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According to health reports, vitamin B12 deficiency in bariatric surgery patients is on the rise. But before you commit to bariatric surgery, you need to know how it will affect your body’s absorption of necessary vitamins and minerals, especially vitamin B12 (cobalamin). In some cases, vitamin B12 deficiency can be just as debilitating as morbid obesity.
If you’ve been struggling to lose weight for most of your life, then you may be considering a Roux-en-Y gastric bypass procedure. Before you go under the knife, you should know the health risks involved with bariatric surgery; vitamin B12 deficiency is one of the most common deficiencies observed after weight loss surgery. Bariatric patients are at an increased risk of developing vitamin B12 deficiency because their digestive tracts have been altered in such a way as to interfere with the natural absorption of this crucial vitamin.
Signs of severe vitamin B12 deficiency include depression, memory loss, chronic fatigue, brain fog, anxiety, and musculoskeletal disorders. (Read this:Vitamin Deficiency symptoms List)
Vitamin B12 is needed for healthy red blood cells and cognitive excellence, plus it protects the nerve cells from harm. So when vitamin B12 levels plummet, as they often do a few years post-bariatric surgery, patients begin to suffer symptoms of vitamin B12 deficiency that affect memory, mental health, and nervous system integrity.
Bariatric Surgery Causes Malabsorption
In healthy adults, vitamin B12 is broken down in the acidic environment of the stomach. Intrinsic factor, which is released by the parietal cells in the stomach, then binds with vitamin B12 in the duodenum. The bound vitamin B12 is then absorbed in the ileum.
During gastric bypass surgery, however, the portions of the gastrointestinal tract responsible for making intrinsic factor, most of the stomach and duodenum, are bypassed, limiting the breakdown of vitamin B12 and its subsequent binding with intrinsic factor, causing vitamin B12 malabsorption, or the inability to digest vitamin B12 naturally from foods or even pill form.
You cannot absorb enough vitamin B12 to prevent severe vitamin B12 deficiency.
Without the right type of supplementation, your vitamin B12 levels will slowly decline, along with your health.
For patients of bariatric surgery, only very miniscule amounts of vitamin B12 are absorbed through the digestive tract; this true for vitamin B12 food sources and vitamin B12 in a pill form. It doesn’t matter if you swallow a vitamin B12 pill whole or get your vitamin B12 in chewable or liquid form; once you’ve had bariatric surgery, vitamin B12 if ingested via the digestive tract will not be absorbed into the body.
To prevent severe vitamin B12 deficiency in patients of gastric bypass or other bariatric surgery, vitamin B12 supplements that deposit B12 molecules directly into the bloodstream are the only real option. There are several non-oral methods of supplying vitamin B12 that are available by prescription or over the counter.
How much vitamin B12 should I take?
Most vitamin B12 supplements are 1,000mcg. Your doctor may recommend weekly, biweekly, or monthly doses of vitamin B12.
For optimum results in preventing vitamin B12 deficiency, bariatric surgery patients may take as much vitamin B12 as they need to prevent debilitating symptoms, as there is no upper limit for vitamin B12 under FDA guidelines, so no risk of overdosing or experiencing any negative side effects.
Plus, the extra vitamin B12 may help with weight loss, as B12 boosts energy, promotes good metabolism, and sustains healthy mental balance.
Do you have any questions or suggestions? Please leave your comments below.
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Gastric bypass surgery offers the morbidly obese a new lease on life, according to research. Recent studies confirm that people who undergo Roux-en-Y weight loss surgery lose the most weight and keep it off, more so than with gastric banding. But while gastric surgery promises a high success rate, the risk for serious complications is significantly higher than with other kinds of bariatric surgery.
What is gastric bypass surgery?
The Roux-en-Y gastric bypass changes the size of your stomach and reroutes food past certain parts of the digestive system. People who undergo gastric bypass surgery achieve a feeling of fullness much quicker than before the surgery, and are thus able to eat less and lose a considerable amount of weight. However, because gastric bypass is a complicated procedure, many problems may arise during or after the surgery.
With the Roux-en-Y gastric bypass, a small egg-sized stomach sack is created and attached to the middle part of the small intestine.
The rest of the stomach, as well as the upper section of the small intestine, are completely avoided, or “bypassed.”
