Vitamins and supplements

[grannyjogger]

Some advice needed about the timings of taking vitamins, supplements and how they might react with prescribed drugs.

The prescribed meds I take daily are 2 x 200mg Hydroxy, 2 x 30mg Lanzoprazole, 2 x Adcal-D3. I've been having loads of GI problems since my cholecystectomy last year (bile reflux as well as long term acid reflux) and a recent endoscopy has diagnosed Grade C gastritis. I also have a 6cm sliding hiatus hernia and very slow transit of food through the gut so I also take fibre supplements (psyllium husk). All in all the old GI system doesn't work too well.

I bought some iron tablets because I thought they might help with fatigue. I also get a lot of cramps (mostly in my feet/toes) so I've been doing a bit of research on good old Dr Google and wondered if magnesium would help. The problem is working out how to avoid taking things that shouldn't be taken at the same time.

I have to take Lanzoprazole first thing in the morning at least an hour before food and at night an hour before bed. Hydroxy has to be taken with food, as does the Adcal but there needs to be 4 hours between the Adcal and iron supplements. I've now discovered that I shouldn't take Adcal within 2 hours of eating foods rich in oxalic acid, phosphate or phytic acid - eg spinach/rhubarb, bran or whole cereals - all of which are pretty good when you have slow transit of food through the gut and can get constipated easily.

I know there are some wonderful contributors out there who have a wide knowledge of the benefits of supplements so it would be good to know how others manage potential conflicts. I know supplements shouldn't be used to replace a good, balanced diet but that's not always possible with GI problems. Any advice would be appreciated.

[PMRpro]

I think you should discuss the iron tablets in particular with your doctor - I'm sure they will have checked your haemoglobin at some point, it is a basic blood test - and if it is OK then you shouldn't really take more iron. The fatigue is almost certainly due to the autoimmune disorder rather than being anaemic (it might not be but i'm sure they'd have told you before if you were) and too much iron isn't good either.

You are best to take the calcium with a meal because it needs an acid environment to be absorbed best - but you are taking lansoprazole which stops acid production so it perhaps is less important when you take it.

You imply you eat spinach - rich in magnesium: High magnesium foods include dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados, yogurt, bananas, dried fruit, dark chocolate, and more. Though magnesium supplements do help poor bowel function!!! However - you can get magnesium sprays to use on skin and an Epsom salt foot and leg bath is also said to improve low magnesium causing cramps and then you wouldn't have to worry when you took it.

[grannyjogger in reply to PMRpro]

Hi

I don't get regular blood tests unless there is something specific. The GI clinic sent me for one to look at liver amylase recently but it is a struggle to get any sort of positive interaction going with the rheumatologists at the hospital I go to - appointments have to be chased after 8 or 9 months and then it is a quick 5 minutes. Don't always see the same person and the responses when I raise any symptom is at best a lack of interest!!. Last year I wrote a list of my symptoms to take with me and ask that they were added to my hospital notes. The nurse specialist had been sympathetic when rocked up for the appointment expecting to see the consultant only to be told it was a nurse appointment just to see "how you're getting on" (that was the first time in 7 years this had happened). So she made my next appointment with "a new rheumy who is quite enthusiastic" and told me to take the list of symptoms (an A4 page full). It took six months for the appointment to come through and it lasted less than ten minutes. The 'enthusiastic new rheumy' wrote to my GP to say she could see no evidence of a systematic disease. I can't remember when any of these rheumatologists last asked for blood tests. So after 7 years of this I tend to look for solutions myself.

The gastro problems have taken over a bit since I had gallstones that caused acute pancreatitis about 18 months ago. There are times when eating anything causes too much pain so although I know what a healthy balanced diet should be, sometimes mine falls far short. I think I will forget the iron tablets for the time being, but I think the Epsom salt bath sounds brilliant. Will definitely give it a go.

Thanks PMRpro

[PMRpro in reply to grannyjogger]

If you have that sort of gut - leaving the iron sounds like a VERY good decision!

You could ask your GP for a basic set of blood tests: urea and electrolytes, full blood count and liver and kidney screen and vit D. It isn't an unreasonable request given your gut problems.

My husband doesn't eat a healthy balanced diet - what's fruit and veg? He thinks chips are veg but has survived cancer for 22 years. His mother didn't either except she ate boiled potatoes not chips - and lived pretty well to 84.

And what about asking for a dietician appointment (you might get one this decade) - and perhaps they might let you have some supplemental shakes or whatever they call them these days.

[grannyjogger in reply to PMRpro]

I wish I could say my diet was always good and healthy, I do eat fruit/veg/only lean meats etc, but I have a tendency to be tempted by biscuits or chocolate, especially when I'm tired and feeling low.

I've got a follow up appointment at the GI clinic this week, there was very good communication following my endoscopy a few weeks ago so I can raise the issue of diet to see if there's any chance they can refer on this fast track protocol. Temporarily I'm on higher doses of Lanzoprazole than usual until any treatment is decided at my appointment. I can discuss bloods when I go back to the GP to get my repeat prescription updated.

Your husband's take on chips made me smile, I'm from Northern Ireland where we loved the potato in all shapes and forms....particularly fried!!!

Thanks for your input - I've just got back from the chemist with a tub of Epsom salts.