FAQ’s

Protein Issues FAQ’S


Vitamin Issues FAQ’S


Surgical and Mechanical FAQ’S


Thoughts FAQ’S


Why do we use protein supplements? Protein is initially broken down in the upper small intestine, just outside the lower stomach, using an enzyme manufactured there called trypsin. Once broken down, protein best is best absorbed in that first 12 to 18 inches out of the stomach. If the food doesn’t go by there any more, how will you break down and extract the protein from the tiny bit of food you can eat? While you can absorb some broken down (pre-digested) protein throughout the intestinal tract, the most absorption takes place right at the beginning, where ALL bypass and RNY patients are not going to get it Supplemented protein is already pre-digested for almost instant absorption. It’s liquid form makes it easier to get in, even into an irritated pouch, and the pre-digestion means you can count on absorbing at least most of it (unless you are very, very distal). Each person needs a minimum of 60g of protein per day. It’s hard for any stapled stomach people to get it in their food, as the high protein foods are so dense, we simply can’t get enough IN to ever reach 60g. Also, since many foods must be combined with bread or grains to be complete, what happens if you can’t eat bread yet? Protein is best absorbed in amounts of no more than 30g at one time. Professional athletes can do a little better, but for weight loss surgery patients, 30g would be a good try. More protein won’t hurt, but is just wasted. Unless you are very distal, two drinks of 30g each is an excellent start toward a healthy protein intake. Protein is the main foundation of our health. If the supply becomes depleted, malnutrition will result. But before that, we’d experience deficiencies in many other vitamins or minerals that show themselves more vividly, such as calcium. Another benefit to supplemented protein is that it satisfies cravings. While we are losing, the sugar cravings can drive us nuts. Part of it is sugar’s hold on us. Part of it is low protein, very common for any of us and part of it is lack of general nutrition. By being well nourished, don’t’ ever go into starvation mode. It keeps the body thinking everything is fine and it is relaxed about allowing us to lose. Let it go into starvation mode, and it retaliates by hoarding even more calories than before surgery. The proteins we offer here are all considered “complete” and contain the full branch chain of amino acids, a smattering of vitamins & minerals and are lactose free, as well as very, very low in carbs, sugars, fats and calories. We also try to stick with smooth and tasty ones. The soys are rather gritty, so we can special order them, but do not stock them. The whey proteins are more flavorful, rarely chalky and never gritty. Most will shake up easily in 4 oz of water or sugar free juice or pop. If your surgeon forbids carbonation, flat pop will still give interesting flavors. Samples are available for a small price plus shipping. We encourage all weight loss surgery patients to consider this valuable resource over the usual milk and Carnation Instant Breakfast. Many of us become lactose intolerant after surgery. Milk is quite high in sugars, and low in protein in comparison. For the pouch space spent, the proteins offered here give much more brain satisfaction and more nutrition than milk or any FOOD type of protein and are more “available” to us for absorption. These samples represent about 20-30g, whatever it says on the label. If it says that 1 scoop – 22g, then this sample is 22g of protein (one scoop). Some brands have tiny scoops, so it takes 2 scoops to reach 30g. Those bags are marked 2 sc = 32g, so you’ve gotten 2 scoops or 32g of protein, for example. The label is from the only brand whose labels come off easily. While each one has slightly different sweeteners and other stats, generally this profile is what you will find in all our proteins. Glutamine enhanced, lactose free, low in sugar, carbs, fats and high in protein with the full branched chain of amino acids. Protein HOLDS onto muscle, while allowing the fat to be flushed away with all that water you’re drinking! ProScore 100 needs to be BLENDED with 6-8 oz of liquid and some ice, to taste. It doesn’t shake well at all, but it is OH SO WORTH the blending! All others will shake up nicely in 4 oz of water. For variety, you can add them to Crystal Light or Diet Ice or Sobe Lean or any other sugar free juices. The ProBlend 55 vanilla is FABULOUS with diet root beer or diet orange pop, but I don’t recommend shaking those unless you are CERTAIN the pops are flat. And yes, flat diet pop is safe. Blending them also takes out the carbonation if you blend them thoroughly. Yes, you can add fruit chunks when your doctor allows, but watch the sugar! We never add them to milk. Bear in mind that these products are made for body builders and weight trainers, as well as professional athletes. They are designed to put weight ON if used with milk! No one really can absorb more than 30g (or so) at one time, except professional athletes. We recommend a 30g “dose” for breakfast and during your mid-afternoon “sleepies” to get the most benefit if you are trying to get 60g per day. If you are a distal, 30g every 2 or 3 hours will get the required amount for you. You can mix up more grams and drink at one time, but you are merely buying the protein, not really getting the benefit of it. It is not advisable to mix it up in advance, as we know it loses its protein integrity (but how much?), and it begins to gather bacteria after as little as 30 minutes. Even refrigerated in a tightly sealed container is no guarantee that you’ll be getting the full safe dose you hope for. We hope that you’ll find one or more brands that you enjoy for your maximum weight loss and best possible health! Thanks!

