Practitioner’s Facts

Why use an “all-inclusive” chewable supplement?

Compliance with any multivitamin supplement regimen can be difficult. Nutritional deficiency, as a result of gastric bypass surgery, is an eventuality without any form of supplementation and even with compliance of a standard multivitamin supplement1. An “all-inclusive” supplement like Bariatric Fusion® improves compliance by decreasing the number of tablets patients need to take to help prevent the risk of developing these deficiencies from the start. The nature of a chewable supplement makes the bariatric vitamins and minerals more available for absorption since the micronutrients begin to be broken down before they reach absorption sites.

What is the benefit of using Vitamin B12 in the form of methylcobalamin vs. cyanocobalamin?

The central nervous system is dependent upon Vitamin B12 for normal function since it is essential for healthy cell replication and growth. Vitamin B12 deficiency is a well-known and common micronutrient deficiency after gastric bypass surgery. Deficiency can lead to impaired cell division resulting in the development of abnormally large cells characteristic of megaloblastic anemia. Neurological symptoms of this type of anemia include general fatigue, numbness, tingling and burning of the feet, and stiffness and generalized weakness of the legs. B12 deficiency can also result from atrophy of gastric parietal cells which can contribute to pernicious anemia.

Cyanocobalamin is converted by the liver into methylcobalamin, the more biologically active coenzyme form of Vitamin B12. This means that the body can use methylcobalamin as is, and does not require any metabolic steps to make it readily available within the central nervous system. Methylcobalamin is used to formulate Bariatric Fusion®, thus making it superior to other forms in the prevention of B12 deficiency and potential neurological complications.

If bariatric surgery patients have less, if any, stomach acid and intrinsic factor, isn’t supplementing with Vitamin B12 ineffective?

Stomach acid is necessary to release B12 from ingested food. Intrinsic factor then binds to Vitamin B12 that has been cleaved from food and helps make it readily available for absorption by active transport. After gastric bypass surgery, it is impossible to consume enough Vitamin B12 in rich foods via diet to meet a patient’s daily needs.

Supplemental Vitamin B12, in a more biologically available form such as methylcobalamin, is passively absorbed later in the digestive tract. At low efficiency, only 1-2% of the available amount of Vitamin B12 is absorbed by simple diffusion, a larger quantity of B12 must be present for potential absorption.

Bariatric Fusion® contains 9,332% DV of Vitamin B12. Although this may seem like an excessive amount of this vital micronutrient, any unused amounts of B12 beyond the body’s actual needs, are simply eliminated and do not become toxic.

Why are calcium carbonate and calcium citrate used?

Most supplements on the market today will choose to either use calcium carbonate or require patients to take additional tablets along with their multivitamin in order to offer calcium citrate. Bariatric Fusion® offers both forms of calcium in order to keep the tablet small, yet ensure better calcium absorption than any other bariatric multivitamin/mineral supplement.

The U.S. Food & Drug Administration has approved calcium carbonate as a safe and reliable source of calcium. Studies have shown that calcium absorption from calcium carbonate is best when taken with meals. After gastric bypass surgery, the small pouch produces less gastric acid than the stomach as a whole but still maintains an acidic pH2.

We recommend that Bariatric Fusion® be taken with food, unless otherwise directed by a healthcare provider, because of easier ingestion of calcium carbonate and better palatability when chewed3. Taking Bariatric Fusion® at mealtimes will promote better calcium absorption in the post-gastric bypass stomach and help patients establish a regular routine that improves overall compliance.

Why does Bariatric Fusion® contain so much Vitamin D when the RDI is only 200–400 IU daily for most adults?

Vitamin D is important for effective calcium absorption and utilization. It may also play an important role in the prevention of certain types of cancer, reduction of heart disease and in the management of depression. Recent studies have shown a need for increased levels of Vitamin D on a daily basis than previously recommended4. Persons living in northern latitudes actually have an increased requirement of Vitamin D based on lack of exposure to sunshine during colder months.

To meet these increased needs, supplementation is typically recommended. Bariatric Fusion® contains 2000 IU of Vitamin D, specifically in the form of D3 from cholecalciferol, which is easier on the liver than the D2 form.

Are iron and calcium absorbed when combined together in the same tablet?

Iron aids in the body’s ability to manufacture enough red blood cells to transport oxygen to all areas of the body. A deficiency in Iron results in anemia. Calcium can inhibit the absorption of Iron in the body. We know that certain factors can affect Iron absorption when Calcium is present, either as food or in a supplement5.

These factors are the

  1. form of iron: Bariatric Fusion® uses ferrous fumarate, which is readily available for absorption and less constipating than other types of iron.
  2. form of the food or supplement: Bariatric Fusion®, a chewable supplement, ensures all the bariatric vitamins and minerals contained are in one of the most available forms for adequate absorption.
  3. ratio of iron to calcium: Bariatric Fusion® only has a ratio of 0.4 mg of calcium to 0.01 mg of iron. To have an inhibitory effect of calcium on iron absorption, the ratio would need to be as high as 3 mg of calcium to 0.01 mg of iron6.

Plus, Bariatric Fusion® includes Vitamin C (ascorbic acid), which aids in iron absorption, and Vitamin D to promote calcium absorption.

Why isn’t there any Vitamin K in Bariatric Fusion®?

Vitamin K is not included in Bariatric Fusion® so as to better manage patients on anti-coagulant therapy. The adult RDI for Vitamin K is 120 mcg for males and 90 mcg for females. It is fairly easy to get enough Vitamin K from a diet, for example, that includes just 3.5 ounces of leafy greens or 1/2 cup of beans and a serving of peanut butter on a daily basis.

Is Bariatric Fusion® the only multiple bariatric vitamin weight-loss surgery patients will ever need?

While no one bariatric vitamin is perfect, Bariatric Fusion® was specially tailored to meet the needs of gastric bypass patients and prevent micronutrient deficiencies that may occur. This chewable supplement ensures better absorption, contains chelated minerals and includes high levels of Vitamin B12, calcium, Vitamin D, folate, and Biotin to maintain proper health and nutrition. The need for additional supplementation would be determined based on individual patient needs due to certain medical conditions and routine lab screening.

References

  1. Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008:87:1128-33.
  2. Miller AD, Smith, KM. Medication and nutrient administration considerations after bariatric surgery. AM J Health-Syst Pharm. 2006;63(19):1852-1857.
  3. McMahon MM, Sarr MG, Clark MM, Gall MM, Knoetgen J, Service J, Laskowski ER, Hurley DL. Clinical Management after Bariatric Surgery: Value of Multidisciplinary Approach. Mayo Clin. Proc. 2006:October;81(10,suppl): S34-S45.
  4. Cannell JJ, Hollis BW, Zasloff M, Heaney RP. Diagnosis and treatment of Vitamin D deficiency. Expert Opin Pharmacother. 2008;9(1):1-12.
  5. Hallberg L. Does Calcium interfere with Iron absorption?. Am J Clin Nutr. 1998;68:3-4.
  6. Hallberg L, Brune M, Erlandsson M, Sandberg AS, Rossander-Hulten L. Calcium: effect of different amounts of nonheme-and heme Iron absorption in humans. Am J Clin Nutr. 1991;53:112-9
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