Vitamin Regimen - BASIC plan

(Add to this based on your particular lab work)

30g of protein supplement made in water, 3 to 6 times per day, no milk, no sugar.
AND 64 oz of water – minimum – Remember 1 oz fluid per day for every 2 lbs of body weight
This vitamin schedule is just a suggestion. You can take them any way you wish as long as you follow the rules listed below.
Since the rules can be complicated, many people wanted a good place to start. That is why this schedule was created.
AM:
1 multi-vitamin
Mid-Morning:
2 iron (25 mg each) Ferrous FUMERATE, Carbonyl iron, or elemental iron if prescribed
Vitamin C (1000mg) ascorbic acid with rosehips if taking iron
Mid-day:
Calcium CITRATE (500mg) with Vit D and Magnesium (250mg)
Vitamin E (400IU E a-alpha tocopheryl sucinate)
Evening:
Calcium CITRATE (500mg) with Vitamin D and Magnesium (250mg)
1 multi-vitamin
Bedtime:
Calcium CITRATE (500mg) with Vitamin D and Magnesium (250mg)
1 sublingual B-12 daily (cobalamin concentrate) or monthly B-12 injection as required
B Complex tabs daily, are also suggested, especially for energy.
--------------------------------------------------------
Some rules for vitamin supplements:

IRON.............
Take iron (ferrous FUMERATE only, NOT ferrous SULFATE!) Iron is NOT a friendly vitamin. Take iron ALONE, NOT with
other meds, juice, dairy products, calcium, etc....ALONE (ok with Vitamin C only), or it will be useless. We have a VERY hard
time absorbing iron, so this is very important!

CALCIUM..........
Take Calcium CITRATE, NOT Calcium Carbonate. Not Tums (This is carbonate). We do not absorb the carbonate! There are
some other types we do absorb one is elemental calcium. Remember.... do not take it with iron. Calcium also needs Vitamin D
and Magnesium to work. If your calcium does not have these in the tablet, then you must add Magnesium and more Vitamin D
also. Take on empty stomach & follow w/ food.

Multi-vitamins.…....
You should use a multi vitamin that is equivalent to Centrum (See vitamin comparison*). You may need to take 2 of these
instead of 1 as we only absorb about 50% at most.

Vitamins A, D, E and zinc and C (and any others you may add)…..Use only dry tablets....we do not absorb anything in an oil type
gel cap, or ones that are enteric coated, or time-release versions.

B-12 injections.... you can get a prescription from your primary doctor for a vial of B-12 that will give you about 30
injections. The B-12 is quite inexpensive. The vial price may be less than your co-pay. If you don't like injections, you can
use the B-12 sublingual. They melt under your tongue like nitroglycerin tabs for heart patients. You can get them many
places, including Trder Joe’s If sublingual, take them daily, whereas injections are monthly.

Remember, these are the BASICS. If your lab work shows drops in any areas, amounts will have to be adjusted.

Some additions...
Problems with hair loss or brittle nails.... add Biotin
Problems absorbing Calcium...add Boron
Problems absorbing iron.........add Copper

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Malabsorption
It is not uncommon for the patient to think the toilet is malfunctioning because several flushings are needed to remove the
stool. A greasy character and truly rancid odor are indicative of increased stool fat, but are often absent until late. These
complaints are often readily passed over by the busy physician. At such time, physical findings are usually absent, but
hyperactive bowel sounds may be noted, especially in small intestinal disease. If symptoms are intermittent or if they
progress slowly over many years, patients may exhibit vague, seemingly unrelated symptoms such as chronic fatigue and
depression, long before the physician considers the possibility of serious organic disease.

Carbohydrate malabsorption will result in symptoms of diarrhea and excessive flatus (gas). Malabsorbed
carbohydrates that enter the colon are fermented by colon bacteria into gases. Stools seem to float on the water because
of their increased gas content (not because of their fat content). This often happens when the gastric bypass patient
begins to eat more carbohydrates, instead of protein. Given sufficient time, fat and muscle will be catabolized. Physical
examination may reveal signs of weight loss from both fat stores and lean body mass. The patient will be weak and will easily
develop fatigue. Fat loss will generally be noted as sunken cheeks and flat buttocks, with wrinkled or loose skin indicative of
loss of subcutaneous fat stores. There may be direct evidence of a reduced metabolic rate. The patient will often be
mentally slowed.

