MiladyB

Calcium and Iron - why do they need to be separate?

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I received this in my email today and I found the stats rather sobering. I thought you all may appreciate the information.

Calcium and Iron- why do they need to be separate?

People are often told that they need to take their calcium and their iron separately, but they may not know why.

The basic issue is this: when calcium and iron are taken together, the absorption of iron can be decreased by up to 62%. Calcium in both food and in dietary supplements appears to have similar effects.

Some of the studies done on calcium and iron competition have shown the following:

Hallberg at al found that giving 165mg of calcium in milk, cheese or as a supplement of calcium chloride, reduced iron absorption by 50 to 60 percent. They also found iron absorption was reduced by 50 to 60% with 300-600mg of calcium added to bread dough.

Gleerup et al found that when they asked volunteers to consume a level of just over 900mg of calcium either with their meals that contained the most iron (lunch and dinner) versus in the morning and in the evening after dinner, they absorbed 30 to 50 percent more iron when they did not have the calcium (from milk and cheese) with the iron containing meals (lunch and dinner). In other words, eating their iron food separately for their calcium foods lead to much better iron absorption.

Cook et al found that a 600mg dose calcium citrate and calcium phosphate reduced the absorption of iron by 49 to 62 percent when given with 18mg of iron (the RDA). They did not find these results with a lower dose of 300mg. They also found 300mg calcium carbonate reduced iron absorption by up to 15%.

Dawson-Hughes et al, found that a 500mg dose of either calcium carbonate or hydroxyapatite reduced iron absorption by 54 to 57%.

Why is this important with weight loss surgery?

After gastric bypass, patients are asked to take 1500 to 1800 mg/day of calcium as calcium citrate per day (this is the level advised in the ASMBS Guidelines). It seems clear that even in divided doses, these levels of calcium are likely to reduce the amount of iron patients can absorb if they take the nutrients together. Because gastric bypass "bypasses" the area of the small intestine where most iron absorption occurs, it is possible that this problem is much more profound after this procedure. We do not know because the studies have not been done. What we do know is that rates of iron deficiency are quite high, and doing what we can to improve the opportunity for iron absorption is important.

What can be done to best support iron absorption after gastric bypass?

The guidelines from the ASMBS specifically advise "Do not combine calcium with iron containing supplements." It would also be advisable to take iron away from calcium-rich meals, especially those containing dairy products such as milk, cheese or yogurt.

How about band patients?

Because band patients have no malabsorption, their risk for iron deficiency should not generally differ from the non-banded population. They may have some increased risk if they have challenges eating meat, but this can often be managed with band adjustments. The ASMBS guidelines do not call for any additional iron in band patients for this reason. That said, in a band patient with anemia, it would likely still be wise to advise them to take their iron and calcium separately. In the patient with adequate iron status, there is not an obvious reason to make this recommendation.

--------------------------------------------------------------------------------

iCook JD, Dassenko SA, Whitaker P. Calcium supplementation: effect on iron absorption. Am J Clin Nutr 1991; 54: 266-273S.

iiHallberg L, Rossander-Hulten L, Brune M, Gleerup A. Calcium and iron absorption: mechanism of action and nutritional importance. Eur J Clin Nutr 1992;46:317-27.

iiiGleerup A, Rossander-Hulth

Edited by MiladyB

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It's interesting that this was sent to you by Bariatric Advantage, who apparently still puts both iron and calcium in some of their multivitamins!

Kelly

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Actually, Kelly, I was just looking at the BA multi-vitamin information and they no longer have iron and calcium together in their multi-vitamins.

http://www.bariatricadvantage.com/catalog/categoryHandler?cat=Bariatric Advantage : Multivitamins : Gastric Bypass/Sleeve : Multi-Formula Capsule&expand=1

http://www.bariatricadvantage.com/catalog/categoryHandler?cat=BariatricAdvantage : Multivitamins : Gastric Bypass/Sleeve : Multi-Formula Chewable&expand=1

It looks as if they recently reformulated their multi-vitamin. Maybe thats the reason for the email. :)

Edited by MiladyB

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They still have both in their Vitaband multis for band patients, though. Even though band patients don't have issues with malabsorption, it's probably still better not to combine the two.

Kelly

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They still have both in their Vitaband multis for band patients, though. Even though band patients don't have issues with malabsorption, it's probably still better not to combine the two.

Kelly

Good point, Kelly. I didn't even look at the Vitaband information. You're right, the iron and calcium are still in there together.

http://www.bariatricadvantage.com/catalog/categoryHandler?cat=BariatricAdvantage : Multivitamins : Adjustable Gastric Band : VitaBand&expand=1

Edited by MiladyB

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According to BA's site, the reason their Vitaband containing both iron and calcium is that malabsorption isn't generally an issue with the band (can't say I'd agree with them!):

Is there an issue w/Iron & Calcium competition in VitaBand?

