Calcium+(Ca)

Most common mineral found in the body. Body of a man contains ~1200g of calcium, women's body contains ~1000 g., this represent s 1-2% of total body weight. 99% of calcium is found in bones and teeth as tricalcic phosphate and calcium carbonate organized in the form of hysroxyapatite. Calcium activates enzymes

=Role of Calcium= Extracellular concentration of calcium ions is strong enough to influence neuromuscular control. A weak concentration could cause nervous disorders such as tetany, hypercalcaemia accompanied by cardiac arrhythmia and lowered neuromuscular excitability.

Necessary for intercellular links, the protection of cell surfaces, and creation of cellular extensions or pseudopodia. Cells benefit from an active mechanism that extracts calcium ions from their stronghold.

Calcium is useful in building the skeleton and maintaining it's solidarity; it comes into play during blood coagulation. If calcium intake is insufficient long-term, the bones risk becoming porous and fragile.

=Daily Needs=
 * 0-6 months || 210mg. ||
 * 7-12 months || 270mg. ||
 * 1-3 years || 500mg. ||
 * 4-8 years || 800mg. ||
 * 9-18 years || 1300mg. ||
 * 19-50 years || 1000mg. ||
 * 50+ years || 1200mg. ||

-Calcium is eliminated through urine, stools and perspiration. -Normal calciuria (calcium level in urine) is approximately 200mg/L -Perspiration causes an average elimination of 300-400mg. -Certain drugs (diuretics, thiazidics) can lower calcium absorption -Normal calcaemia level is maintained by the parathyroid hormone, or parathormone, as well as calcitonin

=Pro-Compounds= -Vitamin D -High Protein Foods -Gastric Acidity -Lactose

=Anti-Compounds= -Accelerated Gastro-intestinal transit -Stress -Excessive Fat or Dietary Fiber -Stomach Alkalinity (Gastric hypoacidity) -In excess: Phosphorus, Boron, Chromium, Copper, Magnesium, Iron, Manganese, Silica, Strontium and Zinc

=Sources= Content in mg/100g.
 * Milk Products and eggs || mg./100g || Sea Products || mg./100g || Fruits & Vegetables || mg./100g ||
 * Parmesan || 1260 || Sardines || 290 || Soya Beans || 255 ||
 * Emmenthal || 1130 || Shrimp || 200 || Watercress || 200 ||
 * Gruyere || 1000 || Caviar || 140 || Fresh Parsley || 195 ||
 * Whole Powdered Milk || 950 || Cockles || 120 || Dandelion || 170 ||
 * Cream of Gruyere || 750 || Oysters || 95 || Dried Onions || 160 ||
 * Livarot || 715 || Mussels || 90 || Chickpeas || 150 ||
 * Roquefort || 700 ||  ||   || White Beans || 120 ||
 * Bleu de Bresse || 490 ||  ||   || Horseradish || 110 ||
 * Munster || 335 ||  ||   || Chards || 110 ||
 * Camembert || 270 ||  ||   || Fennel || 100 ||
 * Concentrated Milk || 245 ||  ||   || Endives || 100 ||
 * Coulommiers || 200 ||  ||   || Spinach || 95 ||
 * Goat Cheese || 190 ||  ||   || Almonds || 250 ||
 * Yogurt || 150 ||  ||   || Hazelnuts || 225 ||
 * Whole Milk || 140 ||  ||   || Dried Figs || 180 ||
 * Low Fat Yogurt || 140 ||  ||   || Brazil Nuts || 150 ||
 * Skimmed Milk || 135 ||  ||   ||   ||   ||
 * Fresh Cream || 120 ||  ||   ||   ||   ||
 * Petit-suisse || 110 ||  ||   ||   ||   ||

Other Calcium-rich Foods
-Common Drinking Water -Mustard Cocoa -Semolina

Calcium-rich Supplements
-Bone Meal -Oyster Powder -Stag Horn -Marine Algae Reindeer Horn -Dolomite

Beware of contamination from lead or other heavy metals
=Deficiency= -Heart Palpitations -Muscle Cramps -Nervousness -Dental Cavities -Swelling in the Arms and Legs

=Excess= -Calcification of soft tissues if not taken w/ magnesium and vitamin D

=Therapeutic Indications= -Spasmophilia -Anorexia -Fatigue -Growth Disorders -Strengthening of Fractures -Pregnancy and Milk Production -Rickets and delay in the growth and development of bones

=Consequences of Variations in Blood Calcium Levels= Hypercalcaemia, or increased calcium levels in the blood can cause: -Renal Disorders: Polyuria, Renal Lithiasis, Nephrocalcinosis and Renal Insufficiency -Digestive Disorders: Anorexia, Nausea, Constipation and Abdominal Pains -Tissue calcification, muscular hypotonia, and a shortened QT space on an electrocardiogram.

