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Following Bariatric surgery, weekly 50,000 IU of standard Vitamin D is not enough – Jan 2024

Dynamic Evaluation of Vitamin D Metabolism in Post-Bariatric Patients

J Clin Med. 2023 Dec 19;13(1):7. doi: 10.3390/jcm13010007.
Alexandra Povaliaeva 1, Artem Zhukov 1, Alina Tomilova 1, Axenia Bondarenko 1, Maksim Ovcharov 1, Mariya Antsupova 1, Vitaliy Ioutsi 1, Ekaterina Shestakova 1, Marina Shestakova 1, Ekaterina Pigarova 1, Liudmila Rozhinskaya 1, Natalia Mokrysheva 1

Background: findings from the previously conducted studies indicate altered regulatory mechanisms of calcium and vitamin D metabolism in obese patients and a role for bariatric surgery in regulating vitamin D metabolism; however, the available data is controversial and does not provide an adequate understanding of the subject.

Methods: we evaluated serum parameters of vitamin D and mineral metabolism (vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3, and 24,25(OH)2D3), vitamin D-binding protein (DBP), free 25(OH)D, fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), total calcium, albumin, phosphorus, creatinine, magnesium) in 30 patients referred for bariatric surgery in comparison with 30 healthy volunteers of similar age, sex and baseline 25(OH)D3. Patients were also followed up with repeated laboratory assessments 3 months and 6 months after surgery. During the first 3 months, patients were prescribed high-dose cholecalciferol therapy (50,000 IU per week), with subsequent correction based on the results of the 3-month visit examination.

Results: Preoperatively, patients with morbid obesity were characterized by a high prevalence of vitamin D deficiency (median 25(OH)D3 level 11.9 (6.8; 22.2) ng/mL), significantly lower levels of active vitamin D metabolite 1,25(OH)2D3 (20 (10; 37) vs. 39 (33; 50) pg/mL, p < 0.001), lower serum albumin-adjusted calcium levels (2.24 (2.20; 2.32) vs. 2.31 (2.25; 2.35) mmol/L, p = 0.009) and magnesium levels (0.79 (0.72; 0.82) vs. 0.82 (0.78; 0.85) mmol/L, p = 0.043) with simultaneous similar PTH levels (p = 0.912), and higher DBP levels (328 (288; 401) vs. 248 (217; 284) mg/L, p < 0.001). The 25(OH)D3 levels remained suboptimal (24.5 (14.7; 29.5) ng/mL at the 3-month visit and 17.9 (12.4; 21.0) ng/mL at the 6-month visit, p = 0.052) despite recommended high-dose cholecalciferol supplementation. Patients also demonstrated an increase in 1,25(OH)2D3 levels (38 (31; 52) pg/mL at the 3-month visit and 49 (29; 59) pg/mL at the 6-month visit, p < 0.001) without a change in PTH or calcium levels during the follow-up.

Conclusion: our results of a comprehensive laboratory evaluation of vitamin D status and mineral metabolism in patients undergoing bariatric surgery highlight the importance of improving current
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Need a gut friendly form of Vitamin D as well as Magnesium


VitaminDWiki – People with with poor digestion need gut-friendly Vitamin D

Gut-friendly, Sublingual, injection, topical, UV, sunshine

Getting Vitamin D into your body has the following chart

Getting Vitamin D into your body also has the following
If poorly functioning gut
Bio-D-Mulsion Forte – especially made for those with poorly functioning guts, or perhaps lacking gallbladder
Sublingual – goes directly into the bloodstream
Fat-soluble Vitamins go thru the slow lymph system
   you can make your own sublingual by dissolving Vitamin D in water or use nano form
Oil: 1 drop typically contains 400 IU, 1,000 IU, or 4,000 IU, typically not taste good
Topical – goes directly into the bloodstream. Put oil on your skin, Use Aloe vera cream with Vitamin D, or make your own
Vaginal – goes directly into the bloodstream. Prescription-only?
Bio-Tech might be usefulit is also water-soluble
Vitamin D sprayed inside cheeks (buccal spray) - several studies
    and, those people with malabsorption problems had a larger response to spray
Inject Vitamin D quarterly into muscle, into vein, or perhaps into body cavity if quickly needed
Nanoparticles could be used to increase vitamin D getting to the gut – Oct 2015
Poor guts need different forms of vitamin D has the following
Guesses of Vitamin D response if poor gut

Bio FormSpeedDuration
10Injection ($$$)
or Calcidiol or Calcitriol
D - Slow
C -Fast
10 Sun/UVBSlowLong
(skin patch/cream, vagina)
Fast nano
9Nanoemulsion -mucosal
perhaps activates VDR
9?Inhaled (future)FastNormal
8Bio-D-Mulsion ForteNormalNormal
6Water soluble (Bio-Tech)NormalNormal
(some goes into gut)
3Coconut oil basedSlowNormal
2Food (salmon etc.)SlowNormal
2Olive oil based (majority)SlowNormal

10= best bioavailable, 0 = worst, guesses have a range of +-2
Speed: Fast ~2-6 hours, Slow ~10-30 hours
Duration: Long ~3-6 months, Normal = ~2 months

16+ VitaminDWiki pages with BARIATRIC in title

This list is automatically updated

Items found: 17
Title Modified
Following Bariatric surgery, weekly 50,000 IU of standard Vitamin D is not enough – Jan 2024 12 Jan, 2024
Vitamin D interactions with poor gut (Celiac, IBD, and Bariatric surgery) – several studies 22 Nov, 2023
Bariatric Surgery in Adolescents: 41% vitamin D deficient - meta-analysis Nov 2023 22 Nov, 2023
Bariatric surgery increases risk of bone fracture (less vitamin D adsorbed) - June 2023 09 Jun, 2023
Bariatric Surgery and Vitamin D - many studies 30 Apr, 2023
Poor heart rate variability for a year after Bariatric surgery if low vitamin D – Nov 2022 08 Nov, 2022
Bariatric Surgery lowered risk of severe liver disease (not a surprise) - Nov 2021 11 Nov, 2021
Weekly oral Vitamin D recommended before surgery (Bariatric in this case) – RCT June 2019 19 Jul, 2020
Bariatric Surgery is Bad for the Bone (reduce vitamin uptake, etc)– 2016 03 Nov, 2019
4 weeks of Omega-3 better than 2 week 800 calorie diet before Bariatric Surgery – RCT March 2019 23 Mar, 2019
Vitamin D probably important for Bariatric Surgery – April 2018 14 Jul, 2018
Obesity special issue in JAMA focuses on Bariatric Surgery (where the money is) – Jan 2018 20 Jan, 2018
Bones helped by Vitamin D, Physical Exercise, etc (this time - Bariatric Surgery) – RCT March 2016 30 Aug, 2017
Bariatric Surgery problems associated with season, latitude (low Vitamin D) – Dec 2015 25 Oct, 2016
Prior to Bariatric Surgery 96 percent were vitamin D deficient – July 2014 25 Oct, 2016
Bariatric surgery less than 30 ng of vitamin D – 82 pcnt teens, 100 pcnt of black teens – June 2012 25 Aug, 2014
Virtually all Bariatric Surgery patients vitamin D deficient – should we routinely supplement – Jan 2011 25 Aug, 2014

Note: Best to have a loading dose before or after any surgery

A Loading dose will provide benefit in weeks instead of 5+ months

Attached files

ID Name Comment Uploaded Size Downloads
20650 Mg dropped.png admin 12 Jan, 2024 39.48 Kb 57
20649 Bariatric 50K_CompressPdf.pdf admin 12 Jan, 2024 119.73 Kb 29