Guest Blog By: Megan Koscinski, MS, RD
If you’ve had metabolic and bariatric surgery (MBS), it is generally recommended to support your micronutrient levels with vitamin supplementation for life to maintain micronutrient levels within normal limits.*
But did you know that many duodenal switch (DS) patients need to take a multivitamin with higher levels of vitamins A, D, E, and K due to an increased risk of deficiency in these fat-soluble nutrients? (1)
In this blog post, we discuss the reason behind the increased dietary supplement need for patients with DS, the side effects associated with ADEK deficiency, and which vitamins are recommended.
Vitamin A, D, E, and K are fat-soluble vitamins. This means they are stored throughout the fatty tissue in your body and are best absorbed in the presence of dietary fat.
Vitamin A is a fat-soluble vitamin that plays a huge role in supporting healthy vision. Vitamin A-rich foods include fruits, veggies, milk, and animal products.*
There are different forms of vitamin A including carotenoids (beta-carotene) and preformed vitamin A (retinol and retinyl). When it comes to the needs of metabolic and bariatric patients, typically, vitamin recommendations refer to the active form of vitamin A, also known as retinol. (1)
This vitamin is essential in supporting phosphorus and calcium absorption, as well as bone health. If you’re out in the sun daily, you’re soaking up some vitamin D. Food sources are limited but include egg yolks, salmon, fortified dairy products, and cereals.*
The form of vitamin D that is commonly recommended to patients with metabolic and bariatric surgery is vitamin D3, also known as cholecalciferol. (1)
Vitamin E is an antioxidant known to support vision, a healthy immune system, and inflammatory responses.*
As with all vitamins and minerals, vitamin E can be found in food sources and dietary supplements. If you’re looking for food sources of vitamin E, nuts and seeds are a good source.
The primary forms of vitamin E are categorized as tocopherols, including alpha-tocopherol. If you see tocopherols on a dietary supplement label, know you are getting some vitamin E.
This vitamin is vital when it comes to healthy bones and blood clotting. Where do you get vitamin K? This fat-soluble vitamin is commonly found in dark green leafy vegetables, and it is also synthesized by your gut bacteria. Yes, you heard that right! Bacteria in the large intestine can produce small amounts of vitamin K.*
Different forms of vitamin K have unique names you might recognize. Vitamin K1, also known as phylloquinone, is produced by plants. While vitamin K2, also known as menaquinone, is produced by bacteria.
Are High Doses of Fat-Soluble Vitamins Needed After Duodenal Switch Surgery?
Both duodenal switch and gastric bypass surgery are considered malabsorptive surgeries due to anatomical changes that result in the malabsorption of nutrients. However, duodenal switch surgery bypasses a larger portion of the intestine, resulting in further malabsorption.
Due to the nature of these procedures, it is nearly impossible to consume enough vitamins and minerals through food sources alone. This is where supplement recommendations come into play to support the adequate intake of vitamins and minerals.*
Duodenal switch surgery encourages fat malabsorption. This sounds like a great outcome, but fat-soluble vitamins are better absorbed with dietary fat intake. When your body can’t absorb fat, that means fat-soluble vitamin absorption sites are decreased as well. (2)*
In other words, the more malabsorptive the procedure, the higher risk of micronutrient deficiency.
Symptoms of Fat-Soluble Vitamin Deficiency
So, how do you know if you’re deficient in any vitamins? Vitamin deficiency side effects can present in different ways, so it’s essential to know the signs.
Vitamin A deficiency is commonly associated with vision problems. Since vitamin A plays a role in supporting healthy vision, it makes sense that deficiency would directly affect your eyesight, including night blindness and xerophthalmia (dry eyes). Deficiency can also take a toll on the immune system, as respiratory tract infections can become more common. (3)*
Vitamin D deficiency most commonly presents as osteomalacia or weak bones. Bone health is directly affected by deficiency and will require vitamin D supplementation as directed by your healthcare provider.*
Vitamin E deficiency side effects are rarely seen because the body stores a large amount of vitamin E in fat tissue. If the vitamin reservoir is diminished, symptoms present as a form of anemia. (4)
The main symptoms of vitamin K deficiency are bleeding and easy bruising. Bone health may also be at risk. (5)
Bariatric Supplement Recommendations*
The American Society of Metabolic and Bariatric Surgery (ASMBS) provides general guidelines for supplement intake after surgery. (1) As mentioned above, all MBS procedures require supplementation to support optimal nutrient levels. However, due to the higher malabsorption rate of fat after duodenal switch surgery, fat-soluble vitamins may be recommended in higher amounts.*
Bariatric providers typically suggest a bariatric-specific multivitamin supplement. If you have undergone duodenal switch surgery, additional recommendations may be made, such as taking vitamin A supplements with your multivitamin.*
The best option for a patient with duodenal switch surgery would be to purchase a capsule or chewable vitamin ADEK tablet that is bariatric-specific.*
Metabolic and bariatric surgery (MBS) can support significant weight loss. However, there is a known higher risk of micronutrient deficiency following surgery.
It is common for patients with MBS to require supplements with vitamin and mineral levels above the recommended dietary allowance (RDA) to meet their increased needs after surgery.*
However, it is possible to reach toxicity levels of fat-soluble vitamins since they are stored within the body for a longer time (as opposed to water-soluble vitamins that are readily excreted by the body). That being said, dietary supplements should be taken based on the guidance of a qualified healthcare provider.
Talk to your healthcare team about including Bariatric Fusion’s High ADEK Multivitamin in your daily routine.
- Surg Obes Relat Dis. 2020; 16(2):175–247 [PMID: 31917200]
- Am J Clin Nutr. 2009; 90(1):15-22 [PMID: 19439456]
- StatPearls Publishing. 2022
- Vitamin E. Merck Manual Consumer Version. 2022
- Vitamin K. Merck Manual Consumer Version. 2022
This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.
*These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not intended to diagnose, treat, cure, or prevent any disease.