Fat malabsorption
Failure to digest or absorb fats results in a variety of clinical symptoms and laboratory abnormalities. These
manifestations are the result of both fat malabsorption per se and a deficiency of the fat-soluble vitamins. In
general, loss of fat in the stool deprives the body of calories and contributes to weight loss and malnutrition. Failure
to absorb the fat-soluble vitamins A, D, E and K also results in a variety of symptoms. Vitamin K deficiency presents
as subcutaneous, urinary, nasal, vaginal and gastrointestinal bleeding. Deficiencies in factors II, VII, IX and X
produce defective coagulation. Vitamin A deficiency results in follicular hyperkeratosis. Vitamin E deficiency is
destructive to the central nervous system. Malabsorption of vitamin D causes rickets, osteopenia and osteoporosis.

Protein malabsorption
Severe loss of body protein may occur before the development of laboratory abnormalities. Clinically, protein
deficiency results in edema and diminished muscle mass. Since the immune system is dependent upon adequate
proteins, protein deficiency can manifest as recurrent or severe infections. Protein deficiency in children results in
growth retardation, mental apathy and irritability, weakness and muscle atrophy, edema, hair loss, deformity of
skeletal bone, anorexia, vomiting and diarrhea. Protein-calorie malnutrition is known as marasmus, whereas protein
malnutrition by itself is known as kwashiorkor.

Protein/Energy Malnutrition
Attempts have been made to classify malnutrition into a predominantly protein-depleted (i.e., kwashiorkor) or calorie-
(energy-) starved (i.e., marasmus) state. In kwashiorkor, the subject ingests a moderate number of calories, usually
as complex carbohydrate (e.g., rice), but very little protein. The liver is therefore supplied with inadequate amino
acids. The liver becomes fatty and enlarged. Furthermore, the liver in kwashiorkor inadequately produces other
proteins, including albumin, and serum albumin falls, with resulting peripheral edema. With marasmus the subject
takes inadequate amounts of protein and calories. The low caloric intake means that only small amounts of
carbohydrate are taken with adequate delivery of amino acids from muscle to the liver for protein production. Fatty
liver does not occur, and serum albumin levels tend to be normal, with no peripheral edema. Often patients fall
between these two extremes of nutritional states, but there are examples of kwashiorkor and marasmus in Western
clinical practice. Anorexia nervosa is a classic example of marasmus. Marked muscle wasting and loss of subcutaneous
tissue (adipose tissue) occur with normal-sized nonfatty livers and no peripheral edema. In contrast, the intensive
care unit patient who has received intravenous dextrose (glucose) without amino acids for a prolonged period will often
show a fatty liver and marked hypoalbuminemia (low albumin levels) and edema.

Clinical features of protein-energy malnutrition vary depending on the severity and duration of nutrient deficiency, age at
onset and the presence or absence of other contributing or conditioning factors. With minimal deficiency, abnormalities may
be subtle - particularly in adults, in whom there are no growth requirements. In these patients muscle wasting and loss of
subcutaneous fat may be present. Weakness and minimal changes in psychomotor function may develop. Nontender parotid
enlargement (glands in the face and neck) may occur, sometimes bilaterally. Patchy brown pigmentation, particularly over the
malar eminences of the face, may occur. A lackluster appearance with thinning and increased shedding of hair from the sides
of the head, particularly on combing or brushing, may develop. Bradycardia may occur. Variable degrees of hepatomegaly may

2
result, sometimes with steatosis. In patients with protein-energy malnutrition following jejunoileal bypass a wide spectrum
of histopathologic change has been observed, similar to findings frequently associated with alcoholic liver disease.

