Calcium dosage

[Elizabeth M Blair]

In addition to being recently diagnosed with Celiac (July) I had a bone density scan and have been diagnosed with osteoporosis in both knees.  I have been taking 600 units of Calcium per day and my doctor and my GI nutritionist both told me to up that to 1200 a day.  But my sister, who has had a long career working with patients who need rehabilitation, and also shepherded our mother safely through her 20 some years of Celiac disease,  told me that I should take that 1200 in two different doses of 600 each.  Which should I purchase - the 600 or the 1200 unit tablets?  Does it matter?

[knitty kitty]

Take smaller doses of calcium throughout the day with meals.  

Also supplement with magnesium.  Low magnesium allows calcium to leach out.  Take twice as much calcium as magnesium.

Vitamin D and Vitamin K are important for bone health.  Trace minerals like boron, zinc, iron, copper, manganese and selenium are important, too.

The Impact of Trace Minerals on Bone Metabolism

https://pubmed.ncbi.nlm.nih.gov/30467628/

An update on magnesium and bone health

https://pubmed.ncbi.nlm.nih.gov/33959846/

[Elizabeth M Blair]

Thank you Kitty Kitty.  I did not realize calcium should be taken with meals.  I just checked my multi-vitamin bottle to see if it includes magnesium. It does and also Vit K and the B vitamins.  I will look online for more information about when best to take Calcium.  Thank you!

[newtonfree]

Knitty kitty is right on the money. Calcium and magnesium are a balancing act and most people get too little of both. Magnesium bisglycinate, sometimes just labeled "glycinate" (same molecule) is much more easily absorbed than the inorganic forms like magnesium oxide and I recommend bisglycinate to nearly everyone, celiac or not.

As KK already said, vitamins D and K (specifically K2) are also essential for proper metabolism of calcium. What we saw when we started giving everyone high doses of calcium without vitamins D and K2 was that they deposited that calcium everywhere but their bones - heart valves, blood vessels, tendons and other soft tissues.

K2 in particular is a relatively recent discovery, and seems to be vital in "directing" calcium away from soft tissues and into bones. When I studied Family Medicine, they didn't even have any recommendations surrounding it. They still barely touch on it in guidelines - Japan and Scandinavia are leading the way and North America is far behind. I'm considered a cutting-edge outlier just for having it on my radar and telling people to make sure they get enough.

Very few people get adequate K2 without supplements because it's often found either in foods uncommon in the western diet (like the incredibly pungent Japanese dish called nattō, or the Eastern european drinkable yogurt called kefir), or in foods that doctors have traditionally told people to eat less of for other health reasons (gouda, blue cheese, chicken liver, egg yolks). Chicken breast is one of the few foods that is 1) common in a Western diet, 2) a source of vitamin K2, and 3) something that isn't out of favour with nutritionists for other reasons!

KK is also correct that taking smaller doses of calcium more frequently (and always with food) is better for absorption. Our bodies are used to digesting snacks and meals, not compacted pellets of minerals. Our gut - especially a celiac one - struggles with the "huge dose of nutrients all at once" approach, which is one of the many reasons you always hear that it's better to get nutrition from food than from pills. But as celiacs especially, pills have their place - but smaller doses taken more frequently and with food is still the ticket.

Also, if you're on prescription medication, speak to your pharmacist before planning your calcium supplementation routine because some pills have to be spaced far apart from any doses of calcium to avoid interactions that could severely impact how much of your medication you absorb.

[Elizabeth M Blair]

Thank you, Newton Free.  This was very helpful. I do eat the foods you mention that have Vit K.  Egg yokes, blue cheese, gouda.  I purchased Calcium tablets with Magnesium and zinc yesterday (333 mg) in order to take it at smaller doses, after KK's post.  I do have one more question.  Most of the foods I eat now have iron in them and on the Mayo Clinic site, which I read yesterday, it said do not take calcium with foods that have iron in them.  So what kind of snacks would be good between meals when I take the calcium?  Cheese? which I eat a lot of because I have lost a lot of weight and would like to get most of it back.

 

[Elizabeth M Blair]

On 10/16/2023 at 6:59 AM, Elizabeth M Blair said:

Thank you, Newton Free.  This was very helpful. I do eat the foods you mention that have Vit K.  Egg yokes, blue cheese, gouda.  I purchased Calcium tablets with Magnesium and zinc yesterday (333 mg) in order to take it at smaller doses, after KK's post.  I do have one more question.  Most of the foods I eat now have iron in them and on the Mayo Clinic site, which I read yesterday, it said do not take calcium with foods that have iron in them.  So what kind of snacks would be good between meals when I take the calcium?  Cheese? which I eat a lot of because I have lost a lot of weight and would like to get most of it back. I did not find an answer to this about not eating foods with iron when taking one of the three calcium tablets per day.   Does anyone suggestions. My other usual snack is almonds and they contain iron.

 

[newtonfree]

On 10/16/2023 at 7:59 AM, Elizabeth M Blair said:

Thank you, Newton Free.  This was very helpful. I do eat the foods you mention that have Vit K.  Egg yokes, blue cheese, gouda.  I purchased Calcium tablets with Magnesium and zinc yesterday (333 mg) in order to take it at smaller doses, after KK's post.  I do have one more question.  Most of the foods I eat now have iron in them and on the Mayo Clinic site, which I read yesterday, it said do not take calcium with foods that have iron in them.  So what kind of snacks would be good between meals when I take the calcium?  Cheese? which I eat a lot of because I have lost a lot of weight and would like to get most of it back.

 

Happy to help.

The reason they say not to take calcium together with iron is that calcium inhibits iron absorption. So it's not specifically dangerous to take the calcium with food containing iron, as long as you understand that the iron in that food will not be properly absorbed. So, if you were relying on that food to meet your daily iron requirement, you'd now be falling short of it.

If you consider the food you took with the calcium to be iron-free in terms of meeting your daily requirement, it doesn't matter that it contains iron. But it is true that it is a "waste" of an iron-containing food, since so many people struggle to meet their iron requirements.

Personally, I take ferrous bisglycinate (often sold as "mild" or "gentle" iron since it doesn't cause the same nausea or constipation as most other pill forms of iron) and just space it apart from any big doses of calcium. But I'm also very early on into my celiac journey, just a few months in to my GFD, and am more heavily reliant on supplements because of what bad shape my gut is in. If your diet is rich in iron and your levels are good on bloodwork, just try to space the calcium a couple of hours apart from the most iron-rich foods you eat in order to preserve their nutritional value.

It's all a balancing act.