Vitimin Help

Hello All,

I just got out of my final pre-op class. Some of the vitimin requirements seemed a little strange. I would love to run the info by y'all and hear your thoughts.

1. Two Multi Vits Daily (centrum complete recommended)
2. Vit B 1000mcg daily sublingual
3. Vit D3 2000mcg daily
4. Calcium 1500 including food, she said that if you're meeting this by diet alone then you don't need supplements. Is this true?
5. no iron the first 6 months, only necessary if range is low. Again, seems strange

anything you would add or change to this list? Thanks!!

IN general, the first year after surgery follows at least these basic requirements -- but after that (and before if necessary) your vitamins/supplements will need to be adjusted according to your lab results. To respond to your specifics from my experience:

1. Two Multi Vits Daily (centrum complete recommended) This is generally the recommendation: to take a high quality ADULT vitamin that meets 100% of daily requirements for vitamins and trace minerals, and double it. A multivitamin is very unlikely to have the DV for minerals such as calcium, magnesium or potassium. Products calling themselves "complete" may not actually provide all the vitamins and minerals, so carefully read labels.
2. Vit B 1000mcg daily sublingual I am assuming that this should read B12? The stomach is very important for B12 absorption. This is because stomach acid helps to release B12 from food, and another substance that is made by the stomach - Intrinsic Factor -is essential for B12 absorption. Some bariatric surgery procedures, such as gastric bypass and vertical sleeve gastrectomy, make B12 absorption more difficult for these reasons. Often people who have these procedures will be required to take additional B12 as an injection, intranasal spray or sublingual tablet. Most find the sublingual tablet the easiest way to take it.
3. Vit D3 2000mcg daily. Most of us need to supplement D3 in order to keep at healthy levels (over 50 but lower than 100) -- DRY D3 is most readily absorbed for RNY patients due to malabsorption. Oil based pills are not ideal.
4. Calcium 1500 including food, she said that if you're meeting this by diet alone then you don't need supplements. Is this true? I have not found this to be accurate. Bone loss is a risk after all types of bariatric surgery and getting adequate calcium is one important part of helping to prevent bone loss. Additionally, it must be calcium CITRATE... not carbonate. The American Society for Metabolic and Bariatric Surgery recommended intakes for calcium after bariatric surgery are as follows: (you will need to adjust according to your DXA bone scans and lab work after the first year)

   Adjustable Gastric Band (AGB): 1500mg calcium
   Gastric Bypass (RNY): 1500 to 1800mg calcium as calcium citrate
   Duodenal Switch (DS): 1800 to 2400mg calcium as calcium citrate

5. no iron the first 6 months, only necessary if range is low. Again, seems strange. This was not the recommendation of my program, but ideally iron should be supplemented individually based on your blood work. Low iron or iron deficiency anemia can be a complication of bariatric surgery, but is especially common after gastric bypass. Iron levels are harder to maintain after gastric bypass because the primary area where iron is absorbed (the duodenum) is bypassed. Many doctors will recommend that patients take iron preventively to protect against developing a deficiency. I took 18 mg the first year, 65 the second, and still needed an infusion by my third year.

Really, keeping a good record of your blood test results-- the trends you see, is the best way to figure out your supplementation schedule after the first year. Most people, unless seriously deficient going in - are able to maintain relatively well during the first 12 months... it's the long term where it becomes even more important.

This is so helpful. Thank you. I thought no calcium or iron was strange. Are there any additional vitamins that you find beneficial?

and yes, I'm meant B12!

:)

I'm happy to share what I take, however, I cannot stress enough that every person is individual and really needs to adjust and tweak what they take according to their labs.

Morning:

Multi, 500mg calcium citrate, 200 mg magnesium glycinate, dry D3 1000 I.U., B-complex, inositol

mid-morning:

500 mg calcium citrate, B12 2500 sublingual (3x a week)

lunch:

Multi, 500 mg calcium citrate

Dinner:

500 mg vitamin C, Iron as ferrous fumarate 60mg

Bedtime:

inositol, magnesium citrate (as Calm), Iron as carbonyl 45 mg, 500 mg of vitamin C

Thanks! I appreciate it

Very helpful, Kat. Would you mind sharing your dosage for inositol & magnesium? thanks!

I personally take 8 grams of inositol, 400 mg. of magnesium glycinate, and 250 to 350 mg of magnesium citrate (depends if I use Calm at night or pills that day) per day.

Thank you so much Kat! This is so helpful.

Great post Kat!