Kidney Stones as a result of TOO MUCH calcium & vitamin D

I have kidney stones (ouch!) I’ve been reading and discovered that they are often caused by too much calcium and vitamin D. Well, gee, that makes sense because we take mega doses of calcium and vitamin D…

So, those who’ve had stones, was it a chronic problem? Did you have to lower any vitamin doses? How were your stones treated?

Jenn

As you said the studies are talking mega doses for normal people. I doubt there's a study on mega doses for DSrs. Maybe RNYrs...who knows?  Our safest bet is to continue to go by our labs, have consistent and timely follow-ups with our docs, and use the most absorbable forms of calcium (citrate, until something better is decided) and D (dry D3).

I see as many RNYrs in the small population on the lightweight board having kidney stones as I see here on the DS board with a much larger population. I have a feeling what I might be seeing is pre-existing issues coming about as we get older regardless of having WLS or mega dosing.
Gina

Wait!  Wait!  Wait!    Where did you learn this from?   I'm wondering.....there are several causes and types of kidney stones.   
I've been seeing an endocrinologist for hyperoxaluria - too high of a level of oxalates in the system.    Hyperoxaluria is the MOST COMMON cause of kidney stones and kidney failure in WLS patients who have had malabsorptive procedures done.   Hyperoxaluria goes hand-in-hand with HYPOcalciremia - too low of a calcium level.   Have you had your D and calcium tested, and a 24-hour-calcium urine clearance test done for calcium and oxalates?    What are they?  If you haven't, you really, really, REALLY need to be tested for this.  

My D was an 8 when I went to see an endo doc.   He did a calcium clearance test and found out my oxalates were sky high, and my calcium was non-existant.  I am now taking 7,000 mg of calcium a day, 150 k IU of D a day and following a low oxalate diet.    I have to take my calcium with meals, because it binds to food as it is passing through the small intestine.   I have successfully brought my D up to a 42 and still climbing, my PTH down and my calcium just within the acceptable lowest range serum-wise.  It's still low in my urine and I'm still spilling oxalates, but those have come down.     If you google "hyperoxaluria+bariatric surgery" you will find some good explanations of why this is so.    I really, really doubt that yours is from too much calcium, and I hope that others don't become alarmed at the heading of this post and decide they need to cut back on their supplements.

Julie,
Do you think the studies' high incident rates have anything to do with the early WLS patients being on calcium carbonate, if anything at all?
Gina

Let me see if I can explain this based on my layman's knowledge.  I posted this a couple of months ago in answer to an earlier query.

"I have enteric hyperoxaluria.   It's fairly  common in individuals with various types of malabsorption, including WLS.    The basic mechanism is competition for calcium, the leading oxalate binding agent.  Bile salts are absorbed in the proximal intestinal tract.   When this doesn't happen, calcium and magnesium bind to the bile acids, and I think it becomes a combination of fat and alkali.    My endo doc described it as similar to making soap.   This leaves very little calcium available for absorption in the lower intestinal tract.   Dietary or supplemental calcium becomes bound to fatty acids instead of to the oxalate, which makes the oxalate just kind of float around in there and greatly increases oxalate absorption in the small bowel.   So my urinary oxalate is super high, and my calcium is super low.    Supplemental calcium will bind with all of this free intestinal oxalate, but I have to take a great deal of it, to increase the chances of it binding.   The hope is that as this slurry of digestive matter is passing through, all of this calcium will attach itself to the oxalates, and that it will grab what it can.   The high amounts of calcium I am taking are just as much for the hyperoxaluria as for my bone health, if not more so.   When you are talking not being able to absorb more than 500 mg at a time, that's for your bones.    So I'm taking 1800 mg at a time at least, with each of my three main meals.    The more I can push into my digestive tract at a time, the higher concentration of calcium in this "slurry." 

Doctors saw a huge increase in hyperoxaluria and kidney failure in JIB patients.    It's one of the reasons they stopped doing the JIB.  However, it is still present in RNY and DS patients.  I believe I read that hyperoxaluria occurs in 10% of malabsorptive patients.    It IS reversible, but most research out there warns that all patients should be vigilant about monitoring their labs for this.  By the time low calcium shows up in the serum, it's too little too late.  That's why the really only accurate way to monitor this is to have a urine clearance test.  Vitalady can back me up on this one  -she's got the same issues going on.

Don't have any kidney stones, do not have calcium issues and my extremely low tanked vitamin D level has been within normal range and trends since being 6 motnhs post-op. I strictly and ONLY follow my surgeon's and endocrinologist's vitamin and supplement regimen as a DSer and also strictly based on my blood results. With their regime that we work out together since the beginning, I never had any issues or low values in any of my blood levels and I am now almost 3 years post-op. My DS surgeon told me to eat food daily that has high value of nutrients in it, especially vitamin A, calcium, and the others. That is what I have dones since being 3 months post-op.

