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Before weight loss surgery it is recommended that all patients start on a daily adult multivitamin, along with any supplements recommended by a treating physician. It is also recommended that you have blood work done to check for any deficiencies before weight loss surgery. This will allow time for treatment of any deficiencies, and prepare your body for weight loss surgery.
After weight loss surgery taking required vitamins everyday must become a habit that continues for the rest of your life. By taking these supplements, you can assure that your body is getting the nutrients it needs. Below you will find a list of vitamins required for weight loss patients.
Here are the vitamins and minerals you should be taking:
The surgeons at Rocky Mountain Associated Physicians (RMAP) do not recommend a certain brand in vitamins. Find your vitamins where it is most convenient for you; your local pharmacy or grocery store are great options. For about the first four months after surgery all large pills will need to be cut into smaller halves, or in a chewable or liquid. Taking children’s vitamins are okay, as long as you take the recommended adult dose as indicated on the bottle.
***Avoid gummy multivitamins as they lack in B vitamins, a vital mineral you need after surgery.
Sublingual Vitamin B-12:
1,000 mcg/day. Take sublingually (a small pill that is placed under the tongue and absorbed directly into the bloodstream) daily or by intramuscular injections, monthly. Take at a time that can become a habit for you.
500-600 mg three times a day. Our bodies only absorb a small amount of calcium at a time. This is why it’s required to take in divided dosages to get in surgery, this pill cut into smaller halves, or in a chewable or liquid. Calcium Citrate chews are okay to use, but be aware of any extra added sugar.
***Do not take your calcium supplement until you are drinking at least 64 oz. of water.
Duodenal Switch (DS) patients are required to take a supplement high in vitamins A, D, E and K. This vitamin needs to be fat-soluble and contain 10,000 IU of Vitamin A, 2,000 IU of Vitamin D, 22.5 IU of Vitamin E, and 300 micrograms of Vitamin K. This supplement can be difficult to find. ADEK vitamins can be purchased at RMAP’s front office: 1160 E 3900 S, Salt Lake City UT, 84124.
Anemia can occur if you don’t ingest enough iron. Many times it’s necessary to take iron (ferrous sulfate). Sometimes multivitamin preparations don’t contain enough iron to meet daily requirements. Your physician needs to determine if an iron supplement is appropriate for you. Don’t start an iron supplement until you have consulted with your physician.
3000 IU Vitamin D3
Visit RMAP on Pinterest to find vitamin online resources.
As you can see vitamin supplementation is very important. This is because restrictive and malabsorptive procedures like the gastric bypass, sleeve gastrectomy, and duodenal switch carry risk for nutritional deficiencies. Severe complications can result if vitamins are not taken as directed.
Please contact Rocky Mountain Associated Physicians if you have any questions regarding vitamin supplements before or after weight loss surgery.
Excuses Verses Safety Nets
By: Dr. Steven C. Simper, MD, FACS
Eating better got easier when “I can’t have that” turned into “I don’t want that.”
When asked to talk at public gatherings, you are frequently given topics that you are not always comfortable with or don’t feel qualified to discuss. One thing you learn is to change the top, and sometimes that’s what I do. I’m a doctor and a scientist. I don’t always feel comfortable discussing subjects that are not scientific, topics that I can put hard facts to or design an exact experience to prove my point. The topic I came up with to discuss is a topic in which we are all experts, and that is “excuses.”
There are excuses defined as “reasons we give for not doing something we know we should do” and there are safety nets defined as “reasons we give for doing things we know we should not be doing.” I’m not sure Webster’s Dictionary will agree with my definitions, but believe me they are accurate. Almost everyone is an expert in giving excuses, especially doctors (after all, we are always giving excuses for why we are late for clinic).
At previous support groups, I have asked patients to give me examples of excuses and of safety nets pertaining to diet and exercise. I thought of a lot of excuses and safety nets, but I was amazed at some of the clever ones proposed by the audience. Here I will share a few with you and maybe shoot a few holes in them while I’m at it.
“I can’t exercises, I’m too busy.”
A tough one, but if it’s important, you need to make time.
“I can’t avoid carbohydrates, I travel and there is nothing else to eat.”
