FW: Calcium citrate; my research

[Guest guest]

Here's the message I sent my surgeon last fall that convinced HIM to switch all

of his patients over to calcium citrate. He's been doing this for 22 years and

had always recommended calcium carbonate because " it's cheaper and it doesn't

matter what kind you take " -- he's changed his tune now... I overheard him

telling a potential patient that " the difference is less than a dollar a month,

but your bones are worth it " when she asked about citrate vs. carbonate... LOL

*I* used those EXACT words on him in October! It's great to know we can make a

difference once in a while. :-)

Z

Open RNY 09/17/01

310/130

http://tinyurl.com/4e3h my AMOS profile

Calcium citrate

Dr. Weber,

I recently heard that you are still recommending Tums (calcium carbonate) for

your gastric bypass patients. Unfortunately, this advice is highly likely to

lead to osteoporosis for those people. We just don't have enough stomach acid to

make use of calcium carbonate. I hope you'll reconsider, and will recommend

calcium citrate to your RNY folks. Here's some references; I'm not making this

up and I've looked into it quite extensively. I take Citracal calcium citrate

only (1890 mg a day in 3 630 mg doses) and have had a baseline DEXA done which

shows completely normal bone density for my age. I'll keep you posted into the

future as I have follow-up tests. Are you following any calcium carbonate RNYers

on this issue?

It was great to see you a few weeks ago and I'll try to drop in on the

in-service sessions again in the future. :-)

Best regards,

310/135

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Optimal Calcium Intake

National Institutes of Health

Consensus Development Conference Statement

June 6-8, 1994

This statement was originally published as:

Optimal Calcium Intake. NIH Consens Statement 1994 June 6-8; 12(4):1-31

For making bibliographic reference to consensus statement number 97 in the

electronic form displayed here, it is recommended that the following format be

used:

Optimal Calcium Intake. NIH Consens Statement Online 1994 June 6-8; 12(4):1-31

________________________________

NIH Consensus Statements are prepared by a nonadvocate, non-Federal panel of

experts, based on (1) presentations by investigators working in areas relevant

to the consensus questions during a 2-day public session; (2) questions and

statements from conference attendees during open discussion periods that are

part of the public session; and (3) closed deliberations by the panel during the

remainder of the second day and morning of the third. This statement is an

independent report of the panel and is not a policy statement of the NIH or the

Federal Government.

The statement reflects the panel's assessment of medical knowledge available at

the time the statement was written. Thus, it provides a " snapshot in time " of

the state of knowledge on the conference topic. When reading the statement, keep

in mind that new knowledge is inevitably accumulating through medical research.

[From Section 4. " What are the best ways to obtain optimum calcium intake " -

**highlighted** text selected by me (JAZ)]

" **For some individuals, calcium supplements may be the preferred way to attain

optimal calcium intake.** Calcium supplements are available as various salts,

and most preparations are well absorbed except when manufactured such that they

do not disintegrate during oral ingestion. **Absorption of calcium supplements

is most efficient at individual doses of 500 mg or less and when taken between

meals.** Ingesting calcium supplements between meals supports calcium

bioavailability, since food may contain certain compounds that reduce calcium

absorption (e.g., oxalates). **However, absorption of one form of calcium

supplementation, calcium carbonate, is impaired in fasted individuals who have

an absence of gastric acid.** Absorption of calcium carbonate can be improved in

these individuals when it is taken with certain food. **The potential for

calcium supplementation to interfere with iron absorption is an important

consideration when it is ingested with meals. Alternatively, calcium

supplementation in the form of calcium citrate does not require gastric acid for

optimal absorption and thus could be considered in older individuals with

reduced gastric acid production.** In individuals with adequate gastric acid

production, it is preferable to ingest calcium supplements between meals. "

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

ASK AHSC

Answers to Health Questions

from The University of Arizona Health Sciences Center (AHSC) in Tucson

MAY 2001

Q I was told to take calcium supplements daily after my gastric bypass

operation. Which is better, calcium carbonate or calcium citrate? Why? And how

much should I take? ( I'm a 55-year-old male, 6'3 " , 205 lbs.) R.H.

