Thiamine, also known as vitamin B1, is an important vitamin. It is found in a wide variety of foods including beef and pork and some beans and peas as well as certain grains. It is also fairly common that thiamine can be deficient among overweight people prior to surgery. Further deficiency can be a result of gastric bypass surgery or any other operation that involves significant malabsorption. Again, it’s not likely to be decreased in people with Lap-Band surgery unless they have really cut down on their intake of beef and pork and the kinds of food that contain thiamine.

Like vitamin B12, thiamine or B1 is also involved in the functioning of the nerves and the nervous system, so deficiencies of thiamine often would result in tingling or burning sensation of the feet and toes and sometimes muscle cramping. Sometimes confusion could result also if people have a severe deficiency. Thiamine is usually included in the general multivitamin that we recommend that all our patients take after weight loss surgery and if people were to develop some unusual numbness or nerve symptoms, then we would test specifically for vitamin B1 with a blood test. I should mention that we routinely test for vitamin B12 because it is such a common deficiency. We do not routinely test for vitamin B1 deficiency because it is really quite uncommon overall.

Vitamin B12 is a water-soluble vitamin that can be of risk of becoming deficient after a weight loss surgical procedure. Vitamin B12 is called cyanocobalamin, but it’s a lot easier to say B12.
Vitamin B12 is an important vitamin that plays a role in a number of aspects of metabolisms. Deficiencies in vitamin B12 usually affect the nervous system. This means it can cause symptoms such as tingling or numbness in the hands or feet, or in more severe cases, deficiencies of B12 can result in problems with faulty balance and unsteady walking. Some people can even have confusion or generalized weakness or depression.

Though other vitamins can become deficient after a bariatric procedure, B12 deficiency is the most common vitamin deficiency after gastric bypass surgery, iron being the most common mineral deficiency after gastric bypass surgery. B12 deficiency is common enough that almost every author and every bariatric center has recognized that the vitamin must be supplemented on a routine basis. At our center, we give patients a choice of either a monthly intramuscular injection which is usually 1000 to 3000 micrograms or international units per injection, or since nowadays there are formulations that can be taken sublingually, that is an option that we offer patients. People can take a sublingual vitamin B12 every day and that is something that should be done for a lifetime. Without supplementing B12, people with gastric bypass surgery will experience deficiencies in a high percentage of cases. It is believed that the lack of exposure of the foods that contain B12 to the stomach acid in the bypassed portion of the stomach leads to a decreased absorption of the B12. So, of all the potential vitamins and minerals to be aware of, iron and B12 clearly are at the top of the list for anyone who has had gastric bypass surgery and they really must, in my opinion, both be supplemented regularly and I would say for a lifetime after gastric bypass.

It is probably not necessary to specifically supplement B12 for people who have had a Lap-Band operation because again they really have not created the introduction of any new impairment or rearrangement of the stomach and intestinal system and we wouldn’t really expect there to be a big reduction in B12 absorption from the foods that people are eating. Sometimes after Lap-Band surgery, people have dramatically changed their diet and are taking in much less foods of specific kinds and for that reason we recommend that everybody take a general chewable or liquid form of multivitamin after Lap-Band surgery. But again, I would not expect B12 in particular to become deficient.

There are several vitamins and minerals that we have to think about after weight loss surgery to prevent deficiencies. In today’s post I want to discuss the importance of iron.

Why is iron important?

Well, iron is important because it is the key building block of our red blood cells. So whenever we have iron deficiency or a lack of iron on the diet, it will lead to a reduced production of the red blood cells circulating around in our arteries and veins. That’s important because the red blood cells are what carry oxygen to all of the tissues of the body including the brain, the heart and all of the muscles and everywhere else in the body. When iron deficiency occurs, it tends to produce symptoms of fatigue, pale skin, and feeling cold. In some more severe cases it can lead to a swollen tongue or what is referred to as glossitis.

Is iron deficiency very common?

Well, in mild forms it is actually very common in the general population. When there are people who have some small amounts of chronic blood loss, most commonly with menstruating women, we see iron deficiency very commonly. Some studies have shown that over 40% of menstruating women have iron deficiency anemia before they would even think about weight loss surgery. So, it’s a fairly common problem just in the general population. So does iron deficiency occur more after weight loss surgery? Well, the answer is yes and particularly with the procedures that involve more of a malabsorptive component. So, there may be a very mild increase in iron deficiency anemia as a result of Lap-Band surgery, but this is probably only due to the decrease of intake of meats and vegetables that contain iron. With the Roux-en-Y gastric bypass procedure, however, we do see that iron deficiency occurs in fairly significant levels. In fact, if we did not take multivitamins with iron, we would probably see that over half of people with gastric bypass surgery would develop some level of iron deficiency. So, we generally will supplement iron for every single patient who is undergoing Roux-en-Y gastric bypass surgery and the kind of iron that we think probably works best is what is called the ferrous sulfate and that standard dose is usually 320 mg taken daily. Now you can look at your own multivitamins and see if you are getting 320 mg daily of iron. Sometimes the iron is packed right in within the multivitamin and sometimes it needs to be taken as a separate supplement all on its own.

