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Dear
Gastric Bypass Patient
Are you taking your
vitamin and mineral supplements each and every day, as directed? Do you realize
that it is necessary to take vitamin and minerals for life following gastric
bypass surgery to avoid the risk of health complications?
Why are vitamins and
minerals important for life? Because the gastric bypass procedure has changed
the anatomy of your stomach and intestines in a manner that can cause deficits
in vitamins and minerals that could negatively influence your health.
Nutrient deficiencies
with the gastric bypass procedure occur for several reasons. First, the surgery
reduces overall food intake. Secondly, the small gastric pouch produces
negligible amounts of digestive enzymes and acid for complete digestion of
certain foods. Third, the small stomach pouch no longer produces a substance
called intrinsic factor that is needed for the absorption of Vitamin B12.
Fourth, the stomach bypasses a portion of the gut that is necessary for the
absorption of many vitamins and minerals.
For all of these
reasons, you will need to take vitamins and minerals for life. Daily
supplements should include a multivitamin that contain close to 100% the RDI
for vitamins A (or beta-carotene), E, C, and D, zinc, selenium, copper,
magnesium, manganese, molybdenum, chromium, and potassium. The multivitamin
should also contain all of the B-complex vitamins, with amounts at least 200%
the RDI for folate, thiamin and other major B vitamins.
If the multivitamin has
been designed for bariatric patients, it will likely also contain vitamin B12
at amounts that greater than 1000% the RDI. With the gastric bypass procedure,
the stomach no longer produces a compound, intrinsic factor, important for the
absorption of vitamin B12.
Studies have shown that
Vitamin B12 deficiencies are common after the gastric bypass procedure and can
have very serious health consequences years and years after surgery, sometimes
even causing permanent nerve damage and a loss of mobility. Signs of B12
deficiencies may include numbness or a loss of feelings in the legs (and later
the arms), unsteadiness when walking, color blindness, confusion, irritability
and depression, swollen and ‘shiny, smooth’ tongue, weakness and anemia.
Supplements of B12 that
are 3300% the RDI and higher have been reported to prevent B12 deficiencies in
more than 95% of gastric bypass patients. Monthly shots of 1000 mcg B12 are
also very effective in prevention of B12 deficits, and daily sublingual intake
of B12 may be helpful in prevention, as well.
Iron and calcium
deficiencies are also common with gastric bypass surgery because the portion of
the gut that absorbs these minerals has been bypassed by the surgical procedure
and because the stomach no longer produces acid needed for optimal absorption.
These minerals must, therefore, be supplemented and at amounts in excess of
those generally included in a daily multivitamin/mineral.
Iron should be taken at
prenatal levels (30 mg or more) and in its most absorbable forms, fumerate
chelate or fumerate citrate. Iron deficiencies may occur shortly after surgery
or years and years later. Symptoms and effects include: pica (a desire to
eat ice, paint, dirt, paste, other such items), fatigue, weakness, and
anemia.
Calcium deficiencies
cause bone loss after surgery, irregularities in muscle, heart, or nerve
functions, defects in certain hormones, and even weight gain. Calcium
supplements for the gastric bypass patient must be in the form of calcium
citrate– NOT calcium carbonate or phosphate or coral calcium. For
optimal absorption, the calcium citrate should also contain vitamin D, ascorbic
acid (vitamin C), or magnesium. The daily calcium needs are at least 1200 to
1500 mg must be taken at different times throughout the day in supplements of
no more than 500-600 milligrams.
Folate deficiencies
have been reported to occur with gastric bypass and can cause anemia, increase
the risk for heart disease, and cause interference with your body’s ability to
produce energy. Folate deficits can be prevented with 200% the RDI. Folate
deficiencies can cause anemia and can increase your risk for heart disease.
Symptoms of a deficiency may include weakness and fatigue.
Thiamin or vitamin B1
should also be contained in your multivitamin at amounts 200% the RDI or
preferably higher. Deficiencies in thiamin may occur following an episode of
vomiting, if you skip meals, or if you fail to take your vitamins.
Deficiencies in
thiamine may have very serious consequences, including an inability to walk, a
loss of memory (sometimes permanent), or even death. Symptoms include muscle
cramps and pain, burning feet, numbness or tingling in legs or arms, racing
heart, confusion, memory loss, and difficulty learning new tasks.
Because of the anatomy
of the gastric bypass procedure, there will always be a risk for vitamin and
mineral deficiencies which could have serious health consequences. It is,
therefore, not only important that you remember to take supplements daily and
FOR LIFE but also that you have regular (annual) blood checks for levels of
vitamins and minerals, particularly iron, folate, vitamin B12 (and thiamin if
symptoms appear), and to have from time-to-time a bone scan, parathyroid
measurement or some other test that may identify calcium deficits.
Overview of Vitamin and
Mineral Requirements:
Daily
Multivitamin/Mineral
-
100% the RDI (or more)
for vitamins A, E, C, D niacin
-
200% the RDI (or
higher) for major B-complex vitamins, particularly folate and thiamin
-
100% the RDI for
minerals, i.e. zinc, manganese, molybdenum, selenium, copper, chromium,
potassium, magnesium, others.
Vitamin
B12
Calcium
Iron
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