Patients with a healthy endocrine system and regulation of calcium metabolism are able to utilize a variety of calcium supplements without problem. Studies have found mild benefits for a number of health problems with use of calcium supplements in these relatively healthy patients. Patients with hormonal imbalance, poor intestinal health, deficiency of activated Vitamin D3 hormone, or problems with liver and kidney health may have difficulty utilizing calcium in the diet, even when taking calcium supplements and Vitamin D3. The primary problem with absorption and utilization of calcium is gradual decrease in bone mass and strength, or ostoeoporosis, but diminished calcium homeostasis may cause or contribute to a wide variety of health problems. Professor K. D. Cashman of the Department of Food Science and Medicine at the University College of Cork, Ireland, wrote in an extensive article published in the British Journal of Medicine in 2002: "Because of the small metabolic pool of calcium (less than 0.1% in the extra-cellular fluid compartment) relative to the large skeletal reserve, for all practical purposes metabolic calcium deficiency probably never exists, at least not as a nutritional disorder." The problem with calcium utilization is thus not solved by taking in high dosages of supplemental calcium when there exists a metabolic health problem that is interfering with calcium utilization. An effective protocol for increasing calcium absorption into the bone involves attention to a number of physiological mechanisms that must be improved for calcium absorption to actually benefit you. There is evidence that taking calcium supplements without addressing these metabolic issues could have negative health consequences.
A long-term Women's Health Initiative United States governmental study was completed and published in 2006 in the New England Journal of Medicine, and concluded that even among healthy postmenopausal women, calcium with Vitamin D supplementation resulted in only small improvement in hip bone density, did not significantly reduce hip fracture, and increased risk of kidney stones. This is because calcium and Vitamin D are tightly regulated chemicals in our body and when there are hormonal imbalances, these are the cause of the calcium and Vitamin D deficiencies, not just dietary insufficiency.
Pharmaceutical medicine has tried to solve this problem in a number of ways, which have had disastrous outcomes for many patients. Synthetic hormone replacement (HRT) was given in the hope that osteoporosis and resulting hip fractures and other problematic bone fractures could be reduced. The Women's Health Initiative reported after a long-term study that there was a mild lowering of risk of osteoporotic fracture with HRT, yet the synthetic hormones caused an alarming number of cases of breast cancer, ovarian cancer, heart attack, stroke, thromboses, Alzheimer's, and other dementias. Reduction in the prescription of synthetic hormone after this report was dramatic, and since this time, there has been an amazing decrease in incidence of breast cancer correlated with decrease in consumption of synthetic hormone replacement. The second line of pharmaceutical treatment for osteoporosis involved the drugs Fosamax, Actonel, Boniva, etc., called biphosphonates, which theoretically work by blocking the release of calcium from the bone. In 2004, the FDA released stern warnings that a high incidence of bone necrosis was linked to Fosomax and other biphsophonate use, and in 2008, finally issued increased warnings concerning the high incidence of severe debilitating pain resulting from continued use, often with onset occurring many months after starting the drug. For many patients, these side effects did not even accompany an increase in bone density. Patients now are turning to Complementary Medicine to find an alternative to these harsh pharmaceutical treatments. Unfortunately, if you are a patient with these health concerns, simple taking of a calcium supplement and Vitamin D3 are not enough to solve the problem.
It is now well known that many commonly prescribed medications cause or contribute to osteopoenia and osteoporosis, essentially a calcium deficiency where it is possible to have an actual calcium deficiency, in the bone, which stores a lot of calcium that is released in a complex manner to supply our bodies with an array of calcium molecules as we need them. Antacids, acid-inhibiting drugs (Proton Pump Inhibitors), antiseizure medications, chemotherapy drugs, synthetic hormones, corticosteroids, aromatase inhibitors, heparin, lithium, diabetic drugs such as Actos and Avandia, some antibiotics (Rifampin and Plicamycin), anticonvulsant seizure medications (Phenobarbital and Phenytoin), anti-depressant SSRIs, contraceptives, immunosuppressant drugs (Methotrexate, Cyclosporine et al), hormone suppressing drugs (Lupron et al), and even synthetic thyroid hormones may all cause significant problems with calcium homeostasis, such as osteoporosis. But osteoporosis is not the only manifestation of calcium dysfunction, just the most obvious one. Disruption of calcium homeostasis may cause a wide variety of health problems, and simply adding a calcium supplement and Vitamin D to the protocol will not solve these problems. Going further and adding drugs to treat osteoporosis that themselves disrupt normal regulation of calcium homeostasis will also not solve the problem. Our medical industry has looked the other way and continued to use these strategies for decades now, and the harm to public health from this obvious malpractice is enormous. It seems inconceivable that doctors that study physiology could even pretend to believe that this addition of calcium supplements, Vitamin D and biphosphate drugs could actually protect their patients.
If you are reading this article to find some simple advice for success with calcium supplementation, go no further. The problem with calcium deficiency, osteoporosis, and other related health problems, is not simple. To truly correct this important health problem, the responsible person does the work, and takes the time, to understand the big picture, and to correct what has gone wrong with your health. To believe that hormonal regulation can be ignored, and that taking a calcium supplement alone will fix your problem is to pretend. To believe that taking a pharmaceutical medicine that supposedly blocks the resorption of calcium from your bone will result in a healthy state of being, when the problems with calcium metabolism are not addressed, is also a pretend state. Will prescribed synthetic hormones solve the problem? As far back as 2002, the National Institutes of Health released the results of long-term studies that showed that synthetic progestins, or progesterone derivatives, such as are prescribed in Depo-Provera and most hormone replacement and contraceptive medications, causes significant osteoporotic bone loss, even in young women. When you actually understand the sequence of events that led to your problems with calcium metabolism, only then can you correct this serious health threat with a step-by-step approach.
