If the calorie and sugar content is not listed, the consumer must decipher the ingredients list or inquire about the contents from the manufacturer, especially if they have any allergies. Thus, choosing a reputable manufacturer that you trust is an important decision after any bariatric surgery, and there are numerous bariatric supplement companies in the industry. Not only should you ensure their vitamins and minerals meet your needs according to American Society for Metabolic and Bariatric Surgery’s (ASMBS) guidelines for your procedure, but doing your research on the forms and delivery methods and asking questions about their lab analysis to verify materials for accuracy should be part of your decision process. Choosing a product from the company’s selection that you can tolerate and adhere to for a lifetime is the other half of the equation.

As a dietitian, helping patients understand issues of advertising false claims, the regulations that exist, and the science behind supplementation, can be daunting, to say the least. The best assurance in recommending a product is to seek out those manufacturers that have been GMP-certified by an independent auditor or by the FTC. The less nutritional deficiencies that need to be treated following bariatric surgery, the better and the healthier the patient will be in the long term. After all, the main reason patients sought surgery in the first place was their health, so disregarding the importance of supplementing the diet with appropriate micronutrients in a form they absorb well, can be counterproductive.

Knowing what you are taking and establishing an open line of communication with your program dietitian, surgeon, or primary care physician, in addition to seeking information from supplement companies, is one of your best bets in maintaining your health after bariatric surgery.

Which Micronutrients Will I Need to Supplement?

Unfortunately, one cannot rely on simply taking a multivitamin to achieve the desired results in preventing micronutrient deficiencies after bariatric surgery. While the majority of vitamin and mineral requirements can be met with the right multivitamins, you will need to focus additionally on calcium, vitamin B12, vitamin D, and potentially iron in addition to that in the multi formula (primarily for menstruating women).

It can be challenging to adhere to the recommended vitamin and mineral regimen required for those who have undergone surgery. In addition to a complete, high-potency vitamin (meeting 200% daily value for most of the nutrients on the label), sleeve gastrectomy and roux-en-y gastric bypass patients need to take additional calcium split into 2-3 doses per day, vitamin D (depending on the amount in multivitamin), and vitamin B-12. Patients who have undergone more malabsorptive surgery such as duodenal switch require even higher potency supplements, including the fat-soluble vitamins (A, D, E, and K). Many specific bariatric formulations of multivitamins exist, which should provide the amounts and forms of micronutrients recommended or best absorbed after bariatric surgery.

Calcium citrate is the preferred form of calcium since it does not require hydrochloric acid in order to be absorbed; calcium carbonate may be taken by those who have restrictive only procedures- gastric band, balloon, and sleeve gastrectomy- and is best taken with a meal while there is churning to assist in absorption. Dosages of calcium should be split into no more than 500-600 mg at once and split evenly throughout the day. Keep the split dosages in mind when selecting a calcium supplement if you spend the majority of your day away from home. Convenience can be key in adherence, and a pill organizer is another key that may be the trick to consistency. Something that is individually wrapped is likely simpler to take on-the-go than a liquid or container full.

Vitamin B12 is recommended at a dose of 300-500 mcg daily in a sublingual form, meaning it dissolves preferably under the tongue or between cheek and gum. Alternatively, patients may choose a nasal spray (which requires a prescription) or an intramuscular monthly injection, also a prescription. Therefore, the form in a multivitamin will not necessarily prevent a vitamin B12 deficiency for the long-term. It is very cost-effective and therefore is a good preventative measure to take for both sleeve gastrectomy as well as those with malabsorptive procedures.

Vitamin D is found to be lacking in 90 percent of bariatric patients preoperatively. A correction dose of ergocalciferol or vitamin D3 (cholecalciferol) should be taken for at least eight weeks when an abnormality presents itself prior to surgery. The standard amount of vitamin D3 in a multivitamin does not supply adequate protection
to prevent bone resorption after surgery. If one is not supplementing a bariatric multivitamin formula containing at least 1000 IU vitamin D3, a maintenance dose should be taken and vitamin D-25-OH levels monitored routinely to ensure levels are not exceeding the normal limits.

More than likely, one who has bariatric surgery will face abnormalities in the area of micronutrients at some point following surgery. Therefore, it is crucial that treatment be aggressive to correct deficiencies along with lifelong screening to prevent bone loss, irreversible damage, and preventable complications.

Common Questions Post-Surgery:

• • • Are some vitamins better than no vitamins? Yes, of course.

• • • Are bariatric formulated vitamins worth the money? Yes, vitamin deficiencies after bariatric surgery can usually be prevented by taking high quality supplements as specifically directed by your surgeon, dietitian or nurse.