In adults and growing children with severe protein-energy malnutrition, clinical features may be even more significant.
Muscle wasting, subcutaneous fat loss, dependent edema and weight loss may be marked. Severe mental apathy and reduced
physical activity may occur. Abnormalities in the hair, particularly of children, may be striking. Severe dyspigmentation may
develop, especially distally; rarely, alternating strands of light and dark hair are observed. Hair may be removed without
pain. Nails may become brittle, with horizontal grooves. An asymmetrical confluent pattern of skin hyperpigmentation may be
seen, particularly over perineal and exposed areas, such as the face. Extensive desquamation may occur, leaving depigmented
areas of superficial ulcers, particularly on the buttocks and backs of the thighs. Gastrointestinal symptoms are common but
variable. These include marked constipation, diarrhea, anorexia or hyperphagia, nausea, vomiting and dehydration. Laboratory
features are also variable. Serum proteins may be substantially reduced, including serum albumin and some higher-molecular-
weight transfer proteins, such as transferrin, ceruloplasmin, lipoproteins, thyroxin and cortisol binding proteins. Serum
amino acid analysis may show a decrease in essential amino acids (i.e., leucine, isoleucine, valine, methionine), and either
normal or depressed levels of nonessentials (i.e., glycine, serine, glutamine). The urinary excretion of urea, creatinine and
hydroxyproline may decrease. Severe electrolyte abnormalities develop, although serum levels may be normal.

Symptoms of Iron deficiency

Anemia: Sometimes accompanying iron deficiency and subsequent anemia may be symptoms of pica and dysphagia. Pica
originally referred to the eating of clay or soil; however the commonest “Pica” in North America is the eating of ice.
Dysphagia: sores on the tongue and esophagus and/or reddened lips with sores. Weakness, fatigue, and edema also can
occur. Physical examination often reveals pallor, and brittle, flat or spoon-shaped fingernails.

Calcium, Vitamin D and Magnesium malabsorption

May lead to bone pain, fractures, paresthesias, tetany, Chvostek’s sign and Trousseau’s sign. Vitamin D deficiency principally
affects the spine, rib cage and long bones with or without fractures, and may cause extreme pain, particularly in the spine,
pelvis and leg bones. Insufficient magnesium may cause seizures and symptoms identical to those of insufficient calcium.

Malabsorption of B-12
The daily requirement for Vitamin B-12 (cobalamin) is 1 mg. The human liver can store approximately 5 mg of B-12
(cobalamin). These large stores account for the delay of several years in the clinical appearance of deficiency after B-12
(cobalamin) malabsorption begins.

Electrolyte and water absorption

Although water and electrolytes are also absorbed in the large intestine, much of this absorbtion and secretion is done in
the small intestine. Since the gastric bypass patient has much of the small intestine bypassed, this overall balance is shifted
toward secretion. Therefore, dehydration is more prominent in gastric bypass patients, requiring a higher than average
intake of water per day.

Short Bowel Syndrome

The severity of symptoms following resections of large segments of the small bowel relates to the extent of the resection,
to the specific level of the resected small bowel and to the reason for which the resection was undertaken. The level of
resection is important because absorption of nutrients is most effective in the proximal small bowel (iron, folate and
calcium). This section is bypassed in gastric bypass surgery. Resection of up to 40% of the intestine is usually tolerated
provided the duodenum (bypassed in gastric bypass) and proximal jejunum (bypassed in gastric bypass) and distal half of the
ileum and ileocecal valve are spared. Resection of 50% of the small intestine results in significant malabsorption, and
resection of 70% or more of the small intestine will result in severe malnutrition sufficient to cause death unless the
patient's malnutrition is aggressively treated. Where, exactly, each gastric bypass patients fits in this, is dependant on the
type of surgery, and the length of bypass, but all result in a significant amount of malabsorption.

