Unjury, the makers of oPurity one-a-day multivitamins have been campaigning hard for their vitamin, boasting updated statistics and continuing their banner of China-Free ingredients.

This morning, I got yet another one of these emails with the following:

Here’s an email from one of the large practices switching from Bariatric Advantage to OPURITY.

“I just wanted to touch base and let you know that after a lot of research with Bariatric multivitamin companies our program has decided to make the switch from recommending Bariartic Advantage to Opurity!

Based on the number of supplements our patients currently need to take and the cost of these supplements, compliance has been poor.

We then plan to stock Opurity Vitamins for our post-op patients. We will be providing our patients information on where to order these supplements from in addition to the option of purchasing them from our clinic, as we currently do with Bariatric Advantage.

I wanted to get in touch with you regarding this decision to make this change in hopes we can work closely with supplying our patients with information, resources and samples on these supplements.”

Just reply to this email if you would like more information about Recommending and Stocking OPURITY® Vitamins at your practice or facility.

Thank you all for recommending OPURITY® Vitamins and UNJURY® Protein.

So I’ve decided to revisit oPurity and examine it according to the ASMBS suggestions, what we know about vitamins so far (with citations, of course), and let you make your own decisions in case your practice is one of the ones deciding to switch.

And I’m going to let out a trade secret here.. one that I probably shouldn’t tell – your doctor’s offices get cash for selling you your vitamins from whatever company they choose to sell. I can’t tell you how much because each company has their own percentage, and it might even depend on volume, but your office selling supplements is not truly an altruistic thing for you, the patient.

Now, keep in mind that offices are struggling to make ends meet. And this is a way for them to increase cash flow. BUT is it truly the best product for you? Don’t assume that it is. Do your research before making that assumption. Several practices are now making their own products and marketing them, for them to be not-so-great products in the end. Use your noggin’ folks.

So this is likely to be long, and might get a bit technical. I’ll do what I can to keep it easy.

Info directly from oPurity.com:

SUGGESTED USE:

Adults: one (1) tablet daily.

Do not exceed suggested use without physician  approval. NOT RECOMMENDED FOR CHILDREN.

As with all supplements, if you are on medication, pregnant or nursing, consult your physician before use.

Ingredients: Fructose, Natural Flavors, Microcrystalline Cellulose, Ascorbic Acid (Vit. C), Calcium Citrate, Zinc Glycinate Chelate, Magnesium Oxide, DLAlpha Tocopheryl Acetate (Vit. E), Beet Juice, Stearic Acid, Biotin, Contains less than 2% of: Beta Carotene (Vit. A), Calcium Pantothenate, Choleocalciferol (Vit. D3), Chromium Picolinate, Citric Acid, Copper Citrate, Cyanocobalamin (Vit. B12), Ferronyl Iron, Folic Acid, Guar Gum, Magnesium Stearate, Malic Acid, Manganese Gluconate, Niacinamide, Potassium Iodide, Pyridoxine HCl (Vit. B6), Riboflavin (Vit. B2), Silicon Dioxide, Sodium Selenite, Sucralose, Thiamin Mononitrate (Vit. B1), Vitamin A Acetate

ALLERGEN INFORMATION: Contains Soy Note: SOY ingredient is soy oil, not soy protein.

You take vitamins for your health. Yet most multivitamins actually use ingredients from China.

OPURITY™ is CHINA◆FREE. We use no ingredients from China, so you have one less thing to worry about.

Purity Guaranteed. Satisfaction Guaranteed. Learn more at www.opurity.com.

ASMBS suggestions for RNY (as this is the Bypass-Optimized Multivitamin) -

So let’s look at a diagram, shall we?

(That diagram is in the forthcoming book. It’s copyrighted to MMC, kay?)

We know from anatomy that certain things are absorbed in certain places through the digestive tract. The above diagram sorta shows you where those things are. (And I got that information from Advanced Nutrition and Human Metabolism, Third Edition by Groff and Gropper.)

But with gastric bypass surgery, we lose a large portion of the stomach’s absorption ability, most of the duodenum, and a great portion of the jejunum. Over time, the body will help to overcome some of the absorption issues in the digestive tract by creating additional micronutrient absorption sites, but absorption will never recover fully, and some micronutrients will always be affected.

