Calcium Research

I have been researching calcium to help me in my quest to improve the information that is given out by some doctors. Below is the results of my research via the internet thus far: Calcium facts [I have pulled out of the statement for the purposes of WLS patients who are evaluating which supplement to take] 1. 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, because food may contain certain compounds that reduce calcium absorption (e.g. oxalates). 2. Absorption of one form of calcium supplementation, calcium carbonate, is impaired in fasted individuals who have an absence of gastric acid. 3. 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. 4. In individuals with adequate gastric acid production, it is preferable to ingest calcium supplements between meals. Above taken from the June 6-8, 1994 NIH Consensus Statement on Optimal Calcium Intake. NIH is the National Institutes of Health. You may find this at http://consensus.nih.gov/cons/097/097_statement.pdf Page 19 of the document (or page 22 of the pdf file). Oxalate, which is present at high levels in some vegetables (e.g., spinach), has been found to depress absorption of the calcium present in the food ... Keep in mind that the overall recommendations on dosages are for people who have normal stomachs. If I am not mistaken the RDA is a 40 year old recommendation. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Because calcium citrate does not require gastric acid for absorption, it is a better choice for patients with achlorhydria (i.e., limited gastric acid production). This is from: http://www.oznet.ksu.edu/ext_f&n/_timely/calcium.htm Calcium in the form of calcium citrate does not require stomach hydrochloric acid for absorption. This means that it is more readily absorbed and utilized by the body and can also be taken on an empty stomach. From: http://www.femhealth.com/CalciumCitrate.html ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Calcium, whether from the diet or supplements, is absorbed best by the body when it is taken several times a day in amounts of 500 mg or less. Calcium also interferes with iron absorption. The exception to this is when the iron supplement is taken with Vitamin C or calcium citrate. Any medication to be taken on an empty stomach should not be taken with calcium supplements. Above from: 1999 Issue of NOF's Quarterly Member Newsletter, Osteoporosis Report. From: http://www.nof.org/prevention/calcium_supplements.htm Also: In the 1994 NIH Consensus statement, page 17. Concern has been raised that increased calcium intake might interfere with absorption of other nutrients. Iron absorption can be decreased by as much as 50 percent by many forms of calcium supplements or milk ingestion but not by forms that contain citrate and ascorbic acid, which enhance iron absorption. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RDA is being replaced by DRI (dietary reference intake). To learn more about DRI go to: www.cc.nih.gov/ccc/supplements This has a great series of pdf downloadable pages on the various vitamins/minerals that we need to know about. From: http://www.gastricbypassfamily.com ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ASK AHSC Answers to Health Questions from The University of Arizona Health Sciences Center (AHSC) in Tucson MAY 2001 Q I was told to take calcium supplements daily after my gastric bypass operation. Which is better, calcium carbonate or calcium citrate? Why? And how much should I take? ( I'm a 55-year-old male, 6'3", 205 lbs.) R.H. A Calcium carbonate has more calcium per gram than calcium citrate, so it would take less volume (fewer pills or less liquid) of the calcium carbonate to provide the same amount of absorbable calcium. Because calcium carbonate requires hydrochloric acid, a stomach acid, to be digested and absorbed, the type and extent of your gastric bypass will determine which calcium supplement is better for you. The recommended intake of calcium for a 55-year-old male is 1,200 milligrams daily based on the 1997 Institute of Medicine guidelines. However, you should check with the dietitian who assisted you after your surgery, or check with your surgeon, for a specific, individualized recommendation. -Deborah Pesicka, R.D., registered dietician, University Medical Center, Tucson ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ We recommend routine monitoring of vitamin D and calcium intake in all patients following obesity surgery. It is recommended that all persons should ingest 1200-1500 mg of calcium and 800 IU of vitamin D per day. This is difficult to achieve after gastric bypass without supplementation. If their dietary intake is inadequate, they should receive appropriate supplementation. If patients have extreme malabsorption, higher doses of calcium and vitamin D may be necessary to maintain normal calcium levels and prevent secondary hyperparathyroidism. We also recommend yearly screening of calcium, alkalin phosphatase, 25(OH)D and PTH. A rise in alkaline phosphatase and PTH would be the first signs of metabolic bone disease and would indicate a need to increase treatment with calcium and vitamin D and further evaluate vitamin D status. In addition, it would alert the physician that other abnormalities associated with malabsorption may also be present, such as anemia. If these tests are routinely performed postoperatively, it could greatly decrease the long-term morbidity associated with GI bypass operations. The above is from: http://www.bariatricoperation.com/articles/Bone_Loss_OSG_p685_s.pdf Case Report about Severe Metabolic Bone Disease as a Long-Term Complication of Obesity Surgery. Keep in mind this particular patient appears to be a very non-compliant individual, but I particularly liked the specific recommendation that could benefit each of us. