Importance of supplementation after bariatric surgery

Every year, there are more and more patients undergoing metabolic and bariatric surgery procedures all over the world. Bariatric surgery helps to reduce weight and normalize or significantly improve many metabolic parameters, such as the levels of glucose, cholesterol, uric acid, and more. Compared to sometimes very wrong and unhealthy diets, bariatric surgery is safer and much more effective. Along with a decrease in body weight, some chronic diseases, such as diabetes mellitus, metabolic syndrome, and diseases of the musculoskeletal system, also step back. [1,2,3] In addition to these health benefits, however, there is a real possibility that the risk of nutritional deficiencies will increase as such patients are observed postoperatively.[1,2,4] In fact, studies have shown that as patients rehabilitate after surgery, transit to a habitual way of life, and face other problems and realities, their adherence to the recommendations of doctors declines. [5] Follow-up visits, routine laboratory tests, and daily nutritional supplementation are essential in the daily routine for people planning to undergo such procedures; failure to comply with these requirements poses risks of nutritional deficiencies which can lead to irreversible diseases. [6] Whereas the complication rate of surgical interventions has decreased significantly over the years (despite the continued increase in the number of such procedures), the sad reality is that nutritional deficiencies after surgery have actually become more often. [7]

The good news is that nutritional deficiencies can be prevented, as studies show that patients following standard recommendations throughout their lifetime can reduce the risk of developing nutritional deficiencies. Following the recommendations helps improve nutritional outcomes and reduce the risk of developing diseases that are the result of long-term nutritional, vitamin, macro- and micronutrient deficiencies. [2]

Daily supplementation is important because postoperative nutritional deficiencies can affect blood, bone, muscle, and nervous system function. Without a blood test and additional tests, patients may not know they have a deficiency or are at risk of developing it because a deficiency is not always manifested as physical symptoms. In some cases this is true – let’s take thiamine as an example. A deficiency of this vitamin can be manifested in the form of vomiting. However, not every nutrient has a characteristic sign or symptom that indicates a deficiency, so people, regardless of whether they have had bariatric surgery or not, may never suspect a deficiency unless they do a blood test (general, biochemical, some additional parameters). [1,2] This highlights the importance of regular nutrient analysis to improve health and reduce the risk of developing diseases described below in four key areas:
  • Blood health: Anemia can be caused not only by iron deficiency but also by nutrient deficiency.[8] Anemia is characterized by a deficiency of red blood cells or hemoglobin in the blood.

  • Bone health: Osteoporosis, other bone diseases, and fractures can develop over time as a result of inadequate nutrient intake, imbalance, or improper digestion. Calcium is retained in bones, and when the body requires this mineral it is "washed out" of the bones if not provided with adequate nutrition or supplementation, making bones brittle and weak.

  • Muscle health and power: Loss of lean muscle mass is a postoperative risk due to inadequate protein intake leading to adverse changes in body composition (fat to muscle ratio). Normal intake of protein provides turgor and elasticity of soft tissues, regulates wound healing, and prevents the formation of stretch marks. Another consequence of an insufficient amount of protein is a decrease in the intensity of reduction in body weight and volume. Studies show that patients who consume little protein lose less fat mass compared to those who consume adequate amounts of protein. [9]

  • Neuropsychiatric health: Nervous disorders can be triggered by nutritional deficiencies, especially in people who have undergone bariatric surgery. These conditions affect neurotransmission and ultimately the organ function. [10] Brain function is highly dependent on fat metabolism and an intensive decrease in fat mass can be the cause of asthenic and other neuropathological conditions.
Preventing micronutrient deficiencies is essential throughout lifetime. Daily supplementation, follow-up, and laboratory monitoring of macro- and micronutrients can help avoid detrimental complications that can be prevented. Fortunately, supplementation is easy with special medicines that come in a variety of formulations to meet your vitamin and mineral needs, given the bariatric surgery you've had.
  1. Clinical pharmacology and rational pharmacotherapy for practitioners: textbook / M.L. Maksimov, R.A. Bontsevich, I.S. Burashnikova [et al.]; ed. Prof. M.L. Maksimov. – Kazan: Publishing house "MedDoc", 2021. - p. 948 ISBN 978-5-6045764-9-6;
  2. Malykhina A.I., Yashkov Yu.I., Maksimov M.L. Unresolved issues of vitamin and mineral support for patients undergoing bariatric surgery. - Obesity and metabolism. 2019. Vol. 16. № 4. p. 31-36.
  3. Pories WJ. Bariatric Surgery: Risks and Rewards. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S89–S96.
  4. Matrana M, Davis W. Vitamin deficiency after gastric bypass surgery: a review. South Med J. 2009;102(10):1025-1031.
  5. Larjani S et al. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery. Surg Obes Relat Dis. 2016;12(2):350-356.
  6. Gletsu-Miller N, Wright B. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;1;4(5):506-517.
  7. Parrott, Julie et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surgery for Obesity and Related Diseases. 2017;13(5):727-741.
  8. Lee YC et al. Predictors of anemia after bariatric surgery using multivariate adaptive regression splines. Hepatogastroenterology. 2012;59(117):1378-1380.
  9. Moize, V et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr Edinb Scotl. 2013;32(4):550-555.
  10. Kumar N. Neurologic complications of bariatric surgery. Continuum (Minneap Minn).2014;20(3 Neurology of Systemic Disease):580-597
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