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Results for : "calcium"

Calcium Lab Results

June 05, 2018 3:26 pm

Calcium is measured to evaluate function and adequacy of a physiologic processes. Calcium plays a critical role in several body functions such as, coagulation pathways, bone health, nerve conduction, and other functions. It is important whenever you are evaluating laboratory results that you look at the whole picture of the person, including medications, other laboratory studies and health history.  One value is not a stand alone result.  There are many factors that effect calcium results.

Factors that effect calcium results: (not an all inclusive list)





Vitamin D deficiency

Magnesium depletion


Renal Disease




The two most common issues following Weight loss Surgery  or Duodenal Switch may be albumin level and Vitamin D level.  Please see past blogs on Vitamin D. Magnesium may also play a role in a Duodenal Switch patient.

The most common calcium result drawn is the total calcium level. Laboratory results may not explicitly label it as such, however, it measures the calcium that is bound to protein. Ionized calcium is the free calcium that is representative of the true total calcium. Ionized Calcium can be measured by ordering specific lab. Alternatively, the Ionized calcium can be calculated by the following formula: Corrected calcium mg/dL = (0.8 * (Normal Albumin – Pt’s Albumin)) + Serum Ca  ) or use the calculator at the bottom of this post.


The low Albumin level accounts for the low calcium level. This may be the reason for a patient with a low albumin/protein level, also having their calcium level reported as low. However, when adjusted for the protein deficiency the corrected calcium comes into normal range. Video of Trouseau’s sign of a patient with calcium deficiency. Calcium bound to albumin Keshishian

The first step in a patient who has low calcium reported, is to make sure their protein and albumin levels are normal, along with Vitamin D.

Calcium levels are managed by two processes major regularly hormones and  influencing hormones. Controlling or major regulatory hormones include PTH, calcitonin, and vitamin D. In the kidney, vitamin D and PTH stimulate the activity of the epithelial calcium channel and the calcium-binding protein (ie, calbindin) to increase calcium absorption. Influencing hormones include thyroid hormones, growth hormone, and adrenal and gonadal steroids.

Further information on protein.

Further information on calcium. 

Videos/Webinars on several of the above topics.

calcium metabolism
Duodenal Calcium Metabolism

Corrected calcium = 0.8 * (4.0 – serum albumin) + serum calcium

Corrected Calcium Level Calculator

Calcium May Cut Cancer Risk

March 06, 2009 11:10 am

Calcium May Cut Cancer Risk

Higher Calcium Intake May Reduce Risk of Colorectal and Other Types of Digestive Cancers
Here’s yet another reason to bone up on calcium. It may help reduce your risk of cancer. A new study shows that older men and women who got the most calcium from food and supplements had a 16% lower risk of colorectal and other cancers of the digestive system than those who got the least calcium.

Among women, those cancer-fighting benefits were even stronger. Women who got the most calcium from food and supplements had a lower risk of all cancer and a 23% lower risk of cancers of the digestive system than those who got the least.

Calcium is already known to boost bone health, but researchers say previous studies on calcium’s effect on cancer have produced mixed results.

“Our study suggests that calcium intake is associated with a lower risk of total cancer and cancers of the digestive system, especially colorectal cancer,” write researcher Yikyung Park, ScD, of the National Cancer Institute and colleagues in the Archives of Internal Medicine.

Calcium May Lower Cancer Risk

The Institute of Medicine recommends 1,200 milligrams of calcium per day for men and women over age 50. Dietary guidelines also call for adults to eat three cups of fat-free or low-fat dairy foods, such as milk, yogurt, and cheese to meet their daily calcium needs. This does not include conditions or diseases that my limit the absorption of the Calcium such as weight loss surgical procedures.

One 8-ounce serving of skim milk or yogurt contains about 300 milligrams of calcium. Other nondairy sources of calcium include beans, broccoli, spinach, and other green, leafy vegetables.

In the study, researchers analyzed data from nearly 300,000 men and 200,000 women 50 to 71 who participated in the National Institutes of Health-AARP Diet and Health Study. Participants answered a questionnaire about the foods and supplements they ate, and cancer rates were linked through state cancer registries over seven years of follow up.

The results showed that total calcium intake was not associated with a lower risk of cancer in general in men, but women who got up to 1,300 milligrams of calcium per day had a lower risk of cancer overall.

However, total calcium intake from both food and supplements was linked to a lower risk of colorectal cancer and other cancers of the digestive system in both men and women.

