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Healthy Forever;
Patient Compliance and Vitamin Supplements
Barbara Thompson
Beyond Change, Vol 3, March 2002, P.5.

“My surgery is over. I made it. Now when am I going to wake up thin?”  If you have had bariatric surgery, you have probably had these thoughts at some point.  It is an easy trap to fall into as you want to believe that weight loss surgery is strictly the work of the surgeon. But the surgery is just one step in a long journey to health that is directly affected by what you as a patient do.  You determine if you will lose 50%, 75% or 100% of your excess weight.  And you determine how healthy you might be by how closely you comply with all of those nutritional warnings given to you by your surgeon and the support staff. 

One of the easiest requirements to follow is the one involving vitamins. Vitamin supplements following weight loss surgery are essential to your good health. Even if you had a habit of taking vitamins in the past, you may get out of the habit immediately following surgery.  The thought of taking vitamins and risking having them get stuck in your newly formed stoma is a bit frightening, so you may put it off. And it is difficult to initially detect the ill effects that the lack of vitamins causes.  After all, you are losing massive amounts of weight and you are feeling so much better despite not taking vitamins.  But you could be feeling even better and in the long run be so much healthier if you just take a few moments to take your vitamins. You have come so far.  Why risk so much? So let’s take a look at why you should take vitamins in the first place.  What makes us so special?

In bypass surgery, a certain portion of the first part of the small intestines, the duodenum, is bypassed.  The food that we eat no longer comes in contact with this part of our anatomy.  Because the body is designed to absorb certain types of food and nutrients here such as iron, protein, B-12 and calcium, we have to make up the difference through oral supplements.

In addition, the absence of the normal amounts of gastric juice available to aid digestion, results in particular challenges for our health.  This can affect calcium and B-12 absorption.

The following is a list of supplements normally recommended by bariatric surgeons:

A Good Multivitamin – A good multivitamin is important to cover all nutritional bases, especially just after surgery when you are very limited in your diet. And the need for good nutrition does not stop when our window of opportunity closes.  It continues forever. Immediately following surgery, you may want to try the chewable children’s vitamins only because you fear a whole pill may become stuck in your stoma. But within a month or two you should graduate to something of a higher quality. There are also adult liquid vitamins available.

B-12 – Vitamin B-12 is essential to growth and cell reproduction and is present in animal foods. B-12 requires gastric acid in the ileum to be present in order to be absorbed.  B-12 can be taken in a variety of forms.  It can be taken sublingually in a 500 microgram pill that dissolves under the tongue.  It can be taken in liquid form, and it can be taken as a monthly injection.

Iron – Without sufficient iron, your body cannot manufacture enough red blood cells that transport oxygen to all parts of the body.  A deficiency in iron results in anemia, which symptoms include light-headiness, weakness and dizziness. Considering absorption issues, the best forms of iron to take are ferrous fumarate or ferrous gluconate.  Iron should be taken on an empty stomach along with Vitamin C in order to aid absorption.. It is important not to take iron the same time as you are taking calcium. 

Calcium – In order to maintain bone strength and to avoid osteoporosis, it is necessary to take a calcium supplement following weight loss surgery. Calcium is also critical in the regulation of blood pressure, blood clotting, as well as muscle and nerve control. Those between the ages of 19 and 50 should take 1,000 mg. of calcium daily. Those over 50 should take 1,500 mg. Because of the absence or reduction of the availability of gastric juice following bypass surgery, the most effective form of calcium to take is calcium citrate rather than calcium carbonate.

A commitment to a vitamin regime is essential to remain healthy for years after your surgery.  It takes little effort, yet the benefits last a lifetime. Years from now you want to feel as good as you look.

Barbara Thompson, MLS is an RNY patient and author of the book Weight Loss Surgery: Finding the Thin Person Hiding Inside You.


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