Bariatric Vitamins - All You Need to Know

Reviewed by:  

Nancy DeLuca, RD

Last Updated:  

11/13/2017

Bariatric vitamins and supplements:

  • Allow your body to function at its full potential
  • Help you avoid malnutrition and vitamin deficiency
  • Vary by procedure and patient
  • Cost between $20 and $125 per month

Read and click the sections below for everything you need to know about vitamins after weight loss surgery.

01Purpose of Bariatric Vitamins
  • Allows each body system to function at full potential

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.

02Vitamin Deficiency Consequences
  • Calcium
  • Iron
  • Folate (folic acid)
  • Protein
  • Thiamin (B1)
  • Vitamins A, B12, D, E, and K
  • Zinc

Not routinely having your blood tested or ignoring your doctor ’s supplementation guidelines can lead to significant problems up to and including death (2) (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.

Wernicke’s encephalopathy

Wernicke’s encephalopahy is a brain injury resulting from a serious Vitamin B1 deficiency. Symptoms include ophthalmoplegia (disturbed or confused eye movement), ataxia (issues walking), and general confusion, among others.

While relatively rare among weight loss surgery patients, conditions like this are possible after surgery because of patients’ altered diet and reduced ability to absorb nutrients, especially if the patient experiences frequent vomiting.

The best way to avoid vitamin deficiency issues like this? Always do what your doctor tells you, including vitamin deficiency tests when appropriate and strict adherence to dietary guidelines.

  • 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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03Vitamins By Procedure
  • Gastric sleeve
  • Gastric bypass
  • Duodenal switch
  • Lap-Band
  • Gastric balloon
  • vBloc Therapy
  • AspireAssist

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)…

Weight Loss & Co-Morbidity Improvement

VitaminSleeveBypassDuodenal SwitchLap BandGastric BalloonvBloc *AspireAssist *
Multivitamin
Yes
  • 111 – 1 to 2 per day, forever
  • – Forms that are easier to digest, like chewable or liquid versions instead of tablets
  • – Take with food (except dairy) to maximize absorption
  • – At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium and zinc
Yes
  • 222 – 1 to 2 per day, forever
  • – Forms that are easier to digest, like chewable or liquid versions instead of tablets
  • – Take with food (except dairy) to maximize absorption
  • – At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium and zinc
Yes
  • 333 – 1 to 2 per day, forever
  • – Forms that are easier to digest, like chewable or liquid versions instead of tablets
  • – Take with food (except dairy) to maximize absorption
  • – At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium and zinc
Yes
  • 444 – 1 to 2 per day, forever
  • – Forms that are easier to digest, like chewable or liquid versions instead of tablets
  • – Take with food (except dairy) to maximize absorption
  • – At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium and zinc
Yes
  • 555 – 1 to 2 per day, forever
  • – Forms that are easier to digest, like chewable or liquid versions instead of tablets
  • – Take with food (except dairy) to maximize absorption
  • – At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium and zinc
  
Calcium
Yes
  • – Must be calcium citrate (NOT other forms of calcium)
  • – 1000-1500 mg. daily, forever
  • – Chewable and liquid versions are best
  • – Try to find one that includes Vitamin D
  • – Take 2 hours apart from Iron supplements (or Multivitamin that contains Iron) to maximize absorption
Yes
  • – Must be calcium citrate (NOT other forms of calcium)
  • – 1000-1500 mg. daily, forever
  • – Chewable and liquid versions are best
  • – Try to find one that includes Vitamin D
  • – Take 2 hours apart from Iron supplements (or Multivitamin that contains Iron) to maximize absorption
Yes
  • – Must be calcium citrate (NOT other forms of calcium)
  • – 1000-1500 mg. daily, forever
  • – Chewable and liquid versions are best
  • – Try to find one that includes Vitamin D
  • – Take 2 hours apart from Iron supplements (or Multivitamin that contains Iron) to maximize absorption
Yes
  • – Must be calcium citrate (NOT other forms of calcium)
  • – 1000-1500 mg. daily, forever
  • – Chewable and liquid versions are best
  • – Try to find one that includes Vitamin D
  • – Take 2 hours apart from Iron supplements (or Multivitamin that contains Iron) to maximize absorption
Yes
  • – Must be calcium citrate (NOT other forms of calcium)
  • – 1000-1500 mg. daily, forever
  • – Chewable and liquid versions are best
  • – Try to find one that includes Vitamin D
  • – Take 2 hours apart from Iron supplements (or Multivitamin that contains Iron) to maximize absorption
  
Folate (folic acid)
Yes
  • For some patients, the folic acid found in a good multivitamin is not enough. Some surgeons do not prescribe additional folate, so ask them to test your folate levels as time goes on to be on the safe side.
Yes
  • – Needed in up to 40% of patients
  • – If deficient, take 200% the recommended daily intake
Yes
  • – Needed in up to 40% of patients
  • – If deficient, take 200% the recommended daily intake
Yes
  • For some patients, the folic acid found in a good multivitamin is not enough. Some surgeons do not prescribe additional folate, so ask them to test your folate levels as time goes on to be on the safe side.
   
