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Specialised supplements

Why you need specialised supplements after surgery

Both macro- and micronutrients are necessary for general health and wellbeing and many are needed in higher quantities after surgery to prevent devastating nutrient deficiencies

After metabolic and bariatric surgery (MBS), your body needs more nutrients than it did before surgery, due to a change in anatomy, decreased food intake, and potential malabsorption of nutrients. Nutrients are divided into two major classes: macronutrients and micronutrients. Macronutrients are needed in large amounts and are commonly referred to as carbohydrates, proteins, and fats. Micronutrients, such as vitamins and minerals, are required in small amounts but are needed for our bodies to function properly.

Both macro- and micronutrients are necessary for general health and wellbeing and many are needed in higher quantities after surgery to prevent devastating nutrient deficiencies. Without proper food and supplement intake, you may experience preventable nutrient deficiencies, particularly in four core areas that can affect your health. Learn more about these potential health concerns and how to avoid them below.

Bone health

Up to 90% of patients are deficient in vitamin D prior to MBS.1 After surgery, your body may also face challenges absorbing calcium and vitamins D and K, as well as other nutrients (such as magnesium) involved in the development and maintenance of bone health.1 Certain procedures can also increase how quickly your body turns over bone, which decreases the total amount of bone in your body. Long-term supplementation with an adequate amount of calcium and vitamins D and K can help prevent bone loss.2

An example of a bone-supporting nutrient found in specialty bariatric supplements includes calcium citrate, which does not require stomach acid for absorption (unlike other forms of calcium, such as calcium carbonate).2 Another important consideration is to take large doses of calcium separately from iron. Iron and calcium compete for absorption in the body; if you take both at the same time you are putting yourself at risk of becoming deficient in one or both of these critical nutrients.

After MBS, the daily nutrient recommendations to support bone health are:

AGB = adjustable gastric band; LSG = laparoscopic sleeve gastrectomy; RYGB = roux-en-y gastric bypass; BPD-DS = biliopancreatic diversion with duodenal switch

Neurological health

Neurological conditions such as encephalopathy, myelopathy, and polyneuropathy (brain, muscle, and nerve conditions) can develop after MBS due to vitamin deficiencies. These conditions have been found to occur not only long-term, but also within weeks4 after surgery and cause symptoms such as burning, weakness, and tingling in the hands and feet.5, 6 Deficiencies of vitamins B1, B12, and E, folate, and the mineral copper, can result in post-MBS neurological conditions that may be prevented by supplementing with these micronutrients,5 and following up annually with your healthcare practitioner.

Long-term deficiency in vitamin B1 (thiamin) can lead to permanent and irreversible damage, including paralysis and issues with cognitive function memory.7

After MBS, the daily nutrient recommendations to support neurological health are:

Blood health (anemias)

Anemias (conditions that affect the production of healthy red blood cells) are prevalent even prior to MBS.6 After many MBS procedures, there is a decrease in the production of stomach acid, which is needed to absorb nutrients. Additionally, due to changes in your gastrointestinal tract after surgery, the absorption of many nutrients such as iron, vitamin B12, and folate is reduced, making it difficult to obtain enough of them from food alone. A deficiency in vitamin A and copper, which are necessary for red blood cell formation, can prevent a correction of iron deficiency anemia.

Left untreated, iron deficiency anemia can result in the need for blood transfusions, which are costly, timely, and carry unnecessary risks. Supplementation with iron, vitamin B12, and folate is recommended for all post-MBS patients to prevent anemia and its symptoms of fatigue, dizziness, and shortness of breath.1

After MBS, the daily nutrient recommendations to support blood health are:1

Muscle health

Although many post-MBS patients can recite their protein needs after surgery, studies indicate that many patients struggle to achieve adequate protein intake 12 months after surgery.8 If you do not consume enough protein after surgery you may lose too much fat-free mass and not enough body fat; a condition that results in muscle wasting known as sarcopenic obesity.

To help maintain the muscle mass you have, it is important to consume adequate protein. The American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines recommend a high-protein diet lifelong after surgery. Many patients are unable to consume adequate protein levels through food alone and require a daily high-quality protein supplement,8 along with a healthy diet, to reach their protein goals.

After MBS, the daily nutrient recommendations to support muscle health:

Why specialty supplements?

Over-the-counter (OTC) multivitamin and mineral supplements often do not provide the specific level of nutrients your body needs to prevent the consequences of a nutritional deficiency after MBS. They are designed for the “general population,” not someone who has unique nutritional needs. To even reach bariatric nutrient guideline recommendations, it could take nine (or more) OTC tablets per day, and you still might not receive the appropriate ratio of nutrients. Specialty bariatric supplements are created to give post-MBS patients the concentrated nutrition they need to prevent nutrient deficiencies that affect the four core concerns.

You’ve already taken the biggest step toward a healthier life. With bariatric-specific supplements and regular, lifelong follow-up care with your healthcare practitioner, you maximize your potential to achieve optimal wellness.


  1. Parrot J et al. ASMBS Integrated Health Nutritional Guidelines for The Surgical Weight Loss Patient — 2016 Update: Micronutrients. SOARD. 2016;12:955–959.
  2. Kim J et al. Metabolic bone changes after bariatric surgery. SOARD. 2015 Mar-Apr;11(2):406-11.
  3. Aills L et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. SOARD. 2008;(4): S73-S108.
  4. Sola E et al. Rapid onset of Wernicke’s encephalopathy following gastric restrictive surgery. Obes Sur. 2003; (13)4:661-662.
  5. Becker D et al. The Neurological Complications of Nutritional Deficiency following Bariatric Surgery. J Obes. 2012. Article ID 608534.
  6. Stein J et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther 2014; 40: 582–609.
  7. Berger JR, Singhal D. The nerologic complications of bariatric surgery. Handb Clin Neurol. 2014;120:587-94.
  8. Andreu A et al. Protein Intake, Body Composition, and Protein Status Following Bariatric Surgery. Obes Surg.2010; 20:1509–1515.

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