Epilepsy Talk
Calcium – Friend or Foe? | July 1, 2022
After talking to a famous epileptologist, I learned that calcium is really a two-edged sword. Which surprised (and scared) me.
I’ve always read that calcium was imperative if you were taking anti-epilepsy drugs — especially Dilantin. Even if your doc “forgot” to tell you!
Speaking of which, a survey found that fewer than one-third of neurologists routinely evaluated AED patients for bone disease. And fewer than 10% prescribed calcium and Vitamin D.
But, at least, most doctors do recommend DEXA scanning at one-to-two-year intervals to monitor changes in bone density during treatment.
Unfortunately, monitoring osteoporosis treatment using DEXA scans is highly controversial. Because bone density changes so slowly that the changes may be smaller than the measurement error of the machine.
However, right now, it’s all we’ve got. So until something better comes along, at least this will give us a clue about what’s going on with our bones.
WHY YOU NEED CALCIUM
Believe it or not, reduced bone mineral density (BMD) has been reported in 20-75% of people taking AEDs.
Most importantly, the risk for skeletal fractures if you have epilepsy, is two to six times greater than in the general population.
These fractures may be caused by seizures themselves or by falls, as we know all too well.
The following drugs have the clearest association with decreased bone mineral density and bone disease:
Dilantin, Mysoline, Phenobarbital, Tegretol, and Valproate.
And antacids may interfere with your absorption of those meds, decreasing the acidity of your stomachand also forming insoluble complexes that cannot be absorbed.
HOW MUCH IS ENOUGH?
The Office of Dietary Supplements suggests children and teenagers nine to eighteen years old consume 1,300 milligrams of calcium.
Healthy adults 19 to 50 should have 1,000 milligrams of calcium. Adults over 50 should consume 1,200 milligrams.
Consuming calcium-containing foods and/or calcium-containing supplements is so safe that although calcium can react with some AEDs, over-dosage hasn’t been reported.
Some of the top calcium-rich foods are:
Cheese, yogurt and milk
Sardines
Dark leafy greens like spinach, kale, turnips, and collard greens
Fortified cereals such as Total, Raisin Bran, Corn Flakes. (They have a lot of calcium in one serving.)
Fortified orange juice
Soybeans
Fortified soymilk (Not all soymilk is a good source of calcium, so it’s best to check the label.)
Enriched breads, grains, and waffles
The two most common calcium supplements are calcium carbonate and calcium citrate.
However, your combined calcium intake from the dietary sources and vitamin supplements should not exceed 1,500 mg per day. Because, your body can only absorb so much calcium at a time.
Your calcium supplements should be divided into two doses daily — with food, in doses of 500 mg to 600 mg — to increase absorption.
Also calcium supplements should be taken one to two hours apart from other supplements or medications. When taken at the same time, calcium can bind those products and pass them unabsorbed from the body.
But, there’s a potential catch to correcting such “nutrient depletions.”
In some cases, taking the nutrient can impair the absorption or alter the metabolism of anticonvulsant drugs.
In other cases, it’s possible that nutrient depletion is part of how the anticonvulsant operates! (Catch-22?)
So physician or nutritional supervision is important when taking any supplements.
THE SURPRISING NEWS
While the majority of calcium in your body is stored within your bones, the rest is in your bloodstream and other body fluids.
Abnormalities in your body’s calcium level can result in significant health problems.
Both low calcium levels (hypocalcemia) and high calcium levels (hypercalcemia) can cause seizures.
According to Epilepsy.com, hypocalcemic seizures can cause generalized tonic-clonic seizures, focal muscle seizures and absence seizures.
Although, hypercalcemic seizures are relatively rare, 20-25% of people who have this calcium deficit require emergency medical attention.
However, chances are that you only have a mild blood calcium deficiency, especially before a seizure.
The good news is that when your blood calcium levels get low, your bones release calcium to bring it back to a good blood level.
(Hmmmm. Is that where osteopenia and osteoporosis come in? You’re between the devil and the deep blue sea!)
Interestingly, a study found that those who were on long-term AEDs, had higher levels of calcium than non-medicated controls.
