Prenatal Vitamins

[ktgrok]

So, the Thorne prenatal vitamins came in the mail today. They are pretty big, but I got all of them in (3 capsules). I may pick up a spray called pill glide at the store tomorrow to see if that makes them easier to swallow. But no nausea so far. 

 

I think it would be easiest and best to take them split up, 1 capsule 3 times a day. But...I am supposed to be taking calcium with D twice a day, and I can't take that at the same time as iron, which is in the Thorne prenatal. Does anyone have an idea of a reasonable schedule to take everything? Or just try to take all 3 at one meal,and calcium at the other two meals? 

 

 

[Guest]

Are you expecting already?! I thought you were just stocking up ahead of time. That's great news!

[ktgrok]

Are you expecting already?! I thought you were just stocking up ahead of time. That's great news!

 

Oh, no, not yet! But I'm hoping we will be trying in about a month, so want to get on them now. From what I understand it's best to have good levels of folate in the blood stream before conceiving.  DH starts his new job on the 14th of this month, and if all goes well will be a permanent hire and have full benefits mid to late April, which is what timing depends on. He's pretty much on board, just wants to know his job is secure and we have health insurance in line. 

 

But that gives me another month or two to lose a bit more weight, so it's all good. 

Edited March 7, 2016 by ktgrok

[Guest]

Okay, I thought I missed something with the nausea comment ;)

 

I've heard it is good to take them for several months before conceiving, same for the men. Helps boost up the nutritional stores.

 

The new job is exciting! I'm so glad he got it and will be eager to hear how the first weeks go and if it is a good fit.

[ktgrok]

Okay, I thought I missed something with the nausea comment ;)

 

I've heard it is good to take them for several months before conceiving, same for the men. Helps boost up the nutritional stores.

 

The new job is exciting! I'm so glad he got it and will be eager to hear how the first weeks go and if it is a good fit.

 

oops I can see the confusion now. I just meant the vitamins on their own don't seem to upset my stomach. I've been taking my bariatric vitamins but wanted to switch to a prenatal with the methylated Bs if possible. So far so good. I've got hubby on vitamins too :)

[ktgrok]

Still having a bit of an issue timing everything I have to take, but doing the best I can. I also was having some heartburn but I think hat was the tea I was drinking, not the new vitamins. That said, when these are gone I'm thinking about switching to this one, as it is a one a day and would make my life easier. (I'd probably add in more iron, and extra b-vitamins in a sublingual)

 

Product-175-chart_image-dde021e0-9580-4b59-b5d1-2d2240e11963.jpg

 

Anyone have a reason I shouldn't take it?

Edited March 11, 2016 by ktgrok

[gardenmom5]

if I were to have anymore - and if I were to advise my daughters (I'm hoping for grandchildren some day.  . . )

 

dudeling took the rainbow light gummy essentials - so I do like that brand.  then he was willing to swallow and I moved him to emerald laboratories - which I like better.

 

I'd advise the emerald laboratories pre-natal.  it's a capsule (NOT a tablet), so if you aboslutely can't swallow it, you can mix it with some applesauce or similar.

they use only the most bioavailable forms.

 

[gardenmom5]

Still having a bit of an issue timing everything I have to take, but doing the best I can. I also was having some heartburn but I think hat was the tea I was drinking, not the new vitamins. That said, when these are gone I'm thinking about switching to this one, as it is a one a day and would make my life easier. (I'd probably add in more iron, and extra b-vitamins in a sublingual)

 

Product-175-chart_image-dde021e0-9580-4b59-b5d1-2d2240e11963.jpg

 

Anyone have a reason I shouldn't take it?

 

yeah - they don't use the most bioavailable molecular forms, but they would be cheaper . . . .

 

  (I have an mthf mutation - and I am uber picky about the form of folate.)  http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/

 

deleted my overly emotional ravings . . . . I apologize.

 

here's a link to the emerald laboratories and what htey have.  http://ultralaboratories.com/EmeraldLabs/Prenatal%20Multi/sl.png

do your own comparison.

