Vitamin Supplements after Weight Loss Surgery
We recommend all weight loss surgery patients take vitamin and mineral supplements ( 2 multivitamins with iron, 1500 mg calcium with 800 units vitamin D, and oral iron 100 mg daily if a menstruating female) and have routine blood test performed at least yearly to confirm your body has an adequate supply and you are in good health. The gastric bypass procedure bypasses the first portion of the small bowel (duodenum) where iron, calcium and “B” vitamin prefer to be absorbed. These vitamin and minerals can be absorbed in other areas of the small intestine, but it requires patients to take larger doses than non surgical patients. In addition up to one third of weight loss surgery patients have vitamin deficiencies before surgery and their diet may not include adequate supplies of some nutrients after surgery, so we recommend supplements even for Lap-band patients where no portion of the bowel is bypassed.
Recent studies have demonstrated that 50% of the US population has a vitamin “D” deficiency and 50% of women will develop osteoporosis by age 50 in patients who haven’t undergone weight reduction surgery. While Vitamin D absorption isn’t affected by weight loss surgery, our lack of adequate intake in modern diets requires everyone to take a calcium supplement of at least 1500 mg daily with at least 800 units of vitamin D for good health.
Your calcium supplements with vitamin D may all be taken together at the same time. It doesn’t have to be taken in multiple doses, and you can’t absorb more than 1500 mg daily, so increasing your dose won’t improve your bone strength beyond the 1500 mg recommended. There is no real difference in bone strength between the different calcium preparations, so chose the one you like best. A Vitamin D in a prescription strength of 50,000 units may be required if patients have a severe D deficiency or bone thinning (osteoporosis or osteopenia) on a bone density study.
Calcium shouldn’t be taken at the same time as iron, or it will block the absorption of iron. We recommend taking your multi-vitamin and iron together and then take your calcium at least 4 hours later. Iron is usually better tolerated with food, and may cause nausea if taken on an empty stomach. Constipation sometimes occurs with iron and can be treated by taking 2 stool softeners daily, like Colace of Miralax.
Some patients may require additional Vitamin B-12. We test blood levels before prescribing additional B-12, since not everyone will require additional supplements. B-12 may be given by injection, nasal spray, or orally by tablet. We recommend 1000 ug oral vitamin B-12 for patients preferring the oral tablet method.
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