Obesity is a complex, multifactorial chronic disease with an escalating global incidence, impacting over 650 million adults worldwide. It is closely linked to a variety of metabolic, cardiovascular, and musculoskeletal diseases, and is a leading contributor to preventable morbidity and mortality. Metabolic and Bariatric Surgery (MBS) stands out as the most effective long-term intervention for obesity, facilitating significant and sustained weight loss while also promoting remission of associated diseases.
However, the anatomical and physiological alterations induced by MBS, including gastric restriction, bypass of absorptive surfaces, altered gastrointestinal transit, and reduced gastric acid production, significantly disrupt nutrient absorption and metabolism, placing patients at lifelong risk of micronutrient deficiencies or, conversely, hypervitaminosis resulting from excessive supplementation. Among these, Vitamin B6 imbalance has emerged as a significant yet under-recognized issue in post-MBS patients.
Among the nutrients affected, vitamin B6 (pyridoxine) presents a unique challenge. Vitamin B6 functions as a coenzyme in amino acid metabolism, neurotransmitter synthesis, and immune regulation. Deficiencies in Vitamin B6 are well-documented and can manifest as glossitis, irritability, and peripheral neuropathy. Notably, B6-related neuropathy may clinically resemble Guillain-Barré syndrome in post-MBS patients. This anxiety surrounding deficiency symptoms often leads to the overconsumption of Vitamin B6, resulting in hypervitaminosis, which can also present with neurological manifestations such as sensory neuropathy and ataxia.
The risk of hypervitaminosis is further exacerbated by the widespread use of high-dose multivitamin formulations post-surgery, many of which contain vitamin B6 at levels far exceeding the Recommended Dietary Allowance (RDA). For males, the RDA is 1.3 mg daily for those aged 19-50 years, increasing to 1.7 mg for those over 50. For females, the RDA is 1.3 mg for those aged 19-50 and 1.5 mg for those over 50. Yet some commercially available bariatric supplements exceed this level several-fold. Studies by Dogan et al. and Homan et al. emphasize the prevalence of vitamin B6 toxicity in post-MBS populations, largely attributable to inappropriate supplementation practices.
Aged 18 to 65 years
Undergoing primary metabolic and bariatric surgery (MBS), including sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one anastomosis gastric bypass (OAGB).
Patients must meet established surgical indications as defined by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), specifically: a body mass index (BMI) greater than 30 kg/m² with at least one obesity-related comorbidity (e.g., type 2 diabetes, hypertension, obstructive sleep apnea)
or a BMI greater than 35 kg/m² irrespective of comorbidities.
Revision or secondary MBS procedures
Known hypersensitivity to vitamin B6 or any component of the supplement formulations
Pregnancy or planned pregnancy during the study period
Any pre-existing medical condition known to interfere with vitamin B6 metabolism. This includes, but is not limited to, severe hepatic or renal dysfunction, peripheral neuropathy, and the use of medications such as isoniazid, phenytoin, or levodopa. Additional exclusions include chronic gastrointestinal conditions affecting absorption (e.g., inflammatory bowel disease, celiac disease), porphyria, or any other clinical scenario that, in the judgment of the investigators, may compromise compliance or the reliability of follow-up.
Parallel
Elan Believe
Dietary supplementParticipants will receive a specialized Elan bariatric supplement matched to the type of MBS they undergo. Elan Believe for SG addresses the distinct micronutrient absorption profiles and physiological alterations associated with this surgical procedure. Importantly, all formulations contain a standardized dose of vitamin B6 of 400 micrograms, facilitating valid comparisons of postoperative B6 levels across procedures.
Elan Compass
Dietary supplementParticipants will receive a specialized Elan bariatric supplement matched to the type of MBS they undergo. Elan Compass for RYGB addresses the distinct micronutrient absorption profiles and physiological alterations associated with this surgical procedure. Importantly, all formulations contain a standardized dose of vitamin B6 of 400 micrograms, facilitating valid comparisons of postoperative B6 levels across procedures.
Elan Supreme
Dietary supplementParticipants will receive a specialized Elan bariatric supplement matched to the type of MBS they undergo. Elan Supreme for OAGB addresses the distinct micronutrient absorption profiles and physiological alterations associated with this surgical procedure. Importantly, all formulations contain a standardized dose of vitamin B6 of 400 micrograms, facilitating valid comparisons of postoperative B6 levels across procedures.
The prevalence of vitamin B6 hypervitaminosis
Defined as a serum pyridoxal 5'-phosphate (PLP) concentration greater than 100 nmol/L, measured at 6 and 12 months postoperatively.
Prevalence of vitamin B6 deficiency
Defined as a serum PLP concentration less than 25 nmol/L.
Serum concentrations of other key micronutrients
Including vitamin B12 (reference range: 150-640 pmol/L), folate, ferritin, zinc, calcium, and parathyroid hormone (PTH)
Incidence of other micronutrient deficiencies
Including vitamin B12, iron, calcium, folate.
Relationship between supplement adherence and clinical outcomes
Adherence will be evaluated using: monthly pill counts Associations between adherence levels and biochemical or anthropometric outcomes will be explored using correlation and regression models.
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