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
Download the PDF from VitaminDWiki
Need a gut friendly form of Vitamin D as well as Magnesium
VitaminDWiki – People with with poor digestion need gut-friendly Vitamin D
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 useful – it 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 | Form | Speed | Duration |
| 10 | Injection ($$$) or Calcidiol or Calcitriol | D - Slow C -Fast | Long |
| 10 | Sun/UVB | Slow | Long |
| 10 | Topical (skin patch/cream, vagina) | Slow Fast nano | Normal |
| 9 | Nanoemulsion -mucosal perhaps activates VDR | Fast | Normal |
| 9? | Inhaled (future) | Fast | Normal |
| 8 | Bio-D-Mulsion Forte | Normal | Normal |
| 6 | Water soluble (Bio-Tech) | Normal | Normal |
| 4 | Sublingual/spray (some goes into gut) | Fast | Normal |
| 3 | Coconut oil based | Slow | Normal |
| 2 | Food (salmon etc.) | Slow | Normal |
| 2 | Olive oil based (majority) | Slow | Normal |
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
Note: Best to have a loading dose before or after any surgery
A Loading dose will provide benefit in weeks instead of 5+ months