Deficiency of calcium is highly related to the factors that tightly control the absorption, deposition into bone, resorption out of bone, metabolism, and excretion rates of calcium. Whenever there is a calcium deficiency, the problem is not a lack of supply in our diet, but a systemic health problem with access to the dietary calcium, and the proper regulation of calcium metabolism. Calcium is found in most of the foods that we eat. It is the backbone of chlorophyll, the green substance in vegetables, and is abundant in all meats. Calcium is also abundant in many grains, beans, legumes, nuts and seeds. Mineral water with high calcium content provides a significant amount of accessible dietary calcium. You may check the calcium content of foods on a link to the UCSF Medical Center website below in the additional information section. It is time that the health community stopped pretending that the problem is solved by simple taking of calcium pills. When excess calcium is taken in the form of supplements, without the holistic correction of the underlying problem, there are significant health hazards, and these are not being addressed.
The physiological factors that determine calcium absorption, deposition into bone, resorption out of bone, metabolism, and excretion, are primarily hormonal regulation from three sources. 1) the hormone typically called activated Vitamin D3, or 1,25-dihydroxycholecalciferol, 2) regulated levels of parathyroid hormone, and subclinical hyperparathyroid, (or clinical hypoparathyroid) states , and 3) regulated levels of calcitonin hormone, with sublinical hypothyroid states. All of these basic mechanisms are strongly interrelated. Chronic deficiency of circulating calcium, even mild deficiency, can result in as much as 100 percent increase in parathyroid hormone concentration, and subsequent risk of parathyroid gland hypertrophy, and a chronic subclinical hyperparathyroid state. These chronic mild circulating calcium deficiencies can also affect the thyroid hormone calcitonin, and contribute to mild sublcinical hypothyroid states. You may read about these problems in a separate article on this website entitled Hypothyroidism and Hyperparathyroidism. Problems with calcium metabolism involve a complex feedback mechanism that may result in more problems than just osteoporosis, and each aspect of this mechanism should be assessed. As we see, much of the dysfunction in calcium metabolism and regulation could be caused by the various commonly prescribed medications mentioned above.
Although calcium metabolism is highly regulated, we often see a relatively wide range of normal total plasma calcium concentration. This may be due to the variance in plasma protein carriers, such as albumin. It is also believed that the state of hydration can alter the albumin concentration. Now hydration would seem to be a simple matter of drinking more fluid, but physiologically, hydration involves the passage of fluid through tissue membranes and the regulation of fluid metabolism. Here too, mineral balance, hormonal balance, and healthy kidney and liver function, are all key to actual hydration health. Without taking a more holistic approach these problems with the calcium metabolism will not be fixed.
The most common symptoms associated with more severe deficiency in circulating calcium include numbness and tingling, or paresthesia, as well as painful wrist and ankle spasm. Often these problems are hastily diagnosed as carpal tunnel syndrome or peripheral neuropathy, and the patient is not made aware of the potential causes of their symptoms with calcium ion accumulation in their tissues and poor muscle firing from a lack of calcium aspartate. Lethargy, and difficulties with mental function are also frequently noted in more severe circulating calcium deficiency, as well as problems with short term memory, insomnia and abnormal heart rhythms. The patient does not connect these common symptom patterns with mineral imbalances, and the mineral imbalances are not sufficiently connected to the underlying health problems. Instead, we cling to a belief that taking the most inexpensive calcium supplements available will somehow fix us. Taking quality calcium supplements in the most intelligent way, is advisable, when accompanied with holistic treatment protocol to help restore the calcium metabolism and regulation. Ignoring the problems with calcium metabolism is not advisable. Signs of circulating calcium deficiency include hypocalcemia on blood tests, weak and brittle nails, dry scaly skin, and poor quality to the hair and teeth. Blood tests may be unclear, as only about 60 percent of calcium released to blood circulation is normally unbound to protein carriers, or active. Hypocalcemia only occurs when this level of unbound calcium, in the form of calclum ions, is low. Contributing factors include low magnesium, which is common, hormone Vitamin D deficiency, which is common, kidney dysfunction, pancreatitis, and of course thyroid and parathyroid dysfunction.
Potential Health Problems with Calcium Supplementation
Our society has been told for some time that we should take calcium supplements, and it is implied that when there is a problem with calcium in the body, all we have to do is fill the tank. When we study our body's physiology, and calcium metabolism, we find that this is patently untrue for patients with health problems that inhibit calcium regulation. There are health problems that may arise for this set of patients from taking an excess of calcium at one time, from taking the wrong type, or conjugation, of calcium, or from taking the relatively high dose of calcium with the wrong types of food, or other supplements.
The first type of problem that may arise in the patient with health problems inhibiting calcium absorption, when taking a calcium supplement, is a deficiency of phosphates. Absorption of calcium in our intestines is difficult, and when there is excess calcium in our diet, as with calcium supplement pills, another exceedingly important nutrient, phosphate, is poorly absorbed, because much of the phosphate is attracted to the calcium and forms insoluble calcium phosphate molecules that cannot easily pass through the intestinal wall, and so are excreted with the feces, or worse, accumulate in the intestinal tissues, causing calcification, potentially contributing to formation of calcium urinary stones.
