ProThera Bariatrics. Bariatric nutritional support made easy.

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2 Many Americans have insufficient dietary intakes of vitamins and minerals. Suboptimal levels, even those well above causing deficiency syndromes, are risk factors for chronic diseases. Suboptimal nutrient levels and associated metabolic abnormalities can be corrected by supplementation. Current RDAs may not be sufficient to prevent subtle metabolic damage and maintain health. It appears prudent for all adults to take vitamin supplements. Bariatric surgical and non-surgical patients have additional nutritional challenges and known deficiencies, making supplementation especially important. REFERENCES 1. Fletcher RH, Fairfield, KA. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002;287: Colossi FG, Casagrande DS, Chatkin R, et al. Need for multivitamin use in the postoperative period of gastric bypass. Obes Surg. 2008;18:

3 ProThera Bariatrics Bariatric nutritional support made easy. Now, healthcare professionals have a complete micronutrient support program to offer their bariatric patients both surgical and medical weight management. With ProThera Bariatrics, patients get the educational tools and nutritional supplements they need for long-term health and well-being, and healthcare professionals get the reference materials and compliance support they need for patient success. ProThera Bariatrics nutritional supplements are provided for exclusive recommendation by healthcare professionals. Designed for the Special Needs of Bariatric Patients High-potency amounts of nutrients Gentle on the gastrointestinal system Highly bioavailable, active nutrient forms Readily absorbed and utilized Small, easy-to-swallow capsules Tasty chewable tablet options Pure ingredients, no artificial additives Well-tolerated, free of most common allergens ProThera multiple vitamin/mineral supplements are carefully formulated to be the cornerstone of each patient s nutritional program. Unlike standard multivitamins, these formulas provide higher amounts of nutrients in forms that can be readily absorbed and efficiently used by the body. See page 8 ProThera operates a GMP 9000 registered facility certified by NSF International, an independent, thirdparty certification organization. GMP 9000 registration integrates both ISO 9001 and GMP registration. 3

4 ProThera Bariatrics The tools you need Obesity is a form of micronutrient malnutrition in which necessary vitamins and minerals are often lacking. Nutrient deficiencies may be present without any visible signs or symptoms. The successful treatment of obesity whether surgical or medical weight management requires continuous clinical nutritional support to address each patient s specialized nutrient needs. The ProThera Bariatrics Nutritional Management Program provides healthcare professionals a comprehensive suite of bariatric nutritional products and related support services to enhance patients long-term health and well-being and promote compliance. Bariatric-Specific Nutritional Supplements ProThera Bariatrics nutritional supplements are formulated to address common nutritional challenges encountered by bariatric surgical and non-surgical patients. Easy-to-absorb nutrient forms that are gentle on the digestive system and pure ingredients free of artificial additives are used for best results and tolerance. Postoperative Nutritional Support VitalActiv and VitaTab Chewable high-potency multiple vitamin/mineral supplements provide essential core nutrients to prevent deficiencies after surgery Nutrient Optimization Specialized nutrient formulas address metabolic needs that require a more focused nutrient approach Weight Management Select botanicals, fatty acids, and protein supplements assist weight management goals Accessible Technical Support Patient educational tools and physician reference materials are just a phone call away or easily accessed at protherabariatrics.com. Patient Handouts Benefits of nutritional supplementation are explained for patient education Technical Documents Technical summaries and product monographs are supplied for physician reference Physician Consultation Patient case review by ProThera s MD, PhD, and nutritionists provided on request 4

5 to help patients succeed. Easy Order Options Choose the order method that best suits your practice. Product Directory Patient-Direct Order Program Practice-specific patient authorization code allows patients to order direct from ProThera Product shipped to patient same day Automatic order option provides 10% savings Office Dispensing No minimum order required Product shipped same day for 1-3 day delivery Toll-Free or On-Line Call to order or request information Visit protherabariatrics.com and log-in to order Private Labeling Add your name and logo to any product label at no extra charge Only 12 bottle per product minimum order 2-day turnaround after label approval Personalized Supplement Packets Combine supplements into convenient cellophane packets No extra charge, only 12 bottle per product minimum order 2-day turnaround after label approval Multiple Vitamin/Mineral Supplements VitalActiv Capsules VitaTab Chewable VitaPrime Tablets VitaPrime Capsules Vitamins Active B Complex Active B Trio Methyl Balance Active B 12 -Folate Benfotiamine (B 1 ) Biotin Vitamin D Vitamin K Minerals Calcium Citrate Powder Chewable Calcium Chewable Cal-Mag Plus D Chewable Iron Chelate Iron Chelate ChromeMate Protein/Amino Acids Whey Protein Plus L-Carnitine L-Carnitine L-Carnitine Tartrate Digestive Enzymes Zymalin Fatty Acids Eicosamax Fish Oil Eicosamax Liquid Fish Oil Conjugated Linoleic Acid (CLA) Fiber SpectraFiber Botanicals Garcinia Cambogia HTP Green Tea Extract TheraSlim GlucoThera GlucoThera Forté

6 P O S T O P E R A T I V E N U T R I T I O N Addressing The Special Nutritional Challenges Of The Postoperative Bariatric Patient. Bariatric surgery can have a tremendous positive impact on patient health. In addition to enabling considerable weight loss, surgery may improve numerous obesity-related health conditions including diabetes, hypertension, arthritis, heart disease, and infertility. However, these surgeries may result in various nutritional deficiencies that can jeopardize overall health and may lead to irreversible nerve and tissue damage. Reduction in food intake and poor absorption after weight loss surgery make it even more difficult to get adequate nutrition from food alone. Weight loss surgery restricts food intake and interferes with the digestive process, thereby restricting absorption of essential nutrients. Both of the two main surgical weight loss procedures gastric banding and gastric bypass limit the amount of food and calories consumed, thereby reducing the amount of nutrients that can be absorbed. Gastric bypass can result in serious nutritional problems and require monitoring throughout a patient s life. While true vitamin deficiency syndromes such as scurvy and beriberi are normally uncommon in Western societies, gastric bypass patients are at risk of either subclinical or even frank nutritional deficiencies unless micronutrient supplements supplying essential vitamins and minerals are taken throughout their life. Deficiencies of protein, vitamin B 12, folate, iron, calcium, thiamine, and vitamins A, D, E, and K are common after surgery, but shortages of other essential nutrients may also occur. Correcting deficiencies is vital to maintaining healthy heart, neurological, and immune functions and is crucial for preserving energy levels, strong bones, and healthy hair, skin, muscles, and joints. Some nutritional deficiencies occur within a year after surgery. Other deficiencies may take years to develop. It is imperative that surgical patients take a bariatric-specific multivitamin and mineral supplement to support a lifetime of good health. Additional nutrients may be required based on the type of surgery and the patient s specific health circumstances. Ensuring Nutritional Needs After Weight Loss Surgery Daily vitamin and mineral supplements formulated for the unique nutritional and absorptive challenges of the weight loss surgery patient are required post surgery. In the first few weeks to several months following surgery, a chewable multivitamin may be easiest for patients to ingest. In the months and years ahead, chewables, capsules, or readily digestible tablets can be used. Standard multivitamins or children s chewables typically do not adequately address the enhanced nutrient requirements and absorption issues of the surgical patient. The ProThera Bariatrics Surgical Support Program includes VitalActiv and VitaTab Chewable multiple vitamin-mineral supplements to provide this essential nutritional foundation. Routine daily use can help maximize the benefits of bariatric surgery and support a lifetime of good health. Standard multivitamins or children s chewables do not adequately address the enhanced requirements and absorption issues of the surgical patient. Nutritional Consequences of Bariatric Surgeries The nutrient deficiencies that may occur after surgery depend on the procedure performed and the nutritional status before surgery. Malabsorptive procedures cause lifelong nutritional deficiencies, some developing years after surgery. Failure to comply with new eating habits can also cause deficiencies. Correcting deficits is critical to maintaining good health post surgery regardless of the procedure performed. Restrictive Surgery Similar nutrient deficits as obese patient Higher incidence of folate deficiency Vitamin D, iron, vitamin B 12, and thiamine deficiencies most common Monitor for hyperparathyroidism and abnormal calcium metabolism Restrictive and Malabsorptive Surgery Considerable lifelong micronutrient-protein malnutrition requiring supplementation Decreased stomach acid production Protein, B 12, folate, iron, calcium, thiamine, and vitamins A, D, E, and K deficiencies most common Decreased lactase production can result in dairy intolerance 6

