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Linus Pauling Institute
Micronutrient Research for Optimum Health
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Calcium is the most common mineral in the human body. About 99% of the calcium in the body is found in bones and teeth, while the other 1% is found in the blood and soft tissue. Calcium levels in the blood and fluid surrounding the cells (extracellular fluid) must be maintained within a very narrow concentration range for normal physiological functioning. The physiological functions of calcium are so vital to survival that the body will demineralize bone to maintain normal blood calcium levels when calcium intake is inadequate. Thus, adequate dietary calcium is a critical factor in maintaining a healthy skeleton (1). Function Structure Calcium is a major structural element in bones and teeth. The mineral component of bone consists mainly of hydroxyapatite [Ca10(PO4)6(OH)2] crystals, which contain large amounts of calcium and phosphate (2). Bone is a dynamic tissue that is remodeled throughout life. Bone cells called osteoclasts begin the process of remodeling by dissolving or resorbing bone. Bone-forming cells called osteoblasts then synthesize new bone to replace the bone that was resorbed. During normal growth, bone formation exceeds bone resorption. Osteoporosis may result when bone resorption chronically exceeds formation (1). Cell signaling Calcium plays a role in mediating the constriction and relaxation of blood vessels (vasoconstriction and vasodilation), nerve impulse transmission, muscle contraction, and the secretion of hormones like insulin (3). Excitable cells, such as skeletal muscle and nerve cells, contain voltage-dependent calcium channels in their cell membranes that allow for rapid changes in calcium concentrations. For example, when a muscle fiber receives a nerve impulse that stimulates it to contract, calcium channels in the cell membrane open to allow a few calcium ions into the muscle cell. These calcium ions bind to activator proteins within the cell, which release a flood of calcium ions from storage vesicles inside the cell. The binding of calcium to the protein, troponin-c, initiates a series of steps that lead to muscle contraction. The binding of calcium to the protein, calmodulin, activates enzymes that breakdown muscle glycogen to provide energy for muscle contraction (1). Cofactor for enzymes and proteins Calcium is necessary to stabilize a number of proteins and enzymes, optimizing their activities. The binding of calcium ions is required for the activation of the seven "vitamin K-dependent" clotting
Other causes of abnormally low blood calcium levels include chronic kidney failure. When blood calcium decreases (e. Regulation of calcium levels Calcium concentrations in the blood and fluid that surrounds cells are tightly controlled in order to preserve normal physiological function (diagram).Linus Pauling Institute at Oregon State University Page 2 of 13 factors in the coagulation cascade (see vitamin K). NaCl salt) excreted by the kidney has been found to draw about 24-40 milligrams (mg) of calcium into the urine.e. However. Several other nutrients (and non-nutrients) influence the retention of calcium by the body and may affect calcium nutritional status. Additionally.. no controlled clinical trials have been conducted to confirm the relationship between salt intake and bone loss in humans (1. Once peak bone mass is achieved. Each 2. calcitriol stimulates the release of calcium from bone by activating osteoclasts (bone resorbing cells) and decreases the urinary excretion of calcium by increasing its reabsorption in the kidneys. inadequate calcium intake may contribute to accelerated bone loss and ultimately to the development of osteoporosis (see Disease Prevention) (1). "coagulation cascade. Because urinary losses account for about half of the difference in calcium retention among individuals. and low blood magnesium levels that occur mainly in cases of severe alcoholism.edu/infocenter/minerals/calcium/ 2/21/2012 . a 2-year study of postmenopausal women found increased urinary sodium excretion (an indicator of increased sodium intake) to be associated with decreased bone mineral density (BMD) at the hip (7). possibly due to competition between sodium and calcium for reabsorption in the kidney or by an effect of sodium on parathyroid hormone (PTH) secretion. calcium-sensing proteins in the parathyroid glands send signals that result in the secretion of parathyroid hormone (PTH) (5). Although animal studies have shown bone loss to be greater with high salt intakes. it does so at the expense of the skeleton (1). each extra gram of sodium consumed per day is projected to produce an additional rate of bone loss of 1% per year if all of the calcium loss comes from the skeleton. Although this complex system allows for rapid and tight control of blood calcium levels. each dependent on the other that stops bleeding through clot formation (4).g. a biomarker of bone resorption. Together with PTH. When blood calcium rises to normal levels. and aminoterminal propeptide of type I collagen.4 grams/day (i. vitamin D deficiency.3-gram increment of sodium (6 grams of salt. the parathyroid glands stop secreting PTH and the kidneys begin to excrete any excess calcium in the urine. calcitriol. a longitudinal study in 40 postmenopausal women found that adherence to a low sodium diet (2 grams/day) for six months was associated with significant reductions in sodium excretion. Nutrient interactions Vitamin D Vitamin D is required for optimal calcium absorption (See Function or Vitamin D). dietary sodium has a large potential to influence bone loss. calcium excretion. these associations were only observed in women with baseline urinary sodium excretions equal to or greater than 3.oregonstate. PTH stimulates the conversion of vitamin D to its active form. in the case of inadequate calcium intake). Calcitriol increases the absorption of calcium from the small intestine." refers to a series of events. In adult women. in the kidneys. Deficiency A low blood calcium level usually implies abnormal parathyroid function and is rarely due to low dietary calcium intake since the skeleton provides a large reserve of calcium for maintaining normal blood levels. 6). The term. A chronically low calcium intake in growing individuals may prevent the attainment of optimal peak bone mass. Magnesium deficiency results in a decrease in the responsiveness of osteoclasts to PTH. However. the mean sodium http://lpi.. Sodium High sodium intake results in increased loss of calcium in the urine.
