Vitamin B12 Absorption Following Bariatric Surgery

As Celebrate does with all our bariatric vitamins, we put much thought and consideration into our formulation and are never done looking at ways to improve our products for bariatric patients. We defer to the research and the vast knowledge we gain from working with many top bariatric programmes. Here is how vitamin B12 absorption works after bariatric surgery, and whether oral vitamin B12 is enough.

Vitamin B12 deficiency: the basics

• Pre-op vitamin B12 deficiencies occur in 5–29% of bariatric patients.
• Post-op vitamin B12 deficiencies occur in 37–70% of bariatric patients.
• Lab tests for vitamin B12 are not the most reliable. More reliable tests (homocysteine and methylmalonic acid) are often expensive and not routinely performed by most bariatric programmes due to their cost.
• Vitamin B12 deficiencies may not appear for 5+ years after bariatric surgery.
• Most bariatric patients prefer to simplify their vitamin routine, so increasing the vitamin B12 dosage helps reduce the number of supplements most patients have to take.*

A question we are asked frequently: Will I still absorb vitamin B12, or does it need to be sublingual?

The simple answer is YES. A more thorough answer requires us to explore how vitamin B12 is digested and absorbed.

Digestion and absorption

Vitamin B12 deficiency is fairly common in bariatric patients because of the complex absorption process:

1. Release from food: when we eat food sources of vitamin B12 (e.g. milk, cheese, eggs, meat), the vitamin B12 must first be removed from the proteins in the food by stomach acid. This is more challenging with a smaller stomach (80–90% smaller after a bypass or sleeve), because of the reduced volume of gastric acid.
2. Intrinsic factor: the vitamin B12 must then combine with intrinsic factor, which is produced by the stomach and combines with vitamin B12 in the duodenum, the first part of the small intestine. This step is also limited by the smaller stomach, and even more so after a gastric bypass, since the duodenum is bypassed.
3. Absorption: if all these steps have taken place, vitamin B12 is absorbed further down the small intestine, in the ileum.

Sublingual versus oral vitamin B12

The long answer also compares oral vitamin B12 (the kind in our multivitamins) with sublingual. A study comparing 500 micrograms (mcg) of oral, sublingual and B-complex vitamin B12 showed similar blood levels, and therefore similar absorption, from all three products (Sharabi, Cohen & Garty, 2003). Even without any intrinsic factor, one to two per cent of oral vitamin B12 is still absorbed. So with 500 mcg of vitamin B12 and a one per cent absorption rate, patients can expect to get 5 mcg – more than twice the recommended intake of 2.4 mcg per day for men and women over 18.

Do I get the same amount of vitamin B12 from my over-the-counter vitamins?

While oral vitamin B12 is a sufficient delivery system, there are multiple factors to consider. Over-the-counter vitamins (non-bariatric brands from your local pharmacy or supermarket) generally contain 12 mcg of vitamin B12. Applying the same absorption rate leaves you with 0.12 mcg – far below what the general population requires, let alone a bariatric patient. Furthermore, Celebrate Vitamins uses a combination of vitamin B12 forms, fifty percent cyanocobalamin and fifty percent methylcobalamin. Some people absorb one form better than the other, so we have you covered no matter what.

Should I just get vitamin B12 injections instead?

A systematic review of randomised controlled studies showed similar results from injections and oral vitamin B12 (Butler, Vidal-Alaball & Cannings-John, 2006). This means multiple studies came to the same conclusion: oral vitamin B12 is an adequate delivery system. If you prefer to stick yourself with a needle once a week, be our guest, but most patients opt for the simpler route of choosing a high-quality bariatric multivitamin.

Why is vitamin B12 so important anyway?

Vitamin B12 is required for the metabolism of proteins and carbohydrates – in other words, it helps us access energy from food. It is also necessary for new cell production, especially cells in the gastrointestinal tract, bone marrow and nervous tissue. Without vitamin B12, we might experience:

• Numbness and tingling in the feet
• Stiff or weak legs
• Impaired mental status, such as confusion or depression
• A beefy red tongue

Besides being a bariatric patient, you might be at further risk of deficiency if you follow a vegetarian or vegan diet or had a deficiency before surgery. The risk also goes up with age, because the body naturally produces less intrinsic factor.

In a nutshell, you can feel comfortable taking Celebrate Vitamins knowing you are getting quality bariatric vitamins in a delivery form appropriate for your health as a bariatric patient. As always, we hope to support your weight loss journey by offering a variety of bariatric vitamin options at the best value. We want you to CELEBRATE weight loss, no vitamin deficiencies, and the option of taking great tasting bariatric vitamins all with one brand – Celebrate Vitamins!

* Please continue to follow up with your bariatric surgical team for routine lab testing and follow the supplement regimen they recommend.

This article is for general information only and does not replace personal medical advice. Always discuss your situation, blood test results and supplementation with your bariatric team or healthcare provider.