This might suggest that one of the reasons that some of these medications are continued long-term is that for some people, they somehow increase the retention of calcium, which may account for some of their anticonvulsant effects! (Wow.)
THE CONTROVERSY
There are also scattered reports that the anti-epilepsy medications Phenobarbital, Tegretol, Valproate, Lamictal, Neurontin and Sabril can cause or contribute to myoclonic seizures in those who previously hadn’t been having those types of seizures.
Why? Because some AEDs can reduce Vitamin D levels which is needed to efficiently absorb the calcium efficiently. (I know, it’s confusing.)
Milk is the best dietary source of Vitamin D. The recommended Vitamin D levels for those up to 70 years old is 600 IU or 15 mcg.
Foods such as spinach and rhubarb can decrease calcium absorption.
And calcium itself can interfere with the absorption of iron, zinc, bisphosphonates and tetracycline.
Now for the really sticky part…
A newly recognized worrisome concern on higher dosages of calcium is an increased risk for hardening of the arteries and heart attacks.
The Women’s Health Initiative (WHI), one of the largest studies evaluating the female population and including some 36,000 women, addressed this concern.
In one subgroup analysis, there was an increased risk for heart disease for women who had taken calcium supplements (with or without vitamin D).
And conversely, in another, there was not.
So now for the $64,000 question: What are we supposed to believe?
The theory is that sudden peaks in blood calcium may increase the risk for plaque progression (hardening of the arteries).
When we eat calcium in our diet, we introduce our bodies to small amounts of calcium at a time.
Taking a supplement, exposes our bodies to much higher amounts of calcium. So the calcium levels in our blood spike.
Our bodies may not be able to absorb or process that amount of calcium as easily (remember the 500mg to 600mg maximum), and the extra calcium may then stick to plaque in the arteries.
Obviously the goal should be to minimize any unnecessary spikes in blood calcium to reduce possible heart risk.
But, there’s no one-size-fits-all.
The first choice (which few of us can adhere to), is to increase your dietary intake of calcium. But the key is consistency.
And since most of us are inconsistent in our diets, a calcium supplement is recommended.
Once again, it’s important to take your supplement with food — divided into two doses daily of 500 mg to 600 mg.
And calcium supplements should be taken one to two hours apart from other supplements or medications.
Ideally, the supplement should also include 600 IU or 15 mcg. of Vitamin D which aids your body’s absorption of calcium.
The object is to switch more supplemental calcium to our bones — where we want it — and less calcium goes towards the plaques where we don’t want it.
Do the benefits of calcium outweigh the possible dangers?
If you’re not in danger of heart disease, or don’t already have it, I’d definitely say “YES.”
Especially when you factor in the effects and potential dangers of AEDs.
In medicine, we often have to look at the risk vs. benefit of any given situation. And then make our own decisions.
I guess that’s why they call it the “practice” of medicine. Because no one has all the answers.
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Resources:
http://www.webmd.com/a-to-z-guides/calcium-ca-in-blood
http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guide-calcium?page=2
http://www.livestrong.com/article/365302-calcium-seizures/
http://www.livestrong.com/article/210436-what-are-the-dangers-of-too-much-calcium/
http://www.healthresearch.com/myoclonic.htm
http://www.netdoctor.co.uk/ate/heartandblood/203185.html
http://www.sciencedirect.com/science/article/pii/S1525505003003871
http://www.sciencedirect.com/science/journal/15255050/5/supp/S2
http://www.webmd.com/food-recipes/features/10-calcium-rich-foods
http://www.medicinenet.com/bone_density_scan/page5.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673405/
14 Comments »
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Most recommendations for those on AEDs for Vit.D3 are 2000 to 5000 IU per day, more in winter months. Always best to test your blood levels too.