the average intake of protein in the U. The RDA for protein is 46 grams/day for adult women and 56 grams/day for adult men. a more recent study that measured caffeine intake found no association between caffeine intake and bone loss in postmenopausal women (13). Increasing intakes of phosphates from soft drinks and food additives have caused concern among some researchers regarding the implications for bone health. adult population) (8).S. Although one observational study found accelerated bone loss in postmenopausal women who consumed less than 744 mg of calcium/day and reported that they drank 2-3 cups of coffee/day (12). one 8-ounce cup of coffee decreases calcium retention by only 2-3 mg (1). On average.S. phosphorus-rich foods also tend to increase the calcium content of digestive secretions.S.oregonstate. caffeine intakes of 400 mg/day did not significantly change urinary calcium excretion over 24 hours in premenopausal women when compared to a placebo (11).edu/infocenter/minerals/calcium/ 2/21/2012 . Caffeine Caffeine in large amounts increases urinary calcium content for a short time. While the effect of high phosphorus intakes on calcium balance and bone health is presently unclear. Protein As dietary protein intake increases. Thus. the overall calcium economy has not been demonstrated to be affected by dietary protein in part due to offsetting changes in calcium absorption (10). White girls excreted the extra sodium on a high salt diet. but black girls went into positive sodium balance. phosphorus does not offset the net loss of calcium associated with increased protein intake (1). Recommended calcium intakes for the U. which resulted in reduced urinary calcium loss compared to white girls (9). Inadequate protein intakes have been associated with poor recovery from osteoporotic fractures and serum albumin values (an indicator of protein nutritional status) have been found to be inversely related to hip fracture risk (3).S. the substitution of large quantities of soft drinks for milk or other sources of dietary calcium is cause for concern with respect to bone health in adolescents and adults. Recently. population are higher than those for populations of less industrialized nations because protein intake in the U. The Recommended Dietary Allowance (RDA) Updated recommendations for calcium intake based on the optimization of bone health were released by the Food and Nutrition Board (FNB) of the Institute of Medicine in 2010. tends to be higher (65-70 grams/day in adult women and 90-110 grams per day in adult men) (3). resulting in increased calcium loss in the feces. tends to decrease the excretion of calcium in the urine. Racial differences on the effect of dietary sodium on urinary sodium and calcium excretion and retention have been reported in adolescent girls. However. The Recommended Dietary Allowance (RDA) for calcium is listed in the table below by life stage and gender. however. is generally higher. the urinary excretion of calcium also increases. Diets high in phosphorus and low in calcium have been found to increase parathyroid hormone (PTH) secretion.Linus Pauling Institute at Oregon State University Page 3 of 13 intake for the U. Recommended Dietary Allowance (RDA) for Calcium Males (mg/day) 200 (AI) Females (mg/day) 200 (AI) Life Stage Infants Age 0-6 months http://lpi. which is typically found in protein-rich foods. However. Phosphorus Phosphorus. as have diets low in calcium (3. 6).
