30+ Vitamin tablets a day may not be needed.

[kyal]

In preparation for the DS (Still no date yet) I have been doing a lot of research and while I reside outside of the US vitamins have come up as a problem for me and a few others I have spoke to here.

I have looked at the vita lady combo, all seems good. The Bariatric Advantage product looks like a great idea in theory but from what I hear it isn't adequate for the DS.

In order to find some thing locally I have contact a friend who is a chemist and makes custom medications. I met him using using his services when I worked with developmentally delayed kids who couldn't take regular medications. He makes badass acetaminophen and ibuprofen laced chocolate frogs and lollypops for kids ;-)

Anyway he has come up with a couple of ADEK solutions using the quantities in the vita lady combo but combining them all together in various forms and I have been surprised with what he has been able to do. Generally speaking by combining ingredients and alternative dosage formats he has been able to reduce those 30+ tablets down to less than 10.

So far he came up with the following combinations.

1. High strength ADEK at 5 tablets a day. Would require a multi vitamin, calcium any if required iron and other mineral supplements.

2. Vitamin A + Vitamin K into a single lozenge, 1 capsule containing D and E, 1-2 Multivitamins, calcium, iron and other minerals as needed.

or

3. A powder containing ADEK, B12 and Calcium which would be mixed with juice for a twice daily dose. He could also add anything else needed to this mix.

All forms are water miscible and in the case of the sublingual lozenge the strength may be able to be reduced due to not being absorbed in the gut.

I guess I am just wondering what people think of this. Has anyone tried to have this kind of thing made before? His also asked me if it would sell since his in the drug dealing business (the legal kind).

K

[Deleted]

You're welcome to give it a try and report back . Heaven knows getting stuff shipped to you from the USA is a heck of a pain. (I have a friend in Oz and we struggle with this.)

[Deleted]

I remember a long time ago (I'm 9 years post-op) hearing about an apothecary in Maryland who would custom build whatever vitamin formula needed. That sounds alot like what you're talking about.

There is also a product here in the US called Vita-4-Life. It was a pre-made "all inclusive" formula sold for WLS patients. I used them for about a year but was supplementing so much because we're not all "one size fits all". That's when I switched to Vitalady's suggested list.

As long as your chemist is willing to tweak the formula as your labs change, I think it could work. Good luck - I hope it does.

[Deleted]

Feb 2, 2012 10:04:51 GMT -5 kyal said:

In preparation for the DS (Still no date yet) I have been doing a lot of research and while I reside outside of the US vitamins have come up as a problem for me and a few others I have spoke to here.

I have looked at the vita lady combo, all seems good. The Bariatric Advantage product looks like a great idea in theory but from what I hear it isn't adequate for the DS.

In order to find some thing locally I have contact a friend who is a chemist and makes custom medications. I met him using using his services when I worked with developmentally delayed kids who couldn't take regular medications. He makes badass acetaminophen and ibuprofen laced chocolate frogs and lollypops for kids ;-)

Anyway he has come up with a couple of ADEK solutions using the quantities in the vita lady combo but combining them all together in various forms and I have been surprised with what he has been able to do. Generally speaking by combining ingredients and alternative dosage formats he has been able to reduce those 30+ tablets down to less than 10.

So far he came up with the following combinations.

1. High strength ADEK at 5 tablets a day. Would require a multi vitamin, calcium any if required iron and other mineral supplements.

2. Vitamin A + Vitamin K into a single lozenge, 1 capsule containing D and E, 1-2 Multivitamins, calcium, iron and other minerals as needed.

or

3. A powder containing ADEK, B12 and Calcium which would be mixed with juice for a twice daily dose. He could also add anything else needed to this mix.

All forms are water miscible and in the case of the sublingual lozenge the strength may be able to be reduced due to not being absorbed in the gut.

I guess I am just wondering what people think of this. Has anyone tried to have this kind of thing made before? His also asked me if it would sell since his in the drug dealing business (the legal kind).

K

Yes...over the last decade, people have come up with the idea of making easier to take combos...problem is, in practice, you and I will probably not NEED the same supplements.

It may be that I need to supplement K at one level but need SHITLOAD of D to make up for how MY body is absorbing stuff. If I have combo supplements, I have to do that math to add or subtract stuff based on my labs...and there you are, back to a whole bunch of pills.

[kyal]

Feb 2, 2012 10:26:22 GMT -5 @en said:

You're welcome to give it a try and report back . Heaven knows getting stuff shipped to you from the USA is a heck of a pain. (I have a friend in Oz and we struggle with this.)

