Bariatric surgery is usually quite effective for obesity.  Unfortunately, it is quite expensive and some patients get severe side-effects including death, an event which happen to one of my patients within days of her surgery.  Low cost, but good quality bariatric surgery is available in other countries, e.g., India, Israel, eastern Europe, etc.  While in the U.S., the cost is roughly $25,000, elsewhere it costs $5,000 or so.

This page will be more devoted to nutritional deficiencies after surgery, since I am running across more such patients in my psychiatric practice as bariatric surgery becomes more common.  The most common micronutrient deficiencies are of vitamin B12, iron, calcium, and vitamin D.

Vitamin D: High Supplementation Needed After Bariatric Surgery: In a study of 116 obese women before and 5 and 10 years after biliopancreatic diversion (BPD), hypovitaminosis D was 76% in the obese status and 91% and 89% at 5 and 10 years after surgery, despite ergocalciferol supplementation. 25(OH)D concentration decreased from 39.2 in obesity (p = 0.0001) to 27.4 and 25.1 nM 5 and 10 years after BPD. Low 25-hydroxyvitamin D does not affect insulin sensitivity in obesity after bariatric surgery. Manco M, et al. Catholic University, Rome, Italy. . Obes Res 2005 Oct;13(10):1692-700. Ed: Obviously, the amount of vitamin D supplementation being used is grossly inadequate.  My recommendation is 2000 units per day, or 500% of the government's daily value.  This can be obtained from iherb.com for about 5 cents a day.

GI: Melatonin Helps Bowel Recovery After Massive Resection: Rats underwent 90% small bowel resection and suffered from diarrhea and weight loss between the first and the sixth postoperative days. The body weight of the SBR/melatonin group showed significant increases at the beginning of postoperative day 10 and day 21 in comparison to that of the SBR/untreated group. The rats treated with melatonin had significantly greater villus height and crypt cell mitosis, while the mucosal thickness was significantly increased. Effects of melatonin administration on intestinal adaptive response after massive bowel resection in rats. Ozturk H, et al. Diyarbakir, Turkey. Dig Dis Sci 2006 Feb;51(2):333-7.

Thomas E. Radecki, M.D., J.D.

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