Nutrition Nook: Lifetime supplementation

Following bariatric surgery not only are you consuming a decreased amount of food, due to your smaller stomach pouch, but there is also malabsorption of vitamins and minerals. This malabsorption occurs after both the roux-en-Y gastric bypass and the sleeve gastrectomy, making it important that you prioritize taking your nutrition supplements just like you brush your teeth, daily! This daily need does not stop once you have healed from surgery or hit your goal weight; deficiencies can occur even 20 to 30 years post-surgery.

Vitamin and mineral deficiencies can cause multiple side effects including, but not limited to, a sore tongue, pale skin, numbness and tingling in extremities, risk of falls, muscle and joint pain, muscle cramping, hair loss, and fatigue. Some side effects from vitamin and mineral deficiencies can also be irreversible if not treated in an appropriate time frame.

Regular lab work is important to identify deficiencies and make sure they are treated. Lab work is completed every six months for the first three years post-surgery and then yearly thereafter.  Below you will find the details of the required and situational nutrition supplements, and bariatric specific supplement brands.

Required Nutritional Supplements:

 Multivitamin (MVI): 200% of daily value

• Bariatric specific multivitamins are based on 200% of daily value (DV), take as directed.
• If choosing a standard over-the-counter multivitamin-multi-mineral supplement make sure that includes 100% of the daily value (DV) for vitamin K, biotin, zinc, thiamin, folic acid, iron, and copper; double the serving size.
• Choose a complete formula.
• Avoid gummy multivitamins that are not complete.

 Calcium Citrate: 1200-1500 mg/day

• Calcium can be found in multiple forms, so make sure to choose the citrate form which is best absorbed.
• You cannot absorb more than 600 mg of calcium at a time, split in divided doses of 500-600 mg for maximum absorption.
• Calcium and iron should be taken 2 hours apart.

Vitamin B12:

• Sublingual (under the tongue tablets or drops): 500 mcg/day
• Nasal Spray (Nascobol): 500 mcg/week
• Intramuscular Shot: 1,000 mcg/month
• You cannot absorb a pill that is swallowed post-surgery.

Situational Nutritional Supplements:

Iron: 45-65 mg/day (ferrous fumarate or ferrous fluconate)

• For anemia or menstruating women.
• Calcium and iron should be taken 2 hours apart.

Vitamin D3: 3000 IU/day

• May need if vitamin D levels are low.
• Helps with calcium absorption.

Bariatric Specific Nutritional Supplement Brands:

• Bariatric Advantage
• Celebrate
• Bariatric Fusion
• Optisource
• Opurity
• Nascobol (nasal spray B12 prescription)

Taking your daily nutrition supplements should be prioritized just like your nutrition to meet your long-term goals and avoid deficiencies. If you often forget to take your supplements, set a reminder on your phone to go off daily or set your vitamins near your toothbrush or coffee pot to make sure it is part of your daily routine.

 If there is a nutrition topic you would like the dietitian to cover in an upcoming newsletter please email metabolicsurgery@erlanger.org.