Bariatric Surgery and Vitamin B12, what do I need to know?


Vitamin B12 deficiency can be a complication after bariatric surgery.

Malabsorptive surgeries such as the gastric bypass and the duodenal switch (rarely performed in the UK) are at higher risk of deficiency.

Vitamin B12 is often prescribed after bariatric surgery to prevent deficiency.

Vitamin B12 is absorbed in the small intestine. The lining of the mouth is also capable of absorbing vitamin B12 from food, but it is a small insignificant amount.

The stomach produces a glycoprotein called intrinsic factor which is essential for the absorption of vitamin B12 in the small intestine.

Why is vitamin B12 needed?

Vitamin B12 helps keep the body’s nervous system and blood cells healthy. Vitamin B12 also helps prevent megaloblastic anaemia.

Deficiency of vitamin B12 occur after bariatric surgery

Bariatric surgeries either reduce the size of the stomach or lessen the absorption of nutrients or both.

In Gastric Sleeve surgery the reduced size of the stomach results in a decrease in ghrelin (the hunger hormone) and reduced food intake.

There is also reduced production of an intrinsic factor which is needed for vitamin B12 absorption.

In Gastric Bypass surgery, the part of the stomach where the intrinsic factor is produced is avoided and never exposed to food.

When does deficiency of vitamin B12 occur?

The liver can store up to 3 years requirement of vitamin B12, so deficiency does not usually happen early after bariatric surgery.

Studies show that a significant number of patients become symptomatic within 1-2 years of gastric bypass surgery if not supplemented with Vitamin B12. Vitamin B12 injections are usually prescribed every 3 months for life following Bariatric Surgery. There are other forms of vitamin B12 available (sub lingual and nasal spray.) You should discuss this with your bariatric surgeon or bariatric dietitian.


Signs and Symptoms of vitamin B12 deficiency:


  • Feeling Weak
  • Fatigue
  • Dizziness
  • Loss of appetite
  • Diarrhoea
  • Painful swollen tongue
  • Pins and Needle sensations in the hands and feet
  • Nerve damage
  • Abnormal heart function
  • Poor Memory


Vitamin B12 supplementation is important after bariatric surgery, especially those patients who have had Gastric bypass surgery.

Obesity: What are my options?

Obesity, its causes and treatment options:

Obesity and its related health conditions are now considered as the world’s biggest health problem.

What are the causes of obesity and how it could be prevented or treated?

Excess weight is mainly due to what we eat and our lifestyle choices. However, some people are at a disadvantage as overeating can be driven by biological factors, genetics and hormones. Some people have a predisposition to gaining weight.

These people can overcome these disadvantages, but it requires modification of eating behaviour and lifestyle changes in the long term and is easier said than done.


Some people seem to be genetically susceptible to obesity. Children of obese parents are much more likely to become obese than children of healthy weight parents. Is this nature or nurture?

Insulin resistance

Insulin is a hormone that regulates energy storage. Elevated insulin levels cause energy to be stored in fat cells instead of being available to use. Elevated insulin levels can lead to insulin resistance

The Western diet promotes insulin resistance which is linked to developing obesity and this contributes to the development of Type 2 Diabetes.

To lower insulin levels, cut back on refined carbohydrates and sugars, combined with increasing fibre intake and activity levels, which will also lead to a decrease in weight and reduction in the risk of developing Type 2 Diabetes.

Leptin Resistance

The hormone Leptin is produced by fat cells and the amount in the blood increases with a higher body fat mass. As a result, leptin levels are high in people with obesity.

In people with a healthy weight, high leptin levels reduce appetite.

In some obese people, the brain does not respond to Leptin, so they keep eating which causes fat cells to produce even more Leptin. This is known as Leptin resistance and the Leptin levels will keep increasing as a person gets fatter.

Underactive Thyroid

This is a condition where the thyroid gland does not produce enough thyroid hormone. This deficiency of thyroid hormone can disrupt the heart rate, body temperature and metabolism.

Symptoms include fatigue, cold sensitivity, constipation, dry skin, depression and unexplained weight gain.

Blood tests can diagnose an underactive thyroid.

Treatment generally involves taking the oral medication Levothyroxine. Levothyroxine is usually continued for life and can reverse the symptoms and help you to return to a healthier weight.


Some prescribed drugs can cause weight gain as a side effect. These drugs alter the function of your body and brain, reducing metabolic rate (reducing calories burned) or increasing appetite resulting in weight gain.

Steroids, also known as corticosteroids, used to treat conditions such as arthritis and asthma increase the appetite in some people, which leads to weight gain.

