Article By: Jessi Beaven, Dietetic Intern
Co-Author: Rachel Ignomirello, MS, RDN, CSOWM, LDN
Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.
Of the 13 vitamins, vitamins A, D, E, and K are the only fat-soluble vitamins, which means they are absorbed by the body with some intake of dietary fat and are stored in the liver and fat cells. Vitamins A and E cannot be made within the body, making them essential to consume through diet.
1) Vitamin A. Sources of vitamin A include egg yolks, fish oils, yellow and orange vegetables, and dark leafy greens. This vitamin is also fortified as retinol in foods like cereal, juices, and alternative dairy. Vitamin A is important for maintaining good vision, strong immune function, and overall reproductive health.
2) Vitamin D. Food sources of vitamin D include fish-liver oil, fatty fish, mushrooms, egg yolks, and fortified foods like orange juice and breakfast cereals. Intake of vitamin D is important for maintaining bone integrity and for calcium absorption.
3) Vitamin E. Vitamin E can be found in foods like nuts, seeds, vegetable oils, dark leafy greens, and cereal grains. Vitamin E is an antioxidant that protects cells and tissues from free radical damage.
4) Vitamin K. Small amounts of vitamin K are synthesized in the colon. Vitamin K is found in dark green vegetables like broccoli, kale, and soybeans and is required for developing blood clotting factors that help the body repair injuries, especially at the skin.
Without enough intake of fat-soluble vitamins, people are more likely to feel fatigued, struggle to see in low light, and have a harder time fighting off infections.
5) Bariatric surgery types and nutrient deficiencies. People with obesity have a higher rate of pre-existing nutritional deficiencies. Following bariatric surgery, a crucial step in the journey is maintaining a strict vitamin regimen to prevent post-op nutrient deficiencies.
The vertical sleeve gastrectomy (VSG) is a restrictive procedure where around 80% of the stomach is removed. The Roux-en-Y gastric bypass (RYGB) is a restrictive and malabsorptive procedure where the stomach size is reduced, and the upper part of the small intestine (the duodenum) is bypassed. Most micronutrients are absorbed in the duodenum and in the next part of the small intestine (the jejunum).
For many patients, nutrient absorption is hindered at the beginning post-op stages. Patients may be more prone to nausea, vomiting, and food intolerances. Due to the reduction of stomach size, meal portions are also significantly smaller.
6) Bariatric multivitamins for life. All WLS patients must take bariatric multivitamins for the rest of their lives to meet their needs. Food alone is insufficient to meet micronutrient requirements, and standard OTC multivitamins are not formulated to match bariatric needs.
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7) Duodenal Switch (DS) and ADEK supplementation. In addition to the VSG and the RYGB, there is also the Duodenal Switch (DS) procedure. With DS, the stomach is made into a sleeve pouch, and more of the small intestine is bypassed. This procedure promotes more macronutrient malabsorption, which includes carbohydrates, fats, and protein. The difference in malabsorption is due to the new location of the small intestine. The DS procedure bypasses the jejunum, where lipids (fats) are usually absorbed. Because of that fat malabsorption, DS patients need additional supplementation of the fat-soluble vitamins: vitamins A, D, E, and K.
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BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.