Men who got the highest levels of total calcium per day through food and supplements had a 16% lower risk of these cancers than those who got the least amount per day. Women who get the most calcium per day had a 23% lower risk than those with the least reported intake per day.

Researchers conclude that “our findings suggest that calcium intake consistent with current recommendations is associated with a lower risk of total cancer in women and cancers of the digestive system, especially colorectal cancer, in both men and women.”
SOURCES: Park, Y. Archives of Internal Medicine, Feb. 23, 2008; vol 169: pp 391-401.

Opinion and Commentary: The above two articles that were taken from internet sites, reflect the continues and ever evolving nature of the science behind most of the recommendations made.
Just imagine the treatment of a patient with a disease process. Almost certainly the surgical and medical treatment that may have been recommended years ago may not be an option today.
This is why it is important for us, providers and patients alike to continue to stay vigilant with our surveillance of our health condition and adapt to any pertinent information that may have an impact on it. One of the most commonly asked question is about the type and the amount of the calcium that patients are required to take.
The issue of the types of the calcium supplement is discussed in great length in the FAQ section of our website (, The table outlines the differences between the types. The bottom line is that for most patients there may not be much of a difference as long as the patients are consistently taking them. There are cases however when we have recommended one type or another.
The most recommended dose is 2000-3000 mg per day in divided dose. Before some of you start calling or emailing us as to how come you were told to only take 1500 and not 2000, remember what I said earlier in this section that this is an ever evolving field. If you have taken 1500mg in divided doses and have had your yearly lab work with no further recommendation from us, do not make any changes unless instructed so.
The other most common concern regarding the calcium, is its relationship with kidney stones. Most common Kidney stone is Calcium Oxalate in post weight loss surgical patients. The treatments Does not include cutting back on Calcium. Calcium Oxalate search of our website will provide further detail.
Ara Keshishian Md, FACS

Parathyroid Scan

July 09, 2018 11:48 am

A Parathyroid scan or Sestamibi scan may be needed if the typical weight loss surgical reasons for elevated PTH levels have been addressed. Sestamibi is a small protein which is labeled with the radio-pharmaceutical technetium-99. This very mild and safe radioactive agent is injected into the veins of a patient with overactive parathyroid and is absorbed by the overactive parathyroid gland. If the parathyroid is normal it will not absorb the agent. The scan below shows the uptake of the agent.

Calcium, Vitamin D and Parathyroid hormone are routinely measured on yearly follow up for most post weight loss surgical (WLS) patients. Elevated parathyroid hormone (PTH) may be caused by Vitamin D deficiency or calcium deficiency (most common in post WLS) or by over active parathyroid gland(s). In the latter case, if one of the four glands  is overactive then this is knows as a parathyroid Adenoma. If all 4 are over active and are secreting too much PTH, this is known as hyperplasia. Ultrasound of the neck, may identify an enraged parathyroid gland (adenoma) which is located behind the thyroid gland. Given the large area where the parathyroid gland may be located, additional tests are needed to not only identify the location of the gland(s) but also to distinguish between single gland (adenoma) or multiple glands (hyperplasia) cause for the elevated PTH. It is important to investigate all avenues and testing in parathyroid hormone elevation and in some cases, not to rely on one test for your diagnosis.  It is also imperative that weight loss surgical patients take their supplements routinely and consistently and have their laboratory studies followed at least yearly.

Informative Video on Vitamin D: here



June 08, 2016 12:11 pm

Achalasia is a motility disorder of the esophagus muscle and or the lower esophageal sphincter (LES).  Normally, this muscle relaxes when you swallow to allow food to pass into the stomach. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the esophagus (peristalsis) is reduced.

Achalasia is usually characterized by difficulty swallowing, chest pain, GERD, coughing, weight loss and vomiting. Due to Achalasia’s common symptoms it is often misdiagnosed as GERD, hiatal hernia or psychosomatic.

How is Achalasia Diagnosed?

  • Upper GI
  • EDG (esophagogastroduodenoscopy)
  • Esophageal Manometry

Achalasia Treatment:

All of the treatments currently used to treat achalasia relax the contraction of the sphincter between the stomach and esophagus. This allows food to pass more easily into the stomach. Available Achalasia treatments include:

  • Botulinum toxin injection
  • Drugs (i.e., nitrates or calcium channel blockers). While they do help some patients, overall they are not very effective.
  • Achalasia balloon dilation
  • Heller’s myotomy is a surgery to cut the muscle between the stomach and esophagus

Further information on Achalasia here.

Surgical Treatment of Achalasia

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