7 P O S T O P E R A T I V E N U T R I T I O N Common Micronutrient Problems After Weight Loss Surgery Routine Nutritional Supplements Thiamine (Vitamin B 1 ) Required for cellular energy production; carbohydrate, protein, and fat metabolism; mental clarity; nerve function; membrane stabilization. Risk of deficiency highest in patients with vomiting (1-3 months postop), those consuming alcohol, and patients not taking supplements. Deficiency associated with calorie deprivation and malabsorption, but may be pre-existing. Vitamin B 12 Needed for synthesis of all DNA; acts as methyl donor and participates in carbohydrate metabolism. Decreased intake and malabsorption due to reduced intrinsic factor leads to low B 12. 1/3 of patients develop deficiency postop. Fast-dissolving tablets or injection. Folate Essential for cell health, DNA synthesis and repair, and methylation reactions. Decreased intake of green vegetables and minimal stomach acid contribute to low levels. 1/3 of patients develop deficiency postop. Biotin Catalyst for synthesis of fatty acids, glucose formation, and metabolism of amino acids. Often used with zinc for hair and nail strength. Vitamin B 6 Needed for functional integrity of the brain; amino acid metabolism. Deficiency exacerbated by use of antibiotics, antihypertensives, and alcoholic beverages. Fat-Soluble Vitamins (A, D, E, and K) Must be monitored regularly to ensure adequate levels long-term as deficiencies take a year or more to develop. Vitamin A/Carotenoids Needed for proper vision; protein synthesis and cell differentiation; formation of mucus cells in the eye, bladder, lungs and intestines; humoral and cell mediated immunity. Deficiency can exacerbate iron deficiency. Vitamin D Required for calcium absorption; important for breast, prostate, colon, and bone health. Intolerance of dairy as a source of vitamin D can exacerbate deficiency. Iron Transports and stores oxygen; needed for metabolism and detoxification (via cytochromes) and wound healing. Important for energy, normal heart function, muscle strength, normal hair growth. Decreased stomach acid limits conversion to absorbable ferrous form of iron. Deficiency seen in 30 to 50% of patients; menstruating females at higher risk. Calcium Essential to bone health; regulation of nerve transmission, heart and muscle contraction; wound healing, and maintenance of blood pressure. Deficits of the fat-soluble vitamin D aggravate the malabsorption of calcium. Hypocalcemia occurs in 15% to 48%. Soluble forms of calcium such as citrate/citrate-malate that don t depend on acidity for absorption are best. Multivitamin & Mineral Supplement Vitamin/mineral supplementation is indispensable because of the decreased food intake of the patient Adult chewable multivitamin for 4 to 12 weeks postop; capsules, chewable, or easy-to-digest tablets thereafter Children s chewable not adequate Needed for life Calcium or Calcium/Magnesium Soluble calcium citrate preferred 1,200 to 1,800 mg calcium daily Vitamin D often included Iron May be needed if not included in daily multivitamin Use well-tolerated, absorbable forms such as chelates Approximately 40 to 60 mg daily Vitamin B 12 Can be absorbed without need of intrinsic factor when taken in large amounts Active forms improve bioavailability Fast-dissolving tablets best for high potency dosing 7

8 M U L T I P L E V I T A M I N S A N D M I N E R A L S VitalActiv Essential Vitamins And Minerals For Postoperative Needs And Lifelong Health. VitalActiv is a high-potency multiple vitamin and mineral formula intended as a daily dietary supplement for weight loss surgery patients. It is formulated to address heightened nutrient requirements after surgery and to compensate for the altered absorption capacity after a gastric bypass procedure. Nutrient forms with greater documented bioavailability and benefit compared to many standard forms are included. VitalActiv contains well-absorbed forms and nutritionally relevant amounts of 28 essential vitamins, minerals, and trace elements in four capsules daily. VitalActiv is free of common additives such as lactose, starch, artificial flavors, preservatives, and colorings for maximum tolerance. VitalActiv Capsules contain: Extra-strength amounts of crucial nutrients Higher than RDA potencies of essential antioxidants, B vitamins, vitamins A and D, and iron are included More complete nutrient families for natural balance and safety 100% natural vitamin E complex (d-alpha, d-beta, d-gamma, and d-delta tocopherol isomers), provides broader antioxidant protection than d-alpha alone Both preformed vitamin A (retinol) and vitamin A precursors (beta- and alpha-carotene) extend more complete vitamin A nutrition All-natural mixed carotenoids, including alpha- and betacarotenes, lutein, zeaxanthin, and beta-cryptoxanthin, offer more diverse antioxidant benefit and are safer than synthetic beta-carotene alone Complete vitamin B-complex supports many metabolic functions and includes significant amounts of B-vitamins most crucial to helping maintain normal homocysteine metabolism Activated folate, B 1, B 12, and other B vitamins for highest absorption and bioavailability Metafolin ** L-5-methyltetrahydrofolate (L-5-MTHF), an active form of folate, unlike folic acid, is absorbed and utilized directly and is the most beneficial form for patients with elevated homocysteine resulting from compromised utilization of folate Core nutritional foundation of 28 essential vitamins, Methylcobalamin and 5-adenosylcobalamin, the active forms of vitamin B 12, are the most reliable oral forms of this difficult-to-absorb nutrient Benfotiamine, a lipid-soluble form of thiamine with high bioavailability, is especially useful for people with impaired absorption minerals, and trace Extra vitamin D 3 to optimize elements daily intake for broad physiological benefit Natural vitamin D 3 is included at 1,000 IU, a higher amount than typically found in daily multivitamins, to help achieve optimal intakes to support bone health and other numerous roles in tissues throughout the body Mineral compounds with validated bioavailability Calcium citrate is a well-studied calcium compound with higher absorption and effectiveness than many other calcium sources Magnesium, chromium, zinc, manganese, and other mineral amino acid glycinate chelates from Albion Laboratories are fully-reacted, low molecular weight mineral compounds with exceptional tolerance and documented bioavailability Extra iron in a well-tolerated, bioavailable form Ready-to-absorb ferrous bisglycinate overcomes decreased stomach acid that limits absorption of common forms of iron Better tolerated than ferrous sulfate or other organic forms of iron 8

