27
Micronutrient Deficiency Replacement After
Bariatric Surgery: Vitamins/Minerals
Vitamin/
Mineral Assessment
Replacement of Deficiency and
Maintenance
Iron Ferritin, iron,
total iron
binding
capacity
• For moderate def iciency, menstruating
women, or patients at risk for iron
def iciency anemia, total elemental iron
oral intake is often 150–200 mg twice
a day
• Maintenance elemental iron
supplementation (in patients without
anemia) is ~18 mg per day
• Ferrous fumarate supplies ~33%
elemental iron (EI), ferrous sulfate ~20%
EI, ferrous gluconate ~12% EI
• Ferrous fumarate 325 mg iron
supplement provides ~106 mg
elemental iron; ferrous fumarate 45
mg (often found in many bariatric
multivitamins) supplies ~15 mg
elemental iron
• Iron supplementation may be
more effective with vitamin C
supplementation 500 mg/d and
when taken separately f rom calcium
supplements, acid-reducing
medications, and foods high in
phytates or polyphenols
• For severe def iciency, IV iron is
sometimes required and is provided in
multiple different formulations, some
that require test doses
• Copper def iciency can contribute to
iron def iciency
Zinc Zinc • Zinc consumption may impair copper
absorption
• Thus 1 mg of copper might best be given
per each 10 mg of zinc administered
• Once zinc is in normal range, if
malabsorption remains a risk, a typical
supplemental dose is zinc 30 mg/d
• If malabsorption is less of a risk, then a
common dose of zinc is 8–22 mg per day
• Many bariatric multivitamins have 7.5–30
mg of zinc
(cont'd)
