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Clinician’s Corner: Post Bariatric Surgery Vitamins

We’ve finished our journey through the vitamin aisle, and many of our patients are in need of our acquired vitamin expertise. This column will address the needs of patients who have undergone gastric bypass surgery.  UPMC Altoona has an excellent Bariatric Surgery Department headed by Dr. Matthew Newlin and Dr. Scot Currie.

  • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.
  • The medical costs for people who are obese are at least $1,500 higher than those of normal weight.

Bariatric surgery is becoming increasingly popular to treat America’s “expanding” epidemic.  Pharmacists are needed to insure that the nutritional requirements are being met for this population.  Your Thompson Pharmacist is the expert in dosage form selection, as well as cost management.  Here are some of the most common deficiencies that may occur with bariatric surgery patients.

CALCIUM: Calcium carbonate requires an acidic environment for dissolution and subsequent absorption in duodenum and proximal jejunum. Bypass may produce relative decrease in stomach acid production. Calcium citrate might be best option. Chewable calcium citrate, or gummies are the best option.

VITAMIN-D: Decrease in fat absorption can lead to deficiency in fat-soluble vitamins. Roux-en-Y gastric bypass and biliopancreatic diversion are more likely to produce vitamin D deficiency than other surgeries. Have the physician check 25-hydroxy-vitaminD levels. Also: 10,000 IU of vitamin A, 2000 IU of vitamin D, and 300 mcg of vitamin K per day.

IRON: avoid sustained release iron and enteric coated products.  Might see decreased iron absorption due to decreased stomach acid production.

VITAMIN B-1 (thiamine):  is absorbed primarily in the duodenum and proximal jejunum. Bariatric surgery bypasses the duodenum and proximal jejunum and thiamine deficiency may occur within three weeks post-op.  If the patient has persistent vomiting or severely diminished oral intake, they are at a higher risk of deficiency. Thiamine deficiency may be made worse by changes in the gut flora.

VITAMIN- B-12 (cyanocobalamin): most common deficiency after Roux-en-Y surgery.  At least 33% of patients will become vitamin deficient.  Noticeable symptoms of a vitamin B12 deficiency can take years to develop, since we carry about 2 years of Vitamin B-12 in our livers. Irritability, weakness, numbness, anemia, loss of appetite, headache, personality changes, and confusion are some of the signs and symptoms associated with very low levels of vitamin B12.  Supplement with 500-1000mcg/day orally per day.  Consider Vitamin B-12 injections if patients are deficient after using the oral forms.

FOLIC ACID: supplement with 0.4-2mg/day. Especially important in women that are still menstruating.

TABLET SIZE: two months after surgery, all medications should be given in a liquid dosage form, a crushed tablet, or an opened capsule. If a tablet must be used, start with the smallest tablet available. Solid dosage forms: recommend smaller than M&M’s candy.

EXCIPIENTS: avoid sucrose, corn syrup, maltose, fructose, lactose, honey, mannitol, sorbitol to minimize dumping syndrome.  Dumping syndrome can occur in up to 50 percent of post gastric bypass patients when high levels of simple carbohydrates are ingested. Dumping may contribute to weight loss in part by causing the patient to modify his/her eating habits. Early dumping syndrome has a rapid onset, usually within 15 minutes, due to rapid emptying of food into the small bowel. Patients may experience diarrhea, vomiting and dizziness.

Your Thompson Pharmacist is an excellent resource for all your vitamin needs, especially if you have undergone bariatric surgery. Go Ahead and ASK…at Thompson Pharmacy, it’s all for YOU!