Postgastrectomy Malabsorption
Postgastrectomy malabsorption frequently follows gastric surgery. The small size of the gastric remnant (pouch) causes in-
adequate mixing of food with digestive juices. With the loss of the pylorus, there may be rapid gastric emptying, poor mixing
of bile and pancreatic secretions, and rapid transit down the small intestine. Incoordinated secretion and poor mixing of bile
and pancreatic juice leads to fat maldigestion. Gastric surgery that allows food to enter into the upper small intestine with-
out dilution and with minimal digestion may "unmask" mild and subclinical celiac disease, lactase deficiency or pancreatic
insufficiency.
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What kind of protein is the best?
BIOAVAILABILITY OF PROTEIN TYPES
The higher on the list, the better the protein source.
The numbers are the BV. (Biologic value)
This is only how easily the (normal) body can absorb them, not the protein grams in each one. The last few need to be
blended to make a complete protein.
And remember…. gastric bypass patients don’t absorb nutrients from food protein very well.
Protein Source
BV
Whey Protein Isolate Blends 100-159
Whey Concentrate (Lactalbumin) 104
Whole Egg 100
Cow's Milk 91
Egg White (Albumin) 88
Fish 83
Beef 80
Chicken 79
Casein (a protein from milk) 77
Rice 74
Soy 59
Wheat 54
Beans 49
Peanuts 43
So, because we (gastric bypass patients) don't have a stomach and the stomach acids, etc, anymore, we don't process the
undigested proteins properly and malabsorb most of them. The same is for the normal food we eat. We don't absorb most
of it. We, therefore, need the more highly absorbed, pre-digested protein supplements...whey which is pre-digested (aka
hydrolized)...in order to get the proper nutrients our bodies need and are no longer able to get from food.

So, whereas whole egg, cow's milk, egg white are near the top of the list of bioavailability for "normal" people, they are not
pre-digested (hydrolized), so for us, they are not as high on the list as pre-digested whey protein. Our bioavailability list
would be quite different from the "normal" person's list.

So, make sure your protein powder or drink states that it is pre-digested or hydrolized. And the best kind of protein would
be a whey blend protein. Second best would be a 100% whey protein. Isolates, though good for a quick acting pick-me-up,
are not sufficient alone for the gastric bypass patients on-going maintenance requirements.

The Biological Value, or BV, of a protein is an indicator of the quality of the protein. It is a measure of a protein's ability to be used by the
body (or its bioavailability). It is a percentage (though the scale is skewed resulting in some BV's of greater than 100) of the absorbed
protein that your body actually uses. Biological Values are indicators of which proteins are best at aiding nitrogen retention in muscles to
help them maintain or grow.

Many of the whey protein powder manufacturers claim that their products have BV values well above regular whey protein by various
techniques such as ion-exchange processing, hydrolization, and adding other ingredients such as specific amounts of limiting essential amino
acids.

Hydrolyzation is a process breaking large peptides into smaller ones. It is sometimes referred to as "pre-digested".

Regular undigested whey will be broken down into di- and tri-peptides via enzymes in the gut (which gastric bypass patients no longer have).
This process takes a while, even in the non-gastric bypass person. Hydrolyzation is useful when protein delivery is needed very quickly so the
body doesn't have to require the time and enzymes doing it. The benefit is of having a quickly absorbed protein to ensure muscle tissue is
flooded with nutrients in a timely manner.

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 Whey Protein Concentrate Protein Blends (Mixed
Whey Protein Isolate (WPI)
(WPC) Protein Sources) **best

