Lots of vitamin info -- very very long

Taken from a few of my blog posts from the past, in no particular order.


General Vitamin Info


Everyone who knows me a little bit, knows that I have strong opinions about vitamins.

I had my surgery 4 years ago with a *wonderful* surgeon.  I truly love Dr. Burry.  His supplement advice was to take two flintstones and tums for the rest of my life.  And I trusted him.  Keep in mind that 4 years ago, there was little nutritional evidence that has since come out about multivitamin regimens in RNY patients.

Surgery was August of 04.  I had regular blood draws.  And in those draws, I was normal for the most part, but slowly trending downwards.  Was I told?  Nope.  Did I ask to see my lab sheets?  Nope.  I *trusted* my healthcare providers.

4 years later, 2 kids later, and my ferritin sucks, my D was in the toilet, and I was in serious pain from my bones being leeched of their calcium.  Osteomalacia is not very fun, let me tell you.  And the zombie-like feeling of not having any iron reserves is pretty crushing as well.  I started to study vitamins, read everything I can get my grubby paws on (and hey, I have a ton of stuff to still go through), and share this info with others in hopes that someone will listen to my advice and not travel this road.  Avoiding a defiency is much easier than recovering from one.


So now what?  Oh.  I thought I'd share and site some info for you.  Take note, JinPA.. this is the kinder, gentler Andrea (don't blame me, I have narcotics floating through my system).


Flintstone vitamins

Ahh yes, the most controversial of the subjects are flintstone vitamins.  First off, let me say right here and now that an adult dose of flinstones (and I'm not talking gummies.. yet) is 2 tablets.  The American Society of Metabolic and Bariatric Surgeons recommends two times the adult dose, so that makes 4 Flintstone chewables a day.  Got it?  Not two.  Not three.  Four.  As in 2+2 == 4.

Perhaps the lamest excuse I see for taking Flintstones vitamins is price.  Yes, times are tough.. but are you really willing to relegate your health to the lowest priced vitamins on the market?  I mean, we had surgery to be in better shape.. and you are willing compromise that health on crap vitamins?  Give me a break.

But, ok.  Let's look at price.
Amazon.com has a bottle of 200 Flintstone Complete vitamins for 17.99.  For ease, let's call it $18.00 ok?  4 a day (remember, bariatric dosing), makes for 50 days, each day costing 36 cents.

Amazon.com has a bottle of 100 Centrum Adult vitamins for $13.16.  For ease, we'll call it $13.20.  2 per day (because they are adult vitamins), makes for 50 days, each day costing 26 cents.

So don't tell me you buy Flintstones for the cost factor, kay?  That argument does not fly when you are taking a bariatric dose of vitamins.  Period.  Moving on.

Additionally, the flintstone complete vitamins are, in fact, missing some key things.  Even Centrum's KIDS vitamins are better for you than flintstones.  Period.


Flintstone Gummies (or any other child's gummy vitamins)

These are not vitmains -- they are candy.  I *cringe* when I even see these in the store.  I would not give these to my toddler.

Why?  Because they are only good in the yummy b-vitmains.  They have no iron, no copper, no selenium, etc.  I mean, really, they are deficient in so many things, it's not even funny.  The first two ingredients are sucrose and fructose.  So two forms of sugar are the first ingredients?  Oh, and the adult dose is 6 vitamins, so 12 per day for a bariatric patient?  Give me a break.. not only is it an insuficient vitamin, it's even more expensive than the bariatric vites that people shy away from due to price tags.


Tums and Viactiv

Note: these are the wrong calciums.  Period.  No discussion.  Calcium carbonate requires a high amount of stomach acid in order to break down into usable parts.  No ifs, ands, or buts.  In a study conducted on post-menopausal normal-gutted women, calcium citrate was found to be 27% more absorbable than carbonate -- and that's with a full complement of stomach acid that RNY, Fobit, and DS'ers don't have at their disposal.  Take calcium citrate.  Chew it, melt it, swallow it, whatever.. but calcium citrate is what you need, and you need 1500-2000mg every day in addition to food sources.


My labs are fine...

Really.  Are they?  Can you say that equivicably?  Is it because you *trust* your doc to have your health as their absolute most important priority in the world?  Or are you now thinking that *maybe* the doc is just looking for numbers that are highlighted by the lab as abnormal results?

