Calcium Dance (Protocols)

PRECAUTION: WORK WITH AND COMMUNICATE TO YOUR MEDICAL DOCTOR BEFORE MAKING ANY CHANGES. THE INFORMATION HERE IS FOR NUTRITIONAL Maintenance AND NOT DISEASE TREATMENT.

CAUTION: Do not consume large amounts over 750 mg of calcium supplements (unless under Medical supervision) without first knowing your dietary calcium intake level, and second, your vitamin K status, with attention to K2.  ref ref Vitamins K2 as MK4 and especially as MK7 are protective against calcium going into arteries leading to Cardiovascular damage. ref

Don't forget about magnesium levels that may be as imprtant as calcium amounts for proper calcium placement and functions.

For a Lifetime of Strong Bones

UPDATE: To benefit immediately from new research, limit calcium supplementation to no more than 600mg unless you know your dietary intake amount. The safest total amount with diet and supplement sources added together is between 600 mg to 1000 mg per day. Dietary daily calcium load is usually between 300 to 800 milligrams. Many foods are fortified with extra calcium, like orange juice and cereals, so supplemental calcium at 600mg may actually be a little high for some. To be fair, here is another study around the same time that arrived at what appears to be an opposite heading, that higher calcium is protective. BUT, look at the dosages for the higher and the truth is revealed (lower <458 mg/d for men, <417 mg/d for women versus the highest quartile of dietary calcium intake (>762 mg/d for men, >688 mg/d for women). ref   Here is another study showing longer term benefits against osteoporosis but not for 3 year fracture prevention. ref  (Note that the long term benefits were assumed and not a verified fact using just the measurement of increased bone density at 3 years.)

...YOU HAVE TO KNOW HOW MUCH DIETARY CALCIUM YOU CONSUME DAILY BEFORE YOU ADD CALCIUM SUPPLEMENTS. 1000-1200 mg minus dietary or food calcium intake determines how much or if you should supplement. ref If daily calcium intake is low, supplements may be necessary. BUT, if consumption is already high, little if any extra calcium supplementation is needed. The concept of supplement calcium load spike is involved here. Therefore, it is wise to take any supplemental calcium in small divided dosages. And never without sufficient vitamin D and vitamin K2, with MK7 preferred over MK4. Elimination of calcium in urine is a factor to acknowledge, but it varies with many different factors. It is a guide not a steady data point. Dietary calcium intake influences amounts and they vary from about 20-250 mg. with over 250 representing excess calcium elimination. Highest ever recorded was 741 mg. but this is rare. The urinary calcium level can be used to determine bone turnover rate. It is often elevated in osteoporosis and renal stone situations. ref ref

From the Harvard Medical School newsletter:

Calcium helps make strong bones, and vitamin D aids calcium absorption. Take a daily vitamin D3 supplement (D3 is the form most easily absorbed) between 600 to 1,000 IU, depending on your blood levels of vitamin D. For calcium, some evidence indicates that large doses of calcium pills may increase the risk of death from heart disease. (ref) So as much as possible, get calcium from food—dairy products*, leafy dark green vegetables, tofu, and sardines. The Recommended Dietary Allowance (RDA) of calcium for men ages 51 or older is 1,000 to 1,200 milligrams (mg) per day. For women ages 51 or older, it's 1,200 mg per day. ****If your diet doesn't provide enough calcium, take a low-dose calcium supplement to reach your RDA, but not exceed it.**** ref

*Dairy products do not contain enough magnesium to balance calcium in body. Be sure to supplement with some magnesium or add foods rich in magnesium. 

REMEMBER: Add food calcium amount together with supplement amount to get to 1,000 or 1,200 milligrams per day. DO NOT SUPPLEMENT 1000 MG. ref The diet has between 300-700 mg. One serving of dairy usually has 300 mg.

Somehow, over a period of time, simple logic (and Science) lost out to marketing rhetoric in telling the bone health calcium story. At fault, science is not even following it's own scientific protocols in examining theories for credibility. The Calcium dance may be one of the most complex nutritional issues of our time. (Extreme view with merit under medical supervision- ref) More is not always better. ref  cautions> ref  Excellent general Calcium info from Harvard Medical> ref  Bone info, ref       

Calcium is vital to health.    

What you think are calcium facts are really marketing stories not entirely based on science, or at least not the whole picture but just small segments. Unless you have an understanding of the principles involved and correctly apply them, you are doomed to suffer mis-steps in the CALCIUM dance. Bones are just the tip of the iceberg for calcium actions, and while difficult to believe, calcium is not even among the top few recommendations from science for healthy strong bones. ref ref  Does the cow look out of place in the jungle? Or is this a cow feeding paradise?

Here is a key bone basic from the US Surgeon General's report ref : "The bony skeleton is a remarkable organ that serves both a structural function, providing mobility, support, and protection for the body, and a reservoir function, as the storehouse for essential minerals."

