Stomachless Lifestyle

Eating Without A Stomach: Help Your Skin, Hair, and Nails Thrive

Eating without a stomach can present challenges. Due to changes in the body’s ability to absorb nutrients after surgery, this is especially true when it comes to making sure you have an adequate intake of certain vitamins and minerals. 

When eating without a stomach, it can be difficult to get enough micronutrients, vitamins and minerals that are required by the body in small amounts. Many micronutrient problems will show up on routine lab work. However, you can also feel and see the impact of some micronutrient deficiencies in the body. One example is changes in hair, skin and nails after stomach removal. 

Unfortunately, certain nutrient deficiencies leading to problems with hair, skin and nails are common after stomach removal. Don’t worry too much though. Those problem caused by eating without a stomach can be corrected.


When monitoring yourself for nutrient deficiencies that may impact your hair, skin and nails after total gastrectomy, consider the following that are known to cause problems for the stomachless:

Vitamin B12: This vitamin is needed to form chemicals that are needed for hair follicle growth. Low B12 levels and related blood counts, also called macrocytic anemia, are linked to hair loss and early hair graying. Without a stomach, your body will have a difficult time absorbing B12. Therefore, if you’re having problems with your hair, skin and nails after total gastrectomy, check on your B12 levels.

Iron: This mineral is important for hair and nail health. Low iron levels and blood counts, also called iron-deficiency anemia, have been linked to hair loss, early hair graying, and thin brittle hair. Low iron levels are also linked to koilonychias, a nail problem with the main symptoms of thin nails that have become flat in shape. Without a stomach, your body may have a difficult time absorbing enough iron. Therefore, if you’re having problems with your hair, skin and nails after total gastrectomy, check on your iron levels.

You should also check the levels of some other vitamins and minerals. Although having your stomach removed should not directly impact your body’s ability to absorb these, you should still check in to make sure your levels are fine.

Vitamin A: This vitamin and its derivatives are very important in regulating skin structure and function. In fact, skin cells have so many receptors for Vitamin A retinoid derivatives that skin is thought to be one of its main targets. Vitamin A both helps skin growth and helps to get rid of unhealthy skin. In fact, it can even help to repair damaged skin such as from UV rays. The vitamin also helps hair remain moisturized and less breakable. Low vitamin A can cause many problems with skin, including rashes and delayed healing. 


Vitamin D: this vitamin is crucial to skin protection and hair follicle health. It activates chemicals that protect skin from microbes and inflammation. The vitamin is also involved in making sure enough blood vessels grow in the skin for an adequate blood supply. Further, it helps to ensure that skin can heal quickly when it is injured. The vitamin is also needed for hair follicle development. Low vitamin D is linked to skin problems like rashes. Further, doctors think that the extent of a person’s vitamin D deficiency might correlate with the severity of their rash. Low vitamin D is also linked to hair loss and early hair graying. 

Vitamin E: This vitamin is very important to skin protection. Vitamin E helps shield skin from free radical damage due to UV rays, including early aging and skin cancer. It also helps to keep the immune system healthy, prevent inflammation, and maintain collagen for skin elasticity and thickness. Low Vitamin E can cause skin ulcers and problems with the structure of collagen. Low Vitamin E is also linked to rashes on the scalp.

Copper: This mineral is important both for protecting skin from UV rays and for stimulating collagen production. Copper also helps to give hair its structure. Since copper is involved in making melanin to give pigment for both skin and hair, low levels may cause problems making pigment. Low levels are also suspected of causing brittle and weak hair and early graying.

Folate: This nutrient is in the Vitamin B family and is sometimes also called folic acid. It has an important role in chemicals that are thought to be important for hair follicle health. Having low folate is linked to problems in hair, skin and nails such as hair loss and early hair graying.


Zinc: this mineral is important in helping to protect the skin from UV rays. When used with Vitamin C, it can also help fight microbes that cause acne. It also helps Vitamin A create strong hair. Low zinc levels have been linked to skin blistering as well as hair loss, thin brittle hair, and white hair.

Selenium: this mineral helps to protect the skin from UV rays. For skin, low selenium is linked to an increased risk of blistering and skin cancer. For hair, low selenium is linked to both hair loss and loss of hair pigment.

Several reasons exist as to why these nutrient deficiencies are problematic after stomach removal. For B12 and iron, the stomach plays a key role in ensuring proper processing by your body. However, it is possible that your stomachless gut may have general absorption problems because, without a stomach, it is much more difficult to absorb enough nutrients. For instance, you may experience problems with one or more of the following:

Dissolving substances: The first step in absorbing nutrients is to ensure they disintegrate and dissolve. The stomach is a muscular organ that squeezes the food until it disintegrates and can dissolve in its acidic environment. The churning action of the stomach is vital to this process. Therefore, if nutrients do not dissolve as expected after stomach removal, it is much more difficult for the body to absorb them. 


pH: The pH of the stomach is naturally very low and acidic. In fact, the stomach lining has special cells that routinely pump out hydrochloric acid, or HCl. This acid helps to break down substances. Further, certain nutrients like iron and calcium absorb better in the acidic environment of the stomach. After stomach removal, a less acidic environment can make it harder to absorb these nutrients.

