Calcium supplement

[rhbishop2]

My GP keeps trying to get me to chew calcium tablets. I understood that this might not be a good idea. Does anyone know the definitive answer on this. I've been on Triptorelin for six years on and off.

Bob

[DFZ4835]

You need calcium and vitamin D to keep your bones strong especially with bone mets. Why he wants you to take calcium without D is a good question. Have you asked him why he wants you to chew calcium?

Dennis

[rhbishop2 in reply to DFZ4835]

They want me to chew calcium because I am on ADT and therefore at risk of osteoporosis. The medication they have given me includes Vitamin D3 but only 400 units. I already take 2000 units daily as a matter of course as all the evidence suggests that boosting D3 can be helpful. A recent article in the Telegraph (quoting the BMJ)

telegraph.co.uk/news/health...

says there is no evidence that taking calcium supplements works. There is also some (disputed) evidence that over-consumption of dairy products can make prostate cancer worse.

I wonder if anyone has other views.

[pjoshea13 in reply to rhbishop2]

If there was no osteoporosis before ADT, why would added calcium prevent it?

ADT reduces testosterone to the point that a man might not make enough estradiol [E2]. E2 is essential for male bone health. Ask your doctor to measure E2. If it is less than 12 pg/mL, ask for a low-dose estradiol patch.

-Patrick

[Scruffybut1 in reply to rhbishop2]

I think the article refers indirectly to happy healthy people not us happy though unhealthy folk. My Zoladex and chemo meant my Onco registered that my calcium levels were not good. That's my levels - not yours. So calcium tablets required. Depletion required addition. Now I only have Zytiga my calcium levels OK so no tablets needed.

[Hidden in reply to Scruffybut1]

sensible

[pjoshea13]

There are epidemiological studies that associate high intake of calcium with aggressive PCa, so the obvious question is: How much calcium does he want you to take?

Excessive calcium blocks the conversion of inactive vitamin D to its hormonal form. As Dennis points out, we need calcium & D for bones, but too much calcium will silence the D. This is bad, not only for bone, but also for PCa.

Be aware that bone health requires much more than calcium. In particular, it needs vitamin K2 for the transportation of calcium to bone.

Elsewhere, I have written about the importance of a good magnesium:calcium ratio. "Chewing calcium tablets" will likely mess that up badly.

-Patrick

[milto27xabc]

i'VE BEEN USING A BONE DIET FOR YEARS WITH GOOD EFFECT--SEE BELOW --SEE REFERENCE #1 RE TOO MUCH CALCIUM--APOLOGIES FOR THE LENGTH---JIM

BONE HEALTH and PROSTATE CANCER

Men being treated with hormone therapy for prostate cancer suffer a number of side effects. One of the most serious is osteoporosis, which weakens the bones and can result in fractures. The normal advice is to take calcium (in food and/or supplements) plus vitamin D and to exercise using weight bearing exercises. In some cases, Denosumab or other bisphosphonates are prescribed. Bone health is measured by a bone mineral density test (BMD) which is quite different from a bone scan, which looks for prostate cancer in the bones.

However the advice tends to be vague (how much and how often?). There is some evidence that the body doesn’t absorb calcium very efficiently and the suggestions on how much vitamin D to take and in what form (sunlight and/or supplements) is variable.

In addition and perhaps more seriously some doctors think that excess calcium is bad for prostate cancer patients. Reference #1.

A clinical study performed at the University of Alberta by Drs Stephen Genuis and Thomas Bouchard in 2012 called Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention, showed some very positive results. Reference #2.

After 12 months on the micronutrients, the 77 patients, (mostly post menopausal women, 38% of whom had tried bisphosphonates without success) all had improved BMD Z scores. The authors compared the COMB patient Z score improvement with published results for strontium ranelate and bisphosphonates and the COMB scores were considerably better. Since some patients refuse bisphosphonates because of reported side effects, the COMB diet offers an alternate treatment. Reference #4 .The authors suspect that the use of several bone health supplements may be synergistic. Follow up on the original COMB study has continued with no fractures reported as of July 2015.

COMB Protocol

1.Vitamin D3:2000IU/day .

2.Vitamin K2 (non-synthetic MK7 form):100 ug/day(same as mcg/day)

3.DHA (Docosahexanoic acid):250 mg/day from purified fish oil

4.Strontium citrate:680 mg/day

5.Elemental magnesium:25mg/day

6.Dietary sources of calcium recommended

7.Daily impact exercising encouraged

I use salmon to replace some of the fish oil supplement(3.5 oz of salmon gives 1500mg of DHA), I take 3000IU/day of Vitamin D3,the Vitamin K2MK7 I take is from Natto, and I take 1Tum/day because I’m lactose intolerant and don’t get as much diary calcium as most people. In total, I take from 4 to 8 pills a day depending on how much sun and salmon I get. My exercise regime is probably more extensive than recommended in the study. I play doubles tennis twice a week, walk for 45 minutes twice a week and use a weight lifting program for 15 minutes 3 times a week.

