Question:
Calcium citrate vs carbonate - repeat of previous post
I'm posting this info again, as I saw a question from a couple of days ago that pertains to this issue. I'm still pre-op, but the calcium issue really concerns me. I want to be healthier post-op, not having to worry about bone loss and osteoporosis. I posted the following information several times on the message board, and also in the Q&A section. I believe it bears another repeat. The research on this issue is in its infancy, and we must all follow it closely to stay current on what we should be doing. Here is my post from 4/30/03:<p>"I want to share this information with all of you. I had been in contact with a researcher at the Univ. of Pittsburgh, who has been conducting a study on calcium absorption of post-op gastric bypass patients. I found the article on the UPMC website: upmc.com. It briefly stated the research being done, and stated that bone loss was at a high rate following surgery. I emailed the researcher and asked a couple questions about the study, including what type of calcium the participants took. I received the following response:<p>"Dear Ms McChesney: Thanks so much for your interest in our research. We have been recommending that people take 1000mg calcium citrate daily because we also were concerned that calcium carbonate would not be absorbed after the surgery. The calcium in Tums is calcium carbonate. Our patients were taking a variety of supplements but largely switched to calcium citrate. A very similar operation used to be done to treat stomach ulcers. The part of the stomach which produces the most acid is bypassed so stomach acid is greatly reduced. We are also strongly recommending that people maintain vitamin D intake in the form of 1-2 multivitamins daily. Most vitamin D doesn't come from food, but is made by the body during sun exposure. This obviously varies with time of year and what latitude you live on. However vitamin D deficiency has been described in people after bypass surgery who weren't taking supplements. I would also suggest to someone who has discovered low bone density after this surgery that they have their vitamin D level checked. If someone is deficient, osteoporosis therapies will not be effective. There are very high dose forms of vitamin D available as a prescription which are given over a month to build levels up fast. Vitamin D deficiency can also cause muscle aches and weakness if it is severe and longstanding. There are many other supplements including iron and B12 which also need to be taken lifelong after the operation! I hope this has been helpful Penny Coates" — Carlita (posted on June 23, 2003)
June 23, 2003
Yes, I read this too, on vitalady.com. I threw out the
previous calcium I had purchased right after surgery in
order to switch to calcium citrate. And that's the ONLY
calcium we can absorb well -- that includes fumarate,
carbonate, this new coral calcium (it's garbage),
and os-cal made from oyster shell calcium. And -- sorry,
everyone who enjoys the chocolate chewy Viactiv -- it's not
calcium citrate either, and NO GOOD. The Vitalady sadly
confirmed the research in her and her husband's case -- they
BOTH have osteoporosis after 6 years taking the WRONG
calcium supplements.
— Wendy H.
June 23, 2003
It was my understanding through many conversations with health/nutritional
folks that we absorb the greatest amount of calcium through coral calcium.
Carbonate being the least amount absorbed (although your labs will look
good!), Citrate was higher and coral calcium being the highest absorption
available. I'd like to know where the previous poster got her information.
If it's from an article or research, I'd like to read it. If not, you do
what's best for you and go with the Citrate which the study suggested.
— Shelly R.
June 23, 2003
<b>Coral calcium is calcium carbonate</b>.
— [Deactivated Member]
June 23, 2003
Coral calcuim is the higest absorption rate for people who HAVE NOT had
gastric bypass surgery. Does not work for us.
— Delores S.
June 24, 2003
In response to the previous post, regarding getting all your calcium needs
from foods ... Foods? Okay, specifically, what foods, and in what amounts
daily, are going to give you the equivalent of taking 1500 mg. daily in
calcium supplements? I'd really like to know. While we're at it, let's
also count all the calories, carb grams, and sugar grams you'll have to
intake in order to ingest all your calcium from food sources in order to
avoid taking calcium supplements. I'm guessing that'd be an
eye-opener.<P>And with regard to coral calcium -- a number of
articles in the press have debunked this overpriced calcium carbonate for
use by anybody (WLS patients or not).
— Suzy C.
June 24, 2003
Mario, I'm sorry, but your information is COMPLETELY INCORRECT. To absorb
calcium from food, or from calcium carbonate, coral calcium, Viactiv,
Tums... that food or supplement has to be exposed to hydrochloric acid
(stomach acid) for AT LEAST one hour. With no pyloric valve in our pouches,
and very minimal if any stomach acid production in our pouches, this is
NEVER going to happen, and the calcium will pass through our systems with
very minimal digestion.<p>The 1994 National Institutes of Health
(NIH) Consensus Statement on Calcium includes language that says that
people with low stomach acid (that would be us) should consume CALCIUM
CITRATE SUPPLEMENTS to help prevent osteopenia and osteoporosis.
