CALCIUM DEFICIENCY, SUPPLEMENTS, BENEFITS AND SIDE EFFECTS

CALCIUM DEFICIENCY, SUPPLEMENTS, BENEFITS AND
SIDE EFFECTS

Calcium Facts

Hypocalcemia (calcium deficiency or lack of calcium) is a condition of low blood
calcium. It may be resulted from low parathyroid hormone levels, kidney
failure, acute pancreatitis, insufficient magnesium, insufficient protein in the
blood, or vitamin D deficiency. Symptoms of low calcium often do not occur
with mild calcium deficiency. As calcium deficiency becomes more severe,
symptoms such as abnormal heart rhythms, muscle cramps, muscle twitching,
or seizures, burning, pricking, tickling, or tingling sensation (paresthesia) of
the hands, feet, lips, and tongue occur. [12-14]

Hypercalcemia is an abnormally high blood calcium levels. It can be caused by
hyperparathyroidism, chronic kidney disease, and overdoses of vitamin D or
calcium. Symptoms of high blood calcium levels may include sleeplessness,
itching, headache, palpitation, apathy, akinesis, leanness, foot gangrene,
dehydration, confusion, loss of appetite, nausea, vomiting, weight loss, and
constipation. In long term, it may lead to vascular calcification. [12-16]

Benefits and uses of calcium
Calcium is essential for many functions in the body, including regulating the
heartbeat, conducting nerve impulses, building and maintaining healthy
bones, stimulating hormone secretions and blood clotting.

Calcium requirements
Calcium is a mineral found in many foods. Getting enough of this nutrient is
important because the human body cannot make it. Even after you are fully
grown, adequate calcium intake is important because the body loses calcium
every day through the skin, nails, hair, and sweat, as well as through urine
and feces. This lost calcium must be replaced daily through the diet.
Otherwise, the body takes calcium out of the bones to perform other
functions, which makes the bones weaker and more likely to break over time.

Calcium is needed for our heart, muscles, and nerves to function properly and
for blood to clot. Inadequate calcium significantly contributes to the
development of osteoporosis. Many published studies show that low calcium
intake throughout life is associated with low bone mass and high fracture
rates. National nutrition surveys have shown that most people are not
getting the calcium they need to grow and maintain healthy bones.
Consequently, calcium pills or supplements for children present a huge
market.

The recommended calcium intake (based on National Academy of Sciences,
1997) for infants (0-6 months) is 210 mg, young kids (1-3 years) 500 mg, kids
(4-8 years) 800 mg, older kids (9-18) 1,300 mg, adult (19-50 years) 1,000 mg
and older adult (50+) 1,200 mg.

Calcium Culprits
While a balanced diet aids calcium absorption, high levels of protein and
sodium (salt) in the diet are thought to increase calcium excretion through
the kidneys. Excessive amounts of these substances should be avoided,
especially in those whose calcium intake is low.

Lactose intolerance also can lead to inadequate calcium intake. Those who
are lactose intolerant have insufficient amounts of the enzyme lactase, which
is needed to break down the lactose found in dairy products. In order to
include dairy products in the diet, dairy foods can be taken in small quantities
or treated with lactase drops, or lactase can be taken as a pill. There are
even some milk products on the market that already have been treated with
lactase.

calcium sources
Experts recommend that adults get 1,000 to 1,200 mg (milligrams) of calcium
each day. Although food is the best source of calcium, most Americans do not
get enough of it from food sources. Calcium-fortified foods (like orange juice,
bread, cereals, and many others on your grocer?s shelves) and calcium
supplements can fill the gap by ensuring that you meet your daily calcium
requirement.

LIST OF FOODS HIGH IN CALCIUM
Calcium in milk is about 300 mg per serving regardless if it is whole milk or
skin milk. Other calcium rich foods include yogurt, cheese, sardines, tofu and
some types of vegetables.

