Why Do I Need Calcium After Bariatric Surgery

Calcium is an alkaline mineral that is mainly found in bones and teeth. Smaller portions of calcium are found in nerves, blood and tissues. It is the body’s most plentiful mineral.

While most people think of bones and teeth when calcium is mentioned, it also plays an important role in reproduction, maintenance of a healthy nervous system, as well as blood vessel contraction.

People who have undergone bariatric surgery are at a greater risk for becoming calcium-deficient and are at risk for developing osteoporosis, a softening of the bones which makes a person susceptible to fractures of the spine, wrists, hip and pelvic bones, etc.

Typically, maintaining a healthy diet in which calcium-rich foods are included is the preferred way to ensure that you are receiving optimal levels of this essential mineral. A list of foods that are considered to be rich in calcium are:

• Dairy products, such as cheese, milk and yogurt
• Dark green leafy vegetables, such as broccoli and kale
• Fish with edible soft bones, such as sardines and canned salmon
• Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes

Some trials have indicated a correlation between healthy calcium levels and decreased blood pressure. A diet that contains the proper intake of calcium and other minerals, along with adding milk, yogurt, and other dairy products is helpful in lowering elevated blood pressure. However, for those who have undergone bariatric surgery, calcium supplementation is vital.

People who have undergone bariatric surgery are at a greater risk of being calcium-deficient and it is virtually impossible to get adequate amounts of calcium through diet alone. After bariatric surgery, the thyroid gland is affected. The thyroid is the body’s master gland when it comes to hormone production.

This gland also plays a key role in regulating blood calcium. Patients have a tendency to develop hyperparathyroidism after bariatric surgery. Hyperparathyroidism is an increase in the PTH hormone. This increase negatively impacts the thyroid’s ability to ensure proper calcium levels.

Why Do I Need Calcium After Bariatric Surgery?

After bariatric surgery, not only is the ability to take in as much food as you were before surgery decreased, but the ability to absorb key nutrients is also diminished. In regards to calcium, following bariatric surgery, the acid level in the intestines is significantly reduced. Approximately 50% of patients who have undergone this procedure are found to have intestinal acid reduction.

Absorption of calcium takes place in the small bowel. Since this area has been affected by bariatric surgery, calcium is no longer easily or readily absorbed.

This decreased calcium absorption can lead to metabolic bone disease, which are disorders of bone strength usually caused by abnormalities of minerals (such as calcium or phosphorus), vitamin D, bone mass or bone structure, with osteoporosis being the most common.

It is therefore important to take calcium citrate in a dosage of 1,500 to 2,000 mg daily, as prescribed by your physician and recommended by the ASMBS. 

In order to maintain adequate serum calcium levels, it is important to institute vitamin D along with the calcium citrate.

The other problem is that your blood work won’t necessarily show a calcium deficiency.

In a calcium-deficient state, your body will steal calcium from your bones in order to meet its needs.

This means that your blood-calcium levels will look good, but your bones have less calcium which leads to more problems…like bone loss, osteoporosis, osteoarthritis and metabolic bone disease.

Calcium needs for VSG patients

Yes, VSG patients are also at an increased risk for developing the same deficiencies as RNY Gastric Bypass patients. Remember, as a VSG patient, the size of your stomach as been reduced by 75%.

This directly affects your body’s ability to produce the amount of stomach acid needed to properly absorb calcium. As you’ll read in a moment, the type of calcium you take may require the missing stomach acid – meaning you may not be absorbing all of the calcium you think you are…

Here’s an excerpt from this study, which evaluates calcium absorption after bariatric surgery.

“After [sleeve gastrectomy], which only reduces the stomach volume, it is generally considered that the effects on the skeleton would be less pronounced than after RYGB. However, recent studies seem to refute this hypothesis as not only RYGB, but also [sleeve gastrectomy] appears to have detrimental effects on bone density.“

Types of Calcium Explained

Calcium is important but not all calcium is created equal. And as a bariatric patient, the type of calcium is important. Generally speaking, there are two different forms of calcium: Calcium Carbonate and Calcium Citrate.

Calcium carbonate is a form of calcium that requires stomach acid to break down and absorb into the body. It is often used to treat heartburn, acid indigestion and upset stomach. Some products will contain this form of calcium because of two reasons.

There are 2 main reasons why a company would put calcium carbonate in its supplements:

1. It’s smaller – you can fit way more elemental calcium in the Carbonate form into a pill/chewable so it’s great for managing pill size or number of pills required
2. It’s cheaper – pretty self-explanatory, right?

Calcium citrate is another form of calcium but does not require stomach acid to digest and absorb. It is most commonly used to treat calcium deficiencies, especially after bariatric surgery since it can be easily digested and absorbed.

Whether you’re a RNY, VSG or DS patient, the type of calcium you take should be Calcium Citrate. You’ll absorb it better and fend off calcium deficiencies better.

Why Bariatric Patients Need Calcium Citrate

It’s virtually impossible for bariatric patients to get enough calcium through diet alone.

After bariatric surgery, the low stomach acid environment dramatically affects your body’s ability to absorb calcium. Patients who have some form of bowel bypass (Gastric Bypass, Duodenal Switch, SADI-S) because the part of the bowel that is responsible for most calcium absorption can’t do its job since it’s been bypassed.

Calcium citrate is better for bariatric patients because it doesn’t require stomach acid to digest which makes it easier to absorb. This means bariatric patients are more likely to absorb calcium citrate vs calcium carbonate since they have a reduction in stomach acid following surgery.

Calcium citrate has also been shown to provide significantly higher bioavailability vs calcium carbonate in bariatric patients. Since osteoporosis can be more prevalent following bariatric surgery it is important to make sure that supplemental calcium citrate is added into the diet since the body’s ability to break down and absorb has been drastically reduced.

What Calcium Citrate Supplement is Right For Me?

Here at Bari Life, we offer more than just one option. This allows you to pick and choose the product that best suits you and your personal needs.

When it comes to calcium citrate, we have created BariBursts – watermelon Calcium Citrate chews designed specifically for bariatric surgery patients. With just one chew three times per day (sleeve and bypass), or one chew four times per day (BPD/DS) you will get all of your recommended calcium, plus a tasty treat every time you pop one in your mouth!

We also have our Just One multivitamin with iron that is designed to pair perfectly with our calcium citrate chews to provide all of the necessary vitamins and minerals needed to stay healthy and prevent vitamin deficiencies after bariatric surgery.

When taken together, you will get everything you need without having to add additional supplements, plus our calcium chews taste amazing!

Our other option is our “complete bariatric vitamin formula” which provides you with all of your vitamins and minerals that you need following surgery. This allows you to get everything you need in one product which makes it not only easier to adhere to long term, but also more cost effective compared to other companies.

Our complete formula comes in two different forms. Easy to swallow tablets and flavored powder (Lemonade and Watermelon). In these products you will get all of the calcium citrate and the multivitamin and iron that you need. 

Any one of the above mentioned products provide a high quality and cost effective solution, while giving you all of your vitamins and minerals including both calcium and iron.