Recommended Bariatric Vitamins and Minerals
- Celebrate: Chewables, soft chews and liquid
- Advantage Bariatric: Chewables, soft chews and liquid (use validation code "LBH")
- NutraMetrix: Liquid vitamins, Isotonix multivitamin (with or without iron), Isotonix Calcium Complete + Vitamin D
Take one vitamin daily (a One A Day or Centrum multivitamin for your age group) until one week prior to surgery. Stop the multivitamin one week prior to your surgery date.
Adjustable Gastric Band Patients
Vitamin/mineral supplements are essential for life because patients can no longer eat enough of the food groups necessary to prevent nutritional deficiencies.
Vitamin Schedule First Month Post-Surgery
Important: The multivitamins and calcium with vitamin D must be in chewable or liquid forms. Otherwise, they could get stuck and cause vomiting or a blocked stoma.
- Step 1: Take one Bariatric Advantage chewable multivitamin and one Calcium Citrate with vitamin D chew.
- Step 2: Wait three to four hours.
- Step 3: Repeat Step 1.
- Step 4: Wait three to four hours.
- Step 5: Take one Calcium Citrate with vitamin D chew.
Vitamin Schedule Beyond First Month Post-Surgery
Important: Adjustable gastric band patients may swallow the vitamins and calcium after the first month because they still have the whole stomach intact and continue to have all the gastric juices to help break down vitamins. They also have all of the small intestine intact for 100 percent absorption. The swelling from the placement of the band has disappeared after 30 days so that swallowing pills is no longer an issue.
- Step 1: In the morning, take a One A Day or Centrum multivitamin for your age group and one Citracal calcium with vitamin D.
- Step 2: In the evening, take a One A Day or Centrum multivitamin for your age group and one Citracal calcium with vitamin D.
Gastric Bypass Patients
Specific vitamins and minerals must be taken for the rest of the patient's life due to decreased stomach size, bypassing some of the small intestine where the vitamins and minerals are specifically absorbed, and a lack of gastric juice in the new stomach to help break down vitamins.
This patient population is on chewable or liquid forms of vitamins/minerals permanently. They may switch to gel-encapsulated forms after the first month post-surgery when the swelling has decreased back to normal. If gel-encapsulated forms are swallowed earlier than one month post-surgery, they can cause blockages.
Why do gastric bypass patients need a shot or sublingual form of B12?
The new stomach pouch does not contain the gastric acid juices necessary to remove B12 from the food or multivitamin the patient is swallowing. The new pouch is disconnected from the rest of the stomach. Therefore, the cascade of proteins that B12 has to attach itself to before being absorbed in the ileum of the small intestine does not occur. Therefore, B12 has to be taken directly into the patient's bloodstream so the patient will absorb all of it.
Why are all the other vitamins necessary for gastric bypass patients?
The surgeon bypasses a section of the small intestine where the vitamins and minerals like to be absorbed, and there is no gastric juice in the new stomach to break down the vitamins and minerals. This is why patients have malabsorption and must take specific types of vitamins and minerals to ensure that they absorb them.
- Step 1: In the morning, take one Bariatric Advantage Passion Fruit Chewable Iron daily and either one Sublinqual B12 every other day or one B12 shot monthly.
- Step 2: Wait four hours. (Calcium and iron bind together and then the body won't absorb either one.)
- Step 3: Take one Bariatric Advantage chewable multivitamin and one Calcium Citrate with vitamin D chew.
- Step 4: Wait two hours (to absorb the first dose prior to taking the next dose).
- Step 5: Take one Bariatric Advantage chewable multivitamin and one Calcium Citrate with vitamin D chew.
- Step 6: Wait two hours.
- Step 7: Take one Calcium Citrate with vitamin D chew.
- Step 8: Wait four hours.
- Step 9: In the evening, take one Bariatric Advantage Passion Fruit Chewable Iron.
Important Information for All Patients
- All vitamins/minerals must be taken as the schedule states, because if the vitamins are taken all at once the patient will only absorb a small fraction of what is needed and the rest will be lost.
- Chronically forgetting to take the vitamins, not taking the vitamins at all or taking them all at once will lead to deficiencies and illness.
- Do not take calcium carbonate forms of calcium. You will only absorb 8 percent of this calcium but will absorb 48 percent of the calcium citrate form. The calcium carbonate forms can also lead to chronic nausea and gas pain in certain patients and cause kidney stones, especially for those patients with a history of kidney stones.
- Do not drink caffeinated beverages until you are able to drink 64 ounces of noncaffeinated fluids; then you may have 16 ounces of a caffeinated beverage.
- Caffeine interferes with vitamin/mineral absorption. Do not drink caffeinated beverages within an hour of taking the vitamins.
- Too much caffeine also can lead to anemia. Caffeine removes iron from your body.
Deficiencies occur when patients don't follow directions or take over-the-counter products not approved by the dietitian. Coming to your follow-up appointments and getting labs drawn prior to the follow-up appointments is imperative to avoiding deficiency issues. Low levels of vitamins/minerals will be addressed quickly before any problems become permanent.
- Thiamine (B1) deficiency = Beri-Beri = anorexia (loss of appetite), altered heart rate, right-sided heart failure, edema, muscle weakness, nerve problems
- Riboflavin (B2) deficiency = magenta tongue (purple color), chelosis (dry, cracked lips), nervous system problems, eye sensitivity to light, skin rashes
- Niacin (B3) deficiency = Pellegra = red neck, diarrhea, dementia, dermatitis (red, crusty skin where sunlight strikes it)
- Biotin (B4) deficiency = dermatitis (dry, scaly skin), alopecia (hair loss)
- Pantothenic acid (B5) deficiency = intestinal distress (vomiting), fatigue, insomnia
- Vitamin B6 deficiency = insomnia, fatigue, dermatitis, glossitis (sore/swollen tongue), depression, confusion, convulsions, anemia
- Folic acid deficiency = megoloblastic anemia, impaired protein metabolism, leukopenia (low white blood cells), thrombocytopenia (low blood platelets and bleeding
- Magnesium deficiency = anorexia, nausea, fatigue, weakness, seizures, muscle cramping, personality changes, abnormal heart rhythms, coronary spasms, hypocalcemia (low calcium), hypokalemia (low potassium)
- Iron deficiency = anemia, fatigue, dizziness, low blood count and stores
- Calcium deficiency = osteopenia, osteoporosis (weak/broken bones)
- B12 deficiency = macrocytic anemia (large red blood cells), leukopenia, thrombocytopenia, glossitis, neuropsychiatric complications (nerve damage, trouble walking, tingling in hands and feet, paralysis)
- Step 1: Take iron pill with first meal, and sublingual B12 under the tongue.
- Step 2: Wait four hours.
- Step 3: Take one chewable multivitamin (MVI) and one calcium chew.
- Step 4: Wait two hours.
- Step 5: Take one MVI and one calcium chew.
- Step 6: Wait two hours, then take last calcium chew.
- Step 7: Wait four hours.
- Step 8: Take last iron pill with last meal.