Thalassemia Patients and Friends
Discussion Forums => Thalassemia-related Issues => Topic started by: maha on June 20, 2009, 04:19:57 AM
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Hassan`s calcium tests have come out a slight higher than the normal range. His serum calcium result is 2.46mmol/L and the normal range is between 2.17 - 2.44. For the last 6 months he has been taking 5ml osteocare daily ( half the dose for his age). Now what should I do? Temporarily discontinue or reduce or continue the same dosage.
His pre tx hb was good at 10, all other reports normal. Its 8 months since he has been on Asunra, and there has been a slow drop in his ferritin since the last four months. His SF last month was 1751. I haven`t recieved his ferritin report this month as yet.
maha
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Maha,
i think you're talking about calcium in blood stream, it will not help him until it get absopted by bones and for that he may need Vit-D , Vit-d wil help his body to absorb the calcium that is present in his blood but unfortunately isn't absorped in his bones, bones cant absorb calcium on its own , bones alway need vit-D to absorb the calcium , soo plz check his Vit-D levels to get knowing if he is deficient in that , in my view vit-d deficiency is only reason of that free calcium in blood ...
What does the test result mean?
Calcium absorption, use, and excretion are regulated and stabilized by a feedback loop involving PTH and Vitamin D. Conditions and diseases that disrupt calcium regulation can cause inappropriate acute or chronic elevations or decreases in calcium and lead to symptoms of hypercalcemia or hypocalcemia.
In most cases, total calcium is measured because the test is more easily performed than the ionized calcium test and requires no special handling of the blood sample. Total calcium is usually a good reflection of free calcium since the free and bound forms are typically each about half of the total. However, because about half the calcium in blood is bound to protein, total calcium test results can be affected by high or low levels of protein. In such cases, it is more useful to measure free calcium directly using an ionized calcium test.
Normal calcium
A normal total or ionized calcium result together with other normal lab results generally means that your calcium metabolism is normal and blood levels are being appropriately regulated.
High Total Calcium - Hypercalcemia
Two of the more common causes of hypercalcemia are:
Hyperparathyroidism, an increase in parathyroid gland function: This condition is usually caused by a benign tumor of the parathyroid gland. This form of hypercalcemia is usually mild and can be present for many years before being noticed.
Some other causes of hypercalcemia include:
Hyperthyroidism
Sarcoidosis
Tuberculosis
Prolonged immobilization
Excess Vitamin D intake
Kidney transplant
Low Total Calcium – Hypocalcemia
The most common cause of low total calcium is:
Low blood protein levels, especially a low level of albumin. In this condition, only the bound calcium is low. Ionized calcium remains normal and calcium metabolism is being regulated appropriately.
Some other causes of hypocalcemia include:
Underactive parathyroid gland (hypoparathyroidism)
Inherited resistance to the effects of parathyroid hormone
Extreme deficiency in dietary calcium
Decreased levels of vitamin D
Magnesium deficiency
Increased levels of phosphorus
Acute inflammation of the pancreas (pancreatitis)
Renal failure
Malnutrition
Alcoholism
NOTE: The result of your total calcium test is measured by your doctor against a reference range for the test to determine whether the result is “normal” (it is within the range of numbers), high (it is above the high end of the range), or low (it is below the low end of the range). Because there can be many variables that affect the determination of the reference range, the reference range for this test is specific to the lab where your test sample is analyzed. For this reason, the lab is required to report your results with an accompanying reference range. Typically, your doctor will have sufficient familiarity with the lab and your medical history to interpret the results appropriately.
While there is no such thing as a “standard” reference range for total calcium, most labs will report a similar, though maybe not exactly the same, set of numbers as that included in medical textbooks or found elsewhere online. For this reason, we recommend that you talk with your doctor about your lab results. For general guidance only, we are providing the reference range for this test from the classic medical text, Tietz Textbook of Clinical Chemistry and Molecular Diagnostics.
