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Nutritional deficiencies are a major concern after weight loss surgery. You eat less food, so you eat fewer nutrients. Sleeve and bypass patients absorb fewer nutrients. You eat less fat, which makes it harder to absorb fat-soluble nutrients like vitamin A. Some bariatric surgery patients take one or two multivitamins, plus an entire barrage of high-dose vitamin and mineral supplements. Others barely take any supplements. Which should you be taking? How do you even know whether you need a supplement? Can you prevent deficiencies just by eating a better diet? VITAMIN A – Vision, immunity, and healthy red blood cells Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS Very low-fat diet Food Sources Orange fruits (mango, cantaloupe) Orange vegetables (carrots, sweet potatoes, Green vegetables (kale, spinach) Liver Deficiency Information Blood test: serum retinol (vitamin A) Consequences of deficiency: impaired vision; changes in iron metabolism Supplement Notes High doses can be toxic – take only if your doctor prescribes them. VITAMIN D – Calcium metabolism and bone health, affects immune function and heart health Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS Very low-fat diet Little skin exposure to sun, live in northern climate, or older age Food Sources Fatty fish (salmon, herring, mackerel) Fortified milk Egg yolks (if you are a bariatric surgery patient, you might mostly be eating egg whites) Some fortified cereals Deficiency Information Blood test: 25-hydroxyvitamin D Consequences of deficiency: osteoporosis (low bone mineral density and higher risk for fractures); possible higher risk for heart disease Supplement Notes High doses can be toxic – take only if your doctor prescribes them. Need for supplementation is very common. VITAMIN B12 – Healthy red blood cells, homocysteine metabolism (important in heart health) Risk for Deficiency WLS that reduces nutrient absorption: gastric bypass, gastric sleeve, BPD-DS. Plant-based diet. Heavy bleeding: e.g., complication after WLS) Older age Food Sources Animal-based foods: meat, fish, poultry, dairy products, eggs Some fortified cereals Deficiency Information Blood test: vitamin B12 Blood test: CBC (complete blood count) Consequences of deficiency: risk of heart disease; megaloblastic anemia; permanent neurological damage; osteoporosis; depression Supplement Notes High doses not likely to be toxic. Supplements may be necessary if you are on antacids such as proton pump inhibitors FOLIC ACID – Healthy red blood cells, homocysteine metabolism (important in heart health), prevention of neural tube defects (for pregnant women) Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y gastric bypass, gastric sleeve, BPD-DS Low dietary intake – especially when grain intake is low after weight loss surgery Food Sources Fortified grains (most grains in the U.S.): including spaghetti, bread, cereal Lentils Asparagus Orange juice Spinach Lima beans Deficiency Information Blood test: serum folate Blood test: homocysteine Consequences of deficiency: cognitive dysfunction; neural tube defects; megaloblastic anemia Supplement Notes High doses can hide vitamin B12 deficiencies. CALCIUM – Bone health, muscle function Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y, gastric bypass, BPD-DS Diet low in dairy products – either because of lactose intolerance or other reasons (such as avoiding milk because of the calories). Food Sources Dairy products: milk, cheese, yogurt (choose fat-free) Fortified milk substitutes (almond milk, soy milk) Fortified orange juice Canned bony fish (salmon, sardines) Green leafy vegetables (absorption is poor) Some fortified cereals Tofu Deficiency Information Blood test: calcium levels – note: this is not a good test for adequate calcium! You can have normal test results and still not have enough calcium in your diet! Dietary intake analysis: see if you get at least 1,200 to 1,500 milligrams per day from your diet. Rough estimate of dietary intake: at least 4 servings of high-calcium foods each day Consequences of deficiency: decreased bone mineral density (osteoporosis and higher risk for bone fractures) Supplement Notes Taking too much calcium can cause kidney stones and be bad for the heart. Ask your doctor how much calcium you should take in a multivitamin and as a calcium (or calcium and vitamin D or calcium and magnesium) supplement. Don’t take your calcium supplement at the same time as iron because you will interfere with absorption IRON – Healthy red blood cells, energy and other metabolism Risk for Deficiency Nutrient malabsorption procedures: Roux-en-Y, gastric bypass, BPD-DS Vegetarian or vegan (plant-based) diet Adolescents and women of child-bearing age. Individuals with excessive bleeding (such as with a post-op complication) Food Sources Fortified grains (most grains in the U.S.): including spaghetti, bread, cereal Meat, seafood, and poultry (animal-based sources have a more absorbable form of iron) Beans and lentils Green vegetables, such as spinach, kale, broccoli Potatoes Raisins Deficiency Information Blood test: serum iron/Fe Blood test: ferritin Blood test: total iron binding capacity (TIBC) (high value means low iron status) Blood test: hemoglobin and hematocrit Supplement Notes Iron supplements can be toxic even if your dose is not that high. Don’t take them unless your doctor prescribes them. That includes iron in multivitamins. Don’t take iron supplements at the together with calcium supplements. Try to take supplements with vitamin C (in food or as a supplement) to increase absorption. THE OTHERS The above deficiencies are most common among weight loss surgery patients, but other deficiencies are possible. You are at risk because of your low food intake as you restrict calories. Malabsorptive procedures, such as gastric bypass and gastric sleeve, also put you at risk. Ask your doctor if you are concerned about any of the following vitamins and minerals. Often, a simple blood test or even a run-through of your daily diet can help you figure out if you need an additional supplement over your daily multivitamin and mineral supplement. B vitamins: B1 (thiamin), B2 (riboflavin), B3 (niacin) Vitamin C Vitamin K Magnesium Zinc The Bottom Line Nutritional deficiencies are a big risk after weight loss surgery, but they depend on a few different factors. Type of weight loss surgery – sleeve and bypass patients are more prone to nutrient deficiencies than lap-band patients. Your diet – eat protein first and choose nutritious foods to lower your risk of deficiencies. Genetics and other uncontrollable factors – women are more likely to need iron supplements, for example, than men. Megadoses of vitamin and minerals can be toxic, so don’t prescribe them for yourself. Instead, contact your surgeon or regular doctor. Simple tests can often let you know your nutrient status so you can know which nutrients to supplement.

