CALCIUM

Calcium is the mineral in your body that makes up your bones and keeps them strong. Ninety-nine percent of the calcium in your body is stored in your bones and teeth. The remaining 1% is in your blood and soft tissues and is essential for life and health. Without this tiny 1% of calcium, your muscles wouldn’t contract correctly, your blood wouldn’t clot and your nerves wouldn’t carry messages.

It is mainly the calcium in your diet that spares, or protects, the calcium in your bones. In addition to their structural role, your bones are your emergency supply of calcium. Your body actually tears down and builds bone all of the time in order to make its calcium available for your body’s functions. If you don’t get enough calcium, your body automatically takes the calcium you need from your bones. If your body continues to tear down more bone than it replaces over a period of years to get calcium, your bones become weak and break easily. This leads to the crippling bone disease called "osteoporosis." Approximately 25 million American women have some degree of osteoporosis; the disease will affect one-third to one-half of post-menopausal women, and 5 million American men suffer from osteoporosis.

Calcium is an essential nutrient your body needs every day. You may already know that it helps build and maintain healthy teeth and bones. But that’s not all. Calcium also keeps your heart beating steadily, your blood working correctly and your nerves and muscles in good shape, too.

 Calcium is key to keeping your body running smoothly. Because your bones are made from calcium, if you do not get enough from your daily diet, your body will "steal" the calcium from your bones to make up the difference. Over the long run this can reduce your bone strength and lead to osteoporosis, a potentially crippling disease of thin and fragile bones.

 Osteoporosis can make your bones so weak, in fact, that they can break with a firm handshake. Because people often do not get enough calcium from their diets, osteoporosis is now a major health concern and one of our most common diseases, affecting over 28 million Americans.

Your need for calcium starts even before you are born and extends throughout your lifetime. However, most people today are consuming fewer dairy products and vegetables that are calcium-rich. Think about your own diet. How many glasses of milk, if any, do you drink a day? When was the last time you had cottage cheese, broccoli, or sardines?

The most recent government survey of the eating habits of Americans confirms that most people are not getting enough calcium. Teenagers, young women and post-menopausal women in particular are consuming far less than is healthy -- and less than their body's need.

 How much calcium do you need each day? On average, if you’re not drinking three glasses of milk per day, you’re not getting enough.

From birth until about age 18, bones are forming and growing. Calcium is essential to this process. That’s why breast milk and infant formulas are rich in calcium. As children grow, it is equally important that their diet remain calcium-rich.

 
Unfortunately, the calcium intake of most Americans peaks at age eight. Think about it. While preschoolers have most of their diet chosen by a parent, by age eight, children are making more decisions on their own. They prefer juice or soda to milk with lunch. They like other snacks besides cheese and crackers.

During late adolescence, through young adulthood, adult bone is formed and reaches its maximum strength and density. Bones continue to accumulate calcium and become stronger after we have stopped growing. The calcium that you provide to your bones when you are young determines how well they will hold up later in life. By age 35 your bones are about as strong as they are ever going to be.

How does Calcium help during childbearing?

No matter what age a woman is when she becomes pregnant, calcium is very important to both the mother and the baby. Calcium from the mother’s body is used by the developing baby, putting increased demands on the mother’s supply. Additional calcium should be consumed for both the mother’s and baby’s health.

 Based on an analysis published in the Journal of the American Medical Association there is evidence that increasing calcium intake can help maintain normal blood pressure in pregnant women. Pregnancy-induced high blood pressure is a serious complication that can put both mother and child at risk.

How does calcium affect menopause?

When a woman enters menopause, her body produces much less of the female hormone estrogen. Loss of estrogen increases the risk of osteoporosis. Simply put, osteoporosis is a thinning of the bones. Bones become weak and fragile and can break easily. That’s why it is so important to take steps to protect yourself from osteoporosis by getting enough calcium every day.

 Calcium by itself has been shown to prevent some bone loss after menopause, and it definitely can help estrogen replacement therapy work more effectively. Recent studies have shown estrogen plus daily calcium is up to three times more effective in building bone than estrogen alone!

 The National Osteoporosis Foundation recommends that women make certain they get adequate daily calcium intake to make hormone replacement therapy and other prescription osteoporosis medications work more effectively. Men are also vulnerable to osteoporosis and need to consume adequate calcium through their older years to prevent further bone loss, and in their younger years to achieve peak bone mass.

How can I increase my calcium intake?

Dairy products provide the easiest, most plentiful sources of calcium in the diet. In addition, try adding broccoli, kale, and salmon, especially with the bones included, to your diet. Many processed foods are now fortified with calcium, including fruit juices, snack foods and breakfast cereals. You might find the easiest way to get the daily calcium you need is to make changes in your diet and take a calcium supplement.

Am I getting calcium from my multi-vitamins?

Maybe, but not much. Read the label. Even in the case of prenatal vitamins for pregnant women, the calcium content may not be enough to meet the daily demands of the mother and growing baby. A multi-vitamin may provide additional nutrients and vitamins that your body needs, but if your diet is low in calcium, you need to take a special calcium supplement.

Do I need other nutrients like Vitamin D with my calcium supplement?

Vitamin D helps your body absorb and use calcium. Unlike calcium, however, vitamin D can be stored by the body for extended periods of time. It does not have to be taken with your calcium supplement.

 Vitamin D is available from fortified dairy products, cod liver oil and fatty fish, and is manufactured by the body in reaction to sunlight. Generally, about fifteen minutes of direct sunlight per day gives you the vitamin D you need. However, the elderly and the homebound, in particular, often do not get enough vitamin D. Also, during the winter season the sunlight in the Northern parts of the U.S. is not intense enough to build up vitamin D in your body.

When should I take a calcium supplement?

If you aren’t getting enough calcium from your diet, you need to take a calcium supplement every day. Here are some tips to help you remember.

