Vitalady Links

[southernlady]

Michelle (Vitalady) was familiar with to most of us...she put these together and then let Gina (Majormom) handle them. When google docs gave Gina fits, they were moved to a private server: These documents are DATED 2010 but only the prices have changed. The type/brand/ and amount are still accurate as of 03/2022

Vitalady's Pre-op Ideas

Vitalady's Labs and Targets

Vitalady's DRNY/ERNY/BPDDS This one is for DS'ers and suggested for those with the SADI/SIPS/LoopDS to start with.

Vitalady's Proximal RNY

Vitalady's VSG

Vitalady's Chewables

Vitalady's Vitamin K2 article
But these documents still belong to Michelle with Gina and I as her agent in storing them/making them available.

Edited to add...we always suggest these as a starting point but follow your own labs and adjust to YOU.

 

[DuodenalSwitchaRoo]

Am I correct in assuming that DNRY ERNY BPDDS is the one for DSers? Sorry if that seems totally stupid, but I want to be 100% sure

 

[southernlady]

Am I correct in assuming that DNRY ERNY BPDDS is the one for DSers? Sorry if that seems totally stupid, but I want to be 100% sure

Yes, it is...the Distal RNY/ the Extended RNY/ and the DS (or as some surgeons refer to it: BPD/DS) all have the same basic starting point since in the RNY so much is bypassed just like the DS.

And these are JUST a starting point...after you get labs post op, they need to be tweaked for YOU!

 

[Will2014]

Guys-what's the deal with the mega doses of vitamins? I recognize that with our malabsorptive issues regular vitamins (especially fat soluble ones like ADEK) are out of the question. But assuming we have bariatric vites designed to be water soluble and thus absorbable for us, why would we need to take such massive doses? Example: vitamin A 100,000 IU daily is shockingly high to me....even dangerous. At toxic levels A can cause a host of problems including blindness. What am I missing here? Here are some links I found describing the risks of vitamin over dosing: http://www.dummies.com/how-to/content/the-dangers-of-vitamin-megadoses.html
http://www.nytimes.com/health/guides/nutrition/vitamin-b12/print.html . I do realize we're all encouraged here to get regular lab checks of our levels and adjust vitamin intake accordingly, but how can people taking these doses NOT be at toxic levels fast? Especially when we WILL be getting vitamins from our food also, albeit with the fat soluble ones at a far lesser amount. What don't I know yet?

 

[Elizabeth N.]

It depends on your labs, for one, and on the type of A, D, or K for another. If you take a "dry A" that is mostly beta carotene post DS, you won't get a heck of a lot of actual vitamin A.....Oh crumb, and of course the reason for this (something about the anatomical changes) has fallen out of my head at this hour of the morning.

Vites that are rendered water soluble will get out of your system faster than their oil based "regular" versions, even though they are originally fat soluble. You can probably explain this part better than I can , cuz you learned A&P for real.

It's really bizarre, I know, and your medically trained brain wants to just short circuit and blow up thinking about it, but it truly works this way. SOME people need relatively minimal supplementation, and other people can't budge a deficiency even with amounts of a supplement that would kill a normal person. My various B vites have been pretty stable for a while just with what I have in my multi (I take 4 Kirkland Daily Multis daily), as has my copper, but my zinc flies around like crazy even with an extra 200 mg (or is zinc in mcg?) daily. Damned stuff bottoms out this time of the semester no matter how much I take, it seems.....Maybe a stress correlation.

My A stays stable in midrange on 50K IU daily. If I miss even a few doses, I can promise you that my test results would be in the teens or single digits. (It goes back up pretty fast, though.) My D, on the other hand, can't be brought about 25 or so even on 200K IU dry D3 daily. I think my next trick will be to add rx D2 at high doses for a month or two and see what happens.

I can tell you from experience that it's a hell of a lot harder to bring up low levels than it is to cut back on large doses in the presence of high levels. Hence my advice is to start with more supplementation than you think you'll need and then adjust based on your own results.

