Initial Post-Op (DS) Vitamins

[OldBroad]

This is what Dr. Elariny's office recommends for days 5-28:

8-12 chewable multivitamins with iron
3000 mcg B12 (sublingual)
50,000 IU D3 (sublingual)
50,000 IU A (sublingual, which I haven't found) in two 25,000 IU doses
2000 mg chewable calcium citrate in four 500mg doses

What I bought:
TwinLab Bariatric support chewable multivitamins
Jarrow Formulas Methyl B-12 lozenges (1000 mcg each)
TwinLab Mega D3 Dots (5000 IU each)
Nature's Plus Water-Dispersable Vitamin A tablets 10,000 IU each
The Vitamin Shoppe Calcium Citrate tablets 250 mg each

The last two items I figured I would grind up and sprinkle in food.

Does anyone have any suggestions about whether this sounds like a good set of supplements for the first few weeks? I will post separately about the post-week four supplements recommended.

Rachael
(DS Scheduled 4/6/2015)

 

[Larra]

Need for B12 seems to be highly variable. I'm 9 years post-op and haven't needed it yet. In fact, for the first couple years my B12 level was crazy high, for no apparent reason. For calcium citrate, I used, and still use the lozenges from Bariatric Advantage that can be either chewed up or just sucked til they dissolve. They are 500 mg each and come in several flavors. The chocolate and wild cherry flavors are pretty good (don't expect gourmet). EN complains that they are chalky, which I guess is true, but they are calcium, so what can you expect. I just can's swallow huge pills so these have really helped me a lot. For multivits, I take one of the standard ones from Costco daily. This seems to be enough for me. Other people take 2. 8-12 seems like a lot.

In general, your body has sufficient stores to get you through the first few tough weeks post-op. The focus is on staying hydrated, which is a lot harder than it sounds. If you can manage that, you're doing great.

The real bottom line for all your vitamins is that you will need to adjust them according to your lab results. I'm glad your surgeon isn't recommending RNY style vitamins (except maybe for the B12) or ADEKs, though. At least you've been given a better starting point than a lot of other people we've seen.

 

[DianaCox]

Whispering - I couldn't bring myself to take ANY vitamins for the first three months. Nothing bad happened, but I eventually scared myself straight.

My regimen for the first few years was minimal, with things added as needed and still forms the basis of my current regimen (YMMV, of course):

• One Prenavite (or generic equivalent) per day (still taking this) (pretty big tablets, and DON'T break them - they are coated to hide the smell)
• Two Citrical (630 mg total) twice a day - horse pills, but I get them down OK
• One chewable 500 mg orange vitamin C from Costco twice a day - they taste like SweeTarts and they are my reward for taking my supplements

At year 3, my zinc started showing low (and I started getting tiny little bumps on my face and shoulders) - added a 50 mg zinc once a day. A couple of years later, added a second.

At year 5, my ferritin/iron started showing low. I tried iron supplements for a year, and they killed my guts. Then I started getting infusions - MUCH easier.

At year 6, my vitamin D3 started showing low. I added Vitalady's 50K IU once a day. Eventually added three more per week to get my D3 up to 88, where I want it.

At year 7, I added Vitalady's vitamin K1, 3 per week. At year 8, added K2, also 3 per week. Upped them both to 4/week this year.

At year 10, I added Vitalady's MgCit (150 mg Mg) - this knocked my PTH down from 50s (OK) to 35 (excellent).

Never took A (my levels are still fine - I eat quite a bit of colorful veggies) or E (Rabkin says it is almost unheard of to need it).

My calcium needs have been minimal, based on my PTH levels. I have lost some bone density - we lose it naturally after weight loss, because we don't NEED to have huge dense bones anymore. We also naturally lose bone density post-menopausally - some of that is hard to prevent. I will hazard a guess that you don't need to take 2000 mg elemental calcium/day, based on y/our build - but taking extra doesn't hurt, especially early out when you are more likely to have loose stools and the calcium will help bind you up. I would suggest that you take what was recommended at first, but if you become constipated, you could cut back without too much worry. But - the lab values tell the story - you'll be keeping an eye on them - we are all different.

