Bariatric surgery can be effective for patients with kidney disease by reducing proteinuria and microalbuminuria and supporting them in kidney transplantation. However, diet plan management for bariatric and kidney patients is difficult, and specific guidelines are few. Therefore, healthcare providers such as Nourish 2 rise, give the most accurate guidelines on supplements to consume so that patients can achieve the best possible results. Bariatric surgery is effective for obese patients, and it is related to morbidities.
1. Introduction
Bariatric surgery is a safe and effective treatment for obese patients who have kidney diseases in stages 4, 5, and 5D, which is known as dialysis. Sleeve gastrectomy is the most commonly practiced weight loss operation among the available surgical methods and is mainly done to facilitate kidney transplantation. However, many kidney transplant patients treated with sleeve gastrectomy remain on the wait list for transplantation for months or even years; some patients don’t even get the transplantation done. Therefore, it is important that the right candidate for the sleeve gastrectomy surgery.
2. Risks vs. Benefits
Weight-loss surgery costs are decreasing with increasingly efficient and improved outcomes. For kidney patients, a decrease in weight has been observed to improve kidney parameters. Weight-loss surgery can reduce healthcare costs by slowing down the progress of the disease or delaying the need for kidney transplantation or dialysis.
Bariatric surgery in kidney patients carries risks. Patients must consider the possibility of malabsorption of nutrients and antirejection medicines. For those undergoing dialysis, there have been no studies suggesting the optimal mineral and vitamin diet plan for kidney patients following bariatric surgery.
Issues with Nutrition
3. A Kidney Patient’s Diet After Bariatric Surgery
Food normally encouraged for patients with bariatric surgery may be limited due to kidney problems. Lab reports should be monitored frequently. For kidney patients nearing dialysis or needing it, guidelines to limit protein and mineral intake should be provided based on laboratory measurements.
A common issue with kidney patients is increased serum phosphorus; foods such as milk, nuts, beans, and whole grains contain high levels of phosphorus. After bariatric surgery, patients are encouraged to consume foods containing high levels of phosphorus to meet their needs for vitamins, fiber, and proteins.
Patients with high levels of serum potassium need to decrease their intake of certain vegetables and fruits in addition to milk or dairy products. Therefore, not consuming certain foods due to high serum potassium or phosphorus levels can also make it mandatory for the patient to reduce consumption of foods high in protein, which can further contribute to protein deficiency.
4. Minerals and Vitamins
The correct amount of minerals and vitamins that patients on dialysis should consume currently needs to be clarified to those who previously had bariatric surgery. Studies show that patients before bariatric surgery had lower levels of vitamins and minerals. These vitamins are folate, B12, vitamin D, and vitamin A. Similarly, minerals include magnesium, selenium, ferritin, and zinc. In addition, low levels of hemoglobin and albumin have also been found in patients before bariatric surgery. Many patients had similar deficiencies before surgery.
- Iron
Inorganic forms of iron or nonheme (Plant) are inexpensive and readily available. Consuming different types of iron supplements is recommended for patients who underwent bariatric surgery. However, patients who take non-organic forms of iron may experience gastrointestinal discomfort like constipation and nausea. An adequate level of stomach acid is needed to absorb nonheme iron, and hydrochloric acid is produced slowly in every type of bariatric surgery.
- Proteins
After weight-loss surgery, healthcare providers encourage patients to achieve and maintain a healthy diet of proteins. This can be challenging for any patient with a smaller stomach pouch and sensitivity to food consumption after surgery. It is difficult for kidney patients on dialysis to maintain adequate protein intake. For those nearing dialysis, a diet plan with limited protein intake is followed. The recommended protein intake should be tailored for patients based on laboratory measures and comorbid chronic conditions.
- Vitamin B12
Vitamin B12 deficiency has been found in patients with bariatric surgery, and increasing B12 intake is important for these patients due to decreased production of their intrinsic factors. B12 deficiency can also lead to degeneration, peripheral neuropathy, and pernicious anemia. In pernicious anemia, the body is unable to make adequate amounts of a protein called “intrinsic factor,” which is required to process B12.
A supplement of orally disintegratable B12 is sufficient to prevent deficiency. However, some patients can require monthly doses of B12 injections to maintain the levels desirable for the body. Stomach acid is needed to process cobalamin, which occurs naturally. However, forms of orally disintegratable B12 used in supplements or added to foods can absorb cobalamin without the help of stomach acid.
In addition, patients with bariatric surgery can also experience thiamine B1 deficiency; if patients do not catch this deficiency on time, repletion of thiamine levels will not eliminate the symptoms immediately; complete elimination will take three to six months after repletion.
Patients should consume this supplement daily as their body will have limited quantities of thiamine. Repletion is effective if doses of 100mg are taken from three days to two weeks following an oral supplement maintenance dose of 20 to 100mg daily to maintain good health.
5. Conclusion
In patients with kidney disease and ones needing dialysis, bariatric surgery can add complications to healthcare following surgery. This surgery is why careful consideration of the procedure type is recommended for patients; this includes active monitoring by a healthcare provider such as Nourish 2 rise, which can help patients maintain their nutritional status and improve overall health by avoiding toxicities and preventing deficiencies. Although bariatric surgery is not performed by third-party healthcare providers, it can be ideal for patients planning to have a kidney or another organ transplant after reaching the planned weight loss. Regardless of the type of bariatric surgery, it is important to monitor nutritional deficiencies.
In addition, adjusting medications may be required immediately after the surgery and also for some time. In an ideal scenario, a standard mineral and vitamin diet is important for patients with kidney disease after bariatric surgery. However, simply following the diet plan is not enough; monitoring toxicities and deficiencies as time progresses is also important for patients who have completed bariatric surgery.
