Citracal Experiment

On March 24, 2010, in Minerals, Reviews, by Andrea

So it is continually brought up by surgeons that pill-form vitamins do not dissolve sufficiently in RNY or DS guts to do any good.  Whether this is due to the shortened gut syndrome or the lack of stomach acid, I’m not quite certain.  However, there are a plethora of surgeons that make this claim.  It’s getting old.

Given this information, I have decided to do a number of experiments with various vitamins and supplements that I currently take.  Some of this is for my own morbid curiosity, and some of it is to help dispel misinformation being spread by the people in white coats.  I know what my own personal labs look like — I know that my vitamins are absorbing.  However, consider this a visual PSA for the community as it were.

Let’s keep in mind that just because something dissolves does not mean it will absorb.  Calcium carbonate will dissolve in a cup of water given the correct conditions.  (And perhaps I’ll try that as well.  I’m not sure.)  However, that does not mean that it will absorb. There are chemical reactions in the body that we can’t see without electron microscopes — and unless someone has a couple thousand dollars they want to give me?  It’s not going to happen here.  So just keep in mind this information is to dispel the “your body cannot possibly dissolve these meds and they will come out solid in your poop” mythical crap.  (Yes, pun intended.  I couldn’t help myself.)

Continue reading »

This is not a good thing, folks.  And it scares me because the things I need to keep my vision, my bones, my blood clotting may go away.

Basically, this act will allow the FDA to pull all nutritional supplements.  And while the Centrums and NatureMades will be fine, what I worry about will be the 50,000 IU water-miscible D3′s that I take, or the 100mg K1′s, or any of the “dangerous” level meds.. or even the heme iron that I’ve FINALLY found that works for me.

So while I’ve always been political, have voted in every election that I have been able to vote in, have called my elected representatives for certain things — I have yet to write a single letter to any politicians.  The time has ended.

Senator John McCain
United States Senate
241 Russell Senate Office Building
Washington, D.C.  20510

Senator McCain:

I am not a constituent of yours.  Nor do I plan to be one in the future.  In fact, I live almost as far away from your Arizona as possible without actually living on a different continent.

However, the Dietary Supplement Safety Act that you are proposing could impact my life in ways you cannot possibly imagine.

Sir, I had Roux-en-Y gastric bypass surgery in 2004.  Like thousands of others who have battled morbid obesity, I have had a surgery that has altered my intestines in a way that severely limits my ability to absorb nutrition from food.  It is because of this fact that I survive daily from nutritional supplements — nutritional supplements that you are attempting to regulate.

I understand the need for regulation against unsafe chemicals that are being marketed and sold to our youth.  As a mother of young children, I can appreciate the desire to protect our children.  However, I see this Act as a way to limit my ability to maintain my health with these absolutely vital supplements.

I know that there are some supplements that are available in prescription form.  Unfortunately, not all of these are acceptable for patients such as myself and only over-the-counter supplementation will maintain my health.  For example, a common prescription to rectify a clinical deficiency of vitamin D is a 50,000 IU dose of vitamin D2 in an oil-suspension.  D2 has been found to be one-tenth the strength of D3 (which is available over-the-counter at your local pharmacy), and with my reconfigured intestinal design, I do not absorb the oil that the D2 is immersed in.  Therefore, what little of the vitamin I might absorb, much of it is lost in the body’s conversion to D3.  In many cases, a 50,000 IU dose of D2 would be equivalent to what I could pick up at CVS as a D3 supplement for anyone — and even worse for me with the fat malabsorption my surgery gave me.  Instead, I can take a 50,000 IU dose of D3 — something your Act would surely take away, relegating me to months of painful recovery as I suffer from osteomalacia or even osteoporosis at the tender age of 31.

While this is certainly an extreme case, it is something that thousands of us face daily.  Vitamin D is not the only vitamin I worry about with this act — high dose vitamin A allows me to keep my vision, vitamin K allows my blood to clot, B12 allows me to have neurological function, and high-dose iron allows my blood to move oxygen through my cells properly.  All of these are in higher-than-normal doses to counteract the surgical implications of my gastric bypass surgery — and it is something I will live with for the rest of my life.

I implore you to examine this issue very carefully as things are not exactly black and white.  I believe safety is needed in the supplement industry — especially as I take so many of them.  However, such strict regulation could seriously impact my ability to live a functional life versus a life of skinny sickness.

I had this surgery to be a healthier individual — this bit of regulation could seriously impair that goal.

Sincerely,
Andrea S. Ullberg
Wilson, NC  27896
andrea@ullberg.us

http://wlsvitagarten.com

Senator Kay Hagan
United States Senate
521 Dirksen Senate Office Building
Washington, D.C.  20510

Senator Hagan:

I am one of your constituents — one that is proud to say that voted for you.  I thank you for the hard work you’ve put forth in representing the people of North Carolina thus far.

