Vitamin A Deficiency After Gastric Bypass Surgery: An Underreported Postoperative Complication
Kerstyn C. Zalesin
1Divisions of Cardiology, Nutrition and Preventive Medicine, Department of Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, MI 48073, USA
2Divisions of Nutrition, and Preventive Medicine, Department of Internal Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, MI 48073, USA
Obesity, defined as a body mass index kg/m2, is a chronic disease with major health and economic implications and is recognized as one of the greatest contributors of excessive morbidity and mortality in the 21st century. Approximately 30% of the American population is obese, making it the leading nutritional disorder in our society . This trend has escalated to epidemic proportions with a disproportionate increase in persons with superobesity, defined as those with a kg/m2.
In 1991, the National Institutes of Health issued a consensus statement concluding that in the morbidly obese, bariatric surgery is the most successful intervention for long-term weight loss . Significant weight loss following bariatric surgery reduces the inherent obesity-specific comorbidities, lowers cardiovascular risk, and provides a survival benefit in this escalating patient population . Weight loss surgery has become increasingly utilized, with greater than 225,000 procedures performed in the United States in 2008 according to the American Society of Metabolic and Bariatric Surgery .
3. Postoperative Treatment
Symptoms Of Vitamin Deficiency After Gastric Bypass
Nutritional deficiencies are often unrecognised in patients who undergo gastric bypass surgery. The symptoms of vitamin deficiency after gastric bypass surgery can vary, depending on which deficiency the patient is suffering from and how severely. The most common symptoms of vitamin deficiency after gastric bypass include:
- Hair loss
However, symptoms experienced by those with vitamin deficiencies can vary significantly depending on which vitamins and minerals they are deficient in. These are just some of the early/acute symptoms experienced by patients long-term symptoms and deficiency problems can be chronic and severe.
Comparison Of Deficiencies Up To 3 Years After A Gastric Sleeve Or A Gastric Bypass
Deficiencies in micronutrients after bariatric operations are frequent. Theoretically, prevalence depends on the kind of surgery and which parts of the gastro-intestinal system are bypassed. In a non-randomized prospective trial, deficiencies after a Gastric Sleeve were measured and compared to Roux-en-Y Gastric Bypass , for up to 3 years after surgery. Postoperatively, all patients were prescribed daily multivitamin supplements.
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Gastric Bypass Vitamin Deficiencies: B12 And Folic Acid
The gastric bypass dramatically improved my well-being. So I am grateful I finally had the surgery after chickening out and cancelling my first surgery date. Months later I would reschedule and this time go through with the surgery on account of my worsening health. Read: My Gastric Bypass Story. And while I am pleased with the outcome such good fortune requires constant vigilance. Gastric bypass vitamin deficiencies often accompany the weight loss and patients need some discipline so as to protect the good health they have won. Read: Bariatric Vitamins is Discontinuing Ever an Option
Vitamin Deficiencies And Prevention Methods After Bariatric Surgery
Erciyes University, Health Science Faculty , Department of Nutrition and Dietetics, Kayseri 38000, Turkey
Kapadokya University, School of Health Sciences , Department of Nutrition and Dietetics, Nevehir 50000, Turkey .
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© The Author 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Folate/folic Acid And Zinc
Folic acid or folate is an important nutrient for the body because it helps make new cells, like neurons and red blood cells. Fortified cereals, legumes, fruits, leafy greens, and other vegetables contain this nutrient.
Folate deficiency can show up as anemia, as well as nervous system and psychiatric problems. For women trying to become or are currently pregnant, folate is vital to the fetus’s healthy development. Deficiency in folate while pregnant can result in birth defects. As for zinc, any process that disrupts the intestinal wall, like gastric bypass surgery, can reduce zinc absorption and cause deficiency.
Bariatric Surgery Patients’ Special Requirements
Hello. I am Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia. Welcome back to another GI Common ConcernsComputer Consult.
I have seen a lot of blogging back and forth recently with questions about bariatric surgery and, in particular, what to do with these patients. This Computer Consult is meant to tell care providers, irrespective of specialty, to be on the alert when somebody tells you that they have had previous bariatric surgery.
