Vitamins
Hello Everyone!
I know that we have talked soo much about vitamins, however, I have another question!
My surgeon and nutritionist do not delve into much detail about vitamins post op. I trust my surgeon very much but the nut is an idiot. However she is my only choice per insurance at least until after the surgery.
The plan is basically 2 multis and 2 tums for the first 8-12 weeks.
I would like to hear your opinions and what, exactly, you recommend taking from the beginning.
I want to be as healthy as I can going forward and these recomendations do not seem like enough for a healing post-op.
Your suggestions and opinions are appreciated!
10/18/10
Tums are the wrong calcium -- calcium carbonate does not work in a low acid environment like what you have. It's pretty much a worthless choice.
The American Society of Metabolic and Bariatric Surgeons has made a series of suggestions for postoperative vitamin supplementation prior to labs dictating otherwise.
Multivitamin
- Adjustable Gastric Band/VSG: 100% of daily value
- RNY: 200% of daily value
- BPD/DS: 200% of daily value
- Choose a multivitamin that is a high-potency vitamin containing 100% of daily value for at least 100% of daily value of 2/3 of nutrients
- Begin with chewable or liquid
- Progress to whole tablet/capsule as tolerated
- Avoid time-released supplements
- Avoid enteric coating
- Choose a complete formula containing at least 18 mg iron, 400mcg folic acid, as well as selenium, and zinc in each serving
- Avoid children’s formulas that are incomplete
- May improve gastrointestinal tolerance when taken close to food intake
- May separate dosage
- Do not mix multivitamin containing iron with calcium supplement, take at least 2 hours apart
- Individual brands should be reviewed for absorption rate and bioavailability
- Specialized bariatric formulations are available
Additional cobalamin (B12)
- AGB/VSG: Not Applicable
- RNY: 350-500mcg if taken orally, 1000mcg / mo intramuscular injection
- BPD/DS: NA
Additional elemental calcium
- AGB/VSG: 1500mg /day
- RNY: 1500-2000mg
- BPD/DS: 1800-2400mg
- Choose a brand that contains calcium citrate and vitamin D3
- Begin with chewable or liquid
- Progress to whole tablet / capsule as tolerated
- Split into 500-600 mg doses; be mindful of serving size on supplement label
- Space doses evenly throughout day
- Suggest a brand that contains magnesium, especially for BPD/DS
- Do not combine calcium with iron containing supplements
- Wait 2 or more hours after taking multivite or iron supplement to take
- Wait 2 or more hours between doses
- Promote intake of dairy beverages and/or foods that are significant sources of dietary calcium in addition to recommended supplements
- Combined dietary and supplemental calcium intake greater than 1700 mg/day might be required to prevent bone loss during rapid weight loss
Additional elemental iron
- AGB / VSG: NA
- RNY: Minimum 18-27mg / day elemental
- BPD/DS: Minimum 18-27mg / day elemental
- Recommended for menstruating women and those at risk of anemia
- Begin with chewable or liquid
- Progress to tablet as tolerated
- Dosage may need to be adjusted based on biochemical markers
- No enteric coating
- Do not mix iron and calcium supplements, take at least 2 hours apart
- Avoid excessive intake of tea due to tannin interaction
- Encourage foods rich in heme iron
- Vitamin C may enhance absorption of non-heme iron sources
Fat-soluble vitamins
- AGB / VSG: NA
- RNY: NA
- BPD/DS: 10,000 IU of vitamin A, 2000 IU of vitamin D, 300 mcg of vitamin K
- With all procedures, higher maintenance doses may be required for those with a history of deficieincy
- Water-soluble preparations of fat-soluble vitamins are available
- Retinol sources of vitamin A should be used to calculate dosage
- Most supplements contain a high percentage of beta carotene which does not contribute to vitamin A toxicity
- Intake of 2000 IU vitamin D3 may be achieved with careful selection of multivitamin and calcium supplements
- No toxic effect known for Vitamin K1, phytonadione (phyloquinone)
- Vitamin K requirement varies with dietary sources and colonic production
- Caution with vitamin K supplementation should be used for patients receiving coagulation therapy
- Vitamin E deficiency is not prevalent in published studies
Optional B complex
- AGB / VSG: 1 per day
- RNY: 1 per day
- BPD/DS: 1 per day
- B-50 dosage
- Liquid form is available
- Avoid time released tablets
- No known risk of toxicity
- May provide additional prophylaxis against B-vitamin deficiencies, including thiamin, especially for BPD/DS procedures as water-soluble vitamins are absorbed in the proximal jejunum
- Note >1000mg of supplemental folic acid provided in combination with multivitamins could mask B12 deficiency
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She is wrong about Tums. Tums is calcium carbonate and we cannot absorb that after RNY because we don't have enough stomach acid. We need calcium citrate. 1500-2000 mg worth, in three or four doses of 500 mg each.
She forgot to mention iron and B12.
Kelly
AM Vitamins:
1 Multivitamin
2 Calcium Chewys
Noon Vitamins:
1 Iron
PM Vitamins:
1 Multvitamin
2 Calcium Chewys
Be sure not to take your Iron with your Calcium because the Calcium will absord the Iron. The Bariatic Advantage and Building Blocks are designed for Bariatric patients, so they have all of the vitamins you need. I do the chewables and the ones I use do not have any chalky taste in them. Hope this helps for you.
Someone with more info may come along and reply to this. We can only absorb so much calcium at a time and need to space it out over the day. I take 8 BA calcium chews a day - in addition to my Celebrate multi vitamins.
You may need to check out how much you are taking at a time.
Penny Highest Weight 255 * Wt loss includes 19 lb lost before surgery
For your post op vitamins - please no TUMS. They are calcium carbonate and we can't absorb calcium carbonate in our non=acidic stomachs. We need calcium citrate. You need to take 1500-1800mg of calcium citrate a day, in 3 daily doses atleast 2 hours apart and not within 2 hours of your iron or thyroid medication, no more than 650mg at a time. You can get chewables at bariatricadvantage.com or celebrate.com. They will send you samples of the various flavors of calcium, multi vitamins and iron if you would like. I love the bariatric advantage cherry lozenges and raspberry chewies for calcium. I take 1 of each, 3 times per day.
For multi - centrum silver chewables are a great multi - take 2 a day and they taste great. You can take them with your calcium since they have no iron in them.
Iron - carbonyl iron is recommended - easy to absorb and easy on the stomach. 45-60mg to start plus 200mg of vitamin C per 30mg of iron. (My NUT starts patients on 150mg of iron)
Vitamin B12 - 1000mcg of sublingual B12 daily or monthly injections. Many need more than this and can adjust after you have labs done.
Vitamin B1 - 100mg of vitamin B1 daily. Vitamin B1 deficiency is very common after RNY and this can prevent this.
Vitamin D3 - most people are vitamin D deficient preop and don't even know it. 5,000-10,000 units of Dry D3 daily is a good starting dose until you get your labs done. Most need much more than that. Make sure it says Dry D3 - you can get 5,000 units of Dry D3 at vitalady.com called D3-5 by biotech