The stomach doesn’t absorb much itself in terms of micronutrients, but what the lack of stomach tissue poses in terms of the RNY poses is more in the lack of Intrinsic Factor and acid production, both of which are needed in the absorption of B12 and iron further down the digestive tract. It is true that both of these continue to be created in the remnant and are joined with the food bolus at the ileum, but iron requires a number of changes to occur before it can be absorbed properly, which leads to such a high incidence of iron-deficient anemia. B12 also requires a number of changes before it can be absorbed properly, which can also lead to deficiency status if not supplemented properly.

So now that we’ve sorta skirted around the issue by looking at basic anatomy, let’s look at oPurity line-by-line. You have the ASMBS recs (remember – 100% of DV x 2 for at least 2/3 of nutrients, 18mg iron, 400mcg of folic acid, selenium, and zinc). I’m going to rate on having ALL micronutrients so you can see what’s out there, what’s missing, etc. for the sake of having full disclosure.

Also keep in mind that oPurity boasts that it is the only bariatric vitamin that is one tablet a day. I will reflect this in the numbers given below. I do not, do not, do not believe that any vitamin should be taken by an RNY patient one time a day. I do not think there is any possible way, even 7 1/2 years out as I am, that we can absorb enough from a vitamin one time a day. (They do make the distinction that calcium must be taken multiple times per day.)

So let’s start with vitamin A. oPurity lists at 7500 IU, with 50% coming from beta-carotene. Vitamin A comes to us in a few different forms, but when it comes to us in vitamins, it is typically in the form of acetate or palmitate and beta-carotene. As patients with achlorhydria (low gastric acid) there is a potential problem with beta-carotene as a form of vitamin A (and yes, this includes foods that are traditionally vitamin A foods such as carrots and pumpkin, but I digress). The reason that beta-carotene is a problem with achlorhydriacs is that beta-carotene requires a fairly acidic environment to absorb properly. We know this due to a study performed using a class of drugs called proton pump inhibitors (PPIs) such as Nexium, Protonix, and Prevacid and two forms of vitamin A. This study focused on giving patients the PPIs to lower the gastric acidity of the patients, then used a gastric probe (fun!) in order to verify the pH of the stomach, and then gave the patients vitamin A in its pure form (retinyl palmitate and pure retinol) or in it’s pre-vitamin A form as beta-carotene. Then blood serum levels were checked on baseline patients, as well as patients given the PPIs. Serum concentrations of beta-carotene were significantly greater at a low gastric pH (ie normal) than those at a high gastric pH (ie achlorhydria, or low gastric acid environment).  Serum concentrations of retinol and retinyl palmitate were not significantly different between the low gastric pH and high gastric pH.  Those with a lower acid content will not absorb beta-carotene fully, if at all.  It is also important to note that as we age, even those of normal stomachs will begin to neutralize their gastric acidity.  This was confirmed by a study published in the New England Journal of Medicine in reference to the breakdown of calcium citrate versus carbonate — but the problem of acidity remains the same. Additionally, beta-carotene is thought to be absorbed in the duodenum, which is bypassed in the RNY and partially in DS procedures.  Since this absorption site is bypassed, beta-carotene does little-to-no good to patients with either surgery – especially coupled with the lower gastric-acid component present in both surgeries as well. Those with Adjustable Gastric Bands (AGB’s) should take note as well – beta-carotene absorbs better when eaten with some fat.  Those who have been extreme in removing fat from their diets should note this key interaction. (Gastric acidity influences the blood response to a beta-carotene dose in humans)

So given that 50% of the vitamin A is beta-carotene, it could be said that only 37500 IU of vitamin A is actually present in the oPurity given the above research information. That would mean, according to the label, that oPurity now only has 75% of the RDA of vitamin A (150% / 2). This clearly means you need 2 a day just to get your vitamin A. (I’m not getting into the fact that I still don’t think you can get 150% of the vitamin A, regardless of source, from one vitamin after a bypass. Just overlook that fact for now because I think you know where I stand on that issue by now, right?)

Next is vitamin C. oPurity has 180mg, which is 300%. That’s fine.

