Author: Heather K. Mackie, MS, RD, LD Week of October 29, 2012 Some individuals might assume that just because they are overweight or obese they are overnourished or getting adequate nourishment. One would think vitamin deficiencies only exist in those individuals that don’t eat enough. However, this is not the case. It is possible to be overweight or obese and have vitamin deficiencies. Why is this Important? When weight loss surgery first began, professionals and patients noticed vitamin deficiencies following surgery and therefore the risks/informed consent had to list and include the possibility of vitamin deficiencies. However, hardly anyone originally checked baseline lab levels of these nutrients prior to surgery (many years ago). While, bariatric surgery definitely poses a risk for vitamin deficiencies following surgery, many patients had some of these deficiencies prior to reaching the operating room. We know it is best to be as healthy and nutritious as possible before having the operation and that is why many surgeons now check vitamin levels prior to surgery. The Stats.We now have more research than existed 15+ years ago and we are beginning to understand how a patient presents for weight loss surgery or that is overweight or obese. The following deficiencies were found to exist in patients that are overweight and/or pursuing weight loss surgery and were some of the most common:
- 60-80% had a vitamin D deficiency
- 43-47% had a vitamin C deficiency
- 35-44% had an iron deficiency
- 25-38% had a thiamin (vitamin B1) deficiency
- 32.6% had a selenium deficiency
- 5-29% had a vitamin B12 deficiency
- 25% had a zinc deficiency
- 24% had a folic acid deficiency
- 14-23% had a vitamin A deficiency
- 5-14% had a vitamin B6 deficiency
What Does This Mean for You? While these stats may or may not be the case for you; it is important to keep in mind that vitamin deficiencies may cause detrimental health concerns.
- For example, vitamin D deficiency symptoms include altered calcium absorption, which can lead to serious bone health consequences. Vitamin D deficiency may also lead to osteoporosis, rickets, osteomalacia (softening of the bones), and muscle weakness and pain.
- Vitamin C deficiency symptoms may include bleeding and bruising easily, hair and tooth loss, and joint pain and swelling.
- Symptoms of iron deficiency (from the associated anemia) may include fatigue, rapid heart rate, palpitations, and rapid breathing on exertion. Iron deficiency anemia lowers hemoglobin content in red blood cells (hemoglobin carries oxygen to active tissues or muscles). Sometimes individuals with iron deficiency anemia have a difficulty regulating their body temperature with exposure to cold. Severe iron deficiency anemia may result in brittle and spoon shaped nails, sores at the corners of the mouth, taste buds will be less able, and a sore tongue.
- Thiamin deficiency (vitamin B1) is often called beriberi. Beriberi has been shown to affect the cardiovascular, nervous, muscular, and gastrointestinal systems. Symptoms may include the following: numbness and pain in the hands and feet, abnormal reflexes, lessened sensation and weakness in the legs and arms, muscle pain and tenderness, difficulty rising from a squatted position, seizures (severe cases), rapid heart rate, enlargement of the heart, severe swelling, difficulty breathing, congestive heart failure, abnormal eye movements, stance and gait abnormalities, and abnormalities of mental function (confusion, apathy, memory disorders, etc.).
- Selenium deficiency may present with muscle weakness, loss of muscle, and cardiomyopathy (inflammation and damage to the heart muscle). Impaired immune function has also been found with selenium deficiency.
- Vitamin B12 deficiency may include numbness and tingling of the arms and legs (legs are more common), difficulty walking, memory loss, disorientation, dementia, and possible mood changes. Vitamin B12 deficiency may also affect the gastrointestinal tract. Some patients may experience a sore tongue, a loss in appetite, and constipation.
- Zinc deficiency symptoms include the slowing or stopping of growth, development, and delayed sexual maturation (in infants and children). Zinc deficiency may also cause characteristic skin rashes, chronic and severe diarrhea, a lowered immune system, longer time for wounds to heal, a lessened appetite, taste changes, night blindness, swelling and clouding of the corneas, and behavioral disturbances.
- Folic acid (also called folate) deficiency leads to less oxygen being carried by the blood and may result in symptoms of fatigue, weakness, and shortness of breath. If folate deficiency occurs during pregnancy, it may lead to neural tube defects (or spina bifida) and/or an increased risk of early delivery and low infant birth weight. Some studies show an increased risk of heart disease with low folate levels.
- Vitamin A deficiency may lead to bitot’s spots (foamy gray, triangular spots of keratinized epithelium on the eye), eye ulcers, scarring of the eye, and possibly blindness. Deficiencies of vitamin A may also increase the chance of infectious diseases and diarrhea. The first sign is typically night blindness.
- Vitamin B6 deficiency symptoms include irritability, depression, confusion, inflammation of the tongue, sores or ulcers of the mouth, and ulcers of the skin at the corners of the mouth. Vitamin B6 may also be involved in immune function, especially in the elderly.
Why Does This Occur? While we don’t know all the reasons for every single nutrient at risk and why overweight patients experience these vitamin deficiencies prior to surgery, we do know a few things. Many individuals seem to eat the same things over and over. Without variety in your eating plan, you may be limiting certain nutrients. Another theory is our soil is not the same soil from the ground 50 years ago. Therefore the items grown in our current soil may not be as nutrient-rich as the items grown 50 years ago. Also, we do know from research that certain nutrients, such as vitamin D, are utilized differently in overweight or obese individuals than their normal-weight counterparts. Meaning when vitamin D is absorbed from the sunlight or from food it has to be converted to its active form. However, this conversion is not as effective in those individuals with higher body fat percentages. What to Do?Of course patients can get baseline blood work completed prior to their bariatric surgery and then supplement according their physician’s recommendations. Another common recommendation is to take a good quality multivitamin in preparation of weight loss surgery. Almost every American can benefit from taking a multivitamin, as these supplements should not have mega-doses of any certain nutrients. Also, as you prepare for weight loss surgery, it is recommended to begin your healthy eating pattern including a variety of foods.
We look forward to CELEBRATING with you on this new journey to wellness!
Please keep in mind a couple things:
- Too much of a good thing is not always good! Just because this blog states “X” percentage of patients have vitamin deficiencies prior to surgery, does not mean this is the case for you. Everyone is different and every patient’s needs are different. It can be dangerous to take mega doses of any nutrient. The healthy balance is just enough of the required nutrients and not too much.
- Talk to your physician(s) about starting any new supplements, vitamins, and/or minerals. It is important to keep your physician in the loop as there may be interactions with certain medications or contraindications for certain medical conditions with certain nutrients.
References: Kimmons JE, Blanck HM, Tohill BC, Zhang J, Khan LK. Associations between body mass index and the prevalence of low micronutrient levels among US adults. MedGenMed. 2006;8(4):59. * Schweiger C, Weiss R, Berry E, Keidar A. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010. Feb; 20(2):193-7. * Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10:1033-7. * Coupaye M, Puchaux K, Bogard C, Msika S, Jouet P, Clerici C, Larger E, Ledoux S. Nutritional consequences of adjustable gastric banding and gastric bypass: A 1-year prospective study. Obes Surg. 2009;19:56-65. * Ernst B, Thurnheer M, Schmid SM, Schultes B. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66-73.