I write to you today, however, to express grave concern about Senator McCain’s Dietary Supplement Safety Act.  This Act, if passed, could cause me and thousands more like me, great personal harm and impact my health and well-being in a way he has not considered.  Please take a moment to understand why.

I had Roux-en-Y gastric bypass surgery in 2004.  Like thousands of others who have battled morbid obesity, I have had a surgery that has altered my intestines in a way that severely limits my ability to absorb nutrition from food.  It is because of this fact that I survive daily from nutritional supplements — nutritional supplements that he is attempting to regulate.

I understand the need for regulation against unsafe chemicals that are being marketed and sold to our youth.  As a mother of young children, I can appreciate the desire to protect them.  However, I see this Act as a way to limit my ability to maintain my health.  If I cannot maintain my health, I will not be able to protect or care for my children myself — which defeats the purpose of the bill.

I know that there are some supplements that are available in prescription form.  Unfortunately, not all of these are acceptable for patients such as myself and only over-the-counter supplementation will maintain my health.  For example, a common prescription to rectify a clinical deficiency of vitamin D is a 50,000 IU dose of vitamin D2 in an oil-suspension.  D2 has been found to be one-tenth the strength of D3 (which is available over-the-counter at your local pharmacy), and with my reconfigured intestinal design, I do not absorb the oil that the D2 is immersed in.  Therefore, what little of the vitamin I might absorb, much of it is lost in the body’s conversion to D3.  In many cases, a 50,000 IU dose of D2 would be equivalent to what I could pick up at CVS as a D3 supplement for anyone — and even worse for me with the fat malabsorption my surgery gave me.  Instead, I can take a 50,000 IU dose of D3 — something your Act would surely take away, relegating me to months of painful recovery as I suffer from osteomalacia or even osteoporosis at the tender age of 31.

While this is certainly an extreme case, it is something that thousands of us face daily.  Vitamin D is not the only vitamin I worry about with this act — high dose vitamin A allows me to keep my vision, vitamin K allows my blood to clot, B12 allows me to have neurological function, and high-dose iron allows my blood to move oxygen through my cells properly.  All of these are in higher-than-normal doses to counteract the surgical implications of my gastric bypass surgery — and it is something I will live with for the rest of my life.

I implore you to examine this issue very carefully as things are not exactly black and white.  I believe safety is needed in the supplement industry — especially as I take so many of them.  However, such strict regulation could seriously impact my ability to live a functional life versus a life of skinny sickness.

Please take the time to examine this issue very carefully.  Many of us depend on these supplements — not for simple well-being but for our actual lives.

Sincerely,

Andrea S. Ullberg
Wilson, NC  27896
andrea@ullberg.us

http://wlsvitagarten.com

Senator Richard Burr
United States Senate
217 Russell Senate Office Building
Washington, D.C.  20510

Senator Burr:

I thank you for the hard work you’ve put forth in representing the people of North Carolina.

I write to you today to express grave concern about Senator McCain’s Dietary Supplement Safety Act.  This Act, if passed, could cause me and thousands more like me, great personal harm and impact my health and well-being in a way he has not considered.  Please take a moment to understand why.

I had Roux-en-Y gastric bypass surgery in 2004.  Like thousands of others who have battled morbid obesity, I have had a surgery that has altered my intestines in a way that severely limits my ability to absorb nutrition from food.  It is because of this fact that I survive daily from nutritional supplements — nutritional supplements that he is attempting to regulate.

I understand the need for regulation against unsafe chemicals that are being marketed and sold to our youth.  As a mother of young children, I can appreciate the desire to protect them.  However, I see this Act as a way to limit my ability to maintain my health.  If I cannot maintain my health, I will not be able to protect or care for my children myself — which defeats the purpose of the bill.

I know that there are some supplements that are available in prescription form.  Unfortunately, not all of these are acceptable for patients such as myself and only over-the-counter supplementation will maintain my health.  For example, a common prescription to rectify a clinical deficiency of vitamin D is a 50,000 IU dose of vitamin D2 in an oil-suspension.  D2 has been found to be one-tenth the strength of D3 (which is available over-the-counter at your local pharmacy), and with my reconfigured intestinal design, I do not absorb the oil that the D2 is immersed in.  Therefore, what little of the vitamin I might absorb, much of it is lost in the body’s conversion to D3.  In many cases, a 50,000 IU dose of D2 would be equivalent to what I could pick up at CVS as a D3 supplement for anyone — and even worse for me with the fat malabsorption my surgery gave me.  Instead, I can take a 50,000 IU dose of D3 — something the Act would surely take away, relegating me to months of painful recovery as I suffer from osteomalacia or even osteoporosis at the tender age of 31.

