Calcium

I am supposed to take 500 mg of calcium 3 times a day at least two hours a part and at least two hours from my prenatal (multi) vitamin which contains iron.  Calcium hinders the absorption of iron and some kinds of medications, so iron should also be taken two hours away from any dairy products.  I take my iron at bed time, which is well after my 6:30 pm dinner time.  But back to calcium...

Our bodies can only absorb 500 mg of calcium about every two hours, hence why I must take 500 mg 3x a day to get my doctor recommended 1500 mg a day.  That is more than the average person is supposed to intake in a day, but since RNY patients have malabsorption as a side effect of surgery we need the additional calcium to make sure we get enough.  The portion of the small intestine that is bypassed is normally where most of our calcium is absorbed.

To aid our bodies in the absorption of calcium, we need to keep a good vitamin D level as well.  Vitamin D assists our body in absorbing calcium and it also helps the kidneys break down and reabsorb calcium that would otherwise leave our body with our urine.  I read that taking vitamin D can also help prevent kidney stones in this manner.  Vitamin D3 is the most easily absorbed by our body, followed by vitamin D2.  My doctor does not recommend taking plain vitamin D.

Calcium and vitamin D are essential is having strong bones and teeth.  Having higher levels of calcium and vitamin D has also been shown to reduce the risk of developing some diseases including osteoporosis and certain cancers, respectively.  More than likely, no matter the type of calcium supplement you find, it will include vitamin D, because the manufacturers know that the vitamin D will aid the absorption of calcium.  That does not mean you have to take calcium and vitamin D at the same time however.  As long as your body has a sufficient level of vitamin D, whether absorbed through your skin from the sun or internally from a pill, your body will be better at absorbing the calcium.

That said, there are several types of calcium.  There are three types I will be addressing: Calcium Citrate, Calcium Phosphate, Calcium Carbonate.

Calcium Citrate is the one I have been told to take.  It is the most easily absorbed by our bodies and since WLS patients already have a difficult time with this, it only makes sense.  It can be purchased in the form of pills, chewables, liquid, and soft chews (not gummies).  I have taken three.  It tends to be the most expensive of the three types.

Calcium Phosphate is often included in other calcium supplements, though I have yet to see a supplement that is pure calcium phosphate.  It is the second most easily absorbed.  It is less expensive than the calcium citrate and the cheapest liquid calcium I can find is a blend of the two.  It is a liquid brand recommended by my doctor.

Calcium Carbonate is the only calcium I have been told to not take at all.  Our bodies have a hard time absorbing it and it must be taken with an acid, like orange juice, to break it down.  Also, it may cause gas or constipation.  From talking to other people, I know many doctors still recommend that their patients take calcium carbonate.  However, per my doctor, studies are showing that for WLS patients calcium carbonate is not an effect choice.  Of course, calcium carbonate is the cheapest and most plentiful calcium out there.  It come in the form of pills, chewables (Tums/Rolaids), chews, liquids, and gummies.

Now, let's go back to calcium citrate.  As I said, I've taken pills, liquid, and chews.  In pills, you can find standard size and petite.  The standard size is so big I can't get them down, but I have always had issues with taking pills.  Other people are probably just fine with them.  The petites are swallow-able, but on the down side you have to take two.  So that means waiting an extra half hour between the pills and increases the number of pills you have to take per day by 3.  I've also found that some brands of the pills tend to upset my stomach.  Pills are, of course, the least expensive way to go for calcium citrate.

In liquid, I have tried multiple brands and flavors purchased both locally and online.  For me, since I have issues with pills, this seems to make the most sense so I went out of my way to find and try as many as I could.  The bottles can get pretty pricey, the ones I tried being in the range of $7.00-$13.00.  I did see some that were even more expensive, but since it wasn't financially feasible for me, I didn't bother trying them.  Since I have to take it 3x a day, a bottle lasts roughly 10 days.  For most bottles, that was ten days of dreading taking the calcium.  All but one brand, was total yuck to me.  Other people have left reviews online where I bought them saying they loved it, so obviously that is just me.  The one brand I take is Wellesse Calcium & Vitamin D3 Natural Citrus Flavor.  It is widely available online and can be found in several stores including Walmart in the pharmacy area.  At my Walmart it is $6.97 a bottle.  At Amazon.com, if you buy a two pack it is $6.23 a bottle plus free shipping with orders over $49.  At Vitacost.com, it is $6.23 a bottle with free shipping on orders over $49, also, sometimes the website emails me coupons for additional savings.  As a side note, there are 2 g carbs, 0 sugars per dose of Wellesse calcium, it contains vegetable glycerin, corn dextrose and sucralose.

The last of the three I've tried: chews, which up until 2 days ago when I read the carb count, were by far my favorite way to take calcium.  My very favorites chews are Calcets Creamy Bites in Lemon Cream.  Always looked forward to them it was like a little piece of dessert.  Then I finally read the label and saw that per chew there are 8 g carbs and 5 g sugar.  Sadness ensued.  They also come in chocolate which I did not like.  At my local drugstore, they cost $11.69 a box that lasts ten days.  So definitely not a cheaper option.

Bariatric Advantage are my husband's favorite brand and way to take calcium.  They are available at Bariatricadvantage.com and at some specialty pharmacy stores.  They come in Chocolate, Caramel, Raspberry, Lemon, Strawberry, Coconut, Tropical Orange, and Peanut Butter Chocolate.  I tried the chocolate and the caramel and did not care for either one, that said I would still like to try the coconut, tropical orange, and chocolate peanut butter.  I would try the lemon too, but they only come in the 250 mg size which has way too many carbs for me.  My husband likes the raspberry and strawberry the best.  They come in 250 mg (take 2 per dose) for $12.95 for a 10-day supply, or in 500 mg for $32.50 for a 30-day supply.  The 500 mg do tend to be grittier than the 250 mg.  The 500 mg have 4 g carbs per dose and the 250 mg have 10 g carbs per dose (5 g per chew).

There is also Celebrate Soft Chews in Berry, Chocolate, and Caramel.  They are available at Celebratevitamins.com and at some specialty pharmacy stores.  Online you can get a 30-day supply for $29.95 or a 90-day supply for $87.95.  I have not tried this brand, but my husband has.  He found them to be a bit chalky compared to Bariatric Advantage.  They have 5 g carbs per dose.

Finally, chewables can be found at both Celebratevitamins.com and Bariatricadvantage.com, I have not tried either.  Celebrate has them in multiple flavors.  A 30-day supply is $19.95 and a 90-day supply is $42.95 with free shipping on orders over $100.  There are 2 g carbs per dose.  It seems pretty comparable both in carbs and price to Wellesse, so I may still try these.  Bariatric Advantage has multiple flavors as well.  A 30-day supply is $24.95 and a 90-day supply is $51.95.  There is only 1 g carb per dose, but since they are more expensive, no free shipping, and the flavors available are less appealing to me, I probably won't try these.

7/18/16 Edit: I have since tried Celebrate chewables, and it is almost solely what I use now.  I love the Orange Burst flavor.  I tried the Cherry Tart and thought they tasted like cough drops.  To me, that is nah-nah, but my husband liked them.  We haven't tried the Berries & Cream flavor.  The first time I ordered through Amazon.com and unfortunately there were many broken pieces in the jar.  The last time I ordered from Celebratevitamins.com and they came with much better packing and only a couple were broken.