Vitamin info:

Mar 22, 2010

Thank you fellow OH member for this great info:

ASMBS suggested supplementation

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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