Why does the B12 take so long to dissolve?
There is a reason why our Sub-lingual B12 doesn't dissolve as quickly as most of the others you will find out there. This is because our B12 is lactose-free. This prevents the tablet from breaking down too quickly to allow for maximum absorption time. The quicker the tablet dissolves, the more you are swallowing therefore not absorbing sub-lingually. We intentionally formulated our B12 to break down a bit slower than most others you will find.

How is D3 different from D2?
Vitamin D2 (ergocalciferol) is differenet from vitamin D3 (cholecalciferol). D2 is the most common commercial form because it can be readily prepared from plant materials that contain the compound ergosterol. Vitamin D3, cholecalciferol, is the form that animals (including humans) synthesize from cholesterol, and is considered to be the natural form of the vitamin. D3 is estimated to be 3 times more potent than vitamin D2

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.

Gluten in Bariatric Advantage Products
Gluten is a component of wheat and other grains that can be an allergen in some people. All of the Bariatric Advantage vitamins are wheat and gluten free.

Labs frequency after surgery
How often should I have lab work after surgery?

Your doctor will recommend a regular schedule of lab work for you after surgery to make sure you are stating healthy. This is often done several times in the first year, and then yearly.

Can anyone take Bariatric Advantage products?

While our products were developed for weight loss surgery patients, almost anyone could use them for general health.

Will insurance pay for supplements?
Will insurance pay for supplements?

Unfortunately, the answer is usually no. Still sometimes people find that can get coverage with a specific written prescription from their doctor. Since vitamins are considered a requirement after gastric bypass and related procedures, many doctors are happy to write a prescription and let patients try to receive reimbursement. One can also look into medical savings accounts or "cafeteria plans" (ask your insurer or your bank), which may provide some tax relief.

What is a chelate?
Most simply, chelate means 'claw or grab.' A chelated mineral is one that has been bound to or �clawed to� another substance � usually an amino acid or an organic acid such as citrate, malate, succinate or aspartate. Sometimes other substances are used as chelators such as gluconate (gluconic acid, an oxidation product of glucose) or picolinate (a derivative of tryptophan). The form of chelate that will be best absorbed depends on the mineral, and varies. Some, like selenium, are best-absorbed bound to an amino acid (selenomethionine), others like calcium, when bound to one or more organic acids (such as citrate or citrate-malate). Overall, chelates are better absorbed that inorganic mineral salts such as oxides and sulfates. These forms are less expensive and occupy less space than chelates, however, so are used by many manufacturers of dietary supplements for all or part of their mineral content.

Allergens in Bariatric Advantage Products
All Bariatric Advantage products are labeled according to FDA guidelines for the presence of common allergens.

Why is there copper in the Zinc-50?
The Zinc-50 capsules contain a small amount of copper. The copper is there to help guard against zinc-induced copper deficiency which can happen if you take enough zinc for a long period of time. If you are taking a high dose of zinc for a long time, your doctor should also be monitoring your copper levels.

Amount of iron in a pre-natal (prenatal) vitamin
The RDA for iron in pregnancy is 27mg. Most pre-natal vitamins provide between 27 and 60 milligrams of iron per day. This is 1 to 2 of the Bariatric Advantage Passion Fruit Iron or 2 to 3 of the Strawberry Iron.

Sweeteners in vitamins
Bariatric Advantage products are designed to be either extremely low sugar/low glycemic or sugar free. Most are sugar free. We use the following sweeting agents either alone or in combination: xylitol, sorbitol, sucralose (Splenda), and fructose.

Should I take extra vitamin A?
Fat malabsorption can occur with some forms of weight loss surgery and this can also mean that some fat-soluble vitamins like vitamin A are not well absorbed. If you are concerned about your vitamin A levels, they can be checked through a simple blood test. Vitamin A can be toxic when taken in excess. so it is best to know if you need more than the level in your multivitamin before taking it on your own.

Will taking zinc stop hair loss?
If you have a zinc deficiency, taking additional zinc may be beneficial for hair. There are many causes of hair loss - some are nutritional and some are not. Other nutritional causes include iron and protein deficiency. If you are losing hair and are concerned about it, your doctor can help you determine whether extra nutrition will be helpful.

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.

Why does the calcium have vitamin K?
Vitamin K is an important nutrient for bone health. Many people do not get adequate vitamin K and deficiency has been shown to contribute to bone loss. Vitamin K can not only increase bone mineral density in osteoporotic people but also actually reduce fracture rates. Additionally, increasing evidence suggests that vitamins D and K are synergistic, and work better for bone health when used together. If you are supposed to avoid vitamin K, please consult with your doctor before trying products with vitamin K.

Supreme B-Complex is now B50-Complex

Bariatric Advantage® is pleased to introduce our NEW B-50 Complex with Active B-Vitamins. After much consultation with both doctors and patients we feel this product now meets the needs of weight loss surgery patients much better than before.

