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Supplements are an essential component of the patient's diet after bariatric surgery. These procedures are performed in patients with 2nd and 3rd degree obesity. They consist of, among others limiting the body's absorption of nutrients from food. In bariatric patients, the use of dietary supplements - vitamins and minerals - is therefore necessary for the rest of their lives. The type of supplement, its dose and route of administration are adjusted to each patient. What supplements are used after bariatric surgery?

Whysupplementation after bariatric surgeryis recommended? Becausebariatric surgeriesmay result in a deficiency of some vitamins and microelements in patients after such procedures. Many patients already have nutritional deficiencies before the surgery, and the surgery itself also favors the formation of new deficiencies

Vomiting shortly after the surgery, decreased absorption area of ​​the intestine, as well as inappropriate choice of food are the causes of protein and caloric malnutrition. Many studies show that protein consumption after bariatric surgery is usually about 0.5 g of protein / 1 kg of correct body weight, and patients are not able to comply with the recommendation to eat the amount of food that would contain 1-1.5 g of protein / kg of correct body weight. . (60-80 g protein / day). In such cases, it is worth considering supplementing with protein supplements with high protein content and low fat content.

How does the digestive system behave after bariatric surgery? Let's use examples of 2 treatments:

  • Sleeve (cuff) resection of the stomach -after this surgery, the stomach is smaller, secretes less digestive enzymes and hydrochloric acid, as a result of which food digestion is incomplete and absorption is impaired. Due to the lower secretion of hydrochloric acid and internal factor, there is an increased risk of deficiency of e.g. vitamin B12 and iron.
  • Gastric shutdown- after this surgery only a small part of the stomach remains and the small intestine is shortened. Consequently, both food consumption, digestion and absorption in the shortened section of the intestine are greatly reduced. Calcium, vitamin D, iron and copper are most actively absorbed in the initial part of the small intestine. Also after this type of surgeryit is absolutely necessary to take appropriately increased and well-chosen doses of some vitamins and minerals.

In order to prevent deficiencies in the body, supplementation is included in the diet of patients after bariatric surgeries, which mainly includes:

  • vitamin D,
  • vitamin B1,
  • vitamin B12,
  • folic acid,
  • zinc,
  • calcium,
  • iron.
Worth knowing

After bariatric surgery, vitamin and mineral supplements are best consumed in the form of liquids or chews as they are easily absorbed.

Vitamin D after bariatric surgery

Vitamin D supports the absorption of calcium, which is essential in the process of building strong bones. Its deficiency after bariatric surgery is associated with reduced absorption in the small intestine (avoidance, reduced contact of fat with bile s alts). After bariatric surgery, absorption can be reduced by up to 40%, and a vitamin D deficiency can lead to overall body weakness and nervous system dysfunction. Usually it is recommended to take from 2000 IU. vitamin D daily. Before starting supplementation with this vitamin, however, it is worth performing laboratory tests to determine an individual dose with your doctor or dietitian.

Vitamin B1 (thiamin) after bariatric surgery

Thiamine deficiency can occur after bariatric surgery due to decreased stomach acid production, reduced food intake, and frequent vomiting. This can lead to nervous problems and memory loss. The daily requirement of vitamin B1 ranges from 1.1 to 1.3 mg.

Vitamin B12 (cobalamin) after bariatric surgery

Vitamin B12 malabsorption after bariatric surgery is a reaction to the removal of part of the stomach. Absorption in the terminal ileum is reduced due to a deficiency of the intrinsic factor. In addition, reduced production of hydrochloric acid (gastric and pancreatic enzymes) impairs the release of vitamin B12 from its connections with the protein. The optimal way to supplement this vitamin is by taking it in the form of sublingual tablets or intramuscular injections. Dosage is: 350-500 µg orally or 1000 µg i.m. once a month.

The assessment of the body's saturation with this vitamin is necessary at least once a year.

Folic acid after bariatric surgery

Folic acid prevents anemia, some cancers and heart disease. A person who has had bariatric surgery should consume 400 micrograms of folic acid daily.

Zinc after bariatric surgery

This mineral is the basic building block of hair, skin and teeth. Its daily requirement is 8-11 mg. Remember, however, that we only use zinc preparations in the case of a deficiency of this mineral. The use of prophylactic zinc, "just in case", is not recommended, and its supplementation is considered in the case of, among others, hair loss, taste disturbance, erectile dysfunction.

Calcium after bariatric surgery

After bariatric surgery, we may be at risk of developing bone diseases. To prevent this, the body should be saturated with about 1200 mg of calcium per day. Its deficiencies after bariatric surgeries are associated with reduced absorption in the duodenum and the upper part of the small intestine. Calcium citrate is the most appropriate preferred form as its absorption is not dependent on the acidity of the gastric juice. It is worth remembering that the absorption of calcium and vitamin D can be reduced by products containing oxalates, alcohol, and coffee.

Iron after bariatric surgery

Iron deficiency is the most common cause of anemia after bariatric surgery. This problem arises for two reasons. The first is the reduction in the capacity of the gastrointestinal tract to absorb iron. The second is that the body does not tolerate red meat, one of the richest sources of digestible iron. The risk of anemia, especially after gastric by-pass bariatric surgery, is greater in obese women who have menstruation. In the event of anemia following bariatric surgery, 65-80 mg of iron should be taken daily. Supplementing its deficiencies in the body will be helped by vitamin C, which increases the absorption of this element even several times. In turn, calcium reduces iron absorption, so these two supplements should be taken 2 hours apart.

SCHEME OF SUPPLEMENTATION

According to current guidelines, the following supplementation scheme is recommended after bariatric surgeries:

  • preparation containing a set of various minerals and vitamins: 1 - 2 tablets / day,
  • calcium supplement: 1200 - 2000 mg / day (preferably citrate) with vitamin D: 400-800 mg / day,
  • iron preparation containing 150-200 mg of elemental iron / day (iron sulphate / fumarate / gluconate),
  • folic acid at a dose of 400 mcg / day,
  • vitamin B12 - in the form of tablets 1000 mcg / day, or 1000 mcg intramuscularly / month or 3000 mcg / 6 months
Important

Poradnikzdrowie.pl supports safe treatment and a dignified life of people suffering from obesity. This article does not contain discriminatory and stigmatizing content of people suffering from obesity.

Magdalena Gajda Specialist forobesity disease; and obesity disease discrimination of people. President of the OD-WAGA Foundation of People with Obesity, Social Ombudsman for the Rights of People with Obesity in Poland and a representative of Poland in the European Coalition for People Living with Obesity. By profession - a journalist specializing in he alth issues, as well as a PR, social communication, storytelling and CSR specialist. Privately - obesity since childhood, after bariatric surgery in 2010. Starting weight - 136 kg, current weight - 78 kg.

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