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Please enter your search term and hit the search button. This will search 333 Question and Answer items published in the NADF newsletter between January 2004 and Present.

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Your search was for "vitamin".
Found 51 matches in 16 Q&A's.


1) Q&A from the June, 2007 NADF newsletter:

QUESTION: I have read calcium supplements are not needed by males, but with this condition is it a good idea to take them (and vitamin D)? If so, what is the recommended dosage, assuming a normal diet with one glass of milk/day?

ANSWER: For men I suggest a good multivitamin that contains some calcium (usually 200-300 mg) and vitamin D (usually 400 units). If he must be on higher than usual steroid doses, this should be increased to vitamin D 800 to 1200 units plus extra calcium such as Caltrate 600, one to two per day. These doses would also be needed by anyone found to have osteoporosis, where other medication to build bone (such as Fosamax, Actonel or Boniva) would be prescribed in addition to the calcium and vitamin D.



2) Q&A from the December, 2007 NADF newsletter:

QUESTION: I have a question about supplemental vitamins. I have been told that because I have celiac and Addison's, I should be taking many supplemental vitamins. I see a nutritionist and belong to a support group for celiac and I get a lot of mixed messages. The biggest problem I have is that it seems no one, even my doctors, know that much about Addison's. It has been a year since I was diagnosed with Addison's and a year and a half with celiac disease. I work a stressful job and feel that I need to retire or find another job, as I have many times when my sodium level has been low. I now know when to recognize this so that I do not have to be hospitalized each time. Any help you can give me would be appreciated. Thank you.

ANSWER: There is no specific vitamin regimen necessary for Addison's disease. However, I usually suggest a general multivitamin/mineral supplement to a good healthy diet. Extra calcium is very important, especially for post-menopausal women. The celiac disease tends to cause a malabsorption of vitamin D. I suggest that anyone with celiac disease have a serum 25-OH vitamin D level checked. If it is low, adding extra vitamin D is essential. Doses of 800 to 1200 U per day are useful for normal to slightly low D levels. If the blood test shows very low levels (below 20), then prescription strength vitamin D should be given and monitored by your doctor.



3) Q&A from the December, 2007 NADF newsletter:

QUESTION: I have just visited my new dentist and again, as with my other dentists, I was given an article on the dangers of using bisphosphonates such as Actonel and Boniva which I have been taking. In June 2006 when I first received this warning, I stopped taking them for six months. My doctors said this warning was mainly for cancer patients and I should continue the drug to prevent bone loss. My bone density test in December 2006 was good for my age and arthritis I have. I do take 1500 mg of calicium with viatmind D daily. My question is — should I continue with Actonel or Boniva? If so, whch do you reocemmend. Also, I suffer from back problems which it seems Addisonians are prone to. The MRI's do not reflect a cause for my type of terrible pain. My hips are fine. I am on 7 mgs. of prednisone; 0.1 mg am + 0.05 mgs fludrocortisone acetate (Impax - Global); 125 mcg Synthroid; 2-3 - 50 mgs of tramadol; 200 mg's Celebrex at night and sometimes 5mg Ambien to help sleep with pain. A multivitamin; the Calcium with D and Omega 1000. My question is: Do you think when I gave up my Premarin three or four years ago, did this cause my pain? Addisonian's don't make hormones that I know of. Could it be possible I need them? Could the lack of hormone be causing my pain? My doctor says, “we just don't know". So I would like your opinion. Thank you.

ANSWER: The back pain and risk of osteoporosis are totally separate. Osteoporosis does not cause symptoms unless there is a fracture. Arthritis, which is not part of the osteoporosis, causes pain. If you do have osteoporosis, you should take the calcium and vitamin D as well as a bisphosphonate. It can be Fosamax, Actonel or Boniva. They all work well to reduce the risk of fracture. They will not help with your back pain. The fear that the dentist has caused is totally inappropriate. The risk of osteonecrosis of the jaw is extremely unlikely with oral bisphosphonates. The only reason the dentist should be involved is if you actually have osteonecrosis, in which case you should stop the medication.



4) Q&A from the June, 2008 NADF newsletter:

QUESTION: I have Addison's and I also have Celiac. I know with Celiac that I have to take extra calcium and vitamin D for osteoporosis. I was reading in your Q & A part that people with Addison's should also take extra calcium. How much calcium should I be taking? I'm a 60 year old female.

ANSWER: For most people I would suggest 1200 mg of calcium per day from calcium carbonate or citrate, plus 800 to 1200 units of vitamin D. If constipation is a problem, add magnesium 250 mg per day to prevent the constipating effect of the calcium. Celiacs often have a significant malabsorption of vitamin D. The serum vitamin D level should be checked. If it is lower than normal, even higher doses of vitamin D may be needed, sometimes prescription strength doses. A bone density every 2 years would be useful to assess the response to the calcium and D.