Whey Protein Isolate powders
go through the best filtering
process to remove fat and
carbohydrates. In general,
these powders will contain a
higher percentage of protein
compared to Whey Protein
Concentrate - generally around
90% protein. These are best
utilized immediately after a
workout and first thing in the
morning when fast-acting
protein is needed most.
Nature's Best IsoPure Protein
Prolab Whey Protein Isolate
Worldwide Extreme Pure Protein
These products contain Whey
Protein Concentrate (generally
around 75% to 80% protein) or
may also have a small amount of
Whey Protein Isolate blended
in. None of these products
contains more Whey Protein
Isolate than Concentrate. Whey
Protein Concentrate is much
more economical than the
Isolates because the process of
removing most of the carbs and
fat is relatively inexpensive
compared to getting the
maximal amounts out to isolate
the protein.
Designer Protein
GEN HumanoPro
Champion Pure Whey Stack
HDT 5 Plus 1
Optimum Nutrition 100% Whey
Many researchers believe that
quick-absorbing proteins like
Whey Protein are best
immediately after a workout and
first thing in the morning when
your body has extra protein
needs, but a mixture of various
slower-absorbing proteins are
better at other times of the day
to spread out the absorption for
several hours. This helps keep
amino acids in the bloodstream
for use by muscle tissue as
needed. Below are products
containing blends of various
protein sources - including whey
protein. These are recommended
for general use throughout the
day and at bedtime.
Champion Nutrition Pro-Score 100
Proto-Whey
HDT Pro Blend 55
MET-Rx Protein Plus
Labrada ProV60
Optimum Nutrition Pro Complex

Vitamins: Sources, Amounts and Important Issues

The Food and Nutrition Board of the National Academy of Sciences is the governing body in charge of setting
the minimum vitamin levels in order to prevent deficiencies in healthy adults also known as the RDA
(recommended daily amounts).

We now know that vitamins are important for maintaining health and preventing disease. No one knows what the
RDA is for a gastric bypass patient due to altered anatomy and a low calorie post-operative diet.

We have seen vitamin deficiencies before surgery despite adequate calorie intake but likely due to poor eating
habits. For bypass patients, in order to maintain good nutritional status, we have learned from measuring blood
levels that a vitamin supplement that exceeds the RDA can provide adequate serum levels.

Vitamin A
Vitamin A is a fat-soluble vitamin also known as retinol (fat soluble-animal source) and beta-carotene (water
soluble-plant source). It functions in the body; to aid in tissue growth and repair; to improve and maintain normal
vision, to maintain healthy skin and mucous membranes, and to fight against infection and boost immunity. If you
are deficient in vitamin A possible symptoms could include night blindness, skin type eczema, weight loss, poor
bone growth and diarrhea. Toxicity is rare, but if taken in excess, you could experience headaches, hair loss and
have anorexia. Common food sources of vitamin A: cod liver oil, beef, liver, eggs, any dark green, red, or orange
vegetables like sweet potatoes, pumpkins, broccoli and apricots.
For Bypass Patients it is Important to Know

5
Alcohol can decrease vitamin A stores. Drugs that affect the liver such as steroids and Dilantin may affect
vitamin A stores. Low vitamin A levels when protein intake is low can correlate with poor nutritional status.
Vitamin A stores can be maintained within normal limits if a vitamin supplement is taken. Some deficiencies have
been seen if there are excessive fatty stools or te vitamins aren’t taken. Vitamin A levels can decrease
transiently after an operation but return to normal after recovery and supplementation. Vitamin A can be lost
from foods during cooking, preparation and storage. Olestra can lower vitamin A levels due to fat malabsorption.

Vitamin B-1 (Thiamin)

Needed for: Normal function of the heart, nerves, muscle tissue and digestive system; aids in carbohydrate
metabolism and energy production. Their function include maintaining normal function of the central nervous
system, muscles and heart, promoting normal growth and development, and is a co-factor in carbohydrate
metabolism (by releasing energy). If you are deficient in vitamin B1, you may experience visual changes, an
unsteady gait, a loss of appetite, have fatigue or nausea and perhaps some mental confusion. Ingestion of high
amounts of thiamine may cause drowsiness. Common food sources of B1 are liver, beans (like navy and black eye
peas), peanuts, raisins and whole grain products.
For Bypass Patients it is Important to Know
Supplementation is suggested since the post-operative diet is low in calories. Antibiotics and oral contraceptive
agents can decrease B1 levels. Avoid over cooking meals, since B1 can be destroyed by heat. Excess alcohol
increases risk for B1 deficiency. Large amounts of raw fish and shellfish can increase your risk for a B1
deficiency. Eating an excess amount of refined carbohydrates and not taking your vitamin can potentially lead to
a sub-therapeutic level of B1 and produce deficiency symptoms.

