B12 and Folate Deficiencies in VSG

On December 6, 2010, in Vitamins, Water Solubles, by Andrea

Cyanocobalamin Injection

I deal with folks of RNY and DS persuasion on a regular basis simply due to the fact that we know we have to do supplementation due to our malabsorption of micronutrients for the rest of our lives.

What AGBers and VSGers fail to understand is that they also need to supplement as well.  And in some cases, it is more than just a simple multivitamin and calcium.

A study was started in June of 2007 of VSG patients and conducted for 12 months afterwards to study the possibility of iron, B12, and folate deficiency with only taking an iron-free multivitamin.  A total of 61 patients were included in the study.  Parameters for those who don’t have access to the whole study (and, if you just read the abstract?  You’d not realize the significance of this study!!  It’s VERY SIGNIFICANT! for VSGers!) like I do.

Tests used to monitor deficiency were as follows:

  • Iron deficiency / Anemia: CBC, soluble transferrin receptor (sTf-R), ferritin, iron, TIBC
  • B12 – vitamin B12
  • Folate – RBC folate (Andrea’s note – this is the definitive test for folate deficiency)

The multivitamin used was an iron-free multi containing 0.2 mg folic acid and 12 mcg cyanocobalamin (B12) for duration of the study.  Those who changed their vitamin regimen (including one SMART person who chose to take an iron-fortified multi) were taken out of the study and not included in the 61 patients listed above.

The things that stood out most about this study:

  • Six months after surgery, 3 patients (2 females, 1 male) developed an iron deficiency.  One patient had elevated sTf-R level; second patient had combined low serum iron and low transferrin sat% and high sTf-R, and third patient had abnormally low levels of ferritin and iron level with low transferrin sat%.
  • Twelve months after surgery, all three affected patients had elevated sTf-R levels.  One patient had low ferritin; low serum iron and transferrin sat% was noticeably decreased in another.
  • The study considered the amount of iron deficiency in this study to be statistically insignificant.
  • One patient with iron deficiency also had a B12 deficiency.
  • Incidence of B12 deficiency increased “significantly” from 8.1% preoperatively to 26.2% 1 year after surgery.
  • Six patients (9.8%) developed a folate deficiency 12 months postoperatively.  Significant decrease of RBC folate levels were seen at 6 months.
  • Six months after surgery, four patients (3 females and one male) developed anemia.  2 remained anemic at 12 months.  At 1 year, 3 patients were anemic.

Thoughts the authors of the study had regarding this study and the results:

  • Obesity is considered a low-grade chronic inflammatory condition.  Ferritin is an acute phase reactant that increases in inflammatory situations.  Therefore, the reduction of ferritin levels observed after bariatric surgery could be attributed in part to the resolution of the coexisting inflammatory state.
  • A significant number of patients developed B12 deficiency after VSG.  Could be attributed to fundus resection, which is the most abundant part of the stomach with parietal cells that release Intrinsic Factor essential for B12 absorption.  Daily administration of 5x the RDA of oral B12 failed to prevent the development of B12 deficiency in patients.
  • Folate deficiency was evident as early as 6 months after surgery.  Despite receiving a multivite with 0.2 mg folic acid following VSG, folate levels deteriorated throughout the study.  Could be attributed to dietary changes.  Patients might require more than the RDA of folic acid to maintain normal folate levels.

It is important to note that the authors of this study were out looking to prove VSG did not affect iron levels as much as RNY does.  And they did.  Thus they tended to downplay the B12 and folate results unless you read the entire study.  In fact, the article is “Impact of Laparoscopic Sleeve Gastrectomy on Iron Indicies: 1 Year Follow-Up” which goes to show that sometimes it really does pay to get our hands on the entire article.

Who wants to pay for my subscription to SOARD?

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5 Responses to “B12 and Folate Deficiencies in VSG”

  1. Lynn B says:

    Being banded my iron fluctuated from 21-144 usually in the 70-80s. Folate was at its lowest at 5.6 and was at 15 last year. Ferritin has been as low as 14, current high (last year 32). B12 was 198 but I got that up to 921 with oral supplements. I have my first blood draw next month (4 months post VSG) and I’m dreading to see if they’ve gotten worse. My nut thinks they’re great – I’ve upped my D and Iron on my own so we’ll see. Any advise would be appreciated and put to use.

  2. Andrea says:

    Be sure they pull a RBC folate and not just a serum folate. Most don’t pull a RBC folate, but it is needed.

    When you get your labs, lemme know.

  3. Mimi says:

    I’m a sleever and would love to start using b12 injections versus the sublingual dropper. Any recommendations?

  4. Andrea says:

    Ask for a script for injectables?

    You can do them at home.

    Or take pill-form? Just monitor your labs..

  5. Rachel says:

    Im posting this everywhere!!! Thanks for looking out for the sleevers :-) Love ya!

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