While this is certainly an extreme case, it is something that thousands of us face daily.  Vitamin D is not the only vitamin I worry about with this act — high dose vitamin A allows me to keep my vision, vitamin K allows my blood to clot, B12 allows me to have neurological function, and high-dose iron allows my blood to move oxygen through my cells properly.  All of these are in higher-than-normal doses to counteract the surgical implications of my gastric bypass surgery — and it is something I will live with for the rest of my life.

I implore you to examine this issue very carefully as things are not exactly black and white.  I believe safety is needed in the supplement industry — especially as I take so many of them.  However, such strict regulation could seriously impact my ability to live a functional life versus a life of skinny sickness.

Please take the time to examine this issue very carefully.  Many of us depend on these supplements — not for simple well-being but for our actual lives.

Sincerely,

Andrea S. Ullberg
Wilson, NC  27896
andrea@ullberg.us

http://wlsvitagarten.com

Please.  Read more about this and do your part to protect yourselves.  This is important.  I’ve rarely taken action such as this and I think this is worth fighting for.

We NEED these supplements.  Don’t let them take them away from us.

My week, in perspective.

I get asked quite often what I take.  I hesitate to put it down, line by line, only because I take things that are higher due to need for deficiency, or due to my headaches, or a few other idiosyncricies.  I also tend to not like to label what brands — simply because sometimes this could be seen as an endorsement when it’s not (I shop sales).

But because it does get asked so often, fine.  This is not the order I take them in, but rather the order I put them back in my container.  Hey, I want easy.

As of February 10th, 2010, I take:

  • 2 Members Mark (Centrum) multivites — after this bottle is gone (ha! 450 in a bottle) I have actual Centrums that I got on MASSIVE discount with good expiration dates
  • 5 Vitalady 140mg Tender Magnesium Citrate capsules — magnesium has been shown to help migraine sufferers in clinical trial; I’m actually about to up this another capsule or two; important to note that magnesium helps with calcium absorption, but if taking for migraines, not to take with calcium
  • 1 NatureMade 500mg Vitamin C — taken with the mag citrate to increase absorption
  • 4 Citracal 250mg calcium citrate, 200 IU D3 tablets & 4 Citracal 200mg calcium citrate, 200 IU D3 tablets — 1 of each x 4 servings gives me 1800mg of calcium a day; I buy Citracal because of coupons and the BOGO deals typical of this brand
  • 1 every other day Members Mark 1000mcg B12 — I over absorb b-vites for some reason; I also, for some reason absorb tablet B12.  Don’t try this at home.
  • 1 every other day NatureMade Liquid Softgel Super B-Complex – I over absorb b-vites and am off the chart
  • 1 400mcg CVS folic acid
  • 3 Proferrin ES heme iron — this I love and need and is the only iron that has worked for me in years
  • 4 Vitalady Tender D3-5 5,000 IU
  • 4 Solaray 100mg Vitamin B2 — Riboflavin of doses of 400mgs has been shown in clinical trials to treat migraines, actually thinking of upping this 200mgs to counter malabsorption
  • 1 GNC 2mg Copper
  • 1 NatureMade 30mg Zinc
  • 1 Vitalady 25,000 IU Tender A-25 Retinyl Palmitate
  • 1 Bio-Tech (Vitalady) 100mcg K1-100 (Phytonadione)

This isn’t a listing of what you SHOULD take by any stretch — only what I take.

We’ve seen some of the stats before — that RNY’ers are not compliant with their supplementation.  There was a study out that measured the efficacy of a multivitamin alone after RNY and in the process we learned that only 33% were actually compliant. You’d think we learned?

No.  We didn’t.

Now, this study was published in 2009 — but is from patients from 2006-2007.  I’m hoping, hoping, HOPING that people out there understand how freaking important their vitamins are, and if not perhaps they will see after reading these two studies.

Keep in mind, these are two studies in order — and neither are very good.  Both show that people, at least around 2005-2007 did not feel like they needed to take their vitamins.  Don’t become a statistic.

A few takeaways:

  • 33% took a multivitamin
  • 5.1% took b12
  • 7.7% took calcium
  • 11.1% took folic acid
  • 12.0% took iron
  • 61.5% took incorrect medication formulations
  • 34.7% took non-immediate-release medications
  • 25.0% took enteric-coated medications
  • 40.3% took enteric-coated non-immediate-release medications

How many do you think were getting appropriate protein levels?  Or their lab work?

The article abstract can be read here.

