Need advice on VITAMIN Regimen -- ONE WEEK POST OP --

 I'm so overwhelmed!  Can someone please share their vitamin/supplement regimen and what can't be combined with what?  I'm one week out, post op.  The only thing I've taken so far are the multi-vits and calcium.

I have liquid multi-vitamins (purchased at Costco) Ditto, calcium. I have picked up my rx for Vit. D. <--- SOFTGELS!  ?!? I have sublingual B Complex with B12, but don't know what I'm doing. I should be picking up liquid COQ10 as a supplement because I'm taking a high dose of statins. I have Ferrous Gluconate for Iron (27 mg) SOFTGELS

I'm so tired and don't want to get "behind", but I already feel I am.  I honestly don't know where to start.

Thanks!

Relax, focus on hydration and heal. You can add the vites within a couple of weeks and all will be well.

Chances are very good the vitamin D will do absolutely nothing for you, because people with malabsorptive procedures do not convert D2 to D3.

Iron needs to be separated from everything else except vitamin C and copper (both of which improve iron absorption and use) by a couple of hours.

Stick your B under your tongue and let it dissolve.

The liquid multi will be insufficient for the long run. It doesn't have enough of anything we need. You will eventually need to change over to a more complete product.

Here's what the ASMBS says you should start with:

A multi with 100% of the RDA of most nutrients.  Take two a day.  Stay away from kids' vitamins and gummy vitamins, because those will not have what you need.  They recommend a multi with iron.  If you take a multi with no iron, you’ll need additional iron at a separate time.  They say to start your multi as soon as you get home from the hospital.

1500-2000 mg calcium citrate.  Make sure it's citrate, not carbonate.  They say you can wait up to one month to start your calcium – not that you should wait, just that you can.

18-27 mg iron for menstruating women, unless your labs show you need more.  (If you’re using a multi with no iron, that would mean you’d need at least 50 mg iron.)  They say to start your iron as soon as you get home from the hospital.

B12.  You can use a sublingual, 350-500 mcg per day, a patch once a week, nasal spray once a week, or shots once a month.  Unless your labs show you need more.  They say you can wait up to three months to start your B12 – not that you should wait, just that you can.

They say a B complex is optional.

Many people also need D3 so you should get your vitamin D level to find out if you do.

As far as what you can take together:

Iron and calcium should not be taken together, unless it’s a very small amount of calcium.  300 mg of calcium or so will block the absorption of iron.  The reason some multis have both iron and calcium is because they often have only small amounts of calcium, maybe 200 mg.  That amount won’t block the absorption of iron but much more will.  Iron and calcium should be taken at least two hours apart.

If your multi has iron in it and you want to absorb that iron, do not take your multi with your calcium.  If your multi has no iron, it’s fine to take your multi with your calcium.

Take your iron with vitamin C for best absorption.  The ratio is 200 mg C to every 30 mg iron.  That’s 30 mg elemental iron, so if you take 325 mg ferrous sulfate, for example, you’re only getting 65 mg elemental iron, so you’d need 400 mg vitamin C (but carbonyl iron is absorbed better than ferrous sulfate).

Keep in mind that people can only absorb about 500 mg calcium at once, so divide your calcium into doses of about 500 mg and take them at least two hour apart.  Keep in mind that the ASMBS recommends 1500-2000 mg calcium citrate per day, so you need three or four separate doses.  And make sure you’re taking calcium citrate, not calcium carbonate.

B vitamins work together so it’s good to take your B’s at the same time.  Your multi has lots of B’s in it, so take it with your B12 if you use a sublingual B12.  If you take a B complex and/or biotin, take that at the same time.

If you take vitamin D3, it does not matter what you take it with.

Zinc and copper don’t work well with lots of other vitamins and minerals, so if you take those, it’s best to take them by themselves.

And as far as the RX D you are taking:

There are two types of vitamin D, D2 and D3. It’s important that we know this because one type, D3, is absorbed well and the other type, D2, is not. Unfortunately, many doctors do not know the difference. They may not even realize there are two types of vitamin D, and if they do know there are two types, they may think they are both equally well absorbed or may have no idea what the difference is. I know it seems like a doctor should know these things, but the reality is, many do not.

D2 must be converted to D3 in the body in order for the body to use it. It takes a fair amount of D2 to make a little bit of D3. I’ve seen anywhere from three units of D2 to make one unit of D3 to ten units of D2 to make one unit of D3.

When your vitamin D level is low, doctors often want to give you a prescription for vitamin D. What they prescribe is called Drisdol, and it’s D2. They prescribe it in 50,000 IU soft gels, those little things that look like footballs and have oil inside. The reason they put it in oil is because vitamin D is an fat soluble vitamin. Being in oil is supposed to make it absorb better. That’s true for non-RNY folks, but is not true for RNY-folks because we malabsorb fat. We need dry D3. But some docs don’t know that, either.

OK. So your D is low and they give you 50,000 IU D2 and usually tell you to take it once a week. That’s not enough if your level is really low – and if your doc is prescribing vitamin D, it’s usually because it’s very, very low. But that’s another topic for later discussion.

If it takes three units of D2 to make one unit of D3 in your body and you take 50,000 IU of D2, you’re really only getting about 16,666 IU of vitamin D. If it takes ten units of D2 to make one unit of D3, you’re really only getting about 5000 IU of vitamin D.

Now, keep in mind that recent research suggests that folks that have not had WLS and that have normal levels of vitamin D need 1000 – 2000 IU per day just to maintain their levels. If you needed 7000 – 14,000 IU per week just to maintain your level, do you think 5000 – 16,666 IU once a week is going to bring your level up? Not likely.

And if had RNY, that prescription D2 in oil will help you even less because you won’t absorb much of it at all because you malabsorb fats. But even if you are pre-op, or had lap band or VSG, the D2 is not going to be sufficient for you.

You cannot get D3 by prescription. It is only available over the counter. Even if your doc knows the difference between D2 and D3 and writes a prescription for D3, the pharmacist will give you D2. That’s because there is no D3 available by prescription and legally pharmacists are allowed to make certain substitutions. You have to get your D3 over the counter and if you had RNY, you need to make sure it is dry D3, not in oil.

Keep in mind that we want our D levels about 80-100.  Lower than that, we are at increased risk for things like osteoporosis, heart disease and some cancers.

Check out www.vitalady.com.  I have followed her vitamin regimen since 4 weeks post op.  ALL of my labs have come back PERFECT!!  



EDITED TO INCLUDE:  I do not order ALL of my vits and supplements from vitlady, but I do follow the plan that she has for RNY.