Vitamin Questions

Happy Holidays Everyone

I have 2 questions - Does anyone use bariatric advantage or any or brand to combine vitamins. It looks like I can replace 4 pills for vitamins ADEK with one. Also, I currently take a CVS brand for Calcium Citrate which takes like a piece of chalk. Does anyone have suggestions for something better.

Can you also post vitamin requirements for DS. I have the right vitamins but I think the amount and number per day I'm off?

Thanks

 

 

Happy Holidays!

I've read a few people that use the multi ADEK's but most of us find  it better and cheaper to split them
out. It can depend on your priorities - I just got used to taking more pills but I understand wanting to simplify things.
Mainly the doses for Vitamins A and D are usually too low in the multi ADEK's. I think if you take more than one the levels of 
E and K are usually fine, or at least they would be for me. You always have to go by your labs.

So some of this depends on your state of health, age, gender , pre-op levels - all that. Here is what I am taking
at about 20 months. If you compare my list with what is in the BA ADEK you will see what I mean about A and D
although again - a lot of this is common but people can be different so your needs may vary. You might also search for
the vitalady vitamin list. The philosophy with that is to start high and then cut back, I started lower and added stuff
either way is fine as long as you pay attention to your labs.

I'm not sure there really is a uniform DS vitamin requirements although some like calcium and a multi are extremely
important. I do 5 doses throughout the day. I think on most people calcium is the determining factor for how many doses
you do in a day since you should try and keep individual doses to the 500-600mg range for max absorption.
I started out with no Vitamin A or K or zinc or iron but added all that as blood work showed that I needed it.
I also sometimes add vitamin K2 to help with the calcium absorption. At 20 months here is what is working
for me.

Early morning-middle of the night
Iron(approx 200 mg elemental iron) and Vit C (1000mg)

First regular dose in the morning
calcium citrate 500-600mg (citrical max or Kirkland calcium citrate)
Magnesium oxide - 250mg
Vitamin D - 50K (Biotech dry)
Multivitamin - centrum or Kirkland

Lunch dose
calcium citrate 500-600mg (citrical max or Kirkland calcium citrate)
Magnesium oxide - 250mg
magnesioum glycinate - 100mg
b-12 sublingual - 500mcg

Late afternoon/dinner
calcium citrate 500-600mg (citrical max or Kirkland calcium citrate)
Magnesium oxide - 250mg
Vitamin D - 50K
Multivitamin - centrum or Kirkland
Vitamin K1 - 1000mcg
Vitamin E - 400IU

Evening
zinc - 45mg avg
vitamin A - 25K (Biotech dry)

Pete

happy holiday

I don't use bariatirc advantage, not sure what you mean by "or any or brand to combine vitamins"  I am not sure what you are saying about replacing # of pills for ADEKs with one.  It will be impossible to get all the vitamins in the correct proportions for Vit ADEK in just one pill, that will NOT happen.

CVS calcium citrate-the one that is compared to citracal, that is and excellent ca citrate, you don't chew them, swallow them, they are calcium they all taste like chalk.   I take 12 of those dinosaur pills a day, yes 12, welcome to Hades.  vitalady has a DS sample vitamin list that you can start with and adjust as your blood work dictates.

Thanks for the info Pete and Airbender,

The doses I am currently taking are much lower than you take. I'm following some hardcopy printout from a nutrionist

associated with the Weight Loss Center and it only includes 1 dose per day of the items you mentioned, particularly the Calcium Citrate. I guess my first blood work will tell. Can you tell me when you started the blood work and how often you have it done now. My original surgeon moved a week before my surgery date, and I had to scramble to get it done with a better surgeon. Now I'm a little disjointed on the follow-up requirements. 

First year I got my labs done every three months.  Six monthly should be fine thereafter.  

Pete posted a great example.  nutritionist information will most likely get you in trouble.  with the DS and a female with 1 dose of calcium citrate you will eventually lose your bones.  the first year test every 6 months after intestinal adaptation and you are stable and you have no issues, that is at about 2 years PO, testing every year the bulk of your assays, but common blood work will still be at 6 months, unless you have issues then more frequently.

