Vitamin B12 Deficiency Before & After Bariatric Surgery

Why do many bariatric patients need to watch for vitamin B12 deficiency either before or after bariatric surgery? Chances are you already know bariatric patients need higher doses of certain vitamins after surgery. Changes to the digestive system after surgery that limit calories also limit vitamins and minerals from being absorbed. What are these changes, and how common is this issue? For vitamin B-12 specifically, there are a couple factors that contribute to the importance of getting enough from your post-op vitamin regimen.

What is Vitamin-B-12 and Its Role

B-12 is a water-soluble vitamin naturally found in most animal products, such as meat, dairy, and eggs. It's also found in fortified foods like bread and cereal. B-12 is required for forming red blood cells, neurological health, and DNA synthesis. Deficiency can cause:

• Megaloblastic anemia
• Fatigue
• Neurological issues
• Numbness
• Tingling of hands and feet
• Impaired balance
• Memory loss

Despite most adults getting plenty of B-12 from their diet, B-12 deficiencies affect about 1.5% - 15% of the general population, in particular older adults and those with gastrointestinal disease. Among those at risk are those who have had bariatric surgery for two primary reasons.¹

Vitamin B-12 Absorption

First, B-12 is broken down by the acid of the stomach. After this initial breakdown, intrinsic factor is secreted into the stomach to bind with B-12 and help it absorb later in the intestines. Bariatric surgery either bypasses (as in Roux-en-Y gastric bypass) or restricts (as in the sleeve gastrectomy) the stomach, resulting in less acid and less secretion of intrinsic factor. The reduced acid and reduced intrinsic factor cause a need for increased B-12 intake from supplements after surgery.²

According to Liz Goldenberg, MPH, RDN, CDN, program coordinator of gastrointestinal, metabolic and bariatric surgery at New York-Presbyterian Hospital, "…the body has the ability to store vitamin B-12 for a long period of time, perhaps years; thus, vitamin B-12 status immediately following sleeve surgery may be normal."³ This means initial good lab results don’t let you off the hook for taking vitamins long-term.

Deficiency Rates

B-12 is one of the most common deficiencies bariatric patients experience after surgery.³ 2-5 years after surgery, the rates of deficiency are < 20% for Roux-en-Y gastric bypass, and 4% - 20% for sleeve gastrectomy patients.⁴ The ASMBS recommends 350-1000 micrograms (mcg) taken orally, daily to maintain good B-12 status.⁴ Fortunately, high quality bariatric vitamins make it easy to meet all vitamin needs after surgery. As with any aspect of health, prevention is key.

References:

1. Office of Dietary Supplements - Vitamin B-12. (n.d.). Retrieved August 31, 2020, from https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
2. Seeniann, J., DO, MPH, & Hoegerl, C., DO, MSc. (2009). Nutritional Deficiencies After Gastric Bypass Surgery. J Am Osteopath Assoc., 109(11), 601-604.
3. Alexander, A. (2019, January 28). Nutritional deficiencies common before and after bariatric surgery. Retrieved August 31, 2020, from https://www.healio.com/news/endocrinology/20190128/nutritional-deficiencies-common-before-and-after-bariatric-surgery
4. Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., . . . Still, C. D. (2020). Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity, 28(4). doi:10.1002/oby.22719

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