A Calcium carbonate has more calcium per gram than calcium citrate, so it would

take less volume (fewer pills or less liquid) of the calcium carbonate to

provide the same amount of absorbable calcium.

Because calcium carbonate requires hydrochloric acid, a stomach acid, to be

digested and absorbed, the type and extent of your gastric bypass will determine

which calcium supplement is better for you.

The recommended intake of calcium for a 55-year-old male is 1,200 milligrams

daily based on the 1997 Institute of Medicine guidelines. However, you should

check with the dietitian who assisted you after your surgery, or check with your

surgeon, for a specific, individualized recommendation.

-Deborah Pesicka, R.D., registered dietician, University Medical Center, Tucson

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

http://www.geocities.com/medcin/calcium.html

<http://www.geocities.com/medcin/calcium.html> Another source, an MD

http://www.askapot.com/prod_info/calcium.htm

<http://www.askapot.com/prod_info/calcium.htm> A nutritional supplement store

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

http://www.myhealthylife.com/myhealthylife/Tips/May01Tip2.asp

<http://www.myhealthylife.com/myhealthylife/Tips/May01Tip2.asp>

Do I need a special supplement if I'm over 65 years old?

People over 65 produce less gastric acid (stomach acid). Gastric acid is

necessary for the absorption of most forms of calcium. If you do not have

adequate gastric acid in your stomach, it is recommended that you consider

taking a calcium citrate supplement. Take this supplement between meals.

What if I'm taking medication that decreases the production of gastric acid?

Again, calcium citrate is a good supplement for you. Take between meals.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Some relevant studies from the NIH position paper on osteoporosis and optimum

calcium supplementation http://www.nlm.nih.gov/pubs/cbm/calcium.html

<http://www.nlm.nih.gov/pubs/cbm/calcium.html> :

JJB. Nutritional biochemistry of calcium and phosphorus. J Nutr Biochem

1991 Jun;2(6):300-7.

Brennan MJ, Duncan WE, Wartofsky L, VM, Wray HL. In vitro dissolution of

calcium carbonate preparations. Calcif Tissue Int 1991 Nov;49(5):308-12. Comment

in: Calcif Tissue Int 1992 Feb; 50(2):197.

Bronner F. Nutrient bioavailability, with special reference to calcium. J Nutr

1993 May;123(5):797-802.

P. Calcium absorption and calcium bioavailability. J Intern Med 1992

Feb;231(2):161-8.

Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited

role of solubility. Calcif Tissue Int 1990 May;46(5):300-4.

Pak CY, Avioli LV. Factors affecting absorbability of calcium from calcium salts

and food. Calcif Tissue Int 1988 Aug;43(2):55-60.

Schnepf M, Madrick T. The solubility of calcium from antacid tablets, calcium

supplements and fortified food products. Nutr Res 1991 Sep;11(9):961-70.

Shangraw RF. Factors to consider in the selection of a calcium supplement.

Public Health Rep 1992 Sep-Oct;Suppl:46-50.

Wabner CL, Pak CY. Modification by food of the calcium absorbability and

physicochemical effects of calcium citrate. J Am Coll Nutr 1992

Oct;11(5):548-52.

Weaver CM. Calcium bioavailability and its relation to osteoporosis. Proc Soc

Exp Biol Med 1992 Jun;200(2):157-60.

Whiting SJ, Pluhator MM. Comparison of in vitro and in vivo tests for

determination of availability of calcium from calcium carbonate tablets. J Am

Coll Nutr 1992 Oct;11(5):553-60.

