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Addressing The Special Nutritional Challenges of the Postoperative Bariatric Patient.

Bariatric surgery can have a tremendous positive impact on patient health. In addition to enabling considerable weight loss, surgery may improve numerous obesity-related health conditions including diabetes, hypertension, arthritis, heart disease, and infertility. However, these surgeries may result in various nutritional deficiencies that can jeopardize overall health and may lead to irreversible nerve and tissue damage. Reduction in food intake and poor absorption after weight loss surgery make it even more difficult to get adequate nutrition from food alone.

Weight loss surgery restricts food intake and interferes with the digestive process, thereby restricting absorption of essential nutrients. Both of the two main surgical weight loss procedures - gastric banding and gastric bypass - limit the amount of food and calories consumed, thereby reducing the amount of nutrients that can be absorbed. Gastric bypass can result in serious nutritional problems and require monitoring throughout a patient's life.

While true vitamin deficiency syndromes such as scurvy and beriberi are normally uncommon in Western societies, gastric bypass patients are at risk of either subclinical or even frank nutritional deficiencies unless micronutrient supplements supplying essential vitamins and minerals are taken throughout their life. Deficiencies of protein vitamin B12, folate, iron, calcium, thiamine, and vitamins A, D, E, and K are common after surgery, but shortages of other essential nutrients may also occur. Correcting deficiencies is vital to maintaining healthy heart, neurological, and immune functions and is crucial for preserving energy levels, strong bones, and healthy hair, skin, muscles, and joints.

Some nutritional deficiencies occur within a year after surgery. Other deficiencies may take years to develop. It is imperative that surgical patients take a bariatric-specific multivitamin and mineral supplement to support a lifetime of good health. Additional nutrients may be required based on the type of surgery and the patient's specific health circumstances.

Ensuring Nutritional Needs After Weight Loss Surgery

Daily vitamin and mineral supplements formulated for the unique nutritional and absorptive challenges of the weight loss surgery patient are required post surgery. In the first few weeks to several months following surgery, a chewable multivitamin may be easiest for patients to ingest. In the months and years ahead, chewable, capsules, or readily digestible tablets can be used. Standard multivitamins or children's chewable typically do not adequately address the enhanced nutrient requirements and absorption issues of the surgical patient. The Healthy Life Bariatrics Surgical Support Program includes Healthy Life Bariatric Post Surgical Multi Vitamins supplement to provide this essential nutritional foundation. Routine daily use of Bariatric Post Surgical Multi Vitamins can help maximize the benefits of bariatric surgery and support a lifetime of good health.

Nutritional Consequences of Bariatric Surgeries

The nutrient deficiencies that may occur after surgery depend on the procedure performed and the nutritional status before surgery. Malabsorptive procedures cause lifelong nutritional deficiencies, some developing years after surgery. Failure to comply with new eating habits can also cause deficiencies. Correcting deficits is critical to maintaining good health post surgery regardless of the procedure performed.

Restrictive Surgery

    * Similar nutrient deficits as obese patient
    * Higher incidence of folate deficiency
    * Vitamin D, iron, vitamin B12, and thiamine deficiencies most common
    * Monitor for hyperparathyroidism and abnormal calcium metabolism

Restrictive and Malabsorptive Surgery

    * Considerable lifelong micronutrient-protein malnutrition requiring supplementation
    * Decreased stomach acid production
    * Protein, B12, folate, iron, calcium, thiamine, and vitamins A, D, E, and K deficiencies most common
    * Decreased lactase production can result in dairy intolerance

Common Micronutrient Problems After Weight Loss Surgery

Thiamine (Vitamin B1)

    * Required for cellular energy production, carbohydrate, protein, and fat metabolism; mental clarity; nerve function; membrane stabilization.
    * Risk of deficiency highest in patients with vomiting (1-3 months postop), those consuming alcohol, and patients not taking supplements.
    * Deficiency associated with calorie deprivation and malabsorption, but may be pre-existing.


Vitamin B12

    * Needed for synthesis of all DNA; acts as methyl donor and participates in carbohydrate metabolism.
    * Decreased intake and malabsorption due to reduced intrinsic factor leads to low B12.
    * 1/3 of patients develop deficiency postop.
    * Sublingual administration or injection.


Folate

    * Essential for cell health, DNA synthesis and repair, and methylation reactions.
    * Decreased intake of green vegetables and minimal stomach acid contribute to low levels.
    * 1/3 of patients develop deficiency postop.


Biotin

    * Catalyst for synthesis of fatty acids, glucose formation, and metabolism of amino acids.
    * Other used with zinc for hair and nail strength.


Vitamin B6

    * Needed for functional integrity of the brain; amino acid metabolism.
    * Deficiency exacerbated by use of antibiotics, antihypertensives, and alcoholic beverages.


Fat-Soluble Vitamins (A, D, E, and K)


    * Must be monitored regularly to ensure adequate levels long-term as deficiencies take a year or more to develop.

Vitamin A/Carotenoid

    * Needed for proper vision; protein synthesis and cell differentiation, formation of mucus cells in the eye, bladder, lungs and intestines humoral and cell medicated immunity.
    * Deficiency can exacerbate iron deficiency.

