For the last two weeks, we have looked at why vitamins are important and what you should be looking for when you buy vitamins and minerals. Now that you the why and what kind, we need to look at what happens when you have too much or too little in your bloodstream. Not having your bloodwork done routinely can lead to vitamin deficiencies and also vitamin toxicity. Between doctor visits, what signs should you be looking for to avoid health problems from vitamin levels that are too high or too low?
Signs and symptoms of vitamin and mineral deficiencies.
Not routinely having your blood tested or ignoring your doctor’s supplementation guidelines can lead to significant health problems up to and including death. Vitamin levels can drop quickly, so it is important to stay on top of it. Here are a few things to look out for, no matter what stage of the bariatric journey you’re at to make sure you are not deficient in vitamins.
Iron Deficiency
Iron deficiency is an increasingly common condition in the United States, even more so among bariatric patients. You may have an iron deficiency if you:
- Feel short of breath
- Have a fast heartbeat
- Have cold hands and feet
- Crave strange substances such as dirt, clay, or laundry detergent(pica)
- Have brittle and spoon-shaped nails or hair loss
- Notice sores at the corner of the mouth
- Have a sore tongue
- Difficulty in swallowing
- Appear pale
- Are tired, dragging, and easily fatigued
These are all signs of an iron deficiency. Iron deficiency can lead to anemia. This is when your body does not have enough red blood cells to carry oxygen throughout the body. It’s fairly easy to detect and diagnose the different stages of iron deficiency with a simple blood test, and treatment can range from supplemental iron pills to transfusion.
Calcium Deficiency
Early stages of calcium deficiency may not cause any symptoms. Studies have shown that almost half of malabsorptive bariatric patients will develop calcium deficiency by 24 months after the surgery.
Some signs of calcium deficiency are:
- Confusion or memory loss
- Muscle spasms
- Numbness or tingling of hands and feel
- Bone pain
- Muscle weakness
The good news is, all of this can be easily avoided with supplements. Long term calcium deficiency can lead to osteoporosis so make sure you keep up with those calcium citrate supplements.
Protein Deficiency
Protein is one of the most important components of your body as it makes up most of your major organs. Not getting enough can lead to a myriad of problems. Some of the symptoms of protein deficiencies are:
- Edema which is the appearance of swollen and puffy skin
- Fatty liver, fat accumulation in liver cells, this leads to liver failure
- Flaky or splitting skin, redness, and patches of depigmented skin
- Hair thinning, faded hair color, hair loss (alopecia), and brittle nails
- Loss of Muscle Mass
- Hip fracture
All of these symptoms will start to show up when you are well into protein deficiency. The only real way to make sure that you are getting enough is to follow your surgeon’s recommendations, get your bloodwork done regularly, and to take the supplements that they recommend.
Vitamins A, D, E, and K Deficiencies
The fat-soluble vitamins, A, D, E, and K are usually the ones that will show up as deficient in people who have had malabsorptive bariatric surgery.
Vitamin A Deficiency – Vitamin A plays an integral role in the differentiation and proliferation of cells in the eyes. If you are noticing any of these, you may have a Vitamin A deficiency:
- Changes in your vision or trouble with your vision, especially at night
- Dry skin and eyes
- Frequent throat and chest infections
- Slow wound healing
- Acne and skin breakouts
Prolonged Vitamin A deficiency can lead to night blindness and increases the risk of disease and death from severe infections.
Vitamin D Deficiency – Vitamin D deficiency is very common. It’s estimated that about 1 billion people worldwide have low levels of Vitamin D in their blood. The primary function of Vitamin D is to raise calcium and phosphate concentrations in the blood. This promotes the regrowth and strengthening of bone. The first signs of Vitamin D deficiency are usually:
- Getting sick or infections often
- Fatigue and tiredness
- Bone and back pain
- Depression
- Slow-healing wounds
- Bone loss
- Hair loss
- Muscle pain
Vitamin D deficiency is relatively easy to fix with supplements and getting outside in the sun a little more. Long term Vitamin D deficiency can lead to liver and kidney disorders and bone softening diseases.