including 534.200 1. more research is needed to clarify whether specific subgroups in the larger population have different calcium requirements with respect to decreasing the risk of colorectal cancer.S. These weak associations might be explained by the presence of groups within the population that differ in their response to calcium.000 1. Total daily intake of calcium ranged from 732 to 1. A case-control study of 511 men found that increased calcium intake was more strongly associated with decreased colorectal cancer risk in men with higher circulating levels of IGF-1 (19). resulting in an increased risk of fracture.087 mg in the examined studies. individually. dietary intakes of calcium ranged from 674 to 1. and increased calcium intake may benefit this subgroup more than others.000 1. 16).200 - 260 (AI) 700 1.oregonstate. For instance.536 men and women.200-2.000 1.300 1.Linus Pauling Institute at Oregon State University Page 4 of 13 Infants Children Children Children Adolescents Adults Adults Adults Pregnancy Pregnancy Breast-feeding Breast-feeding 6-12 months 1-3 years 4-8 years 9-13 years 14-18 years 19-50 years 51-70 years 71 years and older 14-18 years 19-50 years 14-18 years 19-50 years 260 (AI) 700 1. In individuals with familial adenomatous polyposis.000 1. found that those in the highest quintile of calcium intake (from food) had a 14% lower risk of colorectal cancer compared to those in the lowest quintile. In humans.300 1. However. Before conclusions can be drawn. Nearly one third of those who sustain osteoporotic hip fractures enter nursing homes http://lpi. while dietary factors appear to influence the risk for other types of colon cancer.000 1. there is some evidence that individuals with increased circulating levels of insulin-like growth factor-1 (IGF-1) are at increased risk of colorectal cancer. most large prospective studies. but the degree to which these two types of factors influence the risk of colon cancer in individuals varies widely.edu/infocenter/minerals/calcium/ 2/21/2012 .051 mg/day in the ten cohorts (18). Osteoporosis Osteoporosis is a skeletal disorder in which bone strength is compromised.300 1. Colorectal cancer is caused by a combination of genetic and environmental factors. controlled clinical trials have found modest decreases in the recurrence of colorectal adenomas (precancerous polyps) with calcium supplementation of 1.000 mg/day (15. Sustaining a hip fracture is one of the most serious consequences of osteoporosis.200 1.300 1. have reported increased calcium intakes are only weakly associated with a decreased risk of colorectal cancer.000 Disease Prevention Colorectal Cancer Colorectal cancer is the most common gastrointestinal cancer and the second leading cause of cancer deaths in the U. and a recent study found that the protective effect extended up to five years after the intervention ended (17). subjects in the highest quintile of total calcium intake (from food and supplements) had a 22% lower risk of colorectal cancer.300 1. Animal studies are strongly supportive of a protective role for calcium in preventing intestinal cancers (14).000 1. In this pooled analysis.300 1. A pooled analysis of ten prospective cohort studies. the cause of colon cancer is thought to be almost entirely genetic.
and the use of certain medications (e. Kidney stones Approximately 12% of the U. but are not limited to. compared with men in the lowest quintile of calcium intake. population will have a kidney stone at some time. Although osteoporosis is most commonly diagnosed in white postmenopausal women. metabolic disease (e.245 younger women. aged 27 to 44 years. estrogen deficiency. Osteoporosis is a multifactorial disorder. 20). However. The authors of these two studies suggest that increased dietary calcium might inhibit the absorption of dietary oxalate and reduce urinary oxalate. Strategies for reducing the risk of osteoporotic fracture include the attainment of maximal peak bone mass and the reduction of bone loss later in life. another important risk factor for hip fracture (20). increased age. smoking. swimming. Supplemental calcium alone cannot usually restore lost bone in individuals with osteoporosis. exercise later in life. optimal treatment of osteoporosis with any drug therapy also requires adequate intake of calcium (1. men. However. but lifestyle factors can also play a significant role. A 14-year follow-up analysis of the study in men reported that calcium intake was related to a lower risk of kidney stones in those less than 60 years of age but not in men older than 60 years (26). averaging 1. Although calcium is the nutrient consistently found to be most important for attaining peak bone mass and preventing osteoporosis. Support for this idea comes from a study in which people ingested oxalate with or without supplemental calcium (28). visit the National Osteoporosis Foundation Web site. A predisposition to osteoporotic fracture is related to one's peak bone mass and to the rate of bone loss after peak bone mass has been attained.g. but their effects on bone loss are minimal. Other factors that increase the risk of developing osteoporosis include. and the rise is more pronounced in those with hypercalciuria. and children may also develop osteoporosis (20). 23).000 mg/day (21).326 mg/day. Although their cause is usually unknown. High impact exercise and resistance exercise (weights) are likely the most beneficial for preventing bone loss.edu/infocenter/minerals/calcium/ 2/21/2012 . adequate vitamin D intake is also required for optimal calcium absorption (20). can still increase strength and reduce the likelihood of a fall. After adult height has been reached. http://lpi. corticosteroids and anticonvulsants). found that higher dietary calcium intakes were associated with a lower risk of kidney stones (27). abnormally elevated urinary calcium (hypercalciuria) increases the risk of developing calcium stones. even beyond 90 years of age. the skeleton continues to accumulate bone until the third decade of life. Increasing dietary calcium increases urinary calcium slightly. Genetic factors exert a strong influence on peak bone mass. a prospective study in a cohort of 96. female gender. Physical exercise is another lifestyle factor of benefit in the prevention of osteoporosis and osteoporotic fracture. There is evidence to suggest that physical activity early in life contributes to the attainment of higher peak bone mass. A large prospective study that followed men over a period of 12 years found the incidence of symptomatic kidney stones to be 44% lower in men in the highest quintile (1/5) of calcium intake. Exercise in the presence of adequate calcium and vitamin D intake probably has a modest effect on slowing the rate of bone loss later in life. averaging 516 mg/day (24).S. women of other racial groups and ages. a risk factor for calcium oxalate stones. other dietary factors such as sodium and protein are also known to increase urinary calcium (22. Similar results were observed in a large prospective study of women followed over 12 years (25). Providing 200 mg of elemental calcium along with oxalate significantly reduced both oxalate absorption and excretion. One compilation of published calcium trials indicated that the beneficial skeletal effect of increased physical activity was achievable only at calcium intakes above 1..200 mg/day) and vitamin D (600 IU/day) (2. However.g.oregonstate. and nutrition is only one factor contributing to its development and progression (2). hyperthyroidism). For more information about osteoporosis.Linus Pauling Institute at Oregon State University Page 5 of 13 within the year following the fracture. Most kidney stones are composed of calcium oxalate or calcium phosphate. Lower impact exercise like walking. and one person in five dies within one year of experiencing an osteoporotic hip fracture.. and cycling have beneficial effects on other aspects of health and function. Additionally.