I'm a vegetarian also, and just started my soft stage. I definitely have to supplement the protein.. I do so with genepro protein. Dissolves in anything. I'm going to start soft tofu, blended legumes, eggs, fish, special k protein cereal softened with almond milk. I. Also going to try green smoothies with protein powder. Also veggie burgers if I chew them up real good. Also soft cheese

I’ve heard of people developing intolerances to meat after weight loss surgery. It’s a challenge because it makes it harder to get in your protein, but you can probably work it in with cottage cheese, tuna, eggs, and vegetarian sources. As for forcing it, I don’t think that’s a good idea…if it’s making you vomit, you probably shouldn’t push it. That’s a good one to ask your surgeon, though!

Yogi brand tea also makes a variety similar to smooth move called Detox Tea. Whole Foods sell it in the aisle with their herbal teas. I'm vegetarian and if I eat too many Beans I get really loose stools. Beans are also high in Protein, especially black beans, lentil and peas. Some people are hesitant to eat beans because of the carbs, however they haven't effected my weight loss at all. Adding a capfull of Braggs organic apple cider vinegar is also a natural way to stay regular.

I can say as a vegetarian I really don't have any trouble getting my protein in. I imagine being a vegan would be more challenging and likely involve higher doses of soy than I am comfortable with. Especially since so much of the soy we get in the country is highly processed. The real trick was showing the nutritionist that I was serious about making this work. I think once she saw that I did my homework and it was working for me, she felt better about it. Ironically enough I had a uteria episode my very first appointment so they never gave me any issues with needs to keep things as all natural and unprocessed as possible. They had living proof of how bad my allergies could be.

Now to try to convince some surgeons of that. They stress protein but what they mean is meat. How do vegetarians and vegans stay alive and healthy, the ones I know are. They are obviously getting protein in.

I can do some chicken and some turkey. The rest, vegetarian. I do Protein drinks & powders, but I can manage 1.5 out of 2 eggs at a time (1 boiled, 1.5 scrambled which I reheat later on). I also eat Beans, chickpeas, peas, things that are highly protein based. No nuts, but that might be an option for you. My last memories of fish and red meat (several types) are about as positive as my ones of nuts. Its like sodas, after a while, its like whatever & you don't care if you eat it or not.

Vegetarian here. I do a lot of eggs, greek yogurt, cheese, nuts and beans. I occasionally do tofu & edamame. I also eat whole grains like quinoa & farro. I then supplement with unflavored protein powder that can be added to soups as well as used in the protein shakes. I avg about 80 gms of protein a day.