Have you done your own independant research to find out what your numbers should be, and how to get them to that point if they aren't there already?  Have you tracked trends to know when you've started sliding down a slippery slope, or have you trusted someone else to look at the data and spoonfeed you the results?  Do you know how long specific nutrients are stored in your body for long-term storage in case of emergency?  Did you realize that b-12 begins to run out at 6 weeks to 6 months?  That the body has no, nada, zip storage for certain micronutrients?

If you can't answer basic questions about your lab values, please do not tell me your values are "perfect" because I will ask you to validate your claim every single time.


Folks -- WLS is a learning thing.  No, noone has the answers.. but there is quite a bit of research showing the no-no's if you are willing to 1) do the research yourself or 2) listen to someone who has.  Do I know everything?  Nope.. and I will gladly admit that fact.  But I can tell you where I get the nuggets of info I do have and will publish my sources if so asked.  I'm not claiming to be a medical expert, but it doesn't take one to read a study about 137 patients, you know?  It's a matter of actually taking the time, doing the footwork, and understanding the data presented.


Common deficiencies post-WLS

B1 or Thiamin
 - irreversible neuromuscular disorders
 - permanent defects in learning and short-term memory
 - coma  (aww.. this isn't so bad..)
 - death  (Nothing worth worrying about, right?)

B9 or Folate (Folic Acid)
 - forgetfulness
 - irritiability
 - hostility
 - paranoid behaviors

B12 or Cobalamine
 - neurologic sumptoms
 - numbness and tingling of extremeties
 - difficulty walking
 - memory loss
 - disorientation
 - megalobalstic anemia
 - permanent neural impairment
 - extreme delusions
 - hallucinations
 - overt psychois
+ Permanent damage can occur if treatment doesn't start soon enough!

Calcium
 - chronic low intake creates metabolic bone disease presenting as
  - osteoporosis
  - osteomalacia
  - hypoparathyroidism
  - combo of above
 - muscle cramping
 - hypotension
 - bone pain

Vitamin D
 - rachitic tetany
 - mucle pain and spasms
 - weakness
 - bone pain
 - decrease in daily calcium absorption
 - rickets (osteomalacia)
 - osteoporosis
 - concentrations in blood greater than or equal to 80nmol/L, there was a 50% reduction in colorectal cancer rates
 - concentrations in blood greater than or equal to 50nmol/L, there was a 50% reduced risk of prostate cancer
 - risk for type 1 diabetes increased dramatically in vitamin D deficient children
 - higher circulating levels of vitamin D linked to a significantly lower Multiple Schlrosis risk

Iron
 - anemia
 - fatigue
 - hair loss
 - feeling cold
 - pagophagia (constant desire to eat ice -- pica)
 - decreased immune function

Zinc
 - decreased sense of smell
 - altered taste
 - poor wound healing
 - poor appetite
 - hair loss
 - low libido
 - lethargy

Vitamin A
 - problems with skin and mucous membranes
 - dry hair
 - broken nails
 - increased risk of infections
 - linked to anemia and iron absorption
 - ophthalmologic consequences such as night blindness



Why Blood Serum Calcium labs are worthless

Calcium is one of those *vital* things needed for muscle contraction.  The most important muscle, of course, is the heart.  No matter what, if the body has some access to usable calcium, it will maintain your blood serum calcium at a constant rate.  I bet my numbers are the same as yours, same as my mom's, my dad's, my hubby's, your sister's, etc.  Hell, even my dogs and cats might have the same level -- I haven't ventured into vetrinary science to find out.

Point is, this number will only change if you have no more calcium to give or you are in an immediate health crisis (which would, I hope, mean you are in a hospital already).

Again, why?

Well, when the body isn't getting enough elemental calcium, it produce parathyroid hormone (PTH).  That little bugger will go to your bones and start to dissolve them, releasing stored calcium into your bloodstream for all those muscles (and again, the heart) to work.  The body *will* rob Peter to pay Paul, and in this case, the heart is Paul.

So how can we know if we are absorbing enough calcium?  Are *you* dissolving into a pile of mush while you are sitting here?  Here's how you can tell:

1) The most important is a DEXA scan -- this will actually test your bone density.. should be done at least 1x per 2 years, with those who have issues doing it more often.  Sometimes insurance won't pay, and that sucks.  It's your choice whether you want to pay out of pocket or not, but it's the most definitive way to test bone mass.

