Please people... you really need to be aware of this:
If you have Stage 4 cirrhosis, you are at a VERY HIGH RISK for developing osteoporosis. My husband shrank 3 inches, lost several teeth, and bone in his face (which changed the shape of his face) because he experienced SEVERE calcium loss when he had stage 4 cirrhosis! You do NOT want to take this lightly!
It's EXTREMELY easy for this to happen to people with stage 4 cirrhosis, because:
-A cirrhotic liver has an impaired ability to process calcium, so even when you do consume it, your body has a harder time processing and utilizing it.
-Doctors typically prescribe Proton Pump Inhibitors as a "temporary quick fix" to prevent esophageal bleeding, due to portal hypertension. And PPIs can actually cause you to lose calcium. They are known to cause Osteoporosis. You can see the FDA's warning on THIS POST.
-Lasix (aka Furosemide), a common diuretic, can also prevent calcium absorption, and they are commonly prescribed for people with cirrhosis!
-Digoxin (which was prescribed for him because he has atrial fibrillation) can also prevent calcium absorption. Many people who get cirrhosis from alcohol have atrial fibrillation, so I know there must be other people out there who have this same issue!
Many people with Stage 4 cirrhosis also have low hemoglobin / iron levels (and proton pump inhibitors can actually cause lowered iron levels). So there are many people with cirrhosis who will be trying to raise their iron levels, by taking iron supplements and drinking spinach shakes, etc. and you need to know that THIS WILL DO YOU NO GOOD IF YOU ARE TAKING THE IRON AT THE SAME TIME AS THE CALCIUM!!! The last nurse who tested my blood told me that I could easily avoid this problem by just not taking the iron and the calcium at the same time.
Sorry if it seems like I'm "shouting" with the ALL CAPS, but I can't help feeling agitated by the fact that nobody told us this! Not one of Jake's doctors ever bothered to mention this. And I saw five different nurses who told me I'd failed my hemoglobin test when I tried to donate blood, and only ONE OUT OF FIVE nurses actually TOLD me that calcium prevents iron absorption!!! These are people whom you'd think would tell you, because they want you to donate! But nope. Nobody told me, and I'm guessing there's a good chance nobody told you either, so I thought I'd better do a post about it!
By the way, I do not know if, by taking prescription medications, separately from iron and calcium supplements, if that would help to prevent any of these problems, but you should probably check with your doctor AND look it up as well.
I've been researching this liver stuff for THREE YEARS and am still
learning about the dangerous side effects of some of these medications
my husband was on. And I probably do more research than the average person (because this is the kind of thing I do all day), so
I imagine there are a lot of people who don't know about these side
effects, just like I didn't.
It was only when I was recently creating this page (3 years after my husband's
hospitalization), and was revisiting the side effects of Pantoprazole
(Protonix) that I noticed the following:
I thought, that's weird. Why would they put diuretics on
there? I had long considered those to be one of the safer meds my
husband was on (although I knew they can cause dehydration, and also
hair loss if taken for too long). My husband had also been on Digoxin
for years.
FYI I didn't underline Iron in red, but my husband was diagnosed with low ferritin (iron) when he was on PPI's. If you read the rest of this post you will see why (I believe) iron is on this list also.
FYI I didn't underline Iron in red, but my husband was diagnosed with low ferritin (iron) when he was on PPI's. If you read the rest of this post you will see why (I believe) iron is on this list also.
Needless to say, since we never saw this, we never brought this up with
his doctor, so we were completely unaware of the fact that my husband
was taking a dangerous combination of drugs. We just kind of
assumed that his Gastroenterologist was in charge of everything. And
besides, he was the one who gave him BOTH the diuretics, AND the
pantoprazole.... so shouldn't the doctor be the one to bring it up?
Sadly, that's not how it works. If you don't ask, they don't tell.
Unbeknownst to us, my husband was on SEVERAL calcium-depleting drugs at the same time.
I already knew Pantoprazole depleted calcium (well... we found out after he'd already been taking it for 9 months). But I didn't even know, until tonight (while I was doing research for this post), that Digoxin (which he was taking for his heart) and Lasix (one of two diuretics he was taking) ALSO deplete calcium! And a cirrhotic liver already makes a person extremely calcium deficient, so taking THREE things that are known to deplete calcium was just a recipe for disaster. It's no wonder he suffered from severe bone loss!
When I'd think of "dangerous drug combinations" it never occurred to me that the reason they can be dangerous is that they can create not just a deficiency.... but an extreme deficiency, which can have serious long term effects.
(Again... please note that Lasix is the same thing as Furosemide).
Note from Ellie: He was also taking Spironolactone, and this is what the guide said (it doesn't seem to deplete calcium but it does deplete folic acid and sodium).
