Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient (Summary Part 3)

Continued from Part 2. Fat soluable Vitamins/Minerals Vitamin A: "In a study comparing the nutritional consequences of conventional therapy for obesity, AGB and RYBG, Ledoux et al. [135] found... The prevalence of vitamin A deficiency was 52.5% in the RYGB group compared with 25.5% in the AGB group (P <.01)."  In other words - if you had RNY or lapband and thought DSers were the only ones who needed to supplement fat soluable vitamins... you were wrong.  We need vitamin A too!   "Supplementation with 10,000 U of vitamin A, in addition to other vitamins and minerals, appeared to be adequate to prevent vitamin A deficiency."  "It is concluded that vitamin A deficiency should be suspected among patients with an unexplained decreased vision and a history of intestinal surgery, regardless of the lenth of time since the surgery had been performed."  In other words - vitamin A deficiency can be prevented; and since it can cause decreased vision, it's better to be safe than sorry." Vitamin K: "Vitamin K deficiency was also considered by Ledoux et al. [135] using the prothrombin time as an indicator of deficiency.  The mean prothrombin time percentage was lower in the RYGB group versus both the AGB and conventional treatment group, which suggests vitamin K deficiency [135]."  In other words - we have to pay attention to vitamin K too.   Vitamin E: "In a study comparing various surgical procedures, Ledoux et al. [135] found a significant prevalence of vitamin E deficiency among the RYGB compared with the AGB group (P <.05), with 22.5% and 11.8% of subjects presenting with a vitamin E deficiency, respectively."  In other words - almost a fourth of RNYers are vitamin E deficient.  Wow.   Zinc: "In RYGB patients, Madan et al. [27] determined that zinc levels were suboptimal among 28% of PREoperative patients and 36% of 1-year POSToperative patients."  "They postulated that RYGB patients might have a lower dietary zinc intake in the postoperative period that could put them at a risk of deficiency."  In other words - zinc levels were lower than they should be in over a third of RNY post-ops, possibly because of decreased dietary zinc intake (possibly due to intolerance of red meat among some post-ops).  This is another reason it is so important to work through your stages to avoid food intolerances all together.  Fat Soluable Vitamin Suggested Supplementation "They proposed that all RYGB patients should be supplemented with multivitamins as complete as possible, including fat-soluable vitamins and minerals.  A recommendation of 50,000 IU of vitamin A every 2 weeks and 500 mg of vitamin E daily, among other supplements, was suggested to correct most cases of deficiency [135]."  In other words - we could prevent most cases of fat soluable vitamin deficiency by simply making sure out multi-vitamins contain fat soluable vitamins AND doing the additional A (bi-weekly) and E (daily).   Fat Soluable Vitamin Conclusion "Although BPD/DS patients have been known to be at risk for fat-soluable vitamin deficiencies, the reports cited have illustrated that bariatric patients IN GENERAL, including RYGB patients, may also be at risk.  In addition, rare and unusual complications, such as visual and taste disturbances, might be attributable to these deficiencies, as these reports have elucidated."  In other words - DSers aren't the only ones that have to worry about fat soluable vitamins.   Vitamin B6: "Boylan et al. [26] found that vitamin B6 levels, before surgery, were adequate in only 36% of their surgical candidates."  "These investigators subsequently found that the serum levels might not be reflective of vitamin B6 status [148].  When co-enzyme activation of erythrocyte aminotransferase activities was used as a marker of vitamin B6 status rather than the serum vitamin levels, supplementation of vitamin B6 at the U.S. Dietary Intake recommended amounts (1.6 mg) PROVED INADEQUATE for co-enzyme activation of these enzymes in the early postoperative period.  These findings suggest that greater than the recommended amounts of vitamin B6 might be required for normalization of vitamin B6 status in bariatric patients."  In other words - 1/3 of pre-ops are B6 deficient and 1.6 mg per day is not enough to keep from being deficient.   Copper: "Copper status needs to be examined in RYGB and BPD/DS patients presenting with signs and symptoms of neuropathy and normal B12 levels.  The findings would also suggest mutivitamin supplementation containing adequate amounts of copper (2 mg daily value).  Caution should be used when prescribing zinc supplements because copper depletion occurs when >50 mg zinc is given for a long period of time."  In other words - your multivitamin should contain 2 mg of copper.  Some of the same symptoms for B12 deficiency can also indicate copper deficiency.  Warning: Zinc (in doses of >50 mg for a long time) starts "eating" all the copper out of your body.   Continued in Part 4.

At this point I am wondering what is the best vitamin regimen. I know on the RNY board, everyone has different supplement requirements which doesn't make alot of sense to me. Has anyone looked into the liquid vitamin stuff like what Dave (from the RNY board) sells? Just wondering if that would be better (read:easier) than what I am doing now plus what I need to do based on this article.

I've not tried any liquid vitamins.  I just carry Calcium in my purse all day long.  All the rest of my vitamins I take in the morning as soon as I start drinking - except my iron.  I take my iron last thing at night before I go to bed.  (That way I don't have to worry that I'll take Calcium too soon before or after it because I've already taken my 4 doses of calcium by then and I won't be getting up to take ANY supplements during the night!)