Question:
Calcium Options

I am struggling to get down 4 huge Calcium pills a day. Yes i break them up etc., but it seems with the vitamin and my other meds, of which on 2 I ma back on, all I do is take pills in between meals. Are there other options to get in 1000mg of Calcium? Are the osteoporosis prescription drugs smaller? I'm sure I could get my internist to prescibe them and the insurance I have would not question it and I could get up to 12 months worth for 1 co-pay, so it would not be too expensive. I tried dissolving 2 pills in my crystal light but it was so grainy and kept settling to the bottom. Any ideas would be appreciated! Chris — zoedogcbr (posted on February 15, 2003)

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February 15, 2003
I was told to supplement with 1500mg calcium citrate per day.
— [Deactivated Member]

February 15, 2003
A little bit on the expensive side, but my surgeon told me that I could use Viactive...I take 6 of 'em a day... the package says 3, but since we have that malabsorption issue, I upped it to six. It's like 6 little tootsie rolls a day...two at every meal. Have a Sparkling Day!! ~CAE~
— Mustang

February 15, 2003
I continue to be amazed at the people who still take Viactive. It is calcuim carbonate and we only absorb about 8% of it. This is always a hot and heavy issue here and some of the docs even recommend it until they learn better. We need CALCUIM CITRATE. Sorry Christine, This is what all the research shows and most of the people on here are aware of this and have stopped taking them. It is a good chocolate snack though.
— Delores S.

February 15, 2003
www.vitalady.com Her calcium citrate is in capsule form and you only need 3 per day. You get 240 for 14.99. I have researched every calcium citrate they make, and this is the easiest to take and the best bargain.
— joeandteri

February 15, 2003
Delores, are you VERY sure of the facts here? I have quizzed several doctors, done my own research and even asked a pharmacist. The general consensus is calcium carbonate is just fine for us...we absorb it fine and it is easier to take. Cheaper too. Please, people, before you brazeningly give out info that can send us all into a frenzy, be very, very sure of facts. If you can provide FACTS and those facts overrule the facts I have gathered, or vice versa, then something is SERIOUSLY wrong in the medical profession and/or info givers.
— Ginger M.

February 15, 2003
Hi All!! My Dr. has us taking 2 TUMS a day! They have 600mg of Calcium per tablet and are avalible in new smooth disolve which taste great!
— Glenn S.

February 15, 2003
Cite the research.
— Dana S.

February 15, 2003
Ginger - Calcium carbonate needs stomach acid to be metabolized. RNY post-ops don't have the amount of stomach acid required to do so... Ask Michelle Curran (Vitalady). She and her husband both suffer from osteoporosis after taking calcium carbonate faithfully for years BECAUSE IT WAS THE WRONG FORM OF CALCIUM!!!!!!!!! Why do you think Michelle only sells calcium citrate on her site??? You CANNOT go wrong with calcium citrate. You can go drastically wrong by taking calcium carbonate...JR
— John Rushton

February 15, 2003
Calcium Carbonate isn't even absorbed well by "normal" people who have stomach acid to break it down. It must be Calcium Citrate in order for us to absorb it. Tums, Viactive ... nuh uh. They're Carbonate. It's a waste of your time to take it because you're getting nothing from it. It may be cheaper, but 5 or 10 years from now when you're suffering from Osteoperosis will the money you saved still seem worth it?
— KelBurt

February 15, 2003
Many who have posted to this question have asked to see the research on this very hot topic, but they can do their own research on any search engine on the internet. I didn't believe anybody when it came to Carbonate vs. Citrate. I did my homework and found the MANY studies that have been done on this subject. I will paste a little info I found along with a few websites for anyone who'd like to begin their own search. Don't follow blindly just because a doctor says it's so. A doctor isn't ever wrong? Keep in mind, these studies were done on NORMAL folks who have no malabsorption problems like us post-ops. The calcium absorption issue is even worse for us but this will give you an idea of how Calcium Carbonate does NOT absorb as well as Calcium Citrate. In the November, 1999 issue of The Journal of Clinical Pharmacology, Howard J. Heller, MD and his colleagues compared the calcium absorption of Citracal (a calcium citrate formulation) and Os-Cal (a calcium carbonate one) after a single oral dose (500 mg calcium), taken with a meal. 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. Please view these pages for more information: http://irweb.swmed.edu/newspub/newsdetl.asp?story_id=195 http://www.wcanews.com/archives/2000/Jan/jan00b.htm 
— thumpiez