5) Q&A from the June, 2009 NADF newsletter:

QUESTION: NADF recently forwarded the COAST news #175 Summer 2009. On pages 6 & 7 are articles citing information from Autoimmunity Research Foundation/Professor Trevor Marshall. I looked at the website cited in the article, www.autoimmunityresearch.org and the companion website http://www.marshallprotocol.com. I had come across these websites before, and had discounted the theories and this antibiotic “protocol" as probably poor medicine. Marshall's theory of cause may have some base, but his treatments sound so contrary to current medical advice regarding antibiotic use. I have not seen any other research done about his theory of autoimmunity cause. There are other websites indicating that this Marshall Protocol may actually cause Addison's (and other diseases). One of these is http://www.lassesen.com/cfids/MarshallProtocolRisks.htm. I would like to know Dr. Margulies opinion of Marshall's theories & protocol. Since the two articles in the COAST news were so prominent, could we see Dr. Margulies views in the NADF News? Thanks

ANSWER: I had not read this article before. It presents some interesting theories, but I am bothered by the conclusions it makes. Low vitamin D levels are being found in a large percentage of the population, not just people with osteoporosis. Low vitamin D levels have been associated with a higher risk of death from all causes - including heart disease and cancer. The attempt to link replacement of vitamin D with the incidence of autoimmune diseases is illogical. Higher doses of vitamin D are only very recently being suggested, and most of the population is seriously undertreated. I recommend that most individuals should have a baseline 25OH vitamin D level measured. If it is low, I suggest replacement with vitamin D3. I see no reason not to recommend this to people with autoimmune diseases.



6) Q&A from the December, 2009 NADF newsletter:

QUESTION: You have been helpful in the past while we try to help my Dad. He was diagnosed with Addisons a couple of years ago. They are having a horrible time regulating his blood pressure. It constantly fluctuates from extreme lows to too high. He also suffers from extreme confusion and repetition. They took him for a second opinion and this doctor doesn't think he has Addison's because he does not have any pigment discoloration, but they don't know what it is. My mother is constantly trying to regulate his steroids and BP medicines. She is worn out. I had not seen him since his diagnosis. They arrived for a visit a couple of days ago. I was stunned to see the changes in him. When I got home from work he was totally confused and kept repeating the same story over and over (about 15 times in 30 minutes). This confusion had started around 3pm more so after he took his medicine. He took hydrocortisone, sodium. We sat down to eat dinner and he took his medicine (Multivitamin, Calcium with D, Aggrenox, vitamin B and Symvastitin). Very shortly after dinner he was fine. He had a normal conversation and was engaged with us. It was the most unbelievable thing. Everyone thinks he has dementia, but dementia doesn't go away after taking medicine. He has days the confusion is worse and might last all day. Are you aware of this type of problem with Addison's patients? Thank you for any input you can provide.

ANSWER: From the pattern of improvement after eating, one must consider hypoglycemia as a cause of the confusion. True dementia would not respond like that. Also, the fluctuating blood pressure suggests an element of essential hypertension which is now complicated by the coexisting (presumptive) Addison's disease. This is a situation where his doctor should arrange for home blood pressure as well as home blood glucose monitoring, to sort out what really happens. It is important to avoid diuretics for the blood pressure. Often a combination of low dose fludrocortisone with a drug like Norvasc can balance the blood pressure. If hypoglycemia is documented, an adjustment of the hydrocortisone regimen and a change in diet would be necessary.



7) Q&A from the December, 2009 NADF newsletter:

QUESTION: A member would like to know if it is typical to lose bone and muscle mass with Addison's. He is 73 and he has told me several times that he has lost all his bones and muscles.

ANSWER: One of the major problems in the treatment of Addison's disease is to balance the necessary replacement steroid dose for good health and well-being against the negative effects of excess steroid use. In excess, glucocorticoid hormones can cause muscle wasting and weakness as well as osteoporosis, or bone thinning which can increase the risk of fracture. Therefore, these effects are not due to the Addison's disease itself, but from the treatment. That is one of the reasons it is important to adjust the steroid dosage to the lowest dose that keeps the patient comfortable and free of adrenal insufficiency symptoms. At the same time, it is vital to maintain good nutrition, with adequate amounts of protein, calcium and vitamin D. When osteoporosis is found, additional treatment with bisphosphonate therapy (Fosamax, Actonel or Boniva) can be useful.