Some of the advantages of the new product include:

• Small capsule size – these are a very easy-to-swallow
• Activated forms of B-vitamins – we have really upgraded our ingredients to use the active forms of folic acid, B12 and B6 – this means better absorption and metabolism
• Adjustments of levels – we brought some nutrient levels up and others down to make a product that is more specific to the needs of our customers
• Fewer excipients – we have significantly reduced the levels of excipients (non-active ingredients) in this product

For our refill customers: Please note that your daily dose on this product is now 2 capsules. These can be taken at the same time for convenience, or divided into 2 doses if you prefer.

How much vitamin D do I need?
The Recommended Daily Allowance (RDA) for vitamin D is 200 IU for adults up to age 50, 400 IU for adults ages 51 to 70 and 600 IU for adults over 70 years of age. However, there is currently a lot of debate about whether this is enough. Vitamin D is a common deficiency with obesity and with weight loss surgery. Your doctor should be able to tell from your labs if you are getting enough vitamin D and advise you as to how much you need to maintian healthy levels.

Do I need extra vitamin D?
Vitamin D deficiency is relatively common in people with obesity and in those who have had weight loss surgery. The only way to really know if you need more vitamin D is to have lab tests done to check for the levels in your body. Your doctor can provide you with information about this kind of testing.

Can my vitamins be taken with my medication?
There are interactions that can occur between vitamins, minerals and prescription drugs. It is best to ask your doctor or pharmacist about possible interactions.

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.

Should I take vitamins before my surgery?
This is something you should discuss with your surgeon. There is some strong evidence of nutritional deficiencies occurring in obesity, and in pre-op weight loss surgery patients. Some programs recommend vitamins before surgery, others do not. Conversely, there are some nutrients that you may need to stop taking prior to surgery - your doctor should be able to tell you what these are.

Are liquid vitamins better absorbed?
No. Liquid vitamin manufacturers sometimes make surprising claims for their products like “100% absorbable� – this is never true. You never absorb 100% of a nutrient. The things that makes the biggest difference in how well you will absorb a nutrient is how well it breaks down and whether the form itself is well-absorbed.

How can I tell if my vitamins and minerals are absorbed?
While there is intensive medical testing that can be done to answer this question, it is expensive and invasive and in really never done outside of scientific experiments. The easiest way to know how you are responding to the nutrition you are taking is to go to your doctor for regular lab work. Your bariatric surgery program is likely to be testing for all the critical nutrients that you need to worry about after surgery.

Can’t I get all my nutrition from food?
Probably not. Most Americans, even those who have not had weight loss surgery, do not get even their basic nutritional requirements met through food. After surgery, you cannot eat as much and you may have malabsorption (depending on your procedure), so taking nutritional supplements helps to make up for what you cannot get from your diet.

Are liquid vitamins better absorbed?
No. Liquid vitamin manufacturers sometimes make surprising claims for their products like “100% absorbable� – this is never true. You never absorb 100% of a nutrient. The things that makes the biggest difference in how well you will absorb a nutrient is how well it breaks down and whether the form itself is well-absorbed.

What is the most I can take of a vitamin or mineral?
For almost all nutrients there is something called the Tolerable Upper Limit (or UL for short). This number is set by the Institute of Medicine as a guide for safety. It is different for all nutrients. Some nutrients like iron or vitamin A can be very toxic in large doses. If you are concerned that you may be getting too much of a particular nutrient, you should discuss this with your doctor or dietitian.

Why are there so many pills?
Often times the better forms of vitamins and minerals take up more space. For example, calcium citrate takes up two to three times the space as calcium carbonate. Additionally, some nutrients like calcium and iron are best taken separately so they require separate tablets.

Should I take my vitamins with food?
Most vitamins are actually best tolerated and better absorbed if taken with food. Some, like calcium citrate, can be taken either way.

Is there a best time of day to take vitamins?
There is no proven best time to take vitamins, however some people find that if they take a multivitamin or B-complex too late in the day it may keep them up at night.

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.

What is the DV (Daily Value)?
The Daily Value or DV is the recommended amount of a nutrient (a vitamin, mineral, protein, fat, fiber or carbohydrate) that you should get each day. The Percent Daily Value (% DV) is the amount of that nutrient you should get based on assumed calorie intake. The FDA (Food and Drug Administration) generally assumes intake of 2000 calories for an average adult.

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.

Pre-natal (prenatal) nutrition
Women who are pregnant or nursing have specialized nutritional needs. It is of foremost importance that a WLS patient who is pregnant or desires to become pregnant discuss her nutritional needs with her physician. Generally, there are increased needs for iron, calcium, protein and folic acid.

Omega 3: is there a daily value for this product?
There is currently no formal recommended intake level for Omega3 fatty acids. This is likely to change in the future and Bariatric Advantage will update the product information when it does.