February 15, 2003
Just to clarify the 4 pills I am trying to get down are Calcium Citrate as that is what I have been directed to take. This is fine with me. I was just looking for alternatives to the 4 huge pills.If I crush them and mix them in eggs or something else I am eating would that work? Chris
— zoedogcbr

February 15, 2003
Chris...hi - I didn't realize you had crossed over to the losing side! Congratulations!!! Twinlab makes a chewable wafer of calcium citrate - tastes like a sweet tart. There are also liquid calcium citrate supplements out there. I think those Isotonix calcium citrate supplements that are on Barbara Thompson's site dissolve in water too. Good luck in finding something easier for you to take! JR
— John Rushton

February 15, 2003
Hi, I take calcium citrate. I had difficulty with the pills too and hated the chewable and liquid. What works best for me are the capsules. Fro me, they go down the easiest. As an early post op you can open them and add them to yogurt, apple sauce, protein drink etc. Twin Labs makes a good one with the right mix of calcium and Vit D...there are several other capsule options.
— Maureen R.

February 15, 2003
I use a powdered calcium citrate which I mix into my protein shakes. It is a bit grainy, and will settle if you don't keep stirring, but it's significantly easier to get down than the big pills! You can do a search on the web for powdered calcium citrate, there are several brands and manufacturers. -Kate-
— kateseidel

February 15, 2003
Chris, I found it simply impossible to get my calcium in when I was breaking down the capsule and attemting to mix it with water. The stuff just doesn't dissolve and it tasted AWFUL. Finally, I risked it and just started taking the capsules the normal way. No problem. This is just my humble, perhaps controversial opinion, but I think people worry too much about breaking up their pills, and it's mostly in our heads. We have the same esophagus we've always had so nothing is going to get "stuck" there that wouldn't get stuck before. Capsules break down pretty quickly and I don't think there's any danger of them blocking the stoma. I started taking all my pills the 'normal' way fairly early out and have never had a problem. However, I do still snap my multivitamins in half before swallowing because those are huge horse pills! Those can hurt a little going down, but some extra water does the trick. Again, this is just MY opinion, but I would be interested in hearing someone explain why they feel we need to crush all our pills! Maybe the answer is that they feel it's more easily absorbed that way...but my labs come out just fine.
— sandsonik

February 15, 2003
Hi Sandra :). I'm 2 years out, and still break up almost all pills & capsules. The reason isn't because of my esophagus, but because the opening from my new stomach is so small that it's easy to get pills, etc caught in it, and then I end up paying BIG TIME! So, that's why people do it :).
— Anna L.

February 15, 2003
My doctor told me to use tums. It is so much easier than taking those pills. I was also told to use 2 chewable Flintsone complete a day for my vitiamns. A lot eaier believe me.
— Lana Rush

February 16, 2003
Lana, the problem with Tums is that it's calcium carbonate, not calcium citrate. No one absorbs calcium carbonate as well as citrate, but it's even worse for us because we don't have the stomach acids to break down the carbonate anymore. Because of that, the calcium carbonate can cause kidney stones. A chewable or liquid calcium citrate would be a better option.
— sandsonik

February 16, 2003
OMG..we got 'bolded' and 'scolded'. Sorry if anything I posted was offensive to anyone. Sorry, Moderater Person. ;)
— Ginger M.

