Vitamins

So yesterday I called and asked my surgeons office to send me the diet plan and progression for after surgery and I got the email today. They were going to give it to me at my pre-op appointment but thats 2 days before my surgery but I wanted a little more time to prepare and shop for everything. Well on the papers it says that on day 3 to start taking my vitamins but it doesn't say what vitamins. I imagine they might tell me on my pre op but like I said I want to be prepared. If you know my story you know that I am a lap-band patient and just had it removed. My lapband surgeon didnt give me any info ( I went home not even knowing what I was suppose to eat) Which is my fault but I was young and nervous and didnt ask quesions. So anyways this time I didnt have to see a nut or have a psyc or anything. I kind of wish I did get to see a nut because that was 3 years ago and a different surgery. But the diet plan they did give me has a lot of options so I do feel prepared in that way. I have no clue what vitamins I need to be taking or how many or what kinds and I want to get them before my pre op visit. Also can I just ask my primary physician to refer me to a nut?

Each doctor is different it seems on what they have you take. For example mine has me take 2 multi-vits in the AM with b12 sublingual & calcium chew. iron at lunch, calcium 2 hours later, and a calcium b4 bed... just call and ask one of the nurses there in the office. mine are always helpful when i call with a question.

Actually, I wouldn't ask them what vitamins you need because they often give pretty bad advice about that.  I would ask something like "Should I follow the American Society for Metabolic and Bariatric Surgery vitamin guidelines?" and if they say no, you should do something different, I'd ask why.

Here's what the ASMBS says you should start with:

A multi with 100% of the RDA of most nutrients.  Take two a day.  Stay away from kids' vitamins and gummy vitamins, because those will not have what you need.  Even though Flintstones says “complete” on the bottle, they really are not complete but are missing a number of important things.  The ASMBS  recommends a multi with iron.  If you take a multi with no iron, you’ll need additional iron at a separate time.  They say to start your multi as soon as you get home from the hospital.

1500-2000 mg calcium citrate.  Make sure it's citrate, not carbonate.  That means no Caltrate and no Viactiv.  They say you can wait up to one month to start your calcium – not that you should wait, just that you can.

54-63 mg iron for menstruating women (18-27 mg PLUS 18 mg twice a day in your multi, if you use a multi with iron).  36 mg a day for people that do not menstruate.  We absorb carbonyl iron better than ferrous sulfate.  Ferrous sulfate will also make you constipated.  They say to start your iron as soon as you get home from the hospital.

B12.  You can use a sublingual, 350-500 mcg per day, nasal spray once a week, or shots once a month.  Unless your labs show you need more.  They say you can wait up to three months to start your B12 – not that you should wait, just that you can.

They say a B complex is optional.

Many people also need D3 so you should get your vitamin D level to find out if you do.  Don’t bother with the prescription vitamin D, because it’s D2 and in oil so we will absorb very little of it.  Everyone needs D3 and post ops need “dry” D3, not in oil.

Watch out for those all-in-one bariatric vitamins like Optisource and Bariatric Fusion that say they give you everything you need in just four chewable tablets a day.  Four only has 100% of the RDA of most things and we need 200% so you’d need eight a day.  They don’t have the right kind of calcium, so in addition to eight multivitamins a day you’d also need to take calcium citrate.

You can ask your PCP to refer you to a registered dietician (see a registered dietician, not a nutritionist, because nutritionists may not have much education and they don't have to be licensed, the way an RD does).  Your insurance may or may not pay for it.  If your insurance won't cover it, then you don't need a referral to one, you can just find one and make an appointment yourself.  Look for one that is familiar with the ASMBS guidelines.

Thank you!