• Take your calcium supplement with meals. For example, calcium carbonate is most effective with meals, and studies have shown that it may be better absorbed with food.
• Take your calcium supplement in divided doses throughout the day. The body can absorb only so much calcium at one time, so try taking a supplement with two or three of your meals each day.
• Try keeping your calcium supplement in several places (bathroom, kitchen, purse) so if you do forget, you can take it easily.

What problems might I have taking calcium?

It’s very difficult to get too much calcium. Any excess which the body cannot use is excreted from the body in the urine and stool. Daily consumption up to 2,500 mg has been shown to be safe.

If you experience constipation or gas from calcium, your body may be adjusting to the new levels of calcium. If this happens, try starting with a small amount and build gradually to an adequate daily amount. And take your calcium in several doses during the day, for instance at meal times.

What about kidney stones? Are they caused by calcium supplementation?

Additional calcium intake may actually lower your risk for kidney stones. The largest study ever conducted on calcium and kidney stones, published in the New England Journal of Medicine in 1993, and another published in 1997, showed that daily calcium intake above 850 mg decreased the incidence of symptomatic kidney stones.

 Reducing your intake of dietary oxalate, a substance found in wheat bran, rhubarb, beets and nuts may also lower your risk of stones. The most important dietary factor in preventing kidney stones is water. Drink plenty of fluids, but not soft drinks, to help lower your risk for stones. And keep taking your calcium. Restricting calcium intake could increase the risk of stones.

Calcium Requirements of Infants, Children, and Adolescents (RE9904)

AMERICAN ACADEMY OF PEDIATRICS

Committee on Nutrition

ABSTRACT. This statement is intended to provide pediatric caregivers with advice about the nutritional needs of calcium of infants, children, and adolescents. It will review the physiology of calcium metabolism and provide a review of the data about the relationship between calcium intake and bone growth and metabolism. In particular, it will focus on the large number of recent studies that have identified a relationship between childhood calcium intake and bone mineralization and the potential relationship of these data to fractures in adolescents and the development of osteoporosis in adulthood. The specific needs of children and adolescents with eating disorders are not considered.

Approximately 99% of total body calcium is found in the skeleton, with only small amounts found in the plasma and extravascular fluid. Serum calcium exists in 3 fractions: ionized calcium (approximately 50%), protein-bound calcium (approximately 40%), and a small amount of calcium that is complexed, primarily to citrate and phosphate ions. Serum calcium is maintained at a constant level by the actions of several hormones, most notably parathyroid hormone and calcitonin. Calcium absorption is by the passive vitamin D-independent route or by the active vitamin D-dependent route.¹

Understanding calcium needs for different age groups requires a consideration of the variable physiologic requirements for calcium during development. For example, during the first month of life, the regulatory mechanisms that maintain serum calcium levels may not be entirely adequate in some otherwise healthy infants, and symptomatic hypocalcemia can occur. However, in general, hypocalcemia is uncommon in healthy children and adolescents, and the primary need for dietary calcium is to enhance bone mineral deposition.

Calcium requirements also are affected substantially by genetic variability and other dietary constituents. The interactions of these factors make identification of a single unique number for the calcium "requirement" for all children impossible.^2-4 However, several recent dietary guidelines have considered the data about calcium requirements and recommended calcium intake levels that are calculated to benefit most children.

In addition to calcium intake, exercise is an important aspect of achieving maximal peak bone mass. There is evidence that childhood and adolescence may represent an important period for achieving long-lasting skeletal benefits from regular exercise.⁵ For example, Welten et al⁶ showed in a large Dutch cohort of children that regular weight-bearing activity had a greater influence on peak bone mass than dietary calcium.

IDENTIFICATION OF MINERAL REQUIREMENTS DURING CHILDHOOD
Overview

It is recognized that a very low calcium intake can contribute to the development of rickets in infants and children, especially those consuming very restrictive diets (eg, a macrobiotic diet).⁷ There are no reliable data on the lowest calcium intake needed to prevent rickets or on the relationship among ethnicity, vitamin D status, physical activity, and diet in the causation of rickets in children fed low-calcium diets.^8,9

Recent data support the possibility that a low bone mass may be a contributing factor to some fractures in children. A relationship between the adolescent growth spurt and the risk of fractures has been shown.^10,11 Goulding et al¹² reported lower bone mass at multiple sites in a group of 100 girls aged 3 to 15 years with distal forearm fractures compared with age-matched girls. For girls aged 11 to 15 years in the study by Goulding et al¹² a lower calcium intake was reported for those with fractures compared with the control subjects. Wyshak and Frisch¹³ similarly reported that high calcium intakes seem to exert a protective effect against fractures in adolescent boys and girls. They also reported a positive relationship between cola beverage intake and bone fracture. Whether this is attributable to a potential effect of excessive phosphorus in the colas impairing bone mineral status or to the lack of calcium intake related to the substitution of colas for dairy products is uncertain. However, a direct harmful effect of a high phosphorus intake affecting the bone mineral status is unlikely in older children and adults.² Further data on the relationship between calcium intake and fractures are needed before the magnitude of increased fracture risk at different calcium intake levels can be assessed. However, it is reasonable to conclude that low calcium intakes may be an important risk factor for fractures in adolescents. This risk may be an issue that adolescents can more readily relate to than a long-term risk of osteoporosis.

Maintaining adequate calcium intake during childhood is necessary for the development of a maximal peak bone mass. Increasing peak bone mass may be an important way to reduce the risk of osteoporosis in later adulthood.^2,14 This is a more difficult end point to identify than the development of rickets or fractures. Therefore, surrogate markers of mineral status are used to assess the consequences of differing levels of calcium intake. The primary surrogates used are optimization of calcium balance or achievement of greater bone mass in children with increased calcium intake.^3,14,15

In children with chronic illnesses, fractures may occur during childhood secondary to mineral deficiency associated with the disease process or the effects of therapeutic interventions (ie, corticosteroids) on calcium metabolism.¹⁶ However, minimal data generally are not available on the risks and benefits of increasing calcium intake in children with chronic illnesses above current dietary recommendations. Supplementation of vitamin D along with calcium may be necessary for a maximal response.¹⁷

Methods

Multiple approaches are used to assess mineral requirements in children. They include the following: 1) measurement of calcium balance in persons with various levels of calcium intake; 2) measurement of bone mineral content, by dual-energy radiograph absorptiometry or other techniques, in groups of children before and after calcium supplementation; and 3) epidemiologic studies relating bone mass or fracture risk in adults with childhood calcium intake.