February 16, 2003
Well I can easily say that I am more confused then ever. I have emailed my nutritionist and sent some of the data that was listed here on the site. I am hoping she will get back to me, but in the end I will do what she says because I do trust her and my surgeons judgment completely. Never in my life would I have thought there was such a difference of opinion on something like calcium and vitamins. I also take 2 chewable childrens vitamins. Took them when I was pregnaunt and found they give me more of what I need then the others. AND they set best with my tummy. When/if my nutritionist tells me I need more after surgery I will change, but for now she says the chewable kids are good.
— TheresaC

February 16, 2003
Try TUMS Calicum for Life. They are very good and recommend by my doctor.
— barbara A.

February 17, 2003
Isotonix Calcium Plus gives you what you need in two doses a day. I put 3 oz of water in a small cup or the lid of the bottle and measure out 1 small capful, it fizzes for a minute, and I drink it. Tastes like Tang. E mail me and I will tell you how to get it. It is great! And you get the benefit of the water too.
— Mylou52

February 17, 2003
Man, Theresa, I am SO with you on this topic. It is such an important topic and I sure would like to get to the bottom of it all and end up taking what I need to do my bones good in the long run. What bugs me is you have to take 2 of the horse pills (calcium citrate) 2 times a day. Let's see, since you might just have to break those pills in half....well, you could be taking calcium alllllll day long. Somewhere in there you must get in your iron. Iron and calcium are not compatible. I have heard there is a 'timed release' iron (helps prevent problems with constipation iron can cause). Well, if we have this time release thing going on, how will that interact with the on going taking of the calcium citrate horse pills? Just want to do it right. All the DIFFERENT opinions are very comfusing. SO many 'professionals' say there is no difference between the two calciums. Let's face it, IF that is true, then why spend the bigger $$$ on the horse pills you have to take allllll day long? You said it perfectly, Theresa...you had the confidence in your surgeon to do the surgery, and if your labs are good, then you should go on having the confidence in what your surgeon has to say about the vits we must take.
— Ginger M.

February 17, 2003
Ginger - good labs regarding calcium levels don't mean a thing as the body will steal calcium from the bones and teeth for the calcium levels in the bloodstream. You really need a dexascan (bone scan) to detect the loss of calcium in the bones...JR
— John Rushton

February 17, 2003
John...That's an 'affirmtaive' on the bone density test. You can bet your bottom dollar I will have those periodically. Is the bone 'scan' the same as a bone density test I hear so many older people are having done nowadays? Have you any idea how often we should have the test/scan?
— Ginger M.

February 17, 2003
The human body needs calcium to contract the muscles - including the most important muscle, the heart. If you have low levels of calcium in the blood your muscles cannot contract - that is why if your body cannot extract the calcium it needs from your food or supplements, it will take it from your bones. Ideally a dexascan or bone density test would be required before surgery and then a year post-op to see if there was any bone loss. Most docs don't do this. But you can start at any time to get a baseline and then go yearly after that. About the calcium carbonate vs. citrate. I don't have a problem swallowing the citrate capsules that I ordered from Vitalady. So many of us get on here wanting help and advice from long term post-ops with various eating issues or weight maintenance, etc. But when you have someone long-term say "this is my experience with calcium carbonate" everyone wants to pull out the "well, my dr. told me this". Why is it we trust them (the long-term post-ops) for some things but not others? Who decides what they are experts on? Citrate is not hard to find - maybe a little more expensive, but isn't your health worth it? Mine is to me.
— Ali M

February 17, 2003
It's really not an issue of trust. But when you have sooooooooooooooooooo many different opinions, it gets VERY confusing. One expects doctors and nutritionists and druggists to know these things. To have a 'lay' person, long term post op or not, claim to know more than a professional would, is a bit hard to take. I have decided to go with calcium carbonate and have bone density tests taken as needed. I will keep tract and be the first one to switch if it starts looking like the doc was wrong. The ONLY reason I do not switch is because it has NOT been proven to me that calcium carbonate does not work. I have read lots about this and I am just not convinced. But I keep checking and, believe it or not, with an open mind. Only time will tell, huh? Thanks for the input. This is how we all learn. Makes us suspect and that leads to research. Research makes us knowledgeable.
— Ginger M.