A common side effect of gastric bypass is gastric bypass dumpingin which food travels through the stomach and empties into the small intestine too quickly, causing symptoms like diarrhea, nausea, and stomach cramps.
Another common side effect is nutritional deficiency, including vitamin B12 deficiency and many other vitamin, calcium, iron, and magnesium deficiencies.
Patients of gastric bypass surgery must supplement with extra vitamins and minerals, with a special emphasis on vitamin B12 supplements, in order to avoid vitamin B12 deficiency symptoms like nerve cell damage and memory problems.
Laparoscopic adjustable gastric banding surgery is the second-most popular form of bariatric surgery after the gastric bypass procedure. Banding is a good alternative for gastric bypass surgery because it is less invasive.
In gastric banding, the surgeon places an adjustable silicon band around the upper part of your stomach, effectively cinching it to a smaller size.
After banding, your stomach can hold only about 1 ounce of food at one time.
The gastric band is adjusted through a saline solution that may be injected through a small device under the skin.
Most people who undergo gastric banding lose approximately 40% of their body weight.
Gastric banding surgery is completely reversible.
The mortality rate due to gastric banding surgery is 1/2000.
Since the small intestine remains intact, gastric banding surgery does not disrupt your digestive system, and there is no risk of vitamin deficiency, such as vitamin B12 deficiency.
With gastric bypass surgery, food rushes through the digestive system, and essential minerals and vitamins pass through without ever being absorbed into the bloodstream. So while you feed your stomach, you are not feeding the rest of the body the nutrients that it needs to survive. Life-long supplementation of vitamins- vitamin A, vitamin C, vitamin E, and B vitamins-, and minerals is a commitment that gastric bypass patients much make.
Your chances of losing weight following gastric banding are 50/50, and there is a fair chance that you will have complications that require a return trip to the operating room. However, banding-related complications are less severe than bypass-related complications, which can be fatal. Then again, if obesity poses a serious life risk, then you might be better off with the most successful weight loss surgery- gastric bypass.
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If you’ve had bariatric surgery (gastric bypass surgery, lap band surgery), then you’re at risk for vitamin B12 deficiency. Weight loss surgery causes vitamin B12 malabsorption, in addition to difficulty absorbing other vitamins and minerals. Learn about vitamin B12 deficiency symptoms, and ways to get your B12 levels back to normal.
How many types of bariatric surgery procedures are there?
There are many types of weight loss surgeries, including gastric bypass and lap band surgery, but there are two general categories:
Malabsorptive surgery rearranges and/or removes part of your intestines so that you are unable to absorb vitamins from foods, thus bypassing the digestive process. There are no longer any strictly 100% malabsorptive weight loss surgeries, but many such as the Roux-en-Ygastric bypass include a combination of (mostly) malabsorptive and restrictive techniques.
Restrictive surgery shrinks your stomach, thus causing you to feel full earlier and avoid overeating. Examples are the gastric sleeve and gastric banding (lap band surgery).
Why do I need to take bariatric vitamins and minerals after having bariatric surgery?
If you’ve had weight loss surgery, then you are at a high risk for vitamin deficiencies, particularly vitamin B12 deficiency. There are two reasons for this:
If you’ve had malabsorptive surgery, such as a mini-gastric bypass or duodenal switch, then your body is unable to digest water-soluble vitamins such as vitamin B12 from food sources.
One of the procedures of malabsorptive bariatric surgery is the removal of the ileum, the part of your small intestine responsible for digesting vitamin B12.
The only way for you to receive enough B12 to avoid vitamin deficiency is to put it directly into your bloodstream, through vitamin B12 shots (Sublingual B12 pills are not your best option for absorbing vitamin B12.)
With restrictive surgery, such as gastric sleeve, your stomach is unable to contain enough food at one time to avoid vitamin deficiency.
What are the symptoms of vitamin B12 deficiency, and why should I be worried?
Vitamin B12 supports many important functions in your body- B12 boosts energy and mental clarity, aids in producing red blood cells, maintains your metabolism, protects your >nervous system, strengthens cognitive functioning, and reduces your risk of heartattack or stroke.
