Importance of Vitamins and Minerals after Gastric Bypass Surgery

Led by Dr. Monica Ganz
People who’ve had malabsorptive procedures (Roux En Y and duodenal switch) are in danger of vitamin and mineral deficiencies because certain vitamins and minerals cannot be absorbed by the new digestive tract through ingestion.

Vitamins are essential for the release of energy from carbohydrates, fats and proteins. B-12, for example, is a vitamin that can’t be replenished once a person has become truly deficient in it.

Minerals don’t furnish energy but are vital in many other physiologic functions. The body stores and reuses minerals so deficiencies aren’t easily detected.

Many post-ops become deficient in iron and calcium.

Iron
Iron deficiency occurs because the pouch empties too quickly for iron to be absorbed and because RNY and DDS patients have their duodenum – where 50% of iron absorption takes place – bypassed. Symptoms of iron deficiency include fatigue, feeling cold, pica (compulsive eating of non-food items), tongue fissuring and pagophagia (compulsive eating of ice).

Supplements should be in the form of 18mg of ferrous fumerate or amino-iron, which is most absorbable. Taking iron with vitamin C (such as diluted orange juice or even a chewable vitamin C) to help its absorption. Food sources of iron include liver, oysters, shellfish, organ meats, lean meats, poultry and fish (best meat sources), dried beans and vegetables (best plant sources), egg yolk, dried fruits, dark molasses, whole grains and enriched breads and cereals.

Calcium
Calcium deficiency occurs because post-ops can’t eat enough of calcium-rich foods, and the mineral is absorbed in the duodenum. Symptoms of calcium deficiency include fragile bones and hypertension.Supplements should include 1200mg of calcium citrate (plus vitamin D) per day, four servings of dairy products per day. For each missed serving of dairy products, supplement with an additional 500mg of calcium citrate. This is why many post-ops are encouraged to take up to 2400mg per day.Another problem is that calcium deficiency is hard to detect because the body will leach the necessary calcium from the bones. Dexa bone-density tests are the best way to find out whether a post-op’s body is leaching calcium from the bones. Some people also notice teeth problems, such as a loss of enamel.

Vitamins most commonly found deficient in post-ops are vitamin B1 (Thiamin), vitamin B-12 and folic acid.

Thiamin
Thiamin is necessary for the breakdown of glucose for energy, nerve function, good digestion, normal appetite and good mental outlook. Deficiency is rare in the U.S., except in alcoholics. Symptoms include beri beri, fatigue, poor appetite, constipation, depression, etc. Supplementation is as easy as taking a chewable multivitamin (Bariatric Advantage, Optisource, etc.).

Vitamin B-12
Vitamin B-12 aids in the formation of mature red blood cells, synthesis of DNA, stimulates appetite, promotes growth and releases energy. Food sources include liver, kidney, dairy products, fish, clams, oysters, salmon and sardines.Gastric bypass post-ops MUST supplement with B-12 because the pouch doesn’t supply the intrinsic factor required for absorption. Signs of deficiency include pernicious anemia, tiredness and neurological disorders.Supplements can be by mouth, injection or nasal spray. Monthly injections are the safest best.

Folic acid
Folic acid is necessary for formation of red blood cells. Deficiency happens because of poor dietary intake, low iron and alcoholism. Symptoms of deficiency include rapid heartbeat, fatigue, anorexia, pale skin, paranoia, or sore, inflamed tongue. Food sources include soy, leafy greens, organ meats, mushrooms, oatmeal, red beans and wheat. Supplementation is usually as easy as taking a good multivitamin.