Gastric Sleeve

Vertical Sleeve Gastrectomy (VSG), a type of bariatric surgery, involves the removal of approximately 60% of the stomach. The remaining portion takes on a tube or "sleeve-like" shape. This alteration in the stomach's structure can lead to several nutrient deficiencies due to factors such as:

• Decreased stomach volume and dietary consumption: The reduced size of the stomach limits the amount of food and nutrient intake.
• Altered digestive capacity: The reduction in stomach size can affect the body's ability to digest food effectively.
• Decreased gastric acid: The use of proton pump inhibitors (PPIs) and the decrease in stomach volume can reduce gastric acid, essential for digestion.
• Following a bariatric procedure like the VSG, patients commonly experience deficiencies in certain nutrients. These typically include protein, thiamin (vitamin B1), cobalamin (vitamin B12), folate, vitamin D, and zinc both before and after surgery. Post-surgery, additional deficiencies often arise, particularly in calcium and iron.

Source: Aarts, Edo O, Ignace M, Janssen C, Berends FJ. The Gastric Sleeve: Losing Weight as Fast as Micronutrients? Obesity Surgery 21.2 (2011): 207–211. PMC. Web. 27 Feb. 2017.

Gastric Bypass

Gastric bypass surgery, specifically the Roux-en-Y gastric bypass (RYGB), is a prevalent type of bariatric surgery. In this procedure, the stomach is divided into a small upper pouch and a larger lower "remnant" pouch. The small intestine is then rearranged to connect to both sections. Nutrient deficiencies might develop due to:

• Lower dietary intake: The volume of food intake is significantly reduced due to the reduced size of the stomach.
• Altered capacity for digestion: Changes in the stomach and intestine structure can affect the body's ability to digest food.
• Impaired micronutrient absorption: Nutrient absorption can be affected due to bypassing sections of the small intestine, where most absorption usually occurs.
• Patients undergoing gastric bypass surgery commonly experience deficiencies in certain nutrients. Before surgery, deficiencies in protein, thiamin (vitamin B1), cobalamin (vitamin B12), folate, vitamin D, and zinc are common. After the procedure, a broader range of deficiencies can occur, often including calcium, vitamin A, pyridoxine (vitamin B6), vitamin C, iron, and copper, in addition to those prevalent before surgery.

Source: Xanthakos, Stavra A. Nutritional Deficiencies in Obesity and After Bariatric Surgery. Pediatric clinics of North America 56.5 (2009): 1105–1121. PMC. Web. 25 Feb. 2017.

Adjustable Gastric Band

The Adjustable Gastric Band (AGB) is a type of bariatric surgery that restricts the capacity of the stomach. In this procedure, a band is laparoscopically placed around the upper part of the stomach and adjusted to reduce its size. Despite leading to fewer malabsorption issues compared to other bariatric surgeries, there are still notable risks of nutrient deficiency with AGB. Nutrient deficiencies might develop due to:

• Changes in dietary intake: After surgery, the smaller stomach capacity can lead to a decreased food intake.
• Changes in food tolerance: Post-surgery, there may be a decreased tolerance for certain nutrient-dense foods, leading to an altered diet.
• Before the Adjustable Gastric Band procedure, patients often have deficiencies in protein, vitamin A, thiamin (vitamin B1), pyridoxine (vitamin B6), cobalamin (vitamin B12), folate, vitamin C, vitamin D, zinc, and selenium. Post-surgery, additional deficiencies might arise in calcium and iron.

Duodenal Switch

The Duodenal Switch procedure, also known as DS or BPD/DS, is a bariatric surgery method that reduces stomach size, reroutes the intestines, and removes the gallbladder. This surgery, while effective in weight loss, presents notable risks of nutrient deficiency.

Nutrient deficiencies may arise due to:

• Significant malabsorption: As this procedure reroutes the intestines, there may be a significant decrease in the absorption of nutrients.
• Reduced stomach volume and dietary intake: With a smaller stomach size, the quantity of food intake is naturally reduced.
• Decreased capacity for digestion due to changes in stomach size: With a smaller stomach, there's less room for the digestion of food.
• Reduced gastric acid: The use of PPIs and reduced stomach volume can lead to lower levels of gastric acid, which is essential for digestion and nutrient absorption.
• Before undergoing the Duodenal Switch procedure, patients may already have deficiencies in protein, vitamin A, thiamin (vitamin B1), pyridoxine (vitamin B6), cobalamin (vitamin B12), folate, vitamin C, vitamin D, vitamin E, zinc, and selenium. Post-surgery, there might be an onset of deficiencies in calcium, iron, vitamin K, magnesium, and potassium.

Source: Xanthakos, Stavra A. “Nutritional Deficiencies in Obesity and After Bariatric Surgery.” Pediatric clinics of North America 56.5 (2009): 1105–1121. PMC. Web. 25 Feb. 2017.

Gastric Balloon

The Gastric Balloon is a type of bariatric procedure classified as a restrictive surgery. In this procedure, a silicone balloon is placed inside the stomach, which restricts its capacity and thereby reduces food intake. Another similar procedure is the Adjustable Gastric Band (AGB), where a band is laparoscopically placed around the upper part of the stomach to make it smaller. Even though these procedures present less malabsorption issues compared to other bariatric surgeries, they still come with risks of nutrient deficiency.

The nutrient deficiencies that may arise post-surgery are primarily due to:

• Changes in dietary intake: The reduced stomach size limits the amount of food that can be consumed, which can lead to nutrient deficiencies.
• Changes in food tolerance for key nutrient-dense foods: Post-surgery, some patients may develop intolerance to certain foods that are essential for nutrition.
• Before undergoing a Gastric Balloon procedure, patients may already have deficiencies in protein, vitamin A, thiamin (vitamin B1), pyridoxine (vitamin B6), cobalamin (vitamin B12), folate, vitamin C, vitamin D, zinc, and selenium. Post-surgery, there may be an onset of deficiencies in calcium, iron, and possibly others, depending on individual dietary habits.