Question:
Calcium carbonate versus calcium citrate?

Okay, I feel really ignorant about this topic. I am 9 months status post open RNY. My surgeon RECOMMENDED that I take Viactiv. Now I read here that our bodies don't absorb the kind of calcium in the Viactiv calcium chews. You mean to tell me that I've just been taking them for nothing? My calcium levels have come back fine. Could someone tell me WHY we don't observe calcium carbonate and what the different is between that and calcium citrate? I never was a great science student. Thanks!    — MedTrans (posted on September 25, 2003)

September 24, 2003
The simplified reason is that calcium carbonate requires stomach acid to be absorbed. Citrate does not. Those of us with any kind of bypass have very little stomach acid anymore. Therefore, citrate is the way to go. Just bear in mind that doctors are usually only required to take a 1 hour course in nutrition in Med School. So, although they may be good cutters, they're usually not up to par on nutrition issues. It's up to us to teach them, and hopefully, they'll be receptive.
   — Leslie F.

September 24, 2003
Leslie is totally right. Unfortunately blood levels of calcium do not tell the total picture. You need a Dexa Scan and now. You need to see what your bone density looks like. That is what will give you the true picture. I had mine done at 6 months PO and it was fine. It will give us a good baseline for the future. The damage from not absorbing the calcium will not be noticeable for quite a while and then it may be too late to rebuild. The fat on our bodies protected us as pre-ops from probably ever getting osteoporosis. Until the majority of fat is gone and for a while, the impact won't be as noticeable. Please get some calcium citrate. I take Citracal ultradense calcium citrate caplet +D. The coated caplets make it so much easier to get the big pills down. There is the same product without the vitamin D so the pills are smaller but if you can handle the big pills, the vitamin D helps to absorb the calcium better. Your's isn't the first surgeon that isn't fullen enlightened in this area.
   — zoedogcbr

September 24, 2003
Calcium Citrate is absorbed better than other forms of calcium in post-ops. Both my doctor, and those of my support group agree on this bit of information.
   — Stephanie S.

September 25, 2003
There have been studies showing that people with normal stomachs do not absorb calcium carbonate as well as they absorb calcium citrate, so for those of us with the RNY and malabsorbtion issues, it's an even bigger risk that calcium carbonate doesn't do the job. I think many docs still recommend calcium carbonate because they think their patients are more likely to take calcium supplements if they taste like candy (like Tums or Viactiv); I really don't think they recommend calcium carbonate out of a firm scientific belief that it's just as good as calcium citrate (I doubt they spend as much time thinking about it as we do, and typically, bariatric surgeons just don't follow enough of their patients for enough years to know whether or not osteoperosis develops years down the line). In any case, I decided to use calcium citrate because nobody claims we can't absorb *that*, and I don't want my bones caught in the middle of the citrate versus carbonate debate
   — Suzy C.

September 25, 2003
Teresa, as Chris suggests, if you dont have a baseline bone scan get one done NOW. Your blood tests may say that the calcium levels are fine but the only way to know if the calcium is being absorbed is to have an annual bone scan and compare it to the baseline. Your doctor can then adjust your calcium citrate up or down depending on the scans. In one of my support groups, several women who are now 5 years or more out started on carbonate right after their RNY's and they developed osteopenia within 6 mo. They are convinced that switching to citrate helped slow their bone deterioration. It was enough for me to decide that I didn't want to take the risk and to have that bone scan done early.
   — Cindy R.

September 26, 2003
calcium carbonate can also cause kidney stones. I reccommend getting a bone density scan, and switching to calcium citrate, because yeah, the calcium carbonate isnt really absorbed. :-)
   — Katrina K.