March 2021
Jacqui Lewis - BHSc Nutritional and Dietetic Medicine

How Much Calcium You Need Every Day After WLS?

Calcium-rich foods like nuts and cheese

After bariatric surgery, your body won’t be the same. Your ability to absorb nutrients will change, which might cause nutrient deficiency if you do not change your diet.

One issue that WLS patients encounter is calcium deficiency, which is the lack of enough calcium in your body. But how can you get enough calcium and how much calcium do you in a day? Here is a great guide for you.

Importance of Calcium in the Body

Calcium is a key ingredient required to ensure different body organ systems work.

Calcium forms and maintains healthy bones, given most calcium is stored in your bones.
Calcium also helps your heart muscles to work, and transmits signals to your nerves so your muscles contract.

Calcium is the most tightly regulated nutrient in the body - due to its important role in keeping your heart beating

When you’re not taking in enough calcium via food and supplements - the body will release bone mineral calcium to do the job - the result can be disastrous:

Osteopenia (the beginnings of bone degradation) and Osteoporosis (osteo=bone porosis = porous / loosely bound or open) 

Calcium After Bariatric Surgery

After your bariatric surgery, for varying reasons, calcium is poorly absorbed. Intake is often reduced if you're experiencing lactose intolerance, and overall the restriction in the amount of the food you eat means lower levels of all nutrients really.

So specific bariatric supplements are your friend for life to protect you from having to deal with other health issues related to poor nutrition.

The ASMBS (The American Society Of Metabolic and Bariatric Surgery) compiled the Weight Loss Surgery Guidelines, to ascertain the deficiencies commonly brought about by all of the different Bariatric Procedures. Amongst other important nutrients, it has been found that the Prevalence of vitamin D deficiency is reported to occur in up to 100% of post-WLS patients.
Vitamin D and Calcium as you would likely be aware are our bone protecting nutrients, as is vitamin K.

The combination and prevalence of Vitamin D and Calcium deficiency is a major cause of reduced bone density in WLS patients - particularly if you are a Woman, who has had WLS and you have reached Menopause.

The ASMBS, based on their findings from observing more than 30,000 WLS patients, issued a recommended daily supplemental dose of all nutrients in their document. 

Vitamin D and Calcium

Here’s what the ASMBS had to say about Vitamin D and Calcium supplementation

All post-WLS patients should take calcium supplementation. The appropriate dose of daily calcium from all sources varies by surgical procedure:

- Biliopancreatic diversion with duodenal switch 1800–2400 mg/d
- LAGB (Gastric Band) , SG (Sleeve Gastrectomy), RYGB (Roux En Y Gastric Bypass): 1200–1500 mg daily.

The recommended preventative dose of vitamin D in post-WLS patients should be based on serum vitamin D levels:

Recommended vitamin D3 dose is 3000 IU daily, until blood levels of Vitamin D are greater than sufficient (80-100 ng/mL)

To enhance calcium absorption in post-WLS patients Calcium should be given in divided doses. Calcium Carbonate may be taken with meals only. Calcium citrate may be taken with or without meals”  

So we know that you need supplemental calcium - but how do you know if you are not getting enough?

Symptoms of calcium deficiency include:

- Cramps
- Irregular heart rate/ tachycardia
- Aching bones or joints
- Poor hair and nail health - splitting nails, hair fall
- Tingling in fingers or toes
- Stress fractures

Be aware, if you are experiencing symptoms it's likely you have been running low for quite some time. 

But my bloods say I have the right level of calcium in my blood

Your serum calcium will generally look good - because your body is regulating the levels by either using calcium you have consumed, or if not, it will release calcium from the bones - so always ask your Doctor to ensure that your other markers are all in good shape. If you are concerned that you have the symptoms of calcium deficiency, Discuss further Testing with your doctor, measuring bone loss (Bone resorption markers).

Bone resorption tests tell about the rate of bone loss. They can be checked before treatment and again after treatment to see if the rate of bone loss has decreased.

They include:

- C-telopeptide (C-terminal telopeptide of type 1 collagen (CTx))
- Urinary collagen type 1 cross-linked N-telopeptide (NTX)
- Deoxypyridinoline (DPD)
- Pyridinium Crosslinks
- Urinary hydroxyproline
- Tartrate-resistant acid phosphatase (TRAP) 5b
- Bone sialoprotein (BSP) 

DEXA Bone Mineral Density Testing Is A Great Tool 

Ask your Doctor about DEXA Bone Mineral Scans so you can monitor your bone density and have a baseline. This one is non invasive and speedy, and also gives a good impression of your body fat distribution, so overall its a very pertinent test for WLS patients to monitor Bone Density as well as progress on your fat loss.

Dairy is the best form of calcium isn't it? 

Well, Dairy is ok, but there are other excellent sources that are really well absorbed too, ensuring you have a diverse range of foods in your diet is a key for overall health.

Some good sources of calcium are:

- milk, cheese and other dairy foods.
- green leafy vegetables, such as broccoli, cabbage and okra, but not spinach
- soya beans
- tofu
- soya drinks with added calcium
- nuts
- sesame seeds and Tahini pack a massive calcium punch
- fish with edible bones , such as sardines and pilchards

Overall, don't wait for symptoms of calcium deficiency present before taking action.
Every day presents an opportunity to support your long term health with the recommended Bariatric Specific Multivitamin, healthy foods and professional support right throughout the lifespan. 

Further Reading:
Therapeutic Treatment Options for Osteoporosis in the Surgical Weight Loss Population

Jacqui Lewis
BHSc Nutritional and Dietetic Medicine

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