Confused about Malabsorption Re Pills/Vitamins

So at 18 months post-op, I'm 185 lbs. down, looking and feeling very fine! Onederland is within 3-5 lbs!

My question that I've been pondering/researching is this: Why is it that I definitely malabsorbed my birth control pill over the past 1.5 years (spotted and bled for days off-schedule) yet am to believe that I will not malabsorb non-chewable vitamins and supplements I just bought? I made the switch from Bariatric Advantage and Celebrate chewables that are costly to Kirkland brand (Costco's) 500 mg Calcium Citrate with D, magnesium and zinc and Kirkland brand (comparable to Centrum) swallowable multi-vitamins. OH experts I trust have stated that non-chewables are ok this far out, that they maintain good labs. This week I've been taking two multi-vitamins and 1750 mg. (7 a day) Calcium Citrates. I have not missed the gritty taste or the expense, but I still worry about malabsorption of these large oblong pills...

Ease my mind, please!

~Linda

Well first off, it wasn't so much that you were malabsorbing your BC pill as that your system was overwhelmed by all the estrogen being released from the fat as it melted. That was enough to cause spotting and for your BC to not be effective. You were lucky you didn't accidentally get pregnant.

I'm assuming you had RNY since you're asking about malabsorption. The RNY operation cuts the top part of the stomach away, and cuts the remaining stomach from the intestines at a certain length (the number of inches depends on your surgeon's technique). This part of the intestines just below the stomach is where all of the B12, and most of the Iron and Calcium receptors lie. Since this part of the stomach is bypassed, no food passes these receptors and so we tend to get deficient in these three.

Initially after the surgery our system just doesn't know what to do with the food that we present it. Before: the food was mixed with gastric juices in the stomach and didn't get emptied into the intestines until it was disolved into a nutrient rich soup. Now it'****ting a lower section of the guts as chewed up food - not disolved at all (or very little - saliva can disolve food somewhat, which is why we're told to chew, chew chew). The juices are still going to the stomach and don't reach the food until the Y where the old intestines are tied in. Finally the food gets disolved in the guts and the receptors can get the nutrients. But a lot of receptors got bypassed in the process. Thus - malnutrition.

So chewed vitamins and liquid supplements have been somewhat disolved by saliva and can be used by the receptors, where solid pills have to wait until they get to the Y and mix with the gastric juices.

I've been told that our system figures out how to adapt to the new way of disolving food but I'm not sure I'm buying it either. I still do my chewables (3 years post RNY), and make sure my supplements are in liquid gels. I won't ever forget seeing a white tablet in my feces and realizing that it was my Vit D that had made it all the way through my system without being disolved. That was enough to convince me to switch to gels.

BTW, I said all of the B12 receptors are bypassed. THat's why we need to use the sublingual, the blood vessels under the tongue can get the B12 right into our blood stream. OItherwise, you have to go get the shots.

Well, first of all, BC is not vitamins.

Some supplements are more bio-available than others. Some forms are more bio-available than others. Some medicines work better than others with an altered anatomy. Plus everyone is different...

If you put your vitamins in water and they dissolve quickly, they should dissolve in your stomach. Andrea U, whose hobby is vitamins, has some pictures on her blog of dissolved calcium pills and talks about this.

In general, chewables and liquid forms are the most bio-available. Whole food supplements that have no coatings on the pills are also fairly bioavailable. Then you have pills with coatings followed by time-release pills.

I think it's generally accepted that time-release pills don't work well if you have RnY. But, for the others, it's going to depend. I would go by your labs. If your labs are good, then you are getting the micronutrients you need from whatever you are eating and taking as supplements, whether they are pills or chewables.

My big problem with both liquids and chewables for your multi-vitamin is that they are missing micronutrients compared to a high-quality multi. It doesn't matter if the chewable is better absorbed if it hasn't got X in it. (The reason they are missing is because there is no way to make them taste good.)

When it comes down to it, it's all about balance ... what you can take, what you can afford vs. what is the ideal. Sometimes it's worth it to go with a less than ideal solution because the alternative is even worse. But sometimes it isn't. I don't compromise on anything I've had issues with (mostly protein, calcium and potassium) but I'm less rigid in areas I've never had issues.

Thanks for taking the time to reply and explain; I do appreciate it! My labs have been excellent (my first year post-op) having taken chewables the whole time. Just this month I've switched to swallowables, so I shall see what my blood work says...I just don't want to wait until my body shows a deficit, ya know?