Supplement Guide
Maintain a good daily diet to ensure you get all the requirements your body needs
We all know that vitamins and minerals are essential for our health and that we need to maintain a good daily diet to ensure we get all the requirements our bodies need. We also know that for many people with busy lifestyles, this isn’t always possible so that supplements can play a very important role.
Why are vitamins and minerals so important? They’re important, because together, they regulate and control most of the body’s important processes, including vital processes such as nerve and heart functions. They help the body to manufacture body fluids, maintain healthy teeth and bones as well as the production of healthy blood.
Vitamins and minerals also have a direct impact on weight because they help regulate brain activity, hunger, appetite, absorption of nutrients, storage of energy, and metabolic rate, also helping to convert calories into energy.
While foods are the best sources of vitamins and minerals, sometimes it is difficult to get everything your body needs into your diet. This is especially true for those who have undergone bariatric surgery. Because not everyone is able to get all of the nutrition needed from their diet, medical research has identified the specific vitamins that are essential for the body, and supplements have been developed to help.
Bariatric surgery dramatically decreases the body’s ability to absorb vitamins and nutrients mainly because the first section of the small intestine has been bypassed, (gastric bypass surgery), but also because the stomach size has been reduced leading to a reduction in hydrochloric acid and the protein IF, both needed for the proper absorption of vitamins and minerals. The amount of food you can consume/digest is also reduced.
These changes primarily lead to a decrease in the absorption of iron, vitamin B12 and calcium, and if this is not addressed by daily supplementation this will result in malnutrition, or vitamin and mineral deficiencies that can be detrimental to your health. Anaemia, osteoporosis and nerve damage are all conditions that occur with vitamin and mineral deficiencies.
It is important to know that many multivitamin supplements do not contain adequate quantities of certain critical vitamins and minerals for the post bariatric patient. International guidelines therefore emphasise the importance of taking supplements containing the right quantity of vitamins and minerals following weight-loss surgery (gastric bypass or sleeve gastrectomy). This means supplements of iron (54-65 mg daily), copper (at least 2 mg), zinc (between 16-30 mg), folic acid, vitamin B12, calcium and Vitamin D (3 000 i.u.).
After weight-loss surgery, sufficient quantities of vitamins such as vitamin A, vitamin E and vitamin K and minerals such as magnesium are generally possible simply by following a balanced diet and by taking a daily multivitamin supplement.
Based on this knowledge, Bari-Complete has been developed, containing all the vitamins and minerals required following weight-loss surgery.
Essential vitamins after weight-loss surgery
The body requires vitamin B12 (cobalamin) for the normal functioning of the nervous system and to produce red blood cell. Vitamin B12 is found in animal foods such as fish, meat, eggs and dairy products.
A vitamin B12 deficiency is the most common deficiency among people who have undergone bariatric surgery. While about 5% of patients have this deficiency prior to surgery, about 13% have it once surgery is complete. The B12 deficiency tends to occur due to the inadequate digestion of vitamin B12.
Vitamin B12 absorption occurs in the last section of the small intestine (ileum) but only if it is bound to intrinsic factor (IF). If part of the stomach is removed, as in the case of weight-loss surgery (gastric bypass or sleeve gastrectomy), the production of IF is greatly reduced and therefore the ability to absorb vitamin B12.
Early symptoms of vitamin B12 deficiency include cracks at the corners of the mouth and bleeding gums. Severe deficiency can lead to depression, impaired vision, memory loss and even difficulty in walking.
Calcium is a mineral found in a variety of foods, mainly dairy products but also in sardines and green vegetables. It is a key player in the maintenance and development of strong bones and healthy teeth. It also facilitates healthy muscle and nerve function.
There are two main forms of calcium supplements available: calcium citrate and calcium carbonate. It is very important that bariatric patients use nutritional supplements that their systems are able to absorb easily, especially calcium citrate, which is designed for altered digestive systems. Without calcium citrate, bariatric patients may experience a deficiency that could lead to long-term complications and compromised health such as osteoporosis.
Iron
Iron (Fe) is essential for the production and oxygenation of blood in the body. In the body, approximately 70 % of all iron is bound to haemoglobim, with most of the remaining iron being stored in the liver. Iron is lost in the urine and sweat, and also in the shedding of the skin and epithelial cells, daily. The loss of iron is greatly increased in menstruating women.
Iron can be found in many foods such as green vegetables, liver, meat, egg yolks, wholegrain products, nuts, beans and lentils.
After weight-loss surgery (gastric bypass and sleeve gastrectomy) the body produces less hydrochloric acid, so that the ability to absorb iron is reduced. The small intestine (duodenum and part of the jejunum), which is very important for absorption is also disconnected in gastric bypass patients further reducing the amount absorbed.
You should make sure you take 54-65 mg of iron a day after weight-loss surgery. In many cases women with heavy menstrual flows may need higher doses, so it is important to check your iron levels regularly.
Common symptoms of anaemia are paleness, fatigue and lack of energy.
Multivitamins
According to the Harvard School of Public Health, taking a daily multivitamin is similar to having an insurance policy. It will fill in the gaps where your diet is lacking in micronutrients. Multivitamins are available in tablets and powder, and should be taken according to the package directions.
This is especially important for bariatric patients because their diet is destined to be lacking. There will be a great drop in the amount of food that is consumed, leaving a larger area of nutrition uncovered by the daily diet. Taking a multivitamin will at least help to cover the bases on anything you may be missing.
Be sure you are using a vitamin appropriate for adults, not a children’s multivitamin.
What are the recommended Vitamin Daily Allowance after weight loss surgery?
Blood Tests
Regular, life-long, blood tests to check vitamin and mineral levels are essential for the continued health of all weight-loss surgery patients. Your surgeon and dietitian will advise you on the intervals for these tests, and this will vary depending on the results each time. Testing is generally required for B12, vitamin D, folic acid, iron and calcium, but your dietitian may request additional testing.
Bone density measurements are also recommended at longer intervals. This will show any negative changes to the bone density, which will allow early intervention if necessary to prevent the onset of osteoporosis.