BariMelts® are not just regular nutritional supplements. They were specifically designed to help YOU, the Bariatric patient, in long-term nutritional success. If you have had or are planning on undergoing surgical weight loss surgery, you have taken a big step in your life. However, you must know that surgery is just the beginning of the journey. The qualities that make bariatric surgery so successful, specifically the restrictive and malabsorptive aspects of procedures also create special nutritional issues that make bariatric-specific formulated vitamins a vital part of your daily routine.
Weight loss surgery naturally creates nutritional deficiencies for a variety of reasons. Firstly, there is reduced daily food intake due to the procedure making structural changes to the internal anatomy of the body, causing you to eat less than before. Due to this reduced stomach size, the gastric pouch produces only a small amount of digestive enzymes used for the complete digestion of certain foods. It also produces minimal amounts of gastric acid and intrinsic factor which are both required for the proper absorption of Vitamin B12. For gastric bypass procedures, the stomach bypasses a portion of the gut, which is necessary for the absorption of many vitamins and minerals.
Regular over the counter daily multivitamins and/or children’s chewable supplements are not good choices for vitamins and minerals to meet the deficiency of nutrients. Post gastric bypass surgery, patients can choose bariatric specific formulated vitamins to address these concerns.
If bariatric nutritional needs are ignored, deficiencies can occur, causing significant health complications. Also, if you are diligent about implementing a daily bariatric supplement routine, you will likely find yourself feeling healthier, happier, and more energetic!
Functions of Calcium:
Calcium is the most copious mineral in your body. About 99% of your body’s calcium is incorporated into the structure of your bones and teeth. Calcium also plays an important role in your body’s blood clotting abilities. Poor bone health, oral health, or other long-term challenges can be due to lack of proper amount of calcium that you can contribute daily.
If you do not get enough calcium daily, either from your food or supplements, your body will start taking the calcium it needs from your bones. This process is called leaching and, over time, compromises your bone health. If your family history includes any cases of osteopenia or osteoporosis, this becomes more of a concern for you, as this is a genetic disorder.
Calcium rich foods include: milk, yogurt, cheese, sardines, dark leafy greens; like spinach, kale, turnips, and collard greens, soybeans, and fortified soymilk. Not all soymilk is a good source of calcium, so it's best to check the label.
Getting Enough Calcium:
While eating a calcium-rich diet is important, you still will not be able to get enough calcium into your diet, due to the limited size of your pouch. In addition, experts recommend that individuals who have had bariatric surgery take calcium supplements to get enough of this important mineral. The recommended daily dose of calcium for bariatric patients is 1,200-2,400 mg a day, according to the guidelines published by The Obesity Society and American Society for Metabolic & Bariatric Surgery.
Since many changes have been made to your digestive system post surgery, you are at particular risk of challenges with absorption of nutrients, including calcium and vitamin D. Bariatric surgeries may also increase bone turnover and loss of bone mass in you, part of which is due to massive weight loss alone, which always results in the loss of some lean mass - including bone. Therefore, it is critical that you regularly get adequate calcium to reduce the risk of deficiencies, bone loss, and for long-term health.
Biologically speaking, calcium from foods and some types of dietary supplements must become ionized in an acid medium in order to be absorbed in the small intestine. In bariatric patients, certain forms of calcium such as calcium carbonate, found in many over-the-counter vitamins, are not likely to be well absorbed after surgery because they require interaction with hydrochloric acid, which is limited after common procedures. After bariatric surgery, there is less contact of food with stomach acid, making it very difficult to absorb calcium carbonate. For this reason, calcium citrate is generally recommended after bariatric surgery to support absorption.
Points to remember:
The one thing you need to remember is to not take Calcium with Iron. There is research to suggest that they impact each other’s absorption. This also means do not eat iron rich food when taking your calcium. Iron rich foods include: red meat, egg yolks, dark leafy greens, spinach, collards, dried fruit (prunes and raisins), iron enriched cereals and grains, oysters, clams, scallops, turkey giblets, chicken giblets, beans, lentils, chick-peas, soybeans, liver, and artichokes. Ideally, keep a 2 hour gap in between your calcium and iron supplements.
Tips for Bariatric Patients:
The following suggested guidelines could help bariatric surgery patients ensure that they are taking calcium supplements that will meet their needs for life:
First, consult with your physician to be sure you understand the guidelines for nutritional supplementation before and after your surgery, and for the rest of your life.
When selecting a supplement, look for one that uses calcium citrate, the form most commonly recommended after bariatric surgery to support absorption. Make sure that your calcium supplement also contains Vitamin D.
Because bariatric patients generally need more supplemental calcium than adults who have not had this surgery, selecting a dose with a higher amount of calcium – say 500 mg versus 250 mg – means taking fewer pills and may make adherence easier.
About Iron and Iron Deficiency
Functions of Iron:
Iron is a mineral in your body that is very important for building blood cells, carrying oxygen, enzyme functions, immune system function, detoxification, growth and development.
