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I tried doing my own thing but gave up 3 months post-op when my blood work showed deficiency in iron, b1, b12, D. My doc explained it's not always about taking the right supplements, but the right combination of supplements i.e. vitamin D paired with calcium, or the right timing (morning vs evening, food vs without food) etc.

So I started the Nascobal prescription option which includes primarily the nasal spray for B12 but you also get a free vitamin kit every month which (for me) more than offsets the cost of the B12 by not having to buy my own vitamins that weren't working so well anyways. The only thing the Nascobal kit doesn't offer is the recommended levels of B1; so I take an extra B1 in the mornings. My insurance covers the prescription, my copay is $42 monthly. Kinda high looking at annual cost, but less so when I deduct the over $20 monthly I was spending on supplements.

Fair warning, the first 3 weeks (or however long your doc tells you) that you need to crush pills / use chewables...is a dread period of pure torment. The chewable nascobal vitamins are simply, gross. I was soooooooo glad when I could start taking pills again.

Today it's not so bad - 1 normal sized multi in capsule form, 1 tiny iron, 2 horse Vitamin D and 1 tiny B1 every morning...and then 2 horse vitamin D in evenings. And a nose spray once per week for B12.
 
I based my supplements on how my blood tests were. For several years after surgery, I was in a University study which was ultimately published in international Journal of science about bariatric surgery. They didn't tell me specifically what to do; they just checked me once a year with a day or two of testing that included many many vials of blood taken for blood panels. That was so helpful for me because I could see exactly what my levels were in terms of iron and calcium and just general vitamin intake or overtake. A lot of people do take too many vitamins and it can actually be lethal. Water soluble vitamins you can take as much as you want to. Vitamin C is the best example of that. Fat soluble stay in your organs for a lot longer and the older you get, the harder it is to screen them through those organs. So you have to be pretty careful about fat soluble vitamins.

Anyway there really is not a right answer for everyone. I do exactly what my surgeon told me, and exactly what my nutritionist told me. The rest of my supplements are based on my metabolic blood panels I have done at least once a year by my primary care doctor. It's really easy to alter the balance in your metabolic blood panel so make sure that you get it checked as often as you can and adjust your supplements accordingly.

The proof is in the pudding... or in this case, in your personal blood levels.
 
dianeseattle said:
I based my supplements on how my blood tests were. For several years after surgery, I was in a University study which was ultimately published in international Journal of science about bariatric surgery. They didn't tell me specifically what to do; they just checked me once a year with a day or two of testing that included many many vials of blood taken for blood panels. That was so helpful for me because I could see exactly what my levels were in terms of iron and calcium and just general vitamin intake or overtake. A lot of people do take too many vitamins and it can actually be lethal. Water soluble vitamins you can take as much as you want to. Vitamin C is the best example of that. Fat soluble stay in your organs for a lot longer and the older you get, the harder it is to screen them through those organs. So you have to be pretty careful about fat soluble vitamins.

Anyway there really is not a right answer for everyone. I do exactly what my surgeon told me, and exactly what my nutritionist told me. The rest of my supplements are based on my metabolic blood panels I have done at least once a year by my primary care doctor. It's really easy to alter the balance in your metabolic blood panel so make sure that you get it checked as often as you can and adjust your supplements accordingly.

The proof is in the pudding... or in this case, in your personal blood levels.
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How many vitamins do you think you would need to take just from your surgery alone?
 
I take two daily multivitamins, as instructed by my surgeon. I take additional B complex, vitamin C, vitamin d, iron, two probiotics, 500 mg of calcium 3 times a day. the multivitamins, from Trader Joe's, are specially formulated for women and high potency. They're also chewable, as is the vitamin C tab I take every day.

I use pb-8 probiotics which I buy at Amazon. When I can afford it, I also buy fish oil. I had to test the gel capsule's ability to break down before it passed out of my system. I am happy to report that it works just fine.

All my other vitamins I take with water and I have already tested their dissolvability.

The hardest one to find is calcium citrate, in the right dose. Your body cannot absorb more than 500 mg of calcium in each dose. And women need 1500 mg of calcium daily.

Additionally, I prefer calcium citrate to calcium carbonate because it absorbs more fully without any possible side effects. It is almost impossible to get calcium citrate. I walked the supplements aisle at a drug store the other day and went through every brand, and only one was calcium citrate. And it was 640 mg per dose, which I can't understand how they arrived at, but I simply will not settle for less then a perfect dose. At my age especially, I have to make sure my bone density is strong.

And as I mentioned before, I read my metabolic panels like the Bible and check to see that I am within range for every required vitamin or mineral.

