Risks and limits of bariatric surgery: old solutions and a new potential option.

The present review focuses on the side effects that ex-obese patients face following bariatric surgery. We searched through the principal medical indexes (SCOPUS, Web of Science, PubMed, MEDLINE) using the following words, both alone and in combinations: bariatrics; bariatric surgery; anemia; vitamin B12; cobalamin; folate; folic acid; iron; iron supplements; gut microbiota; lactalbumin; α-lactalbumin. To perform exhaustive research, we considered articles published since 1985. Bariatric surgery induces states of nutritional deficiencies. In particular, the surgery results in a drastic fall in the levels of iron, cobalamin, and folate. Despite the dietary supplements which can counteract such decrease, some limitations exist in the nutraceutical approach. Indeed, the gastrointestinal side effects of supplements, the alterations in the microbiota, and the reduced absorption induced by the surgery may impair the effect of dietary supplements, exposing the patients to the risk of developing nutritional deficiencies. Recent literature reports the effect of promising molecules to counteract such limitations, which include α-lactalbumin, a whey protein with prebiotic activities, and new pharmaceutical forms of iron supplements, namely micronized ferric pyrophosphate. If on the one hand, α-lactalbumin enhances intestinal absorption and helps in restoring a physiological microbiota, micronized ferric pyrophosphate has a high tolerability and low or null risk of gastrointestinal side effects. Bariatric surgery represents a valid solution to obesity and obesity-related disease. However, the procedure may induce deficiencies in micronutrients. Data exists on the promising activities of α-lactalbumin and micronized ferric pyrophosphate, which may help in preventing bariatric-induced anemia.