Obesity prevalence in the United States was around 43% in 2017. However, experts have continued to see a rise in obesity since the start of the COVID-19 pandemic.
Obesity is a multifactorial condition. Current approaches include lifestyle changes in nutrition and physical activity, behavioral therapy, pharmacotherapy, and bariatric surgery.
Bariatric surgery is considered an option for those with obesity. It may help to decrease body weight overall and can support the management of chronic conditions such as type 2 diabetes, heart disease, hypertension, and sleep apnea. There are two types of bariatric surgery: restrictive or malabsorptive, with some procedures combining the two types.
[signup]
Considerations for Bariatric Surgery
The gastrointestinal microbiome and hormones are widely affected by obesity but are also rapidly changed post-bariatric surgery. For this reason, assessing micronutrient levels, gut health, and hormone balance is important before and after the procedure.
It's important to understand why these changes occur and what can be done to help enable optimal health following the procedure.
Micronutrient Deficiency Signs & Symptoms
- Fatigue
- Pale skin
- Weakness
- Constipation
- Hair loss
- Mood changes
- Menstrual issues
- Poor concentration
Possible causes of these deficiencies include anatomical changes after surgery that may affect absorption. Reduced acid production and inadequate or unbalanced nutritional intake can also contribute to deficiencies.
Poor Gut Health Signs & Symptoms
- Upset stomach
- Weight changes
- Bloating and gas
- Constipation and diarrhea
- Constant fatigue and sleep problems
- Skin irritations
These symptoms can originate from a low fiber, high processed diet, and a history of antibiotic use. Lifestyle factors including poor stress management, inadequate sleep, and inadequate hydration may also add to the effects of poor gut health.
Hormone Imbalance Signs & Symptoms
- Weight loss or weight gain
- Fatigue
- Muscle aches and weakness
- Mood swings
- Increased or decreased sensitivity to cold and heat
Possible causes of hormone imbalances include medications, autoimmune disorders, diabetes, eating disorders, and stress. Hormone imbalances can be further influenced by pregnancy, lactation, menopause, and conditions such as PCOS or endometriosis.
Functional Medicine Labs Post Bariatric Surgery
Serum lab tests are typically used to assess these areas after bariatric surgery. However, functional medicine tests can provide additional insights into all three areas.
Micronutrients
The SpectraCell Micronutrient test takes into account the entire nutrient picture. Nutrient absorption, use, and function are dependent on a person's biochemical makeup. The SpectraCell micronutrient test evaluates micronutrients within the cell to give a better understanding of the whole story.
Gut Health
The GI MAP functional test takes a deep dive into the gut microbiome. This comprehensive stool test can detect microbial imbalance within the gastrointestinal tract, which can affect metabolic, immune, and digestive health. Since bariatric surgery can disrupt the microbiome, it is important to test for imbalances as the patient recovers.
Hormones
Adipose tissue plays a large part in endocrine system function and hormone communication. Changes in weight after surgery can influence hormone balance overall.
DUTCH testing offers an evaluation of sex hormones, adrenal hormones, cortisol, and melatonin levels using dried urine samples. It can help identify hormone imbalances post-surgery so functional medicine changes can be considered.
Functional Medicine Considerations Post Bariatric Surgery
Lab values can vary significantly for patients who have undergone bariatric surgery based on the body's previously stored micronutrient levels, pre-surgery diet, and hormonal function.
Each patient is assessed individually post-bariatric surgery. Each person's approach is based on the type of bariatric surgery, when that surgery took place, and what supplementation regimen they are currently utilizing.
Whole food nutrition after bariatric surgery can support patients' long-term health as they are able to tolerate real foods over time. Additionally, there are typical micronutrients that are known to become deficient after surgery, which are included in a base supplementation consideration below.
Micronutrient Supplements
- Bariatric formulated multivitamins are complete multivitamins that include micronutrients of concern after surgery, such as Vitamins B1, B12, D, A, and iron, in higher amounts or therapeutic doses.
- A separate Vitamin D plus Calcium is often considered.
- Non-bariatric formulated multivitamin would include an over-the-counter multivitamin with additional supplementation of Vitamins B1, B12, D, A, iron, and calcium.
- Additional micronutrients may be considered based on the patient's micronutrient testing results.
Gut Health Nutrition
Important aspects of supporting a healthy gut microbiome include eating whole foods and focusing on prebiotic fibers. Fermented foods, such as sauerkraut, kimchi, yogurt, and kombucha, are a great addition to a healthy gut as they contain natural probiotics.
Gut Health Supplements
- Depending upon the GI Map results, specific supplementation may be used to address any microbial imbalance.
- Prebiotics and probiotics may be used in a supplemental form for additional support.
- Saccharomyces boulardii helps to support intestinal health and is found to be beneficial in managing digestive concerns.
- Grapefruit seed extract contains properties that may help support digestive balance.
- Ginger is used to soothe the digestive tract and improve symptoms of digestive discomfort.
Gut Health Stress Management
Management of stress, increase in physical activity, and adequate sleep also contribute to healthy gut function.
Hormone Imbalances
Nutrition
Hormone imbalances can be supported with whole foods, ensuring overall protein and caloric needs are being met. Special attention is given to healthy fats to assist with hormone transportation throughout the body. Adequate sleep and stress management are also essential for hormone balance.
Supplements
- Vitamin D3 is part vitamin, part hormone with its 'hormone-like functions. Vitamin D helps regulate blood calcium levels with the parathyroid hormone. It has also been shown to affect estrogen levels.
- Omega 3 Fatty Acids are the building blocks for making steroid hormones involved in reproduction, blood clotting, and inflammation. These healthy fats also aid in the transportation of hormones throughout the body.
- B Complex vitamins help to support and promote hormone and cholesterol production. The various B vitamins involved within the complex include thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), B6, biotin (B7), folate (B9), and B12, which are all linked with various hormones throughout the body, namely brain neurotransmitters and steroid hormones.
- Depending upon the DUTCH results, specific supplementation may be used to address hormonal imbalances. Some examples include DIM, Vitex, or Adrenal Support.
Summary
Bariatric surgery can assist in improving the overall health picture of someone with obesity.
Long-term monitoring of micronutrients, gut health, and hormone balance is essential to support continued whole-body health.
%201.svg){kind=logo}