One serving of milk (8 oz; whole, 1%, 2% or skim milk) provides about 300
mg of calcium. One serving of plain fat-free yogurt (8 oz) provides almost 500
mg of calcium. With extra additions of milk solids or fruit, the calcium content
decreases (diluted). One serving (1 oz) of American cheese, Cheddar cheese,
Mozzarella cheese or Muenster cheese contains about 190 mg of calcium.
One serving of (1/2 cup) of low or high-fat vanilla ice cream gives you about
90 mg of calcium. Serving size of 3.75 oz of canned sardines provides 351 mg
of calcium. One serving of salmon or shrimp (3 oz) provides 181 or 50 mg of
calcium respectively. One cup of boiled soybean provides 261 mg of calcium
and 254 calories at the same time. Serving size of 8 oz of orange juice
fortified with calcium contains 300 mg of calcium and 100 calories. One
serving of dried figs (10) provides 270 mg of calcium and 477 calories. All
foods discussed are good sources of calcium, but they also contain fats and
calories. Serving size of one oz of nuts such as almonds, sesame or
sunflower seeds provide only 30-80 mg of calcium but 14-15 g of fat and
about 165 calories!!

Calcium rich vegetables include raw Chinese cabbage (bok choy; 74 mg of
calcium per serving and drained broccoli (71.6 mg of calcium per serving),
collards (226 mg of calcium per serving), turnip greens (197 mg of calcium per
serving). tofu (204 mg of calcium), and orange (56 mg of calcium preserving).

Calcium Supplements
If you have trouble getting enough calcium in your diet, you may need to take
a calcium supplement. The amount of calcium you will need from a
supplement depends on how much calcium you obtain from food sources.
There are several different calcium compounds used in supplements, such as
calcium carbonate, calcium citrate, calcium phosphate among others. These
compounds contain different amounts of elemental calcium, which is the
actual amount of calcium in the supplement. It is important to read the label
carefully to determine how much elemental calcium is in the supplement and
how many doses or pills to take.

Except in people with gastrointestinal disease, all major forms of calcium
supplements are absorbed equally well when taken with food.

Calcium supplements are better absorbed when taken in small doses (500
mg or less) several times throughout the day. In many individuals, calcium
supplements are better absorbed when taken with food. It is important to
check supplement labels to ensure that the product meets United States
Pharmacopeia (USP) standards.

Calcium supplements are available without a prescription in a wide range of
preparations and strengths, which can make selecting one a confusing
experience. Many people ask which calcium supplement they should take. The
?best? supplement is the one that meets your needs. Ask yourself these
questions: How well does my body tolerate this kind of supplement? Does it
cause any side effects (like gas or constipation)? If so, you may want to try
another kind or a different brand. Is this kind of supplement convenient? Can
I remember to take it as often as recommended each day? Is the cost of this
supplement within my budget? Is it widely available? Can I buy it at a store
near me?

BRANDS OF CALCIUM SUPPLEMENTS
Choose calcium supplements with familiar brand names. Look for labels that
state ?purified? or have the USP (United States Pharmacopeia) symbol. Avoid
calcium from unrefined oyster shell, bone meal, or dolomite without the USP
symbol, because it may contain high levels of lead or other toxic metals. Make
sure that GMP statement is included in the product label.

Special Note on Coral Calcium [10]
The Federal Trade Commission (FTC) has taken legal action against a group
of individuals and companies in connection with the advertising and sale of a
dietary supplement called Coral Calcium Supreme. The FTC alleged that the
marketers--Kevin Trudeau, Robert Barefoot, and their companies--violated
the FTC Act by claiming, falsely or without substantiation, that Coral Calcium
Supreme can treat or cure cancer, multiple sclerosis, lupus, heart disease,
and chronic high blood pressure.
Coral Calcium Supreme is a dietary supplement supposedly made of marine
coral from Okinawa, Japan.

