From the Guidelines
To manage hypercupremia in a patient with a history of gastric sleeve surgery who is taking iron-containing vitamins, I recommend reducing the amount of iron-containing vitamins as suggested by the gastro doctor, and ensuring the patient is taking a complete multivitamin and mineral supplement containing at least 2 mg of copper and 15 mg of zinc per day, as advised by the British Obesity and Metabolic Surgery Society guidelines 1. This approach prioritizes the patient's morbidity, mortality, and quality of life by addressing the potential for mineral deficiencies and excesses following bariatric surgery. The patient should be advised to take iron supplements separately from copper-containing foods, and consider zinc supplementation to compete with copper for absorption. Regular monitoring of copper levels, complete blood count, and liver function is essential to prevent complications. It is also crucial to maintain a balanced diet, avoiding high-calorie-dense foods and beverages, and limiting added sugar to prevent other health issues, as recommended by the nutritional guidelines for adult bariatric surgery patients 1. Additionally, the patient should be educated on favorable eating-related behaviors, such as taking small bites, chewing well, and eating balanced meals with high protein content to reach the recommended daily protein intake. The patient's protein intake should be assessed to determine if they are at risk of developing protein deficiency, and a tailored list of high-protein foods and/or protein supplementation should be provided as needed. Overall, a comprehensive approach to managing hypercupremia in a patient with a history of gastric sleeve surgery requires careful consideration of their nutritional needs and close monitoring to prevent complications.
From the Research
Managing Hypercupremia in Patients with a History of Gastric Sleeve Surgery
To manage hypercupremia in a patient with a history of gastric sleeve surgery who is taking iron-containing vitamins, consider the following:
- Reduce the amount of iron-containing vitamins, as the patient's gastro doctor has already suggested, to minimize excessive iron intake 2.
- Monitor the patient's micronutrient levels, including copper, iron, and vitamin D, to ensure they are within normal ranges 3, 4, 5.
- Consider alternative vitamin supplements that do not contain iron or have lower iron content to prevent hypercupremia.
Nutritional Deficiencies after Gastric Sleeve Surgery
Patients who have undergone gastric sleeve surgery are at risk of developing nutritional deficiencies, including:
- Vitamin D deficiency, which can persist even with supplementation 3, 4, 5.
- Iron deficiency, which can be exacerbated by excessive iron intake 2.
- Copper deficiency, which can increase over time after surgery 4.
- Other micronutrient deficiencies, such as folate, vitamin B12, and zinc, which can occur despite supplementation 4, 6.
Prevention of Micronutrient Deficiencies
To prevent micronutrient deficiencies after gastric sleeve surgery:
- Correct any existing micronutrient deficiencies before surgery, as this may help prevent early postoperative deficiencies 6.
- Provide patients with personalized supplementation plans to ensure they are getting the necessary nutrients 4, 5.
- Encourage patients to follow a balanced diet and monitor their nutrient intake to prevent deficiencies 6.