9 M U L T I P L E V I T A M I N S A N D M I N E R A L S VitaTab Chewable Ideally suited for first use after weight loss surgery. DESCRIPTION: VitaTab Chewable multivitamin and mineral supplement is the best choice for ensuring essential micronutrient needs in the first weeks following surgery, as patients may be unable to swallow regular tablets or capsules until after their initial healing occurs. These specially-formulated chewable tablets provide the ready-to-absorb forms of nutrients and higher amounts that standard children s or adult chewable vitamins lack. After weight loss surgery, patients have unique lifetime nutritional needs as a result of altering the gastrointestinal system. VitaTab Chewable tablets supply vitamins and minerals that can no longer be readily absorbed from food alone in the amounts needed for optimum health. Well-tolerated, highly bioavailable nutrient forms are supplied in a naturallyflavored wafer that can be used safely throughout the patient s life. SUGGESTED USE: Chew 2 tablets twice daily with meals. VCW 60 chewable tablets Serving Size 2 Tablets Amount Per 2 Tablets Calories 10 Total Carbohydrates 3 g 1% Sugars 3 g * Vitamin A (56% (2,500 IU) as natural carotenes 4,500 IU 90% (alpha, beta, beta-crypt oxanthin, zeaxanthin, and lutein) from D. salina and 44% (2,000 IU) as vitamin A palmitate) Vitamin C (as L-ascorbic acid) 180 mg 300% Vitamin D3 (as cholecalciferol) 1,000 IU 250% Vitamin E (as d-alpha tocopheryl succinate plus natural 90 IU 300% mixed tocopherols d-alpha, d-beta, d-delta, d-gamma) from soy Vitamin K 1 (as phytonadione) 80 mcg 100% Thiamine (as thiamine mononitrate) 3 mg 200% Riboflavin 3.4 mg 200% Niacin (as niacinamide) 20 mg 100% Vitamin B 6 (as pyridoxine hydrochloride) 4 mg 200% Folate (as Metafolin ** L-5-methyltetrahydrofolate) 400 mcg 100% Vitamin B12 (50% as methylcobalamin and 12 mcg 200% 50% as 5-adenosylcobalamin) Biotin USP 300 mcg 100% Pantothenic Acid (as d-calcium pantothenate USP) 20 mg 200% Calcium (as calcium citrate) 100 mg 10% Iron (as carbonyl iron) 4 mg 22% Iodine (from potassium iodide and kelp) 150 mcg 100% Magnesium (as magnesium citrate-ascorbate complex) 100 mg 25% Zinc (as zinc bisglycinate chelate***) 5 mg 33% Selenium (as selenium amino acid complex) 70 mcg 100% Copper (as copper gluconate) 0.5 mg 25% Manganese (as manganese bisglycinate chelate***) 2 mg 100% Chromium (as chromium nicotinate glycinate chelate***) 120 mcg 100% Molybdenum (as molybdenum glycinate chelate***) 75 mcg 100% Boron (as boron aspartate-citrate) 1 mg * Vanadium (as bisglycinato oxovanadium) 50 mcg * Choline (as choline bitartrate) 5 mg * Percent Daily Values are based on a 2,000 calorie diet Other Ingredients: Fructose, dextrates, vegetable stearine, silicon dioxide, natural cherry flavor, natural orange flavor, maltodextrin, citric acid, magnesium stearate, and licorice extract. VitalActiv Capsules A popular choice for daily, lifetime use after healing occurs. **Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany ***Albion Laboratories DESCRIPTION: When normal swallowing ability returns, some patients opt for the convenience of a capsule, and VitalActiv is the perfect choice. These medium-size, vegetarian two-piece capsules are able to be more comfortably swallowed compared to larger capsules or tablets often used for regular multivitamins. And, unlike many over-the-counter multivitamins, VitalActiv Capsules are made without lactose, starch, or other fillers that can cause digestive intolerance. This specially-formulated multinutrient supplement creates a sound nutritional foundation for life. SUGGESTED USE: 4 capsules daily with food. VAC 120 vegetarian capsules VitaTab Chewable and VitalActiv Capsules: Support multiple metabolic systems for optimum health Contain easily-absorbed and well-utilized nutrient forms Avoid common allergens Free of artificial colors, sweeteners, and preservatives 9 Serving Size 4 Capsules Amount Per 4 Capsules Vitamin A (50% (3,500 IU) as vitamin A palmitate and 50% 7,000 IU 140% (3,500 IU) as natural carotenes (alpha, beta, beta-cryptoxanthin, zeaxanthin and lutein) from D. salina) Vitamin C (as L-ascorbic acid USP) 180 mg 300% Vitamin D 3 (as cholecalciferol) 1,000 IU 250% Vitamin E (as d-alpha tocopheryl succinate plus natural 90 IU 300% mixed tocopherols d-alpha, d-beta, d-delta, d-gamma) from soy Vitamin K 1 (as phytonadione) 80 mcg 100% Thiamine (75% as thiamine hydrochloride 12 mg 800% and 25% as benfotiamine) Riboflavin (69% as riboflavin and 31% as riboflavin 5 -phosphate) 5.1 mg 300% Niacin (75% as niacinamide USP and 25% as niacin USP) 40 mg 200% Vitamin B 6 (67% as pyridoxine hydrochloride and 33% 6 mg 300% as pyridoxal 5 -phosphate) Folate (as Metafolin ** L-5-methyltetrahydrofolate) 800 mcg 200% Vitamin B 12 (80% as methylcobalamin and 250 mcg 4167% 20% as 5-adenosylcobalamin) Biotin USP 600 mcg 200% Pantothenic Acid (as d-calcium pantothenate USP) 20 mg 200% Calcium (as calcium citrate) 100 mg 10% Iron (as Ferrochel ferrous bisglycinate chelate***) 45 mg 250% Iodine (from potassium iodide and kelp) 150 mcg 100% Magnesium (as magnesium bisglycinate chelate***) 100 mg 25% Zinc (as zinc bisglycinate chelate***) 15 mg 100% Selenium (as selenium amino acid complex) 70 mcg 100% Copper (as copper gluconate) 2 mg 100% Manganese (as manganese bisglycinate chelate***) 2 mg 100% Chromium (as chromium nicotinate glycinate chelate***) 120 mcg 100% Molybdenum (as molybdenum glycinate chelate***) 75 mcg 100% Boron (as boron aspartate-citrate) 2 mg * Vanadium (as bisglycinato oxovanadium) 50 mcg * Choline (as choline bitartrate) 10 mg * Inositol 25 mg * Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), cellulose, L-leucine, and silicon dioxide. **Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany ***Albion Laboratories

10 M U L T I P L E V I T A M I N S A N D M I N E R A L S Optimizing Nutrient Status in Bariatric Patients. Routine daily use of a well-formulated multivitamin/mineral supplement specific to surgical or non-surgical patients is often all that s required to complement dietary intake and maintain essential micronutrient status. However, additional nutrients may be required based on the patient s specific health circumstances. Clinical or laboratory evaluations may reveal need for higher amounts of specific nutrients or other nutritional agents to enhance metabolic processes. The ProThera Bariatrics Program includes various supplements that address common issues. VitaPrime provides easy-to-absorb forms of essential vitamins and minerals for daily metabolic support. VitaPrime Daily nutrient support for non-surgical patients. Iron-free. DESCRIPTION: VitaPrime provides a broad spectrum of vitamins, minerals, and trace elements needed for optimal health and efficient metabolic function, making it a good choice for weight management patients. Significant amounts of essential nutrients in well-absorbed forms are provided in just two tablets daily. Activated forms of folate and vitamin B 12 are included along with efficiently utilized mineral forms and natural fat-soluble vitamins. Compared to common, over-the-counter multivitamins delivered in one tablet daily, VitaPrime offers enhanced antioxidant protection, broader trace element nutrition, and augmented B vitamin support. This core foundation of essential nutrients can be recommended for routine daily use to support energy metabolism, immune function, antioxidant capacity, glucose balance, and general health. VitaPrime is appropriate for both men and women. Iron is excluded for safety with long-term use, as men and many women may not require it. A clear, water-soluble cellulose tablet coating facilitates reliable disintegration and makes the tablets easy to swallow. SUGGESTED USE: 2 tablets daily with food. VTP 60 tablets VTP1 120 tablets Serving Size 2 Tablets Amount Per 2 Tablets Amount Per 2 Tablets Vitamin A (58% (3,500 IU) as natural carotenes 6,000 IU 120% Calcium (as calcium citrate-malate) 100 mg 10% (alpha, beta, beta-cryptoxanthin, zeaxanthin, and lutein) from D. salina and 42% (2,500 IU) Iodine (from kelp) 150 mcg 100% as vitamin A palmitate) Magnesium (as magnesium bisglycinate chelate***) 100 mg 25% Vitamin C (as L-ascorbic acid) 250 mg 417% Zinc (as zinc bisglycinate chelate***) 15 mg 100% Vitamin D 3 (as cholecalciferol) 600 IU 150% Selenium (as selenium amino acid complex) 200 mcg 286% Vitamin E (as d-alpha tocopheryl succinate plus 150 IU 500% Copper (as copper bisglycinate chelate***) 2 mg 100% natural mixed tocopherols d-alpha, d-beta, Manganese (as manganese bisglycinate chelate***) 2 mg 100% d-delta, d-gamma) from soy Chromium (as chromium nicotinate glycinate 150 mcg 125% Vitamin K 1 (as phytonadione) 60 mcg 75% chelate***) Thiamine (as thiamine hydrochloride USP) 25 mg 1667% Molybdenum (as molybdenum glycinate chelate***) 100 mcg 133% Riboflavin (as riboflavin USP) 15 mg 882% Boron (as boron aspartate-citrate) 2 mg * Niacin (67% as niacinamide USP 60 mg 300% and 33% as niacin USP) Vanadium (as bisglycinato oxovanadium) 50 mcg * Vitamin B 6 (as pyridoxine hydrochloride USP) 15 mg 750% Choline (as choline bitartrate) 75 mg * Folate (as Metafolin ** L-5-methyltetrahydrofolate) 400 mcg 100% Inositol 25 mg * Vitamin B12 (50% as methylcobalamin 50 mcg 833% Citrus Bioflavonoids (85 mg as citrus 100 mg and 50% as 5-adenosylcobalamin) bioflavonoid complex, min. 50% bioflavonoids, * Biotin USP 300 mcg 100% and 15 mg as hesperidin methylchalcone) Pantothenic Acid (as d-calcium pantothenate USP) 50 mg 500% Every batch of ProThera tablets and capsules is tested using the official US Pharmacopeia (USP) testing method to ensure appropriate and reliable disintegration. Start Coating Dissolves Interior Dissolves Tablet Disintegrates Other ingredients: Cellulose, carboxymethylcellulose sodium, silicon dioxide, vegetable stearine, vegetable gum, magnesium stearate, natural citrus flavor, and cellulose coating. **Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany ***Albion Laboratories End 10

