Question:
why not calcium carbonate?

why can't we take calcium carbonate. i know you say it can't be absorbed, by why? what's the rationale?    — JOY C. (posted on August 12, 2003)

August 11, 2003
carbonate requirs stomach acid to absorb. RNY'ers have little to no stomach acid.
   — thekatinthehat

August 12, 2003
I did find several things on the web talking about the way calcium carbonate is absorbed and why nutritionists recommend that people take it after a meal: You need a high concentration of acid for the carbonate to be removed from the calcium. That's why you'll see calcium citrate recommended for older folks because the amount of stomach acid people produce decreases as they age. One source I know was a site that talked about vitamins and minerals and how they work in the body.<p>We have had not only our stomach, but also our duodenum bypassed (ASBS site). Those are the most acidic parts of the digestive system: it is like a gradient from more acidic to less acidic (Thank heavens, too. Talk about "fire in the hole!" LOL). So by the time we reconnect with the intestine the environment is simply not acidic enough to get any meaningful absorption of calcium from the carbonate form.<p>Calcium citrate does not require a high concentration of acid to cleave the calcium from the citrate. It is touted as an extremely absorbable form of calcium. It is simply more readily absorbed by ANYBODY.<p>Some of this I pieced together from different sites (including the ASBS site). There is no one site that I am aware of that says "gastric bypass patients do not absorb calcium carbonate." BUT I do know of several people who have developed severe osteoporosis while taking calcium carbonate. And, to me, it is common sense that if you know A) calcium carbonate requires acid to be absorbed (readily documented in many places) and B) RNY patients have had the most acidic portions of their digestive system bypassed, then C must be true: RNY patients had better hedge their bets by taking a more absorbable form of calcium (like citrate).<p>I do know that there is research going on (try searching the library for Pennsylvania--I think that is where the study is being done) and preliminary results are consistent with what I've outlined here. BUT the truth is that I really don't understand what all the fuss is about. Most dr's are so careful to err on the side of caution but my own dr/support group still recommends Viactiv. Why not just be on the safe side? If you're gonna take calcium ANYWAY, why not take a form that you KNOW will be absorbed? It's NOT THAT MUCH MORE EXPENSIVE. And I would rather not have to worry about an irreversible complication years down the road. Because when that bone is gone IT'S GONE.
   — ctyst

August 12, 2003
I can't second Cheri enough when she says, why not be on the safe side. My surgeon too allows his patients to choose between carbonate and citrate. He says that we have "enough" acid remaining in our systems to absorb the calcium. I think my surgeon is one of the smartest people I know and a very attentive post-op doctor but on this I have to disagree with him until all the studies/facts are in. I attend a support group (not my surgeons) and several of the 2-3 or longer years post-op'ers had started on carbonate and by 6 months post-op, they had either developed osteoporosis or had osteopenia (starting stages). That was enough for me. Perhaps they didn't take enough carbonate, but I say, why take the risk? I started with citrate and just got the results of my dexascan back, and at 18 mo post-op, I have gained a tiny bit in bone density, so I know the citrate is working so far.
   — Cindy R.

August 12, 2003
Joy, I e-mailed my surgeon's bariatric nurse specialist and asked her this same question. My surgeon recommends that we take 3 tums daily (carbonate). Her reply was, that everyone absorbs calcium citrate better, but there is no study that shows we do not absorb enough of the calcium carbonate to be effective. She also said that their patients always have great lab results (calcium levels), and until proven otherwise, they feel the carbonate is just as effective for us. I plan to have a bone density test within the next few months, and if things are not perfect, I'll switch. As the others say, doesn't hurt to err on the side of caution.
   — Linda S.

August 12, 2003
Any surgeon that says to use calcium carbonate is just setting their patients up for future osteporosis in my opinion. Why gamble? Also take the citrate with vitamin D as it helps get absorbed even more. <p>This said, if at first the pills are just too big then use the carbonate for the first month or two till things have settled down and then switch. I used the Citracal coated tablets (citrate form) the first couple of months as they were reasonably small in comparison to most, and the coated made it so much easier to get them down. At about 3-4 months I switched to the ones with D, which are huge, but I don't have a problem with them. <p>The surgeon isn't the person who will have to live with this problem in the future so why not go with the mainstream thinking/experience and use the citrate! You are playing russian roulette otherwise with your bones!
   — zoedogcbr

August 12, 2003
This is to Linda - blood tests results regarding calcium don't mean a thing as far as your bones go. The body will steal calcium from your teeth and bones to keep up the blood calcium levels - because the body's priority is to keep that calcium level within a certain range for normal heart function. If your nutritionist doesn't know this, she's not a good nutritionist...JR
   — John Rushton

August 13, 2003
John is right on about the calcium tests --- They do NOT accurately reflect what's going on in your system. The test to get (and post-op DS patients get this because of maximum malapsorption) is PTH. This is a hormone whose levels become high if calcium is being leeched from the bones. If it's high, this means that one is NOT getting proper calcium and one's body is taking calcium from the bones. This leads to osteoperosis. So, you can have a 'normal' calcium range (calcium depletion does not show up until it is really, really serious on this test) but still have low calcium levels! Check with your surgeon/PCP and MAKE SURE they are reading the PTH levels and using THAT test as a guide, not the simple calcium test. I HIGHLY RECOMMEND a bone density (DEXA) scan for ALL preops. My PCP thought I was 'too young' (at 36), but my OB decided it would be useful and ordered one for me. I had one done of my wrist, spine and hip. It showed that I was ok except for my spine, which showed osteopenia (I've had all kinds of trouble with my spine, including arthritis and this could also skewer the results). This is all the MORE reason for me to make sure I get my calcium in!!! I take 6 calcium citrate PLUS (it has VIT D and magnesium --- both essential to enhance calcium absorption - and other minerals). The citrate alone also has Vit D I honestly don't think the issue of osteoperosis has been taken seriously enough in the medical community for post-op WLSers. You are right that the RNY completely bypasses the duodenum and acid-producing areas of the stomach (this is in the 'lower stomach'). But, the duodenum is very absorption-specific: It specializes in calcium, B-12 and iron absorption. The DS has about 3-5 cm of duodenum (still not a lot) -- so we ALL need to ensure we have adequate vitamin supplementation! This means more than the usual person would take. Even though the proximal RNY does not have a lot of malapsortion, the duodenum is totally bypassed. So, it is ESSENTIAL that you get enough iron, calcium and B-12 for LIFE. It is also true that some seem to do fine on calcium carbonate alone. BUt, I wouldn't take the risk! I want to do everything possible to ensure that I keep healthy bones! :) All the best, Teresa
   — Teresa N.