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Specific vitamins and minerals must be taken for the rest of the patient's life due to decreased stomach size, and by-passing some of the small intestine where the vitamins and minerals are specifically absorbed, and a lack of gastric juice in the new stomach to help break down vitamins.

This patient population is on chewable or liquid forms of vitamins/minerals permanently. They may switch to gel-encapsulated forms after the first month post-surgery when the swelling has decreased back to normal. If gel-encapsulated forms are swallowed before 1-month post-surgery, they can cause blockages.

Why Do Gastric By-Pass Patients Need A Shot or Sublingual Form Of B12 ?

The new pouch does not contain gastric acid juices necessary to remove the B12 from the food or multivitamin the patient is swallowing.

The new pouch is disconnected from the rest of the stomach. Therefore, the cascade of proteins that B12 has to attach itself to before being absorbed in the ileum of the small intestine does not occur due to the disconnection. This is why B12 has to be given directly to the patient's blood stream so the patient will absorb all of it.

Why Are All The Other Vitamins Necessary For Gastric-By-Pass Patients?

The surgeon by-passes a section of the small intestine where the vitamins and minerals like to be absorbed and there is no gastric juice in the new stomach for us to break down the vitamins and minerals. This is why patients have malabsorption and must take specific types of vitamins and minerals to ensure that they absorb them.

	Gastric Bypass Vitamin Schedule:

*	In the morning take 1 Bariatric Advantage Passion Fruit Chewable Iron daily + (1 Sublinqual B12 every other day) or 1 B12 shot monthly
*	Wait 4 hours (Calcium and Iron bind together and then the body doesn't absorb either one)
*	1 Bariatric Advantage Chewable Multivitamin + Calcium Citrate with Vitamin D Chew
*	Wait 2 hours (to absorb the first dose prior to taking the next dose)
*	1 Bariatric Advantage Chewable Multivitamin + Calcium Citrate with Vitamin D Chew
*	Wait 2 hours (to absorb the first dose prior to taking the next dose)
*	1 Bariatric Advantage Calcium Citrate with Vitamin D chew
*	Wait 4 hours (Calcium and Iron bind together and then the body doesn't absorb either one) In the evening take 1 Bariatric Advantage Passion Fruit Chewable Iron

2 - Vitamins/Minerals Lap-Band Patients:

Gastric Bypass Vitamin Schedule | Lap Band Vitamin Schedule |Vitamin Deficiency Symptoms | Important Information For All Patients

A LL PATIENTS:
A "One A Day" or "Centrum" Multivitamin for your age group. Swallow one vitamin daily until 1 week prior to surgery and then stop the multivitamin 1 week prior to your surgery date.

Vitamins/Minerals Lap-Band Patients:
Vitamin/mineral supplements are necessary for life because patients can no longer eat enough of the food groups necessary to provide their nutrition needs and prevent deficiencies.

Lap-Band Patients First Month Post-Surgery:
The Multivitamins and Calcium with vitamin D must be chewable or liquid forms. Otherwise they could get stuck and cause vomiting or a blocked stoma.

	Lap-Band Vitamin Schedule For The First Month Post-Surgery:

*	1 Bariatric Advantage Chewable Mutivitamin + 1 Calcium Citrate with Vitamin D Chew
*	Wait 3-4 hours
*	1 Bariatric Advantage Chewable Multivitamin + 1 Calcium Citrate with Vitamin D chew
*	Wait 3-4 hours
*	1 Bariatric Advantage Calcium Citrate with Vitamin D chew
*	Lap-Band Vitamin Schedule For After The First Month Post-Surgery:
*	"One A Day" or "Centrum" Multivitamin for your age group +1 Citracal Calcium with Vitamin D (take in the morning)
*	"One A Day" or "Centrum" Multivitamin for your age group + 1 Citracal Calcium with Vitamin D (take in the evening)

IMPORTANT NOTE:
Lap Band patients may swallow the vitamins and calcium after the first month because they still have the whole stomach intact and continue to have all the gastric juices to help break down vitamins. They also have all of the small intestine intact for 100% absorption. The swelling from the placement of the band has decreased back to normal after 30 days so that swallowing pills is no longer an issue.

3 - Vitamin deficencies

VITAMIN DEFICENCIES ONLY OCCUR IN PATIENTS NOT FOLLOWING DIRECTIONS, OR TAKING OVER THE COUNTER PRODUCTS NOT APPROVED BY THE DIETITIAN.

	Vitamin deficencies:

Thiamine (B1) deficiency =	Beri-Beri = anorexia(loss of appetite), altered heart rate, right sided heart failure, edema, and muscle weakness, nerve problems.
Riboflavin (B2) deficiency =	magenta tongue (purple color), chelosis (dry cracked lips), nervous system problems, eye sensitivity to light, skin rashes.
Niacin(B3) deficiency =	Pellegra=Red neck, diarrhea, dementia, dermatitis (red crusty skin where areas of sunlight strikes it).
Biotin (B4) deficiency =	dermatitis (dry scaly skin), alopecia (hair loss) Pantothenic Acid (B5) deficiency=intestinal distress (vomiting) fatigue, insomnia
Vitamin B6 deficiency =	insomnia, fatigue, dermatitis, glossitis (sore tongue), depression, confusion, convulsions, anemia.
Folic Acid deficiency =	megoloblastic anemia, impaired protein metabolism, Leukopenia (low white blood cells), thrombocytopenia (bleeding), glossitis (sore/swollen tounge)
Magnesium deficiency =	anorexia, nausea fatigue, weakness, seizures, muscle cramping, personality changes, abnormal heart rhythms, coronary spasms, (hypocalcemia) low calcium, (hypokalemia) low potassium.
Iron deficiency =	anemia, fatigue, dizziness, low blood count and stores
Calcium deficiency =	osteopenia, osteoporosis (weak/ broken bones)
B12 Deficiency =	Macrocytic anemia (large red blood cells), Leukopenia (low white blood cells), Thrombocytopenia (low blood platelets and bleeding), Glossitis (large sore tongue), Neuro-psychiatric complications (nerve damage, trouble walking, tingling in hands and feet, paralysis-wheel chair)

NOTE:
Coming to your Follow-up appointments and getting labs drawn prior to the follow-up appointment is imperative to avoid any deficiency issues. Low-levels of vitamins/minerals will be addressed quickly prior to any permanent problems.