Supplementation for PMR - calcium/magnesium/potassium ratios

[Miserere]

Can anyone recommend the ratios for calcium/magnesium/potassium supplementation for PMR? and which type of calcium is best? Very recently diagnosed and want to preserve bone health. Thank you.

[PMRpro Ambassador]

Why specifically for PMR? There are no recommended ratios that I am aware of for anything as supplements.

There is no real reason for potassium supplementation unless you have had blood tests and been demonstrated to be deficient - too much potassium is dangerous.

There are calcium/vit D supplements - too much calcium is also not a good thing and some people can't cope with the AdCal usually used. Calcium carbonate is the usual - but has its downsides. Dietary calcium is best - if you can get enough from your diet.

Magnesium is mainly taken if people have muscle cramps. Too much of some sorts have a laxative effect.

[Miserere in reply to PMRpro]

Thank you PMRpro - perhaps I should have said steroid use rather than PMR specifically. Whilst researching this disease I have come across several recommendations for calcium and magnesium supplements in particular - hence the question - i.e. Mayo Clinic: The American College of Rheumatology recommends 1,000 to 1,200 milligrams of calcium supplements and 600 to 800 international units of vitamin D supplements for anyone taking corticosteroids for three months or more. I already take D3 and K2 recommended by a chiropractor some time ago. Others recommend also taking magnesium and possibly potassium. I am early in this disease so am trying to be proactive. Thanks for your response.

[CathyMeg in reply to Miserere]

I am advised to take Calcium and D3, K2 as you mentioned but in accordance with PMRpro have been warned of the dangers of taking potassium. Potassium would only be if diagnosed lack from reliable tests. Also there are better and worse forms of Calcium and again would want to check levels of both calcium and magnesium in blood tests. I take a Calcium, Vitamin D, K2 supplement recommended by my trusted Naturopath, equivalent to 1,000mgs Ca a day at night and check levels of Vic D and Ca in blood tests.

[piglette]

Hasn’t your doctor prescribed you with vitamin D with calcium? It is recommended in the guidelines. As PMRPro says ideally ensure vitamins etc are in your diet. They reckon 95% of supplements are just acting as placebos, if that, and boosting up the coffers of the suppliers.

[Miserere in reply to piglette]

Thank you Piglette - as I have responded to PMRpro - I am still researching this disease as I am new to it and want to be as proactive as I can. No prescription from the dr so far.

[piglette in reply to Miserere]

The Rheumatology guidelines say that they should prescribe vitamin D with calcium to counteract the side effects of the steroids. Your doctor should be aware of them or know where to look them up.

[Sophiestree]

Have you read Heron's piece on bone health. It might be worth a read. I have it printed out and highlighted! It's s in the FAQ list My 'Osteoporosis ' Journey. Might help you decide what to take. I don't take calcium or potassium, but do take 4000iU of D3 and also take K2. I have increased my dairy, which I'm not a lover of, and eat yoghurt and cheese daily now. A new one for me.

[Miserere]

Thanks so much Sophiestree - I shall take a look ats that. I also take D3 and K2 in liquid form and I've increased my dairy intake which was almost non-existent. However, I'm beginning ot enjoy a piece of cheese with an apple mid-morning and I'm using yoghurt and milk with berries in shakes. Best I can do ... Thank you for your constructive response.

[PMRpro Ambassador in reply to Miserere]

In that case it is probably a good idea to work out how much calcium you are getting - I used to use calcium/vit D supplements of the sort you have seen recommended for patients on steroids although I took more vit D - like Sophiestree I take 4000 IU per day. A couple of years ago I stopped the calcium because of bladder irritation (quite common) and concentrated on eating more cheese and dairy which I hadn't been eating so much of. The dietician was adamant I needed to cut dairy for cholesterol reasons - then panicked because my calcium intake was far too low (not surprisingly). You can have too much calcium in the diet though - especially when you take supplements. Calcium carbonate is sometimes problematic - bladder irritation and gut bloating are common. My husband can't take calcium carbonate - he almost explodes - but is fine with calcium citrate. For some reason he also ended up with a very high blood calcium level with the usual recommended supplemental level of citrate so only takes half which seems OK.

Over the years I have been on steroids and calcium/vit D supplements my bone density has hardly changed - I don't take vit K2 because I am on anticoagulant therapy and there is concern about mixing them. After 2 years of no calcium supplement my bone density still looked good.