Hypocalcaemia, or low calcium levels in the blood can cause: -Peripheral nervous hyperexcitability (tetany); observed during hypoparathyreosis, pseudohypoparathyroidism, renal insufficiency,osteomalacia -Hypercalcinuria

Hypercalcaemia are found in certain secondary bone cancers, in chronic tubular acidosis as well as idiopathic hypercalcinuria. Potential Contributing Factors of Hypercalcaemia: Potassium Deficiency

Demineralization or bone loss starts around the age of 50 and increases in women following menopause (osteoporosis)

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============================================================================ //Medical Nutrition// CALCIUM-1.5-2% of body weight, with 99% in bones and teeth

Absorption:
• -Phytates (whole grains, seed and nuts), oxalates (rhubarb and spinach) interfere with absorption • -Excess magnesium and malabsorption influences how much is absorbed. • -30% is absorbed primarily in the jejunum if HCl is low, then only 4% will be absorbed in other areas. • -60Yr or more 1/3 of population achlorohydric, increased risk of low bone density • -With menopause ½ of the HCl is present –> problems with decreased absorption • - Forms: Tablet, capsule and liquid forms have different absorption. • Ca citrate, malate, aspartate, ascorbate, gluconate, dolomite, bone meal, amino acid chelates, lactate… Citrate and citrate malate have better absorption in patients with poor absorption, especially if low stomach acid is present. • Ca citrate is 16% calcium as opposed to Ca carbonate, which is 40% elemental. So noticing elemental levels is important. The mixed forms have potentially good absorption with high levels of Ca, but some are contaminated with lead

Regulation:
• -VitD controls levels of Ca, Phos, and Mg absorbed and their deposition into the bone/ muscle. Extreme amounts of VitD cause resorption of bone Ca. VitD might be increasing Ca transport thru cell membranes. • -PTH -If levels of Ca are low in the blood; PTH stimulates bone to release Ca. It also increases formation of 1,25- dihydroxycholecalciferol in the kidneys (active VitD), enhancing Ca and Phos absorption from the intestines if they are present. VitD administration will reduce PTH function. But, without VitD, PTH is unable to remove bone Ca. Decreased Ca ion presence increases PTH dramatically. The PTH glands enlarge in rickets, lactation and pregnancy. PTH levels increase with age. Cordyceps reduces the levels. High PTH with increase blood Ca increases BP. • -Calcitonin has the opposite effects of PTH. It reduces plasma Ca. It reduces osteoclast formation and their ability to release Ca from the bone. Calcitonin has a mild effect. If the thyroid gland is removed with the calcitonin secreting glands no great change occurs to the bones and blood Ca levels. • -Estrogen/Testosterone increase Ca deposition (Est stops Ca excretion from bone) • -Thyroid if elevated decreases Ca levels due to accelerated metabolism • -Cortisol blocks Ca absorption by bones. This can be countered completely by increasing VitD and Ca intake. • -Insulin is inflammatory and inflammatory cytokines reduce bone Ca levels. In areas of arthritis there is seen decreased bone density.

Function
• Bone and teeth- hardness to the matrix • -Assist transport across cells (m. contraction, membrane stability, mast cell rupture increased with lower Ca levels, NT junctions regulated by Ca, -> insomnia, anxiety…) • -The heart requires proper Ca levels for contraction, too much causes tetany with cardiac or respiratory arrest (Ca channel blockers stop this). • -Ionized Ca initiates blood clots causing release of thromboplastin by platelets. Ca also stimulates prothrombin conversion to thrombin (assisting fibrin-> to fibrinogen). • -Contractility of smooth and skeletal muscles.

• Requirements: • RDA: 800mg./day adults 25-50; 1200mg (males and females 11-24); 400 mg 0-1 ½ yr • 600-800mg ½-10 yr; (Recently19-51yr 1000mg/d, >60yr 1200 mg) • Pregnant and lactating 1200mg/d

• Lab serum not good indicator of Ca levels intracellularly. If low <9 though, may indicate levels of minerals are possibly low. Normal 8.5-10.8. Optimal: 9.7-10.1. If low Ca and Phos, with high alk phos = low VitD. If high Ca and phos= HyperVitD • Optimal: 500- 1500mg depending on intake of minerals, protein, phos, Mg, phytates, oxalates, levels of exercise… Paleolithic diets had 1500-2000mg, but higher Mg and K+.

