American Society for Metabolic & Bariatric Surgery Facebook ad: “Feel Like Yourself Again”

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"That's my mom. She's sick. She's been sick for years, and nobody knows what's wrong with her." A sixteen-year-old girl said this to a group of her school friends after a spring choir concert in 2024. Her mother — a woman named Deborah — was standing behind her in the auditorium, close enough to hear every word. She had picked up her bariatric multivitamin refill from my pharmacy that same afternoon. I had rung her up at 3:47 that afternoon. I had asked her how her day was going. She had told me she was going to her daughter's concert that night, that she was proud, that she had picked out a dress. I had wished her a good time and handed her the bottle. Three months later she came back to my pharmacy, set the same bottle on the counter between us, and asked me if I had ever actually looked at the label. I want to tell you what I said to her that day. Because it is the reason I am no longer a pharmacist. Deborah had been a model post-op patient. She had followed her bariatric program's protocol for five years without missing a step. She had shown up for every lab draw, every follow-up appointment, every recommended screening. She refilled the same prescription on the same day every month for sixty consecutive months. She had done everything her bariatric team told her to do. And I had done everything the pharmacy manual told me to do. I verified her insurance every month. I confirmed her dosage every month. I ran the interaction check against the other medications on her profile every month. I asked her if she had any questions about her prescription every month. She never did. Neither did I. There is a specific step in a pharmacist's training that we are taught to perform on every single prescription we dispense. It is called label verification. We look at the bottle. We confirm the drug name, the strength, the form, the count. It is the last check before the medication leaves our hands and enters a patient's body. I performed that check on Deborah's bottle one hundred and forty-four times. I never once, in five years of monthly refills, asked the one question the check was designed to catch. Because it wasn't my job to ask. That's what her bariatric program was for. That's what her surgeon and her dietitian and her follow-up team were for. My job was to dispense what the prescription said to dispense. I had done my job perfectly. And I had handed Deborah the same slowly failing bottle every month for five years while her daughter learned to think of her as sick. My name is Rebecca Torres. I am — was — a licensed pharmacist. I spent twelve years behind the counter of a specialty pharmacy in Nashville, Tennessee, located four blocks from one of the largest bariatric surgical centers in the Southeast. I filled bariatric prescriptions all day, every day, for twelve years. If you had gastric bypass or gastric sleeve surgery at that center between 2011 and 2023, there is a real chance I filled your first bariatric multivitamin prescription. There is a certainty I filled someone's. I left the pharmacy in the fall of 2023 because I asked my manager to let me have a two-minute conversation with post-op patients about the forms of the vitamins we were dispensing. He told me no. He told me twice. The third time he told me that if I kept asking he would report me to corporate for practicing outside my scope. I am writing this letter knowing it is going to reach former customers of mine. Some of them may recognize themselves in what I am about to describe. Some of them may recognize me. If any of you are reading this — I am sorry. I want to explain what I now know that I did not know when I was ringing you up. I did not lose my license. I gave it up. There is a difference. And the difference is why I am writing. After Deborah left my pharmacy that afternoon, I did something I should have done years earlier. I pulled the refill records for every bariatric prescription I had filled in the past decade. The pharmacy's system stored the data by NDC code — the eleven-digit number that identifies each specific product. I ran a report on the five NDC codes that covered every bariatric multivitamin brand our specialty pharmacy dispensed. Between 2013 and 2023, I had personally filled 41,200 bariatric multivitamin prescriptions across those five codes. Forty-one thousand two hundred bottles. I could not track down forty-one thousand customers. But I could pull my own transaction records from the last three years and identify the four hundred and thirty-two customers whose refills I had personally rung up more than twenty times each. These were my regulars. The women whose names I knew. The women I asked about their kids and their jobs. The women I recognized by their walk before they reached the counter. I began quietly calling the ones I still had contact information for. I told them I was doing a follow-up survey for the pharmacy. That part was a lie. I was doing a follow-up survey for myself. I asked each of them three questions. How long had they been taking their current bariatric multivitamin. How many