Question:
How do you all manage day-to-day?

I am 7 weeks post-op lap RNY and I am overwhelmed to the point of tears. How in the world do I get all my vitamins, food, water and exercise in daily without going to bed at midnight every night? How much time, if any, needs to pass between the time I drink my protein and when I can begin drinking water again? Same question for vitamins? Am I washing the protein and vitamins away if I begin drinking water right after? How much time between meals and my protein drinks? Sorry for all the questions but I need help, I can't continue staying up until 11p or midnight to get all this in. Thank you for your respones. Lynn    — Lynn W. (posted on August 28, 2003)

August 28, 2003
I'm over 2 years out but if memory serves I was never told to wait after drinking a protein drink to drink water. The liquid protein drink goes right through your pouch anyway. You only have to wait to drink after a "solid" meal, that way the food stays in your pouch longer and is more satisfying. It is however a good idea to space your protein intake out. For example no more than 30 grams of protein (be it drink or food) every 2 to 3 hours. I was never told to wait after taking my vitamins either and my labs are excellent. Here's how I do my vitamins: As soon as I get up I pop a B-12 under my tongue. After it dissolves I drink water and take my chewable iron and 500 mg vitamin C. I continue to drink water until breakfast then wait half an hour and start drinking water again. Before lunch I take 1 zinc tablet with water, 1 Flintstone complete, another 500 mg vitamin C. I wait another half hour after lunch and start drinking water again. Around 3:00 pm I take 500 mg of Calcium Citrate (has Vit D, Magnesium, and Boron in it too). Before dinner I take 400 units vitamin E, 1 Flintstone, and another 500 mg of Vit C. After dinner I wait another half hour and start with the water again. I take another 500 mg of the Calcium Citrate about an hour after dinner. My last 500 mg of Calcium Citrate and a capsule of Vit A and D are taken just before bed ( 2 hours from the previous dose). My nutritionist said it's best to take iron either 1 hour before OR 2 hours after the Calcium as the calcium blocks the absorption of iron. I keep water at my bedside and even sip it during the night. At your stage I was taking in 48 oz per day; now I get in 100 oz ++. Hope this helps.
   — LLinderman

August 28, 2003
I cannot answer about drinking after protein drinks as I have never used one, but since they are liquid I do not see why drin king afterwards would be a problem. <p>I take B-12 once a week so that's not an issue. I take 1200 mg of calcium citrate with vitamin D which are 4 huge pills. I now am to the point where I take 2 at once, which technically means I may not be fully absorbing the 600 mg as usually 400 mg is the limit, but I find if I have to take them 4 times a day I do not get them all in, so I am actually potentially getting more this way even if I do not absorb some of them. The vitamin D also helps with the absorption. I also get in quite a bit of cheese so I'm comfortable that I am at least absorbing 1000mg a day. My labs at 3 and 6 months looked great. <p>I did not have too much problem coordinating things in because I did not have to fit the protein drinks on. So I had many hours of water drinking between meals to take the vitamins. I took Citracal coated tablets, without vitamin D, the first few months as they were much smaller and the coated pills went down well. I did take them 1 at a time. I also do Rugrats chewables twice a day. I find that now for me it really helps to keep some of the calcium at work. That way when I think of it I can take the pills and not have to get them in all in the am and night, when at home. The further out you get the easier it will get. I don't see any reason why you cannot take your calcium with your protein drinks and use that to wash them down. I might be wrong and if I am I'm sure I will hear about it. I take my multi-vitamin or calcium shortly after a meal quite frequently.
   — zoedogcbr

