Vitamin & Mineral Basics

*I am not a doctor and am simply sharing information:

Source: http://www.muhealth.org/documents/bariatric/bariatric%20book let%20vsg.pdf

 

Water-Soluble Vitamins

B-complex Overview

Vitamin B-complex consists of thiamin (vitamin B1), riboflavin (vitamin B2), nicotinic acid (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin, folic acid (folate), and vitamin B12. Common B-vitamin deficiencies will be discussed in the next few paragraphs. The B-vitamins are routinely given in dosages higher than the RDI (Recommended Daily Intake) for the general population. When evaluating lab tests the B-vitamins should at least be in the normal range but above normal is acceptable. Any excess not used by the body is eliminated through the kidneys. B-vitamins are given in adequate amounts in the bariatric specific multivitamin. If deficient, you may need to take an additional B-50 complex. 

Thiamin or Vitamin B1

Deficiencies may occur following an episode of vomiting, if meals are skipped or if the appropriate vitamins are not taken. Fifteen percent to 29% of patients have low thiamin levels even before surgery. Deficiencies in thiamin can have some very serious consequences, including an inability to walk, a loss of memory (sometimes permanent), impaired learning, or even coma and death. Some other symptoms of thiamin deficiency include muscle cramps, numbness or tingling in legs or arms, racing heart, and confusion. The normal level of vitamin B1 is 70 to 180 nmol/L. Sleeve gastrectomy patients should take a multivitamin with more than 100% of the daily value for thiamin. Early symptoms of thiamin deficiency can often be resolved by taking oral thiamin doses of 20 to 30 mg per day from a thiamin supplement and/or a B-complex supplement until symptoms disappear. More advanced neuropathy will require thiamin shots from a physician.

Vitamin B12

Vitamin B12 deficiencies are common with surgical procedures in which the larger portion of the stomach (fundus) is removed. The smaller gastric pouch does not produce intrinsic factor or hydrochloric acid necessary for vitamin B12 absorption. Deficits in vitamin B12, if left untreated, can cause a number of health problems such as, loss of mental alertness, neuropathies, nausea, muscle weakness, digestive upset, depression, irritability, memory impairment, poor concentration and water retention. The normal level for vitamin B12 is 180 to 914 pg/mL; although, symptoms can start to occur if levels fall below 400 pg/mL. The physicians at Missouri Bariatric Services recommend vitamin B12 levels be greater than 400 pg/mL. Sleeve gastrectomy patients need 350 to 500 micrograms of vitamin B12 daily to prevent deficiency. Only 1% of vitamin B12 taken orally is absorbed. Vitamin B12 is best absorbed when taken sublingually (dissolved completely under the tongue) or as an injection. If taken as an injection, vitamin B12 should be given in a dose of 1,000 micrograms once a month.

Folate

Folate deficiency most often occurs because of inadequate dietary intake and noncompliance with multivitamin supplementation. Malabsorption and certain medications, such as anticonvulsants, oral contraceptives and cancer treating agents, can also be responsible for folate deficiency. Folate deficiencies can increase the risk of heart disease, cause anemia, low prenatal levels in mothers can cause neural tube defects in newborns, irritability, and decrease the body’s ability to produce energy. A normal folate level is 280 to 903 ng/mL. Sleeve gastrectomy patients should take the equivalent of 800 micrograms of folic acid daily. Correcting a folate deficiency can be as easy as taking your multivitamin regularly or taking up to 1,000 micrograms of folic acid daily over three months.

Vitamin C

Deficiencies in vitamin C lead to scurvy. Symptoms of scurvy include bleeding gums, weakness, irritability, muscle and joint pains, weight loss, tooth loss, and hemorrhages under skin and in thigh 30 | P a g e

muscles. Contrary to popular belief, vitamin C does not prevent the common cold. Vitamin C is not required after sleeve gastrectomy, but can help improve iron absorption. A multivitamin or iron supplement with 100% of the daily value for vitamin C is sufficient.

