Just read the following... comments?

I just read the following on the Fitness Board and wondered what others think? Here it is: Well, the final diagnosis is in. I have Osteopenia, one step away from Osteoporosis. I simple slip or fall can cause a fracture or a break. This is all caused from taking the wrong type of calcium supplement for 4 years. And to make matters worse my surgeon is still telling his patients it is ok to take TUMS for their calcium. I just want to scream NO!!!!!!!!!!!!! I now need to take 1500mg of calcium citrate and 800mg of vitamin D daily and that is just in hopes that I don't go into full blown Osteoporosis. My rheumatologist will do another bone density scan in 6 months to see where things stand. She suggested that ALL gastric by pass patients have a bone density scan at least 1 year out of surgery and then every year after that. Since there are no real studies on how we absorb calcium and exactly what type I cannot go after my surgeon or my primary care physician for malpractice. The legal society considers this surgery a "fad" at the moment. One attorney I spoke with said that in a couple of years, less than 5 this surgery will no longer be done because of the premiums for malpractice insurance for the surgeons. They won't be able to afford it. All I can say is please, please watch your calcium intake. Make sure you are getting what you need. I am almost 4 years out of surgery and am paying a huge price for not having the right calcium. I have lost 4" in height over the last 4 years, my fibromyalgia is back and now I have Osteopenia. Please watch your calcium and vitamin D.

Hi Terre, I too wonder about the calcium debate, which is better. I have asked a gazillion times at PMRI, Brett, etc. The answer that I get is that if you take your calcium you will be fine no matter what the source of that calcium is. I asked my pharmacist too, and he said that yes, citrate is somewhat better absorbed but probably minimally so. Others cite studies where the calcium in citrate is better absorbed by a larger margin. I have asked for the source of those studies and how extensive they are but nobody knows where they are located. ( If anyone knows where they are please send me there! ) I am curious as to this lady's family history. I know disorders like this are hereditary. My grandmother had osteoporosis and it's something I am concerned about. Is it something that can be avoided by taking calcium, or will it happen to some degree anyway if you are predisposed to it? LOL I am NO help, I have left the post with more questions than answers. I have been using carbonate ( Viactive ) as well as eating alot of higher calcium food sources in hopes that will be enough. I heard about a citrate chewable that is available, maybe I will look into that. I think I read that it's a Twinlabs product and available at Vitamin Shoppe. The ones I've seen in the drug store are HUGE. That's one thing that has frustrated me since the beginning of surgery, there isn't one standard of treatment. I see one thing and it seems to make sense, then I see an opposing view that seems to make just as much sense LOL. I take it all into consideration then adjust it to what seems to fit my cir****tances as well as what the docs at CHRIAS tell us to do. Then I pray alot that it works Totally answerless, Linda

This is scary stuff! I'm also concerned about the lack of studies regarding calcium and GBP patients. I've asked my PCP and he told me just to make sure I take a calcium supplement. It didn't sound like he cared about what type of calcium. This is truly something to be concerned about for all of us. Thanks for the warning.