11 M U L T I P L E V I T A M I N S / M I N E R A L S V I T A M I N S VitaPrime Capsules Two-per-day multiple formula in capsule form. Iron-free. DESCRIPTION: This moderate potency multiple vitamin/mineral/trace element supplement is similar to VitaPrime tablet formula, but the amounts of calcium and magnesium have been reduced to ensure the formula will fit into two capsules daily to maintain patient compliance. Vegetarian capsules made of plant cellulose are used for VitaPrime and all other encapsulated ProThera products. VitaPrime Capsules is well suited for those who prefer capsules or have difficulty swallowing, as the capsules may be pulled apart and the contents mixed with food if desired. SUGGESTED USE: 1 capsule twice daily with food. VTPC 60 vegetarian capsules Vitamin A (58% (3,500 IU) as natural 6,000 IU 120% carotenes (alpha, beta, beta-cryptoxanthin, zeaxanthin, and lutein) from D. salina and 42% (2,500 IU) as vitamin A palmitate) Vitamin C (as L-ascorbic acid) 250 mg 417% Vitamin D3 (as cholecalciferol) 600 IU 150% Vitamin E (as d-alpha tocopheryl succinate plus natural 150 IU 500% mixed tocopherols d-alpha, d-beta, d-delta, d-gamma) from soy Vitamin K 1 (as phytonadione) 60 mcg 75% Thiamine (as thiamine hydrochloride USP) 25 mg 1667% Riboflavin (as riboflavin USP) 15 mg 882% Niacin (67% as niacinamide USP and 33% 60 mg 300% as niacin USP) Vitamin B 6 (as pyridoxine hydrochloride USP) 15 mg 750% Folate (as Metafolin ** L-5-methyltetrahydrofolate) 400 mcg 100% Vitamin B12 (50% as methylcobalamin and 50 mcg 833% 50% as 5-adenosylcobalamin) Biotin USP 300 mcg 100% Pantothenic Acid (as d-calcium pantothenate USP) 50 mg 500% Calcium (as calcium citrate-malate) 50 mg 5% Iodine (from kelp) 150 mcg 100% Magnesium (as magnesium bisglycinate chelate***) 50 mg 13% Zinc (as zinc bisglycinate chelate***) 15 mg 100% Selenium (as selenium amino acid complex) 200 mcg 286% Copper (as copper bisglycinate chelate***) 2 mg 100% Manganese (as manganese bisglycinate chelate***) 2 mg 100% Chromium (as chromium nicotinate 150 mcg 125% glycinate chelate***) Molybdenum (as molybdenum glycinate chelate***) 100 mcg 133% Active B Complex High-potency, activated forms. DESCRIPTION: Active B Complex provides a full complement of essential B-complex vitamins important for optimal health and functioning of numerous biochemical reactions in the body. B vitamins are required in the diet on a daily basis to support energy production, brain, liver and nerve cell function, and muscle tone in the GI tract. Activated, coenzyme forms of B complex vitamins are provided for situations requiring maximum absorption or higher demand for B-vitamins. Inclusion of Metafolin * L-5-methyltetrahydrofolate (L-5-MTHF), a bioactive form of folate, ensures more immediate effects than folic acid on metabolism. Benfotiamine, the lipid-soluble form of thiamine, is included together with active forms of riboflavin, vitamin B 12, and vitamin B 6. Provided as small, easy-to-swallow vegetarian capsules. Thiamine (as benfotiamine) 50 mg 3333% Riboflavin (as riboflavin 5 -phosphate) 20 mg 1176% Niacin (67% as niacinamide USP 60 mg 300% and 33% as niacin USP) Vitamin B 6 (as pyridoxal 5 -phosphate) 20 mg 1000% Folate (as Metafolin * L-5-methyltetrahydrofolate) 400 mcg 100% Vitamin B 12 (50% as methylcobalamin and 500 mcg 8333% 50% as 5-adenosylcobalamin) Biotin USP 300 mcg 100% Pantothenic Acid (as d-calcium pantothenate USP) 50 mg 500% Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), L-leucine, cellulose, silicon dioxide, and natural citrus flavor. *Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany SUGGESTED USE: 1 capsule daily with food. ABC 60 vegetarian capsules Active B Complex : Complete B vitamin support Higher potency amounts compared to standard B complex Folate, B 12, & other B vitamins in bioactive forms Benfotiamine, a highly absorbable form of thiamine Small, easy-to-swallow capsules Boron (as boron aspartate-citrate) 2 mg * Vanadium (as bisglycinato oxovanadium) 50 mcg * Choline (as choline bitartrate) 75 mg * Inositol 25 mg * Citrus Bioflavonoids (50 mg as citrus bioflavonoid 65 mg * complex, min. 50% bioflavonoids, and 15 mg as hesperidin methylchalcone) Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), L-leucine, silicon dioxide, natural citrus flavor, and cellulose. **Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany ***Albion Laboratories 11