The calcium balance technique consists of measuring the effects of any given calcium intake on the net retention of calcium by the body. This approach has been the most commonly used to estimate requirement for minerals. Its usefulness is based on the rationale that virtually all retained calcium must be used, especially by children, to enhance bone mineralization. It therefore is reasonable to expect that the dietary intake that leads to the greatest level of calcium retention is the intake that will lead to the greatest benefit for promoting skeletal mineralization and decreasing the ultimate risk of osteoporosis.

The substantial limitations involved in obtaining and interpreting data about calcium balance are well known. These include substantial technical problems with measuring calcium excretion and the difficulty obtaining dietary intake control in children. Both of these are necessary for adequate balance studies. These problems have been partly overcome by the development of stable isotopic methods to assess calcium absorption and excretion.²⁰ Nevertheless, more data are needed to establish the "optimal" level of calcium retention at different ages and the effects of development on calcium balance.⁶

A major advance in the field during the last 25 years has been the development and improvement of methods to measure total body and regional bone mineral content by using various bone density techniques. Currently, the technique used in many studies is dual-energy radiograph absorptiometry. This technique can rapidly measure the bone mineral content and bone mineral density of the entire skeleton or of regional sites with a virtually negligible level of radiation exposure. Furthermore, recent enhancements in the precision of the technique have made it particularly suitable for assessing the effects of calcium supplementation on bone mass in children of all ages.

Several groups have directly assessed the effects of calcium supplementation on bone mass by using dual-energy radiograph absorptiometry or similar techniques.^22-25 These studies, however, also have limitations. First, most supplementation studies done in children involved relatively short-term supplementation of 1 to 2 years. This period may be inadequate to fully assess the long-term benefits of calcium supplements on bone mineral density. The second is that these studies generally have been done using only 1 level of supplementation, which frequently has been given in pill form. This limited dosing approach makes it difficult to identify an optimal intake level or determine the relative benefits of dietary calcium versus supplements as a method of increasing calcium intake in children.

Several investigators have performed population-based epidemiologic studies relating childhood or adult bone mass or fracture risk to calcium intake in childhood. Although many of these studies are limited by their retrospective design, they have generally shown a positive association between calcium intake in childhood and childhood and adult bone mass.

RECOMMENDATIONS BY AGE GROUP
Overview

Infants

The optimal primary nutritional source during the first year of life is human milk. No available evidence shows that exceeding the amount of calcium retained by the exclusively breastfed term infant during the first 6 months of life or the amount retained by the human milk-fed infant supplemented with solid foods during the second 6 months of life is beneficial to achieving long-term increases in bone mineralization. Available data demonstrate that the bioavailability of calcium from human milk is greater than that from infant formulas or cow's milk, although this comparison has not generally been made at comparable intake concentrations, ie, such as found in human milk.²⁹ Nevertheless, it has been deemed prudent to increase the concentration of calcium in all infant formulas relative to human milk to ensure at least comparable levels of calcium retention. Relatively greater calcium concentrations are found in specialized formulas, such as soy formulas and casein hydrolysates, to account for the potential lower bioavailability of the calcium from these formulas relative to cow's milk-based formula. Specific concentration requirements cannot be set readily, but all formulas marketed should have demonstrated a net calcium retention at least comparable to that of human milk.

Premature infants have higher calcium requirements than full-term infants while in the nursery. These may be met by using human milk fortified with additional minerals or with specially designed formulas for premature infants.³⁰ After hospitalization, there may be benefits to providing formula-fed premature infants formulas with higher calcium concentrations than those of routine cow's milk-based formulas.³¹ The optimal concentrations and length of time needed for such formulas are unknown.

Children

Few data are available about the calcium requirements of children before puberty. Calcium retention is relatively low in toddlers and slowly increases as puberty approaches. Most available data indicate that calcium intake levels of about 800 mg/d are associated with adequate bone mineral accumulation in prepubertal children. The benefits of greater levels of intake in this age group have been studied inadequately.^20,32 One study found a benefit of calcium supplements to children as young as 6 years of age.¹⁶ However, further supporting data are needed for this finding. Perhaps of most importance in this age group is the development of eating patterns that will be associated with adequate calcium intake later in life.

Preadolescents and Adolescents

The majority of research in children about calcium requirements has been directed toward 9- to 18-year-olds. The efficiency of calcium absorption is increased during puberty, and the majority of bone formation occurs during this period. Data from balance studies suggest that for most healthy children in this age range, the maximal net calcium balance (plateau) is achieved with intakes between 1200 and 1500 mg/d. That is, at intake levels above this, almost all of the additional calcium is excreted and not used. At intakes below that level, the skeleton may not receive as much calcium as it can use, and peak bone mass may not be achieved. Virtually all the data used to establish this intake level are from white children; minimal data are available for other ethnic groups. The exact level that is best for a given person depends on other nutrients in the diet, genetics, exercise, and other factors.

Several controlled trials have found an increase in the bone mineral content in children in this age group who have received calcium supplementation. However, the available data suggest that if calcium is supplemented only for relatively short periods (ie, 1 to 2 years), there may not be long-term benefits to establishing and maintaining a maximum peak bone mass.^34,35 This emphasizes the importance of diet in achieving adequate calcium intake and in establishing dietary patterns consistent with a calcium intake near recommended levels throughout childhood and adolescence. Unfortunately, long-term studies evaluating the consequences of maintaining currently recommended calcium intakes beginning in childhood or early adolescence are not available. Most available epidemiologic data, recently reviewed by the National Academy of Sciences and the National Institutes of Health, support the view that maintaining such a diet will increase peak bone mass and lower the incidence of fractures.

