Vitamin and Mineral Supplementation and Monitoring for Patients Having Bariatric Surgery. Dietitians

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1 Vitamin and Mineral Supplementation and Monitoring for Patients Having Bariatric Surgery Dietitians We put our patients first by working as one team; leading and listening, and striving for the best. Together, we make the difference. Patient information Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust

2 Why are vitamin and mineral supplements recommended? After any type of bariatric surgery there is a risk of developing vitamin or mineral deficiencies. This is because you will be eating smaller portions of food, which makes it more difficult to get enough vitamins and minerals from your diet alone. We therefore recommend that all patients who have had bariatric surgery take certain vitamin and mineral supplements for the rest of their lives. Most supplements are available on prescription, but others you will have to purchase yourself. Which supplements, and how much you need to take, depends on which type of bariatric surgery you have. This leaflet will explain what you need to take. We also advise that you have routine nutritional blood tests after bariatric surgery to monitor your nutrition. If you choose not to follow these recommendations or you choose alternative products, you may be at risk of developing nutrient deficiencies. These can have various symptoms and may lead to complications, such as osteoporosis (thinning of the bones), and some of these may be irreversible. Intragastric balloon or gastric band If you have an intragastric balloon or gastric band we recommend that you take the following supplements every day for life (or while the balloon is in place) to reduce your risk of deficiencies: One A-Z complete multivitamin and mineral supplement per day Forceval is the only suitable multivitamin and mineral available on prescription, and is available in soluble or capsule form. Forceval contains everything you need. Multivitamins and minerals are also available to buy from chemists and supermarkets but we cannot guarantee these contain everything you need Calcium and Vitamin D You need to take mg of calcium and 65-75ug of vitamin D everyday to ensure good bone health. The easiest way to achieve this is by taking one Calcichew D3 Forte Tablets (chewable) or Adcal D3 Tablets (chewable), three times per day. This is available on prescription. 2

3 We advise you also purchase an additional vitamin D tablet containing 25ug and take one to two tablets per day. Available examples include: Boots Vitamin D3 25ug tablets and Holland and Barrett Sunvite Vitamin D3 25ug tablets. First two weeks after your surgery For the first two weeks after your surgery all medications including vitamin supplements need to be in a chewable or soluble form. As this is for a short period of time we advise you obtain a chewy multivitamin and mineral such as Centrum Fruity Chewables for adults, Bassett s Active Health multivitamins with minerals for adults, or a shops own brand chewable/soluble multivitamin and mineral. Forceval Soluble is a multivitamin and mineral available on prescription. You need to take one tablet/dose per day. The Calcichew D3 Forte Tablets/ Adcal D3 Tablets are already chewable and you can start the extra vitamin D after the first two weeks. Gastric bypass or sleeve gastrectomy If you have a gastric bypass or sleeve gastrectomy, we recommend that you take the following supplements every day for life to reduce your risk of deficiencies: Two A-Z complete multivitamin and mineral supplements per day Two Forceval are the only suitable multivitamin and mineral supplements available on prescription, and are available in soluble or capsule form. Two Forceval contain everything you need. Multivitamins and minerals are also available to buy from chemists and supermarkets but we cannot guarantee these contain everything you need Calcium and Vitamin D You need to take mg of calcium and 75ug of vitamin D everyday to ensure good bone health The easiest way to achieve this is by taking one Calcichew D3 Forte Tablets (chewable) or Adcal D3 Tablets (chewable), three times per day. This is available on prescription. We advise you also purchase an additional vitamin D tablet containing 25ug and take one to two tablets per day. Available 3

4 examples include: Boots Vitamin D3 25ug tablets and Holland and Barrett Sunvite Vitamin D3 25ug tablets. Iron This is available on prescription as Ferrous Gluconate 300mg one tablet per day and we advise that you take this to avoid developing iron deficiency. This provides 35mg of iron. Vitamin B12 You will need to start having regular vitamin B12 injections six months after your surgery. To prevent you developing a vitamin B12 deficiency we recommend you have this done at your GP surgery every three months. An injection is the most effective way for your body to absorb this vitamin after a gastric bypass or sleeve gastrectomy. First two weeks after your surgery For the first two weeks after your surgery all medications including vitamin and mineral supplements need to be in a chewable or soluble form. As this is for a short period of time we advise you obtain a chewy multivitamin and mineral such as Centrum Fruity Chewables for adults, Bassett s Active Health multivitamins with minerals for adults, or a shops own brand chewable/soluble multivitamin and mineral. Forceval Soluble is a multivitamin and mineral available on prescription. You need to take two tablets/ dose s per day. The Calcichew D3 Forte Tablets/Adcal D3 Tablets are already chewable and you can start the extra vitamin D and iron after the first two weeks. Taking your vitamins and minerals To make sure that your vitamins and minerals are well absorbed we suggest that you: Avoid taking your Calcichew D3 Forte Tablets, Adcal D3 Tablets or calcium supplements at the same time as your multivitamins and minerals or iron supplement. Spread your Calcichew D3 Forte Tablets, Adcal D3 Tablets or calcium supplements through the day (for example, do not take all three in one go) Take your multivitamins and minerals and iron with vitamin C 4

