Weight Loss Surgery - Nutritional Supplements after WLS

Without going into a huge long pitch for my own credentials - I educate people as to the therapeutic use of supplements for a variety of health issues as part of my professional life (among other things). Since there are so many questions about supplements, and since some of the suggested levels are inadequate for people who have had WLS I wanted to post this information again. This isn't an all inclusive list. There are certainly other supplements that are important but I didn't want to open the floodgates and overwhelm in one post. So I've written some of the more critical ones in my view. *Anyone who has questions about my credentials can PM me. *

Biotin - recommended generally for therapeutic purposes (as opposed to daily optimal) in ranges of 8-9000 mcg.

Zinc - supplement MUST have copper added to prevent further problems. Hair loss can be associated with Zinc deficiency. Take 30 mg. supplement in a form that has copper added to prevent copper deficiency as well.

CLA - Conjugated Linoleic Acid is a critical supplement. - 750 mg.

B12 and Folic Acid- 5000 mcg of B12 and 400 - 800 of Folic. *Note* Most B12 supplements are in the 500 to 1000 mg levels and for anyone who has had WLS or who has any heart health concerns these levels are too low.

Chromium - 200 mcg

Alpha Lipoic Acid - 1200 mg daily and must be taken before you eat. It needs the food on top of it. This is normally consumed with a morning meal, and then again with an evening meal. ALA is prescribed in European countries instead of glucophage (Metformin) but must be taken in proper doses. Its is highly successful in treating Insulin resistance.

Calcium - I never suggest less than 1200mg. of calcium daily no matter what the source. Recent studies have shown that when women increased their lactate calcium levels with NO other weight loss efforts, they lost weight. The benefits were measurable with as little as an increase of 600mg. daily, then upward in increments of 900 and optimal with 1200 mg. daily. There have been three large studies documenting this and the benefits seemed dependent on the calcium coming from a dairy source. This also seems of particular benefit to women with PCOS.

Iron - A good liquid multivitamin can be your best source of supplemental iron. But nothing beats spinach!

Vitamin C is critical. Minimum 2500 mg. daily and I prefer at least 3000 up to 6000. Increase from what you're taking currently gradually to avoid hitting what is called bowel tolerance which means you get the runs.

CoEnzyme Q10 - strong antioxidant, important to support the heart especially during weight loss. 200 mg. daily minimum dosage recommended. This is an expensive supplement but a critically important nutrient.

L-Carnitine - for those of you fortunate to live in the US because we can't get it in Canada. This amino acid is proving to be a significant aid in both leptin resistance and insulin resistance. The benefits in weight loss are well documented and daily dose is suggested to be 1-5000 mg. daily and taken one time a day. Well worth trying.

Last but not least - PROTEIN. Each person metabolizes protein differently and some people do better with one source over another. Soya is the least desirable. Particularly in light of the estrogen surge that happens with radical weight loss anyway. Some people can get more from whey sourced protein, some need egg, some dairy and so forth. Just because you're getting enough protein in grams does not mean your body is getting it from a protein source that is optimal for you.

Thanks for the info Hubs! I copied it into my journal so I can refer back to as I need to.

I found out the hard way that you really have to make sure you are getting enough iron & that your doctor is doing the correct test to monitor your iron levels. All my metabolic panels have been coming back okay, so my old internist assumed everything was okay...new one did a more specific test for iron & I'm anemic (irronically she did it because of slightly elevated liver enzymes & expected it to be high, not low). Who knows how long this has been going on, but I can tell a difference since I started the prescription iron supplements.

Oh Hubs, THANK YOU!!! This is such a wonderful list and I love the way you have explained the "whys" of each one. I have copied it so I can refer back to as well. I see some pretty glaring holes in my regimin and I don't want to take any chances for issues down the line.

Hubs, thank you so much for putting this down for all of us. I can't think of anything more helpful.

I have a question though ~ how does one know what type of protein is optimal for their body?

Protein is something I think should best be handled by understanding it the same way we've talked about different sources of calcium. I think protein is one food group that people get a pretty good sense of in terms of what works for them. When proteins aren't being properly digested they create all sorts of problems.

My best suggestion is to rotate as much as possible. If chicken doesn't work, try turkey or fish. If scrambled eggs are a problem, try poached. If mozzarella or other soft cheeses don't feel comfortable, add parmesan. The general rule of thumb is that dairy or animal sourced proteins have complete amino acids but if you don't eat much animal protein then remember that grains and legumes have to be combined. Its tough to get enough protein through grains and legumes without finding yourself HEAVY into carb problems at the same time. Nuts and seeds are a great addition but chew them really well.

Which is another point. We all know to chew our food so it doesn't get stuck, but even that may not be enough. The digestive enyzmes in our saliva are so important and really, you can't chew your food enough. For some people, particularly with proteins, supplemental enzymes can be a godsend.

One other important comment I'd like to make is about water. Water is SO important and I'm a proponent of the 8 cups a day rule. BUT! Those of you who drink water with meals, especially just before eating or with food are going to have WAY more difficulty getting your nutrients out of your food simply because you're washing away those digestive enzymes and diluting them at the most critical point. Try to drink your fluids (all fluids not just water) seperately and between meals.

LessLori, this is the thread I was talking about. Zinc deficiency in particular can factor into hair loss as well as the B vitamins.