August 28, 2003
Vitamin Regimen - BASIC plan (Add to this based on your particular labwork) 30g of protein supplement, made in water, 3 to 6 times per day,no milk, no sugar. AND 64 oz of water, minimum This vitamin schedule is just a suggestion. You can take them any way you wish as long as you follow the rules listed below. Since the rules can be complicated, many people wanted a good place to start. That is why this schedule was created. I find it a good idea to put the vitamins all out in a pill case for the week. Then I can see what I have taken, or if I have missed something. My pill case has sections for 7 days....4 sections for each day...... > Vitamin Schedule: > AM: > 2 iron (25 mg each) Ferrous FUMERATE or elemental iron > 1 Vit C (1000mg)ascorbic acid with rosehips > > mid-day: > 1 calcium CITRATE(500mg) with Vit D and MAgnesium (250mg) > 1 Vit E (400IU E a-alpha tocopheryl sucinate) > 1 multi-vitamin (equal to Centrum) > > evening: > 1 calcium CITRATE (500mg) with Vit D and MAgnesium (250mg) > 1 zinc (50mg zinc gluconate, chelated) > 1 Vit A&D (10,000 IU Vit A & 400 IU Vit D3) > > bedtime: > 1 calcium CITRATE (500mg) with Vit D and MAgnesium (250mg) > 1 multi-vitamin (equal to Centrum) 1 sublingual B-12 daily (cobalamin concentrate) or monthly B-12 injection Add B Complex tabs for energy, if desired * multi-vitamins: (equal to Centrum) vit A 5000 IU, 25% as beta-carotene, vit C 120mg, vit D 400IU, vit E 60IU, thiamin (B1) 1.5mg, Riboflavin (B2) 1.7mg, Niacin (B3) 20mg, Riboflavin (B6) 2mg, Folate (folic acid) 400mcg, B12 6mcg, biotin 30 mcg, pantothenic acid 10mcg, calcium 162mg, iron 18mg (ferrous fumarate), phosphorus 100mg, iodine 150mg, magnesium 100mg, zinc 22.5mg, copper 3mg, selenium 45mcg, manganese 2.5mg, chromium 120mcg, molybdenum 75mcg, chloride 72mg, potassium 80mg, silicon 2mg, boron 150mcg, tin 10mcg, vanadium 10mcg, nickel 5mcg, lutein 275mcg Some rules for vitamin supplements: IRON............. Take iron (ferrous FUMERATE only, NOT ferrous SULFATE!) Iron is NOT a friendly vitamin. Take iron ALONE, NOT with other meds, juice, dairy products, calcium, etc....ALONE (ok with Vit C only), or it will be useless. We have a VERY hard time absorbing iron, so this is very important! CALCIUM.......... Take Calcium CITRATE, NOT Calcium Carbonate. Not Tums (This is carbonate). We do not absorb the carbonate! There are some other types we do absorb, one is elemental calcium. Remember....do not take it with iron. Calcium also needs Vit D and Magnesium to work. If your calcium does not have these in the tablet, then you must add Magnesium and more Vit D also. The Calcium listed on the price list above DOES contain the D & Magnesium. Another brand is "Citrical Plus" - ultradense calcium citrate with Magnesium, D and minerals, which can be purchased in most pharmacies or large grocery stores. Multi-vitamins..... You can use children's chewables COMPLETES...like Flintstones COMPLETES, or a generic brand as long as it says COMPLETES, right after surgery (when you can't take large pills yet), but double the dosage on the label as we only absorb about 50% of it. But a regular adult multi-vitamin, either swallow or chewable is better long-term because it contains more essential vitamins than the children's. Remember to double the dosage on any multi you take, not just chewables. Vitamins A,D,E and zinc and C (and any others you may add)...... use only DRY tablets....we do not absorb anything in an oil type gel cap, or ones that are enteric coated, or time-release versions. B-12 injections....you can get a perscription from your primary doctor for a vial of B-12 that will give you about 30 injections. The B-12 is quite inexpensive. I paid under $5 for the vial, and that was regular price (less than my copay would have been.) If you don't like injections, you can use the B-12 sublinguals. They melt under your tongue like nitroglycerin tabs for heart patients. You can get them many places, including GNC stores. If you choose the sublinguals, you will need to take them daily, whereas the injections are monthly. Remember, these are the BASICS. If your labwork shows drops in any areas, then these amounts will have to be adjusted. Some additions..... Problems with hair loss or brittle nails....add Biotin Problems absorbing Calcium......add Boron Problems absorbing iron.........add Copper
   — Shari M.

August 28, 2003
Make a plan and it won't be so overwhelming any more. I take a calcium citrate when I get up in the morning around 6:00. Just before leaving for work a little after 8:00, I take a multivitamin. Around 10:00 a.m. I take another calcium citrate. At lunchtime I take my second multi, and then sometime in the afternoon I take my final calcium citrate. That allows me plenty of time to make up a dose of something if I miss it at my regular time when things get busy. Just remember to leave about 2 hours between calcium and iron since iron interferes with calcium absorption. Drinking water soon after liquid protein or vitamins is not a problem. The protein and vitamins are absorbed in your intestines, not your stomach, so washing the protein and vitamins through the pouch does not interfere with absorption in the intestines. The reason you should not drink around the time of eating is that the liquid will wash the food into the intestines (where it will be absorbed), but it leaves your pouch empty, and you'll feel hungry sooner than if the food stayed in the pouch longer. Drinking does not affect absorption--only fullness (so to those of you who think that drinking after eating something you regret washes away the sin, you're really only making the matter worse. You're still going to absorb the calories, plus now you're going to make yourself hungry sooner by washing it out of the pouch.)
   — Vespa R.

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