Supplements After Bariatric Surgery and With Celiac Disease or Other Absorption Problems

See a clinician first

Nutrition after weight-loss surgery, or with celiac disease or another absorption problem, is led by a specialist team and a dietitian. This page explains what official bodies and reviews say; it cannot tell you what to take. Do not start, stop or change a supplement or any prescribed medicine on your own. The British guideline says people after bariatric surgery should seek early advice for prolonged vomiting or poor dietary intake, and that possible nerve involvement (for example unexplained sensory or gait symptoms) needs urgent specialist advice. [1] Outside this page, see deficiency testing and its limits.

What absorption problems are

MedlinePlus says that in a malabsorption syndrome the small intestine cannot absorb nutrients from foods, and lists celiac disease, lactose intolerance and short bowel syndrome among the causes. [2] Bariatric surgery changes how much is eaten and absorbed. [1] The common point is that eating well or taking a standard multivitamin may not be enough, and needs are individual.

After bariatric surgery

These are British recommendations for adults. We could not read NIH Office of Dietary Supplements or Health Canada pages for this round. Amounts differ by procedure and person, so none are listed here.

Pregnancy after bariatric surgery. BOMSS says women planning pregnancy should take additional folic acid, should replace retinol vitamin A in supplements with the beta-carotene form or use a preconception or pregnancy-specific supplement, and should have nutritional screening each trimester. [1] They should be referred to specialist antenatal care. [1] See prenatal and postnatal vitamins.

With celiac disease

The NHS says celiac disease damages the small intestine so the body cannot properly take in nutrients, and that complications can include osteoporosis, iron deficiency anaemia and vitamin B12 or folate deficiency anaemia. [4] The treatment, MedlinePlus says, is a gluten-free diet for life. [5] The American College of Gastroenterology says treatment requires strict adherence to a gluten-free diet and lifelong medical follow-up. [6]

Two label points matter. MedlinePlus says gluten may also be in products you swallow, including vitamins and supplements. [5] A gluten-free claim on a label is a claim to check; see gluten-free and other label claims. And a 2019 narrative review of 73 studies found that, in people on a gluten-free diet for over two years with good compliance, deficiencies were still detected in up to 30% for vitamin B12, 40% for iron, 20% for folic acid, 25% for vitamin D and 40% for zinc. [7] It is a narrative review, not a trial, so treat the figures as indicative only. We do not reproduce its suggested supplement amounts. See celiac disease.

Other absorption problems

For short bowel syndrome, lactose intolerance and other causes of malabsorption, the sources we read give no supplement guidance. Proper evidence not found here for general supplement recommendations; MedlinePlus says to see your provider. [2]

Testing and its limits

Blood tests can show a low level, but ranges differ between labs and countries, and results can be affected by illness, medicines and supplements. A symptom such as tiredness cannot diagnose a deficiency. BOMSS and NICE describe monitoring as part of a shared-care plan between the specialist service and primary care. [1][3] Do not treat a suspected deficiency alone.