I’m confused. Several people have told me they only take one or two chewable multi Vitamins daily, like a Flintstones or Centrum. I’m seeing in this article from Johns Hopkins that they recommend a regimen that has much higher doses of vitamins & supplements taken at different times during the day.. Any opinions?

http://www.hopkinsmedicine.org/johns_hopkins_bayview/_docs/medical_services/bariatrics/nutrition_roux_en_y.pdf

Vitamin and Mineral Supplementation for

Roux-en-Y Gastric Bypass

Multivitamin (MVI) with Minerals:

 Take 1 or 2 MVIs every day for a lifetime. Serving size will depend on

individual products. MVI(s) must provide at least 200% RDA for Iron

(36mg), folic acid (800mcg) and thiamine (3mg) and 2 mg of copper. It

is best if MVI also contains selenium and zinc.

 Chewable and liquid vitamins are best absorbed. Suggest vitamins in

this form for at least the first 3-6 months if not for a lifetime. If you

decide to switch to a pill form after 6 months, soft gels or capsules may be

better absorbed than tablets.

 Do NOT take MVI in gummy form. Gummies do NOT have all the

vitamins and minerals you need.

 Take with food (except dairy) to help with absorption.

Calcium:

 Choose Calcium citrate. Avoid calcium carbonate (Tums®, Viactiv®,

OsCal®, Caltrate®), calcium triphosphate, oyster shell, bone meal, etc.

 Take 500-600 mg of calcium three (3) times per day to equal at least

1,500 mg per day. Separate doses by at least 2 hours for maximum

absorption. Look at the serving size on the label and adjust your dose to

make sure you’re getting 500-600 mg of elemental calcium each dose.

 Chewable and liquid vitamins are best absorbed. Suggest vitamins in

this form for at least the first 3-6 months if not for a lifetime. If you

decide to switch to a pill form after 6 months, soft gels or capsules may be

better absorbed than tablets.

 Chewy (NOT Gummy) calcium citrate supplements are acceptable.

Do NOT take calcium in gummy form. Gummies are not calcium citrate

and are not the best absorbed.

 Must contain Vitamin D.

 Take 2 hours apart from iron supplements or MVI with iron for

maximum absorption.

Iron:

 Menstruating women and/or patients with iron deficiency anemia need

more iron.

 If MVI contains iron- Take an additional 18-29 mg elemental iron per

day. If MVI does not contain iron- Take 60-65 mg elemental iron per

day. Total intake should be 54-65 mg elemental iron a day.

 Taking Vitamin C at the same time as iron can increase absorption.

 Chewable and liquid vitamins are best absorbed. Suggest vitamins in

this form for at least the first 3-6 months if not for a lifetime. If you

decide to switch to a pill form after 6 months, soft gels or capsules may be

better absorbed than tablets.

Vitamin D:

 Take 3,000 International Units of Vitamin D3 per day.

 Chewable and liquid vitamins are best absorbed. Suggest vitamins in

this form for at least the first 3-6 months if not for a lifetime. If you

decide to switch to a pill form after 6 months, soft gels or capsules may be

better absorbed than tablets.

 Vitamin D is best absorbed when you take it with food.

Vitamin B12:

 Take 500 mcg sublingual (under your tongue) tablet or liquid once a

day or 1000 mcg sublingual tablet or liquid every other day. OR

 1000 mcg shot once a month (injections prescribed by your primary care

physician).

 500 mcg nasal spray once a week (available by prescription from your

bariatric provider or primary care physician).

Dietitian: __________________________________

For more information, please contact the Johns Hopkins Bayview Medical Center's

Clinical Nutrition Department at 410-550-1549.

To schedule an outpatient nutrition appointment with a dietitian, call 410-550-7728.

Rev. 5/2015

Clinical

This seems pretty in line with what My surgeon requires:

2 multivitamin-- with the same stipulations as above. taken 1 in the am, 1 in the pm.

1500mg calcium (though I had been taking oyster shell b/c they are easier to swallow...guess I won't anymore), spaced out from MV since they compete for absorption...something to do with the iron). My calcium had D3 in it-- so the D3 is covered. Spaced out since the body only absorbs 500mg at a time.

I also take prescription D since my level is super low. (50,000IU/weekly)

B12- 3X wek sublingual-- my B12 mg is high so i don't need it daily.

There list has no B12-- I take that too.

I was never told about a nasal spray or that I needed extra Iron.

I would guess most RNY patients take the extras (calcium, D, B12) *in addition to* the 1-2 MVI (multivitamins) they've told you about. I do.....

btw - these recommendations are pretty much the same as what my surgeon's office recommended for me

There are a lot of conflicting standards and each surgeon has a preference. I live by the American Bariatric Association guidelines which had worked for me long term. The last time I checked it was simpler than the information you listed.

While my Dr recommends a specific brand of bariatric Vitamins I stick with his basic standard simply because its easier logistically. Otherwise I run out & miss a week or so. His standard is based on the ABA (Sorry if I have the full name wrong Any search engine should include the correct term in the results.)

No coated or gummies as they are often not well absorbed:

-Calcium 1000/ day

--citrate not carbonate

--D3 is usually included with calcium

-Multi that includes 200% B complex vitamins & 100% everything else

--minerals like selenium, chromium, zinc, etc should be included in your multi

-Iron 30mg menstruating women & 18mg after menopause

--elemental not ferris sulfate

--with multi or separate allow at least two hours between calcium and iron supplements

-Supplements should be Water soluble for proper absorption

I take my supplements four times a day 2 1/2 hours apart (multi+ iron/ calcium+ D... repeat sequence) My only issue was low folic acid, a B Vitamin, when I used a coated tablet six months post op.

Building Blocks (my surgeons preference) and other bariatric formulas should simplify things for you. Compare formulas to the American Bariatric web site to be sure your choice measures up. The only bariatric brand I find at my pharmacy is grossly inadequate. This is why I use quality "normal" supplements. Most bariatric brands require multiple daily doses because the body uses supplements more efficiently this way.

I'm wary of children's chewables given the need for higher adult concentrations of certain vitamins and the need for water soluble formulas. You may hear terms like "dry D". It's wls speak for water soluble and not inhibited by mal absorption.

The brand Superior Source makes many sublingual supplements that are appropriate after wls. However, their multi vitamins do not meet bariatric standards. You would need to use multiple products to get what's required.

Early on I read all the details of studies just as you are doing. From my research the well known bariatric brands cover it all. Just beware of the candy like formulas as they can easily add over fifty calories a day and even induce sweet cravings.

Edited August 18, 201510 yr by MSWDiet

That is exactly what my doctor prescribed. I use bariatric advantage for vitamins and calcium