Background:  Following Roux-en-Y gastric bypass (RYGB), life-long vitamin supplementation is recommended.  However, no studies are available to demonstrate the effectiveness of any vitamin regimen on post operative blood vitamin levels. We sought to determine if the recommended daily regimen of the Bariatric Fusion Chewable Vitamin was sufficient to prevent commonly encountered nutritional deficiencies seen after RYGB.   

Methods:  100 patients undergoing RYGB from the Synergy Bariatrics practice in Western New York were retrospectively analyzed for at risk vitamin and mineral deficiencies.  Patients were required to have at least one-year of continuous Bariatric Fusion Chewable Vitamin as their only supplementation, and laboratory assessment at the baseline and one-year follow-up for target vitamins and minerals.

Results:  After one-year of continuous supplementation with Bariatric Fusion Chewable Vitamins without any other supplements, 100% of patients were within the normal range for vitamin B₁, folate, and calcium. The large majority of these patients were also within the normal ranges for vitamin B₁₂ (93%), iron (86%), and vitamin D (84%).

Conclusion:  Patients using the recommended daily regimen of Bariatric Fusion Chewable Vitamins had normal concentrations of most important vitamins and minerals.  

This study has not yet been published and should not be quoted by third parties. It is the confidential information of Synergy Bariatrics until published.

Background:  It is recommended that Roux-en-Y gastric bypass is preceded by a high-protein dietary intervention to reduce potential surgical complications.  Because it is known that the size of the liver is reduced from this type of dietary intervention, we sought to determine if the Bariatric Fusion Complete Nutrition dietary intervention would diminish insulin resistance complications in addition to weight loss in patients with morbid obesity and Type 2 diabetes mellitus (T2DM). 

Methods: 15 patients with morbid obesity and T2DM underwent a 2-week dietary intervention with Bariatric Fusion Complete Nutrition consisting of four daily shakes    (7g carb, 0g fat, 27g protein) mixed with water or skim milk (9 g carb, 0g fat, 6g protein). Patients were instructed to consume a minimum of 64 oz of clear liquids (i.e. water, flavored water, Crystal Light, Propel).  Thus, the 14-day dietary intervention had a strict range of 550-785 calories distributed as 28-64g carb, 0g fat, and 108-132g protein.  Anthropometric characteristics and a fasting blood draw were performed immediately prior to the start of the diet (day 0) and on the day of surgery (day 14).

Results:  Following the 2-week dietary intervention weight was significantly decreased from 340.0 ± 72.9 to 328.9 ± 72.9 pounds (p<0.001). Fasting plasma glucose (148.5 ± 30.6 vs. 123.15 ± 35.6 mg/dL, p=0.0169) and insulin (19.0 ± 11.0 vs. 13.5 ± 5.7 uU/ml, p=0.0236) concentrations were also reduced.  Insulin resistance as determined by the homeostasis model of assessment (HOMA-IR) was diminished from 7.3 ± 4.9 to 4.1 ± 2.0 (p=0.0140).

Conclusion:  The Bariatric Fusion Complete Nutrition diet was associated with significant weight loss and correction of the insulin resistant state in patients with morbid obesity and T2DM.  These findings support the continued use of the 2-week high protein, low-carb, no-fat diet before Roux-en-Y gastric bypass and highlight the importance of macronutrient intake on the maintenance of the hallmark insulin resistant state in obesity and T2DM.

This study has not yet been published and should not be quoted by third parties. It is the confidential information of Synergy Bariatrics until published.

people who are severely obese. In most patients, obesity-related

health problems disappear or greatly improve. For example, very

soon after a malabsorptive procedure, type 2 diabetes can improve

to the point that little or no diabetes medication is necessary.

Likewise, insulin-treated patients require much less insulin, and

most can discontinue insulin therapy by 6 weeks after surgery.

Bariatric surgery can also improve or resolve other conditions,

such as hypertension (high blood pressure), high cholesterol,

non-alcoholic fatty liver disease, obstructive sleep apnea, joint

disease, asthma, and infertility due to polycystic ovarian

syndrome. If you were taking medications before surgery to treat

conditions such as diabetes, high blood pressure, or high

cholesterol, you may need to adjust your dosage right after

surgery. It is important for your doctor to monitor such conditions

in follow-up exams.

