Vitamin B12 after sleeve gastrectomy

You may have heard about vitamin B12 and its importance after a sleeve, but do you know why? Or if you should be taking a supplements? What about the symptoms of deficiency – will it really hurt if you don’t take your supplement? Let’s take a look.

What is vitamin B12 and why do we need it?

The human body needs vitamin B12 to make red blood cells, nerves, DNA, and carry out other functions. Like most vitamins, B12 can’t be made by the body and must be eaten (either in food or as supplements).

Some people don’t consume enough vitamin B12 to meet their needs, while others can’t absorb enough, no matter how much they take in. Weight loss surgery that changes the anatomy of the digestive system such as bypass or sleeve gastrectomy, can lead to malabsorption of B12 from food. This is because to be absorbed, vitamin B12 needs to come into contact with a thing called Intrinsic Factor in the stomach. In the case of a bypass, food doesn’t come into contact with intrinsic factor. After a sleeve, a combination of smaller meals, less intrinsic factor, and/or a shorter transit time in the stomach can contribute to B12 deficiency.

How common is B12 deficiency after a sleeve gastrectomy?

Whilst B12 deficiency is most common after a gastric bypass, studies suggest ~12% of patients who have had a sleeve do develop a B12 deficiency (Sameh & Hossam, 2017). However, some medications make B12 deficiency more common, including: nitrous oxide, neomycin, metformin, colchicine, proton pump inhibitors, and seizure medications. Having other malabsorptive disorders such as Coeliac Disease, can also make deficiency more common.

What are the symptoms of a deficiency?

Symptoms of a B12 deficiency are pretty rare, only occurring in ~1% of sleeve patients at 12 months post op. However, they aren’t good, so it’s still a good idea to keep an eye out for them.

Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly. Given the array of symptoms a vitamin B12 deficiency can cause, the condition can be overlooked or confused with something else. Vitamin B12 deficiency symptoms may include:

• strange sensations, numbness, or tingling in the hands, legs, or feet
• difficulty walking (staggering, balance problems)
• anemia
• a swollen, inflamed tongue
• difficulty thinking and reasoning (cognitive difficulties), or memory loss
• weakness
• fatigue
• vision impairment

if you experience any of these symptoms, please be sure to ask for a blood test to check for B12 deficiency.

How can I prevent B12 deficiency?

1. Eat foods containing B12 regularly. Animal products such as meat, eggs, poultry and dairy are the best source. Grains that have been fortified are another source – for example, breakfast cereal.
2. Test regularly. The guidelines recommend testing B12 before surgery, and then six months and 12 months post-sleeve gastrectomy and yearly after that. If you are diagnosed with B12 deficiency or take medications that increase your risk , you should be tested every three months.
3. Supplement. According the ASMBS, the dose varies based on the route of supplementation:
   1. Orally by disintegrating tablet, sublingual, or liquid: 350–500 mg daily
   2. Nasal spray as directed by manufacturer
   3. 1000 mg monthly as injection (this will need to be ordered by your doctor)

If you’d like to know more about other vitamins and minerals after a sleeve read this post. And if you’d like to know what supplements to take and when, you can download my super easy to follow supplement schedule below.

References:

Sameh, H. E. Hossam, E. (2017). Nutritional deficiency after sleeve gastrectomyt: A comprehensive literature review. EMJ Gastroenterol 6[1]:99-105. https://www.emjreviews.com/gastroenterology/article/nutritional-deficiency-after-sleeve-gastrectomy-a-comprehensive-literature-review/

Parrott, J., Frank, L., Rabena, R., Craggs-Dino, L., Isom, K.A. & Greiman, L. (2017). American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surgery for obesity and related diseases. https://asmbs.org/app/uploads/2008/09/ASMBS-Nutritional-Guidelines-2016-Update.pdf