Vitamin E Deficiency – Vitamin E is mainly involved in immune system function. It serves as the primary defense in the prevention of both chronic and acute illnesses. Signs of Vitamin E deficiency include:
- Frequent and longer illnesses
- Vision problems
- Loss of muscle mass and weakness
- Balance problems
- Difficulties concentrating
- Digestive issues
- Hair and skin problems
Long term deficiency can cause neurological problems, anemia, and can cause wounds to heal more slowly. Additionally, individuals with vitamin E deficiency are more at-risk for both infectious diseases and the development of tumors.
Vitamin K Deficiency –Vitamin K is necessary for the activation of certain clotting factors in the liver which are responsible for coagulation and bone strength. Some of the symptoms of low Vitamin K are:
- Cuts continue to bleed
- You are losing bone strength
- Arthritis
- Heart problems
- You bruise easily
Your vitamin K levels can be tested via a blood test. Long term low levels of Vitamin K increases the risk of osteoporosis and heart disease.
Vitamin B Deficiency
Having a deficiency of Vitamin B affects the heart, digestive system, and nervous system. If not caught and treated quickly, learning and memory could be permanently affected. Vitamin is also known as Thiamin. Early symptoms of a deficiency include:
- Tingling in the hands
- Fatigue
- Irritability
- Uneven sleep
- Abdominal discomfort
If these symptoms are ignored long enough, though, things can get much worse. Deficiencies can eventually lead to anemia and neurological disorders Ultimately, coma and death could be the result if supplements are not taken.
Vitamin deficiencies can occur quickly after bariatric surgery. This is one of the reasons it is so important to get bloodwork done regularly. I am over 18 years out and make sure I get my bloodwork done every year. If I am running lower than normal on a specific vitamin, my doctor will occasionally put me on an every 6 or even 3-month schedule for bloodwork.
Toxicity and Overdose
It is close to impossible to overdose from diet alone. Using supplements, it is possible, this is one of the reasons that bloodwork is so important. What are some of the signs and consequences of toxic levels of vitamins and minerals?
Iron
Iron is so important to stay healthy but too much can be deadly. The main symptoms associated with too much iron in the blood include:
- Severe vomiting
- Diarrhea
- Abdominal pain
- Dehydration and lethargy
- Fatigue
- Joint pain
- Abnormal heart rate
- Faintness or weakness
- Decreased libido
Treating iron poisoning normally involves a procedure called whole bowel irrigation. A solution is swallowed or given through a tube that is passed through the nose and down into the stomach. The solution will help flush the body of the excess iron. In more serious cases, a procedure called chelation may be necessary. This is where a chemical that helps bind iron and other metals in the body is given through an intravenous (IV) line. The iron is then can be passed out of the body through the urine.
After receiving care, most symptoms will improve within 6 to 24 hours after their onset. If profound poisoning is inadequately treated, shock and death can occur.
Calcium
Calcium is essential for keeping your teeth and bones strong. Although there is little likelihood you could overdose on calcium from food alone, it is possible to get too much from supplements. High levels of calcium in your blood can cause the following symptoms:
- Little or no urination
- Swelling, rapid weight gain
- Nausea
- Vomiting
- Constipation
- Increased thirst
- Muscle weakness
- Bone pain
- Confusion
- Lack of energy
The consequences of calcium toxicity can be dangerous, leading to soft tissue calcification and life-threatening organ dysfunction.
Protein
Protein is one of the macronutrients that are essential for the optimal functioning of the body. However, too much protein, especially with no fat or carbs, can be harmful. Protein is one of the few nutrients that it is possible to overdose on through just diet. This has been seen more recently with the prevalence of many high-protein diets. Some of the signs of protein poisoning are:
- Nausea
- Headache
- Mood changes
- Weakness
- Fatigue
- Slow heart rate
- Low blood pressure
- Hunger and food cravings
- Diarrhea
The treatment for protein poisoning is easy. It simply involves consuming more fats and carbohydrates and decreasing the intake of protein. If you are taking supplements, your surgeon will adjust the amount that you are taking depending on your bloodwork results. Protein toxicity occurs when a person who has impaired kidney function has too much protein. This can lead to kidney failure if not properly treated.
Vitamins A, D, E, K
Because fat-soluble vitamins are not readily excreted, they can accumulate to toxic levels if taken in excess. Fat-soluble vitamins, if taken in high doses, can build up in your body fat and cause complications. While a well-balanced diet cannot cause toxicity, overdosing on fat-soluble vitamin supplements can.
