Question:
If the only place in the body where Calcium is absorbed

in the dueodenum part of the intestine and people with gastric bypasses dont have one anymore how is someone with a gastric bypass going to absorb the calcium they take I also heard that just taking pills wont work because it passes thru your system so fast. Thanks for any help.    — Donna B. (posted on June 10, 2002)

June 10, 2002
Sorry, I don't have an answer for you but am very interested in the question! I plan on asking my surgeon on my next visit. Good luck.
   — Renee D.

June 10, 2002
From what I understand, calcium is absorbed less efficiently in RNY patients than regular people, but religious supplementation with calcium citrate will work. Write Michelle Curran. She can give you some great tips.
   — Terissa R.

June 10, 2002
OK. I have done some research and I understand your confusion and think I can help clear it up. CALCIUM CARBONATE (Tums, Viactiv, most calcium pills) requires a high level of acid to remove the carbonate portion from the calcium so that your body can absorb it. If your stomach and duodenum are bypassed (as in RNY) you CANNOT absorb calcium of this type. As a matter of fact, unless it is taken with meals so that the stomach is stimulated to produce a lot of acid, normal people do not absorb calcium carbonate very well, either. The reason it is most often used in supplements is because it is cheap. <p>There are other types of calcium, in particular CALCIUM CITRATE and CALCIUM CITRATE MALATE that do NOT require a high level of acid to remove the citrate portion from the calcium. Those types are absorbed just fine even if your stomach and duodenum are bypassed. Unfortunately, calcium citrate is not available in tasty Viactiv-like chewies like the carbonate kind, but there are wafers, tablets, and capsules available. Citracal (the most well-known calcium citrate line of products) even has a "liquitab" which dissolves in a small amount of water--if you can find it available.<p>Hope this helps with the confusion!
   — ctyst

June 10, 2002
My understanding is that the duodenum is the primary, but not exclusive, site of calcium absorptio. Other sections of the small intestine do absorb some calcium, just not as efficiently, and this is why we must supplement calcium, to compensate for the malabsorption. But it *can* be compensated and adequately absorbed is supplemented sufficiently, and anyone who tells you otherwise is lying to you. In addition, intestinal adaptation may enhance absorption over the long-term. The fact is that calcium supplementation is a must after any form of WLS, and the amount of supplementation will vary according to the procedure and how distal a bypass you have. I'm a DS patient, and my doc recommends around 2000mg per day of calcium. One thing to keep in mind when you read scare tactics about calcium and osteoporosis is that a certain (not insignificant) percentage of the non-WLS population will get osteoporosis. Of course or risk is higher after surgery, but in our case at least we know to monitor out levels, so there's an argument to be made for the idea that we might be LESS at risk than the general population for that reason. Diligence and monitoring and proper supplementation -- with all of that, the odds are that we can stay healthy indefinitely after WLS.
   — mmagruder