Another one of those "vitamin" threads

Hi all,

I am gearing up towards the DS surgery being performed here in Indianapolis by Dr. Margaret Inman on 2/25.  I am both excited and scared.  At least there were other people getting the DS going through the classes but the size of the DS class was simply dwarfed by the number of people getting RnY and GS.  Of all the things I am facing with this surgery I think one of the biggest things that bother me is the feeling of relative isolation.  There aren't many active DS forums and very few active threads compared to other surgeries.  Nevertheless I feel I am doing the right surgery for me.

Now onto the question at hand.

Much has been said on this board about the need to supplement with very high amounts of vitamins and I have struggled to reconcile that with what both the doctor and nutritionalist say, who are emphatically against taking such high doses unless it becomes a problem in your bloodwork.  The nutritionalist was very knowledgeable about the DS surgery and the recommendations I got were in fact written for a DS patient.  I asked a couple times in the class to try to understand the disconnect in their instructions and what I've been reading and they swear up and down that the average DS patient does fine with their instructions and that its based on much medical research and past experience with doing the surgery.

What they have recommended is the following per day

• 4 x Flintstones vitamins  (which supposedly covers the iron supplementation)
• 2400mg Calcium Citrate w/ Vit D  (I am using Wellesse liquid for this)
• 5000mg Vit D (covered by the flintstones vitamins + wellesse calcium liquid)
• 2 x 1000mg sublingual B12
• 1 x B complex (I am using Wellesse liquid B Complex for this)
• 1 x probiotic (I am using Now Foods Probiotic-10 50 Billion Powder from Amazon)

The levels of Vit ADK are supposedly covered by the flintstones vitamins.  They also recommended bariatric vitamins like Bariatric Advantage which were both expensive and didn't have THAT much more of ADEK.. if I took 5 flintstones vitamins instead of 4, I would likely cover the difference.

I am conflicted about whether to follow their advice and give it a chance to fail, vs start taking 25k IU or 50k IU dry vitamins going on the advice of people here.  Did all of you start off trying vitamins like the regimen above and have ill effects?  It seems so strange that the Dr and Nut would double down on this regimen and warn others of taking the high dose vitamins saying they can do more harm than good.

Just trying to do the best I can do for myself.

Thanks

They may have given you a piece of paper that says these are great for the DS, but I can tell you from both personal experience and from contact with DS'ers here and on other websites that this is a recipe for failure.

Actually, I do like their calcium citrate advice, provided they also told you that it needs to be divided into multiple doses throughout the day.

B12 - after 9 years, I still don't need to supplement B12 at all. Of course I get it checked with my labs and would gladly supplement it if needed, and some people do need it, but I haven't. And even if you do need it, there is no reason you can't just get the cheap stuff at the drug store. B12 is a water soluble vitamin and we should absorb it just fine. People with gastric bypass, on the other hand, do need to supplement B vitamins and don't absorb B12 well. they need either the subliinqual form or injections. You probably won't need any. Actually, all the B vitamins are water soluble and you might not need any, and certainly if you do need them you can get the drug store stuff for these. Then just follow your labs and adjust as needed.

However, the fat soluble vitamins will NOT be well absorbed. and ADEK's are almost useless. If anything, they will fool you into thinking you are doing the right thing because they do contain the right stuff, just so little of each as to be insufficient. This one I know from personal experience (as well as the experience of many others). I now take 50,000 units of D twice daily. My D level was ok with just once daily, but my PTH kept going up (what, they didn't discuss PTH?? Shame on them!) Now with 1000,000 units daily my PTH is going in the right direction. You might not need as much as I do, but for sure 5000 is nowhere near enough.

Same idea for A and K.

As far as multi's go, I don't know what's in Flintstones but it seems crazy to me to take 4/daily when you could take 1 or 2 regular multi's and do just fine with them. I take the standard multi sold at CostCo.

Oh, and did they discuss zinc or copper?? At all??

I have the utmost respect for Dr. Inman as a surgeon from all I have heard about her, but I truly believe this advice is inadequate. There are too many bariatric surgeons who won't do the DS and speak ill of it because they worry about, among other things, nutritional deficiencies. With DS surgeons (she isn't the only one) giving out inadequate recommendations, these deficiencies are inevitable. Save yourself a lot of misery by understanding the malabsorption of the DS for yourself and staying ahead of your vitamin needs. It is far easier to maintain good levels than it is to catch up once they tank.

Larra

No there was no discussion around zinc or copper, or PTH for that matter.  I should mention I'm trying to stay away from pills because I tend to need a good amount of liquid with them or they get stuck in my throat which is a very unpleasant experience, so at least until I can take 2-3oz of liquid in one swallow I am trying to stick with chewables, liquid or powder forms.

