Masters Diet Nutrition Bariatric Surgery Bariatric Vitamins FAQs answered by a Registered Dietitian

Bariatric Vitamins FAQs answered by a Registered Dietitian

If you are thinking about bariatric surgery, you have probably heard something about needing to take vitamins for the rest of your life. But you may have many questions about this. You may be wondering why this needed or what type of vitamins specifically you should take. I hear these questions often as a bariatric dietitian, so today, I have decided to dedicate this post to answering the most common FAQs about bariatric vitamins.

Disclaimer: These recommendations will be general recommendations based on the ASMBS guidelines that work for most people pursuing bariatric surgery. However, please always follow the advise of your healthcare providers and follow any special guidance that may be given to you based on your individual medical history. Some medical conditions may impact which vitamins you should take. Please, make sure you discuss plan for vitamins by your medical provider who is aware of your medical history.

Why do I need to take vitamins after bariatric surgery?

Bariatric surgery works because it makes it a lot easier to maintain an extreme caloric restriction needed to lose weight quickly and then maintain this weight loss thereafter. It does this by restricting the amount you are able to take in and/or absorb. But it doesn’t just limit the amount of calories you take in. It also limits how many vitamins and minerals you are able to take in and absorb. This means that your vitamins and mineral needs are way higher than they were before surgery and you are at high risk of developing deficiencies if you don’t get extra vitamins and minerals in some way.

What can happen if I don’t take vitamins?

Not taking vitamins can lean to all kinds of nasty vitamin deficiencies. Most notably, B12 (cobalamin) and B1 (thiamin) are 2 vitamins that deal with the nervous system and brain. Deficiencies in these vitamins can be very serious in that they can cause permanent damage to the nervous system and/or brain if they aren’t treated right away. Another serious side effect that can happen is bone loss from not taking enough calcium. You will need to take calcium supplements after surgery because bariatric surgery makes it harder to get enough of and absorb calcium. You body uses calcium for all kinds of functions, and a certain level of calcium has to be circulating in your bloodstream at all times. If your body isn’t getting enough calcium in your diet to maintain these levels, the body will take the calcium it needs from the bones. This will weaken your bones and put you at greater risk for bone fractures. These are a few of the most serious deficiencies that can occur, but there are several others as well.

I already take a regular multivitamin I get at the grocery store/pharmacy. Will this be good to continue for after bariatric surgery?

It’s great that you are taking a regular multivitamin pre-surgically. Not only is this providing you with extra vitamins but it is also getting you into the habit of taking vitamins. Unfortunately, a regular multivitamin will not be a good fit for after bariatric surgery. The first reason for this is that it will not be strong enough. The American Society of Metabolic and Bariatric surgery has a set of guidelines based on extensive research that determine what vitamins you should take and how much of them. The amounts suggested in these guidelines are very high, much higher than the average multivitamin. To illustrate this, take a look at the picture below of a label for a common over-the-counter multivitamin. I have highlighted in yellow every vitamin that doesn’t contain high enough amounts to meet the ASMBS guidelines. This would remain true for the majority of these vitamins even if you took 2 of them a day.

The other problem with over-the-counter multivitamins is that they are usually in the form of pills that are harder to digest. Many surgeons want their patients to take chewable vitamins, at least in the beginning stages. This helps you heal safely and absorb your vitamins more easily.

So which vitamins should I take?

For the reasons mentioned above, I usually recommend that you take a vitamin that is formulated for bariatric surgery. Bariatric-formulated products are tailored to meet your specific needs and will make it much easier and more convenient to get what you need with less products. (Because who wants to have 10 different vitamins bottles?!)

The most common (and easy) recommendation for bariatric vitamin products involves 2 products: A bariatric multivitamin with iron and a chewable calcium citrate product. Let’s briefly explain the basics of both.

The Bariatric Multivitamin with Iron: The bariatric multivitamin can have everything in the ASMBS guidelines except for calcium. They are usually available with or without iron. If you don’t get the option with iron, you will need a separate iron. Most people are trying to avoid too many separate products, so I usually recommend getting one with iron for convenience.