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Comment by Andy — July 1, 2022 @ 10:11 AM
I am always getting my D levels checked when I get my medicine levels checked from my neurologist, and then when I get my total CBC levels done 1 time a year. I think it should be 6 months, but my family doctor tells me I am as healthy as a teenager, & a horse, which he never knew me any when I was a teenager. I do use a few things that many like 99.9% of the people would never consider, like taking a good pure 100% virgin coconut oil, in place of butter, which gives me at times acid reflux when I have too much butter, but the coconut oil is not ever going to cause that, just the reverse & calms it. Pure 100% virgin coconut oil like the CARRINGTON FARMS brand, is 1 of the best to use, as I remember having taken it to PREVENT seizure activity after taking the drug ZARONTIN which has MSG type chemicals on the drug by having hyrogenized SOY BEAN & or VEGETABLE oils in the drug. SOME AED’s will have both especially the generic names. So when only taking 25mgs of the drug ZARONTIN, I started to take 1 tsp full of coconut oil, when I took the drug & I never had 1 sign of any seizure activity. I imagine olive oils that are 100% PURE & VIRGIN will do the same. But that’s the BOG PHARMA trying & wanting to sell more drugs that we do not need to take, when you use the right oils to help both brain & heart health. I also will take more D vitamin after half of the fall season is over to when the 1st half of the spring season is over. I WILL always take a good magnesium that has NO STEARTATES which all stearates no matter if they are calcium or magnesium stearate both can be in your drugs & the DO cause more seizure activity to happen. Now I am backing off the D vitamin because I am getting free from the sun for now, as I may take 2 or 3 tablets in a week IF I think about it, as I am not going to waste D vitamin if I do not need to use it. B complex is an everyday thing 365 days a year.
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Comment by James D — July 1, 2022 @ 1:48 PM
Magnesium L-threonate might a better option for people on AED. This is what my son’s naturopath doctor prescribes to him and has been approved by his neurologist. You can always get enough dietary calcium (generally) if you eat milk products, drink milk, or even eat a lot of certain veggies, like Broccoli.
Magnesium is a mineral salt and is harder to come by from food sources. There are multiple types of Magnesium, but Magnesium L-threonate is considered the best due to its higher absorbability. Also, numerous research studies indicate that the beneficial components of magnesium L-threonate primarily target the brain. It has been shown to help with age-related memory loss, emotional disorders, neuroinflammation, and enhance cognitive function.
It’s worth googling about. I can only speak from anecdotal experience that it has helped (over time) my son’s short term memory challenges and helped calm some of his anxiety. We consider it as important as his AED meds (Brivlera and Fycompa).
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Comment by Mai Watson — July 1, 2022 @ 2:10 PM
Mai, thanks for the tip. And the education. I knew zip about Magnesium L-threonate, until you brought it up.
https://www.lifeextension.com/wellness/supplements/magnesium-threonate-benefits
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Comment by Phylis Feiner Johnson — July 1, 2022 @ 2:20 PM
Magnesium L Threonate crosses the Blood Brain Barrier.
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Comment by Andy — July 1, 2022 @ 3:19 PM
I have used that a few times a few years ago. Never had a problem with it, except affording it but there is another as good I believe which is MAX MAG 300 made by DaVinci Labs. It seems to help my sleep somewhat with the brain ingredients it has in it, plus it is around $23.00 for a 30 day 120 CT supply. You can get that from NHC.com The other MAG L- THERONATE I found on Mercola.com and the cheaper way to buy that is a 90 day supply. Both do not have the Magnesium Stearate which I know causes more seizure activity that you will find in most to all AED’s & other brands of magnesium.
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Comment by James D — July 1, 2022 @ 7:06 PM
Where I was, I was eating Sushi, ‘cuz I can’t make it and I 💟 almost every kind of Sushi I’ve introduced myself to.
As for Calcium I don’t drink cow’s milk, but I drink a lot especially when I’m in the mood Almond and Soy milk that provides just as much Vitamin D and Potassium as I am as my doctor wants me to take multi-vitamins which I learned from two pharmacists which ones that are a benefit to me personally with my Epilepsy and healthy environments as was once was in and what was too much and could be harmful to me on the long time.
That with something my doctor(not neurologist) learned from Epilepsy Australia 20 years ago.
Ever hear of Bolthouse beverage? It’s made in the USA, I don’t know if it’s sold there. I drink it when I can! It’s low in sodium, 7g of protein, their considered smoothies Strawberry/Banana, Carrot, Green, health drinks, even lay back and forget about the idiots that tried to you day or weekend… Like my favorite Vanilla Chai!