For more information on reference ranges, please read Reference Ranges and What They Mean.
i think you must read this complete article that is answering all about calcium and the test which are important to monitore calcium like :
A total calcium level is often measured as part of health screening. It is included in the Comprehensive Metabolic Panel (CMP) and the Basic Metabolic Panel (BMP) –
for complete article please visit : http://www.labtestsonline.org/understanding/analytes/calcium/test.html
Edited :
Note: Sis, i dont want to make you worried soo i cutted one reason out of this quotation that is a sumthing to worry abt but that is very RARE reason so i cutted that out , if youu want to read more abt Hypercalciumia, then let me know i will send post more links that i found during research , dont worry sis and check the article i posted above ,,. Hassan's Calcium Level isn't too high to worry about , but you have to keep a good eye on that and keep monitoring his calcium levels , and add to ask docotr for keep monitoring and taking steps if he feel's that is necessory in his case ... only thing at the moment you have to do is to keep an eye on calium as well as your keepin on other things :) .. Best Of LUCK Sis, and lots of Regards for Hassan :)
Best Regard for Hasan :
Take Care
Umair
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Maha,
Some sources list the high normal level at 2.6 but the level at which concern is raised is around 3.25, so Hassan isn't really out of range at all. Like many tests there is some degree of error also, and when there is concern, an inonized calcium test will be run to confirm the findings. I do want to stress that even though Hassan's calcium is in the upper range of normal, it is not high, and not high enough to suggest that the ionized calcium test be run (of course, this would be at the discretion of his doctor).
Calcium levels are affected by vitamin D and most importantly, the parathyroid. Oakland recommends that both vitamin D levels and parathyroid hormone be regularly monitored. Monitoring parathyroid hormone is very important because a poor functioning gland is usually a sign of iron overload on the gland in thals and this can have a great effect on bone strength. High calcium levels from calcium intake normally require large doses of calcium and vitamin D to be taken over an extended period, but if this is a cause of high calcium, it can normally be detected with the vitamin D test.
Unless Hassan is getting a large amount of vitamin D through supplements and the sun, he is probably not absorbing too much calcium. I would suggest having the other tests done annually and also watching his next calcium test to see what the level is. By any chance, do you have the results of a previous calcium test for Hassan?
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Hi Andy
Hassan gets 375 IU of vit D from supplements daily. We stay in the top floor of the building and we have the sun shining brightly only behind the windows, which is opened only during winters.
The only other time he was tested for calcium was 1 1/2 years back and at that time he was in the high normal range. I will repeat the calcium test next month and also check his vit D. Andy, the doc doesn`t know he is taking osteocare. Can I continue to give osteo care?
Hassan is just 3 years old and has had 23 transfusions to date and had also started chelation early, so can there still be chances of iron overload in the gland.
His doc has already seen the report and probably didn`t think it of any concern, so he did not give us a visit during his afternoon rounds, but he doesn`t know Hassan is taking a calcium supplement :dunno
Please let me know if I can continue osteocare as he takes only 2 glasses of milk a day. His third glass has been substituted with orange juice since the last 8 months.
thankyou
maha
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Hi Maha,
At this time there is no reason to change anything. The high end of normal is still normal and the level necessary to assume a problem is actually much higher. In addition, thals with iron damage to the organs tend to have hypoparathyroid, which results in calcium deficiency. The parathyroid hormone level is checked for this very reason. It should be tested (probably annually), as it is an indicator of other problems in thals.
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Success!!! Success!!! Success.
I just couldn't resist showing how much I am joyful about what happened recently, and it has a lot to do with calcium, hence my reply here.
About two years ago I diagnosed myself that I have vitamin D deficiency. Unfortunetely due to inefficient health services, I was not being diagnosed properly from that moment on, and also the prescribed treatment was good for nothing (only 500 IUs of vitamin D daily to take, when my vitamin D blood level was below detection).
So I had to supplement vitamin D on my own, which was not easy, because strange things happened with my calcium level and I could't count on doctors' help as they were against large doses of vitamin D from the very beginning (this is the syndrom of a doctor scared of vitamin D overdosing, very common in my country).
My calcium was higher than normal from the very beginning of vitamin D supplementation (10-20% above normal range so it was not that high). There is something like secondary parathyroidism after long period of vitamin D deficiency, but in my case parathyroid hormone was in normal range.
I didn't know what was going on. I had to supplement vitamin D anyway, because I felt better and better every day. But the calcium was still high.
After 2 months of feeling better because of now increased vitamin D level, I suddenly felt much much worse, and I started itching. This itching lasted until about two months ago when I came across this information:
Magnesium may be in some cases calcium antagonist (kind of difficult to explain it now, I am still doing research) and magnesium deficiency may be the cause of itching.
Without any further ado, I started taking magnesium in daily doses three times higher than RDA.
