Bariatric Vitamins by Procedure &
7 Tips to Avoid Problems and
Maximize Weight Loss

Reviewed by: Nancy DeLuca, RD

Bariatric vitamins vary by procedure and patient, but almost every patient will need to take them for the rest of their lives to avoid potentially serious complications and to maximize weight loss…

Why Bariatric Vitamins are Important After Surgery

It has become common knowledge that taking vitamins is beneficial to your health. But not many people really understand why… we just do it because we’re “supposed to”.

Simply put, your body must have the right amounts of the right vitamins and minerals to function at its full potential. In addition to keeping you healthy, their benefits directly relate to achieving weight loss goals.

  • Vitamins regulate your body’s core processes such as…
  • Appetite and hunger
  • Brain activity
  • Nutrient absorption
  • Metabolic rate
  • Fat and sugar metabolism
  • Thyroid and adrenal function
  • Energy storage

Food is the best way for your body to get the vitamins and minerals it needs. Despite our efforts to create the perfect multivitamin, we have not been able to replicate the complexity of what is found in healthy foods.

Consider broccoli. It is extremely rich in vitamins and fiber which are completely integrated in to the molecular structure of the vegetable itself. The fact that it contains the individual Vitamins A, C, K and folate (among many other nutrients) is not the only reason that it's healthy.

More importantly, broccoli is healthy because of how nature has built the nutrients into the broccoli. Nature has…

  1. Built in specific amounts of each nutrient
  2. Created the vegetable so that each nutrient interacts with the other nutrients and elements of the broccoli in precise ways
  3. Made the healthy elements of broccoli accessible to absorption by your body

Plucking out the single Vitamins A, C, K and folate and taking them in a pill form can not reproduce the natural effect.

Still, medical research has found specific vitamins themselves (rather than specific foods) to be essential for your body. If your diet does not give you everything you need, vitamin and mineral supplements can help to offset what your body doesn’t get from food.

After bariatric surgery, your body is especially vulnerable to vitamin deficiencies because surgery either…

  • Reduces your body’s ability to absorb vitamins (malabsorptive procedures)
  • Doesn’t allow your body to hold as much food from which to draw vitamins (restrictive procedures), or
  • Both of the above

Bariatric Vitamins Page Reference:
List of Malabsorptive & Restrictive Procedures

Primarily Malabsorptive:
(a)  Duodenal Switch
(b)  Laparoscopic Gastric Bypass Surgery (also has restrictive component)
(c)  Mini Gastric Bypass Surgery (also has restrictive component)

Primarily Restrictive:
(a)  Adjustable Gastric Banding (Lap Band Surgery)
(b)  Gastric Sleeve Surgery
(c)  Vertical Banded Gastroplasty (“Stomach Stapling”)

In addition, as many as 80% of bariatric surgery patients don’t get enough vitamins before surgery, so the right bariatric diet and bariatric vitamins are that much more important following surgery.1

Making sure your body has the right amount of each vitamin will keep you healthy, help you lose weight and help your body keep the weight off.

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Which bariatric vitamins you will need for each type of weight loss surgery

bariatric vitamins

All types of bariatric surgery will likely require some sort of vitamin and mineral supplementation for the rest of your life.

With that said, certain procedures put you at a much greater risk for deficiency, namely the malabsorptive procedures like the duodenal switch and gastric bypass procedures. But the same changes that can cause vitamin deficiency also reduce the amount of calories that your body absorbs which usually results in more weight loss.

Weighing the upside of extra weight loss with the downside of potential vitamin deficiency is a big part of choosing between the different types of bariatric surgery. For example, if you already have deficiency problems, that may be the deciding factor for going with a restrictive procedure.

While restrictive procedures don’t affect nutrient absorption to the same extent, they still carry a risk of deficiency by…

  • Limiting the amount of food you can eat (and therefore the amount of vitamins and minerals you consume)
  • Causing intolerance to certain nutrient-rich foods

For restrictive procedures, you’ll probably be taking a multivitamin that contains at least 100% of the normal recommended daily value for most vitamins and nutrients. The malabsorptive procedures will most likely require at least 200% of the normal recommended daily value.

