Hi All. I was told by my Medical Oncologist to take Vitamin D. I’m starting biphosonate infusion with my next chemo.
Hi Chirpy bird,
I have been on vit D for several years after my GP decided to test my levels one day. (I was an office worker). When I was admitted for my lumpectomy, they clearly tested my blood, and without saying anything to me, my dosage was increased from 800UI to 1000UI daily. Clearly it is something that is on the radar for some surgeons. I am due to have a bone density scan but have been told that could be in a few months, during which time I will be taking letrozole. x
After 3½ years on anastrozole, I've just started taking alendronic acid once a week. I had a blood test but my GP hasn't prescribed vit D or calcium. I have taken cod liver oil capsules for years and also eat quite a lot of dairy because I don't particularly like meat so looks like I'm getting enough from my diet.
you don't take calcium tablets at the same time as bisphosphonates. Usually bisphosphonate is first thing i the morning, then calcium at lunch and teatime. But very common to be on both. (I'm a GP)
Ktk, I don't think there is any objection to taking Vit D tablets (on their own) with bisphosphonates. That's what I"m doing, my Consultant Medical Oncologist and BCN both know this and have advised this to continue.
As for not having Ca tablets with bisphosphonates, this doesn't ring true. I would imagine you are advised not to self-medicate, as Ca levels must be within a certain range: too high or too low and you can be quite ill. If you take Ca tablets, I would think it's important to have them on prescription, or at least on the advice of your doctor/oncologist, and to have regular blood tests.
Bisphosphonates slow down bone turnover as they control the osteoclasts that are responsible for this. That slows down release of Ca from the bone into the blood steam, which can lead to very low Ca levels in your blood if your intake of Ca is low anyway. Patients having bisphosphonate infusions have to have a blood test before each infusion to check their Ca level is appropriate. It it's too low, they can't have the infusion and are prescribed Ca tablets to bring the level up. Taking Ca tablets if the level in your blood is normal is not, I would think, advisable.
If you don't trust your doctor's advice on this, you could ask a pharmacist, preferably one dealing with cancer treatments. It is part of a pharmacist's job to advise doctors on drug usage.
I take a combined vit D and calcium tablet twice a day. I had a dexa scan done before I was diagnosed with bc, which was lucky as my oncologist was able to see that I have osteoporosis in the spine so instead of putting me on letrozole I was put on tamoxifen as it is kinder to the bone density. I have these repeated every two years now, having recently had one which showed that everything is stable so it is obviously working
Here is a useful article on Vitamin D from Breast Cancer Care.
When to consider a vitamin D supplement.
Published 13 Sep 2016
Recently, there have been media reports about new Public Health England guidelines on vitamin D. This vitamin is an exception to the rule that most people will get enough of the vitamins they need through eating a varied diet.
Vitamin D isn’t found very widely in the diet. Instead, it is mostly made in the skin through exposure to ultra-violet light. This is why it’s sometimes called the sunshine vitamin and why you get less vitamin D in the winter months in the UK.
Foods that contain vitamin D include oily fish, egg yolk, liver, red meat, butter and fortified fat spreads, and some fortified breakfast cereals.
Vitamin D is vital for good bone health because it allows you to absorb two essential minerals, calcium and phosphate. These two minerals help to build and repair bones and teeth.
It’s thought that around one in five adults in the UK may have low levels of vitamin D although a lack may not cause symptoms. It’s thought that symptoms such as aching muscles, joint pains, or tiredness and depression are sometimes caused by having too little vitamin D.
There are some risk factors and groups of people more likely to be deficient in vitamin D. These include:
In the UK, sunlight is only strong enough to make vitamin D on exposed skin in the middle of the day during April to September. Also, the further north you live, the less you are likely to be exposed to enough ultra-violet light in the summer.
Previously, only children and adults over age 65 were recommended to take a daily vitamin D supplement. In July 2016, the Government’s Scientific Advisory Committee on Nutrition recommended that all adults should consider taking a daily supplement of 10 micrograms of vitamin D from October to March, as it may not be possible to absorb enough of the vitamin during the winter months.
It’s not advisable to take more than the recommended amount of vitamin D as an excess can lead to a build-up of calcium, causing serious ill-health.
Although the benefits of sunlight for vitamin D production are clear, it’s difficult to know exactly how much exposure you need. Also, excessive sun exposure increases the risk of skin cancer, so it’s important to enjoy the sunshine safely.
If you’ve had axillary node surgery you should take particular care to avoid sunburn, as this could trigger lymphoedema (a swelling of the arm, hand or chest area).
Women whose cancers are sensitive to the female hormone oestrogen may be offered a hormone therapy called an aromatase inhibitor (AI). AIs reduce the amount of oestrogen in the body which, in time, may lead to a loss of bone density (osteoporosis). So it’s likely that your specialist will arrange a scan to check your bone density before starting an AI and at repeat intervals while you are taking it. Depending on the findings of scans you may be recommended to take a supplement of calcium and vitamin D to help protect your bones. In this case, you probably won't need to add an additional supplement but if you are unsure, talk to your specialist.
If you’re concerned about whether you’re getting enough vitamin D you can talk to your specialist team or your GP about whether to take a supplement.
If you’re currently receiving treatment or taking a drug prescribed for another condition, it’s always best to check with your specialist or GP before taking any supplement, as some supplements may interact adversely with prescription medicines.
So there we have it. I'm off for tea now with semi-skimmed cow's milk and Wensleydale cheese to boost my Ca levels.
Ah Ha, Chirpy Bird; indeed, I do have some thoughts on vitamin D.
Some years ago, I asked my GP to test my blood for vitamin D level, partly because of chronic fatigue. It came out at rock bottom. I had not at that time had any falls that had produced fractures, but there was clearly a risk. So, I am now prescribed Colecalciferol 800IU tablets, one daily, for eternity. Subsequent blood tests have shown my Vit D level to be normal. This was all before BC appeared.
Vitamin D on my list of medications has impressed my oncologist, who has also put me on Bisphosphonate (Zoledronic acid) infusions every six months, and initially Letrozole (came out in a nasty rash), followed by Anastrozole. (The Anasty is now causing trouble, it seems, so that is being investigated. I shall report back in due course.)
D is a vitamin you can have too much of if you don't need it, so you could chirpily ask your GP about it! X