September 23, 2011
Julie Parrott
ABOUT THE AUTHOR, Julie Parrott, MS, RD, LD, Prime Surgicare
Julie Parrott, MS, RD, LD, has been part of the Prime Surgicare team from the start and plays an important role in pre-and post-surgical nutritional counseling and support for all of our bariatric patients. She is also a popular leader of our Bariatric Support Group Meetings held for our patients.
Three pieces to the dietary supplement puzzle
As a weight loss surgery patient, you know that the numerous forms of dietary supplements, tablets, capsules, chewables and powders, as well as drinks and energy bars can be overwhelming. How do you know which choices are the best for you? Imagine a puzzle with only three pieces. Let’s put the three pieces of the puzzle together:
Which supplements do I really need?
One of the primary goals of weight loss surgery is to restrict the quantity of food you eat at one time. This affects your ability to eat a variety of nutritious foods within your first six weeks after surgery. Your individual history and prior eating patterns may also leave you susceptible to developing specific nutrient deficiencies. At Prime Surgicare, we monitor your nutrient levels before and after surgery to prevent nutritional deficiencies from developing or worsening.
According to the most recent research guidelines, all weight loss surgery patients should be taking:
- a multivitamin and mineral supplement
- calcium citrate with vitamin D
Additionally, we recommend that you take vitamin B12 and iron each day if you had the sleeve gastrectomy or the gastric bypass (we discuss supplement and dose at pre-operative and post-operative visits).
After your first six weeks of surgery, you may also be taking specific supplement(s) based on your particular surgery or nutrient deficiency (recommended to you by your primary care practitioner or surgeon’s office). These supplements may include protein supplements and specific vitamins such as vitamin B12 or vitamin C; minerals like iron or magnesium; herbs such as garlic; and specialty products like glucosamine chondroiton, probiotics, and omega 3 fatty acids.
What form or type of vitamin should I take?
We recommend that you take a chewable, powder or liquid form of supplement for the first four weeks after surgery. You should be able to tolerate most capsules or tablets after this time. The newer gummy vitamins may taste great, but they do NOT contain all the vitamins and minerals you need as a bariatric patient. In fact, many of the gummy vitamins do not contain the recommended 100% Daily Value for many nutrients, particularly thiamine (vitamin B1), so forego this option. The recommended daily amount (100% DV) for adults is 1.5 mg per day.
Why is thiamine so important?
Thiamine (vitamin B1) is an important nutrient for taking energy from food and turning it into energy for your brain, nerves and heart. It is needed by the body to process carbohydrates, fats, and proteins.
What happens if I don’t get enough thiamine?
Your body stores very little thiamine, so deficiency can happen very quickly - especially if you are not eating much or if you are vomiting for any reason. When you don’t get enough thiamine, you may have difficulty concentrating, weakness, changes in memory, burning feet and loss of balance among other symptoms.
Where can I get thiamine?
Thiamine is found in fortified cereals, beans/peas, nuts and pork, foods difficult for a weight loss surgery patient to obtain in the first six weeks after surgery. Some beverages, like coffee, black tea and alcohol, can also inhibit thiamine absorption.
How much do I take?
When it comes to supplements, there is no “one size fits all”. What you need depends on your particular situation, and the staff at Prime Surgicare will help you identify the dosage that’s optimal for you.
However, there are a few tips that will help you:
- Read the Supplement Facts. All products labeled as dietary supplements carry a Supplement Facts panel that lists the contents, amount of active ingredients per serving, and other added ingredients (like fillers, binders, and flavorings).
- Pay attention to how a “serving size” is defined. Different products define a serving size differently. For instance, do you need to take six capsules, two chewable tablets or just a single chewable to provide the percent daily value (% DV) listed on the Supplement Facts?
- Who is the supplement intended for? An adult? A child? Pregnant and Lactating woman? An adult who had weight loss surgery?
- Look for a seal of approval. The dietary supplement or dietary ingredient manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. The FDA has established standards for dietary supplements (ensuring identify, purity, strength, composition-in short, that you are getting what the manufacturer claims you are getting). Also, several independent organizations (like U.S. Pharmacopeia, ConsumerLab.com, NSF International) offer quality testing and allow products that pass these tests to display their seals of approval.
- Keep track of all your supplements. Because vitamins and minerals are present in many different supplements, it’s very important to keep a list of all the supplements you take. The U.S. Office of Dietary Supplements (ODS) has created a handy (and free!) mobile app for consumers called My Dietary Supplements (MyDS). Simply enter the names and amounts of your dietary supplements, and they’ll be stored on your iPhone or iPad for your use anytime, anywhere-for example, when seeing your doctor or shopping. MyDS is available from the iTune store. http://itunes.apple.com/us/app/myds/id399053073?mt=8 Download MyDS. MyDS gives you:
- An easy way to keep track of the vitamins, minerals, herbs, and other products you take-right in the palm of your hand.
- Access to science-based, reliable information on dietary supplements.
Use Reliable Sources
Not all information on dietary supplements is accurate or useful. In fact, there is quite a lot of misinformation out there. We recommend to patients a wealth of reliable information available at the following government websites:
Appendicitis can be a challenging condition to diagnose because abdominal pain can arise from a number of health problems. Symptoms can include consistent and worsening pain in the lower right abdomen and gastrointestinal problems (vomiting, constipation, diarrhea). See your family doctor if you experience any of these symptoms. The doctor will diagnose the condition by applying gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Other signs your doctor may watch for include abdominal rigidity and a tendency to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). 
