The Importance of Vitamin B12 Following Bariatric Surgery

Vitamin B12, also known as cobalamin, has many functions in the body. It is necessary for red blood cell production, cell metabolism, DNA formation, and nerve function. B12 also helps the body metabolize fat, protein, and carbohydrates and is, therefore, necessary for digestion and absorption. Many researchers also believe that vitamin B12 can support bone and eye health.  Because the body cannot produce B12, it is considered an essential nutrient. This means it needs to be absorbed from the food we eat. Extra B12 is stored in the body for future use, mainly in organs such as the liver and kidneys. These stores of B12 can last for several years before they run out and a person experiences a deficiency. Still, the vitamin must be consumed daily to reduce this risk.

B12 is a water-soluble vitamin found naturally in many foods. This vitamin is mainly found in animal foods, including but not limited to fish, meat, poultry, eggs, and dairy. Some of the richest sources of B12 are liver, sardines, and clams, while other foods have B12 added during processing, such as fortified breakfast cereals. B12 is present in some plant foods, such as mushrooms and algae, but it is not as bioavailable as the B12 found in animal foods. This means that your body has a more challenging time digesting and absorbing the B12 found in plants. Because of this, many people following a plant-based or vegan diet must take a supplement to meet their B12 requirements, as they are not getting enough of the vitamin from food alone.

The recommended daily intake of vitamin B12 is 2.4 micrograms (mcg) per day. Most people get plenty of B12 if they eat a balanced diet, especially if their diet contains animal
proteins. For example, a 3-oz portion of lean steak (about the size of a deck of cards) contains almost seven micrograms of B12. Though red meat is high in B12, other lean animal proteins such as fish and turkey have plenty of B12 and are generally healthier for a balanced diet.

Does B12 Give Me Energy?

Since B12 is essential for many bodily processes, many people think consuming or taking extra B12 can help increase energy. This theory may be partly because B12 plays a role in the body’s energy production, mainly through DNA formation. However, there is currently no solid scientific evidence supporting this theory in people with sufficient vitamin levels. Many energy drinks label B12 levels as a marketing technique. Often this advertising leads people to believe that these products are healthier than they really are. The best way to boost energy naturally is by eating a healthy diet, drinking lots of water, and getting plenty of physical activity.

Vitamin B12 and Bariatric Surgery

Vitamin B12 is vital after bariatric surgery. When we eat foods with B12, it binds to the protein in the food. Once it enters the stomach, acid and several enzymes unbind B12 to be absorbed. Then, B12 combines with a particular enzyme called intrinsic factor secreted by the stomach. Without this enzyme, B12 cannot be absorbed by the small intestine. Because bariatric surgery involves removing part of the stomach, intrinsic factor production may be compromised.

Therefore, if vitamin B12 cannot be adequately absorbed and moves through the intestines undigested, it will be excreted in the stool.

B12 Deficiency

Since vitamin B12 is needed for many body functions, not having enough can cause several health issues. B12 deficiency may lead to anemia, which causes a malfunction in the nervous system over time. Many signs may indicate B12 deficiency, and they tend to develop slowly and gradually worsen over time. Early symptoms include fatigue, a low appetite which may lead to weight loss, having a sore mouth or tongue, nausea and vomiting, and the onset of depressive symptoms. Later signs of B12 deficiency include vision problems, difficulty speaking, and numbness in the hands and feet.

Since bariatric surgery reduces the body’s ability to digest and absorb vitamin B12, most people cannot obtain the amount they need daily from food alone. In this case, a supplement can help fill the nutritional gap. B12 supplements come in several forms: oral, sublingual, and intramuscular. Oral supplements, the kind typically found in pill form, are the most common. However, oral supplements may not be the best option for bariatric surgery, as it still requires intrinsic factors to be broken down in the stomach. Sublingual B12 is absorbed under the tongue and doesn’t require intrinsic factors, as it bypasses the intestines. Intramuscular forms of B12 are popular as they typically only need to be injected once every few weeks or months, depending on the person’s needs.

Though it is possible to take too much B12, most health professionals recommend about 350mcg per day for bariatric surgery patients, with 1000mcg per day being the safe upper limit. The best way to determine which supplement to take and how much is to discuss different options with your doctor. A blood test can easily detect B12 deficiency, so it’s essential to follow up on routine blood work, especially for those that have had bariatric surgery. While many people know the importance of following a healthy diet and vitamin regimen immediately after surgery, it’s essential to follow these guidelines for many years, especially if given specific recommendations by a doctor, dietitian, or other health care practitioner.

Chloe Seddon is a registered dietitian nutritionist who holds a Master’s Degree in health promotion from the University of Connecticut. She specializes in nutritional counseling, with a focus on a non-dieting approach to maintain healthy weight and goal-oriented lifestyle changes for long term success. She teaches intuitive eating and easy meal preparation to help clients sort through the myriad of nutritional misinformation to focus on having a balanced and happy relationship with food. She counsels clients with a range of issues, including chronic disease management, sports nutrition, disordered eating and weight loss. Chloe currently works as a nutritional counselor and educator providing group and individual consulting. She believes that balancing food, eating and exercise should be enjoyable and healthful.