 

99% of nutritionists do not understand a DSers needs long-term.  It's important to keep on top from the very beginning, for it can take monts or even years to bring plunging vitamin levels up to a normal range (I speak from experience).  Fortunately, the DSers here and on other boards share what has worked with the majority of us.  The ADEK Multi's aren't nearly enough of what you need and much more costly than you need to spend.  Some vitamins cannot be effective if taken together with others, so it's important to space them out appropriately.  There's no need to buy designer bariatric vitamins, for this reason.  You can get most vitamins over the counter and the dry A, D, K and E seperately online from Amazon or Vitalady.  On Vitalady.com, they have a DS regimen that is a great starter kit.  I've not heard of anyone going deficient with this regimen.  It's overkill for some, but let your bloodwork determine what you can back off on.

It's also important to have a baseline bone density scan starting out so you will have something to compare with later.  I have tried the Bariatric Advantage advanced Multi EA, but it smells horrible (to me) and I felt pretty crappy all day the 2 days I took it (could be just me) so I am happy with all of my bottles and doses.  KP

You need to get used to the idea right now that there is no 'simple' way to keep YOUR vitamin levels good. This is a very complex dance you have begun, and what YOU need to take will forever depend on what YOUR lab results show.

Most of us take several different pills several times a day. There are several reasons for this. Some vitamins should be taken at least two hours away from other vitamins. Some vitamins need to be spread out over several doses per day.

ADEKs simply don't supply enough A and D unless you take so many of them you're over-dosing on E and K. Buy them separately, so you can adjust how much of each YOU take, based on YOUR labs.

I keep emphasizing YOU and YOUR because this is a very individual task. No two human bodies start out the same, and no two react to surgery the same. Heck, no two surgeries can be identical!

Vitalady has a very good list of what DSers should start out with. You can find it on her website. Not everyone needs to take exactly this, forever. Some people can take less, some people require more. Time, and thorough labs will tell what YOU need to take.

DO NOT CUT CORNERS. Your life and health depend on adequate supplementation.

I like how Pete describes the two philosophies of being shooting for the top of the range and perhaps lowering your daily doses or shooting somewhere in the middle and perhaps upping your daily doses.  I am firmly in the second camp, although I do agree it carries more risk.  I am just too much of a vitamin wimp to stay on the other road.  

 

According to The American Society for Metabolic and Bariatric Surgery (ASMBS), it is common to see BPD/DS patients have issues with the following vitamins:

• Vitamin A (almost guaranteed needed by 4 years post op)
• Vitamin D
• Vitamin K
• Zinc

On the other hand it is rare to see us struggle with (YMMV)

• Vitamin E
• Vitamin B's

 

Now, to your question about combination vitamins:

I take Celebrate Multi-ADEK.  Just 3 a day, but I did think that it left me a little vulnerable in the Vitamin A department with just 17,000iu.  My three month labs showed I was in the lower third of normal range of Vitamin A, so, I'm adding one tiny VitaLady Tender A-25 (25,000iu) and will see how I'm trending at six months.   There is extra D in my calcium pills and also I use Biotic Research Drops. 

 

Yes, I realize it is ironic that I'm supplementing two of the four (AD out of ADEK) and will probably move that up to three at some point (ADK of ADEK), but I think it still buys me a simpler program.  Especially, if I end up at 3 Celebrate Multis, plus one tiny A and K). 

 

Another options you may want to look at is the program from Mexicali Bariatric Centers.   They do maybe one quarter as many pills at the full VitaLady. 

 

One thing that might be confusing of the chart below is that most of the independent experts who have recommendations for BPD/DS is that you base your multivitamin on "a high quality daily vitamin like Centrum".   ASMBS and VitaLady say two a day but Mexicali Bariatric have you take four.  It makes comparing these programs very difficult unless you flush out the program with the multivitamin broken out and added into the different buckets.   So in the chart below, the left most column has done just that.   The center column has the amount of extra supplement that they want you to take on top of the four mulits.    So,  for the calcium citrate, they want you to take 2,400 iu on top of the amount of calcium you get in 4 centrum (200 each), so in total you would get 2400 + 800 = 3,200 iu.  (Compared to 2.2K in the VitaLady program and 2.2K to 2.8K in the ASMBS recommendations). 