Recent data obtained in African American adolescents suggest a link between lower diastolic blood pressure and increased calcium intake. Further studies are necessary to evaluate this relationship in children of multiple ethnicities and age groups.

ACHIEVING RECOMMENDED INTAKES

The gap between the recommended calcium intakes and the typical intakes of children, especially those 9 to 18 years of age, is substantial . Mean intakes in this age group are between approximately 700 and 1000 mg/d, with values at the higher side of this range occurring in males. Preoccupation with being thin is common in this age group, especially among females, as is the misconception that all dairy foods are fattening. Many children and adolescents are unaware that low-fat milk contains at least as much calcium as whole milk.

Knowledge of dietary calcium sources is a first step toward increasing the intake of calcium-rich foods.  The largest source of dietary calcium for most persons is milk and other dairy products. Other sources of calcium are, however, important, especially for achieving calcium intakes of 1200 to 1500 mg/d. Most vegetables contain calcium, although at low density. Therefore, relatively large servings are needed to equal the total intake achieved with typical servings of dairy products. The bioavailability of calcium from vegetables is generally high. An exception is spinach, which is high in oxalate, making the calcium virtually nonbioavailable. Some high-phytate foods, such as whole bran cereals, also may have poorly bioavailable calcium.^38-40

Several products have been introduced that are fortified with calcium. These products, most notably orange juice, are fortified to achieve a calcium concentration similar to that of milk. Limited studies of the bioavailability of the calcium in these products suggest that it is at least comparable to that of milk. It is likely that more such products will soon become available. Breakfast foods also are frequently fortified with minerals, including calcium. Calcium intakes on food labels are indicated as a percentage of the "daily value" in each serving. This daily value is currently set as 1000 mg/d. Therefore, it is important to instruct families about reading and interpreting food labels.

Several alternatives exist for children with lactose intolerance. Lactose intolerance is more common in African Americans, Mexican Americans, and AsianPacific Islanders than in whites. Many children with lactose intolerance can drink small amounts of milk without discomfort. Other alternatives include the use of other dairy products, such as solid cheeses and yogurt, that may be better tolerated than milk. Lactose-free and low-lactose milks are available. Increasing the intake of nondairy products, such as vegetables, may be helpful, as may the use of calcium-supplemented foods.

For children and adolescents who cannot or will not consume adequate amounts of calcium from any dietary sources, the use of mineral supplements should be considered. Although supplements vary in their bioavailability, they may have bioavailability comparable to or greater than that of dairy products. Decisions about their use must be made on an individual basis, keeping in mind the usual dietary habits of the person, any individual risk factors for osteoporosis, and the likelihood that the use of the supplement will be maintained.

CONCLUSION

Recent studies and dietary recommendations have emphasized the importance of adequate calcium nutriture in children, especially those undergoing the rapid growth and bone mineralization associated with pubertal development. The current dietary intake of calcium by children and adolescents is well below the recommended optimal levels. The available data support recent recommendations for calcium intakes of 1200 to 1500 mg/d beginning during the preteen years and continuing throughout adolescence as recommended by the National Institutes of Health Consensus Conference and the National Academy of Sciences. Currently, evidence is inadequate to alter the dietary recommendations for children with chronic illnesses or those taking medications, such as corticosteroids, that alter bone metabolism. However, an effort should be made to achieve at least the recommended intake levels. The provision of adequate vitamin D also may be important for children with chronic illnesses.

RECOMMENDATIONS

1. Pediatricians should actively support the goal of achieving calcium intakes in children and adolescents comparable to those in recently recommended guidelines. The prevention of future osteoporosis, as well as the possibility of a decreased risk of childhood and adolescent fractures, should be discussed as potential benefits to achieving these goals. Currently, relatively few children and adolescents achieve dietary calcium intake goals.
2. To emphasize the importance of calcium nutriture, pediatricians should consider including the following questions about dietary calcium intake.
   • What do you drink, either white or chocolate milk, with your meals?
   • Do you drink milk with meals, snacks, or cereal or any other time during the day?
   • Do you eat cheese, yogurt, or other dairy products such as cottage cheese?
   • Do you drink calcium-fortified juices or eat any calcium-fortified foods?
   • Do you eat any of the following: broccoli, tofu, oranges, or legumes (dried beans and peas)?
   • Do you take any mineral or vitamin supplements?
3. For children and adolescents whose calcium intake seems deficient, specific information about the sources of dietary calcium should be provided. Adolescents may need to be reminded that low-fat dairy products, including skim milk and low-fat yogurts, are good sources of calcium that are not high in fat.

1. 
   Dietary Calcium Intake (mg/d) Recommendations in the United States^2,3*

   Age	1997 NAS3	1994 NIH2
   0 to 6 mo†	210	400
   6 mo to 1 y†	270	600
   1 through 3 y	500	800
   4 through 8 y	800	800 (4-5 y)
   		800-1200 (6-8 y)
   9 through 18 y	1300	800-1200 (9-10 y)
   		1200-1500 (11-18 y)

   * Recommended intakes were provided in different forms by each source cited. The Food and Nutrition Board of the National Academy of Sciences (NAS) released Recommended Dietary Allowances until 1997. In 1997, it chose to use the term adequate intake for the recommendations for calcium intake but indicated that these values were to be used as Recommended Dietary Allowances. The NIH Consensus Conference did not specify a specific term but indicated that these values were the "optimal" intake levels. Dietary recommendations by the NAS are set to meet the needs of 95% of the identified population of healthy subjects. The NAS guideline should be the primary guideline utilized.
   † For infant values, the 1994 NIH Consensus Conference indicated values for formula-fed infants, whereas the 1997 NAS report used the infant fed human milk as the standard.

