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High FSH, low calcium. What next?

17 replies

Threeisme · 12/05/2021 22:49

Just had a phone consultation with GP. FSH was 38 (No idea what it should be?) Calcium was very low. I'm mid 40s - she suggested HRT straight away via patch or gel but has also prescribed calcium supplements in the meantime. I'm so confused and didn't ask anywhere near enough questions. Will the supplements alone do anything? Is this perimenopause or actual? I have a mirena but still have periods every few months. She kept alluding to my age and it being too early but is it?

OP posts:
Cormoran · 13/05/2021 01:28

You need vitamin K2 together with vitamin D to ensure calcium goes in your bones (and teeth) and not your arteries.

FSH indicated reduced fertility. If this is you or a sign of menopause is more complicated.
If you have more questions, book a consultation.

What prompted the blood test in the first place? Do you have any other sign? Feeling hot when nobody else seems affected? Poor sleep? Vagina dryness ?

JinglingHellsBells · 14/05/2021 13:35

@Threeisme

Just had a phone consultation with GP. FSH was 38 (No idea what it should be?) Calcium was very low. I'm mid 40s - she suggested HRT straight away via patch or gel but has also prescribed calcium supplements in the meantime. I'm so confused and didn't ask anywhere near enough questions. Will the supplements alone do anything? Is this perimenopause or actual? I have a mirena but still have periods every few months. She kept alluding to my age and it being too early but is it?
@Threeisme There is quite a lot here in your post.

First, what was the reason for the blood tests? What symptoms do you have? What makes you think you are menopausal?

It's pretty easy to find FSH levels online for a) fertile women and b) women post menopause. From memory, I think 38 is in the post meno range BUT

1 a single blood test for FSH is not accurate. You need two tests on 2 months, each done on days 2-5 of your cycle.
Was this done?

2 Low calcium can be caused by many things, such as coeliac disease or thyroid issues. It's not just due to not eating enough calcium. It needs further assessment not simply supplements. Do you avoid dairy in your diet or have digestive issues? That's the starting point. Research shows that adding calcium as supplements is not always the right thing to do depending on the reasons for it.

3 You ought to be able to get all the calcium needed in your diet. 700mgs for peri meno and 1000mgs daily for post meno women.

4 Vitamin K- the NHS website advises not to use supplements. You ought to be able to get enough in your diet. The amount needed is 1mcg per kilo body weight. Green veg like spinach has masses, as does broccoli . There are some tables online showing food values for Vit K.

Threeisme · 14/05/2021 22:29

Thank you both for your comments. I definitely need to book another appointment to ask more. I'd filled out an online form to my gp re menopausal symptoms - brain fog, anxiety, dryness, night sweats. I was asked to go for a blood test (just one, no idea what day in my cycle as I have a mirena) then the gp called me. Caught me off guard, at work, and I didn't take it all in. I was sent a link to menopause matters, told that a prescription was at the chemist and to call back if I wanted the HRT.

OP posts:
Cormoran · 15/05/2021 01:47

K1 comes from leafy green K2 doesn’t ( food sources are fermented foods) and it is K2 that you need to fix calcium in bones and not arteries.
Spend some time
On pubmed and you will drown in medical studies. On the crucial importance of K2. There is 10 to 15 years gap between research and change of protocols.

JinglingHellsBells · 15/05/2021 07:55

@Cormoran

K1 comes from leafy green K2 doesn’t ( food sources are fermented foods) and it is K2 that you need to fix calcium in bones and not arteries. Spend some time On pubmed and you will drown in medical studies. On the crucial importance of K2. There is 10 to 15 years gap between research and change of protocols.
Are you a nutritionist? @Cormoran What surprises me is if this is true, why aren't drs saying the same thing? I have three friends using Adcal prescribed by drs for their bones. It doesn't contain Vit K and neither do products OTC. I agree that the NHS can be woefully behind with its advice but even so... I know there is advice that calcium supplements can be harmful to arteries and that calcium should come from diet, ideally.

Going back to the OP, 'low calcium' is something that needs investigating to see if it's purely down to diet, or if there are other things going on that prevent it being absorbed.

Cormoran · 15/05/2021 11:09

Look it up, start here
pubmed.ncbi.nlm.nih.gov/32219282/
pubmed.ncbi.nlm.nih.gov/32244313/
pubmed.ncbi.nlm.nih.gov/31711322/
and 230 more studies which I let you judge by yourself.

K2 has been in the national health recommendation in Japan since 1995 and part of the protocol for the prevention of osteoporosis.

