Vitamin and Nutritional Deficiencies and the Duodenal Switch
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printer-friendly versionThe Duodenal Switch (DS) is a powerful procedure which many physicians feel has the best weight loss profile for those who have chosen to undergo weight loss surgery (WLS). It is also the most malabsorptive of the surgical treatments for obesity and as such carries more potential risk for dietary deficiencies. This is a review of potential long-term nutritional complications associated with the DS and the treatments commonly used to remedy them.
The most common nutritional complications that are seen with the DS are fat-soluble vitamin deficiencies (vitamins A, D, E and K). In patients who religiously take their prescribed vitamin supplements, the incidence of these deficiencies is about 10 percent, however in individuals who do not take the appropriate supplements; it can be as high as 30 percent. The severity of these problems varies from asymptomatic (no symptoms) to severe and potentially disabling. In order to minimize the potential to develop problems, I recommend that all of my DS patients take the following dietary/vitamin supplements:
1) AQUAdek ? 2 per day
2) High potency multivitamin with iron and minerals ? twice the normal adult dosage
3) Calcium Citrate -1500mg per day
Every year, anyone who has undergone a DS procedure, should undergo blood testing to make sure they have not started to develop any of the problems described below:
VITAMINS
Vitamin D - crucial for the absorption of calcium and maintenance of healthy bones and teeth. The most common vitamin deficiency seen in DS patients. In spite of some patients? commitment to taking their supplements, they still develop a deficiency. I treat deficiencies of Vitamin D with a highly absorbable form called cholecalciferol (Vitamin D3). Dairy products are excellent sources of vitamin D.
Vitamin A - important for vision, healing, and healthy skin and nails. Deficiencies can manifest as nightblindness, brittle/dry hair & nails or slowly healing cuts/wounds. Good sources of Vitamin A include yellow/orange vegetables as well as dairy products.
Vitamin E - is primarily an anti-oxidant in the body, and deficiency is uncommon. Vitamin E is critical to the body?s ability to deal with super-oxides which can damage the cells. Tomatoes, carrots, sardines, herring and spinach are healthy natural sources of Vitamin E.
Vitamin K - plays a critical role in blood clotting pathways. Deficiencies of vitamin K generally manifest as bruising easily or prolonged bleeding ( from the gums or small cuts). Good natural sources of Vitamin K are green leafy vegetables.
MINERALS
Zinc - important for immune function and fetal development. Deficiencies in Zinc are quite common in DS patients. Good sources include oysters, red meat and
poultry. Cereals and breads can decrease the absorption of Zinc.
Iron - important in the formation of red-blood cells. Deficiency may result in anemia, fatigue and confusion. Good sources include soybeans, chicken liver, red meat, oysters and clams. Taking 500-1000 mg of vitamin C with the iron can increase absorption.
Be sure to follow-up with your bariatric surgeon at least yearly and be faithful to your supplements. Good health!
Paul Cirangle, MD, FACS, is the Director of the Bariatric Surgery Program at California Pacific Medical Center and Medical Director of the Surgical Weight Loss Center of Hawaii.
