-62% for BD, and 8-50% for DS surgeries.
Research shows that iron deficiency can happen after any bariatric procedure, regardless of routine supplementation, making it even more important to stick to your iron regimen to minimize your risk.
Vitamin A is important for immunity, reproduction, vision, and cellular functions.
Vitamin A deficiency is reported in up to 70% of patients 4 years after bariatric surgery, especially those who undergo gastric bypass or duodenal switch surgeries.
It appears that people who show signs of protein-calorie malnutrition after bariatric surgery are at a higher risk for developing vitamin A deficiency.
Zinc is needed for immunity, wound healing, cellular function, and DNA and protein synthesis.
Zinc deficiency is reportedly seen in up to 70% of patients after duodenal switch surgery, 40% after gastric bypass, 19% after sleeve gastrectomy, and 34% after gastric banding procedures.
Zinc is primarily absorbed in your duodenum and proximal jejunum, so if your bariatric procedure leaves these sites bypassed, you may be at a higher risk for zinc deficiency even if you routinely supplement it.
People who experience chronic diarrhea, before or especially after bariatric surgeries, are also at a higher risk for zinc deficiency.
Copper plays an essential role in enzymatic processes, connective tissue synthesis, and iron metabolism.
Copper deficiency is seen in up to 90% of people following duodenal switch and in 10-20% of people after gastric bypass.
Common Recommended Dosages for Bariatric Vitamins and Minerals
Below are some of the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines for vitamin and mineral dosages after bariatric surgery.
Keep in mind that your doses may differ based on individual needs and conditions, including which procedure you had. Many recommendations are higher than the RDA for the general population.
Vitamin B1 (Thiamin): Take at least 12 mg per day, in addition to a 50 mg dose from a B-complex supplement or multivitamin once or twice daily.
Vitamin B12 (Cobalamin): The dose depends on the route of administration. You should take 350-500mg if taken by mouth as a disintegrating tablet, as a liquid spray, or in sublingual form which you place under your tongue. If you take vitamin B12 as an injection or intravenously, this is typically dosed at 1000 mg per month. Vitamin B12 sprays are also available, and you can typically follow the manufacturer’s recommended doses for these.
Folate (Folic Acid): Take at least 400–800 ug of oral folate daily as part of your daily multivitamin. If you’re a woman of childbearing age, increase your dosage to 800-1000 ug per day.
Iron: If you’re at a low risk for iron deficiency anemia, take at least 18 mg of iron daily as part of your multivitamin. Premenopausal women and people who have had RYGB, SG, or BPD/DS procedures should take a total of 45–60 mg of elemental iron daily from all sources. This includes if you take a multivitamin or other supplements that contain iron. To promote optimal absorption, it’s recommended that you take iron supplements in divided doses, and at different times than calcium supplements, acid-reducing medications, and foods that are high in phytates and polyphenols (e.g., grains, nuts, legumes).
Vitamin D: The recommended dose of vitamin D is based on how much vitamin D you have in your bloodstream, which is determined through serum laboratory tests. Vitamin D3 should be given in doses of 3000 IU per day, until your serum vitamin D levels reach at least 30 ng/mL, the minimum level considered to be sufficient for overall health
Calcium: Calcium supplement doses depend on which bariatric procedure you had. The recommended dose for BPD/DS is 1800-2400 mg per day, while 1200-1500 mg/day is recommended for LAGB, SG, and RYGB. Calcium supplements should be taken in divided doses to optimize absorption. Calcium carbonate should be taken with meals for best absorption, whereas calcium citrate may be taken with or without food.
Vitamin A: The dose for vitamin A depends on the type of procedure you have had. A dose of 5000 IU per day is recommended for LAGB, 5000-10,000 IU per day after RYGB and SG, and 10,000 IU per day after a DS.
Vitamin E: The dose for vitamin E depends on the type of procedure you have had. After having a LAGB, SG, RYGB, or BPD/DS, a dose of 15 mg per day of vitamin E is recommended.
Vitamin K: The dose for vitamin K depends on the type of procedure you have had. A dose of 90-120 ug per day is recommended after RYGB, LAGB, and SG, and a dose of 300 mg per day following a DS.
