VITAMINS
For all surgery types before and after surgery.
SHOPPING LIST
MULTIVITAMINS + IRON + B-COMPLEX
VITAMIN B-12
CALCIUM CITR + D3 + MAGNESIUM CITR
PROBIOTICS
VITAMIN SCHEDULE
SHOPPING LIST
Individuals who undergo gastric sleeve or bypass surgery have reduced ability to absorb vitamins and electrolytes which places them at higher risk of developing nutritional and vitamin deficiencies (especially gastric bypass patients). These deficiencies include, but are not limited to, vitamin A, B, C, D, E, K, folate, calcium, iron, zinc, and magnesium.
Begin taking vitamins as soon as you start the pre-op diet and get into the habit of taking them daily FOR THE REST OF YOUR LIFE.
Stop taking vitamins 3 days before surgery, or when you start your liquid diet stage.
Resume taking vitamins 1-2 weeks after surgery or as soon as you can tolerate pills (you may use liquid vitamins, chews, or a pill crusher).
You will need to purchase the following vitamins:
- Multivitamins (ideally a bariatric brand with Iron and B-Complex)
- Calcium Citrate + D3 + Magnesium Citrate (often combined 3-in-1)
- Omega-3
- Probiotics
Note! It is not required to purchase bariatric vitamins specifically (Calcium Citrate, Omega-3, and Probiotics do not need to be bariatric brands; though they are often better tasting and are higher quality products). You can choose any brand if you reach the recommended doses of each vitamin. Keep in mind that standard over the counter (OTC) vitamin brands are formulated to meet the nutritional needs of the general population. Bariatric patients require a much higher level of 13 micronutrients that regular OTC brands will not meet; this is why we recommend using bariatric formulated brands when available.
Below you will find recommendations for each vitamin, brand, and dosage.
NO GUMMIE VITAMINS OF ANY KIND AFTER SURGERY!
Multivitamins with Iron & B-Complex
Dosage
Bariatric formulated Multivitamin with iron & Vitamin B-Complex:
1 serving daily (each brand has different serving sizes, read the label carefully, one serving may require 1, 2, 3 or even 4 capsules or chews.) The table below suggests only bariatric-formulated options.
Non-bariatric multivitamins:
2 serving sizes daily (200 % Recommended Daily Allowance (RDA))
We recommend capsule presentation, as chewable tablets are often reported by our patients as unpalatable. Listed below in the order or preference by the nutritionists.
Iron:
Be sure to choose a multivitamin with 36 – 45 mg of Iron per serving (or per recommended daily dosage). Otherwise take iron separately (this is especially important for bypass patients who often develop iron deficiency).
Spacing:
Always allow at least 2 hours between Calcium Citrate and Iron (or multivitamins that include iron) for better absorption. If ferrous sulfate has unacceptable side effects (nausea or stomach pain), ferrous gluconate is a possible alternative for patients who cannot tolerate ferrous sulfate. Be aware that iron intake will cause dark stools (it is normal), and may cause constipation, bloating, and gastrointestinal pain as side-effects.
Vitamin B-12
All bariatric formulated multivitamins already include the recommended dosage of vitamin B12. If you are using Bariatric multivitamins, you may skip the rest of this section and proceed to Calcium Citrate section.
If your non-bariatric multivitamin brand does not include B12 or the dosage is low, be sure to take it separately as B12 or part of B-Complex. See the recommended daily dosage below:
Vitamin B12 (Cobalamin) use one of the options:
- 500 – 1000 mcg per day (ideally sublingual dissolvable pills or liquid form)
- 1000 mcg twice a month by injection (only if necessary, to be determined after the first post-op lab work at 3 months post-op)
Your lab values will be high when taking this amount of B vitamins. We expect this high lab value; taking the B complex helps prevent a deficiency. Your nutritionist will adjust your intake based on your post-op lab work that is recommended at 3-, 6-, 12-, and 24-months post-op.
B-vitamins can be taken on an empty stomach, all others should be taken with a meal.
Calcium Citrate with D3 & Magnesium Citrate
Dosage
Calcium Citrate: 1500-2000 mg/day
Vitamin D3: 800-2000 IU /day
Magnesium Citrate or Magnesium Glycinate: 400 – 500 mg per day (do not use Magnesium Oxide)
Divide this into 2-3 servings per day to reach the daily recommended dosage and for better absorption. Choose a brand that contains Calcium Citrate with vitamin D3 and Magnesium (otherwise take Magnesium separately). Avoid Calcium Carbonate or Calcium Caltrate.
