Browse the evidence

Long-term mineral and multivitamin supplementation should be prescribed to every bariatric patient according to the procedure, with periodic laboratory surveillance to individualize supplementation based on demonstrated deficiencies.

Take your prescribed multivitamins and minerals every day for the rest of your life after surgery. The type and dose depend on your surgery. Get regular blood tests to check your levels, and adjust your supplements based on those results. This prevents serious health problems like anemia and bone loss.

Bariatric surgery (RYGB, SG, BPD) causes significant long-term nutritional deficiencies (iron, B12, Vitamin D, calcium, protein) due to anatomical bypass and malabsorption, necessitating lifelong monitoring and supplementation.

If you have had bariatric surgery, you must commit to lifelong blood tests and taking specific supplements (iron, B12, Vitamin D, Calcium) as prescribed. Your body can no longer absorb nutrients efficiently, and skipping supplements risks permanent damage like anemia or bone loss.

Pre-operative nutritional assessment and correction of deficiencies (especially Vitamin D and Iron) is critical before bariatric surgery to mitigate post-operative risks.

Before your surgery, ask for a full nutritional panel, specifically checking Vitamin D and Iron levels. Correct any deficiencies now to give your body the best chance to recover without severe complications.

Consuming 2-3 servings (approx. 48g) of whole grains daily reduces the risk of cardiovascular disease, type 2 diabetes, and certain cancers.

Aim for 2-3 servings of whole grains daily (approx. 48g). This simple dietary shift is strongly linked to a 20-30% reduction in Type 2 Diabetes risk and lower cardiovascular disease risk. Prioritize whole wheat, rye, oats, or barley over refined white flour products to access the protective phenolic acids and fiber concentrated in the bran.

Exclusive breastfeeding without vitamin D supplementation causes severe vitamin D deficiency and rickets in infants because breast milk contains inadequate vitamin D levels.

If you are breastfeeding your baby, you must give them 400 IU of vitamin D daily starting from the first few days of life. Breast milk alone does not have enough vitamin D to protect their bones. Continue this daily supplement until your baby is drinking more than 1000ml of vitamin D-fortified formula per day.

The protective association between plant-based diets and type 2 diabetes risk is strengthened when the diet emphasizes 'healthy' plant foods (fruits, vegetables, whole grains, legumes, nuts) and excludes refined grains and sugars.

Not all plant-based diets are created equal. To maximize your protection against type 2 diabetes, focus on 'healthy' plant foods: fruits, vegetables, whole grains, legumes, and nuts. Avoid relying on refined grains, starches (like white potatoes), and sugars, which are also plant-based but do not offer the same protective benefit. The stronger the focus on these healthy foods, the greater the reduction in diabetes risk.

Plant sterols and stanols (PS/PS) reduce LDL-C by 8-12% through competitive inhibition of intestinal cholesterol absorption, with efficacy plateauing at approximately 3 g/day.

If you have moderately elevated cholesterol and are not on statins, adding 2-3 grams of plant sterols/stanols daily (found in fortified spreads or supplements) can lower your LDL by about 10%. Take them with meals, preferably in fat-based spreads like canola oil, to maximize absorption. This is not a substitute for statins if you are at high cardiovascular risk.

Soluble fibers (beta-glucan, psyllium, glucomannan) reduce LDL-C by 5-15% through mechanisms including bile acid excretion and increased fecal cholesterol excretion, with additional benefits on triglycerides for glucomannan.

Incorporate 5-10 grams of soluble fiber daily. Oats (beta-glucan) and psyllium husk are effective for lowering LDL. If you also have high triglycerides, glucomannan (konjac root) may offer additional benefits. Start with a lower dose to minimize gastrointestinal side effects like bloating.

Adherence to a Mediterranean Diet (MD) reduces the incidence and severity of metabolic syndrome, type 2 diabetes, and cardiovascular disease by mitigating systemic oxidative stress and chronic low-grade inflammation through the intake of polyphenols, fiber, and unsaturated fatty acids.

Replace processed foods and saturated fats with a diet centered on vegetables, fruits, legumes, nuts, and olive oil. Prioritize fiber-rich foods to support gut microbiota and reduce inflammation. This dietary pattern is a proven strategy to lower the risk of heart disease, diabetes, and metabolic syndrome.

Curcumin supplementation (150–1500 mg/day) administered before and/or after exercise reduces exercise-induced muscle damage (EIMD), subjective muscle pain, and inflammatory markers (CK, TNF-α, IL-6, IL-8) in physically active populations.

If you engage in intense exercise, particularly eccentric movements, taking 150-1500mg of curcumin (preferably a bioavailable form) before and after your workout can help reduce muscle soreness and inflammation. Most studies show benefits when taken for several days surrounding the exercise event. It is generally safe for humans even at higher doses.

Vitamin E is recommended for patients with NASH and advanced fibrosis who do not have diabetes, and pioglitazone is recommended for patients with NASH and diabetes.

If you have NASH with advanced fibrosis and no diabetes, ask your doctor about Vitamin E. If you have NASH and diabetes, ask about Pioglitazone. These are guideline-recommended options to manage the disease.