Vomiting and dumping syndrome are possible side effects of operations that reduce the size of the stomach. Vomiting occurs most commonly during the first few postoperative months, when you are adapting to a small stomach pouch. Vomiting can result from eating foods that are too tough—you need to gradually progress from liquid to soft to solid food. It may also be due to eating too quickly or too much, taking bites that are too big, or not chewing your food enough. Vomiting can also be caused by dehydration. To prevent vomiting, you need to pay attention to signs of fullness, eat slowly, and drink plenty of fluids. AGB patients may need an adjustment of the band. Dumping syndrome refers to a group of symptoms, such as nausea, weakness, light-headedness, and abdominal cramps, that occur when the undigested contents of your stomach are “dumped” into your small intestine too quickly. This rapid emptying can be triggered by too much sugar or fatty foods. Dumping symptoms tend to decrease with time and can usually be controlled with certain nutritional changes, such as:

• avoiding drinking liquids within 30 minutes of a solid-food meal

• increasing the amount of protein you eat

• avoiding simple carbohydrates (such as sugary foods and drinks), which are easily digested

• increasing your intake of fiber and complex carbohydrates (such as wholegrain foods), which take longer to digest

If this approach doesn’t work, then your doctor may prescribe a medication for you to take before meals to manage your

symptoms.

There are four operations commonly offered in the United

States for weight loss.

• Adjustable gastric banding (AGB).

 In this restrictiveprocedure, an adjustable band is placed around the top of

the stomach, creating a small pouch that holds only a little

food. When the pouch is full, feelings of hunger go away

and you are ready to stop eating even though you have had

a small meal. Patients who have AGB lose less weight than

those who have malabsorptive procedures. Weight loss

depends on following a strict diet.

• Roux-en-Y gastric bypass (RYGB).

 RYGB is mainly a restrictive operation but also includes some malabsorption.

Food intake is limited by stapling the stomach to create a

small pouch. Absorption is somewhat limited by cutting

and reattaching the small intestine so that the upper third

of the small intestine is bypassed and the remaining

portion is joined to the pouch.

• Biliopancreatic diversion with duodenal switch (BPDDS).

BPD-DS works by restriction and malabsorption.

 It shortens the distance between the stomach and the

colon (large intestine) even more than RYGB and causes

more malabsorption. Most of the stomach is removed and

a tube-like stomach (called a vertical gastric sleeve) is

created. The sleeve remains connected to a very short

segment of the upper small intestine, which is then directly

connected to a lower part.

• Vertical sleeve gastrectomy (VSG).

VSG reduces the size of the stomach, so it restricts food intake

 but doesn’t decrease absorption by the intestines. VSG has mainly

been performed as the first part of BPD-DS. However,

recent studies suggest that some patients who undergo

VSG lose weight with that procedure alone.

There was a study that confirmed post operative gastric bypass patients will absorb alcohol at a faster rate than people who have not undergone the surgery. It will also take a post operative patient longer to reach sober levels after consuming alcohol than those who have not undergone the surgery. A study was conducted on 36 post operative patients and a control group of 36 subjects who have not undergone the surgery. Each subject was given a 5 oz of glass of red wine and the alcohol in their breath was measured to evaluate their alcohol metabolism. The gastric bypass group had an average peak alcohol breath level at 0.08%. The control group had an average peak alcohol breath level of 0.05%. It took on average 108 minutes for the gastric bypass patients group to return to an alcohol breath of zero, while it took the control group an average of 72 minutes to return to an alcohol breath of zero.Patients who have undergone gastric bypass surgery will have a lower tolerance than people who have not gone through the surgery. It will also take a gastric bypass patient longer to return to a sober level after drinking alcohol than a person who has consumed alcohol that has not had the surgery.

ABSTRACT

Background: Despite the increasing use of Roux-en-Y gastric bypass

(RYGBP) in the treatment of morbid obesity, data about postoperative

nutritional deficiencies and their treatment remain scarce.

Objective: The aim of this study was to evaluate the efficacy of a

standard multivitamin preparation in the prevention and treatment of

nutritional deficiencies in obese patients after RYGBP.

Design: This was a retrospective study of 2 y of follow-up of obese

patients after RYGBP surgery. Between the first and the sixth postoperative

months, a standardized multivitamin preparation was prescribed

for all patients. Specific requirements for additional substitutive

treatments were systematically assessed by a biologic workup

at 3, 6, 9, 12, 18, and 24 mo.

Results: A total of 137 morbidly obese patients (110 women and 27

men) were included. The mean (_SD) age at the time of surgery was

39.9 _ 10.0 y, and the body mass index (in kg/m2) was 46.7 _ 6.5.

Three months after RYGBP, 34% of these patients required at least

one specific supplement in addition to the multivitamin preparation.

At 6 and 24 mo, this proportion increased to 59% and 98%, respectively.

Two years after RYGBP, a mean amount of 2.9_1.4 specific

supplements had been prescribed for each patient, including vitamin

B-12, iron, calcium _ vitamin D, and folic acid. At that time, the

mean monthly cost of the substitutive treatment was $34.83.

Conclusion: Nutritional deficiencies are very common after

RYGBP and occur despite supplementation with the standard multivitamin

preparation. Therefore, careful postoperative follow-up is

indicated to detect and treat those deficiencies.

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While weight loss surgery can and does change lives for the better, it requires lifelong lifestyle changes. This includes taking supplements of important vitamins and nutrients to stave off deficiencies that can be caused by the surgery.

