FAQS
BARI-COMPLETE - HOW DO I TAKE IT?
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Weight-loss surgical patients take 1 Bari-Complete sachet 3 times a day dissolved in a glass of water (about 200 ml) or as directed by your dietitian.
CAN IRON AND CALCIUM BE INCLUDED IN THE SAME SACHET WITHOUT AFFECTING ABSORPTION?
Recent studies show that it is the ratio between iron and calcium that can affect the absorption of the iron, and that in order to avoid any possible reduction in the absorption of the iron, the ratio of calcium to iron must be under 220:1 1 (Gaitan, et al. J Nutr 2011 Sep 27;141(9):1652-6). The ratio in Bari-Complete is 25:1, well below this ratio. The absorption of the iron from Bari-Complete is further enhanced as the powder is dissolved in water and iron absorption is improved when the supplement is in a liquid/soluble form. The inclusion of vitamin C in the formulation also helps with this, as the presence of vitamin C improves iron absorption. The big problem with iron supplements is adherence, because they frequently cause stomach-related side effects, particularly when taken in one high single dose. We have therefore divided the iron content up so that one sachet contains 20 mg. This reduces the probable risk of side effects and therefore improves adherence.
WHAT VITAMINS AND MINERALS ARE IMPORTANT TO TAKE AFTER WEIGHT-LOSS SURGERY?
After weight-loss surgery, vitamin and mineral supplementation is unfortunately no longer a lifestyle choice, but critical for your continued health. The following are the more important minerals and vitamins that need to be supplemented daily. Calcium Current guidelines recommend 1500 mg of calcium citrate per day. Calcium deficiency leads to osteoporosis. Calcium is needed for bone tissue, for healthy functioning of the muscles and nerves, and for normal blood clotting. Zinc Current guidelines recommend 16-30 mg of zinc per day. Zinc deficiency can lead to poor wound healing and infection defence, anaemia, depression, aggression and learning difficulties. Skin changes, white flecks on the nails and hair loss can also occur. Zinc is essential for a good immune system and also for the metabolism. Zinc is also needed for healthy skin, nails and hair. Iron Current guidelines recommend is 54-65 mg of iron per day following weight-loss surgery regardless of age or gender. Women with heavy menstrual flows may need higher doses. Iron deficiency results in anemia, with a resultant lack of energy, tiredness and paleness. More severe anemia leads to dizziness, headache, palpitations, shortness of breath and a buzzing in the ears. Iron is essential for the production and oxygenation of blood. Regular iron level checks are important after surgery. Vitamin B12 (Cobalamin) Current guidelines recommend 500 μg of B12 per day (tablet form) if you do not receive vitamin B12 injections. Mucous membrane problems can be early symptoms of a vitamin B12 deficiency, for example, a sore tongue, bleeding gums or cracks at the corners of the mouth. With a severe vitamin B12 deficiency, depression, eyesight and memory problems and even difficulty walking can occur. Vitamin B12 is necessary for normal functioning of the nervous system and for the formation of blood cells. Vitamin D Current guidelines recommend 3000 i.u./75µg per day A deficiency in vitamin D3 leads to a depletion of calcium in the body’s skeleton, with symptoms including frequent bone fractures, fatigue and muscle weakness. Vitamin D plays an important role in the body’s metabolism of calcium and phosphate, and in bone mineralisation Folic acid Current guidelines recommend 400µg of folic acid per day. Folic acid deficiency can result in anemia, with tiredness, dizziness, headache, etc. Severe anemia gives rise to shortness of breath and sometimes angina Folic acid is needed for production of protein.
SHOULD I TAKE BARI-COMPLETE BEFORE BARIATRIC SURGERY?
You should not change to Bari-Complete before having your surgery as this has been specifically formulated for the post-bariatric patient after consultation with various bariatric surgeons as well as following the international bariatric supplementation guidelines available. You should however, start with this immediately after your surgery as advised by either your surgeon or dietitian. Many of the vitamins and minerals are included in higher quantities than used in pre-surgery patients, as there are many important changes that take place due to the surgery, many of which affect the ability to absorb vitamins and minerals. For example, post-surgery patients have a far smaller stomach area so that the amount of acid produced is drastically decreased. This decrease affects various aspects, one of which is the absorption of calcium, essential for both bone health, the prevention of osteoporosis as well as muscle contractions. Bari-Complete therefore includes a calcium in the citrate form which is in itself acidic, so that this is the only form recommended by the bariatric surgeons, dietitians and the various international bariatric societies, as this improves the absorption of the calcium. Bari-Complete also includes more calcium than required by non-bariatric patients as their daily requirements are higher. Please also note, that when you start taking the Bari-Complete, you need to take 3 sachets daily in divided doses. This is also very important because even without surgery, we cannot absorb more than 500 mg to 600 mg calcium at any one time, so taking this all at once simply means that you will excrete most of it and you will definitely develop osteoporosis over time. Bari-Complete contains ALL your daily vitamin and mineral requirements in the 3 sachets, and you will not need to take any additional products at all unless you are a high risk for anemia, then you MAY need to take an additional low dose iron product, such as the Bari-Iron 20 mg capsules, but your dietitian will be able to advise you should this be necessary. You will however need to have a vitamin B12 injection on a regular basis, but again, your dietitian will advise you about this.