Increased dietary intake of calcium is known to decrease the gastrointestinal absorption of lead. especially in children living in urban areas. Although the cause of PIH is not entirely understood. Further research is required to determine whether women at high risk for PIH would benefit from calcium supplementation above the current recommendations. leading the authors to suggest that reduced salt intake should be recommended for calcium stone-forming patients (30). A study of 85 calcium stone.oregonstate. was the dietary factor most strongly associated with urinary calcium excretion (29).500 pregnant women found no effect of 2. as measured by urinary sodium excretion. calcium metabolism appears to play a role. women in the placebo group had a mean intake of 980 mg/day. Data from epidemiological studies suggest an inverse relationship between calcium intake and the incidence of PIH. preeclampsia includes the development of edema (severe swelling) and proteinuria (protein in the urine). where it may remain for more than 20 years.300 mg/day (34). preeclampsia. while those in the supplemental group had a mean intake of 2.. multiple gestations (e. meeting current recommendations for calcium intake during pregnancy may help prevent PIH. Although the use of lead paint and leaded gasoline has been discontinued in the U. diabetes. and to have low IQ's. as well as in pregnant women with low dietary calcium intake. Pregnancy-induced hypertension (preeclampsia) Pregnancy-induced hypertension (PIH) occurs in 10% of pregnancies and is a major health risk for pregnant women and their offspring. Risk factors for PIH include first pregnancies.g. in women at low risk of PIH and with adequate calcium intake the benefit of calcium supplementation was judged small and unlikely to be clinically significant (33). are more likely to develop learning disabilities. Abnormal growth and neurological development may occur in the infants of women exposed to lead during pregnancy.282 postmenopausal women reported that a combination of supplemental calcium (1. the only dietary change proven effective in reducing kidney stone recurrence is increasing fluid intake. and some autoimmune diseases. only 59% of children ages 1-3 years and 41% of children ages 4-8 years had calcium intakes meeting the recommended levels (35). and eclampsia. A study of over 300 children in an urban neighborhood found that 49% of children aged 1 to 8 years had blood lead levels above current guidelines. However. A systematic review of randomized placebo -controlled studies found that calcium supplementation reduced the incidence of high blood pressure in pregnant women at high risk of PIH. Findings that calcium stone-forming patients with lower calcium intakes are more likely to have decreased bone mineral density also call into question the therapeutic use of dietary calcium restriction. a recent randomized. Preeclampsia may progress to eclampsia (also called toxemia) in which lifethreatening convulsions and coma may occur (32).000 mg of supplemental calcium on PIH. a crosssectional study of 282 patients with calcium oxalate stones found that dietary salt. At present. A large multi-center clinical trial of Calcium for Preeclampsia Prevention (CPEP) in over 4. double-blind. PIH is a term that includes gestational hypertension. twins or triplets).Linus Pauling Institute at Oregon State University Page 6 of 13 Although calcium stone formers have been advised to restrict calcium intake in the past. Adequate calcium intake also prevents exposure to lead mobilized from the skeleton during http://lpi. Adequate calcium intake could be protective against lead toxicity in at least two ways. For the general population. lead toxicity may result in kidney damage and high blood pressure.S. In this study. In adults. lead toxicity continues to be a significant health problem. Lead toxicity Children who are chronically exposed to lead. chronic high blood pressure.000 mg/day) and vitamin D (400 IU/day) was associated with a significantly increased risk for kidney stones.edu/infocenter/minerals/calcium/ 2/21/2012 . In addition to gestational hypertension. placebo-controlled trial in 36. indicating excessive lead exposure. behavioral problems. Once lead enters the body it tends to accumulate in the skeleton.. but the results of experimental research on calcium supplementation and PIH have been less clear. However. Gestational hypertension is defined as an abnormally high blood pressure that usually develops after the 20th week of pregnancy. even in small amounts. More controlled trials are necessary to determine whether supplemental calcium affects the development of kidney stones (31).forming patients found that those with low bone mineral density were significantly more likely to have a high salt intake and high urinary sodium excretion. However.
