A functional approach: Micronutrient deficiencies after metabolic and bariatric surgery

Deficiencies of micronutrients following metabolic and bariatric surgery can arise from several mechanisms. This includes deficiencies before surgery, reduced food intake post-surgery, malabsorption, and inadequate supplementation. Since those with obesity have a higher risk factor for malnutrition and micronutrient deficiencies, all patients should be screened and deficiencies corrected pre-and post-surgery.

As a reminder, here are common micronutrient deficiency signs & symptoms:

• Fatigue 

• Pale skin 

• Weakness 

• Constipation 

• Hair loss 

• Depression 

• Menstrual issues 

• Poor concentration 

Due to anatomical changes as a result of surgery, there may be decreased absorption of vitamins and minerals requiring supplementation. Other reasons for deficiencies include reduced acid production in the stomach and decreased nutritional intake. This is why supplementation of vitamins and minerals is lifelong after surgery.

Importance of micronutrient screening

Oftentimes, blood tests are typically used to assess these areas after metabolic and bariatric surgery. However, functional medicine tests can also allow a more profound insight into nutrient deficiencies. It may be necessary to dive deeper into micronutrients at the cellular level because nutrient absorption, use, and function are dependent on a person's biochemical makeup. Evaluating micronutrients within the cell gives a better understanding of the whole story.

Lab values can vary significantly for patients who have undergone metabolic and bariatric surgery based on the body's previously stored micronutrient levels, pre-surgery diet, and hormonal function. I assess each patient individually post-metabolic and bariatric surgery. Each person's nutritional plan is based on the type of metabolic and bariatric surgery, when that surgery took place, and what supplementation regimen they are currently utilizing. Whole food nutrition after metabolic and bariatric surgery will support patients' long-term health as they are able to tolerate various foods over time. Additionally, there are typical micronutrients that are known to become deficient after surgery, which are included in a base supplementation recommendation below. 

Micronutrient Supplementation

It is important to remember that micronutrient supplementation is life-long post-surgery. There are many choices for supplementation, the most common being bariatric formulated or non-bariatric formulated (“over-the-counter”). The metabolic and bariatric formulated multivitamins include micronutrients that are of the highest concern after surgery, such as Vitamins B1, B12, D, A, and iron. A separate Vitamin D and Calcium are often recommended to be added to a bariatric regimen. A non-bariatric formulated multivitamin that would include an over-the-counter multivitamin with additional supplementation of Vitamins B1, B12, D, A, iron, and calcium. Considerations such as price, ease of use, and taste may influence your choice between regimens, but making sure all necessary nutrients are included in your daily intake is key.. Typically any additional micronutrients may be prescribed based on the patient's micronutrient testing results. We provide a variety of functional testings at Katie Chapmon Nutrition, one being Hair Tissue Mineral Analysis for micronutrients. This includes collecting a hair tissue sample and provides important information on micronutrient levels in the body over a period of the previous few months. This is different from blood testing as these levels may only reflect the previous hours or days.

We want to make sure that any vitamin supplement has all the vitamins and minerals you need. It's important to think about if anything makes it hard for you to take vitamins. Sometimes it's easy to forget, or the vitamins are too big or taste strange, or you want to have some inexpensive options, or they give you side effects. Whatever the case may be, we are here to provide a more individualized approach to vitamin and mineral deficiencies and supplementation where support is needed both before and after surgery.

Interested in learning more about how we support micronutrient deficiencies and weight loss surgery?

We’d love to work with you! Schedule a complimentary Meet + Greet session. We look forward to finding individualized solutions to fit your needs and being a partner with you in your bariatric journey.

Published: May 6th, 2024.

This blog post was written by Amanda Sikkema MS, RD, LD, CSCS, a dietitian at Katie Chapmon Nutrition. She works with clients virtually and is accepting new clients.