Everyone requires vitamins following bariatric surgery. Without taking daily vitamins, there is a significant risk for nutritional deficiencies. Before bariatric surgery, you likely were able to meet most of your dietary needs with your diet. Yet, even so, most bariatric surgery patients struggle with vitamin deficiencies even before surgery. Here are 8 tips to help you stick to your bariatric vitamin schedule so you can achieve all of your health goals.

Tip #1: Know what vitamins you need to take

Taking the right vitamins for you is the obvious first step in creating and sticking to a vitamin regimen. Everyone has unique vitamin requirements after bariatric surgery. Your vitamin needs depend on:

• What type of bariatric surgery you have
• Your medical history (such as other health conditions)
• Your lab results
• Your age, sex, and if you are pregnant or breastfeeding

Because every person is unique, bariatric surgery patients require a personalized vitamin regimen. To decide what vitamins you need to take, you will want to work closely with your bariatric surgeon and a nutritionist. Your doctor will likely recommend you get bloodwork regularly following surgery to meet your nutritional needs.

The American Society for Metabolic and Bariatric Surgery has a specific recommendations for each type of surgery. However, there are some general recommendations that will apply for most bariatric patients. It may need some tweaking based on your individual needs:

Vitamins B1 (thiamine) - Minimum of 12 mg daily. Ideally, patients will take 50 mg daily from a B-complex multivitamin.

Vitamins B12 (Cobalamin) - Vitamin B12 can be taken via oral, intranasal, or intramuscular routes. Oral B12 is not always ideal, as changes in your gut anatomy make it harder to absorb B12 due to a lack of intrinsic factors. Therefore, intranasal or intramuscular doses lead to better absorption.

• Oral B12 - 350-500 mcg daily (liquid, pill, or sublingual tablet)
• Nasal spray - dose depends on the manufacturer
• Intramuscular injection - 1000 mcg monthly

Folate - 400-800 mcg daily through a multivitamin. (This dose needs to be higher for women who are pregnant or may become pregnant).

Iron - At least 45-60 mg daily. However, menstruating women often require higher doses to prevent anemia.

Vitamin D and calcium - Most bariatric surgery patients need 1200-1500 mg/d of calcium daily. Doses of vitamin D depend on your blood levels, so this is one of the labs that your doctor will regularly check. Keep in mind and your skin also synthesizes vitamin D with sun exposure, so your time outside may also impact your vitamin D levels.

Vitamin A, E, and K - Dosing for these vitamins depends on your type of bariatric surgery. For example, people who have gastric bypass surgery need: Vitamin A = 5,000-10,000 IU/d, Vitamin E = 15 mg/d, Vitamin K = 90-120 ug/d

Zinc - Most people can get the zinc they need through a multivitamin. Make sure your multivitamin contains 100-200% of your recommended dietary allowance (RDA) for minerals.

Copper - 2 mg/d, which often is in a multivitamin, or 200% of the RDA

Tips #2: The form of the vitamin can affect the absorption

There are a few restrictions for people who have bariatric surgery. Firstly, gummy vitamins are not recommended for people after bariatric surgery. Gummy vitamins often do not meet your RDAs, and they can also be hard to break down in your gut, especially right after surgery. Additionally, they usually have sugars and other additives that can irritate your stomach.

Secondly, many people struggle to swallow and digest pills shortly after surgery. Eventually, you should be able to tolerate medications just fine. Still, in the first few weeks after surgery, you may be better off taking liquid suspensions of your vitamins and minerals, if possible.

Tip #3: Watch out for any interactions

Some medications can interfere with your ability to absorb specific vitamins and minerals. The best way to determine if you have any interactions with your medications is to make sure your doctor knows everything you are taking. For example, people taking thyroid medication like Synthroid (levothyroxine) should separate this medication from when they take calcium by at least 4 hours. Calcium blocks levothyroxine absorption, so it can cause you to have a worsening of your symptoms of hypothyroidism.

Also, some vitamins need to be taken separately from other vitamins, like calcium and iron. Additionally, calcium can be found in some medications like antacids to help with acid reflux or heartburn.

Tip #4: Schedule when you take your vitamins around meals

Remembering to take your vitamins can be challenging, so creating a vitamin schedule around mealtimes can be an easy way to remember to take them. For example, people often start their day with a small protein-rich breakfast like a protein shake and their multivitamin. Then, about 3-4 hours later, they take their calcium supplement to separate it from certain morning medications and iron in their multivitamin.

It is helpful to work with a nutritionist to design your post-bariatric surgery vitamin regimen and help you create meal plans that maximize your nutrient intake while keeping calories and volume at a minimum.

Tip #5: Sign up for a vitamin subscription plan so you never run out

Life often gets the best of us, and we forget to refill our medications or swing by the store to pick up more vitamins before we run out. Fortunately, there are creative ways to ensure you never run out of your necessary vitamins and minerals. Many companies now offer vitamin subscription plans so that they get mailed to you on a regular schedule. Because you take the same amount of vitamins each month, a subscription plan can offer a predictable and reliable solution for people who often run out of their vitamins.

Tip #6: Set specific alarms or reminders, especially at the beginning

Most of us are quite attached to our smartphones, so using the alarm or reminder system on your phone is a great way to stay on top of your vitamin schedule. It can be hard to remember your vitamins right after surgery, as it is usually a new addition to your routine. Furthermore, it can be even harder to remember them once you go back to work, as you will be less focused on your recovery and more concerned with other tasks at hand.

Tip #7: Use a pillbox

Pillboxes are an excellent solution for all types of medications, including your supplements. There are so many different pillboxes on the market, including those that alarm when it is time to take your next dose or simple ones that separate the days of the week. Shop for a pillbox that works for you and spend a little time at the beginning of each week setting up your vitamins so that you don’t have to fuss with it every time you take your vitamins throughout the week.

Tip #8: Put your vitamins in an obvious place

There likely is a spot or two in your home where you find yourself multiple times a day. Perhaps it is at the kitchen sink or on the bathroom counter. Put your vitamins in a place where you are sure to see them that will help cue you to take them on time. Some people even keep them on their work desk, so they serve as a frequent reminder not to miss a dose.

Now that you have had a chance to peruse some ideas for staying on top of taking your vitamins, it is time to meet with your doctor to make sure you are taking the right vitamins. Once you have verified this information, you can create a personalized bariatric vitamin regimen that works for you and helps you stay on track with your health goals.