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Vitamin and Mineral Supplementation in Thalassemia

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kammelya:
Hi Andy,
    I used seabuckthorn oil softgels, and i feel more energetic. Contains a lot of vitamins, and it's good for the liver. It's  the only thing that worked for me so far. What is your opinion on this?
    And about folic acid... i feel really dizzy and my vision blurs after i take it, so i do not take them anymore. It could be side effects or just coincidence?
   Thank you for being here for us!

Andy Battaglia:
Sea buckthorn is an excellent antioxidant and good source of many nutrients. For folic acid, try it in the form of L-Methylfolate. Many people find it more tolerable and it works much better.

kumarritesh04:
Hi Andy,
I am a thal major 27 years old, transfusing 2 packed red cell every 15 days. I was taking 500mg of calcium daily from almost 10 years. 2 Years before I came to know from Dexa-Scan that osteopenia has been developed in my bones. So my Dr. Advice me to take 1000 mg of calcium with vit.D calcirol scehets.
Now, my Dexa is some what stable but slightly down even after increseing calcium.
Now, I came to know with some interesting facts about calcium suplements that max calcium suplements we use contains calcium carbonate salt. Prolong consumption of which can leads to stone formation in kidneys.
I have read that when someone has to take calcium suplement for long times he should use suplements with calcium citrate which is more soluble in water than calcium carbonate.
Also taking calcium citrate with mellate i.e. Calcium citrate mellete increase the absorption of calcium by 25% more that calcium carbonate.
Now the resoan for using calcium carbonate in supplements is its low cost as calcium carbonate tab is available @ Rs 3-4 pr tab of 500mg in India and of calcium carbonate mellate is about Rs.10-11/tab of 500mg.
After reading all this I afraid of stone as I was taking it from almost 10 years and it was of calcium carbonate salt.
I also go though internet regarding this and got the same thing.
Now the question is that whether we have to take calcium suplemets that contains calcium citrate mellate or reduce the intake of calcium.
Secondly, is there any affects of different salts of calcium suplements in thals.
Andy, if you have any idea about this please share with us.

Regards
Ritesh

kumarritesh04:
Hi All
Please do reply if any one has some.idea about that.

Regards
Ritesh

Andy Battaglia:
Yes, the most easily absorbed type of calcium is calcium citrate.
http://healthletter.mayoclinic.com/editorial/editorial.cfm/i/356/t/Building%20blocks%20of%20bone/

--- Quote ---Calcium citrate

This type of calcium supplement is the most easily absorbed, is less likely to cause abdominal discomfort and doesn't have to be taken with meals.
--- End quote ---

There was an interesting study of nurses and kidney stones that showed a decrease in stones among women who had a high calcium intake from diet, while those who took supplements were 20% more likely to develop stones. It was theorized that the timing of when women took the stones contributed to the likelihood of getting a stone. They recommend that calcium supplements only be taken with meals and preferably with meals containing oxalates, as calcium binds with oxalates and then cannot be absorbed and won't pass through the urine. This seems contrary to what we may believe, but the mechanics of it does make sense.
http://www.medicinenet.com/script/main/art.asp?articlekey=1887&page=2

--- Quote ---The relationship between dietary calcium and kidney stones is complex. It is known-and this study confirms--that increasing amounts of dietary calcium are associated with fewer kidney stones. It is believed that this occurs because the increased amounts of calcium from food binds to oxalate from food in the intestine, and the complex of calcium and oxalate cannot be absorbed into the body. This reduces the amount of calcium and oxalate that needs to be eliminated from the body in the urine and prevents the formation of calcium/oxalate stones in the kidneys. In fact, calcium supplements have been used successfully to decrease the elimination of oxalate in the urine.

Why then, were calcium supplements associated with more kidney stones in the nurses? The study's investigators hypothesize that the reason is the time at which the nurses took the calcium supplements. The calcium and oxalate in food can bind to each other only if they are present at the same time in the intestine. If calcium supplements are taken with meals containing the most oxalate, everything is fine, and the calcium and oxalate bind. If calcium supplements are taken with meals that contain little or no oxalate, the oxalate doesn't bind to calcium, and the oxalate is absorbed from the intestine and then eliminated in the urine. Furthermore, if calcium supplements are not taken with food, more calcium is absorbed and eliminated in urine. (This would increase the risk for developing stones.) It turns out that 57% of the nurses in the study taking supplements were not taking them with meals, and 24% were taking the supplements only with breakfast, the meal least likely to contain oxalate. Thus, more than three-quarters of the nurses taking calcium supplements may have been absorbing and eliminating more calcium in their urine or were not gaining the benefit of the binding of calcium and oxalate in the intestine.

The study's investigators conclude that a high intake of dietary calcium reduces the risk of kidney stones but supplemental calcium increases the risk. They suggest that the risk of kidney stones among women taking supplemental calcium might be reduced by consuming the supplements with meals, particularly meals which contain the most oxalate-lunch and dinner.
--- End quote ---

So, to decrease the chances of getting stones, take calcium with meals containing oxalates, and work on getting more dietary calcium and less supplemental calcium.

But beyond calcium, which is not the most important part of the equation, what is your vitamin D level? Is the calcitriol doing the job? This has far more to do with bone strength than calcium. Are you also taking daily zinc, which is proven to strengthen the bones of thals? And are you getting adequate weight bearing exercise to strengthen your bones? And, you should also understand that calcium should not be taken alone. Not only should it be taken with vitamin D, but it should be taken in a bout a 2:1 ratio with magnesium, so if you take 1000 mg calcium, take about 500 mg magnesium. The two minerals work together to control the heartbeat and an imbalance created by taking calcium alone can cause heart palpitations. Magnesium also has great value to thals.

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