|
|
|
Pre-natal (prenatal) vitamins
Pre-natal vitamins are a common recommendation after weight loss surgery. They are often suggested for the higher iron content relative to standard vitamin preparations. Studies have shown, however, that several key nutrients - particularly iron and to a lesser degree folic acid - are less bioavailable in pre-natal products than when taken alone. This is thought to be due to competitive absorption, but may also be due to some nutrients not being well released from the complex matrix.
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|
VitaBand for other procedures
We have had numerous questions about the use of VitaBand for those with other procedures such as RNY or DS. Some health professionals may prefer it based on simplicity and price, however, it is not nearly as good as the other products (Orange, Tropical, or Capsules) for these other procedures. The primary reason is the use of calcium carbonate, which is fine for Lap-Band patients who still have adequate stomach acid. Additionally, in the VitaBand formula, iron and B12 are included. It is really best for RNY and DS patients to take iron separately from calcium, and to use B12 as a sublingual or an injection.
|
BA Tropical v. ADEKs
Dose
Comparisons – Contents per
Tablet
BA
Tropical vs. AXCAN ADEKs
|
Nutrient
|
BA
Tropical
1
Tablet
(Recommended
Dose is 2-3)
|
ADEKs
1 Tablet
(Recommended
Dose is 1-2)
|
|
|
Amount
|
%
DV
|
Amount
|
%
DV
|
|
A
|
5,000
IU
|
100%
|
9000
IU
|
180%
|
|
C
|
60
mg
|
100%
|
60
mg
|
100%
|
|
D3
|
667
IU
|
75%
|
400
IU
|
100%
|
|
E
|
250
IU
|
833%
|
150
IU
|
500%
|
|
K
|
60
mcg
|
75%
|
150
IU
|
190%
|
|
B1
|
3
mg
|
200%
|
1.2
mg
|
80%
|
|
B2
|
1.7
mg
|
100%
|
1.3
mg
|
80%
|
|
Niacin
|
25
mg
|
125%
|
10
mg
|
50%
|
|
B6
|
2
mg
|
100%
|
1.5
mg
|
80%
|
|
Folate
|
400
mcg
|
100%
|
200
mcg
|
50%
|
|
B12
|
50
mcg
|
833%
|
12
mcg
|
200%
|
|
Biotin
|
150
mcg
|
50%
|
50
mcg
|
15%
|
|
Pantothenic
Acid
|
10
mg
|
100%
|
10
mg
|
100%
|
|
Calcium
|
100
mg
|
10%
|
0
|
0
|
|
Magnesium
|
50
mg
|
12%
|
0
|
0
|
|
Zinc
|
15
mg
|
100%
|
7.5
mg
|
50%
|
|
Selenium
|
134
mcg
|
192%
|
0
|
0
|
|
Copper
|
1
mg
|
50%
|
0
|
0
|
|
Manganese
|
2
mg
|
100%
|
0
|
0
|
|
Chromium
|
100
mcg
|
84%
|
0
|
0
|
|
Molybdenum
|
75
mcg
|
100%
|
0
|
0
|
|
Choline
|
2mg
|
>1%
|
0
|
0
|
|
Flavonoids
|
12.5mg
|
NA
|
0
|
NA
|
|
Inositol
|
5mg
|
NA
|
0
|
NA
|
|
Vanadium
|
25mcg
|
NA
|
0
|
NA
|
|
|
Tropical Multi Label
The Tropical multi can be taken in two ways - as 2 tablets/day for RNY patients or as 3 tablets/day for DS patients. The label on this product (Supplement Facts Box) shows the amount of nutrition is one tablet because of the different dosing possibilities. The Orange Multi is intended to be taken in only one way - as 2 tablets daily. The Supplement Facts Box for this product reflects the Total Daily Dose - or the amount of nutrition in two tablets. This can confuse people who are not careful label readers.
|
|
Why does B-complex make my urine bright yellow?
This is caused by the riboflavin (vitamin B2), which has an intense yellow color. This is a natural process and no cause for alarm.
|
|
Can I open the capsules?
Any of the capsules can be open and mixed into a liquid or soft food.
|
|
Is there vitamin K in the multivitamins?
Blood thinners such as coumadin are fairly common medications used by bariatric patients. For this reason, three of our multivitamin are made without vitamin K - the Orange Chewable, the Capsules and VitaBand. If you need to avoid vitamin K, you should not take the Tropical Multivitamin.
|
|
I take a children’s chewable vitamin, are yours different?
