calcium malabsorption that does not resolve with supplementation

[Allias]

Hello, I have chronic malabsorption of calcium, iron and vitamin B9 linked to celiac disease. I manage to compensate for the deficiencies thanks to iron and vitamin B9 supplements but not calcium (I have tried a lot of calcium supplements and different easily absorbable forms of calcium citrate, calcium chloride, calcium bisglycinate, etc.). Symptomatically, I have the typical symptoms of a calcium deficiency (neck spasms, neuropathy, etc.). Biologically, I have high PTH, low ionized calcium levels, normal total calcium levels, normal vitamin D levels, and normal calcitriol (active form of vitamin D), normal magnesium levels, high alkaline phosphatase levels. I am coming to you because I cannot find a solution. Can ferritin, which is not in the optimal levels, hinder calcium absorption? Because I noticed that in my blood tests from when I was as a teenager when my ferritin was below 100 there was a high level of alkaline phosphatase. or maybe the gene that codes the protein transporting calcium is defective linked to an iron deficiency. I also thought it was linked to the malabsorption of fatty acids which chelated calcium in the intestine so I tried not eating anything for 2 days then taking calcium supplements but it didn't work. Thank you in advance for your answers.

[trents]

Welcome to the forum, @Allias!

May we assume you have been officially diagnosed with celiac disease? You do not address this at all but I assume you are a celiac since you are posting on a forum dedicated to that medical condition. Or, perhaps you are investigating the possibility of celiac disease as the reason for your poor calcium, folate, and iron absorption?

High Alkaline Phosphatase levels point to liver or bone disorders. Elevated liver enzymes are a common symptoms of celiac diease and, in fact, was what led to my own diagnosis of celaic disease over 20 years ago.

[Scott Adams]

Welcome to the forum. I just want to mention that B9 is a vitamin where too much can be toxic:

Vitamin B9 (Folate): The UL for Folic Acid is set at 1,000 mcg (1 mg) per day for adults. This limit primarily applies to synthetic folic acid found in supplements and fortified foods, not naturally occurring folate in food. High intake of folic acid can mask the symptoms of Vitamin B12 deficiency, which can lead to neurological damage if left untreated. This is because folic acid supplementation can correct anemia caused by B12 deficiency without addressing the underlying neurological damage. Some studies suggest that excessive folic acid intake might increase the risk of certain cancers, such as colorectal cancer, particularly in individuals who have precancerous lesions.

[knitty kitty]

Welcome to the forum, @Allias,

For the growth and maintenance of bones, more vitamins and minerals are needed than those you are taking.  

Bones need calcium, as well as magnesium and iron, but also trace elements like zinc, copper, selenium, manganese, and boron.  

Bones need vitamins like Vitamin D and Folate (not synthetic Folic Acid which the body doesn't utilize well), but bones also need Vitamin A,  Vitamin K, Cobalamine B12, Pyridoxine B6, Riboflavin B2, Choline B4, and Thiamine B1.  

High PTH and high alkaline phosphatase (ALP) levels may indicate a deficiency in Thiamine B1.  The enzyme Alkaline phosphotase combines with Thiamine to make Adenosine Triphosphate (ATP), the "energy coinage" used in the body which is required to build bones or perform any body function.  Increased levels of ALP and PTH are produced when there's not sufficient Thiamine to meet the demands.  Bones, the liver, the thyroid and the gastrointestinal tract can all make ALP when there's a shortage of Thiamine in each of those organs.  The gastrointestinal tract makes ALP when increased thiamine absorption is required.  Thiamine is needed to attach to calcium so it can be absorbed.  

Thiamine deficiency disorders include muscle spasms in muscles like the neck muscles, and neuropathy.  

What is your Vitamin D level?

Do talk to your doctor and nutritionist about supplementing with essential nutrients while recovering.

 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914453/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352179/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459027/

https://pubmed.ncbi.nlm.nih.gov/4003329/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568373/

https://pubmed.ncbi.nlm.nih.gov/36428888/

https://pubmed.ncbi.nlm.nih.gov/1156856/

https://pubmed.ncbi.nlm.nih.gov/38034619/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10398819/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451766/

Edited October 13 by knitty kitty
Typo correction

[Allias]

No, all this is related to calcium. Why would I then have a low ionized calcium level and a high PTH (hormone that controls the balance of blood calcium)? Your thiamine story doesn't hold up.

