Orchard Chiropractic Centre - Jersey

Are Calcium Supplements Required?

Thursday 04 October 2018

At Orchard Chiropractic Centre, Jersey, we enhance our manual therapy with dietary advice and therefore stock nutritional supplements. One supplement that is routinely recommended by G.P's and has featured heavily in the news is calcium. It has been predominantly recommended to those who are at risk of developing osteoporosis and during pregnancy, because everyone knows that calcium is required for maintenance of healthy bones. However, as with most dietary advice there appears to be a down side- high serum calcium levels (high levels of calcium in the blood) has been linked to increased risk of coronary disease[1]. There is also conflicting advice as to whether calcium supplementation should include other vitamins and minerals. So what should we believe? Without getting too deep into the chemistry, lets take a step back and consider what we know about calcium and whether we actually need more of it in our diets.

 

What is Calcium and why do we need it?

Calcium is a reactive earth metal. Although our bodies need calcium, it cannot be used in its pure form. Calcium is only bioavailable when it is bound to other chemicals to form compounds such as calcium citrate.

Most people are aware that calcium is used in the body to form and strengthen teeth and bones, but it is also vital for muscle contraction, conducting nerve impulses, clotting blood, maintaining blood pressure and normal heath rhythm,  and many chemical processes necessary for survival.

 

Do I need to take calcium supplements?             

Supplementation with calcium plus vitamin D has been shown to be effective in reducing fractures and falls (which can cause fractures) in institutionalized older adults. However, among community-dwelling older adults over age 50, the benefits of supplementation with these nutrients on fracture resistance are much less clear[2].

The link between high serum calcium levels and ischaemic heart disease is not clear, but there appears to be an increased risk of developing heart disease with calcium supplementation above 1000mg/ day. "A reanalysis of data from the Women’s Health Initiative (WHI) found that calcium supplements (1,000 mg/day) taken with or without vitamin D (400 IU/day) increased the risk of cardiovascular events in women who were not taking calcium supplements when they entered the study. While there is no established biological mechanism to support an association between calcium and CVD, some scientists hypothesize that excessively high calcium intakes from supplements might override normal homeostatic controls of serum calcium levels and produce a temporary hypercalcemia. Hypercalcemia is associated with increased blood coagulation, vascular calcification, and arterial stiffness, all of which raise CVD risk"[3].

The US Institute of Medicine 2010 recommendations are 1000mg calcium for those aged 19-70 or 1,200mg for females aged 51-70. In the UK, the recommended RDA is 700mg daily. The WHO recommendation is 400- 500mg daily. So who is correct? The following tables list the average calcium contents in various food groups:

Calcium Content of Foods

Dairy and Soy

Amount    

Calcium (mg)   

Milk (skim, low fat, whole)

1 cup

300    

Buttermilk

1 cup

300

Cottage Cheese

0.5 cup

65

Ice Cream or Ice Milk

0.5 cup

100

Sour Cream, cultured

1 cup

250

Soy Milk, calcium fortified

1 cup

200 to 400

Yogurt

1 cup

450

Yogurt drink

12 oz

300

Carnation Instant Breakfast    

1 packet

250

Hot Cocoa, calcium fortified

1 packet

320

Nonfat dry milk powder

5 Tbsp

300

Brie Cheese

1 oz

50

Hard Cheese (cheddar, jack)    

1 oz

200

Mozzarella

1 oz

200

Parmesan Cheese

1 Tbsp

70

Swiss or Gruyere

1 oz

270

Vegetables

Acorn squash, cooked

1 cup  

90    

Arugula, raw

1 cup

125

Bok Choy, raw

1 cup

40

Broccoli, cooked

1 cup

180

Chard or Okra, cooked

1 cup

100

Chicory (curly endive), raw    

1 cup

40

Collard greens

1 cup

50

Corn, brine packed

1 cup

10

Dandelion greens, raw

1 cup

80

Kale, raw

1 cup

55

Kelp or Kombe

1 cup

60

Mustard greens

1 cup

40

Spinach, cooked

1 cup

240

Turnip greens, raw

1 cup

80

Fruits

Figs, dried, uncooked

1 cup  

300    

Kiwi, raw

1 cup

50

Orange juice, calcium fortified

8 oz

300

Orange juice, from concentrate    

1 cup

20

Legumes

Garbanzo Beans, cooked

1 cup

80    

Legumes, general, cooked    

0.5 cup

15 to 50

Pinto Beans, cooked

1 cup

75

Soybeans, boiled

0.5 cup    

100

Temphe

0.5 cup

75

Tofu, firm, calcium set

4 oz    

250 to 750    

Tofu, soft regular

4 oz

120 to 390

White Beans, cooked

0.5 cup

70

Grains

Cereals (calcium fortified)    

0.5 to 1 cup    

250 to 1000    

Amaranth, cooked

0.5 cup

135

Bread, calcium fortified

1 slice   

150 to 200

Brown rice, long grain, raw    

1 cup

50

Oatmeal, instant

1 package

100 to 150

Tortillas, corn

2

85

Nuts and Seeds

Almonds, toasted unblanched

1 oz.

80

Sesame seeds, whole roasted    

1 oz.

280

Sesame tahini

1 oz. (2 Tbsp)    

130    

Sunflower seeds, dried

1 oz.

50

Fish

Mackerel, canned    

3 oz.    

250

Salmon, canned, with bones    

3 oz.

170 to 210    

Sardines

3 oz.

370

 

One thing that is quite clear from the tables, is that the western diet is actually high in calcium and one will easily consume 1000mg calcium per day. In spite of enjoying a diet rich in calcium, the West still has the highest levels of osteoporosis in the World. In stark contrast, Japan and Peru have very low incidence of osteoporosis despite a diet that is comparatively low in calcium.

This suggests that calcium deficiency is probably not the major cause of osteoporosis in the west and therefore, calcium supplementation is unlikely to be the cure. Having said that, high calcium intake does not necessarily lead to high calcium uptake as poor gut health will impair calcium absorption. One key food group missing from the western diet that features in the Japanese diet and promotes a healthy gut is fermented food. Fermented food is naturally rich in vitamin K2 and increases the bioavailability of vitamins and minerals, including  magnesium.

The significance of Vitamin K2, Vitamin D and Magnesium

The importance of the interaction between magnesium and calcium cannot be overstated: Magnesium keeps calcium dissolved in the blood, converts vitamin D into its active form to aid calcium absorption and it stimulates the hormone calcitonin which draws calcium from the blood and soft tissues into the bones. Bioavailable magnesium is found in green leafy vegetables, brassica,  nuts, legumes, some fruit and oily fish.

Vitamin K2 is primarily found in fermented food, high fat dairy products, grass fed animal products especially organ meat, certain green leafy vegetables and fish. Vitamin K2 activates the GLA protein which has been shown to inhibit arterial calcification and it activates osteocalcin which influences bone mineralisation [4]. Due to intensive farming methods, the western diet is very low in vitamin K2.   

 

Conclusion

It would appear unlikely that calcium deficiency due to low calcium intake is a significant cause of disease in the west and calcium supplementation is does not appear to be effective at preventing osteoporosis. If you are concerned about developing osteoporosis, a healthy diet containing fermented food, exposure of your skin to the sun and high impact exercise appear more likely to preventative than calcium supplements.

Should you require, further information, please do not hesitate to speak to our chiropractors, Charles or Cardin. 



[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620030/

[2] https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

[3] https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/

 


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