5 containing food if possible- such as a small amount of orange juice, fruit and vegetables Other medicines: If you are taking Thyroxine, avoid taking it at the same time as your multivitamins and minerals, iron and calcium as they can prevent you absorbing the Thyroxine. It is recommended that you take the Thyroxine four hours before or four hours after your supplements. If you are taking an anti-coagulant such as Warfarin, you should choose a multivitamins and mineral preparation that doesn t contain vitamin K. Forceval does not contain vitamin K however other multivitamin and mineral preparations may. If this is unavoidable you should speak to your GP to have your INR monitored. Suggested regimen: Multivitamins and minerals and iron can be taken all together at breakfast (try to include a vitamin C containing food if possible). Then spread your calcium supplements throughout the day by taking one with lunch, one with dinner and one before bed. You can take your vitamin D at the same time as one of these calcium doses. For example: With breakfast With lunch With evening meal Before bed A-Z complete multivitamin and minerals Iron Calcium and vitamin D Calcium and vitamin D Calcium and vitamin D plus additional vitamin D 5

6 Nutritional monitoring - blood tests For all types of bariatric surgery routine nutritional blood tests are needed every three months for the first year, and then yearly after that, for life. Blood testing will be more frequent if any deficiencies are suspected by a health care professional or found. If a deficiency is found, you may be offered further dietary advice or extra supplementation may be recommended. We advise that you have the following routine nutritional blood tests: Full blood count Urea and electrolytes (including phosphate and magnesium) Glucose Liver function tests Iron Ferritin Folate Vitamin B12 Lipid Profile Triglycerides Calcium PTH 25-Hydroxyvitamin D (once a year) Other nutritional tests may be done following the advice of a health care professional. 6

7 Planning ahead You might like to use this space to plan your vitamin and mineral supplementation and monitoring: Request on prescription: A-Z complete multivitamin and mineral Things to plan Forceval (soluble for first two weeks after surgery) One tablet per day (intragastric balloon or gastric band) Two tablets per day (gastric bypass or sleeve gastrectomy) Calcium & vitamin D Calcichew D3 Forte Tablet (chewable) or Adcal D3 Tablet (chewable) Three tablets per day Iron (only for patients having a gastric bypass or sleeve gastrectomy) To arrange Nutritional blood tests Vitamin B12 injections (only for patients having a gastric bypass or sleeve gastrectomy) Ferrous Gluconate (300mg) Book at GP surgery One tablet per day Every three months in the first year, then yearly for the rest of your life. Start six months after surgery then have every three months Supplements to purchase over the counter Extra vitamin D 25ug per tablet One to two tablets per day 7

8 Important information for women if you are planning a pregnancy or have become pregnant We advise that you contact your GP to discuss this further. All patients who have had bariatric surgery require 5mg of folic acid, available on prescription, when planning a pregnancy and up to the end of the 12th week of pregnancy. If you have had a sleeve gastrectomy or gastric bypass we advise that you reduce your multivitamin and mineral complete A-Z supplement to one a day. All other supplements should remain the same unless advised otherwise. Pregnancy should be avoided in the first two years after bariatric surgery. Before trying to become pregnant, you should have your routine nutritional bloods tested as soon as possible at your GP surgery to check for any nutritional deficiencies. These are the same routine nutritional blood tests that you would normally have done regularly (every three months in the first year and yearly thereafter) after bariatric surgery. If there are any concerns about your nutrition, the team may also check vitamin A, vitamin E, vitamin K (INR), zinc, selenium and copper levels. Please contact the bariatric dietitians for a specific patient information leaflet regarding pregnancy and bariatric surgery. Further support If you have any queries or concerns please contact one of the Bariatric Dietitians on or

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