000 mg of calcium daily (46. More information about the DASH diet is available from the National Institutes of Health (NIH).Linus Pauling Institute at Oregon State University Page 7 of 13 bone demineralization. while the fruit/vegetable diet reduced systolic blood pressure 2.84 mm Hg in diastolic blood pressure (39). Additionally. including estrogen replacement therapy and physical activity. fluid retention.oregonstate. double-blind.5 mm Hg and diastolic blood pressure 3.200 mg of calcium/day.4 mm Hg and diastolic pressure by 5.000-1. including but not limited to fatigue. (2) a diet rich in fruits (~5 servings/day) and vegetables (~3 servings/day). have also been inversely associated with blood lead levels (37). An analysis of 23 large observational studies found a reduction in systolic blood pressure of 0.2 mm Hg systolic and 2. and supplemental calcium has been shown to decrease symptom severity (44).000 mg/day. with 1. and (3) a combination diet rich in fruits and vegetables as well as low-fat dairy products (~3 servings/day) (40). Similar positive effects were reported in two double-blind. The combination diet represented an increase of about 800 mg of calcium/day over the control and fruit/vegetable rich diets for a total of about 1. 47). Large-scale clinical trials are needed to determine whether increasing dietary calcium intake or taking calcium supplements has therapeutic benefits in treating and preventing PMS. Premenstrual Syndrome (PMS) PMS refers to a cluster of symptoms.8 mm Hg diastolic compared to the control diet (41). 549 people were randomized to one of three diets for eight weeks: (1) a control diet that was low in fruit. However. A large systematic review of 42 randomized controlled trials examining the effect of calcium supplementation on blood pressure compared to placebo found an overall reduction of 1. and dairy products. Low dietary calcium intakes have been linked to PMS in several studies. This research indicates that a calcium intake at the recommended level (1.1 mm Hg more than the control diet. and breast tenderness. http://lpi. compared to a 30% reduction observed in the placebo group (45).200 mg/day) may be helpful in preventing and treating moderate hypertension (42).5 mm Hg more than the control diet.000-1. increased calcium intake has been associated with decreased blood lead levels. irritability. while the reduction for the fruit/vegetable diet was 7. In a randomized. cross-over trials that administered 1. The combination diet reduced systolic blood pressure 5. supplemental calcium (1. Lead in the blood of a pregnant woman is readily transported across the placenta resulting in fetal lead exposure at a time when the developing nervous system is highly vulnerable. Disease Treatment High blood pressure (hypertension) The relationship between calcium intake and blood pressure has been investigated extensively over the past two decades. vegetables. that begins sometime after ovulation (mid-cycle) and subsides with the onset of menstruation (the monthly period) (43).0 mm Hg more than the control diet.283 mg/day) from foods had a 30% lower risk of developing PMS compared to those with the lowest calcium intake (median of 529 mg/day from foods) (48). probably related to increased bone demineralization with the release of accumulated lead into the blood (36).200 mg/day) for three menstrual cycles was associated with a 48% reduction in total symptom scores. placebo-controlled clinical trial of 466 women.edu/infocenter/minerals/calcium/ 2/21/2012 .15 mm Hg per 100 mg calcium (38). placebocontrolled. the combination diet reduced systolic blood pressure by 11. A case-control study in women participating in the Nurses' Health Study II found that those who consumed the most calcium (median of 1. moodiness/depression.500 mg/day being the most common dose. Among those participants diagnosed with hypertension. Calcium supplementation in these randomized controlled trials ranged from 500-2.44 mm Hg in systolic blood pressure and a reduction of 0. Other factors known to decrease bone demineralization.34 millimeters of mercury (mm Hg) per 100 mg of calcium consumed daily and a reduction in diastolic blood pressure of 0. In the DASH (Dietary Approaches to Stop Hypertension) study. in postmenopausal women.8 mm Hg and diastolic blood pressure 1. calcium intake from supplements had no effect on PMS in this study. A recent study of blood lead levels during pregnancy found that women with inadequate calcium intake during the second half of pregnancy were more likely to have elevated blood lead levels.