12 V I T A M I N S Active B Trio Activated forms of B 12, folate, and B 6. DESCRIPTION: Active B Trio supplies bioactive forms of three essential B vitamins in small, easy-toswallow vegetarian capsules. This formula includes Metafolin * L-5-methyltetrahydrofolate (L-5-MTHF), a bioactive form of folate, to help ensure more immediate effects on metabolism compared to folic acid, the form of folate commonly used in fortified foods and supplements. Vitamin B 12 is provided as methylcobalamin, an active form with metabolic benefits that may not be provided by other forms of vitamin B 12. Also included is pyridoxal 5 -phosphate, the active, coenzyme form of vitamin B 6 that supports numerous metabolic steps includng red blood cell and neurotransmitter production. This form of vitamin B 6 is particularly well-suited for individuals with amino acid imbalances or nutritional deficiencies. SUGGESTED USE: 1 capsule daily with food. ABT 60 vegetarian capsules Methyl Balance Activated B vitamins and TMG. Vitamin B6 (from 41 mg pyridoxal 5 -phosphate) 25 mg 1250% Folate (as Metafolin * L-5-methyltetrahydrofolate) 800 mcg 200% Vitamin B12 (as methylcobalamin) 1,000 mcg 16,667% Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), cellulose, L-leucine, and silicon dioxide. *Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany DESCRIPTION: Methyl Balance supplies bioactive forms of four essential B vitamins together with betaine (also known as trimethylglycine or TMG) to synergistically support methylation processes and normal homocysteine metabolism. The body s methylation process is vital for formation of essential cell components such as proteins, nucleic acids found in DNA and RNA, and phospholipids that form nerve cell membranes. Methylation turns on genes, activates enzymes, drives detoxification reactions, influences hormone secretion, and helps maintain normal metabolism of homocysteine. SUGGESTED USE: 1 capsule daily with food. Vitamin B 2 (as riboflavin 5 -phosphate) 30 mg 1765% Vitamin B 6 (from 25 mg pyridoxal 5 -phosphate) 15 mg 750% Folate (as Metafolin ** L-5-methyltetrahydrofolate) 800 mcg 200% Vitamin B 12 (as methylcobalamin) 1,000 mcg 16,667% Bioactive Folate vs Folic Acid Although folic acid is the common form of folate used for nutritional supplements and food fortification, it needs to be activated to provide nutritional benefit. Folic acid must be converted to tetrahydrofolate by the intestines and liver before it can be used by cells for critical folatedependent metabolic reactions. The body s ability to transform folic acid is easily overwhelmed and unmetabolized folic acid enters the bloodstream and can be taken up by cells. Unmetabolized folic acid is not only biologically useless it inhibits folate-dependent chemical reactions involving DNA synthesis possibly increasing genetic mutations. Many people have gene mutations that impair their ability to make bioactive folates, especially L-5-methyltetrahydrofolate (L-5-MTHF). Up to 25% of people have a genetic variant for the enzyme that reduces their ability to make L-5- MTHF. These people are particularly vulnerable to folate deficiency. Sufficient folate is required for normal blood formation, immune system function, cell division, and homocysteine metabolism, which is important to maintaining integrity of the inner lining of blood vessels. ProThera routinely includes L-5-MTHF, a bioactive form of folate in VitalActiv, VitaPrime, and other formulas to support optimal folate nutrition. Unlike folic acid, this biologically active folate requires no chemical transformation to be used by the body. Metafolin L-5-methyltetrahydrofolate (L-5-MTHF): Also known as L-methylfolate, this premethylated folate requires no extra steps by the body to be absorbed and enter the circulation. Readily taken up and usable by cells, L-5-MTHF is the predominant folate in circulation and the only folate that crosses the blood brain barrier. L-5-MTHF is essential for the conversion of homocysteine into methionine leading to the synthesis of S-adenosylmethionine, the critical carbon source for the majority of the body s vital methylation reactions. Betaine (trimethylglycine) 600 mg * MBA 60 vegetarian capsules Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), cellulose, L-leucine, and silicon dioxide. **Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany 12

13 V I T A M I N S Biotin High-potency, 5,000 mcg. DESCRIPTION: Biotin is an important B vitamin and cofactor for four carboxylase enzymes that participate in the endogenous production of glucose, synthesis of fatty acids, and catabolism of amino acids. Deficiencies of biotin have been linked with blood glucose dysregulation, hair loss, brittle nails, and neurological dysfunction. High-dose biotin supplementation has been found to favorably modulate glucose tolerance and insulin sensitivity as well as cholesterol and triglyceride levels. Biotin deficiencies are not common in the general population but may be seen in persons with impaired gastrointestinal absorption due to disease or surgery. ProThera s high-potency Biotin provides 5,000 micrograms of this essential nutrient per capsule and is recommended for persons who may be at increased risk for biotin deficiency. Active B 12 -Folate Lozenge formula, active coenzyme forms. DESCRIPTION: Active B 12 -Folate combines the active coenzyme form of vitamin B 12, methylcobalamin, with an active form of folate, Metafolin * L-5-MTHF. This high-potency, bioactive formula was created to bypass normal absorptive mechanisms for vitamin B 12 and folate which may be impaired due to aging, illness, or gastrointestinal surgery. Fast-dissolving, lozenge tablets allow for quick release into the bloodstream. Vitamin B 12 and folate play an integral role in DNA synthesis and thus are essential to cell division and proper functioning of virtually all tissues in the body. Rapidly proliferating cells such as enterocytes, leukocytes, and skin cells are especially dependent upon active forms of these nutrients. Vitamin B 12 and folate also participate in methylation and proper metabolism of homocysteine, a potentially harmful metabolite of methionine. Dietary B 12 can be reliably obtained only from animal products and is a singularly difficult vitamin to absorb. Folate deficiencies have been reported following bariatric surgery. Active B 12 -Folate may be especially beneficial for vegetarians and persons with impaired gastrointestinal absorptive function due to aging, illness, or surgery. SUGGESTED USE: 1 capsule daily with food. BTN 90 vegetarian capsules Biotin USP 5,000 mcg 1667% Other ingredients: Cellulose, vegetarian capsule (hydroxypropyl methylcellulose, water), L-leucine, and silicon dioxide. Serving Size 1 Tablet Amount Per Tablet Folate (as Metafolin * L-5-methyltetrahydrofolate) 800 mcg 200% Vitamin B 12 (as methylcobalamin) 1,000 mcg 16667% Other ingredients: Mannitol, vegetable stearine, silicon dioxide, carboxymethylcellulose sodium, and magnesium stearate. *Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany Benfotiamine Highly-absorbable form of thiamine. SUGGESTED USE: 1 tablet daily with food. ABF 60 tablets DESCRIPTION: This naturally occurring, lipid-soluble derivative of thiamine (B 1 ) is highly bioavailable and has up to 3.6 times higher absorption than water-soluble thiamine salts. Benfotiamine is an ideal form for vitamin B 1 repletion. Thiamine functions as a coenzyme in the oxidative metabolism of glucose and fatty acids and the subsequent generation of energy in the form of ATP. While deficiencies are generally not common, the elderly, heavy consumers of alcohol, and persons with impaired absorptive capacity due to disease or surgery are at significantly higher risk. Bariatric surgery patients often present with a thiamine deficiency prior to surgery, but an acute, potentially life-threatening deficiency may also develop following surgery, especially in the presence of excessive vomiting. Benfotiamine may be taken by anyone at risk for a thiamine deficiency and is especially recommended for pre- and post-bariatric surgery patients. SUGGESTED Supplement USE: Facts One capsule daily with food. BEN 60 vegetarian capsules Thiamine (as benfotiamine) 150 mg 10000% Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), L-leucine, cellulose, and silicon dioxide. SUGGESTED USE: 1 capsule daily with food. BEN 60 vegetarian capsules 13

