Most of the US population is nutrient-depleted in some vitamin or another as our general diet does not provide us with sufficient quantities of these substances. In addition, our agricultural soils are not the same as they were just a few generations ago - a carrot from 1960 and another from 2017 may not have the same amount of nutrients. Keeping some of these factors in mind, the American Dietetic Association has recommended that all Americans take supplements to fill these voids in their diets. This is recommended for the general population who has their stomachs and digestive tracts intact.
Now, imagine the scenario after weight loss surgery. The pouch is reduced in size significantly and so one is limited to the amount of food that can be ingested at any given time, i.e. only about one cup of food. This drastically limits the amount of nutrients absorbed. Even if you eat nutrient-dense food, you are likely still deficient in daily vitamins and minerals.
Thus, to keep your body working at maximum efficiency, you need to supplement your food with vitamins every day for the rest of your life, something likely imparted to you from your WLS surgeon. This is because not only are you unable to consume enough food (quantity) to meet your vitamin and mineral requirements, but also because you will have a decreased ability to digest and absorb certain nutrients, especially if you have had gastric bypass surgery.
It is recommended that you take a Multivitamin supplement, plus additional supplements of Calcium, Iron, Vitamin B12, and Vitamin D3.
Ideally, you should begin the vitamins and mineral supplements regimen when you decide to have the surgery as it is beneficial to go into surgery as healthy as possible. To ensure that all these supplements are taken in the correct dose and form, Bariatric-specific supplements, which have been designed for maximum absorption, are recommended.
Start taking one BariMelts® Multivitamin twice a day regardless of your surgery. Consider taking more or fewer tablets based on your procedure type, but always after consulting with your healthcare practitioner. Pay close attention to how you feel and the results of any blood tests.
There is typically only a small amount of Calcium in some multivitamins. Therefore, it is recommended taking an additional 1000mg-1500mg of Calcium daily. After your surgery, you will need to take a chewable form because most non-chewable supplements are too large and difficult to swallow.
We designed BariMelts® Calcium to dissolve smoothly in your mouth and take up little room in the pouch. We also spent a great deal of time formulating a product that does not have the typical chalkiness associated with Calcium supplements.
There are different forms of Calcium, including Calcium Carbonate and Calcium Citrate. Calcium Citrate is perhaps the most efficiently absorbed form of Calcium following gastric bypass because it dissociates without the presence of stomach acid, something Bariatric patients are often lacking.
Doctors from the Mayo clinic recently looked at 97 patients from the past 20 years who had bariatric surgery. They found that 21 of these patients had suffered a total of 31 fractures – this is more than twice the fracture risk of the general population. Most fractures occurred an average of seven years after surgery, with the primary locations being in the hands and feet. Other sites of fractures were the hip, spine and upper arm.
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. The American Society for Metabolic and Bariatric Surgery (ASMBS) recommended intakes for calcium after bariatric surgery are as follows:
• 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*
Spread your Calcium intake over several doses as there is research to suggest that the body cannot absorb more than 500mg at one time.
It is important not to take the Calcium and Iron supplements at the same time, as they may interfere with the absorption of each other. Take them at least two hours apart from one another.
It is recommended that you take an Iron supplement daily, in addition to any Iron in your Multivitamin. Nausea and constipation are common side effects of Iron supplementation.
However, if there is still a problem with nausea and/or constipation, try taking your Iron every other day instead of daily.
Again, avoid taking the Calcium and Iron supplements at the same time, as they interfere with the absorption of each other. Take your Calcium and Iron at least two hours apart from one another.
Your Iron supplement may also be best absorbed when taken with food, specifically acidic ones like citrus or vegetables. BariMelts® has added Vitamin C directly into the melt to help with the absorption.
Vitamin B12 and other B Vitamins
Vitamin B12 is digested and absorbed differently than most vitamins. After gastric bypass surgery, you may no longer be able to digest and absorb sufficient amounts of B12 to maintain health. Often you must take your B12 in a form that absorbs very efficiently. There are three ways to do this:
A monthly Vitamin B12 injection can be obtained at your primary care physician’s office after gastric bypass surgery.
A weekly nasal spray is also an option for your B12 needs.
Another option is to take sublingual B12 that dissolves in the oral cavity or “sublingually.”
The American Journal of Clinical Nutrition - Vitamin D3 deficiency: A worldwide problem with health consequences*
Everyone on the planet needs Vitamin D3, not just Bariatric surgery patients.
However, supplementation alone is not enough. Exposure to sunlight is a must for the Vitamin D3 to function effectively. Roll up your sleeves and enjoy the sunlight!
Other sources of Vitamin D3 include cold-water fish like salmon and egg yolks.
Not all pills are created equal
If you need to consume regular tablets, capsules or pills for medication reasons, they need to be in powder form before consuming, so crush and/or open them.
This is because you likely will not be able to absorb whole pills as well as you did before surgery, and pills may have difficulty passing through your new digestive system.
Make sure you check with you pharmacist if your medication can be opened or crushed. You may need to get a different form of your medication. Always discuss these with your doctor before use.
Medications Change with Weight Loss
After surgery, you should resume taking your usual medicines for other conditions. Check-in with your primary care doctor frequently to make sure you are taking the correct dose.
You may need a smaller dose of your medications for medical conditions related to obesity. As you lose weight you may need to adjust your medications for diabetes and or hypertension as you may not need as much as you did previously while you lose weight. If you are feeling different or dizzy for any reason, call your doctor.
Extended Release Medications
Extended release medications may not be absorbed properly and should probably be substituted with medications that don't have a timed-release component. This is especially true with Gastric Bypass patients. As always, consult your healthcare practitioner to determine the best solution for you.
NSAID’S are NO-NO’s
If you haven’t already been told, avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, Ibuprofen, Advil, Motrin, Aleve, Naproxen, Vioxx, and Celebrex. These medications increase your risk of developing ulcers, which are more difficult to diagnose and treat following Bariatric surgery. Check with your primary care doctor or pharmacist when starting a new medication.
100% Daily Values for Common Nutrients*
|Nutrient||100% Daily Value|
|Vitamin A||5,000 IU|
|Vitamin C||60 mg|
|Vitamin D||400 IU|
|Vitamin E||30 IU|
|Vitamin K||80 mcg|
|Vitamin B-1||1.5 mg|
|Vitamin B-2||1.7 mg|
|Vitamin B-6||2 mg|
|Vitamin B-12||6 mcg|
|Pantothenic Acid||10 mg|
Note: These values do not reflect specific recommendations for weight-loss surgery patients. Patients should talk to their surgeon for recommended vitamin intake.