Question:
Dietician said no diff between citrate & carbonate --Teach me

During the initial large group consult, the dietician, who seemed knowledgeable in most other areas, mentioned that we would all have to take calcium after surgery. I expected this. When I looked in her handout, I noticed she had listed some forms that were citrate and others that were carbonate. HELP! I recall that one can't be absorbed and leads to osteoporosis. I asked her about it, but she shrugged me off and replied to the group, "Oh, either's fine. Just be sure to take it." Please educate me, so that I can educate her and spare others the dangers of osteoporosis (my mother has it, so I know it's hidden and awful maladies). Thanks.    — Mary Ann B. (posted on August 22, 2002)

August 22, 2002
Calcium carbonate (think of eggshells) requires hydrochloric acid (stomach acid) to be digested and absorbed. Tums are calcium carbonate and what do Tums do to acid? <p> It really depends on the type of WLS surgery that you had as to whether the calcium carbonate can be properly absorbed. However, keep in mind that vitalady.com (who sells vitamins especially formulated for WLS patients) does not offer any products which do not contain calcium citrate.
   — John Rushton

August 22, 2002
I would also like to add that Michelle (vitalady) Curran and her husband have both been diagnosed with osteoporosis because they both took calcium carbonate. It is true that it needs acid to be broken down and be absorbable. We don't even have the acid anymore. The citrate is a more bioavailable form, even in regular folks. My nutritionist also had all of the patients on Calcium carbonate until I did some research and presented the facts to her. There is definitely a learning curve in this area and she was very thankful that someone had taken the time to get all of the required info to make the change. Now everyone in our group is on the citrate. Some are just behind the times and need to be informed. Maybe you are that person to inform her. I just felt like I had to be my own advocate and do the research for ME. We really have to take on that responsibility, because nobody else will. Remember to take your calcium in 500mg. increments as that is the most that can be absorbed at a time. And for some reason our bodies do a much better job at absorbing the citrate in the evening and night hours. But you still have to take a couple of doses during the day. Good for you for looking into this! Do even more research on the internet. There is lots of stuff out there.
   — Cheri M.

August 22, 2002
My dietican said that since I have a history of kidney stones that I should not take the Tums which are calcium carbonate but should take calcium citrate. I also want to prevent osteoporosis (which my mother has) and believe that the information provided by Michelle Curran is quite credible. So, I am sticking with calcium citrate. Hope this helped a bit. Hugs and Prayers.
   — Kathleen K.

August 22, 2002
I have an interesting thought. If we were to take calcium carbonate with sf lemonade (acidic) could we digest it???
   — Robert L.

August 22, 2002
The acidity in citrus type foods/drinks probably doesn't even compare to the gastric acidity level. But how much acidity is enough to absorb carbonate? That IS an interesting question Robert.
   — Cheri M.

August 23, 2002
I believe that it's the *chemical* reaction of the hydrochloric acid in the stomach acid with the calcium carbonate. Calcium chloride, carbon dioxide & water are the results of the reaction. Ca CO3 reacts with HCl very easily - that's why the Tums takes care of the excess stomach acid. It's been years since my high school chemistry, but I remember the experiments with the marble and the dilute hydrochloric acid...
   — John Rushton

August 23, 2002
Maryann, you are smart to research this topic. I, too, had a surgeon that thought there was no difference between the two. I went to a different support group, where hundreds attend, and they have dieticians/nutritionists that have looked into this and calcium citrate NOT carbonate is the way to go. This support group has some long term post-ops in it that were initially put on carbonate and a few of them developed the initial signs of osteoporosis within 6 months. Don't take the chance!!
   — Cindy R.