Calcium!! Repost---

(Sorry, Another Re-Post for newer Guys....Skip if you don't need it!) Everything I've picked up about- Calcium! Calcium, and Vitamin D Are Completely Connected in that your body won’t absorb the Calcium Without the Vitamin D. Think of it as a Talent contest, And Vitamin D is Calcium’s Ventriloquist Dummy. One (D) is useless without the other, And the other (Calcium) can’t get "onstage" with out his little friend. So, What is Calcium (w/vitamin D,) and what does it do? Calcium is the most abundant mineral in the human body. The teeth and bones contain 99% of the body's calcium. The remaining 1% is in the extra-cellular fluids and blood. Calcium is a building block for bone. Adequate dietary calcium intake is one of the important factors For maintaining healthy and strong bones. But the average person- (and this info was listed as-…average woman) In the United States consumes less than 500 milligrams of calcium per day in there diet, Which is less than the recommended amount. Vitamin D is necessary for the intestines to absorb dietary calcium. Vitamin D comes from food and is also produced by the skin upon exposure to sunlight. Active people living in sunny regions can produce most of the vitamin D they need from their skin. But in the northern United States, there is insufficient sunlight during the winter For adequate vitamin D production by the skin. And vitamin D deficiency is common among those individuals who spend the majority of their time indoors. Inadequate calcium intake contributes to osteoporosis, Which is typically associated with Women,

But can occur in either sex when They are not getting enough Calcium.

Children with prolonged vitamin D deficiency can develo*****ets, And will develop bowing of the extremities due to weak bones. In adults, vitamin D deficiency can lead to osteoporosis And osteomalacia (both conditions of weakened bones).

Calcium is needed in the body for- Regulating the heart beat, Clotting the blood, Proper thyroid function, Nerve impulse transmission, and building strong bones and teeth. Calcium deficiency can result from several factors- reduced intake of calcium and vitamin D containing foods; (Not as much food intake in general) (2) bypass of the duodenum, (Where most calcium absorption typically occurs) and (3) malabsorption of vitamin D (Due to mis-mixing of pancreatic and biliary juices in the jejunum.) Now unlike deficiencies of vitamin B12, and iron, For which periodic blood testing is a sensitive indicator of status, Calcium deficiency is more difficult to detect Only 1% of the body’s calcium is in the blood stream. The rest waits in "The Bank,"- Our bones, teeth and marrow. When blood stream calcium is low, The body regularly "Borrows" calcium from bones and marrow. Consequently, blood stream calcium is seldom low Even when the body intake is insufficient. The blood stream calcium may be adequate, But the bone calcium level has been depleted. All the money is "Gone from the Bank" Even though there seems to be enough "on the Streets." That’s how a blood test for calcium Will not register a severe bone calcium deficiency. A bone density scan is required to do this. There are 2 types of bone density tests. Some machines (called peripheral) measure Such sites as your finger, wrist, or heel. Other machines (called central) measure your hip, spine, or total body. Both tests are simple and painless. Some tests use sound waves (ultrasounds). Others use small amounts of radiation to determine The thickness or density of bones. Bone Mineral Density (BMD) tests are safe, painless, and easy. Your doctor can answer questions you have about the BMD test. To check on "Your Account Balance in the Bank!" (Now hold on to that "Bank" Analogy, Because it’ll come in handy later on…) Extreme Calcium deficiency, or Hypocalcemia, Is defined as reduction of calcium levels in the bloodstream Below a certain normal range, and has its own clinical manifestations. The main syndrome is -Tetany, - A type of cramp that is a symptom of metabolic imbalance. The muscles of the hands and feet cramp and there is A numbness or tingling around the mouth and fingertips. In Extreme cases- nausea, vomiting, and convulsions. Tetany may be caused by too little calcium, as well as- Low potassium, or magnesium in the circulation or by an over-acid or over-alkaline imbalance in the overall body. These symptoms respond to treatment with calcium. A clinically detectable deficiency of calcium To this extent is actually quite rare. Why don’t WLS Folk get enough? (Stop the innuendoes, this is about Calcium…) Besides the Biggie- The major portion of the intestine That does the job of absorbing Calcium Has been By-Passed! There are other reasons. Many gastric bypass patients are unable to tolerate dairy foods Because of a Lactose intolerance. Since the majority of calcium comes from dairy foods, Which are also an important source of vitamin D, Avoiding Dairy foods can have a significantly impact on calcium absorption. Another, and perhaps more important factor Affecting calcium absorption - Is the form of the calcium. (Well, that and the lack of stomach acids in RNY’ers) Calcium is most commonly available as calcium carbonate and calcium citrate. Calcium carbonate, - Table chalk, has a higher concentration of calcium and is less expensive. However, calcium carbonate is not absorbed well in a non-acidic environment. Calcium Carbonate is the cheapest and most available calcium on the market. Think Tums, Coral Calcium, Dolomite, Bone Meal or Oyster Shell And most all of the "Chewable" supplements. It is also the least effective calcium. And this is true for Non-WLS Folks as well. Calcium Carbonate is 40% elemental calcium, But due to the molecular structure, only about 2 to 4% of it is usable by the body And for that little bit to be absorbed, it needs stomach acid. It is Very good at relieving "Acidy Stomach" but as a Calcium Supplement? Not so good! One other "black mark" against it? Calcium Carbonate is usually The source of excessive "free Calcium" in ones body That can result in kidney stones, and calcium deposits. Anyone who’s passed a Kidney Stone or had a "spur" in a shoulder joint Will advise skipping these benefits of Calcium Carbonate! Many Docs do tell their Patients "just use Tums." But that info is based on there quickie "Intro to Nutrition –101" course They took their first year of Med School. Tums a great at first when they are also helping to soothe a "fussy pouch," But as a source for life? Not so good.