How about the old-fashioned sack lunch? After all, on your diet it should be small and easy to carry.
“I can’t drink water. I have never been a water drinker.”
Yes you are. Everyone is or you couldn’t live.
“I can’t avoid buying chips and sodas and always having them available for my family even if they are always tempting me.”
Those things are not good for you or your family either. You will be doing them a favor by insisting on a healthier life style for them as well.
These are just a few common excuses and if you notice, they all have something in common, that being the word can’t. When you say, “I can’t,” what you really mean is, “I won’t.” Every parent knows this and scolds their children when they make excuses in this way, but we adults do it all the time ourselves. What I do is simple. Replace the word can’t with won’t and the true nature of the situation is revealed. I find I’m ashamed to use won’t and more often than not this forces me into doing things I was trying to avoid. Try it next time you think, “I can’t (won’t) go to the gym today.” I suspect that more often than not you will make a special effort to get there.
“John at my office had a gastric bypass surgery and he eats anything he wants, so I can too.”
John will fail in the long run and so will you if you follow his advice.
“My calcium is chocolate covered so it must be alright. I’m just taking calcium.”
“The newspaper reports that chocolate is good for you, so I can have all I want, right?”
Do I need to say more?
“I can drink soda as long as I let it go flat first.”
How long will it be before you no longer let it go flat?
“I have been so good all week it will be alright to cheat a little on my diet over the weekend. After all, I deserve it.”
You may deserve it, but you’ll also pay the price.
The list of safety nets really goes on and on. This makes sense given that most of us can easily discern a good excuse from a bad excuse, but with safety nets we are aided by our family, neighbor, the news, media, and of course, the advertising industry. These groups give us many reasons to stray from the path that we know is right for the easier path that often got us into trouble in the first place. Deep down, we all know what is right even with the bombardment of misinformation that often clouds the issues. The only defense I have for safety nets is: “You have to be truly honest with yourself (the one-person you cannot really fool) and make the right choices.”
So how does all this pertain to self-determination? Well, no one said life is fair. It’s not fair that some people are lucky enough to be able to eat what they wish without worrying about their weight. It’s not fair that you were born with the genetics and metabolism that predisposes you to easy weight gain and to live in a society of such easy life styles with convenient stores on every corner filled with things you shouldn’t eat. But you have made the choice to do something about it. You decided to have weight loss surgery, and you know that surgery is not the solution, just a tool. Only you can decide to use your tool properly and decide daily that you do not stray from the path you have set for yourself. But the good news is if you do what you know is right, you will be the one that receives the benefit of a healthier, fuller, and longer life. Your family also benefits as well. Only you can do it, but I know you can. Just keep fighting. It’s worth it.
About the Author:
Dr. Steven Simper, MD, FACS, performed his first bariatric procedures in 1984 at Wilford Hall Medical Center, in Texas. Currently, he performs laparoscopic gastric bypass, sleeve gastrectomy, duodenal switch, and revisional surgery. In addition to general surgery procedures. He joined Rocky Mountain Associated Physicians in 2001, and began performing laparoscopic gastric bypass. Since 2008, he has developed his skill and expertise with the powerful biliopancreatic diversion with duodenal switch (DS). He is among a handful of surgeons who perform this procedure. He both proctors other surgeons and is a speaker at bariatric conferences in regards to the duodenal switch procedure. In following his patients, and witnessing results, he has become a strong advocate for this procedure in the select individual who needs a powerful surgery.
Happy Pioneer Day (Utah)!!
Our office will be closed on Friday, July 23rd for the Holiday, but our after hours line will still be open for any emergent medical concerns (801) 268-3800.
***All medical questions and concerns should be directed to your primary care physician or your bariatric surgeon/medical assistant. We will open again for regular business hours on Monday.
Have a safe, healthy, and fun holiday!
The surgeons at Rocky Mountain Associated Physicians (RMAP) recommend all weight loss surgery patients to be drinking a minimum of 64 ounces (8 cups) of water, but we prefer you to be well above that. Water helps with a multitude of ills: dehydration, nausea, hunger, low energy or fatigue, and kidney stones. When encountering a physical or emotional difficulty post weight loss surgery, often our answer will be to you is: Drink more water!
