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Micronutrient and Macronutrient Needs in Roux-en-Y Gastric Bypass Patients

Roux-en-Y surgery creates an increased risk for deficiency of certain nutrients. Decreased intake in combination with varying degrees of malabsorption presents unique challenges to achieving the macronutrient and micronutrient status needed to thrive. Lifelong preventative actions, such as supplementation, regular follow-up, and thorough patient education are mandatory for accomplishing all the benefits and avoidance of the health risks involved in Roux-en-Y gastric bypass surgery. Given the nature of the procedure and the individuals undergoing the procedure, no clear protocols have been determined. The focus, therefore, is on risk reduction and careful monitoring and follow-up, versus risk elimination.

Recommendations for RYGB patients are the following (Links added are mine, not a thorough list, will add more):

• Chewable, liquid, or powder multivitamin containing RDA levels of iron and zinc taken daily.

• Bariatric Advantage Pre-Operative Complete Vitamin and Mineral Formula - Chewable
• Bariatric Fusion Vitamins
• Building Blocks Multiple Chewable Vitamin for Gastric Bypass
• Celebrate Bariatric Supplements Multivitamin Chewable Mandarin Orange
• Celebrate ENS Multivitamin & Calcium Drink Mix
• SmartForme Vitamin Drink Mix

• Sublingual B12 (500–1,000mcg) once per week, IM injection (1,000mcg) once per month, or nasal gel or B12 patch (1,000mcg) once per week; increase based on follow-up labs

• Bariatric Advantage Sublingual B12
• Building Blocks B12 Spray
• Celebrate Bariatric Supplements B-12 Sublingual Dietary Supplement
• Or nasal spray, injected, dermal patch

• Chewable, liquid, powder, or lozenge 1,000 to 1,500mg calcium citrate with vitamin D in divided doses; increase based on follow-up labs.

• Bariatric Advantage Calcium Citrate Chewy Bite Chocolate Flavored
• Bariatric Advantage Calcium Citrate Lozenges
• Bariatric Advantage Calcium Crystals with Vitamin D
• Bariatric Advantage Lemon Calcium Citrate Chew
• BuildingBlocks Chewable Chocolate Calcium Citrate
• BuildingBlocks Chewable Orange Calcium Citrate
• Celebrate Chewable Calcium Citrate in Orange, Mixed Berry and Hot Cocoa
• Calcet Calcium Citrate Creamy Bites

Some programs may also recommend a separate daily B-complex or thiamine (Vitamin B1).  Also, some of us require additional vitamins and supplements, namely IRON and VITAMIN D.  Other trace elements may be suggested after you have bloodwork done.

• Bariatric Advantage Chewable Iron 60 mg.
• Bariatric Advantage Liquid Vitamin D-3 10,000 IU Supplement
• Vitamin D3-50 (Vitamin D3/ Cholecalciferol) 50,000 IU 
• Sundown High Potency B1
• Building Blocks 30mg Chewable Iron

Here's a Very Thorough Schedule that I found online:

Time What to take What to eat or drink

7 am (or upon awakening)

• Calcium citrate, 500 mg elemental
• Vitamin D, 200-400 IU 
• Magnesium citrate, 200 mg elemental 
• Whey protein shake, 30 gm

8 am

• Vitamin B-12 sublingual tablet
• Breakfast

9 am

• Iron supplement(s)
• Vitamin C, 500 mg Glass of water

11 am

• Calcium citrate, 500 mg elemental
• Vitamin D, 200-400 IU 
• Magnesium citrate, 200 mg elemental 
• Glass of water 

12 noon n/a

• Lunch

1 pm

• Multi-vitamin
• B-100 tablet Glass of water

2 pm n/a

• Whey protein shake, 30 gm

3 pm

• Calcium citrate, 500 mg elemental
• Vitamin D, 200-400 IU 
• Magnesium citrate, 200 mg elemental 
• Glass of water

4 pm

• Multi-vitamin
• B-100 tablet
• Glass of water

5 pm

• Iron supplement(s)
• Vitamin C, 500 mg Glass of water

6 pm

• n/a Dinner

7:30 pm n/a

• Whey protein shake, 30 gm

8 pm

• Vitamins A & D capsule
• Vitamin E capsule 
• Zinc tablet 
• Glass of water

10 pm (bedtime)

• Calcium citrate, 500 mg elemental
• Vitamin D, 200-400 IU 
• Magnesium citrate, 200 mg elemental 
• Whey protein shake, 30 gm

Middle of the night, if you wake up for any reason

• Calcium citrate, 500 mg elemental
• Vitamin D, 200-400 IU 
• Magnesium citrate, 200 mg elemental 
• Glass of water