(Explanation-Read the labels: Check the milligrams of "elemental calcium" You're getting per pill, not the amount of calcium gluconate, For instance, or calcium citrate. No pill is pure calcium. The mineral has to be combined with something else: Carbonate, citrate, gluconate, etc. The ‘Elemental amount, Is that portion of the product That is purely Calcium. Yes?) Calcium citrate is much more absorbable, because it relies much less on Stomach acids to "prep" it for absorption. Often labeled as- "Chelated for better absorption." It’s the kind found in Citrical And most of the Supplements marketed to Bariatric Patients. However, It is (21%) elemental calcium, And even though it is readily absorbed, it still takes nearly 10 times The dosage to equal the amount absorbed. Example- 1000 mgs. of elemental Calcium Consumed = 105 mgs. elemental Calcium absorbed Multiple doses spread across the day (typically 3) would be needed to supply All of the Calcium, if None is consumed through food. This is due to the "Bypassing" of those primary area of the intestine Responsible for absorbing Calcium, not the Stomach Acid Thang! Yes? More "Types of Calcium Supplements" later. Suffice to say these two Are the most Used on the market. So- What are recommendations for adequate calcium and vitamin D intake? The National Institutes of Health Consensus Conference on Osteoporosis Recommend the following calcium intake: 800 mg/day for children ages 1 to 10 1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen 1200 mg/day for teenagers and young adults ages 11 to 24 1500 mg/day for post menopausal women not taking estrogen 1200mg to 1500 mg/day for pregnant women and nursing mothers The total daily intake of calcium should not exceed 2000 mg. The Food and Nutrition Board of the Institute of Medicine recommended the following vitamin D intake: 200 IU daily for men and women 19 to 50 years old 400 IU daily for men and women 51 to 70 years old 600 IU daily for men and women 71 years and older An average multivitamin contains 400 IU of vitamin D. For patients with established osteoporosis, The recommended dose of vitamin D is 400 IU twice a day. For example, they can take combination pill That contains calcium 500mg and vitamin D 400IU twice a day. This is all working on the assumption of A normal and complete digestive system that absorbs "normally." So What? The Blood Tests Don’t tell us how well we are actually doing, And by the time a Bone Density test is "ordered" We may already be Way Low! How do we By-Passers get enough Calcium? Particularly getting it into our "Bank" of bones So that we don’t get blind-sided by Osteoporosis or Osteomalacia? 3 ways- 1.) Food Choice, coupled with- 2.) Supplements, (and good ones, covered later) and 3.) Exercise! Exercise? Yes! In much the same way that the body detects extra stress on muscles and responds by "building" more, The body will detect increased stress on the skeletal system and begin increasing Bone Density!- Making extra Deposits in the Bank! "Mid to High Impact Exercise" will cause the body to work to increase Bone density. High impact exercise –A simple definition would be Any activity where your feet leave the ground at the same time. Jumping rope, running, and jumping jacks are high impact exercises. As to why do it, research shows that engaging in some higher impact activities Will help make a positive contribution to bone health. Activities for bone health are generally described as weight bearing. Weight bearing exercises put stress on the skeletal structure And your bones react by supporting the stress. Walking and weight lifting fall into this category, But current studies are showing that some higher impact activity Can make a more significant contribution to bone health. It makes sense if you think about it – When you lift weights your muscles react by becoming stronger and toned. If you jump up and down, your bones react similarly. How much high impact activity should you do? This largely depends on you and your current level of health and fitness, But because of the intensity and stress of high impact exercise, Short bouts are generally recommended. The Surgeon General’s high impact activity recommendation For a healthy population is 50 three-inch jumps per day. "Jumping-Jacks!" Who knew? Oddly enough, the vibrations alone of impact exercise will Lead directly to increased Bone Density. The potential for "Passive" bone building made national headlines Back in August 2001 when the journal "Nature" published a study Using sheep at the State University of New York at Stony Brook. Adult sheep exposed to gentle vibrations for 20 minutes a day Increased their bone density by 34% over one year. A recent study, Published by the American Society for Bone and Mineral Research in 2004, Looked at the effect of vibration on post menopausal women (Once again - those most at risk of developing osteoporosis). Significant increases in hip bone density were seen over the 6 month study. While the percentage was low, this is still the first therapy To show any actual increase, or reverse, Of bone loss in post menopausal women. An increase in bone density, muscle strength and flexibility Was achieved in a remarkably short amount of time: 10 minutes of vibration vibrating (30-50 times/sec) Is the equivalent of 40 minutes of weight lifting. A number of "Vibration Exercisers" now fill the pages Of "Arthritis Today" Magazine. For those of us without a Big Ole Vibrator (the innuendoes must stop!!!) Exercise will have to do. Even the subtle impact of regular walking, is enough to aid in the Increase of bone density. Specifically, it is important to alternate forms of high impact exercises (Running, dance exercise, tennis, racquetball, squash) With low/moderate impact aerobic exercises (Walking, swimming, stair-climbing, step classes, rowing, cross-country skiing). Prudent advice is no more than every-other-day for high-impact activities; Perhaps less if you are still overweight, de-conditioned (out of shape) Or you have an injury history Or current problems with feet, ankles, knees, hips or low back. So Exercise puts Calcium away for a rainy day, We have to get it to the bank through supplements and Food Choices. Some of the main sources of calcium in American diets are dairy products. It has been estimated that as much as 75% of the calcium consumed In the U.S comes from Dairy sources. However, many people, particularly By-Passers, are unable to adequately digest milk Due to lactose intolerance. Lactose is the sugar found in milk. Approximately 70 - 90 percent of adults are lactose intolerant to some degree. People who are lactose intolerant, have a number of other options for getting calcium.