Dumping syndrome is painful and often embarrassing,with strict adherence to a few simple dietary rules, you can avoiding experiencing it in the future.
Here are four basic rules for preventing gastric bypass dumping symptoms:
1) Eat slowly.
Eating or drinking hurriedly is a certain way to cause dumping later.
Because your body no longer has the control mechanism that regulates how quickly food enters your small intestines, it is up to you to make sure that your stomach receives food to digest at a slow, steady pace before sending it on through your gastrointestinal tract.
So eat at a leisurely pace, chew your food carefully, and take small bites.
2)Avoid simple sugars.
Certain foods, such as ice cream, cakes, and cookies (the very things that got you fat in the first place) are likely to cause the unpleasant side effects of dumping, such as dizziness, hypertension, nausea, and diarrhea.
Check food labels, and avoid anything that lists sugar, glucose, or dextrose (or anything ending in –ose) as one of its first three ingredients.
Never drink liquids while eating, as that causes dumping symptoms, like nausea and vomiting.
Always leave a no-drinking window of thirty minutes before and after eating.
Additionally, drinking during a meal will cause you to eat less, which can lead to malnutrition.
To avoid dehydration, remember to drink small sips of water between meals, amounting to 64 ounces per day. Don’t rush- the same rules apply for eating as they do for drinking water.
4) Eat protein with your meals.
Half of your dinner plate should include a source of protein, such as lean beef, chicken, fish, eggs or dairy. Because it takes longer to digest protein, you’re less likely to overeat or eat too quickly.
In addition, protein foods are high in vitamin B12, a nutrient that you should be including in your daily supplements, as well as in your regular diet.
Considering Banding? Don’t Bypass This…More and more of the morbidly obese are turning to weight loss surgery, such asgastric bypass, as a quick-fix solution to weight loss. But is the grass always greener afterbariatric surgery?
As with any invasive surgery, bariatric surgery carries many risks, some of which can be life threatening. Complications may arise during the operation, or even years later. Roughly, 5% of bariatric surgery patients experience complications post operation. In addition, what you assumed would be a one-time stint on the operating table might culminate into a series of necessary follow-up procedures, such as gall bladder removal or treatment for twisted bowels.
Below is a list of complications that sometimes occur after weight loss surgery:
Respiratory disorders, such as sleep apnea or other breathing difficulties may arise.
Leaky gut, leaking of fluids from the intestines or stomach, may require additional surgery.
Infections are a risk with any surgery.
Blood clots are a common complication during surgery that could result in stroke. Patients often wear tight diabetic socks during surgery to avoid developing blood clots.
Bowel obstructions caused by thick scar tissue is rare, but still possible with abdominal surgeries.
Ulcers are another side effect that results from usage of NSAID medication such as ibuprofen.
Gallstones occur after 1/3 of all gastric bypass surgeries. They are extremely painful, and the only way to treat them is to have the gall bladder removed.
Kidney stones are highly correlated with gastric bypass surgery.
Twisted bowels or internal hernias occur when intestines become dislodged during or after surgery. It is rare, but deadly: the chances of survival are 60%.
Vitamin B12 deficiency often results when bariatric surgery patients neglect to supplement with vitamin B12. Symptoms of vitamin B12 deficiency include chronic fatigue, depression, numbness, or tingling in hands and feet, altered taste perception, and brain fog, among many others.
Candyland to Bandyland “Women are Angels…And when someone breaks their wings, They simply continue to fly….on a broomstick…They are flexible like that…”
Carrie’s Gastric Bypass Journey“Follow me on a life changing journey. The gastric bypass surgery on March 20, 2006 will change my life forever…hopefully for the better. Follow me from fat and unhealthy to thin and fit.”
Diminishing Dawn“This page begins with some general information and then turns into my story detailing every part of my surgery from start to finish.It covers the decision to go the WLS route, to how to apply for surgery to be paid through OHIP, to pre op, surgery and post op.”
Losing Weight and Changing Habits“How did I wake up one day to find myself at 286 pounds and completely miserable in my own body? It happened, I can’t blame anyone but me…”
Miles To Go “This blog is named “Miles To Go” in honor of my surgeon, Dr. David Miles. I hope this conveys my gratitude to Dr. Miles and his staff at Miles Surgical for giving me the opportunity to have many more ‘miles to go’.”