 

I've calmed down now.  I just got a 'gift bag' full of "advocare". i loath advocare. previously, after much struggle - I found the pages that has what's *actually* in it.  not. impressed. - at. all.  I won't even use the products in the gift bag. 

 

Edited March 12, 2016 by gardenmom5

[ktgrok]

yeah - they don't use the most bioavailable molecular forms, but they would be cheaper . . . .

 

calcium CARBONATE????

 

glucosamine salt for folate????  (I have an mthf mutation - and I am uber picky about the form of folate.)  http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/

 

pyrodoxine hydroclorate?  (I know drs like to rx that one - but it is NOT the most bioavailable!!!!)  for b5 - I will only use P5P or I will keep looking.

(and methylcobalamin for b12.  shots into abdominal? fat are the most absorbable. sublingal is next.)

 

seriously - I wouldn't waste my money.

 

here's a link to the emerald laboratories and what htey have.  http://ultralaboratories.com/EmeraldLabs/Prenatal%20Multi/sl.png

do your own comparison.

 

The folate is L-methylfolate, which is the only reason I considered it. The glucosamine salt version is also known as Quatrafolate and is recommended by www.mthfr.net.  The calcium if part carbonate, part citrate, but I take calcium citrate with mag and D twice a day anyway, which is why I'm trying to streamline the multivitamin part, because timing the calcium with the iron is becoming a pain. I considered Emerald but it's like 8 capsules a day or something, which doesn't help. I'd stick with the Thorne with 3 a day before doing that. I've been researching the B5 versions...all I've found so far is that pyridoxine has to be converted to P5P by the liver, so if you have liver issues or certain COMT issues that can be a problem, but otherwise should be fine? If you have other info, I'm all ears. I do take a sublingual B12 (methylcobalamin) in addition to any prenatal as I know sublingual is better absorbed vs oral, not sure I want/need to switch to injections. 

 

I'm pretty happy with the Thorne one, but was hoping to simplify to one tablet a day. 

Edited March 11, 2016 by ktgrok

[gardenmom5]

The folate is L-methylfolate, which is the only reason I considered it. The glucosamine salt version is also known as Quatrafolate and is recommended by www.mthfr.net.  The calcium if part carbonate, part citrate, but I take calcium citrate with mag and D twice a day anyway, which is why I'm trying to streamline the multivitamin part, because timing the calcium with the iron is becoming a pain. I considered Emerald but it's like 8 capsules a day or something, which doesn't help. I'd stick with the Thorne with 3 a day before doing that. I've been researching the B5 versions...all I've found so far is that pyridoxine has to be converted to P5P by the liver, so if you have liver issues or certain COMT issues that can be a problem, but otherwise should be fine? If you have other info, I'm all ears. I do take a sublingual B12 (methylcobalamin) in addition to any prenatal as I know sublingual is better absorbed vs oral, not sure I want/need to switch to injections. 

 

I'm pretty happy with the Thorne one, but was hoping to simplify to one tablet a day. 

 

there are many forms of folate. not all are created equal.

http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/ he discusses the differences - sometimes very small differences.

 

they are mixing the l-methylfolate in with glucosamine salt - you have no idea how much L-methylfolate you're actually getting.  the label is deceptive.

 

calling it "l-methylfolate" isn't enough information to determine which one.  some are a complete waste of money.  (btw: I won't buy supplements from this guy's site - but he does do alot of research on mthf.)

 

there is a rx for deplin - which is 7.5 or 15mgs of methylfolate.  I can't tell you the difference, but I felt better on the thorne.  a local compounding pharmacy will custom make methylfolate capsules with the same quality as the thorne - for about 1/2 price.  (she said the price really drops even more after 100 capsules.)  I'm just barely starting with that.

you could check if there is a compounding pharmacy near you that does/could-do something similar - or one to which your dr could call in a rx and mail it to you.

[ktgrok]

That's actually the link where I found the info on it, lol. It's WAY down at the bottom of the page, where it explains it. "Quatrefolic: What is this?

