folic acid?

Dear Gastric Bypass Patient

http://www.bbvitamins.com/Research.aspx

by: Cynthia Buffington

Are you taking your vitamin and mineral supplements each and every day, as directed? Do you realize that it is necessary to take vitamin and minerals for life following gastric bypass surgery to avoid the risk of health complications?

Why are vitamins and minerals important for life? Because the gastric bypass procedure has changed the anatomy of your stomach and intestines in a manner that can cause deficits in vitamins and minerals that could negatively influence your health.

Nutrient deficiencies with the gastric bypass procedure occur for several reasons. First, the surgery reduces overall food intake. Secondly, the small gastric pouch produces negligible amounts of digestive enzymes and acid for complete digestion of certain foods. Third, the small stomach pouch no longer produces a substance called intrinsic factor that is needed for the absorption of Vitamin B12. Fourth, the stomach bypasses a portion of the gut that is necessary for the absorption of many vitamins and minerals.

For all of these reasons, you will need to take vitamins and minerals for life. Daily supplements should include a multivitamin that contain close to 100% the RDI for vitamins A (or beta-carotene), E, C, and D, zinc, selenium, copper, magnesium, manganese, molybdenum, chromium, and potassium. The multivitamin should also contain all of the B-complex vitamins, with amounts at least 200% the RDI for folate, thiamin and other major B vitamins. 

If the multivitamin has been designed for bariatric patients, it will likely also contain vitamin B12 at amounts that greater than 1000% the RDI. With the gastric bypass procedure, the stomach no longer produces a compound, intrinsic factor, important for the absorption of vitamin B12. 

Studies have shown that Vitamin B12 deficiencies are common after the gastric bypass procedure and can have very serious health consequences years and years after surgery, sometimes even causing permanent nerve damage and a loss of mobility. Signs of B12 deficiencies may include numbness or a loss of feelings in the legs (and later the arms), unsteadiness when walking, color blindness, confusion, irritability and depression, swollen and ‘shiny, smooth’ tongue, weakness and anemia. 

Supplements of B12 that are 3300% the RDI and higher have been reported to prevent B12 deficiencies in more than 95% of gastric bypass patients. Monthly shots of 1000 mcg B12 are also very effective in prevention of B12 deficits, and daily sublingual intake of B12 may be helpful in prevention, as well.

Iron and calcium deficiencies are also common with gastric bypass surgery because the portion of the gut that absorbs these minerals has been bypassed by the surgical procedure and because the stomach no longer produces acid needed for optimal absorption. These minerals must, therefore, be supplemented and at amounts in excess of those generally included in a daily multivitamin/mineral. 

Iron should be taken at prenatal levels (30 mg or more) and in its most absorbable forms, fumerate chelate or fumerate citrate. Iron deficiencies may occur shortly after surgery or years and years later. Symptoms and effects include:  pica (a desire to eat ice, paint, dirt, paste, other such items), fatigue, weakness, and anemia. 

Calcium deficiencies cause bone loss after surgery, irregularities in muscle, heart, or nerve functions, defects in certain hormones, and even weight gain. Calcium supplements for the gastric bypass patient must be in the form of calcium citrate– NOT calcium carbonate or phosphate or coral calcium. For optimal absorption, the calcium citrate should also contain vitamin D, ascorbic acid (vitamin C), or magnesium. The daily calcium needs are at least 1200 to 1500 mg must be taken at different times throughout the day in supplements of no more than 500-600 milligrams.

Folate deficiencies have been reported to occur with gastric bypass and can cause anemia, increase the risk for heart disease, and cause interference with your body’s ability to produce energy. Folate deficits can be prevented with 200% the RDI. Folate deficiencies can cause anemia and can increase your risk for heart disease. Symptoms of a deficiency may include weakness and fatigue.

Thiamin or vitamin B1 should also be contained in your multivitamin at amounts 200% the RDI or preferably higher. Deficiencies in thiamin may occur following an episode of vomiting, if you skip meals, or if you fail to take your vitamins.

Deficiencies in thiamine may have very serious consequences, including an inability to walk, a loss of memory (sometimes permanent), or even death. Symptoms include muscle cramps and pain, burning feet, numbness or tingling in legs or arms, racing heart, confusion, memory loss, and difficulty learning new tasks.

Because of the anatomy of the gastric bypass procedure, there will always be a risk for vitamin and mineral deficiencies which could have serious health consequences.  It is, therefore, not only important that you remember to take supplements daily and FOR LIFE but also that you have regular (annual) blood checks for levels of vitamins and minerals, particularly iron, folate, vitamin B12 (and thiamin if symptoms appear), and to have from time-to-time a bone scan, parathyroid measurement or some other test that may identify calcium deficits. 

Overview of Vitamin and Mineral Requirements:

Daily Multivitamin/Mineral

 

100% the RDI (or more) for vitamins A, E, C, D niacin

200% the RDI (or higher) for major B-complex vitamins, particularly folate and thiamin

100% the RDI for minerals, i.e. zinc, manganese, molybdenum, selenium, copper, chromium, potassium, magnesium, others.

Vitamin B12

At least 1200% the RDI for supplements either:

1000 mcg monthly shots

1000 mcg daily sublingual

Calcium

100% the RDI (or more) Calcium Citrate with ascorbic acid (vitamin C), vitamin D, or magnesium

Iron

Greater than 100% the RDI for fumerate or iron chelated to an amino acid or to citrate