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.
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.
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:
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:
I Need to Take How Many Betaine HCL Pills?
Best Betaine HCL Supplement Brands
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
Here's some info on Calcium and Vitamin D (you need both) from the National Osteoporosis Foundation. For the full article please go here:
What is Calcium and What Does it Do?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?
What is Vitamin D and What Does it Do?
Reading Food Labels – How Much Calcium am I Getting?
How Much Calcium Do You Need?
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-Count
Jake'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!