Calcium-surgeon and PCP disagree

Ok, I went to my PCP for follow-up and I showed her the list of supplements recommenmded by the surgeon.

Copy and Paste from my surgeon:
"We recommend that our sleeve patients take daily supplements. These include complete chewable or liquid multivitamins with iron twice a day, chewable calcium citrate (2000 mg) with vitamin (take separately from MVI with iron), and vitamin B12 (300 mcg sublingual) daily."

She says that taking 2000 mg of calcium is too much and sites that studies show large amounts of calcium supplements have been linked to artery issues.
She says that 1200 mg is max and that I should include the calcium that is in the Pepcid and tums.
 
She did say she does not have enough knowledge with WLS to properly follow up. I appreciate her honesty and will be making an appt with a GI guy.

Any help with this would be greatly appreciated.

Donna

my pcp said the same thing about the calcium .... i don't know what to do either.

i just looked at my calcium and it is only 600mg each .... so my two a day is okay .... makes both docs happy lol.

While I have nothing scientific to back it up, my assumption on the 2000 that seems so commonly recommended takes into account the reduced amount of calcium you will be getting from normal food sources. That being said, I only take 1200 a day for no other reason than the calcium pills make me sick. As for the calcium in tums and such, you generally aren't going to absorb as much of that as it isn't as soluble, I believe.

I did a quick search and found some interesting reading on calcium consumption. A few things stood out.

They recommend about what your pcp recommends but mention that absorbtion is better with food sources rather than supplements so that may account for the increased supplement size. Also, it says 'High protein diets increase calcium excretion, particularly if the protein comes from meat.' That may factor into it as well. I didn't verify sources but here is the link: http://www.enzymestuff.com/calcium.htm

My calcium levels have been fine since I had the VSG. I get my calcium primarily from milk, cheese, more cheese and greek yogurt. My PCP/Cardiologist said a calcium supplement wasn't necessary since I was getting what I needed from the foods I ate.

This was good news to me as I didn't look forward to more pills.

I would do a bone density test and see where you are at with the calcium. If you need 1200, take that, and if you need more then take that. I don't think there is a one size fits all prescription. Our bodies are different in the way they work and absorb things. And if you don't need any, then all the better. I would think that 2000 is too much though. Unless you are not absorbing much from food and flushing out the rest with the high protein diet.

Personally I would always go with the recommendation of the specialist over the opinion of the PCP.  The reality, based on my experiences, is that the PCP simply do not know the specifics like we assume they do.  Their daily job is general medicine, not the details involved with nutritional requirements of WLS patients.   I've encountered several PCPs that have no clue what the sleeve even is.  We tend to assume that PCPs should know it all.  Honestly they're at the bottom of the Dr hierarchy.

You'll get a different opinion from every doc you see.

What do your labs say?

IMO, THAT is the only thing that matters. Your labs and a bone density test should be the determining factor NOT whether a surgeon or a PCP said to, or not to.

Also, don't waste your time with Calcium Carbonate, (check your Tums) because your body can't digest it very well. Go with Calcium Citrate.

Keep in mind that checking your calcium level isn't enough - because if your body doesn't get enough calcium from your diet, it will steal it from your bones in order to keep your blood levels where they need to be for your heart, other muscles, and nerves to function.

That's why people recommend the bone density testing.  However, a caveat there is that some bone loss is normal for morbidly obese people who are losing a lot of weight - our bones got more dense than normal from carrying all that weight in the first place!  So the test has to be interpreted correctly.

There is a lab you can have drawn that will provide insight on if your body is pulling calcium from your bones or not, but I can't think of it off the top of my head.  I'll look it up and edit this post.

Also - one danger of taking too much calcium is kidney stones - not fun!

Edit - here is info about labs from a post by poet_kelly:
So if we don't take in enough calcium or don't absorb the calcium we take in for some reason (like if our vitamin D level is too low), our bodies produce extra parathyroid hormone (PTH), which sucks calcium out of our bones to keep that level in our blood good.  As long as you have bones and teeth to suck calcium out of, that calcium level in your blood will likely be OK. 

If it drops low, it may mean you have problems with your endocrine system or other potentially serious health problems, but it doesn't mean you aren't getting enough calcium.

For lab results that tell you about calcium, what you want to know is your D level and PTH.  If the D is below 80, that means you won't absorb calcium well, no matter how much you take. Doesn't mean you won't absorb any, you will.  But maybe not enough and you will be at increased risk for osteoporosis as well as other unpleasant things.

If the PTH is on the high side (even in the normal range, just on the high side), it suggests you are indeed leaching calcium out of your bones.

Blood plasma levels aren't enough to ensure we are taking in enough calcium.

I was instructed to take 1200-1500mg per day in my losing stage (due to reduced food consumption), and 1000mg in maintenance.

Calcium carbonate in pepcid, tums and rolaids need an acidic environment to be absorbed properly so if you're on a PPI the calcium carbonate is not being absorbed properly. It's pretty much the cheapest and least assimilated form of calcium on the market especially for those of us who have altered guts. Plus, too much calcium carbonate can lead to kidney stones. I avoid them completely.


Here's the nutrition and vitamin recommendations from the ASMBS guideline. It's lengthy, and very "medical", but if you take the time to read through the vitamin recommendations it can help you, and maybe even help your doctor become educated on bariatric needs.

http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/bgs_final.pdf