Bariatric surgery, also called weight loss surgery, assists severely obese individuals to lose significant amounts of weight and keep it off. However, restricting food intake and, in some cases, a rerouting of the digestive system predisposes patients to nutritional deficiencies that could affect their health if not detected and treated.
Bariatric Surgery
Bariatric surgical procedures include restrictive, malabsorptive and combination procedures, according to Highland Hospital. Some procedures, including vertical banded gastroplasty and gastric banding or Lap-Band, restrict the size of the stomach, causing the patient to feel full after eating a small amount of food. Others, called malabsorptive procedures, speed weight loss by blocking the absorption of calories and nutrients. Combination procedures, including gastric bypass and biliopancreatic diversion with duodenal switch or BPD/DS, create a smaller stomach and bypass part of the small intestine. Nutritional deficiencies occur most often in patients having combination procedures.
Protein Deficiency
A healthy adult needs between 46 and 56 g of protein per day. After bariatric surgery, however, you will need at least 60 and 80 g per day to preserve lean muscle mass during rapid weight loss, says Linda Aills, R.D., lead researcher in a study published in the September 2008 issue of "Surgery for Obesity and Related Diseases." Protein deficiency may occur after any type of bariatric surgery but most commonly after BPD/DS because bypassing the small intestine blocks about 25 percent of the protein in food from absorbing. Protein deficiency may cause hair loss, weakness, muscle wasting and anemia. To prevent protein deficiency, eat your protein first before adding other foods and use protein shakes or other supplements if necessary to meet your daily goals.
Vitamin Deficiencies
Malabsorptive procedures such as BPD/DS that block absorption of about 72 percent of the fat you eat, also prevent fat-soluble vitamins -- A, D, E and K -- from absorbing efficiently, according to Aills. Bypassing the first parts of the small intestine prevents absorption of B12 and folate as well because these vitamins normally absorb in those areas. The reduction in food intake after all types of bariatric procedures also puts you at risk for vitamin deficiencies. Since these nutrients play important roles in the proper functioning of your body, your surgeon will instruct you to take one or two high-quality multivitamins daily to prevent deficiencies. If laboratory tests indicate that you need even more of a certain type of vitamin, you will need to take supplements according to your surgeon's instructions.
Mineral Deficiencies
After bariatric surgery, certain minerals -- zinc, calcium and iron -- may not absorb well and your diet may not provide enough of these nutrients to keep your body functioning efficiently, says Aills. Calcium, an essential nutrient for building strong bones and teeth, also requires vitamin D to help it absorb, so your surgeon will instruct you to take calcium citrate supplements with vitamin D every day. Multivitamins containing iron help prevent iron deficiency anemia but you may also need to take additional iron supplements if your surgeon advises it. Although zinc deficiency occurs in some bariatric surgery patients, the effects require more research, says Aills.
Time Frame
Bariatric patients begin to take protein, vitamin and mineral supplements within 24 hours of surgery unless complications occur, according to Highland Hospital. Your need for vitamin and mineral supplements will continue for the rest of your life but you may not need protein supplements if at some point you can eat enough protein-rich food to meet your daily needs of 60 to 80 g per day, says Aills. Your surgeon will monitor your blood levels of key vitamins and minerals frequently during the first year after surgery and annually thereafter.
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