OSTEOPOROSIS: CALCIUM WITHOUT ADDING POUNDS (SUPPLEMENTS)
‘Get your calcium from food from the dairy or grocer and not from the chemist’ is the general advice, as your body absorbs dietary calcium more thoroughly than the calcium in supplements. However, for many people that is insufficient for their daily calcium needs. Are you:
pregnant or breast-feeding your baby?
convalescent after an illness or surgery?
on a medically supervised weight-control diet of less than
1000 calories per day?
a strict vegetarian who avoids all dairy products?
having dental problems as a result of periodontal disease?
suffering from a special malabsorption disease?
over fifty, and finding it difficult to eat sufficient dairy
products?
If you answer yes to any of these questions, you should discuss calcium supplements with your physician, to get the vital mineral without consuming more calories. Your doctor can advise you on your personal daily calcium needs, particularly if you are already taking antibiotics or a diuretic, have kidney disease or other intestinal disorders your NHS doctor or clinic may prescribe:
Calcium lactate gluconate with calcium carbonate (Sandocal 1000, 1 tablet daily)
Calcium carbonate (Titralac, 2 to 3 tablets daily)
Hydroxyapatite (Ossopan 800, 4 to 5 tablets daily)
Calcium carbonate (Calcichew, 2 to 3 tablets daily)
Calcium citrate (Cacit, 1 tablet daily)
The amount of calcium in a vitamin-mineral tablet is usually insufficient, since calcium is too bulky to be incorporated in amounts up to 500mg in a vitamin preparation. Supplements come in tablet, powder or liquid form, and are best taken between meals with small amounts of milk or yogurt, which have the lactose and vitamin D to help you absorb the calcium. Since more calcium is lost from your body while you are asleep, be sure to reserve some of the daily supplement for just prior to bedtime — the milk will also help you sleep.
Of the many non-prescription calcium supplements you can buy, most contain one of three calcium compounds (occasionally a combination of them), varying widely in the proportion of calcium they contain. To reduce cost, look for your chemist’s own label instead of brand names, and ask the pharmacist for information if the label is insufficient.
Calcium carbonate (40 per cent calcium). This is the highest available concentration of calcium, meaning that generally it is the least expensive because you need to take fewer tablets. This compound is often derived from oyster shells and may contain sweeteners and flavourings. (In Japan, this supplement is often made from tons of pearls, too flawed or tiny for jewellery.) The AMA Division of Drugs recognizes calcium carbonate as the preferred type of oral calcium supplement, although it can cause constipation or gas. Since calcium carbonate needs gastric acid for absorption, the elderly (or those who have had part of their stomachs removed) may find it a problem if their stomachs produce less acid. This compound is commonly used in antacids, and may cause rebound stomach acidity (a vicious circle of acid secretion, antacid, acid, antacid and so on). If you suffer from a chronic duodenal ulcer you may induce excess acid when taking high doses of calcium carbonate.
Calcium lactate (13 per cent calcium). A little more expensive, containing less calcium. Since this compound is usually derived from lactic acid or lactate salts (chemically unrelated to lactose), there should be no problem of lactose intolerance. Calcium lactate appears to be the least gastrically irritating and more soluble for older persons with low stomach acid output.
Calcium gluconate (9 per cent calcium). Because of the small percentage of calcium, it needs to be taken more often throughout the day. It has a very sweet taste.
You will also find in health-food stores or by mail order ‘chelated’ calcium tablets. Chelation is supposed to improve the absorption in the intestine, anchoring the calcium to other chemicals; it can, however, make the tablets more expensive.
Calcium chloride and calcium levulinate may also be in your health-food store or at the chemist: the first compound can irritate the stomach, and is more used in pickle recipes. The latter, with a low percentage of calcium, has a bitter, salty taste.
Several brands of calcium supplements have the addition of vitamin D to promote calcium absorption. However, D is a fat-soluble vitamin, and it is easy to overdose. Most people acquire sufficient vitamin D through exposure to sunlight, so ask the advice of your doctor on this point.
Bone meal and dolomite These products, usually available as tablets or powder, should be avoided. Bone meal supplements are usually produced from finely milled cattle bone. All bone meal contains a certain amount of lead, originating from the diet of the animal, and generally speaking, there is a greater quantity of lead as the animal gets older. Dolomite is a form of limestone, with a similar risk of lead contamination. The US Food and Drug Administration has issued a warning to doctors and the public about these products connected with the danger of lead poisoning. Since calcium supplements are frequently used by pregnant and nursing women, and by children unable to digest milk, doses of lead can be hazardous, causing effects ranging from anaemia to severe brain damage to death. The lead content in the different brands can be highly variable, according to tests done by the US Consumers
Union in 1982, and dolomite supplements were a little lower in lead than the bone meal products. Although the products are not dangerous by themselves at the recommended dosages, the conclusion was that these particular calcium supplements could add appreciably to the exposure people already have from lead in the air, water and food. If some people exceed the dose, on the principle that more is better, they would have an even higher risk of lead exposure. Even though the prices of bone meal and dolomite are usually somewhat lower than other calcium supplements, the variability of lead in them dictates that they should be avoided, especially as many forms of calcium are available.
How much calcium is too much?
Medical authorities consider that almost everyone can consume 1500mg of calcium daily — but no more than 2000mg — with little risk of adverse health effects, considering an intake both from diet and supplements, although no one yet knows the long-term effects of very high supplementation. Symptoms of calcium overdose include constipation, stomach upset, dry mouth, thirst and increased urination. Too much calcium can cause calcification of the arteries (arteriosclerosis) and can create kidney stones if you are predisposed to this problem.
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