 

Daily Vitamin Recommendations:	Mexicali Bariatric Center DS	Mexicali Bariatric Center DS with 4 Centrum
Protein:	80 to 100 g	80 to 100 g
Multivitamin:	2 every 12 hours	(4 centrum included below)
pills
Calcium Citrate:	2,400 mg	3,200 mg
Vitamin A:	10,000 IU	24,000 IU
Vitamin B complex:	1 shot every month or 1 pill every week	(See individual B vitamins below)
Vitamin D:	2000 IU daily (or 50,000 IU every week)	3,600 IU daily (or 1,600 iu daily + 50K weekly)
Vitamin E:	250 IU	370 IU daily
Vitamin K:	200 mcg daily	300 mcg daily
Iron: elemental	100 mg intramuscular once a month	72 mg + 100 mg intramuscular once a month
Zink:	50 mg every 3rd day	44 mg + 50 mg every 3rd day
PLUS
Boron		300 mcg
Chloride		288 mg
Chromium		150 mcg
Copper:		2 mg
Iodine		600 mcg
Magnesium		200 mg
Manganese		9.2 mg
Molybdenum		180 mcg
Nickel		20 mcg
Pantothenic Acid		40 mg
Phosphorus		80 mg
Potassium		320 mcg
Selenium		220 mcg
Silica:		8 mcg
Tin		40 mcg
Vanadium		40 mcg
Vitamin B – Biotin		120 mcg
Vitamin B: Niacin		80 mg
Vitamin B: Riboflavin		7.2 mg
Vitamin B-1 Thiamin:		6 mg
Vitamin B-12		24 mcg
Vitamin B6: HCI		8 mg
Vitamin B-9 Folic Acid:		1600 mcg
Vitamin C:		240 mg
Citrus Bioflavonoids
Inositol USP/FCC
Choline
Vanadium

 

 

Ok, next chart shows all the main players programs flushed out and showing their recommendations for the troublesome vitamins/minerals.    This is as close as I can get to comparing apples to apples in many, many hours of work. 

Daily Vitamin Recommendations:	ASMBS with 2 Centrum	Celebrate	Bariatric Advantage	Mexicali Bariatric Center BPD-DS with 4 Centrum	Twinlab Bariatric	VitaLady RNY & DS with 2 Centrums
`	90 g/d			80 to 100 g		120 to 150 g
Approximate # pills a day	~15	~7	~7	~15	~13 pills	~35
Calcium Citrate:	2200-2800 mg	1,500 mg in cal	150 mg in MV 1,500 in cal	3,200 mg	300 mg in MV 2,000 mg in cal	2,200 mg
Vitamin A:	17,000 IU	7,000 iu in MV	15,000 iu	24,000 IU	150,000 iu	107,000 IU
Vitamin D:	2400 IU	1,000 iu in cal 3,000 iu in MV	2,001 iu in MV 1,500 iu in Cal	3,600 IU	1,200 iu in MV 1,600 iu in cal 1,600 iu in D+K	50,800 IU
Vitamin E:	30 IU	300 iu in MV	750 iu	370 IU daily	90 iu	860 IU
Vitamin K:	350 mcg	80 mg in cal 540 mcg in MV	180 mcg	300 mcg daily	180 mcg in	1,050 mcg
Iron: elemental	36 mg	30 mg in iron	30 mg in iron	72 mg + monthly shot	30 mg	336 mg
Zink:	22 mg	15 mg in cal 15 mg in MV	22.5 mg	44 mg + 50 mg every 3rd day	15 mg	122 mg

 

Honestly, there is such a wide disparity in the ranges that I'm not sure there is much to be learned from reading this at all.  On top of that, everybody's body is different.  The BRIGHT, BRIGHT lining is that we only have to guess for three to six months.  After that we will have our actual blood work results in our greedy little hands and can say "Oh, I need to add some vitamin A."