This is now one of the most commonly performed surgeries, not only in the United States but also emerging worldwide. This is due to the obesity epidemic and the significant improvement that we see not only in weight reduction but also in the metabolic consequences, such as diabetes, hyperlipidemia, and cardiovascular risks, and even cancer risk.
In my experience, one of the things that does not happen commonly enough is the routine monitoring of these patients. The Centers for Medicare & Medicaid Services now requires you to perform this operation to be a recognized Center of Excellence, and there are certain criteria that equate to this. There are many patients who have had these bariatric procedures who may perhaps just land in your lap. Therefore, you really need to understand that these patients need to be watched routinely.
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How Your Body Absorbs Vitamin B12
Vitamin B12 absorption follows this process.
During digestion in the stomach, hydrochloric acid separates Vitamin B12 from the R-protein. This is the protein that binds the vitamin to food.
The separated vitamin B12 attaches to intrinsic factor, a protein made by the parietal cells in the stomach.
The Intrinsic factor- vitamin B12 complex then binds to a vitamin B12 transporter called transcobalamin II. The transporter enters the degraded vitamin into circulation.
People with pernicious anemia cannot make intrinsic factor and their bodies therefore find it difficult to absorb vitamin B12 from food or supplements.
What Happens If I Dont Take Vitamins After Gastric Bypass
Not taking vitamins after gastric bypass surgery and skipping vital supplementation can be incredibly dangerous. Nutrients work together, not individually. The body relies on a steady supply of these essential nutrients together not independently. Thats why after gastric bypass surgery, you cant simply eat enough food and potentially absorb nutrients in the same way before surgery you need to supplement your daily healthy food intake with vitamins and mineral supplements.
So, what happens if you dont take supplements and vitamins after gastric bypass surgery? There are a number of specific conditions that can be driven by inadequate mineral and vitamin absorption after gastric bypass. These include:
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Strengths And Limitations Of This Study
This meta-analysis summarised the late outcomes of haematological changes and relevant nutritional deficiencies after Roux-en-Y gastric bypass by including a large sample and exclusion of small trials.
In our meta-analysis, there is not much uncertainty as to the effect of RYGB on development of anaemia, low ferritin and vitamin B12 deficiencies.
Our findings can be translated into clinical practice by implementing preoperation and postoperation surveillance of ferritin and vitamin B12 levels, and nutrient supplementation.
This study is limited by heterogeneity across studies without formal quality assessment.
Research Design And Methods
For recruitment, patients with morbid obesity who underwent a postoperative check-up after bariatric surgery were enrolled at the obesity clinic of the 1st Department of Medicine at the Hospital Landstrasse, Vienna, Austria between 2010 and 2019. Patients were referred by their general practitioner or the associated surgery department for postoperative evaluation. The study was approved by the institutional Ethics Committee and complied with the Declaration of Helsinki, including current revisions , and the Good Clinical Practice guidelines. All subjects gave written informed consent before the beginning of the study. All patients were treated by an interdisciplinary team of surgeons, endocrinologists, dietitians and, if necessary, psychologists.
Four hundred and eighty-five patients following bariatric surgery were available after the first year of surgery and were investigated in this cross-sectional, retrospective study. During the following years, the rate of participants decreased steadily. All patients underwent close nutritional counseling by a trained dietitian directly after surgery, after 6 months, and at least once a year. In patients with deficiencies, dietary follow-ups were performed more frequently on an individual basis. Depending on their vitamin status, patients received one or more supplements in addition to the standard supplementation and were regularly instructed to adjust the dose accordingly.
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Gastric Bypass Surgery And Nutrient Deficiency
Gastric bypass surgery for obesity increases the risk of nutrient deficiencies1,2. This operation makes the stomach smaller, so that less food can be eaten and bypasses part of the intestine, so that less absorption can occur. These surgical modifications result in weight loss, but also impair nutrient absorption.
B vitamin deficiencies can develop after this procedure and, if not addressed, may lead to serious and even irreversible damage3. The complex of B vitamins is critical for many aspects of health including the functioning of the nervous system, the building of blood cells, the maintenance of DNA, and the harnessing of energy from food.