Bile salts: Fatty vitamins like Vitamins A, D, E and K rely on a complex route within the body to be absorbed. Once they go past the stomach and into the intestine, they go through the liver, bile, and then back into the intestines, and finally back to the liver. After stomach removal, the nutrients may not be able to get into the bile as easily. This is especially true of surgeries where the bile inlet is delayed. Bile salts help to break down fatty vitamins so they can be absorbed. With less ability to get into the bile, in turn, fatty vitamin absorption decreases.

Eating without a stomach, even if you are eating healthy foods, may not be enough to overcome vitamin deficiencies that lead to hair, skin and nail problems. In these cases, you may need to take supplements. However, the same problems absorbing vitamins from food may also impact vitamin absorption from supplements. Therefore, choosing the best form of supplements is key. Some tips include:

Use liquid, chewable, dissolvable or injectable vitamins: Because the stomach is normally tasked with dissolving vitamins, choosing dosage forms that are already dissolved, that dissolve easily, or that are injectable, makes absorption much easier. Therefore, choosing a vitamin that dissolves in your mouth or in a liquid dosage form clears one of the biggest vitamin hurdles you face. Alternatively, you can choose a chewable vitamin, as these dissolve more readily than tablets. 


Use formulations that don’t require stomach acid: Due to a lack of acid after stomach removal, it may be better to choose formulations of vitamins that do not rely as much on stomach acids to be absorbed. For example, using calcium citrate instead of calcium carbonate, which requires acid for absorption. In addition, using an iron supplement that contains Vitamin C may help with absorption due to the extra acid from this vitamin.

Have your lab work checked on schedule: At least every 6 months, perhaps even every 3 months, your doctor should order blood tests. These tests should check for deficiencies common after stomach removal, like thiamine, Vitamin B12, folate, Vitamin A, Calcium, Selenium, Iron, Zinc, Copper, and Vitamin D. Other parameters like albumin, parathyroid hormone, iron panel, complete blood count, complete metabolic panel and lipid panel should also be checked on a regular basis.

People who take supplements after some stomach surgeries are less likely to have hair loss, and may even be able to stop or reverse their hair loss. However, it is important to note that in some cases, especially with Vitamin A and selenium, taking too much may also cause problems. Some supplements to consider for hair, skin and nails include:

Nature’s Way Alive! Multi-Vitamin Citrus Flavor Liquid: As a liquid, this supplement is easily absorbed. The liquid contains many nutrients linked to hair, skin and nails that are difficult to absorb from food when eating without a stomach, like Vitamins A, D, E, B12, folate, zinc, selenium and copper.

Mega Premium Liquid Multivitamin: This supplement comes as a liquid, which is easily absorbed. It contains nutrients in which deficiencies are common after gastrectomy like Vitamins A, D, E, B12, folate, iron and selenium.

Centrum Liquid Adults: This liquid supplement is easily absorbed. It contains nutrients that are hard to absorb when eating without a stomach, like Vitamins A, D, E, B12, iron and zinc.

Bariatric Choice – All-in-One Bariatric Multivitamin: This chewable vitamin is designed for people after bariatric surgery, who face much the same nutrient absorption problems as gastrectomy patients. It contains hard-to-absorb nutrients important for hair, skin and nails like Vitamins A, D, E, B12, folate, iron, zinc, selenium and copper.

BariMelts Dissolvable Bariatric Multivitamin: This vitamin is designed to dissolve in your mouth before you swallow it, without chewing. It was created for people who underwent bariatric surgery. It contains Vitamins A, D, E, B12, folate, zinc, selenium and copper.

Eating without a stomach and maintaining proper nutrients for healthy hair, skin and nails can be hard. However, with the appropriate lab monitoring and supplement choices, success is possible.


1. Park K. “Role of Micronutrients in Skin Health and Function.” Biomolecules & Therapeutics, May 2015. Accessed July 31, 2019.

2. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. “The Role of Vitamins and Minerals in Hair Loss: A Review.” Dermatology and Therapy, March 2019. Accessed July 31, 2019.

3. Katsogridaki G, Tzovaras G, Sioka E, et al. “Hair Loss After Laparoscopic Sleeve Gastrectomy.” Obesity Surgery, published December 2018. Accessed July 31, 2019.

4. Ruiz-Tovar J, Oller I, Llavero C, et al. “Hair Loss in Females after Sleeve Gastrectomy: Predictive Value of Serum Zinc and Iron Levels.” The American Surgeon, published May 2014. Accessed July 31, 2019.

5. Goluch-Koniuszy ZS. “Nutrition of Women with Hair Loss Problem During the Period of Menopause.” Menopause Review, March 2016. Accessed July 31, 2019.

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Jessica Pyhtila

Dr. Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, MD. She is a double board certified Geriatric Pharmacist (BCGP) and a Pharmacotherapy Specialist (BCPS). She has given multiple medical presentations on medication and nutrient management after bariatric surgery and integrative and functional nutrition for optimal health.

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