A Word About Vitamins…

Several studies have been completed for the purpose of identifying those patient populations that really require, or will benefit from vitamin supplementation.  One such population is patients who have undergone bariatric surgery.  Weight loss surgical procedures are fundamentally classified as either restrictive or malabsorptive.  Restrictive operations for weight loss restrict the amount of food that a patient can eat at any given time allowing for portion control and hunger control.  Examples of these procedures include the Lap-Band and Laparoscopic Sleeve Gastrectomy operations.  Malabsorptive operations such as the Gastric Bypass or Jejuno-ileal Bypass decrease the amount of calories, nutrients, etc. that the patient will absorb from each meal.  It is very important for all bariatric surgery patients to take vitamins but there are some differences between patients who have had these different operations.

When a bariatric patient first goes home after surgery there is always that 4 or 5 week period where pills have to be crushed.  In this instance, it’s typically easier to take chewable or “gummy” style vitamins.  These are usually available everywhere however unless labeled ‘adult’ they are often for children and the dose must be doubled.  For example with the “Flintstone” vitamins adult patients need to chew two daily.

All bariatric surgical patients, regardless of what procedure they’ve had done, should take an adult multivitamin daily.  Centrum, Centrum Silver, Men’s or Women’s One-A-Day will usually suffice.  It’s also recommended that all patients take a calcium supplement daily.  I usually recommend Citracal.  Calcium Citrate gives more bioavailable calcium per dose and doesn’t have carbonate which can produce more gas.  A supplemental amount of 1000 mg daily is suggested.  For Sleeve Gastrectomy and Gastric Bypass patients, a vitamin B12 supplement should be taken daily.  Oral pill form B12 will not be optimally absorbed so in these patients B12 supplementation should be taken as the under the tongue drops daily or in shot form once monthly.  A new prescription nasal spray called Nascobal is available and is taken as one spray in one nostril once weekly.  Lap-Band patients can absorb B12 normally so the single, daily multivitamin usually provides enough.  If extra B-supplementation is needed, these patients can take a B-complex pill daily.

Some patients have told me about www.vitapal.com.  They have ordered various chewable and gummy forms of the adult vitamins and supplements and have been happy with the customer service.  Bottom line : TAKE YOUR VITAMINS!

– Dr. Minkin