Stressed spelled backwards is desserts… ?! “I’m a 23 year old college student. I was happily banded on April 7, 2010. It’s the BEST thing I’ve ever done for myself. This journey is rocky, but I love every bit of it!”
Trying to stay Skinny in Texas “A blog about my journey after lap band surgery and my quest to keep the weight off . As well as everything life throws at me in between!”
That Fat Chick “This blog has chronicled my journey from when I first made the decision to have weight loss surgery — back in 2008 — to when I had it — 2009 — and how my weight and life have changed since then.”
Malissa Jones, once nicknamed “Britain’s fattest teen” is now quite possibly Britain’s skinniest…and unhappiest teen, following gastric bypass surgery.
Lose weight now, she was told, or your life is at stake
At the age of 16, Ms. Jones was warned by her doctor that she would have only months to live, unless she lost weight. Morbidly obese, Malissa weighed in at 34 stone. (In American-speak, that’s 476 pounds.) Having already had a mild heart attack a year earlier, Malissa was told to lose 280 pounds, lest the next heart attack be her last.
Her diet consisted of mainly junk food like chocolate and potato chips. At 5’8, Malissa consumed about 15,000 calories a day, more than 7 times the amount recommended for a girl of her age with her build. Malissa had all the symptoms of obesity; she suffered from angina, a cardiovascular disease normally associated with old age, at the tender age of 15. At nighttime she was forced to wear an oxygen mask, because doctors warned that her heart and lungs couldn’t withstand the force of her weight while she was lying down.
In 2008, at the age of 17, Malissa Jones made headlines when she became the youngest person ever in the UK to receive gastric bypass surgery, of which the cut-off age is generally 18. The $20,000 NHS funded operation entailed stapling her stomach to a significantly smaller size and “bypassing” her digestive system so as to limit food absorption. For this reason, gastric bypass patients are unable to digest vitamins such as B12 from food sources, and must submit to a lifetime of vitamin supplements in order to prevent severe vitamin B12 deficiency.
The surgery was a success, at least at first. Two years post surgery, Malissa had lost half her body weight, although she still carried about 28 pounds of loose, excess flabby skin, a side effect which causes quite a bit of dismay among bariatric surgery patients.
“I’m too thin. My body shocks me. But swallowing is painful.
Eating a tiny amount gives me stomach cramps or makes me sick,” admits Malissa.
At the age of 20 she became pregnant. Doctors were concerned that her newly stapled stomach might rupture from the weight of the baby’s womb; at six months Malissa suffered liver failure, so she was forced to have a Cesarean birth. Her baby boy, named Harry, died only one hour after surgery of malnutrition. During her pregnancy, and likely as a result of her weight loss surgery, she was not physically able to eat enough food to support herself and the baby. Malissa was devastated.
Today, Malissa once again battles for her life, only now her enemy is anorexia nervosa
Now, Malissa is 21-years-old and weighs a mere 112 pounds. Diagnosed with anorexia nervosa, she admits that she has food phobia, and that eating makes her feel physically ill. Sometimes, she says, she would rather die than make herself eat. ”I’m too thin. My body shocks me. But swallowing is painful. Eating a tiny amount gives me stomach cramps or makes me sick,” admits Malissa.
Her regular daily diet consists of 3 cooked carrots, some turnips, and a roast potato, amounting to 300 calories, although she was advised to consume between 500 and 1,000 calories per day. Once again, Malissa is told that because of her weight she will likely die of a heart attack within months, only now the challenge is to eat enough to keep her alive.
Too late for regrets
In an interview from 2009, Malissa admits that she wishes she had never had the gastric bypass surgery, and that she liked her body better before when she was fat. The cost for excessive skin removal is $33,000, more than this 21-year-old, who had to quit her job because of disability caused by anorexia, can afford to save up. While the NHS agreed to pay for her $20,00 weight loss surgery, they have not agreed to fund the plastic surgery required to remove the scarred, wrinkled, overhanging skin which typically results from rapid weight loss.
“At least it was firm and curvy, not droopy and saggy,” she says. “I had nice firm arms – now the skin just hangs and I have to cover them up because they look so awful.”
