Potential Vitamin and Mineral Deficiency

[SeattleGirl72 3]

Hello all -

I am going through the pre-op process for Gastric Sleeve and have been doing some research to be better prepared post-op.

One topic that is really concerning me is the risk of low Thiamin/B1, Iron and Vit D3. My original understanding was that as long as you follow the post-op instructions and take your recommended vitamins/supplements long term, that you will be Ok. However, after reading a number of posts online, it sounds like even then you could develop major complications due to extremely low levels that Dr's may not be able to address?

Any info, pointers, or advice would be much appreciated.

Thanks

[Sassafras1 63]

I'm pretty new to this but from what I've read here, everyone who takes their recommended Vitamins is doing well and their regular blood tests are all good. Being obese also develops into major complications which are not easy to address... I know what I'd prefer.

[Foxbins 625]

I had a sleeve for nine years and my Vitamin and mineral levels were perfect. I just took my Vitamins and Calcium every day.

[Arabesque 6,476]

One of the reasons I was leaning towards sleeve surgery was because issues with malabsorption were less frequent than with other weight loss surgeries, or so I understood.

I stopped taking my Vitamins early this year after I started maintenance (made me nauseated so I wouldn’t eat) & my bloods have come back twice since then with all my levels being very good. My bone density is excellent too. My surgeon & dietician are happy with me but we’ll keep monitoring just to make sure. I do eat a balanced diet: Protein, vegetables, fruit, dairy, whole/multi grains, low fat, etc. And I think I just absorb my nutrients well - genetics play a part here I think.

We’re all different & those who’ve had issues may naturally not absorb nutrients via food &/or supplements as well as others. Some sleevers happily give up regularly taking vitamins yet others continue to take supplements for myriad reasons.

Follow your team’s instructions re vitamins & keep up with your blood tests to monitor your levels. That way it there are any significant drops in your levels they are picked up quickly & something can be done about it. There’s a difference between being aware of possible complications & worrying about something that may not happen.

Good luck with your surgery.

[catwoman7 10,863]

except for Iron, deficiencies supposedly aren't that common as long as you stay on top of your supplements. Iron can be tricky because some people have a hard time absorbing oral iron, so they have to get it from infusions. But the majority can absorb oral iron just fine.

also, most deficiencies can be corrected by increasing your supplement intake. Iron, of course, is the one that can be tough to increase once it's low. I've been able to bring mine up by increasing my (oral) iron intake, but some people can't and have to have an infusion to bring it up.

you'll be getting regular labs drawn to see where you are, and they'll have you increase or decrease supplementation if your levels get out of range. I've had to increase my iron and decrease my Calcium in my five years of being post-op. So just stay on top of your supplements and get your labs done when you're supposed to, and you should be fine.

[Napua 42]

Presently taking BariMelts Vitamins. These works well for me during my liquid diet for surgery scheduled on the 28th. I know the Barimelts vitamins will do good, these vitamins are made for gastric bypass and sleeve patients.

[GreenTealael 24,859]

Even if a deficiency occurs, labs are ordered so often in the beginning, most things are rarely missed or corrected in a timely fashion.

Edited August 21, 2020 by GreenTealael

[SeattleGirl72 3]

13 hours ago, Arabesque said:

One of the reasons I was leaning towards sleeve surgery was because issues with malabsorption were less frequent than with other weight loss surgeries, or so I understood.

I stopped taking my Vitamins early this year after I started maintenance (made me nauseated so I wouldn’t eat) & my bloods have come back twice since then with all my levels being very good. My bone density is excellent too. My surgeon & dietician are happy with me but we’ll keep monitoring just to make sure. I do eat a balanced diet: Protein, vegetables, fruit, dairy, whole/multi grains, low fat, etc. And I think I just absorb my nutrients well - genetics play a part here I think.

We’re all different & those who’ve had issues may naturally not absorb nutrients via food &/or supplements as well as others. Some sleevers happily give up regularly taking Vitamins yet others continue to take supplements for myriad reasons.

Follow your team’s instructions re vitamins & keep up with your blood tests to monitor your levels. That way it there are any significant drops in your levels they are picked up quickly & something can be done about it. There’s a difference between being aware of possible complications & worrying about something that may not happen.

Good luck with your surgery.

Thank you all for your helpful responses

[RickM 1,747]

Of the mainstream procedures, the sleeve will be the most benign of them when it comes to supplement needs and the amount of trouble one can get into by ignoring them and the labs. Supplementing with the sleeve is largely an individual thing - there is much more influence by individual variations and dietary habits than there is from the surgery. I've never heard of B1 being a particular problem, but given that the primary dietary source is from the grain complex, and many people are into low carb dieting (Atkins, Keto, etc.) that minimizes that food group, it isn't surprising that such deficiencies would be showing up - not from the procedure, but from the chosen diet. My wife is chronically low in Potassium, but that is just her, not her WLS (as DS in her case.) That is managed by checking levels periodically and adjusting supplements as needed - just as if she had never had WLS.

I have heard it hypothesized that there might be some Iron absorption issue with the sleeve owing to the somewhat more rapid transit times of food through the stomach, but I haven't seen any validation of that concern. The malabsorbing (RNY, DS) procedures specifically do malabsorb minerals such as iron to varying degrees as much of the mineral absorption happens in the duodenum which is bypassed entirely (in the RNY) or partially (in the DS) so iron levels can certainly be more of a challenge with those patients. I had a bleed a few years ago that sapped my iron/ferritan levels, but was able to restore them to normal in a few months by doubling my oral iron supplement; most with an RNY or DS would need iron infusions to recover from those levels.

I tend to lose a bit of D normally so have been supplementing that since before my VSG and continue to do so at moderate levels (2-5k IU) both from that perspective, and also our surgeon prefers to see us in the higher end of the normal range on the blood levels; some in the malabsorbing camp will use 50k IU supplements to keep things in line (particularly the DS folks who specifically malabsorb fat soluble Vitamins such as D)

I know quite a few long time DS people (10-20+ years) and have seen very little problem as long as labs are regularly taken (annually usually) and responded to; however ignore those at your peril as weird things can happen if you don't. And that's with the DS, which is the fussiest of the procedures in that regard. With a sleeve, you are much more likely to get into trouble by something that you bring to the table - whether that be intrinsic or behavioral - but that is good reason to keep up with periodic lab checks just the same (my labs are a lot simpler than those of a typical DS or RNY person, as there is less that is needed to be monitored with the VSG.)