Wood RJ, Serfaty Lacrosniere C. Gastric acidity, atrophic gastritis, and calcium

absorption. Nutr Rev 1992 Feb;50(2):33-40.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

[Guest guest]

Here's the message I sent my surgeon last fall that convinced HIM to switch all

of his patients over to calcium citrate. He's been doing this for 22 years and

had always recommended calcium carbonate because " it's cheaper and it doesn't

matter what kind you take " -- he's changed his tune now... I overheard him

telling a potential patient that " the difference is less than a dollar a month,

but your bones are worth it " when she asked about citrate vs. carbonate... LOL

*I* used those EXACT words on him in October! It's great to know we can make a

difference once in a while. :-)

Z

Open RNY 09/17/01

310/130

http://tinyurl.com/4e3h my AMOS profile

Calcium citrate

Dr. Weber,

I recently heard that you are still recommending Tums (calcium carbonate) for

your gastric bypass patients. Unfortunately, this advice is highly likely to

lead to osteoporosis for those people. We just don't have enough stomach acid to

make use of calcium carbonate. I hope you'll reconsider, and will recommend

calcium citrate to your RNY folks. Here's some references; I'm not making this

up and I've looked into it quite extensively. I take Citracal calcium citrate

only (1890 mg a day in 3 630 mg doses) and have had a baseline DEXA done which

shows completely normal bone density for my age. I'll keep you posted into the

future as I have follow-up tests. Are you following any calcium carbonate RNYers

on this issue?

It was great to see you a few weeks ago and I'll try to drop in on the

in-service sessions again in the future. :-)

Best regards,

310/135

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Optimal Calcium Intake

National Institutes of Health

Consensus Development Conference Statement

June 6-8, 1994

This statement was originally published as:

Optimal Calcium Intake. NIH Consens Statement 1994 June 6-8; 12(4):1-31

For making bibliographic reference to consensus statement number 97 in the

electronic form displayed here, it is recommended that the following format be

used:

Optimal Calcium Intake. NIH Consens Statement Online 1994 June 6-8; 12(4):1-31

________________________________

NIH Consensus Statements are prepared by a nonadvocate, non-Federal panel of

experts, based on (1) presentations by investigators working in areas relevant

to the consensus questions during a 2-day public session; (2) questions and

statements from conference attendees during open discussion periods that are

part of the public session; and (3) closed deliberations by the panel during the

remainder of the second day and morning of the third. This statement is an

independent report of the panel and is not a policy statement of the NIH or the

Federal Government.

The statement reflects the panel's assessment of medical knowledge available at

the time the statement was written. Thus, it provides a " snapshot in time " of

the state of knowledge on the conference topic. When reading the statement, keep

in mind that new knowledge is inevitably accumulating through medical research.

[From Section 4. " What are the best ways to obtain optimum calcium intake " -

**highlighted** text selected by me (JAZ)]

" **For some individuals, calcium supplements may be the preferred way to attain

optimal calcium intake.** Calcium supplements are available as various salts,

and most preparations are well absorbed except when manufactured such that they

do not disintegrate during oral ingestion. **Absorption of calcium supplements

is most efficient at individual doses of 500 mg or less and when taken between

meals.** Ingesting calcium supplements between meals supports calcium

bioavailability, since food may contain certain compounds that reduce calcium

absorption (e.g., oxalates). **However, absorption of one form of calcium

supplementation, calcium carbonate, is impaired in fasted individuals who have

an absence of gastric acid.** Absorption of calcium carbonate can be improved in

these individuals when it is taken with certain food. **The potential for

calcium supplementation to interfere with iron absorption is an important

consideration when it is ingested with meals. Alternatively, calcium

supplementation in the form of calcium citrate does not require gastric acid for

optimal absorption and thus could be considered in older individuals with

reduced gastric acid production.** In individuals with adequate gastric acid

production, it is preferable to ingest calcium supplements between meals. "

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

ASK AHSC

Answers to Health Questions

from The University of Arizona Health Sciences Center (AHSC) in Tucson

MAY 2001

Q I was told to take calcium supplements daily after my gastric bypass

operation. Which is better, calcium carbonate or calcium citrate? Why? And how

much should I take? ( I'm a 55-year-old male, 6'3 " , 205 lbs.) R.H.