edu/infocenter/minerals/calcium/ 2/21/2012 . Phytic acid is a less potent inhibitor of calcium absorption than oxalate.2 4. cabbage. along with their calcium content and the number of servings of that food required to equal the absorbable calcium from one glass of milk (49). cooked 1/2 cup.0 8. some food components have been found to inhibit the absorption of calcium.S.0 1. mustard.2 2. cooked 1/2 cup. However. Yeast possess an enzyme (phytase) which breaks down phytic acid in grains during fermentation. Dairy foods provide 75% of the calcium in the American diet. Food Serving Calcium (mg) Servings needed to equal the absorbable calcium in 8 oz of milk 1. and turnip greens) contain calcium that is as bioavailable as that in milk. For more information on the nutrient content of foods.0 1.3 3.Linus Pauling Institute at Oregon State University Page 8 of 13 Sources Food sources Average dietary intakes of calcium in the U. However. cooked 1/2 cup. cooked 1/2 cup.1 9.5 0.7 3. cooked 1/2 cup 1/2 cup. calcium set Bok choy Kale Broccoli Spinach Rhubarb Fruit punch with calcium citrate malate 8 ounces 8 ounces 1. Dairy products represent rich and absorbable sources of calcium. Only concentrated sources of phytate. such as wheat bran or dried beans.3 9. substantially reduce calcium absorption (1).oregonstate. but certain vegetables and grains also provide calcium. lowering the phytic acid content of breads and other fermented foods. especially in females.62 Milk Yogurt Cheddar cheese Pinto beans Red beans White beans Tofu. also known as oxalate. it is typically during the most critical period for peak bone mass development that adolescents tend to replace milk with soft drinks (1. cooked 8 ounces 300 300 303 45 41 113 258 79 61 35 115 174 300 Supplements http://lpi. is the most potent inhibitor of calcium absorption and is found at high concentrations in spinach and rhubarb and somewhat lower concentrations in sweet potatoes and dried beans. Oxalic acid. cooked 1/2 cup. cooked 1/2 cup.5 16. 3). search the USDA food composition database. The table below lists a number of calcium rich foods. Only about 25% of boys and 10% of girls ages 9 to 17 are estimated to meet the recommendations. While the calcium rich plants in the kale family (broccoli.5 ounces 1/2 cup. the bioavailability of the calcium must be taken into consideration.9 1. bok choy. are well below the RDA for every age and gender group.
However. No multivitamin/multimineral tablet contains 100% of the recommended daily value (DV) for calcium because it is too bulky. and if not treated. look for supplements that are labeled "lead-free" and avoid large doses of supplemental calcium (more than 1. calcium carbonate (antacid). this condition is not usually related to calcium intake. no one can guarantee entirely lead-free food or supplements.S. Hypercalcemia has been reported only with the consumption of large quantities of calcium supplements usually in combination with antacids.5 grams/day for two days to 30 years. so trace amounts of lead in calcium supplementation may pose less of a risk of excessive lead exposure than inadequate calcium consumption. take no more than 500 mg of elemental calcium at one time.000 mg elemental calcium.5 mcg/1.000 mg of elemental calcium. in a large prospective study. although calcium citrate and calcium citrate malate can be taken anytime (50). only from calcium supplements. Safety Toxicity Abnormally elevated blood calcium (hypercalcemia) resulting from the over consumption of calcium has never been documented to occur from foods. To determine which calcium preparation is in your supplement. manufacturers have made an effort to reduce the amount of lead in calcium supplements to less than 0.500 mg/day). in amounts averaging between 1 and 2 mcg/1. you may have to look at the ingredient list. Mild hypercalcemia may be without symptoms or may result in loss of appetite. nausea. calcium supplements may be necessary for those who have difficulty consuming enough calcium from foods.oregonstate. constipation. Since the treatment for peptic ulcers has changed. bone meal. eliminating their beneficial effect of decreasing intestinal oxalate absorption. However. This effect may be related to the fact that calcium supplements can be taken without food.edu/infocenter/minerals/calcium/ 2/21/2012 . dolomite). and adequate calcium intake is protective against lead toxicity. This condition was termed milk alkalai syndrome and has been reported at calcium supplement levels from 1. Lead in calcium supplements Several years ago concern was raised regarding the lead levels in calcium supplements obtained from natural sources (oyster shell. dry mouth. The federal limit is 7. and the resulting pill would be too large to swallow. Although the risk of forming kidney stones is increased in individuals with abnormally elevated urinary calcium (hypercalciuria). calcium citrate. investigators found measurable quantities of lead in most of the 70 different preparations they tested (51).5 micrograms (mcg)/1. thirst. death. calcium lactate. abdominal pain. and calcium citrate malate. http://lpi.000 mg of elemental calcium (52). More severe hypercalcemia may result in confusion. Calcium preparations used as supplements include calcium carbonate.5 to 16. calcium gluconate. A recent study found measurable lead in eight out of 21 supplements. The "Supplement Facts" label. but rather to increased excretion of calcium by the kidneys. Calcium carbonate is generally the most economical calcium supplement. vomiting. To maximize absorption. While most calcium sources today are relatively safe. In 1993. Overall. now required on all supplements marketed in the U. particularly in the days when peptic ulcers were treated with large quantities of milk. increased dietary calcium has been associated with a decreased risk of kidney stones. and frequent urination. Since then. Calcium inhibits intestinal absorption of lead.Linus Pauling Institute at Oregon State University Page 9 of 13 Most experts recommend obtaining as much calcium as possible from foods because calcium in foods is accompanied by other important nutrients that assist the body in utilizing calcium.. and sodium bicarbonate (absorbable alkalai) (1). lists the calcium content of the supplement as elemental calcium. Most calcium supplements should be taken with meals. coma. the risk of developing kidney stones in women taking supplemental calcium was 20% higher than in those who did not take supplements (25). the incidence of this syndrome has decreased considerably (3). Because lead is so widespread and long lasting. delirium.