This is what I read: Spironolactone (potassium-sparing diurectic) DEPLETES folic acid and sodium. AVOID the following herbs which may cause undesirable interactions: buchu, cleavers, dandelion, gravel root, horsetail, juniper, and uva ursi. Avoid taking potassium supplements (or using potassium-based salts) while using this drug.
I know that many people take dandelion root for the liver, so... it might be best to just take it separately. I'm really not an expert but that is what I would tell my husband to do.CALCIUM ALSO DEPLETES IRON!
I've talked to many people with cirrhosis who have very low hemoglobin/iron levels and are trying to raise them. I tend to be iron deficient, and my Mom and sisters are, too. So I have had to learn how to increase my own iron levels, over the years. I donate blood regularly, and it is actually a good way to see where my iron levels are at.
I only learned last week, when I failed yet another hemoglobin check, that CALCIUM DEPLETES IRON LEVELS! That was about the 5th time I've failed my hemoglobin check before attempting to donate blood. It was only after my last FAIL (last week) that the woman who tested my blood, informed me that calcium depletes iron levels. I had no idea. I've been taking a LOT of calcium in the last 9 months, since I've been trying to heal a cracked tooth... so it doesn't surprise me that I've failed my hemoglobin test so many times in the last 9 months!
I never fail if I'm taking my Visalus Vitamins regularly, but I ran out, and even spinach shakes combined with Vitamin C (which helps iron absorption) couldn't bring my levels up high enough to donate (your hemoglobin has to be 12.5).
A good friend gave me some stuff called Hemaplex that enabled me to pass, easily, but I ran out of that too. So I have just been taking a bunch of my own supplements... which didn't work, either.
If you do take iron supplements to raise your hemoglobin, please be sure you don't overdo it. I've overdosed on iron three times in my life and two of those times I was SO NAUSEOUS, and the time I accidentally overdosed on Hemaplex (forgetting you're supposed to take one a day for 5 days, not five at once), I started to "white out" (like a blackout but everything was turning white). I started glugging the water I keep talking about, and within a minute, my eyesight went back to normal.
The other two times I got sick, it was just from taking two Geritol supplements (in addition to taking other supplements that may have had iron also). That's what I get for waiting till the last minute to try to raise my iron levels, in order to donate!
From this page:
Calcium
Calcium makes it harder for your body to absorb either supplemental iron
or iron from food, according to the National Institutes of Health.
Calcium competes for absorption with iron in your intestines and reduces
its uptake. This means that a multi-mineral supplement is likely not
the best way of getting iron due to the negating effects of the calcium
and some other minerals. Instead, eat iron-rich foods -- preferably
without calcium-rich dairy products -- or take iron supplements separately from other minerals.
Another rich source of calcium that can negatively impact iron
absorption is antacid tablets, commonly taken for heartburn but also as
an inexpensive calcium supplement to help prevent osteoporosis.
So, yeah.. just be sure to take the iron SEPARATELY from the calcium,
and hopefully this will solve the problem. I guess I will find out if it
works, the next time I try to donate blood!
If you're trying to raise your Calcium levels...
I've heard it's good to take calcium with a hydrochloric acid supplement. You can read about this HERE. But if you're going to do this you need to take with caution (scroll down to see why).
Also, from this article:
http://scdlifestyle.com/2012/
Jake has not taken this
yet but I am planning to get this for him (probably this brand, as
it had good reviews, was cheap, and supposedly you're supposed to take
the one with pepsin).
Country Life Betaine Hydrochloride with pepsin 600 mg - 250 Tablets
Here's some info on Calcium and Vitamin D (you need both) from the National Osteoporosis Foundation. For the full article please go here:
https://www.nof.org/patients/treatment/calciumvitamin-d/
I've heard that some calcium supplements are better-absorbed than others, so I've spent a lot of time looking up reviews of different brands on Amazon.
A few years ago I was reading about Algae-Cal, which is supposedly absorbed better than regular calcium, but it's on the pricey side. But if it really does prevent osteoporosis... I don't care if it was 100 bucks a bottle, it'd be worth it. So I am listing that, plus some other alternatives.
My husband's liver specialist told him to take Citracal but he hated that the pills were so big and didn't take them as regularly as he should have. It is crazy to think of how much damage he might have been able to prevent, if we'd known there were "petite sized" Citracal pills available, so my husband would have actually TAKEN them (I still don't know how much Citracal would have helped him, but it does have good reviews on Amazon) So here is a list of the different ones you may want to look into. Just be sure you take it SEPARATELY from the iron!
Natural
Calcium and Magnesium Supplement - AlgaeCal Plus (90 Capsules) -
All-Natural, USDA Certified Organic Algae - 3 Vitamins and 73 Trace
Minerals Aid in Restoring Strong and Healthy Bones
If you're trying to raise your Calcium levels...