2) Blood tests that *do* help to indicate your melting ability are 25(OH)D and the PTH.  If the PTH is high (and keep in mind, we want no little buggers swimming around in us ideally), and the D is low (mineral required to hold that bone mass), then you are melting as we sit.  Vitalady has suggested that we want our D levels to be 80-100 at the very minimum.  She knows more about lab values than I do, so I'm going with her number.


So next time you see "I've been taking Tums and my calcium levels are perfect", you will know why this number really doesn't mean squat.



My thoughts on Chewable Vites and comparison chart

Ok.  First off, everyone know my position that Flintstones, in of themselves, make horrible supplementation choices except immediately post-op.  8weeks out and you need to be on grown-up vitamins?

Why?  Well, there are a number of reasons:

1) There aren't the same amount of nutrients in the vitamins as the adult sized.. and the RDA on children's vitamins, is for, you know, children.
2) There aren't the same different nutrients (as in, children's do not have a full complement) between the two.


According to the American Society for Metabolic and Bariatric Surgery, an ideal multivitamin would be:
 - A high-potency vitamin containing 100% of daily value for at least 2/3 of nutrients (remember that 66% for later.. there is a quiz)
- Choose a complete formula containing at least 18mg iron, 400mcg folate (folic acid), as well as selenium and zinc in each serving
- Individual brands should be reviewed for absorption rate and bioavailablity

Now, these are doctors, nutritionists, nurses, patient educators, and dieticians that have come up with these guidelines.  Don't like them?  Don't blame me, got it?

Now, here's where I'm going to *really **** some people off.. and hey, I'm fine with that.  Your doctor, nurse, PA, nutritionist, and dietician do not walk on water, and are not infallible.  Period.  Noone can know everything.  YES, THAT INCLUDES ME.   Why do I say this?  Do not follow *anyone* (including me) blindly when it comes to your health.  Do not give me "my brilliant surgeon is in a Bariatric Center for Excellence and he went to school and you're just a lowly Viking mama who has too much time on her hand" because I'm going to point out the single (yes one) nutrition class your surgeon took in his, most likely, 3rd year of medical school.

Do not follow your surgeon blindly.  He/She may be the best surgeon in the world.. but they do not know everything.  Got it?  Do your own research, take your health into your own hands and study study study.

So knowing the current (and quite often) debate of Flintstone-only (please note -- people who are only using Flintstones as their vitamin source.. we'll discuss calcium on another day) versus adult vitamins, I put my thoughts to the test.  I made a crappy little chart with pencil and paper (and yes, my hubby was laughing at me as he muttered "Excel.. excel.. excel..." so I could actually compare some vites.

Now, I also know I'm going to hear a few "buts" here:

1) "I'm 6 weeks out and my labs are *perfect*  -- you're stupid and don't know what you are talking about".
 - Well, the body holds onto a store of all micronutrients.. kinda like a rainy-day bank.  When the body doesn't get what it needs, it goes into that storage and makes withdrawals.  That's fine and dandy until you don't have anything left.
 
So Andrea, how long do these reserves last?  -- Glad you asked.  They can last anwhere between 6 weeks and 1 year, depending on the nutrient.  Hell, even calcium will last for years, as long as you still have bones.  Point is, most deficiencies don't even begin to appear until you are over a year post-op.  Period.  End of story.

2) "My friend knows a friend who had surgery 10 years ago, takes Flintstones, and their labs are *perfect*"
 - Really?  I'd really love to see those labs.  I'd like to see labs drawn every 6 months for that duration, cause I can bet there are some trends going down on those lab charts.  "Fine" and "perfect" are relative terms.  You can be within normal range for "normal" people, but for us, that normal range may be critically low.  Lab values only take a look at the established guidelines for normal humans at a specific weight, height, and age.  They do not take in account special needs, such as designer stomachs.  Additionally, looking at that, most docs and nurses only look for things the lab has marked as being off-kilter.. it doesn't look at a number that is steadily dropping and has been for 6 months.. as long as that number is "normal" your labs are "perfect".  I dunnow bout you, but I'd rather catch a problem before it actually, you know, becomes a problem.

