Friday Q&A: calcium supplements; the Ozempic plateau; dry November; & light boxes for seasonal blues

An assortment of your questions!

Nov 17, 2023

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Question #1 (about calcium supplements) is free for everyone. Questions #2-4 (on Ozempic weight-loss plateau, dry November & light boxes for seasonal blues) are for paid subscribers only.

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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

QUESTION #1: CALCIUM SUPPLEMENTS (edited for clarity)

Many women I’ve spoken with get conflicting information regarding calcium supplements postmenopausal and I’m hoping you can clarify some of the lurking questions including: how many mg per day is necessary? which calcium supplement is preferred (carbonate, citrate) and which is least likely to cause constipation? Along with taking Vitamin D, do you recommend calcium supplements with any of the numerous nutrients being advertised such as potassium, magnesium, zinc, vitamin C and vitamin K? -Beth

Dear Beth,

Calcium and vitamin D are important for many reasons, mostly for keeping bones strong and helping to prevent osteoporosis.

How many milligrams per day do you need? Premenopausal females and males of all ages should consume at least 1000 mg of calcium/day. Postmenopausal females should consume 1200 mg of calcium/day. The total daily calcium intake includes calcium from the foods you eat plus any supplements you take. Your body doesn't produce calcium, so you must get it through other sources. Ideally you would get all of your calcium through food including:

Dairy products, such as cheese, milk and yogurt
Dark green leafy vegetables, such as broccoli and kale
Fish with edible soft bones, such as sardines and canned salmon

However, some people have a difficult time getting enough calcium despite eating a healthy, balanced diet—for example people who follow a vegan diet, have lactose intolerance, or who have certain bowel or digestive diseases that decrease their ability to absorb calcium.

In these situations, calcium supplements may help you meet your calcium requirements.

Which calcium supplement should you take? Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of calcium—referred to as elemental calcium. Elemental calcium is important because it's the actual amount of calcium in the supplement—i.e., what your body absorbs.

The two most common calcium supplements may be labeled as Calcium carbonate (40% elemental calcium) and Calcium citrate (21% elemental calcium). Your body must be able to absorb the calcium for it to be effective. All varieties of calcium supplements are better absorbed when taken in small doses (500 mg or less) at mealtimes.

Calcium carbonate is effective and is the least expensive form of calcium but it is the most constipating. It is best absorbed with a low-iron meal (such as breakfast) and may not be absorbed well in people who also take proton pump inhibitors or H2 blockers for gastroesophageal reflux.

Calcium citrate is absorbed equally well when taken with or without food and is a form recommended for individuals with low stomach acid (more common in people over 50 or taking acid blockers), inflammatory bowel disease or absorption disorders.

Vitamin D is necessary to help absorb calcium. Vitamin D is normally made in the skin after exposure to sunlight, and there are a few foods that naturally contain small amounts of vitamin D, such as canned salmon with bones and egg yolks and some fortified foods.

In terms of the other vitamins or minerals that are offered with calcium, beware of online internet salesmen who tie a second supplement to your calcium because they claim to know what you need. Having said that, magnesium is good for constipation so may want to consider this combination.

Note that calcium can interact with other medications and vitamin D levels are measurable in blood—so make sure you review all of your medications and lab tests with your doctor!

QUESTION #2: OZEMPIC WEIGHT LOSS PLATEAU

I take weekly Ozempic for diabetes and weight loss. I have lost 10 lbs and my sugar levels are so much better but I have plateaued on weight loss. I am freaking out b/c it worked well for so long. Any suggestions? - Ivan

Dear Ivan,

I am seeing this a lot.

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