I'm on 7.5mg of prednisolone. At my rheumatologists appointment today I advised him that I wouldn't be taking up his recommendation of Alendronic Acid despite having a very small amount of osteoporosis in my lower lumber region. I advised him that I was taking Caltrate which has 600mg calcium/200 IU Vit D3, and in addition taking an extra 2000 IU Vit D3 and a tablespoonful of cod liver oil every day. I eat full fat yoghurt every day, cheese and any other calcium rich foods I can lay my hands on. "Not enough" says my rheumy and writes me out a prescription for Calcichew and advises me to take 2 a day with my evening meal. I could just as easily take 2 of the Caltrate but somewhere I seem to remember a posting or comment that questions the wisdom of taking too many calcium supplements (something to do with absorption maybe??). Would appreciate any advice.....thanks
What dosage of calcium supplement is recommended ... - PMRGCAuk
What dosage of calcium supplement is recommended when on prednisolone?
You are right, 2x Caltrate is probably preferable ( Calchichews do have side effects for many people, my husband can take the citrate variety so they must be very innocuous!) However - when he took 2 doses a day he became hypercalcaemic - and it wasn't because of a large amount of dietary calcium I can assure you! I'd use a food diary and a bit of common and work out how much calcium you get in your diet. It sounds fine to me - I gave up the equivalent of calcichews a couple of years ago because it was causing grit to form in the urine and cystitis. It didn't seem to make a lot of difference to my dexascan results last autumn, Dietary calcium is preferable and you don't need that much more. Piglette uses an app I think to calculate all sorts of dietary things,
Thanks PMRpro. Good to receive your input. For some reason my rheumy doesn't seem to consider the benefits of additional Vit D3. When I next see my GP I might ask her to check my levels of calcium and Vit D.
Most mainstream doctors don't seem to - but without enough vit D you won't absorb the calcium properly. It has a lot of other positives too. I knew mine was very low - they happily check it here, but then, I pay towards the test!!! On 4000 IU I maintain a level in the good range. On just the combined supplement, the blood level falls steadily so I have to start all over again. Blood calcium levels usually look OK even if you need more as the blood scavenges it from the bones.
so I too have been advised to take vitD3, actually 4000 units, so have been for few years now, and also told to take calcium tablets, last bone density back in oct 2019 just showed some ostopenia, and just had bone density done again this past friday, don,t know results yet, but over the last 4 yrs on couple of occasions, have had bad shoulder pain, usually left one, in joint, had ultrasound done those times, shows calcification, my question is, what,s your opinion on taking the amount of D3 and650 units of calcium? also was reading should be taking K2 with these supplements, having another attack of what I think is calcification in left shoulder now for number of weeks,?
It;s probably more calcium than I have taken for the last couple of years- and I'm fine so far.I assume you have read Snazzy's reply just below this one?
Is the calcification just in the shoulder? It can be a feature of one form of inflammatory arthritis which sometimes also appears like PMR.
have had some in other shoulder, but disappated over few weeks, quite long time ago, but left shoulder is the worst, and has flared up 2 or 3 times, including now, over last few years, technician explained, it,s like grains of sand, get into tendons, and that,s what causes pain, although on reading an article, on google? suggested pain happens when body is reabsorbing calcium deposits? but now Im thinking of checking re amound of calcium supplement Im taking, and about K2, although as Ive seen, many say dr,s dont pay too much attention to supplements, so don,t get much advice on that subject, I did have VitD check couple years ago, forget results, but think was around then rheumy or GP, can,t remember, advised to take the vit D supplement,
Calcium supplements of all types have me cystitis until I cut the dose to about 200mg. It also gave me indigestion. It can be easily got in a more easily assimilated form from foods. One thing I don’t scrimp on is vitamin D because without that the calcium doesn’t get to the right places. It might be worth getting a vitamin D level checked because some people are deficient even with sunshine and decent diet. Mine was rubbish so I had to have a high dose loading course for 3 months. Also, vitamin K2 which helps the calcium not to end up in arteries and unwanted places. I too refused AA for my osteopaenia for a number of reasons 4 years ago. My next DEXA scan is soon! 😬
Please may I jump in and ask people what they think about Adcal-D3. I was prescribed them with my first batch of steroids. One with breakfast and one with evening meal.