Vitamin B-2 (Riboflavin)

Needed for: Energy production, immune system function, healthy skin.

Vitamin B-3 (Niacin)

Needed for: Energy production, healthy skin, and digestive system function. The body can manufacture niacin
from the amino acid tryptophan.

Vitamin B6 (Pyrodoxine)

Needed for: Energy production, red blood cell formation, immunity, nervous system and hormone function.

Vitamin B-12
Needed for: Energy production, red blood cell production, utilization of folic acid, nervous system function.
Vitamin B12 is also known as cobalamin. Cyanocobalamin is the synthetic form. B12 has many functions with the
most important being the nerve function. B12 and folate are metabolically interrelated. B12 converts folate to
an active form. B12 is responsible for the manufacturing and normal functioning of red blood cells. It also helps
metabolize carbohydrates and fats and synthesize proteins. B12 binds to Intrinsic factor, produced in the
stomach. This no longer happens in the pouch, which is left after gastric bypass, causing B-12 deficiency in
many patients. Deficiency symptoms can be manifested as anemia, nerve damage, fatigue, dementia and even
coronary artery disease. There have been no reported toxic effects with high does of B12.
Vitamin B12 for Bypass Patients
Heat and moisture may change the action of the vitamin. Store in a cool dry place. High intake of vitamin B6
reduces B12 absorption. Smoking decreases vitamin B12 metabolism. For improved absorption, take B12 one hour
before meals. Colchicine reduces absorption of B12.

Folic Acid
Needed for: Energy production, red blood cell formation and growth. This is essential for prevention of certain
birth defects.

6
Pantothenic Acid
Needed for: Carbohydrate, fat, energy and protein metabolism.

Biotin
Needed for: Energy production, fatty acid synthesis and the breakdown of certain amino acids.

Vitamin C (Ascorbid Acid)

Needed for: Normal growth, wound healing, disease and infection resistance, bone and teeth formation, more
efficient iron absorption. The best and most common sources of vitamin C are fruits and vegetables. Vitamin C is
a water-soluble vitamin, that is important if formation of collagen (a protein that gives structure to bones,
cartilage, and muscle). It maintains the capillaries and aids in the absorption of iron. Vitamin C is a known
antioxidant that prevents cell damage. Eating a variety of fruits and vegetables ensures appropriate intake of
the vitamin. If you are deficient in vitamin C, you may experience muscle weakness, loss of teeth, easy bruising,
nosebleeds and frequent infections. Vitamin C assists in calcium absorption and can increase iron absorption.
Smoking increases requirements for vitamin C.

Vitamin D
Needed for: Normal growth; healthy bones, teeth and nails; proper absorption of calcium and phosphorus.

Vitamin E (tocopherol)
Needed for: Cell membrane integrity and protection.

Folate
Folate and Folic Acid are interchangeable terms. Folic acid is the synthetic form of folate, which is found
naturally in some foods. Folate is primarily known for preventing neural tube defects, a form of spinal cord
deformity in newborns, preventable by taking folate. Folate is essential for the synthesis of RNA and DNA, the
genetic material of cells. It plays a vital role in growth and development of cells. Folic acid is necessary for
aiding in protein metabolism. It also may be protective against heart disease by lowering homocysteine levels.
Folic acid is absorbed from the small intestine.
Of all vitamins, a folate deficiency is most common due to a diet poor in vegetables, primarily dark green leafy
vegetables, increased alcohol consumption, and also contributing is folate-increased sensitivity to heat and light.
Symptoms of folate deficiency include loss of appetite, inflamed tongue and diarrhea. A folate acid deficiency
can damage the lining of the gut and lead to further malnutrition.
Folate for Bypass Patients
NSAIDS (Motrin, Advil and Aleve) and anticonvulsants elevate folate requirements. Excess alcohol intake
can lead to a deficiency. If vitamins are not taken daily an increased risk for a deficiency exists. Taking
additional B vitamins in a daily supplement form rather than through food only ensures proper micronutrient
nutritional status. If you are of childbearing age, please take a folic acid supplement to prevent neutral tube
defect. Prenatal vitamins contain twice the RDA for folate.

