VITAMINS-what you need to know and take

Updated Vitamin & Mineral Recommendations:

I promised my next blog would be an update on the nutrition guidelines after receiving my certificate in adult weight training through the Academy of Nutrition and Dietetics.  I did cover much of this information in the nutrition class I offered through our office.  We had a great turnout and I hope you were able to make it.  Thank you all for all the positive feedback! 

The recommendation for vitamins is to take a complete multivitamin.  Follow the directions on the bottle for how many to take if taking a bariatric specific vitamin from Bariatric Advantage (bariatricadvantage.com), Celebrate Vitamins (celebratevitamins.com) or Unjury (unjury.com).  This can vary.  If choosing a vitamin over the counter, the recommendation is to take 1 serving for the band and two servings for the sleeve.  Make sure the vitamin has 100% of the RDA (recommended daily allowance) for folic acid, thiamine, copper and zinc.  These are nutrients that are sometimes found to be deficient after bariatric surgery without supplementation.  The % RDA is listed on the Nutrition Facts label.  I would typically recommend taking the vitamin in the chewable or liquid form; however, there are now some alternatives.  Some vitamins offer a “petite’ version such as “One a Day Vitamins” which is tolerated well post band and sleeve.   Read the label for the serving size.  Because they are small, the serving size is usually two. In that case, you would need two for the band and 4 for the sleeve because I asked you to double them for the sleeve.  There is now also a capsule option through both Bariatric Advantage and Celebrate vitamins.  Be sure to read the suggested serving size because it can range from 3-6 capsules a day.  Capsules are OK as they do turn and pass through the small sleeve passageway just fine! 

The recommendation is to take a multivitamin that contains iron.  The standard recommendation is 18 mg iron for band patients and 45-65 mg iron for sleeve (and bypass) patients.  Iron is always better absorbed with vitamin C.  If your multivitamin has iron in it, it will also contain the vitamin C.  If you take a separate iron supplement, it will probably come with a source of vitamin C.  If not, consider taking the iron with a vitamin C supplement.  Keep in mind that calcium interferes with the absorption of iron so calcium should be separated from iron by at least 2 hours.  We do not typically push the iron in our practice as it can have some negative consequences such as nausea and constipation. We or your Primary Care Doctor may check labs at 3 months, 9 months and 1 year to assess the nutritional adequacy of your diet and supplements. We will then suggest supplements as needed.    

Calcium is also recommended in the chewable or liquid form.  This recommendation remains the same at 500-600 mg calcium 2-3 times per day (total recommendation is 1200-1500 mg per day.)  I typically take into account someone’s dietary calcium as well when making recommendations.  Keep in mind that a yogurt typically has 200-250 mg calcium and an 8 ounce glass of milk (even skim and 1%) has about 300 mg calcium.  To figure out the calcium on the label, look at the bottom of the nutrition facts label and calcium will be listed as a percent.  For example, Chobani’s label reads “20% calcium.” This is based on the standard recommendation of 1,000 mg calcium per day.  So, 20% of 1,000 = 200 mg calcium from that yogurt.  All you have to do is add a zero to the percent and that tells you how many grams of calcium you are getting from that food. 

Citrate is the best absorbable form of calcium and does not need to be taken at meal times although some people find it better tolerated that way.  Calcium Citrate is highly recommended for sleeve patients.  Band patients can take any form of calcium.  Calcium carbonate is acceptable, but not as readily absorbed and must be taken with meals.  If the bottle does not say the type of calcium right on the front, look at the Nutrition facts under calcium and it should say what form is provided.  If it still doesn’t say, look in the list of ingredients and the form of calcium will be specified.  Calcium typically has vitamin D3 in it which helps in absorption of the calcium.  See how much vitamin D you get from your multivitamin and calcium supplements.  The total recommended dosage for vitamin D3 is 3,000 IU per day.  This often takes the vitamin D that is in the multi and in the calcium supplement, plus an additional 1,000 IU vitamin D.  Again, we do monitor this value over time to make sure your vitamin D is adequate.

The final recommendation for sleeve patients only (well, bypass too, but not the band) is to add 500 mcg B12 per day.  The dosage is much higher than the RDA.  The RDA is only 2.4 mcg/day.  You will find some B12 in your multivitamin, but not enough to meet the needs of our sleeve patients.  Band patients do not need B12 supplementation.  B12 is a very tiny pill that is often in a dissolvable and/or sublingual (under the tongue) form.  There is no interaction with other nutrients with this vitamin supplement.  Vitamin B12 is often called the energy vitamin because its function is to aid in breaking down nutrients into a usable form of energy. The process is done in the stomach which is why there is such an increase in the recommended dosage for sleeve patients where 75-80% of the stomach is removed. 

We covered so much more in my class and I have so much more to tell you, but I am getting information overload just writing this.  Please contact me at janesylvestre@massweightloss.com or call our office at 508-668-4400 if you have any questions.  I am in our office Mondays through Wednesdays.  I’ll keep filling you in with more info with each blog I write- so keep reading!    We are planning some additional classes in the near future as well so stay in touch with the practice.  Enjoy this beautiful weather. 

Jane