Vitamin D

    * Required for calcium absorption important for breast, prostate, colon, and bone health.
    * Intolerance of dairy as a source of vitamin D can exacerbate deficiency.


Iron

    * Transports and stores oxygen; needed for metabolism and detoxification (via cytochromes) and wound healing.
    * Important for energy, normal heart function, muscle strength, normal hair growth.
    * Decreased stomach acid limits conversion to absorbable ferrous form of iron.
    * Deficiency seen in 30 to 50% of patients; menstruating females at higher risk.


Calcium

    * Essential to bone health; regulation of nerve transmission, heart and muscle contraction; wound healing, and maintenance of blood pressure.
    * Deficits of the fat-soluble vitamin D aggravate the malabsorption of calcium.
    * Hypocalcaemia occurs in 15% to 48%.
    * Soluble forms of calcium such as citrate/citrate-malate that don't depend on acidity for absorption are best.

Routine Nutritional Supplements

Multivitamin and Mineral Supplement


    * Vitamin/mineral supplementation is indispensable because of the decreased food intake of the patient.
    * Adult chewable multivitamin for 4 to 12 weeks postop; capsules, chewable, or easy-to-digest tablets thereafter.
    * Children's chewable not adequate
    * Needed for life


Calcium or Calcium/Magnesium

    * Soluble calcium citrate preferred
    * 1,200 to 1,800 mg calcium daily
    * Vitamin D often included


Iron

    * May be needed if not included in daily multivitamin
    * Use well-tolerated, absorbable forms such as chalets
    * Approximately 40 to 60 mg daily


Vitamin B12

    * Can be absorbed without need of intrinsic factor when taken in large amounts
    * Active forms improve bioavailability
    * Sublingual form best for high potency dosing


Healthy Life Bariatric Post Surgical Multi Vitamin - Essential Vitamins and Minerals for Postoperative Needs and Lifelong Health.

Healthy Life Bariatric Post Surgical Multi Vitamin is a high-potency multiple vitamin and mineral formula intended as a daily dietary supplement for weight loss surgery patients. It is formulated to address heightened nutrient requirements after surgery and to compensate for the altered absorption capacity after a gastric bypass procedure. Nutrient forms with greater documented bioavailability and benefit compared to many standard forms are included. Healthy Life Bariatric Post Surgical Multi Vitamin's contains well-absorbed forms and nutritionally relevant amounts of 30 essential vitamins, minerals, and trace elements in four chewable tablets or four capsules daily. Bariatric Post Surgical Multi Vitamin formulas are free of common additives such as lactose, starch, artificial flavors, preservatives, and colorings for maximum tolerance. Each of these full-spectrum formulas contain:

Extra-strength amounts of crucial nutrients

    * Higher than RDA potencies of essential antioxidants, vitamins A, B, and D, and iron are included.

More complete nutrient "families" for natural balance and safety

    * 100% natural vitamin E complex (d-alpha, d-beta, d-gamma, and d-delta tocopherol isomers), provides broader antioxidant protection than d-alpha alone.
    * Both performed natural-source vitamin A (retinal) and vitamin A precursors (beta- and alpha-carotene) extended more complete vitamin A nutrition.
    * All-natural mixed carotenoids, including alpha- and beta-carotenes, lutein, zeaxanthin, and beta-cryptoxanthin, offer more diverse antioxidant benefit and are safer than synthetic beta-carotene alone.
    * Complete vitamin B-complex supports many metabolic functions and includes significant amounts of B-vitamins most crucial to avoiding toxic build-up of homocysteine.

Activated folate, B1, B12, and other B vitamins for highest absorption and bioavailability

    * 5-methyltetrahydrofolate (5-MTHF) and folinic acid, the active forms of folate, unlike folic acid, are absorbed and utilized directly and are the most beneficial forms for patients with elevated homocysteine resulting from compromised utilization folate.
    * Methylcobolamine and 5-adenosylcobalamin, the active forms of B12, are the most reliable oral forms of this difficult-to-absorb nutrient.
    * Benefotiamine, a lipid-soluble form of thiamine with high bioavailability, is especially useful for people with  impaired absorption.

Extra vitamin D3 to optimize daily intake for broad physiological benefit


    * Natural vitamin D3 is included at 1,000 IU, a higher amount than typically found in daily multivitamins, to help achieve optimal intakes to support bone health and other numerous roles in tissues throughout the body.

Mineral compounds with validated bioavailability

    * Calcium citrate is a well-studied calcium compound with higher absorption and effectiveness than many other calcium sources.
    * Magnesium, chromium, zinc, magnese, and other mineral amino acid glycinate chalets from Albion Laboratories are fully-reacted, low molecular weight mineral compounds with exceptional tolerance and documented bioavailability.

Extra iron in a well-tolerated, bioavailable form

    * Ready-to-absorb ferrous bisglycinate overcomes decreased stomach acid that limits absorption of common forms of iron.
    * Better tolerated than ferrous sulfate or other organic forms of iron.

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