8) Q&A from the June, 2011 NADF newsletter:

QUESTION: I have had Addison's for about 6 years now and have been taking vitamin D3 for about 2 years. I recently started taking 10,000 IU a day. I never really thought about how much that was until I did some research about it. Some research says that is not too much. Others say it is too much. I am 48 years old and my doctor told me the other day that since 2007 I have had 6% bone loss. So is 10,000 IU vitamin D3 too much? If so, how much should I take per day? Thank you.

ANSWER: First, the vitamin D issue has nothing to do with the Addison's disease. There has been much controversy about vitamin D lately. Low levels of vitamin D from lack of sunlight, dietary abnormalities, or from a relative lack of absorption of vitamin D from the intestines are quite common. Recent improvements in the accuracy of laboratory measurements of D allow us to assess vitamin D deficiency much better than a few years ago. Most labs will report a level of 25-hydroxy D (the best way to look at it) below 30 as abnormal. Levels below 30 can contribute to decreased absorption of calcium and a tendency toward osteoporosis, which will increase the risk of fracture. If osteoporosis is found, a measurement of vitamin D should be made. Supplements of vitamin D to bring the blood level up to normal should be given. Although some would aim just to bring the level to above 30, I think it should be over 40 in someone with osteoporosis. Most people can achieve these levels with vitamin D doses of 1000 to 2000 units per day, but some require much higher doses, especially if there is bowel malabsorption. The important point is to check the blood level of D as well as calcium to assess the effect of any regimen.



9) Q&A from the March, 2012 NADF newsletter:

QUESTION: Can you give us some information on the interaction between prednisone (as well as other corticosteroids) and calcium (acid neutralizing agents)?How much AI patients be concerned?

ANSWER: The interaction of glucocorticoids and calcium has several facets. Many people take calcium antacids with their steroids because they think they need it to reduce the incidence of heartburn from the steroids. In fact, that is rarely needed. Glucocorticoids are known to cause calcium loss leading to osteoporosis, but research has shown that the replacement doses used to treat Addison’s disease do not increase that risk. I do recommend calcium supplements for postmenopausal Addisonian women, but the dose is the same as other women. vitamin D is important to assess in all postmenopausal women, and vitamin D supplementation to achieve blood levels above 30 is important. High doses of glucocorticoids may suppress vitamin D levels as well as activity, but normal replacement doses should not effect vitamin D.



10) Q&A from the September, 2014 NADF newsletter:

QUESTION: Since I was diagnosed with Osteopena, I have learned that DHEA and testosterone are needed for strong bones and muscles. Is this true?

ANSWER: I am not in favor of this type of treatment. First of all, osteopenia is not at high risk for fracture. Osteoporosis is high risk. I recommend adequate vitamin D levels, good nutrition, and regular exercise to slow the gradual loss of bone mineral. There is good evidence that estrogen replacement will help in menopausal women, but that is not a good enough reason to prescribe estrogen. Low DHEA and T levels in menopause are normal. DHEA can be taken orally in women with Addison’s disease for its general improvement in sense of wellbeing, but its effect on bone is probably very minor. I see no reason to give any form of progesterone - orally or skin cream except to balance any extra estrogen treatment. By itself, progesterone has no benefit.



11) Q&A from the June, 2018 NADF newsletter:

QUESTION: Can I take my thyroid hormone replacement meds and hydrocortisone at the same time, like first thing in the morning?

ANSWER: Yes, they can be taken together. However, vitamins, calcium, iron, antacids and food should be taken at least half an hour after thyroid hormone to avoid changes in absorption.



12) Q&A from the September, 2018 NADF newsletter:

QUESTION: I am 73 years old and was diagnosed with Addison's disease in 2008. Most of this time has been uneventful, as long as I take my medication. Over the past several years, I occasionally have had the sensation of tingling and weakness in my hands, feet and lower legs. It has been happening on a regular basis for the past 2 months, and I am getting concerned.

ANSWER: The tingling in hands and feet are not directly related to the Addison's disease. I suggest further evaluation with your doctor. Among the things to look for would be diabetes and low vitamin B12.



13) Q&A from the March, 2022 NADF newsletter:

QUESTION: I was diagnosed with autoimmune primary adrenal insufficiency in March 2021. I’m quite stable on a replacement dose of hydrocortisone and fludrocortisone, despite occasional episodes of nausea, dizziness and fatigue. How often is it recommended for someone with Addison’s to see an endocrinologist for follow-up? And what additional testing is recommended at follow-up? Specifically, I’m interested to hear about recommendations for follow-up testing of cortisol, aldosterone, ACTH, adrenal antibodies, curve test, etc., and whether this is useful. I’ve been told that now that I have a diagnosis, no additional testing is necessary other than checking my electrolytes levels. I guess I was just thinking this might be helpful to see if there was any improvement in cortisol production once on a replacement dose.

