1. Reading Supplement Labels

2. Supplement Facts Serving Size # of pills to take
Serving size is the number of pills that make up the daily requirement or the amount represented on the label
Be sure to read the serving size – it is different for many supplements
Under supplement facts, the serving size tells you how many pills make up the amount and % daily value. Consult the directions to determine how many pills are to be taken daily. It is also important to point out to patients that whatever amounts are listed on the supplement facts, need to be divided by the # of pills in the serving size to determine how much of each supplement is in each pill.
This is usually understood with exception of calories. Patients are often confused by the number of calories that are in each (chewable) pill.

3. Supplement Facts
(1)serving size and (2)amount of a vitamin or mineral per serving must match
A product cannot list the serving size as 2 tablets and the amount of a vitamin per serving for one tablet. 1 2
According to FDA guidelines, the (1)serving size and (2)amount per serving must match. A product cannot list the serving size as 2 and the amount per serving as 1.
But because the FDA does not aggressively regulate and police companies, some companies choose to ignore this.

4. Supplement Facts
The Daily Value is the amount of a specific vitamin or mineral needed each day for most people. The amount in each serving is measured as a percentage
Daily Values are not specific for gastric bypass and you may be encouraged to take more than the daily value
Levels are determined by the FDA.
% DV (% Daily Value) is the amount of a specific vitamin / mineral needed daily, measured as a percentage. These levels are specified by the FDA. These values are not determined for surgical weight loss patients, so in most cases your requirements will exceed the daily value %.

5. Supplement Facts Units of measure or weight such as IU, mg, mcg
Check the amount of a vitamin or mineral in a serving against the amount recommended by your bariatric team.
You may need more than one serving per day to meet these recommendations.
Units of measure such as IU, mg, mcg specify the quantity of each vitamin or mineral that is contained in the serving size.
1 g = 1000 mg
1 mg = 1000 mcg
.3 mcg = 1 IU

6. Supplement Facts
The form of each nutrient is as important as the amount!
Some forms of vitamins are better for surgical weight loss patients.
Look for:
Ferrous Fumarate (iron)
Calcium Citrate
Vitamin D3 (Cholecalciferol)

7. Supplement Facts
What does it mean when a nutrient is made up of more than one form?
Does the order matter?
Why do some have % and some don’t?
It really depends on the vitamin or mineral that we are discussing. With vitamin A, there is a definitive reason that some manufacturers utilize a blend. The thought is that a blended approach to vitamin A is the safest and most effective approach to having only pre-formed (acetate or palmitate) or water soluble beta-carotene.
In the case of magnesium or calcium, the use of forms such as oxide or phosphate are because they take up much less space in the tablet / capsule. But as we know with these minerals that citrate is much more readily absorbed. With calcium, the citrate form is an absolute. With magnesium, look for a supplement that has as high a % of magnesium as possible.
You need to be cautious of products that list oxide first without the %. This may mean that they are only putting in trace amounts to claim the form on their label. The product listed first without % may be anywhere from 51%-99% with the second product being anywhere from 1%-49%.

8. Directions Panel
The directions will provide instruction on how, when and how much you are to take of a given supplement.
They will also provide product care instructions.
If they contain iron, they must have an iron overdose warning.
They must contain an FDA disclaimer.
A companies full address must be listed on each bottle. 1 2 3 4 5

9. Directions Panel
The expiration date and lot number (manufacturing tracking number) must also be listed.
These will be stamped on to a bottle during production (side or bottom).
0340C7 EXP 04/09
The expiration date and lot number (manufacturing tracking number) must also be listed.
-If a product passes the expiration date, the effectiveness of the contents cannot be guaranteed.
-The lot number will help identify the bottle in the event of a problem.

10. Multivitamin Guidelines (RXY, Sleeve or BPD/DS)
Vitamins A,C,D,E Min 200% RDI (%DV)
Folic Acid Min 100% RDI (%DV)
B Vitamins Min 200% RDI (%DV)
B mcg per day
Avoid time released
Avoid enteric coating
Avoid incomplete children’s formulas
Begin with chewable or liquid and progress to capsule as tolerated.
Note that we do not recommend taking a tablet MVI Unless a tablet is made specifically for rapid release, it is unlikely that it will break down properly in the gut following surgery Even if it is developed this way, because of the large number of nutrients that is involved in a MVI, a greater amount of bonding agents are required along with increased pressure to properly form and hold these types of pills. So it would still be unlikely to absorb completely in a surgically altered gut. Today, I know of no products that meet this requirement.
Aills L, Blankenship J, Buffington C, et al.  Bariatric Nutrition: Suggestions for the Surgical
Weight Loss Patient.  SOARD September 2008, preprint accessed on 7/8/07 at

11. Multivitamin Guidelines (Lap Band)
Minimum 100% RDI (%DV)
Avoid time released
Avoid enteric coating
Avoid incomplete children’s formulas
Begin with chewable or liquid and progress to capsule as tolerated. Ag

12. Calcium Guidelines (RXY or BPD/DS)
AGB
RYGB
BPD/DS
Calcium Citrate
1,500
1,500-2,000
1,800-2,400
*Levels indicated are mg/day
Max mg of Calcium per serving, this is usually at least 2 pills. Be sure to check the serving size on calcium
Products that contain magnesium and a minimum of 400 IU of Vitamin D are preferred.
Begin with chewable / liquid and progress to capsule or tablet as tolerated.
Do not take with iron or with multivitamins that contain iron. Separate dose by a minimum of 2 hours)

13. Iron Guidelines Iron dosage 18-30 mg per day.
Menstruating women and those at risk for anemia, including men, are encouraged to take mg per day of iron.*
Avoid enteric coated
Avoid excessive intake of tea.
Vitamin C may enhance absorption iron.
* Consult your dietitian or surgeon regarding proper dosage.

14. Purchasing Vitamins Do Don’t Read labels. Buy from reputable vendors.
Check expiration dates.
Ask about return policies.
Keep your iron supplements away from children.
Don’t
Purchase from dollar or deep discount stores which may have inferior products.
Share your vitamins with children or other family members who don’t have the same needs.