Got that crap all taken care of?  Good, let's move on.


I went to wikipedia and got the complete RDA's and compared Optisource Bariatric Vitamins, Centrum Silver Chewables, Centrum Kid's Chewables, Flintstones Complete, and Flintstones Gummies.  (And yes, it's pretty accurate info.. given that there is an RDA category for about 10 segments of people, the Wiki article gives a good average)

The totals reflect 4 optisource, 2 Celebrate Multivites, 2 centrum chewable, 2 centrum kids', 2 flintstones, and 2 flintstone gummies. 

Highlighted vites are those that meet the RDA.


Vitamin A - RDA 3000
Optisource - 7500
Celebrate - 10,000
Centrum - 8000
Centrum Kids - 7000
Flintstones - 6000
Flintstones Gummy - 4000

Vitamin C - RDA 90
Optisource - 60
Celebrate - 180mg
Centrum - 150
Centrum Kids - 120
Flintstones - 120
Flintstones Gummy - 120

Vitamin D - RDA 200
Optisource - 400
Celebrate - 800
Centrum - 800
Centrum Kids - 800 
Flintstones - 800
Flintstones Gummy - 400

Vitamin K - RDA 120
Optisource - 160
Celebrate - 40mcg
Centrum - 0
Centrum Kids - 20
Flintstones - 0
Flintstones Gummy - 0

Vitamin B6 - RDA 1.3mg
Optisource - 2000
Celebrate - 12mg
Centrum - 14
Centrum Kids - 4
Flintstones - 4
Flintstones Gummy - 2

Vitamin E (tocopherol) - RDA 15
Optisource - 0
Celebrate - 60
Centrum - 140
Centrum Kids - 60
Flintstones - 60
Flintstones Gummy - 40

Biotin - RDA 30
 Optisource - 150
Celebrate - 600
Centrum - 90
Centrum Kids - 90
Flintstones - 80
Flintstones Gummy - 150

Calcium - RDA 1000
Optisource - 1000 (as carbonate)
Celebrate - 0
Centrum - 400 (as carbonate)
Centrum Kids - 216 (carbonate) 
Flintstones - 200 (dicalcium phosphate)
Flintstones Gummy - 0

Chloride - RDA 2300
Optisource - 0
Celebrate - 0
Centrum - 0
Centrum Kids - 0 
Flintstones - 0
Flintstones Gummy - 0

Chromium - RDA 35mcg
Optisource - 120
Celebrate - 200
Centrum - 200
Centrum Kids - 40
Flintstones - 0
Flintstones Gummy - 0

Choline - RDA 550
Optisource - 0
Celebrate - 0
Centrum - 0
Centrum Kids -  0
Flintstones - 76
Flintstones Gummy - 76

Copper - RDA 900mcg
Optisource - 2mg
Celebrate - 2mg
Centrum - 4mg
Centrum Kids - 4mg 
Flintstones - 4mg
Flintstones Gummy - 0

Cyanocobalamin (B12)  - RDA 2.4
Optisource - 500
Celebrate - 350
Centrum - 50
Centrum Kids - 12
Flintstones - 12
Flintstones Gummy - 10

Fluoride - RDA 4
Optisource - 0
Celebrate - 0
Centrum - 0
Centrum Kids - 0
Flintstones - 0
Flintstones Gummy - 0

Folate (B9)  - RDA 400
Optisource - 0
Celebrate - 800
Centrum - 1000
Centrum Kids - 800 
Flintstones - 800
Flintstones Gummy - 400

Iodine - RDA 150
Optisource - 150
Celebrate - 150
Centrum - 200
Centrum Kids - 300 
Flintstones - 300
Flintstones Gummy - 80

Iron - RDA 8
Optisource - 30 
Celebrate - 0
Centrum - 0
Centrum Kids - 36
Flintstones - 36
Flintstones Gummy - 0

Magnesium - RDA 420
Optisource - 400
Celebrate - 100
Centrum - 100
Centrum Kids - 80
Flintstones - 40
Flintstones Gummy - 0

Manganese - RDA 2.3
Optisource - 2
Celebrate - 2
Centrum - 9
Centrum Kids - 2 
Flintstones - 0
Flintstones Gummy - 0

