Optimal health after gastric bypass is possible if nutrition is a major focus of treatment. Because of specialized needs due to decreased absorption of some vitamins and minerals, a well-balanced supplementation program is needed. The importance of your full participation in health decisions can not be stressed enough for non-compliance to be eliminated. Taking the best forms of vitamins and minerals will ensure better assimilation and, in the long run, will be more cost-effective for you.

The RDAs only focus on the prevention of nutritional deficiencies in groups of people. They do not define optimal intakes for an individual, and special nutritional needs such as those produced by gastric surgery are not covered by the RDAs. A tremendous amount of scientific research indicates that the optimal level for many nutrients may be much higher than their current RDAs. Decreased food intake, nutrient-depleted foods, altered absorption and biochemical individuality all point to using Optimum Daily Intake (ODI) rather than RDAs as the basis for vitamin and mineral supplementation after gastric bypass.

Important Aspects of Supplementation
1-Choose high potency supplements.
Taking a high-quality preparation that provides all of the known vitamins and minerals serves as a foundation of a sound nutritional program. Choose preparations by companies that manufacture in small frequent batches. The table below is a composite listing of the ODI dosages and the best absorbable form for each of the vitamins and minerals.

2-Timed-released formulas are not always better.
Time-released vitamins are active over an 8-12 hour period and may be hampered by the timed-release process in gastric bypass. They are not recommended.

3-Keep quantities of B vitamins balanced.
One should not take high doses of a single B vitamin without increasing the amount of all the others. This is important because B vitamins tend to work together, and compete for absorption in the intestines.

4-Aim for maximum absorption.
Look for supplements that dissolve quickly. Nutrients bound up in hard-coated tablets may never make their way into the blood stream. Loose powder, soft-gel capsules or quick dissolving tablets are fast-acting forms that permit optimal absorption. Supplements can be cut up into several small pieces or be chewed before swallowing without loss of potency. In order to get the full benefits of nutrients over a 24-hour period, a supplement may be broken in half. Half should be taken in the morning and the other half 8 hours later. B-complex vitamins should be taken early in the day to prevent sleep difficulties later at night.
Most supplements are best taken with meals to promote better absorption and tolerance. On an empty stomach, water-soluble vitamins can leave as quickly as 2-3 hours after ingestion, while fat-soluble vitamins remain in the body for about 24 hours, with excess amounts being stored in the liver longer.

5-Use chelated minerals.
Minerals are best absorbed from the digestive tract in their chelated form where they are bound to other substances. There are many chelation vehicles on the market with a wide variation in absorption. The ones with the highest absorption efficiencies are malate, ethanolamine, phosphate, ascorbate, citrate, fumarate, peptonate, succinate, lysinate, glycerate, picolinate and acetate. Moderate high efficiency absorption vehicles are amino acid chelate, aspartate, chloride, sulfate, gluconate and phosphate. The lowest absorption efficiency vehicles and the least expensive are carbonate and oxide.

6-Monitor vitamin A and D intakes.
Vitamin A and D have the potential for toxicity. Up to 1,000 IU of vitamin D and 15,000 IU of vitamin A (dietary and supplement sources combined) can be taken safely. Vitamin D is best utilized when taken with vitamin A in natural sources such as fish oils.

7-Check mineral ratios in supplements.
Zinc and copper antagonize each other. To maintain good health, keep the ratio between zinc and copper at 10:1 or 15:1. Calcium and magnesium should be present in supplements in a ration of 2:1 ratio. Magnesium taken in a 1:1 ratio to calcium could cause diarrhea in susceptible individuals. Vitamin D should be taken with calcium supplements to promote absorption.

8-Monitor vitamin-mineral combinations.
Iron fumarate and sulfate destroy vitamin E. It is not affected by iron chelated to gluconate, fumarate or citrate. Vitamin C taken concurrently with vitamin B-12 destroys its activity. Zinc is required to utilize vitamins A and B. Bioflavonoids (vitamin P) are essential for the proper absorption of vitamin C. Selenium improves vitamin E activity considerably. High coffee, soft drink and sugar intakes deplete B vitamins, zinc and calcium.

9-Synthetic versus natural preparations.
Most vitamins are synthetic even if their labels say “natural”. The cost of “all natural” vitamins would be prohibitive. The body recognizes and uses molecules of most synthetic vitamins. One notable exception is vitamin E. Synthetic vitamin E, the dl form, has very little vitamin E activity. Use the d form only. Synthetic fat-soluble vitamins are difficult for the liver to utilize properly. Use natural North Atlantic fish oil sources free from heavy metal residues to provide vitamins A and D to treat impaired health, especially in sun-starved climates.

10-Do not adjust supplement dosages without supervision.
Some practicioners advocate periodically discontinuing or at least reducing the dosages of vitamin and mineral supplements for 1-2 days per week during leisure time, and for one or more weeks every 3-4 months, especially when on vacation or in a quieter, cleaner, less stressful environment. This is not possible with the high nutrient requirements demanded of the gastric bypass. For example, studies have shown vitamin B-12 levels to decline rapidly over a 3-month period when supplementation was discontinued. Keep in mind that modifying your vitamin / mineral supplementation without the super vision of your dietitian or physician, may precipitate a deficiency.

11-Oral versus injectable preparations.
Oral vitamin therapy is more reliable, less burdensome and less costly than the injectable form, but does require compliance on your part. However, if the oral form of a vitamin or mineral is not working well, you may require the injectable form. For example, you may require injectable iron or vitamin B-12 due to intolerance or diminished intestinal ab sorption.