With hypoparathyroidism, it helps to find the right calcium supplement

Note: This column describes the author’s own experiences with calcium supplements as well as general supplement brands. Not everyone will have the same response to treatment. Consult your doctor before starting or stopping a therapy.

When I was diagnosed with hypoparathyroidism and told to take calcium supplements, it was as if the doctor were speaking a language I didn’t understand. I stood in the supplement aisle at the pharmacy, stared at a plethora of bottles in every color, and tried to figure out which was best.

With hypopara, as the disease is often called, low parathyroid hormone causes hypocalcemia, or low calcium levels in blood. Calcium supplements are often an imperative part of treatment.

I picked up one bottle of calcium carbonate, then another of calcium citrate. A third was calcium gluconate, and there was a dusty one in the back called calcium phosphate. And what about calcium lactate or acetate? And do the added vitamin D levels matter? I checked the price tags, the ingredients, and the descriptions, but I was left with more questions than answers.

I learned that picking the right supplement required some research, and at the time, I didn’t know any other hypopara patients to ask.

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Learning about my treatments

The first important step I took was finding a supplement brand that was trusted and proven safe. Unlike prescription medication, supplements don’t go through the U.S. Food and Drug Administration for testing, which means there’s no federal agency overseeing their strength, ingredient, or purity claims.

As a result, a supplement company can say there are 200 mg of calcium per pill, only to have 100 mg or 500 mg instead. If the strength varies from batch to batch, or if ingredients are added to the batch without being on the label, there could be serious adverse effects. There are also concerns about contamination with heavy metals, bacteria, or pesticides.

One way manufacturers work to gain consumer trust is third-party testing, when a supplement is sent to a company that’s not affiliated with the manufacturer for laboratory testing to confirm that what’s printed on the ingredient label matches what makes up the supplement. Not all testing companies are created equal, but some of the most trusted are NSF, ConsumerLab.com, U.S. Pharmacopeia, and Banned Substances Control Group.

Armed with this knowledge, I began seeking out trusted supplement brands. I talked to several pharmacists and also learned that CVS Pharmacy requires its entire supplement stock to be third-party tested. (That’s true of several other pharmacies, too.) Common brands such as Nature Made, Thorne, and Ortho Molecular are known for being high quality and accurate, while products sold by multilevel marketing companies are often not tested.

The most common and often most cost-effective calcium is calcium carbonate, found widely in pills, capsules, powders, chewables, and antacids, although using antacids long term for hypopara can cause stomach issues.

My choice and its use

After years of trial and error, I found that calcium citrate works best for me. I take the Citracal Calcium Citrate Petites, finding the pill size and strength to be ideal for my multiple daily doses.

For me, good medication habits include always reading the supplement bottle before restocking, since ingredients and strength can change without warning. I’ve had to switch calcium brands multiple times after companies changed the strength or added additional ingredients such as zinc, copper, and manganese, which in high doses can have serious adverse effects.

Since hypopara patients often take more calcium than the recommended daily dose on the bottle, ingredient changes that are fine for consumers without hypopara may be higher risk for me as a hypopara patient.

Serving size is important. With calcium, the serving size is frequently two pills — meaning that when the bottle says “500 mg per dose,” that translates to 250 mg per pill. At every appointment, my endocrinologist reviews with me what kind and how much calcium I’m taking, at what times, and how much vitamin D is in each pill. Along with lab tests, this process allows my doctor to make adjustments to my supplementation as needed.

While different forms of calcium instruct consumers to take it with or without food, hypopara specialists recommend that hypopara patients always take their calcium with food, as it helps manage phosphate levels.

When the blood phosphate level gets too high, functioning parathyroids will send a signal to the kidneys to excrete phosphate in the urine. Without this signal, high phosphate can increase the symptoms of hypopara and the risk of kidney damage. By taking calcium supplements with food, the calcium binds to the phosphate and reduces phosphate absorption.

It’s important to note that third-party supplement testing doesn’t guarantee efficacy or safety. That’s why I not only talk to my medical team before starting a new supplement, but I also reach out to my hypopara friends for their personal feedback. Choosing the right supplement was overwhelming at first, but now that I have a concise plan, it’s made all the difference.

Note: Hypoparathyroidism News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Hypoparathyroidism News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to hypoparathyroidism.