Amount of folate in a pre-natal (prenatal) vitamin
Folic Acid (folate) is a very important nutrient in pregnancy. Most pre-natal (prenatal) vitamins provide 600 to 1000 micrograms of folic acid per day. All Bariatric Advantage multivitamins provide 800 micrograms of folic acid. To reach the level of 1000 micrograms (1mg) the addition of our B12 with folate adds another 200 micrograms.

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 my vitamins need to be taken with or without food?
Many of the common nutrients found in a multivitamin are better absorbed when taken with some food.

Calcium can usually be taken on an empty stomach if desired. Your dietitian will likely give you guidance on the best way to take your vitamins each day.

What is PDCAAS?
Protein Digestibility Corrected Amino Acid Score (PDCAAS)

A PDCAAS value of 1 is the highest, and 0 the lowest as the table demonstrates the ratings of common foods below.

Food	Serving size	Grams Protein	Calories	BV	PDCAAS
Chicken breast, boneless, cooked	3 oz. (85 g)	27	128	79	.91
Ground Beef, lean, cooked (15% fat)	3 oz  (85 g)	24	197	80	.91
Tuna, canned in water	3 oz (85 g)	23	99	83	0.90
Egg, hardboiled	1 large	6	78	93.7	0.97
Milk (1%)	1 cup/8 oz (244 g)	8	102	84.5	0.94
Yogurt, low-fat, plain	1 cup/8 oz (227 g)	12	143	84	0.95
Tofu	3 oz (85 g)	13.5	123	64	0.93
Salmon, baked	3 oz (85 g)	18.8	175	76	1.0
Rice	1 cup (158 g)	4.3	205	64	0.47
Peanut butter, chunky, unsweetened	2 Tbsp (32 g)	7.7	188	83	0.52
Corn (cooked kernels)	½ cup (82 g)	2.6	72	60	0.42
Peas (cooked)	½ cup (82 g)	4.1	62	76	0.73
Oatmeal, cooked	1 cup (234 g)	13	129	55	0.57
Whey Protein (isolate)	1 oz (28 g)	24	100	159	1.0
Whey Protein (concentrate)	1 oz (28 g)	22	113	104	1.0
Soy Protein	1 oz (28 g)	23	100	74	0.96

Sources:

1. Health Canada, Nutrient Value of Some Common Foods (1999)
2. Tufts University School of Medicine; Harvard University
3. USDA National Nutrient Data Bank

Can capsules be opened?
Sometime customes wish to open capsules into a liquid or soft food rather than swallow them. For all Bariatric Advantage products, this is fine. Customers should note that products designed to be swallowed in capsules are not sweetened or flavored in any way, thus they will have a very strong flavor of the nutrients they contain. This is generally better masked in a soft food (apple sauce is a very good choice) rather than in a liquid, but either is fine.

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.

Do BA products contain Allergens?
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). The one thing we are not required to disclose that could cause an allergy is flavor agents. We use almost all natural flavor agents.

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

What is the difference between Omega-3, Omega-6, and Omega-9?
There many kinds of fatty acids found in the human diet. The two essential fatty acids are the omega 3 and omega 6 groups.

The important omega 3s include α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), all of which are polyunsaturated. Dietary sources include flax, hemp, walnuts, and fatty fish. Most research indicates that our modern diets do not contain sufficient omega 3 fatty acids for good health, and for this reason it can be health-supportive to supplement them from a source like fish oil.

Omega 6 fatty acids that are important include linoleic acid (LA) and arachadonic acid (AA). Dietary sources include almost all animal products, and common sources like palm and soybean oils. Most research indicates that the modern American diet is abundant in these fats, and that relative to our omega 3 fatty acids, we have a very high % of omega 6 in what we eat. Excess omega 6 fats interfere with the health benefits of omega 3 fats; in part because they compete for the same rate-limiting enzymes. Most people, therefore do not need to supplement these fatty acids.

Omega 9 fatty acids are non-essential fatty acids that primarily come from sources such as nuts, avocados, olive oil and animal fats. They are fairly plentiful in the American diet and as they are non-essential, they are usually not supplemented.

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.

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.

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.

What is the Recommended Daily Intake of Protein for a Person Who Has Had Bariatric Surgery?
There is not an exact amount of protein that is recommended after bariatric surgery; however both the American Society of Metabolic and Bariatric Surgeons (ASMBS), and the joint committee of the ASMBS/American Academy of Clinical Endocrinologists/The Obesity Society have offered some guidance. ASMBS advises that for a gastric bypass patient a range of 60 to 80 grams per day is a common recommendation. They advise that a higher average intake of 90 grams/day would be good for DS patients. The ASMBS/AACE/TOS committee advises a range of 60-120 grams of protein per day after all surgeries. Because protein needs vary somewhat by size, gender and procedure, it is a good idea to ask your doctor or dietitian what is right for you.