Vitamin D, 1600 IU, 400%. I think you need more. Much, much more. It IS D3 rather than D2. There are still some bariatric companies using D2 (WHY?) so other than I still think you need more, taking 2 oPurity (which you’d need just for the A above) will net you 3200 IU, which combined with your calcium will get you closer to where I would want you to be. D toxicity in RNY patients is hard to do.

Vitamin E, 60 IU, 200%. We’re getting back to the “being able to absorb 200% at one time” area once again. However, vitamin E deficiency in RNY patients, while theoretical, is extremely rare. In fact, in all of the lab sheets I have looked at? I’ve not seen it once. Of course, I can’t say many docs pull it, but it’s still very rare.

Vitamin K, 0  Now this one, I have a severe problem with. Vitamin K has two forms available in the US as supplements, and neither are toxic in any dose. The only time people have a problem with vitamin K is if they are on prescription blood thinners or have a blood clotting disorder – and you know if you are one of these people – trust me. More often than not, you need K rather than not need it. And the more RNYers I see coming 3+ years out of surgery, the more I’m seeing vitamin K deficiency. Also, Topamax (aka Dopamax) is becoming quite a popular medication for RNY patients for a number of reasons and Topamax eats vitamin K. (These are all anecdotal, no I don’t have studies, but I’ve seen lots of labsheets including my own. Are you also a low K’er? Lemme know. Cause I know I’m gonna be asked to prove this.) Vitamin K1 (phylloquinone) is the most common in supplements and is necessary for blood clotting, while K2 (menaquinone) is used by the body in bone formation. If you start bruising for little-to-no reason? You need to get your vitamin K checked, along with clotting factors.

Thiamin 6mg, 400% – Thiamin is absorbed in the duodenum and jejunum, and has been known to be a problem in some RNYers. If you’re taking 2 of these, this should be fine, and a b-complex hedges your bets. Regardless, everyone should be getting this drawn anyway… right?

Riboflavin 4.3mg, 253% – Riboflavin is absorbed in the duodenum and jejunum, but deficiency is rare. That doesn’t mean I haven’t seen it.

Niacin 40mg, 200% – Niacin, like thiamin and riboflavin, is absorbed in the duodenum and jejunum. Deficiency isn’t as common, but it’s possible.

Vitamin B6 5mg, 250% – B6 is absorbed in the Jejunum, so absorption isn’t as likely to be as impaired as other micronutrients. Additionally, B6 has been added to EVERYTHING these days.

Folic Acid 800mcg , 200% – Folate is extremely important to women who might be looking to have children after weight loss surgery. 800mcg is the minimum that is suggested to normal-gutted patients to help prevent neural tube defects, and those ladies have normal intestinal tracts. Luckily, folate is absorbed in the duodenum, jejunum, and ileum, so absorption is going to be higher than some of the other vitamins – but I would not take just 800mcg if one is planning on having children. It is important to note that too much can mask a B12 deficiency, so it is extremely important to have thorough testing. Additionally, it needs to be noted that a serum folate test is not an accurate marker for folate insufficiency – you need a RBC folate test to see what your true level is. Most docs only order the serum level.

Vitamin B12 350mcg, 5833%

This is what oPurity says about B12 on their page:

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.

Again, directly from an email:

Please also consider recommending and stocking the most trustworthy – and only China-Free™ Multivitamins, OPURITY.

The only once-per-day multivitamin.

Speaking to trustworthiness – well, as I’ve shown above, I can’t see how oPurity can claim to be a once-a-day bariatric vitamin. Therefore, claiming to be one somewhat negates the trustworthiness, does it not?

And then, banking over and over again on people’s fears about Chinese products and ingredients? (Don’t get me started over the fears they’ve played into over regain and their protein product..) Well, when it’s played up over and over and over again, it reeks of fanaticism and eventually one begins to wonder if it goes even beyond into radicalism.

There’s a point in which one has to say “enough is enough” and decide what one’s integrity and morals are. Yeah, you can take this vitamin 2x a day and probably get by with okay labs, fill in the holes with calcium and iron as you need to.. maybe a b-complex for those of you with really resistant b’s.. But this company continually bashes their competitors by name, plays on the fears of their patients with regain and supply chain issues, and has the audacity to say they are the most trustworthy of companies because they get their ingredients from places other than China?

Thanks, but I’ll take my chances somewhere else.