Why Vitamin B12 Is Necessary after Bariatric Surgery?

Bariatric surgeries are surgical procedures that are performed on obese people to bring about weight loss. Usually, this is achieved by changing the size of the stomach (often by using a gastric band) to limit the food intake.

However, to stay healthy even after bariatric surgery, it is highly recommended to consume vitamin B12. This is because patients often suffer from B12 deficiency due to malabsorption after the surgery.

What is Vitamin B12, you ask? Vitamin B12 is water soluble and is actually the largest vitamin present. The structure of vitamin B12 is far more complex than that of any other vitamin.

Importance of Vitamin B12

Vitamin B12 is an important vitamin and therefore, even after bariatric surgery, which leads to very low amounts of cobalamin in the body, it needs to be present. The body needs Vitamin B12 for maintaining the proper metabolism of cells. The vitamin also assists in the proper functioning of the entire nervous system. The production of red blood cells and the regulation of proteins in the body are also dependent upon the absorption of Vitamin B12.

However, for the proper absorption of Vitamin B12, it is necessary that your body must have Vitamin B6 and vitamin E. This is because these vitamins actually convert non-active cobalamin into the required active form.

What Leads to the Deficiency of Vitamin B12 after Bariatric Surgery?

Vitamin B12 is usually absorbed in the mouth, initially, in tiny amounts, through the mucous membrane. This vitamin binds with an intrinsic factor in the stomach that is secreted and moves down to the intestine as a combination of compounds. It is then absorbed in the ileum.

In a bariatric surgery like laparoscopic gastric bypass, the part of the stomach that releases the intrinsic factor is bypassed. Therefore, food does not enter this portion and no intrinsic factor is stimulated. Now, since the intrinsic factor is not present in patients who have undergone such a surgery, the Vitamin B12 present in food is not absorbed in the ileum. This leads to its deficiency.
Vitamin B12 deficiency can also happen after laparoscopic gastric sleeve surgery. However, since the surgery doesn’t stop the absorption completely, the chances of any such deficiency are rare.

Deficiency of Vitamin B12 in the Body

The deficiency of Vitamin B12 or cobalamin occurs when the body is unable to absorb the vitamin. Thus, for patients who have had bariatric surgery, the deficiency does not arise from an improper or insufficient diet but from their inability to absorb cobalamin.
Often, obese individuals who opt for bariatric surgery have other issues like type 1 diabetes, thyroid problems, problems with the gastrointestinal tract (very common in elderly people) or even an autoimmune disorder known as pernicious anemia. All this can lead to the improper secretion of the intrinsic factor in the stomach which, in turn, does not allow sufficient punts of vitamin b12 to be absorbed.
There are few other reasons as well which might lead to vitamin b12 deficiency after bariatric surgery and these are given below:

  • Improper digestion of protein-bound vitamin B12. This usually happens because of achlorhydria and very quick intestinal transit
  • Proteolysis (by pepsin and trypsin) of intrinsic factor before it can bind and form a compound with Vitamin B12.
  • Symptoms of Vitamin B12 Deficiency after Bariatric Surgery
  • If a deficiency of Vitamin B12 occurs after bariatric surgery, as is common, then the symptoms might just be very random and rather nonspecific. However, it is necessary to identify these symptoms and immediately consult the doctor.

The usual symptoms are listed below.

  • The patient will experience periods of nervousness.
  • For quite some time after the surgery, the patient might continue to feel very tired and might be unable to do much work.
  • A deficiency of Vitamin B12 often leads to the sudden occurrence of dandruff.
  • There will be issues with clotting of blood and it will be observed that in case of a cut, the wound takes a much longer time to heal.
  • The patient will find that there is a certain soreness in the tongue once the surgery is done.
  • Women who undergo bariatric surgery might start having menstrual problems due to the definition of vitamin b12.
  • The reflexes of the patient might slow down significantly if there is a deficiency of vitamin b12.

How Can The Necessary Vitamin B12 Be Supplied to The Body After a Bariatric Surgery?

The best way to counter deficiency of Vitamin B12 is by consuming B12-rich food. Patients could also consume prescribed supplements and medications. As mentioned before, a deficiency of Vitamin B12 that occurs after bariatric surgery can be prevented. Therefore, it is necessary to have a proper diet and then supplement that diet to ensure best results.

Dietary Vitamin B12 is found mostly in foods sourced from animals. For example, venison, liver, seafood like shrimp or scallops are rich sources of Vitamin B12. For vegetarians, Vitamin B12 can be found in dairy products, certain cobalamin rich cereals, miso, and tempeh.

Other than incorporating food items that are packed with Vitamin B12 in the diet, your doctor might also suggest a few supplements. These supplements are usually in the form of cobalamin compounds like cyanocobalamin and hydroxocobalamin. These supplements are very common and can be found at pharmacies where they are sold over the counter. They are usually available at pharmacies in the form of throat lozenges.

The best way to take Vitamin B12 supplements is by keeping the tablets under the tongue and allowing it to dissolve. Vitamin B12 always needs to be absorbed by the mucous membrane and this sublingual method is the easiest way of absorption. The throat lozenges that pharmacies sell are meant to be kept in the mouth for a period of time till they dissolve completely.

The sublingual delivery of Vitamin B12 through supplementation is very effective in case of people who have had a bariatric surgery done as the Vitamin B12 is absorbed directly into the bloodstream.

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