Zinc: Zinc is recommended after all bariatric procedures, and can be taken as part of your multivitamin. Following a BPD/DS, a recommended dosage is 200% of the zinc RDA, or 16-22 mg per day. Around 8-22 mg per day is suggested after a RYGB, and 8-11 mg per day is recommended a fter SG or LAGB. Because zinc can actually inhibit copper absorption, a supplementation ratio should be 8-15 mg of supplemental zinc per every mg of copper.
Copper: The dosage for copper also depends on the procedure done. Around 200% of the RDA for copper, or 2 mg per day, is recommended after a BPD/DS or RYGB. Following a SG or LAGB, 1 mg per day is sufficient. Copper gluconate or copper sulfate are the recommended forms of copper for people after bariatric surgery.
Which Bariatric Vitamins Are Best?
The best vitamins to take after gastric bypass and other bariatric surgeries depend on a number of factors. The most important thing after bariatric surgery is to take your vitamins consistently and, as long as they meet the ASMBS guidelines, you don’t need to worry too much about the brand.
If you would like extra help finding multivitamin that works best for you can download my multivitamin spreadsheet.
Tips to Help You Remember to Take Your Vitamins
Life after bariatric surgery comes with several adjustments, and it can be overwhelming to try and remember everything regarding your new diet and lifestyle habits, especially in the beginning stages.
Here are some tips that can help you remember to take your vitamin and mineral supplements:
- Keep them in a visible place. What does your morning routine look like? If you consistently spend time at your bathroom sink, or a certain spot in your kitchen every morning, this can be a good place to put your morning vitamins. The same approach can be applied in the afternoon or evening. Thinking about a good place to keep supplements that you need to take around the same time every day will help keep them visible and at the forefront of your mind.
- Use a labeled medication box. These portable, plastic containers often have multiple compartments that can be used for AM and PM doses. Some even have room for taking divided doses every day. This is also a good way to prevent taking multiple doses if you can’t remember what you’ve already taken that day.
- Set an alarm. Many people find it helpful to set an alarm – or multiple alarms – on their phone, since that’s something they carry with them all day. An alarm can be a good reminder to take your supplements throughout the day at the same time. If you don’t want to set an actual alarm, another option is to put a reminder in your calendar on your phone. When it’s approaching time to take your supplement, you’ll get a calendar notification on your screen.
- Pack some extra doses in your to-go bag, your car, or your desk at work. If you spend a lot of time away from home and aren’t necessarily in the same place at the same time every day, this can help prevent forgetting doses. If you forget to bring your pill box, for example, you’ll still have an extra dose available wherever you are.
- Record your doses. This could be as simple as keeping a notepad and putting a tally mark next to each medication on the date or time that you took it. There are also apps you can download to your phone that can be used to record when you took a dose. This can help prevent both forgetting or double-dosing your vitamins. Some apps even have the capacity to give you dose reminders, such as apps like Walgreens, CVS, MyMedSchedule, and MediSafe.
Rather, it’s about finding supplements that you can stick with. It’s important to look at how many times you need to take the vitamin in a day. Some people might do better with an all-in-one multivitamin formula that provides everything they need, versus taking a variety of single vitamins and minerals to get all of their needs met.
The Bottom Line
The vitamin and mineral regimen prescribed to you following surgery will be dependent upon several factors, but most of all, your individual needs and health concerns. The procedure you have done, your nutritional status before surgery, medications, and your nutrition-related lab work done following surgery will all be considered.
Bariatric vitamins are essential to support your healthy diet, but do not replace nutritious whole foods. It’s very important for vitamins and a healthy diet to go hand-in-hand for optimal long-term success.
Plus, preventing nutrient deficiencies is much easier than treating ones you can develop from not following your prescribed regimen. These deficiencies are entirely preventable.
The best thing you can do for your health following bariatric surgery is to create positive vitamin and food habits, and stick to them. Communicate with your dietitian and healthcare team to make sure that you’re doing everything you can to keep your nutritional needs adequately met.
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