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.

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

Help my relationship is changing!


After weight loss surgery your lifestyle changes, your habits change, your body shape is decreasing, your energy is increasing, and your health is often improving.

These things can often have a positive effect on your personal relationships, especially when your partner or significant others are understanding and supportive of the changes. Often their quality of life can improve too!

These changes can be very positive although at times relationship difficulties can arise.

The people in your life can react differently towards you, such as trying to consciously (or unconsciously/not realise they are doing it) sabotage your efforts,

They might not have faith in the fact that you can stick to your new lifestyle.

There could be jealousy, jealous of your successful weight loss and your courage at having done something positive to improve the quality of your life and your health.

Sometimes there is insecurity, they may worry that now you may want to find a different partner, friends might find the new you ‘boring’

Try to speak to your partner/the important people in your life as to how they can support you, explain what you have had done and the changes this will mean to your life long term, placing emphasis on all the positive gains… better health, improved energy, encourage them to voice their fears and openly discuss the changes.

For long term success following bariatric surgery and to avoid the real risk of future weight gain, it is essential that permanent behaviour changes are made, and emotional needs are understood and met in a healthier way.

Are you prepared to make the long-term changes to achieve a long-term good result?


Don’t kid yourself, Bariatric Surgery is not a quick fix. Yes, you are more than likely to lose weight in the early weeks and maybe months after surgery, but that weight can and often is regained.

For long term success you certainly must change your dietary and lifestyle habits and become more physically active, but have you considered that bariatric surgery can only help with your physical hunger but not your emotional hunger?

Have you used food as a means of coping with your emotions in the past? For example, eating when you feel low in mood, anxious or stressed?

You are going to need to learn different healthier means of dealing with your emotions. Who is going to guide and support you? If you can no longer self soothe or calm yourself with food, how will you manage with these emotions?

Choose a Bariatric provider who offers an after-care package that will fulfil your potential needs. Check out the experience and specialty of each member of the team, not just the Surgeon! Of course, when you are looking for a provider, check out the experience and safety record of your bariatric surgeon. The National Bariatric Surgical Register (NBSR) gives information on every bariatric surgeons’ statistics.

Your Aftercare programme, does it cover dietary, lifestyle and psychological support? Are the team Weight loss surgery specialists? Not simply an aesthetic clinic adding on weight loss surgery procedures. Bariatric Surgery is a real specialty which should be managed by experts in the field.


Surgery Overview.

Your bariatric team should discuss the differences between the different procedures, the pros and cons of each procedure before you decide.

It is vital to understand that bariatric surgery is only a tool to help you lose weight. You will have to make life long changes: dietary changes, lifestyle, activity and mindset changes. Otherwise you most likely will get poor results and/or regain weight.

I will explain how the different weight loss operations work and what lifestyle changes needed to achieve and maintain a good weight loss result.


The gastric band works by restricting the amount of food eaten and reduces your portion sizes, but only when used correctly. It is quite easy to cheat the gastric band by eating the wrong texture of food.

An adjustable Silicone band is placed around the top of the stomach which creates a small stomach pouch. The band has tubing attached which leads to a port, which is placed underneath the skin. The band is adjusted by a needle entering the port, injecting fluid in or out to the port to increase or decrease the level of restriction felt. Only health professionals trained in this procedure can do band adjustments.

On average patients lose approximately 40-50% of their excess weight loss in the first two years after surgery, when they work with the band correctly.

The gastric band is reversible, it can be removed if problems happen. Long term risks are things such as: Band slippage, erosion, problems with the port or tubing, band infection and esophageal dilation.


Gastric Band rules to live by..

Once you have moved through the post-operative dietary stages:

  1. Eat dry Textured food (except for the early weeks following surgery and following gastric band adjustments) Wet mushy foods will slide through the band and you will feel very little restriction.
  2. Do not eat and drink together
  3. Keep calories in drinks low
  4. Take only small bites of morsels of food
  5. Chew thoroughly, approximately 20 times for each morsel of food
  6. Wait a minute after you have swallowed your food before putting more food into the mouth.
  7. No snacking between meals.
  8. Mindful eating to a avoid vomiting and stretching the stomach pouch above the band
  9. Multi vitamin and mineral supplement for life.

Generally, patients who tend to eat large savoury meals and do not have a particularly sweet tooth can be suitable for a gastric band.

Sometimes a patient may choose a gastric band as they feel the other surgical options are too drastic.

The gastric band requires a strong commitment to attending clinical follow up for gastric band adjustments appointments and to a strong commitment to following the rules of how to work with the band.



Approximately 75% of the stomach is removed. This reduces the amount of food that you can eat. Ghrelin (The hunger hormone) is reduced which reduces your appetite. On average patients lose approximately 70% of their excess weight lost in first two years following surgery. Generally, there are less long-term problems in comparison to the gastric band. However acid reflux can occur and if you over eat, over time the new stomach can stretch

Gastric Sleeve rules to live by..

Once you have moved through the post-operative dietary stages:

  1. Normal balanced healthy diet
  2. Separate eating and drinking (Do not drink and eat food together, wait 30 mins after finishing food, before having a drink)
  3. Keep calories in drinks low
  4. Mindful eating to avoid stretching the pouch long term
  5. No snacking between meals
  6. Multi vitamin and mineral supplement daily for life
  7. Vitamin B12 injection every three months for life



The gastric bypass restricts your portion size and not all the calories you eat are absorbed. Your appetite is reduced. A small stomach pouch is made (approx. size of a golf ball) which is connected to a loop of the small bowel (The duodenum is bypassed). The remaining stomach and small bowel are reconnected further downstream where all the digestive juices from the stomach, liver and pancreas mix with food and allow some of it to be absorbed.

On average patients lose approximately 80% of their excess weight in the first two years after surgery. The gastric bypass can put type two diabetes into remission. Many patients tell us that their likes and dislikes of food have changed for the better. Dumping Syndrome is common, especially during the first year after a bypass. Nutritional deficiencies can occur as not all nutrients are absorbed. You can stretch the pouch by repeatedly over eating.


Gastric Bypass rules to live by..

Once you have moved through the post-operative dietary stages:

  1. Separate eating and drinking (Do not drink and eat food together, wait 30 mins after finishing food, before having a drink.)
  2. Keep calories in drinks low.
  3. Mindful eating to avoid stretching the pouch long term.
  4. Avoid snacking between meals.
  5. Multi vitamin and mineral supplement daily for life.
  6. Vitamin B12 injection every three months for life.