02/29/2024 Note on Vitamin D and Osteoporosis
Actually, it was my younger daughter who encouraged me to share my learning experience fighting osteoporosis. It was a great surprise for her that her very active and outdoorsy mom would fall and fracture her wrist. Yet that was what happened to me one day while playing tennis at the age of 70+. The fracture led to bone density testing and my osteoporosis diagnose. Next came looking for the reasons leading to my condition and ways to improve it, as I described in my previous posts:
- blood serum Calcium testing and the need to take calcium supplements.
- choosing the most appropriate Calcium supplement.
- After that image testing of my parathyroids to make sure that they function properly. Because even though I was taking sufficient amounts of calcium from the diet and by calcium supplements, my blood calcium levels did not increase enough. Low calcium levels in the blood stimulates the release of parathyroid hormone which triggers release of calcium from the bones into the blood and ultimately leads to resorption of the bones and osteoporosis.
Yet, after all of the above checks and improvements my doctor went back to the crucially important question – is my vitamin D blood level within the healthy range. Why vitamin D? Because vitamin D is needed in order for calcium to be absorbed from the food in the small intestine. The active vitamin D form in the small intestine stimulates the active calcium transfer from the intestine to the blood circulation. When vitamin D is low and the body cannot properly absorb calcium, there is an increased risk of falls, bone fractures and development of osteoporosis.
Now, I wanted to say that lately more and more doctors talk about the importance of vitamin D and what is considered a healthy blood level of vitamin D. Vitamin D is tested and reported as 25 (OH) vitamin D. Most labs report the optimum range of vitamin D, 25-OH to be 30 – 100 ng/ml. Insufficiency from 20-29 ng/ml, and deficiency as less than 20 ng/ml. But lately more and more doctors consider that the healthy level of vitamin D, 25-OH should be above 40 ng/ml or even better above 50 ng/ml.
More on vitamin D in my next post.
02/15/2024 Note on Buying Calcium Supplements
When buying a Calcium supplement, we are looking for the label on the back to read, for example:
Calcium (as Calcium Citrate) 400 mg
or
Calcium (elemental) 400 mg
Or
Calcium 400mg
It should not say
Calcium Citrate 400 mg.
As calcium citrate contains about 21% elemental calcium, that will mean that the elemental calcium in the tablet is only 82 mg.
Also, for better absorption it is good to take Calcium supplement together with vitamin D3. Some calcium supplements contain additionally vitamin D3. I personally am taking a Bayer brand calcium citrate CITRACAL petites which contains Calcium 200 mg and additionally vitamin D3 250IU per tablet.
02/13/2024 On Calcium
This is my 2nd posting on Calcium. The first one was related to the choice and dose of Calcium supplement. I described how by bringing my Calcium intake to 1200 mg daily both from diet, about 200-300 mg, and additionally by taking Calcium citrate supplement, my blood serum Calcium increased substantially. Yet my urine Calcium was still below the normal level. There could be a couple of reasons for low urine Calcium, one of which is that the parathyroid glands do not produce enough parathyroid hormone (PTH). The parathyroid glands are 4 small pea size elongated disks located in the neck behind the butterfly-shaped thyroid gland. The parathyroid glands make the parathyroid hormone which regulates the amounts of Calcium in the bones and blood. The parathyroid glands secrete PTH in response to low blood Calcium levels with the purpose to increase it. PTH acts on the kidneys, bones and intestines. In the bones, PTH stimulates the release of Calcium which is deposited and stored there. In the kidneys, PTH signals to retain Calcium rather than flushing it out of the body through urine. It also stimulates the production of active vitamin D. In the small intestines PTA signals to absorb more Calcium from the food.
This way Calcium, along with Phosphorus, is crucial for healthy bones. Overproduction and release of PHT in the blood (hyperparathyroidism) in the long-run can lead to loss and too little Calcium in the bones resulting in weak brittle bones that break easily (osteoporosis). Low PTH (hypoparathyroidism) leads to abnormally low Calcium levels in the blood and increase of Phosphorus blood levels. Extra Phosphorus causes the pull of Calcium form the bones, making them weak.
So, my endocrinologist wanted to see the results of my PTH blood tests and imaging of my parathyroid glands for any abnormalities. The normal range for PTH blood test is 15 to 65 pg/ml. Most people can actually function totally normally with just one normally functioning parathyroid gland.
02/02/2024 On Calcium and Vitamin D
- Vitamin D forms, levels in blood serum, supplements and UV exposure
- Recommended intake
- Brain aging
Why do we need to make sure that Vitamin D level in our serum is in the recommended range? Because Vitamin D is utilized in our body 3-4 times faster than other vitamins. It is very important as it regulates the synthesis of ionized Calcium
Fighting osteoporosis, it took me a long time to achieve healthy levels of serum Calcium. It was a tricky process. First came the realization that from diet alone it would be impossible for me to meet the recommended daily intake (RDI) of calcium for adults which is 1000 mg daily and increases to 1200 mg per day for women over age of 50. So, if I managed to take from cheese, milk, yoghurt and nuts about 200 mg per day, I would still need to take about 1000 mg of calcium in the form of calcium supplement.
Which form of Calcium supplement? I went from taking Calcium carbonate to switching to Calcium Hydroxyapatite for better absorption and finally choosing Calcium Citrate as the best choice.
That was a long process involving blood and urine tests after 2-3 months of taking each calcium supplement.
I learned that Calcium carbonate supplements contain the highest amount of elemental calcium, about 40% by weight but are not so easily absorbed and bioavailable. Then I tried Calcium hydroxyapatite which is more easily absorbed than calcium carbonate. My blood tests did not show much improvement. And finally Calcium citrate proved to be the best choice for me, the most digestible version. It is more easily digestible for people with low stomach acid which is common in people over 50 and also for those taking antacids and acid blockers. Also, for improving absorption it is better to split the 1000 mg Ca supplement into two doses of 500 mg and take them one in the morning and the second in the afternoon.
Even after taking 1000mg Calcium citrate supplement daily for about two months, my endocrinologist was not quite happy with my Ca serum results. He wanted to do some additional testing of other organs engaged in Calcium regulation. So next came image testing of my parathyroid glands for proper functioning.
