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Can Chlorthalidone Cause Hypercalcemia?
Question: Hello sir/mam..I am XXXX ..age-26 years..I take chlorthalidone 12.5 mg and telmisartan 20 mg..medicine ctd-t 12.5/20 and my bp is under control..i was thinking about starting with cholecalciferol 400IU daily as a preventive measure for osteoporosis..My question is..1. will vit D3 cause over calcium build up in serum as calcium buildup is a side effect of thiazide diuretics?
2.I was also thinking about starting magnesium glycinate due to its high bioavailability at 100 mg dose..shall i start with Mg?
3.Can i take taurine to strengthen my heart muscle at 500mg daily as its known to enhance the contractility of heart muscles (myocytes) and ventricles and also calms the sympathetic nervous system which is upregulated in patients having HTN?
4.can i take coenzyme q10/ubiquinone at 30mg daily as its a component of the tca cycle which produces ATP inside mitochondria and research has shown it has antioxidant capacity to lower LDL cholesterol and also lowers systolic hypertension and strengthens myocytes?
I know these supplements are not regulated by FDA.Kindly help me in deciding whether i should consume it or not (especially taurine and co q10 as a lot of positive scientific journals have publications in their favour).Thanks and regards..XXXX.
2.I was also thinking about starting magnesium glycinate due to its high bioavailability at 100 mg dose..shall i start with Mg?
3.Can i take taurine to strengthen my heart muscle at 500mg daily as its known to enhance the contractility of heart muscles (myocytes) and ventricles and also calms the sympathetic nervous system which is upregulated in patients having HTN?
4.can i take coenzyme q10/ubiquinone at 30mg daily as its a component of the tca cycle which produces ATP inside mitochondria and research has shown it has antioxidant capacity to lower LDL cholesterol and also lowers systolic hypertension and strengthens myocytes?
I know these supplements are not regulated by FDA.Kindly help me in deciding whether i should consume it or not (especially taurine and co q10 as a lot of positive scientific journals have publications in their favour).Thanks and regards..XXXX.
Brief Answer:
please see details
Detailed Answer:
Dear Sir
1. Thiazides like chlorthalidone tend to cause hypercalcemia i.e. high calcium level in blood. Vitamin D3 supplement in a young male is justified only when there is a documented deficiency of vitamin D. In a patient replete with vitamin D there is no role of supplementation to prevent future osteoporosis. Rather, recommendation is to maintain normal vitamin D and calcium levels, Avoid smoking, moderation of alcohol, healthy diet and regular exercise. Thiazide diuretics themselves were found to favorably effect bone metabolism.
2. If someone takes more than required vitamin D3, toxicity may apper which may be more profound in presence of hypercalcemia. However, at what level toxicity appears and how severe it will be, varies from individual to individual.
3. Despite a number of positive studies in patient having weakness of heart muscle, there is no conclusive evidence of role of Coenzyme Q in patients with heart disease. Hence, our standard guidelines do not recommend their use. neither, there is recommendation for their use in healthy persons for prevention of heart disease.
4. Almost similar is the status of taurine. We do not recommend this for cardiac health in our practice, nor it is recommended by studies. The body of evidence available to support its use in mild hypertensive is too meagre to make a recommendation.
5. Magnesium should be supplemented only in documented cases of hypomagnesemia. Though Thiazides may cause hypomagnesemia, unmonitored supplementation is not recommended.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear Sir
1. Thiazides like chlorthalidone tend to cause hypercalcemia i.e. high calcium level in blood. Vitamin D3 supplement in a young male is justified only when there is a documented deficiency of vitamin D. In a patient replete with vitamin D there is no role of supplementation to prevent future osteoporosis. Rather, recommendation is to maintain normal vitamin D and calcium levels, Avoid smoking, moderation of alcohol, healthy diet and regular exercise. Thiazide diuretics themselves were found to favorably effect bone metabolism.
2. If someone takes more than required vitamin D3, toxicity may apper which may be more profound in presence of hypercalcemia. However, at what level toxicity appears and how severe it will be, varies from individual to individual.
