FitForMe live webinar: Preventing Deficiencies after a Sleeve Gastrectomy

“In the first year after a Sleeve Gastrectomy, 75% of all patients develop one or more deficiencies. This shows that taking no food supplements, is definitely not an option. We need to instruct our patients to take their multivitamins.”

This is one of the conclusions Laura Heusschen drew during a webinar where she, together with Dr. Edo Aarts and Marieke Smelt, presented the results of new research into deficiency prevention after a Sleeve Gastrectomy.

High deficiency prevalence after a Sleeve Gastrectomy

54% of all bariatric procedures being a Sleeve Gastrectomy in 2018, it is currently the most performed bariatric surgery type worldwide. Some think that there is little risk of developing nutritional deficiencies after this procedure. However, as Laura Heusschen, researcher at Rijnstate Hospital in the Netherlands, found during a 12-month RCT on the effectiveness of WLS Optimum, deficiencies often occur after a Sleeve Gastrectomy, especially for iron, folic acid, vitamin B12 and vitamin D.

Over the study period, Sleeve Gastrectomy patients using WLS Optimum (1.0) were less likely to develop anemia, compared to patients using standard multivitamins. Also, PTH levels were less elevated. However, deficiencies were still highly prevalent in both patient groups. This showed the need for an increase of nutrient dosages in WLS Optimum 1.0, to meet the elevated nutritional needs of Sleeve Gastrectomy patients.

The effectiveness of WLS Optimum

Marieke Smelt, who works as a physician assistant general surgery at Catharina Hospital in Eindhoven, came to a similar conclusion in her clinical study on the effectiveness of WLS Optimum. In her study, 970 Sleeve Gastrectomy patients were followed for 48 months, during which blood serum values were measured to identify their nutritional status.

“I would suggest that Sleeve Gastrectomy patients could benefit from the specialized WLS Optimum, but this supplement needs adjustments for iron and vitamin B6.” – Marieke

Compared to standard multivitamin supplementation, WLS Optimum was found to effectively prevent nutritional deficiencies among Sleeve Gastrectomy patients. Significant differences in blood values were found for ferritin, vitamin B1, B12, D and folic acid. Furthermore, WLS Optimum decreases the risk of developing vitamin B1, B12 and folic acid deficiencies. However, more iron deficiencies and vitamin B6 hypervitaminosis were found.

The results of product optimization

Based on these studies, it was concluded that the composition of WLS Optimum needed to be further tailored to the specific nutritional needs of Sleeve Gastrectomy patients. In 2017, and again in 2019, WLS Optimum was optimized, increasing the dosages of most nutrients, but decreasing the dosages of others, like vitamin B6.

The effectiveness of the new composition (2.0) was studied by Laura among 75 Sleeve Gastrectomy patients over 12-month period. She concludes: “It is necessary to take multivitamin supplements after a Sleeve Gastrectomy, preferably a specialized one, such as WLS Optimum. The optimized WLS Optimum seems very good to prevent deficiencies and maintaining stable serum values.”

Compared to the 1.0 version, the improved WLS Optimum led to less vitamin B12 (11% vs 25% in old version) and phosphate (0% vs 24%) deficiencies. Furthermore, serum levels for zinc were found significantly higher. For vitamin B1 and ferritin, improved serum levels were also observed, although still decreasing over time. This shows for a need to slightly further increase the vitamin B1 and iron dosages. However, it was seen that when patients are compliant, the decrease is very minor.

The trend of improved blood values continues over 2 and 3 years of follow-up. Over this period, not using a supplement is again proven not to be an option. These patients were found to have the lowest values for almost all nutrients.

The right advice for vitamin B12 supplementation

During the webinar, the question was raised whether usage of intramuscular injections is still to be advised. For most Sleeve Gastrectomy patients, the amount of 1000 mcg in WLS Optimum 2.0 suffices to prevent vitamin B12 deficiencies. The researchers therefore stated that generally, additional vitamin B12 injections aren’t needed, since they are used as deficiency treatment in stead of prevention.

Conversely, some patients have elevated vitamin B12 levels. The researchers were asked if for
these patients, WLS Optimum should still be advised. Serum values are not the best marker to define vitamin B12 deficiencies. Furthermore, attention should be given to the full nutritional spectrum, rather than focussing on one specific nutrient.

“It’s not just about vitamin B12, it’s about all the other things that are also in WLS Optimum. In my opinion, you should look at the reason for the high vitamin B12 values, but still, you should still keep advising patients to use WLS Optimum.” – Edo

The need for lifelong supplementation

Supplementation compliance is generally low among bariatric patients. Laura found that only 60% of the patients in her study still took their multivitamins after 12 months, even when provided free of charge.

Low compliance and insufficient dosages increase the risk of long-term deficiencies. Marieke concluded that despite standard supplementation, nutritional deficiencies are common after a Sleeve Gastrectomy and that prevalence increases progressively over the years. This shows the need for lifelong usage of specialized food supplements and regular monitoring of the nutritional status.

“I think everyone has stories from patients that never have any deficiencies, despite not using any supplementation. But keep in mind that patients are taking them for the long term. Even if they are not deficient now, or don’t have any complaints, that doesn’t mean that they won’t become deficient or get complaints in 2, 3 or 10 years.” – Laura