Vitamin D: An Essential Nutrient

The Absolute Necessity of Vitamin D Supplementation in Bariatric Surgery Patients

When I work on a white paper like the one you are about to read, I will often review at least 25 or 30 research papers on the topic. I have to tell you that in my years of reviewing research, I have never seen more definitive information regarding a nutritional deficiency and the resultant need for supplementation as I have with regards to Vitamin D and bariatric surgery patients. - Dr. Andrew Myers

Let’s begin with some facts. Most patients who undergo bariatric surgery have a preexisting deficiency of Vitamin D (as well as a host of other nutrient deficiencies, but that is a discussion for another paper). Several research studies talk about the need to optimize Vitamin D levels prior to surgery, however, in practice, that does not seem to be as critical a consideration as it should be. Nonetheless, what the research shows is that those patients who are deficient before only suffer greater deficiency after surgery. I am going to explain to why you are more susceptible to Vitamin D deficiency later in this paper. First, I want to share with you why Vitamin D is so important with regards to the healthy function of our bodies.

Vitamin D – Vitally Important to your Health

Let’s start with the most basic definitions, if we may please. Does everyone understand what a “vitamin” is? A vitamin is a nutrient which is “essential” (meaning – you can’t live without it!) to the health and functioning of our bodies. Vitamins are “essential” because our bodies can’t make them and they have to come from our daily diet (e.g., food or supplements).

Vitamin D is a fat-soluble vitamin, meaning that it dissolves in fats and oils and can be stored in your body for a long time.

Vitamin D is completely different than most other vitamins. Vitamin D is actually a steroid hormone that is produced when our skin is exposed to the sun. Sun exposure rarely provides adequate vitamin D, making it necessary to obtain it from supplements or your diet.

I lead with supplements because so few foods, if you can call them that, contain significant amounts of Vitamin D. They include cod liver oil, which is great if you are Norwegian; salmon (good); beef liver and egg yolk. That’s it. See why supplements are basically the only way to get enough Vitamin D?

The problem with Vitamin D intake is so huge that at least 40% of the US population is deficient and with even higher levels of deficiency amongst certain populations. Bariatric surgery patients suffer deficiency at a level of 80 plus percent.

Here are some of the benefits of vitamin D:
  • Reduced risk of osteoporosis. Higher doses of vitamin D can help prevent osteoporosis by promoting bone health and function.
  • Better strength. Vitamin D can increase physical strength in both upper and lower limbs.
  • Immune health. Vitamin D is a critical nutrient in support of healthy immune function.
  • Mood management. Studies show that vitamin D may help to promote a healthy mood.
  • Heart health. Vitamin D3 has a restorative effect on the cardiovascular system, supporting repair mechanisms in the blood vessels.
  • Support for weight management. Optimal levels of Vitamin D may aid in weight loss and decrease body fat.
  • Live longer. Some studies suggest that vitamin D may help you live longer based on its broad range of health benefits.

With activities across a wide range of body systems, I hope you will agree that Vitamin D is truly an essential supplement for everyone, especially you after bariatric surgery.

Vitamin D and Bariatrics

I’ve already mentioned that most bariatric surgery patients present with Vitamin D deficiency prior to their procedure. What happens after surgery? Well, generally things get worse.

The causes of vitamin D deficiency are multifactorial. Here’s what the research indicates are the issues.

  • Insufficient exposure to the sun. Vitamin D is the “sunshine Vitamin”. If you don’t get enough sun exposure to your skin, then you don’t get the natural benefits of Vitamin D production.
  • Inadequate intake. This one is pretty straight-forward. We just don’t eat foods high in Vitamin D and if your overall food intake is reduced post-surgery, this can also create an impact.
  • Poor absorption. Post-surgery, your digestive system may not absorb Vitamin D as efficiently.
  • Hepatic steatosis or fatty liver - increased buildup of fat in the liver – can also lead to a decrease in the liver’s production of Vitamin D.
  • Bile salt deficiency associated with bariatric surgery procedures (the absorption of vitamin D requires the presence of bile salts).
  • Malabsorption of vitamin D sometimes due to intestinal bacterial overgrowth problems.
  • Reduced bioavailability of Vitamin D in relation to its deposition in adipose (fat) tissue present in cases of excess obesity. As a fat-soluble vitamin, Vitamin D can get “trapped” in our own fat stores.