Cushing Syndrome:

A very rare syndrome affecting less than 1 in 50,000 people is caused by high levels of cortisone in the body. Weight gain is a common symptom, particularly on the chest, face and stomach.

Processed foods and addiction

Processed foods are usually full of cheap refined ingredients and additives which promote overeating, lack of satiety and addiction.

Many high-fat and sugary junk foods stimulate the reward centres in the brain.

Some people become addicted to these foods, the same way someone would become addicted to alcohol or drugs.

The brain chemistry changes and addiction are difficult to overcome.

As processed junk food is available everywhere, in some poorer neighbourhoods it can be difficult to source healthy foods locally.


Added sugar is probably the single worst aspect of the modern diet. Sugar changes the hormones and biochemistry of your body when consumed in excess, leading to insulin resistance.

Excessive sugar intake is considered to be one of the main causes of obesity.



The food industry

Food marketing is unethical at times and unhealthy foods can be marketed as healthy foods and sadly, this is often targeted at children. Many of today’s children are becoming obese and addicted to junk foods before they are even able to make their own choices.

It is easy to use the above reasons as excuses not to aim for a healthier lifestyle and healthier weight.

Emotional eating:

Unfortunately, often the body’s natural response to uncomfortable emotions is to reach for food as comfort. This is usually foods high in sugar and fat as these foods very temporarily give a boost in feelings of wellbeing. Food can and does temporarily fill an emotional void.

Often with professional help it is possible to find ways of dealing with emotions in a way that does not include food. Whether this is to help to change habits, to deal with stress, anxiety, depression and past traumas etc., qualified professionals can help with these issues.

Relying on exercise only:

Exercise is great and we all should do it but relying on exercise alone to lose weight isn’t going to work. Unless you change your dietary intake, you are unlikely to see any reduction in weight. In theory you can enjoy all foods in moderation if you are mindful about portion size.

Motivation to lose weight:

Be prepared, plan well balanced nutritious meals in advance.

Stay hydrated, drink plenty of water.

Aim to achieve quality sleep.

Get sound professional advice on medical weight loss options available.

Treatment options:

Psychological support:

If you feel that emotional/comfort eating is an issue to you, ensure you factor in expert professional support to deal with emotional eating as well as physical hunger. This can involve many aspects of treatment such as habit change, removing triggers, finding non-food alternatives to dealing with negative emotions, dealing with past traumas, anxiety, stress and depression. The Gateway Health programme, unlike other bariatric providers, deals with the psychological aspects following weight loss surgery aftercare.

Diet pills:

Why rely on pills? Many pills flush out vital vitamins and minerals which are essential for losing weight and avoiding disease.

We understand the desperation to lose weight in the short term, but we are concerned with your long-term health.

Drugs do not give a long-term solution and can be very costly… for example the average cost of a MONTHLY private prescription for the weight loss drug Saxenda is approximately £600-800! When you consider the costs of paying for these drugs over many, many months AND their side effects, would it not be more cost effective to look for a permanent solution?

If you can lose weight eating smaller portions and exercising more then we sincerely congratulate you.

However, we understand this is easier said than done.

There are many other factors in the mix….  genetics, metabolic, biological, behavioural and psychological barriers to losing weight …

Gateway Health offer only time served, evidence-based weight loss surgeries.

Our gold standard after care programme addresses dietary, exercise, behavioural and psychological issues, which result in superior weight loss results and weight maintenance.

Call Gateway Health 0345 9000 339

Bariatric surgery is without doubt the most effective weight loss method available.

Choose a Bariatric provider who not only has UK leading safety statistics (check out he NBSR – national Bariatric Register) but also provides an all-encompassing after care programme.

Gateway Health are the market leaders in Bariatric Surgery with the most comprehensive support and after care programme with industry leading results.

The truth about weight loss surgery.

As your body weight increases, your life expectancy decreases.

People who are severely obese often have a number of weight related medical conditions that greatly increase the risk of dying early. For example, type 2 diabetes, high blood pressure, high cholesterol, heart disease and stroke, gall bladder disease, some cancers and sleep apnoea.

The risks of bariatric surgery are less than most other operations, including gallbladder and hip replacement surgery.

Many bariatric patients have poor health prior to surgery but the surgical risks are still exceptionally low.

Gateway Health’s lead Bariatric Surgeon Mr Roger Ackroyd has an exceptional safety record.

All UK Bariatric surgeon’s outcomes can be found on the national Bariatric Register. (>nbsr)

There are many studies that show improvement or resolution of life-threatening obesity-related diseases following bariatric surgery.

The benefits of bariatric surgery far outweigh the risks.