500 2.000 mg/day or more had a risk of developing advanced prostate cancer that was three times higher than men whose calcium intake was less than 500 mg/day and a risk of developing metastasized prostate cancer that was more than four times greater (53). Gao et al. men with higher dairy product intakes had a 11% higher risk of prostate cancer compared to those with lower dairy product intakes (59). another prospective study of U. the findings of studies conducted in humans on serum calcitriol levels and prostate cancer risk have been much less consistent. High levels of dietary calcium may lead to decreased circulating levels of calcitriol. The UL is listed below by age group. Although this study did not examine supplement use. Neither study found calcium intake to be associated with an increased risk of total prostate cancer or non-advanced prostate cancer. three out of six case-control studies and two out of four cohort studies reported statistically significant associations between prostate cancer and calcium intake (57). followed more than 50. calcitriol was found to have protective effects.642 men participating in the UL (mg/day) 1. one Serbian case-control study found increased calcium intake to be associated with a decreased risk of prostate cancer (58). a prospective study in 14. Similar results were observed in a case-control study in Sweden.oregonstate. One review reported that seven out of 14 case-control studies and five out of nine prospective cohort studies found statistically significant positive associations between prostate cancer and some measure of dairy product consumption. Of those studies that examined calcium intake. physicians found that increased intake of calcium from dairy foods was associated with an increased risk of prostate cancer (55). More recently.Linus Pauling Institute at Oregon State University Page 10 of 13 In 2010. The physiologic mechanisms underlying the relationship between calcium intake and prostate cancer are not yet clear.000 male health professionals for eight years and found that men whose calcium intake was 2.500 3. reported that men with higher daily calcium intakes had a 39% increased risk of developing prostate cancer compared to those with lower intakes. Not all epidemiological studies have demonstrated an association between calcium intake and prostate cancer.000 mg/day) was associated with an increased risk for prostate cancer (56). However.000 http://lpi.133 male smokers. More recently. However.000 3. the Food and Nutrition Board of the Institute of Medicine updated the tolerable upper intake level (UL) for calcium.edu/infocenter/minerals/calcium/ 2/21/2012 . combined).S. In a meta-analysis of six prospective studies. which compared the calcium consumption of 526 men diagnosed with prostate cancer to that of 536 controls (54). found that high calcium consumption (> 1. Tolerable Upper Intake Level (UL) for Calcium Age Group Infants 0-6 months Infants 6-12 months Children 1-8 years Children 9-13 years Adolescents 14-18 years Adults 19-50 years Adults 51 years and older Do high calcium intakes increase the risk of prostate cancer? Recent epidemiological studies have raised concern that high calcium intakes are associated with increased risk of prostate cancer.S. only half of the distinct studies included in this meta-analysis reported an association between higher calcium intakes and prostate cancer. A large prospective cohort study in the U. each 500 mg/day increase in calcium intake from dairy foods was associated with a 16% increase in the risk of prostate cancer (advanced and non-advanced. followed for 17 years. However.000 1. Most recently. In experimental studies conducted in prostate cancer cell lines and animal models.000 2. a prospective study in a cohort of 29.500 2. the active form of vitamin D.
it is advisable to separate doses of these medications and calcium rich foods or supplements by two hours. omeprazole) may decrease the absorption of calcium carbonate and calcium phosphate (50.000 to 1. Recent Research Calcium and weight loss Diets with higher calcium density (calcium per total calories) have been associated with a reduced incidence of being overweight or obese in some studies. These studies were not designed to examine the effect of calcium on obesity or body fat. may decrease the efficacy of calcium channel blockers (62). therefore. a slight reduction in body fat mass was observed in the high-dairy group (1.. and their significance was unclear until recent studies in cell culture and animal models indicated that low calcium intakes could result in hormonal and metabolic changes that increase the tendency of fat cells to accumulate fat (66).edu/infocenter/minerals/calcium/ 2/21/2012 .400 mg of calcium/day) at the 6-month follow-up (70). 64). it is reasonable for men to consume a total of 1. The lack of agreement among studies suggests complex interactions among the risk factors for prostate cancer and may also reflect the difficulties associated with assessing calcium intake in free living humans.g.g. Drug Interactions Taking calcium supplements in combination with thiazide diuretics (e. most supplements and food sources other than meat). They found that those with higher calcium intakes had a 32% increased risk of prostate cancer. but calcium intake was not found to affect magnesium retention in humans (1). Calcium may decrease the absorption of tetracycline. High doses of supplemental calcium could increase the likelihood of abnormal heart rhythms in people taking digitalis (digoxin) for heart failure (61). A placebo-controlled calcium supplementation trial found significantly greater weight loss in elderly women supplemented with 1. bisphosphonates. cimetidine) and proton pump inhibitors (e.000 to 1. quinolone class antibiotics. More recently. Use of H2 blockers (e. However. however.Linus Pauling Institute at