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VITAMIN SUPPLEMENTS AFTER
GASTRIC BYPASS SURGERY
It is important that you take vitamin supplements everyday for the rest of your life after having a gastric bypass. 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 & 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 calcium, iron, B12 and Vitamin D supplements.
Begin taking a multivitamin twice a day while on liquids during the first 2 weeks. Add your calcium, iron, B12, and Vitamin D supplements when you progress to soft foods in the third week following your surgery.
To make sure you are taking everything you need, in the correct dose, and in the correct form, we recommend Bariatric Advantage supplements. These are specifically designed for bariatric patients and their specific needs.
Multivitamins
Start taking one chewable multivitamin/mineral supplement twice a day while on liquids. When you progress to soft foods, take them with meals. For the first few months after surgery, we recommend that you take either liquid or chewable multivitamins because they are easier to digest and absorb. Find a “complete” multivitamin/mineral supplement, meaning one that has 100% of the Daily Value (DV) for all of the vitamins and minerals. Specifically, we recommend one of the following (generic, store-brand equivalents are fine too).
- Bariatric Advantage® Chewable Multi Formula (twice a day)
- 1 Flintstone’s® Complete (twice a day)
- 1 Centrum® Chewable (twice a day)
About two months after surgery (or when you are able to take pills and can tolerate solid foods), you can switch to a non-chewable as tolerated. We recommend any of the following, to be taken twice a day with food (generic, store-brand equivalents are fine):
- One-A-Day® Men’s/Women’s Formula (twice a day)
- Centrum Performance®
- Centrum Silver® based on your age (twice a day)
Take one multivitamin, twice a day (for example 1 at breakfast, 1 at lunch), rather than both at the same time to maximize your absorption of each vitamin.
Calcium
There is typically only a small amount of calcium in multivitamins. Therefore, we recommend taking an additional 1000mg-1200mg 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 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 Bariatric Advantage calcium which provides citrate in a chewable.
- Bariatric Advantage Calcium Citrate Chewy Bites (2 chews twice a day)
- Bariatric Advantage Calcium Citrate Lozenges (1 lozenge 3 times per day)
If you choose an over the counter brand, we suggest starting with a chewable form of calcium carbonate. The following are some examples.
- Viactiv Soft Calcium Chews (2 chews per day)
- Caltrate 600 Plus Chewables (2 tablets per day)
Switch to a non-chewable form of calcium citrate when able to tolerate a solid pill. Take 1 dose (500mg-600mg) twice a day with meals for a total of 1000-1200 mg of additional calcium per day. Be sure to check the dose on each individual brand to be certain you are getting the correct amount.
- Citrical Caplets (2 caplets, twice a day with food)
Again, take your calcium supplements twice a day in 2 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 2 hours apart from one another.
Iron
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, either ferrous fumarate, or ferrous gluconate. Ferrous fumarate and ferrous gluconate can both be found in over-the-counter iron supplements. Because they are the most absorbable forms of iron, they may also cause the least side effects. Listed below are some specific products we recommend. Take your iron supplement once a day with food.
- Bariatric Advantage Chewable Iron
- GNC Iron 18
- Ferro-Sequels®
- 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 2 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 a vitamin C supplement (ascorbic acid) or 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 two ways to do this.
- Most patients opt for a monthly vitamin B12 injection at their primary care physician’s office after gastric bypass surgery. Some patients also give themselves their monthly B12 injection.
- Another option is to take sublingual (under the tongue) B12 lozenges or drops that dissolve under your tongue. A 500 mcg supplement may be taken daily. A 1000-2000mcg supplement may be taken every other day. If you purchase the 5000 mcg strength, 1 per week should be sufficient. Specific products are listed below.
- Sublingual B12 Microlozenges (all three doses are available at Vitamin World® stores or www.vitaminworld.com)
- B12 drops 1000mcg at Vitamin World
- B12 5000 Zipmelts® (at GNC)
- Bariatric Advantage Sublingual B12 with Folate®
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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 will vary 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 1 dose per week)
- GNC Vitamin D3 1000 IU (take daily)
Sample Daily Vitamin/Mineral Schedule (Note: this is an example. There is more than one way to do this!)
Breakfast:
- 1 chewable multivitamin/mineral supplement
- 1 chewable calcium
- Sublingual B12 lozenge or drops
- Vitamin D
Note: if Bariatric Advantage Vitamin D, take one time per week, not daily!
Lunch:
Dinner:
- 1 chewable multivitamin/mineral supplement
- 1 chewable calcium
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