The team at Gateway Health are highly qualified bariatric experts who are committed to providing compassionate and individualised care.

We offer only time served evidence- based weight loss surgeries.

Our expert aftercare programme addresses dietary, exercise, behavioural and psychological support, resulting in superior weight loss results and long-term weight maintenance.


The truth about portion sizes following bariatric surgery.


Bariatric surgery creates a portion control system. There are slight variances with the different surgery options, but generally:

  1. In the early days following weight loss surgery you will only be eating a few spoonfuls of pureed food several times a day.
  2. After 3-4 weeks you will progress onto small portions of soft, mushy foods
  3. After 3-6 months you will have typically progressed onto a normal texture diet, your portion size is typically a side plate portion of food.

There is no reason why you cannot follow a normal healthy eating pattern, eat out with friends and have a normal healthy social life.

The Gateway Health team prepare you fully before surgery so that you are organised and have appropriate foods ready at home for after your discharge from hospital.

We give you step by step written advice also and follow up daily after your discharge from hospital, to reassure and guide you through the dietary stages and to be on hand for any questions or advice you may need.

Our aftercare also includes behavioural and emotional change support.

Everybody is motivated to lose weight for different reasons, what’s yours?

We all know that losing weight decreases your risks of dying early from weight related illnesses such as type 2 diabetes, heart disease, stroke, some cancers, high blood pressure, high cholesterol etc.

But there are many other benefits to losing weight …….

Improved sleep

Less joint pain

Increased energy

Increased confidence

Improved mood

Better complexion

People usually treat you better

Your children will eat better

You often are more open to trying new experiences and activities

Breathe easier

Clothes look and fit better

Sex drive improves

Your memory may improve

Food tastes better

You save money as not spending as much on food


Whatever your reason to lose weight, whether it is to improve health, confidence, mood, energy levels or to live longer…….. you get all the benefits if you make a success of it.

The Dangers of Yo-Yo Dieting


Obesity is a main cause of preventable illness and death in the developed world.

It is estimated that at any one time at least 25% of the population is trying to diet and yet the obesity epidemic continues to grow.

Losing weight improves health, right? Absolutely if the weight loss can be maintained in the long term.

However, there is a group of people who do not benefit, these are those people who lose weight, regain the weight, lose weight, regain weight and so on, we call this yo-yo dieting or weight cycling.

A study shows that up to 35% of men and up to 55% of women report having yo-yo dieted.

We find that many Gateway Health patients have a history of yo-yo dieting prior to choosing Bariatric surgery.

Often before making the final decision to choose bariatric surgery, many patients tell us that they will try one last diet. We always wish them well, but sadly know that a significant number of those patients will be back in touch soon to book their surgery.

Long term yo-yo dieting causes multiple health problems, plus of course leads to much frustration.

When dieting the hormone leptin decreases and your appetite increases as your body is trying to increase its depleted energy levels.

Studies show that yo-yo dieting often leads to loss of muscle mass as well as fat, but when the weight is regained it is usually just fat that is regained, particularly around the abdomen. Abdominal fat or ‘belly’ fat increases the risk of type two Diabetes

Studies also show that several cycles of yo-yo dieting can cause fatty liver disease (excess fat inside the cells of the liver.) A fatty liver changes the way the liver metabolises sugars and fats, these changes increase the risk of getting type two Diabetes.

Yo-yo dieting has also been shown to increase the risk of Coronary Heart Disease (narrowing of the arteries that supply blood to the heart). The more times someone yo-yo diets the higher the risk.

The weight re-gain after a diet can also cause hypertension (high blood pressure.)

The negative health problems as a result of yo-yo dieting can last years but can fade and resolve once weight is lost and maintained over years.

If you are frustrated with one diet after another, the constant up and down weight, worried about the adverse health effects that this is causing, why not consider weight loss surgery?

Surgery for obesity is the most effective proven method in terms of weight reduction and improvement in obesity related health conditions, often these conditions disappear completely.

Gateway Health are a highly qualified experienced team of Bariatric experts who are committed to providing compassionate, caring individualised care. We offer time served, evidence-based weight loss surgery procedures alongside an aftercare programme that addresses dietary, lifestyle and psychological support, which we know is needed to prevent weight regain in the years following surgery.

Our prices are competitive and all consultations are free of charge.

Gateway Health 0345 9000 339


Preventing common problems after surgery.

Tips to prevent common problems:

Eat slowly, chew foods thoroughly and stop eating as soon as you feel satisfied to avoid discomfort, nausea and vomiting and ultimately stretching your stomach pouch.

