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Bariatric Surgery

Vitamins and Minerals

After weight-loss surgery, you need to take vitamin and mineral supplements every day for the rest of your life. If you do not take your vitamin and mineral supplements after surgery you will become malnourished! 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 after having gastric bypass surgery.

We recommend that you take a multivitamin, plus extra supplements of calcium, iron, vitamin B12, and vitamin D. 

Begin taking all required vitamins and minerals the day you wake up in your own bed following surgery. Example: Surgery on Monday; discharge on Wednesday; wake up at home on Thursday morning. Start taking supplements on Thursday morning.

To make sure you are taking everything you need, in the correct dose, and in the correct form, we recommend bariatric-specific supplements.

Check our Sample Daily Schedules for timing, so you get the most out of your daily supplements.


Multivitamins

Start taking one chewable multivitamin/mineral supplement twice a day (bypass) or once a day (band) while on liquids (Phase 1 diet).

When you progress to Phase 2 (soft foods), take your supplement with meals.

We recommend one of the following:


About 3 months after surgery (or when you are able to take pills and can tolerate solid foods, in Phase 3), you can switch to a non-chewable if desired. However, we recommend a bariatric-specific chewable multivitamin long-term over any other product. If you choose to take an over-the-counter vitamin, we recommend any of the following, to be taken twice a day with food (generic, store-brand equivalents are fine):

  • Celebrate Vitamins® multivitamin capsule (available at www.celebratevitamins.com)
  • One-A-Day® Men’s/Women’s Formula
  • Centrum Performance®
  • Centrum Silver® based on your age

Take one multivitamin, twice a day (for example one at breakfast, one at lunch), rather than both at the same time to maximize your absorption of each vitamin.


Calcium Supplement

 

There is typically only a small amount of calcium in multivitamins. Therefore, we recommend taking an additional 1000mg-1500mg of calcium everyday when you progress to soft foods. At this stage after your surgery, you will need to take a chewable form because most non-chewable supplements are too large and difficult to swallow. There are different forms of calcium such as calcium carbonate and calcium citrate. Calcium citrate is the most efficiently absorbed form of calcium following gastric bypass.  However, citrate is difficult to find in a chewable form, so we recommend a bariatric-specific calcium which provides citrate in a chewable form.
  • Bariatric Advantage® Calcium Citrate Chewy Bites (2 chews 2 times per day)
  • Bariatric Advantage® Calcium Citrate Lozenges (one lozenge 2 times per day)
  • Celebrate Vitamins® Chewable Calcium Citrate (one chewable 2 times per day)
  • OpurityTM Calcium Citrate (2 chewables 2 times per day)

Taking a liquid vs. chewable form of calcium citrate is acceptable.

  •  Wellesse Calcium and Vitamin D3 liquid

Available at:

  • Kroger
  • Rite Aid
  • Walgreens
  • Walmart
  • Order directly at 800.232.4005

     
Switch to a non-chewable form of calcium citrate when able to tolerate a solid pill, if desired. Take one dose (500mg-600mg) twice a day with meals for a total of 1000-1200mg of additional calcium per day. Be sure to check the dose on each individual brand to be certain you are getting the correct amount.
  • Citracal-any version
 
Again, take your calcium supplements twice a day in two smaller doses rather than taking one large dose all at once because you will absorb the smaller doses better. Also, calcium is best absorbed with taken with food. 
 
It is important to not take the calcium and iron supplements at the same time, as they interfere with the absorption of each other. Take your calcium and iron supplements at least two hours apart from one another.

 

Iron Supplement

We recommend that you take an iron supplement daily when you progress to soft foods, in addition to the iron in your multivitamin. Iron does come in a chewable form, but the pill should be small enough that you can swallow it without difficulty.

Nausea and constipation are common side effects of iron supplementation. For this reason, we recommend you take one of the most absorbable forms of iron: ferrous fumarate, ferrous sulfate or ferrous gluconate. All three forms of iron can both be found in over-the-counter. Listed below are some specific products we recommend. Take your iron supplement once a day with food.