Customer testimonial regarding Protein:

“I had a very rough first six months, constant throwing up, tearful, hungry, shaky, almost in a state of panic because I could not keep down food AND my weight loss was very slow. I could stomach sugar free Carnation Instant Breakfast with skim milk and thought I was doing well for myself. Then I found this group and the powerful whey protein supplements.

Once I learned how to make them palatable I leaned on them for virtually ALL my protein nutrition. I quit throwing up and crying everyday. I quit feeling panicked and hungry all the time. Finding that stability and equilibrium allowed me to begin experimenting with eating a bite of food here and there. One bite did not make me sick and I felt no need to eat more than one bite. Over the past six months I’ve learned to eat again without being sick. Tiny amounts, chewing well, relying on shakes when my pouch feels “grouchy” and knowing it’s ok cause I don’t “need” food that day. My surgeon warned us that if we “ate ice cream and potato chips everyday we would regain our weight.” Ok, I heard that and determined not to do that. What he did not discuss and what did not occur to me was that ALL simple carbs were harmful to my weight loss process. Dense protein foods were very painful and hardly ever stayed down. I was living on mashed potatoes & gravy, cheese toast, and sugary carbs. Listening to the experiences here and drinking the protein shakes has completely turned my life around. I’ve lost 82 pounds and remain 85 pounds from goal, but I’m much healthier and happier since discovering the shakes. It takes a bit of perseverance. I can honestly say I LOVE the taste of shakes now, but at first I thought they were the most disgusting things imaginable.” Nancy B [top]


What’s the difference between all in one capsule and separate element vitamin and mineral form? Those patients with a malabsorptive bariatric procedure lose seven elements due to malabsorption, besides protein. Vitamins A, B-12, D & E and the minerals Iron, Calcium & Zinc. The following comparison is based on Dry Form product rather than the more common Oil Soluble Form which is not recommended for people with malabsorptive procedures. Comparison (based on minimum suggested for distal RNY)

Element
Individual
Typical all in one
A
17,500 IU
350% RDA
45,000 IU
900% RDA
B-12
12 mcg
200% RDA
18 mcg
300% RDA
D
2,400 IU
600% RDA
2,400 IU
600% RDA
E
800 IU
2,600% RDA
400 IU
1,300% RDA
Calcium
2,364 mg
230% RDA
2,000 mcg
200% RDA
Iron
336 mg
1,859% RDA
266 mcg
1,478% RDA
Zinc
145 mg
900% RDA
100 mg
667% RDA
Cost per *
day
$1.06
$1.57
month
$32.25
$47.75
year
$386.90
$573.05
Advantages
Convenience
Have to sort Pre packaged
Quantity *
17 capsules or tablets 12 capsules
Size
Small to large capsule & tablets (depending on element) Large Capsule
Frequency
5 doses/day (to keep iron separate) 4 doses/day
Adjustability
Each element is adjustable without effecting other elements Must add supplemental or adjust all based on number of capsules taken
Variables
Some elements allow you to choose between chewable, lozenge, tablet, capsule form, and flavors (price will vary on form) Capsule or tablet form
* price & quantity includes multiple vitamin and vitamin C

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What should I ask a surgeon at the consultation?