One must be specific and not just say vitamin K, because K1 (phytonadione) ) and K2 (menaquinone) are different and are co-factors in different genes, cellular pathways, proteins .

For bones, it is K2 . Reason why there are so many supplements now that combine calcium-K2-vitamin D, mixing them in one combination or the other.

JinglingHellsBells · 15/05/2021 11:31

It's not good then is it @Cormoran that drs are still giving women Adcal?
They clearly don't know about this.

It might be happening in Japan, but not in the UK!

I also can't find any supplements in the UK that include Vit K along with calcium- any ideas?

Cormoran · 15/05/2021 11:39

uk.iherb.com/search?kw=K2

JinglingHellsBells · 15/05/2021 11:43

Just for info, after some research, this paper from Cambridge includes trials on Vit K through diet- so leafy green veg- and shows improvements in bone density.

]]www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/importance-of-calcium-vitamin-d-and-vitamin-k-for-osteoporosis-prevention-and-treatment/C30A29EDA3064CC8313079BAF4C486C6]]

Cormoran · 15/05/2021 21:00

Seriously, you never heard of the role of K2 for bone density, you do a 10 min google search and come back to educate me on vitamin K with an outdated 2008 paper.
All nutrients have a role on multiple pathways as illustrated by this image.

Nutrition is an evolving science. We learn things everyday . You learnt something today.

High FSH, low calcium. What next?
JinglingHellsBells · 15/05/2021 21:32

What's your professional training @Cormoran?

I'm happy to listen and learn so do carry on with info which you clearly have- as a layperson or a professional?

I perhaps know more than you think. The Royal Osteoporosis Society is a very reliable source. They mention Vit K but do not recommend supplements. I didn't do a quick google, but spent a lot of time looking at various research papers. The jury is still out on supplementation so it's not as absolute as you say. No one I know being treated by consultants to osteoporosis is on it. I wonder why?

JinglingHellsBells · 15/05/2021 21:54

@Cormoran I thought you may like to read this from the Royal Osteoporosis Society which is THE expert society in the UK on bone health.

theros.org.uk/media/v2pdyew4/ros-further-food-facts-and-bones-fact-sheet-december-2019.pdf

What are the benefits of vitamin K for my bones?
Vitamin K ‘turns on’ a protein called osteocalcin
which is necessary for bone building and bone
healing. Some studies have shown that people with
low intakes of vitamin K have lower bone density
and a higher risk of fractures, although results have
been varied and inconsistent. Vitamin K deficiency
is usually a consequence of a medical condition
which affects the absorption of food such as
Crohn’s or coeliac disease or severe liver disease.
Which foods contain vitamin K?
Vitamin K is present in commonly-eaten foods
and is easily absorbed. There are different forms
of vitamin K, with vitamins K1 and K2 being the
main ones. Vitamin K1 is obtained mainly from
plant sources, and vitamin K2 is produced from
some animal products and through the action of
naturally-occurring bacteria present in the gut.
These gut bacteria are involved in helping the body
produce, break down, convert and absorb different
types vitamin K.

Vitamin K1: is found in green leafy vegetables,
broccoli, spinach, cauliflower, asparagus, okra,
parsley, fruit, cereals and vegetable oils. Smaller
amounts are in meat, eggs, dairy and cheese.
Vitamin K2: most is provided by the bacterial flora
of the gut. It’s also found in fish, meat, liver and
eggs, soy foods and some fermented dairy, such as
cottage, ricotta, brie and Gouda cheeses, yoghurt
and Kefir (fermented milk). In general the UK diet
is not rich in vitamin K2. Japanese diets contain
higher amounts largely due to ‘Natto’ (a Japanese
dish of fermented soya beans).

Should I take a vitamin K supplement?
Evidence on the effects of vitamin K supplements
on bone health and strength isn’t strong, so
currently supplements are not recommended.
Studies have shown that a diet rich in vitamin K
foods is linked to lower risks of hip fractures in
older people, however taking vitamin K1 or K2
supplements did not always result in improved
bone strength.