He told me taking megadoes of calcium is ok for us DSer, because calcium is the biggest issue we have with malabsorption of, and can take from 1500-2000mg daily in calcium supplement that is a high amount, but, as DSer we need it and consider a normal daily dosage for us. I get the additonal calcium from food such as drinking milk and eating food daily that also has calcium.  This does help alot and also prevent osteoporosis from developing. He told me don't go over 2500mg of calcium a day, unless I am showings trends with my bloodwork that warrant for me to take more and that depends on other things and with careful medical guidance. He told me repeatedly, do not take more than 10,000IU max of vitamin D daily or do not take more than 50,000IU vit D a week, if I have normal levels. I have been pounded on this by both of my physicians. My Ds surgeon have warned me from the start when I had my surgery that all I needed due to my tanked vitamin D level was 50,000IU a week and it take a few weeks to have it go up and he was absolutely right! His main concern was Vit D causes the excessive calcium we are suppose to absorb to leak out and instead of getting deposited to our bones, it can't handle to absorb anymore and starts to leak out and leech onto the soft tissues that is kidney and other muscles known as calcification and may lead to kidney stones.

So, right now with my PCP who is a endocrinologist, we have been debating over taking 5,000 IU a day which I am not comfortable with or taking my choice 10,000 IU a day of vit D, which I prefer and considered a safe level for me. So, we are carefully monitoring this to make sure it does not cause any issues, which I hope doesn't since my DS surgeon said this was a safe and ok level for me to take daily with no deficiencies and never had any deficiencis developed because I followed my DS surgeon's supplement regime. I told my PCP, I want to stick with 10.000 IU a day and he finally ok'ed it. I was originally pushing for 20,000-25,0000IU a day, but he said no, I am do not need that amount. He kept telling me, I do not have any deficiencies in vitamin D, calcium or any other levels that I need to take so much and he told me to play it safe and not let it cause any underlying issues because I suddenly want to take more than he is requesting. So, I am now taking 10,000IU a day that comes out to 70,000IU a week. That is how he calcuates it, daily and per week. I was on 50,000IU once a week for 2 1/2 years. So, we will see how this turns out. Only thing is, he is very strict to how much vitamin D I take into my system and what it does. In addition, to work calcium into our system and not let it leech to go the soft tissues, calcium works with co-factors suppplements to work correctly to get absorb into our bones, does help prevent kidney stones and calcification from happenign and that is what I am also taking - magnesium, boron, zinc and vitamin K2.

 Do you mind if I ask currently what your vitamin level is?

These are the recent results. Bare in mind, I focus most of my food intake around not only high protein, but food that is high in vitamins, minerals and omega 3 since I was 3 months out and still do. I have eaten for almost 2 years straight 3-5oz grill salmon for breakfast daily, drank 1 quart of milk daily, 1-2 cups of yogurt daily and added fresh strawberries to it, regardless what flavor is the yogurt, and every day ate some sort of (8-9oz overall total daily) red meat whether steak, ground beef, etc. If not red meat, seafood. All this has helped me alot with absorbing nutrients, as well as take my daily supplements.

Total Protein 7.2
albumin  4.1
Pre-Albumin 31
AST  34
ALT  49
Vit A 84
Vit D 71
Calcium 9.3
PTH 54
B1 46
B6 12.8
B12 724
zinc 132

I started taking the Wellesse 1/4 cup 2x a day that equals 10,000IU total of liquid vit D3 daily to take a few days and on other days take the pill form of D3 10,000IU a day. I hope this will continue to keep my blood results at a steady level. I have also started taking Floradix liquid iron on a daily basis. I am beginning to slowly gain some weight back and that is what I wanted. It is not easy to gain weight for me, but want to go back to 140 lbs in which I felt comfortable at..

BPD/DS results in increased oxalate production in the intestines, and the easiest way to address this (easier than following a low-oxalate diet) is to take calcium carbonate (i.e. Tums) with meals. Calcium carbonate is not that well absorbed in weight-loss surgery patients, which is okay if you are taking it to reduce calcium oxalate stones. It binds to the oxalate in the intestines, making it less absorbable and, therefore, less likely to form stones.

John D Husted, MD

Dr Husted,
again thank-you for your expertise views/ advice and comments here.

I  read  this over and over  and due to my pre-op labs  8  level  on my D . I did take the advice and take 50k IU  Vit D3  daily  will do so  until  MAY (approx)  surgery date.

I sure do not want to form and kidney stones. So  my questions is  ... if I would   take  tums with my meals would it  prevent  stones from forming since I am taking a huge dose of  D?

I only ask this because of the 50k IU of Vit D that I started recently.

Thank-you,
Rose