In January 2004, a Federal court ruled in favor of the FTC against defendant
Robert Barefoot and his companies Deonna Enterprises, Inc., and Karbo
Enterprises, Inc., prohibiting them from making unsupported health claims
about their product or any other coral calcium product or dietary supplement.
The defendants are required to recall any product packaging that makes
these claims and to notify resellers and distributors of their products about
the FTC's action. The FTC is allowed to recover all of Robert Barefoot's
royalties associated with Coral Calcium Supreme infomercial marketing.

The case against Kevin Trudeau and his companies is still pending.
In related efforts, the FTC and Food and Drug Administration (FDA) sent
warning letters to Web site operators making similar claims about coral
calcium products. The agencies warned the operators to remove any false or
deceptive claims from their Web sites immediately.
[SOURCE: Coral Calcium, Consumer Advisory, National Center for
Complementary and Alternative Medicine Online Publication, January 9, 2006]

CALCIUM ABSORPTION
Most brand-name calcium products are absorbed easily in the body. If you
are not sure about your product, you can find out how well it dissolves by
placing it in a small amount of warm water for 30 minutes and stirring it
occasionally. If it hasn?t dissolved within this time, it probably will not
dissolve in your stomach. Chewable and liquid calcium supplements dissolve
well because they are broken down before they enter the stomach.

Calcium, whether from food or supplements, is absorbed best by the body
when it is taken several times a day in amounts of 500 mg or less, but taking
it all at once is better than not taking it at all. Calcium carbonate is absorbed
best when taken with food. Calcium citrate can be taken anytime.

Combination Products
Calcium supplements are available in a bewildering array of combinations
with vitamins and other minerals. Calcium supplements often come in
combination with vitamin D, which is necessary for the absorption of calcium.
However, calcium and vitamin D do not need to be taken together and/or in
the same preparation in order to be absorbed by the body. Minerals such as
cobalt magnesium and phosphorus also are important but usually are
obtained through food or multivitamins. Most experts recommend that
nutrients come from a balanced diet, with multivitamins used to supplement
dietary deficiencies.

Calcium supplements side effects
Tolerance: For certain people, some calcium supplements may cause side
effects such as gas or constipation. If simple measures (such as increasing
your intake of fluids and high-fiber foods) do not solve the problem, you
should try another form of calcium. Also, it is important to increase the dose
of your supplement gradually: take just 500 mg a day for a week, then slowly
add more calcium. Do not take more than the recommended amount of
calcium without your doctor?s approval.

Calcium Interactions: It is important to talk with a doctor or pharmacist about
possible interactions between your over-the-counter and prescription
medications, and calcium supplements. For example, calcium supplements
may reduce the absorption of the antibiotic tetracycline. Calcium also
interferes with iron absorption. So you should not take a calcium supplement
at the same time as an iron supplement - unless the calcium supplement is
calcium citrate, or unless the iron supplement is taken with vitamin C. Any
medication that you need to take on an empty stomach should not be taken
with calcium supplements.

Do not overdose yourself with calcium supplement or related products,
though studies have shown that doses as high as 2-3 g of calcium carbonate
(i.e. maximum 1200 mg of calcium) a day appear was not associated with
prostate risk. [4,6] Actually, iron, zinc, and calcium are all involved in the
metabolism of reactive oxygen species and may compete with each other for
similar binding sites. Excessive dietary intakes of these micronutrients have
been associated with altered risks of colorectal, breast, and prostate
cancers. [3] Excessive calcium may lead to serious side effects. Gao X and co-
workers at Tufts University, Boston, observed that high intake of dairy
products and calcium is associated with an increased risk of prostate cancer
in a meta-analysis of various studies. [2] While, Tseng M and co-workers from
Cox Chase Cancer Center, Philadelphia, further suggested that dietary
calcium was strongly associated with increased risk of prostate cancer. [5]