Vitamin K
Needed for: Production of proteins required for normal blood clotting.

Note: In addition to their other roles, vitamins C, E and beta-carotene (which the body converts into vitamin A)
are known as "antioxidants." Certain minerals and other substances also act as antioxidants. Antioxidants can
offset the damage caused by free radicals, the unstable, highly reactive molecules formed during the
metabolism of glucose and fatty acids to provide energy. Free radicals are also produced in the body by
pollutants, ultraviolet light from the sun and drinking alcohol. Free radicals react with and damage many
components of tissues, including cellular DNA, or genetic material. Damage from free radicals may lead to
conditions such as cataracts, cancer, heart disease and even aging.

7
Minerals
The minerals we need in our body are those found in rocks, metals, soil and water, though they may be in slightly different
forms. While each mineral plays a unique role, collectively they support the body's enzyme systems and keep blood and other
body fluids balanced and healthy. Minerals, the major components of bones, also help regulate blood pressure and heart
muscle contraction, heal wounds and conduct nerve impulses. The minerals needed in relatively large amounts are: calcium,
phosphorus, magnesium, sodium, potassium, chloride and sulfur. Other minerals needed in smaller amounts, called "trace
elements," consist of iron, copper, fluorine, iodine, selenium, zinc, chromium, cobalt, manganese and molybdenum. Although
the body can't produce any minerals of its own, minerals are found in a large variety of fruits, vegetables, beans and grains.

Calcium
Needed for: Healthy bones, nails, muscle tissue; assists in blood clotting and heart and nerve functions.
Chromium
Needed for: Normal release of energy from glucose.
Copper
Needed for: Enzyme reactions, iron metabolism
Fluoride
Needed for: Healthy bones and teeth those are resistant to decay.
Iodine
Needed for: Regulation of body temperature, thyroid hormone synthesis, metabolic rate, reproduction, growth and nerve and
muscle function.
Iron
Needed for: Formation of healthy red blood cells and prevention of anemia; helps carry oxygen to cells. The recommended
iron intake is higher for women between the ages of 11 and 50 to compensate for iron loss during menstruation.
Magnesium
Needed for: Energy production, normal heart and nerve function and prevention of muscle cramps
Phosphorus
Needed for: Growth; maintain bone density; assists in energy production; and regulates blood chemistry
Potassium
Needed for: Regulation and balance of body fluids, promotes normal heart rhythm; prevents muscle cramping
Selenium
Needed for: Antioxidant properties protect vitamin E and polyunsaturated fats in the body
Sodium
Needed for: Regulation of body fluids and maintenance of acid-base balance; aids in nerve transmission and muscle
contraction
Zinc
Needed for: Normal appetite and taste, wound healing, healthy skin and normal growth

The Bottom Line: Vitamin and mineral supplementation is a life long commitment for gastric bypass patients.
Knowledge is your best armor. Eating a balanced diet and taking your supplements provides the best route to
fulfilling your nutritional requirements.

What are vitamins? Vitamins are nutrients that are essential for maintenance of normal metabolic functions.
Vitamins are supplements both synthetic and natural and come in many forms. The water-soluble vitamins are
Thiamine (B1), Riboflavin (B2), Niacin (B3), Panethanic Acid (B5), Pyridoxine (B6), Biotin, Cobalamin (B12), Folic
Acid, and ascorbic acid (Vitamin C). The fat-soluble vitamins are vitamin A, D, E and K.

The water-soluble vitamins are not significantly stored by the body and need to be replaced daily by food or
supplement to maintain adequate levels. These vitamins can be rapidly depleted in conditions interfering with
intake or absorption. The fat-soluble vitamins are better stored in the body, and if not excreted, toxic levels
could occur. For the gastric bypass patient, who malabsorbs fat, fat-soluble vitamins cannot be digested
properly, and are excreted without doing their job. Vitamins in dry form only are therefore suggested. If your
vitamins are in an oil base, they are doing you no good.