Did you know that vitamin & mineral supplementation typically begins at the time of discharge from the hospital, usually 2–4 days after surgery? Any idea what the must-have vitamins and minerals are for your body? What about when to take them and how much to take? The right supplementation is so important to your success.

Hi, I’m registered dietitian nutritionist Dr. Susan Mitchell. You’re listening to the Bariatric Surgery Success podcast episode number 53. Most of my career I’ve worked in some type of media, particularly radio where I did morning drive nutrition spots for over 18 years. That’s what lead me to start podcasting and ultimately to you. I created Bariatric Surgery Success to provide you with life-changing information based on science along with simple strategies and tools to help you be successful in your transformation and your entire journey. So happy you’ve connected with me. You’re in the right place and I’m glad you’re listening.

Let’s get right to it…

Vitamin and mineral supplementation is a lifelong part of bariatric surgery. When you have weight loss surgery, vitamin and mineral supplementation is one of those items that will be on your daily to-do list from now on. Call it a behavior modification, lifestyle change or a tweak to your daily routine. However you look at it, supplements are part of your new lifelong strategy for success.

Nutritional deficiencies are common after weight loss surgery and the type of surgery performed does make a difference. For example, vitamin and mineral deficiencies are more common after procedures like Roux-en-Y gastric bypass or biliopancreatic diversion as compared to sleeve gastrectomy and adjustable gastric banding. That’s why you always hear me say to circle back with your health care team for clarity if you’re unsure about which supplements they recommend for your procedure. Recommendations vary between surgical centers and even professionals groups so don’t be surprised if your supplements suggestions are different from someone else you know who’s had surgery.

Let’s start with three important tips to keep in mind:

1. As I mentioned at the start of the podcast, vitamin & mineral supplementation usually begins when you go home from the hospital which is typically 2–4 days after surgery. So if you’ve had surgery and are home now, you should have started on supplements. We’ll talk about which ones in a minute.

2. Your body has changed in it’s ability to absorb vitamins and minerals. How much it’s changed depends on the surgical procedure. When selecting your products, chewable or suckable pills, or liquids are a really good idea the first 3-6 months. Then if you choose and your health care provider doesn’t have you on any specific regimen, you can switch to capsules or tablets.

3. Routine vitamin and mineral screenings/lab tests should be part of your care from your health care team. How often and what they screen for will vary with your procedure.

A lot has changed in the vitamin-mineral world. In the not-to-distant past, bariatric-specific supplements weren’t common so we combined various over-the-counter products to get what we needed. Today, many companies provide a wide variety of bariatric supplements. In fact, there so many to choose from, it’s easy to become overwhelmed or unclear about which ones to take. You’ll need to do some label sleuthing and I’ll show you how.

So which supplements do you need? Let’s dig into the general suggestions for bariatric surgery knowing that your health care team may tweak these. Today, in part 1, we’ll talk about multivitamin and mineral supplements along with vitamin B-12.  In part 2, we’ll cover iron, calcium and vitamin D and thiamine.

First on the list. Take a complete multivitamin plus mineral supplement that is bariatric specific. What the heck does that mean? Complete means it contains the typical A-Z formulation of vitamins and minerals similar to what you find in an adult supplement but in amounts recommended for bariatric surgery. Make sure it includes both vitamins and minerals and specifically check for vitamins A, D, E, K, folic acid and thiamin along with the minerals iron, zinc, selenium and copper. If it’s a good quality bariatric supplement it will contain all of these and more.

Here’s a need to know: you can find a multi both with and without iron. It’s fine to take your iron in the multi as long as you haven’t been put on a higher dose.  Also, the numbers of multis you take everyday will vary based on the brand. Typically the dose will be one or two tablets, capsules or chewables per day. How do you know?

Label sleuth time. This is what I want to show you. Do you have a vitamin container near by? Go get one. Now take a look at the Supplement Facts label which you’ll find on the back of most products. This Supplement Facts label is what you’ll find in the US and I realize that if you’re listening from another country, you’ll have a different label. At the top of the label you’ll see the serving size such as 1 chewable tablet. Then you’ll see listed each vitamin and mineral along with the amount per serving and the percent Daily Value. Percent daily value or DV is the percentage that chew provides of your daily needs for each of the vitamins and minerals listed.  You’ll want to see 100-200% Daily Value for most every vitamin and mineral but there will likely be a few that are higher such as thiamine, vitamin B12 or even iron.

Don’t miss this tip: Sometimes you need more iron than what’s in your supplement and we’ll talk about that in part two but if you multi contains iron which it usually does, be sure and take your calcium separately, wait about 2 hours or more from the time you take the multi or the calcium will not be absorbed well by your body.

Vitamin B-12 aka cobalamin: the dose is 250-500 micrograms (ug) a day with most suggestions in the 350-500 microgram range daily or 1000 mcg every other day.  The dose depends on your surgery, your lab results and the route of administration…meaning under the tongue, you swallow it, etc. Sometimes an intramuscular injection of B12 or a nasal spray will be ordered by health care team. You can take B12 at any time or with any other supplements. It’s likely that your multi will have enough B-12 in it so check the label before you buy additional. Be sure and discuss your lab screenings with your health care team before you decide to take any extra.

Today’s Science 101 on Vitamin B-12. The absorption of B-12 can be affected by bariatric surgery due to changes in acid production and reduced availability of what’s called the intrinsic factor. This intrinsic factor helps the B-12 to be absorbed and used by the body. When it’s not there or insufficient, B-12 doesn’t get absorbed and used as it should. You could experience neurological symptoms which include numbness and tingling of your arms, legs and skin plus feel like your coordination is off. This is a prime reason why routine screenings are so important and typically done every six months or so. These screenings help your health care provider pick up on a possible deficiency hopefully before it becomes a problem.

Check out the Supplement Facts on a number of products to see what you like best. As I’ve shared before I partner with ProCare Health Plus if you receive my Breaking Down Nutrition newsletter, there will be a 10% off code in there this week too. If you don’t receive the newsletter, you can sign up for it on the home page of my website Breaking Down Nutrition.

Decide what works best for you. Ask questions if you’re not sure. You’re worth it!