Micronutrients and You: Calcium and Bariatric Surgery Patients

After bariatric surgery, patients experience permanent changes to their digestive system in the way that nutrients are absorbed and processed. It’s important for both patients and their physicians to understand the role of ongoing nutritional support so they can maintain good health. This series of articles will focus on the importance of micronutrients for bariatric surgery patients. Specifically, the special needs they now have based on the surgical changes to their digestive systems, as well as the evidence-based products offered by Bariatric Advantage to support bariatric surgery patients in maintaining good nutrition and good health.

Calcium and Bariatric Surgery Patients

Calcium is the most abundant mineral in the human body. Ninety-nine percent of whole-body calcium is incorporated into the structure of bones and teeth. Calcium also plays a vital role in the body’s clotting capabilities. Lack of adequate calcium can contribute to poor bone health and other long term challenges.

When people do not get enough calcium, the body takes calcium from their bones. Over time, this “borrowing” of calcium can cause decrease bone health. Studies indicate that individuals who undergo bariatric surgery may be at risk for long-term challenges with bone health due to nutritional and other causes[1].

Getting Enough Calcium

Eating a calcium-rich diet is important. Calcium containing foods include dairy products, calcium-fortified products like soy and rice drinks, and leafy greens. In addition, experts recommend that individuals who have had bariatric surgery take calcium supplements to get enough of this important mineral. The recommended daily dose of calcium for bariatric patients is 1,200-2,000 mg a day, according to the guidelines published by the American Society for Metabolic & Bariatric Surgery, The Obesity Society, and The American Association of Clinical Endocrinologists.

Due to the changes that have been made to their digestive systems, bariatric surgery patients are at particular risk for challenges with specific absorption, including calcium and vitamin D. Bariatric surgeries may also increase bone turnover and loss of bone mass in patients, part of which is due to massive weight loss alone (which always results in the loss of some lean mass – including bone). Therefore, it is critical that bariatric patients regularly get adequate calcium to reduce the risk of deficiencies, bone loss, and to long-term health.

However, many types of commercially available calcium supplements may not be optimized for bariatric patients. Biologically, calcium from foods and some types of dietary supplements must become ionized in an acid medium in order to be absorbed in the small intestine. In bariatric patients, certain forms of calcium such as calcium carbonate (found in many over-the-counter vitamins) are not likely to be well-absorbed after surgery because they require interaction with hydrochloric acid which is limited after common procedures. After bariatric surgery, there is less contact of food with stomach acid, making it difficult to absorb calcium carbonate. For this reason, calcium citrate is generally recommended after bariatric surgery to support absorption[2].

Tips for Bariatric Patients

The following suggested guidelines can help bariatric surgery patients ensure that they are taking calcium supplements that will meet their needs for life:

• First, consult with your physician to be sure you understand the guidelines for nutritional supplementation before and after your surgery, and for the rest of your life.
• When selecting a supplement, look for one that uses calcium citrate, the form most commonly recommended after bariatric surgery to support absorption.
• Make sure that your calcium supplement also contains Vitamin D
• Some patients may prefer a form of calcium other than the traditional tablets that are swallowed. “Chewy bites” are a tasty option with the texture of a caramel candy, and are available in different flavors. Powders and chewable tablets are also popular choices for those who dislike swallowing pills.
• It is best to look for options that are low in sugar or sugar-free.. Lactose-free options are also available.
• Because bariatric patients generally need more supplemental calcium than adults who have not had this surgery, selecting a dose with a higher amount of calcium – say 500 mg versus 250 mg – means taking fewer pills and may make adherence easier.

To learn more about Bariatric Advantage’s new 500 mg Calcium Citrate Chewy Bite, the first to combine 500 mg Calcium Citrate and 500 IU of Vitamin D3 in one tasty, sugar-free soft chew, read the official press release here. To learn more about calcium and bariatric nutrition call 800.898.6888 or visit www.bariatricadvantage.com.

[1] Berarducci A, Haines K, Murr MM2009 Incidence of bone loss, falls, and fractures after Roux-en-Y gastric bypass for morbid obesity. Appl Nurs Res 22:35–41

[2] Goode LR, Brolin RE, Chowdhury HA, Shapses SA. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12:40-47. [EL 2]

Reviewed and Prepared by:
The Science Desk
Bariatric Advantage