If you are bored with the bland taste of H2O, there are ways to spice it up! You can try adding diluted sugar free flavoring to your water, like Crystal Light or Propel. You can also try squeezing lemon or lime juice into your water, or adding sliced cucumbers.
*Be aware that artificial and natural sweeteners can increase your appetite. Dr. Steven C. Simper talks more on the topic of artificial sweeteners and what it does to your body here: Why Are Sugar Free Drinks and Artificial Sweeteners Bad?
Some believe that calorie absorption can increase years out from weight loss surgery, when in fact it is the same absorption as when you first had weight loss surgery.
Your stomach gets more efficient at emptying food into the small intestine years out from weight loss surgery, which is why are able to eat more food at each sitting. It’s advised that bariatric patients never consume more than 6-8 ounces/meal to maintain weight. Over-consuming will lead to weight gain.
Dr. Steven C. Simper addresses the common concern of being able to eat more with this, “Every weight loss surgery patient will be able to eat more with time. With time the outlet of the of the Roux-en Y Gastric Bypass, Duodenal Switch, and Sleeve Gastrectomy will dilate, and the pouch will empty more quickly, allowing you to eat more.”
Our philosophy at Rocky Mountain Associated Physicians (RMAP) is to build healthy habits that will last a lifetime; point being to utilize natural/real food for energy sources. We recommend eating between 40-60 grams of protein/day after bariatric surgery, which equates to 160-240 calories/day. This is very achievable by eating more natural sources of protein such as yogurt, cheese, beans, tofu, deli meats, chicken, ground beef, steak, and even vegetables.
Protein shakes are very calorie dense for a small volume and they will empty your pouch faster than regular food, leaving you hungry sooner. The habit of drinking your calories and your stomach emptying faster can lead to weight gain after surgery. Protein supplements are also not always available wherever you may go in the world. Learning how to eat appropriately on food is the best route to making lifestyle changes.
There are several patients after weight loss surgery who have been very successful at weight loss and maintenance by choosing to use protein supplements on a more regular basis. Who are we to argue success in that circumstance? Our philosophy simply stems from the success we have seen in the majority of our patients, and not the exception.
There are circumstances after weight loss surgery when protein supplements are recommended. Please discuss the use of protein supplements with your surgeon/provider before adding them into your routine meal plans.
~Happy Memorial Day~ Remember, the National Moment of Remembrance, established by Congress, asks wherever you are at 3 p.m., local time, on Memorial Day, to pause in an act of national unity for a duration of one minute.
Our office will be closed on Memorial Day, Monday, May 31st. If you have any emergent medical questions or concerns, you can call (801) 268-3800 and the answering service will page your doctor. Our office will resume regular hours on Tuesday. Have a safe and wonderful weekend! What are you plans for the holiday weekend?
Our surgeons and staff members of Rocky Mountain Associated Physicians (RMAP) seek to be a partner in your health. During the first year after surgery you will have multiple follow-up appointments scheduled. After your first year you are asked to have an annual physical and blood work done, which can be done by your primary care physician, and have to results faxed to us. This helps your continued progress, maintenance, and to monitor your health.
Follow-Up Visits Are Important
Follow-up visits are appointments set up with your surgeon’s office to monitor your health and weight status. They also provide an opportunity for you and your provider to evaluate the progress towards your goals. They allow you to focus on the positive changes that occur and for the use of a problem-solving approach toward the obstacles that you may be experiencing.
Your surgeon will assist you in establishing patient-selected incremental goals as well as long-term goals. By keeping up with your follow-up appointments you allow your surgeon to make an assessment of your health and instruct you on modifications that need to be made when necessary.
You should schedule an appointment to see your surgeon/assistant for follow up visits at:
You will need to have certain blood tests done every year after bariatric surgery. Your family physician or our office can order them one to two weeks before your annual visit. The tests you need are:
Mail or fax a copy of these tests to our office. The tests will be reviewed by your surgeon and placed in your chart. Fax number: (801) 268-3997.
Special Medical Considerations
It’s no surprise that with weight loss surgery your anatomy will change. Because of these changes your physicians (cardiologist, primary, GI, etc.) will need to perform some medical tests with modifications (see below). There are also some over the counter medications you won’t be able to take, such as NSAIDS. Make sure that your primary care physician is aware of these special medical considerations after your surgery.