Molybdenum -  RDA 45
Optisource - 75
Celebrate - 75
Centrum - 50
Centrum Kids - 40
Flintstones - 0
Flintstones Gummy - 0

Niacin (B3)  - RDA 16
Optisource - 20
Celebrate - 40
Centrum - 24
Centrum Kids - 40
Flintstones - 30
Flintstones Gummy - 0

Pantothenic Acid (B5)  - RDA 5
Optisource - 10
Celebrate - 20
Centrum - 20
Centrum Kids - 20 
Flintstones - 20
Flintstones Gummy - 10

Phosphorus - RDA 700
Optisource - 200
Celebrate - 0
Centrum - 250
Centrum Kids - 100 
Flintstones - 200
Flintstones Gummy - 0

Potassium - RDA 4700
Optisource - 0
Celebrate - 0
Centrum - 0
Centrum Kids - 0
Flintstones - 0
Flintstones Gummy - 0

Thiamin (B1)  - RDA 1.2mg
Optisource - 1.5
Celebrate - 12
Centrum - 4.4mg
Centrum Kids - 3mg
Flintstones - 3mg
Flintstones Gummy - 0

Riboflavin (B2)  - RDA 1.3mg
Optisource - 1.7
Celebrate - 12
Centrum - 5.4 mg
Centrum Kids - 3.4mg
Flintstones - 3.4mg
Flintstones Gummy - 0

Selenium - RDA 55
Optisource - 70
Celebrate - 0
Centrum - 45
Centrum Kids - 0 
Flintstones -  0
Flintstones Gummy - 0

Sodium - RDA 1500mg
Optisource - 20
Celebrate - 0
Centrum - 0
Centrum Kids -  0
Flintstones - 20
Flintstones Gummy - 0

Zinc - RDA 11
Optisource - 30
Celebrate - 15
Centrum - 30
Centrum Kids - 30
Flintstones - 24
Flintstones Gummy - 0


Still with me?  Hello?  Wakeup.  Here's the summary.

Flintstones Gummy vites suck.  The Flintstones kids aren't really much better.  There are a few supplments in which Optisource fared better than Centrum, but not many (and with half the pills and half the cost...) and Centrum Kid's is a pretty good vite, too (if you can find it.. I personally can't).


This info is for you to make your own decisions.

If you read through all this, that's super.  Give yourself a gold star.  And remember.. it's your health.. noone is going to advocate for you as they should.. it's up to you to be an adult and take charge of your health.



WLS Labs

Info taken from the ASMBS Reccomendations for Postop Bariatric Nutritonal Supplementation... pages 5 and 6.

Suggested biochemical monitoring tools for nutritional status

Serum thiamin - B1 (thiamin)
Normal range: 10-64 ng/mL
Postop deficiency: Rare, but occurs with RYGB, AGB, and BPD/DS

PLP - B6 (pyridoxine)
Normal range: 5-24 ng/mL
Postop deficiency: Rare

Serum B12 - B12 (cobalamin)
Normal range: 200-1000pg/mL  (Andrea's ideal is around 1200-1800)
Postop deficiency: Common with RYGB in absence of supplementation, 12-33%

RBC folate - Folate
Normal range: 280-791 ng/mL
Postop deficiency: uncommon

Ferritin - Iron
Normal range: Males 15-200 ng/mL, Females 12-150 ng/mL  (Andrea's ideal is 200)
Postop deficiency: common with RYGB for menstruating women (51%) and patients with super obesity (49-52%)

Plasma retinol - Vitamin A
Normal range:  20-80 mcg/dL
Postop deficiency: common (50%) with BPD/DS after 1 yr, <= 70% at 4 yrl may occur with RYGB/AGB

25(OH)D - Vitamin D
Normal range: 25-40 ng/mL (Andrea's optimal is 80-100)
Postop deficiency: Common with BPD/DS after 1 yr; may occur with RYGB; prevalence unknown

Plasma alpha tocopherol - Vtiamin E
Normal range: 5-20 mcg/mL
Postop deficiency: Uncommon

PT - Vitmain K
Normal range: 10-13 s
Postop deficiency: Common with BPD/DS after 1 yr

Plasma zinc - Zinc
Normal range: 60-130 mcg/dL
Postop deficiency: Common with BPD/DS after 1 yr; may occur with RYGB

Serum albumin - Protein
Serum total protein
Normal range: albumin 4-6 g/dL; total protein 6-8 g/dL
Postop deficiency: Rare, but can occur with RYGB, AGB, and BPD/DS if protein intake is low in total intake or indispensible amino acids


Why Gummy Vitamins Suck

There is often a ton of hoopla on the boards about flintstone vitamins.  Another day, another post.  But the newest craze of vitamins is the "gummy vitamin," and these are the absolute worst things you can call a vitamin.  In comparison?  Flintstones are a ton better.