times in the past two years had their bariatric team told them their ferritin was low. And how had they felt, physically, over the past year — better, worse, or about the same as when they had started. I reached one hundred and eighty-three women. One hundred and fifty-one of them told me their ferritin had been called low at least once in the past two years. Ninety-four of them had been called low three or more times. Thirty-seven had received iron infusions. Not one of them told me she felt better than she had a year ago. I want to tell you what struck me hardest about those phone calls. It was not the numbers. The numbers I had almost expected once Deborah had asked me her question. What struck me was that every single one of those women thanked me for calling. They thanked me for asking. They thanked the pharmacist who had been dispensing them a slowly failing bottle every month for years for taking the time to check in. I hung up from the last call and sat in my car in the pharmacy parking lot for almost an hour. That was the day I first went to my manager. The night after I made the last of those phone calls, I did something I had not done since pharmacy school. I sat down at my kitchen table with an empty bottle of one of the bariatric multivitamins I had been dispensing for a decade. I put it under a desk lamp. I turned it so the supplement facts panel faced me. And I read it — not the way I read a label at the counter, checking for the drug name and strength and count, but the way I had been trained to read a chemistry text in my second year of pharmacy school. Ingredient by ingredient. Form by form. I need to tell you what pharmacists are actually trained to know, because most people do not realize we know it. We spend three years of graduate school studying pharmacokinetics — the science of how the body absorbs, metabolizes, distributes, and eliminates chemical compounds. We learn which forms of which nutrients are absorbable in which tissues under which conditions. We learn what a stomach acid pH of 1.5 does to a mineral salt. We learn what happens when you remove seventy-five percent of the parietal cells that produce that acid. We learn what happens when you bypass the duodenum, where the majority of iron and calcium and folate absorption occurs in a normal human body. We are trained to know all of this. And then we go behind a counter and dispense whatever the prescription says, because our scope of practice does not authorize us to modify a physician's order without written authorization. I looked at that supplement facts panel for probably forty-five minutes. I recognized every form on it. Ferrous sulfate. Cyanocobalamin. Folic acid. Calcium carbonate. These are the cheapest, least bioavailable forms of the four most important nutrients in a bariatric patient's protocol. They are the forms designed for a stomach with normal acid production and a small intestine with an intact duodenum. They are not designed for anyone I had ever dispensed a bariatric multivitamin to. I had known this. I had studied it. I had passed a licensing exam that tested me on it in 2011. And I had spent twelve years handing bottles across a counter without once connecting the chemistry I had been trained in to the label I was reading. That was the night I understood what my job had actually been. I had been a delivery mechanism for a formula that a bariatric surgical center had recommended, an insurance formulary had approved, and a supplement manufacturer had priced to fit inside that approval — and no single person in the chain, myself included, had ever asked whether the chemistry inside the bottle would work in the body it was being handed to. Let me walk you through what actually happens to a standard bariatric multivitamin after a post-op patient swallows it. I am going to explain this the way I would have explained it if I had ever bothered to think about it during the twelve years I was dispensing it. Two things have to happen for the iron in your multivitamin to reach your bloodstream. The capsule has to dissolve in stomach acid. And the released iron has to be absorbed through specialized cells in the duodenum, the first section of your small intestine. Bariatric surgery permanently disrupts both. Gastric bypass and gastric sleeve surgery remove somewhere between seventy and eighty percent of the acid-producing cells in your stomach. Post-op, you produce roughly one-fifth of the acid you did before. At that reduced acidity, ferrous sulfate — the iron form in nearly every bariatric multivitamin on the market — does not dissolve. It passes through your stomach chemically intact. And whatever iron did make it through has no working absorption cells in a duodenum your surgeon rerouted around. Two mechanisms. Both required. Both surgically removed. The same problem, in slightly different chemistry, applies to the other three nutrients on that supplement facts panel. Cyanocobalamin B12 needs intrinsic factor, produced by cells the surgery removes. Folic acid needs an enzyme conversion in tissue the surgery bypasses. Calcium carbonate needs the same acid ferrous sulfate needs — the acid your stomach no longer produces. Every one of