Vitamins....RNY

If you have too much B12 you just pee it out. It would be very hard to OD on it. You can absorb a small amount of B12 your small intestine. That would be why your multi vitamin has such a high dose. It counts on that partial intestinal absorption. Most B12 is absorbed in the area of the stomach that has been separated from your pouch. RNY patients have a hard time keeping their B12 in normal range. I can't take any B12 other than injections, and I have two per month. Nothing else works for me. I know people who have to do injections weekly just to stay in range.

I had my first VBG surgery over thirty years ago and a revision 7 years ago due to mechanical failure. My doctors at Mayo Clinic have always told me to avoid vitamins with oral B12 and Vitamin D and just take a double dose (one in the morning and one at night) of an ordinary adult multi vitamin like Centrum. There is no reason to spend extra money on bariatric vitamins. I was told to supplement with additional B12 and D3. If you read the article on today's front page of OH, it starts to go into vitamin supplementation. The second part of the article will be about B12. I look forward to any new information. Maybe the vitamin formulas have changed since my surgery. Until then I will keep doing what I'm doing. My labs are all on the high end of normal. It took a few years of tweaking the dosages though.

It may take years for a deficiency to show up, so the best advice I have is to start a spread sheet with all your lab numbers and watch for downward trends. Then you can see if what you are doing is actually working. Everyone is different. I have to take additional Magnesium, Zinc, K2, and Vitamin A, based on tracking my lab numbers. Any doctor that tells you that taking a "one size fits all" vitamin is all you need to take is woefully misinformed. I've seen lots of folks, who have taken their multi vitamins faithfully, come back to OH deficient and asking for advice.

Thank you. I will indeed start a spreadsheet with the results of my upcoming labwork. I feel really, really good, but realize as you said that deficiencies can be subtle, sneaky things that can take their time to do harm. I will begin a different approach to supplementation.

Thank you Amy. They are telling me my iron is normal at 84 but my ferritin is 8. B12 is in the 800's and D is low. My drs office didn't really seem to know what to do. May have to contact my surgeons office. They are going to prescribe me a Ferrex iron only because I asked. Wondering if maybe I need infusions. Thanks for your help

You will NEVER get your ferritin number up with oral supplementation at this point. At 8, your ferritin is dangerously low. Your best route is infusions. Ask for a referral to a hematologist ASAP. Many of us are not showing signs of anemia and have "normal" iron. Our bodies are using the stored iron (ferritin) instead of iron from food. Since most iron comes from meat, (and we can't eat much meat), it makes sense that our bodies would turn to the stored iron. Symptoms of low ferritin are fatigue, restless leg syndrome, heart palpitations, hair loss, depression, lethargy, etc.

At 800, your B12 is not too bad. You should be able to get that number up with sublingual tablets. Don't let it drop below 400. We can get permanent nerve damage from low B12.

As I understand it-- (disclaimer, I'm a science nerd but not a medical professional):

Vitamin D is a fat-soluble vitamin. RNY'ers malabsorb fats, which means the vitamins floating in the fat/oil inside a capsule won't be absorbed either. Therefore, you're best off taking a "dry" vitamin D, which might be a powder inside a capsule or a tablet. You can buy it over the counter at a vitamin store; look for something like this.

If you have a ferritin of 84, that's within the "normal" range, which is 20 to 200. (Source) This summary from the ASMBS also defines deficiency as ferritin under 20. (See page 2 of this document.)

Your current iron level is good to know, but you'll also want to track the TRENDS of your iron. When you get it checked the next time, see if it's staying level or starting to drop. Ferritin measures your body's backup stores of iron, so if it's decreasing that means that your body is using up its iron reserves.

Over the counter D3 is what you should be taking. Make sure it is not in gelcap form. It must be in a dry tablet form. Many people get a prescription from the doctor, but that is D2 and we don't absorb it well. Over the counter D3 is a much better choice post WLS. You want your vitamin D levels to be between 60 and 80. Your D level is VERY low. You will need to do some heavy duty supplementation to get that number up. I had to take 10,000 mg 3 time per week for several months to raise my numbers. If you do a large dose, make sure you get retested frequently. High D is not good either. I bet you are pretty fatigued with those numbers.

I like to keep my numbers at the high end of normal. I want my ferritin to be around 150. If it gets below 50, you can start feeling fatigue, restless leg syndrome, and other symptoms.

B12 is a water soluble vitamin and if its high it really does not effect you. I like mine to be over 1000. I keep it at around 1200.

Extra iron supplementation is common after WLS. Many of us simply do not absorb iron well. Make sure your iron is a 65 mg elemental iron. If it does not say elemental iron, you are not taking an iron that we can absorb. Carbonyl iron is what I take. It's easily absorbed and also easy on the stomach. Many ferrous irons can cause constipation.

Thank you! I just found out my ferritin is 8. Does an iron pill bring that up too?

Unfortunately, probably not with it already being so low.

Yes, you take a dry D3, and they are over the counter.

I found some dry D3 tablets at Wal Mart a couple of years ago. They will say "tablets" on them not "soft gels". If you can't find them at anywhere locally, there's always the internet. ( Yay for online shopping! ) Nature Made was the brand.

There's a huge range of "normal" for ferritin ( 5-200 ng/mL according to my lab results ) levels. You want closer to the higher end of normal. My personal aim is 100 or higher.

Keep in mind that you also need to be on the lookout for level up or down trends in your numbers from here on out. If it were me in this situation, I'd be getting blood work done every 3 months for the next year or two to monitor your levels to make sure you're absorbing your supplements, then taper off to every 6 months.

Wait a minute.... You're saying that the Bari Advantage vitamins and calciums I've been taking faithfully for the past 6 months are not absorbable by RNY recipients?

DANG!!! Why on earth wouldn't the doctor/nurse/nutritionist tell me that????

And I just stocked up on another year's supply.

DANG!!!!