Cal­cium sources dif­fer, needs re­main the same

Cape Breton Post - - HEALTH/ADVICE - Keith Roach To Your Good Health Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­corpo rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avai

DEAR DR. ROACH: I am a 64year-old woman with a thin frame who was re­cently di­ag­nosed with os­teo­poro­sis. In the past 10 years, my bone den­sity has de­clined de­spite reg­u­lar ex­er­cise, a diet high in dairy prod­ucts and tak­ing cal­cium car­bon­ate sup­ple­ments.

My doc­tor pre­scribed For­teo in­jec­tions for one year to hope­fully im­prove my bone den­sity, and then tran­si­tioned me to Pro­lia.

From what I’ve read, cal­cium car­bon­ate sup­ple­ments are not easily ab­sorbed and did lit­tle to pre­serve my bone den­sity. I now take a plant-sourced cal­cium sup­ple­ment ( from al­gae lithotham­nion cal­care­ous and coral­lioides) that claims to be more "bioavail­able" than cal­cium car­bon­ate. Is al­gae­sourced cal­cium bet­ter than more-tra­di­tional cal­cium sup­ple­ments? I have found no stud­ies that ad­dress this, and I want to take the cal­cium sup­ple­ment most likely to im­prove bone den­sity. — C.H.

AN­SWER: Although cal­cium sup­ple­ments by them­selves do lit­tle to pre­vent os­teo­poro­sis, for men and women tak­ing med­i­ca­tion for os­teo­poro­sis, the body needs cal­cium to put into the bones. The ideal source is from the diet (sup­ple­ments in­crease kid­ney stone risk and may in­crease cal­cium in ar­ter­ies), but it can be dif­fi­cult to get enough cal­cium from diet, es­pe­cially if you don’t like or don’t want to in­gest dairy prod­ucts. Hence, many peo­ple rely on sup­ple­ments.

Cal­cium car­bon­ate is the cheap­est and most fre­quently taken sup­ple­ment, but it is not par­tic­u­larly well-ab­sorbed. It needs to be taken with food to be ab­sorbed well at all. Cal­cium cit­rate is bet­ter ab­sorbed and bet­ter tol­er­ated than cal­cium car­bon­ate. It is what I usu­ally rec­om­mend for peo­ple who take sup­ple­ments and who don’t tol­er­ate cal­cium car­bon­ate.

Al­gal cal­cium has a dif­fer­ent crys­tal struc­ture from cal­cium car­bon­ate. A 2010 study from Ja­pan did show a 57 per­cent in­crease in ab­sorp­tion of el­e­men­tal cal­cium com­pared with cal­cium car­bon­ate. How­ever, it is sig­nif­i­cantly more ex­pen­sive, and re­quires many pills a day.

Cal­cium is ab­sorbed bet­ter when it’s taken in smaller amounts, so I would say it is im­por­tant to space out sup­ple­ment use. It is hard to ab­sorb more than 600 mg at a time. I still rec­om­mend cal­cium car­bon­ate taken with food as the first choice, but cal­cium cit­rate or al­gal cal­cium are rea­son­able al­ter­na­tives if the cal­cium car- bonate isn’t well-tol­er­ated. Peo­ple with os­teo­poro­sis should aim for a to­tal of 1,200 mg el­e­men­tal cal­cium from a com­bi­na­tion of diet and sup­ple­ments.

DEAR DR. ROACH: Dur­ing an an­nual phys­i­cal, my pri­mary physi­cian dis­cov­ered a soft lump on the top cen­ter of my head. He was not con­cerned other than to say that I will need to have that re­moved some­day. That was 10 years ago. It has never both­ered me or given me any pain. It feels per­fectly round on top and I would es­ti­mate its size to be 1/2 inch di­am­e­ter at the base and 3/8 inch high.

I am an ac­tive 75-year-old male and in good health. Is this a cyst? What does that mean, and what, if any­thing, should I do? — S.H.

AN­SWER: It does sound like a cyst, most com­monly an epi­der­moid (some­times called se­ba­ceous) cyst, but it could be a pi­lar cyst as well. Both of these are be­nign cysts of the hair fol­li­cle com­plex. Although they some­times can spon­ta­neously rup­ture or be­come in­fected, af­ter 10 years of be­ing sta­ble, I would say the risk of yours caus­ing prob­lems is small, and you don’t need to do any­thing about it.

There are other pos­si­bil­i­ties, such as a lipoma (a be­nign fatty tu­mor). Still, if it is un­chang­ing, it doesn’t need treat­ment un­less it both­ers you. A gen­eral doc­tor, der­ma­tol­o­gist or sur­geon can help.

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