Okay—that is an old saying about hyperparathyroidism, but I love how it flows out of my mouth so much, I thought I would use this as an excuse to talk about calcium oxalate stones. The jejunal-ileal gastric bypass Invisible manikin with only kidneys showingpatients had a high incidence of kidney stones made from it. Weight loss surgery patients who have a distal bypass, or have a duodenal switch, also have a malabsorption of fat, and can have increased absorption of oxalate, leading to stones. To counter this, the more calcium they take, the more sodium will combine with oxalate in the gut, and the less likely they will have kidney stones. Of course, there are many other types of kidney stones, and the proper way to work up kidney stones is to have the stones analyzed and then figure out what the cause is from. Nevertheless, taking calcium is a good thing for weight loss surgery patients who have under-gone the duodenal switch.

Magnesium and Phosphorus

While these should be checked yearly, with simple blood tests, there is no evidence that weight loss surgery causes a problem with their levels, nor is there evidence to consider supplementation of these minerals. Diarrhea can cause reduction of magnesium, so with some distal bypass patients a magnesium level should be checked if they are having diarrhea.

Zinc

Also the stuff used to galvanize steel, but that is for another book. Zinc can be measured, and since about 30 per cent of zinc is absorbed in the proximal bowel, some reduction can be expected in bariatric patients. Non-specific syndromes of deficiency such as rashes on the face and limbs, balding, skin ulcers, poor appetite, lethargy, taste abnormalities, or an assortment of other non-specific syndromes have been attributed to zinc. Taking a vitamin which includes zinc is a good preventative measure.

Minerals for weight loss surgery patients

Every month in some magazine they list another mineral or element which is the key to life. Some months it is iodine, copper, selenium, and a host of others. Some vitamins put everything into them, including these trace elements. We know of the toxicity of some of these, and not of others, and no doubt there will be an article about Einsteinium, or some other very small element which someone with a lab and a few bariatric patients will publish. Again, having a supplementation of some of these elements is not a problem, but some are not needed, and some might be harmful. The old saying, “just because a couple of aspirin are good doesn’t mean you need to take the whole bottle.”

Iron stores

Recommend Ferrous Sulfate or Ferrous Gluconate 300-350 mg per day. This should not be taken with Calcium. Chromagen Forte does provide a better source of iron than the other two, however this is by prescription.

Vitamin Chart

One A DayFlintstonesCentrum
Chew
Vista
Vitamin A100%100%70%100%
Vitamin D100%100%100%100%
Vitamin E100%100%100%167%
Vitamin K31%0%13%75%
Thiamin (B1) 100%100%100%800%
Riboflavin (B2)100%100%100%765%
Niacin (B3)100%100%100%80%
Pyridoxine (B6)100%100%100%700%
Folate100%100%100%100%
Calcium16%10%11%15%
Iron100%100%100%22%
Zinc100%100%100%73%
Vitamin C200%100%100%200%

Calcium supplements

Viactive500 mg Calcium Carbonate 25% Vit. D 50% Vit. K
Cal-1001000 mg Calcium Carbonate (dissolves in liquid)
Citracal
(ultradense)
2 tablets 400 mg Calcium Citrate
Tums500 mg of Calcium Carbonate
Tums 5001250 Calcium Carbonate

Calcium and iron should NOT be taken together.