The Importance of Calcium

Just like all “essential” nutrients, calcium cannot be produced by the body; it must be absorbed from the food and supplements we consume. Most of us don’t give a lot of thought to our calcium intake. We take it for granted that it’s plentiful in many of our favorite cheesy meals, yogurt, and dairy delights. However, if you are a bariatric surgery patient who cannot eat enough or digest those foods anymore, you may have early signs of a calcium deficiency and not realize it.

Gastric bypass and biliopancreatic diversion with duodenal switch bypass the primary area of your digestive tract that absorbs calcium and other weight loss surgeries make it difficult to eat enough food to get proper nutrition. Therefore, calcium deficiency in bariatric patients not taking a calcium  supplement is almost a given and, over time, may be dangerous.

Calcium’s Functions

Calcium is a mineral that is vital to human life. You may have seen it listed on supplements as calcium citrate, calcium carbonate, calcium lactate gluconate, calcium citrate malate, and calcium phosphate. It is an essential element and the most abundant mineral in the human body. When you absorb calcium as you should, your body uses what it needs, then stores the rest in your bones for backup, leading to strong bones and teeth.

Calcium is not only crucial for building and maintaining healthy bones and teeth it is also essential for growth, reproductive health, blood clotting, and proper muscle, nerve, and hormone function. It has also been shown to facilitate weight loss. Without the adequate support of calcium plus vitamin D3, and other vital nutrients, a calcium deficiency can cause serious health issues.

Deficiency Symptoms & Risks

It is possible to have a calcium deficiency, or Hypocalcemia, and not know it for years until your bones are thin and spongy or your heart stops functioning normally. Early signs can be thin, brittle nails and muscle cramps – things that most of us don’t worry about. We buy nail-strengthening polish or eat more bananas for the muscle cramps and carry on. When small changes start happening, whether you’ve had bariatric surgery or not, don’t ignore them. They are your body’s early-warning system.


When you lack calcium, your system depletes it from your bones to function properly. Over time, the siphoning of calcium causes bones to become soft and sponge-like. What happens when there isn’t enough bone left? The human body is amazingly adaptive, but only for so long. Eventually, your bones will become very fragile, leading to easily broken bones from osteopenia or osteoporosis, among other issues including but not limited to:

  • brittle nails
  • muscle cramps, twitching, spasms
  • tingling/numbing in hands/feet/face
  • heart palpitations
  • delusions
  • depression


  • insomnia
  • irritability
  • periodontal disease
  • rickets
  • tooth decay

“The body uses bone as a reservoir for and as a source of calcium in order to maintain constant levels of calcium in the blood, muscle, and intracellular fluids.” – National Institutes of Health

How Much Should I Take & What Kind?

Because bariatric patients have absorptive limitations and diet restrictions, according to bariatric nutritional guidelines, the best calcium supplement for all gastric bypass and other weight loss surgery patients is one require low to zero stomach acid for absorption, and does not have to be consumed with food.  The most popular form for bariatric patients is calcium citrate (not calcium carbonate) plus vitamin D.

The procedure you choose, your age, and various test results will determine what your medical team decides is your recommended daily amount. The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends for adjustable gastric band, sleeve gastrectomy, or gastric bypass patients, 1,200 to 1,500 mg per day. Biliopancreatic diversion with or without a duodenal switch – 1,800-2,400 mg per day.

  • Calcium citrate is recommended. There is also TruCal®, an easily-absorbed, all-natural, calcium that’s equal to or greater than calcium citrate as it does not need stomach acid and provides a more balanced array of nutrients similar to your bone make up.
  • Recommended daily amounts: 1200-2400 mg – check with your healthcare team to determine what is right for you.
  • Taking calcium with vitamin D3 is a must – the D3 helps deliver the calcium to your bones.
  • Take in several doses throughout the day – a body can only absorb about 500 mg at a time.
  • Take separately from iron (2-hours apart) – they compete for absorption and you can end up with anemia and a calcium deficiency.

