Nutritional Deficiencies in Restrictive Procedures

October 26, 2012

Nutritional Deficiencies in Restrictive Procedures: WLS is well known as a cause for nutritional deficiencies, especially with malabsorptive procedures like the RNY, GB, and DS. With the increase in restrictive procedures, like the Gastric Sleeve and Lap-Band, the short-term risks are probably diminished, but without proper follow-up and supplementation, the patient can have nutritional deficiencies. These are very easy to treat and correct, but even easier to prevent with knowledge and timely supplementation.

All types of bariatric surgery lead to very reduced total calorie intake, especially in the first six post-operative months, typically ranging from 700 to 900 kcal/d. It is precisely this low caloric intake that can cause lack of nutrition from protein to micronutrients and minerals.

Protein Deficiencies

One main concern after WLS is muscle mass loss. Protein deficiencies can cause hypoalbuminemia, anemia, hair loss, and lack of energy. We encourage our patients to start with physical activities (light exercise for under an hour a day,)such as walking or working on the elliptical trainer, this helps with the healing process, pulmonary function, and muscle metabolism. We ask patients to start with protein supplementation 1.5 grs/kg of ideal weight. We recommend clear protein drinks the first 10 days after surgery and all other protein shakes after 10 days. We encourage our patient to continue drinking protein during the first 18 months after surgery.

Micronutrition

Iron deficiency has two main causes: lack of intake and alteration in absorption. Even though gastric sleeve surgery has no malabsorption, the small surface of the stomach can lead to changes in the chloridric acid secretion that can potentially result in anemia, especially after the iron reserves have been depleted. The treatment includes oral iron with vitamin C or iron shots every week.

Zinc deficiency can be related to multiple organic alterations. Some of the most common ones are alopecia (hair loss), taste alterations, and nail problems. Part of the hair loss supplementation for gastric sleeve patients includes zinc 50mg daily.

Fat Soluble Vitamins

Vitamin A (Retinol), vitamin E (tocopherols), vitamin K (naphthoquinones), and vitamin D are fat soluble vitamins. Lack of these can cause visual alterations, neurological dysfunction, night vision impairment, bleeding, and bone mineral alterations. Most multivitamins contain enough liposoluble vitamins since there’s no malabsorption, a proper diet with multivitamin supplementation can prevent complications. Any clinical symptoms and the specific deficiency present will guide treatment recommendations.

Water Soluble Vitamins

Perhaps the first micro deficiency after WLS involves B1, B6, and B12. The clinical onset includes Beriberi, Pellagra, neurological alterations, visual impairment, and anemia. The treatment includes sublingual or nasal B12, intramuscular shots of thiamine, and niacin rally.

We encourage our patients to follow an early and strong protein and vitamin supplementation regime to prevent deficiencies. This includes protein shakes daily, a chewable or liquid multivitamin, and chewable calcium, zinc, B12 and iron.

ABOUT THE AUTHOR Dr. Edgar Campos is a clinical bariatric doctor and nutritionist with over 10 years of experience with pre-op and post-op bariatric patients. He also supports patients with non-surgical options for weight loss such as the balloon procedure and nutritional guidance. Dr. Campos  practices medicine at Mexicali Bariatric Center as the medical advisor and bariatric doctor.  He is an 8-year post-op gastric sleeve patient himself. Read more articles from Dr. Edgar Campos!

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