• 2% of Our Body Weight

• Most Abundant Mineral

• Active Biological Functions

• Structural Role
Biological Functions Of Calcium
 Calcium Deficiency Disorders

•Muscle Cramps

• Eczema

• Hypertension

• Insomnia

• Indigestion

Reference : American Journal of Hypertension. 1996 Feb; 9(2): 144-56

 STRUCTURAL ROLE

BONES

• Protect Organs
• Support the Body
• Give Outer Shape
• Help in Mobility
 Calcium Deficiency Disorders

•Brittle Nails
•Tooth Decay
• Rickets
•Osteomalaci
a
• Osteopenia
• Osteoporosis

Fractures
 RDA Of Calcium
Special Needs of Women:
Ages 1-3: – Pregnancy
400 to 600 mg – Breast-feeding
per day – Menopause
1500 mg per day

Ages 50+:
1200 to 1500 mg per day

Ages 4-8:
800 to 1200 mg
per day Ages 9-18:
1200 to 1500 mg Ages 19-50:
per day 1000 mg per day
Reference: National Academy of Science, Food & Nutrition Department recommendations; National Institutes of
Health recommendations.
 Calcium In Diet

• Milk (250 ml) 306 mg

• Cheese (45 g) 432 mg
• Yogurt (250 g) 406 mg
• Bread white(1 slice) 20 mg
• Rice white(125 g) 15 mg
• Potato (1 medium) 07 mg
• Peanuts (125 g) 56 mg

Reference: National Academy of Science, Food & Nutrition Department recommendations; National Institutes of
Health recommendations.
 Bone - Mass
• 90% of the total Bone-mass is
formed up to the age of 18-20
years.

• 10% Bone-mass is formed from

20 to 35/40 years.

• After 35/40 years,Bone-mass

decreases continuously.
Reference : The New England Journal of Medicine 327 (1992): 82 – 88.
 BONE - MASS
Clinical outcomes – a dilemma ?

Clinical Picture Osteoporosis

is not well-
defined until
osteoporosis is
diagnosed!!

Bone pain Bone pain Osteoporosis

Seemingly Normal

No. of years
 BONE MASS

HOW TO DETERMINE

BONE MASS
 KINDS OF BMD TESTS

• Bone Sonometer
• DEXA
(Dual Energy X - ray Absorptiomertry)
 Bone Sonometer

A clinical bone sonometer measures BMD in less than a

minute by passing sound waves through the heel of the foot
 DEXA
(Dual Energy X - ray Absorptiomertry)

DEXA uses only one-tenth the radiation of standard

X-ray. While the patient rests on a firm bed, a photon
beam aimed at the hip, spine, or wrist measures bone
density.
 RESULT EVALUATION

Calcium Requirements
T - Score Diagnosis (for adults)

Balance Diet + 260 mg

- 1.0 & Above Normal Elemental Calcium

Balance Diet + 260 mg

-1.0 to -2.4 Osteopinea Elemental Calcium (Twice daily)

Balance Diet + 500 mg

-2.5 & Below Osteoporosis Elemental Calcium (Twice daily)
Bone Health
in
Pakistan
BMD TEST RESULTS
IN
PAKISTAN

TOTAL TESTS 427701 100% 47%

Normal 170499 40% 13%

Osteopenia 203119 47%

40%
Osteoporotic 54083 13%
Up to July 16,2005
 BY PROVINCES
Base: 190419 SINDH DIAGNOSIS Base: 207995 PUNJAB DIAGNOSIS

