Surgical Complications – Vitamin and Mineral Deficiencies

December 20, 2013 | All Articles, post-tsb-team |

The body needs many vitamins and minerals to be able to function properly. Vitamin deficiencies can be mild or severe depending on the vitamin as well as length of time the body has been deficient. I will discuss some of the vitamin and mineral deficiencies that may occur in bariatric patients. These include fat soluble Vitamin D, Water soluble vitamins Thiamine (B1), Vitamin B12, Folate, and Biotin. Minerals include Calcium, Phosphorus, Magnesium and Iron.

Vitamin D Deficiency

Vitamin D is made in the liver and activated in the kidneys. It is a necessary nutrient to promote calcium balance in the body for bone and muscle health. New studies have shown that Vitamin D plays a role in the inhibition of abnormal cellular growth, stimulates insulin secretion and promotes immune function. A growing body of evidence suggests that Vitamin D may prevent cardiovascular disease, cancer and diabetes.

Foods with significant amount of Vitamin D include fatty fish such as salmon, tuna, sardines, shrimp and mackerel and eggs.

Vitamin D status depends on several factors. Obesity is associated with Vitamin D deficiency even in patients who have not undergone bariatric surgery. Deficiency is thought to be due to decreased sun exposure, insufficient intake and reduced availability from deposition in fat. Other factors include geographical location, race, and age. Skin color and tone also affect how much Vitamin D can be synthesized in the body. Poor dietary intake, malabsorptive disorders, steroid use, impaired renal function. Decreased sunlight exposure can cause low levels of Vitamin D. Approximately 15 minutes of sun exposure is found to be adequate. There is little evidence of skin cancer risk if exposure is limited.

Subclinical Vitamin D deficiency is associated with osteoporosis, increased risk of falls and possible fractures. Vitamin D stores decrease with age, especially in the winter months. Identification and treatment of vitamin D deficiency is important for musculoskeletal health and even extraskeletal health, including immune and cardiovascular systems.

Expert opinion from the National Osteoporosis Foundation, International Osteoporosis Foundation, and American Geriatric Society suggest that a minimum level of 30 ng/ml is necessary in older adults to minimize the risk of falls and fracture. All adults who do not have regular sun exposure should consume at least 600 to 800 international units of Vitamin D 3 (cholecalciferol) daily. The two most commonly available forms of vitamin D supplements are cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). Those individuals with concentrations of less than 20 ng/ml need supplementation of 50,000 IU of Vitamin D2 or D3 orally every week for six to eight weeks and then at least 800 units of vitamin D thereafter. For individuals with malabsorptive issues, such as Gastric Bypass, may require higher doses of vitamin D of 10,000 to 50,000 units daily.

Evaluation with serum 250HD measurement is important before starting any supplementation. For low risk adults, routine screening is not recommended, but rather, intake 600-800 international units of vitamin D daily. Further, it is important for your health care provider to inquire about additional dietary supplements that patients are taking before prescribing extra Vitamin D.

For high risk adults, measurement of serum 250HD concentrations is useful to ensure that supplementation is adequate. Vitamin toxicity is rare, and these symptoms include nausea, vomiting, anorexia, confusion, constipation, weakness and weight loss. In addition, all patients should maintain a daily total calcium intake of 1000 mg to 1200 mg. daily.

Below is a picture of rash associated with Vitamin D deficiency.

Below is an image of Enlarged joints

Below is an image of spinal curvature

Summary:

Vitamin	Metabolism/Function	Deficiency or Excess	Food Sources
Vitamin D	Some storage in liver, liver synthesizes calcidiol, kidney converts calcidiol to calcitriol Functions as hormone in absorption of calcium and phosphorus; mobilization and mineralization of bone	Rickets, Soft bones, enlarged joints, enlarged skull, deformed chest, spinal curvature, bowed leg, osteomalacia,(softening of bones), renal osteodystrophy (bone mineralization deficiency associated with chronic kidney disease)	Fortified milk, fish-liver oils, exposure to ultraviolet rays of sun

References:

Dawson-Hughes, M. B. (2013). Treatment of vitamin D deficiency in adults. UpToDate, 1. Kushner, M. R., & Cummings, M. S. (2013). Overview of medical management of patients after bariatric surgery. UptoDate, 1-36. Pharmacist’s Letter/Prescriber’s Letter. (2008, March). Prevention an dTreatment of Vitamin D deficiency. p. Vol. 24.

…more next month!!