Dear Dr. Roach: My primary care physician wanted me to stop taking calcium (and the vitamin D that accompanies it) due to risks such as kidney stones. However, my endocrinologist, whom I see for thyroid issues (I’m currently on levothyroxine), thinks that I should continue with it.
What does one do when doctors give conflicting advice? What are the risks if I continue? I’m taking two Citracal tablets each day with 4,000 units of vitamin D. As of late, I have not been taking it very regularly at all. What damage am I doing?
D.H.
Calcium and vitamin D are necessary for bone health, but unless a person is severely deficient or has a condition known to improve with vitamin D, giving supplements has not been proven to be of much (if any) benefit. There is a small risk of kidney stones with calcium supplements and a possible increase of the risk of heart disease. (There’s conflicting evidence on heart disease.) So, unless there is a strong reason to use calcium (such as osteoporosis), I don’t recommend calcium supplementation, although I do recommend calcium in my patient’s diet.
Paradoxically, dietary calcium decreases kidney stone risk, even though calcium supplements increase the risk. (It’s thought to be the high amount in the blood after taking the supplement.) Although vitamin D may not be helpful for most people, it is seldom harmful at doses below 8,000 units daily.
When your physicians disagree, it’s OK to ask them to discuss it. I never mind calling my patients’ expert consultants, and the newer medical record systems can make it very easy to briefly communicate.
Dear Dr. Roach: What are the symptoms of Clostridioides difficile (C. diff)?
A.T.
C. diff is an unfortunate, all-too-common gastrointestinal infection. The cardinal symptom is watery diarrhea, often with fever and abdominal cramping. C. diff is usually associated with antibiotics that kill healthy bacteria in the gastrointestinal tract, which allow C. diff to take over. However, not all cases are associated with antibiotics. Just being in a hospital (or recently having been in one) is a risk, as is being older.
The spectrum of C. diff runs from asymptomatic (a small percentage of people have bacteria in their colon all the time without problems) to mild disease to severe and life-threatening disease.
Looking for C. diff is only appropriate in people with a new onset of diarrhea (a usual criterion is three watery bowel movements in a day) with no other explanation, especially if they have one of the risk factors that are listed above. C. diff is more likely in people taking proton-pump inhibitors like omeprazole, and it is one more important reason as to why physicians shouldn’t prescribe antibiotics lightly.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
