The Vitamin D and Calcium Balance

When bariatric surgery is performed in centers that measure long-term results, most patients are found to have little risk of developing significant mineral or vitamin deficiencies if they follow the nutritional and supplement guidelines. The two main procedures performed worldwide are the gastric Sleeve and Gastric Bypass result in significantly weight loss, around 75% of excess weight, but carry some risk for developing nutritional deficiencies if you don’t follow a healthy diet and don’t take your vitamin and mineral supplements as directed.

The fact is, however, many patients struggling to lose weight are already deficient in Vitamin D and other nutrients before they have surgery. Vitamin D is important in absorption of calcium and is also important in maintaining a healthy amount of calcium in your bones. After surgery, adequate intake of calcium is important. Foods with high calcium content include milk, cheese, cottage cheese, yogurt, broccoli, tofu, greens and eggs. These healthy foods should make up a part of the weekly diet for all patients.

As an additional precaution, all gastric bypass and gastric sleeve patients should take between 2,000 and 5,000 IU (International Units), or about 100 micrograms of supplemental Vitamin D per day. In addition, Dr. Q recommends patients take 1000-to-2000 mg of supplemental calcium daily. This can be in the form of calcium carbonate (such as TUMS®), or calcium citrate. Calcium citrate has better absorption than calcium carbonate and may be advantageous for people who have had kidney stones in the past.

Calcium deficiency can result in osteoporosis and osteopenia — or weakening of the bones.  Although most patients after a gastric bypass will not develop calcium deficiency, the change in calcium absorption is unpredictable, so all patients should have their calcium levels evaluated annually.

Numerous studies have shown that successful weight loss after bariatric surgery improves arthritis and decreases joint pain. Patients should support these positive results through careful attention to nutrition and appropriate Vitamin D and Calcium supplementation.