Vitamins?

I went to Drug Emporium to replenish my stash tonight and dropped quite a bit of dough on various supplements.  Now that I'm up to taking a full pill bottle in the morning and evening, I thought I'd check with the rest of you to see what you're taking!

As of today, I'm on

Morning:
1 chewable adult multivitamin
2 calcium citrate (630 mg)
1 magnesium (400 mg)
1 sublingual D3 (10,000 IU)
1 sublingual B12 (2500 mcg)
1 B complex
1 dry Vit E (400 IU)
1 vitamin C chewable (500 mg)
3 glucosamine/chondroitin (1500/1200) <- for my knees, since I'm a runner
1 MSM (1000) <- also for my knees

Evening:
1 chewable adult multivitamin
2 calcium citrate (630 mg)
1 magnesium (400 mg)
1 sublingual B12 (2500 mcg)
1 B complex
1 vitamin C chewable (500 mg)
1 zinc (50 mg chelated)
1 vit A (10,000 IU) 
3 glucosamine/chondroitin (1500/1200)
1 MSM (1000)

Lots of stuff, huh?  I am only concerned about the A and E; experts, is it really probable we can achieve a toxic level of a vitamin?  Would it be safer to err on the side of caution in our case?  Malnutrition is the only thing that really scares me about RNY at this point... I don't want to fall apart when I'm 40.

So, what do YOU take?

My only thought is that you need to be sure if you're taking your calcium at the same time as your multi that it doesn't contain iron. They cancel out each other.

Since I'm over 50, yes, believe it or not....lol I don't need iron, so I take them all together.

As far as everything else, let's see what our vitamin gruru Wendy I has to say.

Morning when I start drinking after breakfast:
1 prescription multivitamin (Therobec via Dr Baker prescription)
2 Super 50 B-Complex vitamins
2 Citracal Plus 

After starting to drink after each of my remaining 3 meals throughout the day:
2 Citracal Plus

At bedtime:
5 regular dose sublingual B-12 (usually - although now I'm taking sublingual liquid because they were out of the other the last time I ran out - but i will go back on them as soon as the liquid runs out because i hate the taste of the liquid)

It is DEFINATELY possible to achieve toxicity of a vitamin (although ALMOST impossible with regards to B vitamins). 

You're concerned with A and E you said - but I didn't really understand if you were saying you were concerned with a DEFICIENCY in A and E or TOXICITY of A and E.

With regards to supplementation, the following is according to the bariatric nutrition suggest paper posted by the ASMBS.
 
Vitamin E

Typically RNY post-ops who do not have a HISTORY of vitamin E deficiency maintain adequate levels of vitamin E with just taking their multivitamin alone (and no additional vitamin E supplmentation).  So as long as you're taking your multivitamin, typically that should be enough vitamin E without adding any extra to it.  

Vitamin A

Vitamin A deficiency is a little more prevalent in RNY and lapband post-ops than the regular population (although not nearly as prevalent as in DS patients).  Even among those who ARE vitamin A deficient, vitamin A deficiencies tend to peak around 6 - 9 months post-op (probably because by then you're back onto real foods and eating a varied diet by then so it starts to pick back up with increased fat intake).  Of those who were deficient in vitamin A, 28% were deficient at 6 months, but that had fallen to 17% at a year.  Vitamin A supplementation (in addition to your normal multivitamin) is not typical for RNY post-ops.  As with vitamin E, typically, whatever is in your multivitamin is enough.  (This is NOT true with a long-limb, or distal, RNY post-ops or of course with DS.)

With regards to toxicity, the following is according the National Institute of Health.

Vitamin E

Tolerable Upper Intake Levels (in females over 19) = 1000 mg (1500 IU) 

major adverse effects of too much vitamin E:
hemorragic side effects (ex. increases risk of hemorragic stroke) 
increased overall mortality rate (in doses even below 1000 mg or 1500 IU per day)
interaction with other drugs (ex. anticogulants/antiplatelets, zocor, niacin, chemotherapy, etc)

Overall mortality rates increased in persons taking high doses of vitamin E even well below the upper intake level.  Overall death rates begin to increase in people taking vitamin E in doses of 150 IU.  So since taking more than 150 IU of vitamin E makes it more likely for you to die for apparently any reason, I'd probably think twice about supplementing it with any more than is in your multivitamin unless your serum levels actually show you need it. 

Vitamin A

Tolerable Upper Intake Levels (in females over 19) = 3000 mcg (10,000 IU) 

4 major adverse effects of too much vitamin A:
 birth defects
liver abnormalities
reduced bone mineral density (which may result in osteoporosis)
central nervous system disorders

Toxic symptoms can also arise after consuming very large amounts of preformed vitamin A over a short period of time.
Some signs of acute toxicity include:
nausea
vomiting
headache
dizziness
blurred vision
muscular uncoordination

Considering how we as women, and RNY post-ops to boot, have to watch our bones so closely, I wouldn't supplement any excess A other than what's in your multivitamin either - again unless your serum levels show you need it. 

Just my 2 cents. 

Wen

Wow!  I'm glad you weighed in on this.  The supplements weren't terribly expensive, so I won't feel too bad if I end up chucking them.  I read something the other day about those two vits being the fat-soluble ones and how we should be careful about maintaining levels (maybe from vitalady?) so I sprang for them.

I'll definitely have to check the amounts of A and E in my current multi.  I was more concerned about toxicity, but you addressed deficiency, too, so you rock - which  you already knew. :)