these is basic pharmacokinetics. Every pharmacist in America has been tested on it. And every bariatric multivitamin sold at retail in this country in 2024 was formulated to be dispensed to bodies for which the underlying chemistry does not work. I dispensed forty-one thousand of these bottles. You have been paying somewhere between $15 and $45 a month, plus whatever your insurance pays on the other side, for a delivery system that has been leaving the pharmacy in your hands and leaving your body in your toilet, unchanged. Here is what I read on that empty bottle at my kitchen table. And here is what I want every one of my former customers to understand about what I did and did not do at that counter for twelve years. There are alternative forms of iron, B12, folate, and calcium that do not require stomach acid, that do not require a functional duodenum, and that do not require the body to perform any conversion process to become usable. These forms have existed in the pharmacological literature since the 1980s. They are not new. They are not experimental. They are on the same board exam I passed in 2011. The iron form is called ferrous bisglycinate. It is iron molecularly bonded to two amino acids. The bond acts as a carrier — the body absorbs the amino acids through a completely different pathway than the one bariatric surgery disrupts, and pulls the iron in with them. No acid required. No duodenum required. The B12 form is called methylcobalamin. It is B12 in the active form the cells actually use. No intrinsic factor needed. No liver conversion needed. The folate form is called L-5-MTHF, sometimes labeled methylfolate. It is folate in the active form the body needs to build red blood cells. Skips the enzyme conversion entirely. And the calcium form — the one that most bariatric multivitamins on the market include and should not — is where the pharmacist in me has to say something particular. Calcium should not be in a bariatric multivitamin at all. Not because calcium is bad, but because when you combine calcium with iron in a single dose, the two minerals compete for the same absorption pathway. Calcium wins. The iron loses. Even if you had used ferrous bisglycinate, throwing calcium into the same capsule would have partially blocked the iron from being absorbed anyway. The bariatric supplement industry has been putting them in the same bottle for two decades because it looks comprehensive on the supplement facts panel. I dispensed thousands of these bottles knowing this. Knowing it in the way you know something that is on page four hundred of a textbook you read in graduate school and never opened again. These four alternative forms — ferrous bisglycinate, methylcobalamin, L-5-MTHF, and no calcium in the same bottle as the iron — have been available to formulate around since I was in pharmacy school. Every pharmacist licensed after 2005 has been trained on them. Not one bariatric multivitamin I dispensed in twelve years used all four. Three weeks after I gave up my license, I did the search I should have done in 2013. I opened my laptop at my kitchen table — the same table where I had sat under a desk lamp studying the empty bottle a few months earlier — and I built a spreadsheet. Column one: the four form specifications a bariatric multivitamin needed to actually work in a post-op body. Chelated iron. Methylated B12. Active folate. No calcium in the same formula. Column two: every bariatric multivitamin brand I could locate through pharmacy databases, wholesaler catalogs, and direct manufacturer listings. I found forty-seven bariatric multivitamin products on the American market that fall. Six of them used at least one of the four correct forms. Two used at least two. One used three. Only one product met all four specifications. The product is called Potent Nutra. It is a small American manufacturer based in Salt Lake City. They make a single bariatric multivitamin — twenty-three nutrients total, formulated specifically for post-surgical anatomy, dosed as two capsules with breakfast and dinner. I want to describe the label the way a pharmacist reads a label. Because this is the specific check I never once ran on any bottle I dispensed for twelve years. The iron is forty-five milligrams of ferrous bisglycinate. Chelated. No acid required. The B12 is methylcobalamin. Active form. No conversion required. The folate is L-5-MTHF. Active form. No conversion required. There is no calcium in the formula. The manufacturer removed it deliberately, because they understood what the rest of the industry apparently did not — that calcium in the same bottle as iron blocks the iron. I looked at the supplement facts panel for a long time. I read it the way I had been trained to read a label — ingredient by ingredient, form by form. Every single form on the panel was the correct one for the anatomy the product was designed to serve. Zinc as picolinate. Magnesium as glycinate. Selenium as selenomethionine. Vitamin D3 paired with K2 for bone support without the calcium interference problem. Somebody at that company had done the work I had been licensed to do and never done. They had taken the pharmacokinetic problem seriously. They had priced