Importance of supplementation after MBS

The number of people undergoing metabolic and bariatric surgery (MBS) procedures globally has steadily increased, allowing people to not only lose weight but reverse certain chronic conditions.1 Along with these health benefits, however, is the real possibility of an increased risk for nutrient deficiencies as patients progress from surgery.2 In fact, research has established that as patients progress from surgery, adherence to their providers’ recommendations drops.3 Follow-up visits, routine lab work, and daily supplementation are expected behaviors for persons planning to undergo these types of procedures; failure to comply puts one at risk for nutritional deficiencies that can lead to irreversible conditions.4 While the incidence of surgical complications has dropped significantly over the years (despite the continued prevalence of these procedures), the unfortunate reality is that postop nutrient deficiencies have actually increased.5

The good news is that nutrient deficiencies can be prevented, as research indicates that patients who comply lifelong with standard recommendations may decrease their risk of developing a nutrition- related deficiency. Compliance helps improve nutrition outcomes and reduce the risk for conditions that result from long-term nutrient deficiencies.

Daily supplementation matters because postoperative nutrient deficiencies can impact blood, bone, muscle, and neurological health. Without routine bloodwork, patients may not know that they are deficient or at risk for becoming deficient—deficiencies do not always manifest as physical symptoms! In some instances, this does happen; take thiamin, for example—a deficiency in that vitamin can manifest as vomiting. However, not every nutrient has a distinctive sign or symptom that indicates deficiency, so people, regardless of whether they have undergone MBS, may never suspect any type of deficiency unless they get blood work done. This speaks to the importance of routine nutrient testing to optimize health outcomes and reduce the risk for the conditions described below in four key areas:

Blood health: Anemias may be induced by nutrient inadequacies beyond just iron.6  Anemia is characterized by red blood cell or hemoglobin deficiency in blood.

Bone health: Bone disorders and fractures may develop over time as a result of inadequate nutrient intake or malabsorption. Calcium is stored in bones, and when the body demands this mineral, it is pulled from bone if it is not provided by the diet or supplementation, making bones brittle and weaker.

Muscle health: Loss of lean muscle is a postoperative risk due to inadequate protein intake, and this induces unfavorable changes in body composition (proportion of fat to muscle). Another impact of inadequate protein is reduced weight loss, and studies show that patients who consume low protein lose more fat free mass compared to those whose intake is adequate.7

Neurological health: Neurological disorders may be induced by nutrient deficiencies particularly in persons who have undergone MBS;8 these conditions impact the nerves and ultimately, organ function.

Staying ahead of micronutrient deficiencies involves a lifelong commitment! Daily supplementation, follow-up care, and micronutrient screening go a long way toward avoiding preventable devastating complications. Fortunately, supplementation is easy with specialty product formulations, which come in a variety of flavors and potencies to meet your vitamin and mineral requirements—in as little as two chewable tablets per day!


  1. Pories WJ. Bariatric Surgery: Risks and Rewards. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S89–S96.
  2. Matrana M, Davis W. Vitamin deficiency after gastric bypass surgery: a review. South Med J. 2009;102(10):1025-1031.
  3. Larjani S et al. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery. Surg Obes Relat Dis. 2016;12(2):350-356.
  4. Gletsu-Miller N, Wright B. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;1;4(5):506-517.
  5. Parrott, Julie et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surgery for Obesity and Related Diseases. 2017;13(5):727-741.
  6. Lee YC et al. Predictors of anemia after bariatric surgery using multivariate adaptive regression splines. Hepatogastroenterology. 2012;59(117):1378-1380.
  7. Moize, V et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr Edinb Scotl. 2013;32(4):550-555.
  8. Kumar N. Neurologic complications of bariatric surgery. Continuum (Minneap Minn).2014;20(3 Neurology of Systemic Disease):580-597.

Submitted by Claudia Arroyos