Fat-Soluble Vitamins

Vitamin D

Vitamin D is a fat soluble vitamin and can be made in your skin when exposed to sunlight. Vitamin D is needed by nearly every cell of the body and helps calcium absorb in the intestine. Deficiency can result in skeletal disorders, such as rickets, osteoporosis, and osteopenia. Symptoms of rickets are sleeplessness, constant head movements, and bone bending under the body’s weight leading to bow legs. Beyond poor bone health, vitamin D deficiency may increase the risk of developing some of the following chronic diseases: certain forms of cancers, including colon, breast, and prostate; type 1 diabetes mellitus; inflammatory bowel disease; multiple sclerosis; rheumatoid arthritis; metabolic syndrome; hypertension and peripheral vascular disease. Studies have shown that overweight and obese individuals are at higher risk for vitamin D deficiency. A normal range of 25-hydroxy Vitamin D (one form of the vitamin) is 30 to 80 ng/mL. Moderate sun exposure will help your body make its own vitamin D. Sleeve gastrectomy patients should take approximately 1,000 to 2,000 IU vitamin D daily through a combination of multivitamin and calcium + vitamin D supplements. Vitamin D deficiency (levels less than 20 ng/mL) will be corrected with a prescription for 50,000 IU vitamin D taken twice weekly for three months.

Vitamin A

Deficiencies in vitamin A lead to night blindness, kidney stones, mild skin problems, and inflamed mucous membranes. These symptoms of deficiency are rare. Since vitamin A is a fat soluble vitamin an excess intake can also be hazardous. Symptoms of excessive intake include loss of appetite, dry skin, hair loss, headaches, and nausea. Sleeve gastrectomy patients should take a multivitamin that contains more than 100% of the daily value for vitamin A.

Vitamin E

Vitamin E deficiency is rare after weight loss surgery. Vitamin E deficiency in adults can lead to lethargy, apathy, poor concentration, irritability and muscle weakness. Since vitamin E is also a fat soluble vitamin it is hazardous in excess. Excess vitamin E can cause nausea, diarrhea, muscle weakness, high blood pressure, and palpitations. Sleeve gastrectomy patients should take a multivitamin that contains at least 100% of the daily value for vitamin E.

Vitamin K

Vitamin K deficiency is rare after weight loss surgery. Vitamin K is required for maintenance of normal levels of the blood clotting proteins. Vitamin K is often included in very small doses or not at all in multivitamins due to the fact that it may interfere with anticoagulation medications, such as 31 | P a g e

Coumadin. Discuss with your physician an appropriate level of dietary vitamin K if you take anticoagulants.

Minerals

Overview

Vitamins cannot be digested and metabolized without the aid of minerals. Although the body can manufacture a few vitamins, it cannot manufacture a single mineral. All tissues and internal fluids of our body contain varying quantities of minerals. Minerals are constituents of the bones, teeth, soft tissue, muscle, blood, and nerve cells. They are vital to overall mental and physical well-being. Minerals act as catalysts for many biological reactions within the body, including muscle response, the transmission of messages through the nervous system, the production of hormones, digestion and the utilization of nutrients in foods.

Iron

Iron deficiencies can occur after sleeve gastrecomy due to decreased stomach acidity, poor compliance with vitamin and mineral supplementation, and decreased intake of iron-rich foods. Iron should be taken for life and in a form that is readily absorbable. The most absorbable forms of supplemental iron are fumarate, gluconate or iron chelate. Long-term studies have found that the risk of iron deficits following gastric surgery are NOT reduced over time and may occur even with iron supplementation. Some symptoms of iron deficiency may be weakness, skin pallor, constipation, and anemia. A normal range for serum iron in males is 31 to 144 mcg/dL and women is 25 to 156 mcg/dL. Ferritin, a storage form of iron in the body is also measured. A normal range for ferritin in males is 23.9 to 336.2 ng/mL and in females is 11 to 306.9 ng/mL. Approximately 30 mg of iron daily is recommended for sleeve gastrectomy patients.

Calcium

Calcium deficiencies may occur because the stomach pouch produces little or no acid necessary for optimal calcium absorption. Calcium supplements are, therefore, required of the VSG patient and is most effective in the form of calcium citrate, NOT calcium carbonate, phosphate, or coral calcium. For optimal absorption, the calcium citrate should contain vitamin D, ascorbic acid (vitamin C), and/or magnesium. Calcium deficiencies cause bone loss, irregularities in muscle, heart, or nerve functions, defects in certain hormones, and weight gain. A normal range for serum calcium is 9.0 to 10.5 mg/dL. Serum calcium is not an indicator of calcium in the bones. Sleeve gastrectomy patients should take 1,500 to 2,000 mg of calcium citrate daily. 1,500 mg daily is the minimum amount of calcium known to prevent bone loss after surgery.