  1. How much common channel will I have?
  2. How many supplements should I take? If they say none, ask if you CAN take them. If this is sloughed off, RUN.
  3. Do you separate/transect the lower stomach? Do you remove the lower stomach?
  4. How big is the pouch?
  5. Can/should I drink milk after surgery?
  6. What about sugar?
  7. What about fats?
  8. How often do I need labs?
  9. How long am I off foods?
  10. Of my excess weight, what percentage will I lose?
  11. Of my excess weight, what percentage will I keep off?
  12. How strict a “diet” will I still be on?
  13. Is obesity a mental or mechanical problem?
  14. How common are staple line disruptions?
  15. How common are ulcers around the stoma?
  16. If I am still nauseated or vomiting after 3 weeks, what will you do for me?

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Why did/should I have Weight Loss Surgery? Copied with permission, I thought it might help some fresh post-ops or about to be reaffirm their reasons for having this done. This patient belongs to Dr. Marcus’ support group in the MD-DC area. Barbara and her sister sat down one day and devised this list to help her decide to go ahead with her surgery. It is so powerful that again that I want to share it. Please pass it on as you see fit. ~~~~~~~~~~~~~~ Making a DecisionBy Barbara Cummings

  1. When was the last time you shopped in a regular clothing store, like Hoechst’s?
  2. When was the last time you wore size 8 underpants?
  3. Do you have more than 1 belt in your drawer that you have never worn?
  4. Can you shower in the communal room at the local health club?
  5. Can you swim? Do you? With normal sized people?
  6. Could you take an aerobics class and stay to the end?
  7. When was the last time you rode a roller coaster?
  8. When you fly, do you have to ask for a seat belt extension?
  9. Does your car seat belt cut you across your neck?
  10. When was the last time you could wear “one size fits most?”
  11. When you go upstairs, does your heart pound until you think it’s going to jump out of your chest? Does it hurt?
  12. Can you climb a flight of stairs without pain in your knees? Two flights?
  13. Have you ever looked longingly at people using scooters in Wal-Mart?
  14. When was the last time you went to the beach? In a bathing suit? To swim? And not thought people were looking at you?
  15. Do you buy your clothes in a department store, or is Lane Bryan, Dress Barn Woman, Fashion Bug Plus, and Roman’s the stores you go to?
  16. When was the last time you had on sexy underwear?
  17. Is your neck bigger than most people’s heads?
  18. Is your leg bigger than most people’s waists?
  19. Have you run out of diet solutions, having tried every one of them in the past, only to fail?
  20. If you had a medical emergency, would the paramedics have to struggle to get you into the rescue vehicle? Could they perform CPR on you, or, because of your fat, would they have to use paddles?
  21. Have you ever cried because of you are overweight?
  22. Have you ever lost a partner or spouse because you are overweight?
  23. Have you ever lost a job because you are overweight?
  24. Have you ever been denied a job or promotion because of your size?
  25. Have you ever gone into therapy for weight related problems like depression or sexual dysfunction?
  26. Was the therapist overweight and struggling, or was s/he normal weight, with no idea what you were going through?
  27. Have you ever been in therapy, only to find that you’re listening more to the therapist’s problems than yours?
  28. Have you ever taken more than one prescription drug for weight control?
  29. If there were a fire in your building and you were on the fifth floor, would you be able to go down the stairs in less than three minutes?
  30. Do you have health problems related to overweight — like diabetes, arthritis, knee or hip joint pain, heart palpitations, irregular heart beat, etc.,
  31. Do you think a thyroid pill will help all your problems?
  32. Can you look at yourself naked in the mirror, or do you avert your eyes?
  33. When was the last time someone other than your partner/husband/wife/children told you that you were beautiful? Pretty? Pleasingly plump? Any compliment about your appearance at all? Lately?
  34. Can you still fit behind the wheel of a car without pushing the seat way, way back? Would you consider it dangerous to ride with a driver who can’t reach the pedals? Can you reach them easily?
  35. Do the seats in your chairs and sofas have indentations where you sit? Do you crush the seat cushions wherever you sit? Has anyone ever asked you not to sit on a chair? Did you understand that it was because you might break it?
  36. If you were asked to go sailing, could you?
  37. Does your greatest night out (date) consist of an “all you can eat” restaurant?
  38. Can you fit comfortably in the seats at your local theater?
  39. Can you slide easily into a booth at a restaurant?
  40. Can you clean yourself thoroughly after normal bodily functions?
  41. Can you sit without your knees bowing out to the side?
  42. When was the last time you crossed your legs?
  43. When was the last time you tied your shoes without sitting down? Do you ever call your husband/wife/children to help tie your shoes?
  44. Does your shoe wardrobe consist mostly of slip-ins?
  45. Do you ever wonder where the beauty and joy went?
  46. When was the last time you DIDN’T wear queen/king size?
  47. Have children ever been afraid of you? What about your grandchildren? Do they run to hug you, or do they hang back? Did you ever consider that it might be because your weight overwhelms or frightens them?
  48. Do you want to be there when your children have grandchildren? Do you want to be able to play with them, really play with them?
  49. Could you buy a fancy, beautiful mother-of-the-bride dress, and be comfortable in it? Would you look gorgeous in it?
  50. When was the last time you could cuddle a child IN YOUR LAP?
  51. Has your son or daughter had to fight a kid because they called you fatty?
  52. If your child were your size, would you be okay with it, or would you do whatever you could to help him/her achieve a normal weight? Including surgery? If so, why not you? Don’t you deserve what your child deserves?
  53. Do you fear the surgery? If you do, do you also fear: Amputation? (It’s in the cards.) Kidney failure? (Wait. It’s coming.) Heart attack? (At your weight, you probably won’t make it.) Stroke? (Reduced blood flow in overweight people and high blood pressure — it’s a probability.) A wheelchair existence? (‘Nuff said.) A really short life span? (Almost guaranteed)