Oregon State University Page 11 of 13 Melbourne Collaborative Cohort Study found that calcium intake was not associated with prostate cancer risk (60). when provided intravenously. probably due to a compensatory increase in iron absorption. which is recommended by the Food and Nutrition Board of the Institute of Medicine (see RDA). on body fat and body weight. meta-analysis of all seven studies revealed that dairy intake was no longer associated with a significantly increased risk of prostate cancer (60). Individuals taking iron supplements should take them two hours apart from calciumrich foods or supplements to maximize iron absorption.400 mg of calcium/day) in healthy young women did not alter body weight or fat mass compared to the control group (< 800 mg of calcium/day) (69). hydrochlorthiazide) increases the risk of developing hypercalcemia due to increased reabsorption of calcium in the kidneys. calcium supplementation up to 12 weeks has not been found to change iron nutritional status. Such studies are currently underway. higher dietary calcium intakes were associated with weight loss whether participants were in the exercise group or the control group (67). Calcium-Nutrient Interactions The presence of calcium decreases iron absorption from nonheme sources (i. However. Controlled feeding studies where calories remain fixed are needed to quantify the likely small effect of calcium. In a two-year exercise trial.. High calcium intakes in rats have produced relative magnesium deficiencies. repeated their meta-analysis (59) to include this most recently published study. and levothyroxine.200 mg/day of calcium (diet and supplements combined). dietary and oral supplemental calcium do not appear to affect the action of calcium channel blockers (63). Gao et al. Although a number of studies did not find high calcium intakes to affect zinc absorption or zinc nutritional status. a 1-year dairy product intervention (1.300 to 1. if any.g. http://lpi.200 mg of calcium/day compared to a control group (68).. Calcium. however..e.oregonstate. Until the relationship between calcium and prostate cancer is clarified. a study in ten men and women indicated that 600 mg of calcium consumed with a meal decreased the absorption of zinc from that meal by 50% (65).
Weaver.000 mg/day of calcium. Children and adolescents (9-18 years) To promote the attainment of maximal peak bone mass. Following these recommendations should provide adequate calcium to promote skeletal health and may also decrease the risks of some chronic diseases. Linus Pauling Institute Oregon State University Updated in October 2007 by: Victoria J. while pregnant and breast-feeding adults (19 years and older) should consume a total of 1. Adults (women aged 19-50 years. older men should consume a total (diet plus supplements) of 1. Ph.200 mg/day of calcium. Taking a multivitamin/multimineral supplement containing at least 10 mcg (400 IU)/day of vitamin D will help to ensure adequate calcium absorption (see Vitamin D). Older men (71 years and older) To minimize bone loss. Older women (51 years and older) To minimize bone loss.300 mg/day of calcium. men aged 19-70 years) After adult height has been reached.D.200 mg/day of calcium. Ph. postmenopausal women should consume a total (diet plus supplements) of 1.300 mg/day of calcium. adult women (50 years of age and younger) and adult men (70 years of age and younger) should consume a total (diet plus supplements) of 1.oregonstate. children and adolescents should consume a total (diet plus supplements) of 1.D. Taking a multivitamin/multimineral supplement containing at least 10 mcg (400 IU)/day of vitamin D will help to ensure adequate calcium absorption (see Vitamin D). Drake.edu/infocenter/minerals/calcium/ 2/21/2012 .Linus Pauling Institute at Oregon State University Page 12 of 13 Linus Pauling Institute Recommendation The Linus Pauling Institute supports the recommended dietary intake (RDA) levels set by the Food and Nutrition Board of the Institute of Medicine.000 mg/day of calcium. Distinguished Professor and Head of Foods and Nutrition Purdue University http://lpi.D. Linus Pauling Institute Oregon State University Reviewed in October 2007 by: Connie M. Pregnant and breast-feeding women Pregnant and breast-feeding adolescents (under 19 years of age) should consume a total of 1. Ph. To promote the attainment of maximal peak bone mass and to minimize bone loss later in life. References Written in April 2003 by: Jane Higdon. the skeleton continues to accumulate bone until the third decade of life when peak bone mass is attained.
Associate Professor Departments of Epidemiology & Biostatistics and Urology University of California.D. The information on micronutrients and phytochemicals contained on this Web site does not cover all possible uses. side effects. Sc.oregonstate. or nutritional counseling services on this site. The information is made available with the understanding that the author and publisher are not providing medical. The information should not be used in place of a consultation with a competent health care or nutrition professional. Liability for individual actions or omissions based upon the contents of this site is expressly disclaimed.edu/infocenter/minerals/calcium/ 2/21/2012 . http://lpi. San Francisco Last updated 11/30/10 Copyright 2001-2012 Linus Pauling Institute Disclaimer The Linus Pauling Institute Micronutrient Information Center provides scientific information on health aspects of micronutrients and phytochemicals for the general public. and interactions.Linus Pauling Institute at Oregon State University Page 13 of 13 Does a high calcium intake increase the risk of prostate cancer? Reviewed in June 2007 by: June Chan. precautions. actions. It is not intended as medical advice for individual problems. psychological.
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