Surgical techniques and other aspects of gastric bypass surgery have changed over the years, but one fact remains the same: gastric bypass surgery can cause nutritional deficiencies. After bariatric surgery, a general term for weight-loss surgery, you need to take vitamins, including B-12, to prevent health problems from malnutrition. Bariatric surgery disrupts your ability to absorb vitamins and also decreases your food intake.
Bariatric Surgery Effects
In gastric bypass surgery, the most common type of weight-loss surgery in the United States, according to MayoClinic.com, part of the stomach and between one and four feet of the small intestine are cut off from the digestive tract. This greatly decreases the area available not only to hold food but also to break down and absorb it into the body. Since the whole point of bariatric surgery is to decrease food intake along with absorption, decreased calorie intake leads to less B-12 available for absorption. While the amount of small intestine and stomach still available varies with different types of bariatric surgery, all have the potential to cause nutritional deficiencies from poor intake or absorption
Effects on B-12 Absorption
Vitamin B-12 needs both stomach acid and intrinsic factor to break it down and carry it into the small intestine for absorption. Removing part of the stomach decreases the number of cells that produce both. Bypassing the upper part of the small intestine, along with the fact that nutrients move more quickly through the decreased section of digestive tract, allows less time and area for B-12 absorption. More inflammation than normal in the stomach and acid-production blockers often given to prevent ulcers after gastric bypass also affect absorption.
Symptoms of Deficiency
Because B-12 is essential for the formation of red blood cells, anemia is one of the hallmark signs of B-12 deficiency. Because red blood cells carry oxygen, anemia can cause fatigue, weakness, shortness of breath on exertion, pallor and loss of appetite. Vitamin B-12 also helps maintain neurological function. Deficiencies can cause numbness and tingling in the extremities, confusion, difficulty thinking, memory loss, depression, dementia and poor balance. The tongue may turn red, swollen and painful. Neurological symptoms can occur even before anemia develops, the Office of Dietary Supplements warns.
Treatment
Vitamin B-12 supplementation is essential after bariatric surgery and will be a life-long necessity. Taking B-12 in a form that bypasses the digestive system and directly enter the bloodstream gives the best absorption. B-12 injections, which patients can give themselves once a month or receive from the health provider or daily B-12 lozenges taken sublingually, by holding them under the tongue until they dissolves, have the best absorption rates.
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