Since 1950’s, • American women have had increasing amounts of Ca in their diets to counter brittle bone disease, osteoporosis, which is a leading cause of death in elderly women. • Osteoporosis continues to increase. • Why? In 1988 the National Women’s Health Network announced its findings that countries with lesser Ca intake had higher bone density and strength – less osteoporosis. • The biggest factor seems to be Magnesium intake. • Mg increases calcitonin and decreases PTH. • In a study reviewed by the International Journal of Clinical Nutrition, when Ca and VitD were given and no magnesium all women but one in the study became Ca deficient. • Then they were given magnesium, their blood Ca and Mg levels rose and bone Ca increased. • The mg affected normalization of estrogen/progesterone by working with BVit It was shown women have a Mg deficiency. • Dairy has a 9:1 Ca :Mg ration plus high protein. • This disrupts the bone Ca balance and the protein pulls Ca from the bone. Grains and beans have high levels of Mg. White rice has Mg removed. • -Ca supplementation in adolescent girls increased bone density as measured by DEXA (JAMA 1993, Aug18) • Calcium rich foods: Dairy, turnip greens, lambs quarters, yeast, rice, and broccoli • Deficiency: Rickets, Osteomalacia, muscle cramps, HBP, osteoporosis (?), periodontal disease, hyperactivity, insomnia, lead toxicity, Pica (Ca and Zn) • Caused by decreased intake, blood loss, menorrhagia, lead toxicity, and malabsorption

• -Mg addition to the diet 200-1000mg (to bowel tolerance) increased bone density 11% with lower Ca 500mg (Guy Abraham MD). (TL1993 Aug/Sept p906-908) Mg def causes PTH hormone secretion (See article J Cl Endoc and Metab;19,1067, 1966) • -Ca supplementation in adolescent girls increased bone density as measured by DEXA (JAMA 1993, Aug18) • -Ca supplementation in adolescent girls increased bone density as measured by DEXA (JAMA 1993, Aug18) • Calcium rich foods: Dairy, turnip greens, lambs quarters yeast, rice, and broccoli • Deficiency: Rickets, Osteomalacia, muscle cramps, HBP, osteoporosis (?), periodontal disease, hyperactivity, insomnia, lead toxicity, Pica (Ca and Zn) • Caused by decreased intake, blood loss, menorrhagia, lead toxicity, and malabsorption

Treatment:
• Osteoporosis 1-2gm/d or 500mg/d with Mg, boron, VitK, D. -Citrate is best absorbed, but need to take lots of pills • . Dr. Joe Pizzorno ND has found that women with osteoporosis have a genetic variation (SNP – Single Nucleotide Polymorphism) that reduces VitD production. These women respond to higher doses of VitD and Calcium normalizing bone density. (Textbook)Leg cramps including in pregnancy • Hypercholesterolemia differing research results. • Hypertension (esp. salt sensitive) • Blood clots –easy bruising can be due to Ca def and also VitK/D def. • Periodontal disease • Insomnia 500-1000mg at bedtime • Smooth and skeletal muscle relaxation- restless legs, Dysmenorrhea, Arthritis • Anxiety • Hyperactivity • Depression (post menopausal) • Lead toxicity • Prevention of calcium oxalate stones (Ca Citrate plus B6 and water/ no sugar/bad fats. • Prevention of colon cancer (recent large study had refuted this – Am J of Epidemiology 2005; 161 – 39,876 women greater than 45yr, colon cancer rates not significantly affected by Ca and VitD intake) • Ca increases insulin sensitivity  2000mg/d • PMS 1200mg/d – mod=severe PMS reduced 48% • Pre-eclampsia – 1800mg Ca reduced it 50% from 29th week on

Toxicity:
• Asthma increases phopholipase A2 –PGE2. • Kidney stones increased with calcium carbonate and some other forms – Citrate reduces? Interactions: • Thyroid -calccarb interferes with absorption • Digoxin -calcium can increase digoxin toxicity • Tetracyclines inhibits absorption & vice versa • Corticosteroids depletes • Can cause Mg, Iron, and Zn def.