DS Vitamin List from Surgeon - Opinions?

I received a list during my consultation and am curious what the vets think of this list.  I've seen several posts on vitamins but I've been a bit lost in understanding all of them.  The simple list my surgeon's office gave me seems to make sense so I thought I would just see what you think.  (You know, I really am an intelligent gal...edu-ma-cated and all.  Ha!)

1. One BA Chewable Multi ADEK or individual A,D,E,K in water-soluble form  three times daily

2. Pepcid Complete twice a day for first six weeks, the begin Calcium.

3. One BA Calcium Citrate Lozenge three times a day OR two scoops BA Calcium Crystals twice a day OR two BA Calcium Citrate Chewy Bites three times a day (six chewy bites total daily) OR 600 mg generic Calcium Citrate plus 400IU Vit D three times daily.

4. One BA Sublingual B12 daily OR generic 500 mcg daily OR 1,000 mcg B12 IM for deficiency.

5. One BA Chewable Iron daily or Ferro-Sequels (iron fumarate) 50 mg daily.

That's it. 

Does this seem like overkill or reasonable until I get labs to help me with adjustments?  Missing anything?  The Bariatric Advantage is just a suggestion and frankly I will probably stick with that brand because I'm not too concerned about the cost and it seems easier...maybe.

Whaddaya think?

Well, no.

Unfortunately, most bariatric surgeons, including those who do the DS, provide poor vitamin advice.


I think she did ok on the calcium, at least for starters. You may need to adjust that in the future.

You will need a multivit daily, which I don't see here. I get mine at CostCo.

ADEK's are totally inadequate - they sound perfect as they contain the right components, but they don't have enough of anything to compensate for the malabsorption of fat soluble vitamins that the DS creates. You will need the "dry" form of D, A, and K, all of which can be purchased from Vitalady or from BioTech. Many people also take dry E, but I've never heard of a vitamin E deficiency.

B12 - you might or might not need to supplement this at all. This is more of a gastric bypass problem. I'm over 6 years post-op and still haven't needed any form of B vitamins (and I do get levels checked).

Iron - very individual here, I don't know what you will or won't need.

So definitely NOT overkill, in fact she understated what you will need. I would add zinc to the list (I take 50 mg 3 times/week, bought from any drug store), and some people need copper. As you can see, the needs vary, but the multivits, calcium citrate, and dry forms of the fat soluble vitamins are universal for us. Please don't fall for the lure of ADEK's. I did the first year, and my D level dropped from low normal down to 7 (waaay below normal level!). With proper supplementation, it's now 55.

Who is your surgeon?

Larra

Great info!  My surgeon is Bernita Bernsten.  She has Dr. Carlyle Dunshee help with the surgeries as well.  From what I've found, they are great with the DS and revisions.  I'm very lucky to have them just 2 1/2 hours away.

My worry with the calcium is that I love the chewy ones and they have a little sugar in them.  At six per day, I might need to change that to the non-chewy ones.  I can't "afford" that sugar.

The multi is a combo of multi and ADEK.  I hear a lot of folks don't think the BA ones have enough of each so I'll need to look into that.

What does "dry" form mean?  Chewable or pill form?

I've been taking a B100 complex for about two years.  It really helps with energy for me so I'll probably keep that up.  Just don't want to overdo it because I know too much of some vitamins can be harmful.

As for Vit. D, I currently take 1,000 IU of D3 because it was low a few months ago.  So I suspect I will need even more than the Multi ADEK provides.  Maybe even a prescription. 

Thanks again for the feedback!  I'm curious what "dry" means.

Dr. Bernsten has an excellent reputation.

The chewy calcium citrate do contain carbs. I use the lozenges. Somewhat chalky, but they don't taste bad and they have 500 mg of calcium citrate each.

"dry" forms of the fat soluble vitamins are little capsules. They contain no oil, so we will absorb them. They work great for us. If you read the label on the ADEK's, you'll see that the amounts are just insufficient. You will likely need 50,000 units of D daily, for example. The A and K are less, but still way more than a "normal" person would take. But that's what we need.

Forget the prescription vitamin D. Rookie error! They are oil based and you won't absorb the D they contain. And if your D is low now, get it going up NOW, before your surgery. It is always easier to maintain a good level than it is to catch up. Do the catching up now, while you have normal absorption. I doubt that 1,000 units daily will do the trick even now.

If you are someone who needs B complex, of course you should continue taking it.

Larra

Again, great info!  Glad to hear my surgeon has a good rep.  I've done so much research that my eyes are crossed.  My sister actually had the DS with her but she lost too much weight and had bowel issues.  I specifically asked Dr. B about that and she said they now only make the CC 150 cm instead of 100 and that seems to have "fixed" the issues.  I found that interesting.

I am taking an oil based Vit. D3 now so I'll look for something dry.  Great idea to get up to speed on those before surgery!  I was on a Vit. D3 of 50,000 IU pre-op and it helped get me up to where I needed.  Then I didn't need that much so they put me on 1,000 just to help a bit.  I'll make sure to check that out more.

I've never had bad Vit. B results but I've always taken the B100 complex.  So I'll probably stick with that unless they get too high.

I would love to take all vitamins in a capsule, split them open and dump them into a little shot glass and boom!  The pills themselves take me about 30 minutes to take because I can't take them all at once.  This is something I'm trying to prepare for since my tummy doesn't like too many at once.

Thanks again!

That list means absolutely nothing without a good long look at your lab results. 

When I took Celebrate "DS Essentials", they contained absolutely NO Vitamin A at all.  None.  So why did they call them "DS Essentials"???  Lesson to be learned is to always read the label.  A smart DSer never takes "ADEK" all-in-one.  Because a smart DSer tailors their own vitamins according to their own lab results.  You might need way more D than A, for example.  In that case, the ADEK is no longer useful to you. 

Also, there are so many vitamins left out of your surgeon's recommended list. 

I would investigate all my options, including but not limited to Vitalady, the other DS site, BJ's Bariatrics, GNC, and all your local vitamin shops.  I shop around for the best prices on my vites.  I end up ordering the glut of them from Vitalady, but I still shop around periodically to keep the prices fresh.

I also splurge on my calcium and buy Calcets.  I know myself too well, and I will NOT swallow a large calcium pill.  The Calcets are a treat I allow myself, and I justify the cost by skimping on other things in my life.  (Not shoes)

Most of the DS vets start with Vitalady's list and then tweak based on lab results.

Here is a copy of her list:
www.gblcreations.com/Resources/Gina/ProgramDRNY_ERNY_BPDDS3- 2010.pdf

Michelle (Vitalady) does not maintain the lists on her web site...Gina (majormom) maintains them offsite for her but Michelle put the list together.

Michelle also has prepackaged kits but most of us order based on what we still have on hand and what our labs say we need.

Liz

My surgeon gave me a similar list.  I talked to the staff about my concerns with all incumbant vits like the ADEK-Multi.  I was told that this is what the ASMBS recomends for DS patients.  They said they start all patients on a specific universal regimine and then once labs are done they adjust the plans for each individual.  They said that because no one body is alike, some of the levels that vitalady recomends can be toxic for some and they didn't recommend going that route. 

You've been on here longer than I have. How many DSrs have you seen post that they became toxic following VItalady?  I think the surgeon's office is blowing smoke and just want eveyone to follow the same program at first whether it's enough or not. Our docs and practices don't like being challenged. Keep challenging them!  : )

--gina
 

I'm completely with you, Gina!  My PCP is a good family friend, so I'm hoping I won't have any issues with monitoring and adjusting.  He's always been supportive so he's willing to help me however I need it.