Researchers have found deficiencies of vitamins B1 , B2 , B6 , B9 , and B12 in gastric bypass recipients2,4,5. Signs and symptoms include anemia, fatigue, impaired cognition, mood changes, numbness, tingling, burning hands and feet, muscle weakness, and abnormal gait. Beri-beri and Wernicke-Korsakoff syndrome, diseases resulting from severe thiamine deficiency, have appeared in patients after gastric bypass surgery6,7.
After surgery, gastric bypass recipients should be routinely monitored for nutrient deficiencies and confirm with their doctor that their supplement regimen includes adequate amounts of the B vitamins8.
1. Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Seminars in Nephrology. 2013 Jan:33:75-89.
Heartburn, gas, reflux… your body has a message for you. Listen up!
Review Articlevitamin Kwhat Is Known Regarding Bariatric Surgery Patients: A Systematic Review
Major malabsorptive surgeries are a risk-factor to develop vitamin K deficiency.
The strength of evidence supporting pre-surgery vitamin K screening is weak.
The oral dose or vitamer type for post-surgery supplementation is uncertain.
The exact protocol for vitamin K deficiency treatment is still experiential.
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Gastric Bypass Vitamin Deficiencies
There are a few weight loss surgery options to choose from – gastric sleeve, gastric bypass, duodenal switch and the adjustable gastric band. Weight loss surgery, no matter the method, can be life-changing for the person receiving it.
Going through gastric bypass surgery is a large feat on its own. According to the American Society for Metabolic and Bariatric Surgery , gastric bypass surgery is a two-step process.
First, the stomach is made into a small pouch. This pouch can hold approximately 30 cubic centimeters in volume. Next, the small intestine is divided, and the bottom end of the small intestine is connected to the stomach pouch created. This results in a stomach pouch with tiny amounts of food and liquid and a reduced ability to absorb nutrients and calories via the small intestine.
Pros of gastric bypass surgery mentioned by ASMBS:
Significant long-term weight loss
Restriction placed on the amount of food consumed
50% or greater excess weight loss maintained
Cons of gastric bypass surgery mentioned by ASMBS:
Can result in long-term vitamin and mineral deficiencies
Is a more complex procedure that can result in complications
Requires adherence to a dietary and lifelong vitamin and mineral supplement regimen and going to follow up appointments
In particular, seven vitamins and minerals require close monitoring post-gastric bypass to avoid deficiency:
Vitamin deficiencies are always a concern for bariatric patients.
Thiamine Deficiency In The Bariatric Surgery Patienta Multidisciplinary Challenge In The Clinic And The Community
This column is dedicated to covering a variety of topics relevant to the multidisciplinary care of the bariatric surgical patient.
Barbara Hodges Klick, RD, MPH, is Program Manager, Bariatric Surgery, at the University Hospital Case Medical Center, Cleveland, Ohio, and University Hospital Geauga Medical Center in Chardon, Ohio.
Funding: No funding was provided in the preparation of this manuscript.
Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.
Bariatric Times. 2013 10:2021.
AbstractThiamine deficiency in the bariatric patient is a complication that can result in serious and permanent side effects. Educating community healthcare providers on the higher likelihood of thiamine deficiency in the bariatric patient, as well as the causes, symptoms and treatment of this deficiency can significantly impact the health and overall wellbeing of the bariatric patient.
Community physicians, emergency personnel, advanced practice providers, physical therapists, nurses, and dietitians are all involved in the care of the bariatric patient. Each one of these providers plays an integral role in the diagnosis and/or management of vitamin deficiencies, including thiamine deficiency. This article will discuss symptoms and treatment of thiamine deficiency, which can be used as a springboard for educating community healthcare providers.
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Vitamin B12 Deficiency After Weight Loss Surgery
Research shows that most patients with obesity suffer from a deficiency of micronutrients such as Vitamin B12 before surgery. These deficiencies persist even after surgery. In this post, we will discuss Vitamin B12 deficiency, its symptoms, why it is prevalent after gastric surgery, and, what to do about it.
