Bariatric Lab Tests 

Patients who have had a surgical weight loss procedure, whether the Roux en Y Gastric Bypass, Adjustable Banding, or Vertical Sleeve Gastrectomy, require close monitoring of nutritional status, physical and mental well being for the rest of our lives.

For the first year we see our Bariatric Surgeon and team, but after that we are often on our own as monitoring is passed along to our Primary Care group. Not all General Physicians are aware of the nuances of our special status and may not know we are prone to a particular set of deficiencies different from other patients. We have to be our own advocates and help our medical team take good care of us but we are ultimately responsible for our own longterm care. It’s just like real life!

Bariatric Lab Tests 101


In our Facebook BariatricEating Support Group we have many many ice chewers who *think* they *like* chewing ice and their PCP or PA has not done a Ferritin test to check stored iron levels – it’s a safe bet they are iron deficient and have no idea it can lead to heart damage and death. (they laugh about finding others who also eat Sonic crushed ice by the cupful. It’s. Not. Funny.) We push post ops to have labs done and they return to tell us their Ferritin was ‘3’ and they were given an emergency blood transfusion, with those in the ‘5 to 10’ range having IV Iron Infusions. Proper Replenishment: Additional Iron such as Ferrochel® used in Journey Gentle Iron, 40 to 60mg daily (which is elemental equivalent to 300 to 325 non elemental Fe)



Anyone who has been around for five or more post op years knows a few who have died with neurological complications of undiagnosed thiamine/B1 deficiency – starting with numbness in fingers, unexplained ‘tripping’ around the house and progressing to hospice. Proper Replenishment: Taking a multi with ALL the B vitamins. Gummies and Flintstones do not have all the B’s as they compromise taste. Bariatric vitamins have the B’s. 



Eight years after my gastric bypass, Osteomalacia or Soft Bones complicated my orthopedic surgeon’s placement of screws for a leg fracture from a motorcycle accident. A serious D deficiency had turned my bones into ‘a stick of cold butter’ and I needed immediate supplement therapy. It took three years and change of doctors to get my D levels above 50ng/ml. Proper Replenishment: Vitamin D3, 50,000IU once weekly x 8 weeks.


Recommended Annual Lab Tests For Post Bariatric Patients

Highlighted tests are more important for a bariatric patient than a non-op and may not be routine for your doc, so don’t be intimidated to show them this list. Other tests may be needed if you present symptoms.

CBC – Complete Blood Count
Comprehensive Metabolic Panel (evaluates organ function – liver, kidneys, electrolytes, protein, calcium, glucose)
Lipid Profile (Cholesterol/Triglyceride Levels)
Ferritin, Iron Profile
Vitamin A
Vitamin B1; Thiamine
Vitamin B12; Folate
Vitamin D, 25 OH
iPTH – Parathyroid Hormone

Bone Density (DEXA) at 2 years post op
Thyroid Panel (TSH,T4) – for those with thyroid disease

Take good care of your body, its the only place you have to live! The major surgical alterations you’ve made to your body last forever – be smart – bariatric vitamins are important for the rest of your life. 

42 thoughts on “Bariatric Lab Tests 101

    • Melinda says:

      Ms Luby o this B6 causes gas? I have had terriable gas for a few yars now mostly in the evenings and at night all I have to do is roll over in bed or move an there it blows. Could anything else be causing the problem?

      • Susan Maria Leach says:

        Melinda… its probably the foods you are choosing. Do you eat a lot of sugar free foods, hard candies or chocolates. Sugar free ice cream causes problems too. Some people have trouble with dairy causing gas as well.

    • Patricia Sills says:

      I have been wondering how can a tiny stomach produce so much gas. My bariatric doctor tested me for many things only to tell me i was eating too fast. I would belch even in the middle of the night when i didnt even drink. Thanks i will go next week to my local doctor and try that b6 shot

  1. Beth says:

    I wish after my surgery I would have been more careful. I am 12 years out and I am slowly gaining. I need help in getting back on track.

