Vitamin Question - AGAIN!!!

I didn't take you as being rude and I don't want to come across that way either. I just want you to make sure you are looking at the whole picture on this. I wish you well.

Reading with great interest here, and not posting what I consider minimums, however I would post what labs should be run.

I have to mention that the whole COE thing only means that certain requirements are met. large furniture, a toilet that won't crack under us, "a nutritional program", follow up stats, stuff like that. It was a good thing, in many ways but it can be misleading in others. The main thing to us is the doc has to have done XX number of surgeries AND have some of the above peripherals.

Since I work with a lot of these docs, some have said they had ZERO time in nutrition or what they got was about an hour and your basic calories in/calories out. What they know about supplements is minimal, mostly rx only and dosing for intact ppl, and based on the study date they last read.

Some of the greatest docs have asked for my miniaturized versions of which elements we malabsorb and why, and the best way to supplement around those issues. That's OTC supps.

Mind you, I'm not saying anything negative about the docs! I often tell my surgeon they remind me of Top Gun. Arrogant and daring (and some are way cute, but that's another topic) and my surgeon agreed that it does take a certain personality to literally take a life IN YOUR HANDS. My hat's off to them for diving into this whole field, since the obese were once referred to as the "mud of surgery", because we're hard to work on and fatty tissue doesn't heal well.

I loved a "blue million opinions"! LOL And that's an under estimate!

The main thing is to start with some sorta vitamin plan, ideally getting your basics from your clinic, but then adding the experience of those further out who have suffered from deficiencies that were not even KNOWN "then", as in my case. Add it to your knowledge base.

The critical part is to test, test, test. Keep your own spread sheet. If you find an element that is trending down or UP (some things are BAD when they go up), and track it. If your medicals blow you off, CHECK IT. Our docs love the spread sheets, BUT they are not nearly as OCD about my levels as I am.

I read a lot of stuff and I don't care so much about "WNL" or within normal limits, as I do about keeping myself (and dh) in OPTIMAL ranges and that is up to me.

Repeat, I adore my docs, they walk on water, but I want them over THERE ---->, studying the surgical side of our world. The trivia of vites isn't interesting to them, and some docs won't even run bare bones testing. But I DO want them to know everything there is to know about small bowel obstruction; partial blockage; which surgery types and styles are more prone to issues and if I have a problem, exactly WHERE might that problem manifest according to my surgery type, date and so on. THAT is where I want my surgeon's head.

Since I travel, if I stop in your city and I have abdominal pain I can't identify, and i call your doc, I want him to have read the latest journal I have in my own hand. If we need to cut me, at least know what you're looking for, KWIM?

Let me know if you want me to post the list of labs. They are gathered from many docs around the country. If I've seen a pattern of scary results, they made the list.

Being a Center of Excellence doesn't mean you will get good vitamin advice.  You might, but it's no guarantee.  A Center of Excellence is required to have a registered dietician on staff, but that dietician is not required to have any special training or experience dealing with WLS.  That makes no sense to me, but there it is. 

The ASMBS is the organization that designates Centers of Excellence and they also have issued very specific vitamin recommendations.  However, Centers of Excellence are not required to provide patients with those recommendations.  Some Centers of Excellence tell patients to take calcium carbonate, to take Flintstones, etc.

People really do need to educate themselves to make sure they are getting what they need.

Kelly

There is nothing wrong with regular D but the Dry D is better absorbed after surgery. If you are taking regular D and your labs are good, then you should be fine. I was a little low at 6 months out so I ordered some Dry A&D from vitalady. My A was also low. There is really no set regimen except the basic multi, B12, Calcium etc because we are all different in our needs. Our requirements really should be based on our labs.

Karen

If we were to put all the details of vitamins down, the post would be so long, it wouldn't be funny :-)

- Vitamins ADEK are what's known as fat-soluble vitamins.  This means that they typically need a bit of fat to absorb properly in the digestive tracks.  Dry formulations (also known as water-miscible) have been changed so they do not need the fat to absorb well.  This is beneficial to people who malabsorb fats and oils due to a condition or surgery such as ours.

- Calcium carbonate is a formulation that is commonly found in chewables at walmart, target, cvs, etc.  However, this formulation requires a high-degree of stomach acid -- something that RNY, DSers, and even VSGers do not have.  It is also something that decreases as people age.  Therefore calcium citrate, a formulation of calcium that does not require as much stomach acid to break down is the best form for us to take.  However, finding a chewable form is much more difficult and thus the problem.

The American Society for Metabolic and Bariatric Surgery recommends the following after RNY unless your labs indicate you need something different.

A multi that provides 200% of the RDA of most stuff.  That means two a day with most brands, but read the label to make sure.

1500 - 2000 mg calcium citrate.  We cannot absorb calcium carbonate because we lack stomach acid.  We can only absorb about 500 mg calcium at a time, so break up the doses and take them at least two hours apart.  Do not take your iron at the same time as your calcium

18 - 27 mg iron.  To increase absorption, you can take your iron with vitamin C.  Don't take it with calcium

B12.  You can use sublinguals, a nasal spray, a patch, or injections.

Kelly

Regular D is mostly found in a oil based compound. Fats are not absorbed well at all. THAT is why we need Dry D3.   Next time when at the store, take a peek at the ingredients list and you will ususally find some form of oil there. Same with the prescription D2.

Becky,

You just can't go wrong with Bariatric Advantage chewable vitamins and they are delicious and I actually look forward to taking them.  I take two multi vitamins a day, 4 calcium citrate lozenges (400 mg. each), spaced 2 hours from each other ), 29 mg. chewable iron,and I get a B-12 injection monthly.  Bariatric vitamins are designed to fit all our needs. 

I decided a month ago to try to "cut some corners" and I started taking prenatal vitamins and calcium citrate "horse" pills.  Big mistake.   I no longer looked forward to taking my vitamins and calcium, and therefore wasn' as faithful with my regimen.  The whole idea for changing was to save myself out of pocket money.  Then I found out that with a "medically necessary" letter from my surgeon, I could get the Bariatric Vitamins covered under my health spending account.  If you don't have a health spending account .... it is a life saver.  My vitamins cost me $100 for a 3 month supply.  That's not counting my injections monthly.  I decided it wasn't worth cutting corners for my nutritional needs.

Good luck to you and your hubby on your journey together! 

Gay