The articles in this section illuminate some of the many factors about healthy bones:

• Calcium Driver > Blood levels, not bone density levels
• Kidney Mineral Balance
• Vitamin D and D gene polymorphisms
• Hormone Function - Parathyroid, Thyroid, Estrogen
• Rank, RANKL, OPG system of bone cell development and control
• Body Movement - Stress Torque on Bones
• Dietary Factors, especially Vegetables and Fruits
• Effects of chronic calcium supplement spikes in blood levels
• On minerals, potassium appears to play significant role for bone health in postmenopausal women. ref

From Harvard Medical website the following is copied due to it's importance:

In particular, these studies suggest that high calcium intake doesn’t actually appear to lower a person’s risk for osteoporosis. For example, in the large Harvard studies of male health professionals and female nurses, individuals who drank one glass of milk (or less) per week were at no greater risk of breaking a hip or forearm than were those who drank two or more glasses per week. (2, 3) When researchers combined the data from the Harvard studies with other large prospective studies, they still found no association between calcium intake and fracture risk. (4) Also, the combined results of randomized trials that compared calcium supplements with a placebo showed that calcium supplements did not protect against fractures of the hip or other bones. Moreover, there was some suggestion that calcium supplements taken without vitamin D might even increase the risk of hip fractures. A 2014 study also showed that higher milk consumption during teenage years was not associated with a lower risk of hip fracture in older adults. (27)

Here are study results mentioned above for milk drinkers exhibiting more hip fractures when 3 or more glasses consumed per day. Three glasses of milk could supply over 900 mg of calcium. But not nearly enough magnesium. Questions about study are also mentioned. Direction but not absolutes.

Copied next is a report from Italy, thus might not be completely USA similar, that shows supplemental calcium load has to be added to dietary amounts to get to 1000 - 1200 mg per day.

J Int Med Res. 1999 Jan-Feb;27(1):1-14.

Dietary calcium and mineral/vitamin supplementation: a controversial problem.

Celotti F1, Bignamini A.

Abstract

There is a consensus that adequate calcium intake during bone development, and possibly in adulthood and senescence, helps to prevent bone resorption and osteoporosis. The uptake of dietary calcium should be sufficient to maintain both normal serum calcium concentrations and parathyroid hormone levels in the low normal range throughout the day, otherwise, increased bone resorption occurs. Calcium intake varies with race and with environmental and dietary conditions. Estimating the appropriate amount of calcium to be added to dietary sources for an optimal supplementation regimen is therefore difficult. Few intervention studies have evaluated the dose-effect relationship for calcium supplementation conclusively. The mechanisms regulating fractional calcium absorption as a function of intake suggest that very high daily doses are probably useless. They may be unsafe in the long term because of the risks of hypercalciuria and kidney stones, and of an imbalance in the ratio of calcium to magnesium. Concomitant supplementation with limited amounts of magnesium may reduce this risk and improve mineralization. Dietary intake is 500-600 mg/day in most studies, making 400 mg/day an appropriate supplementary dose for most premenopausal women (RDA 1000 mg/day). After the menopause and during lactation (RDA 1200-1500 mg/day), 800 mg/day is probably appropriate, particularly if low doses of vitamin D are taken concomitantly.             PMID:10417956

Calcium: Too Much or Too Little

Supplements have a major flaw. This flaw is also found unfortunately in some nutritional information. It concerns how much of a particular nutrient is needed to be consumed daily. Let's look at calcium to discover how this flaw might have developed. Scientists measured the amount of calcium people excrete out each day in Developed Countries. This usually is an average about 350 mg, but many mechanisms influence this number. This number includes some calcium that was previously re-absorbed back into the body, so it is not all from the calcium consumed that day. This amount could be up to 250mg, so the needed daily dietary amount could be reduced. Since calcium absorption can vary from 10-50%, the average is about 33% making the daily requirement 3.3 X 300-400, or 1000 to 1200 mg. This also includes an amount for an extra margin of safety. Plus, the Professionals look at how much is in the body and what is happening to bones. But, there is more to the story that just elimination or bone density, especially since the body recycles calcium. Read this reference for complete information.

Thus, the question that has to be answered is this: How do people maintain bone strength in Countries where only 300 - 500 mg of calcium is consumed daily? And the people have stronger bones with less fractures than here in America.

It is not only how much the typical diet contains of calcium, but what happens in the body to either hold and recycle or eliminate calcium. And, there are other nutrients or conditions that interact to change these recycled or eliminated amounts. And whether or not the body needs calcium at that moment as determined by blood levels. With calcium, the body has very elaborate processes to recycle, store, assimilate or eliminate calcium to control this blood level at just the required level. The true driver of calcium behavior, absorption, and elimination is blood levels not bone density. Hormones are very involved here. Primarily estrogen which may explain why women need slightly more calcium than men. Some people have strong bones on little calcium intake while others have weak bones consuming lots of calcium. ref Thus, just looking at calcium alone is not enough. Or just adding extra calcium does not always result in stronger bones, even though bone density is increased. And this is also why using averages does not work for all people.

