Supplements: what you should be taking and why

One of the questions I ask every single one of my patients is “Are you taking your supplements?” I’m not asking to be annoying, I’m asking because it’s extremely important that you do take supplements after sleeve gastrectomy, even if it is a bit of a hassle sometimes.

Due to your sleeve, your stomach is no longer a regular stomach, which is obviously why it works so well for weight loss, but is also why you are now at risk of nutrient deficiencies. The reason we see nutrient deficiencies in people who have sleeve gastrectomies are two fold: malabsorption due to the speed with which food passes through your stomach, and also the volume of food you can eat. Your meals are now so small, there is just no way you can get the Recommended Daily Intake for certain nutrients due to sheer lack of volume!

Take calcium for example: the recommended Daily Intake is  1000mg/day for a 19-50 year old female (and even more once you get to 51!). That equates to 3-4 serves of dairy every day. After your sleeve, to eat 3-4 serves of dairy each day would mean that you’re really not able to eat much else! 

So what supplements should you be taking?

The most common nutrient deficiencies that rear their heads after sleeve gastrectomy are iron, vitamin D, vitamin B12, vitamin B1 (thiamin), folate and fibre. So, the AMSBS guidelines recommend you take the following supplements after sleeve gastrectomy every day:

• 2 adult multivitamin plus mineral supplements (each containing iron, folic acid, and thiamine). For the first 1-3 months, these should be chewable (until you are able to swallow tablets comfortably again). Ask your dietitian for their advice about specific brands of chewable or tablets. Do NOT take the gummy multivitamins as these do NOT have all the vitamins and minerals you need.
• 1200 to 1500mg of calcium in total – a mix of calcium eaten in your diet and as a calcium citrate supplement. Taking calcium citrate, rather than calcium carbonate is extremely important so make sure you check the bottle. You also need to spread the doses out over the day (see below for an example of how to structure your tablets over the day) and avoid taking with iron.
• At least 1000IU of vitamin D (this may be as part of the calcium supplement or as a separate tablet)
• Vitamin B12 either as a sublingual spray daily, or an injection every three months. This dosage will depend on your B12 levels which should be monitored. Ask your dietitian what the best dose for you is.
• 45-60mg iron via multivitamins +/- additional supplements.
• Fibre – a daily supplement in capsule or powder form: see this post for more information.

You should be having regular blood tests (every 6-12 months) to check for deficiency and may need to adjust this regime depending on your results.

How do I take my supplements after sleeve gastrectomy?

Timing is everything with supplements after sleeve gastrectomy… certain vitamins and minerals don’t play well together. For example: if you take iron and calcium at the same time you won’t absorb as well, and if you take all your calcium at once, you’ll only absorb a small amount and your body will ditch the rest. So… It’s important to spread your supplements over the day. Here’s a good example of how to put them into your daily routine:

• Breakfast:  Multivitamins & B12
• Mornign Tea: 500-600mg Calcium with vit D
• Lunch:  500-600mg Calcium with vit D
• Dinner:  Multivitamin +/ iron 
• Before bed:  500-600mg Calcium with vit D (at least 2 hours after iron)
• *You may take vitamin B12 at any time during the day as it doesn’t interact with other vitamins or minerals.

Finally…

Please remember, these are general guidelines and supplements may need to be adjusted to meet your individual needs. Please make sure you see your GP regularly for blood tests and your dietitian to help prescribe your supplements.