After a couple of days something happened, something that seemed a miraculous recovery - I stopped itching and I felt much much better, less tired, almost new-born man.
The funny thing is that around the time the itching began I had my magnesium level checked and it was on the low side of normal range, but still within normal range, not flagged.
So now I'm thinking that magnesium blood level is not very reliable information. It has to be a huge deficiency before magnesium blood level starts to drop. Maybe erythrocyte magnesium level is more informative, does somebody know?
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One (but not only as I read) of the ways in which higner magnesium level can lower calcium level is the fact that higher magnesium supresses parathyroid (so not only calcium supresses parathyroid) thus lowering calcium absorbtion.
http://www.mgwater.com/hypomagnesemia.shtml
Magnesium homeostasis, parathyroid glands, and blood calcium
Hypermagnesemia suppresses the activity of the parathyroid glands [Buckle et al. 1968, Massry et al. 1970a].
Also, see:
http://cat.inist.fr/?aModele=afficheN&cpsidt=13755981
So if you have problems with high calcium level you should probably start taking magnesium, even if parathyroid hormone is within normal range (as it was in my case). This may simply mean that you are magnesium deficient and no other test will show it (as it was in my case).
I did not have my calcium level checked yet, but lack of itching is pretty convincing that it was magnesium deficiency.
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Magnesium deficiency can be very devastating especially for thals - it reduces levels of antioxidants in erythrocytes, and it seems that this reduction is quite significant. And reduction of levels of antioxidants means shorter erythrocyte life span.
http://www.springerlink.com/content/h705m74501n60305/
The influence of hypomagnesemia on erythrocyte antioxidant enzyme defence system in mice
These findings support previous reports on the hypomagnesemia – induced alteration in endogenous enzyme antioxidant defences and glutathione redox cycle of mice.
Also, see:
http://www.jci.org/articles/view/32559/version/1
Sorry for being overenthusiastic, but that is what happens when you get the diagnosis after endless unsuccessful attempts to diagnose what is going on and it seems that this is the last of your health problems.
Surely you should consider for yourself all of the advantages and problems of taking magnesium, I am only pointing where to look for a possible cause of hypercalcemia, and possibly other problems.
So, if somebody has some more information about magnesium, please let me know.
B.
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The magnesium connection with calcium has been well studied in terms of heart function, so I am not surprised to see a connection elsewhere in the body. Doctors tell people to take calcium but don't tell them that without vitamin D, it won't be absorbed and also that the heart needs both calcium and magnesium to regulate the heart beat, and taking calcium alone, can lead to irregular heart beats. The parathyroid not only affects calcium levels, but is affected by calcium levels, so it is a very tricky subject. Many thals mistakenly think that they are getting too much calcium if their blood calcium level is high but it is not so simple. Vitamin D levels should also be tested. And from what you are saying here, magnesium levels should also be checked if a parathyroid problem is suspected.
I don't know if you saw my recent post, but even after taking 2000 IU vitamin D daily since October, my level was only 19! (Normal range is 30-60 and I expect the low end is wrong). My doctor told me to raise it to 3000 IU daily and get tested again in six months. The itching interests me too, as it is a problem I also experience and not only in cold, dry weather. Maybe I should try magnesium supplements too.
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the person who made the connection with magnesium is right!
Dore
I am using my iPhone and cannot see the name of the person.
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Thanks Bigg for this informative post and congratulatons for finally resolving the problem.
But if serum magnisum in blood is not a reliable measure for magnisium what other tests should we do???????????
Andy
From the time i started using magnisium for my son the doctor always comments that his heart beats are very stable( thanks God)
manal
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That is very interesting. Does this mean that the typically recommended 2:1 ratio Calcium: magnesium isn't correct?
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That is very interesting. Does this mean that the typically recommended 2:1 ratio Calcium: magnesium isn't correct?
It's interesting, but it gets even better. Look what I found out:
http://cat.inist.fr/?aModele=afficheN&cpsidt=2767209
http://clinicaltrials.gov/ct2/show/NCT00809042
http://www.ncbi.nlm.nih.gov/pubmed/6930882
http://www.ncbi.nlm.nih.gov/pubmed/1665466
and previously given link:
http://www.springerlink.com/content/h705m74501n60305/
and especially this one (page 53):
http://books.google.pl/books?id=NuEZZhoW4mcC&pg=PA54&dq=Beta+thalassemia+magnesium&ei=k8dEStrsNoSszgTM1Jhk
These all pages say:
- Magnesium deficiency reduces antioxidant content in erythrocytes, what is not good for thals. If magnesium deficiency is really causing such a reduction as described in one of the above articles (superoxide dismutase lower by 32%), it would seem that it's better to supplement magnesium than take L-carnitine for example, as superoxide dismutase is most potent antioxidant there is and additionally you use your own body mechanisms which again is better, as there are no side effects, etc.