**
Off topic
I’m really finding out what my neurologist and my doctor said after volunteering when I found about marajuana and side effects of that and like minded drugs.
They trigger me to have severe Epileptic seizures! I’ve had 3 in less then 6 days!
The hospitals think/assume that it’s my AEDs that are the problem!
How about this while I was unconscious from an Epileptic Seizure a few weeks ago, the wise ass stole my wallet, AND my AEDs that had my name on the bag with the AEDs in them and everything that was my AEDs had my name on them with phone number of the pharmacy!
Yes, paramedics knew as I was still Postical and bloody.
They called for police, if there is such… There was a police officer’s business card in the wallet they/she stole!
Sorry for this last bit Where are my friends that I spent every Fourth of July with?? What happened to my fiancé?
The last was dumb, a bunch of stoners stole my letters from my new apartment that I had left for medical reasons… After my first apartment air quality was trashed I ended in the hospital on O2, et cetera no family were ever contacted!
What the hell is Medic Alert contact lists for?!
Anyway fish is broiled the way YOU like it, is good Omegas like Blueberries and Raspberries and Spinach ….
🇺🇸🍓🎶🎉It’s Fourth of July long weekend try to enjoy the weekend even with the pandemic!
🎉🎉🇺🇸🍓☮🔕🍓🐾
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Comment by Tabitha — July 1, 2022 @ 5:35 PM
I came across this earlier today. Might be of interest to some of us: “Lycopene … may contribute to stronger bones: Lycopene’s antioxidant action may slow down the death of bone cells, reinforce bone architecture and help keep bones healthy and strong.”
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Comment by L J — July 2, 2022 @ 11:40 AM
Thanks LJ! Great info.
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Comment by Phylis Feiner Johnson — July 2, 2022 @ 1:11 PM
Here’s the Lycopene reference:https://www.healthline.com/nutrition/lycopene#other-benefits
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Comment by L J — July 2, 2022 @ 1:16 PM
After 40 years on Dilantin I was diagnosed with Osteoporosis. Have taken Vitamin D, exercised a lot and tried calcium supplements. Unfortunately, the calcium affects my medication absorption and triggers seizures. Doctor wants to get me off the Dilantin but seems to be the only drug that controls my tonic clonic seizures. Oh well🙄
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Comment by Ian Collins — July 4, 2022 @ 10:59 AM
That’s a tough one. Even with you taking bone building supplements.
Unfortunately, most bone health supplements lack the combination of ingredients necessary to improve bone density, and rely too heavily on calcium alone. With a variety of bone health supplements on the market, we looked at common pitfalls to help you make the most informed choice.
While most people get enough calcium from their diets, the problem is that it’s not easily absorbed by our bodies.
To ensure a high level of absorption, look for Calcium Hydroxyapatite, a mineral form of calcium derived from bovine bone, which is bioidentical to the calcium already in our body. Also, make sure that it is paired with Vitamin D3, as this unique pairing has been clinically proven to better support bone density and lower bone mass
You might try a supplement with
Vitamin K2
Cissus Quadrangularis
Vitamin D3
Calcium Hydroxyapatite https://smarter-reviews.com/lp/sr-top-ingredients-for-bone-health?tr=nROq2Wp&gclid=Cj0KCQjwn4qWBhCvARIsAFNAMijxbMoP7Iok6D3bssaf54BqJRleK-jZISat7_yTbx57Xwgoy0D39ykaAtSuEALw_wcB
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Comment by Phylis Feiner Johnson — July 4, 2022 @ 11:11 AM
Also check out magnesium L-threonate and vitamin B6, B12 and Folate (B9). Rxisk.org is a site that lists the metabolic risks of AEDs and other medicines and is a good place to start your research on interreactions between meds and supplements. Homeopathic treatments can be useful as well when supplements aren’t practical. They have helped me to reduce keppra dose to 1/3 of what neuro wanted (and I didn’t)
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Comment by Andy — July 4, 2022 @ 11:53 AM
Wow! You’re full of info. And the website tip is a good one. Thanks, Andy!
No one knows a prescription drug’s side effects like the person taking it. https://rxisk.org/
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Comment by Phylis Feiner Johnson — July 4, 2022 @ 12:00 PM