What You Need to Know About Vitamin D after Bariatric Surgery
J.K Champion MD
January 2010
There has been renewed interest by the medical community recently in the role of Vitamin D in the maintenance of good health that needs to be shared with our patients. Let me first begin by stating that Vitamin D absorption from the diet is not affected by weight loss surgery, however, over 50% of the entire population of the United States has a vitamin D deficiency. This article will review facts about vitamin D; including how we get it, what happens to our body when it gets low, and how do we prevent and treat vitamin D deficiency.
Vitamins are organic substances which are essential for normal metabolism, growth and development of the body. We get vitamin D in our diet and from exposure to sunlight. It is present in milk, fatty fish such as salmon, tuna and cod, and eggs, butter, and dietary supplements.
Vitamin D’s principal function is related to our body being able to use calcium and phosphorous, which are the minerals which make up our bones. Vitamin D is essential for the normal absorption of calcium and phosphorous from our GI tract. In addition, vitamin D is necessary for normal muscle function, cardiovascular health and the function of our immune system. Deficiency of vitamin D is best known for its effect on our bone strength or bone density and can cause osteoporosis which leads to fractures of the hip and spine as we grow older. These fractures heal poorly in thin bone and are very painful. At present 50% of women and 20% of men will develop osteoporosis by age 50 (this is in patients who haven’t undergone bariatric surgery) and experience a fracture related to their poor bone density in their lifetime. Low vitamin D also results in an increase in autoimmune disorders like type 1 diabetes, multiple sclerosis and Chron’s disease and can interfere with our body’s defense against bacterial or viral infections. Deficiencies also increase the risk of some cancers (prostate, pancreas, colon, ovary and breast) and can lead to higher rates of hypertension and cardiovascular disease. Chronic muscle pain and fibromyalgia has been reported to resolve in up to 90% of patients when their vitamin D deficiency is corrected. We are just coming to understand the role of vitamin D which was rarely tested in the past. Current testing has revealed that 50% of the current population has a vitamin D deficiency. A major reason testing is not done more frequently is the current cost of the lab exam which can run from $160-400, and is rarely covered by insurance.
Vitamin D can be obtained in our diet, but requires we eat a fatty fish such as salmon 2-3 times weekly. Other foods such as milk and diary products which contain vitamin D are actually fortified artificially with the addition of vitamin D by the supplier of the product. It was previously thought that we needed only 400 units of vitamin D daily along with 800 mg of calcium, and many of the over the counter supplements contain this quantity in 2 tablets daily. We have since learned this isn’t enough and the government has suggested 800 units of vitamin D and 1500 mg of calcium daily. Even this amount may not be enough and we often have to prescribe a super strength vitamin D with 50,000 units which is taken either weekly or every other week.
It has been documented that patients who undergo gastric bypass surgery are at higher risk of metabolic bone disease such as osteoporosis due to reduced absorption of calcium, however, we have monitored our patients with bone density testing yearly in the office and our incidence of osteoporosis has decreased after surgery due to our insistence our patients take the calcium and vitamin D supplements and be monitored closely. Patients who don’t return to our office for follow up should ask their family physician to order a bone density study yearly to insure adequate calcium replacement. Blood tests which measure calcium are not adequate to monitor calcium supplements. Routine vitamin D blood test can be reserved for patients with demonstrated abnormal bone density tests or known vitamin D deficiency due to the cost of the test at this time.
We are just beginning to understand the importance of vitamin D for good health in all people. Remember: it’s extremely important for our patients to take their calcium supplements with vitamin D and have routine testing done yearly to insure adequate replacement of nutrients in their diet.
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