Hey guys, This has been a subject near and dear to my heart since the very beginning also. I have done much research on it and was left with more questions than when I started as well. My final decision was to err on the side of caution and go with calcium citrate, and absorb the extra cost hopefully helping to protect my long term health. Since my surgery my mother has been diagnosed with osteoporosis and when her doc heard that I had bypass surgery, he strongly suggested that I should consider taking 1500 - 1800 gms of calcium citrate per day to protect my health. Our nutritionists said that taking the citrate wouldn't hurt us, but there was no study that it was much more bio-available than the carbonate either. The citrate would cost a bit more to use though, but I decided that was a cost I considered worth it. And have been doing citrate since the second month of my surgery. I use Osteo Enhance Plus by Sci Fit Nutrition. It provides precise ratios of chelated Calcium Citrate, magnesium, and vit D to help with maximum absorption. It is also enhanced with boron to support proper bone density. It comes in capsule form, and I was taking the capsules every since I started taking them, (for a short time I tried another brand) anyway, when I went to the meeting with Brett that said no more pills I have since opened them up and add them to something to get them in, however I am considering going back to taking the capsules as it is much more convenient to get them in that way and I have not had any problems with them. Still tossing that one up in the air. I take 3 a day to get the recommend amount. I considered the chewables, but am not all that fond of that idea ... not sure I want to trade one problem for another. And there seems to be some buzz about the chewable causing some problem with the dental area, I don't know about that as I have not done any real research cause I wasn't taking them. But come to think of it, I need to check into it cause my children take chewables every day ... GEESHHHHHH!!!! I purchase the Osteo Enhance Plus from Vitalady. I also put a recommendation to it on the PMRI site with a link to the actual page for that vitamin. You can find it by clicking my www button at the bottom of this post under the catagory of "We tried we liked". Michelle (Vitalady) has a lot to say about vitamins, specifically calcium as both she and her husband are dealing with issues because of taking carbonate instead of citrate. She is now a 100% advocate for citrate. At any rate, it is very interesting reading on her web page. I highly suggest you take a peek at it if you are interested in this area. Now about research ... here is a link to the information that was presented at the June American Society for Bariatric Surgery Conference. http://www.asbs.org/html/pdf/asbs_abstract_booklet.pdf ****at the bottom of Page 20 of the document - page 22 on my pdf, in the conclusion it states that calcium citrate has significantly greater bioavailabilithy than calcium carbonate following RYGB. **** There is a lot of information out there, I am never certain where the truth lies sometimes, so I tend to err on the side of caution. We can only do as much research as possible and do what we feel is best. In the end we are the ones that have to live with our decisions. My real concern is the amount of longer term post ops that I am reading about with calcium deficiencies. And even a bit more concerning to me is the fact that is seems they do not show up on our labs until they are quite advanced. It was recommended to me to get a base line bone density test from my moms specialist, especially since it runs in my family, my frame is small, I was never a milk drinker and I am a bypass patient, I am even more prone to problems in this area. He also stated to keep a sharp eye on my height. Wishing everyone the best in finding what will work for you. Hugs, Tammy Here is a post that I just found that links you to the page I posted above. I think it may help you all out also. ****************************************************** For all of you out there who keep asking about the calcium bio-availability issue...The first randomized, blinded, clinically controlled trial assessing the absorption of calcium citrate vs. calcium carbonate following Roux-En-Y gastric bypass has been conducted. The abstract of this study has been presented at this years 21st Annual ASBS (American Society for Bariatric Surgery) meeting this June. Go to the following web address: www.asbs.org/html/pdf/asbs_abstracts_booklet.pdf to download the meeting abstracts and then scroll down to page 20. As a Doctor of Pharmacy and someone who holds a nutrition degree, appropriate vitamin supplementation is an issue I hold dear to my heart. I urge you, for the sake of your health, to take note of this study in additon to all of the other numerous medical publications that are available. And remember, just because your surgeon/local pharmacist/dietician may have recommended Tums or some other form of carbonate doesn't mean that his/her advice was meant to be misguided-we are all human and all make mistakes! Simply put, the vast majority of practicioners do not study the bioavailablity and pharmakokinetic parameters regarding drug absorption & metabolism to the extent that pharmacology and nutritional reserch analysists do. It is not their job, it is not part of their clinical background, and unfortunately it is not a topic that is widely presented in medical institution facilities. Chances are, if they have told you to take a product containing calcium carbonate they have just not had the exposure to the research and information that is available, or the proper educational background to make a more appropriate recommendation. Feel free to share this information with them, as well as the numerous other medical literary sources that are availble on the topic so that they may make more appropriate recommendations in the future based on scientific evidence based medicine, instead of based on misinformation. The evidence is out there, it's just a matter of getting the word out. If you have questions regarding where to find more sources of information regarding this topic feel free to e-mail me, or check out the National Library of Medicine's website at www.ncbi.nlm.nih.gov and perform your own literature search (key word search: type in 'bioavailability of calcium citrate' or 'calcium citrate AND calcium carbonate AND absorption') .Take care of your health! Sarah A. Fussy, Pharm.D., PhD, BS nutrition science (lap RNY 6/2/03 -140lbs) [email protected]