Calcium and PPI medicationsby Jennifer Mitchell Wilson B.S. Dietetics, Dietitian, Health Professional
Calcium is an essential mineral in the human body. It is needed for the proper formation of bones and teeth and is also found in the blood and other cells where it regulates metabolic functions. When previous headlines blared about the increased risk of hip fractures with PPI use many AR patients began to worry. I have also had many parents ask me how these medications will affect their child's bone development.
The bottom line is that the research to date is not perfect and does not provide us with all of the answers we need to these questions. According to some commentaries on the PPI and hip fracture research there may be several variables that were not taken into account. Some of those include additional medications those study participants were taking that also have the potential to increase fractures.
A huge issue that was also not addressed was nutritional intake. In an older population with acid reflux it is possible that dietary consumption of calcium is also inadequate. This could be due to a number of factors including palatability issues. It would be interesting to see if the fracture results would be duplicated with the above factors taken into consideration.
By now you are probably wondering where this leaves you, the AR patient, currently taking a PPI. While I would never presume to give you medical advice I can tell you what I have chosen to do:
I try to use the lowest dose of my PPI medication that affectively controls my AR and work with my daughter's doctors to do the same for her as well. For children on PPIs it is important to discuss a timeline for weaning from them if (and/or when) they are no longer needed. By no means is this a suggestion that anyone decrease their medications.Improper control of AR can cause a whole host of other problems (See my post on Listen to your Dentist for my hard learned lesson).
I include calcium rich foods that are readily absorbed in our diets every day Some good sources of bioavailable calcium include: yogurt, milk, cheese, fortified OJ, fortified soy, some greens, cabbage and tofu. It is important to note that some foods that seem to have high calcium content are also not readily absorbed. So while they look good on paper, less than 5% of that calcium may actually make it into the body.
I take a calcium supplement derived from calcium citrate. While calcium carbonate is cheaper it becomes relatively insoluble in neutral pH and requires stomach acid to be utilized. Calcium citrate on the other hand is much more soluble and does not require stomach acid to be absorbed. If it causes stomach upset you can try taking it with meals.
Many experts also recommend including vitamin D and magnesium to this regimen.
I participate in weight bearing exercise at least 5 days per week. If you can't make it five days per week start out smaller and work your way up. Some examples include: walking, low impact aerobics or any exercise where your bones are supporting your body weight. (Yes mom, gardening counts!). Things like swimming, which does not require your bones to support your weight, does not have the same positive affect on bone density.
Last but NOT least: Discuss your concerns with your doctor!! Please do not make any changes to your current treatment plan, supplements or exercise regimen with out your doctor's consent.
For more information on this issue please see Jan Gambino's wonderful blog entries entitled, New Study Links PPI Use to Hip Fractures and More Thoughts on Calcium Absorption, Gastroesophageal Reflux and PPIs.