One last thought: Put on your scientist hat and look at the studies, not just at articles like the ones you've linked. Where is the evidence to support those claims? (I don't know the answer because I didn't read the articles; this is a general statement.) Look at the studies that are cited, IF some are cited. Look at the research methods, results, etc. You know how to interpret a study, I'm sure. Do the cited studies REALLY support the claims in the article? If so, how solidly?

AND......Of these supposed horrible things that can happen with megadosing, how truly dangerous are they and how treatable are any symptoms/conditions that could arise? How long do you have to megadose to get them? Remember as well that if a study is done on humans, they are not DSers, therefore you cannot simply generalize the results to us as we are a special population.

If the above links are similar to others I've read over time, their citations will be to in vitro studies anyhow, for the most part.

ETA: Oh FMR. I clicked on the Dummies link. What patent BULLSHIT. And not a single reference/citation in sight. C'mon Will, you know better than to believe that shit . At least use the NIH site!

 

[Will2014]

I hear you Elizabeth, and just so you know I've done ZERO research on those 2 links I posted. Just found them last night after googling mega dosing with vits or something similar after I saw the amounts and was shocked. But there are MANY strange occurrences in this amazing human body of ours which are poorly understood. Give a cerebral stimulant like Ritalin, Adderall, or Dexedrine to a 6yr old child and you have a major depressant effect calming ADHD symptoms and allowing them to learn. It's very over used-but necessary in some cases of kids. Give the same drugs to an adult and it's off to the amphetamine super highway! Racing thoughts, hyperactivity, etc. Give a normal adult a benzodiazepine like Xanax, Valium, or Ativan and it's chill out time. Give the same to a ramped up geriatric with agitated dementia and you've got a raging inferno of confusion on your hands. It's called a paradoxical effect-literally it's the opposite of what should occur. Using concrete, inflexible logic I should expect the exact same result from medications from ALL human patients. But the truth is-such is not the case, as in the examples I've sited. I just figured there is something major about this issue I've not learned yet, and thank you for pointing some of those reasons out. And I hear and receive your warning to aim high for vitamin intake to start, rather than to play catch up when levels are low. If severe vitamin deficiency is anything like recovering from dehydration (by oral intake alone-no cheating with IV's), then it's a state I'd rather not ever be in. Once one is severely dehydrated, the body literally shuts down certain areas to conserve moisture, allow for waste clearance, etc. Even pounding glasses of water takes time, because the body's 1st use of this new bolus of water is to restore shut down areas, flush the kidneys, etc. Only then is water made available for rehydration. Sooooooooo....it's just easier for folks to stay hydrated than to catch up-especially for those with tiny stomachs like ours who can't pound fluids. It's also possible that science just doesn't understand all of this yet. Did you know they have no idea how Tylenol lowers body temps? "Oh....(mumble mumble)...it reduces prostaglandin synthesis...acting on the hypothalamus...(mumble mumble)..." The fact is the most widely used medication (horribly overused may I add) on Earth for past 30 yrs, and they still don't know how it works! Perhaps our new DS systems are changed somehow in how we relate to vitamins

 

[Elizabeth N.]

Some of it might be about where the substances are most absorbed, like B vites and iron are most readily absorbed in the duodenum, for instance. I don't know much about what gets absorbed where except for those, without looking it up.

 

[southernlady]

Some of it might be about where the substances are most absorbed, like B vites and iron are most readily absorbed in the duodenum, for instance. I don't know much about what gets absorbed where except for those, without looking it up.

http://bariatricfacts.org/threads/vitamins-minerals.54/#post-293 The graphic attached to Gina's post.

 

[brooklyngirl]

Liz beat me to the punch, I have that image saved as a reference

 

[Will2014]

Ok, but are you all in agreement that you need those very large amounts of vitamins to stay at optimum levels? For instance, the Vit A daily amount for Vitalady is literally 20x's the recommended daily amount. Has this been proven to you all as the necessary amount for you...us? I realize no two people are alike, but is this the proper average dose? Anyone see it differently? I bought a bottle of Opurity multivitamins and it claims to be designed for absorption by folks like us who've had bypass/ sleeve surgery. It also claims to provide well in excess of the RDA of all the vitamins for each chewable tablet. For instance it has 1600 IU vit D (D3) which is 4x's the RDA for D. Vitalady recommends 50,000 IU's of the same....approx. 31 x's the RDA. Just trying to double check with you all...does this seem correct to you?

