Bariatric Surgery and Vitamin Deficiency
Bariatric surgery can lead to positive weight loss outcomes, but can also put you at high risk for vitamin and mineral deficiencies.
Weight loss surgery causes caloric restriction, malabsorption of nutrients, or a combination of both. It is important to adhere to a daily bariatric vitamin and mineral regimen or follow the recommendations made by your doctor.
Vitamin and mineral deficiencies are more likely to occur based on the type of bariatric surgery performed and can easily be prevented.
Learn more about the role of vitamin A, deficiency, and supplementation after bariatric surgery in this blog.
Why is Vitamin A Important?
The vitamins A, D, E and K are considered fat-soluble vitamins. Fat-soluble vitamins are stored in the liver and fatty tissue for later use. They also require dietary fat for adequate absorption.
Vitamin A is important because it plays a role in immune function, vision, reproduction, bone growth and tooth development. It also helps to maintain the normal function and maintenance of your organs.
Forms of Vitamin A
Different forms of vitamin A can be found in food sources and supplements.
Retinol and retinoic acid forms are found primarily in dairy products, fish and liver. Beta carotene is another form that is considered an antioxidant. It’s found in fruits and vegetables that are orange or dark green in color. Both of these forms can also be found in supplements.
Generally, bariatric recommendations are made referring to retinol sources because retinol is highly absorbed. It takes about twice the amount of beta carotene to meet the body’s vitamin A requirements when compared to retinol.
Signs and Symptoms of Vitamin A Deficiency
Vitamin A is an uncommon deficiency in the general population. It’s more common in developing countries. However, weight loss surgery creates a higher risk of deficiency in the bariatric population.
Vitamin A is typically absorbed in the first portion of the small intestine. It requires the consumption of dietary fat to be adequately absorbed by the body. For the Bariatric population, depending on the procedure performed, there’s a higher risk of deficiency.
Some common signs and symptoms of deficiency are acne, dry hair, insomnia, fatigue, growth impairment, hyperkeratosis (aka thickening skin), night blindness, and immune impairment.
You should be getting routine blood work done as a bariatric patient to check on vitamin and mineral levels. It’s also important to look out for any signs of deficiency and reach out to your healthcare provider if you have concerns.
Why is Vitamin A a Higher Risk in the Duodenal Switch (DS) Procedure?
Vitamin A supplementation is recommended for all bariatric procedures. The
American Society for Metabolic and Bariatric Surgery (ASMBS) nutritional guidelines stated that within 4 years post-op, they found that vitamin A deficiency occurs in up to 70% of patients that have had gastric bypass and DS.
Highly malabsorptive procedures like DS, result in dietary fat malabsorption. Vitamin A requires dietary fat in order to be properly absorbed, in turn, vitamin A becomes a very high risk of deficiency.
It has also been studied that there’s a higher prevalence rate of certain nutrient deficiencies among individuals with obesity considered for bariatric surgery. Vitamin A is one of those nutrients that has about 14% deficiency rate in the obese population.
There are bariatric ADEK multivitamins available that contain higher levels of these fat-soluble vitamins to accommodate for the malabsorption and restriction.
Vitamin A Supplementation After Bariatric Surgery
The ASMBS guidelines recommend vitamin A supplementation based on each procedure. To put into perspective, the Recommended Dietary Allowance (RDA) for the average individual is 700 - 900 mcg/day based on gender. Below are the recommendations for bariatric patients based on the procedure performed:
Gastric band : 1500mcg/day retinol (5,000 IU)
Gastric Bypass and Sleeve Gastrectomy : 1500mcg/day - 3000mcg/day retinol (5,000 - 10,000 IU)
Duodenal Switch : 3000 mcg/day retinol (10,000 IU)
Keep in mind, recommendations vary for individuals who have a history of vitamin A deficiency.
If you are pregnant or planning to become pregnant post-bariatric surgery, it’s extremely important to reach out to your bariatric team on the supplements you are taking. High levels of vitamin A in most bariatric supplements can pose a health concern for pregnant women. Some vitamin levels may have to be adjusted.
You can learn more about pregnancy after gastric bypass in our blog.
A bariatric multivitamin is necessary for prevention of vitamin and mineral deficiencies.
What happens when you are low or deficient in one vitamin or mineral? There are supplements called corrective vitamins.
They're offered as the most bioavailable, or absorbable, form of a single vitamin. They can also be offered as a combination of specific micronutrients that work together to aid in absorption and achieve normal blood levels in the body. For example, Vitamin A, Iron with vitamin C, Calcium and vitamin D, and Vitamin B12.
Dry Vitamin A
There are water-soluble and fat-soluble vitamins.
Water-soluble: requires regular replacement in the body because you generally excrete what you don’t need at the time (ex: B-vitamins and vitamin C)
Fat-soluble vitamins: stored in the liver and fatty tissue for later use; it's more common to reach toxic levels if you take more than recommended because they are eliminated slowly over time (vitamins A,D,E,K)
Vitamin A is a fat-soluble vitamin. There are fat-soluble vitamins available in the water-soluble form for those with severe absorption issues when it comes to a fat based supplement. This product can be found under different names, but all refer to the same thing (example: dry vitamin A, water-miscible, water-soluble).
The question is...Is this required after bariatric surgery? Not necessarily. Everyone has their own individual needs. Some may require higher needs than the next person that had the same procedure done. That being said, before purchasing any fancy vitamin supplement please consult with a qualified healthcare professional to best assist you in deciding whether a dietary supplement is suitable based on your individual needs.
Consider checking out: Gastric Bypass and Kidney Stones
Compared to over-the-counter multivitamin supplements you can buy at the local store, bariatric specific multivitamins usually follow the ASMBS guidelines.
These guidelines were produced by experienced healthcare professionals to ensure that bariatric patients receive all of the vitamins and minerals they need at much higher doses than the average multivitamin supplement to avoid nutritional deficiencies.
Bariatric Fusion provides multiple options for a daily vitamin/mineral regimen necessary for all patients after weight loss surgery.
**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 physician or another qualified health 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.