  • Bariatric Advantage® Chewable Iron
  • Celebrate Vitamins® Chewable Iron
  • GNC Iron 18
  • Ferro-Sequels® (contains a stool softener as well)
  • Fergon

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 iron and calcium at least two hours apart from one another.

Your iron supplement is also best absorbed when taken with food. Iron supplements may also be better absorbed when taken with something acidic. This can be any food high in vitamin C such as fruit or vegetables.


Vitamin B12

Vitamin B12 is digested and absorbed differently than most vitamins. After gastric bypass surgery, you will no longer be able to digest and absorb sufficient amounts of B12 to maintain health. You must take your B12 in a form that directly enters the bloodstream, not through the digestive tract. 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. Our doctors or physician assistants can write a prescription so you can give yourself the monthly B12 injection.
  • A weekly nasal spray (Nascobal®) is an option for your B12 needs. Our doctors or physician assistants can write a prescription for you.
  • Another option is to take sublingual B12 lozenges or drops that dissolve under your tongue. A 500 mcg supplement may be taken daily. A 1000-2000 mcg supplement may be taken every other day. If you purchase the 5000 mcg strength, 1 per week should be sufficient. Specific products to ask about include:
    • Sublingual B12 Microlozenges (all three doses are available at Vitamin World® stores or www.vitaminworld.com)
    • B12 drops 1000 mcg (at Vitamin World)
    • B12 5000 Zipmelts® (at GNC)
    • Bariatric Advantage Sublingual B12 with Folate®

Vitamin D

In addition to the amount of vitamin D found in your multivitamin and calcium supplement, begin taking 1000 IU of a supplemental vitamin D (cholecalciferol D3) a day. The pill is usually small enough to swallow without difficulty, but size varies among different brands. You may begin the vitamin D when able to tolerate the size pill you purchase. We recommend the following:

  • Bariatric Advantage® Dry Vitamin D3 (take one dose per week)
  • Bariatric Advantage® Liquid Vitamin D3 (take one dose every two weeks)
  • GNC Vitamin D3 1000 IU (take daily)

 


Sample Daily Vitamin/Mineral Supplementation Schedules

You may find it helpful to write out a schedule of when to take your vitamin and mineral supplements, to be sure that they are all absorbed properly.  Here are examples:

 

Sample Schedule 1 (Bypass)

Breakfast

  • 1 chewable multivitamin/mineral supplement
  • 1 chewable calcium
  • Sublingual B12 lozenge or drops
  • Vitamin D

Note:  If you are taking the Bariatric Advantage Vitamin D supplement, take it ONLY 1 TIME/ WEEK!

Lunch

  • Iron supplement (18-30 mg elemental iron if a man or post-menopausal woman; 50-65 mg elemental iron if a pre-menopausal woman)

Dinner

  • 1 chewable multivitamin/mineral supplement
  • 1 chewable calcium

 

*Remember to separate Iron and calcium by 2 hours to optimize effectiveness

 

 

Sample Schedule 2 (Bypass)

(Note: This is an example based on using an over-the-counter multivitamin.)
 

Breakfast:       
1 chewable multivitamin/mineral supplement
Sublingual B12 lozenge or drops
Vitamin D (Note: if Bariatric Advantage® Vitamin D, take one time per week, not daily!)
Lunch:                                                             
Iron (18-30 mg elemental iron if a pre-menopausal woman, not necessary as a man or post-menopausal woman)
Mid-Afternoon:
1 chewable calcium
Dinner:
1 chewable multivitamin/mineral supplement
 
Bedtime:
1 chewable calcium
 
*Remember to separate Iron and calcium by 2 hours to optimize effectiveness
 
 

Sample Daily Vitamin/Mineral Schedule 3 (Band)
 

Breakfast

  • 1 chewable multivitamin/mineral supplement
  • Vitamin D (Note: if Bariatric Advantage® Vitamin D, take one time per week, not daily!)

Lunch

  • 1 chewable calcium

Dinner

  • 1 chewable calcium

 

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