Calcium is absorbed from food in excess and is lost into the urine. This high
level of calcium in the urine causes crystals of calcium oxalate or calcium
phosphate to form in the kidneys or urinary tract. Some diuretics and calcium-
based antacids may increase the risk of forming kidney stones by increasing
the amount of calcium in the urine. [9] One epidemiologic trial found that
supplemental calcium increased the risk of kidney stones by 20%. [7] Unlike
calcium supplements, dairy, the key source of dietary calcium, may have
factors that prevent the rise in urinary calcium including citrate and
phosphate. Actually, the data that dietary calcium prevents kidney stones is
still controversial. There is no trial that has directly compared higher calcium
intake to lower calcium intake. [8,9]

REMOVAL OF EXCESSIVE AMOUNT OF CALCIUM
Chelation is a chemical process in which a substance is used to bind
molecules, such as metals or minerals, and hold them tightly so that they can
be removed from a system, such as the body. In medicine, chelation has
been scientifically proven to rid the body of excess or toxic metals. For
example, a person who has lead poisoning may be given chelation therapy in
order to bind and remove excess lead from the body before it can cause
damage.

In the case of EDTA chelation therapy, the substance that binds and removes
metals and minerals is EDTA (ethylene diamine tetra-acetic acid), a synthetic,
or man-made, amino acid that is delivered intravenously (through the veins).
EDTA (the calcium remover) was first used in the 1940s for the treatment of
heavy metal poisoning (or build up). EDTA chelation removes heavy metals
and minerals from the blood, such as lead, iron, copper, and calcium, and is
approved by the U.S. Food and Drug Administration (FDA) for use in treating
lead poisoning and toxicity from other heavy metals. Although it is not
approved by the FDA to treat CAD, some physicians and alternative medicine
practitioners have recommended EDTA chelation as a way to treat this
disorder. [11]

When used as approved by the FDA (at the appropriate dose and infusion
rate) for treatment of heavy metal poisoning, chelation with EDTA has a low
occurrence of side effects. The most common side effect is a burning
sensation experienced at the site where the EDTA is delivered into the veins.
Rare side effects can include fever, hypotension (a sudden drop in blood
pressure), hypocalcemia (abnormally low calcium levels in the blood and
symptoms of low blood calcium), headache, nausea, vomiting, and bone
marrow depression (meaning that blood cell counts fall). Injury to the kidneys
has been reported with EDTA chelation therapy, but it is rare. Other serious
side effects can occur if EDTA is not administered by a trained health
professional. [11]

OSTEOPOROSIS
Collagen is a protein that provides a soft framework, and calcium phosphate
is a mineral that adds strength and hardens the framework. This combination
of collagen and calcium makes bone strong and flexible enough to withstand
stress. There are two types of bone found in the body ? cortical and
trabecular. Cortical bone is dense and compact. It forms the outer layer of
the bone. Trabecular bone makes up the inner layer of the bone and has a
spongy, honeycomb-like structure.

Throughout life, bone is constantly renewed through resorption and
formation. During resorption, old bone tissue is broken down and removed by
special cells called osteoclasts. During bone formation, new bone tissue is
laid down to replace the old. This task is performed by special cells called
osteoblasts. Osteoclast and osteoblast function is regulated by several
hormones including calcitonin, parathyroid hormone, vitamin D, estrogen (in
women) and testosterone (in men), among others.

During childhood and the teenage years, new bone is added to the skeleton
faster than old bone is removed. As a result, bones become larger, heavier,
and denser. For most people, bone formation continues at a faster pace than
removal until bone mass peaks during the third decade of life. To make reach
the greatest possible peak bone mass, one needs to get enough calcium,
vitamin D, and exercise.

After age 20, bone loss occurs. For many people, this bone loss can be
prevented by continuing to get calcium, vitamin D, and exercise and by
avoiding tobacco and excessive alcohol use. Osteoporosis develops when
bone removal occurs too quickly or replacement occurs too slowly or both.
You are more likely to develop osteoporosis if you did not reach your
maximum peak bone mass during your bone building years.
Women are more likely than men to develop osteoporosis. This is because
women generally have smaller, thinner bones, and because they can lose
bone tissue rapidly in the first 4 to 8 years after menopause (PMS) due to the
sharp decline in production of the hormone estrogen. Produced by the
ovaries, estrogen has been shown to have a protective effect on bone.
Women usually go through menopause between ages 45 and 55. After
menopause, bone loss in women greatly exceeds that in men. However, by
age 65, women and men tend to lose bone tissue at the same rate. While
men do not undergo the equivalent of menopause, production of the male
hormone testosterone may decrease, and this can lead to increased bone
loss and a greater risk of developing osteoporosis.

