So I love my Doctor and 9 out of 10 people who work in his office but my NUT is a NUT, OK. I have done a ton of research and I never heard that once sleeved I will not absorb any B-12 through my stomach ever again. Is this even remotely true? I suspect that this may be true for by-pass patients, but I have never heard of this for sleevers. Although obviously it is a very important Vitamin that we all must be sure to take. She says that the 3333% of the USRDA of B12 that's in my BodSmith liquid prenatal Vitamins will not be absorbed in my stomach and that I must take it sublingually. Is this true?

My nut said the same about B12

My NUT says sublingual B-12 also.

My NUT also required sublingual

Me too.

They gave us a sample of nasal spray b12, my surgery is not until 8/3, have not used it yet.

I have been taking a standard oral B complex including B12 for several years before and after my VSG and my lab readings for B12 are always top of the scale or above. My doc's program doesn't call for any specific B12 supplementation, though it is part of his routine lab protocols so that it can be addressed as needed. It seems that while our absorption of B12 via the intrinsic factor in our stomachs may be somewhat affected by our VSG, the general mania about routine liquid/sublingual/injectable B12 supplementation may be yet another carryover from RNY practice.

My surgeon is the one who advised me to get the sublingual B12 and I do. I didn't think to ask why though. (and i'm usually full of questions) I will ask at my next follow up visit in August.

If you care about actual evidence, consider this:

I'm nearly a year out.

I always ate lots of Protein throughout my weight losing phases. And now I still eat lots of protein, averaging 100 grams a day.

I am at goal (actually 7 pounds below goal) and have been for 3 months.

I take only a multivitamin/mineral (Centrum chewable).

8 months post-op I had that huge expensive panel of blood tests, which includes a B12 test. My B12 result was smack dab in the normal range, as were all my other results.

So your NUT's warnings and advice certainly don't apply to me.

I'm now going to say something I wouldn't have said (or thought) a year ago. Although some NUTs out there must be good, the NUTs I've seen personally and many other patients' NUTs I've heard about here aren't terribly educated about bariatric surgery. Most of them don't offer much more insight than the basic stuff we learned in high school or at Weight Watchers.

From the AACE/TOS/ASMBS guidelines for nutritional support of bariatric patients:

• R54(113-116)-r. Baseline and postoperative evaluation for Vitamin B12 deficiency is recommended in all bariatric surgery and annually in those with procedures that exclude the lower part of the stomach (e.g., LSG, RYGB) (Grade B; BEL 2). Oral supplementation with crystalline vitamin B12 at a dosage of 1000 μg daily or more may be used to maintain normal vitamin B12 levels (Grade A; BEL 1). Intranasally administered vitamin B12, 500 μg weekly, may also be considered (Grade D). Parenteral (intramuscular or subcutaneous) B12 supplementation, 1000 μg/mo to 1000-3000 μg every 6 to 12 months, is indicated if B12 sufficiency cannot be maintained using oral or intranasal routes (Grade C; BEL 3).
  
• R56(119)-r. Nutritional anemias resulting from malabsorptive bariatric surgical procedures might also involve deficiencies in vitamin B12, folate, Protein, copper, selenium, and zinc and should be evaluated when routine screening for Iron deficiency anemia is negative (Grade C; BEL 3).

Additionally, this study assesses whether B12 supplementation is required for VSG patients, which found 20% of patients developed a vitamin B12 deficiency. It describes the reason for this deficiency as follows:

• Vitamin B12 usually absorbed from the small bowel at the terminal ileum in the presence of the intrinsic factor which IS secreted by the parietal cells in the body of the stomach. Resection of a significant proportion of the gastric body during LSG may reduce the production of intrinsic factor. Vitamin B12 deficiency can be manifested as anaemia (megaloblastic/macrocytic anaemia) or it can be more serious with neurological sequelae including spinal cord degeneration, which if untreated may lead to permanent neurological deficit.

TL;DR = Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach which is necessary for the absorption of vitamin B12 later on in the small intestine. If part/most of the stomach is removed, there is the possibility of less production of intrinsic factor and subsequently less absorption of B12.

Edited July 31, 201511 yr by nosnhojm