After weight-loss surgery, you will digest and absorb nutrients differently. Due to these differences, vitamin and mineral supplementation is essential. Knowing what supplements you need to take after bariatric surgery is critical to your long-term success. Research shows that the majority of post-op weight loss surgery patients have one or more deficiencies without proper nutrition and supplementation.
Studies have shown that after bariatric surgery, patients do not get the minimum requirements of thiamin (B1), niacin (B3), pantothenic acid (B5), pyridoxine (B6), folate, calcium, biotin, and iron.
Side Effects of Vitamin Deficiencies
- Muscle loss
- Hair loss
- Cracked and dried skin
- Weak and brittle bones/osteoporosis
- Nerve damage
- So much more
After gastric bypass and sleeve gastrectomy, you do not produce enough gastric acids or intrinsic factor (IF) to absorb vitamin B12 properly. Both stomach acid and IF work to release B12 from food and assist with the absorption of the vitamin. For this reason, a B12 supplement is needed in the form of a sublingual tablet, nasal spray, or injection.
This is mainly a concern for gastric bypass patients. With gastric bypass surgery, the prime area (the duodenum) of iron absorption is avoided with the surgery. Taking an iron supplement will assist in preventing iron deficiency, or anemia.
Be sure to choose calcium citrate and not calcium carbonate. After gastric bypass or sleeve gastrectomy, you will not produce the stomach acid needed to activate and absorb calcium carbonate.
Swallowing vitamins and minerals may be difficult after bariatric surgery. It is best to choose supplements that are chewable or dissolve in liquids.
Hair loss is a common side effect of rapid weight loss. It will typically occur between 3 and six months after surgery and can last up to 12 months after surgery. While this is temporary and your hair does grow back, it can be frustrating.
Possible Nutritional Deficiencies:
- Not enough high-quality protein: Be sure to get a minimum of 60 grams of protein daily.
- Iron, the micronutrient most related to hair loss: Ferritin levels below 40 or Hgb below 11g/dL are associated with hair loss.
- Essential fatty acids are needed to supplement with linoleic and linoleic acid. Barlean’s Essential fatty acid is recommended.
- Biotin: 1 – 2.5 mg per day is recommended.
- L-Lysine makes up 27% of the protein in hair. A supplement of 1.5 – 2 grams per day is recommended. Also found in fish, meat, and eggs.
To minimize your hair loss, be sure to get a minimum of 60 grams of protein daily, take the recommended bariatric vitamin and mineral supplements daily, add biotin to your supplement regimen, and use Nioxin shampoo.
Required Vitamins for Gastric Bypass and Sleeve Gastrectomy:
- Bariatric-specific multivitamin: 1 serving per day
For gastric bypass patients, get a multivitamin with iron.
- Calcium citrate: 1500 – 2000 mg per day
Take only 500 – 600 mg at a time for best absorption.
- Vitamin D3: 2,000 IU daily (You can purchase calcium that includes D3.)
- B12: 500 mcg (sublingual, nasal spray, or injection)
- B1 (thiamin): 100 mg
Not Required but Highly Recommended:
- Chromium picolinate
- Digestion enzymes
Recommended Vitamin Schedule:
- AM: Multi-vitamin, B12
- Mid-morning shake: 500 – 600 mg calcium citrate, vitamin D3, and thiamin (B1)
- Lunch: 500 – 600 mg calcium citrate
- Dinner: 500 – 600 mg calcium citrate
Tips for Taking Vitamins:
- Do not take on an empty stomach.
- Do not take iron and calcium supplements together.
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One Month and Beyond
At this phase, you start back on solid foods. Start with 2 to 4 ounces of solid food per meal and then slowly increase the amount of solid food per meal until you are eating at least 4 ounces per meal but no more than 6 ounces.
At each meal, you want to have at least 3 ounces of protein. In the beginning, mentally identify your protein source. You may wish to get a digital pocket scale to weigh your food at the start, so you know what 3 ounces of protein looks like as well as what 4 to 6 ounces of food is visual. You will find it is easier for non-protein foods to go down, so you may gravitate to choosing non-protein foods. You want to train yourself right at the beginning to eat protein. Eat three bites of protein to everyone bite of something else (3 to 1 rule).
It is easy to get certain foods stuck, so from this phase forward, it will be crucial for you to slow down and chew your food thoroughly, pausing between bites.
Eat protein first. Make sure you have 3 ounces of protein at each meal. Add 1 to 3 ounces of healthy fats, fruits, vegetables or starches if you can tolerate them. Pay close attention to how you feel with the introduction of new foods.
- Meatless products
- Cottage cheese
- Low-sugar Greek yogurt
Difficult to Tolerate:
- Red meat
Items like bacon, sausage, salami, bologna, pastrami, pepperoni and hot dogs are considered fats, not protein.
Remember that raw vegetables are harder to digest. In the beginning, they can easily irritate your pouch. Don’t forget to take small bites and chew thoroughly. With gastric bypass surgery, you may want to wait approximately four months before trying raw vegetables. It is recommended to try one new food at a time and to try them while at home.
- Fresh or frozen cooked vegetables, like green beans, carrots, sweet potatoes and squash
Difficult to Tolerate:
- Raw vegetables
- vegetables with tough skin or seeds, like celery or tomatoes
- Vegetables like cabbage, cauliflower or broccoli may cause gas distress.
With all fruits, eat as part of your meal after you have had at least three bites of protein. Remember that the acid in citrus fruits can irritate your pouch. Do n’t forget to avoid the membrane portion (skin) of the fruit.
- Fresh fruit, peeled with no skin
- Canned fruit in water or natural juice that has been drained and rinsed
Difficult to Tolerate:
- Fruits with skin or seeds
There are two types of carbohydrates: whole grains and simple sugars. Focus on eating whole grains, such as:
- Ezekiel bread
- Whole grain tortilla
- Sweet potatoes
Minimize simple, refined grains, like candy, white rice, pasta, cereals and processed sugars, including cookies, cakes, and pastries.
You want to limit the amount of starch you have at each meal to 1 or 2 ounces. Be sure that you only eat a starch with your protein. Starches can act like a sponge in your pouch, leaving you little to no room for healthy proteins and essential fats.
Oils and Essential Fats:
It is important to include essential fats in your daily meal plan to prevent deficiencies. Examples of healthy fats are:
- A variety of nuts
- Oils, like olive, grapeseed or coconut
Fats to Minimize:
- Fried foods
- Saturated fats, like bacon, sausage, pepperoni, salami and bologna
- Mayonnaise/Miracle Whip
- Salad dressings
- Sour cream