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 NUT just informed me that I should make sure my multi vitamin is with minerals. She also recommended iron as well as calcium

My surgeon has me wearing the multivitamin patch. No problems at all. Easy....absorbs well....can buy it on bariatric pal or amazon

Sent from my SM-G930P using BariatricPal App

My surgeon has me wearing the multivitamin patch. No problems at all. Easy....absorbs well....can buy it on bariatric pal or amazon

Sent from my SM-G930P using BariatricPal App

I bought these and my NUT said no but when my chewable vitamins run out I'll be on regular food. I'm going to try them then.

I take b12 shots, b complex, multivitamin and D3 because like b12 I was already severely deficient. I haven’t bothered with calcium. If my levels are low at my 3 month blood test I’ll reevaluate. I just can’t take meds 3 Times a day.

On 12/11/2015 at 4:33 AM, swimbikerun said:

@@erp I think the question comes "where is it absorbed" at?

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_minerals.html

Here is the answer. Calcium is absorbed in the small intestine. If small quantities of calcium are consumed, it's absorbed in the upper small intestine (the part that's bypassed for RNY). If large quantities are consumed its absorbed further down.

So it seems like sleevers don't need as much calcium as RNYers.. but I'm sure I don't have all the facts, so please follow your doctor's plan.

The problem is, it depends. Reason why I say that is I remember reading an article indicating after 2 years the intestines do compensate. Now *specifically* what is meant for each vitamin/mineral, remains to be seen and we are all individual.

9 hours ago, Berry78 said:

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_minerals.html

Here is the answer. Calcium is absorbed in the small intestine. If small quantities of calcium are consumed, it's absorbed in the upper small intestine (the part that's bypassed for RNY). If large quantities are consumed its absorbed further down.

So it seems like sleevers don't need as much calcium as RNYers.. but I'm sure I don't have all the facts, so please follow your doctor's plan.

I can speak to the calcium carbonate versus citrate issue. It's not about where it's absorbed it's that carbonate needs an acidic environment to be broken down efficiently. If you take acid blockers or have less stomach acid produced because of less stomach, citrate is optimal. Of course individual mileage may vary.

I had some issues with my parathyroid glands (which regulate blood calcium) and had to have three of the four removed. My endocrine surgeon made the normal recommendation for his patients and gave me lots of calcium carbonate... I wound up with tetany from low blood calcium and it took a long time for us to get it regulated again post op because we didn't take into account the lower acid in my stomach to break down the carbonate. I had a bone density scan (typical when you have parathyroid issues) and we found a ton of undigested calcium carbonate showing up on the scan in my intestines!

Oh, wow! Thank you so much, Jess, for sharing your experience.

Guess I did well by spending the extra $$ on citrate! (The chewables are out of sight, but at least I'll actually take them!)

If the lack of acid affects calcium that much, I bet other nutrients have similar issues... including protein. I'll see what I can find out....

Ok, I have spent a couple hours perusing the internet, and have found some interesting info.

Basically, several nutrients usually need the acid and enzymes produced by the stomach to be broken down and later absorbed. Protein, calcium, iron, vit. B-12... (and several others).

The body loves back-up systems, and protein absorption appears to have one. Even though protein is usually broken down by the stomach acid and enzymes, people that have had their entire stomachs removed (complete gastrectomies) can still effectively absorb protein through their intestines.

Despite this fact, protein deficiency at one year postop has been shown to be as high as 38% in RNY patients, and a whopping 52% in sleeve patients. Yes, you read that right. Sleeve patients may well be MORE at risk of protein malnutrition than bypass patients. I believe this is due to sleeve patients' tendency to not worry as much about their macros because they didn't get a "malabsorptive" procedure.

I did find a study that showed protein consumption greater than 60g a day was associated with minimal lean body mass losses. From that study, it looks like 60g a day should be the minimum protein consumption for bariatric patients (DS patients need much more than this).

http://bariatrictimes.com/protein-and-the-bariatric-patient/

Quote

The RDA for protein is set at 0.8g/kg/day or approximately 50g per day for normal adults.

The protein requirement for an individual is significantly increased when an individual is not meeting his or her overall energy/caloric needs compared to an individual who is in positive nitrogen balance.16 Pellett and Young17 showed that nitrogen balance was severely compromised when dietary energy intakes were less than 35kcal/kg. Researchers have concluded that adding 100g of carbohydrate per day decreases nitrogen loss by 40 percent in modified protein fasts.

To give an idea, 35kcal/kg for me is 2500 calories if I were at goal weight. More like 3500cal at my current weight. Which means that we all are at risk of protein deficiency if we consume the RDA of protein during the first year or two postop.

I did keep seeing 2 answers as to how much protein we need. One is 60-80g/day. The other is to multiply your weight at 25 bmi (in kilograms) by 1.1-1.5g.

So for me, my weight at 25 BMI is 159.5lbs. Which is 72.5kg. My protein range should be 80g to 109g.

I don't know which range is "better". It may have to do with the carbohydrate consumption as in the quote above. If we are eating 100g of carbohydrate, then we can eat the lower amounts of protein. If we aren't eating that many carbs, then we need the higher levels.

Since 80g shows up in both estimations for me, I figure that's probably the ideal amount for me (especially since I do get more carbs than many bariatric folk).

But for those that are eating 50g or fewer carbs a day, I highly recommend multiplying your 25bmi weight in kg by 1.5 to figure out your protein goal. If it's different than your program's recommended goal, then discuss this with your team.

Thanks@Berry78 for sharing! I now remember hearing that about B12 early out as well and have been carefully to supplement that but had forgotten why.

Being post menopause I hadn't worried about Iron but came back as deficient back in May which triggered an order for a colonoscopy because, well post menopause they assume it's a GI bleed unless proven otherwise. The colonoscopy was clear so we added iron supplements. Now that makes sense!