This is a new form of methylfolate that uses glucosamine instead of calcium to bind the L-methylfolate. Quatrefolic is also a quality form of L-methylfolate."

 

At leat, that's how I'm reading it. I could certainly contact them to make sure it is a version of methylfolate bound to glucosamine, not methyfolate and a separate glucosamine. 

Edited March 12, 2016 by ktgrok

[Murphy101]

Does anyone else think that in our efforts to simply get basic nutrients into our families or sustain our homes in a healthy efficient manner, we should qualify for some honorary degree?

 

There should be some kind of spyware in our devices that after we have sufficiently researched what feels like every possible combination of elements, their uses, effects, and best forms and when to not use them, we get a certificate in the mail.

[ktgrok]

Does anyone else think that in our efforts to simply get basic nutrients into our families or sustain our homes in a healthy efficient manner, we should qualify for some honorary degree?

 

 

 

Seriously!

 

I did email them to ask about the folate, for more clarification. 

[Murphy101]

I finally ran out of my previous ones that I hated.

 

So I recently ordered these.

 

Mega Food Baby & Me

 

http://www.amazon.com/gp/product/B00GZ9H8PU?psc=1&redirect=true&ref_=oh_aui_detailpage_o01_s00

 

And

 

Nordic Naturals DHA

 

http://www.amazon.com/gp/product/B002CQU55A?psc=1&redirect=true&ref_=oh_aui_detailpage_o01_s00

 

I just want to note some issues with the Mega Food.

One, I sure hope the "vegetable lubricant" doesn't come back to bite me in the butt. Just.. Why is that a necessary ingredient?

 

Two, they aren't very big, just itty bit bigger than a tylenol3. But you have to take FOUR per day. Ugh. No way. I'm going to hope for 1 and be thrilled if I ever can manage 2.

 

Three, Why the heck can science make concentrated fish oil taste like strawberries ( the DHAs above) but can't manage to make any multivit not smell and taste like someone opened a lawn bag of mowed grass that someone mixed with spoiled milk and pressed it into a pill mold? WHY?!

 

Ugh.

[ktgrok]

LOL! I have some of those Baby and Me ones, and yeah, no way could I take 4 of those. I just mailed them to my girlfriend for her to try. I got the Honest Company ones, and so far so good, Zero stomach upset, no burping, etc. The ones I got are the old version (all they had at my local Target) but the new ones on the website say they are vanilla scented, which sounds awesome. I'm adding in a sublingual B12 for extra B12, and extra iron. And I am still taking my calcium/magnesium/D twice a day. 

[ktgrok]

For anyone wondering, I figured I'd go ahead and post what the one bariatric nurse/midwife sent me, as far as guidelines. I've got an email into her to clarify a few points, but otherwise, this was what she sent me. Still waiting for the Honest Company new formulation to get here, but if those don't work out I'm going to give up and stick with my bariatric vitamins. They make me feel great. They do have high A and E, but I spent many hours reading actual research studies, WHO guidelines, etc and although higher than current recommendations they are under what has been found to be teratogenic. And my levels were tested recently and were not high, just middle range, so I feel pretty comfortable doing that. They don't have the right kind of folic acid, but I'm taking extra of that in the right form. And given that I'm heterozygous and only for one gene I'm deciding I just can't worry too much about that. If those end up being the vitamins I tolerate best than it is what it is. 

 

 

Post Bariatric Surgery Pregnancy /Obstetrical Management

 

Bariatric Surgery is a time of change with great nutritional demands on the body. It is recommended that the post Bariatric patient not become pregnant during the first 12 months following surgery. Due to the high nutritional needs during rapid weight loss. This weight loss can be achieved safely with adequate nutritional intake.

Pregnancy is another time of great nutritional demands and the following are guidelines for obstetrical management in the pregnant Bariatric patient to achieve a healthy mother and infant.

 

General Nutritional Guidelines

65-90 gms protein per day. This may require protein supplements especially during the 1^st and 2^nd trimesters with the use of protein shakes.

