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Weight Loss Surgery Supplements

June 11, 2012 Written by JP       [Font too small?]

For better or for worse, bariatric or weight loss surgery has been become a mainstay in modern medicine. Obesity and related health conditions, including diabetes and heart disease, are on the rise and more and more physicians are recommending gastric bypass as a last ditch solution. Given this reality, I’ve researched this topic thoroughly with the knowledge that I’d likely be working with quite a few bariatric clients as part of my consultation service. Today, I’d like to share some of findings I’ve encountered along the way.

More often than not, there’s a considerable difference between what doctors recommend and what I’ve learned. Typically, there is some common ground. In the field bariatric medicine, this means testing for nutrient deficiencies and supplementing accordingly. However, many physicians are unaware of certain lesser known supplements that may be of particular benefit. That’s where I come in. I put together a packet of evidence-based information for patients and physicians to discuss together. And, when there’s willingness to try out some of the options I suggest, the results are frequently a pleasant surprise for all parties involved.

When it comes to nutritional support for bariatric surgery, I’ve learned the following: 1) Ironically, many supplements that are marketed for weight loss patients are not the best options. The primary reason is that the nutrients contained in these supplements are rarely provided in highly bioavailable forms or optimal dosages. 2) Encapsulated supplements tend to be more effective than chewable wafers, softgels or tablets. Why? I suspect it’s because capsules often contain fewer extraneous ingredients and higher concentrations of nutrients. 3) Taking supplements in conjunction with fatty foods or supplements seems to enhance absorption of fat soluble nutrients including Vitamins A, D, E and K. This latter point may seem obvious, but since many bariatric supplements come in fat-free chewable or powdered forms, it bears repeating.

In particular, there are three supplements that are rarely used by allopathic physicians treating bariatric patients. The first is emulsified fish oil, a source of omega 3 fatty acids that is combined with ingredients such as lecithin to render it easier to digest. It’s well established that gastric bypass surgery affects the assimilation of dietary fats. This same surgery can negatively impact the availability of certain medications such as antidepressants. Supplementing with emulsified fish oil, as is found in products such as Coromega or Barlean’s Omega Swirl, assists the absorption of mood elevating omega 3 fatty acids. The addition of magnesium and potassium citrate, likewise, serves a specific purpose for those who’ve undergone weight loss procedures: it helps minimize the risk of kidney stones, while simultaneously contributing well absorbed forms of two frequently deficient minerals. Last, but not least, is whey protein isolate. Maintaining optimal protein status is vital to the preservation of lean body mass during any period of significant weight loss. Consuming protein from healthy dietary sources such as chicken, eggs, fish and grass fed meat is the premier way of ensuring adequate amino acid intake. However, when diet isn’t enough, whey protein powder is perhaps the best alternative because of its high protein efficiency ratio (PER).

In closing, I want to mention something that is unlikely to come up in standard medical consultations. An issue that affects a fair share of bariatric patients is hair loss or thinning. Ensuring adequate nutrient and protein intake is the first line approach to addressing this prevalent concern. Still, this isn’t always enough. In such instances, some clients have reported positive changes in hair growth when high dosages of biotin (a B vitamin) and Biosil (a form of the trace mineral silica) are incorporated into a comprehensive dietary protocol. In terms of dosage, biotin is often used in a daily dose of 5 to 10 mg/day and Biosil at 10 mg/day. Both supplements are generally regarded as safe, and may even support other aspects of appearance and health, including nail and skin integrity.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - The Effect of Gastric Bypass on the Pharmacokinetics of Serotonin (link)

Study 2 - Omega-3 Fatty Acid Augmentation of Citalopram Treatment for Patients (link)

Study 3 - Fat Malabsorption and Increased Intestinal Oxalate Absorption are (link)

Study 4 - Meta-Analysis of the Effects of Eicosapentaenoic Acid (EPA) in Clinical (link)

Study 5 - Hypocitraturia and Hyperoxaluria After Roux-en-Y Gastric Bypass (link)

Study 6 – Reduction of Renal Stone Risk by Potassium-Magnesium Citrate (link)

Study 7 - Effects of Whey Protein Supplements on Metabolism: Evidence from (link)