I toss all my supplements back in two handfuls. But I couldn't have done that at first - my throat and gag reflex were uber-sensitive for weeks after surgery.

What is MISSING from this regimen is a probiotic. Get something good, preferably with Saccharomyces boulardii in it (helps keep C. diff in check, supposedly). I have had good luck recently with one Primal Defense Ultra in the AM, one Culturelle at night.

Don't sweat it the first few weeks if you have a hard time with them - but don't forget them!

Now, did you get the memo about protein? The goal is NOT 90 g/day from the outset - aim to get 30 g/day by 30 days out; 60 g by 60 days; 90 by 90. DON'T try to gag down more than your stomach can handle until it heals. You have plenty of stores. But don't slack off on the 30-60-90 goal either.

 

[OldBroad]

I'll post about protein and post-28 days vitamins later. But thanks for the tips. BTW, what is PTH?

 

[DianaCox]

PTH = parathyroid hormone. It is the most sensitive (or easiest to test?) measure of whether you are absorbing enough calcium.

Your blood calcium levels are essentially irrelevant to determine this, because the body TIGHTLY controls blood calcium levels - proper levels are critical and the acceptable range is very narrow, because the functioning of all muscles - in particular the heart muscle - require that they stay in this narrow range. By the time that blood calcium gets out of whack, you are in SERIOUS trouble.

PTH is the hormone that the parathyroids release when blood calcium starts to get low - it causes calcium to be leached from your bones and teeth to keep the blood calcium in the normal range. So you want your PTH to stay at low end of the range.

 

[Elizabeth N.]

I think that sounds great for your first few weeks. You might not need all that B12, though.

Larra's right, I can't stand those calcium wafers. Early out I used UpcalD, liquid calcium citrate (Blue Bonnet is one brand), and then discovered I could just let regular cal cit tablets fall apart in a little water and then stir them into something or take them straight.

 

[southernlady]

The Dry A by BioTech is a capsule and is very small. Can be pulled apart and put in yogurt if needed. Actually so is the D3 and K (can't remember the E) that is made by BioTech. Don't need sublinguals and may find it cheaper to find the capsule D3 50,000. (I get mine from Vitalady altho she is selling her business and stock may be limited right now) and at Amazon (Prime member and most of those have free shipping)

With that said, *I* don't take any A, E, or any of the B's other than what is in my Kirkland Daily multi (three a day). That is what my labs tell me and getting hard copies is critical.

Like Diana mentioned, I also need to whisper! I tried taking the entire Vitalady regimen at first and made myself sick...so I was closer to 6 months out before I scared myself enough to get back in line.

But assuming you have decent lab levels going in, you can live off your stores for the first 6-12 months.

The first month, focus on hydration. IF you start your vitamins, start with the multi...give those a few days before adding the D. And slowly work your way up to a full amount.

 

[DianaCox]

One more thing - experience has taught us that it is FAR better to set out your dosages at LEAST two weeks and preferably 4 weeks at a time, to ensure that you don't have the excuse of the annoyance of having to open the bottles, remember what you are supposed to take when, etc., to skip dosages - PLUS, when they are already set out, the OCD in you will make you not want to miss a dose, because then you will have a messed up set of vites. Trust me, this works.

I just did my four week set this morning. Including all the supplements I take, plus my melatonin, levoxyl, Protonix and Adderall, it takes me about 20 min to set it out for four weeks.

 

[southernlady]

One more thing - experience has taught us that it is FAR better to set out your dosages at LEAST two weeks and preferably 4 weeks at a time, to ensure that you don't have the excuse of the annoyance of having to open the bottles, remember what you are supposed to take when, etc., to skip dosages - PLUS, when they are already set out, the OCD in you will make you not want to miss a dose, because then you will have a messed up set of vites. Trust me, this works.