Children’s vitamins are generally designed for healthy small children, to supplement their diet. They are not designed for adults, and they are really not designed for adults who have undergone weight loss surgery. Many children’s vitamins are missing some key nutrients (it is common to not have essential nutrients like selenium or chromium), and use nutrient forms that are less bioavailable (not as easy to absorb). This is even true in some products that say they are “complete.” It is also common for children’s products contain many “other” ingredients – coloring agents, preservatives, starches, fats and more.
|
|
Do I need to take a chewable vitamin?
It is usually recommended to take a chewable vitamin for somewhere between 3 and 12 months after surgery. You need to ask your surgeon or dietitian (RD), when your program will allow you to stop chewable vitamins if you want to do so. Many weight loss surgery patients prefer to keep taking chewable vitamins because they are more comfortable with this form than with swallowing a pill. There is no harm in continuing a chewable vitamin if you are not comfortable swallowing or if you prefer them for some other reason.
|
|
Do BA products use “dry" of fat soluble vitamins?
Yes. Bariatric Advantage products only use the water-miscible (also called water-dispersible, water-soluble, or dry) forms of vitamins A, D, E and K.
|
|
Can I take calcium with my multivitamin?
You can take calcium together with your multivitamin. If, however, you rely on your multivitamin for iron, you may want to try to separate them by a couple of hours.
|
|
Should I take Thiamine?
Thiamine deficiency can occur before or after weight loss surgery. A good multivitamin should provide thiamine, and this is enough for most people. However, if you have a deficiency, your doctor may instruct you to take more. If you are concerned about whether you get enough thiamine, you should discuss this with your doctor.
|
How are BA multis different from Centrum?
Our multis all contain on average 200 to 400% of the RDA for each of the B-vitamins in a daily dose – which is 2-4 times the levels in Centrum. So generally patients should not require additional Bs unless they have a deficiency. The exception is B12 which is absorbed very differently from the other B vitamins. I recommend a sublingual or an injection with RNY.
Just an additional note on Centrum – they lack selenium and chromium (essential elements) and include many ingredients that we simply won’t use either because the form is inappropriate for RNY patients (dibasic calcium, magnesium oxide, etc) or because they are unnecessary (gums, preservatives, 4-5 sweeteners, colorants, lactose). Here is their ingredient list:
Sucrose, Dibasic Calcium Phosphate, Mannitol, Calcium Carbonate, Stearic Acid, Magnesium Oxide, Ascorbic Acid (Vit C), Pregelatinized Starch, Microcrystalline Cellulose, dl-Alpha Tocopherol Acetate (Vit E), Contains <2% of: Acacia, Aspartame, Beta Carotene**, Biotin, BHT, Calcium Pantothenate, Carbonyl Iron, Carrageenan, Chromic Chloride, Citric Acid, Cupric Oxide, Cyanocobalamin (Vit B12), Dextrose, Ergocalciferol (Vit D), FD&C Yellow 6 Aluminum Lake, Folic Acid, Gelatin, Glucose, Guar Gum, Lactose, Magnesium Stearate, Malic Acid, Manganese Sulfate, Mono and DiGlycerides, Natural & Artificial Flavors, Niacinamide, Phytonadione (Vit K), Potassium Iodide, Potassium Sorbate, Purified Water, Pyridoxine Hydrochloride (Vit B6), Riboflavin (Vit B2), Silicon Dioxide, Sodium Ascorbate, Sodium Benzoate, Sodium Citrate, Sodium Molybdate, Sodium Silicoaluminate, Sorbic Acid, Starch, Thiamine Mononitrate (Vit B1), Tocopherol, Tribasic Calcium Phosphate, Vanillin, Vitamin A Acetate (Vit A), Zinc Oxide, May Also Contain: Fructose, Maltodextin.
