ASMBS Guidelines -- the bottom line?
I've been poking around the ASMBS site, hoping to find a "bottom line" simplified summary of their guidelines. I can't find one. Does anybody here know if such a thing exists?
I did find a scientific document for medical professionals, but frankly it's way too much information to sort through, and a lot of it is stuff the average patient doesn't need to know in that much detail. What we need is the same information, but summarized so that it's accessible and understandable.
http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/bgs_final.pdf
I did find a scientific document for medical professionals, but frankly it's way too much information to sort through, and a lot of it is stuff the average patient doesn't need to know in that much detail. What we need is the same information, but summarized so that it's accessible and understandable.
http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/bgs_final.pdf
- Barb, who is at GOOOOOOAAAAAAL!
HW: 274 SW: 244 GW: 137 CW: 137!
Keep on swimming! Keep on swimming!
A friend did this a long time ago with the ASMBS Guidelines that were in that same doc:
| Roux-en-Y Gastric Bypass | |
| Multivitamin-mineral supplement
|
200% of daily value |
| Additional cobalamin (vitamin B12)
|
1000 µg/month as injection OR 350-500 µg/day as oral tablet |
| Additional elemental calcium
|
1500-2000 mg/day |
| Additional elemental iron (beyond that provided by multivitamin)
|
Add a minimum of 18-27 mg/day elemental for a total of 50-100 mg/day of elemental iron. |
| Optional B Complex
|
1 serving/day |
| Adjustable Gastric Banding | |
| Multivitamin-mineral supplement
|
100% of daily value |
| Additional cobalamin (vitamin B12)
|
As needed based on laboratory markers |
| Additional elemental calcium
|
|
| Additional elemental iron (beyond that provided by multivitamin)
|
|
| Optional B Complex
|
1 serving/day |
| Duodenal Switch | |
| Multivitamin-mineral supplement
|
200% of daily value |
| Additional cobalamin (vitamin B12)
|
As needed based on laboratory markers |
| Additional elemental calcium
|
1800-2400 mg/day |
| Additional elemental iron (beyond that provided by multivitamin)
|
Add a minimum of 18-27 mg/day elemental for a total of 50-100 mg/day of elemental iron. |
| Optional B Complex
|
1 serving/day |
| Fat-soluble Vitamins
|
10,000 IU of vitamin A
2000 IU of vitamin D 300 µg of vitamin K |
The ASMBS does not include recommendations for the vertical sleeve gastrectomy, but recommendations for that surgery can be inferred based on the recommendations for the other restrictive-only procedure, the adjustable gastric band, and accounting for the lack of intrinsic factor in the VSG stomach.
| Vertical Sleeve Gastrectomy | |
| Multivitamin-mineral supplement
|
100% of daily value |
| Additional cobalamin (vitamin B12)
|
1000 µg/month as injection OR 350-500 µg/day as oral tablet |
| Additional elemental calcium
|
1500 mg/day |
| Additional elemental iron (beyond that provided by multivitamin)
|
As needed based on laboratory markers |
| Optional B Complex
|
1 serving/day |
ASMBS dietary guidelines -- I think they're tossed IN with the supplements....
Here are a few...
Here are a few...
Follow your particular instructions of course, but here are some plans from other Bariatric Surgeons and nutritionists when you find yourself needing a reminder or re-start.
From Highland Hospital, download-able plans:
- Diet #1 (Discharge Diet): Liquid Meal Plan.
- Diet #2: Pureed Meal Plan.
- Diet #3: Soft Meal Plan .
- Diet #4: Lifestyle Meal Plan (Face Sheet).
- Fruit: Lifestyle Meal Plan (Fruit).
- Protein: Lifestyle Meal Plan (Protein).
- Starch: Lifestyle Meal Plan (Starch).
- Fats: Lifestyle Meal Plan (Fats).
From Brigham + Women's Hospital, Boston:
I can summarize it for you.
Take two multis a day. Adult multis with 100% of the RDA of most stuff, including minerals like selenium.
Take 1500-2000 mg calcium citrate a day, in doses of 500 mg each.
Take B12. 350-500 mcg sublingual daily, or shots of 1000 mcg once a month.
If you menstruate, take 54-63 mg iron. If you don't, take 36 mg iron.
Take a B complex if you want to.
Take two multis a day. Adult multis with 100% of the RDA of most stuff, including minerals like selenium.
Take 1500-2000 mg calcium citrate a day, in doses of 500 mg each.
Take B12. 350-500 mcg sublingual daily, or shots of 1000 mcg once a month.
If you menstruate, take 54-63 mg iron. If you don't, take 36 mg iron.
