ASMBS Supplementation Guidelines

Below is an overview of the supplementation guidelines that I recieved from Duke Metabolic and Weight Loss Surgery. They have distilled the information that appears in the document above into this easy to read form.

Daily Multivitamin

- chewable of liquid for the first 3 wks following surgery

- must contain 400mcg Folate, 18 mg Iron, and 15mg Zinc

- Gastric bypass and Biliopancreatic diversion patients need to take 2 multivitamins everyday

- LapBand only need 1 multivitamin daily

Calcium Citrate

- Chewable or Petite version until 3 months post op

- LapBand patients need 1500mg daily*

- RNY patients need 1500 to 2000mg daily*

- DS patients need 1800 - 2400mg daily*

* Limit calcium dosage to 400 to 600mgs every 4 hours to ensure effective absorptionand do not take within 2 hours of iron supplimentation, this will usually mean taking your multivitamin 2 hours before or after your calcium.

Additional Iron (for women who have had RNY or DS and are menstruating or have a history of anemia)

- Add 18 - 27mgs of elemental iron per day for a total dose of 50 to 100mgs, including iron in your multivitamin.*

- liquid forms of ferrous fumarate, ferrous sulfate and ferrous gluconate are the best absorbed forms of iron.

* You may want to add an over the counter stool softener such as Colace when starting an iron supplementation regimen to reduce problems with constipation when taking iron. 

Vitamin B12

- RNY patients should either take a sublingual 350mg B12 or obtain a monthly injection from their PCP. 

Vitamins A, D, E & K

- DS patients need 1 ADEK tablet daily

Here is a link to the supplementation guidelines from the American Society of Metabolic and Bariatric Surgeons (ASMBS) which are the governing body of bariatric surgeons. You will find a table that provides the information on page 7 as well as the details of what you need and why you need it. You may want to check these recommendations against your current regimen to be sure that it is complete and up to date. If you find that your regimen is incomplete, you may want to contact your surgeon to discuss modifying your supplementation regimen. This recommendation address all bariatric surgeries.

Thanks for posting this!!

Barbara, I have a question for you or anyone who may know the answer...

I know that a proper vitamin regimen along with eating properly really is key with any WLS. Have you ever heard of anyone who had malnutrition issues despite following these guidelines?

Yes and no. If you follow the guidelines, you should be fine, but the reason that they have you run labs is to see if you have any addition supplementation needs. I was doing fine, but some of my labs started to show a vitamin D deficiency even with recommended supplementation. They added a course of 50K IU and that brought it up to where it needs to be. This is the reason that it's important that you go in for checkups and lab work. So, I guess the answer to your question is that yes, you may develop some deficiencies, but with monitoring and management, they are taken care of and not allowed to become dangerous. 

I hope that helps.

If you are having a DS, then YES!  1 ADEK daily is NOT ENOUGH for DSers to maintain healthy levels.  The vast majority of us need to take separate dry forms in order to get enough in.  For instance, right now I take 100,000 vitamin A, 100,000 - 150,000 vitamin D, 400IU vitamin E and 2,000 vitamin K.

Also, Dr. Sudan does not test for vitamin K (and may not test for E either, I can't recall).  I had my PCP run all my labs and it turned out I was deficient in vitamin K.  Had I just followed Dr. Sudan's advice and not bothered to do my own research and demand my own labs be done, I'd have never known. 

(FYI - other than the labs and supplementation advice, I love Dr. Sudan.  You should also know that most DS surgeons offer equally crappy advice when it comes to this area.)

Yes, Barbara, that does answer my question! Thanks so much!

I made the mistake of watching some Youtube videos of women who didn't necessarily care for their WLS. I know that it is a huge commitment and I know that there are side effects and occasionally complications. I want to know the good, the bad and the ugly but sometimes it gets to be overwhelming!

Thanks, again! I'm sure I'll be getting in touch with you soon about the group meetings. Tomorrow is my barium swallow and bloodwork.

1 ADEK a day is going to cause the vast majority of DS patients some serious issues down the road.  Most of us need to take much higher doses of the dry forms of these vites than can be obtained even in taking several ADEKs per day.  I also believe the form of A in many ADEKS is not absorbed by DS patients.  There are also studies that indicate that K should not be taken with A & E as they interefere with eachother.

I also wanted to add that it seems heme iron is more easily absorbed by a lot of people.  (Proferrin)

Oh, and many DSers also need to supplement their B vites, too.