Vitamin D after bariatric surgery

Read all you need to know and more about vitamin D, about what the symptoms of a vitamin D deficiency are and how to supplement vitamin D after your (mini) gastric bypass or sleeve surgery.

What do you need vitamin D for?

Vitamin D helps us support the health of our bones, teeth and muscles. Vitamin D is used by our muscles to move. Our nerves use it to send signals from our brain to the rest of our body. For our immune system, vitamin D also plays an important supporting role.

Symptoms of Vitamin D deficiency:

• Insomnia
• Diarrhoea
• Weaker bones (osteoporosis)
• Burning sensation in the mouth
• Less energy
• Nervousness
• Depression

How do I make sure I get enough vitamin D?

About 25% of the vitamin D we need, we get through our diet. There are certain foods that provide vitamin D, such as:

• Eggs, especially yolks
• Oily fish such as salmon, mackerel, herring and tuna
• Dairy products enriched with vitamin D

A second way we get vitamin D is through direct exposure to sunlight. Especially in northern countries(like the Netherlands), people get little sunlight. Especially if people work indoors and do not spend much time outside every day, their exposure to direct UV light is limited.

Vitamin D deficiency after bariatric surgery

Vitamin D deficiency is the most common deficiency after (mini) gastric bypass or sleeve surgery. Almost every bariatric patient is at risk of developing vitamin D deficiency. There are several reasons for this.
Many patients struggling with obesity, are already vitamin D deficient even before they start surgery. Studies show that obese people tend to get less sunlight exposure. In addition, their vitamin levels can be low due to poor food intake. Moreover, obese people often have reduced Vitamin D storage capacity due to too much fatty tissue.
It is important to treat these deficiencies before surgery so that they do not lead to extremely low values after surgery.

Impaired absorption/Malabsorption and Vitamin D

During gastric bypass surgery, the stomach (and sometimes the intestines) are altered. This affects vitamin D absorption. Intestinal changes and lowered levels of certain bile salts and enzymes interfere with proper vitamin D absorption.
Patients with a Sleeve or (mini) Gastric Bypass often do not get enough food to absorb enough vitamin D.
Therefore, it is almost always necessary to take extra Vitamin D supplements after bariatric surgery.

How much vitamin D should I take after bariatric surgery?

This varies from country to country and even from hospital to hospital. Always consult your own bariatric centre for their advice. Generally, 3000 IU (75 mcg) of vitamin D3 per day is advised. Through blood checks, the doctor can see if more may be needed.
Calcium products often also contain vitamin D. This promotes calcium absorption and does not need to be added to the daily vitamin D intake.

Why vitamin 'D3'?

Vitamin D3, also known as cholecalciferol, is the most commonly recommended form of vitamin D. Vitamin D3 is the form our body produces from sunlight. It is also known as the 'animal' form of Vitamin D, which is more potent than other forms of the vitamin such as vegetarian Vitamin D2 from plants.

Vitamin D and calcium

Vitamin D regulates some minerals, such as calcium and phosphate. It is often combined with calcium in a supplement because they work together: Vitamin D helps the absorption of calcium in the small intestine and bones.
If vitamin D is deficient, the body does not form enough calcitriol, also known as 'active vitamin D'.  This leads to reduced absorption of calcium from the diet. Your body will deplete its calcium stores in the bones. So you can develop a calcium deficiency, which can lead to osteoporosis (osteoporosis) .

Is too much Vitamin D dangerous?

Vitamin D can be harmful to our bodies if we take in too much of it. However, for bariatric or obese patients, the regular upper limits may still be too low, so always consult your bariatric doctor for the right dosage. Symptoms of excess Vitamin D can include:

• Vomiting
• Muscle weakness
• Confusion
• Kidney stones
• Kidney failure or cardiac arrhythmias in severe cases