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Blond woman smiling into the sun to help her bone health after wls

Good Calcium Levels Say Little about Bone Health after WLS

During your annual round of blood tests, your doctor should be checking your calcium levels since absorption decreases after both a VSG and gastric bypass.  That said, there is much more to your bone health than calcium levels alone. In fact, a calcium level in good range does not necessarily indicate that you are getting the calcium you need.  Likewise, a low calcium level does not necessarily mean you aren’t getting enough calcium.  Below are some things to consider regarding calcium and bone health after WLS. 

Absorption of Calcium and Bone Health after WLS 

WLS greatly reduces calcium absorption.  With both a gastric bypass and a VSG, this is because the amount of hydrochloric acid (HCl) is reduced, and your body needs HCl to help with calcium absorption.  There is an additional issue with a gastric bypass in that the main part of the intestine that absorbs calcium is bypassed during the operation.  Another thing to be aware of are medications that can reduce calcium absorption.  Specifically, medications that treat heartburn and GERD – such as proton pump inhibitors like omeprazole – can have a negative effect on the absorption of calcium since it further reduces HCl levels.  Lastly, your body needs Vitamin D to absorb calcium.  Many people go into their WLS with low Vitamin D levels and struggle to keep them in range afterwards.  As you can tell, there are many reasons why the absorption of calcium and bone health are of concern after WLS. 

Why Calcium Labs are Misleading 

With calcium absorption so affected after surgery, it could be easy to think that all you need to do is look at the calcium level in your blood to see if everything is ok.  The issue here is that your body works very hard to keep your blood calcium levels stable.  So, even if there is not enough calcium coming in through supplements or food, the body will use stored calcium instead.  Where do you think this calcium comes from?  That’s right…your bones. Over time, this can weaken your bones and put your more at risk for fractures and osteoporosis. 

How to Evaluate Bone Health after WLS

You may be wondering, if looking at calcium levels isn’t reliable, what else should be tested?  As mentioned above, you need Vitamin D to properly absorb calcium.  That’s why Vitamin D should always be checked and remedied if needed. Another marker to test is the Parathyroid Hormone (PTH). When the body is not getting enough calcium, the PTH works harder to maintain the proper calcium levels in your blood.  This means that high PTH levels may indicate that you are not getting enough calcium and/or vitamin D.  For a full list of labs to test after surgery, click here.

Your doctor may also suggest that you test your bone density with a DEXA can before and/or after your bariatric surgery. These are often done before surgery and at 2 years after surgery. 

Ways to Maintain Bone Health after Bariatric Surgery  

  • If you haven’t had surgery yet, you should have your vitamin and mineral levels checked and correct any that are low.  For example, many people have low Vitamin D before surgery that should be corrected. 
  • Make sure your supplements contain both Calcium and Vitamin D. The Nordic guidelines recommend least 500mg of Calcium Citrate and 20mcg (800IU) of Vitamin D daily. Baricol Complete contains 1000 mg of Calcium Citrate and 45mcg (1800IU) of Vitamin D.
  • Do weight bearing exercises. They not only help build and maintain muscle mass but also bone mass. Most exercises other than those done in the water or those done while seated (i.e. cycling) are weight bearing.  
  • A note on taking calcium and iron together.  You may have heard not to take iron and calcium together as calcium can hinder iron absorption.  However, the science on this is inconclusive and dose dependent. That is, the ratio of calcium to iron would need to be much higher to have a significant effect on iron absorption. The bigger concern is taking the required vitamins and minerals at all. That’s why Baricol is an all-in-one product so that you are sure to get all the recommended micronutrients after WLS. Having trouble remembering to take your supplements? Get into a good routine with our free BariBuddy app! 

Ready for more? Check out some of our other blog posts!