I am 6 1/2 years Still learning What's the Correct amount Calcium & MultiVitamins

Reading posts of people that had Rny are not all taking the same amount of multi vitamins and/ or Calcium.. In my literature I was given pre op said 4 multi vitamin and 4 calcium citrate, they were to be chewable's.  Along with the B12 2X Daily 500 mg. each.. ok different brand multi vitamins are different amount of mlg. of calcium. Well as time went on I was taking 4 calcium, only to learn that ,that was too much thats what clogged my artery again P.O. and caused me a heart attack, then i learned that taking only 3 isnt enough P. O. well some calcium brands are 500 mlg. per 2 tablets, some are 600 mlg. per 2 tablets.

 

When I asked if i could take the regular calcium from walgreens because it was buy one get one bottle free and they were not chewables. Nurse said that was ok..I'm sure she was aware i was a pervious heart patient.. As the literature said to be chewables..really? i said.. wondering if i should have been taking the chewables instead and maybe prevented them last 3 heart attacks P.O.

I also wonder if these surgeons in all  different states that perform Rny tell their patients different amounts of vitamins and calcium..shouldnt they all be the same amounts?!  Is it 3 or i it 4 calcium pills per day?>>>>>No Nurse told me to take vitamin K2 to protect my heart , an O H member mentioned it.. dont remember who it was but if i never have another heart attack i owe it to that O H member for providing me with that information.vitamin K2 keeps the heart healthy .. I didnt know that.. well enough of my rambling.. It's a never ending learning thing after Weight Loss Surgery.. I am proud of myself for maintaing this weight loss. I amaze myself every day..Figured i'd be one of the ones that regained at least half of it back but i have never regained...PeaceV and happy halloween to everyone...Wendy

Shouldn't people's vitamin plans be based on individual needs?  Someone with a history of multiple heart attacks isn't going to have the same needs as someone with no heart problems.  I have a history of anemia, so I should take more iron than someone who has normal iron levels.  On the other hand, I had a dexa scan last year showing I have 127% of expected bone density, so I don't need extra calcium.  It really does vary based on the individual.  I plan to have my labs drawn regularly after surgery so I can make adjustments based on my needs, not general assumptions.

Surgeons give us a starting point, but we're all different, and our bloodwork determines our needs from there.  They say chewables for RNY because they have a difficult time swallowing pills at first.  Over time, though, that can change.   

Face it, a surgeon's specialty is cutting, not nutrition.  They took maybe a semester course on nutrition enough to know that everyone needs vitamins.  With your heart problems, you should really be seeing someone that specializes in how your body is processing nutrients.  On the low end, it may be someone like a nutritionist or dietician, or on the higher end, an endocrinologist.

With most doctors they will say 4 multi vitamins if your buying the Bariatric ones and most of those have the calcium in them as well. But there isnt a need to buy special vitamins. Your body needs 200% of the normal multi. But taken at two different times in the day. So 2 multi vitamins taken 2 hours apart. Also you need between 1500 and 2000 mg of Calcium Citrate, 5,000-15,000 units of a dry vitamin D3, B12(you cant take to much of this so I take 2000 mcg a day to keep my levels over 1000) Iron with Vitamin C(this will depend on what your iron is). Your body can only handle 500 mg of calcium at a time, so you need to take then 2 hours apart, and dont take iron with calcium since they dont work together.

http://asmbs.org/2012/06/asmbs-integrated-health-nutritional -guidelines-for-the-surgical-weight-loss-patient/

You are wanting to look at Table 5 on this webpage.

