The Calcium Issue: Carbonate vs. Citrate

Some doctors tell patients to take Tums to get their calcium. Tums are calcium carbonate. Some doctors tell their patients to take Viactivs. Viactivs contain calcium carbonate. I've had it drumming into me by many on these boards and by my nutritionist and my surgeon that the only calcium for a post-op is calcium citrate. Here is why... This is an excerpt from NIH on calcium ( put astericks about the two important sentences): (http://consensus.nih.gov/1994/1994OptimalCalcium097html.htm) "For some individuals, calcium supplements may be the preferred way to attain optimal calcium intake. Calcium supplements are available as various salts, and most preparations are well absorbed except when manufactured such that they do not disintegrate during oral ingestion. Absorption of calcium supplements is most efficient at individual doses of 500 mg or less and when taken between meals. Ingesting calcium supplements between meals supports calcium bioavailability, since food may contain certain compounds that reduce calcium absorption (e.g., oxalates). ***However, absorption of one form of calcium supplementation, calcium carbonate, is impaired in fasted individuals who have an absence of gastric acid. ***Absorption of calcium carbonate can be improved in these individuals when it is taken with certain food. The potential for calcium supplementation to interfere with iron absorption is an important consideration when it is ingested with meals. ***Alternatively, calcium supplementation in the form of calcium citrate does not require gastric acid for optimal absorption and thus could be considered in older individuals with reduced gastric acid production. ***In individuals with adequate gastric acid production, it is preferable to ingest calcium supplements between meals." Take from this what you will! Just wanted to share... I'd hate to see someone end up with osteopenia or osteoporsis. I have osteopenia but not from the WLS - I have parathryoid issues (regulation of calcium levels is off and was pre-WLS). I care about you folks! Kathy

My surgeon is VERY strict about this issue- citrate only!

Thanks Kathy for the link. My sister promotes the benefits of Coral Calcium & I wondered how it relates to calcium carbonate/citrate. I've been doing a little research & haven't gotten a satisfactory answer yet. Have you found any information on Coral Calcium?

I know nothing about coral calcium. I did a quick search and a found a pro-coral calcium website and it was talking about needing stomach acids for calcium absorption so I suspect it is more like carbonate. Kathy

So Kathy, what are good Calcium choices. My doctor told me Viactic Chews were o.k. I will see him next week. What are you taking?

We use the Twinlabs Calcium Citrate Wafers. They sort of remind me of sweet tarts (if you stretch your imagination). Bariatric Advantage has ones that are chocolate, mint or cinnamon that don't taste too bad (I've had samples). Kathy

Thanks again Kathy. That's what our Bariatric Nurse said. Rosie

I have to step in here. Yes, Citrate is the best. However...Carbonate is also okay. We don't have the gastric juices in our stomach, but they do come in a bit down the line in the intestines. My surgeon (who's been doing this for 30 years) said that as long as you're getting your levels checked regularly (which we all should) and the calcium levels are okay, then carbonate is fine (it is #1, MUCH easier to find, and #2, MUCH easier to take, and #3 MUCH cheaper). I have a bottle of the Twinlabs Citrate and they are ENORMOUS and it says the serving size is 4 tablets/day. When I was very newly pre-op it took me 45 minutes to eat ONE of those. There was no way I could get in four of them a day. That's when I started taking Tums (per my surgeon) but now I take Caltrate - two a day. I think either is fine, BUT if your calcium levels go low, then Citrate definitely. Just my .02 ~ take it or leave it! Michelle

Michelle, Your .02 is worth far more than that! Kathy

Always take Citrate - it absorbs better. LIquids and powders are best. For Gastric Bypass it is a must, for Lap Banders, it is important. Get rid of the Tums and Flintstones! We dont' need that crap.