The Importance of Calcium ? - Dr Shreedhar Archik

Dr Shreedhar Archik - Orthopedics Surgeon Mumbai Dadar

Calcium as most of us know is an important part of our bones. Calcium gives our bones the necessary strength to carry our body weight. Calcium is also required for functioning of all the muscles and the most important muscle being the heart of course. Without calcium, muscles would not contract normally, blood would not clot and nerves would be unable to carry messages. Calcium and bone health go hand-in-hand. Increasing scientific evidence indicates that adequate calcium intake reduces the risk of several major chronic diseases, most notably osteoporosis, a potentially crippling disease of thin and fragile bones. Calcium also helps protect against colon cancer, high blood pressure and recurring premenstrual syndrome, and possibly cardiovascular disease and kidney stones (well most think it causes stones). The daily requirement of calcium varies significantly during our life time. The growing phase during the childhood obviously needs more calcium than the younger phase. Women need maximum during pregnancy and lactation. After menopause ladies need additional calcium whereas men require it to fight the senile (post 65 years) osteoporosis. Diseases like hypothyroidism, rheumatoid arthritis, chronic steroids usage. Kidney failures mean increasing the calcium requirement. The World Health Organization gives us the daily required dose according to the age group and I am making it simple for you here. Most adults need between 1,000 and 1,500 milligrams (mg) of calcium every day. Requirements for young children and adolescents range from 800 mg to 1500 mg daily. Calcium can be found in foods from each of the five food groups. Some good sources: 8 ounces of plain yogurt /Dahi (450 mg); 8 ounces of milk (300 mg); an ounce of cheese (200); 3 ounces of fish with bones (370 mg); one cup of broccoli /spinach/methi (90 mg); and one cup of cooked soybeans, (130 mg). There are also many new calcium-fortified foods, such as orange juice, rice and pasta that provide a good source of calcium.

It is important to know certain facts about calcium since there are a lot of myths circulating about how much and when and why.

Vitamin D is absolutely essential for the absorption of calcium and has very few dietary sources. Vitamin D is naturally produced under our skin when it is exposed to sunlight (they taught it this in our school days). Unfortunately with increasing pollution in our metros the sunlight has lost its importance or strength. Add the fact that most of the affluent people are indoors most of the time or travel in cars with dark glasses! The recommended dosage of Vitamin D :
  • 400-800 international units (IU) a day
  • 400-600 IU/day for those over 50
  • 600-800 IU/day for those over 70.
  • Multivitamins often contain only 200-400 IU.
Make sure food sources plus supplements do not exceed 1000 IU/day. A traditional Indian diet itself is usually deficient in the calcium content and the best designed diet can give you a maximum of 300 mg of calcium (that too if you keep having the same diet every day!). Do you now get it? All of us need calcium because of our lifestyle and dietary habits.

Having established the need of calcium let us see what are the myths or facts surrounding the calcium use. It is important to note that calcium absorption form the gut is much better at night so if you are going to take a pill take it at night. Calcium is also absorbed better with food so take the tablet at the end of your meal (especially carbonate salt, whereas citrate can be taken any time). It is now easy for you to decide how much you need. Subtract 300mg (dietary source) from the daily requirement according to your age and that is what you need in the medicinal form. The other myth is “too much calcium is bad”, true but if it is really too much, so see the chart and decide whether it is too much! Most patients feel 2 tablets are too much! Most of the patients believe that one should take calcium every alternate month to avoid side effects! Well your muscles require it every day so why take only 6 months a year? You will be surprised as to how many people really believe this, just ask around. The other problem is the availability of various salts in they market! There is calcium carbonate which is cheap and easily available but the absorption is slightly poor. Then there is calcium citrate which is very good from all aspects and then there is ionic calcium and few other new salts. Most of the tablets have vitamin D added to them. The confusing starts when patient X who is taking a carbonate tablet reads his foil which states 500mg of calcium carbonate and compares it with the prescription of patient Y who takes calcium citrate which reads calcium citrate 1000mg. Patient X then tells Y that his doctor is giving him a “double” dose!! Both doses are similar but the 500-1000 mg difference is because of the salt, so it is comparing oranges with apples, but patients too often fall pray to this confusion! Best solution is to seek your doctor’s help. It also too common to see young ladies stopping the calcium as soon as they deliver. While they are breast feeding the calcium requirement is the highest and the baby never suffers but the mother’s stores i.e. bones get depleted. If one has successive pregnancies then imagine the plight of the mother.

So what about the diet. All milk and milk derived products are rich in calcium. Fish is a good source. Green leafy vegetables like palak (spinach) and Methi are again a good source. Rajma/lentils/kidney beans are again a good source of calcium. Raagi or Nachani flour can be added to the routine atta to increase calcium intake. Raagi biscuits are available over the counter and are excellent afternoon snack. Almonds and Banana are also a good source. One should also look at the calorie content while consuming these food items otherwise the calcium intake is good but one puts on a lot of weight eating Bananas. Solutions consult a doctor or a dietician before eating almonds!

If you are running low on calcium you feel tired, lethargic, you fatigue out easily. One may become irritable and start complaining about generalized aches and pains all over. Bright sparks get their blood calcium levels done and feel happy that it is normal. Calcium is mobilized from its stores i.e. bones to keep the blood level normal and therefore blood levels are usually normal though you may be deficient. I would strongly advise one to get the Vitamin D3 level checked once in a while which can sort out most of the problems of calcium deficiency. Remember one need Vit D for calcium to get absorbed. The ideal level for Indians is near 25 though your lab would suggest a normal range from 7 to 9. Below 15 and you are sure to show symptoms.

So do I take calcium tablets as per the chart and feel secured? NO, life is cruel; one needs to regularly exercise to keep the calcium inside the bones! And excessive alcohol and smoking cause calcium loss! All ladies need calcium after forty and the shorter their stature the sooner they will exhaust their calcium stores.
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