Frequently Asked Questions

1. What is Bariatric surgery?

WEIGHT LOSS SURGERY
Medical Weight Loss
Weight Loss after Bariatric surgery is due to restriction, malabsorption, and malnutrition. The results are fast initially due to the physical inability to consume enough calories to maintain the current weight, so stored fat/ muscle is then used to keep your body functioning. A starvation state will mean the loss of precious muscle tissue and bone density, and retention of adipose tissue or fat, so correct nutrition and supplements are important for life.
Gastric Bypass

Gastric bypass surgery refers to a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both.
Duodenal Switch

The duodenal switch (DS) procedure, also known as biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.

Sleeve Gastrectomy

The sleeve gastrectomy (SG) is a restrictive weight loss operation. The outer part of the stomach is removed and the shape of the stomach is changed from a sac to a long narrow tube (sleeve). The gastric volume is reduced from approximately 2L to 100-150 mL

Adjustable Gastric Band

A laparoscopic adjustable gastric band is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to slow consumption of food and thus reduce the amount of food consumed.

Intragastric balloon

The intragastric balloon is an inflatable medical device that is temporarily placed into the stomach to reduce weight. It is marketed to provide weight loss when diet and exercise have failed and surgery is not wanted or not recommended.

 

Listen to the podcasts:

What is Bariatric Surgery? What can I expect?

Ensuring long term success after Weight Loss Surgery

2. Why do I need special bariatric vitamins after gastric bypass surgery?

Bariatric vitamins are formulated specifically to meet the needs of a patient after undergoing weight loss surgery. The amounts and the forms of these supplements are also important and play a critical role in your long-term health. Bariatric surgery patients simply have a much greater need for vitamins and minerals than people who have not had surgery.

Absorption of nutrients
It's well known: you take in nutrients via your food that are essential for the health of all of your body.
Your ability to absorb nutrients is heavily affected after surgery, and you now have very limited space coupled for food - and it's very difficult to take in enough nutrition through food alone to keep you healthy for the rest of your life.

Supplements help you to bridge this gap and prevent chronic conditions that are linked to lack of nutrition.

The role of Nutrients (Vitamins, Minerals, Amino Acids)
 

Nutrients in food and supplements all have varied but essential roles in protecting the body from disease, as well as creating an overall feeling of health and wellness.

Vitamins:
B Group - Healthy development of Red and White blood cells, Energy Production, healthy mood, memory, and clear thinking, hormonal balance.
Contribute to a healthy immune system, protect DNA from damage.
Vitamin A - Healthy skin and eyes, night vision.
Vitamin C - Aid wound healing, maintain skin elasticity, protect immune system
Vitamin D - Protects bones by aiding calcium absorption, protects immune system, prevents autoimmune disorders

Minerals:
Magnesium -
Relax, Sleep, Reduce stress and tension, improve recovery, assist in bone density
Potassium -
Regulate heart rate, maintain electrolyte balance, muscle contraction regulate hart rhythm
Phosphorus -
An essential mineral primarily used for growth and repair of body cells and tissues.

Calcium - Is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium helps our blood clot, nerves send messages and muscles contract, aids weight loss
Iron -
energy production, transport of oxygen, healthy immune system, red blood cell health, memory, mood. 

Amino Acids - (Protein) healthy hair, skin nails, healthy mood, maintain lean muscle tissue, increase metabolic rate, curb hunger, maintain healthy blood glucose levels.

So you can see - deficiency of one or two of these nutrients, and many systems of the body can be affected
B group deficiency, for example, effects your Immune system, Endocrine, Energy Production, Brain and Nervous system red blood cells and your skin...

Macro and Micro
Proteins, fats and carbohydrates are also called macronutrients. Your body needs many of these because these substances function as fuel for your body. In addition, they are also necessary for the development and maintenance of your muscles, hormones, organs, enzymes and your blood.

Vitamins and minerals are also referred to as micronutrients. Vitamins and minerals do not provide energy but are necessary for many processes in your body.

3. Why do you put so much B-12 into your multivitamin?

Vitamin B-12 is a critical water soluble vitamin that is difficult to absorb following bariatric surgery due to decreased levels of gastric acid and a substance called intrinsic factor. In order for your body to absorb the necessary levels, we need to provide a very large amount by comparison. At this level, research has shown that the vast majority of patients will not need an additional sublingual.

4. I love your chewables, do I have to switch to capsules?

Of course not. Our entire program is designed to provide you options so that you can make the final decision on what supplement form is right for you. Keep in mind that our capsules are less expensive and can end up saving you a few dollars each month. Not quite enough to offset the rising gasoline prices, but we are working on it.