To prevent nutritional deficiencies always take your vitamin and mineral supplements as directed by your bariatric team alongside a healthy balanced diet. Symptoms of deficiencies can be: fatigue, achy muscles, tingling feet, calves or hands.

Some hair loss can be experienced around months 4-8 post surgery, this is caused by rapid weight loss and/or lack of protein or vitamins/minerals in the diet. To prevent this, patients should consume the amount of protein recommended by their bariatric dietitian (usually 60mg daily) and take vitamins/minerals as directed. Gateway Health patients are usually recommended to take 2 x complete multi vitamin and mineral supplements per day or 1 x prescribed Forceval vitamin and mineral supplement a day. Be reassured that we do find that hair does grow back after 12 months and often thicker than it was before surgery.

Dehydration is caused by drinking too little fluid or by persistent vomiting. Signs and symptoms include dark and strong-smelling urine, dry mouth, headache, and fatigue.  Drinking with meals is to be avoided after bariatric surgery, so it is important to sip liquids frequently throughout the day to avoid dehydration.

Dumping syndrome is caused by food emptying too quickly from the new stomach after gastric bypass surgery. Signs and symptoms include diarrhoea, nausea, cold sweats, and light-headedness. Avoid eating or drinking refined sugars and high-fat foods or drinks and wait for 30 minutes after finishing your meals before drinking.

After weight loss surgery you eat less food and fibre. To prevent constipation drink plenty of water, exercise daily, include fibre in your diet and we find taking a fibre supplement such as Benefiber or Fibresure is helpful. (found in large supermarkets near the vitamin aisle)

If you find it difficult to follow advice, whether that is due to poor motivation, poor understanding of nutrition/what is required, poor planning, lack of knowledge as to how to prepare meals/meet your dietary needs or emotional eating …. It is important to seek professional expert advice to avoid a poor result and future weight regain.

Weight loss surgery is just a tool, if long term dietary, exercise and mind set are not changed, weight regain is a real possibility. Find a bariatric provider who can expertly meet all of your individual needs.

What do you value most?


Values are the things in life that we most care about and consider important.

There might be values you think are important, and others that don’t matter so much to you.

Below is a little activity that I think is very interesting and can be quite insightful, to see what is most important to you and whether you are doing enough to meet your own personal values?


Below are some common values, read through them and consider what is important to you.


1.Write a few notes next to each value on the list below


  1. Give each value a score as to how important it is to you:

(0 = not important, 10 = very important).


  1. Give each area a rating according to how successfully you have lived your life in accordance with this value in the past month

(0 = not at all well, 10 = very well).


  1. Look at the rated scores for Number 2 compared to the rated scores for Number 3, are your values in sync?


When the scores for Number 2 and Number 3 match you are being true to yourself, to your personal values.

When your scores do not match up, how can you make changes in your life to even the scores out?




What kind of family relationships do you want? What sort of brother / sister / mother / father / aunt / uncle / niece / nephew do you want to be? How do you want to be in those relationships?



What kind of partner do you want to be? What kind of relationship do you want to be a part of? What sort of partnership do you want to build? What kind of person do you want to be in a relationship?



What sort of parent do you want to be? What qualities do you want your children to see in you? What kind of relationships do you want to build with them?



What sort of friend do you want to be? What friendships are important to cultivate? How would you like to act towards your friends? What kind of social life matters to you?



What kind of work is valuable to you? What qualities do you want to bring as an employee? What kind of work relationships would you like to build? What kind of work matters to you?



How would you like to grow as a person? What kind of skills would you like to develop? What matters to you about education and learning? What would you like to know more about?



How would you like to enjoy yourself? What relaxes you? When are you most playful?



What kind of relationship do you want with God / nature / the Earth?



What kind of environment do you want to be a part of? How do you want to contribute to your community? What kind of citizen would you like to be?



What kind of values do you have regarding your physical wellbeing? How important to you is your health? How do you want to look after yourself?






Marriage / Couple / Intimacy




Friendships / Social life


Career / Employment


Education / Personal growth & development


Recreation / Fun / Leisure




Citizenship / Environment / Community


Health / Physical wellbeing


One of the UK’s leading bariatric* surgeons has expressed serious concern about the extremely poor levels of aftercare being provided to many weight loss surgery patients by private hospitals who offer ‘cut-price’ surgery both here and abroad.

Consultant laparoscopic and bariatric surgeon David Kerrigan, the Royal College of Surgeons’ representative who advised the government on the NICE obesity guidelines in use today, said the lack of follow up care provided by some hospitals was ‘shocking’ and could put patients’ lives at risk.