Take a B complex if you want to.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
multivitamin 2 times per day - centrum silver tablet or chewable are great choices they have everything you want in a multi - if you find something else, you need to compare to centrum silver to make sure it has the same amounts - you also need to make sure it has selenium in it. You dont want iron in your multi - just take a separate iron supplement with vitamin C - see below
calcium citrate - 1500-2000mg per day in 3-4 daily doses - no more than 650mg per dose atleast 2hours apart and not within 2 - 4 hours of your iron or thyroid medication. If you want chewables - bariatric advantage has some great flavors and you can get samples - the lozenges are 500mg each and take 3 or 4 times daily - I love the cherry ones. The chewies are 250mg each, take 2 at a time 3 or 4 times daily, I love the raspberry and have heard the caramel are delicious too. You can mix and match for a total of 1500-2000mg
for tablets - get citrical - maximums or petites - maximums are 630mg for 2 tablets - take 2 tablets 3 times per day for a total of 1890mg for 6 tablets.. For petites -much smaller pill but have to take alot more, 600mg fo 3 tablets, take them 3 times daily for 1800mg total of 9 tablets/
B12 - You need to take either sublingual daily, minimum of 1000mcg or a monthly injection to start and then adjust your dose based on labs. Unfortunately many dont get labs for awhile, so they dont know if it is working for awhile and end up severely B12 deficient by 6 months out if they dont get labs at 3 months to find out the 1000mcg isnt enough. Most need alot more than the 1000mcg daily. YOu can start on that or choose to start higher = there is no danger to a higher level but sever danger to a deficient level - nerve damage and for long enough period it can become permanent. Injections are also a great option but many need them more often than monthly, like 2 times per month or even weekly
iron - carbonyl iron plus vitamin C - staring minimum dose is 60mg of iron plus 400mg vitamin C. Most need alot more. My NUT starts all patients at 150mg of iron and 1000mg of vitamin C. You can get great iron at vitalady.com called Tender irons they are easy on your stomach, highly absorbable, non=constipating and they work great for us - they come 2 ways early out they have a chewable - 25mg of carbonyl iron and then you have to add a 200mg vitamin C for each one. Then once you can swallow pills, they have the capsules which are 60mg each with the vitamin C already in them. That is what I take and they work great. You can start with 1 or 2 and then adjust based on your labs.
vitamin D - Dry d3 - minimum of 5,000 units per day but almost everyone needs more. 75 % of the population is vitamin D deficient and dont even know it. It is sad but true. Once deficient, you need high doses around 50,000 units weekly or 2 times per week depending on how badly you are deficient.
B complex - the ASMBS recommends a B complex as optional but you have to be careful and it isn't really necessary and here is why. They have either 50mg or 100mg of all the B vitamins. we get all the B vitamins in our multis that we take 2 times per day and those dose are really high and while some of the B vitamins are water soluable meaning we would pee out the excess, B 6 isnt' one of them. Many of us get too much B6 in our systems over time just from our multis which doesnt' really cause a problem because we dont get too get too high but them you add all the vitamin waters and gaterade type drinks that are all loaded with vitamin B6 and our B6 levels go skyhigh which get toxic. If you then add a B6 supplement of 50mg or 100mg per day which is a very high dose and things can get bad. The B12 in it is useless because we cant absorb it in a pill, so B complex really isnt a great idea. what you need in the b complex that is absolutely essential is thiamine at 100mg, so you should just take a separate thiamine (b1) supplement daily
B1 - 100mg daily - absolutely essential or you can get nerve damage and cognitive damage just like B12 deficiency.
anything else is based on your labs over time. I hope this helps.
calcium citrate - 1500-2000mg per day in 3-4 daily doses - no more than 650mg per dose atleast 2hours apart and not within 2 - 4 hours of your iron or thyroid medication. If you want chewables - bariatric advantage has some great flavors and you can get samples - the lozenges are 500mg each and take 3 or 4 times daily - I love the cherry ones. The chewies are 250mg each, take 2 at a time 3 or 4 times daily, I love the raspberry and have heard the caramel are delicious too. You can mix and match for a total of 1500-2000mg
for tablets - get citrical - maximums or petites - maximums are 630mg for 2 tablets - take 2 tablets 3 times per day for a total of 1890mg for 6 tablets.. For petites -much smaller pill but have to take alot more, 600mg fo 3 tablets, take them 3 times daily for 1800mg total of 9 tablets/
B12 - You need to take either sublingual daily, minimum of 1000mcg or a monthly injection to start and then adjust your dose based on labs. Unfortunately many dont get labs for awhile, so they dont know if it is working for awhile and end up severely B12 deficient by 6 months out if they dont get labs at 3 months to find out the 1000mcg isnt enough. Most need alot more than the 1000mcg daily. YOu can start on that or choose to start higher = there is no danger to a higher level but sever danger to a deficient level - nerve damage and for long enough period it can become permanent. Injections are also a great option but many need them more often than monthly, like 2 times per month or even weekly
iron - carbonyl iron plus vitamin C - staring minimum dose is 60mg of iron plus 400mg vitamin C. Most need alot more. My NUT starts all patients at 150mg of iron and 1000mg of vitamin C. You can get great iron at vitalady.com called Tender irons they are easy on your stomach, highly absorbable, non=constipating and they work great for us - they come 2 ways early out they have a chewable - 25mg of carbonyl iron and then you have to add a 200mg vitamin C for each one. Then once you can swallow pills, they have the capsules which are 60mg each with the vitamin C already in them. That is what I take and they work great. You can start with 1 or 2 and then adjust based on your labs.
vitamin D - Dry d3 - minimum of 5,000 units per day but almost everyone needs more. 75 % of the population is vitamin D deficient and dont even know it. It is sad but true. Once deficient, you need high doses around 50,000 units weekly or 2 times per week depending on how badly you are deficient.
B complex - the ASMBS recommends a B complex as optional but you have to be careful and it isn't really necessary and here is why. They have either 50mg or 100mg of all the B vitamins. we get all the B vitamins in our multis that we take 2 times per day and those dose are really high and while some of the B vitamins are water soluable meaning we would pee out the excess, B 6 isnt' one of them. Many of us get too much B6 in our systems over time just from our multis which doesnt' really cause a problem because we dont get too get too high but them you add all the vitamin waters and gaterade type drinks that are all loaded with vitamin B6 and our B6 levels go skyhigh which get toxic. If you then add a B6 supplement of 50mg or 100mg per day which is a very high dose and things can get bad. The B12 in it is useless because we cant absorb it in a pill, so B complex really isnt a great idea. what you need in the b complex that is absolutely essential is thiamine at 100mg, so you should just take a separate thiamine (b1) supplement daily
B1 - 100mg daily - absolutely essential or you can get nerve damage and cognitive damage just like B12 deficiency.
anything else is based on your labs over time. I hope this helps.
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