Posts Tagged ‘Calcium’

Vitamin D is necessary in order to absorb Calcium from your diet.  Your skin can make some Vitamin D from the Mid-day Sun, but only in the “summer”.  The sun is high enough above the horizon at mid-day only 5 months of the year in Iowa.  Over half of Iowans are low on Vitamin D as summer ends in September.  7 out of 8 Iowans are low by mid April when we can first get a few minutes a day of Vitamin D.  That’s the Good News.

The Bad News is that Sun Block blocks Vitamin D production in skin.  You need to risk Sunburn and Skin Cancer “naturally” if you want to make your Vitamin D “naturally”.  Plus you need to expose enough skin (determined by your age and personal genetics) to make enough Vitamin D.

Foods naturally high in Vitamin D3 include “yummy” Seal Blubber and Cod Liver Oil.  Most Fish Oil does not have much D3.  Vitamin D2 from plants (like mushrooms) is much less long lasting than  D3, so we are talking pounds of mushrooms daily.

Your easiest and safest move is to take extra Vitamin D3.  The amount of D3 in your multiple vitamins and minerals, calcium supplements, and milk combined are very rarely enough.  Most of us need 2,000 to 5000 units of additional D3 daily.

Test for 25-hydroxy Vitamin D Level to tell if you are taking enough to get between 40 and 80 ng/ml in your blood.

Help to Take Control Naturally by getting enough Vitamin D.

Jay Ginther, MD

Calcium is responsible for the stiffness and strength in bones. Calcium is what we measure when we measure Bone Mineral Density. Without sufficient calcium intake you cannot have strong bones.

Most people can absorb 500-600 mg Calcium at a time, if taken with food containing Protein.  This only works if your Vitamin D level is high enough.

You need to consume 400-500 mg  in each of 3 meals to  reliably get 1200-1500 mg every day. This is necessary because most people  will pee and poop and sweat out at least 1000 mg of calcium daily.

Calcium is best absorbed when eaten in foods.

You can Take Control Naturally with diet alone.

Milk, Cheese, and Yogurt are all high in Calcium, but amounts can vary.  Check the label to see how many ounces are needed to make at least 200 mg.  (Check “serving size” and remember that “20%” is 200 mg when dealing with calcium.)

Some vegetables are high in Calcium.  One cup of cooked Collards, Black-eyed Peas, or 1.25 cups cooked or finely chopped Kale or Okra each have 200 mg.  4 cups of chopped Broccoli is 200 mg.  Of course you can eat these raw, if you prefer.

If you do not get enough calcium in your diet alone, Calcium Supplements are needed.

Jay Ginther, MD

You have started taking Osteoporosis Medication.  You think you have entirely eliminated your Fracture Risk.  Then, WHAM – you have a Fracture!  What went wrong?

It is time to re-evaluate.  There are many possible reasons for your fracture.

First, all osteoporosis medications gradually become effective over months.  Therefore, if you fracture within the first few months, there has not been enough time for it to become fully effective.

By two to three years, all osteoporosis medications Decrease Fracture Risk by 1/2 to 2/3.  That is very good, but not perfect.

Second, you need to be sure you are getting enough Absorbable Calcium in 3 doses of 400-500 mg In Foods or With Foods – every day.  You need to have a high enough Vitamin D level to absorb the Calcium.  You need Magnesium too – a Multiple Vitamin and Mineral (taken with a full meal) should be enough.  You also need Protein (1gram per kg of body weight).  If you had Secondary HyperParathyroidism, it must be resolved.

Third, Bisphosphonate pills are sometimes not absorbed adequately.  When they work, we actually absorb less than 1% of the drug taken.  If this is a problem, Reclast or Prolia can get around the absorption issue.  Of course, skipped doses do not work at all.

Fourth, there may be other issues causing fragility.  A Complete Bone Health Evaluation will usually identify Diabetes, HypoThyroidism, Colitis, Irritable Bowel Syndrome, Lactose or Gluten sensitivities, etc.  These need to be fixed too.

Finally, your Osteoporosis may be too severe to be ideally treated with Antiresorptives.  Very low BMD and T-scores, multiple Fragility Fractures, Vertebral Fracture Deformities (especially multiple) are all indications that you probably should start with the Anabolic, Forteo, to build up your Bone Matrix enough that a Antiresorptive can then be the best treatment.

Fracture while on medication?  Time to re-evaluate.  Then modify your program if needed.

Jay Ginther, MD

Diabetes + High BMD = Brittle Bone

August 11, 2015 @ 8:50 pm
posted by Dr Ginther

Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD).  This is good?  WRONG !!

High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen.  This means that glucose (sugar) molecules are incorporated into the collagen protein chains.  This distorts and stiffens the Bone Matrix.

Normally, stiffer is better,  Calcium stiffens the bone matrix, which strengthens the bone.  But too much of a good thing is bad.  Too stiff becomes brittle.  Brittle bones break more easily than “stiff enough” bones.

Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics.  Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.

We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves.  Now we know that high blood sugars in diabetics are bad for bones too.

Take Control of Your Future.  If you have diabetes, work with your primary doc to get your blood sugars under control.

Jay Ginther, MD