Download - Musgrove Park Hospital

Dietitians
We put our patients first by working as one team;
leading and listening, and striving for the best.
Together, we make the difference.
Musgrove Park Hospital is part of
Taunton and Somerset NHS Foundation Trust
Patient information
Vitamin and Mineral
Supplementation and
Monitoring for Patients
Having Bariatric Surgery
Why are vitamin and mineral supplements recommended?
After any type of bariatric surgery there is a risk of developing
vitamin or mineral deficiencies. This is because you will be eating
smaller portions of food, which makes it more difficult to get
enough vitamins and minerals from your diet alone. We therefore
recommend that all patients who have had bariatric surgery take
certain vitamin and mineral supplements for the rest of their lives.
Most supplements are available on prescription, but others you will
have to purchase yourself.
Which supplements, and how much you need to take, depends on
which type of bariatric surgery you have. This leaflet will explain
what you need to take. We also advise that you have routine
nutritional blood tests after bariatric surgery to monitor your
nutrition.
If you choose not to follow these recommendations or you choose
alternative products, you may be at risk of developing nutrient
deficiencies. These can have various symptoms and may lead to
complications, such as osteoporosis (thinning of the bones), and
some of these may be irreversible.
Intragastric balloon or gastric band
If you have an intragastric balloon or gastric band we recommend
that you take the following supplements every day for life (or
while the balloon is in place) to reduce your risk of deficiencies:
One A-Z complete multivitamin and mineral supplement per day
• Forceval is the only suitable multivitamin and mineral available
on prescription, and is available in soluble or capsule form.
Forceval contains everything you need.
• Multivitamins and minerals are also available to buy from
chemists and supermarkets but we cannot guarantee these
contain everything you need
Calcium and Vitamin D
• You need to take 1200-1500mg of calcium and 65-75ug of
vitamin D everyday to ensure good bone health.
• The easiest way to achieve this is by taking one Calcichew D3
Forte Tablets (chewable) or Adcal D3 Tablets (chewable), three
times per day. This is available on prescription.
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• We advise you also purchase an additional vitamin D tablet
containing 25ug and take one to two tablets per day. Available
examples include: Boots Vitamin D3 25ug tablets and Holland
and Barrett Sunvite Vitamin D3 25ug tablets.
First two weeks after your surgery
• For the first two weeks after your surgery all medications
including vitamin supplements need to be in a chewable
or soluble form. As this is for a short period of time we
advise you obtain a chewy multivitamin and mineral such as
Centrum Fruity Chewables for adults, Bassett’s Active Health
multivitamins with minerals for adults, or a shops own brand
chewable/soluble multivitamin and mineral. Forceval Soluble is
a multivitamin and mineral available on prescription. You need
to take one tablet/dose per day. The Calcichew D3 Forte Tablets/
Adcal D3 Tablets are already chewable and you can start the
extra vitamin D after the first two weeks.
Gastric bypass or sleeve gastrectomy
If you have a gastric bypass or sleeve gastrectomy, we recommend
that you take the following supplements every day for life to
reduce your risk of deficiencies:
Two A-Z complete multivitamin and mineral supplements per day
• Two Forceval are the only suitable multivitamin and mineral
supplements available on prescription, and are available in
soluble or capsule form. Two Forceval contain everything you
need.
• Multivitamins and minerals are also available to buy from
chemists and supermarkets but we cannot guarantee these
contain everything you need
Calcium and Vitamin D
• You need to take 1200-1500mg of calcium and 75ug of vitamin
D everyday to ensure good bone health
• The easiest way to achieve this is by taking one Calcichew D3
Forte Tablets (chewable) or Adcal D3 Tablets (chewable), three
times per day. This is available on prescription.
• We advise you also purchase an additional vitamin D tablet
containing 25ug and take one to two tablets per day. Available
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examples include: Boots Vitamin D3 25ug tablets and Holland
and Barrett Sunvite Vitamin D3 25ug tablets.
Iron
• This is available on prescription as Ferrous Gluconate 300mg
one tablet per day and we advise that you take this to avoid
developing iron deficiency. This provides 35mg of iron.
Vitamin B12
• You will need to start having regular vitamin B12 injections six
months after your surgery. To prevent you developing a vitamin
B12 deficiency we recommend you have this done at your GP
surgery every three months.
• An injection is the most effective way for your body to absorb
this vitamin after a gastric bypass or sleeve gastrectomy.
First two weeks after your surgery
For the first two weeks after your surgery all medications including
vitamin and mineral supplements need to be in a chewable or
soluble form. As this is for a short period of time we advise you
obtain a chewy multivitamin and mineral such as Centrum Fruity
Chewables for adults, Bassett’s Active Health multivitamins with
minerals for adults, or a shops own brand chewable/soluble
multivitamin and mineral. Forceval Soluble is a multivitamin and
mineral available on prescription. You need to take two tablets/
dose’s per day. The Calcichew D3 Forte Tablets/Adcal D3 Tablets are
already chewable and you can start the extra vitamin D and iron
after the first two weeks.
