Getting enough...calcium

[Missy Wombat]

I was just revisiting some of the material out there on vegetarian kids and noted that calcium intake is one area where vegan kids often don't meet the RDIs. Adults can be just as bad.

How do you get your calcium? Any good tips or tricks for increasing your calcium intake? what do you swear by?

[Missy Wombat]

Quote:
Vegetarian Starter Kit
Calcium in Plant-Based Diets

Many people choose to avoid milk because it contains fat, cholesterol, allergenic proteins, lactose sugar, and frequent traces of contamination. Milk is also linked to juvenile-onset diabetes and other serious conditions. Happily, there are plenty of other good sources of calcium.

Keeping your bones strong depends more on preventing the loss of calcium from your body than on boosting your calcium intake.

Some cultures consume no dairy products and typically ingest only 175 to 475 milligrams of calcium per day. However, these people generally have low rates of osteoporosis. Many scientists believe that exercise and other factors have more to do with osteoporosis than calcium intake does.

Calcium in the Body

Almost all of the calcium in the body is in the bones. There is a tiny amount in the blood stream which is responsible for important functions such as muscle contraction, maintenance of the heartbeat, and transmission of nerve impulses.

We constantly lose calcium from our bloodstream through urine, sweat, and feces. It is renewed with calcium from bone. In this process, bones continuously lose calcium. This bone calcium must be replaced from food.

Calcium needs change throughout life. Up until the age of 30 or so, we consume more calcium than we lose. Adequate calcium intake during childhood and adolescence is especially important. Later, the body begins to slip into “negative calcium balance,” and the bones start to lose more calcium than they take up. The loss of too much calcium can lead to soft bones or osteoporosis.

How rapidly calcium is lost depends, in part, on the kind and amount of protein you eat as well as other diet and lifestyle choices.

Reducing Calcium Loss

A number of factors affect calcium loss from the body:

* Diets that are high in protein cause more calcium to be lost through the urine. Protein from animal products is much more likely to cause calcium loss than protein from plant foods. This may be one reason that vegetarians tend to have stronger bones than meat eaters.
* Caffeine increases the rate at which calcium is lost through urine.
* Diets high in sodium increase calcium losses in the urine.
* Alcohol inhibits calcium absorption.
* The mineral boron may slow the loss of calcium from bones.
* Exercise slows bone loss and is one of the most important factors in maintaining bone health.

Sources of Calcium

Exercise and a diet moderate in protein will help to protect your bones. People who eat plant-based diets and who lead an active lifestyle probably have lower calcium needs. However, calcium is an essential nutrient for everyone. It is important to eat calcium-rich foods every day.

The “Calcium in Foods” chart on the following page gives the amount of calcium found in some excellent plant sources. A quick glance shows how easy it is to meet calcium needs. The following sample menus each provide close to 1,000 milligrams of calcium.
CALCIUM IN FOODS
(content in milligrams)
Grains
Brown rice (1 cup, cooked)

20
Corn bread (1 2-oz. piece)

133
Corn tortilla

42
English muffin

92
Pancake mix (1/4 cup; 3 pancakes; Aunt Jemima Complete)

140
Pita bread (1 piece)

18
Wheat bread (1 slice)

18
Wheat flour, all-purpose (1 cup)

22

Wheat flour, Pillsbury’s Best (1 cup)
238
Whole wheat flour (1 cup) 40
Fruits
Apple (1 medium) 10
Banana (1 medium) 7

