Calcium supplements are derivatives of natural
products, such as oyster shell or bone. Some are marketed primarily as antacids.
Calcium carbonate and phosphate preparations have the highest concentration of
elemental calcium, about 40 percent. Calcium citrate contains 21 percent
elemental calcium, and calcium lactate and gluconate contain 13 and 9 percent,
respectively. Absorption of calcium citrate is 25 percent higher than that of
calcium carbonate.
In women, calcium supplements offer the greatest protection against
forearm fractures early in menopause, whereas they offer the best protection
against broken hips later in life.
If
your diet does not include an adequate amount of calcium, a high quality
calcium supplement could provide you with health benefits. It's the easy way to keep your bones healthy and strong.
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Food sources of Calcium
The NIH recommends milk and other
dairy products as a primary source of calcium. In addition, a variety of other
foods are excellent sources of calcium as well. Dark green, leafy vegetables and
foods with added calcium can be healthy ways to get enough calcium. By eating a
wide variety of foods with calcium, you can help make sure to get the calcium
you need each day.
Calcium Dosage recommendations
A high dietary calcium intake combined with vitamin D can increase bone
density and reduce fractures in older women and, probably, men. The Institute of
Medicine recommends that persons 19 to 50 years of age consume 1,000 mg per day
of calcium and that persons older than 50 years consume 1,200 mg per day. The
average American consumes less than 800 mg of calcium per day.
Taking calcium with food in dosages
of 500 mg or less increases absorption. Calcium preparations must be dissolved
before they can be absorbed; the absorption rate for calcium is about 20 to 30
percent. The absorption of calcium supplements differs by preparation. Foods
such as spinach, rhubarb and wheat bran can decrease calcium absorption. Calcium
can interfere with absorption of iron, zinc, bisphosphonates and tetracycline.
Absorption also requires adequate doses of vitamin D. The recommended daily
intake of vitamin D is 200 IU for adults younger
than 50 years and 600 IU for those older than 70 years. Vitamin D
supplementation is especially important in elderly persons because skin
synthesis and absorption of vitamin D may be impaired.
Calcium side effects
The most common adverse effects of calcium supplements are
constipation, intestinal bloating and excess
gas. Adverse effects occur most frequently with calcium carbonate. Switching
preparations or increasing fluid intake may relieve symptoms. Patients who form
calcium-containing stones are generally advised not to take calcium supplements.
However, a low intake of calcium can aggravate the risk of stone formation by
increasing absorption and urinary excretion of oxalate. Calcium is best taken
during meals.
High blood calcium level in
elderly
In elderly people, higher levels of calcium in the blood are associated
with poorer mental function and faster decline in cognitive ability. Some
diseases that increase blood calcium -- such as kidney failure, cancer and
excessive parathyroid gland activity.
Additional benefits of Calcium
Calcium supplements may help treat
premenstrual syndrome. The
rational for calcium supplementation in women with PMS lies in several studies
suggesting that PMS patients have altered calcium homeostasis and increased risk
of osteoporosis.
Do calcium supplements reduce the bone fracture risk?
Another New England Journal of Medicine study creates confusion -- and misleads
the public -- regarding the role of calcium and bones. The abstract starts out,
"The efficacy of calcium with vitamin D supplementation for preventing hip and
other fractures in healthy postmenopausal women remains equivocal." (Equivocal
means open to two or more interpretations; ambiguous.) And the article
concludes, " Among healthy postmenopausal women, calcium with vitamin D
supplementation resulted in a small but significant improvement in hip bone
density, did not significantly reduce hip fracture, and increased the risk of
kidney stones."
Now, if you just read the headlines on TV or newspaper articles,
and read the conclusion of the researchers, you may be tempted to throw out your
calcium supplement bottle. But, I suggest you hold on to it. Let's dig deeper
and find the hard facts.
Here are the facts: 36,000 postmenopausal women, 50 to 79 years of
age were randomly assigned to have either 1000 mg of calcium carbonate with 400
units of vitamin D daily or placebo. The study went on for 7 years. Women who
took the calcium with vitamin D supplementation had a small but significant
improvement in hip bone density. When all the women were included in the
statistics, the overall study did not show a reduced rate of hip fracture. But,
when the researchers limited their analysis to women who had consistently taken
the supplements, the results showed a nearly 30 percent reduced risk of hip
fracture. The side effect was an increased risk of kidney stones. Muddling the
results of this study was that over half of study participants were on hormone
replacement therapy, which is known to reduce fracture risk. Another
complicating factor is that calcium intake from diet and other sources — in
addition to the supplements given as part of the study — were not accounted for.
The study's lead author, Dr. Rebecca D. Jackson of Ohio State
University in Columbus, says, "Calcium is the foundation for helping to ensure
bone health, but women 65 and older and those with osteoporosis, or risk factors
for the condition such as cigarette smoking, may need more aggressive treatment
to keep their bones strong. We have a host of options available that have been
approved by the FDA as effective agents for the treatment of osteoporosis."
This statement immediately makes me suspect. Is she trying to push the new,
expensive drugs made by pharmaceutical companies. Since studies came out a few
years ago pointing out the potential dangers of estrogen and progestin, drug
companies have been more aggressive in pushing drugs to treat or prevent
osteoporosis. These drugs fall into four categories: bisphosphonates (alendronate
and risedronate sodium), calcitonin, selective receptor molecules (raloxifene
hydrochloride) and the newest category, the bone formation agents (teriparatide).
Osteoporosis drugs may slow bone loss, promote bone growth, reduce the risk of
fractures but at what short term and long term cost? Not only are these drugs
expensive, but we have no idea on the long term dangers that they may pose. It's
quite possible to take a drug and have a lesser risk for fracture, but then die
sooner from a side effect of the drug.
My suggestions: We favor the use of calcium and vitamin D supplements to
maintain healthy bones, both in older men and postmenopausal women. Since there
could be an increased risk for kidney stones, my thought is to not take more
than 1,000 mg of calcium a day, but limit calcium supplement intake to 500 to
1,000 mg for women and 200 to 800 mg for men. This is a wide range since the
amount of a calcium supplement you may need depends on how much you get in your
diet. Men can lose bone mass, too, but not as much as women. I also recommend
400 to 800 units of vitamin D. Drink plenty of water or fluids in order to
reduce any potential risk for kidney stones.
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