Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN
Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.
1) What is calcium? Calcium is the body’s most abundant mineral. We need it to build and maintain strong bones. In fact, almost all calcium is stored in bones and teeth, which is what gives the skeleton a rigid structure. Beyond bone health, calcium also supports nerve conduction, muscle contraction, and blood clotting. After 30 years, bones start to lose calcium over time. However, a healthy lifestyle can reduce this loss by getting enough dietary calcium and doing weight-bearing exercise.
2) What happens if I’m calcium deficient? When a person is unable to get enough calcium through diet, the body will pull it from bones to maintain the other important functions for the heart and muscles. This is why a calcium deficiency may not show up on a person’s bloodwork. Serum (blood) levels of calcium will appear normal even if bone density is worsening. As people get older, bone loss speeds up and can lead to osteoporosis (brittle bones) and even fractures (broken bones). Bone health can be measured by a bone mineral density test. Calcium deficiency signs include cramping, brittle nails, tooth decay, insomnia, and more.
3) How much calcium do I need after surgery? After metabolic and bariatric surgery (MBS), vitamin and mineral supplementation is critical to support long-term health. This includes calcium. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), all patients who have a gastric bypass, sleeve gastrectomy, or gastric band need 1,200-1,500 mg of calcium each day. Patients who have a biliopancreatic diversion with or without the switch need 1,800-2,400 mg of calcium per day. This calcium requirement is for life. In my experience, too many patients stop taking calcium because they see “normal” lab results. This is dangerous, though, because patients over five years out from MBS are most at-risk for bone disorders due to inadequate bone strength.
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4) How can I meet guidelines? The daily calcium doses can be met through both food and supplements. Most of us probably know the top food source of calcium because our favorite celebrities and athletes would sport a milk mustache and ask, “Got Milk?” Those famous ads would often tout the benefits of calcium and how dairy is one of its best sources. They weren’t wrong; milk, yogurt, and cheese are excellent sources of calcium. According to the Institute of Medicine, over 70% of calcium intake in the United States comes from dairy products or foods with added dairy ingredients.
Growing up, I personally remember always having a milk carton on lunch trays and being offered milk at dinner time. For patients with milk sensitivity or lactose intolerance, I always suggest looking for calcium-fortified plant-based milks. Other great sources of dietary calcium include canned sardines (with bones), soy (including fortified soy milk), green leafy vegetables like spinach or kale, and even protein supplements. For example, two of the most popular ready-to-drink protein shakes on the market have around 600-700mg of calcium. To help figure out dietary intake, I encourage patients to read the Nutrition Facts label since calcium is always listed.
For patients unable to meet calcium needs through diet alone, calcium supplementation will be needed. For bariatric patients, calcium citrate is the preferred form. Many over-the-counter supplements use calcium carbonate, but this form must be taken with food. Calcium citrate can be taken with or without meals, does not require stomach acid to be absorbed, and is a lower risk for kidney stone formation. Patients should also make sure that the calcium supplement contains vitamin D, which supports calcium absorption and bone health.
5) Are there any special considerations when taking calcium?
- Calcium should be taken in divided doses. The body can only absorb 500-600mg of calcium in one sitting. This is why bariatric companies offer calcium citrate supplements in that amount. I suggest spacing out calcium supplements from each other by at least 4-hours.
- Calcium should also be spaced away from iron. Iron and calcium compete for absorption in the body, so taking them together may end up in deficiency. I suggest spacing out iron from any calcium source/supplement by at least 2-hours.
- Calcium may also interact with certain medications. For instance, patients with hypothyroidism will have to avoid taking calcium around their levothyroxine prescription. Patients should always check with their healthcare providers about medication interactions and timing notes.
BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.