If it seems like the deck is stacked against you, there is good news. Several published research studies have shown that with consistent supplementation bariatric surgery patients can stabilize their Vitamin D levels and actually maintain healthy levels over time.

Supplementation is the Simplest Solution

I considered reviewing for you all of the published studies showing that Vitamin D supplementation is critical for bariatric surgery patients, then I thought to myself, “why?” Listing every trial and its findings is much less important than this very simple recommendation: YOU need to be supplementing every day with Vitamin D3.

The real question from my review of the research is how do I convince each of you that something as simple as daily Vitamin D3 supplementation can radically impact your health over time?

How about if instead of describing the negative effects of a Vitamin D deficiency, let’s talk about all the good stuff that happens when you achieve healthy levels.

You will not get sick as often.

You will feel less fatigued and tired.

You’ll have less bone and back discomfort.

Your mood will improve.

You’ll be protecting your bone health.

Your hair, skin and nails will be healthier.

You’ll have fewer muscle aches.

You’ll probably lose some body fat.

I hope this sounds as good to you as it does to me.

Now let’s talk about how to make this happen for you. It’s as simple as being 100% consistent with a 5,000 IU Vitamin D3 daily supplement.

Let’s discuss the real-world clinical component of my simple recommendation. How quickly you will see a change in your Vitamin D3 levels is highly personal and depends on a host of individual issues. How long have you been deficient? What type of bariatric surgery did you have performed? Do you have other health issues that impact or increase your need for Vitamin D?

While I can’t answer each of these questions for you on an individual basis, what I can say is this, “Please start today with your Vitamin D3 supplementation. It is one of the most important proactive steps that you can take to improve your personal health.”

I hope that you have found this white paper helpful and that you take care of yourself.

Bariatric Eating Vitamin D3 Reference List

Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev. 2005;10(2):94-111.

Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81(3):353-373. doi:10.4065/81.3.353

Lamberg-Allardt C. Vitamin D in foods and as supplements. Prog Biophys Mol Biol. 2006;92(1):33-38. doi:10.1016/j.pbiomolbio.2006.02.017

Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31(1):48-54. doi:10.1016/j.nutres.2010.12.001

Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood). 2017;242(10):1086-1094. doi:10.1177/1535370216688567

Rizzoli R, Boonen S, Brandi ML, et al. Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Curr Med Res Opin. 2013;29(4):305-313. doi:10.1185/03007995.2013.766162

Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med. 2007;167(16):1730-1737. doi:10.1001/archinte.167.16.1730

Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States BMJ 2014; 348 doi:

Tomlinson PB, Joseph C, Angioi M. Effects of vitamin D supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis. J Sci Med Sport. 2015;18(5):575-580. doi:10.1016/j.jsams.2014.07.022

Shaffer JA, Edmondson D, Wasson LT, et al. Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials. Psychosom Med. 2014;76(3):190-196. doi:10.1097/PSY.0000000000000044

Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009;19(7):468-483. doi:10.1016/j.annepidem.2009.03.021

Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial [published correction appears in Am J Clin Nutr. 2008 Mar;87(3):794]. Am J Clin Nutr. 2007;85(6):1586-1591. doi:10.1093/ajcn/85.6.1586

Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-1503. doi:10.1016/S0140-6736(01)06580-1

Bischoff-Ferrari HA. Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Adv Exp Med Biol. 2008;624:55-71. doi:10.1007/978-0-387-77574-6_5

June 22, 2020
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