Vitamin D after sleeve gastrectomy: Have you checked yours?

Did you know that around 35% of people with a sleeve have Vitamin D deficiency after surgery with some studies showing up to 90%?! So, have you had your Vitamin D levels checked? Are you taking your supplements? In this post, I take you through step by step what you should be doing to look after your Vitamin D levels and why.

Why care about Vitamin D?

Vitamin D is essential for bone health – to prevent osteoporosis. It has also been associated with other health benefits including cancer prevention, cardiovascular and metabolic disease health as well as mental health and immunity. The majority of our vitamin D comes from the sun, but we also get Vitamin D from food – mainly fish, eggs and dairy.

Why are people at risk of vitamin D deficiency?

There are numerous reasons why you might be at risk of Vitamin D deficiency.

• Less sun exposure. The ‘Slip Slop Slap’ campaign did it’s job and we are more cautious of the sun than ever which is great for our risk of skin cancer but not so great for our Vitamin D levels. Lots of us also work long hours or do night shift reducing their exposure to the sun.
• Overweight people are at higher risk of vitamin D deficiency because vitamin D is a fat soluble vitamin – it literally gets stuck in fat cells and is less available for the body to use. The more fat cells you have, the less Vitamin D available for the rest of the body.
• Older people have thinner skin, which is less efficient at converting UV to Vitamin D, so the other you get, the more likely you are to have a deficiency.
• People with darker skin have more melanin which is also more difficult for the sun to penetrate.

What can you do to prevent vitamin D deficiency?

1. Take your bariatric multivitamin and mineral supplement – this contains a good dose of vitamin D (many over the counter supplements contain an insufficient amount). If you don’t take a bariatric multi, make sure you are taking a vitamin D supplement as well.
   
2. Eat oily fish and eggs regularly – although these are good sources of vitamin D, these alone without sunshine are not enough to sustain levels.
3. Get your vitamin D checked regularly – depending on your level of vitamin D you may be advised to take additional vitamin D supplements, or if it’s very low, you may be offered a high dose vitamin D injection.
4. Follow the Cancer Council recommendations for sun exposure below for the best balance between skin cancer protection and Vitamin D. You can check the UV index in most Weather apps or at the BOM website.
   

For most people, adequate vitamin D levels are reached through regular incidental exposure to the sun. When the UV Index is 3 or above (such as during summer), most people maintain adequate vitamin D levels just by spending a few minutes outdoors on most days of the week.

In late autumn and winter in some southern parts of Australia, when the UV Index falls below 3, spend time outdoors in the middle of the day with some skin uncovered. Being physically active (e.g. gardening or going for a brisk walk) also helps boost vitamin D levels.

Cancer Council Australia

References for this article: Sameh, H. E. and Hossam, E. (2017).  Nutritional Deficiency After Sleeve Gastrectomy: A Comprehensive Literature Review. EMJ Gastroenterol. 6[1]:99-105.