their product to make the correct forms possible. And they had accepted the lower margins that come with formulating around chemistry instead of formulating around a supplement facts panel that looks impressive. I ordered a bottle to my own home and I called the pharmacist listed on the manufacturer contact page. She answered on the second ring. I asked her whether the company had done third-party testing on release rate and bioavailability. She said yes and sent me the assay reports before I hung up. I sat with those assay reports for two hours. Every specification checked. Every claim on the label was supported by the underlying chemistry. I had spent twelve years dispensing bottles I now knew were wrong. Two hours reading assay reports told me this one was right. When I left the pharmacy, I did not disappear from my former customers' lives. Twenty-three of the women I had called during my investigation asked me to stay in touch. They wanted to know what I was learning. Several of them had been to their bariatric teams and been told there was nothing more to do — that their labs had plateaued, that their symptoms were normal, that some patients just do not recover the way others do. They wanted to know what I found. I told them what I found. And with their permission, I asked them to try Potent Nutra and to send me their next round of lab results when they had them. Nineteen of the twenty-three agreed. This was in November of 2023. By March of 2024, sixteen of them had drawn labs at their standard three-to-four month follow-ups. I want to tell you what I saw when I opened those reports. Because I have now looked at enough of them, and enough of the ones that have come after, that I feel I can speak about a pattern honestly. Ferritin — the marker most of these women had been watching drop for years — was trending up in fourteen of the sixteen. In two of them, it had already crossed back into the low-normal range. Nobody's had crashed further. B12 levels had climbed in thirteen of sixteen. Two were unchanged. One had declined slightly, though that patient had also been through a stressful surgery of her own during that window. Hair shedding, which I did not ask about clinically but which many of them volunteered, had slowed in the majority. Several told me their brushes were "not sad" anymore — a phrase I have now heard from enough of my former customers that I understand it belongs to this specific community. Energy was harder to measure. But when I asked them, ten of the sixteen told me they had done something in the previous month that they had not been able to do a year earlier. Climbed the stairs without stopping. Stood through a full grocery shopping trip. Made it through a workday without needing to lie down when they got home. None of this is dramatic. I want to be clear about that. Nobody in this group woke up transformed on day three. Ferritin does not rebuild in ten days. Hair follicles do not sprout new growth overnight. What the human body does, when given the right chemistry, is slowly begin to catch up on what it has been missing. I have watched this pattern hold across more than eighty women now. I did not run a clinical trial. I do not have IRB approval or a control group. But I have twelve years of pharmacokinetic training and enough labs in front of me to say that the correct chemical forms, delivered to bodies that have been starving on the wrong ones, produce measurable movement in the direction those bodies have been trying to go for years. Deborah was one of the sixteen. If you are reading this and any of what I have described sounds familiar, I want to say something directly. I want to say it because I have thought a great deal, in the two years since I left the pharmacy, about the specific women I stood across a counter from. What they told me about their weeks. What they were wearing. Which ones came in with their husbands. Which ones came in alone. Which ones stopped coming in and I did not follow up because I was busy. If you were one of my customers between 2011 and 2023, I want to name what I did not do for you. I did not read the label the way I was trained to read a label. I did not ask whether the chemistry inside the bottle matched the anatomy your surgery had given you. I did not have the conversation with you that would have taken two minutes and might have saved you two years. I dispensed what your prescription said to dispense, I asked you how your day was going, and I sent you home with a bottle that was quietly failing you the entire time I was smiling at you across the counter. If you were not my customer — if you filled your prescriptions at a different pharmacy in a different city — I want you to know that the pharmacist behind that counter almost certainly did the same thing. Not because she was careless. Because the profession as currently structured does not give her the room, the time, or the authority to run the check that would have caught it. She was doing her job the way she was trained and permitted to do it. So was I. That does not excuse what happened to you. It explains it. If your labs have been called low for years and your bariatric team has told you to be patient — the bottle is the reason. Not you. Not your body. Not your compliance. If your hair has been thinning past every reassuring milestone your program promised — if the shed did not stop at six months, if the regrowth never quite arrived, if you have started avoiding overhead lighting and photos taken from above — that is not what your body wanted to do to you. That is what the chemistry inside your capsule could not do for you. If you have been exhausted for years in a way that no amount of protein or water or sleep has repaired — if the brain fog you were told would clear became your baseline, if you are older than you should feel and tireder than you should be — you are not losing your grip on your own vitality. You have B12 in your bloodstream that your cells cannot use, because the form on the label was never going to work in the body it was handed to. If you have looked in the mirror in the past year and thought that you look sick — or worse, if the people who love you have started to look at you the way they look at someone who is sick — I need you to hear something specifically from me. You are not sick. You have been chemically starved by a formula that was never designed for your body, dispensed by a system that was not structured to catch its own error, and paid for month after month by a woman who trusted the people on the other side of the counter to know what they were doing. I was one of those people. And I did not know. There is another way. If you decide to try it, the company sells it in a three-bottle bundle at the price of two — a six-month supply. Every order is backed by a sixty-day money-back guarantee. If your body does not respond, you send back what is left and they refund you. I asked the company directly about their return process before I began recommending them to anyone. It is the simplest guarantee I have seen in this industry, and I have looked at a lot of them. I want to say one more thing before I close, because I know some of the women reading this were customers of mine. I have thought about what to say to you specifically since the afternoon Deborah walked back into the pharmacy and set the bottle on the counter. Some of what I have thought about, I have already said in this letter. Some of it I cannot say in a letter — because what I owe you specifically is not a paragraph, it is a conversation, and I do not have your phone number. What I can say is this. You did nothing wrong. You took a prescription your bariatric team gave you to the pharmacy your team referred you to and you filled it every month for as long as you were told to. The failure was not in your compliance. The failure was in the chain of professionals who were supposed to catch what nobody caught. I was one of those professionals. And the reason I am writing this letter, instead of standing behind a counter somewhere still handing out those bottles, is that once you understand what I understand now, you cannot keep doing what I was doing. You can, however, do something for your own body starting tomorrow morning. The two capsules you take with breakfast tomorrow can be the first two capsules whose chemistry is actually compatible with the anatomy your surgery gave you. Everything downstream of that — the labs, the hair, the energy, the way the people who love you look at you — takes longer, and comes back at the pace bodies come back. But the chemistry starts working the same morning you swap the forms. That is the only thing I can offer you at this point. It is not enough for the years the wrong forms cost you. It is what I have. I am Rebecca Torres. I was a pharmacist for twelve years. I gave up my license because I could no longer stand behind a counter and dispense what I now understand was never going to work. This is the formula I would have wanted to dispense. Deborah has my phone number. She uses it. Her ferritin is trending up for the first time in eleven years. Her daughter has started inviting her to school events again. That is all I know how to offer. It is what I should have been offering the whole time. — Rebecca Torres, PharmD (retired) P.S. If you are within the first year of your bariatric surgery — if the incisions have healed but the shed has not fully started or has just begun — this letter is for you with more urgency than for anyone else. The first twelve months post-op are the window during which the wrong chemical forms do the deepest damage to your ferritin stores. Starting on the correct forms in that window can spare you the years I watched too many of my customers lose. I wish I could have handed a bottle of Potent Nutra to every first-time bariatric customer who came through my counter in 2011. I am telling you now instead. P.P.S. If you have already tried three or four different bariatric multivitamins and none of them worked — you were not doing anything wrong. You were switching between different products that all used the same underlying chemistry. The forms were the same. That is why nothing changed. This one is different at the chemistry level, not at the marketing level. That is the entire reason I gave up my license to tell you about it.

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