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ http://healthlink.mcw.edu/article/964794298.html By measuring blood levels of calcium, they demonstrated that calcium citrate is 2.5 times more bioavailable (easier for your body to use) than calcium carbonate. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ http://jaxmed.com/articles/medications/calcium.htm Calcium citrate has the advantage of being absorbed when gastric acid secretion is low (very common after menopause and in those taking acid reducing medications). In addition, the citrate form is protective against the formation of calcium-rich kidney stones. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ http://healthlink.mcw.edu/article/989700612.html Bone Density is Not Related to Blood Calcium Level Q: I'm a bit confused over a calcium blood test that I had done. I'm 54 and have been on both estrogen and progesterone for the last few years. Because I have a small frame and have always been concerned about osteoporosis, I've been very religious about calcium intake and have worked out with weights for about 27 years. I had my first bone density test in fall and it already showed some thinning even though my blood test came back showing a high calcium count. How can this be? Could you explain please? A: The level of calcium in your blood does not reflect how much calcium is in your bones or how "dense" and strong they are. On bone density tests, they compare your bones to women your age ("Z score") and to young women ("T score"). Every woman over 50 will show bone density loss compared to 20 year-old women, so that may be the "thinning" that your test showed. You've been doing three important things for your bones: good calcium intake, exercise/weight-training, and estrogen. Even hormones are not absolute protection though. In a recent study of over 800 women, about 10% of those on hormones lost some density in their spine and hips. This is still much better than the 60% of women not taking hormones who lost bone density. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ http://www.nlm.nih.gov/pubs/cbm/calcium.html Listing of citations from various authors on the topic Anderson JJB. Nutritional biochemistry of calcium and phosphorus. J Nutr Biochem 1991 Jun;2(6):300-7. Brennan MJ, Duncan WE, Wartofsky L, Butler VM, Wray HL. In vitro dissolution of calcium carbonate preparations. Calcif Tissue Int 1991 Nov;49(5):308-12. Comment in: Calcif Tissue Int 1992 Feb; 50(2):197. Bronner F. Nutrient bioavailability, with special reference to calcium. J Nutr 1993 May;123(5):797-802. Charles P. Calcium absorption and calcium bioavailability. J Intern Med 1992 Feb;231(2):161-8. Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited role of solubility. Calcif Tissue Int 1990 May;46(5):300-4. Pak CY, Avioli LV. Factors affecting absorbability of calcium from calcium salts and food. Calcif Tissue Int 1988 Aug;43(2):55-60. Schnepf M, Madrick T. The solubility of calcium from antacid tablets, calcium supplements and fortified food products. Nutr Res 1991 Sep;11(9):961-70. Shangraw RF. Factors to consider in the selection of a calcium supplement. Public Health Rep 1992 Sep-Oct;Suppl:46-50. Wabner CL, Pak CY. Modification by food of the calcium absorbability and physicochemical effects of calcium citrate. J Am Coll Nutr 1992 Oct;11(5):548-52. http://www.sodbrennen-welt.de/science/1989/1989_2517700.htm Weaver CM. Calcium bioavailability and its relation to osteoporosis. Proc Soc Exp Biol Med 1992 Jun;200(2):157-60. Whiting SJ, Pluhator MM. Comparison of in vitro and in vivo tests for determination of availability of calcium from calcium carbonate tablets. J Am Coll Nutr 1992 Oct;11(5):553-60. Wood RJ, Serfaty Lacrosniere C. Gastric acidity, atrophic gastritis, and calcium absorption. Nutr Rev 1992 Feb;50(2):33-40. Other links of interest might be: http://www.natlife.com/PPS/CCM.htm http://shop.store.yahoo.com/marcella75/calcium1.html http://gastricbypass.netfirms.com/vitamins.htm http://www.nutratherapeutics.com/html/pf-sports_nutrition.html http://www.bariatricoperation.com/articles/Bone_Loss_OSG_Masonj3oju.pdf Review: Bone Disease from Duodenal Exclusion. http://www.bariatricoperation.com/newsletters/september.pdf Check out page 8 of this interesting newsletter, they are instructing their patients to make a specific change in calcium supplements. http://lesann.tripod.com/calcium_supplements.htm http://healthlink.mcw.edu/article/950813818.html Screening for Osteoporosis http://www.nutrition.org/cgi/content/full/129/1/9 Calcium absorption

Oh my, what a great deal of research! Thank you ever so much for taking the time to share it with us. How are you doing?

I am doing great. I am down at least 35 1/2 pounds now. I am back doing my pre-surgery project of last summer (stopped when I had a major fibromyalgia outbreak) of painting the inside of my house. I have 2300 sq ft with vaulted ceilings in a couple areas so have a big job ahead of me. I am getting rid of the white look and going with a variety of colors. I sure hope it looks good once it is done otherwise I will be repainting it. I should be a pretty good painter by the time I am done. This is a solo job for me because my husband is a terrible painter and I am picky. haha. I did the research because I was so frustrated with the lack of consistency in calcium recommendations between surgical places. It is our bones they are messing with!! I really wanted to put the information out there for people so see and hopefully heed because it is important to our future health. Sandra