“In a controlled study, seven years after surgery, patients had a three-fold increase in spinal fracture and a five-fold increase in hip fracture compared to same age controls who had not had a bariatric procedure.” Endocrine Society

Vitamin D as it Relates to Calcium

Taking calcium without adequate vitamin D can lower absorption rates and hinder the calcium being delivered to your bones (and the unavailable calcium may cause issues like kidney stones and plaque). Besides skeletal, nerve, hormone, and muscle disorders, deficits in calcium and vitamin D increase the risk of breast cancer, colon cancer prostate gland cancer, chronic inflammation and autoimmune diseases such as type 1 diabetes, inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA). Metabolic disorders are also on the list, including metabolic syndrome, high blood pressure, and peripheral vascular disease.

“Vitamin D deficiency is one of the most commonly occurring micronutrients in the obese population. Prevalence figures as high as 80 to 90% of vitamin deficiency could be reported, the extent of the deficiency ranging from discreet to severe.” – National Institutes of Health

Calcium from Food Vs. Supplements

The ASMBS recommends bariatric surgery patients get calcium from dietary sources and supplementation proportionate to the type of surgery and your weight loss team’s recommendations. If you have calcium in your bariatric multivitamin, it would be a very small amount and not enough to alter the need for more.

Calcium citrate is the form of calcium endorsed by the ASMBS for supplementation. Compared to calcium carbonate, it does not require stomach acid for absorption, there’s less risk of kidney stones and constipation, and calcium citrate can be taken with or without food. Be sure to avoid calcium made of dolomite, oyster shell, and bone meal – these may contain metals and lead. And, as mentioned previously, anywhere from 1200-2400 mg/day will be recommended by your weight loss team.

When it comes to getting calcium through diet, keep in mind we only absorb roughly 30% of the calcium we consume, all things being “perfect.” It’s important to note certain medications, like long-term corticosteroids (prednisone), minerals like sodium and iron, excess protein, caffeine, colas, and processed foods, too much insoluble fiber (wheat bran for example), and lifestyle choices like smoking, alcohol, stress, and lack of exercise will deplete your calcium.

In addition to your calcium citrate or ProCare Health Calcium with TruCal supplement, you can get calcium from the following foods*.

Dairy foods (non-fat or low-fat – the calcium level does not change)

1 cup of milk – 291-302 mg
1 cup of yogurt – 345-415 mg
1 ounce of American cheese – 174 mg
1 ounce of cheddar cheese – 191 mg
1 ounce of mozzarella cheese – 207 mg
½ cup ricotta cheese – 337 mg
1 cup of fortified soy or rice beverage – 250 mg-300 mg
½ cup ice cream – 80 mg-90 mg

Protein foods

1 cup beans (cooked) – 90 mg
½ cup soybeans (cooked) – 130 mg
½ cup tofu – 204 mg
½ cup hummus – 66 mg
3 ounces canned salmon (with bones) – 167 mg
3 ounces canned sardines (with bones) – 371 mg
4 ounces salmon – 300 mg
½ cup almonds – 188 mg
1 tablespoon sesame seeds – 88 mg
1 cup calcium-fortified orange juice – 300 mg
1 orange – 92 mg
½ cup dried figs – 144 mg
½ cup rhubarb – 174 mg


½ cup broccoli (cooked) – 89 mg
½ cup kale (cooked) – 90 mg
½ cup collard greens (cooked) – 74 mg
½ cup spinach (cooked) – 61 mg


1 cup fortified cereal – 200 mg-300 mg
1 English muffin (wheat) – 175 mg
2 slices bread (white) – 70 mg

The enzyme lactase can help with digestion if you are lactose intolerant. You can now find lactase-added and lactose-free versions of dairy products in stores.


Calcium & Vitamin D in a Chocolate Bar or Sea Salt Caramel!