5. I am a lap band patient and I would like to mix chewables and capsules, is this ok?

Absolutely! Regardless of your surgery, if you would like to take our multivitamin in a capsule (our Capsule is coming soon) form but you prefer your calcium and iron in a chewable form, that is perfectly ok. Our products are created to be almost identical in content between our capsules, tablet and chewable forms.

6. Why do you formulate your vitamin A using 50% pre-formed and 50% beta-carotene in your multivitamin?

We believe that by doing this, we are optimizing your ability to absorb the necessary amount of vitamin A that your body needs. When you take vitamin A as a preformed (retinyl acetate or palmitate), your body can use it immediately but it is possible to get too much. When you take vitamin A as beta-carotene, your body must first convert the beta-carotene before it can be used. It is possible that following surgery, your body lacks the ability to convert all that it needs. Hence, our 50/50 approach.

7. Why are your levels of vitamin D higher than most others? Is it safe to take this much vitamin D?

All of our products are developed by bariatric dietitians, so you can be sure that they are safe. We continue to see an increased number of vitamin D deficiencies across the country following bariatric surgery so we have opted to create a protocol with high vitamin D levels (yet well below the upper limits set by the FDA).

8. I have heard that niacin can cause a negative reaction, is this true?

Yes, this is why it is important to know what to look for on a supplement label. You should always make sure that the niacin listed on the label says as niacinamide.

9. What about lap band vitamins?

The question is also often posed regarding patients that have had an adjustable gastric band (lap band). While their needs are not quite as drastic, these patients also require vitamin and mineral supplementation. After this surgery, the volume of food being consumed will drop dramatically and with that, the level of nutrition. And by taking a complete bariatric vitamin as well as calcium, you can be sure that you are getting the appropriate level of supplementation and that they are in the proper forms.

10. Why is thiamin so important?

Thiamin (vitamin B1) is a water soluble vitamin that is critical for your central nervous system and it is also a vitamin that cannot be stored in the body for extended periods of time. So it is important that thiamin is a part of your daily supplement in order to replenish your body's supply. Low levels of thiamin may lead to potentially life threatening complications.

11. Why do you have so many different things in your calcium?

While calcium is critical, this mineral alone is not enough to provide strong healthy bones. Calcium cannot be absorbed without vitamin D. And magnesium, zinc, copper, vitamin K, and boron are all necessary for long term bone health.

12. Why is calcium citrate better than calcium carbonate?

All forms of calcium require that gastric acid be present for calcium to be properly absorbed. Calcium carbonate simply requires a much higher level of gastric acid to be present, which can be a problem, especially for a person that has had a malabsorptive procedure. Calcium citrate is actually 2.5 times more readily absorbed than calcium carbonate.

13. Should I only take citrate forms of minerals - what about magnesium?

In most cases citrate or chelated forms are the best because they are easier for your body to absorb. Magnesium is best absorbed in the citrate form.

14. What is an amino acid chelate?

Chelate is a term that simply means attached to. When an item is listed as an amino acid chelate, it means that we have bound those molecules to this. When minerals are chelated, it is easier for the body to absorb them.

15. Why do you separate your iron supplement for duodenal switch, sleeve gastrectomy, and gastric bypass patients?

The way that our protocol works, patients will usually take calcium in the morning and late afternoon / early evening along with their multivitamin. Since calcium and iron need to be taken at least 2-4 hours apart because they will compete for absorption, it is necessary to separate the iron from the multivitamin.

16. Why do you add vitamin C to your iron?

In order for iron to properly break down and absorb, it needs to be in an acidic environment. Including vitamin C in our formulation ensures that the acid required for this process will be present.

17. Will your chewable iron stain my teeth?

Some will, but ours will not. We have formulated our chewable iron by using a coated ferrous fumarate as the form. The coating is just enough to prevent staining but it will not have any problem breaking down in your gastric pouch following surgery.

18. I am a gastric bypass patient and I had surgery 3 months ago, can I take capsules now?

We always recommend that prior to making changes in your supplement protocol that you first speak with your bariatric surgeon or dietitian. From an absorption standpoint, our capsules and tablets are as effective as our chewables.

Patients Tips

Remember to take your vitamins!

Use our app to remind you to take your vitamins! Keep a bottle at home on the bench and one one your desk at work.

Don't leave them in the car in warmer months when temps are above 25 degrees.

Supplement at Meal times.

Take your supps with your meal or soon after. Chewing and swallowing food, gets your body ready to digest and absorb nutrients so this is the best time to supplement. Fat-soluble A,D,E,K need the little bit of fat to help them be absorbed - use good fats like avocado, olive oil, or oily fish where possible.