February 17, 2003
I usually keep a low profile on this subject, once I've said my piece. But as I sit here on what's left of my hips, and ponder my having been "rated" for long term care ins. BECAUSE of my osteoporosis, I have to state again. I could've written several of the paragraphs in this discussion prior to 2000. I knew my doc knew more than anyone on earth, esp more than some "internet lady" (1999). I resisted the full dexascan & got an ankle scan (2000). Red herring. I believed the lab results. When I got kidney stones (1997), I thought the urologist was nuts. THEN I got the dx with brittle bones. THEN I took it seriously. But it was way too late for me. My doc's office was wrong about calcium being calcium. They have corrected their view today. (I do believe it was staff interposing their personal opinion, not his own.) You see, I had several chances to change my ways before I got this deep into trouble. If I fall on my living room rug, my wrist will snap. You can make your own choice, of course, as I did. But do be fully aware of the cost when you gamble. My husband, too. He fell last summer, just a little tumble. We just got his permanent handicap sticker in the mail. It would've been a fairly serious injury, BUT he would've still had bones around the injury. They're pretty crispy, though not as bad as mine. It's like ripples in a brook.
— vitalady

February 18, 2003
One clarification... seems that carbonate might be OK for VBGers since you all still have a duodenum (where calcium is absorbed), stomach acid (needed for calcium carbonate), and no malabsorption issues. It the RNYers (include me in that list) that have the triple strike against us in terms of absorbing the calcium and need to try and optimize our chances using the more absorbable citrate. BTW, it's the DEXASCAN that will give you true results on the condition of your bones. My pcp gives me a script for it so there's no cost.
— mom2jtx3

February 18, 2003
Just one more comment from mee. You don't have to take horsepills for your calcuim. Vitalady sells the capsules and they can be opened and put in your shake or something.
— Delores S.

February 18, 2003
I too agree that the varying *opinions* on calcium carbonate vs. calcium citrate can be VERY confusing for new post-ops as well as some long term post-ops; however, I have REALLY been researching this subject...have read articles from the AMA, several orthopedic journals, obesity surgery, gastroenterology, and other medical publications. My surgeon even recommended I take one Tums chewable tablet three times/day. Now he is definitely highly skilled in his area of expertise but, guess what? I've switched to calcium citrate ONLY because I am an RNY and have found (through what I've read in medical journals) that it is absorbed better and you don't have to take as many. I just hope it's not too late since I've taken it for the last 5 months and made the decision to change to calcium citrate just 2 weeks ago. As a matter-of-fact, calcium citrate has a chewable form at www.vitaminshoppe.com like an orange flavor and I'm getting it after I finish my current supply of the *pills*. I'm not altogether sure if it's best in the dry form or chewable, but I'm a "believer" as far as which is best, and have the support of several physicians at my place of employment. DOn't let anyone tell you that "it doesn't matter as long as it's calcium". That is NOT TRUE. The thing to do is do your own research, then make your own, independent and unbiased decision for yourself. I'm satisfied with MY decision and will continue my journey towards this end. That's my 50 cents worth...LOL Yourdivaness (Hadiyah) Lap RNY 9/3/02 down -84.
— yourdivaness

February 19, 2003
You might want to try the gelatin capsules; they *look* big but go down pretty easily. My surgeon had us start take normal pills at the one month mark, and I don't normally have a problem with them. I'm currently taking the store brand calcium citrate/vit. D/magnesium capsules from Vitamin Shoppe. Osteoporosis drugs can be awfully hard on the stomach and can cause ulcers, so they wouldn't likely be prescribed as an alternative to calcium supplements if you don't yet have osteoporosis.
— Celia A.

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