    • Melinda says:

      Beth Im 10 yrs out an have gained 40 pounds back from my lowest of my maintained for most of my yrs and Im just sick, I know its not all my fault but some is and I have some issues as to where I cant walk much so exercise is a issue though I nver exersised from my 410 pounds to the 167 an then 170 i maintained for years I just did my daily routuine an was mindful of my eating an more on the go. All I here now is exersise bla bla bla u cant do it if u cant hardly walk on a day to day base I do what I can most is depression meds, an stress from chronic pain Id like to have the pouch retightend or a new procedure the sleeve but not sure if it can be done. So hang in there Beth ur not alone <3

  2. Val says:

    I am 5years out. After about a year, I slowly began to start back eating my drug of choice;sweets! It used to make me throw up but now it doesn’t . I have now gained back 40 pounds. This is depressing! Any suggestions?

  3. Franklin says:

    I have a lot of neuropathy issues in my feet. My Neurologist said that many Bariatric patents get low on their copper and this can cause neuropathy, so he does test that annually. However, mine is OK, but my sodium does dip too low periodically.

    • Lynne Quinn says:

      I have neuropathy. I’ve been through every test and doctor. Finally my neurologist found my vitamin B6 was way too high. 92.8, should only be about a 20. Its getting better but no B vitamins for me

  4. Sheryl says:

    Susan, Where can we find what the numbers should be then? And can you tell me what is involved in an IV Iron Infusion? will insurance pay for it? I want to be better informed this time at my annual dr. appt. to review my labs. and push back if she tells me to up my vitamins. Have been down this road for too long and want to feel better now. Thanks

  5. Faye Hunt says:

    I had my gastro bypass about 10 years.. I am having problem with weight gain and my body retain a lot of gas
    My question is how do I get back on track to start loosing weight again..what do you recommend ?

  6. Shari says:

    I am sixteen years post RNY. My Dr. won’t refer me to a bariatric specialist for a checkup and he refuses to listen to me when I try to explain about our differing needs at WLS patients. An issue I have had, besides the iron so low I’ve had several blood transfusion and iron infusions, is severe, agonizing leg cramps. These are unlike any pain I have ever experienced. It feels like my feet and legs are trying to twist off. It’s excruciating and happens during the night, and is sometimes worsened by doing virtually any extra walking during the day. My Dr just rolls his eyes and says everyone gets leg cramps sometimes. This is way above and beyond normal. I have had bruises in my calves from the cramping of my leg muscles. Surely this can’t be normal? Is this possibly deficiency related?

    • Jennifer Sarracino says:

      I am 15 years out and no one has followed up on my labs in many many years, but now that I am wanting to get BOT not only with diet, exercise but labs too. I took the lab list from her to my PCP and she ordered without question. She thought it was great I was working to get back on track and in the right health, after all we need to put ourselves first.

    • Pam says:

      Have you researched Restless Legs Syndrome? It can show as jumpy…crampy…itchy legs that just have to move. It is often exacerbated by iron deficiency and copper deficiency. Low calcium and magnesium levels can cause severe leg cramping. A referral is not always needed to see a bariatric doctor. Call offices. I am 20+ years post rouyen-y and seeing my first post bariatric doc in January for labs for minor nutrients due to symptoms. A GP that does not want to refer you needs to be changed. Any doc that feels secure in their treatment of you should not fear a referral. Good luck.

    • Steff says:

      Iron deficiency causes leg pain. Also you may get bone pain from metabolic bone disease that we are prone to. You can get toe cramps if your electrolytes are off. I’m 13+yrs out and am having bone pain in my leg going to 2nd doctor for other opinion. Since I’m a registered nurse I will advocate for myself.

    • Tee says:

      I used to get very very sever leg cramps and foot cramps. I quit tucking my bed covers on my bed so it doesn’t press on my feet. Well no matter what it worked. I haven’t had cramps in quite some times.This may sound crazy but what ever it worked for me and I was having cramps every single night all night. Try this I hope it will help you.

  7. Anne says:

    I would like to know where the information was obtained about the neurological complications from lack of B1 including untimely death…or any specifics on the statement(s) in that particular portion of the article. Thank you so much!

