My surgeon and NUT both say to do a twice daily chewable Multivitamin, chewable probiotic, and 3 times a day Calcium citrate chewable.

But, everything I read for research is for RNY. For example, must use citrate form of calcium to bypassing the first part of the small intestines. But for VSG, there is no intestinal bypass.

AFTER complete healing of the sleeve, is there a real need to stay with chewables or calcium citrate instead of calcium carbonate?

My surgeon and NUT both say to do a twice daily chewable Multivitamin, chewable probiotic, and 3 times a day calcium citrate chewable.

But, everything I read for research is for RNY. For example, must use citrate form of calcium to bypassing the first part of the small intestines. But for VSG, there is no intestinal bypass.

AFTER complete healing of the sleeve, is there a real need to stay with chewables or calcium citrate instead of calcium carbonate?

Yes, calcium carbonate is not readily absorbed regardless of surgery. It is an inferior form of calcium. Cal citrate is recommended for it's ability to be absorbed. Additionally VSG, can create some absorption issues but not to the extent of RnY.

@@erp I think the question comes "where is it absorbed" at? If calcium isn't absorbed in the stomach there is no basis for the carbonate/citrate difference.

I'm continuously corrected about how VSG can create absorption issues. I have other GI issues that contribute to those problems. If someone doesn't, just a VSG, what is the medical basis/research of absorption problems?

These are questions I've been asking (and did of my surgeon) without any science behind it, at least that I could get from then and I could find.

Lots of medical practices treat RNY and sleeves the same. I just don't think they knew enough. At the end of the day, for both, supplements should be patient specific, based on lab values.

I don't seem to have any malabsorption issues. I don't take calcium, because when I did, my labs were dangerously high. I take multiple Vitamins and Vitamin D. My vit d levels were super low before surgery, so not even sure I can pin the need for that on the sleeve.

You won't know what you need without labs.

@@MichiganChic Bingo! Try getting bariatric practices to do that though. Its all about the $$$$/surgery. That is where the $$$ come in, and to the hospital.

I'm not absorbing Iron even though I have the sleeve. The Vitamins and supplements I take have more than the recommended amount. At the moment, I'm speculating whether the mal-absorption has to do with my hormone issues (period stopping/early menopause). I don't see a specialist for a few weeks. The lack of iron really makes you so tired and drained and I may be getting iron shots down the road.

I recently asked my NUT about the Cal Citrate vs. Cal Carbonate for me since I had the sleeve. I was prompted to ask because I see that carbonate is more redly available in store locally. She explained that even though I have no absorption issues because of the sleeve, the carbonate needs more stomach acid to breakdown properly. Because we have less bile in a smaller stomach than we did before, the carbonate won't be broken down properly thus, not absorbed properly even by us with the sleeve. I am still taking cal citrate chews since my labs indicate everything is good, not high or low.

I'm not absorbing Iron even though I have the sleeve. The Vitamins and supplements I take have more than the recommended amount. At the moment, I'm speculating whether the mal-absorption has to do with my hormone issues (period stopping/early menopause). I don't see a specialist for a few weeks. The lack of iron really makes you so tired and drained and I may be getting iron shots down the road.

Meehan are you taking your iron?

I take mine with my C at a meal when I am not eating anything with calcium or near when I take my calcium supplements. Calcium is supposed to interfere with iron absorption.

I was told to do calcium citrate chews 3x day separate from other supplements but found that even with setting an alarm, I was missing more doses than I was getting as I was always doing something and would get distracted before I could get back to my purse or whatever to get the calcium does. My personal solution\work around (YMMV) was to switch to a once per day slow release calcium citrate capsule. I still take a multi vit morning and night, a probiotic in the morning (my choice, not prescribed) extra D3, and iron+C mid day with no other supplements. Calcium levels have been perfect using either method for me. Iron levels had been slightly low, so I switched to a chewable iron + C hoping for a little better absorption. Time will tell whether that's made a difference.

@dlappjr Have they proven that or just guessing? The reason why I ask is because that's a lot of money and trouble finding a product like that difference for guessing with no research.

I also say that as someone who does have other stomach/intestine issues that I can get it from a carbonate source.

I've not used chewables anything before or after surgery; however, I did not restart my multivitamin or calcium citrate (they're the biggest pills) until a week or two after surgery per my surgeon (plus I was back in the hospital with complications so I was see him and the bariatric fellow MD working with him) every day. That being said, even at more than a year out, I do NOT take all my supplements and medications at the same time, I space them out so everything doesn't hit my tiny tummy all at once.

@dlappjr Have they proven that or just guessing? The reason why I ask is because that's a lot of money and trouble finding a product like that difference for guessing with no research.

I also say that as someone who does have other stomach/intestine issues that I can get it from a carbonate source.

I did not ask them if they were pulling the info out of thin air. My assumption is that they are the pro's so they know. They don't sell me the cal citrate, I buy it online or at a pharmacy, so they have nothing to gain by picking one over the other. I also don't have a need to question their motives. They have a plan in place that makes them a Weight Loss Center of Excellence, so I am fine taking them at their word, even if it is a slight bit more expensive to get citrate over carbonate. The NUT did say that it must be cheaper to produce carbonate, since that is much easier to find than citrate. It just isn't something I feel I need to dig too deep into. Seeing as every plan I have ever researched online or heard from others here on this forum or directly from my surgeons office calls for Citrate, then that is enough confirmation for me. You should check with your nurses or surgeons at the office you go to and see what they say.

I don't have them. I was dumb enough to trust them and started reading and researching. They are a Center of Excellence also. There were some mistakes made, which is something I try to tell everyone about. Just because everyone else is doing it, doesn't make it right.

When the thing is to get people to commit to surgery, a big $$$$ item, and no one really has common sense, studied a good number (and the outliers like me) of those with the surgery over 2, 5 years out, its the profit from the surgeries that drives things.

Bariatric surgery practices run 40-45% profit. I found that out when I checked. The conflicts of interest are there to get you in. To do after care, not really. Seen people dumped right after surgery.

I wonder if taking so much calcium (and so often) could be causing the Iron deficiency that some develop.

My iron level has always been great (170ish on the lab report which shows 'normal to be 51-212). Labs done every 3 months for 15+ years. I give blood regularly and they test then too.

I started taking calcium supplements per recommendation of my surgeon's office (started 2 months pre-op).

Had my normal quarterly bloodwork done 1 week post-op, and now my iron is 51, at the low end of 'normal.'

I'm going to speak with my NUT and surgeon next week during appointments.

My surgeon told me that he's not convinced that sleeve patients need the calcium the way RNY patients do--this was when I asked about a potential link between calcium supplements and heart problems (which came up when my dad was in the hospital for heart failure recently). He told me that he was OK with me taking 1/2 of the recommended calcium citrate, saying that the risk is small but so is the benefit. I haven't had my 6 mo labs yet, so we'll see where I am then.

I haven't had my 6 mo labs yet, so we'll see where I am then.

I'd love to hear about your labs. When did you start the reduced calcium citrate?

And BTW, totally jealous! Our starting 'stats' are similar and you just reached your goal!! I hope to be in your shoes, as it were, in 6 months time!