The competition between Iron and Calcium is much more of a concern with the gastric-bypass patient due to the malabsorption properties of the procedure. Because malabsorption is not generally a concern with the adjustable gastric-banding procedure, the patient has a much greater ability to absorb the Iron and Calcium when taken together. The Calcium and Iron are included in the VitaBand Multi-Formula to assist the patient in reaching their recommended daily value as advised by their physician/program. We offer additional Iron and Calcium supplements to assist the patient in reaching their recommended daily value.

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Yes, but even when malabsorption isn't an issue, iron and calcium still interfere with each other, don't they? I think that is the case in everyone, not just people who have had RNY. Even if I did not have malabsorption, I would want to have the best chance of absorbing the vitamins I took.

Kelly

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Corrine, this is true, this is what they say.

However, the recommendation not to mix calcium and iron has been out there for the general public as well (and I posted links in the "I love Celebrate Vitamins" thread) so their mixing them is not really doing anyone any real favors.

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I just posted BA's statement.

I did post that "can't say I'd agree with them!".

But it's a fact that with the exception of multivitamins for seniors, you'll find that most contain iron and calcium.

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I just posted BA's statement.

I did post that "can't say I'd agree with them!".

But it's a fact that with the exception of multivitamins for seniors, you'll find that most contain iron and calcium.

I didn't mean to imply you agreed or otherwise. Sorry if you felt that I did!

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I didn't mean to imply you agreed or otherwise. Sorry if you felt that I did!

Ah sweetheart!

I didn't mean to come over as snapping at you - I apologise. You're the last person in the world I'd do that too - smiley-hug002.gif

Got a lot of pain in the tummy again today so I've had to hit the happy juice again ..... sorry - I shouldn't be operating a computer right now. :o

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Ah sweetheart!

I didn't mean to come over as snapping at you - I apologise. You're the last person in the world I'd do that too - smiley-hug002.gif

Got a lot of pain in the tummy again today so I've had to hit the happy juice again ..... sorry - I shouldn't be operating a computer right now. :o

Aww.. no problems at all! And I didn't take it as snapping so we're good, honey!

I wish you weren't in so much pain :( You poor thing!

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Aww.. no problems at all! And I didn't take it as snapping so we're good, honey!

I wish you weren't in so much pain :( You poor thing!

I can deal with it for the most part but this afternoon it just wouldn't go away. Adhesions are a bi$ch as you well know.

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I know we're not supposed to take calcium and iron together, but what is the best time to take them? Like calcium after breakfast and iron after dinner? My docs just told me to do supplements after I had something in my stomach.

Lol sorry if this is confusing, I'm just adding calcium into my diet and trying to find a time to take it around my meals and my 15 other meds and the iron is kinda like a puzzle, lol.

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I know we're not supposed to take calcium and iron together, but what is the best time to take them? Like calcium after breakfast and iron after dinner? My docs just told me to do supplements after I had something in my stomach.

Lol sorry if this is confusing, I'm just adding calcium into my diet and trying to find a time to take it around my meals and my 15 other meds and the iron is kinda like a puzzle, lol.

I think I read somewhere that calcium is best with food and iron best on an empty stomach. But I'm not sure it matters a whole lot. I do iron at bedtime because then I don't have to worry about eating anything with calcium anytime soon because I'll be sleeping.

Kelly

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I'm really getting confused about when to take everything. I also take synthroid in the morning and I'm not supposed to take it with anything else. I'm curious to know what other's full regimen with meds and vitamins is. I have a nutrition consult soon. I've not had one yet, but we are doing it over the phone. I'd like to get a list of questions ready before the call since I'm paying $100 an hour - eek!

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My vitamin/pill regime is in this thread here, if you're interested:

http://www.thinnertimesforum.com/post-op-gastric-bypass/38410-jobu-my-box.html

I should forewarn you.. the thread took a turn for the silly. lol..

Edited by mistymee

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I'm really getting confused about when to take everything. I also take synthroid in the morning and I'm not supposed to take it with anything else. I'm curious to know what other's full regimen with meds and vitamins is. I have a nutrition consult soon. I've not had one yet, but we are doing it over the phone. I'd like to get a list of questions ready before the call since I'm paying $100 an hour - eek!

Most people do something like this:

Breakfast- multi, calcium, B12

Lunch- calcium

Dinner- multi, calcium

Bedtime- iron

Now. If your multi has iron in it, this won't work because you can't take it with your calcium if you want to absorb the iron. Since you have to take your synthroid by itself, you might want to do something like:

wake up- synthroid

after breakfast- multi, calcium, B12

and so on.

Kelly

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