Nutritional deficiencies after sleeve gastrectomy

There is a reason we dietitians are always harping on about taking supplements is to avoid nutrient deficiencies after sleeve. Nutrient deficiency is common, but if you’re proactive with your food choices and supplementation, you should be able to manage without too much trouble.

Why all the deficiencies after sleeve gastrectomy?

Removing most of the stomach reduces not only the amount of food you can eat, but also the amount of vitamins and minerals you can absorb from your food. Add to this potential nausea, food intolerance and lack of appetite and you have the perfect storm for a nutrient deficiency.

The most common vitamin and mineral deficiencies after sleeve gastrectomy include vitamin B12, iron, calcium and vitamin D. I’ll summarise each of these deficiencies below. Nutritional deficiencies can occur in up to 44% of patients several years after their operation (this figure includes all types of surgery, but is typical of SG), so they are definitely something you need to be aware of.

A recently published article highlighted the importance of monitoring and supplementation after sleeve gastrectomy as it found that at four years post-op 28.6% of participants had an iron deficiency, 12.5% folate deficiency, 15% had a B12 deficiency and 86% had a vitamin D deficiency. The scary thing is that all of these values were much lower than within the first 1-2 years post op, so deficiencies are a very common occurrence.

Here’s a run-down of the top deficiencies after sleeve gastrectomy.

Vitamin B12

Vitamin B12 needs a little magic protein called intrinsic factor to be absorbed.  Intrinsic factor is produce in the stomach, so without so much stomach, less is produced and you absorb less B12.

B12 deficiency can lead to weakness and fatigue due to anaemia and tingling or numbness in fingers/toes due to peripheral neuropathy.

Folate

Folate is another important vitamin for red blood cell production, so a lack of folate will cause anaemia. Folate is particularly important in women of childbearing age. A folate deficiency during pregnancy can lead to birth defects in the baby. Folate is found in a wide range of foods, so it’s not usually a problem, but due to the restricted volume, it’s common that sleeve patients won’t get enough.

Iron

Iron deficiency is common after a sleeve for a few reasons. You’ll have less stomach acid which helps the absorption of iron, especially if you are still taking reflux medication. Often people tend not to eat so much red meat as it can be a little more difficult, but is also one of the best sources of iron.

Iron deficiency will also lead to fatigue and weakness due to anaemia.

Vitamin D

Up to 90% of bariatric patients have a vitamin D deficiency even before they have surgery, so vitamin D deficiency remains one of the most common deficiencies after sleeve gastrectomy. This is due to the way vitamin D is stored in fat cells. The standard amount of vitamin D in a general multivitamin won’t give you enough to correct or prevent deficiency so you must supplement daily.

Vitamin D deficiency may leave you feeling generally unwell, give you bone pain or muscle fatigue, or even give you no symptoms at all, so it’s important to have regular blood tests to check your levels.

Calcium

Lack of calcium is due mainly to the fact that you can’t eat 3-4 serves of dairy a day anymore. Calcium is extremely important for bone health. If you don’t eat enough calcium each day, your body will start to pull it out of your bones to correct the amount of calcium in your bloodstream. Long term, this will lead to weak bones or osteopenia and eventually osteoporosis.

In a nutshell

Don’t let all of this deter you from having a sleeve, but let it scare you into taking your supplements every day and getting regular blood tests. In a recent study, only 37% of sleeve patients were still taking their supplements daily four years after their surgery. If you experience any symptoms mentioned or anything else that isn’t quite right, speak with your bariatrician, GP or dietitian straight away.

You can also read more about the supplements you need to take every day here and download my recommendations for supplement brands to try below.

To learn more about the supplements you should be taking, read this post and then download the Supplement Guide below.

References:

Ben-Porat, T. et al, (2017). Nutritional deficiencies four years after laparoscopic sleeve gastrectomy-are supplements required for a lifetime? Surg Obes Relat Dis. 2017 Mar 2. pii: S1550-7289(17)30105-3. Accessed at https://www.ncbi.nlm.nih.gov/pubmed/28416186

Snyder-Marlow, G. et al, (2010). Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. Journal of the American Dietetic Association. Accessed at https://doi.org/10.1016/j.jada.2009.12.022

Lim, RB., (2010). Benchmarking best practices in weight loss surgery. Current problems in Surgery. Accessed at https://doi.org/10.1067/j.cpsurg.2009.11.003