A Functional Medicine Approach to Bariatric Surgery

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 disease. Current treatments include lifestyle changes in nutrition and physical activity, behavioral therapy, pharmacotherapy, and bariatric surgery.

Bariatric surgery is an effective long-term solution for those with obesity. Not only does it help to decrease body weight overall, but it also can help manage 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.

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Complications from 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 deficiencies, gut health, and hormone balance are of vital importance 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
• Depression
• Menstrual issues
• Poor concentration

Possible causes of these deficiencies include anatomical changes after surgery that cause malabsorption or decreased absorption specifically. Reduced acid production and inadequate or unbalanced nutritional intake can also contribute to deficiencies.

Poor Gut Health Signs & Symptoms

• Upset stomach
• Weight gain
• 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 caused by pregnancy, lactation, menopause, and diagnoses 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 allow a more profound insight 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 disrupt 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 made.

Functional Medicine Treatment 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.

I assess each patient individually post-bariatric surgery. Each person's treatment 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 will 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 recommendation 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 recommended.
• 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 prescribed based on the patient's micronutrient testing results.

Gut Health Nutrition

Important aspects of feeding 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 will be used to address any microbial imbalance directly.
• Prebiotics and probiotics may be used in a supplemental form of additional support.
• Saccharomyces boulardii helps to support intestinal permeability and is found to be beneficial in treating diarrhea.
• Grapefruit seed extract contains antibacterial and antifungal properties to help to support digestive balance.
• Ginger is used to soothe the digestive tract and improve symptoms of digestive distress.

Gut Health Stress Management

Management of stress, increase in physical activity, and adequate sleep also contributes 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 regulates 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 is used to address hormonal imbalances directly. 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 are essential to ensure continued whole-body health.