CALCIUM

Adequate DAILY Calcium intake is necessary for anyone taking any form of inhaled corticosteroid (nose or chest)

REQUIRED TOTAL DAILY INTAKE in mg/day elemental CALCIUM

Less than 6 mos of age = 400mg ; 6 to 12 mos = 600mg ; 1-5 yrs. = 800mg ; 6-10 yrs. = 800-1200mg

All 11-24 yrs. = 1200 (1500mg maximum)

WOMEN : 25-50 yrs. = 1000mg ; pregnancy or breastfeeding =1200 (1500mg maximum)

Over 50 yrs. or after menopause + taking estrogen = 1000mg

Over 50 yrs. or after menopause and not taking estrogen = 1200mg (1500mg maximum)

MEN : 25-65 yrs. =1000mg ; over 65 yrs. = 1200mg (1500 maximum)

*** ANY ADULT ON CORTICOSTEROIDS = 1500mg ***

PREFERRED CALCIUM SOURCE IS DIETARY

Calcium rich foods, particularly dairy products. Most Canadians consume 300mg per day minimum, and if you consume 3 cups of milk daily you don’t need supplements.

Examples ; 8 oz. (1 cup) (250 ml.) of yogurt = 450mg , of whole milk = 250mg , of skim milk = 300mg

Cheese(1oz.) = 200mg , tofu(4oz.) = 150mg , fish or 2 eggs = 50mg , dk. green leafy veg's =90mg

SUPPLEMENTS - Calcium and Vitamin D

A calcium supplement should be taken, if you do not reach your required calcium intake EVERY day. It should contain the proper amount of elemental calcium with Vitamin D (Vitamin D promotes calcium absorption). For adults the total daily minimum Vitamin D intake should be between 400-800 i.u. to promote optimal calcium absorption. RECENT studies suggest that a daily Vitamin D intake of 1000-2000 i.u. reduces the risk of developing several cancers and is likely a very good idea. Do not take Vitamin D in doses that exceed 4000 i.u. per day, as this can be toxic. Individuals with a history of kidney stones, etc. must be very cautious about taking any more than the minimum amount of calcium and vitamin D recommended for age/sex. Buy calcium preparations that have 250 or 500 mg elemental calcium with Vitamin D (and supplement with additional Vitamin D as required). Vitamin D levels can easily be measured in a blood test (different techniques can give different results) and in general a blood (serum) level of under 50nmol/L is inadequate and requires Vit D supplementation, above 50 nmol/L is adequate, above 75 nmol/L is recommended for individuals with or at risk of osteoporosis (i.e. those on steroids-topical or systemic), and 125nmol/L is the safe upper limit. As time and population studies go on, these recommendations may be adjusted, but these numbers reflect a solid consensus.

FACTORS THAT DECREASE BODY CALCIUM

-low calcium intake

-immobilization (lack of physical activity)

-low estrogen levels (menopause)

-increase in urinary calcium loss due to high protein or high sodium intake

-corticosteroids decrease calcium absorption and cause a net calcium loss

HIDDEN FACTORS INCREASING BODY CALCIUM

-some antacid preparations (TumsTM , RolaidsTM , etc.)

DANGERS OF CALCIUM IN YOUR DIET

-be very cautious & ask your physician if you have a history of kidney stones

-most calcium in your diet reduces iron absorption (exception: calcium citrate)

-calcium reduces absorption of tetracycline & other drugs

-do not take calcium supplements of bone meal or dolomite as they may contain lead

-calcium supplements should be taken with meals or alone, never with other medicines/pills

ADDITIONAL WAYS TO PREVENT OSTEOPOROSIS

-spread calcium intake out over the entire day (do not take all your calcium in one dose)

-exercise regularly (particularly axial loading, i.e. walking while carrying small hand/wrist weights)

-estrogen replacement therapy Bruce Sweet M.D. 2015