I'll be giving them a try when I am switched EN. For the high powered ADEK caps he has quoted me a little over $100 per month which is very comparable with other suppliers as there is no shipping to pay.

For now I have ordered some sub lingual Vitamin D 25000 IU and B12 5000mcg as these are two vitamins that I am deficient in already. In theory this hopefully will be too much since sub lingual should be more fully absorbed than via the oral route.

Can't argue with apple pie flavored vitamins ;D

[bb212]

I only take about 9 vitamins a day.

I supplement A, D and Calcium (4 pills), a dry omega 3 chew and two mulivites a day- but it's Dr. Stewart's multivite which has a lot more AEDK, Bcomplex and other vites and than regular ones so there are some things I don't have to suppliment with more smaller pills. So far so good, but everyone's vites needs are different. Go with that works for you, just watch your labs to make sure you're getting what you need.

[huskerchad]

As others mention, this would never work on a one-size-fits-all basis, so it has to be individually tailored. I think a lot of compounding pharmacies could do this for you. I have no idea of the cost but I do go to one of these for some medicine for my cat (yes, really) and I can guess that it would be hundreds of dollars a month to have that done. It's like anything else in life, you have to decide what is worth spending your money on. If taking fewer pills matters a lot to you, maybe it's worth it. I don't mind taking the pills at all, and I wouldn't be able to get away from the number of doses (4) I take anyway because spreading that out is the only way I was able to keep my calcium numbers right.

[Deleted]

This could be a potential business (well, not an ENTIRE business, but certainly a sideline) for your friend, compounding supplements customised to WLS patients' individual needs.

[kingy]

Heya, I really hope this works! The only thing I'd be concerned about is not mixing certain vitiamins (eg, Iron needs to be taken away from other vits) and the amounts of the vitmains, as some of them we can't absorb more than a certain level in one sitting for eg. Calcium. No point taking 1000mg of caclium in one hit, when apparently the human body can only absorb 600mg at a time, stuff like that.

If something does come of this, I'd be really keen to get on board!

[kyal]

Feb 3, 2012 15:38:39 GMT -5 kingy said:

If something does come of this, I'd be really keen to get on board!

Hey Kingy,

It's developing nicely so far. I can tell you now I won't be ordering a lot of my vitamins from OS when I am switched.

I really do wish I had the DS now. If only so I could use my self as a guineapig and test the sub lingual doses to see if they really are absorbed better. If they are it could mean much lower but more effective doses of the fat soluble vitamins which would in turn reduce the cost dramatically.

I'm aware Iron can't be added and the restrictions on calcium. I actually advised a lady in the pharmacy when picking up my meds on calcium today.. She was picking up the cheapo carbonate and I told her the citrate is better.

I have been told point blank though that there is no need to take all these tablets and that a lot of them can be combined in larger dosages. Have ordered some samples of B12 + D in apple pie flavour to see if I can get the levels that I am deficient in now up to normal.

Will keep you posted.

[rklc2002]

I only take Optisource (4 chewables per day) and 2000 IU Vitamin D. The only thing I was low on was Vitamin D, so the doctor suggested I up that to 5000 IU. The vitamins are pretty manageable so far!!

[bugirll]

Feb 4, 2012 15:40:12 GMT -5 rklc2002 said:

I only take Optisource (4 chewables per day) and 2000 mg Vitamin D. The only thing I was low on was Vitamin D, so the doctor suggested I up that to 5000 mg. The vitamins are pretty manageable so far!!

That seems grossly inadequate. What do your labs look like, specifically?

[Deleted]

Feb 4, 2012 15:40:12 GMT -5 rklc2002 said:

I only take Optisource (4 chewables per day) and 2000 mg Vitamin D. The only thing I was low on was Vitamin D, so the doctor suggested I up that to 5000 mg. The vitamins are pretty manageable so far!!

You're also not quite four months out. How "low" is your D?

[kyal]

Feb 4, 2012 15:40:12 GMT -5 rklc2002 said:

I 2000 mg Vitamin D.

Is that 2000/5000 mg or IU? There is a difference.

According to the Journal of Clinical Nutrition you body uses between 3000IU and 5000IU a day. You need at least 10000IU to start raising levels in a non DS person, considering your capacity to absorb would have been lowered to below 25% your going to need at least 40000IU a day.

I believe the Vitalady plan is 100000IU.

YMMV but do the math.

K

[rklc2002]

This was my labs from 3 months. The low was Vitamin D and high were my liver counts.