<p>Sure, you can try to get calcium from food, from inferior
supplements, or other sources, but *I* want to have my bones in 40 years! I
am almost 36 and take 2000 - 2500 mg a day of calcium citrate in the
product Citracal Plus. Here's what this gets me over the course of a
day:<ol><li>2000 mg calcium citrate (200% RDA) <li>1000
IU vitamin D3 (as cholecalciferol) (248% RDA) <li>40 mg vitamin B6
(as pyridoxine hydrochloride) (2000% RDA) <li>320 mg magnesium (as
magnesium oxide) (80% RDA) <li>40 mg zinc (as zinc oxide)(264% RDA)
<li>4 mg copper (as copper gluconate) (200% RDA) <li>4 mg
manganese (as manganese gluconate) (200% RDA) <li>4 mg boron (as
sodium borate) (no RDA established, but studies have proven that it helps
bones absorb and use calcium)</ol> This product costs me about
$12/month since I take 8 tablets a day. I consider that completely trivial
in light of the fact that I could live 60 more years, hopefully with my own
teeth and strong bones!
— Julia Z.
June 24, 2003
The MAJOR SITE for calcium absorption is the duodenum...the duodenum is
BYPASSED in gastric bypass patients. That's why we need calcium citrate
supplements (also please use the ones with Vit. D and magnesium for MAXIMUM
absorption). You won't absorb enough from food...not anymore, if you have
had a gastric bypass. I don't think enough of us understand WHY we need
these supplements, and it's worth it to do your own research to gain this
understanding. Osteoporosis is insidious...it will creep up on you, even
when your labs say things are okay. Calcium will be leached from your
bones first (when there's a deficiency). Once that process has started,
you're on your way to osteoporosis, full bore. I for one don't want my
back to be shaped like an "S", nor to have my bones get so
brittle that they break when I sneeze. That's the reality of osteoporosis.
— [Deactivated Member]
June 24, 2003
Mario, NOPE. First of all, that number of calcium milligrams ISN'T the
number of mgs in the tablet, it's the number of mgs of BIOAVAILABLE
ELEMENTAL calcium... a 250 mg tablet is likely to weigh about 1200 mg
because the body can only use about 21% of the calcium citrate. As another
poster mentioned, your blood tests can LOOK good, but the reality is that
your body will steal calcium from your bones and put it into your blood
until your bones are completely fragile. The REAL way to tell how your
calcium storage centers (bones and teeth) are doing is to have a DEXA-Scan
(Dual Emission X-Ray Absorptiometry) which is a painless x-ray of the hip,
pelvis, and spine. Your body needs calcium for proper muscle function...
and do you remember the biggest muscle in your body? The HEART. If you
don't get enough calcium into your body, your heart rhythm can become
irregular and you can die. Don't be stupid with your health, please.
<p>From MedLine: "Calcium is the most plentiful mineral
found in the human body, accounting for 1.5% to 2% of an adult's total body
weight. The teeth and the bones contain the majority of the body's calcium
(about 99%). Calcium in these tissues is concentrated in the form of
calcium phosphate salts. Nerve cells, body tissues, blood, and other body
fluids contain the remaining calcium. <p>"Calcium is one of
the most important minerals for the growth, maintenance, and reproduction
of the human body. Calcium is essential for the formation of and
maintenance of healthy teeth and bones.
<p>"The bones incorporate calcium into their structure. Like
other tissues in the body, bones are continually being reabsorbed and
re-formed. Teeth incorporate calcium in their structure in a manner similar
to bones.
<p>"Calcium has other functions in addition to maintaining
healthy teeth and bones. Blood coagulation, transmission of nerve impulses,
muscle contraction and relaxation, normal heartbeat, stimulation of hormone
secretion, activation of enzyme reactions, as well as other functions all
require small amounts of calcium.
<p>"Green leafy vegetables such as broccoli, collards, kale,
mustard greens, turnip greens, and bok choy or Chinese cabbage are good
sources of calcium. Certain green vegetables are less effective sources of
calcium. While their calcium content appears to be high, their fiber and
oxalic acid content interferes with the absorption of calcium.
<p>"Other sources of calcium are salmon and sardines canned
with their soft bones. Shellfish, almonds, Brazil nuts, and dried beans are
also sources of calcium. It is difficult, however, to eat adequate
quantities of these foods to achieve optimal calcium intake.
<p>"Low intakes of calcium for prolonged periods of time can
lead to calcium deficiency. This condition leads to osteoporosis, loss of
the jaw bone (and secondary oral health problems), hypertension, and other
disorders."
— Julia Z.
June 24, 2003
I am amazed that with the incredibly accurate medical information that has
been cited in this thread... that ANYONE would be silly enough to stick
with taking the Tums or any form of calcium carbonate after reading this is
beyond reason. The NIH consensus is very clear that anyone with an absence
of stomach acid should take calcium citrate. The University of Pittsburgh
study of gastric bypass and calcium levels is alarming... it shows that
while we are losing weight, the calcium is leaching from our bones at an
incredible rate and that we need to make sure the supplements that we DO
take are absorbed. They are recommending calcium citrate and are doing
another study. WOW... great medical detective work everyone. Thank you very
much as I was searching for the definitive answers and you have given them
to me. I have been taking Calcium Citrate already but would only take it
occasionally as I didnt think it was this important. ciao, Suze
— SusanMaria
June 24, 2003
Somebody said "we're going to be popping pills for
eternity"...right, we are. Didn't your doctor/surgeon/nutritionist
tell you...you have to supplement FOR LIFE after gastric bypass. I'm
amazed that some folks just can't be educated on here. All I can say
is...good luck...you're going to need it.
— [Deactivated Member]
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