I call "bullsh*t" on RNY program nutritionists.

Now Jupiter, you have opened up an entirely new subject! lol

Yes I think the supplementation should be covered by insurance...  BECAUSE it is not a "luxury" but for us, its a necessity.  I guess we could all have a million wls march on capitol hill and plead our case for this one...  if the insurances are going to cover the wls, they should also plan on the cost of keeping people healthy...  prevention cost less than fixing all the complications...  But insurance companies don't see it that way.

Here is my experience...I am still pre-op. My experience so far with a nutritionist has been abysmal. I have gone to him two times. He gave me no information other than a SINGLE PAGE handout detailing what I should eat. It did not include anything about supplementation. He also mixed up my file with another person's somehow, and went as far as to call me by her name and verify her address with me (HIPAA violations, anyone?) In all fairness, I have not yet seen the nutritionist at my surgeon's office...the one I have seen is through my medical group and was a prerequisite for surgery approval. I am not required by my surgeon to see his nutritionist before surgery. I have merely been told that a nutritionist "is available if needed." The packet I was given by my surgeon's office was very detailed and provided me with multiple meal plans and many suggestions. It also detailed the required supplements and where I could purchase them. I had to sign a waiver saying I would follow supplementation guidelines. I had to take a test created by my surgeon's office in order to get a date, but there were few questions about nutrition that were included. I have done extensive research on my own, and I have a number of awesome resources I have to turn to if I have questions, but if I didn't, I don't think I would have understood how extremely vital supplementation is.

Right-- and for every person posting on here there's literally dozens with no support network and no real understanding. And those people are factored into efficacy statistics.

Mightn't it be worth the establishment's while to educate their patients...ESPECIALLY those of poor education or income--- rather than underplay the role of supplementation as not to "overwhelm" them???

I agree. It surprises me to see so many questions about supplements and the quality of some of the supplements people are taking.

I am fortunate that my program has an informed nut and great support system.  I was provided a detailed comprehensive list of vitamins and supplements that would be needed and why they were needed.  Everything I am taking is consistent with what others on the board have suggested.

Everyone needs to be informed as it can be years before symptoms can arise from vitamin deficiencies.

To everyone who has had surgery get on  a daily regiment of vitamins, and be sure they are appropriate. Do your research and be informed.

Nancy

I'm sorry to hear that there are programs that aren't properly educating folks.  Mine did a pretty good job of it (I think anyway) - had to attend a 4 hour education session before they would do the surgery (just with the folks that were scheduled for surgery).  I'm including below what they told us (and included in 'the bible' they sent home with us) for reference - maybe it will give you good questions for your own surgeon/nutritionist.

While they will "fine tune" their recommendations after blood work the initial recommendation for the 5 week to 6 month phase (the other phases weren't much different, but were liquid/chewables which you could continue if you wanted) was:

* B12: either daily oral tablet 300 micrograms min OR 1 x month injection of 1000 micrograms OR daily 1000 mcirogram tablet sublingually
* Quality Multivitamin 3 times a day (they recommend Celebrate Bariatric vitamins)
* Calcium 500 mg and vitamin D tablets 2 x a day  (I'm doing it 3 x a day since I don't get the intake they want via food)
* 1 anti-oxidant tab 2 x a day
* 1 iron tab per day
* Omega 3 capsules (1000 mg DHA+EPA) per day
Also, Benefiber 2 x a day

They also instruct you that you must not take vitamins or iron with tea; do not take iron with milk, milk based products, tea or calcium.  There needs to be at least 2 hours in between taking any calcium supplements and taking an iron supplement.

I must be one of the lucky ones. My surgeon's program is great. On my first visit I was given a notebook with almost everything in it. Including a complete list of allowed and disallowed foods at each stage. His progam includes access to his nurse and nutritionist for life. Each of the teams lists their phone numbers and email addresses and they are always prompt with answers whenever I submit a question. My surgeon's does recommend Flintstones but only for the first two months, then they advise choosing an adult multi. This corresponds with the rule about not swallowing pills whole for two months. I'm not sure that all the people who are asking these basic questions on the board are because they werent given information from their surgeons. I think some of it has to do with people rushing through the process and not paying attention to the details in their rush to get surgery. There has to be a certain amount of personal responsibility in finding out what you need to do to be successful and healthy after surgery. There is a ot of information on this site and all over the internet, but people have to be proactive and look for it.
Karen

