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Bariatric surgery is a transformative intervention for individuals with obesity, necessitating comprehensive postoperative care to ensure optimal recovery and long-term success. One crucial aspect of postoperative management is the consistent, long-term use of dietary supplements to address nutritional deficiencies common in this population. (Sherf-Dagan 2017)

Vitamin and mineral supplementation is a cornerstone in the post-bariatric surgery regimen. The altered gastrointestinal anatomy often leads to decreased absorption of key nutrients, including B vitamins, vitamin D, and iron. (Lupoli 2017) Furthermore, protein supplementation is beneficial for supporting muscle preservation and promoting wound healing. Practitioners should consider appropriate supplements to prevent or correct deficiencies and associated complications. 

Regular monitoring of nutritional status through blood tests is necessary to identify deficiencies promptly and adjust supplement regimens accordingly. (Sherf-Dagan 2017)

Multivitamin

Variable based on ingredients and formulation, lifelong daily supplementation is recommended (Heusschen 2021)(Shankar 2010)

• Bariatric surgery impacts nutrient absorption by altering the anatomy of the digestive system, leading to changes in the way nutrients are absorbed and processed by the body. Micronutrient deficiencies are common following bariatric surgery, necessitating the lifelong daily use of multivitamin supplementation. (Heusschen 2021)(Shankar 2010) Vitamin B12, calcium, vitamin C, vitamin D, vitamin K, thiamine, folic acid, iron, zinc, magnesium, and selenium are among the most common nutrient deficiencies identified in individuals post-bariatric surgery. (Malone 2008)
• Individuals who didn’t adhere to a standardized multivitamin supplementation (MVS) regimen after laparoscopic Roux-en-Y gastric bypass exhibited a higher number of nutritional deficiencies on average (4.2 vs. 2.9), with a significantly higher number of non-adherent patients having more than five deficiencies. (Ledoux 2014)

Variable based on formulation and dependent on the type of surgery performed (Mansoori 2021)

• B vitamin deficiencies are common post-bariatric surgery, particularly among individuals who have undergone Roux-en-Y gastric bypass. High doses of oral B12 are typically recommended following a Roux-en-Y gastric bypass, whereas lower doses of vitamin B12 may be more appropriate for those receiving a gastric banding or laparoscopic sleeve gastrectomy. (Mansoori 2021) 
• Roux-en-Y gastric bypass patients are more likely to experience vitamin B12, while sleeve gastrectomy and gastric banding patients are more likely to experience thiamine deficiency. (Mansoori 2021)
• A systematic review (SR) showed that oral supplementation doses of ≤15 μg vitamin B12 aren’t sufficient for the prevention of vitamin B12 deficiency in individuals following Roux-en-Y gastric bypass; however, doses of 1,000 μg were shown to be effective. (Mahawar 2018)
• Three-month supplementation with B vitamins led to a significant 48% increase in serum vitamin B12, a modest elevation in serum folate, and no reduction in blood thiamine- concentrations. (Moore 2014)

Address common post-bariatric nutrient deficiencies with the evidence-based ingredients in this protocol. 

Vitamin D

≥ 2,000 IU daily, ongoing with regular nutritional surveillance (Giustina 2023)

• According to a SR and meta-analysis (MA), the prevalence of preoperative vitamin D insufficiency was 57%, when defined as 25(OH)D < 20 ng/mL, with a median 25(OH)D level of 19.75 ng/mL. After surgery, high-dose oral vitamin D supplementation (≥ 2,000 IU daily) was associated with a lower rate of vitamin D insufficiency and higher 25(OH)D levels. (Giustina 2023)
• A 2022 SR and MA showed that among patients undergoing bariatric surgery, vitamin D supplementation, particularly at dosages exceeding 2850 IU daily and in those with a body mass index (BMI) greater than 50 kg/m2, modestly improved vitamin D status, prevented an increase in parathyroid hormone (PTH) serum concentration, and had no impact on serum calcium levels. (Mokhtari 2022)
• Another SR and MA of 12 studies summarized that daily vitamin D supplementation of more than 800 IU was effective in preventing postoperative vitamin D deficiency and improving 25(OH)D levels. (Li 2017)

Iron

~45–60 mg daily, ongoing with regular nutritional surveillance (Sherf-Dagan 2017)(Mechanick 2013)(Bjørklund 2021) 

• According to a SR, iron deficiency affects 16.6% of individuals post-bariatric surgery, specifically 24.5% post-Roux-en-Y gastric bypass and 12.4% post-sleeve gastrectomy. Populations most at risk for iron deficiency post-procedure include premenopausal females and individuals with preoperative iron deficiency. (Enani 2019)
• Prophylactic ferrous sulfate supplementation has been shown to prevent iron deficiency in menstruating women post-Roux-en-Y gastric bypass. (Brolin 1998)
• Clinical practice guidelines for patients following bariatric surgery may include supplementation of ferrous sulfate, fumarate, or gluconate, aiming to deliver a daily dose of 150–200 mg of elemental iron. However, ferrous bisglycinate has been shown to effectively increase hemoglobin concentration and reduce gastrointestinal adverse events compared to conventional iron salts such as ferrous sulfate, ferrous fumarate, and ferrous gluconate. (Mechanick 2013)(Fischer 2023)

Protein

~20 g of protein daily for 6 months minimum (Taselaar 2023)(Al-Shamari 2022)

• According to an MA, exceeding recommended protein intake after bariatric surgery was found to be associated with greater weight and fat mass loss, particularly in patients consuming ≥ 40 g daily above recommended protein values. (Golzarand 2024)
• A randomized controlled trial (RCT) suggested that protein supplementation may help prevent muscle loss and protein malnutrition that can result from low protein intake following bariatric surgery. (Al-Shamari 2022)
• Whey protein supplementation post-surgery exhibited a significant 75% increase in protein intake, resulting in greater body weight loss (1.86 kg) and fat mass loss (2.78 kg). (Gomes 2016)
• Consider increasing the recommended dose if a plant-based protein source is preferred.

Calcium

1,200–1,500 mg daily through diet and supplementation (Ormanji 2020)(Mechanick 2013)

• According to the Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient, it’s recommended that calcium intake be in the range of 1200–1500 mg daily, ideally through a combination of dietary supplements and regular intake of calcium-rich foods such as dairy products, seafood, almonds, and green vegetables. (Mechanick 2013)
• One study showed that patients with sufficient levels of vitamin D (≥ 30 ng/mL) and adequate calcium intake (> 1,200 mg/day) experienced a significant drop in intestinal calcium absorption from 33% before surgery to 7% after six months of RYGB. (Schafer 2015)
• Calcium citrate led to a notably higher peak serum calcium concentration compared to the control group. Additionally, it resulted in significantly lower minimum PTH levels. (Tondapu 2009)