14 V I T A M I N S Vitamin D 3 Naturally derived, high-potency 1,000 IU and 5,000 IU. DESCRIPTION: Vitamin D 3, also known as cholecalciferol, is the natural form made in the skin as a result of sunlight. It is sequentially hydroxylated in the liver and kidneys to become its active form 1,25-dihydroxyvitamin D, a powerful secosteroid hormone. Vitamin D 3 is best known for its role in bone metabolism and calcium homeostasis. It increases intestinal calcium and phosphorous absorption, increases kidney reabsorption of filtered calcium, promotes bone mineralization, and induces osteoclast maturation facilitating bone remodeling. Ongoing research has revealed that vitamin D is also an immunomodulator and is at the heart of the innate immune system. Vitamin D is a transcriptional activator and through a nuclear transcription factor known as the vitamin D receptor, it can activate the transcription or repression of over 900 genes and may regulate the expression of more than 27,000 genes. Vitamin D supports the normal growth and differentiation of cells and inhibits excessive or disordered cell growth. Many experts now recommend vitamin D daily intakes in the range of 2,000 to 4,000 IU. SUGGESTED USE: 1 capsule daily with food. Measurement of 25-hydroxyvitamin D and calcium levels is highly useful to assess the proper daily dose. DRUG INTERACTIONS: The following medications increase vitamin D catabolism and may lower serum 25-hydroxyvitamin D levels: phenytoin, fosphenytoin, phenobarbital, carbamazepine, ketoconazole, and rifampin. Vitamin D 3 should not be taken at the same time as cholestyramine, colestipol, orlistat, mineral oil, and Olestra drugs because they inhibit vitamin D 3 absorption. VTD (1,000 IU) 100 vegetarian capsules VTD5 (5,000 IU) 100 vegetarian capsules 1,000 IU % DV 5,000 IU % DV Vitamin D 3 1,000 IU 250% 5,000 IU 1250% Other ingredients: Cellulose, vegetarian capsule (hydroxypropyl methylcellulose, water), L-leucine, and silicon dioxide. Vitamin K 2 Naturally derived, long-acting. DESCRIPTION: Natural vitamin K 2, also known as menaquinone-7 (MK-7), is supplied in this product. Vitamin K 2 has a longer serum half-life than K 1 indicating a higher degree of bioactivity. Naturally produced in the intestines by microbial organisms, vitamin K 2 synthesis may be damaged after bariatric surgery. Vitamin K is essential for proper blood clotting, bone mineralization, and cardiovascular health. In skeletal tissue, vitamin K activates the protein osteocalcin which is essential for attracting calcium into bones. Research indicates vitamin K 2 may be more effective at activating tissue proteins than K 1, which is completely taken up by the liver. Deficiencies of fat-soluble nutrients such as vitamin K are not uncommon in patients undergoing bariatric surgery. Vitamin K deficiencies are typically noted a year or more following surgery and should be monitored regularly. Vitamin K 2 is recommended for persons who may be at higher risk of vitamin K deficiency due to insufficient intake or impaired absorption or intestinal synthesis following surgery. SUGGESTED USE: 1 capsule daily with food. DRUG INTERACTIONS: High doses of vitamin K antagonize the anticoagulant activity of Coumadin (warfarin) and related drugs. VK2 60 vegetarian capsules Vitamin K 2 (as menaquinone-7) 50 mcg 63% Other ingredients: Cellulose, vegetarian capsule (hydroxypropyl methylcellulose, water), L-leucine, and silicon dioxide. 14

15 M I N E R A L S Chewable Calcium Ready-to-absorb calcium citrate with vitamin D. DESCRIPTION: These convenient chewable wafers provide calcium citrate with natural vitamin D 3. Calcium is needed for structural support of bones and teeth as well as for muscle contraction, membrane stabilization, normal blood clot formation, cell signaling, and neurotransmitter release. Vitamin D supports the health and strength of skeletal tissue and is an important immunomodulator. Dietary calcium is frequently lower than recommended, especially for persons on restricted diets. Dietary sources of vitamin D are very limited and exposure to sunlight is usually insufficient to meet daily needs. The ability to ingest and absorb adequate amounts of both calcium and vitamin D are further impaired following bariatric surgery. Chewable Calcium is recommended when calcium and vitamin D are needed and may be of particular benefit for persons with impaired gastrointestinal function due to illness or surgery. Serving Size 1 Tablet Amount Per Tablet Total Carbohydrates <1 g <1% Sugars <1 g * Vitamin D 3 (as cholecalciferol) 100 IU 25% Calcium (as calcium citrate) 250 mg 25% Percent Daily Values are based on a 2,000 calorie diet. * Daily value not established Other ingredients: Fructose, honey, lecithin (from soy), vegetable stearine, natural orange and pineapple flavor, magnesium stearate, and citric acid. CONTAINS SOY. SUGGESTED USE: 1 to 4 tablets daily. CHC 120 chewable tablets Calcium Citrate: A Superior Form of Calcium While there are many supplemental forms of calcium, none are better documented than calcium citrate and calcium citrate-malate, the primary forms used in ProThera calcium-containing supplements. These readily-soluble, highly absorbable forms do not require gastric acidity for absorption. They are also safe, well-tolerated, and cost-effective. About 40% more calcium is absorbed from calcium citrate forms compared to calcium carbonate or milk. This enhanced bioavailability is especially important for people on restricted diets or with impaired gastrointestinal function due to illness or surgery. Chewable Cal-Mag Plus D Bioavailable calcium and magnesium plus vitamin D. DESCRIPTION: Calcium and magnesium citrates are supplied in a 2:1 ratio with natural vitamin D 3 in convenient chewable wafers. Magnesium complements calcium and vitamin D by supporting bone strength and remodeling. It is also vital for energy production and proper cardiovascular function. Dietary calcium, magnesium and vitamin D are frequently lower than recommended, especially for persons on restricted diets. The ability to ingest and absorb adequate amounts of these nutrients may be further impaired following bariatric surgery. Chewable Cal-Mag Plus D may be of particular benefit for persons with impaired gastrointestinal function following illness or surgery. SUGGESTED USE: 2 tablets twice daily. CHCM 120 chewable tablets Serving Size 2 Tablets Calcium Citrate Powder Ultra-fine citrate powder. Amount Per 2 Tablets Calories 5 Total Carbohydrates 2 g <1% Sugars 2 g * Vitamin D 3 (as cholecalciferol) 100 IU 25% Calcium (as calcium citrate) 250 mg 25% Magnesium (as magnesium citrate) 125 mg 31% Percent Daily Values are based on a 2,000 calorie diet *Daily value not established Other ingredients: Fructose, honey, vegetable stearine, lecithin (from soy), natural orange and pineapple flavor, magnesium stearate, and citric acid. CONTAINS SOY. DESCRIPTION: This calcium supplement provides calcium citrate in powder form for convenient supplementation. Calcium Citrate Powder is an excellent alternative to chewable calcium and is often a preferred choice for gastric bypass patients. The pleasant, unflavored powder dissolves easily in liquids or can be mixed with foods. Each 1 ½ teaspoon contains 500 mg of pure calcium citrate with no added ingredients. Supplies 120 servings per container. Serving Size 1 Heaping Scoop (1½ teaspoon or approx. 2.5 g) Amount Per Serving Calcium (as calcium citrate) 500 mg 50% Other ingredients: None. SUGGESTED USE: 1 heaping scoop daily mixed with food or beverage. CCP Net wt oz (300 grams) 15

16 M I N E R A L S P R O T E I N / A M I N O A C I D S Iron Chelate Exceptional tolerance and bioavailability. DESCRIPTION: Iron Chelate is a breakthrough in iron nutrition. Through a special process, elemental iron is bound to two glycine amino acids to form a highly bioavailable and well-tolerated chelate called ferrous bisglycinate. Better tolerated than iron salts such as ferrous sulfate, Iron Chelate is ideal for persons who require supplemental iron but react poorly to ordinary forms of iron or may be unable to properly absorb iron. Iron deficiency has been commonly reported in bariatric patients, both before and after surgery. Iron Chelate is recommended for persons who may be at risk of iron deficiency because of insufficient intake, excessive loss due to heavy menstruation, or impaired absorption following surgery. SUGGESTED USE: 1 capsule daily with food. IRN vegetarian capsules Chewable Iron Chelate A bioavailable and taste-free form of iron. DESCRIPTION: This convenient chewable tablet option contains an exceptionally well-tolerated and taste-free form of iron produced by attaching iron to three glycine amino acids forming iron trisglycinate, a well-absorbed form of this essential mineral. Supplies 30 mg of elemental iron. Natural cherry flavor. SUGGESTED USE: 1 tablet daily with food. IRN-CH 100 chewable tablets Iron (as Ferrochel ferrous bisglycinate chelate*) 30 mg 167% Other ingredients: Cellulose, vegetarian capsule (hydroxypropyl methylcellulose, water), magnesium stearate, and silicon dioxide. *Albion Laboratories Serving Size 1 Tablet Amount Per Tablet Calories 5 Total Carbohydrates 2 g <1% Sugars 2 g * Iron (as ferrous trisglycinate chelate**) 30 mg 167% Percent Daily Values are based on a 2,000 calorie diet *Daily value not established Other ingredients: Fructose, dextrates, silicon dioxide, natural cherry flavor, vegetable stearine, and magnesium stearate. **Albion Laboratories Ensuring Protein and Amino Acid Status in Bariatric Patients. Maintaining adequate protein intake is crucial for both surgical and non-surgical patients on restricted diets but doing so is often difficult. Protein is one of the main nutrients affected by bariatric surgery and protein malnutrition occurs frequently. Malabsorption of protein resulting from a decrease in enzyme secretions or bypassing segments of the stomach and small intestine where most protein is absorbed is a primary cause. Deficiencies may also be caused by reduced intake resulting from aversion to meat, chewing difficulties, or protein intolerance. Reduced calorie diets can also result in low protein intake if improperly balanced. An adequate supply of dietary protein is essential to maintain cellular integrity and function, reproduction, and overall health. Protein is a major functional and structural component of all cells. All enzymes, membrane carriers, blood transport molecules, hair and fingernails, serum albumin, keratin, and collagen are comprised of protein. The amino acid constituents of protein act as precursors of many coenzymes, hormones, nucleic acids, and other molecules essential for life. The ProThera Bariatrics Program includes readily absorbable protein and amino acid supplements to conveniently enhance dietary intake. Protein is essential for function of all cells in the body. Peptides and amino acids from protein play important roles in immunity, neurological function, detoxification, and energy production. 16