These include: Non dairy sources of calcium such as legumes, Leafy green vegetables, Tortillas produced on limestone surface, (yes, this one is true!) Tofu, nuts and foods where bones are consumed such as sardines and salmon. There is also- Lactose reduced milk, Or a just smaller portions of the dairy products as the body allows. Yogurt with live cultures and aged cheeses are Tolerated because the bacteria Used in the production process eat away the Lactose Leaving just the "good part" of the Dairy. The Specific Calcium Content of Selected Dairy Foods---------- Buttermilk – 1 cup = 452 Mgs Elemental Calcium Cheese, American – 1oz = 174 Mgs Elemental Calcium Milk 2% - 1 cup = 297 Mgs Elemental Calcium Skim Milk - 1 cup = 302 Mgs Elemental Calcium Yogurt – 8oz = 400 Mgs Elemental Calcium The Specific Calcium Content of Selected Nondairy Foods ------- Almonds – 1/4 cup = 92 Mgs Elemental Calcium Pinto Beans – 1/2 cup = 64 Mgs Elemental Calcium Mustard Greens – 1/2 cup = 50 Mgs Elemental Calcium Canned Salmon – 3.5ozs. = 185 Mgs Elemental Calcium Tofu – ¼ cup = 100 Mgs Elemental Calcium Orange – medium sized. = 52 Mgs Elemental Calcium Broccoli - 1 cup = 70 Mgs Elemental Calcium Nutritional info is available all across the web