This is because phosphate and calcium are highly charged ions, and calcium is electropositive while phosphate is highly electronegative. Normally, phosphate is easily absorbed, but in the presence of excess calcium, it is very poorly absorbed. This causes health problems beyond the inhibition of calcium absorption, because phosphate molecules are very important to bodily function. One example of phosphate metabolism is the molecule adenosine triphosphate, which essentially provides power for our muscles. Phosphate is a simple molecule, with phosphorus surrounded by four oxygen radicals. Oxygen is an ion that provides most of the direct energy in our body, and in many patients, the oxygen needs increase when we have a worsening chronic musculoskeletal problem. Deficiency of phosphate may contribute to the chronic pain syndromes that so many patients complain of. Also, when the ration of calcium to phosphate is altered, and the product of concentrations of calcium and phophate exceeds 70, precipitation of calcium phosphate crystals in soft tissue is much more likely. Calcified joint tissues create arthritic conditions and gradually result in such problems as the "frozen shoulder" syndrome. The first significant problem with calcium supplementation is thus problems with intestinal absorption and potential phosphate deficiency over time.
A related problem involves poor quality phosphates in the diet. Soft drinks are high in phosphorus, and excess meat and simple carbohydrates, such as unrefined sugar and refined flours, all create excess phosphates that bind to the calcium we eat and cause the calcium to be bound and excreted. There has been a clinical observation and warning for some time concerning patients with endocrine deficiencies and poor calcium metabolism and the regular consumption of soft drinks, excessive red meat, and high glycemic index carbohydrates.
We see that when we actually pay attention to our basic physiology, that medical advice driven by market forces, or given by physicians that have been trained to treat serious disease, but have little knowledge of nutrition and healthy physiology, may cause serious problems for us. Excess calcium supplementation, wrong types of calcium supplement, and problems with calcium homeostasis have been shown to contribute or cause a variety of health problems, including kidney and urinary stones, high serum creatinine concentration affecting kidney disease, and potential inflammatory problems such as calcified joint tissues and cardiovascular disease. Calcium may be a very useful medicine, but professional and intelligent prescription and assessment will alleviate these concerns.
Calcium homeostasis is very important to our health. In one of the foundation texts of the study of medicine, Guyton and Hall's Human Physiology and Mechanisms of Disease, the author states that "about seven eighths of the (normal) daily intake of calcium is not absorbed, and therefore excreted in the feces; the remaining one eighth that is absorbed is used mostly for formation of bone, and the excess (not allowed in this process) is eventually excreted in our urine." If the calcium excreted in the urine is bound to specific chemicals, such as oxalic acid, this may contribute to kidney stone formation. Calcium in blood circulation needs to quickly conjugate to carriers that direct it to the proper location to affect calcium channels, cell signaling, or deposition in bone, and if this is poorly controlled, large charged calcium ions will accumulate in tissues pathologically. The authors of Guyton and Hall's Human Physiology and Disease, who are perhaps the most prominent physiologists in the world, devote an entire chapter to the problems of calcium absorption, deposition into bone, resorption from bone, and utilization in the body. Obviously, calcium homeostasis is important in medical care and should not be treated lightly.
Calcium is the most regulated molecule in our body. This is because it is a large mineral molecule that is highly electropositive and attracted to other molecules, and plays an extremely important role in many of the cells and tissues of our body, both in muscles, bones and organs. When there is a problem with the complex regulation of calcium in our bodies, various health problems occur, with the most publicized problem being osteoporosis, or weakening of our bones. Simple taking of calcium supplement is problematic because even absorption of the calcium pill in the gut is highly regulated and dependant on a number of factors, especially levels of the hormone that our various forms of Vitamin D promote, and parathyroid hormone. Calcium is poorly absorbed from the intestinal tract because of both the relative insolubility of its chemical compounds, and also because large molecules do not readily cross through membranes. Active calcium transport is dependant on a carrier protein, both in the small intestine and in the colon, called calcium-binding protein, that is an expression of Vitamin D metabolism. This Vitamin D metabolism involves hormonal activation in the kidney regulated by parathyroid hormone, and healthy protein metabolism of the liver.
How regulated is the calcium metabolism? To illustrate, calcium absorption alone, meaning the amount of calcium that your consume, either in food or with calcium pills, is highly regulated by a hormone that is activated from circulating prohormone Vitamin D in your kidney. One form of this Vitamin D, cholecalciferol, is stored in your liver, and converts to 25-hydroxycholecalciferol. When there is too much of this form of Vitamin D, it inhibits more conversion. When the 25-hydroxycholecalciferol circulates to the kidney it can be transformed into the active hormone 1,25-dihydroxycholecalciferol, but needs a regulated level of parathyroid hormone to achieve this hormonal conversion. Small variances in circulating calcium levels highly affect the levels of parathyroid hormone. The activated hormone D3 targets many tissues in the body, including the intestinal lining, and the liver, affecting the calcium-binding protein, and enzymes that are needed for calcium absorption. When any of these factors are negatively influenced, circulating calcium is decreased, which immediately affects parathyroid hormone levels, as well as thyroid calcitonin. As complex as this elaborate feedback system of regulation sounds, the actual mechanism of calcium regulation is even more complex. This tells us that it takes more than just taking some calcium supplement to correct our calcium deficiency.