 

[brooklyngirl]

Will- I am FAR from an expert on these things, but I can tell you this- I struggled with getting in my vitamins in the beginning. I tried to do the full vitalady regimen and I would gag on them, I would retch them back up, I would get stomach pains when I did get them all down, I'd sometimes get the runs from them, so I slacked off. So for months I was taking 1 vit A 25,000 a day and 1 vit D 50,000 a day (just using those as an example since you mentioned those, they weren't the only things I was taking) and I showed up below range on my last labs on both of those vitamins.

 

[southernlady]

@Will2014, you need to just go for it...don't try to over think this. We aren't sure exactly why it works but it does. Start with what Vitalady recommends and then as you get your post op labs, you can adjust.

Right now, I am still tweaking my K...was taking one but was the absolute bottom end of normal so I take two now. (Not taking any, I was way below normal). I do not take extra A or E based on MY labs except for what I get in my Kirkland Daily multi (three a day). But I do take extra D. I take 50,000IU every day and 100,000 IU on weekends to stay at the optimum end of normal. My D tanks in a heartbeat. If I skip a month of that, I am pulling it back out of the toilet.

The thing is, Vitalady doesn't recommend this just "at a whim", she has been working on this with herself, her dh, and thousands of other actual WLS patients for almost 20 years. She is a walking encyclopedia on what works for us. Her problem is she is NOT a medical person so she has a hard time getting people to listen. That and while RDA studies may show toxic levels, they are all done on NORMAL NON-WLS people. Not us. What she has been able to do is help many of us have the best levels we can and PROVE to the doctors that we don't ALL suffer vitamin/mineral malnutrition.

Back in October, I had back surgery...and had a set of basic pre-surgery labs pulled. My surgeon said my levels were the best he had ever seen ESP in someone who has had weight loss surgery.

As to D levels, that is still a moving target. When I was first diagnosed with seriously LOW D (as they couldn't even find it), the range was 20-50, that was in 2007. Then it moved to 30-80, now it's 35-100. They keep adjusting the range. So if I come in over 100, I am not gonna freak out even if my doctor does cause I know ALL I need to do is drop a part of what I take for one month and it's back to below the middle of the range.

 

[Will2014]

Thanks Brooklyngirl and Southernlady. Ok, I think what I'm gonna do is buy the pre made up monthly pack and just see how things go with my labs. Another question, as I think about consuming 31 pills per day. Do any of you crush them into smoothies or something? I assume none would be timed release, due to our reworked plumbing, so I assume it wouldn't matter. Is that correct? Also, what about men vs. woman's daily needs? Men need less iron, for instance, than a premenopausal woman. Do they have a male+ female version?

 

[Elizabeth N.]

Ok, but are you all in agreement that you need those very large amounts of vitamins to stay at optimum levels? For instance, the Vit A daily amount for Vitalady is literally 20x's the recommended daily amount. Has this been proven to you all as the necessary amount for you...us? I realize no two people are alike, but is this the proper average dose? Anyone see it differently? I bought a bottle of Opurity multivitamins and it claims to be designed for absorption by folks like us who've had bypass/ sleeve surgery. It also claims to provide well in excess of the RDA of all the vitamins for each chewable tablet. For instance it has 1600 IU vit D (D3) which is 4x's the RDA for D. Vitalady recommends 50,000 IU's of the same....approx. 31 x's the RDA. Just trying to double check with you all...does this seem correct to you?

What do you think will happen if you follow the veterans' advice for three or six months? Do you really think you'll die of vitamin poisoning?

RDA is a) to prevent malnutrition, not to provide health; b) for NORMIES; c) based in nothing except supposition. You are welcome to prove me wrong on any of these assertions using recent human subjects research.

Yes, those things are correct for me and for a bunch of other DSers.

There are DSers out there who claim they are doing just fine with shit like Opurity, which I wouldn't use if it were given to me, much less would I pay that company a single dollar for their shit. I do not believe the majority of them because they clearly don't now what they are talking about when we attempt to engage them in discussion about their actual nutritional status. Once in a while, someone shows up who DOES appear to be doing well and to know their stuff. I don't need the fingers of both hands to count those folks that I've encountered since 2006.

