VITAMIN SUPPLEMENTS AFTER GASTRIC BYPASS SURGERY
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VITAMIN SUPPLEMENTS AFTER GASTRIC BYPASS SURGERY
It is important that you take vitamin supplements everyday for the rest of your life after having a gastric bypass. If you do not take your vitamin and mineral supplements after surgery you will become malnourished! This is because not only are you unable to consume enough food (quantity) to meet your vitamin & mineral requirements, but also because you will have a decreased ability to digest and absorb certain nutrients after having gastric bypass surgery. We recommend that you take a multivitamin, plus extra calcium, iron, B12 and Vitamin D supplements.
Begin taking a multivitamin twice a day while on liquids during the first 2 weeks. Add your calcium, iron, B12, and Vitamin D supplements when you progress to soft foods in the third week following your surgery.
To make sure you are taking everything you need, in the correct dose, and in the correct form, we recommend Bariatric Advantage supplements. These are specifically designed for bariatric patients and their specific needs.
Start taking one chewable multivitamin/mineral supplement twice a day while on liquids. When you progress to soft foods, take them with meals. We recommend one of the following:.
Bariatric Advantage® Chewable Multi Formula
- Available in the office or online at www.bariatricadvantage.com
- Celebrate vitamins chewable (available at www.celebratevitamins.com)
- Opurity chewable (available at www.opurity.com)
- Centrum® Chewable
About two months after surgery (or when you are able to take pills and can tolerate solid foods), you can switch to a non-chewable if desired, however, we recommend a bariatric-specific chewable multivitamin long-term over any other product. If you choose to take an over-the-counter vitamin, we recommend any of the following, to be taken twice a day with food (generic, store-brand equivalents are fine):
- One-A-Day® Men’s/Women’s Formula
- Centrum Performance®
- Centrum Silver® based on your age
Take one multivitamin, twice a day (for example 1 at breakfast, 1 at lunch), rather than both at the same time to maximize your absorption of each vitamin.
There is typically only a small amount of calcium in multivitamins. Therefore, we recommend taking an additional 1000mg-1200mg of calcium everyday when you progress to soft foods. At this stage after your surgery, you will need to take a chewable form because most chewable supplements are too large and difficult to swallow. There are different forms of calcium such as calcium carbonate and calcium citrate. Calcium citrate is the most efficiently absorbed form of calcium following gastric bypass. However, citrate is difficult to find in a chewable form, so we recommend Bariatric Advantage calcium which provides citrate in a chewable.
- Bariatric Advantage Calcium Citrate Chewy Bites(2 chews twice a day)
- Bariatric Advantage Calcium Citrate Lozenges (one lozenge 2-3 times per day)
Switch to a non-chewable form of calcium citrate when able to tolerate a solid pill. Take one dose (500mg-600mg) twice a day with meals for a total of 1000-1200mg of additional calcium per day. Be sure to check the dose on each individual brand to be certain you are getting the correct amount.
Again, take your calcium supplements twice a day in 2 smaller doses rather than taking one large dose all at once because you will absorb the smaller doses better. Also, calcium is best absorbed with taken with food.
It is important to not take the calcium and iron supplements at the same time, as they interfere with the absorption of each other. Take your calcium and iron supplements at least 2 hours apart from one another.
We recommend that you take an iron supplement daily when you progress to soft foods, in addition to the iron in your multivitamin. Iron does come in a chewable form, but the pill should be small enough that you can swallow it without difficulty.
Nausea and constipation are common side effects of iron supplementation. For this reason, we recommend you take one of the most absorbable forms of iron, either ferrous fumarate, or ferrous gluconate. Ferrous fumarate and ferrous gluconate can both be found in over-the-counter iron supplements. Because they are the most absorbable forms of iron, they may also cause the least side effects. Listed below are some specific products we recommend. Take your iron supplement once a day with food.
- Bariatric Advantage Chewable Iron
- GNC Iron 18
However, if there is still a problem with nausea and/or constipation, try taking your iron every other day instead of daily. Again, avoid taking the calcium and iron supplements at the same time, as they interfere with the absorption of each other. Take your iron and calcium at least 2 hours apart from one another. Your iron supplement is also best absorbed when taken with food. Iron supplements may also be better absorbed when taken with something acidic. This can be a vitamin C supplement (ascorbic acid) or any food high in Vitamin C such as fruit or vegetables.
Vitamin B12 is digested and absorbed differently than most vitamins. After gastric bypass surgery, you will no longer be able to digest and absorb sufficient amounts of B12 to maintain health. You must take your B12 in a form that directly enters the bloodstream, not through the digestive tract. There are two ways to do this.
- Most patients opt for a monthly vitamin B12 injection at their primary care physician’s office after gastric bypass surgery. Some patients also give themselves their monthly B12 injection.
Another option is to take sublingual (under the tongue) B12 lozenges or drops that dissolve under your tongue. A 500mcg supplement may be taken daily. A 1000-2000mcg supplement may be taken every other day. If you purchase the 5000 mcg strength, 1 per week should be sufficient. Specific products are listed below.