WBC 6.10
RBC 5.09
Hemoglobin 14.10
Hematocrit 43.00
MCV 83.00
MCH 28.00
MCHC 33.20
RDW 15.40
Platelets 302.00
Glucose, Serum 75.00
Sodium, Serum 140.00
Potassium, Serum 3.80
Chloride, Serum 102.00
Carbon Dioxide, Total 27.00
BUN 13.00
Creatinine, Serum 0.80
BUN/Creatinine Ratio 16.25
Calcium, Serum 9.90
Protein, Total, Serum 7.00
Albumin, Serum 4.20
Globulin, Total 2.80
A/G Ratio 1.50
Bilirubin, Total 0.40
Alkaline Phosphatase, S 100.00
ALT (SGPT) 51.00
AST (SGOT) 46.00
Vitamin B12 (MMA, HCy optional) 674.00
Vitamin D, 25-Hydroxy 22.0

My doctor said that he thinks Optisource has a good coverage of my needs (at least at this point). I was doing 2000 IU Vit D, but now I'm doing 5000 IU, but I will be doing 1 of Vita-lady's 50,000 IU weekly. I also do 2 Tums nightly for the calcium. Is anyone spotting something that my doctor missed? He's a vetted surgeon, so I have a ton of faith in him.

My doctor said that because of my height and intestine length, he was able to leave my common length a little longer. My common channel as well 200 cm (620 cm in total intestine length). My losses will likely be slower, but I'm satisfied with the results so far. 69 pounds down since Oct 14.

Thanks!

[Deleted]

Where are your iron related tests? Ferritin, total iron, total iron binding capacity, %saturation.

Your D is dangerously low and 5K IU will NOT fix that. Nor will 1 50K per week. Tums are the WORST POSSIBLE option for calcium. You need calcium CITRATE (like Citrical) and you need a good 1500 mg of elemental calcium per day. MINIMUM.

Your B12 is very low as well. I would be speeding off to the doc for B12 injections, as I would have significant neurological symptoms with B12 that low.

Whatever doc is telling you this stuff is wrong. But most docs usually are about these things.

[Deleted]

Oh, and where are your protein and prealbumin levels? You need those. And vitamin A.

ETA: Ooops, I see the protein now. It is "okay" but not wonderful.

[rklc2002]

Feb 5, 2012 21:34:01 GMT -5 @en said:

Your B12 is very low as well. I would be speeding off to the doc for B12 injections, as I would have significant neurological symptoms with B12 that low.
.

I see that the Vitamin B12 is to be between 200 and 900. Mine is 674. Do you have different results on what the normal ranges should be?

I'll change up my good 'ol Tums for Citrical. My calcium seems decent though at 9.9 where normal ranges are 8.4 to 10.4.

I don't have iron results. I can't see that they have been run. For my 6 month labs, I'm scheduled for CMC, CMP, Vit B12 and Vitamin D OH-25. It looks like these are the ones that he normally runs. What labs do you have run in addition to those I mentioned above and how often? I'll follow up with my doctor on that.

[KathyF]

Do you have your PTH? I agree with EN that your D is way too low. You need to take one of those 50,000 IU of D every day. And your calcium will almost always be normal because your body will rob your bones and teeth to maintain your calcium blood levels. 2 tums is not even sufficient for someone with a normal digestive track much less one like ours.

[pandykorn]

Feb 5, 2012 21:02:40 GMT -5 rklc2002 said:

This was my labs from 3 months. The low was Vitamin D and high were my liver counts.

WBC 6.10
RBC 5.09
Hemoglobin 14.10
Hematocrit 43.00
MCV 83.00
MCH 28.00
MCHC 33.20
RDW 15.40
Platelets 302.00
Glucose, Serum 75.00
Sodium, Serum 140.00
Potassium, Serum 3.80
Chloride, Serum 102.00
Carbon Dioxide, Total 27.00
BUN 13.00
Creatinine, Serum 0.80
BUN/Creatinine Ratio 16.25
Calcium, Serum 9.90
Protein, Total, Serum 7.00
Albumin, Serum 4.20
Globulin, Total 2.80
A/G Ratio 1.50
Bilirubin, Total 0.40
Alkaline Phosphatase, S 100.00
ALT (SGPT) 51.00
AST (SGOT) 46.00
Vitamin B12 (MMA, HCy optional) 674.00
Vitamin D, 25-Hydroxy 22.0

My doctor said that he thinks Optisource has a good coverage of my needs (at least at this point). I was doing 2000 IU Vit D, but now I'm doing 5000 IU, but I will be doing 1 of Vita-lady's 50,000 IU weekly. I also do 2 Tums nightly for the calcium. Is anyone spotting something that my doctor missed? He's a vetted surgeon, so I have a ton of faith in him.