On top of your multivitamin, your dietary professional may recommend additional supplementation depending on your body and the surgery you choose. Following are the primary vitamin deficiency risks for the “Big 5” surgeries (O = deficiency is especially common; x = deficiency is possible)…


Duodenal Switch Laparo-scopic Gastric Bypass Surgery Gastric Banding (Lap Band Surgery) Gastric Sleeve Surgery Vertical Banded Gastro-plasty
O = deficiency is especially common
x = deficiency is possible

Also see How Much Weight Loss Surgery Vitamins Cost & Where to Find Them section below

Note: This chart intentionally leaves blank deficiencies that are rarer in nature. Consult with your doctor and receive routine blood work to determine which vitamins are appropriate for your bariatric diet.
*All procedures have at least a small element of both malabsorption and restriction.
References: A, B, C
Type of bariatric surgery* Malabsorptive Malabsorptive Restrictive Restrictive Restrictive
Thiamin (Vitamin B1) x x x x x
Folate x x x x x
Iron O O
Calcium x x
Protein
x x

Duodenal Switch (BPD/DS)  Laparo-scopic Gastric Bypass Surgery Gastric Banding (Lap Band Surgery) Gastric Sleeve Surgery  Vertical Banded Gastro-plasty (VBG)
Vitamin A O x x x x
Vitamin B12 x O
Vitamin D O x
Vitamin E x x
Vitamin K O x
Zinc x x
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What happens if you don’t take your bariatric vitamins as prescribed?

Not routinely having your blood tested or ignoring your doctor’s supplementation guidelines can lead to significant problems up to and including death2,3

  • Calcium deficiency – leads to osteoporosis.
  • Iron deficiency – can cause anemia (when your body does not have enough red blood cells to carry oxygen throughout the body), increased feelings of fatigue and hair loss.
  • Folate (folic acid) deficiency – can also lead to anemia.
  • Protein deficiency – protein is one of the most important components of your body as it makes up most of your major organs. Not getting enough can lead to a myriad of problems, including muscle deterioration, organ failure, gallstones and even death.
  • Thiamin (Vitamin B1) deficiency – affects the heart, digestive system and nervous system. If not caught and treated quickly, learning and memory could be permanently affected. Ultimately, coma and death could be the result.
  • Vitamin A deficiency – can lead to night blindness and increases the risk of disease and death from severe infections. During pregnancy after weight loss surgery, it increases the risk of night blindness and child mortality.
  • Vitamin B12 deficiency – can cause fatigue and tingling in the hands and can eventually lead to anemia and neurological disorders.
  • Vitamin D deficiency – can lead to liver and kidney disorders and bone softening diseases.
  • Vitamin E deficiency – causes neurological problems, anemia and can cause wounds to heal more slowly.
  • Vitamin K deficiency – increases the risk of osteoporosis and heart disease and can cause you to bruise more easily.
  • Zinc deficiency – will give you brittle nails and can lead to hair loss.

The only way to catch some of the above deficiencies is through regular blood tests. Symptoms that start to show are often confused with other bariatric surgery side effects, and even a physical exam from your doctor may not be enough for a diagnosis.

In short, take bariatric vitamins very seriously. If you’re not prepared stick to a strict regimen forever, don’t move forward with surgery.