Bariatric
Advantage™ Chewables vs. Centrum® Chewables
|
Nutrient
|
BA
Orange per serving
Amount
%DV
|
BA
Tropical per serving (2 Tablets)
Amount
%DV
|
BA
VitaBand per serving
Amount
%DV
|
Centrum
Chewables per serving
Amount
%DV
|
|
A
|
7500
IU
(100%
carotene)
|
150%
|
10,000
IU
(50-50
carotene-retinol)
|
200%
|
5000
IU
(100%
carotene)
|
100%
|
3500
IU
(29%
carotene)
|
70%
|
|
C
|
120mg
|
200%
|
120mg
|
200%
|
120mg
|
200%
|
60mg
|
100%
|
|
D3
|
100
IU
|
25%
|
600
IU
|
25%
|
600
IU
|
150%
|
400
IU (as D2)
|
100%
|
|
E
|
30
IU (natural)
|
100%
|
500
IU (natural)
|
100%
|
30
IU (natural)
|
100%
|
30
IU (synthetic)1
|
100%
|
|
K
|
0
|
0
%
|
120mcg
|
150%
|
0
|
0%
|
10mcg
|
13%
|
|
B1
|
6mg
|
400%
|
6mg
|
400%
|
3mg
|
200%
|
1.5mg
|
100%
|
|
B2
|
3.4mg
|
200%
|
3.4mg
|
200%
|
3.4mg
|
200%
|
1.7mg
|
100%
|
|
Niacin
|
50mg
|
250%
|
50mg
|
250%
|
50mg
|
250%
|
20mg
|
100%
|
|
B6
|
4mg
|
200%
|
4mg
|
200%
|
4mg
|
200%
|
2mg
|
100%
|
|
Folate
|
800mcg
|
200%
|
800mcg
|
200%
|
800mcg
|
200%
|
400mcg
|
100%
|
|
B12
|
100mcg
|
1666%
|
100mcg
|
1666%
|
50mcg
|
833%
|
6mcg
|
100%
|
|
Biotin
|
300mcg
|
100%
|
300mcg
|
100%
|
300mcg
|
100%
|
45mcg
|
15%
|
|
Pantothenic
Acid
|
10mg
|
100%
|
10mg
|
100%
|
10mg
|
100%
|
10mg
|
100%
|
|
Calcium
|
200mg
(citrate)
|
20%
|
100mg
(citrate)
|
20%
|
600mg
(citrate-carbonate
blend)
|
60%
|
108mg2
|
20%
|
|
Magnesium
|
50mg
(citrate)
|
12%
|
50mg
(citrate)
|
12%
|
50mg
|
12%
|
40mg3
|
10%
|
|
Iron4
|
0
|
0%
|
0
|
0%
|
18mg
|
100%
|
18mg
|
100%
|
|
Phosphorus5
|
0
|
0%
|
0
|
0%
|
0
|
0%
|
50mg
|
5%
|
|
Iodine6
|
0
|
0%
|
|
|
0
|
0%
|
150mcg
|
100%
|
|
Zinc
|
15mg
(citrate)
|
100%
|
15mg
(citrate)
|
100%
|
15mg
|
100%
|
12mg7
|
80%
|
|
Selenium8
|
100mcg
(selenomethionine)
|
143%
|
134mcg
(selenomethionine)
|
192%
|
55mcg
|
79%
|
0
|
0%
|
|
Copper
|
1mg
(citrate)
|
50%
|
1mg
(citrate)
|
50%
|
2mg
|
100%
|
2mg9
|
100%
|
|
Manganese
|
2mg
|
100%
|
2mg
|
100%
|
2
|
100%
|
1mg
|
50%
|
|
Chromium
|
100mcg
|
84%
|
100mcg
|
84%
|
120mcg
|
100%
|
20mcg
|
17%
|
|
Molybdenum
|
75mcg
|
100%
|
75mcg
|
100%
|
75mcg
|
100%
|
20mcg
|
27%
|
|
Choline
|
2.35mg
|
>1%
|
2mg
|
>1%
|
5mg
|
1%
|
0mg10
|
0%
|
|
Flavonoids
|
12.5mg
|
12.5mg
|
0
|
0
|
|
Inositol
|
5mg
|
5mg
|
5mg
|
0
|
|
Vanadium
|
25mcg
|
25mcg
|
25mcg
|
0
|
|
Other
ingredients
|
Invetek
base, stearic acid USP, natural orange flavor, natural creamsicle
flavor, citrus flavor blend, magnesium citrate NF/FCC, sucralose
|
Invetek
base, lemon flavor, stearic acid USP, citrus blend flavor, natural
pineapple flavor, magnesium citrate NF/FCC, sucralose
|
|
Sucrose,
mannitol (wheat)11,
stearic acid, pregelatinized starch, microcrystalline cellulose,
acacia, aspartame, BHT, carrageenan, citric acid, dextrose, FD&C
yellow #6, gelatin, glucose, guar gum, lactose (milk)12,
magnesium stearate, malic acid, maltodextrin, mono and
di-glycerides, natural and artificial flavors, potassium sorbate,
purified water, silicone dioxide, sodium benzoate, sodium citrate,
silicoaluminate13,
sorbic acid, starch, vanillin14.
|
1
Synthetic vitamin E is significantly less (about 1/3) bioactive than
natural vitamin E. The estimate of relative activity is as follows:
RRR-alpha-tocopherol
(natural or d-alpha-tocopherol):
all-rac-alpha-tocopherol
(synthetic or dl-alpha-tocopherol):
2
From Dibasic Calcium Phosphate, Tribasic Calcium Phosphate and
Calcium Carbonate. These are poorly soluble forms for those with
malabsorption and low stomach acid.