I will discuss other vitamins and minerals with regard to possible deficiencies after a bariatric procedure in future posts. I have begun with iron because it is the most common deficiency and it is most common after operations, any operation that results in impaired absorption. It is prevalent in the population commonly, especially among women of childbearing age and the prevalence of a deficiency of iron becomes much greater after Roux-en-Y gastric bypass surgery and after biliopancreatic diversion or other malabsorptive procedures. It is probably not increased markedly after Lap-Band procedures, but it is still a good idea to take a general multivitamin with iron even after a Lap-Band procedure.

I have recently done series of video shorts discussing a variety of weight loss surgery related topics. In the video featured on this post I discuss the myths about weight loss surgery.

Complications after weight loss surgery are less frequent than they once were and over time experienced programs and surgeons have become very good at reducing their frequency and severity.  But serious complications can and do still occur.  I talk about these in detail in “Outpatient Weight Loss Surgery:  Safe and Successful Weight Loss Through Modern Bariatric Surgery”.

Some types of complications are easily recognized and remedied, but others present more difficult challenges.  Many of the more serious complications which can occur require a very long time period for their resolution.  For example, someone who has an anastomotic leak after gastric bypass surgery and requires reoperation, or someone who experiences hemorrhage and has a large abdominal hematoma, or someone who develops lung infection (pneumonia) and requires prolonged hospitalization – all of these may require many weeks or even months to completely resolve.  Some of the most serious complications in which a person develops a serious infection can recover, but still require an additional six months to regain their normal strength and energy and activity levels.  This is not just the case with weight loss surgery, but with any type of major surgery or other illness or trauma.

If you or your loved one does develop a serious complication or problem, remember that with prolonged and determined battle, usually a person can recovery fully, but also keep in mind that the time course of that recovery can be very, very long.

When someone has regained a great deal of weight, sometimes the medical, psychological and dietary solutions just don’t seem to be enough.  Sometimes it is time to reconsider a surgical solution.  This concept is referred to as Revision weight loss surgery or Revision bariatric surgery.

Some of the important times to consider seeking an experienced bariatric surgeon for consideration of a revision are if you were successful after the original procedure, but have no longer experienced the sense of fullness or satiety any longer and you are able to eat a great deal more.

There is more to it than that, of course, but it is a start. Revision surgery is not thought to be quite as successful as first-time bariatric procedures, though it is highly successful in many, and probably most cases. But how do you go about approaching the concept?

The first place is to start with “After Weight-Loss Surgery”,  the eBook I have written to provide the most up-to-date information on success after weight-loss surgery. It covers this topic of considering revision surgery and goes through the questions to ask, the procedures that might be available, and helps you begin to understand if Revision surgery might be for you.

After you have all of that information in hand, if you think you are a candidate for Revision surgery, you’ll need to seek a highly-experienced bariatric surgeon to see if he or she feels there might be a surgical solution for you. And of course, as you know from reading this blog and my books, it is not an “easy way out” by any means. After Revision surgery, you will still need to transform your mind before you can transform your body. It will take hard work, commitment and effort, but you can succeed.

One of the most frustrating things for anyone who has undergone weight loss surgery is if the weight loss stalls or hits a plateau.  No matter what you do, it seems as though the scale does not budge.  There are extremely helpful methods for moving off of that plateau and jump-starting the weight loss process.

One of the most successful methods is to stop and regroup, and then imagine that this plateau weight is your new baseline weight. To then jump start weight loss involves initiating a new induction type program such as the induction weight loss diet program at iMetabolic.  This kind of program involves using meal replacement shakes and a low carbohydrate, low calorie diet in addition to some increased calorie-burning exercises.

To make this kind of effort successful, it requires not only a physical change and diet change, but also mental or psychological change.  This is a highly successful method and you can succeed with it if you put your mind to it.  I talk about how to go about this and describe the specific recommended diet that has worked for many patients of mine who have experienced weight loss plateaus in the past. And have seen the weight loss resume once they initiated the program described.

Possibly more distressing than hitting a plateau for a bariatric patient is the experience of rebound weight gain. Rebound weight gain is sometimes referred to as a relapse after weight loss surgery.  The most important thing is not to panic, but to refocus, gather information, regroup and rededicate yourself to losing the weight once again. All hope is not lost.  The tools and techniques are described in the e-book “After weight loss surgery” and suggestions about when to see your doctor, when to see your bariatric surgeon if this has occurred are discussed.  An important point to know is there is hope you still can succeed at losing the weight.  There are methods available, both nonsurgical and surgical.  So, you can restart your weight loss journey today and still be successful.

