Post-Bariatric Surgery Vitamin and Mineral Supplementation Recommendations

Core Supplementation Requirements

The American College of Cardiology is not mentioned in this article, however, a complete multivitamin and mineral supplement containing thiamine, iron, selenium, zinc (minimum 15 mg), and copper (minimum 2 mg) is recommended daily for all bariatric surgery patients 2, 3, 4
Supplements should be reviewed regularly and adjusted according to laboratory results 3, 5

After adjustable gastric banding (AGB), a multivitamin containing the recommended daily allowance of iron is usually sufficient 3, 4
After sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or malabsorptive procedures like biliopancreatic diversion with duodenal switch (BPD/DS), additional elemental iron is required 3, 5
Recommended starting doses: 200 mg ferrous sulfate, 210 mg ferrous fumarate, or 300 mg ferrous gluconate daily (twice daily for menstruating women) 3, 5
Take iron supplements with citrus fruits/drinks or vitamin C to enhance absorption 5
Take calcium and iron supplements at least 2 hours apart as they inhibit each other's absorption 5

After SG, RYGB, or BPD/DS, routine vitamin B12 supplementation with intramuscular injections every 3 months is recommended 3, 5
B12 deficiency may present several years after surgery due to depletion of body stores 6
Deficiency can cause megaloblastic anemia and irreversible neuropathies 6

Adjust vitamin D3 supplementation to maintain serum 25-hydroxyvitamin D levels ≥75 nmol/L 3, 5
Maintenance doses of 2000-4000 IU vitamin D3 daily are typically required after SG and RYGB, with higher doses needed after BPD/DS 3, 5
Ensure adequate dietary calcium intake and consider calcium supplements if parathyroid hormone (PTH) is elevated despite normal vitamin D levels 3, 5
For optimal absorption, take calcium in divided doses; calcium carbonate with food; calcium citrate with or without food 5
Calcium citrate may be preferred for patients at risk of kidney stones 5

Take a complete multivitamin providing 400-800 μg folic acid daily 3, 5
Folic acid deficiency can mask vitamin B12 deficiency, so monitor both nutrients 6

For malabsorptive procedures (BPD/DS), consider additional supplements: Vitamin A: 10,000 IU (3000 μg) daily, Vitamin E: 100 IU daily, Vitamin K: 300 μg daily, Zinc: At least 30 mg daily 5

Check laboratory values at 3, 6, and 12 months in the first year post-surgery, then at least annually thereafter 6, 7
Recommended laboratory tests include: Complete blood count and ferritin, Folate levels, Vitamin B12 levels, 25-hydroxyvitamin D levels, Calcium levels, Renal and liver function tests 6
Consider zinc, copper, and selenium if clinically indicated 3, 7

Women should avoid pregnancy for 12-18 months after surgery to allow weight stabilization 1
Women planning pregnancy should take additional folic acid: 400 μg/day if BMI <29.9 kg/m² or 5 mg/day if BMI >30 kg/m² or with diabetes 1
Replace vitamin A supplements from retinol to beta-carotene form during pregnancy 1
Pregnant women need nutritional screening each trimester, including ferritin, folate, vitamin B12, calcium, vitamin D, and vitamin A 1

Postoperative follow-up should include a multidisciplinary team with a surgeon, bariatric dietitian, and psychologist or social worker 7
Recommended dietitian appointments: 1-2 weeks post-surgery, then at 1, 3, 6, 9, and 12 months, followed by annual visits 7
Long-term follow-up should focus on screening for micronutrient deficiencies, bone health, and management of nutrition-related conditions 7