I just did my four week set this morning. Including all the supplements I take, plus my melatonin, levoxyl, Protonix and Adderall, it takes me about 20 min to set it out for four weeks.

And I tried that method...apparently I am not OCD enough for skipped doses to matter. But both dh and I find it easier to keep it all in bottles on the table between our easy chairs.

 

[Dave0168]

I've been searching the forums for a definitive answer on immediate post-op supplements but have come to realize one may not exist as everyone is going to be different as far as what they need based on labs.

I am concerned that what my surgeon/NUT office is recommending in their literature (which is what I assume I am supposed to follow post-op until my first set of labs) may not be adequate. Here is their list:

1. 100% DV multi-vitamin 2x daily (with at least 18 mg Fe, 400 .cg folic acid, selenium, zinc and copper
2. Calcium Citrate min 1800 mg/day
3. Dry A @ 10,000 IU
4. Dry D @ 2000 IU
5. K 300 mcg

(The multi starts soon after discharge, the rest at day 15)

These D levels concern me the most based on what I have been reading here.

Protein requirements and hydration don't worry me as I don't think I'll have trouble with those but the confusion around the supplementation and the side effects if it's done wrong seriously concern me.

Beyond hydration and protein early on, what should I be doing supplement wise or does their plan seem adequate to the first labs?

 

[DianaCox]

I wouldn't worry about how much to supplement D3 so early out - but it seems a waste of time and money to bother with 2000 IU, dry or not. And you probably have a good store of Vit A in your big old fatty liver (I STILL don't need any, but YMMV) - at least the dosage given for A makes sense.

Men can take prenatals, by the way. So can old postmenopausal women

I'm not a fan of oversupplementing, both for medical and practical reasons - why pay for something you're just going to piss out (water solubles) and I'm not confident that "too much" is always benign.

However, I would suggest NOT going below 1200 mg of calcium/day, if only because you NEED calcium in your gut to bind to oxalates in your diet, to prevent them from being absorbed into your blood and thus to be filtered by your kidneys - and where you can form oxalate kidney stones. Even though it may seem paradoxical to take more oral calcium to prevent calcium oxalate stones (and indeed, even some nephrologists continue to be confused about this!), it is to ensure that the oxalates are never absorbed in the first place - calcium precipitates oxalates either in the gut OR in the kidney.

Speaking of which, too much vitamin C isn't a good thing either - because it is converted into oxalate in the blood! http://www.hindawi.com/journals/ijn/2011/146927/ (and this guy was taking less than 1000 mg/day vitamin C - which is how much I'm taking!)

In conclusion, the use of vitamin C must be scrutinized closely both in patients with normal renal function and with underlying renal insufficiency. According to Auer et al. [25], “surveys have indicated that about 66% of the general public take ascorbic acid either on its own or as part of a multivitamin preparation and that ingestion of megadoses of this vitamin in excess of the recommended daily allowance is common”. This figure is extremely concerning given the increasing percentage of the general public developing chronic kidney disease.

 

[Dave0168]

Thanks Diana, I think that puts me at ease a bit. I kind of thought early on most levels wouldn't be as critical.

They do push the importance of the Ca Citrate but never gave the reasons. It is good to know exactly why we need what we need.

 

[Sheanie]

It's definitely an individual thing. YOU have to go by YOUR lab values. My vitamin A tanked early out, and I supplement very high to keep it normal. I take 150,000mg a day of dry A to stay normal. But I take FAR LESS vitamin D, only 50k every 3 days. I'm highly unusual.

My point is this: Follow your own levels, tweak your own amounts, and do what works for YOU.

 

[Sheanie]

And, very importantly, it's WAY cheaper and easier to KEEP your labs high than to try and RAISE them when they tank. I have the bills to prove it.