I've heard it's good to take calcium with a hydrochloric acid supplement. You can read about this HERE. But if you're going to do this you need to take with caution (scroll down to see why).
Also, from this article:
http://scdlifestyle.com/2012/
I Need to Take How Many Betaine HCL Pills?
It’s very common for people to stop short of their needed Betaine HCL dosage. In fact, in the beginning I was nervous about taking 6 pills at a meal. But trust me. there is nothing to worry about. Dr. Wright reports that the common Betaine HCL dosage range in his clinical practice is 3,250-4,550mg per meal. That means there are also plenty of people who need above 5,000mg for an effective dosage.
Remember, a normal functioning stomach is capable of producing and handling extreme acid ranges. If your dosage starts getting extremely high without any GI distress (step #3), you must use your GI symptoms as a guide instead. These include burping, bloating, farting, and stool consistency. Keep everything else the same in your diet as you wait for these indicators to change for the better. Just because you can take 20 pills, doesn’t mean you should. It could be that at 11 pills all of your problems disappear. For this group of people, try to find the minimum dose needed to help your GI symptoms and for Pete’s sake go get more testing to figure out what is going on!
Best Betaine HCL Supplement Brands
When choosing a Betaine HCL supplement it’s important to choose one that includes pepsin. It’s assumed by the medical research that when supplementing with HCL you need to supplement with pepsin. That is why most Betaine HCL supplements you’ll find include it and Dr. Wright recommends it.
Jake has not taken this
yet but I am planning to get this for him (probably this brand, as
it had good reviews, was cheap, and supposedly you're supposed to take
the one with pepsin). Country Life Betaine Hydrochloride with pepsin 600 mg - 250 Tablets
Before Supplementing With Betaine HCL Read This
It’s important to understand the risks of Betaine HCL supplementation. It’s generally safe for most people. However, in the book “Why Stomach Acid is Good For You,” Dr. Wright recommends doing so under the guidance of a physician.
No, seriously… it’s a good idea to find someone qualified to watch over
your health and decisions. Your health isn’t a game, so get the right
help.
People
that are “high risk” shouldn’t take Betaine HCL without supervision.
You’re high risk if you’re consuming any anti-inflammatory medicines.
Examples of those are: corticosteroids, aspirin, Indocin, ibuprofen
(Motrin, Advil) or other NSAIDs. These drugs can damage the GI lining
and supplementing with HCL could aggravate it, increasing the risks of bleeding or ulcer.
Okay
red tape and warnings aside – you can do this safely and it will help
your health tremendously when you correct low stomach acid levels. Did
you know your stomach wall is about 5mm thick? And did you know the
stomach is built with ridges on the inside that act like a rock crusher
as it pulverizes your food?
I tell you this because I want you to know that your
stomach isn’t some mamby pamby organ, it’s a beast that can easily
handle extreme acid levels. The amazing part is, if this acid got out of
the stomach it could burn right through every other cell in the body.
Our stomachs were built to create and contain acid and making short work
of what we eat. Supplementing with Betaine HCL will help it work like it was designed, because every meal you eat with low acid it has to work harder than it should.
Here's some info on Calcium and Vitamin D (you need both) from the National Osteoporosis Foundation. For the full article please go here:
https://www.nof.org/patients/treatment/calciumvitamin-d/
What is Calcium and What Does it Do?
Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium helps our blood clot, nerves send messages and muscles contract. About 99 percent of the calcium in our bodies is in our bones and teeth. Each day, we lose calcium through our skin, nails, hair, sweat, urine and feces, but our bodies cannot produce new calcium.
That’s why it’s important to try to get calcium from the food we eat. When we don’t get enough calcium for our body’s needs, it is taken from our bones.
Vitamin D supplements can be taken with or without food. While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement.How Much Vitamin D Do You Need?
| WOMEN AND MEN | |
|---|---|
| Under age 50 | 400-800 international units (IU) daily** |
| Age 50 and older | 800-1,000 IU daily** |
What is Vitamin D and What Does it Do?
Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.
- Choose brand-name supplements with proven reliability. Look for labels that state “purified” or have the USP (United States Pharmacopeia) symbol. The “USP Verified Mark” on the supplement label means that the USP has tested and found the calcium supplement to meet certain standards for purity and quality.
- Read the product label carefully to determine the amount of elemental calcium, which is the actual amount of calcium in the supplement, as well as how many doses or pills to take. When reading the label, pay close attention to the “amount per serving” and “serving size.”
- Calcium is absorbed best when taken in amounts of 500 – 600 mg or less. This is the case when you eat calcium rich foods or take supplements. Try to get your calcium-rich foods and/or supplements in smaller amounts throughout the day, preferably with a meal. While it’s not recommended, taking your calcium all at once is better than not taking it at all.