Not only are pediatric dentists warning against the various gummy vites (because the first two ingredients of Flintstones Gummies are two forms of sugar), they hold very little nutritive value.

Now, keep in mind, that I am speaking of multivitamins.  I have seen a D gummy that looks acceptable for normal-gutted folks.  Is it oil or water-miscible and thus usable by us?  I don't know -- and maybe I'll check some day.  The calcium gummies are alright for normal-gutted folks, but not for us as they are either carbonate or dicalcium phosphate (which, like carbonate, requires a fair amount of stomach acid to absorb properly).

So I've decided to pull out a few of the biggest offenders -- including an adult gummy multivite and let you make the decision for yourself.  I can preach the horrors of these pieces of candy until the cows come home -- and some will listen to that.  But I'd rather you take a gander for yourself and learn *why* I am so freaking adamant that my toddler does not even get them.

So come along now. 

+ For purposes of this post, I am using the RDA's for Males 31-50 and non-lactating non-pregnant Females 31-50.
+ Conversions from IU to mcg are based on an average of values set forth by the RDA.  It is not an exact science as various forms of each vitamin will translate from IU to mcg differently.  If you really want this specific info, lemme know.
+ This test will evaluate a single dose adult dose per the label (2 vitamins, 6, etc.) for the following vitamins - VitaFusion Adult Gummies (dose = 2 vites), L'il Critters Gummy Bear Vites (dose = 2 vites), Flintstones Gummy Vitamins (dose = 2 vites)
+ RDAs do not take in account lack of Intrinsic Factor or malabsorption -- *we* need more of these things, but until they form a Bariatric RDA, then we have to go with what the government is giving us
+ Values flagged in red do not meet the RDA for either subgroup

Vitamin A
RDA M 900 mcg/day, F 700 mcg/day
VitaFusion 400 mcg
L'il Critters 400 mcg
Flintstones Gummies 320mcg

Vitamin C
RDA M 90 mg/day, F 75 mg/day
VitaFusion 30 mg
L'il Critters 20 mg
Flintstones Gummies 30 mg

Vitamin D
RDA M 5 mcg/day, F 5 mcg/day
VitaFusion 5 mcg
L'il Critters 5mcg
Flintstones Gummies 2.5mcg

Vitamin E
RDA M 15 mg/day, F 15 mg/day
VitaFusion 7.5 mg
L'il Critters 8mg
Flintstones Gummies 10mg

Vitamin K
RDA M 120 mcg/day, F 90 mcg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Thiamin
RDA M 1.2 mg/day, F 1.1 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Riboflavin
RDA M 1.3 mg/day, F 1.1 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Niacin
RDA M 16 mg/day, F 14 mg/day
VitaFusion 10 mg
L'il Critters 0
Flintstones Gummies 0

Vitamin B6
RDA M 1.3 mg/day, F 1.3 mg/day
VitaFusion 2mg
L'il Critters 1.04mg
Flintstones Gummies 1mg

Folate
RDA M 400 mcg/day, F 400 mcg/day
VitaFusion 400mcg
L'il Critters 260 mcg
Flintstones Gummies 200mcg

Vitamin B12
RDA M 2.4 mcg/day, F 2.4 mcg/day
VitaFusion 6mcg
L'il Critters 5.1mcg
Flintstones Gummies 5mcg

Pantothenic Acid
RDA M 5 mg/day, F 5mg/day
VitaFusion 10mg
L'il Critters 5.2mg
Flintstones Gummies 5mg

Biotin
RDA M 30 mcg/day, F 30 mcg/day
VitaFusion 0
L'il Critters 60mcg
Flintstones Gummies 75mcg