If you need it because your diet is a bit low on calcium then it is OK if it agrees with you. I used it for years and was fine. I also used a couple of other versions but eventually the side effect of forming urinary grit got too much and my dexascan had been fine still so I cut the combined supplement, started eating more calcium-containing foods and upped my vit D to 4000 IU all year round. So far it seems fine.
Thanks. Is it OK to take it at the same time as the prednisolone tablets. I seem to remember reading something about not taking calcium supplements at the same meal?
Should be a couple of hours bewteen pred and calcium - we always say pred for breakfast, calcium for lunch and tea/dinner - absorbed better with some food.
Oh goodness, here we go again. Nobody told me that! I've always taken my Calceos and Pred first thing in the morning. Why the gap between the two?
Because the calcium is thought to coat the pred tablets in the stomach and interferes with the pred being broken down. And further down the gut the pred interferes with calcium absorption.
I’ve been chugging everything down at the same time as well. Wonder why GP didn’t mention it when she prescribed. Now wondering if the prescribed iron tablets are ok to be taken with everything else! Any advice please?
Do you really need the iron tablets? Low level anaemia is often part of PMR and iron supplements aren't always the correct management.
Prescribed because without them the levels drop drastically. Have had all the relevant tests for internal bleeds which have,thankfully, been negative. No idea what’s really going on in there!
I took it all through my GCA years (4.5) - GP suggested I stay on it when finished Pred (2016).
Had a DEXA scan in 2019, all okay, but recommendation was to stay on Adcal-D3 (same dose) - so I did! No problems….
Glad to hear that. Thanks xxx
Adcal gave me heartburn. I had to stop it.
It hasn't done that to me so far but I hate the awful sweetness. Seems very unhealthy?
Yes, I also didn't like the texture. But it was the heartburn that did it for me.
My husband about took off with the wind and bloating!!! He's fine with calcium citrate though.
Hi there,Well I declined AA too after being told I had osteopenia in my lower spine. Went online and found "Save Our Bones" So much info. According to SOB and their extensive research, the only calcium absorbed from dairy is from plain yoghurt and kefir. And the body cannot cope with more than 500mg at one time. Also cannot absorb calcium citrate or carbonate effectively. I now take a small amount of calcium from marine algae which is better absorbed by the body. What I learned has been the complexity of bone chemistry and its not just simply about bombarding your poor old digestive system with more calcium that it can't absorb. You need a host of other minerals and vitamins for your bones. GPs aren't the best for nutrition and diet advice. I also do targeted exercises for my spine and hips. AA is a big Pharma scandal! It's made up of stuff used in the oil, laundry and detergent industries. Good luck!
Many thanks for your reply. I eat plain Greek Yoghurt and goat's kefir (which also has the benefit of having Vit K2). I'm going to carry on taking my 1 tablet of Caltrate a day but no more. I'll also take a look at the SOB site. x
" the only calcium absorbed from dairy is from plain yoghurt and kefir"
That's a bit sweeping - the bioavailability of calcium from milk is about 30%, much the same as most food sources containing calcium. I would agree it is likely to be MORE from fermented dairy products but the amount gained from milk is not negligible. Much like the fact that potatoes are an important source of vit C on the UK diet - simply because lots of potatoes means lots of vit C even if the level of vit C in spuds doesn't compare to some other foods.
ncbi.nlm.nih.gov/pmc/articl...
It's to do with the alkaline /acid balance in the blood. Milk has calcium in it but because it's acid forming the calcium is cancelled out really because the body takes it out of the bones or utilises it to return the blood to an alkaline balance. There is medical research for this. The fact that nations that don't consume dairy (like Japan) don't have massive fracture stats like the West bears some testament to this.
