Ask Mark …


Mark Mangus, RRT EFFORTS Board

Kay from Florida asks Mark if taking extra calcium helps with preventing osteoporosis.

Mark replies, Calcium is the mineral that is essential for building and maintaining strong bones. It helps muscles work and nerves carry messages between the brain and other parts of the body. It can be found in yogurt, milk, cheese, canned salmon and sardines, broccoli, kale and collard greens, and fortified cereals and juices.

Tums are an inexpensive means to take in calcium carbonate (200 mg to 400 mg per tablet). When calcium and magnesium are taken in one combination supplement, they compete with each other for absorption, reducing the absorption of both. If you look at the vitamin and supplement shelves at any store, you’ll see lots of combinations and choices of calcium supplements.

Ideally, calcium supplements should be taken separately from magnesium. Vitamin D and zinc must be taken or present in the diet to help with calcium absorption and metabolism. Most folks are more deficient in vitamin D than they are in calcium and take supplemental vitamin D at a dose of about 5000 IU/day.

Calcium and magnesium supplements have not been shown to help with strengthening bones, much less counteracting osteo- porosis. Most supplements are not in a form that is readily absorbed and utilized by the body. Calcium carbonate is the more common of the two main types of calcium supplements. You should eat something when you take it to help your body to best use it. It doesn’t matter if you take calcium citrate with or without food. When you compare products, check the labels to find out how much actual calcium you’ll be getting in a dose.


image059-1Cyndi from EFFORTS tells Mark that she‘s taken prednisone for over 20 years and wonders if she will ever be able stop it.

Mark responds, Prednisone, ordered to decrease inflammation, covers up your symptoms to feel better. Your symptoms are masked, they are still there, but you just can’t “feel” them. As you taper off Prednisone, your body starts to ‘ramp up’ production of cortisol, as you need to have a certain level in order for your body’s systems to function normally. The masking effect retreats and the symptoms that were there all along begin to increase. The most difficult part of coming off prednisone is that you have two choices: you can continue to taper and wait for your body to ‘get used’ to the return of ‘feeling’ the symptoms, such that you become ‘de- sensitized’ to their effects and severity, or you get down to a dose where the symptoms become so hard to tolerate that you have to increase the dose until you feel better again.

Your physician may have you decrease the dose much slower. We find that some folks

  • especially those who have been on predni- sone for a long time – must taper in smaller I’ve known many who got down to 10 mg and then had to drop 1 mg per week from there to stop completely. There is some degree of return of symptoms. By going so much slower, your body – and your mind for that matter – have a better oppor- tunity to get used to those symptoms before you further decrease the dose.

No one wants to learn that they will not feel as good “off” prednisone as they do when they are “on” prednisone. But, unfortunately, that is true with steroid treatment. That is also why so many folks end up on a contin- uous dose of a few to several milligrams of the drug, in many instances, for the rest of their life.

Steroids affect the adrenal glands which produce and regulate the hormone corti- sol, the body’s natural form of steroid and ADH (anti-diuretic hormone) which regulates sodium and water balance in the body.

While taking steroids, your adrenal glands will reduce or stop production of cortisol. If you suddenly stop taking prednisone at high doses – after taking it for more than a week or two, you might induce a crisis where the adrenal glands are unable to start producing cortisol and ADH production is affected. This can affect your blood pressure, sodium levels and your body’s water balance.


Major and Minor Side Effects of Prednisone

Major Side Effects

  • Increased blood sugar for diabetics
  • Difficulty controlling emotion
  • Difficulty in maintaining train of thought
  • Weight gain
  • Immunosuppression
  • Facial swelling, severe
  • Depression, mania, psychosis or other psychiatric symptoms
  • Unusual fatigue or weakness
  • Mental confusion/ indecisiveness
  • Blurred vision
  • Memory and attention dysfunction (Steroid Dementia Syndrome)
  • Abdominal pain
  • Peptic ulcer
  • Painful hips or shoulders
  • Steroid-induced osteoporosis
  • Stretch marks
  • Insomnia
  • Severe joint pain
  • Cataracts or glaucoma
  • Anxiety
  • Black stool
  • Stomach pain or bloating
  • Severe swelling
  • Mouth sores or dry mouth

Minor Side Effects

  • Nervousness
  • Acne
  • Skin rash
  • Appetite gain
  • Hyperactivity
  • Increased thirst
  • Frequent urination
  • Diarrhea
  • Reduced intestinal flora
  • Leg pain/cramps
  • Sensitive teeth
  • Headache
  • Induced vomiting


Mark Mangus RRT, BSRC, is a member of the Medical Board of EFFORTS (the online support group, Emphysema Foundation For Our Right To Survive, www.emphysema. net). He generously donates his time to answer members’ questions.