While I don't have any big problems with my nutritionist, I can say she didn't give me a whole lot of guidance.  She gave me a booklet, which she wrote, called "What Can I Eat?"  which I found mildly helpful in the first few weeks post-op.  But there were things that she never went over that would have been helpful to know.  I would love it if Bariatric NUT's would explain the different types of sugar so that we don't freak when we see that milk has sugar in it.  I wish they would stress the difference between complex and simple carbs and that we DO need carbs in our life post-op.  I wish NUT's would start overruling the ridiculous notion that snacks cannot be part of a healthy food plan and that the "3 meals a day" rule is best. 

For my NUT my only major complaint is that she sort of has a blanket mentality.  She doesn't help people based on their individual needs.  For example, I'm the type of person who needs targets set.  In the beginning it would have been nice to have some idea of a caloric range even if it was not exact.  In the absence of one I always thought I was overeating and turned out to only consume 3-400/calories a day up until 3 mos. post op. 

I think a good practice would be a practice that has it's NUTS, psychologists, and surgeons in constant dialogue.  Because our emotional/mental state affects how we view our eating and nutrition which affects how well we do with this pouch our surgeon made.  It seems like three silos going at the same time to me: the NUT says one thing, the surgeon another, and your psychologist (if you're seeing one) usually doesn't know what the hell is going on.

For my NUT my only major complaint is that she sort of has a blanket mentality.  She doesn't help people based on their individual needs.  For example, I'm the type of person who needs targets set.  In the beginning it would have been nice to have some idea of a caloric range even if it was not exact.  In the absence of one I always thought I was overeating and turned out to only consume 3-400/calories a day up until 3 mos. post op. 

I had the same issue-- this is another "game" I see played--- if they give you a caloric range, then it's a "diet" and because people are sick of diets, they prefer to let you think you get cut open and a magic process occurs and will deliver you from obesity.

The BEST I could get after talking with three nutritionists is a percentage range. (30/30/40) I wanted something more concrete, but no one could help me.

I find they all operate (literally) in their own capacity with little interraction. My surgeon, I have no doubt, is one of the best laparoscopic surgeons there is--- but that's what he does-- surgery.  When I told my surgical staff (who I trust immensely, btw) my issues about my nutritionist, they rolled their eyes and said, "Yeah, we get that a lot. " GAH.

I think my surgeon's office has wonderful staff that are extremely informative.  The only issue I have is they also say Flintstones vits are OK, and the hospital even stocks them in the Bariatric section of the gift shop.  However, they also stock Bariatric Fusion and Bariatric Advantage, among other brands, so there are lots of opportunities for doing it right.  My surgeon's office is great about keeping us informed of any new products and are always very helpful with any pre-op or post-op questions/concerns.   

I'm learning too.  I found that the nutritionist that we see post-op and that is convered by my insurance is not educated in the more modern nutritional needs vs. the myths.  I am considering paying out of pocket for the nutritionist that takes a radical nutritional approach.   I can't repeat what she told me because I don't understand it yet, but she said that there are ways to ensure that we are absorbing more nutrients.  I found her through another hospital and heard she was a young, radical thinker, that is constantly learning and refining her program.  She also said that I wasn't getting enough D and that I needed to add the omega 3 fish oil for brain health. 

Her concern is that the majority of americans are not getting nutritionally balanced diets and as bariatric patients we really can be malnourished quickly.  She said that they are finding that in some cases down the road - years - that some are having neurological problems because, she says, they didn't get the nutrition they required to maintain a healthy brain.

Don't quote me on the above, as I am tired today and may not have said this absolutely right. 

I'm struggling with sugar cravings when I am emotional - well, which is quite a bit, and she told me that there are "food - mood - connection"  articles and books on the web to help me get in some food that will alleviate the problem.  I haven't been eating the sugar, but I substitute with some of the things suggested by you and others and it is keeping the cravings at bay for now.

I did go out to google and do a search and a lot does come up so I'll be reading about it this week.

Thanks for bringing this up because I was just struggling with this this week and it was very timely.  I hate paying for a nutritional evauation that is so far off the mark!

Hugs,
Cindy