High consumption of processed meats causes an increased risk of fatal coronary heart disease (CHD).

Limit processed meats like bacon, sausages, and deli meats. They are linked to a 37% higher risk of fatal heart disease per daily serving. Choose unprocessed meats, fish, or plant-based proteins more often.

Novel plant-based meat alternatives should be treated as sensory meat alternatives but not as true nutritional replacements for animal meat due to differences in nutrient bioavailability and complex food matrix interactions.

If you are swapping animal meat for plant-based alternatives to improve health, recognize that you are gaining sensory satisfaction but may lose specific nutrient benefits. To maintain nutritional status, ensure your overall diet includes diverse plant sources to compensate for lower bioavailability of nutrients like B12, Iron, and Zinc, or consider supplementation if you are not consuming fortified products.

Plant-based meat alternatives generally provide lower bioavailability of key micronutrients (B12, Iron, Zinc) compared to animal meat, even when fortified, due to food matrix effects and anti-nutrients.

When eating plant-based meats, be aware that you might not absorb as much B12, Iron, or Zinc as you would from animal meat, even if the label says they are equal. To mitigate this, pair these foods with Vitamin C (to help iron absorption) and consider getting your B12 and Zinc status checked if you rely heavily on these products.

Combined exercise and weight loss induces a favorable shift in HDL particle size (increase in large HDL2a and HDL2b subclasses) compared to exercise alone, which does not alter HDL distribution.

Combining exercise with weight loss improves the quality of HDL cholesterol (larger particles) more than exercise alone, which may offer additional cardiovascular protection.

Global mean potassium intake (2.25 g/day) is significantly below the World Health Organization's recommended target of >3.5 g/day, with only 14% of the global population achieving this level.

Most people globally do not eat enough potassium. To improve cardiovascular health, aim to increase potassium intake towards the WHO recommendation of >3.5 g/day, focusing on affordable sources like beans, potatoes, and leafy greens, especially if your sodium intake is high.

SGLT-2 inhibitors reduce ectopic fat deposition, specifically liver fat (NAFLD) and visceral adipose tissue, in patients with T2DM.

SGLT-2 inhibitors not only lower blood sugar but also directly reduce fat stored in the liver and around organs. This is particularly beneficial if you have fatty liver disease, a common complication of Type 2 Diabetes.

Elevated levels of Branched-Chain Amino Acids (BCAAs) such as leucine, isoleucine, and valine are predictive markers for Type 2 Diabetes risk across multiple ethnic groups, with specific associations to insulin resistance.

High levels of circulating BCAAs (leucine, isoleucine, valine) are a strong predictor of Type 2 Diabetes risk, even in people with normal blood sugar. This suggests that how your body processes amino acids is key. If you have risk factors, focus on metabolic health through balanced nutrition and exercise rather than just high-protein supplementation, as elevated BCAAs may indicate underlying insulin resistance.

Higher circulating levels of marine omega-3 polyunsaturated fatty acids (EPA and DHA) are associated with a significantly lower risk of total and ischemic stroke, with no increased risk of hemorrhagic stroke.

Aiming for higher blood levels of EPA and DHA (specifically an omega-3 index of 8% or higher) is associated with a lower risk of stroke. This can be achieved through dietary intake of 1-2 seafood meals per week or supplementation with approximately 1000-1600 mg/day of EPA+DHA, depending on your baseline levels.

Increasing urinary sodium excretion by 1 gram per day is associated with a significant increase in systolic blood pressure (approx. 1.7 mmHg) and diastolic blood pressure (approx. 0.5 mmHg).

For every additional gram of sodium you consume (roughly 1/3 of a teaspoon of table salt), your systolic blood pressure may rise by about 1.7 mmHg. To mitigate this, ensure your potassium intake is adequate, as the study shows potassium helps lower blood pressure.

Increasing urinary potassium excretion by 1 gram per day is associated with a significant decrease in systolic blood pressure (approx. 1.1 mmHg) and diastolic blood pressure (approx. 0.9 mmHg).

Increasing your potassium intake by 1 gram per day can lower your systolic blood pressure by about 1.1 mmHg. Focus on potassium-rich foods like fruits and vegetables to help counteract the effects of sodium.

A higher sodium-to-potassium ratio (gram-to-gram) is significantly associated with increased systolic and diastolic blood pressure, with the effect being most pronounced in low-salt regions.

Your sodium-to-potassium ratio is a critical determinant of blood pressure. A higher ratio (more sodium relative to potassium) significantly raises blood pressure. To lower your ratio, reduce sodium intake and increase potassium-rich foods, especially if you live in a region with lower salt intake.

High-fibre interventions (e.g., high-fibre bread, whole grains) reduce NAFLD grade and liver enzymes (ALT, AST) independently of weight loss.

If you have fatty liver, increasing your fibre intake through whole grains or high-fibre bread can improve your liver enzymes and disease grade, even if you don't lose weight. This is a simple, sustainable dietary change that directly benefits liver health.

Dietary factors such as plant-based foods and specific dietary models possess anti-inflammatory properties and anti-atherogenic potential.

Eat more plant-based foods to reduce inflammation and protect your arteries.