Dried figs (10 figs; 187 grams)
269
Naval orange (1 medium) 56

Orange juice, calcium-fortified (8 oz.)
300*
Pear (1 medium) 19
Raisins (2/3 cup) 53
Vegetables
Broccoli (1 cup, boiled, frozen) 94
Brussels sprouts (1 cup, boiled, 8 sprouts) 56
Butternut squash (1 cup, boiled) 84
Carrots (2 medium, raw) 38
Cauliflower (1 cup, boiled) 34
Celery (1 cup, boiled) 64
Collards (1 cup, boiled, frozen) 348
Kale (1 cup, boiled) 94
Onions (1 cup, boiled) 46
Potato (1 medium, baked) 20
Romaine lettuce (1 cup) 20
Sweet potato (1 cup, boiled) 70
Legumes
Black turtle beans (1 cup, boiled) 103
Chick peas (1 cup, canned) 78
Great Northern beans (1 cup, boiled) 121
Green beans (1 cup, boiled) 58
Green peas (1 cup, boiled) 44
Kidney beans (1 cup, boiled) 50
Lentils (1 cup, boiled) 37
Lima beans (1 cup, boiled) 32
Navy beans (1 cup, boiled) 128
Pinto beans (1 cup, boiled) 82
Soybeans (1 cup, boiled) 175
Tofu (1/2 cup, raw, firm) 258
Vegetarian baked beans (1 cup) 128
Wax beans (1 cup, canned) 174
White beans (1 cup, boiled) 161
Source: J.A.T. Pennington, Bowes and Church’s Food Values of Portions Commonly Used. (New York: Harper and Row, 1989.)
* package information

Source: http://www.pcrm.org/health/VSK/VSK5.html

One of the great things is that foods that are often high in calcium tend to be those rich in iron and magnesium too My preschooler DD and I have been known to polish off a whole packet of dried figs in one sitting.

If you take calcium supplements be careful as there was an article a few years back that pointed out that Ca supplements could actually INCREASE your risk of oxalate stones which is a bit contrary to what you would expect. The purported mechanism was that most people tend to take their tablets on an empty stomach first thing in the morning not with food. The researchers suspected that if oxalate was present [ie in your breakfast] then the calcium would go down a different metabolic pathway that was less likely to cause stones. But if you had them on an empty stomach this didn't occur and next thing you could get kidney stones if you were that way inclined.

Re boron, good sources are flaxseeds, avocado, peanuts, prune juice and pecans.

[petit-pois]

I HIGHLY recommend getting the boook "The China Study" by T. Colin Campbell. He will totally explain why getting enough calcium/protein really is not that difficult. He has been involved with many, many studies that show a plant based diet (with little to no dairy) is extremely beneficial in preventing cancer and disease. Bascially, what I have learned in my years as a vegan is that it is not how much calcium you ingest, but how much you are able to assimiliate. Dr. Campbell explains it beautifully and I could not do it justice in a short email. I've read a million veg books and I have learned MORE from this book than any other. I believe he has a website with a short excerpt from the book

Hope that helps...

[flower7]

Check out Quinoa. It has more calcium than milk and is also a complete protein as well as being a good source for iron, phosphorous, B vitamins, and vitamin E. There are quite a few recipes on Zaar that use it.

[yogi]

I second petit-pois!
The China Study was the book that made me decide to seriously stop eating dairy. Here is the site
http://www.thechinastudy.com/about.html
and if you want to read what others' reviews are on it - http://www.amazon.com/exec/obidos/ASIN/1932100385/qid=1115217082/sr=2-1/ref=pd_bbs_b_2_1/102-4702551-0286505

[Kumquat the Cat's friend]

flower7 wrote:
Check out Quinoa. It has more calcium than milk and is also a complete protein as well as being a good source for iron, phosphorous, B vitamins, and vitamin E. There are quite a few recipes on Zaar that use it.

I was very reluctant to try quinoa because the way they made it seemed strange (fermentation) and because they say it's similar to mushrooms (which I hate). Very recently there was a newspaper article that my BF told me about that said some people get a very violent reaction to it. Have you tried it?

[Kumquat the Cat's friend]

Kumquat the Cat's friend wrote:

flower7 wrote:
Check out Quinoa. It has more calcium than milk and is also a complete protein as well as being a good source for iron, phosphorous, B vitamins, and vitamin E. There are quite a few recipes on Zaar that use it.

I was very reluctant to try quinoa because the way they made it seemed strange (fermentation) and because they say it's similar to mushrooms (which I hate). Very recently there was a newspaper article that my BF told me about that said some people get a very violent reaction to it. Have you tried it?

Ooops, sorry let me clarify. Unfermented quinoa is just a high protein grain. Fermented quinoa is made into a meat substitute. That's what the article my BF talked about was referring to. I wouldn't hesitate to try the unfermented kind, which was what you were referring to.

