From the Research
For a patient who has undergone Roux-en-Y gastric bypass with a zinc level of 53 mcg/dL, I recommend a daily zinc supplement of 25 mg elemental zinc, as this dose has been shown to be effective in maintaining zinc levels in patients who have undergone this type of surgery 1. This supplementation should be taken in divided doses, such as 12.5 mg twice daily, to maximize absorption. The supplement should be in the form of zinc sulfate, zinc gluconate, or zinc citrate, taken with food to minimize gastrointestinal side effects but not with high calcium or iron supplements which can interfere with zinc absorption. Patients who have undergone bariatric surgery have reduced absorption capacity due to bypassing the duodenum and proximal jejunum where zinc is primarily absorbed. Even with normal serum levels, supplementation is important for long-term maintenance as deficiency can develop over time and cause symptoms like hair loss, poor wound healing, altered taste, and compromised immune function. Some key points to consider when supplementing zinc in these patients include:
- Reduced zinc absorption capacity after surgery, with a decrease of 52% in zinc absorption 24 months after Roux-en-Y gastric bypass 1
- Importance of regular monitoring of zinc levels every 3-6 months to adjust the dosage as needed, with the goal of maintaining levels in the middle to upper range of normal
- Potential for zinc deficiency to develop over time, even with normal serum levels, due to reduced absorption capacity and altered zinc homeostasis after surgery 2, 1