- Magnesium deficiency causes dehydration of erythroctyes.
- There is research going on concerning supplementation of magnesium in thalassemia and it confirms that magnesium deficiency is harmful.
Conclusion:
We have a possible new "miraculous cure", after wheatgrass, vitamin D, and so on...
I'm joking here a little, but it was "miraculous cure" for me and I think supplementation can really make a big difference.
But if serum magnisum in blood is not a reliable measure for magnisium what other tests should we do?Huh?Huh?Huh??
Well, that is exactly the problem.
I read somewhere that only a little part of body's magnesium is in blood, and to make things even worse kidneys try to keep this level at constant. So the level in other parts of body may be lower than in blood.
This is described here (however this page seems not to present scientific approach to the case, well, I don't know)
http://www.mgwater.com/laboratory_test.shtml
Good test for thals would be test of magnesium level in erythrocytes, but this is not widely available - I can't find any lab doing this test, but in these research papers this method is used.
Looks like the only method to deal with magnesium deficiency is supplementation on trial and error basis.
Beside being unable to test the deficiency there is still incomplete research pertaining to absorbability of different magnesium supplements - so even if you take magnesium carbonate or oxide (low absorbability) in recommended or even higher doses (recommended based on the content of magnesium in these supplements without taking into consideration absorbability), you will not replenish magnesium anyway. This was my case - I used to supplement magnesium, but to no effect.
Some guidelines in this matter:
http://answers.google.com/answers/threadview?id=416926
and this book again (page 30):
http://books.google.pl/books?id=NuEZZhoW4mcC&pg=PA54&dq=Beta+thalassemia+magnesium&ei=k8dEStrsNoSszgTM1Jhk
There are also magnesium sulfate shots - completely absorbable, but on prescription only, so you have to have low blood magnesium level, which may be a problem to "obtain", even if there is deficiency.
I don't know if you saw my recent post, but even after taking 2000 IU vitamin D daily since October, my level was only 19! (Normal range is 30-60 and I expect the low end is wrong). My doctor told me to raise it to 3000 IU daily and get tested again in six months. The itching interests me too, as it is a problem I also experience and not only in cold, dry weather. Maybe I should try magnesium supplements too.
If you are itching, magnesium supplementation is a good starting point. I would only recommend much higher doses at least at the beginning. I took three times the RDA, and it was magnesium citrate, so very well absorbable. As soon as I switched to cheaper brand (magnesium carbonate), the itching was starting to gain.
Magnesium soothens nerve cells, so that they do not overreact to normal incentives - this overreaction is felt as itching.
I used to take 10 000 IUs of vitamin D a day until I was quite sure that my level was OK. I calculated that in order to raise my blood level by 7, I have to take 100 000 IUs (you can calculate how much you have to take based on the data for the period since October).
So the calculation was simple - I had to raise my blood level by 35, so I had to take overall 500 000 IUs. In order not to do this for a 1000 days with the dose of 500 IUs a day (ridiculous!), I decided to take 10 000 a day, and in 50 days my treatment was over.
I hope I explained this well.
Anyway, if it is possible to suppres parathyroid by taking magnesium (in order to avoid hypercalcemia), taking high doses of vitamin D seems more feasible now than ever.
Waiting on your comments.
B.
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Hi Maha,
Little Miss A's serum calcium came high as well (I don't know the number). We were giving her 400IU of vitamin D as supplement, one or two cup of milk and one caltrate plus tablet (contains 400IU of vitamin D and 600 mg of calcium and traces of essential minerals including magnesium etc). We were advised by Dr. Sochett to stop giving her the Vitamin D supplement and just continue with caltrate and milk.
You are giving Hassan osteaocare and Vit D supplement together and I beleive Osteocare contains vitamin D, plus milk has some vitamin D as well. Its not strange that Hassan's serum calcium came high.