  8. PAULA DODSON says:

    I’m 11yrs. out(11/30/2004)RNY. The center /hospital where I had my surgery closed one year after my operation. So, I’ve had to deal with the “mainstream” medical profession(THEY ARE CLUELESS ABOUT OUR CHEMISTRY. THIS IS JUST ONE OF 5PCPs). Ergo, my frustration….My PCP(of 3yrs.) FINALLY drew lab work and found my ferritin to be (7.3) . She orders “Enteric Coated Ferrous Sulfate” . I’ve told her many of times NO NSAIDS, and only “IMMEDIATE RELEASE ” medications.Anyway, Her next suggestion is…”EAT A DIET RICH IN IRON ie:RED MEAT & SPINACH”(apparently forgetting I have a”pouch”).So, the final, and last suggestion offered is a referral to a hematologist.(better/worse..IDK?)I’m trying to avoid the transfusion. Iron Carbonyl pills (INS.does not cover are $85.00 /mo). Comments? Advice ? WHAT IRON ARE WE SUPPOSED TO HAVE ANYWAY??

    • Chris says:

      I had the iron IV and it was like immediate boost in my over all feeling… was such a relief….only Takes about 20 minutes and then you can concentrate on getting some Fe supplement….and Medicare will pay for the IV instead of the $130/month Fe vitamin the Dr ordered…..I find working with my oncologist is easier than my GP

    • Helen says:

      I had iron infusions over a few week period and not only did I get immediate relief but my hair grew back. Now again since I moved I have to fight docs again

    • Jayne says:

      I am 17 years post RNY. Since starting taking pre-natal vitamins I have had great iron levels! It’s the only thing that help to raise my iron!

  9. Jose says:

    I and my guys appeared to be foowlling the nice tips and hints on the website then all of the sudden I had a terrible feeling I had not expressed respect to the website owner for those strategies. Most of the ladies are already passionate to read all of them and have in effect truly been having fun with these things. Thank you for simply being simply kind and also for using this form of great information most people are really eager to discover. My very own sincere apologies for not saying thanks to you sooner.

  10. Barbara says:

    I have not had my surgery yet. My paperwork is being submitted today. I took the 6 month required classes. Reading modules and writing my goals. The doctor kept increasing my insulin. Over the 6 months I gained 8 pounds. Do you know if I will be rejected?

    • Susan Maria Leach says:

      Barbara, you are going to need to get serious about this and stick to their plan prior to surgery. Many people ARE turned down before surgery for gaining weight. It depends on your surgeon and your medical condition. Gaining just prior to surgery can be dangerous for you. You can still go on a strict ATKINS diet and drop the 8 in very little time. Join our support group and they will help you.

      • Carla says:

        They are saying they will turn me down from surgery because I have now lost too much weight. I feel frustrated. BMI is not high enough.

  11. Michelle says:

    I too am having the serious gas issue and the iron deficiency. My GP told me to take vitamin C with my iron as it helps absorption. And get more fiber. I’m now using Meta fiber wafers, two in the AM and two in the afternoon. I’m training for my 5th half marathon, but the exhaustion is killing me.

    • Pam says:

      I am experiencing the same issue. Fatigue and shortness of breath on exertion. Iron levels were low but are now low normal. Hemoglobin was low but now low normal. Take vitamin C. Researching I found that low copper keeps iton from binding with hemoglobin and iron will not store. Check copper levels. It could be that simple. I am having a battery of labs done in December to check the micro minerals that are not checjed by a GP. Seeing the bariatric doc in January after a 20+ year hiatus. My GP agrees with this new approach and welcomes the help. Good luck.

  12. Stephanie says:

    I’m 4 years post sleeve, I been suffering with leg cramps at night for about a year. Should I go to my primary care physician or to a Bariatric Surgeon for relief?

    • Alison Garcia says:

      Hi Stephanie, for your lab tests, your primary care physician can order those lab tests. Take that article or list to your doc and show him, that way you are on the same page on what’s necessary for your continuing good health. -Alison

  13. Tammie says:

    Hi I’m 5 yrs out gastric bypass doing great I do have my blood levels tested twice a year i make sure all is good. I do take all my vitamins that are needed. I also do my part I hit the gym 3 times a week. I have gained 6 pounds that’s my go back & forth weight I will lose 6 pounds and then regain it that’s my play space I do check my weight every other day so I do keep check on it

  14. Sheila says:

    I definitely agree they need to find a different doctor if they won’t get a referral but many doctors who have patients that need referrals to go to a specialist with her insurance don’t want to refer them because it takes money out of their pocket. . Greed the root of all evil

    • Suzanne Shaw says:

      You should bring that up with your Dr and speak with them about your current lab results! It could be a few things, but vitamin issues are one thing you can fix!

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