A treatment protocol that actually works
There are a number of health factors that you need to familiarize yourself with if you are to succeed with restoration of a healthy calcium level in your bones and circulating to your tissues. The common reaction to our complex health problems, especially hormonally related health problems, is to grasp for the simple magic pill solution. You can't be blamed for this desperate reaction, because of course everyone wants this magic pill solution. There are many people around you that reinforce this simplified belief system, because it sells products very efficiently. If one person tells you that all you have to do is to take a certain calcium product, poor quality Vitamin D, and synthetic hormone replacement, and another person tells you that the solution is a lot more complex than that, you naturally believe the first person. This article is written to tell you the truth about what you need to do to actually get healthy. Despite what the pharmaceutical giants and ridiculous TV ads tell you about the guaranteed success of harsh medications to correct osteoporosis and calcium deficiency, the clinical picture has not shown proof of this success. The patient that seeks understanding and guidance in an intelligent approach to their problems, is sure to find health and success that can translate into so many different benefits. This proactive approach is worth the trouble, but requires some integration of your standard health care with Complementary Medicine.
A number of types of calcium supplement are available on the market, and the general impression is that if you take the right type of supplement that you are guaranteed to increase the calcium deposition into your bones. While this may be correct if the patient is relatively free of problems that may affect calcium regulation, for most patients with a need for calcium deposition or circulating calcium, there exists various problems that will make simple calcium supplementation ineffective for them. Obviously, each person has a unique health makeup, and finding the right way to correct calcium deficiency involves attention to a number of details. Your physician often lacks the time needed to address these details on an individual basis. Since the problems with calcium metabolism are not considered a significant health problem, the physician will almost always just prescribe calcium supplements, sometimes with magnesium and Vitamin D. It is up to the patient, with analysis and guidance from a knowledgeable Complimentary Medicine physician, to take control of this somewhat complicated problem and make it work.
The most widely prescribed calcium supplement, calcium citrate, renders the circulating calcium non-ionized. Even if this calcium supplement is absorbed through the lining of the intestine, a non-ionized form of circulating calcium is able to pass into tissues through the capillary beds, but is not able to be utilized directly for use, since it is not ionized. Excess amounts of calcium citrate, and other forms of supplemental calcium, are thus deposited in the joint tissues through the capillary bed, and cause excess calcification of the joint, often resulting in frozen should syndrome, which is calcific capsulitis. Other tissue calcification pathologies also may occur.
To make calcium supplementation actually work for you, you absolutely need to understand the factors that control absorption, deposition, and utilization of calcium in your body. Without addressing these factors, calcium supplementation may be a waste of money, or worse, contributing to calcium deposits in your joints and tissues, as well as potentially contributing to the formation of calcium urinary kidney stones.
The basic needs of the human body in the absorption, deposition, resorption, and utilization of calcium involve these factors: 1) a consistent supply of stored or ingested Vitamin D, in various forms; 2) a hormonal balance that provides consistent parathyroid hormone for conversion of the prohormone Vitamin D types to the D3 hormone; 3) healthy liver function; 4) healthy kidney function; 5) healthy intestinal epithelium, or membrane lining; 6) healthy formation of calcium-binding protein and certain enzymes, primarily in a healthy liver, and 7) healthy thyroid metabolism, our source of regulated hormone calcitonin. While this scenario is more complicated than we would like, this is the truth. It takes a holistic health approach to effectively create a healthy calcium and Vitamin D metabolism. Simply taking calcium and Vitamin D, in whatever form, dosage, or quality, is insufficient to guarantee success with health problems related to poor calcium metabolism, such as osteoporosis. The good news is that attention to these health problems will result in improved health and quality of life beyond the treatment of osteoporosis, and will be worth it in the long run.
Estrogen deficiency is also primarily linked to osteoporosis. This is because the estrogens also promote calcium deposition into the bone. Some female athletes may induce an estrogen deficiency, and this produces an abscence of menstruation in many young female athletes. Heavy exercise also may hinder calcium uptake. Eventual risks of weakened bones and other health problems increase for this subset of women. For these young female athletes, proper calcium supplementation will have noticeable benefits. For the estrogen deficient older woman, the benefits from simple calcium supplementation will not be apparent. Estrogen deficiency, like most hormonal problems, is best treated by restoration of the whole endocrine system.
The forms of Vitamin D prohormone and D3 hormone itself, the key to calcium regulation, along with parathyroid hormone
The hormones called activated Vitamin D3 or D2 control both absorption of calcium in the gastrointestinal tract, deposition into bone, and resorption into the circulation. This hormone Vitamin D3/D2 is not the same as the vitamin supplements that you consume, which have no physiological activity of their own, but must be converted to active hormone in the kidneys or other tissues. There are a number of molecules in the body that are called Vitamin D, with 5 distinct types of prohormone, and numerous metabolites of these prohormones. In the past, vitamin supplements used one of these metabolites that was the cheapest, and most easily assimilated. This created potential problems if taken in high dosage, relating to imbalance of the various forms of Vitamin D in the body. Finally, Vitamin D3 was routinely prescribed, in one of 2 forms, cholecalciferol, or 25-hydroxycholecalciferol (calcitriol). Cholecalciferol is the form that our bodies generally utilize, is stored in our liver in this form. D3 cholecalciferol is derived mainly from a type of cholesterol that is stored in our skin and activated by direct strong midday sunlight, though. This mechanism is our chief source of cholecalciferol Vitamin D3, and is itself highly regulated. Studies show that exposure to weak sunlight has much less effect, and that exposure to midday sunlight for more than 10 minutes triggers a mechanism that stops the cholecalciferol from forming. In the diet, cholecalciferol is generally derived from meat sources. Cholecalciferol goes through a number of transformations before it becomes the molecule that stimulates the formation of the hormone active Vitamin D3. Plant sources of this prohormone are called Vitamin D2, which is perhaps equally as effective in stimulation of the formation of active Vitamin D2 hormone. All of the conversions of the 5 types of Vitamin D prohormone to active D hormone are dependant upon parathyroid hormone, and hormonal balance, as well as phosphate levels and circulating calcium ions. Problems with protein metabolism and body acidity may also affect these regulating cofactors indirectly. This is the holistic catch to calcium metabolism. No matter what form or dosage of Vitamin D, or what form or dosage of Calcium that you take, unless there is a hormonal balance, healthy metabolism, and regulation of acidity, there will be dysfunction and deficiency of calcium. Since calcium is the chief neutralizer of body acidity, an unhealthy chronic cycle may occur.
