Protein malnutrition

It can occur for a number of reasons, including poor dietary choices, too small a stomach or poor protein absorption. It can occur even several years after surgery. Protein malnutrition is accompanied by swelling and the patient reduces lean body mass (muscle). In all cases of suspected protein malnutrition, the patient must be consulted by a bariatric physician.

Iron deficiency anaemia

This is common after bariatric surgery, especially after GB. However, other causes should also be considered and investigated. If iron supplementation does not reduce iron deficiency anaemia, intravenous iron or blood transfusion may be required. Oral iron supplementation can be taken with meals or drinks containing vitamin C to aid absorption. In contrast, it cannot be combined with calcium-rich meals or calcium supplementation. If the anaemia is not due to iron deficiency or blood loss, other nutritional causes should be considered, including folic acid, vitamin B12, zinc, copper and selenium.

Folic acid and vitamin B12 deficiency

Low levels of folic acid may be an indication of poor choice of multivitamin supplements. However, it can also be an indication of malabsorption, especially if other nutritional deficiencies exist. Vitamin B12 deficiency should be considered before including additional folic acid.

Calcium, vitamin D deficiency

Vitamin D deficiency can lead to secondary hyperparathyroidism. Calcium deficiency can lead to early osteoporosis. Care should be taken to ensure an adequate supply of both components in the diet and to correct deficiencies with supplementation, taking care not to combine calcium and iron supplementation.

Zinc, copper and selenium deficiency

Unexplained anaemia, poor wound healing, hair loss, neutropenia, peripheral neuropathy or cardiomyopathy may be symptoms of zinc, copper or selenium deficiency. Zinc and copper administered at the same time can have an antagonistic effect, so it is worth paying attention to the levels of both components and taking them in the right way for correct absorption, maintaining the proportion. If additional zinc supplementation is required, maintain a ratio of 1 mg of copper for every 8mg - 15mg of zinc.

Compensating for vitamin and micronutrient deficiencies can be complicated, so it is worth consulting a nutritionist or doctor. Specialist advice should particularly be sought in the following cases:

• Freshly identified biochemical deficiency - vitamins and micronutrients below normal.
  Unexplained symptoms that may indicate vitamin and micronutrient deficiencies.
  Women who have undergone surgical treatment for obesity and are planning to become pregnant or are pregnant.
  Patients gaining weight