But what works for me might not work for someone else. There is no cookie-cutter metabolism. One thing people have reported frequently in this group is chronic iron deficiency that is genetically inherited. There are people here who have written about having to go into the hospital for iron infusions. So I would never suggest to them that they take the exact supplements I do. You have to find out how your body is handling your nutrients and adjust levels accordingly.

I feel strongly that this is something people should discuss with their bariatric teams. Malnutrition kills and bariatric surgery promotes malabsorption, which can lead to malnutrition very easily. Nutrients and water intake are probably the two most important elements of the post-operative life to keep in perfect condition.
 
I forgot to mention that you should never take two minerals in the same time period.

Don't take calcium with iron and don't take iron with calcium.

I never took vitamins in my whole life and I thought vitamins were kind of a scam. After preparing for bariatric surgery and then taking additional supplements after surgery, I realized I was wrong. It is very important to understand nutrition, and if you have bariatric surgery it is required. It takes a while but it is really worth the education.

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How To Take Vitamins Properly - ConsumerLab.com

Find out the best way to take vitamins and minerals and which vitamins and minerals should be taken together or separately for proper absorption. ConsumerLab answer explains the best way to take vitamins and minerals.
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The vitamin regimen is different for everyone. Your dr may tell you to start with a whole slew of vitamins only to find out after surgery that you only need a couple. I have seen people who have the sleeve done state they only need the multi vitamin because their vitamin deficiency and nutrient absorption isn't as bad as those that have RNY. I personally take two flintstone vitamins a day along with three calcium chews, an iron chew, b1, b12, and vitamin d which is in my hair, nail, skin vitamin. So far my labs are showing good levels on everything so for me, that was the magic combo. I am all about routines so once I had a routine down, there really wasn't much to it.

But I will agree with gzar. The first several weeks are torment with taking the vitamins. I am a person who would not normally be bothered by it, but I was. I had a few days where I just didn't want to do it anymore and refused to take my vitamins along with eat any more food. Knowing I NEEDED to do it wasn't enough. I just needed to rebel. Of course, the next morning I was fine and back at it again. But the mental turmoil you will go through shouldn't be overlooked. This is a complete change in your lifestyle. I'm sure you will do great, but be prepared for the moments when you just feel fed up with it all. If it happens, take the day or a few hours and wallow in it. Then start all over again with a smile on your face because it will get better and you will feel amazing!
 
Well I was in a University study at the same campus where I had my RYGB. They did test before surgery and then at brief intervals for the first year, and then annually. But because I had Graves disease and other stuff my personal doctor does metabolic panels on me about twice a year.

Did you have your metabolic panels done by your surgeon? If so, I imagine you're on a schedule and will be called in for a check-up and metabolic panel. I doubt that anyone has any kind of identical follow up to anyone else, but you could call your surgeon

And of course, people here will share after they are finished enjoying this beautiful weekend.
 
Pennynguyen said:
how soon after surgery do they normally test your metabolic counts?
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My program has it at 6 and 12 months post op, but my annual physical fell 3 months after, so we ran them anyway and it actually gave bariatrics a glimpse of what I was doing well and what went sideways, so at the six month bloodwork they had to take me off vitamin d for a few months because I was off the charts with too much at both draws, but at 6 months I was approaching a danger zone. This was weird because for years pre-surgery I was on the same dose of D and was barely hanging on to the low part of normal. I have follow up bloodwork now on 9/4 at 9 months post op to check on the D levels and do a spot check on my TSH to see if my hypothyroid meds need adjusting. TSH was normal at 3 months, so we’ll see what the number is at 9.
 
dianeseattle said:
Well I was in a University study at the same campus where I had my RYGB. They did test before surgery and then at brief intervals for the first year, and then annually. But because I had Graves disease and other stuff my personal doctor does metabolic panels on me about twice a year.

Did you have your metabolic panels done by your surgeon? If so, I imagine you're on a schedule and will be called in for a check-up and metabolic panel. I doubt that anyone has any kind of identical follow up to anyone else, but you could call your surgeon

And of course, people here will share after they are finished enjoying this beautiful weekend.
Click to expand...
Thank you for sharing your experience with me. My surgeon did not do any blood work before surgery so im not sure what it should be, I dont back to surgeon til October but I do see my primary doctor September 14 should i ask him if he can do it.
 
I asked my dietician my vitamin questions on Friday. She said start my vitamins and calcium a week before surgery. Then do not start them again until a month post op. My surgeon has found that most of his patients have nausea problems associated with vitamins if they take them before a month. He wants to be able to tell the difference between post op complications and vitamin intolerance. So that’s what I’m doing! I can take my BC and thyroid meds still since they are small and I can crush them.
 
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