Vitamin D Supplementation Should Be Increased
51 and 49% of the patients showed at least one deficiency at 1 and 2 years after a Gastric Sleeve, respectively. This indicates that a standard multivitamin does not suffice for the prevention of nutritional deficiencies. Gastric Sleeve patients seem to have a special need for increased vitamin D dosages, to fit the specific nutritional needs ater their operation type.
Iron and calcium supplementation after Roux-en-Y Gastric Bypass
Nutritional supplements containing both iron and calcium prevent deficiencies after Roux-en-Y Gastric Bypass and allow for simplified intake In order to prevent vitamin and mineral deficiencies after malabsorptive and restrictive bariatric surgery, lifelong nutritional supplementation is recommended. However, since several tablets have to be taken separately and scheduled in time to avoid potentially competitive absorption
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Vitamin B12 Importance After Bariatric Surgery
Vitamin B12 is one of the eight B vitamins it is a water soluble vitamin and also called cobalamin. It is worth noting that vitamin B12 is the largest and structurally the most complex vitamin.
Vitamin B12 deficiency is one of the most common deficiencies observed after a gastric bypass. The absorption of vitamin B12 in the body begins in the mouth where tiny amounts are absorbed through mucous membranes. The vitamin binds to intrinsic factor secreted by the stomach it is this combination of compounds that is absorbed further down in the intestines, in a portion called the ileum.
Clams As A Natural Source Of Vitamin B12
During laparoscopic gastric bypass, the portion of the stomach responsible for making intrinsic factor is bypassed. This portion of the stomach therefore never encounters food and therefore is never stimulated to produce intrinsic factor. This lack of intrinsic factor decreases the amount the body is able to absorb vitamin B12 after gastric bypass and to a lesser extent after laparoscopic gastric sleeve surgery.
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Woman Suffers Serious Vitamin Deficiency After Gastric Bypass Surgery
A woman developed disease because, after her weight-loss surgery, she did not take her multivitamin, as reported in a Case Report released on October 10, 2008 in The Lancet.
The obesity epidemic is well documented around the world, and has affected developed countries in great magnitude. One treatment for obesity is gastric bypass surgery, which actually limits the size of the stomach cavity to help curb the patients appetite.
The woman, 27 years old, was admitted the hospital after three weeks of reported dizziness, loss of appetite, and vomiting. She had undergone gastric bypass surgery, without complications, at University College Hospital, London, UK.She was prescribed a standard treatment of multivitamins and lansoprazole, which prevents stomach acid production, upon discharge from the hospital.
When she was examined, she had lost almost 20 kilograms and presented with a rapid heartbeat and dehydration. This led to an initial diagnosis of gastric outflow obstruction, but this diagnosis could not be confirmed by endoscopic examination. Blood tests were consistent with dehydration, so she was ultimately administered intravenous fluids with glucose and drank high-sugar energy drinks.
Can glucose make you faint? Suehana Rahman, Antonia I Scobie, Mohamed Elkalaawy, Louise E Bidlake, Alberic G Fiennes, Rachel L BatterhamLancet 2008 372: 1358
Other Markers Of Nutritional Status
Duodenal switch patients had a significantly greater mean BMI loss than did gastric bypass patients from baseline to 1 y after surgery: 22.8 ± 4.7 compared with 16.3 ± 4.3 . These values correspond to weight losses of 41% and 30%, respectively. We found time × procedure interactions for hemoglobin and total cholesterol , but not for triacylglycerols . Duodenal switch patients had lower mean hemoglobin and total cholesterol concentrations than did gastric bypass patients at each postoperative visit .
Mean body mass index and hemoglobin, total cholesterol, and triacylglycerol concentrations after gastric bypass and duodenal switch surgeries. *,Two-factor repeated-measures ANOVA: *significant change after surgery significant difference in the change over time for the 2 surgical procedures . Reference intervals: hemoglobin, 11.715.3 g/dL and 13.417.0 g/dL serum total cholesterol, 3.57.0 mmol/L serum triacylglycerols, 0.452.60 mmol/L.
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