Don't Be a frequent fryer!

Choose cooking methods that don't add fat to your foods: baking, grilling, roasting, poaching and steaming.

Don't like chewing your vitamins?

Just after surgery, if chewing vitamins is not your thing, you can try the capsules split open into a teaspoon of yoghurt or apple sauce or mix it in a smoothie. Your dietitian will tell you when you can swallow them whole.

Want to mix up your supplements?

There is nothing wrong with taking your multivitamin in a capsule form and your calcium in a chewable form or vice-versa. Or you can take BN Chews one month, and BN Caps and Chewable calcium the next.

Read Food Labels.

When Shopping, take a look at the back label on the product.

The front label is to sell you the product - the back is the facts. Watch out for 'low fat' it often means 'high sugar'. Fat is not the enemy - sugar is!

 

Nausea & Vomiting

Possible Causes

- Not chewing thoroughly

- Eating too fast

- Eating too much

- Food intolerance

- Low fluid intake

- Stenosis or stricture

- Too much fluid close to mealtime

- Low stomach acid

 

Possible Side Effects

- Band erosion

- Esophageal irritation (Barrett's Esophagus )

- Dehydration

- Thiamine deficiency

- Protein-calorie deficiency

Helpful Tips

Anti-emetic medications prescribed by your surgeon

Drink warm fluids (peppermint or chamomile tea, chicken bouillon) 15-30 minutes prior to a meal.

Look at healthy ways to support digestion Pre and Probiotic foods and supplements can help improve overall digestive health too!

 
Eating Out
 

Fast food survival - A big problem with fast food is that many innocent-looking nuggets and patties are loaded with added fats, flavorful chemicals, and high-fructose corn syrup, which wreak havoc on your blood sugar levels.

Even a standard burger whilst it looks like to pieces of bread with a bit of meat and salad can contain waaaaay more fat and calories than you would expect if you made the same thing at home!
A simple meat and salad sandwich/plate is a good go to.

Or kebab plate in a kids size with a good serve of chicken - don't touch the lamb or the beef its laden with fat you don't need.

Burrito bowl is a good option too as it has good proteins, salad and you can leave what you cant manage to take home for another meal.

Learn to dismantle your food.

Ask if you can substitute the grilled chicken breast for the crumbed chicken breast, wholemeal/rye bread for white bread, lettuce cups for buns, or ask for extra veggies. Ask for salsa or mustard instead of dressings and sauces you don't know what they contain.. Don't be afraid to ask for what you need. If anyone gives you any problem, claim a severe food allergy. They'll usually get over the attitude and become very helpful.
You are paying, so you have a right to choose what works for you- so don't apologize, keep your eye on your end game!

 

General Guidelines

  1. Don't store tempting foods at home thinking you'll just have them now and then!  If you are craving something, and you have to make a concerted effort to go and get it - chances are, the craving will pass!
  2. Don't talk on the phone, read, or watch TV in the kitchen (or any other place that food is stored).
  3. Serve all meals in the kitchen, no platters on the table. If you really want seconds, wait 20 min, and then see if you still feel the need. Often, your body is just registering that you have eaten 20 min after you started, so seconds should be left till later when you can see if you really are still hungry, or just the food is so yummy!!
  4. Eat and don't be afraid of food. It may sound crazy to those trying to lose weight by severely restricting their daily caloric intake, but the problem with this old school of thought is that not eating actually slows metabolism. Every cell of the body is like a flashlight bulb. When our bodies don't get enough food or fuel, every cell burns less brightly. Recent studies show that eating smaller meals every three to four hours aids metabolism and weight loss.
  5. Cravings behave like waves: they build, crest, and disappear. If you can "surf the urge," you have a better chance of beating it all together. Studies also show that music helps in beating back the craving wave. Upbeat music seems to work the best, so crank up the stereo!
 

Exercise

  • Get a pedometer and start tracking your steps. Average your steps over one week, then make small increases. Try increasing your average by 500 steps per day for the next week to increase your activity. Work towards 10,000 steps per day. For example, if your average is 3,000 steps per day, then aim for 3,500 steps per day next week and then 4,000 steps per day the week after that.
  • Do you find walking boring? Take someone along with you or get a dog. If your lifestyle does not allow for you to keep a dog, borrow a neighbour's dog or visit a humane society once a week and offer to walk some dogs. They are great walking companions. If your joints will not tolerate walking, try a recumbent bike or get in a pool.
  • If you don't want to join a gym, or local pool to swim/water walk, then check with your local hotel. Many have indoor swimming pools and you may be able to work something out with hotel management where they may let you swim/water walk, for a small fee.