What vitamins and minerals should I be taking after surgery?

You’ve probably heard your bariatric team talk about the importance of vitamin and mineral supplements after bariatric surgery. That’s because vitamin and mineral deficiencies are one of the most common side effects of bariatric surgery, and can lead to some serious consequences if they aren’t treated.

Different vitamins and minerals are responsible for different functions in your body, which means deficiency can have a wide variety of symptoms. Different deficiencies can affect your eyesight, brain function, motor functions (like walking), energy levels, bone health, and so much more. I know it sounds scary, but here’s the good news – the risk of vitamin and mineral deficiencies after bariatric surgery can be easily managed with the proper daily supplementation.

Bariatric surgery changes how well your body is able to absorb certain nutrients. This is permanent. Your body will not adjust to this over time, which means you need to supplement these nutrients lifelong after any type of bariatric surgery procedure. Regardless of whether you have a sleeve gastrectomy or a Roux-en-Y gastric bypass, you will need vitamin and mineral supplements for the rest of your life to prevent deficiencies and stay healthy.

*Note that this post is meant for those who have had a sleeve gastrectomy or Roux-en-Y gastric bypass. These recommendations are not applicable to a duodenal switch.

So, what nutrients should you be supplementing after surgery?

The American Society for Metabolic and Bariatric Surgery (ASMBS) has created vitamin and mineral supplementation recommendations that most programs use as a guide when recommending supplements to patients. These guidelines were most recently updated in 2016, and are based extensive research to meet the needs for the average person after bariatric surgery. They give recommendations on the amount of calcium, vitamin D, vitamin B12, iron, folate, thiamin (vitamin B1), vitamin A, vitamin E, vitamin K, zinc and copper that you need each day after surgery. Your program dietitian should be familiar with these guidelines and has likely used them to develop the standard supplementation recommendations they provide to you. Most programs daily supplementation guidelines suggest something similar to the following:

1 Prenatal Multivitamin OR 2 Complete Women’s Multivitamins

• This will include iron, folate, thiamin, vitamin A, vitamin E, vitamin K, zinc and copper.
• It will also include calcium, vitamin D, and vitamin B12, but the doses will be too low to meet your needs after surgery.
• You need higher doses of these vitamins than someone who has not had bariatric surgery, which is why a prenatal is often recommended. They have a higher concentration of vitamins and minerals, and often line up well with the recommendations from the ASMBS. If you don’t take a prenatal, sometimes taking 2 of a women’s multivitamin can do the trick (avoid gummies and men’s multivitamins – they will not have the right nutrients or doses to meet your needs).
• You can also purchase a bariatric-specific multivitamin. However, these don’t always include iron. Make sure you check the nutrition label and add an iron supplement if it doesn’t have any (you should connect with your bariatric team about how much iron to add).

500 mcg Vitamin B12

• This is usually a good starting point, but it’s not uncommon to need 1000 mcg of vitamin B12 each day to keep your levels stable.
• This will likely be adjusted based on your bloodwork, so make sure you follow the recommendations from your bariatric team.

1200-1500 mg Calcium

• This should be split into 500-600 mg doses because your body will not absorb more than that at one time (yes, unfortunately this does mean you need to take calcium several times per day!).
• The preferred form is calcium citrate for best absorption after surgery.
• If you’re not taking a calcium citrate, make sure you keep your calcium supplement separate from your multivitamin (or any iron-containing supplement). Aim to keep them separate by at least 2 hours.

2000-3000 IU Vitamin D3

• This is a good starting point, but can fluctuate significantly based on your bloodwork results.
• This will likely be adjusted based on your bloodwork, so make sure you follow the recommendations from your bariatric team.

However, it’s important to remember that the amount of supplementation you need after bariatric surgery might be different than a friend or family member who has also had surgery. How your body reacts to surgery, your own personal nutrition needs, and your medical history may impact what your program recommends to you. That’s why it’s so important that you:

1. Complete your bariatric bloodwork on a regular basis (make sure you always complete the requisition from your bariatric team, as they test for certain vitamins and minerals that are not standard for other practitioners).
2. Follow the vitamin and mineral supplementation recommendations provided by your program dietitian. These recommendations might be a bit different than what is listed above, but that’s because they will be personalized to you based on your bloodwork and personal health situation.

If you have questions about your vitamin and mineral supplements or are struggling to take your supplements, always connect with your bariatric team.