15.4% 10.8%
34.0%
43.8%

45.4%
50.6%

Normal Osteopenia Osteoporosis Normal Osteopenia Osteoporosis

Base: 19803 N.W.F.P DIAGNOSIS Base: 9484 BALOUCHISTAN DIAGNOSIS

8.6% 8.6%

50.8% 47.3%
41.4% 44.1%

Normal Osteopenia Osteoporosis Normal Osteopenia Osteoporosis

Up to July 16, 2005

BMD TEST RESULTS
IN
MULTAN

45%

TOTAL TESTS 39131 100%

13%
Normal 16377 42%
Osteopenia 17779 45%
42%
Osteoporotic 4975 13%

Up to July 16, 2005

 Comparative Analysis by Gender
Multan
100
5.0
17.0 13.0
90

80
36.0
70
45.0
60
51.0 Osteoporosis
50 Osteopenia
40 Normal

30 59.0
20 42.0
32.0
10

0
Male Female Total

Up to July 16, 2005

 BMD TEST RESULTS
PARTICIPANTS

TOTAL TESTS 25 100%

Normal 6 24%
Osteopenia 15 60%
Osteoporotic 4 16%
Why Calcium Crisis ?
 Why Calcium Crisis

• Low Calcium Intake

• Vitamin Deficiency
• Calcium Robbers
• Drugs
• Sedentary Life
 Why Calcium Crisis
Low Calcium Intake

Low intake of Dairy products Due to:

• Change in Dietary habits.

• Quality of Milk.
• Financial reasons.
 Solution
Low Calcium Intake

• Increase use of Dairy Products

• Prescribe Calcium as nutritional
supplement from a RELIABLE SOURCE.
 Why Calcium Crisis
Low Calcium Intake

Decline in Food Quality

“New UK Study” Shows Decline in Fruits and
Vegetables Mineral Content

Mineral in Fruits & Vegetables % Decline

• Calcium 46
• Magnesium 25
• Sodium 50
• Iron 25
• Copper 75
SOURCE: The Journal of the American Medical Association 2002; 287:3116-3126, 3127-3129
 Why Calcium Crisis
Vit. Deficiency

VITAMINS

&

BONE HEALTH
 Why Calcium Crisis
Vit. Deficiency

Different Vitamins are important

• Vitamin D

• Vitamin B6

• Vitamin C
 Why Calcium Crisis
Vit D Deficiency

Vitamin D

•Helps in absorption of calcium

through GIT. Calcium Uptake
 Solution to
Vit D Deficiency

• 15 minutes exposure to sunlight /

day provides 400 I.U. of Vitamin D.

• Recommend vitamin D along with

calcium supplements.

Reference : The New England Journal of Medicine 326.18 (1992): 1213 – 1216
 Why Calcium Crisis ?
Vit Deficiency

Vitamin B6
• Breaks down Homocysteine (metabolite of protein
methionine) which interferes with collagen cross-
linking.
• Helps in production of HCl, necessary for
calcium absorption & prevents achlorhydria.
• Helps in controlling PMS, nausea,
vomiting, & stress.

Reference: Clinical Science 68 (1985) : 21 P, 2 - Act Orth Sc63 (1992): 635 – 638
 Solution to
Vit B6 Deficiency

• Increase use of fruits

& vegetables.

• Recommend vitamin B6
along with calcium supplement.
 Why Calcium Crisis
Vit Deficiency

Vitamin C

•Required for collagen formation.

Reference : The Science of Human Nutrition, Harcourt Brace Jovanovich, Inc. 1990.
 Solution to
Vit C Deficiency

• Increase use of citrus fruits

• Recommend vitamin C along

with calcium supplements.
 Why Calcium Crisis ?

CALCIUM ROBBERS
Why Calcium Crisis ?
Calcium Robbers

ACID – ALKALINE

IMBALANCE
 Why Calcium Crisis ?
Calcium Robbers

ACID / ALKALINE BALANCE

Normal pH of body fluids is slightly above 7
Which ensures best functioning of

• Metabolism

• Enzymes

• Immunity

• Repair mechanism
Reference : Journal of the American Geriatric Society 30 (1982): 613
 Why Calcium Crisis
Calcium Robbers
ELEMENTS AFFECTING pH
Acid Forming Elements
• Phosphorus
• Sulfur
• Chlorine
• Iodine