   TABLE 2
   Approximate Calcium Contents of 1 Serving of Some Common Foods*

   Food	Serving Size		Calcium Content
   Milk†	1 cup	240 mL	300 mg
   White beans	1/2 cup	110 g	113 mg
   Broccoli cooked	1/2 cup	71 g	35 mg
   Broccoli raw	1 cup	71 g	35 mg
   Cheddar cheese	1.5 oz	42 g	300 mg
   Low-fat yogurt	8 oz	240 g	300-415 mg
   Spinach cooked‡	1/2 cup	90 g	120 mg
   Spinach raw‡	1-1/2 cup	90 g	120 mg
   Calcium-fortified orange juice	1 cup	240 mL	300 mg
   Orange	1 medium	1 medium	50 mg
   Sardines or salmon with bones	20 sardines	240 g	50 mg
   Sweet potatoes	1/2 cup mashed	160	44

Calcium & Magnesium:  Both elements share left / right-sided cell receptors and are essential to human health.  Calcium (Ca) and magnesium (Mg) have become the "Gold Standard" when discussing supplements, mineral ratios, paired cell receptors, or many nutrition-related health issues in general.     Calcium is now the most promoted nutrient by proponents of conventional, nutritional, and alternative medicine - yet at the same time, the assumed need is based purely on the speculation that the body's calcium intake is well below its requirements.   Of the approximately 1,000 g of calcium in the average 70 kg adult body, almost 98% is found in bone,   1% in teeth, and the rest is found in blood, extracellular fluids, and within cells where it is a co-factor for   a number of enzymes. Calcium promotes blood clotting by activating the protein fibrin, and along with   magnesium helps to regulate the heart beat, muscle tone, muscle contraction and nerve conduction.     Parathyroid hormone (PHT) secreted by the parathyroid gland and calcitonin secreted by the thyroid   gland maintain serum calcium levels at a range of between 8.5 to 10.5, whereby calcium is mobilized from bone reserves, and intestinal absorption of calcium is increased as needed.  The parathormone   can also affect renal functions to retain more calcium.  When blood calcium rises from too much para-   thyroid activity, calcitonin reduces availability of calcium from bone.     The calcium to phosphorus ratio in bone is about 2.5:1, while the ideal dietary phosphorus / calcium ratio is estimated to be about 1:1.  Many dietary factors reduce calcium uptake, such as foods high   in oxalic acid (spinach, rhubarb, chocolate), which can interfere with calcium absorption by forming   insoluble salts in the gut.  Phytic acid, or phytates found in whole grain products, foods rich in fiber,   excess caffeine from coffee, colas, tea..., as well as certain medications may all reduce the absorption   of calcium and other minerals, or leach calcium from bone.  Normal intake of protein, fats, and acidic   foods help calcium absorption, however high levels of these same sources increase calcium loss.     Chronic calcium deficiency is associated with some forms of hypertension, prostate and colorectal   cancer, some types of kidney stones, miscarriage, birth (heart) defects in children when the mother is   deficient in calcium during pregnancy, menstrual and pre-menstrual problems, various bone, joint and   periodontal diseases, sleep disturbances, mental health / depressive disorders, cardiovascular and/or   hemorrhagic diseases, and others (see bottom of page).   Elevated calcium levels are associated with arthritic / joint and vascular degeneration, calcification of   soft tissue, hypertension and stroke, an increase in VLDL triglycerides, gastrointestinal disturbances, mood and depressive disorders, chronic fatigue, increased alkalinity, and general mineral imbalances.   High calcium levels interfere with Vitamin D and subsequently inhibit the vitamin's cancer-protective effect unless extra amounts of Vitamin D are supplemented.     Magnesium: There are about 19 g of Mg in the average 70 kg adult body, of which approximately 65%   is found in bone and teeth, and the rest is distributed between the blood, body fluids, organs and other   tissue.  Magnesium is involved in the synthesis of protein, and it is an important co-factor in more than   300 enzymatic reactions in the human body, many of which contribute to the production of energy, and   with cardiovascular functions.  While calcium affects muscle contractions, magnesium balances that   effect and relaxes muscles.  Most of magnesium is inside the cell, and while iron is the central atom in   hemoglobin, magnesium is the central core of the chlorophyll molecule in plant tissue.     Although the process of absorption for magnesium is similar to that of calcium, some people absorb   or retain much more magnesium than calcium (or more calcium than magnesium), so the commonly   suggested supplemental intake ratio of 2:1 for calcium and magnesium is really an arbitrary value that   can change significantly under various individual circumstances. (see also Acu-Cell "Mineral Ratios").     Low levels of magnesium can be a causative, contributing, or aggravating factor with kidney stones   (usual recommendations for prevention are 400mg of magnesium oxide and 50mg of Vitamin B6 daily),   high blood pressure, mitral valve prolapse (MVP), arrhythmia, tachycardia, coronary artery spasm and   other types of heart problems, premenstrual syndrome (PMS) or menstrual cramps, tetany (sustained contractions, convulsions), (pre)eclampsia - particularly when too much iron and not enough folic acid was taken during pregnancy, insomnia, anxieties, chronic constipation, hyperactivity - particularly with children, and others (see bottom of page).   However, frequent and excessive use of magnesium sulfate (Epsom salt) or antacid remedies such   as Milk of Magnesia can eventually trigger a number of medical problems resulting from other minerals   such as calcium, sodium, iron, or potassium getting out of balance.  This is more prevalent with kidney   diseases and may include severe fatigue, depression, low blood pressure, gastrointestinal problems,   dizziness, dehydration / dry skin, diarrhea, muscular / joint problems and cardiovascular diseases.     Serum Calcium may change with kidney, or parathyroid diseases, but it doesn't change with high or low dietary calcium intake, subsequently it cannot be used as a deficiency or excess indicator --- the body simply makes up any additional needs from bone reserves.  Other methods to assess someone's   calcium requirements include a 24-hour urine collection (not accurate at all), or a bone scan.  The latter   doesn't measure calcium specifically either, but assesses overall bone density, which reflects the total content of all other minerals present in bone as well.  In other words - there is no standard, mainstream test available to accurately assess nutritional requirements for calcium, magnesium, and most other essential trace minerals outside of using intracellular measurements, for which White Blood Cell, Red Blood Cell, or Acu-Cell Analysis can be used.   However, as mentioned above, changes in serum calcium provide important information about various hormonal or organic disturbances, including excessive Vitamin D status, or the possible presence of cancer with elevated serum calcium levels.     