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Why do we need calcium? Since my diagnosis with osteoporosis in August, 2000, I am NOW, belatedly,trying to learn a little more about it. I drank milk til I was 45, and a lot of it. I have taken calcium carbonate faithfully since my surgery. I had kidney stones in 1997, too much carbonate. Did I learn? No, took citrate for 3 months, then right back to carbonate. It’s cheaper. As I learn things through the Osteoporosis Foundation and through literature on the subject, I add the summaries here. I’ve learned that we put calcium into our “bank” until early adulthood, then we start taking it out. Caffeine, carbonation and some meds hurry the process. Losing weight also helps this along. Normally we shed/regrow bones cells like other cells. However, with the ever lightening body weight, the bone cells think they don’t need to regenerate, so they don’t! AND we don’t absorb calcium as well as we did when we were younger. And we don’t absorb it without a stomach. Tums are carbonate less and may or may not contain Vitamin D. Also, some acid is required for absorption of calcium. What do Tums do to acid? I do not offer any products which do not contain calcium citrate. I had special calcium citrates capsules made for us. They are swallowable as is, or they can be opened and stirred into something. They are 240 pills for $15 (about $5/month) for 3 per day. Each cap contains 500mg calcium citrate, 200 IU D, 250 mg magnesium. We can only absorb 500 mg of calcium at one time, so they are made to be as much calcium per pill as we can manage. Citracal is the only brand name that I know is formulated correctly. It runs about $13/month and if the bottle is the one that says “2 tablets = 630mg”, then you would need to take 5 per day. I have recently developed another product for use by those who already have their diagnosis or who want to just be more careful. I’m calling them Super Calcium, but they have a really boring name on the label. EACH PILL contains the same as the above, 500mg calcium citrate, 250mg magnesium, 200IU of vitamin D PLUS 1 mg of boron and 33mg of ipriflavone 240 for $20 Along with using a good calcium citrate, my PCP’s office recommended SIMPLE weight bearing exercise. Just heft a can of veggies in each hand. Now, even I can do that. My osteoporosis is fairly advanced and I only got the DEXASCAN due to peer pressure. I’d never have known it if it hadn’t been a constant topic of conversation. I had a foot scan which showed me to be so far superior that I’d NEVER have to worry. However, I was told that isn’t a true reflection. Tragically, my peer group was right and now, for my little economy ride for 6 years, I will pay dearly. Instead of just taking the citrate, I’ll also take Tri-boron to increase absorption, ipriflavone to decrease bone loss, as well as trying to take the prescription preparations. So far, I am unable to tolerate the side effects of either one. Don was also diagnosed recently. He has taken much larger doses of calcium, but that makes no difference since it was the wrong kind. He took both carbonate and oyster shell. Some brand names that are NOT citrate are Caltrate 600 & OScal. I strongly recommend that anyone over 40 or post-op have this scan done ASAP. It’s painless and not even expensive. You don’t have to have all of these, just one or two is enough. Your justification for having it might include:

  • being post-menopausal
  • lactose intolerance
  • MASSIVE WEIGHT LOSS
  • having had any obesity surgery
  • it’s in your family
  • recent bone breakage
  • use of caffeine or carbonation after age 20
  • use of nicotine
  • being fair or of Northern European descent
  • being small frame

August 2001 dexascan shows no change whatsoever. In my case, without the ability to use the prescriptions available, that is GOOD news. That means that the mineral preparations have at least held the line. [top]


What’s the difference between distal, medial and proximal procedures? Let’s assume that we all start with 300″ of (small) intestine. We don’t, but we need to have a figure, so that’s it. If you’ve seen pix you’ve seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y. The “junction” of the sides is the determiner if a procedure is proximal or distal. The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach. This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas. There is no food here. This is the LEFT side of the Y. This is the portion that is bypassed. The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb. This is the RIGHT side of the Y. The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur. This is the part that is still in use and is also referred to as the common channel. If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal. If the junction occurs at a far distance from the stomach, it is said to be distal. That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another. Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements, though in varying doses. We are all missing the stomach and its normal digestive function. Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time. Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight. My doctor measures what is in use, not what is not. So, in my case, I have a 40″ common channel, then 60″ was used to reach the pouch. The bypassed portion is then ABOUT 200″. Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72″, use 60-80″ for the right side of the Y, and the common channel will be 100-200″. [top]


What is the Gastric Bypass/RNY surgery? The gastric bypass (RNY) procedure is a combination of the old intestinal bypass and the VBG, taking the best features of both, but leaving the worst features behind. In a routine RNY, the pouch is stapled OR separated off from the balance of the stomach. From the lower stomach, the intestine continues down for a length, and this is the LEFT side of the “Y”. The digestive juices from the lower stomach, pancreas and gallbladder travel down this route. Normally, most of the absorption of food takes place in the first 12 to 18 inches here. The intestine is cut and the lower section is brought up to the pouch and attached. The food travels this route, down the RIGHT side of the “Y”. The digestive juices and the foods meet at the junction of the “Y” and the distance they travel together for digestion and absorption is called the common channel or common limb. The proximal type procedure is the least radical. In this procedure, only a short amount of the LEFT side of the Y is bypassed, leaving the longest amount of common channel. The weight loss is the least of these procedures, but carries the least nutritional risk, if properly supplemented. The distal bypasses the most intestine, leaving the shortest common channel, which gives the best weight maintenance long term, but poses the most serious nutritional risks if supplements are not used properly. The medial is somewhere in between. It is important to recognize that what Dr. A may call a distal, DR B may call a proximal. The terms in themselves do not designate any specific limb measurements. Some doctors will quote only a 5% difference in long term weight maintenance between a proximal and distal. However, that may be using THEIR measurements. Other doctors will quote as much as 50% difference in long term rates. But again, the definition is all in the meaning of the speaker. It is helpful to know either how much you have bypassed OR how much common channel you have. [Top]


How does RNY affect nutrition? All RNY procedures will still affect nutrition to a degree. Digestion occurs in the stomach, then absorption in the intestine. So, all RNY will lose SOME amount of the same elements. The elements digested in the lower portion of the stomach include: protein, calcium, iron, zinc, B12 and the fat soluble vitamins, A, D and E. Some people experience shortages in magnesium and potassium, as well. Proximals have a better chance of absorbing with their common channel. The food spends a longer time exposed to digestive agents. They can usually supplement with just a small dosage of the above mentioned elements and a multi-vitamin. Even 2 or 3 multi-vitamins alone may not cover these elements with enough of the most absorbable forms. Distals will be able to absorb very little of these elements, so much use larger doses of supplements. But just taking more multivitamins won’t work as some elements would then be too high. [Top]