Taking your vitamins and minerals
To make sure that your vitamins and minerals are well absorbed we
suggest that you:
• Avoid taking your Calcichew D3 Forte Tablets, Adcal D3 Tablets
or calcium supplements at the same time as your multivitamins
and minerals or iron supplement.
• Spread your Calcichew D3 Forte Tablets, Adcal D3 Tablets or
calcium supplements through the day (for example, do not take
all three in one go)
• Take your multivitamins and minerals and iron with vitamin C
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containing food if possible- such as a small amount of orange
juice, fruit and vegetables
Other medicines:
• If you are taking Thyroxine, avoid taking it at the same time as
your multivitamins and minerals, iron and calcium as they can
prevent you absorbing the Thyroxine. It is recommended that
you take the Thyroxine four hours before or four hours after
your supplements.
• If you are taking an anti-coagulant such as Warfarin, you should
choose a multivitamins and mineral preparation that doesn’t
contain vitamin K. Forceval does not contain vitamin K however
other multivitamin and mineral preparations may. If this is
unavoidable you should speak to your GP to have your INR
monitored.
Suggested regimen:
Multivitamins and minerals and iron can be taken all together at
breakfast (try to include a vitamin C containing food if possible).
Then spread your calcium supplements throughout the day by
taking one with lunch, one with dinner and one before bed. You
can take your vitamin D at the same time as one of these calcium
doses. For example:
With breakfast
A-Z complete multivitamin and minerals
Iron
With lunch
Calcium and vitamin D
With evening meal Calcium and vitamin D
Before bed
Calcium and vitamin D plus additional
vitamin D
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Nutritional monitoring - blood tests
For all types of bariatric surgery routine nutritional blood tests are
needed every three months for the first year, and then yearly after
that, for life. Blood testing will be more frequent if any deficiencies
are suspected by a health care professional or found. If a deficiency
is found, you may be offered further dietary advice or extra
supplementation may be recommended.
We advise that you have the following routine nutritional blood
tests:
• Full blood count
• Urea and electrolytes (including phosphate and magnesium)
• Glucose
• Liver function tests
• Iron
• Ferritin
• Folate
• Vitamin B12
• Lipid Profile
• Triglycerides
• Calcium
• PTH
• 25-Hydroxyvitamin D (once a year)
Other nutritional tests may be done following the advice of a
health care professional.
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Planning ahead
You might like to use this space to plan your vitamin and mineral
supplementation and monitoring:
Things to plan
Request on prescription:
A-Z complete
Forceval (soluble for One tablet per day
multivitamin and
first two weeks after (intragastric balloon
mineral
surgery)
or gastric band)
Two tablets per day
(gastric bypass or
sleeve gastrectomy)
Calcium & vitamin D
Calcichew D3 Forte
Tablet (chewable)
or Adcal D3 Tablet
(chewable)
Three tablets per
day
Iron (only for
patients having a
gastric bypass or
sleeve gastrectomy)
To arrange
Nutritional blood
tests
Ferrous Gluconate
(300mg)
One tablet per day
Every three months
in the first year, then
yearly for the rest of
your life.
Start six months
after surgery then
have every three
months
Vitamin B12
Book at GP surgery
injections (only for
patients having a
gastric bypass or
sleeve gastrectomy)
Supplements to purchase over the counter
Extra vitamin D
25ug per tablet
One to two tablets
per day
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Important information for women if you are planning a pregnancy
or have become pregnant
We advise that you contact your GP to discuss this further. All
patients who have had bariatric surgery require 5mg of folic acid,
available on prescription, when planning a pregnancy and up to
the end of the 12th week of pregnancy.
If you have had a sleeve gastrectomy or gastric bypass we advise
that you reduce your multivitamin and mineral complete A-Z
supplement to one a day. All other supplements should remain the
same unless advised otherwise.
Pregnancy should be avoided in the first two years after bariatric
surgery. Before trying to become pregnant, you should have your
routine nutritional bloods tested as soon as possible at your GP
surgery to check for any nutritional deficiencies. These are the
same routine nutritional blood tests that you would normally have
done regularly (every three months in the first year and yearly
thereafter) after bariatric surgery.
If there are any concerns about your nutrition, the team may also
check vitamin A, vitamin E, vitamin K (INR), zinc, selenium and
copper levels.
Please contact the bariatric dietitians for a specific patient
information leaflet regarding pregnancy and bariatric surgery.
Further support
If you have any queries or concerns please contact one of the
Bariatric Dietitians on 01823 343394 or 01823 343397.
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B Greenslade/V Krawec/Jul15 review Jul17