Zinc

Zinc is an antioxidant nutrient necessary for protein synthesis, wound healing, prostate functions, and male hormone activity. Also, zinc regulates muscle contractility, is important for blood stability, maintains the body’s alkaline balance, helps in normal tissue function, and aids in the digestion and 32 | P a g e

metabolism of phosphorus. Symptoms of deficiency may include prolonged healing of wounds, white spots on finger nails, stretch marks, fatigue, decreased alertness, and susceptibility to infections. A normal range for serum zinc is 60 to 120 mcg/dL. Sleeve gastrectomy patients should take a multivitamin with 100% of the daily value for zinc. Should deficiency develop, 40 mg of zinc daily over three months is recommended.

Magnesium

Magnesium deficiency is rare. Magnesium plays a role in regulating the neuromuscular activity of the heart; maintains normal heart rhythm; necessary for proper calcium and vitamin C metabolism; converts blood sugar into energy. Symptoms of deficiency include calcium depletion, heart spasms, nervousness, muscular excitability, confusion, and kidney stones. Sleeve gastrectomy patients should take a multivitamin with magnesium. Taking up to 300 mg of magnesium per day may be necessary to correct deficiency.

Potassium

Potassium works with sodium to regulate the body’s waste balance and normalize heart

rhythms, aids in clear thinking by sending oxygen to the brain, preserves proper alkalinity of body fluids, stimulates the kidneys to eliminate poisonous body wastes, assists in reducing high blood pressure, and promotes healthy skin. Deficiency may result in poor reflexes, nervous disorders, respiratory failure, cardiac arrest, and muscle damage. Potassium is tightly regulated by the body and should remain in a range of 3.5 to 5.0 mEq/L. If potassium is outside of the normal range you should contact your primary care physician. Potassium is not included in multivitamins due to the risk of creating adverse events.

Selenium

Selenium deficiency is rare after weight loss surgery. Selenium is a major antioxidant nutrient that protects cell membranes and prevents free radical generation thereby, decreasing the risk of cancer and disease of the heart and blood vessels. Medical surveys show that increased selenium intake decreases the risk of breast, colon, lung, and prostate cancer. Selenium also preserves tissue elasticity, slows down the aging and hardening of tissues through oxidation, and helps in the treatment and prevention of dandruff. Deficiency may result in premature aging, heart disease, dandruff, and loose skin. Sleeve gastrectomy patients should take a multivitamin with 100% the daily value of selenium.

Copper

Copper deficiency is rare weight loss surgery. Copper is necessary for the absorption and utilization of iron, helps oxidize vitamin C, and works with vitamin C to form elastin, a chief component of the Elastin muscle fibers throughout the body, aids in the formation of red blood cells, and helps proper bone formation and maintenance. Symptoms of deficiency include general weakness, impaired respiration, and skin sores. Sleeve gastrectomy patients benefit from taking approximately 2 mg of copper daily. 33 | P a g e

Manganese

Manganese is another antioxidant nutrient that is important in the blood breakdown of amino acids and the production of energy, necessary for the metabolism of vitamin B1 and vitamin E, and activates various enzymes which are important for proper digestion and utilization of foods. Manganese is a catalyst in the breakdown of fats and cholesterol, helps nourish the nerves and brain, and maintains sex hormone production. Symptoms of deficiency include paralysis, convulsions, dizziness, ataxia, loss of hearing, and digestive problems. Manganese should be included in the multivitamin.

Chromium

Chromium works with insulin in the metabolism of sugar and stabilizes blood sugar levels, cleans the arteries by reducing cholesterol and triglyceride levels, helps transport amino acids to where the body needs them, and helps control the appetite. Medical research has shown that people with low levels of chromium in their bodies are more susceptible to cancer, heart problems, and diabetes. Deficiency may result in glucose intolerance in diabetics, arteriosclerosis, heart disease, obesity, and tiredness. Chromium should be included in the multivitamin.

Iodine

Iodine deficiency has not been reported after weight loss surgery. Iodine aids in the functioning of the thyroid gland, regulates the body’s production of energy, helps burn excess fat by stimulating metabolism, and assists mental function and speech. The condition of hair, skin, and teeth depends on a well-functioning thyroid gland. Symptoms of deficiency may include slow mental reaction, enlarged thyroid gland, dry skin and hair, weight gain, and loss of physical and mental vigor. Iodine should be included in the multivitamin.

 

Great Summary!

Thanks!