Only looking at Hassan, it is a same calcium plan Little Miss A was taking and I suggest to stop the vit D supplement. Repeat the tests in two to three months.
There are so many other diets that also contains calcium and Little Miss A was referred to the Dietician which actually told us the actual amount of calcium she was taking at the time.
Please consult a Dietician to calculate the calcium intake by Hassan.
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CF,
Has your daughter's vitamin D level been tested?
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Sharmin,
Your question about the ratio is one that has interested me for years. When I first researched this topic, over and over I saw the recommended ratio of 2:1. However, I did also find sites that made the assertion that since magnesium is not as readily absorbed as calcium, that the correct ratio would be 1:1. Also, as Bigg is pointing out, without adequate vitamin D, these minerals will not be adequately absorbed.
After my own experience, I would be very hesitant to cut vitamin D intake without a test to show that the level is in range.
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Hi Canadian family
Hassan gets less than 400IU of vit D and 150mg of calcium from supplements, which I feel is less than the daily requirement. I will check his vit D next month and only then adjust his supplements.
maha
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.. I saw the recommended ratio of 2:1. However, I did also find sites that made the assertion that since magnesium is not as readily absorbed as calcium, that the correct ratio would be 1:1. Also, as Bigg is pointing out, without adequate vitamin D, these minerals will not be adequately absorbed.
I don't think it's good when different sites give this kind of ratio, without any explanation, why there is this ratio and not the other, and also without any explanation how to adjust it. It is not good to use this ratio without any adjustment - for example thals need more calcium and more magnesium than ordinary people, but how does this change the ratio? How much more of any particular microelement?
Calcium, magnesium and potassium are for sure very difficult to balance (I mean really balance, not just make blood results look good) - just to mention a few things that have influence:
- calcium: PTH, calcitonin, vitamin D, sodium intake (when you eat a lot of sodium - ordinary salt - it has direct on calcium level, this method is used in fighting hypercalcemia, they give salt solution), balance with phosphorus ....
- magnesium: misleading blood test results (with calcium it is different - there is the method to measure bone density), absorbability issues...
- sodium ...
- potassium ...
For now it is impossible to take into account all the factora and the ratio is kind of useless.
Maybe if somebody knew how to take all of this into account, we would know how to treat some cases of resistant ostheoporosis, instead of poisoning people with not very nice drugs or even strontium.
Unfortunetely I myself do not know.
After my own experience, I would be very hesitant to cut vitamin D intake without a test to show that the level is in range.
Oh, no I was tested in the meantime - my vitamin D level was 36 - so it is in normal range anyway. But since then I was not tested, because this last test confirmed entirely the number of vitamin D IUs I have to take to raise blood level to a particular level. Such calculations (as decribed in previous post) may be helpful in assessing when you have to do the next blood test and if the dose you get is sufficient. One more thing to know about vitamin D is that 400 IUs are used up daily. So these 400 IUs have to be
subtracted from the dose. I did not want to make the things more complicated in the last example, but when I got 500 IUs a day, this really meant 500 - 400 = 100 IUs a day, so supplementation would have to last for 5 000 days = 14 years. This explains, why small doses are completely uneffective. Of course daily usage may be only 300 IUs, but you get the idea.
I am a little afraid about getting too high vitamin D level due to my hypercalcemia and problems that are described as a consequences of high vitamin D - mainly calcification of arteries and other things. How can this be counteracted?
B.
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One more link about magnesium deficiency and thalassemia:
http://bloodjournal.hematologylibrary.org/cgi/reprint/90/3/1283
And one more thought crossed my mind, why the body tries to keep blood magnesium at constant level within normal range - because it tries to protect erythrocytes. So the serum blood magnesium can be at normal level but other tissues may be deficient. But the serum magnesium will be on the low end of normal range for example, and this already may make a big difference in somebody with thalassemia.
I don't know if what I'm saying has any sense, but it's just a thought.
B.
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Hi Andy,
The vitamin D was tested. The doctors showed particular worry over the high vitamin D levels. At the appointment we were only concerned about the osteoporosis and didn't bother to the calcium and Viit D figures. However, we will be repeating the Vit D test in two months time and at that time decision will be made to start the supplement again. Thanks for reminding us.
Maha,
Hi Andy
Hassan gets 375 IU of vit D from supplements daily. We stay in the top floor of the building and we have the sun shining brightly only behind the windows, which is opened only during winters.