When modern medicine attempted to supplement this Vitamin D3 hormone directly, we found that serious health problems occurred because it was difficult to prevent overactivity by this increase in activated Vitamin D3 hormone. This course of therapy was discontinued, which shows the need to restore healthy natural hormonal balance in the body. Today, we use a type of cholecalciferol that is absorbed easily, preferably a liquid form, and generally start at a 5000 IU dose daily. By also restoring endocrine, thyroid and kidney health we are able to better utilize this supplement.
Science has understood for many years that there are at least 5 types of prohormone, or hormone precursor, called Vitamin D. All 5 of these Vitamin D forms can be utilized by the body to create the two forms of hormone D3, 1,25-Dihydroxycholecalciferol and 24,25-Dihydroxycholecalciferol, in your kidneys. They have also known that that there are at least 20 metabolites of these 5 Vitamin D prohormones that do not convert to D3 hormone, but play various roles to keep our body healthy. Recently, research has uncovered the fact that the various forms of Vitamin D play important roles in most cellular processes in the body, making it one of the most important regulatory cofactors in the human body. Serious cardiovascular pathologies have now also been linked to Vitamin D deficiency. Unfortunately, there is tight regulation of this group of vitamins, and high dosage of a particular type of Vitamin D may contribute to poor regulation in the body. Nature has provided us with a large variety of sources of the various Vitamin D molecules, including many dietary sources, metabolic sources, and even production of the vitamins by the healthy flora and fauna in our intestines, the Biome. We also have a complex metabolism to insure that the various metabolites of Vitamin D are produced in relation to need. To really achieve success, we need to make this whole system work. A more holistic approach is needed.
Most of the hormone D3 that is created, or activated, in a healthy kidney metabolism is derived from 7-dehydrocholesterol in the epidermis of the skin, when the skin is exposed to direct sunlight of a narrow wavelength of UVB 270-300 nanometers for approximately 10-15 minutes. This creates cholecalciferol, or Vitamin D3. Sufficient supply should result if you expose your face, neck, hands and arms outside to direct sunlight at midday 2-3 times per week. The same prohormone Vitamin D3 cholecalciferol can be added to your system by taking a pill. The question is whether the oral intake of cholecalciferol is being absorbed. Studies that show that Vitamin D intake in a select population does not produce the desired results, and like our calcium deficiencies, reflects the fact that our Vitamin D metabolism is not so simple as just filling up the tank. Vitamin D2, the prohormone derived from plant sources, can also be taken orally, and is called ergocalciferol, although some studies have indicated that it is much less effective than D3 cholecalciferol in preventing osteoporotic bone fractures.
The regulation of calcium metabolism and the rate of conversion of Vitamin D prohormones of activated Vitamin D hormone in the kidney is so important to our health that our bodies have 7 additional metabolic factors in addition to parathyroid hormone that control the D3 hormonal conversion. These are endocrine modulators, estrogens, calcitonin from our thyroids, growth hormone and prolactin from our pituitary gland, insulin, and cortisol. The variety of health problems that could effect D3 hormonal conversion and calcium metabolism are thus numerous, including endocrine imbalance, emotional stress affecting the hypothalamus, subclinical thyroid and parathyroid dysfunction, hormonal imbalance in the menstrual cycle, insulin resistance in diabetes or metabolic syndrome, and adrenal stress syndromes. Various medications, especially synthetic hormones, could have a significant effect on this D3 hormone metabolism. When there is a calcium problem in the body, it is best to just admit that you need to work to achieve better overall health, and to do this, you need to see a Complementary Medicine physician with knowledge of this physiology, and take a comprehensive holistic approach.
The different types of calcium supplement; pros and cons
To repeat, there is no actual nutritional deficiency of calcium, only a problem with the regulation of calcium metabolism in the body. Calcium supplements may be of very limited benefit, and calcium is found in a wide variety of foods, which generally give a more bioavailable calcium. Nevertheless, some patients may still benefit from calcium supplements.
A large variety of scientific studies are conducted to determine the benefits of one type of calcium supplement over another. Many of them report contradictory findings. Study design, differenced in the health profiles of participants, and means of measurement account for much of this manipulation. Since measurement of actual calcium bone deposition is problematic, much study data relies on animal studies, which may not reflect human physiolgoy exactly. Different types and conjugations of calcium supplement do have different profiles for reaching targeted tissues or bone deposition. Here again, there seems to be no simple answer to the question of which type to take. Below are some helpful pieces of the puzzle.
Calcium carbonate contains the highest percentage of elemental calcium, up to 40%, depending on quality. Calcium citrate contains about 21%, calcium gluconate 9.3%, and calcium lactate 13%. On the surface, this would seem to imply that calcium carbonate and citrate were the best forms, but this is misleading. Studies have shown that despite the percentage of calcium, nearly the same amount is absorbed for each type, implying again that other factors determine bioavailability. Numerous studies have shown that organic salts, such as gluconate and lactate, provide much better bioavailability than inorganic salts such as carbonate or phosphate, though. Solubility of the form into ionized calcium is also considered when addressing bioavailability. Labels are sometimes misleading, implying that there is 1000mg of calcium, when actually there is 1000mg of the conjugation, with as little as 10% being actual calcium.
