Did you know that calcium absorption is a major issue for bariatric patients? Approximately 85% of all calcium supplements sold in the United States contain calcium carbonate (also known as limestone, or chalk) – and this form of calcium is rarely recommended for bariatric patients because of several key features: 1) it acts as a functional antacid, 2) it requires a highly acid environment to be absorbed, and 3) as a direct result of surgical alteration of stomach size – most people will no longer have the physical capability to absorb any of the elemental calcium from it.
The two forms of calcium that bariatric patients hear bantered about most frequently are CALCIUM CITRATE and CALCIUM LACTATE. Both of these are excellent sources of calcium, however, one has a distinct advantage over the other. If we are speaking about the best form of tableted calcium for people who have not had surgical alteration of their GI tract – then I would agree that calcium citrate pills are ideal. However, when you take into account how bariatric surgery affects the stomach and/or small intestine, and knowing that a large percentage of bypass surgeries involve bypassing at least part of the duodenum (which is where calcium is normally absorbed) – then calcium lactate becomes the winner.
Furthermore, calcium is a bulky mineral. You have to take a lot of it to be able to absorb the percentage you actually need. That is why calcium tablets are usually fairly big. Knowing this, vitamin manufacturers have two choices when they configure their supplements – they can either divide the dose into multiple tablets or capsules, or they can compress it into one or two giant ‘horse’ pills and compress them to the point that they are veritable cement bullets. This leaves bariatric patients in a catch-22, — they usually do not want to feel full and bloated from taking a lot of pills, but they also know if they take one of the highly compressed tablets, that they will likely absorb very little from it.
The solution is to take powdered calcium, and the ideal form of powdered calcium is calcium lactate. Calcium lactate is considered to be one of the most neutral forms of calcium. It is not chalky or soapy like calcium carbonate, and it lacks the bitterness of calcium citrate. If you need a calcium that is readily absorbed, and has a high solubility factor, which means that you can easily mix it into any beverage you so choose — then calcium lactate is the one to choose. It is significantly more soluble over other forms so you can fit a larger dose in a smaller serving size. Naturally gentle on the stomach, powdered calcium lactate provides the most available surface area for absorption once it passes into the small intestine.
That isn’t to say that you can’t get calcium citrate in powdered form. There are a few commercial preparations that use it, but powdered citrate does not mix readily into beverages. If you put a spoonful of it into a glass of water, you would have to stir and guzzle the contents very quickly or you would lose a significant amount as it would settle to the bottom of the glass or stick to the sides. Having to chug a big glass of bitter, gritty calcium, 2-3 times a day may not be appealing to many people.
That said, it is my belief that most Americans do not have a calcium issue. Per capita, American’s has one of the highest calcium consumption rates in the world yet they have one of the highest rates of osteoporosis. This tells me that we don’t have a calcium issue, but a magnesium and co-factor issue. We know that 80% of women are magnesium deficient. If you are going to supplement with calcium, please speak to your physician about adding a magnesium supplement to your regimen. Vitamin C enhances the absorption of both calcium and magnesium, so they are good nutrients to pair together. My office carries a supplement which contains a balanced ratio of calcium, magnesium, and vitamin C. Please contact us for details.