Some bariatric surgeries — such as gastric bypass, biliopancreatic diversion (BPD) and duodenal switch (BPDDS) — work by malabsorption, meaning that the body blocks the absorption of certain vitamins and minerals. This can result in serious nutritional shortfalls. Other restrictive procedures — such as Lap Band — also may cause nutritional shortfalls because people can no longer eat certain types of food and must restrict the volume of those foods that they can tolerate.

Nutritional needs vary based on the individual as well as the type of surgery, but here’s a primer on your post-bariatric surgery nutritional needs.

Multivitamins:  Most bariatric surgeons will suggest a daily multivitamin after weight loss surgery. However, multivitamins alone may not meet your specific nutritional needs. Talk to your doctor to see if you have to supplement your supplement.

Tip: Chewable and liquid multivitamins are the most easily absorbed, and are recommended after all bariatric surgery procedures. They are also less likely to cause heartburn and ulcers after gastric banding and gastric bypass surgery.

Protein:  You must consume sufficient amounts of protein after bariatric surgery. Protein speeds wound healing, preserves lean body mass and enhances fat-burning. Most registered dieticians (RDs) recommend eating high protein foods first to avoid becoming too full, too fast, and not having room later on. Most people need to eat approximately four ounces (or more) of protein each day. Specific recommendations vary. Talk to your doctor or an RD.

Iron:  Anemia is common in the months and years following weight loss surgery. Iron deficiency is the most common cause of anemia after bariatric surgery. This risk is heightened after gastric bypass and other malabsorptive surgeries in women who are still menstruating, and in the super-obese (body mass index of 50 or above). Some people may need more than what is found in their multivitamin. Talk to your doctor about how much iron you need.

Tip: Do not take iron supplements with tea, cola, coffee, calcium citrate or the thyroid medicine levothyroxine because they can interfere with absorption. Taking vitamin C with your iron supplements aids iron absorption. Either a Vitamin C pill or glass of orange juice can do the trick.

Vitamin B12:  Most multivitamins do not contain adequate levels of B12. Some surgeons may suggest (and offer) monthly vitamin B12 shots. Others may recommend 500 micrograms of B12 taken under the tongue (sublingually) daily. These are readily available at many drug stores. Regardless of the form, vitamin B12 may help boost your metabolism, and enhance your weight loss efforts as you begin your life after bariatric surgery.

Folate:  Folate or folic acid is another B-vitamin. Folic acid is known to prevent neural tube defects in pregnant women. It also prevents anemia, certain cancers and heart disease. Your multivitamin should contain 400 to 800 micrograms of folate. Ask your doctor if you need more. Foods that are rich in folic acid include leafy green vegetables, citrus fruits, berries and melon, dried beans, peas and nuts. Enriched breads, cereals and other fortified grain products also contain folic acid.

Calcium:  Calcium is important for bone health. After weight loss surgery, you may be at risk for the brittle bone disease osteoporosis and related fractures. This is a direct result of the nature of the surgeries. To compensate, most surgeons recommend a diet rich in calcium, combined with 1,200 to 1,500 milligrams of calcium supplements, split into two doses and taken twice daily. Older women may require more calcium.

Vitamin D:  Vitamin D aids the absorption of calcium, which is needed to build strong bones after weight loss surgery. It is known as the sunshine vitamin because the human body produces it only when exposed to sunlight. Vitamin D also is added to multivitamins and milk.

Vitamin D deficiency is linked to a host of chronic diseases, including certain cancers, heart disease, osteoporosis, stroke, diabetes, immune system problems and inflammatory diseases. What’s more, obesity increases risk of Vitamin D deficiency.

Recommendations for vitamin D supplements are tiered based on blood levels. Most surgeons recommend supplementation starting at 2,000 international units per day. Get tested to see where you stand.

Vitamin A:  Some people may become deficient in vitamin A following weight loss surgery. This fat-soluble vitamin is important for vision, particularly at night. The risk of vitamin A deficiency is heightened after BPD and BPDDS. Your surgeon should test your levels and suggest supplements accordingly.

Zicn:  Zinc deficiency may occur after bariatric surgery. This mineral is an essential building block for hair, skin, and teeth. Make sure your multivitamin contains adequate amounts of zinc.

Vitamin B1 (Thiamine):  Thiamine deficiency may occur after weight loss surgery due to reduced acid production, restriction of food intake and frequent vomiting. This may lead to nerve problems and memory loss. Make sure your multivitamin contains sufficient thiamine, especially if you are vomiting frequently after surgery.

There are many companies that manufacture supplements specifically for people who have had bariatric surgery. See if there is a specific product line that your surgeon recommends. These supplements will likely be needed for the rest of your life. Do not stop taking them without discussing it with your bariatric surgeon or primary care doctor.

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