How to take your vitamins after bypass
Specific vitamins and minerals must be taken for the rest of the patient's life due to decreased stomach size, and by-passing some of the small intestine where the vitamins and minerals are specifically absorbed, and a lack of gastric juice in the new stomach to help break down vitamins.
This patient population is on chewable or liquid forms of vitamins/minerals permanently. They may switch to gel-encapsulated forms after the first month post-surgery when the swelling has decreased back to normal. If gel-encapsulated forms are swallowed before 1-month post-surgery, they can cause blockages.
Why Do Gastric By-Pass Patients Need A Shot or Sublingual Form Of B12 ?
The new pouch does not contain gastric acid juices necessary to remove the B12 from the food or multivitamin the patient is swallowing.
The new pouch is disconnected from the rest of the stomach. Therefore, the cascade of proteins that B12 has to attach itself to before being absorbed in the ileum of the small intestine does not occur due to the disconnection. This is why B12 has to be given directly to the patient's blood stream so the patient will absorb all of it.
Why Are All The Other Vitamins Necessary For Gastric-By-Pass Patients?
The surgeon by-passes a section of the small intestine where the vitamins and minerals like to be absorbed and there is no gastric juice in the new stomach for us to break down the vitamins and minerals. This is why patients have malabsorption and must take specific types of vitamins and minerals to ensure that they absorb them.
Gastric By-Pass Vitamin Schedule:
In the morning take 1 Bariatric Advantage Passion Fruit Chewable Iron daily + (1 Sublinqual B12 every other day) or 1 B12 shot monthly
Wait 4 hours (Calcium and Iron bind together and then the body doesn't absorb either one)
1 Bariatric Advantage Chewable Multivitamin + Calcium Citrate with Vitamin D Chew
Wait ~2 hours (to absorb the first dose prior to taking the next dose)
1 Bariatric Advantage Chewable Multivitamin + Calcium Citrate with Vitamin D Chew
Wait ~2 hours (to absorb the first dose prior to taking the next dose)
1 Bariatric Advantage Calcium Citrate with Vitamin D chew
Wait 4 hours (Calcium and Iron bind together and then the body doesn't absorb either one) In the evening take 1 Bariatric Advantage Passion Fruit Chewable Iron
IMPORTANT INFORMATION FOR ALL PATIENTS:
All Vitamins/minerals must be taken as the schedule states because if the vitamins are taken all at once, the patient will only absorb a small fraction of what is needed and the rest is lost.
Chronically forgetting to take the vitamins, not taking the vitamins at all, or taking them all at once will lead to deficiencies and illness.
Do not take Calcium Carbonate forms of Calcium. You will only absorb 8% of this calcium and will absorb 48% of the Calcium Citrate form.
The Calcium Carbonate forms can lead to chronic nausea and gas pain in certain patients, and may lead to kidney stones forming especially for those patients with a history of kidney stones.
Do not drink caffeinated beverages until you are able to drink 64 ounces of non-caffeinated fluids and then you may have 16 ounces of a caffeinated beverage.
Caffeine interferes with vitamin/mineral absorption. Do not drink caffeinated beverages with the vitamins (wait 1 hour after you drink "the cup of coffee" to take the vitamin, or drink "the coffee" and wait 1 hour to take the vitamin.
Too much caffeine can lead to anemia. Caffeine removes the iron from your body.
VITAMIN DEFICENCIES ONLY OCCUR IN PATIENTS NOT FOLLOWING DIRECTIONS, OR TAKING OVER THE COUNTER PRODUCTS NOT APPROVED BY THE DIETITIAN.
Thiamine (B1) deficiency = Beri-Beri = anorexia(loss of appetite), altered heart rate, right sided heart failure, edema, and muscle weakness, nerve problems
Riboflavin (B2) deficiency =magenta tongue (purple color), chelosis (dry cracked lips), nervous system problems, eye sensitivity to light, skin rashes
Niacin(B3)deficiency = Pellegra=Red neck, diarrhea, dementia, dermatitis (red crusty skin where areas of sunlight strikes it)
Biotin (B4) deficiency =dermatitis (dry scaly skin), alopecia (hair loss) Pantothenic Acid (B5) deficiency=intestinal distress (vomiting) fatigue, insomnia
Vitamin B6 deficiency =insomnia, fatigue, dermatitis, glossitis (sore tongue), depression, confusion, convulsions, anemia
Folic Acid deficiency =megoloblastic anemia, impaired protein metabolism, Leukopenia (low white blood cells), thrombocytopenia (bleeding), glossitis (sore/swollen tounge)
Magnesium deficiency =anorexia, nausea fatigue, weakness, seizures, muscle cramping, personality changes, abnormal heart rhythms, coronary spasms, (hypocalcemia) low calcium, (hypokalemia) low potassium
Iron deficiency =anemia, fatigue, dizziness, low blood count and stores
Calcium deficiency =osteopenia, osteoporosis (weak/ broken bones)
B12 Deficiency =Macrocytic anemia (large red blood cells), Leukopenia (low white blood cells), Thrombocytopenia (low blood platelets and bleeding), Glossitis (large sore tongue), Neuro-psychiatric complications (nerve damage, trouble walking, tingling in hands and feet, paralysis-wheel chair)
NOTE:
Going to your Follow-up appointments and getting labs drawn prior to the follow-up appointment is imperative to avoid any deficiency issues. Low-levels of vitamins/minerals will be addressed quickly prior to any permanent problems.
I dont have as strict of a vitamin schedule as this post. My surgeon has me on just 5 pills a day. Well 6 if you count the Actigall. I take that once a day to protect my gallbladder. I take a Centrum chewable each morning and night and a Calcium chewable with Vit D each morning and night. Then I crush a B12 once a day. So its not that bad. I would FLIP if i had as harsh as a schedule as the one posted above! LOLOL
HAPPY FRIDAY!!!