3
From Magnesium Oxide. This form has poor solubility for those with
malabsorptive procedures and l;ow stomach acid.
4
We omit iron form our multivitamins that are intended for
malabsorption so that it can be easily separated from competitive
minerals like calcium and to allow for flexible dosing.
5
Phosphorus is not necessary in dietary supplements as it is ample in
food. There is phosphorus in Flintstones because it is present in
the calcium form, Dibasic Calcium Phosphate.
6
Iodine is the only allergen to a nutrient that occurs relatively
commonly. It is also frequently prohibited in those with thyroid
disease.
7
100% from Zinc Oxide – a poorly soluble form for those with
malabsorption
8
Centrum lacks the essential nutrient selenium. Selenium has been
found to be deficient in obesity and after weight loss surgery.
9
100% from Cupric Oxide– a poorly soluble form for those with
malabsorption
10
Centrum lacks choline, an essential nutrient for cell membranes and
nerve health
11
Wheat/gluten intolerance occurs in approximately 1 in 300 adults of
European heritage.
12
Lactose intolerance is a common problem
13
An anticaking agent that is also used as a commercial pesticide.
14
Centrum actually contains 24 nutrients and 31 excipients.
|
|
Is there an issue w/Iron & Calcium competition in VitaBand?
The competition between Iron and Calcium is much more of a concern with the gastric-bypass patient due to the malabsorption properties of the procedure. Because malabsorption is not generally a concern with the adjustable gastric-banding procedure, the patient has a much greater ability to absorb the Iron and Calcium when taken together. The Calcium and Iron are included in the VitaBand Multi-Formula to assist the patient in reaching their recommended daily value as advised by their physician/program. We offer additional Iron and Calcium supplements to assist the patient in reaching their recommended daily value.
|
|
Is there iodine in the multivitamins?
Bariatric Advantage multivitamins including Orange, Tropical, Vita-Band and Capsule products are are free of iodine and shellfish derrivatives, making them safe for those with iodine sensitivity or those needing to avoid iodine for other reasons.
|
|
Daily Dose
All multivitamins should be taken according to the labeled instructions unless a customer has been directed to take more or less by their physician.
|
|
Are Bariatric Advantage products Only for a Bariatric patient?
Our products are specifically designed with the bariatric surgery patient in mind, however many would be fine for those who have not had surgery.
It is always best to talk to a qualified health professional before starting any new nutritional product, especially if you have a health concern.
|
|
Do your products contain any allergens?
I would like everyone to take a look at the case below. We invest a lot of time and money in our labels and making sure that they conform to the latest FDA requirements for dietary supplements. Part of the labeling requirements since 2005 has been the meticulous disclosure of allergens in our products. The allergens that must be disclosed BY LAW are any component or derivative of any of eight allergenic foods: milk; eggs; fish such as bass, flounder, and cod; crustacean shellfish such as crab, lobster, and shrimp; tree nuts such as almonds, walnuts, and pecans; peanuts; wheat; and soybeans. The law also identifies as a major food allergen any ingredient that contains protein derived from any of these eight foods. We have some dairy ingredients (whey protein in our meal replacements), a couple of soy ingredients, and one fish-derived ingredient. These are clearly disclosed in the allergen warning which is on the left panel of our labels (when you look at the front of the bottle the part to the left of the product name). Please remember that if any of you are talking to people with allergies to either review the label with them or ask them to read it. In general, customers don’t look a the more than the name of the product – that is how we end up with a highly allergic customer taking a product with an ingredient to which she is allergic.
|
|
Why are Vitamins A, E and D measured in IU rather than grams, mg, or mcg?
Some vitamins – specifically A, E and D – are expressed as a unit of biological activity (IU, International Units), rather than as weight such as grams, milligrams or micrograms. Occasionally, it is helpful to know the weight of a nutrient expressed this way.