The different types of calcium conjugations allow for the calcium to be broken down in different ways. These molecules may be dissolved in water, broken down by stomach acids, or carried in a conjugated state by calcium-binding protein, which is created in accord with levels of a hormone activated from Vitamin D prohormone. The different forms have various bioavailability profiles, but actual absorption is still completely dependant on the D hormone. If the stomach acids are not healthy, increased water solubility may help bioavailabilty. Flora in the lower gut that favors acid states, such as acidophilus, may increase absorption here.
Calcium lactate can be absorbed at a wider variety of pH, or acid-base, states, and is better absorbed because of this. This salt is used in baking powder, found in aged cheeses, and antacids. Products that contain calcium lactate derived from natural fermentation are purportedly even easier to assimilate.
Calcium gluconate-lactate is often recommended for deficient calcium states. despite the fact that you have to take a large number of pills to provide 1000 milligrams of elemental calcium, commonly 10-20 per day.
Studies have found that calcium absorption and bone deposition from drinking mineral waters with high calcium content was excellent. This is a healthy dietary source of calcium, and the natural array of minerals helps increase the bioavailability of calcium.
Many multimineral and multivitamin products use D1-calcium-phosphate in their products. This type of calcium is insoluble and interferes with the absorption of the nutrients in the multi-nutrient product.
Calcium formate is a relatively new form or calcium salt created to provide increased bioavailability. Studies show that calcium formate is superior to calcium citrate nd carbonate in delivery of calcium to the bloodstream and depression of serum parathyroid hormone. Calcium formate also has a lower molecular weight, high percentage of calcium content, and high water solubility at neutral pH.
Coral calcium is a type of chelated natural calcium that is balanced in nature with a number of other minerals for improved bioavailability. Small studies have shown that is appears to absorb a little better than calcium carbonate supplement, and has a greater effect on neutralizing endemic acidity. It is more expensive and widespread use may add to damage of the coral reefs, though. Nevertheless, coral calcium has some advantages. It easily becomes ionic in water, called solubility, and hence, may benefit tissue problems and cellular metabolism better, and may be more bioavailable for people with poor stomach function. Some studies claim that other health advantages are linked to calcium aspartate found in the coral calcium.
Calcium aspartate has been effectively utilized to reduce muscle spasm and aid the contractile physiology in chronic myofascial pain syndrome. Aspartate is a form of aspartic acid, that is utilized in neuromuscular tissues to produce ATP and energy. Aspartate is also part of key ion channel receptors in the nervous system, such as N-methyl-D-aspartate, or NMDA, receptors. These receptors linked to neural synapse strength, neuron survival, and neuron protection. Calicum ion activates these receptors, and calcium aspartate, if utilized by our tissues properly, could both supply ionized calcium and components beneficial to the muscles and nerve cells. Asparate may also be more bioavailable in the lower gut with health flora and fauna, which break down aspartate easily into various components, and is an acidic amino acid, also accounting for increased calcium bioavailability.
How to best utilize calcium supplements and maximize the absorption and utilization
After addressing the systemic issues, such as hormone Vitamin D deficiency, hormonal imbalance, liver function, and the array of issue mentioned above, the taking of calcium supplements will work best if you observe a few rules of physiology. Calcium supplements should be taken with calcium rich foods, and foods that are rich in magnesium, chlorophyll, and other minerals. Paul Pritchford, the famed nutrient expert, recommends taking the supplements in smaller doses spread through the meals, and eaten with whole grains, legumes, leafy greens and seaweeds, all high sources of calcium and magnesium. The exception would be foods containing oxalic acid, such as chard, kale, rhubarb, cranberries, plums, almonds and cashews. If the oxalic acid binds to the calcium, it forms an insoluble salt that cannot be absorbed, and may be excreted in the urine, contributing to kidney stone formation. Excess zinc can easily interfere with calcium absorption, so taking calcium supplements with other drugstore products containing zinc should be avoided. Taking calcium with iron reduces the effect of both minerals, and this concurrent intake of iron supplement with calcium supplement should be avoided.
Paul Pritchford also recommends taking the calcium supplements with plenty of green vegetables (except oxalate-rich kale, chard and spinach), and take them with a mineral rich product, like alfalfa or barleygrass supplements, or kelp powder. Red clover is also mineral rich, and has been shown to be an effective aid in treatment of menopausal and postmenopausal syndromes. If the calcium supplement contains smaller amounts of magnesium, selenium, manganese, and iodine, this may also improve absorption, and a number of studies have indicated that magnesium deficiency in the body is associated with poor calcium absorption as well. Silicon-rich foods may also benefit the calcium deficiency. These include whole cucumbers with the peel, celery, strawberries, parsnips, dandelion greens, steel cut oats, millet, buckwheat, and brown rice. A leafy green that is recommended with calcium supplements is chard, a highly nutritious green.