Chewable Calcium Citrate: The reason calcium is a separate product is twofold. Firstly, it must be separate because taking iron and calcium together is not recommended. Calcium and iron interfere with each other. This means that taking them together can lead to iron-deficiency anemia, a condition that can make you feel weak and fatigued. To avoid this risk, it is recommended to wait 1-2 hours after your multivitamin with iron to take your calcium. The other reason is that your body can’t take in a lot of calcium at one time. Your calcium needs will range from 1200-1500 mg for those getting the Gastric Sleeve or Gastric Bypass and 1800-2400 mg for those getting the Duodenal Switch. However, your body can only absorb about 500-600 mg at a time. Calcium products therefore usually come in 500 mg doses and you must take multiple doses to get to your recommended level of calcium. Calcium should also come in the form of calcium citrate since this type of calcium absorbs more easily than other types of calcium. Calcium Citrate reduces your risk for developing kidney stones.

Let’s break down some examples of vitamins that are great choices.

Bariatric Multivitamins Examples:

  • Standard bariatric multivitamin with 45 mg of iron: This is a good option for most people getting a gastric bypass or a gastric sleeve. It contains 45 mg of iron, which is considered enough for those who are at risk for iron deficiency, namely if you get menstrual cycle or if you have ever had low iron. The example below is a reputable product designed to be taken once daily.
BariatricPal’s Chewable Multi with 45 mg iron
  • Standard bariatric multivitamin with 18 mg of iron: This is a standard multivitamin appropriate for those getting the gastric sleeve or the gastric bypass, but it has a lower dose of iron, 18 mg. This amount of iron is considered adequate if you don’t have any risk factors for developing an iron deficiency. Because too much iron can contribute to constipation, this can be a good option to consider if you don’t have risk factors for iron deficiency such as a history of iron or a having a menstrual cycle. The example below is a reputable product designed to be taken once daily.
Procare Health Bariatric Multi with 18 mg iron
  • High ADEK vitamins: This is the option recommended to those who are pursuing a Duodenal Switch. If you are getting this type of bariatric procedure, you will be absorbing less vitamins compared with the gastric sleeve or gastric bypass. Therefore, you need a vitamin that is even more potent than the above two examples. These are called High ADEK, because they are high in the specific vitamins that need to be increased for the duodenal switch. Please, note for the example below, you will need to take 2 chews daily rather than just 1 chew daily.
Bariatric Advantage High ADEK Multi with Iron

Calcium Citrate Examples:

  • Calcium Citrate Soft Chews: These are the most popular option for bariatric patients when it comes to getting in their calcium and for a good reason. “Soft chews” are similar in texture to starbursts. They come in a wide variety of flavors, including caramel, strawberry, watermelon, cinnamon roll, and on and on. Many people compare taking these to eating a few pieces of candy everyday. These almost always come in doses of 500 mg each. Ideally, someone getting a gastric sleeve or gastric bypass should take 3 daily and someone getting a duodenal switch should get 4 daily, unless otherwise advised by your healthcare provider. Almost every company that specializes in bariatric vitamins has some variation of this. In the examples above, I will link the 3 companies mentioned above. Sticking to the same company can often make things easier so that it is easier to order all your products from the same place.
BariatricPal Calcium Citrate Soft Chews
  • Calcium Citrate Powder: As popular as the calcium soft chews are, they are not going to be everyone’s cup of tea. For this reason, I would like to include another option as well: powdered calcium. Procare Health makes a wonderful powdered calcium that comes as a stick packet. 1 packet is the equivalent of 1 calcium soft chew. Each stick packet has 500 mg, so 3 daily would provide the 1500 mg most people are recommended to get. The powder is tasteless and can mixed with a variety of things, although it does need to be something “of substance”. Calcium won’t dissolve in water because it is a mineral salt. However, it will be fine in food or in a thicker liquid. Some people even like to take it on its own like a pixie stick, or make a “drizzle” by mixing it with a small amount of water. For a more low cost options, you could measure out your own powdered calcium as well. BulkSupplements does make a cost effective option for this that is available for purchase on Amazon. But be very careful of dosing out the correct serving size if you do this. The pack suggests a 1000 mg serving which is 1/2 tbsp. However, it is recommended to take calcium in doses of 500-600 mg at a time. Doing the math, 3/4 tsp would be 500 mg and 1 tsp would be 667 mg. So you can either take 3/4 a tsp three times to get 1500 mg (the upper end of the recommended range for sleeve and bypass patients) a day or 1 tsp twice a day to get 1200 mg a day (the lower end of the recommended range for sleeve and bypass patients). Those getting a duodenal switch may be recommended to add another calcium serving.
Procare Health Calcium Citrate Stick Packets

Are there any products I should avoid?