Study 8 - Protein Intake Compliance of Morbidly Obese Patients Undergoing (link)

Study 9 – Hair Loss in Long-Term or Home Parenteral Nutrition: Are Micronutrient (link)

Study 10 - Effect of Oral Intake of Choline-Stabilized Orthosilicic Acid on Skin (link)

Gastric Bypass Surgery May Affect Drug Absorption

Source: Diabetes Care. 2011 June; 34(6): 1295–1300. (link)

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5 Comments & Updates to “Weight Loss Surgery Supplements”

  1. JP Says:

    Note: Probiotics are another class of supplements that can be useful for bariatric patients. Please check out the following study:

    http://www.springerlink.com/content/m21j21645701k911/

    Be well!

    JP

  2. JP Says:

    Updated 10/27/15:

    http://www.soard.org/article/S1550-7289%2815%2900297-X/abstract

    Surg Obes Relat Dis. 2015 Jul 18.

    Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial.

    BACKGROUND: Gastric bypass surgery is the recommended treatment for severely obese patients. However, postoperative symptomatic gastrointestinal (GI) episodes are common complaints.

    OBJECTIVES: To determine if administration of probiotics improves symptomatic GI episodes after gastric bypass surgery.

    SETTING: Hospital-based bariatric center.

    METHODS: This double-blind, randomized trial was conducted between March 2010 and September 2010 with 60 patients who underwent gastric bypass for severe obesity and experienced postoperative symptomatic GI episodes. Patients were randomly assigned to the probiotics group A (n = 20; 1 g Clostridium butyricum MIYAIRI twice daily); probiotics group B (n = 20; Bifidobacterium longum BB536 twice daily); or digestive enzymes group (n = 20; Aczym, containing 100 mg takadiastase N, 20 mg cellulase AP, 50 mg lipase MY, and 100 mg pancreatin, twice daily). Quality of life was measured using the modified Gastrointestinal Quality of Life Index (mGIQLI) before and after the 2-week intervention.

    RESULTS: Preintervention patient characteristics and mGIQLI scores were similar among the 3 groups. After the 2-week intervention, the mean mGIQLI score improved from 57.4 to 63.9 points in the entire sample and also within each group for 7 items specifically for 7: excessive passage of gas, foul smell of flatulence, belching, heartburn, abdominal noises, abdominal bloating, and abdominal pain.

    CONCLUSIONS: Administration of probiotics or digestive enzymes may improve symptomatic GI episodes after gastric bypass surgeries and improve quality of life, at least initially.

    Be well!

    JP

  3. JP Says:

    Updated 07/04/18:

    https://www.ncbi.nlm.nih.gov/pubmed/29968187

    Obes Surg. 2018 Jul 2.

    Changes in Bone Mineral Density Following Weight Loss Induced by One-Anastomosis Gastric Bypass in Patients with Vitamin D Supplementation.

    BACKGROUND: Little is known about changes in bone mineral density (BMD) following weight loss after one-anastomosis gastric bypass (OAGB) and the role of serum vitamin D and its supplementation on bone metabolism. We evaluated BMD after OAGB as a function of vitamin D supplementation with respect to a minimum threshold of 25-hydroxy-vitamin-D [25(OH)D] concentration, which could prevent or decelerate an eventual bone loss.

    METHODS: Fifty bariatric patients who participated in the randomized controlled trial were included in this analysis. BMD and anthropometric measurements by DXA and laboratory parameters were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery.

    RESULTS: OAGB resulted in a 36% total body weight loss with a decrease in body fat and an increase in lean body mass. A significant decrease in BMD was seen in lumbar spine by 7%, left hip 13%, and total body 1%, but not in forearm. Bone turnover markers increased significantly but with normal parathyroid hormone concentrations. Weight loss was not associated with changes in BMD. A serum 25(OH)D concentration > 50 nmol/l at T6 and T12 (adequate-vitamin-D-group; AVD) showed a significant lower bone loss, compared to the inadequate-vitamin-D-group (IVD; < 50 nmol/l). Lower bone loss in the left hip showed a strong correlation with higher 25(OH)D concentrations (r = 0.635, p = 0.003).