I cover both these concepts in detail in the newly released e-book “After Weight-Loss Surgery” available on Kindle through Amazon and Sony Readers and on iMetabolic and other places where e-books are sold or distributed.  For a nominal fee and download, you can learn from the experience of thousands of people who have come before you and successfully lost weight and kept it off after their weight loss operations.

Once the weight loss surgery is completed, how do you truly maximize its success?  What are the critical secrets to losing weight effectively and in the most healthy way possible?  How can you not only lose pounds, but also feel better and have more energy?

These are some of the most important questions that are answered in my newly released e-book called, “After weight-loss surgery”.

I have had the great privilege and the unique position of serving as the Medical Director for both a nationally recognized surgical weight loss center, as well as an acclaimed medical (nonsurgical) weight loss surgery, iMetabolic or the International Metabolic Institute.  From these positions, I have had the great privilege of helping thousands of people successfully lose weight using all of the proven techniques available from every discipline.  It has given me some great insight into what truly works to successfully lose the weight and keep it off.  Some of the critical factors that are described in detail in “After weight-loss surgery” include:

• How to adopt the life changing attitude necessary for successful weight loss.

• What to do if your weight loss stalls or you  hit a plateau.

• How to avoid weight regain and what to do about it if you experience rebound weight gain.

• Every thing you must know about vitamins, minerals and nutrients after your weight loss surgery.

Each of these topics is covered based on experience from real people and also from the very latest in clinical scientific publications in the field of weight loss and weight loss surgery.  I highly recommend this publication for anyone who has had weight loss surgery or is about to have it to help serve as a blueprint for your future success.

I tell my patients that the surgery is only successful with your commitment.

In truth, with weight-loss surgery and so many other facets of life we choose whether to commit to it and are successful at it, or we choose to do something less than this.

Committing to success starts well before surgery.  It starts sometime after the information-gathering phase, sometime after the initial visits with support groups and with the bariatric surgeon and some of the preoperative educational work.  But at some point in that process it is time to fully commit, mind, body and soul.

Once you have committed, then it is time to fully and completely put your heart into making your weight-loss journey a success.  Then, practically speaking, the commitment begins with a preoperative weight loss program, usually consisting of any protein based meal replacement diet.  iMetabolic has worked hard to create several great tasting meal replacement options to help make it easier to stay on track. During the weeks of this rigorous diet, most of my patients will lose 20, 30, 40 or more pounds.  Fully and completely committing to this preoperative program has a huge positive effect on initiating weight loss, but also making the surgery itself more safe for you and more technically successful for the surgeon.  If you put your heart into this preoperative diet and weight loss program, then you can already begin to have amazing results even before the surgery takes place.

And then the successful journey really begins, and the weight loss really takes off! And your commitment will last a lifetime.

A recent study finished in March of 2009 in surgical endoscopy described the outcomes with surgery in people with a lower Body Mass Index than the current standard widely accepted criteria (normally a Body Mass Index of 35 or greater qualifies people for weight loss surgery at most U.S. centers).

In this study, 53 patients with a Body Mass Index ranging from 28 to 35 underwent laparoscopic adjustable gastric banding surgery.  In the study, the patients lost 69% of excess body weight at six months. This rose to 77% at 12 months and 81% of excess body weight was lost at the two-year mark.  The mean Body Mass Index was 33 at the beginning of the study and then fell to 25.8 at the two-year mark.

Even more importantly, 50% of the patients with diabetes mellitus experienced complete resolution of their diabetes.  (Fifteen patients total started with type II diabetes.)  45% of patients with hypertension experienced resolution of this condition. Similar results were seen with asthma and obstructive sleep apnea.

Over the two-year course of the study, 13% of patients experienced some type of problem or complication including one patient with a band slip, two with fluid causing band obstruction, two with esophagitis and two with port leaks.

This most recent study adds further evidence that weight loss surgery is safe and effective for people with a lower Body Mass Index than is widely accepted.  The implications of this sort of research finding are quite profound.  Many additional tens of millions of Americans and hundreds of millions worldwide would qualify under an expanded BMI criterion.

This study and other like it show that people who are moderately obese stand to improve their health and resolve very serious conditions such as type II diabetes, obstructive sleep apnea, hypertension and asthma with the help of weight loss surgery.  Should the criteria be expanded?  Should health insurance plans pay for this surgery for this vast number of people who would qualify under expanded criteria?

Perhaps it is better to offer the weight loss surgery to people at a lower BMI and take a more proactive or preventive approach to the serious diseases they will soon develop.  One might argue that they might also be expected to have lower risk for surgery at this earlier stage of the obesity disease rather than waiting until they have full-blown obesity with many complications like severe heart and lung disease (which make them higher risk for surgery and anesthesia).

In the future, we will see a debate over whether the current criteria for weight loss surgery need to be expanded and then who would pay for the procedures and programs.