My doctor said that because of my height and intestine length, he was able to leave my common length a little longer. My common channel as well 200 cm (620 cm in total intestine length). My losses will likely be slower, but I'm satisfied with the results so far. 69 pounds down since Oct 14.

Thanks!

My D was 23 BEFORE surgery. I take 150k IU DAILY and i just got up to 44.... four months after surgery.
Your body will depelete reserves and then the D will plummit faster than you could ever hope to keep up with it. Take 50kIU or more daily. D can be pretty fickle to bring up and maintain- if it wasnt then so many Americans wouldnt have low D without surgery.

[Deleted]

There are other ways to get vitamin D. You body will make it naturally from the sun. ( or a UV-B light source, such as a tanning bed).

There has been much reseach to this effect. The link below is sorta old, but still relevent.

www.usatoday.com/news/nation/2005-05-21-doctors-sunshine-good_x.htm

[Deleted]

Feb 5, 2012 22:13:05 GMT -5 rklc2002 said:

Feb 5, 2012 21:34:01 GMT -5 @en said:

Your B12 is very low as well. I would be speeding off to the doc for B12 injections, as I would have significant neurological symptoms with B12 that low.
.

I see that the Vitamin B12 is to be between 200 and 900. Mine is 674. Do you have different results on what the normal ranges should be?

I'll change up my good 'ol Tums for Citrical. My calcium seems decent though at 9.9 where normal ranges are 8.4 to 10.4.

I don't have iron results. I can't see that they have been run. For my 6 month labs, I'm scheduled for CMC, CMP, Vit B12 and Vitamin D OH-25. It looks like these are the ones that he normally runs. What labs do you have run in addition to those I mentioned above and how often? I'll follow up with my doctor on that.

Please go to the labs folder and get familiar with Vitalady's lists. They will help you get what you really need.

The lab "norms" are for "normies." We are not normal, so many times we need more of various things than is on the lab lists.

The calcium level that gets run is not about actual calcium that you need. Calcium is an electrolyte, needed to keep your heart beating, so your body controls blood levels quite closely. Those numbers mean absolutely NOTHING about bone health. With your D so terribly low, it only goes to reason that you are not taking enough calcium.

You also need a PTH level run RIGHT NOW. Do not wait for 6-month labs. And get vitamin A RIGHT NOW as well. You are not supplementing A and you could be night blind by month 6. It's a whole lot easier to prevent deficiencies than to treat them.

Next time, use the Vitalady lab list and start aiming for the target values she suggests. What your doctor is doing is going to land you in serious business malnutrition sooner or later.

[vanishingmom]

I would be VERY interested in this as long as he could customize them to our individual needs. The shipping to the USA thing would have to be overcome too. I'm having a horrible time swallowing pills. Regardless of the trouble I take them anyway because after all this is what I signed up for. So to be able to lessen the amount would be wonderful.

The only real concern I have is the customization.

[Deleted]

Feb 6, 2012 8:09:21 GMT -5 @ds4life said:

There are other ways to get vitamin D. You body will make it naturally from the sun. ( or a UV-B light source, such as a tanning bed).

There has been much reseach to this effect. The link below is sorta old, but still relevent.

www.usatoday.com/news/nation/2005-05-21-doctors-sunshine-good_x.htm

Some people have better results than others with sunlight (or the fake variety). I've experimented with this three summers in a row and didn't even get 20 points out of it. So there's no way I'm going to expose my super pale self to a tanning bed for that measly little bit.

There are some other folks around, though, who seem to get a LOT more benefit from regular sun exposure than I do.

[Deleted]

Feb 6, 2012 8:33:26 GMT -5 vanishingmom said:

I would be VERY interested in this as long as he could customize them to our individual needs. The shipping to the USA thing would have to be overcome too. I'm having a horrible time swallowing pills. Regardless of the trouble I take them anyway because after all this is what I signed up for. So to be able to lessen the amount would be wonderful.

The only real concern I have is the customization.

You could talk to USA compounding pharmacies about this. There are a couple in our general area.

[vanishingmom]

Feb 6, 2012 8:35:38 GMT -5 @en said:

Feb 6, 2012 8:33:26 GMT -5 vanishingmom said:

I would be VERY interested in this as long as he could customize them to our individual needs. The shipping to the USA thing would have to be overcome too. I'm having a horrible time swallowing pills. Regardless of the trouble I take them anyway because after all this is what I signed up for. So to be able to lessen the amount would be wonderful.

The only real concern I have is the customization.

You could talk to USA compounding pharmacies about this. There are a couple in our general area.

Now you're going to have me on a mission lol
I bet you have links or info you just might be willing to share. How could you not? You're EN after all.

