Calcium, Kidney Stones and Baby Aspirin
I want to address two issues we encounter frequently in the office and both of which are associated with a great deal of misinformation and “internet mythsâ€. Please be aware there is no one in charge of regulating the content of web sites and anyone can say anything on the internet and about half of it is wrong. Let’s talk about calcium supplements after bariatric surgery and the use of low dose aspirin to prevent heart disease.
There is a literal internet war going on over opinions regarding the best calcium supplements. Let me settle it for you. There is no “best calcium supplementâ€. The two most common calcium products in the United States are calcium carbonate and calcium citrate. You can chose either and feel good about your choice. We routinely recommend at least 1500 mg of calcium with 800 units of extra vitamin D for patients who have had bariatric surgery. Vitamin D absorption isn’t decreased by bariatric surgery, but we now know 50% of the US population is vitamin D deficient and Vitamin D helps with absorption of calcium in the diet. .
Kidney stones aren’t more common in bariatric surgery patients and calcium supplements don’t cause kidney stones in most patients. Most kidney stones are calcium oxalate stones, but it is the oxalate which is the problem. Poor hydration or excessive amounts of foods high in oxalate such as ice tea will lead to kidney stones. Any post-op patient who has a kidney stone needs to try and have the stone analyized by a professional lab so we can determine what chemicals are in it. Your kidney doctor will know how to do this. There are rare cases where the stones are pure calcium and the patient is absorbing too much calcium, and in that case we would stop the calcium supplements.
Calcium carbonate with extra Vitamin D is in Viactive and Caltrate. It is the most common and most popular calcium product. It is inexpensive and more concentrated than calcium citrate so the pill is usually smaller, which is nice if you have a small stomach outlet. It is better absorbed with food, so take it with meals.
Calcium citrate which is in Citracal can be absorbed without food so it can be taken anytime. It has been reported to be better absorbed than calcium carbonate, but no one has shown any difference in bone density, so it doesn’t appear to matter. Calcium citrate has been reported to cause more intestinal gas and bloating, so avoid it if this is an issue.
Calcium of any type interferes with iron absorption, so take the iron and calcium at different times at least an hour apart. The calcium supplements can be taken all at once and doesn’t need to be divided into multiple doses over the course of the day.
A low dose of aspirin (81mg or a baby aspirin) has been suggested to reduce the risk of heart disease. It appears to be effective in men but it definitely increases the risk of bleeding or ulcers after gastric bypass surgery. Aspirin in women under the age of 65 has not been shown to prevent heart disease, so there is no cardiac reason to take it. About one in four patients who take aspirin or plavix after gastric bypass surgery will have an episode of bleeding from the GI tract or stomach. Aspirin can also cause Lap-band or VBG patients to have a band erosion and the band will need to be removed. Antacids medications called proton pump inhibitors such as Nexium, Prilosec or Prevacid may reduce the risk. In summary we recommend low dose aspirin after bariatric surgery only in patients who have a proven need for it such as having had a heart attack, coronary bypass or stent placed, and then they must take medication to protect the stomach.
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