5-6 meals per day of approx 6oz per meal

Minimum of 25% of meals from complex carbohydrates (fruits/vegetables/100% whole grains)

Minimum of 25gms non saturated fats

Minimum of 64oz water per day

 

The dietary protein recommendations for pregnancy are 1gm/kg per day. For the obese patient >300lbs it is 0.8gm/kg/day and an additional 15-25gms/day for each baby.  

 

       Current Dietary Association Guidelines

Weight/lbs

Protein Intake/gms/day

100lbs

60-70gms

150lbs

84-94gms

200lbs

105-115gms

250lbs

128-138gms

300lbs

124-134gms

350lbs

142-152gms

400lbs

160-170gms

 

Supplements

Multivitamins 2 x per day

-       not to include > 2 x the daily intake of Vitamin A,D,and E ( fat soluble vitamins can be toxic,Vit A beta-carotene is a non toxic form and often found in pre-natals.

-       caution not to exceed > 5000 IU Vitamin K

Folic Acid 1-2 mg per day

Vitamin B-12 1 1000mcg per day or 1000mcg SQ or IM monthly (GBP)

(If deficient 1000mcg 2 x month + 1000mcg sublingual/daily)

Thiamine 1-2 mg per day (If deficient 100-200mg/day)

Calcium 1000 1500mg per day (Citrate preferred)

Vitamin D 1000- 2000 IU per day (If deficient 4000-5000IU/day-D3 or 50,000 IU 1-2xweek D2)

Fiber 25 gms per day (if not tolerating use stool softeners)

Omega 3 fatty acids 1000 -2000 mg per day

Ferrous Fumerate 30-60mg/day (absorption always better with Vit C&folic acid)

 

Labwork

Standard prenatal labs

B-12 and folate

Vitamin D (25-hydroxy)

Iron profile to include ferritin

Prealbumin level

• The above should be done Q 6weeks throughout pregnancy to follow continued demands of pregnancy on the post - op Bariatric patient.
• GTT  (GBP) – consider FBS & 2hr PP X 1week due to the intolerance of glucose load

 

Weight Gain During Pregnancy

Underweight

BMI <20

Normal

BMI 20-25

Overweight

BMI 25-30

Obese

BMI 30-35

Obese

BMI > 35

Twins

 

Triplets

28-40lbs

25-35lbs

15-25lbs

15lbs

15lbs

35 – 45lbs

50lbs

 

Exercise

5 X week of 30â€

Heart rate not to exceed 130

 

Ultrasounds

First trimester viability and early R/O NTD especially in the GBP R/T folate

Second Trimester – Review of Systems

Third Trimester – growth scans

 

Follow Up with Bariatric Surgeon

Each trimester during pregnancy and whenever concern arises

 

Special Considerations

Lapband

v  Hyperemic can put the lapband patient at risk for band slippage. Symptoms may include; N/V,GERD, Intolerance to solid foods, abdominal pain or pain at port site.

v  Fills during the 1^st trimester are not done and may actually need to be reduced if hyperemic or poor weight gain throughout pregnancy. A fill may be done if needed after 14 weeks by her surgeon

v  Discomfort at port site due to growing abdomen

v  Increased gallstones, kidney stones with rapid weight loss as well as the potential increased risk with pregnancy.

Gastric Bypass

v  Hyperemesis can put the GBP patient at risk for ulcerations of the gastric pouch. Symptoms may include N/V, intolerance to foods, GERD

v  Abdominal pain can be a sign of intestinal hernia or other surgical etiology and consult with Bariatric surgeon is advised.

v  Medication – tablet (cut into ¼’s) or suspension is advised. No extended release or gelatin capsules due to possible poor absorption as well as limited gastric secretions

v  Antiemetics such as Reglan may be advisable due to its increased gastric emptying and postpartum if breast milk supply is in question.

v  Increased gallstones, kidney stones with rapid weight loss as well as the potential increased risk with pregnancy.

