Feeling weak and tired, or fatigue after bariatric surgery is not normal and may be a sign of a vitamin or mineral (micronutrients) deficiency. Micronutrient deficiencies after bariatric surgery can and will develop unless a tight treatment protocol is followed that involves nutritional supplements and regular monitoring of levels.
Bariatric surgeries change the body’s capacity to absorb vitamins, minerals and nutrients. This is because some surgeries such as the gastric bypass and duodenal switch remove or bypass part of the small intestine so that the body absorbs fewer calories (called malabsorption) and aids weight loss. However, this malabsorption also impacts the nutrients your body needs to be healthy. Add to that, the amount of food that can be eaten will be significantly less, so all patients regardless of which bariatric surgery undergone will be taking in fewer nutrients.
Hence there is a serious requirement for nutritional supplements to address vitamin and mineral deficiencies. Click here to buy top brand bariatric vitamins from our friends at BariatricPal.
My Struggle with Chronic Fatigue after Bariatric Surgery
Finding the cause of my fatigue after bariatric surgery is a regular event for me. I’ve been twice diagnosed with iron deficiency. And I once battled iron deficiency anemia. The resulting fatigue took many months from which to recover using oral iron supplements — and close to a year for my blood work to return to normal. A word to the wise, if you are diagnosed with iron deficiency anemia, seek iron infusions. A friend of mine felt fine after just three infusions when she had iron deficiency anemia after her duodenal switch. My supplement of choice for maintaining iron levels is Trace Minerals Research Liquimins Ionic Iron.
I also experienced a dramatic depletion of energy after my StomaphyX surgery. After a period of exploration to discover what the cause of the fatigue might be, I was directed by a bariatric surgeon to begin taking sublingual vitamin B12.
On another occasion my Endocrinologist found that I was Vitamin D deficient and directed me to begin supplementation. Vitamin D deficiency is common after bariatric surgery. Reports have identified the deficiency to be as high as 84% in bariatric patients.
It is worth noting that I’ve suffered a number of other micronutrient deficiencies. Although they did not result in fatigue, deficiencies of magnesium and potassium caused pain and weakness in my legs and cramping in my feet. My supplements of choice are Natural Vitality Natural Calm Magnesium Citrate and Nature Made Potassium Gluconate.
Nutritional Supplements for Fatigue after Bariatric Surgery
There are a number of macro and micronutrients that increase energy. The focus of this article will be on three supplements that I’ve used to combat fatigue after bariatric surgery: vitamin B12, vitamin D3, and ribose. I discuss the use of supplemental iron in the article, “Prevent Iron Deficiency after Gastric Bypass.”
which formulation of Vitamin B12 — sublingual, intranasal, intramuscular — best treats Fatigue after Bariatric Surgery?
Vitamin B12 is one of the more common deficiencies that present following bariatric surgery. It is estimated that 9% to 14% of this patient population has vitamin B12 deficiency going into surgery, and the condition is exacerbated by malabsorption following the procedure. Oral vitamin B12 is therefore not efficacious in patients who have undergone bariatric surgery with a malabsorption component. Sublingual (under the tongue), intranasal spray, or intramuscular injection are the recommended routes of administration. The University of Washington Medical Center recommends 1000 micrograms (mcg) of vitamin B12 daily for those who have had bariatric surgery.
Reported online in the journal Surgery for Obesity and Related Diseases, “before objective efficacy data on high-dose oral vitamin B12, intranasal, or sublingual formulations become available, the intramuscular formulation should remain the preferred route of B12 supplementation in patients undergoing RYGB [gastric bypass].”
Vitamin B12 is needed for cell metabolism as well as the correct operating of the brain and nervous system. The use of B12 to reduce pain has been examined in people with back pain and nerve pain. A vitamin B12 deficiency can cause pernicious anemia. The immune system can be effected to such degree that the possibility for infection increases. Additional conditions include nervousness, inadequate blood clotting, menstrual problems and tiredness.
Vitamin D3 fights Fatigue after Bariatric Surgery
Most of the population is vitamin D deficient. Vitamin D deficiency is even more prevalent under the following conditions: colder climates, during months when there is less light, and among people who work indoors. This is because vitamin D is a product of sunlight. It is formed in the skin due to an action of ultraviolet light. Dietary sources are fatty fish, liver, eggs, and fortified foods.
Vitamin D3 also is needed for absorption of calcium and to maintain serum calcium to preserve bone mineralization. Calcium and vitamin D3 are critical for the promotion of bone growth as well as maintenance of the bones. The health benefits of vitamin D3 include prevention of cancer, cardiovascular disease, hypertension, and diabetes.
Symptoms of vitamin D3 deficiency are muscle pain, bone fractures, fatigue, low immunity, depression, and problems sleeping. The highest level of vitamin D3 available in a bariatric supplement protocol is 1600 IU.
Ribose helps some overcome Fatigue after Bariatric Surgery
I found ribose useful to address my fatigue after gastric bypass. However opinions of ribose are divided between those who endorse it and those who do not.
Ribose is a kind of sugar that is produced slowly in the body and is not found in food at all. Many people who have low energy have difficulty producing and maintaining ribose because ribose is metabolized differently than regular sugar. It is not clear if metabolizing ribose is effected further by gastric bypass surgery.
Some people have found that ribose produces excess energy, and they complain of feeling hyper. These symptoms can be remedied by lowering the dose that is being taken or by taking the dose along with food.
Patients with diabetes or low blood sugar should speak to their healthcare provider before taking ribose. Ribose has been shown to decrease blood sugar levels and could interfere with diabetes medications that do the same thing.
While there is some evidence that Ribose can be effective for chronic fatigue syndrome, the evidence is not concrete. There also is some evidence that ribose can be useful to help address fibromyalgia, congestive heart failure, and coronary artery bypass surgery. Further research is needed to determine exactly how useful ribose is those areas mentioned above.
Monitor Vitamin Levels after Bariatric Surgery
Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist post-surgery. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with type 2 diabetes.
Bariatric practices can vary in how often they monitor vitamin levels. Commonly a practice will monitor calcium, vitamin B12, ferritin, folate and iron indices with blood tests at 3, 6, 12, 24 months postoperatively and annually thereafter for all patients who undergo bariatric surgery. This may be inadequate for all patients.
Therefore, it is very important that your physician (whether it is your bariatric surgeon, endocrinologist, or primary care doctor) recognize the clinical signs of micronutrient deficiencies — and it is important that you be aware of them, too — both to enable early intervention and to minimize long-term adverse effects.
According to a review in Nature, further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, physicians should inquire about and treat symptoms that suggest nutrient deficiencies.
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