Calcium and magnesium belong to a group of "parasympathetic" elements (which includes chromium and copper), that exhibit anti-inflammatory or degenerative properties at higher amounts, in contrast to elements such as potassium or iron, which are pro-inflammatory when high:      inflammatorydegenerative    <--------------------------------------- Ca, Mg, Cu, Cr -------------------------------------->    low amountshigh amounts        degenerativeinflammatory    <---------------------------------------- K, Fe, Mn, Zn  --------------------------------------->    low amountshigh amounts     An interesting aspect about these trace minerals is the similarity of medical conditions that result   from both, excessive, or deficient levels.  For instance, low calcium or copper levels increase the risk for vascular (cerebral) hemorrhage, while high levels promote vascular degeneration (arteriosclerosis).   With arthritis, low calcium or copper levels cause inflammatory types of joint disease, while high levels   cause degenerative (osteo-arthritic) joint damage.     Depression can be related to high and low levels of calcium and/or magnesium also, with low levels being oftentimes associated with anxieties as well.  After comparing the backgrounds of patients who required very high doses (4,000+mg) of calcium a day - just to barely reach normal levels, it turned out that a very large percentage had a history of benzodiazepine (tranquilizers / sedatives) use.   These drugs either affected their body's ability to utilize calcium and/or magnesium properly, or those   minerals levels in these patients had already been extremely deficient before taking any medications, provoking insomnia, anxieties, or other symptoms, and resulting in drugs (benzodiazepines) being prescribed instead of having the real cause (mineral deficiencies) corrected.  Unfortunately, this type   of symptomatic drug therapy continues to be a trademark of modern medicine.     Drugs such as Aspirin, or other NSAIDs increase magnesium (and sometimes calcium) requirements   also, but they are more dependent on frequency or dosages used, or on someone's kidney functions,   which are generally affected by these drugs.  At the same time, the extra requirements for magnesium or calcium are just an additional percentage of the Recommended Dietary (or Daily) Allowance (RDA).     Osteoporosis can result from both, low and high levels of calcium, magnesium, phosphorus, and also   chromium, copper, silicon and fluoride - but mostly as a result of their improper ratios to one another.   There are just as many patients with excessive, as with deficient calcium levels, whereby the treatment chiefly consists of having them supplement whichever co-factors are low in ratio to calcium, which may include manganese, phosphorus (protein), magnesium, zinc, Vitamin C..., or the use of acid-raising   digestive aids to increase solubility or bioavailability of calcium. (see also Acu-Cell "Osteoporosis").     Random intake of high amounts of calcium for the prevention of osteoporosis can be bad news for a   person's cardiovascular system, since it is frequently promoted without any individual assessment to   prove that it is indeed calcium which is really needed, and not any of several co-factors which help absorption of calcium into bone.  As mentioned already, the foremost treatment when dealing with mineral-related medical conditions is to correct their ratios.  Deficiency symptoms - particularly those involving calcium and copper - can still take place despite their levels being above-normal when either   associated, or interactive minerals are higher yet.     Individuals who exhibit below-normal calcium or magnesium levels get away with more atherogenic   (junk) diets compared to those with normal or higher levels, and I always point out to patients that once their calcium or magnesium levels are raised, they will have to watch their sugar and (trans) fat intake more.  The reasons are very simple:      Calcium  raises:VLDL TriglyceridesMagnesium  raises:LDL Cholesterol    Calcium  lowers:MCT & SCTMagnesium  lowers:HDL Cholesterol    Calcium  lowers:Total TriglyceridesMagnesium  lowers:Total Cholesterol    Calcium  lowers:PhosphorusMagnesium  lowers:Sodium      MCT = Medium Chain TriglyceridesSCT = Short Chain Triglycerides     For the above reasons, calcium and magnesium, at higher amounts, exhibit atherogenic properties.   They also lower phosphorus and sodium respectively, which, if lowered too much, will have an additive   effect of low phosphorus independently raising VLDL triglycerides, and low sodium independently   raising LDL cholesterol.  This degenerative effect produced by high levels of calcium and magnesium   generally takes place over a number of years - not just in a few months.   Short-term studies have demonstrated that magnesium may reverse atherosclerosis, however, while this may be true initially, it can have the exact opposite (LDL-promoting) effect in the long run.  This is   why it is so important to compare and evaluate nutritional studies which not only use identical amounts   and types of nutrients and the same testing methods, but also similar lengths of trials.  Obviously, human   and animal study results are not always interchangeable either.     High concentrations of magnesium have been shown to have antithrombotic action and to inhibit platelet aggregation and adhesion in vitro, while intravenous magnesium is known to inhibit platelet function in vivo, additive to Aspirin, so the antiplatelet effect of intravenously administered magnesium might be of benefit to those with acute coronary syndromes when given before the development of an occlusive thrombotic clot.  However, Myocardial Infarctions (heart attacks) can still take place either despite of, or because of long-term oral intake of high doses of magnesium if intracellular levels of   magnesium have gone excessively high, and sodium levels have gone excessively low.     To help boost calcium levels in individuals with chronically low calcium absorption, supplementing   Vitamin B5 (pantothenic acid) can be helpful in inhibiting the antagonistic action of phosphorus (if high), while taking extra Vitamin B2 (riboflavin) will increase magnesium uptake by inhibiting sodium and iron.   A Magnesium+Vitamin B2 combination can be effective in relieving one-sided migraines if caused by   elevated iron or sodium.  Titanium implants support calcium, but not magnesium retention.     Higher amounts of Vitamin B6 will also increase magnesium retention, although this only takes place   following long-term oral supplementation, while regular Vitamin B6 injections will quickly result in a   high magnesium / low calcium ratio.   If not matched to a patient's requirements (which happens frequently when Vitamin B6 + Vitamin B12 injections are given at Weight Loss Clinics), a severe calcium deficiency develops.  This by itself -   or when aggravated by an overstimulated thyroid from the regular Vitamin B6 + B12 shots - can result   in insomnia, heart palpitations, chest pains, anxieties, depression, mood swings, joint / muscle pains,   and other symptoms.  (see also Acu-Cell "Diets").     