Trip Answers

Question answered:10/03/08

We found a number of reviews discussing vitamin supplements after gastroplasty.

 

In 2002 NICE published ‘Guidance on the use of surgery to aid weight reduction for people with morbid obesity’ [1], which reported:

 

“Surgery to aid weight loss can cause side effects (unwanted effects), both at the time of the operation and in the long-term. These can include nausea (feeling sick), vomiting, diarrhoea, heartburn, vitamin deficiency, and ‘dumping syndrome’, which is an unpleasant reaction after eating food with a high sugar content.”

 

In 2006 the American Family Physician the review ‘Caring for Patients After Bariatric Surgery’, stating:

 

“Patients undergoing malabsorptive procedures (i.e., RYGB and biliopancreatic diversion) are at higher risk of nutritional deficiencies compared with restrictive procedures (i.e., VBG and adjustable laparoscopic banding). Adherence to an appropriate diet high in protein and vitamin supplementation is an effective way to avoid this complication. Patients require lifelong supplementation with a high-potency multivitamin with iron, vitamin B12 (1,000 mcg intramuscularly monthly or 100 mcg orally daily), and calcium (1,200 mg daily). Menstruating women may develop anemia refractory to oral iron supplementation and may require parenteral iron infusions. The family physician plays an important role in ensuring long-term compliance with nutritional supplementation, which often is neglected by patients in the years after their surgery, and in ensuring that patients receive appropriate lifelong routine monitoring (Table 4). The family physician may be the only medical professional involved years after the surgery is performed who can ensure that patients meet their overall nutritional needs.”

 

The abstract of a 2005 review in Obesity Surgery [3] states:

 

“Deficiencies in vitamins and other nutrients are common following the Roux-en-Y gastric bypass (RYGBP), biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPDDS), and may become clinically significant if not recognized and treated with supplementation. This paper presents a review of the current literature and evidence of the most commonly deficient vitamins and minerals following weight loss surgery, including protein, iron, vitamin B12, folate, calcium, the fat-soluble vitamins (A, D, E, K), and other micronutrients. The deficiencies appear to be more substantial following malabsorptive procedures such as BPD, but occur with restrictive procedures as well. The review suggests that further studies are needed to evaluate the clinical significance of the nutritional deficiencies, and to determine guidelines for supplementation.”

 

A 2006 article [4] reports:

 

“In general, patients undergoing restrictive procedures have the least risk for long-term diet-related complications, whereas patients undergoing malabsorptive procedures have the highest risk....
....Supplement prescriptions vary among practitioners and usually involve at least a multivitamin with minerals. Some practitioners may add other supplements only as needed for diagnosed deficiencies; others may prescribe additional prophylactic supplements. The most common nutrient deficiencies are of iron, folate, and vitamin B12. However, deficiencies of fat-soluble vitamins have been reported in patients with malabsorption procedures, and thiamin deficiency has been reported among patients with very poor intake and/or nausea and vomiting. Frequent monitoring of nutrition status for all patients can aid in preventing severe clinical deficiencies.”

 

References

1) http://www.nice.org.uk/nicemedia/pdf/Fullguidance-PDF-morbid.pdf
2) http://www.aafp.org/afp/20060415/1403.html
3) http://www.ncbi.nlm.nih.gov/pubmed/15802055
4) http://www.ncbi.nlm.nih.gov/pubmed/16617236
 

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