17 P R O T E I N / A M I N O A C I D S Whey Protein Plus L-Carnitine Pure, instantized whey protein isolate provides complete protein nutrition. DESCRIPTION: Whey Protein Plus L-Carnitine is an excellent source of high-quality, bioavailable protein. This 100% pure, microfiltered whey protein isolate formula provides a broad spectrum of essential and non-essential amino acids, including the important branched-chain amino acids leucine, isoleucine, and valine. Enriched with 400 mg of L-carnitine, Whey Protein Plus L-Carnitine is often a preferred choice for persons trying to lose weight as it activates satiety signals that affect both short-term and long-term regulation of food intake. It is also an excellent choice after bariatric surgery when obtaining adequate protein is often difficult. Whey Protein Plus L-Carnitine dissolves easily in liquids, has no added sugar, zero calories from fat, and no lactose or cholesterol. It is derived from cow s milk using a patented process that preserves bioactivity of whey proteins and other constituents such as lactoferrin and glycomacropeptides. Dietary protein is essential for the synthesis, maintenance, and repair of body tissues as well as production of all major body proteins including collagen, albumin, hemoglobin, non-steroidal hormones, antibodies, digestive and metabolic enzymes, cellular receptors, lipoproteins, glycoproteins, and proteoglycans. Peptides and amino acids from protein also play important roles in immunity, neurological function, detoxification, and energy production. Whey protein is high in branched-chain amino acids which can help improve energy, inhibit muscle breakdown, regulate blood sugar, and suppress appetite. L-carnitine is essential for transport of fatty acids into mitochondria for betaoxidation (fat burning). Studies indicate supplemental L-carnitine may increase fatty acid oxidation, reduce fat mass, preserve muscle mass, and reduce muscle fatigue. Whey Protein Plus L-Carnitine is designed to provide high-quality protein to persons who may have reduced intake of dietary protein or an impaired ability to digest and absorb protein due to illness or surgery. Scoop included. SUGGESTED USE: 1 to 2 scoops daily mixed in water or other beverage. WHEY oz (300 grams) Serving Size 1 Scoop (Approximately 15.8 grams) Amount Per Scoop Amount Per Scoop Calories 55 Total Carbohydrate <1 g <1% Protein 14 g 27% Calcium 65 mg 7% Phosphorus 32 mg 3% Magnesium 10 mg 3% Sodium 23 mg <1% Potassium 73 mg 2% Whey Protein Microfiltered Isolate 15 g * Typical Amino Acid Profile: L-Alanine 675 mg * L-Arginine 260 mg * L-Aspartic Acid 1,484 mg * L-Cysteine 309 mg * L-Glutamic Acid 2,370 mg * Other ingredients: Lecitihin (from soy). Glycine 222 mg * L-Histidine 231 mg * L-Isoleucine 925 mg * L-Leucine 1,416 mg * L-Lysine 1,280 mg * L-Methionine 273 mg * L-Phenylalanine 425 mg * L-Proline 875 mg * L-Serine 610 mg * L-Threonine 963 mg * L-Tryptophan 223 mg * L-Tyrosine 414 mg * L-Valine 820 mg * L-Carnitine (as L-carnitine tartrate) 400 mg * Contains milk and soy. Complete, high-quality protein Broad-spectrum of essential and non-essential amino acids Easily digested, readily absorbed Free of added sweeteners Exceptional tolerance Lactose- and cholesterol-free Mixes and dissolves readily 17

18 A M I N O A C I D S E N Z Y M E S L-Carnitine: Crucial for Heart & Skeletal Muscle Energy L-carnitine, a quaternary amine synthesized from the amino acids lysine and methionine, is highly concentrated in cardiac and skeletal muscle. It is an accessory nutrient, meaning that supplemental amounts may be required for optimal health. L-carnitine is also a conditional nutrient as the body cannot make adequate amounts under certain conditions such as growth and pregnancy. People with kidney disease, diabetes mellitus, liver dysfunction, hyperlipidemias, and heart disease often have low levels. L-carnitine is essential for fatty acid oxidation and exceptionally important for tissues that primarily rely on fatty acids as an energy source such as the heart and skeletal muscle. L-carnitine has been shown to facilitate weight loss, improve glucose tolerance, and enhance insulin sensitivity. It supports normal heart function in people with heart failure and angina pectoris. L-Carnitine Pure USP form, 250 mg. DESCRIPTION: Heart and skeletal muscle contain abundant amounts of L-carnitine which is essential for meeting tissue energy demands. Normal endogenous production of L-carnitine can be inadequate in people with kidney disease, diabetes, liver dysfunction, hyperlipidemias, and cardiac problems, thus requiring supplementation. These capsules contain 100% pure L-carnitine produced according to USP guidelines and are free of potentially harmful synthetic D-carnitine. SUGGESTED USE: 1 to 6 capsules twice daily with food. CRN2 60 vegetarian capsules L-Carnitine Tartrate Stabilized for longer shelf-life. DESCRIPTION: L-Carnitine Tartrate is a stable, moisture resistant form of L-carnitine in which the positively charged amine group in L-carnitine is bonded with the negatively charged hydroxyl oxygen in tartaric acid. SUGGESTED USE: 1 to 6 capsules twice daily with food. L-Carnitine USP** 250 mg* Other ingredients: Cellulose, vegetarian capsule (hydroxypropyl methylcellulose, water), silicon dioxide, and magnesium stearate. **Carnipure brand, a licensed trademark of Lonza, Ltd. Used under license from Lonza, Ltd. L-Carnitine (as L-carnitine tartrate)** 500 mg* Other ingredients: Carboxymethylcellulose sodium, vegetarian capsule (hydroxypropyl methylcellulose, water), silicon dioxide, and magnesium stearate. **Carnipure brand, a licensed trademark of Lonza, Ltd. Used under license from Lonza, Ltd. Zymalin Multi-enzyme digestive support. DESCRIPTION: Zymalin is a broad-spectrum digestive enzyme supplement to assist in the breakdown and utilization of dietary macronutrients. More complete breakdown of foods may enhance nutritional status by increasing the availability and absorption of dietary nutrients. Improved digestion may also reduce gastrointestinal symptoms such as gas, bloating, and discomforts associated with consuming irritating or allergenic foods. Zymalin contains proteases, carbohydrases, and lipase derived from microbially-derived enzymes which operate over a wide ph range. Zymalin provides neutral and acid proteases for broad-spectrum proteolytic activity. Amylase, cellulase, and alpha-galactosidase help break down starches and difficult-to-digest carbohydrates. Lipase aids in fat digestion. The formula is suitable for vegetarians and sensitive individuals as it contains no enzymes derived from animal sources or from potentially allergenic plants. Zymalin can be used for anyone wishing to improve digestion of their daily meals, but may be best suited for persons with impaired digestion due to illness or surgery. SUGGESTED USE: 1 capsule with each meal. DRUG INTERACTIONS: Carbohydrase enzymes such as amylase and cellulase may increase the intestinal availability and absorption of glucose and could potentially interfere with the efficacy of oral hypoglycemic drugs or insulin. ZML 90 vegetarian capsules Enzyme Blend (derived from Aspergillus niger, 700 mg* Aspergillus oryzae, and Rhizopus oryzae) with the following minimum enzyme activity: Lipase 1,500 FIP** Protease 45,000 HUT** Acid Protease 150 SAP** Amylase 11,000 DU** Cellulase 18,000 CU** Alpha-Galactosidase 300 GaIU** Other ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), cellulose, slippery elm bark, marshmallow root, silicon dioxide, and magnesium stearate. **Units are those used in edition five (V) of the Food Chemicals Codex (FCC) CRN5 60 vegetarian capsules 18