Vitamin A
Vitamin-A toxicity is most commonly caused by over-supplementation. An excess of Vitamin A can be either acute(short term) or chronic(long term).
Symptoms of acute Vitamin A toxicity can include:
- Headaches
- Drowsiness
- Irritability
- Abdominal pain
- Nausea
- Vomiting
Symptoms of chronic Vitamin A toxicity can include:
- Blurry vision
- Bone pain
- Decreased appetite
- Nausea and vomiting
- Sensitivity to sunlight
- Dry, rough, itchy, or peeling skin
- Dry, cracked fingernails
- Jaundice
- Ulcers in the mouth
- Hair loss
- Respiratory infection
- Confusion
Continued excess of Vitamin A can lead to permanent liver damage, osteoporosis, kidney damage, and intracranial swelling.
Vitamin D
Vitamin-D toxicity is rare but can happen if you take large doses of Vitamin D supplements along with a heavy intake of fortified foods. The main symptoms of Vitamin D toxicity may include:
- Kidney stones
- Nausea
- Recurrent vomiting
- Constipation
- Excessive thirst and urination
- Confusion
- Weight loss
Vitamin D toxicity, if left untreated, can progress to bone pain and kidney problems, such as the formation of calcium stones. Treatment normally includes decreasing Vitamin D supplements along with restricting dietary calcium. If the case is severe, your doctor might also prescribe intravenous fluids and medications, such as corticosteroids or bisphosphonates.
Vitamin E
Toxicity from Vitamin E is most commonly caused by over-supplementation and is otherwise very rare. You would need to take relatively large amounts of Vitamin E for months, even years to reach levels that would be considered toxic. The signs of Vitamin E toxicity include:
- Muscle weakness
- Fatigue
- Nausea
- Diarrhea
- Bleeding
Long term excessive Vitamin E intake can cause blood thinning and lead to fatal bleeding. It can also interfere with blood clotting, which is your body’s natural defense against excessive bleeding after an injury. High levels of Vitamin E has also been linked to an increased risk of hemorrhagic stroke, or a stroke caused by bleeding in the brain.
Vitamin K
Vitamin K toxicity is uncommon but can be found in those who are administered menadione injections, a synthetic Vitamin K precursor, and in people who are taking supplements but not following up with their bloodwork. There are different types of Vitamin K. Vitamins K1 and K2, which are consumed orally and are in most supplements do not cause symptoms. They are not toxic, even in large amounts. Toxicity can be caused by menadione, sometimes called Vitamin K3, which is a synthetic, water-soluble Vitamin K that is sometimes used in supplements. Symptoms of Vitamin K toxicity include:
- Low blood sugar levels
- Increase blood plasma volume, which increases the thickness of your blood
- Shortness of breath
- Increased perspiration
- Bluish discoloration of lips, fingernails, and palms
Prolonged overdosing can lead to permanent liver damage. Because of the different types of Vitamin K, it is important to check your supplements so you know what you are taking.
Vitamin B12
Because it is a water-based vitamin, an overdose of Vitamin B12 is almost impossible. However, there are some groups of people that may be at a greater risk of Vitamin B12 overdose. This includes people with kidney and liver disease, those with diseases related to the blood, and people who have diabetic nephropathy. For people who are at greater risk, the main risk is an increased risk of cardiovascular events. There are some negative side effects associated with Vitamin B12 injections. The most common complaints include:
- Headache
- Swelling
- Rash
- Facial flushing
- Itchy skin
- Dizziness
- Numbness
- Diarrhea
- Vomiting
- High blood pressure
- Cold symptoms
- Anxiety
Vitamin B12 is a water-soluble vitamin, which means that when we ingest too much of it, the excess amounts are flushed out of the body through urine. This makes it nearly impossible to overdose on the nutrient. Additionally, we know that only a small percentage of Vitamin B12 taken orally is actually absorbed.
Since many types of vitamin toxicity include similar symptoms (dizziness, fatigue, nausea) it is important to keep up with your bloodwork to make sure you are treating the correct deficiency or toxicity. Yearly bloodwork for the rest of your life is important and finding a doctor who has a good understanding of the potential challenges associated with bariatric surgery is crucial.
Working with your doctor to figure out what supplements you need and sticking to it is the key to success.