Question:
I have a question about calcium and osteoporosis

I've always heard to take calcium citrate rather than calcium carbonate because the citrate gets absorbed where the carbonate doesn't. Lately I've been hearing opinions and evidence that the calcium citrate may not be effectively absorbed as well, possibly leading to osteoporosis and bone mass loss. Do any longer term post-ops have personal expeience with being diagnosed with osteoporosis after taking calcium citrate? Also, if the calcium citrate is not being absorbed in our digestive tract, are there any other options for getting enough calcium? Is the calcium we take in through our diet, like from cheeses, dairy and milk products, etc being absorbed or malabsorbed like the supplements? Any insight with this would be appreciated. Thanks    — Jeanne R. (posted on August 7, 2001)

August 7, 2001
Both the MDs I work with, plus my GYN, tell me to use Tums to get my calcium. It is far cheaper than other products and tastes a heck of a lot better. I take one in the morning and one at night. My WLS, at his seminar, answered a similar question and also suggested Tums. Hope this helps.
   — Dianne C.

August 7, 2001
There is so much dis-information on the subject of absorbable calcium and osteoporosis. What I KNOW to be true is this: post-op, our bodies malabsorb calcium. Therefore, calcium should be taken in the form of calcium <i>CITRATE</i> because it is the most optimally absorbed form.<br><br>Tums, Viactiv chews, etc., are all calcium <i>CARBONATE</i> and are <b>NOT</b> absorbed because they require the stomach's acids to be absorbed (acids which we no longer have access to, due to the division of our stomachs and the rerouting of our intestines).<br><br>I take Twinlab calcium citrate wafers -- they look and taste like huge sweet tarts.<br><br>As far as blood tests go, they are inaccurate at determining the health of your bones. The only way you can <i>KNOW</i> how your bones are doing and if your BONES are benefiting from your calcium supplements is to have a Dexa-Scan.<br><br>Personally, although the calcium supplements I take <i>are</i> expensive, I would rather put the money into supplements now, than into hospitalization, surgeries, walkers, wheelchairs, etc., down the line because my bones are brittle.
   — webgrrlie

August 7, 2001
I have read similar items regarding calcium citrate vs. carbonate. I specifically asked about this at my check-up last week at the surgeon's office. The nurse practitioner (who is very knowlegeable and has worked with WLS patients for many years) told me that neither kind is absorbed very well after surgery. Her opinion is that it makes very little difference which kind you take, as long as you do take it. She still recommends TUMS or the equivilent (I buy the cheaper knock-off at Wal-Mart). Perhaps this is an attempt by manufacturers to sell higher priced Calcium supplements. In any case, I trust the advice of my doctor and try my best to follow it. I do know that my surgeon's practice has performed thosands of bypass operations over the years, and they recommend Tums. Of course this is just my humble opinion, I could be wrong.
   — Jonathan M.

August 7, 2001
The one thing we CAN be sure of is that Tums & carbonate are not absorbed. A casual survey among those 1+ yrs post-op showed that over 70% of those who had had dexascans already had damage (osteopenia) or full osteoporosis. I refer to us as the Tums generation. If you go to the ASBS web site, you'll see that osteoporosis is an expected side effect of WLS. You will also note that Tums is the recommended choice. Coincidence? Personally, we used a higher grade of carbonate with D, high doses and still have advancing osteoporosis. There is not much treatment for us, as the #1 choice of meds is not good for us post-op, and the 2nd choice is rather 2nd rate. I have been using a high dose (per single pill) citrate for a year, along with other minerals to enhance calcium absorption, and am due for my re-scan in a month or so to see if we can even slow the progress of the disease. I would NEVER recommend Tums to anyone, even intact, as a source of calcium--just not absorbable. But to someone without stomach acid, the idea is simply amusing if it wasn't so critically sad. There is no proof (that I know of) that the citrate actually works, but there is ample proof that Tums and other forms of carbonate DO NOT WORK. Some brand names that are not good are Viactiv and Caltrate. Surprised? Caltrate is actually carbonate. Also, many people who are taking citrate, formulated correctly with D & magnesium still will not get enough in because the labelling is tricky. It may appear that 1 pill = 630mg, for example, but it may be 2 pills or as many as 4 pills to reach that dosage. Please be careful to read the packaging as if your bones depend on it.
   — vitalady

August 9, 2001
Both my surgeon and former pcp recommend Tums for calcium. Both say that the "designer" forms of calcium are an out and out waste of money and are no more effective than plain, old Tums.
   — [Anonymous]