Alkaline Forming Elements

• Sodium
• Potassium
• Magnesium
• Iron
Reference: Journal of the American Geriatric Society 30 (1982): 613
Why Calcium Crisis ?
Calcium Robbers

How To Maintain

Acid Alkaline
 Why Calcium Crisis ?
Calcium Robbers

How To Maintain Acid-alkaline Balance

• Know Your pH
• Take Diet with Acid /Alkaline Ratio 35/65
• Avoid Over cooking, Freezing, Canning or Preserving

Take Fruits & Vegetables

 Acid/Alkaline Balance

Alkaline Foods

MOST MORE LOW LOWEST

ALKALINE ALKALINE ALKALINE ALKALINE

Baking Soda Spices Green Tea Ghee

Plums Cinnamon Vinegar Coconut Oil
Lentils Soy Sauce Cod Liver Oil Olive Oil
Onion
Poppy seed Almond Beats
Cashew Potato Turnips
Pepper Mushroom
Reference: Serammune Physicians Lab, Reston, Virginia, 1995
 Acid/Alkaline Balance
Alkaline Foods

MOST MORE LOW LOWEST

ALKALINE ALKALINE ALKALINE ALKALINE

Sweet Potato Garlic Pumpkins Squashes

Lime Grape Fruit Lemon Oranges
Water melon Mustard Green Apple Apricot
Raspberries Mangoes Peach Bananas
Gingerroot Papaya

Reference: Serammune Physicians Lab, Reston, Virginia, 1995

 Acid/Alkaline Balance
Acid Foods

Lowest LOW MORE MOST

Acid Acid Acid Acid

Honey Almond Oil Coffee Jam / Jelly

Sugar
Cream Mutton Saccharin
Coca
Cow’s milk Chicken White Vinegar
Yogurt
Ice cream.
Egg Goat’s Milk
Beef
Sunflower Oil Black Tea Fried Food
Canola Oil
Why Calcium Crisis ?
Calcium Robbers

Sugar
&
BONE HEALTH
 Why
WhyCalcium
CalciumCrisis
Crisis?
Calcium
Calcium Robbers
Robbers

SUGAR
• Burning of calories require lot of B vitamins.
• Increases the urinary excretion of essential nutrients
like…… Ca , Mg ,Cu, Zn & Na .
• Decreases Ca absorption
• Increases production of HCl
Resulting in Ca deficiency & BONE resorption!
Reference: Federal Proc. 44 (1985): 251.
 Why Calcium Crisis ?
Calcium Robbers
Sugar Content of Selected Food
Food Amount TSF Sugar

• Cola Drinks 12 oz 10
• 7-Up 12 oz 07
• Apple -Cidra 12 oz 09
• Chocolate 1 piece 15
• Jam-jellies 1 oz 4-6
 Why Calcium Crisis ?
Calcium Robbers

Solution to Sugar

• Avoid high amount of sugar.

• Increase calcium intake.
Why Calcium Crisis ?
Calcium Robbers

CAFFEINE
&
BONE HEALTH
 WHY
WhyCALCIUM CRISIS
Calcium Crisis ?
CALCIUM ROBBERS
Calcium Robbers

CAFFEINE

• Increases urinary excretion of

Ca ,K , Mg , Na & Cl.

•Lowers blood calcium

which increases PTH.

Reference: Nutrition Research 117.7 (1987): 1229 - 33

 WHY
WhyCALCIUM CRISIS
Calcium Crisis ?
CALCIUM ROBBERS
Calcium Robbers

The Caffeine Count

• Coffee 5 oz 40-150 mg
• Tea 5 oz (Brewed 5 minutes) 20-50 mg
• Colas 36-48 mg
• Milk chocolate (1 oz) 6 mg
• Baking chocolate (1 oz) 35 mg
Why Calcium Crisis ?
Calcium Robbers

FATS
&
BONE HEALTH
 Why Calcium Crisis ?
Calcium Robbers

FATS & BONES

• Important for Ca absorption and

metabolism

• Quantity & Quality is important

Reference: Alan R. Liss, 1984

 Why Calcium Crisis ?
Calcium Robbers

Essential fatty Acid deficiency

• Loss of normal synthesis of “bone connective

tissue matrix”

• Loss of normal cartilage

• Bone demineralization

Reference: Barnard, Neal, The Power of Your Plate 1990

 Why Calcium Crisis ?
Calcium Robbers

FATS & BONES

QUANTITY

• 15-25 % Calories from fats.