How many grams of protein supplement a day do we need? This discussion goes on indefinitely. “Health nuts” maintain that 1g per pound of body weight is ideal. Of course, they’re not dealing with a body that may weigh 450 lbs today, either! Other figures that are tossed around are .8g of protein per kg of body wt. That’s .8g of protein per 2.2#. What does that mean? If you weighed 150 lbs, you’d need 55+g. BUT then other sources insist that we need 1.2 g per kg during rapid weight loss. So, for the same person of 150 lbs, the need would be 83g per day. All that said, let me say that men lose their weight so fast that they often lose muscle at the same speed as fat. My personal bias is that a man shouldn’t consider taking less than 120g a during the rapid weight loss stage, even if he is very proximal. In general, for women with a proximal, we suggest 60g of protein a day. When on a plateau, we suggest adding another 30g dose of protein, as well as another glass of water. Any food proteins or bars are in addition to the counted supplements. [Top]


Would we be okay in taking in more protein supplement than the required amount? It would be difficult for ANY weight loss surgical patient to get TOO MUCH protein. In general, the more protein you get in, the better the weight loss, and the more muscle and hair retention. The skin tone and tautness also seems to be better with those who are generous with their protein supplement. [Top]


How do I take my protein supplement? We suggest taking it in 30g increments, roughly. It doesn’t do any good to take more at one time as it cannot be absorbed. Bearing in mind that these products are made for the sports nutrition industry, which is geared toward building and maintaining muscle, we listen to their guidelines as well. They do not use milk unless they are planning to GAIN. We do not use milk with them. Milk (even skim) is packed with sugar, so it will cause weight GAIN, which is what most of us don’t want. Also, using them with straight fruit juice may cause weight gain or dumping from the high sugar content. We suggest using them with water or sugar free pops (flat is good, too) or juices, such as Crystal Light or sugar free Tang. Although the directions may call for 12 to 16 oz of liquid, we recommend starting with 4 oz and adjusting to taste. [Top]


When do we start protein supplements? Should we start before surgery? How long after surgery should we start consuming them? The sooner the better! Pre-op, they will merely strengthen tissue and muscle and prepare you for healing. The latest we would suggest would be Day 7 after surgery. If your doctor would normally permit milky type products, start as soon as he would allow those. [Top]


What is the best tasting protein powder you have found? This is a toughie! I am a chocoholic! I like chocolate for my first choice, followed by an easy second of chocolate, with perhaps a different chocolate in positions 3-10, with a follow up in vanilla and grape! I personally use ProScore 100 chocolate as my favorite for home use. It’s thick ‘n rich and blends up beautifully with water & ice. For the time I spend in the car, I use the ProBlend 55 chocolate and vanilla, 50/50. I don’t know, it just tastes creamier to me that way. I have about 50 disposable plastic bottles (such as those in which diet pop is sold) pre-filled with 30g of my combo and carry some in each car. I can add cold water wherever I am, shake and go. I also use the ProBlend 55 vanilla with diet root beer and ice for a treat every now and then. I use others periodically, but these are my best friends. But you really can’t make YOUR choice based on my taste. If it was up to me, there would BE no other flavors beyond chocolate! Some of the ones that are less pleasing to me are the absolutely height of ecstasy to someone else. I have tried many brands over the years which fit the nutritional profile we aspire to meet. But these are the ones that have proven to be the most popular. I continue to add to the stable as new products are found. There are some products that do not meet our criteria or are sold in packaging designed for the part time user rather than the daily user. These may be too expensive to use for life, so I have not carried them. [Top]


When should we start vitamins and mineral supplementation? We start on Post Op Day 7. [top]


