OPURITY- Bypass-Optimized Chewable Multi
What do we mean by “Optimized”? What are Optimal Vitamin Intakes?
We started with the ASMBS
[1] recommendations
[2] and the research that was the basis for the recommendations. We then did a full review of the medical literature – by nutrient – for bypass patients. We got input from PhDs, MDs, and Registered Dietitians who work with Bariataric Patients.
Here are the highlights for key nutrients:
Vitamin D
Vitamin D is important for calcium absorption, bone health and plays a role in prevention of certain types of cancer, heart disease and other chronic disorders. Supplemental Vitamin D, combined with calcium, is essential because bone loss is a common problem following weight loss surgery.
OPURITY uses all Vitamin D3, the form of Vitamin D made by the human body.
Studies have found that 60% to 80% of bariatric pre-op candidates have low Vitamin D.
The ASMBS recommends double the standard RDI of 400 IU, that is, 800 IU per day.
We believe 800 IU might also be insufficient for two reasons: a) there is limited data on the needs of gastric bypass patients, and b) the recommendations for the RDI are also under review, and might be raised. At the same time, the risk of overdose toxicity from 1200 IU, for bypass patients is extremely low.
About so-called “Dry” or “water-miscible” Vitamin D”
Some vitamin makers appear to imply that so-called “dry” or “water-miscible” Vitamin D might have superior absorption. We found no support for this, nor any reason to believe it. “Dry” Vitamin D is actually regular Vitamin D that is encased in a capsule. So in fact, the Dry Vitamin D (or Vitamin A or Vitamin E) requires an extra step for absorption – removing the encapsulation – to be to where the regular Vitamin D already is.
Vitamin B12
Vitamin B12 is an essential nutrient required for healthy blood cells and to preserve normal nerve function. Changes created in the gut by gastric bypass surgery result in depleted Vitamin stores because absorption from food is limited and ultimately results in a Vitamin B12 deficiency.
There are two key steps necessary to absorb Vitamin B12:
1. Vitamin B12 in food is always bound to a carrier. Once food containing Vitamin B12 reaches the stomach, the acidic environment is ideal to break the Vitamin B12 from the carrier.
2. Also, intrinsic factor, a compound needed for active absorption of Vitamin B12, is synthesized in the stomach. Both of these steps in Vitamin B12 absorption are hindered because weight loss surgery reduces the size of the stomach, the acidity of the stomach and the ability to produce enough intrinsic factor.
It is possible to absorb Vitamin B12 without intrinsic factor if intakes are very high. A limited set of studies have shown that individuals given high levels of Vitamin B12 can absorb about 1%-2% even in a low acid environment and without intrinsic factor. This is called “passive” absorption. OPURITY™ provides 5833% of the daily need as recommended by bariatric experts.
However, patients should remember that a Vitamin B12 deficiency results in permanent damage to the nervous system. It is essential to have regular medical check-ups and lab testing to confirm that you are meeting your Vitamin B12 needs. Until medical research more thoroughly confirms the reliability of passive absorption, patients should not rely on this approach without regular testing.
Thiamin, Riboflavin, Niacin and Vitamin B6
All of these “B” vitamins have important roles, and OPURITY™ Bypass-Optimized Multi provides 200% of the RDI, consistent with ASMBS Guidelines.
It is particularly important to supplement with Thiamin because the “reserves” in the body are small, and need daily replacement. In one study, 15% of pre-bariatric surgery patients were low in thiamin.
Folic Acid
Folic acid is an important B-complex vitamin. Deficiencies can lead to weakness, fatigue, difficulty with concentration, and irritability. However, overdoses have risks as well. Overdoses can mask B12 deficiency. OPURITY™ provides 800 mcg, which is considered sufficient for bypass patients, but not enough to mask any potential B12 deficiency.
Iron
Iron deficiency anemia is the most common nutritional deficiency in the world.
Your entire body needs oxygen, and every cell depends on red blood cells to deliver that oxygen. To build red blood cells, iron is essential. Supplemental iron is needed to prevent anemia, a common side effect of weight loss surgery. Common symptoms of anemia are fatigue, and reduced capacity to exercise.
Getting enough iron is difficult because the body normally absorbs only 10% of iron from foods. Iron absorption is greatest in an acidic environment. Weight loss surgery reduces the size of the stomach and its ability to make enough acid for the best iron absorption. Plus, gastric bypass usually bypasses the duodenum and proximal jejunum, the most efficient absorption sites.
OPURITY uses a special iron, Ferronyl® Iron, which supports easier digestion, more complete absorption, and thus good iron levels in the blood. Each tablet has 30 grams, consistent with ASMBS recommendations.
A note about Iron in multivitamins, and calcium: Calcium blocks iron absorption depending on how much calcium is present. OPURITY™ Bypass-Optimized Multi uses only moderately low levels of calcium to minimize interference with iron absorption. We provide a separate chewable, Calcium Citrate Plus, which we recommend be taken at different times.
Vitamin A
Vitamin A is important to maintaining good vision, gene expression, growth and immune function and more. At the same time, excessive Vitamin A can be toxic as well; chronic toxicity can cause reduced bone density, disorders of the brain and spinal cord, and liver abnormalities. For these reasons, it is most important to get Vitamin A dosage right.
At the same time, each source of Vitamin A has strengths and weaknesses. Beta-carotene has reduced overdose toxicity risks. Vitamin A Acetate has efficacy advantages. For these reasons, we believe a mix of half Acetate, half Beta-carotene is optimal.
Vitamin C
A 2009 study in Obesity Surgery reports that almost 50% of pre-surgery patients are deficient in Vitamin C. OPURITY- Bypass-Optimized Chewable Multi provides 200% of the RDI for Vitamin C, consistent with ASMBS Guidelines.
What’s different about OPURITY™ is the source of our Vitamin C. Approximately 90% of the world’s ascorbic acid (Vitamin C) is made in China. It’s an excellent bet the multi you have been using uses ingredients from China, including Vitamin C. OPURITY uses no ingredients from China, for your safety.
Calcium
Sufficient calcium is essential to maintenance of healthy strong bones. The duodenum and proximal jejunum are important sites for calcium absorption, and these are usually bypassed in RNY Gastric Bypass Surgery. As a result, because bone loss is a common problem following weight loss surgery, use of a calcium plus Vitamin D supplement is essential.
Because higher doses of calcium inhibit iron absorption, we use only low levels of calcium in our multivitamins. Your primary sources of calcium should be a combination of dairy foods and calcium-specific supplements taken at a different time from the multivitamin.
Other Ingredients
Sugar alcohols: We use no sugar alcohols and never will.
Other bariatric multivitamins DO use mannitol or sorbitol. Why you care:
the Cleveland Clinic notes, “sugar alcohols can cause diarrhea, bloating, or gas”.
Check the label of your previous multivitamin brand.
Artificial Colors: OPURITY™ Multivitamins use no artificial color.
Check your (check your bariatric brand for “FD&C colors” or “yellow #6” or “red #40”). Many people prefer to avoid them. Other bariatric multivitamins use them.
Sweeteners: OPURITY™ multivitamins use approximately 1.5 grams of a combination of dextrose and fructose, as well as a small amount of sucralose.
Every bariatric brand we checked does use one or more sugars, a high-intensity artificial sweetener, and most use a sugar alcohol as well.
[1] American Society for Metabolic and Bariatric Surgery
[2] Aills L, Blankenship J, Buffington C, Furtado M, and Parrott J. (2008). ASMBS Allied Health nutritional guidelines for the surgical weight loss patient. Surgery for Obesity and Related Diseases, 4, S73-108.