[Snnib in reply to PMRpro]

Can you give me more info on calcium and bladder irritation, I'm having trouble with my water works lately, am on vit d and calcium but I do eat a a lot of cheese yoghurt and milk. Feel irritation down below alot but no water infection shows up had scan on bladder all ok. I'm on 7mg pred at the moment. Thanks.

[PMRpro Ambassador in reply to Snnib]

Exactly that - if you are taking a relatively high calcium amount as calcium carbonate which is the usual NHS supplement, you excrete the excess via the kidneys - pred encourages that and is why you need a good amount of calcium to increase the likelihood of the body not scavenging it from bone. Especially if you are at all dehydrated then the urine becomes concentrated enough for grit to form - you can also find gall stones forming in fact. The grit irritates the bladder and urethra and you get cystitis symptoms. I don't know if the same applies for other calcium salts but it is very common with carbonates.I found it particularly bad when travelling and not drinking as much as usual but eventually it was happening more often.

[Snnib in reply to PMRpro]

Thanks for your helpful reply will try just taking vit d and see how I go.

[PMRpro Ambassador in reply to Snnib]

That's fine as long as you have calcium in your diet - it's not only in dairy though so look it up

[Miserere in reply to PMRpro]

Thank you PMRpro - my low consumption of dairy made me want to look at this.

[benhemp in reply to PMRpro]

I thought the conflict between anticoagulants and vitamin K were for K1, not K2. No?

[PMRpro Ambassador in reply to benhemp]

In theory yes - but some experts aren't happy about K2 either.

[Suffererc in reply to Miserere]

I take Vitamin D3 2000IUs daily and K2. Can’t take calcium (Adcal) made my heart race. Blood test showed my calcium level was normal anyway. Can’t take yogurt, Greek or plain makes too much acid. Eat loads of cheese and eggs . So feel fine .

[PMRpro Ambassador in reply to Suffererc]

The blood level doesn't really mean a lot in this context: if the blood level is too low, the body robs the bones to make it up. Which is why an excess of calcium is recmmended to be sure everything has plenty,

[Pixix]

My doctor prescribed Calceos within a few weeks of my diagnosis. It’s 1250mg calcium carbonate (equivalent to 500mg elemental calcium and 10mcg of colecalciferol (400 IU vitamin D3). I was on Vit D for other reasons so stopped that and I take magnesium because I have fibromyalgia and muscle cramps a lot but took this years before pmr and it doesn’t help the Polymyalgia. Hope this helps. Luckily I had the Calceos tablets handy so could copy out the ‘ingredients’.

[Joanbill13]

I’m just totally confused with all the numbers now. What should I be taking ! I think I will give up. I only know at the moment I don’t feel well. I think it’s a flare. Have cystitis. Maybe too much calcium. Will reduce dose and see what happens.

[PMRpro Ambassador in reply to Joanbill13]

Not worth worrying about the numbers! You need calcium (preferably dietary but if you don't get enough that way, a supplement) and vit D. If you cut the calcium - make sure you take some extra vit D. I don't worry about anything else - unless I get muscle cramps in which case, I take some magnesium,

[Joanbill13 in reply to PMRpro]

You are so good an answer from Italy to Upminster essex in one minute. You’ve guessed I’m having a down 5 minutes. Have got muscle cramps so taking a magnesium pill. Think I will stick to vit d and diet calcium for a trial. Have so much pain in pelvic girdle and buttocks just now. Plus cystitis. Had such a good run till now. I don’t think long car journey to Devon helped.

[PMRpro Ambassador in reply to Joanbill13]

You have my sympathy! Have you spoken to the GP about the buttock pain? That could be piriformis syndrome. No wonder you are having a down - and more than 5 mins would be fair too!

[Joanbill13 in reply to PMRpro]

I think it could be. I ache all over that area and “below”. I have to sit on a cushion. Feel fine when l wake up in the morning after a night flat on my back. Not much sympathy from OH but thats understandable. Have a phone appointment with GP Monday. Thank you as usual for your support.

[PMRpro Ambassador in reply to Joanbill13]

Hope the GP is sympathetic - and even more so, helpful ...

[Joanbill13 in reply to PMRpro]

She is very good as a rule

[Thelmarina in reply to Joanbill13]

Bloomin’ Aida, you are in the wars! I do hope you get some relief soon 🌺

[Joanbill13 in reply to Thelmarina]

Haven’t heard that expression for a few years. Brings back memories of my grandma 😀

[Thelmarina in reply to Joanbill13]

😂