Choline
RDA M 550 mg/day, F 425 mg/day
VitaFusion 40mg
L'il Critters 40mcg (note, MCG, not MG)
Flintstones Gummies 38mg

Calcium
RDA M 1,000 mg/day, F 1000 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Chromium
RDA M 35 mcg/day, F 25 mcg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Copper
RDA M 900 mcg/day, F 900 mcg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Fluoride
RDA M 4 mg/day, F 3 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Iodine
RDA M 150 mcg/day, F 150 mcg/day
VitaFusion 0
L'il Critters 42mcg
Flintstones Gummies 40mcg

Iron
RDA M 8 mg/day, F 18 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Magnesium
RDA M 420 mg/day, F 320 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Manganese
RDA M 2.3 mg/d, F 1.8 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Molybdenum
RDA M 45 mcg/day, F 45 mcg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Phosphorous
RDA M 700 mg/day, F 700 mg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Selenium
RDA M 55 mcg/day, F 55 mcg/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Zinc
RDA M 11 mg/day, F 8 mg/day
VitaFusion 0
L'il Critters 2.7mg
Flintstones Gummies 2.5mg

Potassium
RDA M 4.7 g/day, F 4.7 g/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Sodium
RDA M 1.5 g/day, F 1.5 g/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0

Chloride
RDA M 2.3 g/day, F 2.3 g/day
VitaFusion 0
L'il Critters 0
Flintstones Gummies 0


So given this information, why would *anyone* take a gummy vitamin, much less an adult bariatric patient who needs a ton more vitamins than the normal human?  If you can help me to understand, I'd appreciate it -- but for all I can see, these are just expensive candy.  Period.


Iron Info

Some of the things discussed in our post-op health can be a bit confusing.  Iron is one of those things, IMHO.  So how about a session just on iron?


What is iron?
Iron is a mineral that can be found in plants, animals, soil, air, water, meteorites, and rocks, including on the surface of the moon.  Here on earth, plants absorb iron through their root systems; animals eat these plants.  Humans consume these plants and animals.  Many think iron is a heavy metal, which it is not.  Iron is an essential micronutrient.  Essential used in this way means that the body does not produce the nutrient; micronutrient means that the body only requires tiny amounts to function.


Types of iron?
There are two forms of iron - heme and nonheme.  Nonheme iron primarily comes from plants and heme iron comes primarily from meat. 
Nonheme iron represents the majority of iron humans consume in their diets and is the type of iron in most supplements.  Nonheme iron is inorganic and is found in grains such as rice, wheat and oats.  It's also found in nuts, fruits, vegetables, most iron pills, fortificants, or contaminant iron such as from water, soil or cooking utensils.
Meat, especially red meat is the best source of heme iron.  Heme iron is easily absorbed by the body and the best source of iron for people who are iron deficient.


Iron terminology
Transferrin - a protein that is the major transporter of iron and ideally is saturated with 25-35% iron; when working properly, transferrin binds to iron and transports it to all tissues, vital organs, and bone marrow so that normal metabolism, DNA synthesis, and red blood cell production can take place
Ferritin - a protein that acts like a large holding vessel; contains iron that we don't presently need
Hemaglobin (hgb) - a protein that transports oxygen to the body
Hematocrit (hct) - proportion of blood volume that is occupied by red blood cells


So someone who is anemic can still have normal hemaglobin and hematicrit numbers because their ferritin is being depleted in order to maintain those counts.  But if the ferritin is in the toilet and no relief comes, the hgb and hct will eventually fall as well.


Info courtesy of the Iron Disorders Institute


Calcium Reminders

Just a friendly reminder --

Tums, Optisource, Rolaids, Viactiv, and Caltrate are calcium carbonate.

Calcium carbonate is not bioavailable in pH-neutral environments, and is 21% more bioavailable in folks without designer stomachs and intestines.

We want to take calcium citrate -- available as Citracal (but not the Bone Density Builder stuff -- that's mostly carbonate), some house branded calcium supplements, and a few specialty companies that make chewable and liquid versions.

Also, be leery of anything that claims a full dose of calcium (500mg +) in a small quantity, such as a 2g scoop or a teaspoon.  Calcium citrate is a very large molecule, and of that molecule only 24% is actual calcum.  Unfortunately, there are some companies that list 500mg of calcium citrate versus 500mgs of calcium from calcium citrate.  It's a subtle difference -- but if it seems too good to be true, then it most likely is.