“I have long been concerned about hospitals who in effect abandon patients after surgery to keep costs down and make a bigger margin then just turn a blind eye when things go wrong,” said Mr Kerrigan, former secretary and founder member of the British Obesity Surgery Society.

“It takes a great deal of money and commitment to put the resources in place to allow patients 24/7 access to the surgeon and his team and provide specialist medical advice at every step of the way following bariatric surgery.

“What I strongly object to is the way in which certain private hospitals offer surgery on the cheap at the expense of the aftercare and the patients never see the surgeon again.

“In my opinion, it’s absolutely vital that the surgeon who operated is directly involved in the patient’s aftercare. Some hospitals simply have an advisor or a nurse at the end of the phone and it’s just not acceptable.

“Patients often think they’re getting a good deal but sadly cut-price weight loss surgery generally means cut-down care,” adds Mr Kerrigan, who is also medical director of Gravitas, a network of weight loss surgeons in the UK and Ireland committed to working to the highest ethical and professional standards in bariatric surgery.

“Patients need to be cautioned strongly about what they are letting themselves in for. Adequate medically supervised aftercare is essential to ensure that they receive not just a good result, but a safe one.”

As Mr Kerrigan points out, this is particularly critical with gastric banding**. “What patients often don’t realise is that follow up care is absolutely crucial to getting the result they want.

“Sometimes complications can set in months or even years after the operation is performed and need to be picked up quickly under the ongoing care of a surgeon who can deal with a problem at the drop of a hat. If they are not, the patient could be seriously at risk.

“The trouble is, if complications develop and a patient can’t get easy access to a specialist surgeon, it’s often left to the NHS or the local GP to pick up the pieces. Patients may well end up seeing a non specialist who has no idea what to do. It’s a dreadful state of affairs.”

Mr Kerrigan said he was concerned too about the worrying number of reports filtering through about certain private hospitals who bend the NICE guidelines by operating on ‘desperate’ patients with a body mass index (BMI) of less than 35 who do not meet the criteria as they are too light for surgery.

“It’s professionally and ethically wrong for private hospitals to perform specialist surgery outside the NICE guidelines for what can only be described as pure financial gain,” he said.

“Although this has been happening in Europe for a while, it’s disturbing that it now seems to be occurring in the UK too. Bariatric surgery should never be carried out just because a patient is desperate to lose a bit of weight for cosmetic reasons,” he said.

“This type of specialist surgery should not be undertaken lightly. Although it’s an extremely effective and valuable treatment in heavier patients, in lighter ones it’s like taking a sledgehammer to crack a nut.”

Mr Kerrigan added that successful weight loss is very dependent on the strength of the partnership patients develop with their surgeon and his or her team.

“They will need the surgeon’s help long after their operation has been performed if they are to get the most out of it,” he said. “Sadly, not all weight loss surgery providers are willing to make this commitment to their patients.

“The sad truth for many patients is that they don’t realise when they are being sold cut-price surgery that they will not be receiving the complete package of care necessary to maximise the chances of a safe and successful outcome.” ENDS

*weight loss

** An effective weight loss surgery procedure used to help overweight people achieve significant and long-term weight loss.

About David Kerrigan

MD with Distinction (1992), FRCS, FRCSEd (1986), MBChB (1982)

Honorary senior lecturer in surgery at the University of Liverpool, Mr Kerrigan practises at the Spire Murrayfield Hospital, Wirral and is amongst the elite of UK bariatric surgeons. He is medical director of Gravitas, which has created a pioneering network of doctors and surgeons in the UK and Ireland committed to working to the highest ethical and professional standards in bariatric surgery. Awarded the prestigious ‘team of the year’ accolade for innovative surgical practice by the independent Association for the Study of Obesity in 2009, Gravitas treats both private and NHS patients and has helped train many bariatric surgeons in the UK through its fellowship programme for senior surgical trainees. Widely respected by both the public and his surgical peers for his technical skill and commitment to uncompromisingly high standards of bariatric care and aftercare, David Kerrigan is a pioneer of laparoscopic (keyhole) bariatric surgery in the UK and has lectured widely on this subject both here and abroad. His work has been featured in numerous television and newspaper reports.

The diary of a gastric band patient

Follow the gastric band patient diary of Michelle from Nottingham as she follows the Gateway Health programme Read More…..

It’s Official! The Gateway Weight Loss Management Programme produces World Leading results!

Patients on our programme lose, on average, more than twice the percentage of excess weight when compared to other published studies.
In a recent multi-centre study, patients on the Gateway Health weight loss programme achieved a much greater weight loss.