What if vitamins seem to get stuck when we try to take them? Vitamins can be swallowed or chewed. Many take their vitamins with protein, as it is seems to provide a “slide” for the vitamins to slip right through. Some prefer chewables and like the taste & texture and chewing experience. Others will cut their tablets in half or open capsules to take them. Most RNY patients can swallow normal pills. What is available out there for those of us who can’t take a vitamin ‘pill’ because it seems to get stuck in our pouch? All One Vitamin powder is a good place to start. Some have mixed it in with their protein, but others find it not very tasty. Even so, one would need to supplement with additional iron and calcium, as again, this is a multivitamin and not geared specifically to someone who doesn’t have the use of their stomach. [Top]


What is available out there for those of us who can’t take a vitamin ‘pill’ because it seems to get stuck in our pouch? Tablets SHOULD dissolve within 5 minutes in water. If they do, they will dissolve even faster in saliva. Capsules can be “open & dumped” into protein or sugar free drinks, like Tang or Crystal Light. I suggest testing the “empties” in your mouth to see how long they take to dissolve. Not water for these, but in saliva. Then, when you feel comfy doing so, you can swallow an empty or part of an empty to test that. Also, protein supplement tends to act as a buffer in the pouch and sort of makes the pills slide down more easily. Many will take their vitamins this way and get both done at the same time. [Top]


What is the purpose of the A, B, C, D, E , K vitamins as far as our bodies are concerned? VERY briefly (as excerpted from Earl Mindell’s Vitamin Bible): A is for eyes, respiratory strength, builds the immune system B (many B’s, summarized) include growth, digestion, mental health,, hair, skin, nails, mouth sores, eye fatigue, assimilate protein & fat, skin & nervous disorders, anti-aging, muscle spasms & leg r\cramps, help prevent anemia, increase energy, memory & balance C heals burns, gums, wounds; decrease cholesterol, boosts immune system, increases the absorption of iron, may reduce allergy suffering & prevents scurvy D is for bones & teeth, helps assimilate calcium and A. E is for hair, skin, nails, capillary walls, anti-aging, promotes endurance & alleviate fatigue, prevent leg cramps. For men, it contributes to urinary & prostate health as well as sexual function. K is for blood clotting [top]


How do we know which minerals and vitamins (besides the multi) we need to take out of everything that is available out there? The shortages are listed in any physiology book, under the digestive system. Look for which elements are digested in the lower stomach. Also, most RNY literature will list the expected shortages. Protein   iron calcium fat soluble vitamins A, D & E zinc B12   maybe potassium & magnesium BUT we must supplement in specific ways. Since A, D & E are fat solubles and we are now malabsorbing fats ‘n oils to a degree, it would do us no good to take these in soft-gel (oil filled) forms. They need to be taken in DRY form. Iron is a very fussy element. We cannot absorb ferrous SULFATE and taking it will negate the absorption of any Vitamin E. It must be taken with Vitamin C, but cannot be taken with antibiotics; caffeine, milk; antacids of any kind, including medication for ulcer; any minerals, such as calcium. It is better taken on an empty stomach, but it can be taken with non-milk food. Think of iron and C as being on a honeymoon, alone but together. Calcium must be taken with Vitamin D and is best absorbed at night. But only about 500 mg (elemental) can be absorbed at one time, so we suggest taking them over the course of the afternoon, perhaps an hour or two apart. [Top]


What vitamin supplements should we be taking besides a good multivitamin? iron (not ferrous sulfate) Vitamin C 1500mg elemental calcium citrate A (dry form) D (dry form) E (dry form) zinc, 50mg chelated   B12 (sublingual) Maybe potassium or magnesium, based on the first set of labs [Top]


Why don’t your lists of ingredients include the RDA? The RDA is the RECOMMENDED daily allowance for a person with intact digestion AND the ability to get their basic nutrition from food. That does not apply to any WLS person.   Also, the RDA can change from week to week as new information is learned and published. Certain are obtainable from food for us, so the supplement value is more accurate, but some are NOT reachable for us. For example, a multivitamin that contains 30IU of E might cover a normie who is able to absorb 100% of her fats & oils. But for RNY or DS or BPD patients, we lose much of our fat soluble vitamins, so 800 to 1600 IU of E would be more for us than the standard issue for a normie. [Top]

Vitalady, Inc. FAQ’s are here for you to help with any questions you may have pre-op or post-op. Thank you for your time and have a great day!