Last week we looked at why vitamins are important. This week we will tackle what you should be looking for when you buy vitamins and minerals. Not all vitamins are created equal so before driving to the nearest drugstore, let’s look at what vitamins should and should not have.
Let’s start with some guidelines of what not to take:
- No children’s vitamins. They are incomplete in several areas. You can find chewable or liquid adult vitamins if swallowing pills is an issue.
- No gummy vitamins. The main concern with a gummy vitamin is the lack of complete vitamins and minerals. To make it “gummy” manufacturers need to eliminate lots of key minerals. The other concern is in the ingredients list. The first ingredient- sucrose, also known as sugar.
Choosing a Multivitamin
Starting out you may want to choose a chewable or liquid vitamin until you can tolerate a capsule or tablet. Look for a high-quality multivitamin that contains 200 percent of the daily value of at least two-thirds of the nutrients in the product. The vitamin should also contain minerals including zinc and iron. You will probably be taking one to three multivitamins per day.
Minimums that should be in your multivitamin:
- 18mg of Iron
- 400 mcg of Folic Acid
- 2 mg of Copper
- 12 mg of Thiamin
- 3,000 IU of Vitamin D
- 500 mcg of Vitamin B12
- 50 mg of Magnesium
- 11 mg of Zinc
In addition to your multivitamin, you will also be taking a Calcium supplement and a Vitamin B12 supplement. Depending on your bloodwork, you may also be advised to take supplements of:
- Iron
- Fat-Soluble Supplements
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
Calcium
You need a minimum of 1,500 mg of Calcium per day. This should be in the form of Calcium Citrate. Absorption is better compared to calcium carbonate. Calcium should be taken in 500 mg doses three times per day for best absorption. It is important that calcium is not taken within 2 hours of iron. Calcium inhibits iron absorption so separating them is necessary.
Vitamin B12
You should get a minimum of 1000mcg of B12 per day. A B-12 pill that dissolves (melts in your mouth) or chewable tablets are the most common choice for vitamin B-12 supplementation. Vitamin B12 deficiency is the most common deficiency among people who have undergone bariatric surgery. Roughly 5% of patients have this deficiency prior to surgery, and about 13% have it once the surgery is complete.
Iron
Even if you are taking a multivitamin with iron, you’ll need to take an additional iron supplement daily. You may be taking up to 45 to 60 mg per day for patients with a history of iron deficiency. Do not take iron and calcium at the same time. Separate iron and calcium by at least 2 hours. Vitamin C may help with the absorption of Iron.
Fat-Soluble Supplements
Fat-soluble vitamins (A, D, E, K) are not well absorbed after surgery and you will need to take additional supplements for the rest of your life. The amounts will be determined by your surgeon based on your bloodwork. Unlike water-soluble vitamins, excess vitamins are stored in the body and can cause toxicity. It’s important to keep up with your bloodwork to make sure you are not over-supplementing and causing health problems. The recommendations below should be adjusted based on what your surgeon recommends.
Vitamin A is important to bone and tooth formation, and vision. It is recommended that you get 10,000 IU per day of Vitamin A.
Vitamin D encourages the absorption and metabolism of phosphorous and calcium which aids in the development of teeth and bone. 3,000 to 6,000 IU is the recommended supplementation of Vitamin D per day.
Vitamin E is an antioxidant. It helps fight infection and keeps red blood cells healthy. The most common recommended dosage of vitamin E is between 300 to 800 IU per day.
Vitamin K is essential to blood clotting and keeping bones healthy. Most surgeons recommend 160 mcg per day of vitamin K.
Questions to Think About
There are many things to think about when choosing a vitamin and mineral supplement after bariatric surgery. You will want to consider the following:
Does this vitamin give me what I need?
There are a lot of different brands and options when it comes to supplements. It is important to know how to read the nutrition label so you can match what you need. Re-read the section above or talk to your surgeon if you are having trouble identifying if a vitamin or mineral will meet your needs.
How many do I need to take?
Taking three multivitamins, three calcium pills and any supplemental pills spaced throughout the day is a lot. Remembering to take these consistently can be difficult. Fortunately, there are a number of options available. See the tips below for more help with setting up a pill schedule.
Can I afford to take these?
Price is an important factor when choosing vitamins. While you should choose the best vitamin that you can afford, many patients are on a fixed income and need to be price aware. The good news is that there are a number of options that do not need to break the bank, including ordering online at reduced rates.
Can I swallow pills or do I need a chewable or liquid vitamin?
Swallowing pills after surgery can be difficult. Many bariatric surgeons recommend starting with a liquid or chewable vitamin after surgery and then switching to a capsule. For patients that have a hard time swallowing pills, a quality chewable multivitamin can be taken daily.
Is this a brand that I know and trust?
Unlike medication, the FDA (Food and Drug Administration) does not have to approve or inspect vitamins sold in the United States. Look for brands that are labeled with NSF International, US Pharmacopeia, Underwriters Laboratory, or the Consumer Lab seal. These are 3rd party agencies that test supplements to confirm that they actually contain what is on the label.
Vitamin Schedule
Research also has shown that most bariatric patients do not adhere to their recommended vitamin protocol. Taking your vitamins and minerals as recommended by your surgeon is essential to prevent vitamin deficiencies. The best way to keep on top of your vitamins is to establish a schedule.
When the best time to take vitamins depends on the vitamins that you are taking. Some are best to take after a meal while other vitamins are best on an empty stomach.
Water-soluble vitamins, your Vitamin B, are best to take on an empty stomach. I take these first thing in the morning about 30 minutes before eating.
You can take calcium citrate on an empty stomach or with food. I normally take my first does in the morning with my Vitamin B. Taking three doses of 500 mg each spaced throughout the day will make sure you get an adequate amount of calcium.
Fat-soluble vitamins (A, D, E, K) are best taken with a meal that contains saturated fats and oil. The fat is needed to carry the vitamins through the bloodstream. I normally take mine in the morning during breakfast with a multivitamin.
Tips For Sticking To Your Vitamin Schedule
I can remember passwords for accounts I no longer use and even my best friend’s address from high school but for the life of me, I cannot remember to take my vitamins every day. I know how important vitamins are especially after bariatric surgery so it is important to come up with a way to remember to take them. Here are a few tips for sticking to your vitamin schedule:
Use Technology. Everyone has a smartphone and it is rarely more than a few feet from us. Set an alarm on your phone to remind you when to take your supplements.
Get Organized. There are a lot of pills to take and it is important to stay on top of them. If you have a week-long pill organizer you will be able to plan and prep for the week. That way you will never have the excuse that you don’t have time to find the correct pills.
Keep Them Visible. Put your pills in a place where you will be sure to see them every day. Out of sight normally means out of mind.
Whatever you need to do to remember to take your pills, do it. Whatever inconvenience you think it is will be nothing compared to living with the health problems that come with vitamin deficiencies. Speaking of vitamin deficiencies, we will be discussing that and vitamin toxicity in next week’s post.