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It's Not Worth the Risk

By John Angstadt, MD FACS


Vitamins and minerals are important for postoperative patients due to limited food intake and/or malabsorptive bariatric procedures. They play diverse roles in metabolism, nerve conduction, and muscle function. Vitamin deficiencies can have specific, and sometimes devastating, consequences.


In normal digestion, food enters your stomach and mixes with gastric acid. Food then exits the stomach and mixes with digestive enzymes in the first part of the bowel. In this portion of the bowel, a substance called intrinsic factor is released that substantially increases vitamin B-12 absorption later in the digestive process. In the first eight inches of bowel, folate and thiamine are absorbed. The other vitamins and minerals needed are absorbed in the remaining portion of the bowel.


After bypass surgery, approximately 95 percent of your stomach is no longer involved in digesting your food. As a result, there is significantly less acid in your intestinal tract. Your body also absorbs calcium and iron best in an acidic environment. In addition, the area where intrinsic factor is released and folate and thiamine are absorbed is now bypassed. These vitamins and minerals can no longer be absorbed normally.


Your body will not absorb vitamins and minerals as readily and will almost certainly need supplements. If you do not take calcium, your body will pull it out of your bones to keep the blood level stable. We notice this when analyzing your lab work and detecting an elevation of the parathormone level in the blood. In addition, some patients not taking calcium notice a tapering off of their weight loss or even weight gain. If your iron level gets low, you may experience fatigue along with other classic symptoms of iron deficiency. Upon laboratory analysis anemia or low blood count may be diagnosed. When your folate level is low, you will develop a low blood count. However, if your vitamin B-12 or thiamine levels get too low, you may get numbness, pain, or weakness in your lower extremities. Untreated, this can progress to difficulty with walking or balance. If these symptoms are caught in time, the deficiency can be completely corrected. However, in some cases these changes cannot be reversed and there may be permanent nerve damage.

Patients consistently taking supplemental vitamins and minerals are at a much lower risk of experiencing these problems. Vitamins and minerals are critical for normal body functions. Taking supplements is a small thing you should do to help reap big benefits. Stay healthy— take your vitamins.