From the Guidelines
Bariatric patients should be recommended to take a multivitamin and mineral supplement containing at least 15-mg zinc oral daily, with higher doses of at least 30-mg oral zinc daily for those undergoing malabsorptive procedures such as BPD/DS. This is based on the most recent guidelines from the British Obesity and Metabolic Surgery Society, which emphasize the importance of zinc supplementation to prevent deficiency after bariatric surgery 1. The optimal level of zinc supplementation may vary depending on the type of bariatric procedure, with some studies suggesting higher doses for certain procedures 1. However, the general recommendation is to start with 15-mg zinc daily and adjust as needed based on individual patient needs and blood test results. It is also important to note that zinc and copper have an inverse relationship for absorption, and a ratio of 8-15 mg of zinc for each 1-mg copper should be maintained to avoid zinc-induced copper deficiency 1.
Some key points to consider when recommending zinc supplementation for bariatric patients include:
- The type of bariatric procedure, with malabsorptive procedures requiring higher doses of zinc
- The importance of monitoring zinc levels through periodic blood tests
- The need to maintain a balanced ratio of zinc to copper to avoid deficiency or toxicity
- The potential for individual variation in zinc needs, requiring adjustment of supplementation doses as needed
- The importance of taking zinc supplements separately from calcium and iron supplements to minimize competition for absorption.
Overall, the goal of zinc supplementation in bariatric patients is to prevent deficiency and promote optimal health outcomes, including wound healing, immune function, and overall quality of life 1.
From the FDA Drug Label
The solution is a supplementation additive for parenteral nutrition intended to be used in mixtures for parenteral nutrition or diluted in isotonic solutions Recommended daily intakes by intravenous route are the following:
- In adults: 3 to 15 mg zinc/day.
The recommended zinc dose for a bariatric patient is not explicitly stated in the label. However, for adults, the recommended daily intake by intravenous route is 3 to 15 mg zinc/day. Since the label does not provide specific dosage recommendations for bariatric patients, a conservative approach would be to consider the general guidelines for adults and adjust according to individual patient needs and zinc status 2.
From the Research
Zinc Dosage for Bariatric Patients
- The ideal zinc dose for bariatric patients is not explicitly stated in the provided studies, but it is clear that zinc deficiency is a common complication after bariatric surgery 3.
- A study published in 2010 found that the mean supplemental zinc intake was low, at 22 mg/day, and that zinc deficiency was present in 42.5% of the population at 12 months after surgery 3.
- Another study published in 2015 reported a case of acquired zinc deficiency secondary to gastric bypass surgery, which was successfully treated with intravenous zinc therapy after oral supplementation failed 4.
- In terms of zinc absorption, a study published in 2014 found that zinc citrate is as well absorbed as zinc gluconate, and better absorbed than zinc oxide 5.
- A narrative review published in 2024 suggested that zinc glycinate and zinc gluconate are better absorbed than other forms of zinc 6.
- An older study published in 1987 found that zinc picolinate was better absorbed than zinc citrate and zinc gluconate 7.
- The type of surgery and time since surgery can affect zinc absorption and deficiency, with biliopancreatic diversion with duodenal switch (DS) being associated with a higher prevalence of zinc deficiency 3.