It'll be a challenge to get all of your protein in if you can't eat meat, though there are some successful vegetarian sleevers on here that might have some good advice for you. Have you talked to your surgeon? Do you have any trouble with eggs or dairy?

I agree with everyone's comments. I'll use today as my sample day. Mind you I'm vegetarian so my Proteins are mostly plant based. I do supplement with unflavored Isopure. I also tend to eat light for dinner. lunch is my biggest meal because I am most active between 8 am - 2pm. I usually drink 4 -8 ounces of Water when I wake up. Most days I go the gym in the morning and I can't stomach food and then workout. This morning's Protein shake was Fage 0% greek yogurt+a scoop of Isopure unflavored +½tsp cacao powder +½ unsweetened vanilla flavored almond milk. I typically drink half before my workout and the rest on the way home from the gym. (40 gm protein) I carry a water bottle with me everywhere. If I'm not full from the protein shake I start sipping on that. Once I get home I'll make lunch Today was ¾ cup of meatless turkey and left over malai kofta (an Indian dish made with chickpeas, pea, spices in a sauce made of tomatoes and cashews.) It was mostly just the sauce leftover. (15 gm protein) I also often eat a salad with an egg and black Beans for my protein but I wanted to use up the leftovers before they went bad. I'll then refill the water bottle and drink that. Typically another 20 -24 ounces depending on which bottle I grab. Today's snack was 2 pineapple rings. Sometimes I need that bit of sweetness and I'm allergic to artificial sweeteners. Dinner is Soup with a scoop of unflavored Protein Powder. (27 gm protein.) I don't often snack in the evening so I may sip on water. One other thing I try to do is plan ahead. I log my food for the day in the morning before I head out to the gym. I don't eat them often but I keep Protein Bars in the glove compartment of my car along with 1 ounce servings of nuts (usually cashews or pistachios) in case I get snacky. I also have a Blender Bottle storage jar set. It's a tremendous in staying on track. Saturday I was meeting friends at an event. I knew they were serving a continental breakfast but wasn't sure what all that would entail. I carried the top 2 tiers only. The top help my Calcium supplements and the bottom help a scoop of unflavored protein. It fit perfectly in my handbag. At the event I had fruit, yogurt and a cup of coffee to which I added my protein powder.

Agree being vegetarian I don't eat bacon, but I eat eggs, and use coconut oil frequently. I have my choletsral is always within range and my carbs can go high as long as it from green leafy veg/fruit and beans. Unless you are genetically disposed to high cholesterol coconut oil isn't a bad thing.

I am a vegetarian with multiple food allergies. A food allergy is not something that would warrant not having sleeve surgery. What you will need to do is review your food issues with the nutritionist in your bariatric program so that you can develop ways to meet your nutrition goals

I use Isopure unflavored. It's 100% pure whey isolate and nothing else. There are also soy isolates if you can't tolerate any whey at all. Orgain Organic makes a vegan shake, but it's only 16gm per serving however, that's more than the Slim fast shakes which clock in at 10gm. I personally liked the taste of Orgain, especially the chocolate. You could try Whole Foods for non whey Proteins. Vega is really popular among my vegetarian/vegan friends. I would recommend trying as many samples and brands as possible before surgery . Those first few weeks post op you will be dependent on them. Having more than one type to choose from will help with the boredom your palette may feel. I liked the unflavored Protein since I could mix that with Soup or broth and break up the constant sweet taste.

I've read you say this before. I'm genuinely curious what your daily menu was typically that got you to this point. coffee in AM. dinner probably Pasta with sauce and veg, or a pizza. To much bread/sandwiches on the go. WAAAY too much cheese. It really was 50% disordered eating and 50% health issues. Tumor plus early onset menopause to name just a few. Although I was a vegetarian for years, I cleaned up my diet about 4/5 years ago as my allergies progressively got worse. Joined a gym. 3mths after joining gym & quitting soda, swollen feet went down. However I got sick less, but still got sick. I got facial shingles. I gained and lost the same 35 -50lbs over the course of 3 years. Ack! I "liked" it for your response, not for your health issues. Thank you for answering a personal question candidly. You know me well enough to know that if I was being judgey, I'd have included a LOT more sarcasm.