I was diagnosed with prostate cancer in 2005 (PSA 3.8 Gleason 3+3 on biopsy) I had brachytherapy in June 2005 and when my PSA rose to 15 in 2007 a CAT scan showed a swollen lymph node . I went on intermittent hormone therapy to treat metastatic PCa (Lupron every 3 months for about a year and then nothing for about a year, then repeat). I switched to Lupron every 3 months (no holiday) plus Casodex and Avodart daily in Jan/14 and my PSA has been steady at 0.32 and testosterone at 0.7ng/dl (20nmol/l). As of 2016, I’m 84 years old.

I started to use COMB in Jan 2013 and had a BMD test in 2008, in 2011 ,2014 and again in Feb/16 all at Princess Margaret Hospital in Toronto. The results:

My BMD Numbers

DateAug/08Aug/11Jan/14Feb/16

Lumbar Spine

BMD g/cm21.41.42

T Score2.682.803.00

Z score 4.3

Left Femoral Neck

BMD g/cm21.041.038

T Score0.60.80.8

Z score2.4

Left Total Hip

BMD g/cm21.2531.264

T Score1.391.51.5

Z score2.7

Fracture Risk3%LOWLOW

T-Score-BMD compared to a young adult-the number of standard deviations above or below the average. -1 and above is normal bone density.

Z-Score-the number of standard deviations above or below the BMD for someone your age, sex ,weight. -2 or lower means possible trouble.

COST

My cost of the nutrients used in COMB is a maximum of $C1.22/day or $37/month or $445/year. Strontium Citrate makes up about 50% of the total. Bisphosphonates are much more expensive but are prescription drugs and probably covered by insurance or ODP. The offset is the reported side effects from bisphosphonates and the good results from COMB.

Dr Stephen Strum, a widely quoted medical oncologist, has collaborated with Life Extension to market “Dr Strum’s Intensive Bone Formula” which contains potassium citrate, an Ayurvedic herb, calcium, vitamin d3, vitamin k2mk7, magnesium, zinc, winged treebine, boron and silica. The dosage is 10 caps per day at a cost of $US 1.90/day. Reference #3.

CONCLUSION--- the COMP protocol appears to be an effective way to protect and perhaps improve on bone health. It has no reported bad side effects and may be superior to prescription bisphosphonates. It includes calcium and Vitamin D3, which are the standard recommendations for PCa patients but uses less calcium.

I think that weight bearing exercise is perhaps the most important part of any bone health treatment.

I intend to continue to use the COMB protocol with extra exercise and recommend it to my fellow Prostate Cancer patients especially those on hormone therapy. The disease is bad enough without adding broken bones.

If you want to be sure have a BMD before starting COMB and another BMD after 12 months,

Of course, I’m not a doctor and you should consult a medical professional before starting any new treatment. The COMB study only included 77 patients who were mostly women (the few men had better results than the women ). Given the low cost of the supplements there will probably never be a large clinical trial sponsored by a drug company.

In addition to the references I’ve included below, I found the comments on the subject from Dr Strum, Dr Charles Meyers and Chuck Mack valuable and they are frequently noted on the internet ie Google.

HERE’S TO BETTER HEALTH

Jim Milton

March, 2016

[e-mail]

Toronto, Ontario, Canada

NOTE: The reference studies are very long so I’ve included the conclusions below.

Reference #1—Excess calcium

theoncologist.alphamedpress...

CONCLUSIONS(FROM THE REFERENCE)

Calcium and vitamin D supplements are widely prescribed to men with prostate cancer undergoing ADT. Whether supplementation of men undergoing ADT with calcium and/or vitamin D results in a higher BMD than in those with no supplementation has not been tested. Available clinical trial data regarding supplemental calcium at 500–1,000 mg/day and vitamin D at 200–500 IU/day indicate that these regimens are inadequate to prevent BMD loss. Calcium supplements have been implicated in greater risks for cardiovascular disease and advanced prostate cancer. Thus, clinical trials to determine the risk–benefit ratio of calcium and vitamin D supplementation in men undergoing ADT for prostate cancer are urgently needed. Key safety endpoints in such trials should include markers of prostate cancer growth, for example, PSA and PSA velocity, as well as surrogate markers of cardiovascular disease.

Reference #2 ---The COMB study

hindawi.com/jo

 

urnals/jeph/2012/354151/

[herb1 in reply to milto27xabc]

Jim, Pat, et al: Just a note on Strontium citrate. I think it worked for me for several years, but it can mess up X-rays, CTs and bonescans, making them difficult to read and interpret. It makes everything look darker, more "degenerative". You must tell radiologists that you're on this...and you probably have to explain what it does to scans.

Also, remember that DEXA scan T, Z data must be "corrected" for SrCitrate. I don't know about QCT data.

herb s

[rhbishop2]

Thanks for all the info, guys, especially Patrick. That's really helpful. All the best in 2017.