The calcium and Vitamin D supplement I have been prescribed (Adcal-D3) comes with the usual array of advice and warnings on any pharmaceutical. I’m to eat two a day, one in the morning and one in the evening.
The Package Leaflet says that the pills should not be eaten within two hours of food rich in oxalic acid, (eg spinach and rhubarb), phosphate (e.g. bananas) or phytic acid (e.g. whole cereals). So, you set out to eat well, with your breakfast of whole grains and sliced bananas…but now you have to wait two hours before you take your calcium…say mid-morning while you are charging about at work or however you spend your time. Ensuring you take these with a two hour gap between the pill and anything on the long list of foods that affect calcium could be quite a challenge as there are so many. You think beans on toast would be fine? No, the wheat bran is an issue, so are the beans.
Still, the NOS suggests that avoiding a vast array of foods while taking your calcium supplements is not that important. It can be tricky figuring out which advice to trust. It does, however, have a particular warning about wheat bran, which interests me despite the fact that I don’t eat dairy or wheat:
“Wheat bran. Like beans, wheat bran contains high levels of phytates which can prevent your body from absorbing calcium. However, unlike beans 100% wheat bran is the only food that appears to reduce the absorption of calcium in other foods eaten at the same time. For example, when you have milk and 100% wheat bran cereal together, your body can absorb some, but not all, of the calcium from the milk. The wheat bran in other foods like breads is much less concentrated and not likely to have a noticeable impact on calcium absorption. If you take calcium supplements, you may want to take them two or more hours before or after eating 100% wheat bran.”
This suggests that people, thinking they are doing a great job nutritionally, sit down to a breakfast of milk and wheat bran, when this is a particularly unhelpful combination for supporting their bone health. The GP food questionnaires, used to see if you eat enough calcium, don’t take these combinations into account, nor do they know how to cope with vegan/vegetarian diets (or at least the person I saw could give no alternatives when I said I ate no dairy)
The calcium supplements I have been prescribed do say not to eat them within four hours of taking the alendronic acid. I wrote an earlier blog about the impact of the calcium in water on the absorption rates of the drug- which is why the advice says tap water only not mineral water.
All these things make it harder for people to timetable doses well. I check these issues to enable me to maximise the benefit of anything I take. I’m curious to know which of the many possible reasons for not taking medications prescribed for osteoporosis are the ones that really matter to people, reducing ‘compliance’.