[Missy Wombat]

Quote:
Calcium supplementation: the bare bones

CC there is a comment for consumers on this article
John D. Wark, Professor of Medicine, Department of Medicine, The University of Melbourne, and Bone and Mineral Service, The Royal Melbourne Hospital; and Caryl Nowson, Associate Professor, School of Health Sciences, Deakin University, Melbourne

SYNOPSIS

An adequate calcium intake is an essential part of the prevention and treatment of osteoporosis. Two to three serves of calcium-rich foods each day provides sufficient calcium for most non-pregnant adults. If this target is not achievable, calcium supplementation is generally effective, cheap and safe for most people. Calcium carbonate (without vitamin and mineral additives) is the preferred supplement in most cases. Problems with calcium absorption arise due to factors including high-fibre vegetarian diets, achlorhydria, long-term glucocorticoid therapy and vitamin D deficiency. Vitamin D deficiency is extremely common in some ethnic groups and the elderly who are housebound or in residential care. These at-risk groups generally require vitamin D supplementation to achieve adequate intestinal absorption of calcium.

Index words: osteoporosis, diet, vitamin D.

(Aust Prescr 2003;26:126-7)

Introduction

There is strong evidence that an adequate calcium intake is important for healthy bones, and as part of the preventive strategy in individuals at high risk for osteoporosis (for example, patients receiving long-term glucocorticoid therapy). It is also an adjunctive treatment in patients with osteoporosis.1 An adequate calcium intake (and vitamin D status) was a prerequisite for the clinical trials assessing the anti-fracture efficacy of all of the currently available medications for treating osteoporosis, with the exception of calcitriol. Patients being treated for osteoporosis should therefore always have an adequate intake of calcium, and a normal vitamin D status.

Dietary calcium

For most people, calcium requirements are in the range 800-1500 mg daily. These requirements are best met by consuming at least two or three servings of high calcium foods daily (for example, milk products, calcium-fortified soy products). A serving of dairy food contains 200-300 mg of elemental calcium.2 (When checking the true calcium content of foods and supplements, it is the elemental calcium that matters.) Daily physiological needs may be at least 1000 mg during growth, in pregnancy and possibly in the late postmenopausal stage of life. Recommended dietary intakes of calcium (under review) indicate an additional 300 mg daily in pregnancy and an additional 400 mg daily for lactation.

Currently, approximately 60% of dietary calcium comes from dairy foods2 (although this proportion may fall with the introduction of more calcium-fortified foods). People who avoid dairy products usually have an inadequate dietary calcium intake. Where necessary, calcium intake should be boosted by increasing the intake of high calcium foods such as dairy products and calcium-fortified soy products if possible. These products also contain a range of other essential nutrients including protein, phosphorus, magnesium and some vitamins which are of particular importance during growth, pregnancy and ageing.

Calcium supplements: how much, which type, how taken?

Calcium supplements are a very useful way of helping individuals who are unable to consume sufficient calcium from dietary sources. An extra 500-700 mg elemental calcium per day will suffice for most people. The cheapest, easiest way to achieve this objective is with a single calcium carbonate tablet containing 600 mg elemental calcium.

Calcium carbonate contains 40% elemental calcium by weight compared with 21% in calcium citrate. Although calcium citrate is more soluble and its bioavailability may be approximately 25% greater than that of calcium carbonate3 it is also more expensive. Calcium citrate was found to be less cost-effective than a calcium carbonate preparation in a recent study.4 Clinical situations where calcium citrate may be preferred over calcium carbonate include achlorhydria (calcium carbonate requires an acid environment to dissolve, calcium citrate does not), and in patients who need calcium supplements but have a history of kidney stones (citrate in the urine inhibits calcium oxalate precipitation).5 Calcium phosphate preparations have not been studied extensively, but appear to be absorbed adequately.6

In general, it is recommended to prescribe or advise the use of widely available, major brand-name calcium preparations whose absorbability has been well documented. This is because the absorbability of some marketed products is only 40-60% of that of plain calcium carbonate.

Administration

It is generally not important when calcium supplements are taken in relation to meals. Patients with achlorhydria appear to be an exception. Calcium carbonate is very poorly absorbed in these patients when fasting, but is absorbed satisfactorily when ingested with a meal.5 There is some evidence that taking calcium supplements in the evening may be advantageous, by suppressing the nocturnal rise in bone resorption. It is critical that calcium and oral bisphosphonates are taken at least several hours apart as calcium binds with these medications and prevents their absorption.

