Vitamins

For someone who usually plans things, I sure fell down this time!

I am about a week post-op (vsg), and I don't have a vitamin supplement lined up.  I couldn't take them pre-op because I was so weak-stomached, so put off researching them.

Any thoughts about what is best?  I tend to have B and D deficiencies, so I'll take a separate one for them.  Otherwise, what would you guys suggest?

I'm not really sure if you're asking about scheduling or actual vitamins taken or what vitamins to combine/seperate, so I'll just give you my schedule.  (I have researched vitamins a LOT and consider this plan the best for RNY which is why I follow it.  I planned it after a studying an article on bariatric nutrition/etc posted by the ASMBS.)

CALCIUM
I eat 4 times a day with each meal being roughly 4 hours apart.  Since calcium is best spread evenly throughout the day (because it is used fairly evenly throughout the day), I take it when I start drinking an hour after each meal.  Also, since calcium is best taken in doses of 500 mg or less AND RNY post-ops are supposed to get in roughly 1800 - 2000 mg per day, that means I need 4 doses of 500 mg to equal the 2000 mg.  Also, since calcium citrate is the form of calcium most easily absorbed (especially by WLS post-ops who lack adequate amounts of stomach acid to break down other forms of calcium), I take Citracal brand calcium (since it's calcium citrate).  I actually take Citracal Plus since it has magnesium in it and magnesium helps you poo.  (This is where I get my vitamin D too.) 

MULTI-VITAMIN
I take a prescription multi-vitamin prescribed by my bariatric surgeon.  If he didn't prescribe one, I'd take Centrum.  I would NOT take a prenatal vitamin as some people have had trouble with those long-term. 

B-COMPLEX
This is actually not on all surgeons recommended post-op vitamin regimine and it was not on mine.  I started experiencing numbness in my hands and feet on occassion and started researching what that meant, what could cause it, etc.  I determined that it was probably a B vitamin deficiency.  I called my surgeon to OK me beginning a B-Complex vitamin daily and received the okay to do that.  The peripheral neuropathy resolved itself within days and has never returned.  The ASMBS has recommended that B-Complex vitamins possibly become standard post-op procedure.  I agree with this since complications of B vitamin deficiency can be horrible AND permanent.  Luckily, mine weren't.  And it turned out to be a good thing because that's when I started obsessively researching vitamins/nutrition for WLS post-ops on  my own.  The B-Complex vitamins do make me a little nausiated if I don't swallow them fast enough because they taste and smell vile.  So I take alternate between taking 1, then 2, every other day.  I hate them that bad. 

B-12 sublinguals
I take B-12 sublinguals because as an RNY post-op, I no longer absorb B-12 through food.  I have to rely on sublingual or nasal spray B-12 (or of course shots).  I take 5 of the regular strength B-12 instead of 1 megadose B-12 because the regular ones are tiny and that mega one is huge: the 5 tiny ones seem to dissolve faster/easier than 1 huge one. 

So daily my vitamin intake looks like this.

ONE HOUR AFTER BREAKFAST WHEN I START DRINKING
2 Citrcal Plus
1 prescription multivitmain
1 - 2 Super 50 B-Complex vitamins

ONE HOUR AFTER LUNCH
2 Citracal Plus

ONE HOUR AFTER AFTERNOON SNACK
2 Citracal Plus

ONE HOUR AFTER SUPPER
2 Citracal Plus

AT BEDTIME
5 regular strength sublingual B-12

Wow that seems like too much calcium and B12!
My surgeon and nut have me on the folloeing schedule:

Calcium Citrate 600 + 200 D - 3-4 chewables aday
D3 - 1 a week
Centrum MultiVitamin - 2 aday
B12 sublingual 1000mg (its a very tiny pill) - only 1 - 3 x a week M-W-F
B Complex - 1 a day (for my neurothopy too, since I can't take Lyrica anymore)
And I take a presciption RX muscle relaxer at night for the neuropathy and arthritis too.

Everyone is different and you should always check with your dr and nut and have regular blood tests!!
Best wishes

One DOSE of Citracal Plus = 2 tablets.  (It is always important to note how many tablets = 1 dose to ensure that you are getting a full dose of whatever vitamin you are taking.)

Calcium is best absorbed in doses of 500 mg.  2 tablets of Citracal Plus = 500 mg.  The American Society of Metabolic & Bariatric Surgery's recommendation for RNY post-ops is 1800 mg - 2000 mg of calcium per day.  This is best taken evenly throughout the day in the optimum 500 mg doses.  So 8 tablets of Citracl Plus = the recommended 2000 mg per day. 

(In comparison, assuming your calcium citrate chewables are 600 mg each and you do them 3 - 4 times per day, your ingested mg = 1800 - 2400 mg per day, only 1500 - 2000 mg of which is absorbed since calcium is absorbed in doses of roughly 500 mg each.  So I'm really doing not much more than you are at all and I'm ensuring better absorbtion by splitting my doses into 500 mg 4 x per day.)

As a woman, it is even more important that we be vigilant with our bones, so I don't fool around with it.  I take more than the MINIMUM my surgeon recommends because I have done enough research to know that that is not enough. 

B vitamins are water soluable.  There IS no upper limit on B vitamins because they are next to impossible to overdose on - especially given the malabsorption associated with RNY.  Given the absolute HORROR of the side effects of going deficient on B-12 and the near impossibility of getting too much B-12, I'm erring on the side of caution and taking 5 regular sublinguals (which is again, no more than 1 megadose which many people take) daily. 

You may also be interested to learn that 25 - 30 % of B-12 deficiencies are MISSING by blood work (since blood work tests for blood serum levels only and the majority of B-12 is stored in the body's organs). 

Everyone needs to remember that while blood work is EXTREMELY important, it is the LAST PLACE that a deficiency will show up.  The blood pulls the vitamins/minerals it needs from the rest of your body (organs/bones/etc) to maintain adequate amounts.  So by the time the BLOOD is low or out of a vitamin, your bones/organs/etc have already BEEN deficient.  This is why many people become symptomatic of vitamin deficiency when their blood work still shows that they are just fine.