- Sublingual B12 Microlozenges (all three doses are available at Vitamin World® stores or www.vitaminworld.com
- B12 drops 1000mcg at Vitamin World
- B12 5000 Zipmelts® (at GNC)
- Bariatric Advantage Sublingual B12 with Folate®
In addition to the amount of Vitamin D found in your multivitamin and calcium supplement, begin taking 1000 IU of a supplemental Vitamin D (cholecalciferol D3) a day. The pill is usually small enough to swallow without difficulty, but will vary among different brands. You may begin the Vitamin D when able to tolerate the size pill you purchase. We recommend the following:
- Bariatric Advantage Dry Vitamin D3 (take 1 dose per week)
- GNC Vitamin D3 1000 IU (take daily)
Sample Daily Vitamin/Mineral Schedule
(Note: This is an example based on using a bariatric-specific multivitamin)
1 chewable multivitamin/mineral supplement
1 chewable calcium
Sublingual B12 lozenge or drops
Vitamin D (Note: if Bariatric Advantage Vitamin D, take one time per week, not daily!)
1 chewable multivitamin/mineral supplement
1 chewable calcium
Adequate protein intake is of critical importance after bariatric surgery. At each of your 3 small meals per day there should be at least 2oz of a high protein food, and that high protein food should be eaten first. Your total protein intake each day should be at least 60 grams. There are two different kinds of protein: complete and incomplete.
Complete protein is also known as high biological value protein. This means that it contains all of the essential amino acids. Complete protein is found in most foods that come from animals. In general: 1oz. meat, fish, poultry, or cheese=7 grams; 1 egg=6 grams; ½ c. cottage cheese=14 grams; 1 c. milk=8 grams; 1 c. yogurt=6-8 grams of protein.
Lean sources of complete protein that should be a part of your diet everyday include:
- White meat chicken and turkey (not fried)
- Fish and shellfish (not fried)
- Eggs, egg whites, and egg substitutes
- Lean cuts of beef (round, sirloin, flank, tenderloin, rib/chuck/rump roast, ground round)
- Lean cuts of pork (fresh ham, Canadian bacon, center loin chop, tenderloin)
- Veal or lamb chops and roasts
- Lean deli meats
- Reduced fat cheeses, Parmesan, Mozzarella, and Ricotta cheese
- Venison, pheasant
- Low-fat or fat-free cottage cheese and yogurt
- Skim or 1% milk, soy milk, lactose-free milk
High-fat, high-calorie sources of complete protein, which should be consumed less often include:
- Bacon and sausage
- Cheese (American, Cheddar, Swiss, etc.)
- Bologna, salami, pepperoni
- Hot dogs
Incomplete protein does not contain all of the essential amino acids and is found in plant foods. This includes beans, lentils, vegetables, starches (cereals, pasta, bread, grains, etc.), nuts, and peanut butter. These foods definitely count toward your total protein intake everyday, but a greater emphasis should be placed on complete, high biological value sources of protein. In general: ½ c. beans or lentils=10 grams; ½ c. cooked or 1 c. raw vegetables=2 grams; 1 slice bread or ½ c. potatoes=3 grams; ½-1c. cereal=3-6 grams of protein.
Soy is the one exception! Even though soy is plant based, is does contain all of the essential amino acids and is considered a complete protein! Go ahead and include tofu, tempeh, soymilk, soynuts, soybeans, soy cheese, and other soy foods in your diet on a regular basis. In general, 1 c. soy milk=8 grams and 4oz. or ½ c. tofu=7 grams of protein. For more information on soy foods, go to www.soyfoods.com to download a Soyfoods Guide for free!
Of course protein supplements count toward your total protein intake as well. There are so many different protein supplements on the market that it’s hard to keep track of them all! Keep in mind, however, that protein supplements should only supplement your food intake. In other words, focus on food sources of protein first, and then perhaps add 1 supplement a day. Always be mindful of how many calories and grams of sugar are in your protein supplements. Also keep in mind that protein bars may be more filling and satisfying than a protein shake, because liquids go down quickly and easily.
Long term results indicate that VSGers need more vitamin supplementation than what your doctors originally tell you. And everything on that list is right. Even VSGers need to supplement with Iron, Calcium, B-Complex, and a hefty multi-vitamin.
I was horrible about taking vitamins while I was sleeved. My surgeon just told me to take a multi and I'd be fine. I did off and on, but never consistently. When I added the DS in October, my labs came back and I was anemic and my calcium and D were VERY low. While I was in the hospital for my revision, I received an infusion to get my levels back up.
I'm not saying that everyone will become deficient, but no sleeve is created equal.
on 8/26/14 4:54 am
Thanks for the detailed list. However I would like to point that chewables are dangerous as they add artificial flavors to the mix and may result in long term health side effects. I may suggest gastric bypass vitamins without the harmful fillers that will help in coping with malnutrition.