Factors that impair the absorption of calcium supplements

Some dietary constituents can impair calcium bioavailability by forming insoluble calcium complexes.7 These substances include phytates (found in cereals, bran, soybeans, seeds) and oxalates (found in spinach, rhubarb, walnuts). Some vegetarian diets may therefore adversely affect calcium balance, particularly if the calcium content is low due to the avoidance of dairy products.

Inadequate vitamin D nutrition is associated with impaired intestinal calcium absorption and must be corrected for ingested calcium to be effective. As the vitamin D content of our diet is generally low, people with low levels of sunlight exposure (the chronically-ill, housebound, people in residential care, some ethnic groups) are at high risk for vitamin D deficiency. Dark-skinned people, especially veiled women, are an important risk group. Their vitamin D status in pregnancy is a particular concern. Daily needs are probably of the order of 800 IU in these high-risk groups. This can be given as oral vitamin D2 1000 IU daily.

Long-term glucocorticoid treatment also causes calcium malabsorption. In general, when calcium supplements are recommended, vitamin D nutritional adequacy should be assured and other bone-protective interventions may be indicated. Renal impairment is associated with calcium malabsorption and this aspect of the care of patients with renal disease requires specialist advice. Achlorhydria reduces the absorption of calcium carbonate. In theory, proton pump inhibitors might impair calcium absorption, but evidence is lacking. It may be preferable for patients taking proton pump inhibitors to take calcium supplements with meals and perhaps to take calcium in the form of calcium citrate.

Adverse effects

Calcium supplements are usually well tolerated. Occasional adverse effects include constipation, bloating and flatulence. Changing preparations (for example, from calcium carbonate to calcium citrate) may alleviate these adverse effects. Calcium supplementation is contraindicated in the presence of hypercalcaemia or marked hypercalciuria, and during calcitriol therapy for osteoporosis, because of the risk of inducing hypercalcaemia or hypercalciuria. Measurement of the serum calcium, albumin and creatinine should therefore be part of the pre-treatment evaluation of patients presenting with apparent osteoporosis. Caution is also required in renal impairment, sarcoidosis and when there is a history of nephrolithiasis.

What about the additives?

Evidence is lacking that the small amounts of various mineral and vitamin additives present in some marketed calcium supplements improve the effectiveness of the supplements. In theory, the addition of vitamin D might be beneficial, but the amount of vitamin D added (100–200 IU) is insufficient to prevent vitamin D deficiency in someone at risk. An adequate vitamin D supplement of 1000 IU is therefore recommended for these individuals.

Conclusion

There is a strong case in favour of calcium supplementation when an adequate dietary calcium intake cannot be achieved. In most non-pregnant adults, a daily supplement of 600 mg elemental calcium as calcium carbonate is sufficient, though occasionally more may be required. Coexisting vitamin D deficiency is common, particularly in the elderly in residential care, and also needs to be corrected.

R E F E R E N C E S

1. Heaney RP. Calcium, dairy products and osteoporosis [review]. J Am Coll Nutr 2000;19:83S-99S.

2. Angus RM, Eisman JA. Osteoporosis: the role of calcium intake and supplementation. Med J Aust 1988;148:630-3.

3. Sakhaee K, Bhuket T, Adams-Huet B, Rao DS. Meta-analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate. Am J Ther 1999;6:313-21.

4. Heaney RP, Dowell SD, Bierman J, Hale CA, Bendich A. Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr 2001;20:239-46.

5. Levenson DI, Bockman RS. A review of calcium preparations [published erratum appears in Nutr Rev 1994;52:364]. Nutr Rev 1994;52:221-32.

6. Shires R, Kessler GM. The absorption of tricalcium phosphate and its acute metabolic effects. Calcif Tissue Int 1990;47:142-4.