19 F A T T Y A C I D S Omega-3 EPA And DHA Fatty Acids Benefit Bariatric Patients. Most people do not obtain enough omega-3 fatty acids in their diets. These long-chain fatty acids are indispensable to the health of the heart, brain, eyes, bone, skin, joints, and immune system. By modulating eicosanoid production, omega-3 fatty acids favorably influence inflammatory pathways in many of the body s cells and tissues. Emerging research suggests that omega-3 fats may reduce inflammation within fat cells, enhancing the sensitivity of these cells to insulin. Omega-3s also appear capable of controlling the size and growth of adipocytes. Animal and human studies have demonstrated that supplementing with fish oil may lead to significant reductions in fat mass. Most everyone could benefit from increased intake of omega-3 fatty acids, but it is especially recommended for those with a higher risk of developing obesity-related conditions such as cardiovascular disease and diabetes. Omega-3 fatty acids may reduce inflammation within fat cells, increasing their sensitivity to insulin, and lead to significant reductions in fat mass. Eicosamax High-potency, ultra-pure omega-3 fish oil. DESCRIPTION: Eicosamax is an ultra-concentrated, ultra-pure source of omega-3 fatty acids. At nearly 70% EPA and DHA, Eicosamax is over twice as concentrated as most other fish oil products. Advanced molecular distillation technology removes most residual compounds and toxins including mercury to produce an oil with a fresh, non-fishy taste that meets the world s most exacting standards for purity. It is also cholesterol-free. A natural lemon flavor imparts a refreshing taste and a proprietary antioxidant blend of rosemary oil and vitamin E ensures stability. Each batch is analyzed by an independent, third-party laboratory to verify oil purity and omega-3 potency. Eicosamax is available as a liquid or in convenient softgels. SUGGESTED USE: 1 to 6 softgels, or 1 teaspoon of liquid, daily with food. EMX 60 softgels EMX softgels Eicosamax Softgels Serving Size 1 Softgel Amount Per Softgel Calories 10 Calories from Fat 10 Total Fat 1 g 2% Saturated Fat 0 g 0% Polyunsaturated Fat 1 g * Marine Fish Oil Concentrate 1,000 mg * Supplying the following Compound FFA omega-3 fatty acids: Weight** Weight*** Eicosapentaenoic Acid (EPA) 360 mg 330 mg * Docosahexaenoic Acid (DHA) 270 mg 250 mg * Percent Daily Values are based on a 2,000 calorie diet. Other ingredients: Gelatin, glycerin, natural mixed tocopherol vitamin E from soy, natural lemon oil, rosemary extract, and water. **Amounts reported as weight of the fatty acid compound. ***Amounts reported as free fatty acid (FFA) equivalents by weight in accordance with voluntary CRN Monograph. EML 4 fluid oz Eicosamax Liquid Serving Size 1 Teaspoon Amount Per Teaspoon Calories 40 Calories from Fat 40 Total Fat 4 g 6% Saturated Fat 0 g 0% Polyunsaturated Fat 4 g * Marine Fish Oil Concentrate 4,443 mg * Supplying the following Compound FFA omega-3 fatty acids: Weight** Weight*** Eicosapentaenoic Acid (EPA) 1,600 mg 1,467 mg * Docosahexaenoic Acid (DHA) 1,200 mg 1,111 mg * Percent Daily Values are based on a 2,000 calorie diet. Other ingredients: Natural mixed tocopherol vitamin E from soy, natural lemon oil, and rosemary extract. **Amounts reported as weight of the fatty acid compound. ***Amounts reported as free fatty acid (FFA) equivalents by weight in accordance with voluntary CRN Monograph. Eicosamax Fish Oil Highly purified 70% omega-3 content Fresh lemon taste Third-party tested 19

20 W E I G H T M A N A G E M E N T Using Specific Natural Agents To Support Medical Weight Management. Various natural-based agents have been documented to enhance weight management programs. Specific fatty acids and phytonutrient compounds help favorably regulate body composition. Certain plant-derived substances increase thermogenesis while others inhibit enzymes that control starch digestion or fat metabolism. The ProThera Bariatrics Program includes several of the best documented natural supplements that can be used to complement a healthy diet and exercise regimen. Conjugated Linoleic Acid (CLA) Regulator of body composition. DESCRIPTION: Conjugated linoleic acid (CLA) represents a group of naturally occuring isomers of the essential fatty acid, linoleic acid. Studies demonstrate CLA can help reduce body fat mass and/or increase lean body mass. CLA may favorably alter body composition by reducing food/energy intake, decreasing adipocyte size, increasing adipocyte apoptosis, decreasing lipogenesis, and/or increasing fatty acid oxidation. Research suggests CLA may also enhance insulin sensitivity. CLA has proven to be very safe with few or no adverse reactions in human clinical trials. ProThera s CLA contains 78% total CLA, with a minimum concentration of 74% of the biologically active cis-9, trans-11, and trans-10, cis-12 isomers. These active isomers are present in a safe 1:1 ratio to prevent adverse effects associated with use of isolated trans-10, cis-12 CLA. Softgel encapsulation provides protection against atmospheric oxygen and added vitamin E protects against lipid peroxidation. ProThera s CLA, as part of a healthy diet and lifestyle, can be used by men and women as an aid to weight loss. SUGGESTED USE: 1 to 3 softgels daily with food. Garcinia Cambogia Inhibits fat synthesis and appetite. DESCRIPTION: Standardized Garcinia fruit rind extracts have been shown to enhance serotonin availability, reduce appetite, increase fat oxidation, improve serum lipid levels, decrease body weight, and favorably modulate many obesity regulatory genes without impacting the mitochondrial and nuclear proteins required for normal biochemical functions. Contains CitriMax brand dried extract of Garcinia cambogia standardized to contain at least 50% (-) hydroxycitric acid. Garcinia cambogia has no neurostimulatory activity. SUGGESTED USE: 1 to 9 capsules daily with food. Studies suggest the optimal dose for effective weight management is 1,500 mg three times a day with food. GRC 100 vegetarian capsules Garcinia (Garcinia cambogia) fruit, dried extract, 500 mg* min. 50% (-) hydroxycitric acid** Other Ingredients: Vegetarian capsule (hydroxypropyl methylcellulose, water), cellulose, magnesium stearate, and silicon dioxide. **CitriMax brand of (-) hydroxycitric acid. CitriMax is a registered trademark of InterHealth, N.I. CLA9 90 softgels Serving Size 1 Softgel Amount Per Softgel Calories 10 Calories from Fat 10 Total Fat 1 g 2% Saturated Fat 0 g 0% Polyunsaturated Fat 1 g * Conjugated Linoleic Acid (CLA) Oil 1,000 mg * from safflower Supplying a minimum of: Conjugated Linoleic Acid 780 mg * Percent Daily Values are based on a 2,000 calorie diet. Other ingredients: Gelatin, glycerin, natural caramel color, water, and natural vitamin E tocopherols. 20