vitamins

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

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1000 μg/mo

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Begin 0–3 mo after surgery

Oral tablet (crystalline form)

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350–500 μg/d

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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)

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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)

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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