From the Guidelines
For a patient who has undergone Roux-en-Y gastric bypass (RYGB) with a zinc level of 53 mcg/dL, I recommend a daily zinc supplement of 15 mg of elemental zinc, as suggested by the British Obesity and Metabolic Surgery Society guidelines 1. This patient's zinc level is below the normal range, which is common after bariatric surgery due to reduced absorption capacity. The supplement should be taken separately from calcium supplements and iron, ideally 2 hours apart, to maximize absorption. Zinc citrate, zinc gluconate, or zinc picolinate forms are generally better absorbed than zinc oxide. The patient should take this supplement consistently and have zinc levels rechecked in 3-6 months. Long-term supplementation is typically necessary after RYGB due to the bypass of the duodenum and proximal jejunum where zinc is primarily absorbed. Adequate zinc is essential for wound healing, immune function, taste perception, and protein synthesis, all of which can be compromised in zinc deficiency that commonly develops after bariatric surgery. It is also important to monitor both zinc and copper levels, as normally a ratio of 8–15 mg of zinc for each 1-mg copper should be maintained to avoid zinc-induced copper deficiency 1. The complete multivitamin and mineral supplement should provide 2 mg d−1 copper, and people who have had long limbed gastric bypass or BPD/DS may have additional requirements 1.
From the Research
Zinc Dosage for Patients with RYGB
The patient's zinc level is 53mcg/dL, which is below the normal range. According to the studies, patients who have undergone Roux-en-Y gastric bypass (RYGB) often experience impaired zinc absorption and reduced zinc status.
Recommended Zinc Intake
- The study 2 suggests that RYGBP patients received 25 mg of supplemental Zn/d, but it does not specify the exact dosage for patients with a zinc level of 53mcg/dL.
- Another study 3 mentions that dietary plus supplemental zinc doubled recommended zinc intakes in healthy persons, but it does not provide a specific dosage for RYGB patients with low zinc levels.
Zinc Absorption and Status
- The study 3 found that zinc status is impaired after RYGBP, despite increased supplemental zinc intake.
- The study 2 also found that zinc absorption was decreased by 52.0% in RYGBP patients 24 months post-surgery.
- The study 4 found that RYGBP promoted an alteration in zinc plasma and erythrocytes concentrations, which could cause problems for patients in the medium and long term.
Considerations for Zinc Supplementation
- The study 5 found that zinc citrate is as well absorbed as zinc gluconate and may be a useful alternative for preventing zinc deficiency.
- However, the study 5 was conducted in healthy adults, and it is unclear whether the results apply to RYGB patients with impaired zinc absorption.
It is essential to consult with a healthcare professional to determine the appropriate zinc dosage for a patient with a zinc level of 53mcg/dL who has undergone RYGB, as the optimal dosage may vary depending on individual factors, such as the patient's overall health, diet, and absorption capacity.