Bariatric Multivitamins and Monitoring
Bariatric Multivitamins
If you had bariatric surgery, you must take your multivitamins lifelong, look after your nutritional plan, and continue to exercise to increase your chances of staying healthy and reducing the risk of complications. This blog discusses different multivitamins and common problems that patients encounter with micronutrient deficiencies.
The first table compares recent ‘American Society for Metabolic and Bariatric Surgery’ (ASMBS) and ‘British Obesity and Metabolic Surgery Society’ (BOMSS) guidelines for post-operative micronutrient requirements.
The second table then looks at the commonly used post-bariatric surgery multivitamins used in New Zealand and highlights the deficient micronutrients in red.
As you can see, many non-bariatric multivitamins do not meet the guidelines set by international bariatric surgery societies. Lack of Calcium, Vitamin D, Iron, and Vitamin B12 are most concerning as these micronutrient deficiencies are commonly found post-surgery.
Calcium/Vitamin D deficiencies can contribute to osteoporosis/increased fracture risk, and Iron/Vitamin B12 deficiencies can be a cause of fatigue and anaemia after bariatric surgery. Regular intake of multivitamins and screening blood tests can help prevent these nutritional problems. Calcium supplements are usually not included in bariatric multivitamins as they need to be taken separately in divided doses over a day for maximum absorption. To have optimal nutritional support, a bariatric multivitamin + calcium citrate supplementation is the gold standard.
However, many patients who have screening blood tests while on a non-bariatric multivitamin (e.g. Centrum) have normal results without deficiencies. Often these patients have excellent nutrition and have enough micronutrients through dietary intake. Also, taking Centrum or Berocca is better than taking no multivitamins at all! However, once micronutrient deficiencies are found, it may be prudent to change to a bariatric multivitamin and consider additional supplementation.
Monitoring
https://www.medicalweightsolutions.co.nz/blog/follow-up-after-bariatric-surgery1
Here are the recommended monitoring requirements after bariatric surgery. For patients with a duodenal switch, more extensive monitoring is required as per guidelines.
Two aspects of monitoring are commonly overlooked. These include
Calcium, Parathyroid Hormone levels, Vitamin D levels, and Alkaline Phosphatase (part of liver screening)
Raised PTH/ALP and low vitamin D may indicate calcium/vitamin D malabsorption and increased bone loss. If this pattern is found, care must be taken to appropriate calcium/vitamin D supplementation, resistance exercises, and looking into bone density scanning (DEXA), especially for post-menopausal patients.
Copper/Zinc monitoring after gastric bypass
These trace elements are frequently not screened after malabsorptive procedures.
For Roux-en-Y gastric bypass, 21-33% of patients have zinc deficiency, and 2% have copper deficiency.
Symptoms of zinc deficiency can include poor wound healing, dermatitis, hair loss, altered immune function and taste, and infertility.
Symptoms of copper deficiency may include anaemia, many nervous system disorders, and poor wound healing. Copper deficiency may be very harmful.
Guidelines recommend regular monitoring of zinc and copper. It is thought that these tests are expensive but they cost ~$40 NZD each annually. Compared to many expensive blood tests available in the community, it is a small price to pay to prevent easily missed micronutrient deficiencies.
If you do have additional zinc supplements, you must add-in copper supplements in a ratio 8-15mg:1mg, zinc:copper. This is because zinc supplementation can lead to copper deficiency.