20
Long-Term Management
Bariatric Surgery Nutrient Considerations
➤ Deficiency risk varies by procedure: BPD/DS delivers the most
significant average weight loss but also carries the highest rates
of vitamin and mineral deficiencies after surgery.
➤ Common deficits after surgery: Following BPD/DS, gastric bypass,
and SG, the nutrients most often low are thiamine (B1), folate (B9),
vitamin B12, vitamin D, iron, and calcium; other deficits occur
less frequently.
➤ Vitamin D is often low before surgery. Many patients with
obesity start with reduced vitamin D levels, which can worsen
postoperatively without targeted supplementation.
➤ Low vitamin D contributes to osteopenia/osteoporosis, secondary
hyperparathyroidism, and hypocalcemia.
➤ Use bariatric-specific multivitamins. Standard practice is to
recommend high-quality bariatric formulas that typically provide
higher amounts of B12, iron, vitamin C (to aid iron absorption),
vitamin D, and calcium.
➤ Inadequate thiamine intake can lead to beriberi, characterized
by both "dry" (Wernicke-Korsakoff syndrome) and "wet" (cardiac
failure) manifestations.
➤ Low folate may cause megaloblastic anemia.
➤ Insufficient B12 can produce megaloblastic anemia and
neurologic complications.
➤ Inadequate calcium also leads to low bone density, secondary
hyperparathyroidism, and hypocalcemia.
➤ Low iron commonly results in microcytic anemia.