    CONCLUSION: These findings support a dose effect of vitamin D supplementation on bone health and suggest that 25(OH)D concentrations need to be above 50 nmol/l at least during the first postoperative year to decelerate bone loss in patients undergoing OAGB.

    Be well!

    JP

  4. JP Says:

    Updated 07/09/18:

    https://academic.oup.com/ajcn/article-abstract/108/1/6/5042718?redirectedFrom=fulltext

    Am J Clin Nutr. 2018 Jul 1;108(1):6-12.

    Efficacy of oral compared with intramuscular vitamin B-12 supplementation after Roux-en-Y gastric bypass: a randomized controlled trial.

    Background: After Roux-en-Y gastric bypass (RYGB), patients often develop a vitamin B-12 deficiency.

    Objective: Our objective was to investigate whether oral supplementation increases and normalizes low vitamin B-12 concentrations (vitamin B-12 > 200 pmol/L) in RYGB patients as compared to intramuscular injections.

    Design: A randomized controlled trial in RYGB patients with subnormal serum B-12 concentrations was performed. One group (IM B-12) received bimonthly intramuscular hydroxocobalamin injections (2000 µg as loading dose and 1000 µg at follow-up) for 6 mo. The second group (oral B-12) received daily doses of oral methylcobalamin (1000 µg). Serum vitamin B-12 was determined at baseline (T0) and at 2 (T1), 4 (T2), and 6 mo (T3) after start of treatment. Concentrations of the secondary markers methylmalonic acid (MMA) and homocysteine (Hcy) were measured at T0 and T3.

    Results: Fifty patients were included and randomized, 27 in IM B-12 and 23 in oral B-12. The median vitamin B-12 concentration at T0 was 175 pmol/L (range: 114-196 pmol/L) for IM B-12 and 167 pmol/L (range: 129-199 pmol/L) for oral B-12. Vitamin B-12 normalized in all individuals, and there was no significant difference in vitamin B-12 between the two groups. MMA and Hcy concentrations decreased significantly after 6 mo within each group (P < 0.001 and P < 0.001 for MMA and P = 0.03 and P = 0.045 for Hcy, respectively). There was no significant difference between the groups at 6 mo for both MMA and Hcy (P = 0.53 and P = 0.79).

    Conclusion: The efficacy of oral vitamin B-12 supplementation was similar to that of hydroxocobalamin injections in the present study. Oral supplementation can be used as an alternative to hydroxocobalamin injections to treat RYGB patients with low values of serum vitamin B-12.

    Be well!

    JP

  5. JP Says:

    Updated 03/09/19:

    https://academic.oup.com/ajcn/advance-article-abstract/doi/10.1093/ajcn/nqy310/5280996?

    Am J Clin Nutr. 2019 Jan 9.

    Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery.

    Background: Postprandial hypoglycemia is a risk after Roux-en-Y gastric bypass (RYGB).

    Objectives: We speculated that a carbohydrate-reduced, high-protein (CRHP) diet might reduce the risk of hypoglycemia and therefore compared the acute effects of a conventionally recommended (CR) diet and CRHP diet [55/30 energy percent (E%) carbohydrate and 15/30 E% protein, respectively] in RYGB patients.

    Methods: Ten individuals (2 males, 8 females, mean ± SD age 47 ± 7 y; stable body mass index 31 ± 6 kg/m2; 6 ± 3 y post-RYGB) with recurrent postprandial hypoglycemia documented by plasma glucose (PG) ≤3.4 mmol/L were examined on 2 d with isoenergetic CRHP or CR diets comprising a breakfast and subsequent lunch meal.

    Results: Peak PG was significantly reduced on the CRHP diet after breakfast and lunch by 11% and 31% compared with the CR diet. Nadir PG increased significantly on CRHP (by 13% and 9%). Insulin secretion was reduced, and glucagon secretion increased on the CRHP diet after both meals. Glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide secretion were lower after lunch but unaltered after breakfast on CRHP; β-cell function and insulin clearance were unchanged.

    Conclusions: The CRHP diet lowered glucose excursions and reduced insulin secretion and incretin hormone responses, but enhanced glucagon responses compared with the CR diet. Taken together, the results may explain the decreased glucose variability and lower risk of postprandial hypoglycemia.

    Be well!

    JP

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