Recent research has sought other products that may increase intestinal calcium absorption. Inulin and oligofructose combined resulted in an 18% increase in true fractional calcium absorption in studies, and both significantly benefit restoration of the intestinal biota and increase magnesium absorption as well. Inulins are a group of nutritious polysaccharides, in the class of dietary fibers known as fructans, and chicories, such as radicchio and endive, are rich sources, as well as chicory root. In addition, dandelion leaf, garlic, onion, shallot, artichoke, jicama, burdock, banana and agave are dietary sources of inulins and oligofructose. The herbs mugwort (Artemisia vulgaris / Ai ye), wild yam (Dioscorea / Fu ling), Arnica montana, and elecampane (Inula helenium / Xuan fu hua) are also rich sources of inulins. Unfortunately, inulin variants are now widely used in processed foods to achieve synthesized tastes, perhaps creating problems. Both the chemistry of inulins and oligofructose polymers have been used to create synthetic chemicals and tastes in processed foods. The most beneficial chemicals in inulins are the bitter chemicals, though, including aesculin, aesculitin, coumarin, sequiterpene glycosides, and the lactones lactucin and lactucopicin, and synthesized variants in processed foods eliminate these bitter tasting chemicals. Oligofructose is available in supplements, and often combined with standard probiotic bacteria to improve Biome restoration, but are also found in agave syrup, chicories, asparagus, jicama, leeks, onions and bananas, as well as barley and artichoke. Including these foods in your diet, taking probiotic supplement formulas with oligofructose added, and taking these herbs to aid digestive health will do much to improve calcium homeostasis.
Reducing bone loss when there are problems with hormonal deficiency or other causes of calcium deficiency has also been a subject of scientific study. Researchers at the University of California San Francisco found that controlling acid states with potassium bicarbonate improves calcium and phosphorous balance, reduces bone resorption, and increases the rate of bone formation. Natural potassium carbonate extract has long been used to reduce stomach acidity when needed, but is little used today, as aluminum sulfate in antacids became popular, and more intense potassium medicines were used in standard medicine that came with some cardiac risk, discouraging use of natural potassium antacid extracts for no reason. Adopting a diet that is less acidic, or acid-forming, and correcting gastrointestinal dysfunction with healthy restoration, is perhaps important in restoration of calcium metabolism. In addition, taking the correct calcium supplement to improve deposition into the bone storage is important, and supplemental calcium hydroxyapatite is the form of calcium that is stored in bone, and proven to more easily go to bone storage when taking a supplement.
Here is a step-by-step logical guide to correcting these health problems related to poor calcium homeostasis:
Clearly define your symptoms
Symptoms are not something we like to think about, especially when they are chronic. You need to overcome this aversion and clearly define, in writing, what are your symptoms, so that the exact cause of these symptoms can be discovered and treated. Treatment of symptoms is the first step in your recovery, but is not the most important step. To insure sustained benefit, actual reversal of damage to the physiological function in your body must be achieved, and this is not always evident by looking at the symptoms. If you stop your recovery when your symptoms subside, you are not achieving your goals. As you can see by reading the article above, a number of aspects of your health need to be addressed with calcium deficiency, and some of these are subclinical states, meaning that they may not produce significant symptoms. Objective analysis with simple tests that measure active hormonal metabolites and cofactors, and comparison to your symptoms and health profile is very helpful.
Let a Complementary Medicine physician, such as a Licensed Acupuncturist or Naturopathic Doctor, clearly analyze and explain your health profile, so that a successful long-term strategy can be devised to regain a healthy calcium metabolism
When you utilize a professional to guide your return to healthy endocrine function and calcium regulation, you are assured that this gradual return to optimal health is proceeding properly despite the complexities. In the long run, you will find that the quality of life is also improving, as these various aspects of your health are improved. Other health problems that we worry about with aging are also prevented. The time to stop pretending that simply taking a commercial calcium pill will reverse this complex problem is now.
Understand how the drugs you take, or other therapies, work
Sometimes, medication can solve one health problem but cause other significant health problems. A number of medications may affect your endocrine health or liver function, and a larger number may have a detrimental effect on the gastrointestinal health with chronic use. When you know the mechanism of damage, reversal of this damage can be achieved in your therapy. For instance, if you took Interferon, you will note that this drug works by genetically inhibiting protein expression, especially in the liver. After the therapy, liver function and protein expression needs to be enhanced again. Certain nutrient supplements greatly aid this process, such as B vitamins, and these supplements should be combined with foods containing them to insure greatest utilization. A variety of supplements can target certain metabolic problems. Herbal strategies can be used to improve liver function, and utilization of a knowledgeable herbalist can solve many problems. Acupuncture stimulation will be very effective to encourage improved physiological function and will work to increase the effectiveness of the supplements and herbal formulas. Discuss this process with your physician.
Help your body to help itself
The body has a natural mechanism to repair damage, called the immune system. This complex system can be made to work better by both utilizing specific herbs, supplements and acupuncture, and also by decreasing physiological stress and improving general health. Your body has certain limitations or tolerances for stress. When these limitations are exceeded, your immune system will not work effectively. Stress is defined as the physiological needs in the body, not just work deadlines and emotional situations at home. Each individual has a certain capacity for stress. The less healthy you are, the less stress tolerance that you have. To decrease stress and improve your physiological tolerances, you need to decrease work, emotional aggravation, and exposure to harmful chemicals. To improve tolerances, you need to increase therapies, healthy diet, healthy exercise, sunlight, fresh air, and restful periods. You may need to discuss a temporary reduction in the amount of medication that you consume with the prescribing M.D.. When you do all of these things positive results will happen. When you fail to do these things, you will perpetuate your problem. Changes in your lifestyle are difficult, but not as difficult as the changes to your lifestyle that will be forced on you if you don't temporarily deal with restoration of your health.
I hope this short guide to therapy is helpful to you in organizing your physical recovery. You need to work with your physician to insure that this process works as well as you want it to, and stick to a guided therapeutic course till you achieve your goals. Don't let worry consume you and prevent positive action. You also need to address the mental problems that often accompany these harsh therapies, such as depression and anxiety. I hope that I can be your guide to a full recovery.