• 50 G / day might be sufficient.

Reference: “The Changing American Diet” Washington D. C. 1983

 Why Calcium Crisis ?
Calcium Robbers
QUALITY

Use Oils which are Expeller or cold - pressed &

kept refrigerated (cis form)

1st Choice “Fish liver oil / Soy oil”

2nd Choice “Sunflower oil / Corn oil”

Reference: Gittleman, Ann Louise, New York: Pocket Books, 1993

 Why Calcium Crisis ?
Calcium Robbers

Avoid
• Oils treated with chemicals / heat
(trans form)
• Hydrogenated Banaspati Ghee

Reference: Gittleman, Ann Louise, New York: Pocket Books, 1993

 Why Calcium Crisis ?
Calcium Robbers

ANIMAL PROTEIN
&
BONE HEALTH
 Why Calcium Crisis ?
Calcium Robbers
Animal Protein is Important

• One-third of our bone is living protein matrix

• RDA
Male 56 G
Female 44 G

Reference: National Academy of Science, Food & Nutrition Department recommendations; National Institutes of
Health recommendations.
 Why Calcium Crisis ?
Calcium Robbers
Protein Content of Selected Food

Flesh Food Serving Size Grams of Protein

Fish 4 oz 25-30
Beef 4 oz 33
Chicken 4 oz 33
Eggs 1 6.2
Dairy
Yogurt 1 cup 11
Milk 1 cup 8
Grains
Bread 1 slice 2
Rice ½ cup 2.2
 Why Calcium Crisis ?
Calcium Robbers

Excessive Animal Protein

• Produces H2PO4 & H2SO4

• Resulting in calcium resorption

Reference: Clinical Nutrition 59 (1994): 1356 – 61.

 Why Calcium Crisis ?
Calcium Robbers

Solution to excessive Animal Protein

• 45 G meat requires 500 mg calcium for buffering.

• Avoid high intake of animal protein

Reference: Clinical Nutrition 104 (1974):695 – 700.

 Why Calcium Crisis ?
Calcium Robbers

STRESS
Imbalances Endocrine
Gland Functioning

Production of
cortisol •Mobilizes calcium from the bone
increases •Increases urinary calcium loss

Reference : The New England Journal of Medicine 335.16 (October 1996): 1176 – 81.
 Why Calcium Crisis ?
Calcium Robbers

SMOKING & Bone Health

• Liver Toxification

• Anti - Estrogenic / Anti - Testosterone

• Depletes Vitamin C

Reference : The New England Journal of Medicine 315.25 (1986): 1305 – 1309.
 Why Calcium Crisis ?
Calcium Robbers
DRUGS
Drug Decreased Increased
Absorption Excretion
Loop Diuretics *
Tetracycline's * *
Anticonvulsant * *
Gluco corticoids * *
Antacids * *
Thyroid Hormones * *
INH *

Reference: Anon, “Prescribing Harm” USA Today July 27, 1994,

 Why Calcium Crisis ?
Sedentary Lifestyle

Harmful for the development of

bones & muscles.
 Why Calcium Crisis ?
Sedentary Lifestyle
Exercise Program
• Aerobic Exercise (Walking,jogging )

Reference: Bone 9.4 (1988): 201 – 204.

 Why Calcium Crisis ?
Sedentary Lifestyle
Exercise Program
Strength Training Program (Weight Lifting,cycling )
 TAKE
CALCIUM /VITAMIN
RICH
DIET
 AVOID
CALCIUM ROBBERS
Great Flavors