Table 5. Suggested Postoperative Vitamin Supplementation

Supplement AGB RYGB BPD/DS Comment

Multivitamin-mineral supplement
*A high-potency vitamin containing 100% of daily value for at least 2/3 of nutrients	100% of daily value*	200% of daily value*	200% of daily value*	Begin on day 1 after hospital discharge
Begin with chewable or liquid
Progress to whole tablet/capsule as tolerated
Avoid time-released supplements
Avoid enteric coating
Choose a complete formula with at least 18 mg iron, 400 μg folic acid, and containing selenium and zinc in each serving
Avoid children’s formulas that are incomplete
May improve gastrointestinal tolerance when taken close to food intake
May separate dosage
Do not mix multivitamin containing iron with calcium supplement, take at least 2 hr apart
Individual brands should be reviewed for absorption rate and bioavailability
Specialized bariatric formulations are available
Additional cobalamin (B12)
Available forms include sublingual tablets, liquid drops, mouth spray, or nasal gel/spray
Intramuscular injection	—	1000 μg/mo	—	Begin 0–3 mo after surgery
Oral tablet (crystalline form)	—	350–500 μg/d	—
Supplementation after AGB and BPD/DS may be required
Additional elemental calcium Choose a brand that contains calcium citrate and vitamin D3 Begin with chewable or liquid Progress to whole tablet/capsule as tolerated	1500 mg/d	1500– 2000 mg/d	1800– 2400 mg/d	May begin on day 1 after hospital discharge or within 1 mo after surgery
Split into 500–600 mg doses; be mindful of serving size on supplement label
Space doses evenly throughout day
Suggest a brand that contains magnesium, especially for BPD/DS
Do not combine calcium with iron containing supplements:
To maximize absorption
To minimize gastrointestinal intolerance
Wait ≥2 h after taking multivitamin or iron supplement
Promote intake of dairy beverages and/or foods that are significant sources of dietary calcium in addition to recommended supplements, up to 3 servings daily
Combined dietary and supplemental calcium intake >1700 mg/d may be required to prevent bone loss during rapid weight loss
Additional elemental iron (above that provided by mvi) Recommended for menstruating women and those at risk of anemia (total goal intake = 50-100 mg elemental iron/d)	—	Add a minimum of 18–27 mg/d elemental	Add a minimum of 18–27 mg/d elemental	Begin on day 1 after hospital discharge
Begin with chewable or liquid
Progress to tablet as tolerated
Dosage may need to be adjusted based on biochemical markers
No enteric coating
Do not mix iron and calcium supplements, take ≥2 h apart
Avoid excessive intake of tea due to tannin interaction
Encourage foods rich in heme iron
Vitamin C may enhance absorption of non-heme iron sources
Fat-soluble vitamins With all procedures, higher maintenance doses may be required for those with a history of deficiency Water-soluble preparations of fat-soluble vitamins are available Retinol sources of vitamin A should be used to calculate dosage Most supplements contain a high percentage of beta carotene which does not contribute to vitamin A toxicity Intake of 2000 IU Vitamin D3 may be achieved with careful selection of multivitamin and calcium supplements No toxic effect known for vitamin K1, phytonadione (phyloquinone)	— — —	— — —	10,000 IU of vitamin A 2000 IU of vitamin D 300 μg of vitamin K	May begin 2–4 weeks after surgery
Vitamin K requirement varies with dietary sources and colonic production
Caution with vitamin K supplementation for patients receiving coagulation therapy
Vitamin E deficiency has been suggested but is not prevalent in published studies
Optional B complex B-50 dosage Liquid form is available	1 serving/d	1 serving/d	1 serving/d	May begin on day 1 after hospital discharge
Avoid time released tablets
No known risk of toxicity
May provide additional prophylaxis against B-vitamin deficiencies, including thiamin, especially for BPD/DS procedures as water-soluble vitamins are absorbed in the proximal jejunum
Note >1000 mg of supplemental folic acid, provided in combination with multivitamins, could mask B12 deficiency

- See more at: http://asmbs.org/2012/06/asmbs-integrated-health-nutritional-guidelines-for-the-surgical-weight-loss-patient/#sthash.VUhpUWvT.dpuf

 

Great post, angeleigh !!!

I had a DS, but I am studying to become a bariatric dietician for all bariatric patients...inspiration from my surgery.