In low sodium types, regular intake of higher doses of Vitamin B6 creates a somewhat different picture,   where the raising effect on magnesium will also result in an increasingly higher magnesium / calcium ratio, however in addition to lowering lithium and eventually calcium levels, an abnormally high retention of magnesium will result in dramatically lower sodium and silicon, but increased phosphorus levels.   Common long-term effects include spinal degeneration at T1 (with right-sided symptoms in the upper   back / shoulder area) and at L2, along with general osteo-arthritic changes in various joints.   As a result, Vitamin B6 therapy should only be used for someone with an otherwise difficult-to-manage   low magnesium / high calcium ratio (where calcium is always high, and magnesium is always low).     With a low calcium / high magnesium ratio and a general acidic disposition, supplementing larger amounts of Vitamin C in the form of ascorbic acid can be a problem not only for those with a sensitive   stomach, but also for calcium uptake since too much acid results in calcium loss.  While some types of 'Buffered C' such as Calcium Ascorbate help in milder cases, Sodium Ascorbate would be another option in more severe cases, provided there is no sodium sensitivity, or a history of kidney disease.     Boron supplementation may be a consideration for individuals with chronically low calcium and magnesium levels, however since boron inhibits manganese, it would be best suited for those with congestive liver disease who generally exhibit higher manganese levels (manganese inhibits calcium and magnesium), but not for those whose manganese levels are already on the low side.   Adequate Vitamin D levels will assist intestinal absorption of calcium, magnesium and phosphorus.   Excessive intake of Vitamin D will result in above-normal serum calcium levels, and calcium loss from   bone.  So while supplementing much larger amounts of Vitamin D may protect from several types of   cancer or be indicated with certain neurodegenerative conditions such as multiple sclerosis, they can   unfortunately also lead to osteoporosis and calcification of arteries and other soft tissue.     Contrary to the claims of uninformed sources, Low Stomach Acid does not have an inhibiting effect   on calcium absorption, as even patients with no acid production (achlorhydria) absorb calcium normally,   regardless of whether it comes in the form of calcium citrate, calcium carbonate, or milk.  It is very high   stomach acid that may be cause for concern since it will frequently result in a cellular calcium loss, with the same rules applying to magnesium as well.  However, from their lowering effect on acid levels, high calcium and/or magnesium intake can have a significant impact on medical conditions that are affected by abnormally low stomach acid levels.     For instance, soft tissue calcification and spurs are more prevalent with low acid levels, and if infected with Helicobacter Pylori, the bacteria is always more active under low acid conditions also.  In addition,   long-term infections with H.Pylori, or salt-restricted diets can in some individuals reduce stomach acid   levels enough to affect / impair Vitamin B12 uptake.   As a result, the best types of calcium may be chosen based on an individual's tendency for low stomach   acid or constipation, for which calcium citrate is usually better suited, in contrast to a tendency for softer stools or high stomach acid, for which calcium carbonate or calcium oxide may be a better choice.     From more than 25 years of patient feedback on their tolerance, and from monitoring the absorption of   various types of calcium (and other minerals), I have personally found Amino Acid Chelated Calcium to   be the most consistently tolerated, while at the same time needing the least amount of supplementation   to meet requirements.   Nutritional texts stating that "calcium is best taken between meals or in the absence of foods when the stomach is more acidic" were likely written at a time when research findings were primarily based on the older urinary increment tests, but have long since proven invalid.  Scientific studies done with   Radioisotope Analysis or intracellular tests such as Acu-Cell Analysis show clearly that most types of calcium fall into the same 30-40% absorption range, regardless of solubility:      31% for calcium from milk,    32% for calcium acetate (most soluble form),25% elemental,    32% for calcium lactate13% elemental,    27% for calcium gluconate9.3% elemental,    30% for calcium citrate21% elemental,    39% for calcium carbonate(least soluble form)40% elemental,     The range of absorption narrows even further and increases percentage-wise when calcium is taken   in smaller doses of 300 mg - 500 mg throughout the day (as needed), which is particularly helpful for   people who are not able to absorb higher amounts (1,000+mg) of calcium in a single meal.  However   the largest single dose of the day is best taken in the evening since calcium requirements are greatest   during sleep, hence deficiency symptoms such as nocturnal leg cramps or insomnia...   When supplemented with food, overall uptake of all types of calcium is additionally up to 30% greater,   and absorption between calcium citrate and calcium carbonate for instance becomes virtually identical.   Inconsistencies are found only when calcium is supplemented in different forms, such as tablets versus   gelatin capsules, where the gelatin itself may not dissolve properly in a low acid environment.     AAACa / AdvaCAL Calcium - developed by Dr. Takuo Fujita, MD and colleagues - consists of a type   of patented oyster shell supplement that is made by heating calcium to about 800°C in a vacuum, which   breaks calcium carbonate up into calcium oxide and calcium hydroxide.   AACa (active absorbable calcium) is then combined with a heated algal ingredient (HAI) Cystophyllum Fusiforme to form AAACa, which results in better calcium absorption without the need for Vitamin D.   In a number of clinical trials, "AAACA was apparently more effective increasing trabecular bone density   than calcium carbonate or AACA (without the algal ingredient) containing the same amount of elemental   calcium." Some studies also propose that AAACa is capable of reversing bone loss and preventing   malformation of bone.  However, there are some aspects regarding AAACa therapy to consider:     • While the cost of calcium citrate is about 4 - 6x higher than calcium carbonate, the cost of AAACa is     about 40x higher than calcium carbonate!  The question is - does better absorption of AAACa justify     its very high cost if taking larger amounts of other types of calcium also meet calcium requirements?     • For individuals with normal calcium absorption and bone metabolism, the use of AAACa does not     seem to serve a useful purpose considering its exorbitant cost.  When calcium absorption had been     a major problem and several grams of calcium carbonate were needed to meet requirements, even     the 2,000 mg maximum suggested daily amount of AAACa still failed to normalize calcium levels,     which made the use of other types of calcium much more cost-efficient despite the larger doses that     were required.     • Since AACa without the HAI is not much better absorbed than other forms of calcium, it would make     sense to isolate the active ingredient of the Heated Algal that increases calcium absorption and test     it for long-term safety, because a), there seem to be notable changes in stomach acid, potassium,     copper, and other levels, even after just a very short trial with AAACa therapy, and b), some therapies     that are capable to increase bone density are also capable to increase the risk for cancer.     • Vitamin K (as K1 or K2) is also well-established as being able to reduce the risk for osteoporosis, or     - unlike other therapies - reverse bone loss without increasing the risk for cardiovascular disease and   stroke.  At the same time, it is non-toxic even when regularly supplemented at higher amounts, so the   addition of Vitamin K to any form of calcium therapy provides proven benefits for osteoporosis     and other health concerns.     Dr. Fujita, the developer of AAACa, holds some highly unconventional and unshared views on basic   aspects of calcium metabolism. In a 1999 interview, he proposed that:     • "All of us are calcium deficient."   • "The ratio of calcium to magnesium is not important, as long as we are taking enough of both."   • "Too much calcium intake is never dangerous, but too much magnesium can be.       So I think calcium is the only one of which you can take as much as you want and get away       with it, but you shouldn't take too much magnesium."   • "We don't need Vitamin D because HAI performs the same function and it's a natural product."   • "Milk is a very common source of calcium, but it also contains a lot of phosphorus, which       combines with calcium and prevents it from being absorbed..."     From a clinical perspective, AAACa comes closest in absorption and gastrointestinal action to calcium   citrate, in that - unlike calcium carbonate - it does not reduce, but may increase stomach acid levels,   and there is no risk for constipation, but a possibility for looser stools.  If calcium citrate is not tolerated   and cost is no object, AAACa can be a similarly-acting substitute.   In patients with normal stomach acid levels and calcium absorption, 2 - 2½ calcium carbonate tablets   of 500mg each, on average, raise cellular calcium levels as much as 6 AAACa tablets of 167mg each.   Very poor calcium absorption and subsequently severe calcium deficiency requires very high doses   of calcium, regardless of whether they consist of AACa, or any other type of calcium.   Because of superior absorption, Amino Acid Chelated Calcium requires the least supplementation,   although for patients with high stomach acid, Calcium Carbonate is still the best all-around choice.     AAACa formulations do not include Vitamin D, but use the HAI to increase absorption.  However, taking   larger amounts of calcium increases the risk of eventually causing a Vit D deficiency (unless someone's   requirements are met through UV exposure or other sources).  This in turn increases the risk for breast,   colorectal, prostate, lung, pancreatic and ovarian cancer, which Vitamin D is somewhat protective for.   The same applies to any other (chelated) calcium products that contain no Vit D and are supplemented   at higher amounts.     Coral Calcium is a heavily promoted product with lots of anecdotal success stories and the usual   unsubstantiated claims of miracle cures.  Because there are various forms of coral calcium available with many different mineral / nutritional formulations, there is no predictability as to the actual calcium uptake a patient may expect.  For those reasons, and some unwelcome side effects reported, patient response under controlled clinical settings has been mostly negative. (see Acu-Cell "Diets & MLM" for   details on Coral Calcium).     ***        Acid levels in the upper portion of the stomach affect calcium and iron absorption (usually in opposite   directions, depending on the type of minerals ingested), and vice versa, where calcium and iron intake affects stomach acid levels (also depending on the type of minerals consumed).  The same applies to   acid levels in the lower portion of the stomach, which affect magnesium and manganese absorption   (also in opposite directions), and vice versa, depending on the type of minerals consumed.   However, in the event of a high calcium / manganese ratio (both are antagonists), calcium may affect   lower acid levels as well, and in the event of a high magnesium / iron ratio (both are also antagonists),   upper stomach acid levels may be affected by magnesium through that same mechanism:
	Acid production in the upper stomach area can vary from the lower stomach area as a result of their   neurological disassociation, consequently spinal alignment problems at T12 can trigger acid-related stomach disturbances that won't respond to either acid-raising or acid-lowering remedies.  Only spinal   manipulation, or choosing the right minerals according to their acid-raising / lowering, or upper / lower   association will resolve those types of conditions.   High stomach acid can, in the long run, lower calcium and/or magnesium enough to cause chronic   insomnia, not only from the gastric discomfort, but also from an inability of the sufferer to reach deep   sleep, which is difficult to achieve with low calcium.  Chronic daytime fatigue is a frequent result.     Other than malabsorption of a number of important nutrients, or general indigestion or bloating, one   of the greatest threats arising out of long-term low stomach acid situations is the increasing risk for malignancies - not just gastric cancers, but many other types as well.  (see also Acu-Cell "Cancer").   The coincidence of many malignancies with corresponding low acid is nearly 100%.  This in itself calls   for prudence when enticed by the media - or even by a medical practitioner - to supplement very large   amounts of calcium or magnesium, without any analysis substantiating that such action is warranted. ¤        DRI / RDA  for Calcium & Magnesium  +  Vitamin A, D, K  Page 2  >>     ==============================================================================     General recommendations for nutritional supplementation:  To avoid stomach problems and promote   better tolerance, supplements should always be taken earlier, or in the middle of a larger meal.  When   taken on an empty stomach or after a meal, there is a greater risk of some tablets causing irritation, or eventually erosion of the esophageal sphincter, resulting in Gastroesophageal Reflux Disease (GERD).   It is also advisable not to lie down immediately after taking any pills.   When taking a very large daily amount of a single nutrient, it is better to split it up into smaller doses to   not interfere with the absorption of other nutrients in food, or nutrients supplemented at lower amounts.     ______________________________________________________________________________

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