Why are supplements so important?Even with supplementation, postoperative iron deficiency occurs in 20% to 50% of patients and B12 deficiency occurs in 12% to 33% of patients after gastric bypass surgery. This is another reason why bloodwork is so very important. New research shows calcium, vitamin A, selenium, vitamin E, vitamin D, thiamine, and folate as possible other deficiencies. Eating healthy and maximizing your nutrition, as well as taking supplements, can help you avoid these pitfalls. Supplements do not take the place of a good diet, but they can enrich it.
Several good reasons for taking dietary supplements include:
Supply nutrients you are not getting in your diet
Optimizing your micronutrient intake
Overcoming problems with malabsorption
Replacing nutrients lost during illness, surgery and recovery
How long do I need to take my supplement?
You should be taking daily for the rest of your life:
Multivitamin with minerals daily.
Calcium citrate three times per day (providing 1500 mg)
B-50 complex daily.
Additional Vitamin B12 sublingual may be recommended if lab levels reflect low levels.
Iron: generally for menstruating women and person with a history of iron deficiency anemia 27 mg of elemental iron daily. For males or post-menopausal women 18 mg of elemental iron daily.
Which brand do I choose?
When you enter a grocery store or vitamin store it can be very overwhelming with all the various brands and type of products. For specific brand information please contact the Bariatric Clinic at 303-839-6370 for the list of approved supplements. This list has been carefully reviewed by a registered dietitian to ensure your body receives all the vitamins and minerals it needs after surgery. If you do not want the stress or hassle of figuring out which supplements to purchase after surgery please refer to your binder for Bariatric Advantage ordering instructions. We have put together a gastric bypass kit which includes; Bariatric Advantage MVI, iron, B-50 complex and calcium citrate. If you do not wish to purchase the Bariatric Advantage line, please review these simple rules when purchasing your supplements over the counter.
Guidelines when purchasing MVI after gastric bypass
When taking a general MVI such as Centrum or One-A-Day for women double the recommended dose on the label.
When taking a general prenatal vitamin typically 1 tablet per day will meet your daily needs for 18 mg of iron and 800 mcg of folic acid.
Please note when selecting brands such as Bariatric Advantage the Multi-vitamin does not contain any iron. The iron is to be taken in addition to the MVI.
Liquid forms of MVI and food based MVI often lack iron and zinc. Please note that the brands listed on the table Tropical Oasis and Now MVI are incomplete. Additional supplementation of iron and zinc need to be taken in combination with these products.
Liquid forms of MVI often contain sugar and add additional calories of up to 50 per day depending on the brand selected.
Children’s chewable MVI are often incomplete and are not recommend after gastric bypass surgery.
Avoid buying MVI in bulk or at dollar stores.
How to store your vitamins
Store them in a cool, dry place. Do not store in the bathroom or refrigerator because humidity will reduce freshness and efficacy. Keep vitamins away from sunlight because some vitamins are destroyed by light. Keep your vitamins in their original bottle which serves as a barrier to moisture and light. Check the expiration date and take vitamins before expiration to insure label potency. Keep out of reach of children, especially those under 4 years of age. Vitamins containing iron are capped with a special childproof cover. Nevertheless, if your child does swallow more then one iron containing pill CONTACT YOUR PHYSICAN AND POISIN CONTROL CENTER immediately.
Good rules to follow when taking a supplement:
Always take a MVI with food to help prevent stomach upset. Use fresh water to swallow your vitamins. Do not take vitamins with tea, coffee, soda, fruit juice or alcoholic drinks as chemicals in these beverages can cause interactions between nutrients in the formula. If you find it hard to swallow pills or capsules, try changing to a chewable form. Avoid supplements which have enteric coating or time released forms as the absorption can be affected after gastric bypass. When choosing multivitamins that require several does, it is best to divide the doses over more than one meal to get the maximum benefit.
What to look for in your supplement:
Look for nutrient labeled as USP or NF. A USP designation means that the ingredients meet the quality control criteria of the United States Pharmacopoeia. NF means that the nutrient meets the criteria for the National Formulary. These standards are currently available for only about 1800 substances, so not all nutrients are available with this labeling. Look for products that meet the USP requirements for disintegration and dissolution which means they break down in the digestive track in a certain amount of time. This information may not be on the label- you may need to contact the manufacturer. Capsules meeting this code will breakdown in 30 minutes, tablets breakdown in 45 minutes. Minimize "other" ingredients. Look for a supplement that does not have artificial colors, flavors, sugars, and artificial sweeteners. Artificial colors and sweeteners can cause an increase risk of allergic reactions and sensitivities, and sugars and artificial sweeteners may cause discomfort. Avoid herbs and herbal extracts without first consulting your physician. Why? Many herbs have drug interactions or drug – nutrient interactions and can be potentially harmful. In addition, certain herbs require monitoring the same as certain medications to avoid potential permanent liver, kidney or heart damage.
What nutrients are safe?
Remember a supplement is to enrich your new healthy diet, not replace it. You still need to eat healthy as research shows we do not receive the same benefits from supplements as we do from the actual food. Vitamin A: vitamin A over 5000 IU should be in the beta carotene form. Beta carotene is a non toxic form so it can not be overdosed. Vitamin E: look for the natural forms which are listed as "d" forms. An example is d-alpha tocopheryl acetate or succinate. If the form has "dl" then it is synthetic. Natural forms are more readily digestible and absorbed.
Look at vitamin D. Is it D2 or D3? D2 is synthetic (ergocalciferol) and is more difficult for the body to covert to he active form of vitamin D needed for bone health. D3 is the natural form (cholecalciferol) and is more easily utilized. Look for minerals in the more digestible form. Minerals listed as citrates, malates and gluconates are best. Some minerals have specific forms that are more bioavailable. These are: selenium: selenomethionate chromium; chromium picolinate or chromium polynicotinate; iron: ferrous citrate, ferrous glycinate, ferrous fumarate.