Now that you know you need calcium with vitamin D, what if you could get them both in a scrumptious chocolate bar or a piece of heavenly caramel? Now you can fulfill your nutritional needs and your sweet cravings not just once, but twice a day! You will feel like you’re “cheating” but instead, you’re doing great things for your body.

ProCare Health’s one-of-a-kind Calcium Dark Chocolate 500 mg Calcium Plus 500 IU Vitamin D bars are a customer favorite! Our melt-in-your-mouth, 65% bean-to-bar dark chocolate has less than 2g of sugar, is non-GMO, certified Kosher, gluten-free, soy-free, all-natural, and organic, and is made with TruCal®. Our chocolate bars are packaged in the USA and part of the Rainforest Certified Alliance.

Enjoy the creamy texture of our Sea Salted Caramel Chew while getting your calcium, vitamin D and a dose of probiotics! Our Caramel Calcium Chew is specially formulated for bariatric patients and delivers calcium in a non-gritty way. Each chew provides 500 mg TruCal® calcium, 500 IU of vitamin D3 to support calcium absorption, and 500 million CFU’s of probiotics to help with digestion. There are no artificial sweeteners or sugar alcohols, so you can feel confident you are maintaining your optimum calcium levels to support your healthy, active lifestyle.

We also offer Calcium Citrate Powder with vitamin D in convenient pre-measured packets to take wherever you need to go. Or, choose the canister with a value scoop for easy measuring. There’s virtually no taste – just a slight sweetness – it’s a perfect addition to your favorite beverage. With ProCare Health, it’s easy and delicious to get your daily calcium!


About TruCal®

TruCal is all-natural calcium with an absorption rate equal to or greater than calcium citrate. Unlike other calcium forms, TruCal offers a balanced profile of essential minerals and antioxidants with all the healthy parts of milk and very low lactose (.02%). TruCal mimics your actual bone make up and provides Phosphorus, Magnesium, Potassium, Zinc,and Copper, in addition to calcium to provide a supplement for optimal bone health. Like calcium citrate, TruCal does not require stomach acid for absorption, is non-constipating, does not increase the risk for kidney stones, and you don’t have to consume it with food. Thus, making TruCal the superior choice for achieving optimal bone, hair, teeth, and neurological health.

Easy Nutrition & Calcium Supplementation

As you embark on your weight loss surgery journey, the key to a healthy life is proper nutrition and self-care. After reading many of our blogs, you will see that without proper nutrition, deficiencies can cause life-threatening issues, and calcium is no different. Though it may seem overwhelming, you have a medical team and our ProCare Health team in your corner, to simplify the process so you can focus on living life.

We know first-hand how extremely complicated the bariatric vitamin supplementation regimen can be- like giving up desirable flavors and focusing on proteins and nutrient dense foods. That’s why we offer the optimal supplementation you need in capsules, chewables, liquids, and proteins. We strive to make taking them convenient and not feel like it’s taking over your life- and even better enhancing your life!


ProCare Health’s Quality Guarantee

Because ProCare Health only wants the best for you, all our supplements undergo testing that exceeds the industry’s quality expectations. After being produced in a cGMP-compliant plant in the USA, every ingredient of every lot is 3rd party independently tested for quality and efficacy, delivering peace of mind to you. Our Bariatric Multivitamin with 45 mg iron capsule is also approved! No other company provides that level of testing and purity with transparent results available for everyone to see. We would be honored to be part of your weight loss and new life journey and are here to help you.

Many of ProCare Health’s products are free of artificial flavors, sweeteners, gluten, and lactose. Our delicious one-of-a-kind calcium chews and dark chocolate bar are also Kosher, organic, soy-free, and non-GMO.

Please feel free to contact us today with questions or to place an order. 877-822-5808


Learn More

If you want to explore the full range of our bariatric vitamin products, please visit our full product listing.

Bariatric Multivitamin