Gastric Bypass Surgery and Nutrient Deficiency

By Dr. Molly Brass, ND Licensed Naturopathic Doctor 03 Jan 2019

Gastric Bypass Surgery and Nutrient Deficiency

Gastric bypass surgery for obesity increases the risk of nutrient deficiencies1,2. This operation makes the stomach smaller, so that less food can be eaten and bypasses part of the intestine, so that less absorption can occur. These surgical modifications result in weight loss, but also impair nutrient absorption.

B vitamin deficiencies can develop after this procedure and, if not addressed, may lead to serious and even irreversible damage3. The complex of B vitamins is critical for many aspects of health including the functioning of the nervous system, the building of blood cells, the maintenance of DNA, and the harnessing of energy from food.

Researchers have found deficiencies of vitamins B1 (thiamine), B2 (riboflavin), B6 (pyridoxine), B9 (folate), and B12 (cobalamin) in gastric bypass recipients2,4,5. Signs and symptoms include anemia, fatigue, impaired cognition, mood changes, numbness, tingling, burning hands and feet, muscle weakness, and abnormal gait. Beri-beri and Wernicke-Korsakoff syndrome, diseases resulting from severe thiamine deficiency, have appeared in patients after gastric bypass surgery6,7.

After surgery, gastric bypass recipients should be routinely monitored for nutrient deficiencies and confirm with their doctor that their supplement regimen includes adequate amounts of the B vitamins8.

1. Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Seminars in Nephrology. 2013;Jan:33(1):75-89.

2. Stroh C, Manger T, Benedix F. Metabolic surgery and nutritional deficiencies. Minerva Chirurgica. 2017;Oct:72(5):432-441.

3. Punchai S, Hanipah ZN, Meister KM, Schauer PR, Breslauer SA, Aminian A. Neurologic Manifestations of Vitamin B Deficiency after Bariatric Surgery. Obesity Surgery. 2017;Aug:27(8):2079-2082.

4. Clements RH, Katasani VG, Palepu R, Leeth RR, Leath TD, Roy BP, Vickers SM. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. The American Surgeon. 2006;72:1196–1202; discussion 1203–1204.

5. Bordalo LA, Teixeira TFS, Bressan J, Mourão DM. Bariatric surgery: how and why to supplement. Revista da Associação Médica Brasileira. 2011;Jan-Feb 57(1):113-120.

6. Arnadottir LO, Sigurbjornsson S, Gudbjartsson T. Beriberi 10 years after gastric bypass surgery - case report. Laeknagladid. 2016;Nov:102(11):497-499.

7. Carvajal T, Franco DL, Martinez A, Peña IM. Wernicke’s encephalopathy and polyneuropathy associated with vitamin B complex deficiency after a bariatric surgery. Biomedica. 2012;Oct-Dec:32(4):474-484.

8. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;Nov-Dec:26(11-12):1031-1037.