[Wheatwacked]

11 hours ago, Allias said:

normal vitamin D levels

high levels of parathyroid hormone (PTH) can indicate a vitamin D deficiency.

The "normal level" of 25(OH) D is 80 ng/ml (200 nmol/L). That is the level our body sets as it's normal limit when we don't limit sunshine.  For some people like me it takes 10,000 IU a day to maintain that.  Lack of enough sun and malabsorption of vitamin D orally.

 

[knitty kitty]

@Allias,

Do you have low magnesium levels?  

"The serum levels of parathyroid hormone and magnesium depend on each other in a complex manner. The secretion of parathyroid hormone by the parathyroid is physiologically controlled by the serum calcium level, but magnesium can exert similar effects. While low levels of magnesium stimulate parathyroid hormone secretion, very low serum concentrations induce a paradoxical block. This block leads to clinically relevant hypocalcemia in severely hypomagnesiemic patients. The mechanism of this effect has recently been traced to an activation of the alpha-subunits of heterotrimeric G-proteins. This activation mimicks activation of the calcium sensing receptor and thus causes inhibition of parathyroid hormone secretion. In addition to the effects of magnesium on parathyroid hormone secretion, parathyroid hormone in turn regulates magnesium homeostasis by modulating renal magnesium reabsorption. The distal convoluted tubule is of crucial importance for parathyroid hormone-regulated magnesium homeostasis."

Magnesium and the parathyroid

https://pubmed.ncbi.nlm.nih.gov/12105390/

 

[Allias]

yes my magnesium level is normal

[knitty kitty]

Magnesium is stored in your bones, just like calcium.  When you need more magnesium, the body can pull it out of the bones, so low blood magnesium levels might not be reflected.  Thiamine and magnesium work together... a deficiency in either one can affect how the other functions.

Thiamine is needed to regulate calcium ions.  

"Because the endoplasmic reticulum (ER) is the site of calcium ion storage, Thiamine Deficiency and oxidative stress can cause dysregulation intracellular calcium homeostasis and may induce ER stress."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568373/

Alkaline phosphatase levels increase in Thiamine deficient states. 

https://pubmed.ncbi.nlm.nih.gov/168690/

Thiamine is water soluble and nontoxic even in high doses.  There is no harm in trying it for several days and looking for improvement.  

How is your potassium level?  Potassium, calcium and magnesium work together to maintain a balance.  

What is your Vitamin D level?  Are you taking D2 or D3?

What are you eating?  How much of your diet is carbohydrates? 

Are you taking any prescription medications?  Other supplements?  Drink alcohol?

[Allias]

I have already tried thiamine supplementation with a supplement containing group B vitamins and therefore B1 with calcium cane changes nothing. No alcohol, I eat a normal amount of carbohydrates, my potassium, magnesium, sodium, total calcium levels are normal but not ionized calcium which is the active form of calcium in the body my vit d level is normal including the active form of vit d (calcitriol)

[knitty kitty]

What is considered "Normal" Vitamin D can range from 30 to 100 ng/ml.  Celiac people are better off with levels between 73 and 100 ng/ml.  Is yours in that range?

What form of Thiamine was in your B vitamins?  If it was thiamine mononitrate, which is not well absorbed nor biologically active, you would do well to take another form, like Benfotiamine.  In Thiamine Deficiency Disorders, higher doses of thiamine not normally seen in B Complex supplements are needed to overcome the deficiency.  

Benfotiamine can get into cells much easier, bypassing the thiamine/Folate transporters on the surface of cells in the body.  If there's thiamine deficiency, the transporters shut down, and Thiamine as well as Folate cannot get into the cells.  Taking Benfotiamine allows the thiamine to get into cells a different way, piercing through the lipid membrane of cells.  Once sufficient thiamine enters the cells, the transporters can become active again.  High doses of Thiamine are required to do this though.  High doses begin at a minimum of 300 to 500 mg/ day, three times a day.