Please don't quote woo science at me. Milk and other dairy foods are not acid producing and do not make the body acidic. Systemic or blood pH is not influenced by diet. And calcium is not the only thing involved in maintaining blood pH - how you breathe can make a difference too, The amount of carbon dioxide exhaled, and consequently the pH of the blood, increases as breathing becomes faster and deeper. By adjusting the speed and depth of breathing, the brain and lungs are able to regulate the blood pH minute by minute. The effect can be felt in an anxiety attack where people tend to breathe faster and shallower - carbon dioxide increases in the blood and makes the blood more acidic - and causes all sorts of peripheral symptoms like finger tingling.
dairy.com.au/dairy-matters/...
The pH of various parts of the body is governed by physiology, not by what you eat. Blood pH lies betwen 7.35 and 7.45 and must be maintained in that range or you become seriously ill. On the other hand, the pH of the stomach lies nearer 2, very acidic, and that is required for digestion.
news-medical.net/health/pH-...
Guess it's down to what you read and what you believe. You linked in info from the Australian dairy industry. I would choose not to believe everything they say. There is lots of info out there about the ills of too much dairy. You can find evidence everywhere to back up your own theories so it's down to the individual to do their own research and find out what works for them and their bodies.
As a scientist (and physiologist) I am quite capable of assessing the stuff I read. Unfortunately not everyone is trained to assess what they find online and so misinformation often proliferates.
The reason I used that link was because it said it all in people-speak - not because I believe what the dairy industry says.
Perhaps the confusion is over lactic acid which is not to do with dairy?! Though I thought dairy was precluded in arthritic conditions? Checking it out there is no hard and fast answer. As you say it it what suits you. arthritis.org/health-wellne...
"Though I thought dairy was precluded in arthritic conditions?"I have never heard of that before - by whom?
arthritis.org/health-wellne...
does admit the evidence is contradictory and it very much seems to depends on the individual. Observational studies are notoriously unreliable - and they are what are usually available in dietary studies. But given this is an American article - I'd have thought that there was a lot in the standard American diet to blame besides milk and cheese!
Please be careful of calcium supplements- I was taking OTC calcium and vitamin d- blood results showed worrying levels and my GP was going to send me to hospital!! Stopped taking the supplement and my bloods showed an improvement. Now regular blood monitoring!!
WHY don't they tell us these things? Is it that they don't know - or have forgotten? Or are they relying on pharmacists to tell us - which they can't always.
Mostly they are blissfully unaware. If you use a chemist regularly they SHOULD put 2 and 2 together - but they don't ...
Hi there. You’re right about the Vit D. It makes a massive difference (and it’s not only dairy etc that gives you calcium - there’s quite a lot in green leafy veg too - and quite a lot of plant foods - not in the volume if dairy but more absorbable I believe so that compensates a little. Also, allegedly, vitamin K2 helps to keep the calcium in your bones rather than circulating in your blood. I take lots of vitamin D to help with MS and we’re recommended to have Vit k2 with it for that reason. Hope that helps a bit?
That helps a lot to confirm what I've already picked up along the way and have been doing for a while now. Thanks x
I posted links awhile ago, maybe PMRpro can direct you. You can consume as much calcium as you want from food, but according to one paper not more than 800mg/d (increased risk of cardio impacts) supplement, and not to exceed 500mg per dose (higher dose less absorption versus concentration) take 2 hrs before or after a medication. D3 it depends, should get a blood test and get results between 30-50 ng/ml (I take 3,600 IU/d spread out during the day as smaller doses, my last blood result was 33), also add K2 which helps reduce buildup in the arteries and facilitates Ca being directed to the bones. I take 100 ug per day but a paper recommended 180. I take Calcium in the form of the citrate as it’s more easily assimilated. Look it up…
You'll find your posts/replies with the links in on your profile.
But it has to be balanced with magnesium.
True. My Calcium citrate includes D3 & Mg and I supplement with additional D3.
I was told that the body can't absorb more the 800mg of calcium at a time so if taking more then that you should divide your dose. I have also learned that if you take a proton pump inhibitor such as Omeprazole the calcium carbonate will get flushed out without any benefits. It suggested to take calcium citrate instead. But the recommended dosage is different with each type.
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