Reminder: separate the multivitamin with iron from calcium citrate by 2+ hours for maximum absorption.
| Brand | Name | Dosage per day & spacing | Where to buy |
|---|---|---|---|
| Pro Care Health | Calcium Citrate (with D3 & Magnesium) –Capsules | 4-6 tablets: take 2 tablets 2-3x/day | https://procarenow.com/collections/calcium-supplements/products/calcium-citrate-500mg-caplet-120-count |
| Pro Care Health | UpCal D Powdered Calcium Citrate (with D3 only) – Powder | 2-3 packets: take 1 scoop or packet 2-3x/day | https://procarenow.com/collections/calcium-supplements/products/upcal-d-powdered-calcium-citrate-canisters |
| Blue Bonnet | Liquid Calcium Magnesium Citrate + Vitamin D3 – Liquid | 2-3 tablespoons: take 1 Tbsp. 2-3x/day | https://bluebonnetnutrition.com/products/liquid-calcium-magnesium-citrate-and-vitamin-d3-blueberry-flavor?_pos=1&_psq=calcium+citrate&_ss=e&_v=1.0 |
| Celebrate | Calcium Plus 500 (with D3 & Magnesium) –Chewable | 2-3 chews: take 1 chew 2-3x/day | https://celebratevitamins.com/collections/calcium-only/products/calcium-citrate-chewable |
| Bariatric Advantage | Calcium Citrate Chewable 500mg (with D3 & Magnesium) – Chewable | 2-3 chews: take 1 chew 2-3x/day | https://www.bariatricadvantage.com/item/calcium_citrate_chewable_500mg/ |
| Citracal | Maximum Plus Calcium Citrate (with D3 only) –Capsules | 4-6 capsules: take 2 capsules 2-3x/day | https://www.citracal.com/products/maximum-plus |
| Barimelts | Calcium Citrate (with D3 & Magnesium) – Fast melting tablets | 4-6 tablets: take 2 tablets 2-3x/day | https://www.barimelts.com/products/calcium-citrate |
| Opurity | Calcium-Citrate Plus-Chewable (with Magnesium) – Chewable | 4 chews: take 2 chews 2x/day | https://unjury.com/products/opurity-r-calcium-citrate-plus-chewable |
| Kirkland | Calcium Citrate Magnesium and Zinc with D3 – Large tablets | 4-6 tablets: take 2 tablets 2-3x/day | https://www.costco.com/kirkland-signature-calcium-citrate%2C-magnesium-and-zinc%2C-500-tablets.product.11672433.html |
Omega-3
Dosage
Omega-3: 2000 mg per day (with meal).
It is recommended that you start taking Omega 3 (fish oil) during your pre-op diet and resume it as soon as you can tolerate it after surgery, preferably 2- or 3-months post-op. Give preference to brands that source fish oil from non-farmed wild species. If you are allergic to fish, use capsules with flaxseed oil, also a great source of Omega-3.
Probiotics
After weight loss surgery (WLS), the balance between “good” and “bad” bacteria may become altered. This is due to disruption of your GI tract, and use of antibiotics after surgery to help prevent infection. While antibiotics can help keep harmful bacteria under control, they can also wipe out the good bacteria in your body. The number and type of intestinal bacteria is regulated by both intestinal motility and gastric acid secretion, which are both altered with the WLS. Probiotics will also help vitamin B12 absorption and will help decrease intestinal inflammation, bloating, food intolerances, and other types of discomfort that often follow WLS.
There are many over the counter probiotics available, most of them contain only one strain of bacteria. Probiotics with at least 5 billion colony forming units (CFUs) per dose that contain at least seven strains of probiotics appear to be the most effective. Probiotics come in many forms, including pills, powders, liquids, capsules, and chewable tablets.
Probiotics are most effective when taken in the morning on an empty stomach.
Note!
After surgery you will be provided with instructions for your post-operative blood work. It is important to follow them to monitor your vitamin and mineral levels and adjust your vitamin intake as needed. Your bariatric nutritionist will always review your lab work results and guide you accordingly.
To learn more, visit:
Vitamin Schedule for Pre- and Post-op (Sample)
| Time | Example 1 Pre-op & 1 – 2 months post-op | Example 2 2+ months post op | Example 3 If extra iron is needed 3+ months post op |
|---|---|---|---|
| 7:00 am (breakfast) | Probiotic (1 daily dose) Calcium Citr. w/Vit D3 & Magnesium Citr. (1 chew/tablet) | Probiotic (1 daily dose) Bariatric Multivitamin w/Iron (1 daily dose) | Probiotic (1 daily dose) Calcium Citr. w/Vit D3 & Magnesium Citr. (1 chew/tablet) |
| 10:00 am (snack) | Bariatric Multivitamin w/Iron (1 daily dose) | Bariatric Multivitamin w/Iron (1 daily dose) | |
| 12:00 pm (lunch) | Calcium Citr. w/Vit D3 & Magnesium Citr. (1 chew/tablet) | Calcium Citr. w/Vit D3 & Magnesium Citr. (1 chew/tablet) Omega 3 (1 capsule) | Calcium Citr. w/Vit D3 & Magnesium Citr. (1 chew/tablet) Omega 3 (1 capsule) |
| 3:00 pm (snack) | Iron with Vitamin C (1 capsule) * | ||
| 6:00 pm (dinner) | Calcium Citr/ w/Vit D3 & Magnesium Citr.* (1 chew/tablet) | Calcium Citr. w/Vit D3 & Magnesium Citr. * (1 chew/tablet) Omega 3 (1 capsule) | Calcium Citr. w/Vit D3 & Magnesium Citr. * (1 chew/tablet) Omega 3 (1 capsule) |
*Third Calcium intake is recommended for bypass patients only or women after menopause after either gastric sleeve or bypass.
*Extra iron (additionally to multivitamins with iron) only if needed after having post-op lab work done that confirms iron deficiency.
Note! You may take vitamins throughout the day at your convenience (make your own schedule), as long as you do not take Calcium and iron (or Calcium and multivitamins that contain iron) at the same time.