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Supplement Requirements BARIATRICS

Adequate / supplementation is required after surgery to help with proper wound healing, skin remodeling, hair growth, and maintaining long term health. Bariatric surgery can cause multiple vitamin/mineral deficiencies such as , B12, and . It is very important to be committed to a lifelong vitamin/mineral regimen prescribed by your surgeon and dietitian. Listed below are the vitamin/mineral recommendations you will be required to follow after surgery.

REQUIRED

1. Complete with minerals – twice a day (100% RDA of iron and ) 2. with - 500-600 mg three times a day (cannot take all 1500-1800mg/day at one time) 3. Sublingual B12 - 1000 mcg 3 times/week (sublingual= dissolves under tongue) -OR- B12 Shots from our office or PCPs office 1x/month -OR- Prescription B12 Nasal Spray -1x/week 4. Iron (see approved supplements for dosage amount) + 500mg – (for women with menstrual cycle and deficiencies only)

SAMPLE VITAMIN/MINERAL SCHEDULE (The time of day that is listed is not important, the SPACING is! Your multivitamin and calcium supplements must be 2 hours apart for them to be absorbed properly. If you take iron, it must be 2 hours apart from your calcium supplement.)

TIME SUPPLEMENT

8:00 am - Breakfast  Complete Multivitamin with Iron and Zinc

 1000 mcg Sublingual B12 *At least 3x/week

10:30am - Mid Morning  500-600 mg Calcium Citrate with Vitamin D

1:00 pm - Lunch  500-600 mg Calcium Citrate with Vitamin D

3:30 pm - Mid Afternoon  500-600 mg Calcium Citrate with Vitamin D

6:00 pm - Supper  Iron: 29 mg ferrous fumarate ( 500mg vitamin C included) *For women who are still menstruating and those with a deficiency

10:00 pm - Bedtime  Complete Multivitamin with Iron and Zinc

If you have any questions or need additional support, please contact our dietitian, Cala Dittmer, at 706-238-8028 or [email protected]

APPROVED VITAMIN/MINERAL SUPPLEMENTS *Generic brands are approved as long as they compare to the brands below*

Complete Multivitamin with minerals twice a day (100% RDA of iron and zinc) *Must take chewable form for the first six weeks after surgery*

 Flintstones Complete (includes iron and zinc) –CHEWABLE –NO GUMMIES

 Centrum Complete (includes iron and zinc) -OR- Women’s One-A-Day – Chewable or Pill form

 Bariatric Advantage (includes iron and zinc) - Advanced Multi EA Chewable; Ultra Multi Formula with Iron; Chewables Complete; Chewables Essential; Chewables VitaBand; Chewables Pre-Operative

APPROVED VITAMIN/MINERAL SUPPLEMENTS *Generic brands are approved as long as they compare to the brands below*

Calcium Citrate with Vitamin D 500-600 mg 3x per day (cannot take all 1500-1800mg/day at one time)

DO NOT TAKE DURING THE PUREED PHASE (THE FIRST 4 WEEKS AFTER SURGERY). TAKE: 3x/day Please read the label to make sure you are taking the correct number of tablets to reach 500-600 mg per dose. SEE LABEL EXAMPLES TO THE RIGHT

 Citracal: calcium citrate + Vitamin D -NO GUMMIES; NO CHEWS MAXIMUM: 2 tablets, 3x/day -OR- PETITES: 3 tablets, 3x/day  Bariatric Advantage: calcium citrate + Vitamin D CHEWY BITES – 250 mg per chew (Flavors: chocolate, lemon, and raspberry)- 2 chews, 3 times/day = 1500 mg (6 chews total per day). OR 500 mg per chew (Flavor: caramel)- 1 chew, 3 times/day = 1500 mg (3 chews total per day)  Wellesse: Calcium + Vitamin D - LIQUID – 1 Tbsp, 3x/day

*ALWAYS check the ingredients label to make sure CALCIUM CITRATE is the first ingredient.

If you have any questions or need additional support, please contact our dietitian, Cala Dittmer, at 706.238.8028 or [email protected]

B12- SUBLINGUAL -OR- SHOTS -OR- NASAL SPRAY

Begin taking before surgery, and do not stop after surgery.

 Sublingual B12 - 1000 mcg 3 times/week (sublingual= dissolves under tongue) Can be found at any pharmacy. Usually cherry flavored. Allow tablet to dissolve under your tongue completely or for the amount of time specified on the label. *Do not take liquid form due to poor absorption!  B12 Shots from our office or PCPs office 1x/month  Prescription B12 Nasal Spray -1x/week

Iron All women who still have a menstrual cycle are required to take Iron in addition to their Multivitamin

Begin taking immediately after surgery.

 Bariatric Advantage: Ferrous Fumarate 29 mg/day (has Vitamin C included)  Ferrous Citrate 29 mg/day + 500 mg Vitamin C (to help absorption).  Ferrous Gluconate 325 mg/day (generic or Fergon) + 500 mg Vitamin C (to help absorption).

*Do not take Ferrous Sulfate due to poor absorption!

If you have any questions or need additional support, please contact our dietitian, Cala Dittmer, at 706.238.8028 or [email protected]