First off, I must apologize for a lack of pictures in the following post.  My laptop is in pieces on a desk across from me, and I’m waiting for a new one to be delivered.  I am very sad about this unfortunate turn of events as my laptop was my close and dear friend.. but c’est la vie.

It seems for every fad diet there is out there, there is a MLM, or multi-level-marketing company willing to cater to it.  I’ve been asked a number of times about several of these, so I’ve decided to tackle a few of the companies in a series of posts.  While I won’t be covering ALL of the products put out by a company, I will try to cover those most likely pitched to WLS patients.

In all cases, I will be using ASMBS guidelines for supplementation.  As always, use your labs as a final guide for your own supplementation regimen.  As a reminder, those recommendations are as follows:

Multivitamin
- Adjustable Gastric Band/VSG: 100% of daily value
- RNY: 200% of daily value
- BPD/DS: 200% of daily value

  • Choose a multivitamin that is a high-potency vitamin containing 100% of daily value for at least 100% of daily value of 2/3 of nutrients
  • Begin with chewable or liquid
  • Progress to whole tablet/capsule as tolerated
  • Avoid time-released supplements
  • Avoid enteric coating
  • Choose a complete formula containing at least 18 mg iron, 400mcg folic acid, as well as selenium, and zinc in each serving
  • Avoid children’s formulas that are incomplete
  • May improve gastrointestinal tolerance when taken close to food intake
  • May separate dosage
  • Do not mix multivitamin containing iron with calcium supplement, take at least 2 hours apart
  • Individual brands should be reviewed for absorption rate and bioavailability
  • Specialized bariatric formulations are available

Additional cobalamin (B12)
- AGB/VSG: Not Applicable
- RNY: 350-500mcg if taken orally, 1000mcg / mo intramuscular injection
- BPD/DS: NA

Additional elemental calcium
- AGB/VSG: 1500mg /day
- RNY: 1500-2000mg
- BPD/DS: 1800-2400mg

  • Choose a brand that contains calcium citrate and vitamin D3
  • Begin with chewable or liquid
  • Progress to whole tablet / capsule as tolerated
  • Split into 500-600 mg doses; be mindful of serving size on supplement label
  • Space doses evenly throughout day
  • Suggest a brand that contains magnesium, especially for BPD/DS
  • Do not combine calcium with iron containing supplements
  • Wait 2 or more hours after taking multivite or iron supplement to take
  • Wait 2 or more hours between doses
  • Promote intake of dairy beverages and/or foods that are significant sources of dietary calcium in addition to recommended supplements
  • Combined dietary and supplemental calcium intake greater than 1700 mg/day might be required to prevent bone loss during rapid weight loss

Additional elemental iron
- AGB / VSG: NA
- RNY: Minimum 18-27mg / day elemental
- BPD/DS: Minimum 18-27mg / day elemental

  • Recommended for menstruating women and those at risk of anemia
  • Begin with chewable or liquid
  • Progress to tablet as tolerated
  • Dosage may need to be adjusted based on biochemical markers
  • No enteric coating
  • Do not mix iron and calcium supplements, take at least 2 hours apart
  • Avoid excessive intake of tea due to tannin interaction
  • Encourage foods rich in heme iron
  • Vitamin C may enhance absorption of non-heme iron sources

Fat-soluble vitamins
- AGB / VSG: NA
- RNY: NA
- BPD/DS: 10,000 IU of vitamin A, 2000 IU of vitamin D, 300 mcg of vitamin K

  • With all procedures, higher maintenance doses may be required for those with a history of deficieincy
  • Water-soluble preparations of fat-soluble vitamins are available
  • Retinol sources of vitamin A should be used to calculate dosage
  • Most supplements contain a high percentage of beta carotene which does not contribute to vitamin A toxicity
  • Intake of 2000 IU vitamin D3 may be achieved with careful selection of multivitamin and calcium supplements
  • No toxic effect known for Vitamin K1, phytonadione (phyloquinone)
  • Vitamin K requirement varies with dietary sources and colonic production
  • Caution with vitamin K supplementation should be used for patients receiving coagulation therapy
  • Vitamin E deficiency is not prevalent in published studies

Optional B complex
- AGB / VSG: 1 per day
- RNY: 1 per day
- BPD/DS: 1 per day

  • B-50 dosage
  • Liquid form is available
  • Avoid time released tablets
  • No known risk of toxicity
  • May provide additional prophylaxis against B-vitamin deficiencies, including thiamin, especially for BPD/DS procedures as water-soluble vitamins are absorbed in the proximal jejunum
  • Note >1000mg of supplemental folic acid provided in combination with multivitamins could mask B12 deficiency

The first product up for review is Nutrilite Double X Vitamin/Mineral/Phytonutrient.

Nutrilite says:

DOUBLE X Vitamin/Mineral/Phytonutrient supplement delivers a blend of essentials – 12 vitamins and 10 minerals. It features 20 plant concentrates for even broader antioxidant protection and unbeatable health benefits.

Description
Unlike other leading multivitamins, a single serving of DOUBLE X is what you need your vitamin to be – 12 essential vitamins, 10 essential minerals, and 20 plant concentrates, giving you the antioxidant power of tomato, blueberry, broccoli, cranberry, pomegranate, and more. The B vitamins found in the NUTRILITE DOUBLE X Multivitamin unlock the energy in your food, and Double X contains more B6 and B12 vitamins than Centrum® Performance and One-a-Day Active® combined! In a clinical study, NUTRILITE DOUBLE X was shown to improve blood nutrient levels to provide your cells with the energy they need to support a healthy heart, brain, eyes, skin, bones, and immune system.*

*This statement has not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure, or prevent any disease.
Trademarks: Centrum (Wyeth Holdings Corporation, Madison, N.J.); One-a-Day Active (Bayer Healthcare L.L.C., Pittsburgh, Pa.).

