All weight loss surgery patients regardless of procedure need to take a multivitamin supplement daily for life. There are of course other supplements needed, however they will be discussed in later posts.
Complete multivitamin (MVI) supplements are needed with all procedures (gastric bypass, duodenal switch, lap band, and sleeve gastrectomy) because of restriction. All procedures reduce the size of the stomach in some way therefore reducing the amount of food consumed. Generally when an individual eats less than 1400 calories there is not enough food to provide all the nutrients an average adult needs. Procedures that provide malabsorption in addition to restriction, such as the gastric bypass and duodenal switch, increase the need for additional nutrients. Nutrients consumed from food and supplements are not completely absorbed in these patients.
In 2008 ASMBS published post operative suggestions for vitamin supplementation. You can read the entire paper (pdf) at: http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/bgs_final.pdf. Regarding the multivitamin/mineral supplement the suggested regime is 100% of the Daily Value for the Adjustable Lap Band, and 200% of the Daily Value for the Gastric Bypass and Duodenal Switch. In practice we often suggest 100% of the Daily Value for the Sleeve Gastrectomy. What does % Daily value mean?
When choosing a MVI you need to find a supplement that provides 100% of the daily value for at least 2/3 of the required nutrients. This is considered a complete MVI. MVI supplements should also be chewable or liquid. Why is this? Well, most MVI supplements are rather large and may cause irritation if swallowed whole. Oral MVI supplements may not be completely broken down either, especially in patients with malabsorptive procedures.
Some issues I see with MVI Supplementation:
1. Choosing the Wrong MVI
I often see issues where patients choose chewable MVI’s that are not complete. Your surgical team has likely researched supplements extensively to find the most appropriate formulas. Always seek the recommendations of your team no matter how far out from surgery you are. Most over-the-counter (OTC) chewable MVI’s are not complete.
At least once a week I hear about a patient who is taking gummy vitamins, yikes! Gummy vitamins are a perfect example of an MVI that IS NOT COMPLETE. Most gummy vitamins lack iron, thiamin, riboflavin, and niacin. Deficiencies of these nutrients can then occur. For example: a thiamin deficiency can cause a burning sensation in the feet, numbness and tingling in the feet then hands, and can advance to mental confusion, peripheral neuropathy, and visual problems. A deficiency can be corrected and symptoms cured, however some symptoms can be permanent if not caught early. Caution should also be taken with children’s formula. Kids vitamins can also be a problem as many of them are also not complete.
Commonly Recommended MVI Supplements
Centrum: a complete MVI that comes in chewable and liquid. Choose the chewable or liquid under age 50 only.
Flintstones Complete: when I was a kid there was only one type of Flinstone vitamin, now there are ten different varieties including gummy. Only choose the original (non gummy) chewable version of Flintstones Complete.
Centrum Kids: matches very closely to Centrum for adults
Consider formulas designed specifically for weight loss surgery patients:
Celebrate Vitamins, Bariatric Advantage, and Opurity.
2. Patient stops taking their MVI, because they forget or do not want to take it any longer.
Patient’s see their surgeon frequently during the first one to two years following surgery. After this time period patients do not see their team often. This is when I find some patients decide on their own to stop their supplements. Your anatomy has not changed. You still have restriction and possible malaborption depending on your procedure. Deficiencies can occur at any time.
3. Patient stops taking their MVI, because they do not care for the taste.
This may sound harsh, but vitamins are not meant to taste like candy. Think of them as medicine. Sure no one wants to gag every time they take their supplements, but you may never find the perfect tasting supplement. The most important thing is that it gives you what you need.
-Try out different supplements. Some companies will send you sample packs to try.
-Talk to other patients to see what they like.
-Ask your surgical team. Many of us who work with bariatric surgery patients taste test supplements before recommending products. I certainly do!