Bariatric Medicine 

Bariatric Medicine
The American Society for Metabolic and Bariatric Surgery estimates that there are about 1.5 million bariatric patients in this country. While there are several different procedures, they all reduce the amount of food and nutrients ingested.  Bariatric patients can be more susceptible to certain disease states and individual nutrient deficiencies including anemias, metabolic bone disease, neurological disorders, protein-calorie malnutrition, and micronutrient deficiencies.  It is therefore imperative that bariatric patients routinely monitor their nutritional status.  Doc will help you take control of your health by monitoring your labs. To order:

  • Choose between the Bariatric Panel (sleeve or bypass) or the Bariatric Panel Plus (duodenal switch or revision)
  • Select the preferred lab draw location.  Quest and Lab Corp both offer lab draw scheduling for added convenience.   
  • Doc will then send an electronic lab request to your lab and email a copy of the request to you as well. 
  • Once the results are available, Doc will send you personalized recommendations based upon your results. 

Vitamin Supplementation
Bariatric patients can be overwhelmed by the seemingly limitless vitamin and supplement options available.  While many products claim to be the best, ultimately the best vitamin is one that a patient can take on a consistent basis.  Doc recommends that a patient selects a vitamin that they can tolerate, then do labs to measure the effectiveness of the treatment.  So, for example, a patient selects a particular multivitamin, then has labs drawn a few weeks later to identify if deficiencies are identified.  If deficiencies are identified then the patient has the option of additional supplementation to address the deficiencies, or they may elect to choose another multivitamin. Once it is determined that the vitamin supplement regimen is adequate, then lab testing can be done at longer intervals to monitor.  

When navigating through the many options please keep the following in mind:

Multivitamin.  There are many available options, however, the absolute best vitamin is the one you will continue to take on a regular basis. If the best vitamin in terms of content tastes bad then, in time, you will stop taking it. Better to take a vitamin you can tolerate and then do additional supplementation as needed.

Vitamin B12.  The least effective route for absorption of Vitamin B12 is taking on an oral supplement.  Sublingual (under the tongue), nasal spray, transdermal patch, and intramuscular injections are better alternatives.

Vitamin D.    As a fat-soluble vitamin the absorption of Vitamin D is significantly reduced in gastric bypass (RNY), revision and duodenal switch (DS) patients.  If you are experiencing difficultly attaining adequate blood levels you may consider Vitamin D in the transdermal patch or the “dry”  oral supplement formulation. 

Calcium.    Calcium citrate is the preferred form of calcium because it is absorbed much better than calcium carbonate.  Taking calcium within two hours of taking iron will reduce the absorption of both.  

Iron.   Iron is available in many effective forms such as chewable, liquid, pill and transdermal.  The addition of vitamin C enhances the absorption. As noted above, do not take within 2 hours of taking Calcium.

Thiamine.    Thiamine or Vitamin B1 should be adequate with your multivitamin.  However, if you are found to be deficient, this water-soluble vitamin may be supplemented with an oral pill or a transdermal patch. 

As already mentioned, there is not one perfect vitamin choice for every patient.  However, a transdermal patch appears to be the best alternative for most patients.  Doc recommends a company called Patch MD ( www.patchmd.com). 

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