[Deleted]

Feb 4, 2012 5:53:54 GMT -5 kyal said:

...
I have been told point blank though that there is no need to take all these tablets and that a lot of them can be combined in larger dosages. Have ordered some samples of B12 + D in apple pie flavour to see if I can get the levels that I am deficient in now up to normal.

This information is potentially VERY harmful and I hope you ignore it.

If you are not yet at a place where you can commit to possibly taking 30 pills a day...then you are not yet at a place where a malabsorptive surgery is a good idea. It's like saying, "Well I'm going to get a heart transplant, but I don't think I'll need all those anti-rejection drugs." Wrong. Getting a malabsorptive surgery and NOT being ready to go on this program if your labs say you should is as much of a suicide attempt as getting a new heart when you're not quite sure you want to take all those drugs forever.

And your chemist friend likely has ZERO information on what our weird bodies need post-op.

Searching for a cheaper source is a good idea. Waiting to see what YOUR labs say you need is something that some of us do.

But taking 30 pills a day...if that's what you need to do...is just not that big a deal.

[Deleted]

Feb 5, 2012 21:02:40 GMT -5 rklc2002 said:

This was my labs from 3 months. The low was Vitamin D and high were my liver counts.

WBC 6.10
RBC 5.09
Hemoglobin 14.10
Hematocrit 43.00
MCV 83.00
MCH 28.00
MCHC 33.20
RDW 15.40
Platelets 302.00
Glucose, Serum 75.00
Sodium, Serum 140.00
Potassium, Serum 3.80
Chloride, Serum 102.00
Carbon Dioxide, Total 27.00
BUN 13.00
Creatinine, Serum 0.80
BUN/Creatinine Ratio 16.25
Calcium, Serum 9.90
Protein, Total, Serum 7.00
Albumin, Serum 4.20
Globulin, Total 2.80
A/G Ratio 1.50
Bilirubin, Total 0.40
Alkaline Phosphatase, S 100.00
ALT (SGPT) 51.00
AST (SGOT) 46.00
Vitamin B12 (MMA, HCy optional) 674.00
Vitamin D, 25-Hydroxy 22.0

My doctor said that he thinks Optisource has a good coverage of my needs (at least at this point). I was doing 2000 IU Vit D, but now I'm doing 5000 IU, but I will be doing 1 of Vita-lady's 50,000 IU weekly. I also do 2 Tums nightly for the calcium. Is anyone spotting something that my doctor missed? He's a vetted surgeon, so I have a ton of faith in him.

My doctor said that because of my height and intestine length, he was able to leave my common length a little longer. My common channel as well 200 cm (620 cm in total intestine length). My losses will likely be slower, but I'm satisfied with the results so far. 69 pounds down since Oct 14.

Thanks!

Anthone is a gentleman and a sweetie and the surgeon for a few of my friends...going back to when he was at USC. But I've never ONCE in ten years heard ANYONE say what a great followup program he has. I suspect there's a reason for that.

For example...your labs show calcium that is within normal range (if your reference ranges are similar to mine.) What they don't show is whether you are absorbing that from the food you eat...OR....if your body is "borrowing" calcium from your teeth and bones and causing you to, in a while, be toothless and have osteoporosis. You would know the answer to that question if you had the results of PTH testing...but it looks like that wasn't ordered.

So have a ton of faith in your surgeon if you choose...just don't let him slide in ordering labs you need because you don't want to offend him. And remember that MOST bariatric surgeons do not deal with the aftermath of their handiwork on a day to day basis.

[rklc2002]

Feb 5, 2012 22:47:14 GMT -5 KathyF said:

Do you have your PTH? I agree with EN that your D is way too low. You need to take one of those 50,000 IU of D every day. And your calcium will almost always be normal because your body will rob your bones and teeth to maintain your calcium blood levels. 2 tums is not even sufficient for someone with a normal digestive track much less one like ours.

Thanks. I went from the results. I didn't think about the results being skewed because of pulling it from other areas in my body. Interesting. I never thought of that!! Thank you!! This is definitely something I'm taking very seriously!!

[kyal]

Feb 6, 2012 9:21:03 GMT -5 @mscalculator said:

So have a ton of faith in your surgeon if you choose...just don't let him slide in ordering labs you need because you don't want to offend him. And remember that MOST bariatric surgeons do not deal with the aftermath of their handiwork on a day to day basis.

Who better to know about this stuff than the people who live it every day. Show me a Dr with a DS and I bet he would be a hell of a lot more knowledgeable than any old surgeon with a scalpel and the skills to do a DS.