I've read you say this before. I'm genuinely curious what your daily menu was typically that got you to this point. coffee in AM. dinner probably Pasta with sauce and veg, or a pizza. Too much bread/sandwiches on the go. WAAAY too much cheese. It really was 50% disordered eating and 50% health issues. Tumor plus early onset menopause to name just a few. Although I was a vegetarian for years, I cleaned up my diet about 4/5 years ago as my allergies progressively got worse. Joined a gym. 3mths after joining gym & quitting soda, swollen feet went down. I got sick less, but still got sick. I got facial shingles. I gained and lost the same 35 -50lbs over the course of 3 years.

We are a household of specialty eaters -- not by design, but here we are. When I was first married I had been a vegetarian for many years (not anymore) while my husband ate meat. I just didn't cook it for him, etc. And then I was such a major dieter (not anymore), constantly abstaining, restricting and depriving myself. When our son came into our lives I tried to be sure he was not influenced in any way by that and I think I succeeded. We have always had a very healthy dietary household -- my issue was not the kind of foods but the volume. I gained and gained. Meanwhile, about five years ago my husband discovered he is Celiac. Gluten-free is not a fad for him -- he has to be very careful or otherwise three days of absolute misery. So there is that vigilance -- inquiry at restaurants (embarrassing for him), etc. Our son is Asian and he does not tolerate dairy. I'm sure you're getting the picture by now! We all have such different dietary needs. I think this is the take-away not only for our kid but for all of his friends, etc. -- we need to tune into our own bodies and eat what is good for us as individuals. We all love food and we all love to cook. My new way of being with food feels so natural to me and I think that my son and his friends just think I'm taking good care of myself. None of them know that I'm banded but they all have noticed me working out like crazy the last year and a half. They see me making up bottles of my special drink (Water, aloe, splash of cranberry). They see me (old lady) trying to do the PT regime with the weights, etc. Many of these kids have their own issues -- we have a few other gluten-free teens come here loving it that they can have so many things (we have all the GF breads, pastas, Cookies, etc.). They are all trying to learn what they should be doing to be strong and healthy. We have kids who bring stuff into the house that I would never have here -- canned iced tea beverages full of chemicals. What do I do? I read them the ingredients. First up: this can says it is three servings, OMG, I could drink this right down. OMG, how many calories? I don't think I'm creating a generation of food-disordered kids -- I think I'm helping them develop skills for coping with the toxic society they are growing up in. Fast food, what? We would never eat that. But some of our kids' friends do and I am converting them to lovers of apple slices, hummus and carrots, beautiful chili......we are doing them a service.

I don't because being a vegetarian with multiple food allergies is enough of a challenge right. I just try to eat as natural & unprocessed as possible

I use it, but I don't do a specific percentage configuration. ETA: I rechecked because I have my calorie limit set to 900 and I want to get no more than 100gms of Protein a day. My numbers look like this: 900 calories 35 carbs 45 protein 20 fat. I typically get between 80 -100 gm of protein/ 750- 900 calories a day. Doing an average of the 7 days my numbers for this week are 794 calories, 65 carbs, 28 fat, 88 gms protein. I know it's a weird combination, but since I have so far to go I try to keep calories low and protein high. My carbs probably are higher than what most eat, but they are mostly plant based because I am vegetarian.

@@drmeow I thought you were a vet -- thanks to both you and kindle for taking care of our four-legged friends. I agree with the use of antibiotics for humane reasons and pulling the animal out of production. I am curious, what then does the farmer do with it? I will share something curious, at least it is curious to me. I always ate red meat until the day I put my Boston Terrier down. He was my first dog to go and it was done humanely when his quality of life was such that it was what was best for him. My daughter and I were with him while our vet injected him and my daughter sang a lullaby to him as he went "to sleep." Oh crap this was so many years ago and I am now crying as I type this. The event has some trauma in it for me still. Anyway the day after that I never ate red meat again. In an instant red meat completely grossed me out. I guess it opened up my compassion to a new level. I went organic shortly after I watched a few documentaries and researched information online -- I believe the Omnivore's Dilemma was one of the films that I watched. However I recall being completely upset and in tears after watching the trailer for Earthlings and telling my husband we had to eat organic. It was both the physiological (my concern for my health) and psychological (my concern for animal welfare) that caused me to change. Ugh I cannot imagine watching Earthlings. My friend who is a vegetarian said she stopped the film a few times to either vomit or cry. It is on YouTube for anyone who can stomach it. You are right about the farm-raised fish! I only eat wild caught. But like you I avoid shrimp, which I used to love, because so many sources are contaminated that I do not trust it. I will check out the foodsaver. Which of the sealers is the one that you use http://www.foodsaver.com/vacuum-sealers/ ? Thanks also for the explanation about genetics/gene expression and diet.

