Nutritional Deficiencies & Follow-up

Bariatric Support Group

The presentation highlighted nutritional deficiencies,  the need for follow-up to prevent them and how we take in macronutrients and micronutrients in our diet.

Macronutrients are:

2. Protein – body uses it for growth, and used for energy in starvation mode – need 1 gm per kg of body weight (divide your weight in pounds by 2.2 to get kg).  It is important for growing muscle processes and structures, such as bones, muscle, hair and skin.  If you don’t get enough, your body goes into breakdown mode and breaks down lean muscle mass, which can lead to fatigue
3. Fats – stores energy for use as needed – think of fat as energy
4. Carbohydrates – most easily accessible energy, and prevents the body from using fat as energy to promote weight loss. Sugar gets stored as fat.
5. Water – helps to improve the digestive process and helps the body in burning calories

Our body doesn’t really need sugar or carbohydrates.  It was designed to make energy from fats and protein.  When we take in carbohydrates, the body stores it as fat.  Therefore, if we stop taking in sugar and carbohydrates, our body will use the fat we’ve stored as energy and help us to burn that fat off and lose weight.  This is why a low carb diet is important. 

The body needs fat, but it needs to be gotten from good sources that provide essential fatty acids important for brain and cell function.  The good sources are nuts and seeds, avocado, dark chocolate, whole eggs, nut butters, olive oil and green olives, parmesan cheese, salmon.

The micronutrients are vitamins and minerals.  These are required for cell function and in order to lose weight, we need to make sure our cells have enough of these micronutrients. 

• Calcium – calcium is normally absorbed in the 1^st part of the small intestine. In bypass patients, this has been bypassed, so it is reabsorbed in the second part of the small intestine.  If not enough calcium is taken in, the it can decrease your fat loss. 

Your parathyroid hormone also is involved in balancing the amount of calcium with the amount of phosphorus in your body.  If you don’t have enough calcium to balance out the phosphorus, your parathyroid will secrete a hormone that will dissolve bone in order to get the calcium.  This can lead to osteoporosis and bone fractures.  You must make sure you get at least 1500 mg of calcium a day to keep your bones strong.

• Vitamin D – almost everyone in this country is deficient in Vitamin D, which is necessary for calcium absorption.
• Vitamin B12 – many people are deficient in Vitamin B12, especially vegetarians, as the major source is meat. It is often underdiagnosed.  It is important for our energy system, and deficiencies will result in fatigue, hair loss, neuropathy, dementia and anemia.  More than 50% of bypass patients will be deficient in B12, which is why follow up appointments are important to check these levels. 

            A copper deficiency can often present as a B12 deficiency

• Iron – if a patient is deficient in iron prior to surgery, especially women over the age of 40, it is important to get a GI workup to find the cause. If it isn’t found until after surgery, it is sometimes assumed that the iron deficiency is due to the surgery, and the real cause may be missed.
• Zinc – deficiency can result in a lost sense of smell or finding that nothing tastes good. It can also lead to hair loss.
• Thiamine (B1) – normally absorbed in duodenum, so important for bypass patients to take it daily – your body doesn’t store it and it is important for your nerve cells
• Niacin (B3) – the deficiency is described as the 4 D’s: dermatitis, diarrhea, dementia and death

It is very important for bariatric surgery patients to come to follow up appointments and get their lab work done, so we can identify vitamin deficiencies early and get them corrected before they lead to other conditions.  You need to take your bariatric vitamins and calcium daily to prevent deficiencies, and to come in to be seen if you are having increased fatigue, hair loss that goes on beyond 8 – 9 months, altered smell or taste after the first 6 months, or a numbness and burning sensation in your hands and/or feet.  All of these can indicate a deficiency that can be corrected.