7. Gueguen L, Pointillart A. The bioavailability of dietary calcium [review]. J Am Coll Nutr 2000;19:119S-136S.

Conflict of interest: none declared

http://www.australianprescriber.com/index.php?content=/magazines/vol26no6/126_127_calciumsupplementation.htm

[Missy Wombat]

Quote:
Comparison of Common Calcium Supplements

A high dietary calcium intake combined with vitamin D can increase bone density and reduce fractures in older women and, probably, men. The Institute of Medicine recommends that persons 19 to 50 years of age consume 1,000 mg per day of calcium and that persons older than 50 years consume 1,200 mg per day. The average American consumes less than 800 mg of calcium per day. Medical Letter consultants reviewed the efficacy and safety of current calcium supplements (see the accompanying table).
Comparison of Calcium Supplements
Drug Elemental calcium per tablet (mg) Vitamin D per tablet (IU) Tablets per day* Cost†
Calcium carbonate-generic 600 200 2 $ 3.59
CalBurst‡ 500 200 2 6.99
Caltrate + D 600 200 2 5.99
Os-Cal + D 500 200 2 5.25
Tums 500 500 0 2 4.49
Viactivठ500 100 2 6.99
Calcium citrate
Citracal + D 315 200 3 8.24
Calcium citrate + D 315 200 3 8.99
Calcium complex (carbonate, lactate, gluconate)
Calcet 150 100 7 14.68
Calcium phosphate
Posture-D 600 125 2 5.99
*--Needed to provide 1,000 mg elemental calcium daily.
†--Retail cost for a 30-day supply from an Internet pharmacy
‡--Soft chewable preparation
§--Also contains 40 mg vitamin K.
Reprinted with permission from Medical Letter consultants. Calcium supplements. Med Lett Drugs Ther 2000;42(1075):29.

Calcium supplements are derivatives of natural products, such as oyster shell or bone. Some are marketed primarily as antacids. Calcium carbonate and phosphate preparations have the highest concentration of elemental calcium, about 40 percent. Calcium citrate contains 21 percent elemental calcium, and calcium lactate and gluconate contain 13 and 9 percent, respectively. A recent meta-analysis found that absorption of calcium citrate was 27 percent higher than that of calcium carbonate when taken on an empty stomach and 22 percent higher when taken with meals. It did not make a difference which preparation of calcium was taken or in which dosage.

Taking calcium with food in dosages of 500 mg or less increases absorption. Calcium preparations must be dissolved before they can be absorbed; the absorption rate for calcium is about 20 to 30 percent. The absorption of calcium supplements differs by preparation. Foods such as spinach, rhubarb and wheat bran can decrease calcium absorption. Calcium can interfere with absorption of iron, zinc, bisphosphonates and tetracycline. Absorption also requires adequate doses of vitamin D. The recommended daily intake of vitamin D is 200 IU for adults younger than 50 years and 600 IU for those older than 70 years. Vitamin D supplementation is especially important in elderly persons because skin synthesis and absorption of vitamin D may be impaired.

In postmenopausal women with low dietary calcium intake, specially prepared 500-mg tablets of calcium citrate malate were more effective in preventing bone loss than 500-mg tablets of calcium carbonate, although the difference was not significant. In another study, 500 mg of calcium citrate taken with breakfast produced serum calcium levels significantly higher than those demonstrated after 500 mg of calcium carbonate.

The most common adverse effects of calcium supplements are constipation, intestinal bloating and excess gas. Adverse effects occur most frequently with calcium carbonate. Switching preparations or increasing fluid intake may relieve symptoms. Patients who form calcium-containing stones are generally advised not to take calcium supplements. However, a low intake of calcium can aggravate the risk of stone formation by increasing absorption and urinary excretion of oxalate. High calcium intakes can increase stone formation in patients with absorptive hypercalciuria. Those with renal hypercalciuria may experience increased bone loss if calcium intake is too low.

Medical Letter consultants reiterate the need for adequate calcium supplementation in all persons, regardless of age or sex. Calcium carbonate may cause more adverse events. Calcium citrate may be better absorbed than the other calcium salts. The consultants conclude that any calcium supplement taken in dosages of 500 mg or less with meals may improve absorption.

BARBARA APGAR, M.D., M.S.

http://www.aafp.org/afp/20001015/tips/1.html

Sorry about the table in the middle of this but I thought it was a useful article if you are contemplating a commercial supplement.