CAN I GO OFF SOME OF MY MEDICATIONS AFTER SURGERY?
As you lose weight, you may be able to reduce or eliminate the need for many of the medications you take for high blood pressure, heart disease, arthritis, cholesterol, and diabetes. However this must only ever be done in consultation with your doctor. You will however need to take vitamin and mineral supplements each and every day for life, following your surgery.
HOW SOON AFTER MY SURGERY CAN I START TAKING BARI-COMPLETE?
WHY IS CALCIUM CITRATE BETTER THAN CALCIUM CARBONATE?
Acid is required for the optimal absorption of calcium. The secretion of stomach acid is greatly reduced after weight-loss surgery, seriously affecting the ability to absorb calcium in the intestine. Calcium citrate is the calcium salt of citric acid and therefore creates its own acidic environment aiding absorption. The other forms of calcium are alkaline. Studies have shown that absorption of calcium in the form of calcium carbonate is very limited following weight-loss surgery. Calcium citrate is more expensive than all the other forms of calcium, but for the gastric patient it is essential to ensure adequate calcium intake. At least 1500 mg of calcium citrate is needed daily according to national and international guidelines.
WHY IS IT IMPORTANT TO TAKE VITAMIN & MINERAL SUPPLEMENTS AFTER WEIGHT-LOSS SURGERY?
Weight-loss surgeries dramatically alters our body’s ability to absorb vitamins and minerals by reducing the area where absorption takes place, as in gastric bypass surgery that bypasses part of the intestine, as well as reducing the production of substances that aid absorption. This happens when the stomach is reduced, as in the case of gastric bypass and sleeve gastrectomy patients, and the production of stomach acids is reduced proportionally. A change in diet post-op also contributes to this reduction in vitamin and mineral absorption. The most critically affected vitamins and minerals are vitamin D, iron, vitamin B12, vitamin B1, folic acid, calcium and zinc. Vitamin and mineral deficiencies can lead to serious health repercussions, such as iron deficiency/anemia, depression, nerve damage, osteoporosis. Research in this field indicates that supplements and regular checks are needed for the rest of your life to ensure that you do not develop deficiencies.
DOES BARI-COMPLETE CURE DEFICIENCY DISEASES?
No, the doses included in Bari-Complete are intended to prevent the development of any diseases that would occur with continuous long-term vitamin and mineral deficiencies, and as such is a prophylactic treatment. If you have a pronounced deficiency of any vitamin or mineral, a prophylactic dose may not be enough to cure the condition caused by this deficiency and you should consult with your dietitian and or medical practitioner for a suitable treatment.
ARE THERE ALTERNATIVES TO BARI-COMPLETE?
Bari-Complete is a unique product on the South African market. While working with weight-loss surgery experts and dietitians we realized that the care after surgery can be complicated. Bari-Complete was formulated to make life easier for those who have undergone weight-loss surgery. One Bari-Complete sachet 3 times a day replaces four other products in most cases, and many of these other products require that you take numerous tablets/ capsules of each daily. Bari-Complete has been especially tailored for the weight-loss surgical patient, this means, for example, that we have chosen calcium citrate instead of calcium carbonate, because reduced acid secretion following surgery means the citrate form is absorbed far better. It is also in a powder format that is completely dissolved in water prior to taking them, ensuring the ingredients are in their most readily absorbed state. Tablets are not recommended for the bariatric patient as absorption is not always achieved. Bari-Completes ingredients and the quantities thereof, were based on international treatment guidelines, which in turn are based on current knowledge. (Tondapu P, et al. Obes Surg. 2009; 19:1256-61. BOMSS Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery. Report. September 2014. Kulick D., et al. J Am Dietic Assoc. 2010;110:593-599. Mechanick J.I., et al. Surgery for Obesity and Related Diseases 2013; 9
Weight-loss surgical patients take 1 Bari-Complete sachet 3 times a day dissolved in a glass of water (about 200 ml) or as directed by your dietitian.