Calcium level in your labs

Today's PSA...

We all know we need to calcium, right?  And when we get labs done, one of the things they check is the calcium level in our blood.  What we need to understand, though, is that the calcium level in our blood really tells us very little about our calcium intake/absorption.

See, if the calcium level in our blood drops too low, our muscles cannot contract.  The heart is a muscle and if it cannot contract, as in beat, we drop dead.  So if we don't take in enough calcium or don't absorb the calcium we take in for some reason (like if our vitamin D level is too low), our bodies produce extra parathyroid hormone, which sucks calcium out of our bones to keep that level in our blood good.  As long as you have bones and teeth to suck calcium out of, that calcium level in your blood will likely be OK. 

If it drops low, it may mean you have problems with your endocrine system or other potentially serious health problems, but it doesn't mean you aren't getting enough calcium.

For lab results that tell you about calcium, what you want to know is your D level and PTH.  If the D is below 80, that means you won't absorb calcium well, no matter how much you take. Doesn't mean you won't absorb any, you will.  But maybe not enough and you will be at increased risk for osteoporosis as well as other unpleasant things.

If the PTH is on the high side (even in the normal range, just on the high side), it suggests you are indeed leaching calcium out of your bones.

Some surgeons do not routinely order a PTH when they order labs.  If yours doesn't, ask for it.

At one year out, you should get a bone density scan to see the true state of your bones.  However, you don’t want to wait ‘til then to at least try to get enough calcium and keep your vitamin D level above 80.  If you get a bone density scan and find out you’ve suffered bone loss, you’re already in trouble.

Great info., thanks.  I always look forward to your posts.

Definitely great info. The first lab test I've had done is my vitamin d level. Ridiculously low! I have to take the precription vitamin d until gone and then 5,000mg of vit d from then on. It's extremely important.  Bone density scans are also important. I urge everyone to have one every two to four yrs. Granted, I'm speaking as a 33 yr old with osteopenia. That's one of the reasons that they are making sure my vit d levels are good so I can absorb the calcium needed.

I truly love this forum and all of the people that have such vast knowledge. It's truly remarkable how I can learn more from the people than my doctors.

You should know that the prescription is D2, which is not absorbed well.  D3 is much, much better but you have to buy it over the counter.

Kelly

I asked about that, but the doctor told me that it should be okay. The prescription is for 50,000mg three times a week. I figure that he knows what he's talking about and, even if it's not absorbed well, with that many mg, I think/hope that it's gonna raise it to a normal level.

Thank you. If this doesn't work, I will definitely get the D3!

Please don't take what I say as medical advice.

But just consider.

There are two types of vitamin D, D2 and D3. It’s important that we know this because one type, D3, is absorbed well and the other type, D2, is not. Unfortunately, many doctors do not know the difference. They may not even realize there are two types of vitamin D, and if they do know there are two types, they may think they are both equally well absorbed or may have no idea what the difference is. I know it seems like a doctor should know these things, but the reality is, many do not.

D2 must be converted to D3 in the body in order for the body to use it. It takes a fair amount of D2 to make a little bit of D3. I’ve seen anywhere from three units of D2 to make one unit of D3 to ten units of D2 to make one unit of D3.

When your vitamin D level is low, doctors often want to give you a prescription for vitamin D. What they prescribe is called Drisdol, and it’s D2. They prescribe it in 50,000 IU soft gels, those little things that look like footballs and have oil inside. The reason they put it in oil is because vitamin D is an fat soluble vitamin. Being in oil is supposed to make it absorb better. That’s true for non-RNY folks, but is not true for RNY-folks because we malabsorb fat. We need dry D3. But some docs don’t know that, either.

OK. So your D is low and they give you 50,000 IU D2 and usually tell you to take it once a week. That’s not enough if your level is really low – and if your doc is prescribing vitamin D, it’s usually because it’s very, very low. But that’s another topic for later discussion.

If it takes three units of D2 to make one unit of D3 in your body and you take 50,000 IU of D2, you’re really only getting about 16,666 IU of vitamin D. If it takes ten units of D2 to make one unit of D3, you’re really only getting about 5000 IU of vitamin D.

Now, keep in mind that recent research suggests that folks that have not had WLS and that have normal levels of vitamin D need 1000 – 2000 IU per day just to maintain their levels. If you needed 7000 – 14,000 IU per week just to maintain your level, do you think 5000 – 16,666 IU once a week is going to bring your level up? Not likely.

And if had RNY, that prescription D2 in oil will help you even less because you won’t absorb much of it at all because you malabsorb fats. But even if you are pre-op, or had lap band or VSG, the D2 is not going to be sufficient for you.

You cannot get D3 by prescription. It is only available over the counter. Even if your doc knows the difference between D2 and D3 and writes a prescription for D3, the pharmacist will give you D2. That’s because there is no D3 available by prescription and legally pharmacists are allowed to make certain substitutions. You have to get your D3 over the counter and if you had RNY, you need to make sure it is dry D3, not in oil.

Keep in mind that we want our D levels about 80-100.  Lower than that, we are at increased risk for things like osteoporosis, heart disease and some cancers.

I just looked at my bottle. It's 50,000IU Vitamin D. I have to take it 3 times a week for 3 months. My levels of Vitamin D were pretty much non-existent. I'm just hoping that it gets it to a relatively normal level. I have noticed that I feel a whole lot better and my skin is 100 times better (it was sloughing off and leaving raw spots), but like I said, if it doesn't work, I'm heading straight out and getting Vitamin D3. My family doctor (the one who prescribed it) is very familiar with the gastric bypass and it's mal-absorbtion, so I definitely trust him. He's always gotten my mom's labs back on track when they were low (she's 28 yrs post op).

Thanks again for being so informative. I really do learn a lot here! I've even had my mom read some of the topics. She's even learned a lot!

Doubt you'll see much of a result with the prescription D2.  Even "normal" people don't do well with the prescription D2 because the body has to convert it to D3 in order to use it.  Also, because it's in oil, we are going to absorb way less and then still have to try to convert it to D3 so our bodies can use it.