Calcium is an important component of a healthy diet and a mineral necessary for life. The National Osteoporosis Foundation says, "Calcium plays an important role in building stronger, denser bones early in life and keeping bones strong and healthy later in life."
Approximately 99 percent of the body's calcium is stored in the bones and teeth. The rest of the calcium in the body has other important uses, such as some exocytosis, especially neurotransmitter release, and muscle contraction.
In the electrical conduction system of the heart, calcium replaces sodium as the mineral that depolarizes the cell, proliferating the action potential. In cardiac muscle, sodium influx commences an action potential, but during potassium efflux, the cardiac myocyte experiences calcium influx, prolonging the action potential and creating a plateau phase of dynamic equilibrium.
Long-term calcium deficiency can lead to rickets and poor blood clotting and in case of a menopausal woman, it can lead to osteoporosis, in which the bone deteriorates and there is an increased risk of fractures.
While a lifelong deficit can affect bone and tooth formation, over-retention can cause hypercalcemia (elevated levels of calcium in the blood), impaired kidney function and decreased absorption of other minerals. High calcium intakes or high calcium absorption were previously thought to contribute to the development of kidney stones. However, a high calcium intake has been associated with a lower risk for kidney stones in more recent research.
Vitamin D is needed to absorb calcium.
Dairy products, such as milk and cheese, are a well-known source of calcium. Some individuals are allergic to dairy products and even more people, particularly those of non Indo-European descent, are lactose-intolerant, leaving them unable to consume non-fermented dairy products in quantities larger than about half a liter per serving. Others, such as vegans, avoid dairy products for ethical and health reasons.
Fortunately, many good sources of calcium exist. These include seaweeds such as kelp, wakame and hijiki; nuts and seeds (like almonds and sesame); blackstrap molasses; beans; figs; quinoa; amaranth; collard greens; okra; rutabaga; broccoli; dandelion leaves; kale; and fortified products such as orange juice and soy milk. An overlooked source of calcium is eggshell, which can be ground into a powder and mixed into food or a glass of water. Cultivated vegetables generally have less calcium than wild plants.
The calcium content of most foods can be found in the USDA National Nutrient Database.
Recommended adequate intake by the IOM for calcium:
Dietary calcium supplements
Calcium supplements are used to prevent and to treat calcium deficiencies.
Most experts recommend that supplements be taken with food and that no more than 600 mg should be taken at a time because the percent of calcium absorbed decreases as the amount of calcium in the supplement increases.
- The absorption of calcium from most food and commonly used dietary supplements is very similar. This is contrary to what many calcium supplement manufacturers claim in their promotional materials.
- Milk is an excellent source of dietary calcium for those whose bodies tolerate it because it has a high concentration of calcium and the calcium in milk is excellently absorbed. Some studies suggests that the absorption of calcium from calcium carbonate is similar to the absorption of calcium from milk. While most people digest calcium carbonate very well, some might develop gastrointestinal discomfort or gas. Taking magnesium with it can help to avoid constipation. Calcium carbonate is 40% elemental calcium. 1000 mg will provide 400 mg of calcium. However, supplement labels will usually indicate how much calcium is present in each serving, not how much calcium carbonate is present.
- Antacids frequently contain calcium carbonate, and are a commonly used, inexpensive calcium supplement
- Coral calcium is a salt of calcium derived from fossilized coral reefs. Coral calcium is composed of calcium carbonate and trace minerals.
- Calcium citrate can be taken without food and is the supplement of choice for individuals with achlorhydria or who are taking histamine-2 blockers or proton-pump inhibitors. It is more easily digested and absorbed than calcium carbonate if taken on an empty stomach and less likely to cause constipation and gas than calcium carbonate. It also has a lower risk of contributing to the formation of kidney stones. Calcium citrate is about 21% elemental calcium. 1000 mg will provide 210 mg of calcium. It is more expensive than calcium carbonate and more of it must be taken to get the same amount of calcium.
- Calcium phosphate costs more than calcium carbonate, but less than calcium citrate. It is easily absorbed and is less likely to cause constipation and gas than either.
- Calcium lactate has similar absorption as calcium carbonate, but is more expensive. Calcium lactate and calcium gluconate are less concentrated forms of calcium and are not practical oral supplements. The 'chelate' mimics the action that natural food performs by keeping the calcium soluble in the intestine. Thus, on an empty stomach, in some individuals, chelates might theoretically be absorbed better.
- Microcrystalline hydroxyapatite (MH) is marketed as a calcium supplement, and has in some randomized trials been found to be more effective than calcium carbonate.
In July 2006, a report citing research from Fred Hutchinson Cancer Research Center in Seattle, Washington claimed that women in their 50s gained 5 pounds less in a period of 10 years by taking more than 500 mg of calcium supplements than those who did not. However, the doctor in charge of the study, Dr. Alejandro J. Gonzalez also noted it would be "going out on a limb" to suggest calcium supplements as a weight-limiting aid.
Prevention of fractures due to osteoporosis
Such studies often do not test calcium alone, but rather combinations of calcium and vitamin D. Randomized controlled trials found both positive effects. The different results may be explained by doses of calcium and underlying rates of calcium supplementation in the control groups. However, it is clear that increasing the intake of calcium promotes deposition of calcium in the bones, where it is of more benefit in preventing the compression fractures resulting from the osteoporotic thinning of the dendritic web of the bodies of the vertebrae, than it is at preventing the more serious cortical bone fractures which happen at hip and wrist.
Possible cancer prevention
A meta-analysis by the international Cochrane Collaboration of two randomized controlled trials found that calcium "might contribute to a moderate degree to the prevention of adenomatous colonic polyps".
More recent studies were conflicting, and one which was positive for effect (Lappe, et al.) did control for a possible anti-carcinogenic effect of vitamin D, which was found to be an independent positive influence from calcium-alone on cancer risk (see second study below).
- A randomized controlled trial found that 1000 mg of elemental calcium and 400 IU of vitamin D3 had no effect on colorectal cancer
- A randomized controlled trial found that 1400–1500 mg supplemental calcium and 1100 IU vitamin D3 reduced aggregated cancers with a relative risk of 0.402.
- An observational cohort study found that high calcium and vitamin D intake was associated with "lower risk of developing premenopausal breast cancer."
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