I posted a similar article a while ago about choosing and taking vitamin and mineral supplements after bariatric surgery, but I think this information bears repeating. Too many weight loss surgery (WLS) patients:
- stop taking their vitamin and mineral supplements
- forget to take their supplements or do not take them consistently
- take them incorrectly
- take supplements that are not for bariatric patients
All weight loss surgery patients must be on a daily regimen of vitamin and mineral supplements to prevent nutritional deficiencies – this is for life. All, if not most, bariatric surgery patients must be on a high potency multivitamin and calcium with vitamin D. Some patients may need additional iron and B12 depending on blood work results. Let’s take a closer look at the supplements needed after WLS.
What to Look for in a Multivitamin
A good quality, high potency multivitamin is an essential part of the weight loss journey. There are many different types of multivitamins on the market, but not all of them are the best choice for weight loss surgery patients. According the American Society for Metabolic and Bariatric Surgery’s Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient, gastric bypass and gastric sleeve patients should have a high potency multivitamin with 200% Daily Value of at least 2/3 of the nutrients. Additionally, we recommend the following:
- Start a chewable or liquid formulation the day you go home from the hospital.
- You may progress to a tablet or capsule when able – speak to your surgeon or dietitian before switching to a non-chewable multivitamin.
- Avoid time released type supplements
- Choose a multivitamin with at least 18 mg iron, 400 mcg folic acid and contains selenium and zinc in each serving
- Do not take a multivitamin containing iron with your calcium supplements – take 2 hours apart
- Check the serving – not all multivitamins are a “one-a-day.” Some formulations require two or more servings daily.
- DO NOT USE GUMMY TYPE MULTIVITAMINS – they are NOT nutritionally adequate for weight loss surgery patients.
- Read the Supplement Facts label carefully! Not all multivitamins are the same!
Selecting a Calcium with Vitamin D Supplement
It is very difficult to get all nutrients from foods alone due to the limited amount that can be eaten after WLS. Also, patients who have had the gastric bypass or duodenal switch do not absorb all the vitamins and minerals that are in foods. To avoid osteoporosis and dental issues, it is important to take calcium with vitamin D.
We recommend 1200-1500 mg calcium for gastric sleeve and gastric bypass patients (some gastric bypass patients may need 1500-2000 mg calcium daily). Calcium citrate is the preferred form of calcium as it is better absorbed. We suggest starting a chewable or liquid calcium citrate with vitamin D by week four post-surgery. Calcium usually comes in 400 mg, 500 mg or 600 mg doses. Make sure you read the supplement facts labeling carefully so you know:
- What is a dose or serving – it may not be just one chew or wafer
- How much calcium is in each serving or dose
- How many doses do you need to take daily to get in what you need
Calcium should not be taken at the same time as iron or iron containing multivitamins because it can affect how you absorb them. In addition, you can only absorb up to 600 mg of calcium at a time, so all calcium doses should be taken 3-4 hours apart.
Iron and B12
In our practice, we often give our patients a prescription for Ferocon®, which contains both iron and B12. You may get this prescription at your 1 or 5 week post op visit to the office. Ferocon® also contains digestive enzymes to help you absorb it better. If you are taking Ferocon® you usually do not need to take any additional iron or B12.
If you are not taking Ferocon®, and take a different iron or B12 supplement, be sure you know what the dosage is for the iron or B12 supplements you take. Iron and B12 supplements come in different doses and it is possible to take too much or not enough.
Consistency is Key
If you have trouble remembering to take your vitamins – put reminders on your smart phone and/or put your supplements in a place you’ll remember to take them. There are also apps to help remind you as well!
If you need help selecting a multivitamin or cannot tolerate the one you are taking – call the office for guidance. We have a Vitamin and Mineral Shopping Guide to help you choose supplements that are right for you.
Post a comment or question below! I’d love to hear from you.
Source: ASMBS, Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient, L. Aills, et.al. 2008.
Dietitian’s Corner by Lori Skurbe
Dietitian’s Corner is a monthly column for post-op and pre-op patients of bariatric surgery in NJ written by Prime Surgicare’s Lori Skurbe. Lori has been a dietitian for over 20 years with an extensive background in weight management, bariatric nutrition and diabetes education.
Glad to read this article. This is really helpful especially to those people who find it hard to select what is the best vitamins for them. Now we already know what are the guidelines in selecting what is the best multi vitamins for us.