ANSWER: Once a diagnosis of autoimmune adrenal insufficiency is made and replacement hydrocortisone and fludrocortisone is prescribed, I recommend frequent follow up every 2 to 3 months until you are comfortable that the dosages of both medications are optimal. It is important to have face to face meetings with the endocrinologist. The doctor should look for signs of persistent adrenal insufficiency as well as overtreatment - on the physical examination as well as detailed questioning about symptoms, including fatigue, dizziness, nausea, and salt craving. Blood studies should include electrolytes, but also plasma renin to help establish the appropriate dose of fludrocortisone. The dose of hydrocortisone should be the lowest dose that prevents signs and symptoms of adrenal insufficiency. Once there is stability, I suggest face to face meetings every 6 months. There should be a physical exam and discussion of adrenal symptoms and intercurrent other medical history. There should be a discussion of management of any acute medical events and whether appropriate steroids were given. There is no benefit to repeating blood tests for cortisol, ACTH, aldosterone or adrenal antibodies. Since I suggest using the lowest replacement dose of hydrocortisone that prevents signs and symptoms, if there really is some recovery of adrenal reserve (seen in a minority of patients), it will be apparent by allowing a low dose of glucocorticoid. I do not suggest a routine repeat of the entire diagnostic work-up because it has a very low yield of useful information. I do recommend routine re-testing for other autoimmune endocrine conditions, especially thyroid disease and vitamin B12 deficiency. Make sure your endocrinologist is advised about any new medical diagnosis and treatment from other doctors. Make sure you are familiar with appropriate emergency measures for acute illness and injuries.​



14) Q&A from the September, 2022 NADF newsletter:

QUESTION: I was diagnosed with Addison's Disease in 2004 and Hypothyroidism in the early 90s and my medication is stable for both diseases. I have been on a daily dose of 10 mg DHEA since 2005. I started experiencing hair loss last fall and have since been diagnosed with female pattern hair loss. I stopped the DHEA 10 mg a few months ago. I'd like to try to take Spironolactone for the hair loss as my dermatologist recommended this, but know this medication affects potassium. Is it safe for a woman with Addison's disease to take Spironolactone for hair loss?

ANSWER: Spironolactone is not a good idea in Addison's disease. It is a mild diuretic and does elevate potassium. Your doctor should check to see if your serum testosterone is high normal or elevated. If it is, a better medication than spironolactone would be finasteride. It blocks the metabolism of testosterone but does not elevate potassium. As a woman, the dose is a fraction of the dose for men with enlarged prostate. I usually use 2.5 mg every other day. Also, add biotin, a safe vitamin that is good for hair and nails.



15) Q&A from the September, 2022 NADF newsletter:

QUESTION: My daily medications are Hydrocortisone 10 mg in the am, 5 mg in in the afternoon and Fludrocortisone 0.05mg daily. Based on my June 2022 labs, my PCP stated that I have iron deficiency anemia. MCV=84.2, MCH=26.9 (Low), MCHC=31.9 (L), RDW=14.2, Iron=31 (L), TIBC=447, % Iron Saturation=7%, Ferritin=6. What lab values/results determine macrocytic anemia, pernicious anemia, vitamin B12 absorption deficiency or iron deficiency anemia? My PCP prescribed oral Ferrous Sulfate 325mg and vitamin C 200mg every other day. Dr. Margulies what are your recommendations for treatment?

ANSWER: These lab values do indicate iron deficiency anemia. The key values are the low MCV (microcytic), low iron and low ferritin. Absent are the values for hgb and hct. Assuming these values are low, replacement iron is appropriate. Before starting therapy, one must establish the cause of the iron deficiency anemia. Is there bleeding? Where is it coming from? Be careful not to miss a significant cause, like a colon cancer or bleeding ulcer. Pernicious anemia would be ruled out by the absence of macrocytic values (high MCV) and a normal B12. A blood test for anti-parietal cell antibodies is useful to confirm PA when the B12 level is low.



16) Q&A from the June, 2023 NADF newsletter:

QUESTION: My labs show I have positive anti-parietal cell antibodies, but my vitamin B-12 is normal. Does this mean I have pernicious anemia?

ANSWER: Positive anti-parietal cell antibodies means you do have the underlying autoimmune mechanism of pernicious anemia. You should check B12 levels every 6 to 12 months. If it drops, then add B12 therapy.





Questions are normally submitted by NADF members.
Answers are from NADF's Medical Director Paul Margulies, M.D., FACE, FACP.

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NADF does not engage in the practice of medicine. It is
not a medical authority, nor does it claim to have medical
knowledge. In all cases, NADF recommends that you consult your
own physician regarding any course of treatment or medication.





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