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7 Bariatric Vitamins Tips to Prevent Problems and Increase Weight Loss

So far we’ve reviewed the importance of keeping your vitamin levels where they should be for reasons of health and weight loss. To completely avoid the risk of deficiency and to improve your chances for hitting your weight loss goals…

  1. Get blood work done before surgery to establish your baseline vitamin and nutrient levels in your body. This will allow you to compare levels after surgery to determine whether or not any deficiencies are a result of the surgery.
  2. Take your supplements exactly as they are prescribed.
bariatric vitamins
  1. All supplements should have the initials USP (U.S. Pharmacopoeia) or display the USP logo (see right) - USP regulates the quality, purity, strength and consistency of all over-the-counter and prescription medications and many health care products. 
  2. Do not self-prescribe. That includes vitamins and herbal supplements. Nothing should go into your body without your doctor or dietary professional’s approval.
  3. Schedule regular blood work to check for early signs of deficiency.
  4. Ask your doctor about taking probiotics, which are supplements that that contain “good” bacteria similar to the kind that’s found in your body. A recent Stanford School of Medicine study found that weight loss surgery patients who took them had a better gastrointestinal quality of life, increased weight loss and even better breath following surgery.4
  5. Document your vitamin intake with a good free diet journal.  Not only will keeping food journals help you tweak your overall diet to find what works for you, but the reviewing your detailed vitamin and diet history information will help your dietitian or nutritionist provide recommendations to help you avoid vitamin deficiency.
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Who Can Help Prevent Problems
with Bariatric Vitamins?

A big part of choosing the right bariatric doctors and bariatric weight loss center is to make sure they partner with or employ a good dietitian or nutritionist.

As a team, your bariatric doctors should have a process to thoroughly understand your specific dietary needs, including an exam for or discussion about your…

  • Existing health problems
  • Weight history
  • Previous diet habits
  • Blood work before surgery to find and address any deficiencies
  • Specific parts of your life that could affect long-term success such as your…
    • Access to health food
    • Cooking ability
    • Level of family and friend support
    • Work environment and the ability to follow your plan while on the job
    • Readiness for change
    • Goal-setting ability
    • Financial situation
    • Mental health status

If your bariatric doctors don’t go this deep, it’s a good sign that you need to move on to a different doctor or weight loss center.

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How Much Good Bariatric Vitamins Cost & Where To Find Them

The amount you spend on vitamins depends on three things…

  1. Which surgery you have

    You’ll probably need the most bariatric vitamins after duodenal switch surgery. It’s not uncommon for DS patients to pay $125 or more per month following surgery. Gastric bypass is next in line at around $35 to $55 per month.5 The restrictive procedures (AGB, Gastric Sleeve and VBG) will usually cost you between $20 and $35 per month.

  2. Your body and any preexisting deficiencies

    If you already have vitamin deficiencies before surgery, you may need more afterwards to get your body up to the right levels. Some patients’ bodies metabolize vitamins differently which requires additional supplementation of certain vitamins.
  1. Where you choose to buy bariatric vitamins

    Smart shopping applies to bariatric vitamins just as it does with other buying decisions in your life. But now is not the time to “go cheap”.

    Rather than choosing a general supplement, we recommend taking vitamins that have been specifically formulated for bariatric surgery patients.
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References

  1. Flancbaum L, et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity . Journal of Gastrointestinal Surgery Volume 10, Number 7 / July, 2006 pgs 1033-1037.
  2. von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009 Apr-May;24(2):217-26.
  3. J. Fleischer, E. M. Stein, M. Bessler, M. Della Badia, N. Restuccia, L. Olivero-Rivera, D. J. McMahon, and S. J. Silverberg. The Decline in Hip Bone Density after Gastric Bypass Surgery Is Associated with Extent of Weight Loss. J. Clin. Endocrinol. Metab., Oct 2008; 93: 3735 - 3740. 
  4. Gavitt a. Woodard, Joseph Peraza, John Downey, Betsy Encarnacion, John M. Morton. Probiotics Improve Weight Loss, Gi-Related Quality of Life and H2 Breath Tests After Gastric Bypass Surgery: a Prospective Randomized Trial. Surgery, Stanford School of Medicine, Stanford, CA. Available at: http://www.ssat.com/cgi-bin/abstracts/08ddw/
    O13.cgi. Accessed: October 29, 2009.
  5. Gasteyger C, Suter M, Gaillard RC, Giusti V.Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008 May;87(5):1128-33.
  6. New Life Bariatric Supplements' web site

[Last editorial review/modification of this page: 10/9/2013]

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More