Vitamins

Topics, Topics & More Topics… we’ll be adding more and more here. This is just a small beginning. As with any choices you make, check with your physician first.

Multi-Vitamins

We’ve been told by doctor after doctor that no special brand of vitamins are required so if someone is trying to sell you high $ items, think before you spend. You do want to use good quality vitamins with good absorption rates.

In the beginning stages, what we consistently hear is two children’s chewable vitamins per day for the first two weeks and progressing to a regular multi-vitamin (not necessary to be liquid or chewable or crushed).

Calcium Citrate

We get a lot of e-mails about calcium and which are recommended for WLS patients. Here’s a great explanation from US Pharmacists Journal on why it is recommended we use calcium citrate instead of calcium carbonate:

“Calcium is predominantly absorbed into the body by the duodenum, which is bypassed in gastric bypass surgery. As a result, calcium deficiency can be a common occurrence in patients if appropriate life-long supplementation is not initiated. Additionally, the solubility and amount of elemental calcium provided vary greatly among the various calcium salts and thus should be considered when a product is recommended. This is particularly important in bypass patients who do not have stomach acid present in the new stomach pouch to aid in absorption. As a result, the absorption of less soluble calcium salts (calcium carbonate) that require stomach acid for absorption is lower, and the absorption of more soluble calcium salts (calcium citrate) that do not require stomach acid for absorption is higher. RYGB patients are also more susceptible to lactose intolerance, as the lactase enzyme that breaks down milk sugars is secreted at the distal bypassed portion of the stomach. This may result in decreased intake of dairy products, further worsening deficiency.7,12,16-30

Of particular concern regarding calcium supplementation is the number of providers who still recommend calcium carbonate­ containing products to WLS patients, even in the face of the achlorhydric environment that the new stomach pouch creates. Calcium carbonate products are often recommended despite their relatively insoluble nature due to the larger degree of elemental calcium they provide in comparison to other salt forms (carbonate provides 40% elemental calcium, vs. citrate which provides 21%).

To overcome the solubility issue, many providers advise that patients take their carbonate products with food to enhance absorption. It has been proposed that after food intake, the acid-producing parietal cells (located in the body of the stomach) become stimulated to produce more acid, thus improving absorption. This mechanism does not apply to WLS patients, however, as the bottom portion of the stomach is entirely bypassed after surgery and the acid-secreting parietal cells will never again be stimulated by food intake. Absorption of carbonate-containing products will therefore not be enhanced by this means. This is the perfect reason for pharmacists to come into play and to recommend more soluble salt forms such as citrate or microcrystalline hydroxyapatite concentrate (MCHC), which are the most absorbable forms for WLS patients”

B-12

After WLS all patients should be on B-12 for the rest of their lives. You’ll need (on doctor’s recommendation of course) to typically either go with a monthly injection, weekly nasal spray or sublingual pill (not regular swallow pills) .

In Gastric bypass patients an iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia. Absorption of Vitamin B-12 normally requires a substance which is attached to it in the stomach. Since your stomach is mostly bypassed, that substance may not be available in sufficient amounts, and deficiency of Vitamin B-12 can result, causing anemia, enlarged red blood cells, and potential nerve damage.

“Vitamin B12 (Cyanocobalamin)

It is a water-soluble hematopoietic (necessary for manufacture of red blood cells) vitamin occurring in meats and animal products. To be absorbed by the intestine, B12 must combine with intrinsic factor, and its metabolism is interconnected with that of folic acid. The vitamin is necessary for the growth and replication of all body cells and the functioning of the nervous system. Deficiency of vitamin B12 causes pernicious anemia and other forms of megaloblastic anemia, and neurologic lesions.

Vitamin B12 is stored in the liver. A healthy adult has a large reserve supply of B12 available, and B12 levels tend to change slowly.

Most recommendations are to take sublingual B12, 1000 micrograms per week. Sublingual means “under the tongue”. B12 supplements that are swallowed don’t get absorbed well. Sublingual preparations are in a crystalline form and can be absorbed directly into the blood stream through the tissues under the tongue. Other options include monthly injections or weekly nasal sprays.

Your B12 level can be checked with a blood test. It’s recommended that your level be tested every six months so that you can be sure that you have enough of this important vitamin.”

Biotin

It’s not an absolute that you will have hair loss. Some things you can do to help aid in prevention is making certain you get all of your protein in, calcium and some individuals take Biotin as well for hair, skin and nails.

For those who do everything right and still lose hair, don’t let it worry you. It will grow back. Sometimes we have to make trade offs for a short while during the losing phases. Better to lose some hair than still suffer all of the co-morbidities.