3. Despite a number of positive studies in patient having weakness of heart muscle, there is no conclusive evidence of role of Coenzyme Q in patients with heart disease. Hence, our standard guidelines do not recommend their use. neither, there is recommendation for their use in healthy persons for prevention of heart disease.
4. Almost similar is the status of taurine. We do not recommend this for cardiac health in our practice, nor it is recommended by studies. The body of evidence available to support its use in mild hypertensive is too meagre to make a recommendation.
5. Magnesium should be supplemented only in documented cases of hypomagnesemia. Though Thiazides may cause hypomagnesemia, unmonitored supplementation is not recommended.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Hello Sir..I have gone through a lot of research on omega 3 fatty acids..many research suggests that consuming the essential fatty acids like DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) reduces triglycerides and is told to be taken at 500-1000mg daily.Since only ALA (alpha linolenic acid) is found in flaxseed (which I don't consume) and the other two forms DHA, which are found in high amounts in brain and retinal cell membranes and EPA which reduces depression and also has similar roles like DHA are found in tuna,salmon,etc.. which are impossible to get in XXXXXXX
1.can i consume a combination supplement containing both DHA and EPA daily?
2.can u suggest any antioxidants like grape seed extract and astaxanthin which have been found to reduce vascular dysfunction due to HTN and also increase the production of endothelial nitric oxide by neutralising superoxide free radicals and reduce the formation of AMDA (asymmetrical dimethyl arginine) which interferes with XXXXXXX production leading to artherosclerosis?can antioxidants be consumed along with conventional HTN medications like diuretics and angiotensin 2 receptor blockers?
1.can i consume a combination supplement containing both DHA and EPA daily?
2.can u suggest any antioxidants like grape seed extract and astaxanthin which have been found to reduce vascular dysfunction due to HTN and also increase the production of endothelial nitric oxide by neutralising superoxide free radicals and reduce the formation of AMDA (asymmetrical dimethyl arginine) which interferes with XXXXXXX production leading to artherosclerosis?can antioxidants be consumed along with conventional HTN medications like diuretics and angiotensin 2 receptor blockers?
Brief Answer:
No recommendation for omega3 fatty acids or anti-oxidants
Detailed Answer:
Dear XXXXXXX
1. As far as triglycerides and role of omega3 fatty acids is concerned in their reduction, they are recommended only to reduce triglycerides only when levels are more than 500-1000mg% as per various guideline. They do not have any protective role as precautionary step or as a supplement. And even at such high levels medicines are used not to decrease the cardiac risk but to reduce the risk of triglyceride induced pancreatitis. You may refer to ACC guidelines of 2013 on STATINS and NICE guidelines from UK published in 2014 on the issue.
2. No antioxidant, except for one you obtain from fruits, vegetables and those which are produced during exercise are found to be useful in preventing cardiac event. Guidelines from various international bodies on hypertension do not recommend use of antioxidants. Good control of blood pressure and various life style modifications is all that is recommended.
3. Non-pharmacological interventions for high blood pressure including moderation in salt intake, optimization of weight (Goal body mass index of 23 for Indians), daily exercise, meditation, use of nuts and legumes in diet. Moderation of alcohol intake and no smoking.
Sincerely
Sukhvinder
No recommendation for omega3 fatty acids or anti-oxidants
Detailed Answer:
Dear XXXXXXX
1. As far as triglycerides and role of omega3 fatty acids is concerned in their reduction, they are recommended only to reduce triglycerides only when levels are more than 500-1000mg% as per various guideline. They do not have any protective role as precautionary step or as a supplement. And even at such high levels medicines are used not to decrease the cardiac risk but to reduce the risk of triglyceride induced pancreatitis. You may refer to ACC guidelines of 2013 on STATINS and NICE guidelines from UK published in 2014 on the issue.
2. No antioxidant, except for one you obtain from fruits, vegetables and those which are produced during exercise are found to be useful in preventing cardiac event. Guidelines from various international bodies on hypertension do not recommend use of antioxidants. Good control of blood pressure and various life style modifications is all that is recommended.
3. Non-pharmacological interventions for high blood pressure including moderation in salt intake, optimization of weight (Goal body mass index of 23 for Indians), daily exercise, meditation, use of nuts and legumes in diet. Moderation of alcohol intake and no smoking.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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