Information Resources and Links to Scientific Studies
- The Women's Health Initiative reported in 2006 that synthetic hormone replacement with progestins and estradiol showed a mild decrease in risk of osteoporotic bone fractures, but that the increased risk of breast cancer, ovarian cancer, heart attack, stroke, thromboses, Alzheimer's, and other dementias was significantly increased, thereby making this treatment strategy recommened only as a last resort: http://www.aolhealth.com/drugs/hormone-replacement-therapy-for-osteoporosis
- Study findings regarding the rate of osteoporotic bone loss from DepoProvera, a progestin, or progesterone derivative synthetic hormone contraceptive: http://www.nichd.nih.gov/news/releases/bone_loss.cfm
- Fosomax and other biphosphonate drugs used to treat osteoporotic bone loss now come with stern FDA warnings concerning risk of bone necrosis: http://www.adrugrecall.com/fosamax/fosamax.html
- 2008 FDA warnings concerning Fosamax, Actonel, Boniva, Zometa, and other biphosphonate drugs to treat osteoporotic bone loss were added to existing warnings. These new warnings concerned a high incidence of severe and sometime incapacitating pain resulting from use: http://www.fda.gov/cder/drug/infopage/bisphosphonates/default.htm
- U.S. clinical trials concluded in 2006 that even among relatively health postmenopausal women, that calcium and vitamin D supplementation had only a small improvement in hip bone density, did not significantly reduce hip fracture, and increased risk of kidney stones: http://content.nejm.org/cgi/content/abstract/354/7/669
- Many studies, such as this landmark 1980 study, have showed that magnesium deficiency may alter the parathyroid hormone regulation of calcium and bone calcium homeostasis, and that magnesium deficiency is now common in the population of industrialized countries. A supplemental magnesium potassium could restore magnesium deficiency and help restore calcium homeostasis and parathyroid function: http://www.ncbi.nlm.nih.gov/pubmed/6781728
- A 2010 multi-center study of calcium and Vitamin D supplementation and its effect on cardiovascular health in post-menopausal women, at Harvard Medical School, the University of California San Diego, the University of Iowa and other medical institutions, found that standard calcium and Vitamin D supplements did not appear to alter coronary artery calcification or coronary heart disease. The problem with calcified arterial plaque, thrombi and atherosclerosis appears to be related to inflammatory mechanisms and membrane health affected by advanced glycation endproducts (AGEs), not dietary cholesterol or calcium: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2940244/
- A 2015 multicenter study of excess calcium supplementation as a cause of tissue pathology, at the University of California San Francisco, Stanford University in California, and the University of Michigan, U.S.A. found that excessive calcium supplement intake was highly associated with age-related macular degeneration, a growing problem of vision loss in the United States. The study showed that a threshold response rather than a dosage relation was involved, showing that individuals with poor calcium homeostasis, or ability to properly utilize and store the large electrically charged (ionic polar) molecules of calcium, were affected by accumulation of calcium ions in the tissues. Intelligent use of specific types of calcium supplement, and an individualized approach, as well as the obtaining of calcium in the daily diet as mineral maintenance, are thus important: http://archopht.jamanetwork.com/article.aspx?articleid=2212257
- A 2004 report from experts at the University of Cincinnati, and the Cincinnati Children's Hospital Medical Center noted that CoQ10 supplement exerts a significant benefit as adjunct treatment for neurological and muscular diseases via the effect on improved calcium homeostasis, with an excellent safety profile: http://www.ncbi.nlm.nih.gov/pubmed/15298157
- Calcium content in foods is listed on the UCSF Medical Center website: http://www.ucsfhealth.org/adult/edu/calciumContent/index.html
- Wikepedia has a reliable complete explanation of Vitamin D metabolism: http://en.wikipedia.org/wiki/Vitamin_D
- The National Institutes of Health reported findings of Vitamin D deficiency in a large percentage of our population in 2005: http://www.ncbi.nlm.nih.gov/pubmed/16315387
- The Linus Pauling Institute at Oregon State University provides a complete informational article on Vitamin D supplementation and information on which drugs may inhibit Vitamin D metabolism: http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/
- A study at the University of California San Francisco Clinical Research Center found that controlling acidic states with potassium bicarbonate improved calcium phosphorus balance, reduced bone resorption, and increased the rate of bone formation: http://content.nejm.org/cgi/content/abstract/330/25/1776?ijkey=a72aa7b9ae4bcb662db571778f11cc912870d579&keytype2=tf_ipsecsha
- Calcium bioavailability from calcium rich mineral water was found to be excellent: http://www.ajcn.org/cgi/content/abstract/62/6/1239?ijkey=d4a1265bdabf56b011eed6838c3fad6394776f27&keytype2=tf_ipsecsha.html
- A 1996 clinical study at the Red Cross Hospital of Athens, Greece, noted that monotherapy with CoQ10 supplement alleviated calcium depletion in 2 patients with hypoparathyroidism. These experts believed that CoQ10 increased the capacity of the cell mitochondria to produce an active form of the hormone Vitamin D3: http://www.ncbi.nlm.nih.gov/pubmed/8845718
- A 2014 multi-center study of potential problems with higher dosage calcium supplements, by the Geisel School of Medicine at Dartmouth, the University of North Carolina, the University of Iowa, Emory University, and the University of Texas, all in the U.S.A., found that patients treated with 1200 mg calcium carbonate and Vitamin D3 experienced a rise in serum creatinine concentration in the first year that could have a deleterious effect on patients with kidney disease, high alcohol intake or cardiovascular disease. Such study demonstrates the need to individually analyze patients when prescribing calcium supplements: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198086/