ObesityHelp

I feel like I post this so often on the forums, so I thought I'd put it here in my profile too.

It's VERY important that after RNY that we take calcium citrate. This form of calcium is the most soluble in a non-acid environment.  After surgery there is no longer any gastric acid in our pouches - or very little, and what is there is often suppressed with acid blockers for the first year after surgery.  (I'm taking Prevacid per my surgeon's orders.)   The cheaper and more readily available form of calcium - which is carbonate - requires gastric acid to be broken down within the stomach and absorbed by the intestines. 

There's a medical condition called Achlorhydria - which is when a patient has no stomach acid (hydrocloric acid).  By studying this condition we can learn a lot about how we as post-RNY patients should be treated by our doctors and which medications and supplements we need to choose. 

In a study published in the New England Journal of Medicine by R.R. Rekker the calcium absorption rate of achlorhydria patients was studied.  After giving test subject a dose of calcium, the bioavailability (absorption of the dose) was measured.  His finding were:

Calcium Carbonate Absorption = 4%
Calcium Citrate Absorption = 45%

So it's clear that after gastric bypass surgery we MUST take calcium citrate in order to have a chance at having healthy bones and teeth. 

So here's what I take:

UpCal-D ---- this is a powdered calcium citrate with Vitamin D3.  In each tiny scoop I get a dose of 500mg of calcium citrate and 250IU of Vitamin D3.  I mix it with my protein shake, plain water, food or whatever - it's tasteless and dissolves very easily with anything.  I've even started to just pour the dose on my tongue and take a swallow of water - kind of like a Pixie Stix.  It has a slightly sweet taste, not yucky or medicine-y at all.

The best prices I've been able to find are from Colonial Medical.  You can either order directly from their website or from their Amazon storefront.  The 16oz jar w/ 227 servings is $10.95.  The 120-pack box of individually packaged serving sizes is $11.95.  I keep the jar at home to use and keep several individual packets in my purse for when I'm on the go.  Here are the links to their websites:

Amazon -- 16oz Jar
Amazon -- 120-pack Box
Colonial Medical -- 16oz Jar
Colonial Medical -- 120-pack Box

Amazon only ships to US addresses.  But Colonial Medical will ship internationally if you order from their website.

Citrical Creamy Chews ---- These are tiny - 2 bite - chunks of calcium that taste like candy.  They come in lemon, caramel or fudge.  My favorite is the fudge because it gives me my chocolate fix for the day.  Each chew is 500mg of calcium citrate and 250IU of Vitamin D3. They are pretty pricey (about $8 for a box of 30), but because it keeps my sweet tooth at bay, I can justify the cost since I only take 1 or 2 per day.  I make up the rest of my doses of calcium with the UpCal-D.

Unfortunately, these have been discontinued by the manufacturer. So if yo find a box you're lucky.  The Citracal brand was sold to another company and during that sale the Creamy Chews were not picked up.  However, my understanding is that the Creamy Chews "recipe" (or whatever it's called) is still owned by the original company and there is some rumor that they will be put back into production under a different name.  We'll see.

My surgeon's office recommends I take 1200mg of calcium per day.  Which seems like a silly number since the body can't absorb more than 500mg per dose, so you'd would need to take 3 doses anyway, so why not just say 1500mg?  But that's a whole other story....

So, back to my surgeon's recommendation of 1200mg...... because I'm on birth control, my GYN has recommended that I increase my calcium intake above the normal range because Depo Provera tends to leach calcium from the body.  So I take 2000mg per day. 

Here's my calcium schedule:

Pre-Breakfast Protein Shake --- 500mg
After Lunch -- 500mg
After 4:30 Snack -- 500mg
After Dinner -- 500mg

It's best to take calcium with food because it will absorb better.  However, if your meal is very high in iron (green leafy veggies or beef) then you might want to avoid a dose of calcium after that meal and find a different time to take it.  Iron interferes with the absorption of calcium.  That's why I take my multi-vitamins at different times than I take my calcium because my vitamins have iron in them.

If you have any questions about calcium, feel free to ask.  I'll do what I can to shed some light.

Pam