Click to enlarge

The suggested dose is 2 tablets a day, therefore the amounts below will reflect this suggested dose.

Vitamin A (75% from beta-carotene): 10,000 IU
RNY, DS, VSG, and anyone on PPIs do not absorb BC, therefore we don’t count it.  The effective dose of vitamin A is 2,500 IU
ASMBS Recommendations: 10,000 IU for RNY/DS; 5,000 IU for AGB/VSG
Amount needed: RNY/DS – 8; AGB/VSG – 4

Vitamin C: 500 mg
ASMBS: RNY/DS: 120 mg; AGB/VSG: 60 mg
Amount needed: RNY/DS – 1; AGB/VSG – 1

Vitamin D3: 400 IU
Note: ASMBS recommendations are not enough
ASMBS: RNY 800 IU; DS: 2800 IU; AGB/VSG: 400 IU
Amount needed: RNY – 4; DS – 7; AGB/VSG – 2

Vitamin E (from d-alpha Tocopheral succinate): 150 IU
ASMBS: RNY/DS 60 IU; AGB/VSG 30 IU
Amount needed: 1

Thiamin: 11.25 mg
ASMBS: RNY/DS 3 mg; AGB/VSG 1.5 mg
Amount needed: 1

Riboflavin: 12.75 mg
ASMBS: RNY/DS 3.4 mg; AGB/VSG 1.7 mg
Amount needed: 1

Niacin (from niacinamide and nicotinic acid): 40 mg
ASMBS: RNY/DS 40 mg; AGB/VSG: 20 mg
Amount needed: 2

Vitamin B6 (from pyridoxine hydrochloride): 15 mg
ASMBS: RNY/DS 4mg; AGB/VSG 2mg
Amount needed: 1

Folic Acid: 800 mcg
ASMBS: RNY/DS 800 mcg; AGB/VSG 400 mcg
Amount needed: RNY/DS – 2; AGB/VSG – 1

Vitamin B12 (from cyanocobalamin): 45 mcg
Many people cannot get enough B12 from crystalline B12 and must use sublingual or injections.
ASMBS: RNY: 12 mcg, 350-500 mcg additional daily; DS 12 mcg; AGB/VSG: 6 mcg
Amount needed: 1, plus additional for RNY

Biotin: 300 mcg
ASMBS: RNY/DS 600 mcg; AGB/VSG 300 mcg
Amount needed: RNY/DS 4; AGB/VSG – 2

Pantothenic Acid: 50 mg
ASMBS: RNY/DS – 20 mg; AGB/VSG 10mg
Amount needed: 1

Calcium (from calcium carbonate): 750 mg
This does not work in, well, anyone well.  Not counting it.

Iodine (from potassium iodide): 150 mcg
ASMBS: RNY/DS 300 mcg; AGB/VSG 150 mcg
Amount needed: RNY/DS – 4; AGB/VSG – 2

Magnesium (from magnesium oxide): 300 mg
This is the “constipation helper, not the raise your mag levels”

Zinc (from amino acid chelate): 15 mg
Amino acid chelates absorb only in the duodenum, useless in RNY and DS
ASMBS: RNY/DS 30mg; AGB/VSG: 15 mg
Amount needed: RNY/DS – N/A; AGB/VSG – 2

Selenium (from Selenium yeast): 100 mcg
ASMBS: RNY/DS: 140 mcg; AGB/VSG 70 mcg
Amount needed: RNY/DS 3; AGB/VSG 2

Copper (from amino acid chelate): 2 mg
Amino acid chelates absorb only in the duodenum, useless in RNY and DS
ASMBS: RNY/DS 4 mg; AGB/VSG 2 mg
Amount needed: RNY/DS – NA; AGB/VSG – 2

Manganese (from amino acid chelate): 5 mg
Amino acid chelates absorb only in the duodenum, useless in RNY and DS
ASMBS: RNY/DS 4 mg; AGB/VSG 2 mg
Amount needed: RNY/DS – NA; AGB/VSG 1

Chrominum (from amino acid chelate): 120 mcg
Amino acid chelates absorb only in the duodenum, useless in RNY and DS
ASMBS: RNY/DS 240 mcg; AGB/VSG 120 mcg
Amount needed: RNY/DS – NA; AGB/VSG – 2

Molybdenum (from amino acid chelate): 50 mcg
Amino acid chelates absorb only in the duodenum, useless in RNY and DS
ASMBS: RNY/DS 150 mcg; AGB/VSG 75
Amount needed: RNY/DS – NA; AGB/VSG – 3

Additionally, the vitamin is missing vitamin K (critical for blood clotting when in form of vitamin K1 and for bone health when in form of K2) and iron.

Now, I’ll be honest.  I’ve never been a fan of MLM’s in the past and was really surprised to see how well some of Amway’s vites fared (I have more to show later.. this post is way long as it is).. until I got to the chelates.  Sure, the vitamin A isn’t great.. but most aren’t.  People are afraid of preformed A and simply rather use beta-carotene, even though it’s useless for us.  But the chelates are the cinching factor for this vitamin for me.  Chelates work for most people, but the research just shows that it’s not good for WLSers in general.  So while this is a good vitamin for normies, I just cannot suggest it for any RNY or DSer.

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2 Responses to “Double X by Nutrilite (Amway)”

  1. kim says:

    But you pee a really cool neon green!

  2. Richard says:

    And they have really bizarre commercials http://www.youtube.com/watch?v=cW8rnMmYID8

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