Avoid All in one products:  Some products advertise to be an all in one product.  There are a few caveats to this. This is achieved by putting calcium and iron together in the same product.  This is not ideal because iron and calcium compete with each other for absorption.  Moreover, many people assume that this is a once daily product.  In reality, these products are designed to be taken 4 times daily.  This means you will be taking vitamins just as frequently as you would be if you did a once daily multivitamin and separate calcium, just with more added risk of becoming anemic.  Most people also don’t like the texture of these products.  The texture is similar to a Tums, which people often describe as “chalky”.  While the same can be said of the multivitamins with iron referenced above, dealing with this once versus four times a day is a huge difference.  The most popular examples of this on the market are Bariatric Fusion’s Complete Chewable and BariatricPal’s All-in-one Multivitamin and Calcium Citrate Chewable.  Both these brands have other options for products that line up with the ASBMS guidelines but I don’t recommend the above vitamins specifically.  There is one product by Celebrate vitamins that is essentially the same thing but leaves out the iron.  This leaves the possibility you could take this if you take iron separately. This regimen would meet your vitamin needs.  However, most patients do not like this product once again because of how often they need to take it and the “chalky” texture.  

Avoid Multivitamins that leave out copper:  Copper is an important mineral that is often left out.  The reason for leaving out copper has nothing to do with whether your body needs it.  Including copper in a multivitamin adds to the expense of producing that vitamin.  It is also expensive to test for a copper deficiency.  For this reason, many companies see leaving out copper as an easy way to cut costs without running the risk of being blamed for a deficiency. But not knowing about a deficiency doesn’t mean it’s not there.  Copper performs important functions in the body including helping you absorb iron and making something called ATP, which is the stuff that your body makes to give you energy.  For this reason, a copper deficiency can cause you to feel weak and fatigued and even cause neurological problems like numbness in your arms and legs.  Because it is not tested for often and there are so many things that cause fatigue, a copper deficiency can be easily missed.  One thing that can lead to a copper deficiency is taking a zinc supplement or a multivitamin with zinc without copper.  Zinc decreases the amount of copper your body absorbs.  The bottom line: make sure your multivitamin has not just zinc but also copper.  Popular bariatric vitamins that leave out copper include the following: Bariatric Fusion Multivitamin Soft chews and Procare Health Multivitamin Soft Chews. While both these brands have other great products, these particular products are a miss due to the lack of copper.

Avoid Nu-Life Advanced Bariatrics Multivitamin: I have to warn against this product specifically because it is a such prime example of blatantly deceptive marketing. Many people end up buying this from the Vitamin Shoppe, where the employees will likely tell you this is great multivitamin option that caters to bariatric surgery. It is not. This product is astronomically off. The amounts of vitamins contained in this vitamin are nowhere near the ASMBS guidelines. I doubt whoever made this has even heard of the ASMBS guidelines. Most alarmingly, it doesn’t have anywhere close to adequate levels of B1 and B12, and deficiencies in these vitamins can lead to permanent nerve and brain damage. If you are relying on this product, you are putting yourself at risk for serious deficiencies that could do permanent harm to your health. In short, please, do not take nutrition advice from anyone at the Vitamin Shoppe, and please do not buy this product.

Avoid Vitamin Patches: While shopping for vitamins you will likely stumble across vitamin patches like these which purport to give you vitamins in a different way–through a patch on your skin. While this sounds like a really nice idea, current research does not support that patches are effective. As a result, vitamins patches are not recommended by current guidelines. Until vitamin patches make improvements and can prove they are effective in scientific studies, I would not recommend betting my health on them.

So there you have it! I hope that this article has helped shed some light into the world of bariatric vitamins. Those who undergo bariatric surgery do so to improve their health and quality of life. Taking the right vitamins after surgery can you achieve that.


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