 

Duodenal Switch

v  Hyperemesis can put the GBP patient at risk for ulcerations of the gastric pouch. Symptoms may include N/V, intolerance to foods, GERD

v  Abdominal pain can be a sign of intestinal hernia or other surgical etiology and consult with Bariatric surgeon is advised.

v  Antiemetics such as Reglan may be advisable due to its increased gastric emptying and postpartum if breast milk supply is in question

v  Increased gallstones, kidney stones with rapid weight loss as well as the potential increased risk with pregnancy.

v  Fat soluble vitamin deficiencies (A,D,E,K) should be monitored each trimester and replaced if deficient

 

           

Please contact one of our Bariatric surgeons if we can be of further guidance in the management of the post-op Bariatric patient.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                    

 

 

 

 

[Katy]

IDk if anyone already said this, but my sister was told taking chewable children's vitamins (double dose for adults) would work.

 

Thorne makes a chewable vitamin for children with methyl B. It has iron.  Given your medical history, I'd try that.

[ktgrok]

IDk if anyone already said this, but my sister was told taking chewable children's vitamins (double dose for adults) would work.

 

Thorne makes a chewable vitamin for children with methyl B. It has iron.  Given your medical history, I'd try that.

 

It's actually not chewable, it's capsules. Six a day. So that would be 12 a day at least if I doubled it. 

 

Took my regular bariatric one today and feel better. I have no idea what the heck is in it that makes me feel so good when I take it. (I did also take extra folate, as methylfolate, later in the day). Anyone want to take a look and guess what the heck is in this that makes me feel so much better than any other vitamin I take? Maybe the increased thiamine? That seems significantly higher than most other vitamins. Or the niacin. And b12 is super high. That could be it. (note, it lists the amounts per 1 tablet, but the serving size is two tablets...I do take two a day. No idea why it lists it per single tablet. On the actual bottle it does it per two tablets.) https://www1.bariatricadvantage.com/catalog/group/110373/Advanced_Multi_EA

[Katy]

It's actually not chewable, it's capsules. Six a day. So that would be 12 a day at least if I doubled it. 

 

Took my regular bariatric one today and feel better. I have no idea what the heck is in it that makes me feel so good when I take it. (I did also take extra folate, as methylfolate, later in the day). Anyone want to take a look and guess what the heck is in this that makes me feel so much better than any other vitamin I take? Maybe the increased thiamine? That seems significantly higher than most other vitamins. Or the niacin. And b12 is super high. That could be it. (note, it lists the amounts per 1 tablet, but the serving size is two tablets...I do take two a day. No idea why it lists it per single tablet. On the actual bottle it does it per two tablets.) https://www1.bariatricadvantage.com/catalog/group/110373/Advanced_Multi_EA

 

Oh, sorry I must have linked the wrong one from google.  They do make chewable though, it's on the Thorne website.

[ktgrok]

Oh, sorry I must have linked the wrong one from google.  They do make chewable though, it's on the Thorne website.

 

I don't think they do anymore. I searched. Metagenics does, but it would be a ton of them. 

[birchbark]

I have a hard time swallowing big vitamins and I took these during pregnancy, with some extra folic acid in the beginning.

[ktgrok]

I have a hard time swallowing big vitamins and I took these during pregnancy, with some extra folic acid in the beginning.

 

It's not so much how big as how many. Although big is worse. But after I swallow one I get a bit tense and can't get another down. So 6 small pills probably wouldn't work either. 

[ktgrok]

small update!  First I did contact the company, and this was the response to the form of folate in the Honest Company Prenatal:

 

Thanks for reaching out about our Multi Complete Prenatal Once Daily. There is one source of L-Methylfolate and it is in the glucosamine salt form, which is why you see it listed this way on our supplement fact panel. Please let us know if you have any additional questions. 

 

So that is good! And, even better, I've been taking it for a while now (the new updated version),  and I feel really good on it! Better even than on my bariatric vitamins! I do add extra methylfolate and extra B12 (also methylated) just to get to the higher level recommended by my bariatric program. And I take my Calcium Citrate with D twice a day.