Some other symptoms of iron deficiency may include one or many of the following:
Anemia, brittle nails, confusion, constipation, depression, dizziness, fatigue, headaches, inflamed tongue, mouth lesions, loss of appetite, difficulty thinking, shortness of breath, lightheaded, feel cold, headache, brittle nails, hair loss, slow-thinking, leg cramps, restless leg syndrome, ice eating and/or Pica (cravings for non-food items like dirt, starch, paper, etc.).
When you do not have enough iron you may notice that you are tired and weak. Your family and friends may tell you that you look pale or grayish, and the whites of your eyes can become blue-tinted.
If iron becomes too low your doctor may tell you that you have iron deficiency anemia - this happens because there is not enough iron to make blood cells normally and your blood cells become very small and pale.
If iron deficiency continues for a long time you can develop infections, serious heart problems, or problems with pregnancy if you are a woman. It is also more dangerous if you have a serious injury or require surgery, and you have an iron deficiency.
Iron can be found in both foods and dietary supplements. The best food sources are beef, lamb, fish/shellfish, poultry, and egg yolk. There are non-animal sources of iron including dried fruits, kidney beans, lentils, cashews, blackstrap molasses, and cashews - but it is very important to know that the iron in animal protein is much better absorbed than the other sources. If you have an iron deficiency, your doctor will probably ask you to take supplemental iron and watch your dietary intake.
Points to remember:
If you are taking iron, it is also generally recommended that you do not take it at the same time as calcium or calcium containing foods. There is research to suggest that they will cancel each other out in their absorption. Calcium food items include milk, yogurt, cheese, sardines, spinach, kale, turnips, collard greens, fortified cereals, fortified orange juice, soybeans, fortified soymilk, enriched breads, grains, and waffles. Wait about 2 hours until you take your calcium after taking your Iron.
It is also beneficial to take iron supplements with a meal that contains an iron-rich food such as meat.
If you have iron deficiency, it is important that you follow up with your doctor for lab tests and other recommended treatment.
About Vitamin B12 and Vitamin B12 Deficiency
Vitamin B12 is one of the B-complex vitamins. It is important for the function of your nerves and for the production of the DNA and RNA in your cells. It also works together with folic acid to make red blood cells and other compounds that are important for your cardiovascular and immune systems. It works together with the other B vitamins to calm you down and make you feel more energized.
If you do not have enough B12 you may notice that you get tired easily and feel weak. You may experience dizziness; heart palpitations - rapid heart beats, and feels short of breath, poor appetite, sore or swollen tongue, and numbness and tingling of the hands and feet.
It is common for people with low B12 to develop anemia, as they can’t make blood cells normally. during anemia, the cells become large and the nucleus of the cell is not formed properly. If B12 deficiency is allowed to continue for a long time, serious problems can develop such as permanent damage to your nerves, memory loss and dementia.
Some of the symptoms of B12 deficiency are: diarrhea, Irritability, muscle weakness, strange sensations, numbness, or tingling in the hands, legs, or feet, difficulty walking - staggering, balance problems, anemia, a swollen, inflamed tongue, difficulty thinking and reasoning (cognitive difficulties), or memory loss, changes in vision, psychosis, paranoia, hallucinations, burning sensation around mouth, fatigue, yellowish skin and or eyes, depression, and difficulty walking.
You can also get B12 in dietary supplements. It is found in most multivitamins, in B-complex, and alone in tablets, capsules, liquids and sublingual’s - pills that dissolve under the tongue are most preferred. It is also available as a prescription as injections or as a nasal spray. If you have a B12 deficiency, your doctor will probably ask you to take supplemental or prescription B12 and watch your dietary intake.
B12 is only found in foods of animal origins. Good dietary sources of vitamin B12 include oysters, clams, mussels, liver, liverwurst sausage, mackerel, smoked salmon, herring, tuna, canned sardines, trout, fortified soy products, low fat dairy products, kidney, eggs, beef, pork, Swiss cheese, low fat mozzarella, Parmesan cheese, Feta cheese, Gietast cheese, and Tilsit cheese.
Plants do not make B12 – so fruits, vegetables, beans and grains will not supply this vitamin.
Points to remember:
If you have weight loss surgery such as gastric bypass, it is harder for the body to absorb B12 from food and from some types of supplements. For this reason, your doctor may ask you to use a sublingual product, or to get regular injections to prevent problems. If you have B12 deficiency, it is important that you follow up with your doctor for lab tests.
Other possible impacts to your B12 absorption:
- Being over 50 years old
- Taking a proton-pump inhibitor (such as Nexium or Prevacid)
- Taking H2 blockers (such as Pepcid or Zantac)
- Taking metformin (a diabetes drug)
- Being a strict vegetarian
If you checked any of the above you need to take B12 every day. You also need to make sure your doctor checks your B12 level frequently.