In addition to suffering anorexia, Malissa has chronic depression, for which she takes antidepressants; she also suffers gastrointestinal diseases, chronic fatigue and low immunity. Because she is not able to follow a healthy nutritious diet, her immune system has been severely compromised, leaving her at risk for infections.
On a final note, Malissa has this to say to any obese individuals considering gastric bypass surgery:
“I wish I’d lost the weight through exercise and healthy eating. I know this operation was life-saving, but the complications I’m suffering now might still kill me. The truth is I feel I’m no better off than I was before.”
For more information on some of the risks involved with gastric bypass surgery, please read:
Gastric bypass surgery, along with other forms of weight loss surgery (WSL), can be a life saving option for the morbidly obese, but it does have its drawbacks. Teens and adults alike risk losing bone mass and getting severe vitamin B12 deficiency or pernicious anemia, to name just a few potentially harmful side effects.
To the yo-yo dieter, the decision to undergo gastric bypass surgery might seem like that “golden ticket” she’s been searching for all her life, but the post-op reality is often far from the Cinderella-like fantasy she’s been indulging in.
Here are 10 mistakes often made by gastric bypass patients which you should know about before electing for bariatric surgery:
Mistake #1: Not taking your vitamins!
Gastric bypass patients are given a medication to inhibit the production of stomach acids which are essential for digesting vitamins such as vitamin B12. Often in the case that a doctor releases his weight loss surgery patient with the ill advise to take a daily chewable multivitamin, such as the type given to children. The reality is, if you decide to go under the knife for weight loss surgery, expect to make a lifelong commitment to taking a heap of WLS-approved chewable vitamins every day in order to prevent vitamin deficiency, anemia, neurological damage and, in extreme cases, death.
Mistake #2: Thinking your struggles with food are over!
Nothing could be further from the truth; the body may have gotten slimmer, but your brain still longs for the good old days of binge eating. Behavior modification and counseling is crucial for successful weight loss, whether you’ve lost the weight naturally or on the surgeon’s table.
Mistake #3: Thinking you will be slim and trim!
Weight loss surgery patients do lose an immense amount of weight, as promised, but don’t expect to look like Pamela Anderson anytime soon; the reality is, many gastric bypass patients don’t reach their intended goal, nor do they necessarily keep all of the weight off. And remember, all that excess skin doesn’t just shrink back into your body; weight loss surgery patients often resort to plastic surgery, either for cosmetic or health reasons, to have a tummy tuck, arm skin flaps (batwings) removed or facial skin tightened.
Mistake #4: Eating unhealthy foods
Just because you can no longer fit a triple-decker cheeseburger and fries into your now petite stomach doesn’t mean you should try. Weight loss surgery patients are often faced with the difficult challenge of choosing food wisely at parties, evenings out and other situations where the sky is the limit.
Mistake #5: Not staying hydrated!
Bariatric surgery patients run a serious risk of dehydration if they don’t drink 8 servings of water per day. Additionally, water is crucial for avoiding kidney stones or gall stones, an excruciatingly painful and common side effect of many weight loss surgeries.
Mistake #6: Snacking!
Gastric bypass surgery is effective because it prevents you from fitting a large amount of food in you tummy at one time; resist the impulse to consume small mini-snacks throughout the day, lest you find yourself back in your pre-surgery body.
Mistake #7: Not exercising!
Alas, it amounts to this: aerobic exercise and weight training are that unavoidable truth lurking behind every weight loss goal, and bariatric surgery patients are not exempt. Physical exercise increases muscle, improves circulation, burns calories, provides energy and fights depression.
Mistake #8: Eating bad carbs!
Even small amounts of refined sugars and flours can put on the pounds. Avoid white rice, starchy bread rolls and sticky sweets in favor of brown rice or barley, whole-grain breads or crackers and fresh fruits of the season.
Mistake #9: Drinking carbonated beverages!
Weight loss surgery patients are advised to avoid diet sodas and other bubbly drinks; many believe that they can inflate stomach pouch, reversing the effects of the surgery.
Mistake #10: Drinking alcoholic beverages!
Recent reports suggest that post-surgery, many gastric bypass patients develop a sensitivity to alcohol. Doctors recommend holding off on alcohol for at least one year after having any type of weight loss surgery.