Women's Health


One of the most common questions I am asked - and one of the most difficult to answer is "Doctor, what calcium should I take?" There is no easy and straightforward answer to that. I am, however, very glad that everyone is becoming more aware of the importance of calcium - particularly since it is so deficient in most American diets.

The daily requirement for calcium is 1200 to 2000 mg of calcium, if you are small to medium stature. However, most women in the United States get less than 600 mg of calcium daily. The exact dosage depends upon your personal body weight. You also need a minimum of 400 lU of vitamin D daily. Some people require much more if they have been deficient for a long time.

Good dietary sources of calcium include: beans, dark green leafy vegetables, meat stock made with marrow bones, and broccoli. The dark green leafy vegetables also contain small quantities of vitamin D3.

Because it is difficult to get adequate amounts of calcium and vitamin D in the diet, I generally recommend calcium supplementation. However, there are some important facts you need to know about calcium metabolism to protect yourself from false and misleading advertising, some of it very dangerous.

First of all, the most important factor for absorption of calcium is an acid pH. Therefore, Tums[TM] and other antacid products which represent that they provide calcium are simply trying to capitalize on the current public preoccupation with the importance of calcium supplementation. Very little of that calcium can be absorbed when the stomach is alkalinized.

A worse outcome is the risk of developing "milk/alkali syndrome." Milk/alkali syndrome is the result of abusing antacids that contain large amounts of calcium. It was discovered 50 years ago, when the approved medical therapy for peptic ulcer included the ingestion of large amounts of milk or calcium carbonate and soluble alkali. The clinical features include: metabolic alkalosis, hypercalcemia and renal impairment. The symptoms can be quite variable, since there are varying degrees of toxicity. However, metabolic alkalosis can cause cardiac arrhythmias, muscular weakness and hyporeflexia. Severe hypercalcemia (>13 mg/dcl) can be life threatening. Many body systems are affected, including. (1) Central nervous system - impaired thought processes, loss of memory for recent events, emotional lability, depression, loss of smell, somnolence and even coma; (2) Neuromuscular - weakness, joint pain, severe itching, restless leg syndrome; (3) Gastrointestinal - loss of appetite, nausea, vomiting, indigestion, constipation; (4) Kidneys - frequent urination, increase in nighttime urination, and susceptibility to calcium-based kidney stones which can lead to kidney failure; and (5) Cardiovascular - hypertension.

Another factor to consider in your choice of calcium supplementation is the relative absorbability of the different chemical forms of calcium. Calcium citrate is probably the most absorbable; however, it has been demonstrated that calcium is absorbed better when different chemical forms of it are taken together. Therefore, I often recommend a chelated calcium (calcium gluconate) to be taken with calcium citrate.

Other forms of calcium - many of them cheaper than calcium citrate or chelates have serious drawbacks. Calcium carbonate: malabsorbed with those with poor digestion; antacid effect interferes with digestion and may cause milk alkali syndrome; causes intestinal gas; suppresses bone remodeling. Bone meal: may be contaminated with toxic heavy metals; the heating process substantially destroys many of the organic compounds, leading to reduced effectiveness. Oyster shell: calcium carbonate by another name. Chelates: Check carefully to see if they are chelated with soy protein, if you are soy sensitive. Calcium lactate: reactive for people who are milk sensitive, relatively low dose calcium. Dolomite: calcium carbonate mixed with magnesium oxide. This is a mineral which is mined; can be contaminated with heavy metals. The two compounds together are much less absorbable than calcium carbonate by itself. My clearest recollection of x-raying patients in clinic when I was an intern was seeing undissolved dolomite pills in the colon.

To monitor calcium absorption and utilization, a blood test is needed. Just putting calcium supplements in your mouth does not guarantee that the Calcium is being absorbed into your blood stream. Other factors that influence calcium absorption include vitamin D status, parathyroid function and thyroid function. All of those organs are assessed with our standard blood work-up, which includes: a blood chemistry panel, complete blood count, urinalysis and thyroid panel. In addition, we carefully monitor urinary pH, for two reasons, to avoid the formation of kidney stones and to maximize absorption of calcium. Optimum urinary pH for absorption is 6.4 to 6.8; however, calcium stones can be avoided by any pH under 6.8.

Last summer, the New England Journal of Medicine reported that supplementation with calcium and vitamin D will restore bone mass. To maximize your nutritional program, however, you should add weight-bearing exercise and 30 minutes of sunshine daily. The sun exposure should be before 10am or after 3pm. A walk is an excellent choice of activity.

I trust that these guidelines will help you make good choices in your personal life. If you are in good health, generalizations can safely be used; however, if you have any health problems, let me encourage you to make an appointment at the RFHC so that we can assess your unique biochemistry and design a program that will optimize your health. [see Diagnostics/Bloodwork]

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