I followed my surgeon's advice about initial postop supplementation and have regretted it ever since. He was a relative minimalist and believed in waiting for deficiencies to develop and then to treat those. You know, typical medical model: fix illness.

That being said, I've never taken everything Vitalady suggests. But if don't megadose A, D, K1 and K2 I get into big trouble.

Currently I take:

2 Kirkland multis twice a day = 4x the normie dose
100 mg zinc twice a day
100K IU D daily
50K IU A daily
2,000 mcg K1 daily
300 mcg K2 daily (all of these are Vitalady/Biotech)
2,500 mg calcium daily
2 Schiff Move Free glucosamine/chondroitin/etc. pills daily

I do not tolerate any oral iron, so I rely on periodic infusions for that.

The boron and selenium and stuff like that do not appear to make any difference in my bone density, so I don't bother with them. I have osteopenia/mild osteoporosis, which I have elected to address with annual Reclast infusions.

I adjust my stuff based on my labs.

I WISH I had started out with at LEAST this much stuff early out. My A and D went into the toilet in the first three months. The D has never come out, and if I slack off on the A at all, the a levels plummet.

If you want to start out as a scaredy cat vitamin minimalist, based on ZERO EVIDENCE of any true danger to the suggested megadosing regimen in the short or medium term, while there is a LOT of evidence--well, anecdotal evidence--of problems caused by the minimalist approach......Well, be my guest. But IMO it's not a rational choice.

 

[southernlady]

Thanks Brooklyngirl and Southernlady. Ok, I think what I'm gonna do is buy the pre made up monthly pack and just see how things go with my labs. Another question, as I think about consuming 31 pills per day. Do any of you crush them into smoothies or something? I assume none would be timed release, due to our reworked plumbing, so I assume it wouldn't matter. Is that correct? Also, what about men vs. woman's daily needs? Men need less iron, for instance, than a premenopausal woman. Do they have a male+ female version?

Dh is also a DS'er...he takes the full recommended dosage that Vitalady recommends and he has a ferritin most envy (including Vitalady). Me, I can't handle the Tender Iron so *I* am using the Proferrin ES (2 a day) and my levels are still headed down. Post-menopausal women have the same recommendation as men. And that part of my plumbing was removed 20 years ago.

Most of hers are super small...and many are designed with a caplet that is very thin and easy to swallow.

We don't do the pre-packaged, even from the beginning. I did not even bother with the B6 or B12 even from the beginning. I get enough of my B's from my multi. Even with ONLY my multi, my B12 is over 2000. My B6 stays mid range normal.

I did do the A & E but was able to stop those cause I do fine on just the multi.

And I don't do nearly what others do in calcium as my calcium/D/PTH are all in good shape and I still have osteoporosis. (There is a genetic factor at work in mine, my mother had severe osteoporosis, even to the point of a dowagers hump).

Latest labs on me are here: http://bariatricfacts.org/threads/got-my-labs-back.397/
What I am CURRENTLY taking based on my recent diagnosis of osteoporosis:
Kirkland Daily Multi-Vitamin (3 a day)
Fiber (3 a day)
Proferrin ES (12 mgs) (2 per day)
Vit D 50,000 IU (1 per day) and 100,000 IU on Sat/Sun
Vitamin K 1000 (2 per day)
Vitamin K2 (MK-7) 150 mcg (4 per day)
Boron 3mg (1 per day)
Magnesium Citrate (500 mg/150 mg Elemental) (1 per day)
Calcium Citrate 300 IU ((Elemental) (1 per day)
Strontium 300 mg (1 per day)
Lansoprazole 20 mgs (1 per day)
Probiotic (1 per day)
Lactaid pill (1 per day) for lactose intolerance
The multi, the fiber, the PPI, the probiotic, and the lactaid pill are bought at Costco, the rest from Vitalady. BUT I am over 3 years out and tweaking based on MY lab work.

I do know that Vitalady's calcium is a capsule that can be opened and put in something if you need help getting it down as it is a fairly large pill compared to the D, K, A, etc.