For reference: official diet/vitamin guidelines after WLS

I can't imagine the all-in-one pills work effectively. As you stated, iron and calcium are processed by the same receptors and calcium prevents the iron from being utilized. This is why I take the Senior or over 50 multis. There isn't any iron in those formulas. I take iron separately at night before bed in order to get the most bang for my buck.

With that said, some people can effectively utilize their supplements. For example, I take one B12 a week and have high numbers, whereas others need to take it daily. Your best bet is to track your own labs. Don't take a doctor's word that you are fine or in range. You want to watch your patterns. If the numbers drop, up your supplementation. Once you are out of range or deficient, it is much harder to bring them up (and you'll feel like crud or could cause permanent damage).

My doc has me on a prenatal vitamin every day, starting at 6 weeks out.  I haven't had any labs yet, but it is easy to take and I only have to take it once a day.

There's an extra bonus to prenatals-- if you have a health flexible reimbursement account (FHA), you can get reimbursement for prenatal vitamins, but not other kinds. Go figure!

There is a pharmacy here that fills all scripts for prenatal vits for free so I use them....It's great!

A couple of cautions to note on the referenced document. The first is that (as they semi-acknowledge) is that most any piece that purports to give advice for WLS in general is usually aimed at, or derived from, RNY practices (particularly in the general media, but also in professional journals as well. Most of the advice here is general enough to be applicable to other procedures, but there is a fair amount of YMMV in there as well.

The second caution is the real clinker that calls into question anything else they write is their protein advice. The basic quoted 60-80 g is reasonable enough (at least for women, the dominant demographic for WLS, particularly when this piece was written - men generally need 80-100 g due to their higher average muscle mass) but the "ideal" 1.5g/kg body weight is not only misleading but can be dangerous. Think of a 200kg person (440lb to us 'mericans) - this implies a protein requirement of 300g per day, which would be 1200 calories plus that from the fat and carbohydrates in the diet. It would be hard for most 440 lb folks to lose the requisite weight on that kind of diet.

Generally, if you see advice linking protein requirements to overall body weight, skip over it and ignore anything else that source has to give as they are addressing a different audience. Basic rules-of-thumb that associate protein (and metabolic rates such as RMR or BMR as well,) to overall body weight are shortcuts intended for normal weight people with a fairly normal body composition. Protein requirements most closely correlate to lean body mass, or muscle weight, as all that excess fat that we carry coming into this process doesn't require any protein to maintain. I am surprised that the ADA, the publisher of the paper referenced for this factoid in this document, fell into this trap, but it does show that they are not addressing a bariatric audience. Even so, given the overweight nature of the Western populations (and increasingly worldwide,) this type of over-simplification is inexcusable for them.

At any rate, just a word of caution about things published even by notional "professionals" - they can get pretty sloppy sometimes. Often this stuff is delegated to junior staff who don't always understand the context of facts that they pull from other published works.

This piece was written in 2009, so yeah, there wasn't a ton of literature on VSG at the time. Most of the stuff I've found with (reasonably) large sample sizes or longitudinal data addresses only RNY since there's less data on the sleeve.

In regards to protein, I think they mean 1.5g per kilo not of a person's current weight, but his/her IDEAL weight. The wording seems a bit clearer here. So the hypothetical 440lb person may have an "ideal weight" of 160lb/72.5kg (BMI =21 at 6'0") and a protein intake of 108.75g. That's a LOT more reasonable.

Not a scientist, but that's the impression I get from other stuff in the nutrition lit.

Yes, it certainly would be ideal weight, and that's not an uncommon shortcut that dieticians make sometimes. That the authors of this piece didn't know that in their business makes one question their credibility on everything else they write. There is a similar piece linked off of the ASMBS site that some interpret as "ASMBS recommends...." that has several clinkers in it, mostly associated with applying bypass protocols to other procedures without adequately fact checking with the experienced practitioners of those sub-fields.

BTW, I do like your "meat test" which is a lot saner than that silly "pouch test" that doesn't test anything, even for those who have a pouch. Those with the sensibilities to create this new test would probably also appreciate www.dhmo.org.

Oh hell yes that is beautiful. I love all of the responses to the science denial bull**** and this is right up there!

There was another short-lived site that would have been a good link to your meat test site - peta.com (People Eating Tasty Animals) but sadly there is another organization with a similar acronym who has no sense of humor and they pulled rank with Network Solutions to hijack the domain and the originators didn't have the financial clout to deal with the attorneys.