Recovering from weight loss surgery? Take your vitamins!

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the importance of vitamin and mineral supplements after weight loss surgery.

For optimal health, the body needs 13 essential vitamins and nine trace minerals daily. Typically, the best way to get these nutrients is through a varied diet, as outlined in the USDA Food Guide Pyramid. The dietary restrictions following weight loss surgery make it difficult to obtain the daily recommendations of vitamins and minerals from food alone. Therefore, people recovering from weight loss surgery are strongly encouraged to take vitamin and mineral supplements for proper nourishment and to aid their recovery.

Vitamin and mineral supplements are particularly important during the post-surgical period. Weight loss surgery restricts the amount and type of food that can be consumed. Solid foods are reintroduced into the post-surgical diet slowly and gradually, which means it can be an extended amount of time before patients are able to eat a healthy, nutrient-rich diet.

In addition, gastric bypass can cause malabsorption of important nutrients, making it even more important to compensate with vitamin and mineral supplements. Gastric bypass and sleeve gastrectomy can impair the release and absorption of vitamin B₁₂. By bypassing part of the intestines, gastric bypass can also lead to intolerance of calcium-rich dairy and impaired iron absorption. Taking sufficient supplements can prevent irreversible nutritional deficiencies.

The American Society of Metabolic and Bariatric Surgery provides guidelines for vitamin and mineral supplementation following weight loss surgery.

Multivitamin and mineral supplement:

• The supplement should contain 100 percent of the daily value for at least two thirds of the nutrients listed on the nutrition facts label. The product you select should be reviewed and approved by your bariatric team before surgery.
• Chewable tablets are recommended for the first two to three months after surgery.
• Start taking vitamin and mineral supplements on the first day home from the hospital.
• After adjustable gastric band surgery, one multivitamin a day is typically required.
• After gastric bypass or sleeve gastrectomy, two multivitamins a day are typically required.

Calcium with vitamin D:

• For optimal absorption post surgery, take a product with calcium citrate and vitamin D₃.
• Chewable tablets are recommended for the first two to three months after surgery.
• Calcium intake should be between 1500 and 2000 mg daily.
• Doses should be divided. Take no more than 500 to 600 mg at one time.
• Do not take calcium and iron supplements at the same time. They must be taken at least two hours apart.
• Start taking calcium supplements on the first day home from the hospital.

Vitamin B₁₂:

• A sublingual (under-the-tongue) tablet containing 500 micrograms of vitamin B₁₂ can be taken daily or monthly intramuscular injections of B₁₂ can be given by a primary care physician.

• While the body does store vitamin B₁₂, it is recommended that supplementation begin on the first day home from the hospital.

Iron:

• Additional iron may be needed for menstruating women or those at risk for anemia.
• The amount of additional iron required is determined on an individual basis.
• Do not take iron at the same time as calcium supplements. They must be taken at least two hours apart.

Essential Vitamins:

1. Vitamin A
2. Vitamin D
3. Vitamin E
4. Vitamin K
5. Vitamin C
6. Thiamin
7. Riboflavin
8. Folic acid
9. Niacin
10. Vitamin B₆
11. Vitamin B12
12. Pantothenic acid
13. Biotin

Trace Minerals:

1. Iron
2. Copper
3. Zinc
4. Fluoride
5. Selenium
6. Iodine
7. Manganese
8. Chromium
9. Molybdenum

Make sure to consult your health care team before starting or changing vitamin and mineral supplementation following bariatric surgery.

- Karen Buzby, RD, LDN