I thought (quote above) that Hassan was atleast getting 375IU of vit D and Osteocare which includes vit D as well. Anyways, good thing is that you are aware of the situation and handling it.
Regards
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Hi canadian family
I added the vit D he was getting from osteocare and multivitamins, hence the 375 IU. 75IU from osteocare and 300IU from multivitamins.
maha
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Hi
Hassan`s calcium has always been on the higher normal range or slightly above. This past two months I had discontinued osteocare. Probably because I had started him on IP-6 and it has calcium and magnesium added. This time his calcium levels were normal , in the middle of the range. His doc and hema always refuses to check vit D, both have the same answer `trust my eyes`. I did ask his doc if we could give him osteocare, he said Hassan didn`t require it as his calcium is normal. Should I begin to give him osteocare again?
maha
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Hi Maha,
If I were you I will not stop giving him Osteocare. The Calcium and Magnesium in IP6 is added to replace these minerals as IP6 does chelates some calcium and magnesium from the body (IP6 is a chelating agent). The body needs constant supply of calcium for healthy bones. I did asked some experts and it is best to cover the calcium requirement through natural food (milk, cheese, chick peas, broccoli etc). However, it is necessary sometimes to take extra supplement for cases like thalassemia.
The calcium usually found in the form of tablets is calcium carbonate (the molecule is bigger and harder to absorb in the body). The absorption rate of calcium carbonate is approx 50% in the body. What it means that if you are taking 900mg everyday, only approx 450mg is absorbed by the body. Yes, it is true that osteocare contains extra minerals to increase the absorption rate but it is nowhere near the absorption of calcium from natural food (80%-90% absorption rate for natural food calcium).
Osteocare at this time is the best calcium supplement I have seen. I found another supplement in liquid form (calcium ion formula) where you put drops on tip of your tongue and leave it there for a minute or so (it is claimed that the absorption rate is 60% to 70%).
Also, vitamin D is equally important for calcium absorption and it is important to check vitamin D levels on a regular basis. ``Trust your eyes`` formula is not good enough as the vitamin D level in his blood. I would stress with doctors to check vitamin D levels at least if not three than every six months.
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Hi CF
I know IP-6 chelates other minerals also. But as per one of your previous posts ( dunno which one but it was surely you) each molecule of calcium chelated by IP-6 is replaced with 3 molecules of calcium. The doctor never refuses us any test other than the vit D and the occasional glare he gives us each time we request the calcium test. I hope he agrees this time to check Hassan`s vit D. I will also continue with the osteocare.
Is the vit D test kind of expensive or does it require more blood sample than the rest because I cannot think of any other reason for the docs refusal.
thankyou
maha
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Hi Maha,
You are absolutely right about calcium is replaced by 3 molecule comapred to one molecule of IP6. However, a lot depends on which brand you are using and how much calcium and magnesium in the IP6 capsule. In any case, the replacement of calcium is not enough, in my opinion, to warrant the stop of calcium supplement. The thal body needs atleast 500mg of calcium regularly to keep the bones healthy. Do you think the IP6 is providing that much calcium after deduction in one capsule, I think it hardly gives any percentage of the required calcium.
I don't think vitamin D test is expensive at all. It can be done as part of the regular check up.
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With transfusing thals, parathyroid function is often the cause of high or low calcium levels in the body and is unrelated to calcium intake. The parathyroid is very sensitive to iron load, so this too, needs to be considered.
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Good Catch Andy.
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Hi CF
I use IP6 by Jarrow Formulas. It has 85mg calcium and 30mg of magnesium. It definitely does not provide the daily calcium requirement but will surely replace the Ca and Mg chelated by it . It is specifically mentioned that it chelates reactive iron.
maha
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In this discussion of vitamin D and calcuim no one appears to have mentioned skin color.
Main source of D is sunlight, light skin colour less amount of sunlight required to obtain amount required from sunlight.
I live a Australia and we have had very effective programs to get people to put on hats, sunscreen and sunglasses as we have the highest skin cancer rates in the world.
Tasmania the most southern state of Australia had a policy that primary school children should wear hats all round. They had to rethink the policy due to vitamin d problems resulting for migrant children (children of Africian background).
http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Vitamin_D/$File/Vitamin_D.pdf
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Hi Andy,
am taking osteocare tablet daily as it has vit D3.does it fulfill vit d requirement or need to take separately??please give information about tests which r necessary.
komal