Just Google – Nutrition in______________ For any food and you’ll get a lot of hits. For Restaurant and Fast Foods specifically Try out- http://www.dietfacts.com/fastfood.asp Not just Calcium, but the "Whole Enchilada!" Now, If we can’t get in all of the Calcium we need through our foods And this is difficult if you’re not Suckling at a Teat all day, You’ll probably need Supplements. Some info on those- "Types of Calcium Supplements." Already Listed- Calcium Carbonate- Cheap, very available, Not particularly good source of Absorbable Calcium. Calcium Carbonate is 40% elemental calcium, Only about 2 to 4% of it is usable by the body And it requires stomach acids to absorb. Also already Mentioned- Calcium citrate is much more absorbable, No Stomach acids needed to "prep" it for absorption. (21%) elemental calcium, approx. 10% usable by the body. Calcium Lactate – (14%) elemental calcium, only 10% being absorbed by the body. Needs Full Stomach Acid to be absorbable. Not a particularly effective source of Calcium for By-Passers. Calcium Gluconate is a Calcium Salt. Uses gluconic acid, an oxidation product of glucose. (9.3%) elemental Calcium, 5 % useable. Also needs Stomach acid but more importantly Needs good bit of time with bile to become fully absorbable. Particularly responsible for "Free Calcium," And Kidney Stone warnings accompany its use always! Calcium Citrate-Malate Combo is considered the Best. Particularly for By-Passers. Since all calcium is best absorbed in an acid environment This product (Chelated Calcium pared with Malic Acid) Is Perfect for the RNY’er. (21%) Elemental Calcium from Citrate (20%) Elemental Calcium from Malate Together? –100% usable by the body. Calcium Citramate (Citrate-Malate) has demonstrated superb solubility And superior absorption when compared to other calcium salts. It has approximately six times the solubility of either Calcium citrate or calcium malate individually. There are also agents that increase the absorption of Calcium when present Such as Magnesium. Therefore, the end-all- be all Calcium supplement would have- Magnesium, Vitamin D, A Chelated Calcium Source (such as Cal-Citrate) And an acid (such as Malic Acid freed by Cal-Malate) The Accompanying Vitamin D is best absorbed into the system When in the presence of Fats, so not a bad idea to take these With foods that have at least some fat content. Now- Go rushing off to increase Calcium supplements? NO! Unlike the B&C Vitamins that will excrete on out of your system harmlessly If you get too much, There are toxic effects to having too much Calcium! Excessive vitamin D leads to elevated blood calcium levels, Which can cause significant toxicity. (once again these guys are bond together) Symptoms of vitamin D toxicity include loss of appetite, Nausea, vomiting, thirst, excessive urination, muscular weakness, And in severe cases, coma. Consequently, Intake should not exceed 1000 IU daily. Excessively high intakes of calcium Can interfere with the absorption of zinc, magnesium, Iron, phosphorus and other nutrients. An increased intake of calcium in the diet Increases requirements for magnesium, Another mineral important for bone health. Increasing calcium but not magnesium intakes, Causes an imbalance in optimal calcium to magnesium ratios. When calcium in the body is too high compared to magnesium, Excess calcium (free Calcium) may be deposited in the soft tissues. This may result in calcium deposits in places such as the kidneys, the arteries and the heart. While calcium is important for good health, Excessive amounts of calcium in relation To other minerals may do more harm than good. That whole – Out-Of-Balance causes Tetany Syndrome again. A side note- Alcohol and Calcium! Alcoholics tend to develop osteoporosis, at an alarming rate compared to the general population. A greater correlation than that of smoking to Cancer or heart disease. Nuff Said! Gastric bypass patients should receive Calcium either through Supplementation Or in combo with food of 1000 to 1500 mg/d in divided doses through the day. Calcium intakes in amounts greater than 500 mg are not absorbed. So it is better to take supplements three times a day than once a day. But what about the- Blood Tests don’t tell us if we are getting enough?!? That had me way up in arms, Until, I talked to my Dr. The Blood Tests – (a ‘Chem Screen’ is the slang) WILL Show if you are getting too much Calcium And will also allow the Dr. to check the General and specific balances and ratios of minerals. The best course of Action is to get in extra Calcium, particularly The More absorbable types less likely to produce "free-Calcium" And Get extra Exercise to put it away "in the Bank!" Too much of that "free Cal-money" running loose on the streets Leads to gangs of Kidney Stones and Calcification of arteries. I was curious as to why my Doc, and many others, recommend that their patients start out For the first month or two, Taking a supplement such as Tums EX, Which is just Calcium Carbonate. And then later switching to Calcium Citrate. My Doc’s answer? Deficiency is a concern low on the list of possible problems early on. The Tums, make for an intestinal environment that is less acid and corrosive. The stomach acids are joining the food at precisely the point Of one end of the surgical procedure. Having that location Less volatile, tends to make the transition from newly "cut on" guts To healed, By-Passed system, more problem free. The Tums have little to do with supplementing and more to do With soothing the newly formed "Acid intersection." For those first couple of months, the "Bank" can carry you, After that, it’s time to start putting in deposits. So Once again- ASK YOUR DR…..TALK WITH YOUR DOCTOR! Get it in Food, Get it in Supplements, Through Better absorption with Vitamins D and Magnesium And - Put it into use or away in bone density Through Exercise! For more info than you would ever be able to absorb about Calcium- http://www.medicinenet.com/vitamins_and_calcium_supplements/ index.htm Yeah, (profile) I spent some time at the computer waiting for my wound to heal! Best Wishes- Dx

WOW thats a mouth full. You sure are a walking book of knowledge. Have you considered writing a book with all this info. I would love to buy it. Something maybe you have thought about. Keep the info coming.  Tommy

Tommy, Only book from me will be a Theater Textbook….. I’ve just ‘glommed together’ a good bit of info out here over the last 5 years and keep adding it to the file. About everytime I post, someone will have more info to add, and I’ll stick it on the list…. It’s made for some long posts…haha. Hope it’s helpful to some…. Best Wishes- Dx