I’ve read that vitamin K2 supplements may have a beneficial effect linked to taking calcium supplements. Is this true
It’s been suggested that vitamin K2 may play a
part in keeping blood vessels healthy and help to
prevent calcium build-up in arteries. So far, the
studies on this are inconclusive so at the moment
vitamin K2 as a supplement isn’t recommended.
Is there anything else I should know
about vitamin K?
Vitamin K also has a role in blood clotting and
so foods that contain high amounts of vitamin K,
such as liver and broccoli, can affect the action of
anticoagulant (blood thinning) medications such as
warfarin, and make them less efficient. Don’t leave
out these foods if you are taking an anticoagulant,
just make sure that you have a regular and constant
amount. This will help to ensure that vitamin K
levels in the bloodstream are fairly constant and
your blood will clot normally. If you are taking
warfarin, you shouldn’t take a vitamin K supplement
or make any major changes to your diet.

As I posted, in the UK the jury is still out on supplementation.

Maybe in other parts of the world it's a different treatment.

All very interesting.

Cormoran · 15/05/2021 22:00

@JinglingHellsBells

What's your professional training *@Cormoran*?

I'm happy to listen and learn so do carry on with info which you clearly have- as a layperson or a professional?

I perhaps know more than you think. The Royal Osteoporosis Society is a very reliable source. They mention Vit K but do not recommend supplements. I didn't do a quick google, but spent a lot of time looking at various research papers. The jury is still out on supplementation so it's not as absolute as you say. No one I know being treated by consultants to osteoporosis is on it. I wonder why?

Why? Easy. Because UK is so behind in healthcare compared to other similar income countries, reason why UK has also a shorter life expectancy and worse outcome in several countries. www.bmj.com/company/newsroom/uk-health-service-lagging-behind-other-high-income-countries/

This discussion has moved from the original OP's question and I think it has gone off-track enough.
You want to have a discussion about K2, start one in general Health, and maybe we can even touch the role of microbiome on bone health while we are at it, the epigenome and so on. It is fascinating.

JinglingHellsBells · 16/05/2021 09:47

@Cormoran You are being very rude about the UK! It's not that long ago that Australia allowed women to use the better types of hrt that have been available in the UK for many years.

FYI the medical advisor/ director of the Royal Osteoporosis Society has recently been awarded an MBE for his lifelong services to the treatment of osteoporosis and is actively working with patients now. In the UK Vit K is not recommended and it's nothing to do with 'ignorance'.

Cormoran · 16/05/2021 22:27

Why am I rude? It is not me saying it but the British Medical Journal,

"The UK had slightly below average life expectancy (81.3 years compared with an average of 81.7), the lowest survival rates for breast and colon cancer, and the second lowest survival rates for rectal and cervical cancer, maternal death in the UK was higher than average, and is increasing, while the numbers of preventable and treatable deaths were the third highest and highest respectively. "

So is the BMJ it is rude or science-base?

Cormoran · 17/05/2021 05:28

@Threeisme

Thank you both for your comments. I definitely need to book another appointment to ask more. I'd filled out an online form to my gp re menopausal symptoms - brain fog, anxiety, dryness, night sweats. I was asked to go for a blood test (just one, no idea what day in my cycle as I have a mirena) then the gp called me. Caught me off guard, at work, and I didn't take it all in. I was sent a link to menopause matters, told that a prescription was at the chemist and to call back if I wanted the HRT.
@Threeisme in order to bring the discussion back to you and your questions, there is a great book I recommend www.amazon.co.uk/Oestrogen-Matters-Hormones-Menopause-Well-Being/dp/0349421773/ref=sr_1_1?dchild=1&keywords=Avrum+Bluming%2C&tag=mumsnetforu03-21&qid=1621225268&sr=8-1 and in alternative to buying it you can listen to a very interesting podcast of the authors with Peter Attia here peterattiamd.com/caroltavris-avrumbluming/ like all Peter Attia's episode it is long 2 hours + but I highly recommend it.

Of course you deserve better than an awkward phone call while you are at work and they shouldn't just ask if you want HRT or not, but have a discussion about this new chapter in a woman's life and how to feel good (and even great! ) in the transition.

My apologies that the discussion derailed into the benefit or not of vitamin K2, I hope it stays ontopic from now on.

JinglingHellsBells · 17/05/2021 08:58

@Cormoran Going back to basics on the OP's thread, you were the first to reply to her and tell her she ought to take Vit K to prevent arterial plaque build-up. This is not medical advice in the UK and could in fact be dangerous to supplement if not necessary and when mixed with other drugs (see ROS advice).

If you lived in the UK you'd be aware there is often a political slant to the BMJ's views as it's journalism .

I wanted you to read the advice of the Royal Osteoporosis Society on Vitamin K. That was my 'why' question for you :) You have ignored all of that information.

The ROS is led by world experts on bone health and anyone asking for advice should listen to them. :) or even call their help line for advice.

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