A Calcium carbonate has more calcium per gram than calcium citrate, so it would

take less volume (fewer pills or less liquid) of the calcium carbonate to

provide the same amount of absorbable calcium.

Because calcium carbonate requires hydrochloric acid, a stomach acid, to be

digested and absorbed, the type and extent of your gastric bypass will determine

which calcium supplement is better for you.

The recommended intake of calcium for a 55-year-old male is 1,200 milligrams

daily based on the 1997 Institute of Medicine guidelines. However, you should

check with the dietitian who assisted you after your surgery, or check with your

surgeon, for a specific, individualized recommendation.

-Deborah Pesicka, R.D., registered dietician, University Medical Center, Tucson

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

http://www.geocities.com/medcin/calcium.html

<http://www.geocities.com/medcin/calcium.html> Another source, an MD

http://www.askapot.com/prod_info/calcium.htm

<http://www.askapot.com/prod_info/calcium.htm> A nutritional supplement store

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

http://www.myhealthylife.com/myhealthylife/Tips/May01Tip2.asp

<http://www.myhealthylife.com/myhealthylife/Tips/May01Tip2.asp>

Do I need a special supplement if I'm over 65 years old?

People over 65 produce less gastric acid (stomach acid). Gastric acid is

necessary for the absorption of most forms of calcium. If you do not have

adequate gastric acid in your stomach, it is recommended that you consider

taking a calcium citrate supplement. Take this supplement between meals.

What if I'm taking medication that decreases the production of gastric acid?

Again, calcium citrate is a good supplement for you. Take between meals.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Some relevant studies from the NIH position paper on osteoporosis and optimum

calcium supplementation http://www.nlm.nih.gov/pubs/cbm/calcium.html

<http://www.nlm.nih.gov/pubs/cbm/calcium.html> :

JJB. Nutritional biochemistry of calcium and phosphorus. J Nutr Biochem

1991 Jun;2(6):300-7.

Brennan MJ, Duncan WE, Wartofsky L, VM, Wray HL. In vitro dissolution of

calcium carbonate preparations. Calcif Tissue Int 1991 Nov;49(5):308-12. Comment

in: Calcif Tissue Int 1992 Feb; 50(2):197.

Bronner F. Nutrient bioavailability, with special reference to calcium. J Nutr

1993 May;123(5):797-802.

P. Calcium absorption and calcium bioavailability. J Intern Med 1992

Feb;231(2):161-8.

Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited

role of solubility. Calcif Tissue Int 1990 May;46(5):300-4.

Pak CY, Avioli LV. Factors affecting absorbability of calcium from calcium salts

and food. Calcif Tissue Int 1988 Aug;43(2):55-60.

Schnepf M, Madrick T. The solubility of calcium from antacid tablets, calcium

supplements and fortified food products. Nutr Res 1991 Sep;11(9):961-70.

Shangraw RF. Factors to consider in the selection of a calcium supplement.

Public Health Rep 1992 Sep-Oct;Suppl:46-50.

Wabner CL, Pak CY. Modification by food of the calcium absorbability and

physicochemical effects of calcium citrate. J Am Coll Nutr 1992

Oct;11(5):548-52.

Weaver CM. Calcium bioavailability and its relation to osteoporosis. Proc Soc

Exp Biol Med 1992 Jun;200(2):157-60.

Whiting SJ, Pluhator MM. Comparison of in vitro and in vivo tests for

determination of availability of calcium from calcium carbonate tablets. J Am

Coll Nutr 1992 Oct;11(5):553-60.

Wood RJ, Serfaty Lacrosniere C. Gastric acidity, atrophic gastritis, and calcium

absorption. Nutr Rev 1992 Feb;50(2):33-40.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~