The DS vitamin and mineral protocol is much more rigorous, due to the profound malabsorption of the DS, but to answer your question, I use a pill cutter to cut all vites and minerals in tablet form, as opposed to chewables, to ensure the stomach acid gets to the "business portion" inside the tablets,  followed by a warm drink like decaf coffee or tea to help them dissolve.  You may  want to crush yours, and follow with a warm drink to ensure dissolution,  since the stomach acid is greatly reduced in RNY's. Make sure you get a pill crusher with metal blades, because calcium will destroy the all plastic ones. You can invest in a "Silent Knight", like they use in medical facilities, which you should be able to find on Amazon or eBay  DSer's still have anatomical stomachs, although they are about a fourth of the size of an unaltered stomach, and we still produce adequate stomach acid.  That's why RNY's are either chewables or liquid, because stomach acid production is greatly reduced..  Liquid cal/mag is available, and I do prefer the liquid form, even though I can use the tablets. 

Lifetime brand is a good liquid cal/mag product, and you can get it at most health food stores, or you can order it through luckyvitamin.com. Ordering is *much* more economical. Actually, Lucky Vitamin, Amazon and eBay are the places where I get most of my supplements. I still order some things from Vitalady, but not entire packages. As a post-op, I have become an avid label reader.

DSers automatically have to pay more attention to the ADEK's, because those are the vitamins we are most in danger of becoming deficient in. For us, more is better.  I treat the instruction sheets as guidelines only, and use my labs to determine what I need more or less of.  As a WLS patient, is is imperative that you learn to read your own labs, according to your own protocol.  I have a sheet with labs, codes and targets, if you'd like me to e-mail it to you, PM your email address. I also have a picture chart of  the four major bariatiric surgeries that lists the vites for each surgery. For RNY's, the chart lists the following as most at risk:

Nutrients Most At Risk for RNY:
lron
Calcium
Vitamin D3
Vitamin B12
Folate (Vitamin C)
Thiamine

Different hospitals do have different protocols, however, I've found that the Centers of Excellence (certification designation) pretty much line up in terms of information. Nevertheless, with us WLS patients it is always good to research for yourself.  That said, more is better for DSer's, because of our profound malabsorption, but that may not be the case for you.

Personally, what I did post-op was order Vitalady's DS package, then used the list to seek out less expensive sources of the same vitamins and minerals. Let me add that Flintstones vitamins are not going to be enough.  Bariatric Advantage has a line of vites made especially for WLS patients.  While I'm not endorsing them, it may be a good starting point for you, as they have lots of chewable options in adult bariatric strengths.  As for B12, I don't do sublinguals - I take the "Rambo" route, and I self-adminster injections.

Caveat:   I am not a medical professional (yet).  I simply combine what I've learned in the classroom with what I've researched about my surgery to find what works best for *me*.

I amaze myself everyday, too, since I am now able to sit in chairs with arms, and still have room left!

You need to stop looking here for advice and talk to your OWN surgeons because they are the ones who know you!!! If I remember right you are on blood thinners and in that case you should not be taking vit K at least that is what I was told. It's no wonder you have such health situations if you are getting your medical advise from a message board. Go see your own docs or at the very least have your bariatric doc and heart doc get together and come up with a regimen for you to follow!

Jeez, I am sorry you had another heart attack.  You should work closely on your medical case with your medical professionals.

Dick Cheney had 5 heart attacks - I think so, same as you I think???  He has since had a heart transplant and seems to be doing quite well. 

Gosh, I sure am sorry you have so many issues.  My family has heart disease too and it sucks.  Be sure to be on top of all of your medical stuff.    You may want to look into calcium pyruvate.  It is supposed to heal heart tissue.  Just look into it.  You should never take anything without first consulting with your very thorough doctor as I am sure you are on plenty of meds for your heart plus you have a gastric bypass.

 

Feel better please.

 

All Best