25
Micronutrient Deficiency Replacement After
Bariatric Surgery: Vitamins/Minerals
Vitamin/
Mineral Assessment
Replacement of Deficiency and
Maintenance
Vitamins (cont'd)
Vitamin D 25-hydroxyl-
(OH)-vitamin
D
• For mild deficiency, vitamin D3 3,000
IU/d orally. Once vitamin D levels
normalized, vitamin D3 dose should be
at least 1000 IU/d after gastric bypass and
at least 2,000 IU/d after biliopancreatic
diversion/duodenal switch.
• Many bariatric multivitamins have 3,000
IU vitamin D3 (cholecalciferol).
• For severe deficiency (e.g.,
biliopancreatic diversion), vitamin D3
6000 IU daily or vitamin D2 50,000 IU/
wk orally until vitamin D levels in normal
range, then D3 3,000 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 from
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 100–400 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)