Take calcium 2 hours away from iron -- otherwise the iron becomes worthless.

Calcium should be taken in doses around 500mg -- while this is not a steadfast number, it is the recommended amount to guarantee absorption.  Some folks may absorb 600 at a time, others 450.  Shoot for 500 to be safe.

The American Society of Metabolic and Bariatric Surgeons recommend the following amounts of calcium:
Gastric Bypass: 1500-2000mg per day
Gastric Bands (and I'd assume VSG as well): 1500mg per day
DS: 1800-2400mg per day

And finally, for those taking citracal -- it *does* dissolve nicely in a glass of crystal light without changing the flavor.  If the pills seem too large, try doing this instead.

  Can I just note also - those of us without intestinal bypass need to keep an eye on those numbers also. We eat less then the average bear and most "normal" people already have some vit/min issues. 3+ years post op Gastric Band by B12 was very low (now corrected with a sublingual), my iron was very low (on its way back up with supplementation) and my D was 28 (in Oct 2008) and dropped to 25 (in Jan 2009) even though I started supplementing 1000 IU a day - I have an appointment to have it checked again next month - here is hoping its on the rise (taking 2000 iu of D a day).

Thanks Andrea!

Thanks so much for keeping us all up to date on this info, Andrea.  We need to be our own health advocates and we need the education to be able to do that.

Good to see you posting, Andrea. Thanks for the great information, worthy of bookmarking. :)
Blessings,
Mary

I'm a bit confused by my D results.  What do you think?  (I only looked over this with my primary, but I go to my WLS in a week or two where I'll ask for more clarification on this.)

Vitamin D, 25-OH, LCMSMS

 Vitamin D, 25-HYDROXY     30

 Vitamin D, 25-OH, D3          30

 Vitamin D, 25-OH, D2          <4

Below these results it says: D3 indicates both endogenous production and supplementation. D2 is an indicator of exogenous sources such as diet or supplementation.  Therapy is based on measurement of Total 25-OHD with levels <20, deficiency with levels between 20 and 30.  Optimal levels are >30.

I take this to mean that I'm at the low end of normal range, which I guess can be expected for someone living in the North East in the winter.  I just started taking additional Vit D supplements to bump my level up a bit.

However, I don't understand the D2 reading.  Any clues?

-Cynthia

Yeah, you are in the low range of normal.  Considering the research that's been coming out showing a low D level (below 50 especially and below 80 for some) and cancer correlation, I would work on getting that number up as quickly as possible.


There are two forms of D floating around in the body -- 0,25(OH) D is the one we are most interested in.  It's the long-term storage of D3 in the body rather than what you've recently eaten/supplemented with.

Dr. Andrea, hehe, do you recommend taking supplements, eating Vit D rich food, or both, for best results?

Any foods better than others?  Or should I just google it?  Any supplements you recommend?

Thanks, Doc.

-Cynthia

vitalady.com

D3-5's are 5k each
D3-50's are 50k each

Being as low as you are, it would take awhile to get toxic on these.  The chance of overdose is also minimal given the formulation.

To get my number up, I took 10 5k's a day spread out.  Theory being that the body will only process what it can use at *this point in time* and flush the excess.  By giving it multiple sources throughout the day, it will take a little from each, possibly giving a higher result long term.

And of course, high D foods are always better than supplementation.. but given the D is in the oil of products (salmon, fish, etc.) then you might not absorb as well as a "dry" formulation of the vitamin.

Thanks, Andrea.  Luckily, I like everything on this D list:

Salmon, but especially Sockeye

Shrimp

Oysters, Mussels and other mollusks

Mushrooms

Tapioca

Clam Chowder, new england prepared with milk

Pudding

Eel, Tuna, Mackerel (I get all these plus salmon, when I go for sashimi)

Beef Liver

Eggs

Milk

Sardines

 

 

Great post!  Thanks for keeping us all on the straight and narrow.

I just noticed that the numbers you have for iron content in centrum chewables doesn't match the info I have . The Chewables have 18mg per pill -so 36mg per daily dose.  (It's the Centrum Silver that doesn't have iron, I think).