Iron
Yes
  • In some patients, the iron found in a good multivitamin is not enough. Ask your surgeon to monitor your iron levels to avoid any problems.
Yes
  • Some patients may require additional iron, which should be taken with Vitamin C for better absorption. For these patients, Iron supplements must be taken forever.
Yes
  • Some patients may require additional iron, which should be taken with Vitamin C for better absorption. For these patients, Iron supplements must be taken forever.
Yes
  • In some patients, the iron found in a good multivitamin is not enough. Ask your surgeon to monitor your iron levels to avoid any problems.
Yes
  • – Your surgeon may ask you to begin taking Iron, but only take if instructed
  • – 30-60mg/day
  • – Do not take with multivitamin or milk products
  
Thiamin (Vitamin B1)n/a
Yes
  • – Deficiency may occur after vomiting, skipped meals, or missed supplementation
Yes
  • – Deficiency may occur after vomiting, skipped meals, or missed supplementation
n/a
Yes
  • – You may need to begin taking B1 regularly. Your surgeon will let you know if this becomes necessary.
  • – 1-2mg/day
  
Vitamin An/an/a
Yes
  • – Will need additional supplement for all fat soluble vitamins, including A, D, E, and K
  • – 3 fat-soluble vitamin tablets per day (1 per meal)
n/an/a  
Vitamin B12n/a
Yes
  • – 1000 mcg. under your tongue, 2-3 times per week (or 500 mcgdaily). Other options include nasal spray and shots from your doctor.
  • – Must be taken forever
Yes
  • – 1000 mcg. under your tongue, 2-3 times per week (or 500 mcg. daily). Other options include nasal spray and shots from your doctor.
  • – Must be taken forever
n/an/a  
Vitamin D
Yes
  • – Chewable or liquid forms are best
  • – 3,000 International Units per day
  • – Take with food
  • – Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)
  • Talk with your surgeon to be sure, but you may be able to find a calcium supplement that fulfills your Vitamin D requirements.
Yes
  • – Chewable or liquid forms are best
  • – 3,000 International Units per day
  • – Take with food
  • – Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)
  • Talk with your surgeon to be sure, but you may be able to find a calcium supplement that fulfills your Vitamin D requirements.
Yes
  • – Chewable or liquid forms are best
  • – 3,000 International Units per day
  • – Take with food
  • – Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)
  • – Will need additional supplement for all fat soluble vitamins, including A, D, E, and K
  • – 3 fat-soluble vitamin tablets per day (1 per meal)
Yes
  • – Chewable or liquid forms are best
  • – 3,000 International Units per day
  • – Take with food
  • – Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)
  • Talk with your surgeon to be sure, but you may be able to find a calcium supplement that fulfills your Vitamin D requirements.
Yes
  • – Chewable or liquid forms are best
  • – 1000 – 2000 International Units per day
  • – Take with food
  • – Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)
  • Talk with your surgeon to be sure, but you may be able to find a calcium supplement that fulfills your Vitamin D requirements.
  
Vitamin En/an/a
Yes
  • – Will need additional supplement for all fat soluble vitamins, including A, D, E, and K
  • – 3 fat-soluble vitamin tablets per day (1 per meal)
n/a   
Vitamin Kn/an/a
Yes
  • – Will need additional supplement for all fat soluble vitamins, including A, D, E, and K
  • – 3 fat-soluble vitamin tablets per day (1 per meal)
n/a   
Zincn/an/a
Yes
  • Eating less protein after surgery and malabsorption caused by the procedure may lead to zinc deficiency. REF
  • Talk with your surgeon about appropriate zinc supplementation.
n/a   
Copper  
Yes
  • Most DS patients will need long-term copper supplementations. REF
  • Talk with your surgeon about appropriate copper supplementation.
    

04How to Prevent Problems After a Weight Loss Procedure
  • Get tested before the procedure
  • Only take supplements as prescribed
  • Have regular blood work
  • Ask about probiotics
  • Document your vitamin intake

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.
  3. All supplements should have the initialsUSP (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.
  4. Do not self-prescribe.That includes vitamins and herbal supplements. Nothing should go into your body without your doctor or dietary professional’s approval.
  5. Schedule regular blood work to check for early signs of deficiency.
  6. 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).
  7. 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.

05Consult with Your Dietitian
  • General health & weight review
  • Previous diet habits
  • Parts of your life that could hurt your chances of success

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.

06Bariatric Vitamins Cost
  • $20 to $125 per month, depending on procedure

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.
  3. 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.

07Help & Support
  • Patient experiences
  • Ask the expert

We would love to hear your experiences with gastric sleeve complications. Your insights are invaluable to making sure other people have the tools to meet their goals.

We would also be happy to answer any questions you may have about gastric sleeve complications.

Please use the form below to share your experience or ask a question.

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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

* Disclaimer: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. 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