Here is what I would get from the Flintstones vitamins, assuming I take 5 daily.. (2, 2 and 1)

Label 1   Label 2

• Vit A, 15000 IU
• Vit C, 300mg
• Vit D, 3000 IU
• Vit E, 150 IU
• Vit K, 275mcg
• Vit B1, 7.5mg
• Vit B2, 8.5mg
• Niacin, 75mg
• Vit B6, 10mg
• Folic Acid, 2000mcg
• Vit B12, 30mcg
• Biotin, 200mcg
• Pantotheric Acid, 50mg
• Calcium, 500mg
• Iron, 90mg
• Iodine, 750mcg
• Zinc, 60mg
• Copper, 10mg

Wellesse B-Complex Label

Wellesse Calcium Citrate Label

Sublingual B-Complex Label

Here is my problem..  I have pondered this since I began looking into the DS surgery and I just don't seem to understand what the Dr and nut's have to gain by giving inadequate advice.  I also know that taking too much of certain vitamins can lead to toxicity and that I don't want to do. 

If I end up needing to supplement Vit D I would be inclined to use something like this

I still feel very much like all of this is a guessing game, which is why I'm inclined to wait for my first blood test results before i commit to taking huge doses of any one vitamin.  My choices are to follow (or loosely follow by supplementing extra) the instructions I've been given which apparently leads to certain deficiency, or go against those instructions at the urging of many postings I've seen on these forums at the risk of overdose to the point of toxicity.  I just wish there was a better explanation as to why this disconnect exists and is so pervasive and why DS patients are forced between two apparently sub-optimal choices.

I truly appreciate the feedback, I just don't know what to do with all of this just yet  :-/

I get it about the swallowing issue because I have the same problem. I knew, and I believe you know as well, that with the DS we are making a lifetime commitment to taking those vitamins, so I knew I had to do it. But I really, really could not swallow big tablets at first, esp the calcium citrate. The solution for me was the Bariatric Advantage chewable lozenges. They have 500 mg of calcium citrate each, and the chocolate and cherry flavors are not bad at all. The  mint is too minty for my taste, and I never tried the cinnamon. You can either chew them or just suck on they til they dissolve. Easy! Bariatric Advantage also makes a chewy form, some with 500 mg of calcium citrate and some with just 250.

the dry A, D, and K are SMALL, smooth capsules that are easy to swallow, even for people like you and me who have trouble with pills.

Honest! And all these products can be purchased from Vitalady. Of course you can also buy them directly from the manufacturer, but it's easier to just get them at one place and her prices are generally better.

Copper - I haven't needed it yet, but my brother, who also had the DS, developed copper deficiency and now supplements copper to prevent anemia (copper deficiency causes a form of anemia, and even the hematologist didn't realize this was his problem - I was the one who told him to get his copper level checked after I read about it here). Zinc - I only need this 3 times/week. Not my favorite pill, but that's a small number.

Multi - if you take 5 of them, you will STILL be deficient in A, D, and K, and risk overdose of other stuff that you will absorb well. This makes no sense. Find a regular adult multi in chewable or liquid form and go with it.

So as you can see, you really, really do need this stuff, BUT if you put your mind to it you can find forms that you will be able to consume with minimal or no difficulty. You don't need to choose between deficiency or toxicity, these are not your only options. You can take reasonable (for a DS'er) amounts of the right things in doses appropriate for someone who doesn't absorb certain vitamins well and then follow your labs carefully. And for Pete's sake, don't let some office employee tell you over the phone that your labs are "ok" or "normal". You need to follow the trends. If you are headed downward on something but still barely within the normal range, you will be told it's "normal". But you could be headed for trouble. So you need to be proactive and follow your labs yourself, and if something is headed towards deficiency jump all over it BEFORE it tanks.

Larra

I started out trying to do it my surgeon's way and we jus****ched my labs trend downward for the first 9 months. After me pestering him, he agreed to let me try what I had been reading here and go with Vitalady's plan and the vitamins she carries. I haven't looked back since, and he now says keep doing what I'm doing because it's working.  7 1/2 years post-op and doing well. I adjust the amounts of vitamins I take based on my labs but I got them all up into optimal ranges first. 

I think part of the problem with the medical types is they have been taught to treat problems after the fact not prevent the problems from happening in the first place. It seems almost philosophical but I'd rather prevent nutritional problems rather than have to treat malnutrition.

--gina 

Gina

Do you still purchase your vitamins from Vitalady or did you just start there to figure out what you need and now purchase them somewhere else? I am still doing the bare minimum and thinking about switching over to what is suggested for DSers instead of following my surgeons advice.  Now I only take multi 2x calcium citrate 3x D 5x with multi and calcium and B 12 /complex only 1x per day due several B shots and now labs getting high in that area.  I know I should probably be adding A, E and K at the very least.

I still buy from Vitalady. She was very active here when I was a newbie and we talked and I asked questions. I've met her a few times in person and we've talked for hours on the phone in the years since. She knows what she's talking about and I trust her.

--gina

okay thanks.  I am going to reach out to her. I see the dr. this month and I thought he was doing labs so I was going to wait, but he isnt going to do them again until 12 months (June) and I dont want to wait that long. 

Also, on average what do you spend on vitamins per month? Just curious.

It's hard to tell any more since I buy hubby's vites and mine together. Maybe mine are around $50. I don't have to take B-complex or vitamin A, only one multi, B12 and B1 are only every other day, and only 1 iron a day. In the first few years it was more expensive since I was trying to bring up some pretty crappy lab levels.