- Take most calcium supplements with food. Eating food produces stomach acid that helps your body absorb most calcium supplements. The one exception to the rule is calcium citrate, which can absorb well when taken with or without food.
- When starting a new calcium supplement, start with a smaller amount to better tolerate it. When switching supplements, try starting with 200-300 mg every day for a week, and drink an extra 6-8 ounces of water with it. Then gradually add more calcium each week.
- Side effects from calcium supplements, such as gas or constipation may occur. If increasing fluids in your diet does not solve the problem, try another type or brand of calcium. It may require trial and error to find the right supplement for you, but fortunately there are many choices.
- Talk with your healthcare provider or pharmacist about possible interactions between prescription or over-the-counter medications and calcium supplements.
Reading Food Labels – How Much Calcium am I Getting?
To determine how much calcium is in a particular food, check the nutrition facts panel of the food label for the daily value (DV) of calcium. Food labels list calcium as a percentage of the DV. This amount is based on 1,000 mg of calcium per day. For example:
- 30% DV of calcium equals 300 mg.
- 20% DV of calcium equals 200 mg of calcium.
- 15% DV of calcium equals 150 mg of calcium.
How Much Calcium Do You Need?
The amount of calcium you need every day depends on your age and sex.
| WOMEN | |
|---|---|
| Age 50 & younger | 1,000 mg* daily |
| Age 51 & older | 1,200 mg* daily |
| MEN | |
|---|---|
| Age 70 & younger | 1,000 mg* daily |
| Age 71 & older | 1,200 mg* daily |
I've heard that some calcium supplements are better-absorbed than others, so I've spent a lot of time looking up reviews of different brands on Amazon.
A few years ago I was reading about Algae-Cal, which is supposedly absorbed better than regular calcium, but it's on the pricey side. But if it really does prevent osteoporosis... I don't care if it was 100 bucks a bottle, it'd be worth it. So I am listing that, plus some other alternatives.
My husband's liver specialist told him to take Citracal but he hated that the pills were so big and didn't take them as regularly as he should have. It is crazy to think of how much damage he might have been able to prevent, if we'd known there were "petite sized" Citracal pills available, so my husband would have actually TAKEN them (I still don't know how much Citracal would have helped him, but it does have good reviews on Amazon) So here is a list of the different ones you may want to look into. Just be sure you take it SEPARATELY from the iron!
Natural
Calcium and Magnesium Supplement - AlgaeCal Plus (90 Capsules) -
All-Natural, USDA Certified Organic Algae - 3 Vitamins and 73 Trace
Minerals Aid in Restoring Strong and Healthy Bones You can see more information on the AlgaeCal site... they have some really good videos. They even give a "double your money back" guarantee!
Jarrow Formulas Bone-Up, Promotes Bone Density, 360 Caps
(I have bought this for my husband in the past, and put in his shakes, but now I realize that probably wasn't the smartest thing because they were spinach shakes so the calcium was probably cancelling out the iron he'd be getting from the spinach)! So I will have to make him a separate shake, maybe one with fruit, in the evenings. I don't want him to stop drinking the spinach shakes!
Garden of Life Raw Calcium Supplement - Vitamin Code Grow Bone System Whole Food Vitamin with Strontium, Vegetarian
When I looked this up a while back on Amazon, I couldn't help notice the good reviews it had. It was a little more pricey than some of the others, but I still plan to buy it at some point.
New Chapter Bone Strength Calcium Supplement, Clinical Strength Plant Calcium with Vitamin D3 + Vitamin K2 + Magnesium - 120 ct Slim Tabs
I have not tried this one, I'm just listing it because it seems affordable, had good reviews, and I like it that it has Vitamin K2, in addition to D3 and magnesium. Plus, they're "slim tabs"! So maybe my husband would actually take them!
Country Life, Calcium Magnesium, w/Vitamin D Complex, 240 Veggie Caps
I bought this type for myself, from whole foods, when I found I had a tooth abscess. The woman working there told me a lot of people bought it to rise their mouths to re-grow their teeth! It really does seem to work, and the taste isn't too bad, so I am sharing this too.
Citracal Petites with Vitamin D3, 200-CountJake's doctor recommended Citracal. Although my husband didn't take it as regularly as he should have (because he hated the large pills) I did see that they make a "petite" pill now. It just kills me how that one minor issue kept him from taking something that could really have helped him. I was surprised by how many good reviews there are for this, so I am putting it on this page as well.
Please people, DO NOT overlook the importance of getting enough calcium if you have cirrhosis. I wish we could go back in time and take one of these supplements, but we can't, so I just hope you can learn from our mistakes!
Ellie
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