I log food. I watch but am not obsessive about my carbs. However my nutritionist recommended I keep calories low (currently between 700 -900) and carbs at no more than 50. I am vegetarian and my carbs can get a little higher. However they are from the plant based Proteins I eat. I avoid most "white" carbs like bread, pastas, white rice, crackers, etc.... One thing I have noticed is that those types of carbs can be like the never ending monster. If I have them I start to crave them. As long as I don't have them, I am fine. I also try to eat according to my day. A day like today that is a non gym mostly chill out day I eat lighter.

First of all, vegetarian here. I could really use some company. Feel free to come sit by me anytime! Secondly the term "picky eater" chaps my biscuits in the worse way! Why should I eat something that makes me gag? Or has an unpleasant mouth feel? I won't even go into it with people who try to tell me that my allergies are "all in my head". YES, YES, YES!!!! Silly me tried to share a way to make a pizza like meal for someone who said they missed Dominoes Pizza. May as well have recommended they fly to the moon.

I will hit 80 gms of Protein today eating not one single piece of animal flesh. I do not need colace or miralax and have never had an issue with constipation. Like most sleevers, I take supplements & Vitamins, but I get most of my nutrients from natural, plant based foods. I am not saying that everyone has to be or should be a vegetarian. I am saying that avoiding ALL vegetables, not just starchy ones is not a good idea. I have no respect for nutritionist who advocate such a thing. Thankfully I have a nutritionist that is willing to work with me and is open to the concept of plant based diets.

@@drmeow I LOVE my food saver ????. And yes, we do have some organic farmers that do what's right for the animals when it is necessary even if it means removing them from production. Those are the ones I support. And I kind of guessed you were a vet...love your user name ???? @@My Bariatric Life I was raised on home raised/grown food. My dad was a farmer and our neighbors raised various livestock. We had 2 huge chest freezers where we kept all the veggies and fruit and meat my mom froze to carry us through the winter. My mom did not buy candy except for holidays like Easter and Halloween. We drank milk, Water and juice, never soda. Each of us kids were allowed to pick out ONE box of sugar cereal/year. I always went with Captain Crunch Berries. My little brother always went with the one with the best toy. Fast food was a rare "treat"... Maybe 6-8 times/year when we were traveling. I think I was in high school before I had my first piece of white, store-bought bread. Oh yeah, and we were only allowed to watch 1/2 hour TV on weekdays and 1 hour of cartoons on Saturday morning! Mom was a badass When I went to college I rebelled and ate every kind of crap food I could find....along with lots of beer! Didn't care where it came from or what it was...as long as it was cheap and tasty. After college I went through a vegetarian stage. I was very conscientious about what I ate and really shot for healthy stuff. That lasted about 6 years before I went back to not caring anymore. I spent most of my 30's and early 40's eating unhealthy. I became so unhappy with myself I didn't care if I was doing damage by eating crap or not. It wasn't until I had WLS that I started making good food choices again. And I just happen to live in an area now where I have direct access to local farm raised food. Being in the veterinary field is a bonus because I can witness everyone's husbandry practices directly. I guess choosing to eat this way is just a cyclic state of mind for me. Whenever I get on a healthy kick, I research the latest and greatest, but I have witnessed so many theories and "food truths" change through the years, I always take the extreme claims with a grain of salt and ultimately just use common sense.

You need to talk to your nutritionist about that. People have different schools of thought on carbs. I look more at the type of carb and the time of day I eat it. I am a vegetarian and most of my Proteins are plant based, but they are also high in carbs. The way I eat works for me and I am able to lose consistently. However I am not sure that would work for a meat eater. My carbs tendto run between 40 -60 a day and I eat between 700 - 900 calories a day.

@@Terry Lincoln - I'm not a veteran so take this with a grain of salt. I am a long time MFP user. (Milaxx) MFP is not set up for baritraic diets and probably will never have that type of setting. However I don't worry about % as much as I look at types of foods and when those food are eaten. I am a vegetarian and since most of my protein is plant based my carbs tend to be a lot higher than a lot of people would be comfortable with. I also vary my calories consumed based on how active of a day I have. Complex carbs don't slow my weight loss and neither does natural sugar. Too much sodium and processed foods do. So what I did was manual set thing for how my body works. As long as I meet my protein goal, keep my calories low and manage to stay under the other macro nutrients I am fine.