Upper GI Testing
If this test is ever ordered for you please inform the ordering physician that you won’t be able to drink the contrast solution in the amount that is being requested. When undergoing all medical tests that require the use of a contrast you are limited to 120 cc. of contrast liquids for the first 6 months after surgery.
Glucose Tolerance Testing
Some Gastric Bypass patients shouldn’t participate in traditional glucose tolerance testing because the sugary drink could cause the “dumping syndrome” and could give inaccurate testing results. Also, the volume required for the test exceeds the volume your gastric pouch can tolerate.
Never hesitate to ask questions concerning your medications. You will experience the maximum benefits of your medication therapy if you take the medication as directed by your physician and pharmacist. You “new” stomach is now much smaller and therefore more vulnerable to medications that may harm the stomach lining. It’s well worth it to be extra cautious about taking any medications.
You should avoid the following list of medications. This list is not inclusive. When you have doubts about using any medications, please call your pharmacist or physician’s office before taking the drug. After weight loss surgery these medications may cause a stronger effect than they would normally. Therefore, caution should be taken.
Thiamine Deficiency (Beri Beri)
Although extremely rare, Beri Beri has been seen in a few patients. Many primary care physicians fail to recognize Beri Beri when it is presented because of the rarity of its occurrence. Beri Beri is a nutritional deficiency that is often seen in third world countries. In some bariatric procedures some of the jejunum is bypassed and the way vitamins and minerals are absorbed changes. This is why it is imperative that you remember to take a daily multi-vitamin. Beri Beri is caused by a thiamine (vitamin B1) deficiency and affects the cardiovascular, muscular, gastrointestinal, and nervous systems. A person with dry Beri Beri may experience the following symptoms:
Symptoms of Wet Beri Beri include:
Each patient has a unique body structure. Some will lose weight without the need for cosmetic reconstruction surgery. Cosmetic surgery can improve stretched out skin around the abdomen, thighs, breasts, arms, and face in function and appearance. Consult with your surgeon about the advisability and risks of such surgery. In most cases one year should lapse before reconstruction takes place.
Some patients develop a Ventral Incisional Hernia. A hernia is a weakness in the muscle wall, allowing protrusion of the tissues normally contained within the abdominal cavity along an incision line. Hernias are more common in patients who are overweight. The weight puts pressure on the incisional area causing a weakness, tear, or separation. This is the reason that an overweight patient is at greater risk of developing a ventral incisional hernia after surgery.
If you develop a painful bulge in the incisional area, please call and make an appointment with your surgeon, so you can have it checked. If a hernia is strangulated, which can happen but is very rare, you will have excruciating pain. This is because a loop of bowel is caught in the hernia and in this case, you need to have immediate surgery.
Keep in Touch
Your surgeon, nurses, and health and wellness center staff are your unified team with your best interests in mind. Stay in contact. Attend support groups regularly. Where available, attend scheduled classroom instruction. Check the website at www.RMAP.com for interactive events and articles.
We want you to reach improved health and experience an enriched quality of life. We are here to help in any way that we can! We want to be a partner in your health and along for your weight loss journey. However, the necessary adjustments to your present behaviors will be yours to make. The pride and feeling of accomplishment as you lose weight and maintain your weight loss will be yours as well.
Patients often ask if they can use artificial or natural sweeteners after having weight loss surgery. They both can be a great option to spice up your water if you are having a hard time getting in the recommended 64+ ounces. But remember, artificial sweeteners, such as Splenda, Aspartame, and Sucralose that are found in Crystal Light and Propel, along with natural sweeteners, such as Stevia or fruit are known to be potent appetite stimulants. Because of the powerful cravings they can cause, sweeteners should be diluted and used sparingly.
Dr. Steven C. Simper talks more on the topic of artificial sweeteners and what it does to your body here: Why Are Sugar Free Drinks and Artificial Sweeteners Bad?
Links to similar articles:
What to Expect When You Reach Maintenance
The Importance of Water after Weight Loss Surgery
Carbonated Beverages, Caffeine and Alcohol after Weight Loss Surgery
Ways to Curb Hunger Between Meals