Here are some of the common conversions:
Vitamin A
1 IU = 0.3 mcg all-trans retinal = 0.3 mcg retinol = 0.344 mcg retinyl acetate = 0.55 mcg retinyl palmitate = 3.6 mcg Beta-Carotene
1 mcg Retinol = 3.34 IU of vitamin A activity
1 mg of all-trans Beta-Carotene = 1667 IU of Vitamin A activity
1 mcg Beta-Carotene = 1.67 IU of Vitamin A activity
1 mcg dietary Beta-Carotene = 0.167 mcg retinal
Retinol Equivalents (RE) = the Vitamin A activity in foods
1 RE = 1 mcg all-trans retinal = 1 mcg retinal = 3.33 IU Retinol
1 RE = 6 mcg all-trans Beta-Carotene = 6 mcg Beta-Carotene
1 RE = 12 mcg other provitamin A carotenoids
Vitamin E
1 IU = 0.67 mg of d-alpha-tocopherol or 0.45 dl-alpha-tocopherol
1 mg = 1.49 IU d-alpha-tocopherol (natural vitamin E; RRR-alpha-tocopherol)
1 mg = 1.10 dl-alpha-tocopherol (synthetic vitamin E; all-rac-alpha-tocopherol)
Vitamin D
1 IU = 0.025 mcg of cholecalciferol (Vitamin D3)
1 mcg Vitamin D (cholecalciferol) = 40 IU
|
|
Do I need B-complex if I am taking a multivitamin?
A good multivitamin should provide you with a comprehensive B-complex. Some doctors like their patients to take more. Your doctor should tell you if they want you to take an additional B-complex.
|
|
Are water miscible vitamins still fat-soluble?
A water miscible fat-soluble vitamin is one that has been prepared so it can mix or dissolve in water. This may assist with absorption in someone who has fat malabsorption. In the body, the vitamin itself does not become a water-soluble vitamin like vitamin C and the B-vitamins. A, D, E and K remain fat-soluble vitamins in the body.
|
|
Should vitamins be taken with food?
Generally, it is best to take vitamins with food. This is not only because it is easier on the stomach, but also because we were designed to absorb nutrition from our food.
For this reason, almost all nutrients that we would put into a vitamin are better absorbed when taken with food. This is sort of like tricking the body into thinking the vitamins are still in the food and not in a pill. For some nutrients this makes a BIG difference. For example, taken with food, vitamin E is 5 times better absorbed than when taken alone in a pill.
Another thing to keep in mind is that if we are talking about iron, it shouldn't be taken with a dairy (milk, cheese, yogurt, etc). You can improve the absorption of iron if taken with some sort of meat or a vitamin C containing food such as fruit.
|
|
Fat-soluble to water-soluble vitamins.
It depends on the nutrient.
For vitamins A and E, there is actually a chemical ester that is made from the fat-soluble form that makes it truly water soluble. For D and K, they take the nutrients, and very finely spray dry them with some things like lecithin to make them water miscible. None of them are alcohols.
|
Water Miscible, Water Soluble, and Dry.
The fat-soluble vitamins A, E, D and K are typically found in oil preparations. This is because in their natural states, they are oily substances that disperse or dissolve well in a fat such as soybean oil.
In some situations, such as when compressing a tablet or providing nutrition to a person who malabsorbs fat, it is advantageous to use a form of a fat-soluble that is designed to either dissolve or disperse in water.
These preparations give several advantages:
- They are more stable than the oil-soluble compounds.
- They are free-flowing and can be used as a powder or compressed in a tablet.
- They do not have to be emulsified by bile so that they can be more easily absorbed by those who have impaired fat digestion and absorption.
We sometimes call these preparations “dry” because they are in a powder form versus a “wet” oil. They are also referred to as water-miscible or cold water-soluble (CWS). The most common preparation for water-miscible, fat-soluble vitamins is some form of microencapsulation. This is the enrobing of extremely fine particles of the vitamin and is a water-soluble matrix such as acaciamat it using the toolbar.
|
|
Blood thinners and multivitamins.
The only Bariatric Advantage products that have Vitamin K are the Tropical Multi Formula Vitamin, Bariatric Advantage Meal Replacements, and the Calcium Carbonate Chewy Bites – all the others are free of K. For calcium, the crystals and the citrate chewy bites have no vitamin K. If you are on blood thinners, you should always consult your physician about what you can and cannot safely take.
|
|
Iron, B12 and Folate after Sleeve Gastrectomy
A new study has shown that there is a risk of B12 and folate deficiency, and a lesser risk of iron deficiency one year after vertical sleeve gastrectomy. 151 patients who underwent the vertical sleeve gastrectomy procedure in Saudia Arabia, had their labs followed for one year. The incidence of B12 deficiency increased from 8.1% pre-operatively to 26.2% post-operatively. Folate deficiency developed in 9.8% of patients and iron deficiency developed in 4.9% of patients. These findings suggest that vertical sleeve gastrectomy patients are at nutritional risk based on their procedure and should be monitored for deficiency after surgery.
Hakaem HA, O’Regan PJ, Salem AM, Bamehriz FY, Eldali AM. Impact of Laparoscopic Sleeve Gastrectomy on Iron Indices: 1 Year Follow-Up. Obes Surg. 2009 Jul 15.
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|