This simply continues the point that we need to educate ourselves AND our physicians.

Calcium+D may reduce fracture risk

On January 22, 2010, in Fat Solubles, Minerals, Vitamins, by Andrea

Um.  Duh?

But for the 2 of you that have not been paying attention.

Take your calcium (citrate) and D.

From Medscape:

Daily Calcium Plus Vitamin D Supplements May Reduce Fracture Risk

Laurie Barclay, MD

January 22, 2010 — Daily supplements of calcium plus vitamin D, but not of vitamin D alone, are associated with significantly reduced fracture risk, according to the results of a patient level-pooled analysis reported in the January 12 issue of the BMJ.

“A large randomised controlled trial in women in French nursing homes or apartments for older people showed that calcium and vitamin D supplementation increased serum 25-hydroxyvitamin D, decreased parathyroid hormone, improved bone density, and decreased hip fractures and other non-vertebral fractures,” write B. Abrahamsen, from Copenhagen University Hospital Gentofte, in Copenhagen, Denmark, and colleagues from the DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group.

“Subsequent randomised trials examining the effect of vitamin D supplementation — with or without calcium — on the incidence of fractures have produced conflicting results….We used individual patient data methods to do a meta-analysis of randomised controlled trials of vitamin D — with or without calcium — in preventing fractures and investigated if treatment effects are influenced by patients’ characteristics.”

The goals of the study were to identify characteristics affecting the antifracture efficacy of vitamin D or vitamin D plus calcium regarding any fracture, hip fracture, and clinical vertebral fracture and to evaluate the effects of dosing regimens and coadministration of calcium.

Selection criteria were randomized trials with at least 1 intervention group in which vitamin D was given, in which there were at least 1000 participants, and in which fracture was an outcome. The investigators identified 7 major randomized trials of supplementation with vitamin D plus calcium or with vitamin D alone, enrolling a total of 68,517 participants. Mean age was 69.9 years (range, 47 – 107 years), and 14.7% of participants were men. Significant interaction terms were identified with logistic regression analysis, followed by Cox’s proportional hazards models incorporating age, sex, fracture history, and use of hormone therapy and bisphosphonates.

Overall risk for fracture was decreased in trials using vitamin D with calcium (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86 – 0.99; P = .025), and risk for hip fracture was also decreased (HR for all studies, 0.84; 95% CI, 0.70 – 1.01; P = .07; HR for studies using 10 μg of vitamin D given with calcium, 0.74; 95% CI, 0.60 – 0.91; P = .005). There were no significant effects for vitamin D alone in daily doses of 10 μg or 20 μg, nor was there any apparent interaction between fracture history and treatment response. No interaction was noted for age, sex, or use of hormone replacement therapy.

“This individual patient data analysis indicates that vitamin D given alone in doses of 10-20 μg is not effective in preventing fractures,” the study authors write. “By contrast, calcium and vitamin D given together reduce hip fractures and total fractures, and probably vertebral fractures, irrespective of age, sex, or previous fractures.”

Limitations of this study include lack of data for 4 of the 11 identified studies meeting inclusion criteria, and insufficient information about compliance to do a per protocol analysis. In addition, only a single study provided data for vitamin D given alone at the lower dose.

“We must emphasise that this analysis does not allow for a direct comparison of vitamin D against vitamin D given with calcium, but only comparisons between each intervention and no treatment,” the study authors conclude. “Whether intermittent doses of vitamin D given without calcium supplements can reduce the risk of fractures remains unresolved from the studies in this analysis. Additional studies of vitamin D are also needed, especially trials of vitamin D given daily at higher doses without calcium.”

In an accompanying editorial, Dr. Opinder Sahota, from Queen’s Medical Centre in Nottingham, United Kingdom, notes that these findings are important because they show that vitamin D alone, irrespective of dose, does not reduce the risk for fracture.

“Although the evidence is still confusing, there is growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing non-vertebral fractures,” Dr. Sahota writes. “Higher doses are probably necessary in people who are more deficient in vitamin D, and treatment is probably more effective in those who maintain long term compliance. Further studies are needed to define the optimal dose, duration, route of administration, and dose of the calcium combination.”

The National Heart, Lung, and Blood Institute, National Institutes of Health, supported this study. Some of the study authors have disclosed various financial relationships with Novartis, Amgen, Nycomed, Eli Lilly, Procter & Gamble, Merck, Roche, Shire, ProStrakan, Servier, Celltech, ProStrakan, Alliance for Better Bone Health, GlaxoSmithKline, Pfizer, Sanofi-Aventis, and/or Osteologix.

Dr. Sahota has disclosed no relevant financial relationships.

BMJ. 2010;340:b5463.

Page 2 of 41234