Osteoporosis is preventable for many people. Prevention is important
because while there are treatments for osteoporosis, a cure has not yet
been found. A comprehensive program that can help prevent osteoporosis
includes: a balanced diet rich in calcium and vitamin D, weight-bearing
exercise, a healthy lifestyle with no smoking or excessive alcohol intake, bone
density testing and, when appropriate, medication.

Vitamin D
The body needs vitamin D to absorb calcium. Without enough vitamin D, we
can?t form enough of the hormone calcitriol (known as the ?active vitamin
D?). This in turn leads to insufficient calcium absorption from the diet. In this
situation, the body must take calcium from its stores in the skeleton, which
weakens existing bone and prevents the formation of strong, new bone. You
can get vitamin D in three ways: through the skin, from the diet, and from
supplements.

Phytoestrogens and Bone Health
Many postmenopausal (PMS) women are looking for alternatives to hormone
therapy. Of particular interest are phytoestrogens. Phytoestrogens are
naturally occurring plant compounds that are similar in some ways to
estradiol, the most potent naturally occurring estrogen. However,
phytoestrogens tend to have weaker effects than most estrogens, are not
stored in the body, and can be easily broken down and eliminated.
Observational studies have found a lower prevalence of breast cancer, heart
disease, and hip fracture rates among people living in places like Southeast
Asia, where diets are typically high in phytoestrogens.

Phytoestrogens consist of more than 20 compounds and can be found in
more than 300 plants, such as herbs, grains, and fruits. The three main
classes of dietary phytoestrogens are isoflavones, lignans, and coumestans:
� Isoflavones (genistein, daidzein, glycitein, and equol) are primarily found in
soy beans and soy products, chickpeas, and other legumes.
� Lignans (enterolactone and enterodiol) are found in oilseeds (primarily
flaxseed), cereal bran, legumes, and alcohol (beer and bourbon).
� Coumestans (coumestrol) can be found in alfalfa and clover.

APPENDIX I
Calcium also exists as calcium carbonate, calcium chloride, calcium citrate
calcium phosphate calcium hydroxide, calcium gluconate, calcium carbide,
calcium oxalate, calcium sulfate, calcium pyruvate, calcium silicate, calcium
hypochlorite, calcium nitrate, calcium oxide, docusate calcium, calcium
bicarbonate, calcium alginate, ionized calcium, calcium disodium edta,
element calcium, calcium stearate, chelated calcium, calcium fluoride, calcium
sulphate, calcium hydroxyapatite, citracal calcium, calcium phosphorus, bio
calcium, calcium aspartate, calcium propionate, calcium acetate.
THIS ARTICLE IS FOR YOUR REFERENCE ONLY. IF YOU HAVE ANY QUESTION, YOU
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SOURCES
Calcium Supplements: What to Look for, NIH Osteporosis and Related Bone
Diseases-National Resource Center Online Publication January 4, 2006. 2.
Calcium and Vitamin D: Important at Every Age NIH Osteporosis and Related
Bone Diseases-National Resource Center Online Publication January 4, 2006.
3. Exercise for Your Bone Health NIH Osteporosis and Related Bone Diseases-
National Resource Center Online Publication January 4, 2006. 4.
Phytoestrogens and Bone Health NIH Osteporosis and Related Bone
Diseases-National Resource Center Online Publication January 4, 2006. 5.
What Is Bone? NIH Osteporosis and Related Bone Diseases-National
Resource Center Online Publication January 4, 2006.

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