25
Micronutrient Deficiency Replacement After
Bariatric Surgery: Vitamins
Vitamin/
Mineral Assessment
Replacement of Deficiency and
Maintenance
Vitamin D 25-hydroxyl-
(OH)-vitamin
D
• For mild def iciency, vitamin D3 3000
IU/d orally; once vitamin D levels
normalized, vitamin D3 dose should
be at least 1000 IU/d after gastric
bypass and at least 2000 IU/d after
biliopancreatic diversion/duodenal
switch
• Many bariatric multivitamins have 3000
IU Vitamin D3 (cholecalciferol)
• For severe def iciency (e.g.,
biliopancreatic diversion), vitamin D3
5000 IU daily or vitamin D2 50,000
IU/wk orally until vitamin D levels in
normal range, then D3 3000 IU if still
with substantial malabsorptive signs
and symptoms
• Regarding formulation, vitamin D2
(ergocalciferol) is a form of dietary
vitamin D found in plants. Vitamin
D3 (cholecalciferol) is found in foods
of animal origin and is similar to
the vitamin D3 generated when
7-dehydrocholesterol in the skin is
converted by ultraviolet radiation f rom
sunlight. Both D2 and D3 are reported
as 25-hydroxyvitamin D, which is then
converted by the kidneys into the
more active 1,25 dihydroxyvitamin D
(calcitriol). Vitamin D3 may be preferred
(longer half-life and potentially more
potent) than vitamin D2. Although the
most potent, calcitriol is more rarely
used (0.25 or 0.50 mcg/d orally)
Vitamin E A-Tocopherol • A typical dose to treat vitamin E
deficiency is 100 to 400 IU/d orally, with
maintenance dose at least 15 mg per day
(~22.5 IU). Some bariatric multivitamins
may have 20 mg vitamin E per day.
Other bariatric multivitamins have a
wide IU range of vitamin E (7.5 IU–150 IU)
(cont'd)