Concentration Concerns

Some Supplements are too concentrated for the body to process in a normal matter without impacting other nutrients. In plant foods, minerals are found with fibers that limit the absorption rate. In foods like milk, Calcium is readily absorbed with only fats and proteins to slow absorption. ref Calcium carbonate supplement has the highest percentage of calcium making it the obvious choice of many consumers who dislike taking so many pills. But, consuming a high dose of calcium at one time not only decreases the absorption percent, it can spike calcium blood (plasma) levels with resulting possible adverse consequences as copied below from reference:** ref   

"Sodium ion channels in the cell membranes of nerves and muscle are particularly sensitive to the calcium ion concentration in the plasma.^[4] Relatively small decreases in the plasma ionized calcium levels (hypocalcemia) cause these channels to leak sodium into the nerve cells or axons, making them hyper-excitable (positive bathmotropic effect), thus causing spontaneous muscle spasms (tetany) and paraesthesia (the sensation of "pins and needles") of the extremities and round the mouth.^[5] **When the plasma ionized calcium rises above normal (hypercalcemia) more calcium is bound to these sodium channels having a negative bathmotropic effect on them, causing lethargy, muscle weakness, anorexia, constipation and labile emotions.^[5]"

WHAT IS NEEDED IS AN OPTIMAL CONSUMPTION AMOUNT OF CALCIUM WITHOUT GOING TOO LOW OR TOO HIGH OVER THE LONG TERM. On cardio- ref  A variety between High and Low calcium intake days is really OK and actually beneficial if balance points are maintained long term. The long term approach in the U.S. has been to error daily on the side of consuming extra calcium which now according to ongoing longer term research studies may NOT ALWAYS BE HEALTHY for bones, heart, or prostate and some other related issues. To continue enriching so many foods with calcium and taking extra in supplements is .....perhaps not wise unless the total picture is known.

CALCIUM IONS ?

If you noticed in the above copy, the effects were related to levels of calcium IONS in blood plasma and not just overall calcium amounts. Some calcium is bound to proteins and some calcium exists as free ions. There is a difference to the body. It is the amount of calcium ions that trigger body actions to balance blood calcium. ref

From last reference- "PTH increased by 400% within 10 minutes in response to decreased ionized calcium"

How does the body regulate the balance between the two forms? Besides albumin protein binding levels, turns out the pH or chemistry of the blood also influences ion amounts. Lower blood pH, indicating higher acids, increases calcium ions, probably by changing protein binding attraction. Maybe there is more to the pH story and what you eat does make a difference.  ref  Calcium ions have a normal level that is almost half the total blood calcium amount. The very elaborate body process mentioned above involves: Parathyroid gland PTH hormone, Kidneys, Liver, Bone storage or release of calcium, pH regulation, thyroid gland, and the intestinal tract, all to help maintain this critical calcium ion balance.  

Men Only

Of special interest is that in men, high normal range blood calcium ions (ionized calcium) levels are associated with increased risk for prostate problems. Here are some factors to consider from a dietary perspective. 1. Increase fluid intake, mainly water or non sugar drinks, but not sugar-free sodas. Dehydration increases calcium concentration in blood. Your Kidneys function to control calcium levels. 2. Limit vitamin D intake. 3. Limit calcium containing foods, I.e. dairy, and calcium supplements. Dairy also increases phosphates just like some Colas. 4. Be physically active. And 4. Visit your MD to monitor functions of the above mentioned organs, glands, and hormones. ref

Women Only Mostly

Women may need slightly more calcium. Since the daily requirement for calcium is 1000 to 1200 mg, first one has to consider how much the diet contains and then add in supplements to get up to 1000 or 1200. Average American diets supply 648-968 mg of calcium. Yes some people consume less. Each serving of dairy adds 300 mg, so dairy consumers may only need to supplement magnesium to help balance food calcium back to 1.5 -2 to 1 balance over magnesium. ref This means calcium supplements only up to 600 mg are on average needed. Plus, as you explore the many articles on this website, there are many misconceptions about the role and amount of calcium and/or vitamin D play in bone health. They are just two of many factors to consider. Read these articles article and article.

VITAMIN D & K on Calcium

Problems develop when supplements of just calcium are consumed without supporting bone building and calcium requlatoring cast members. Vitamin D directs the production of osteocalcin which when activated by vitamin K2 binds calcium into bone crystals. Vitamin D also regulates calcium assimilation, plus it also participates in immune system activities through the direction of CD44.

NOTE: Vitamin D and osteocalcin levels are often not directly related since many other conditions like inflammation or other nutrient levels like magnesium can also influence.

Vitamin K2 also acts on a protein, Matrix GLA, in the arteries that prevents calcium binding into the artery wall. ref Both vitamin D and vitamin K have been decreasing in the diet and through limiting sun exposure since1950's. 

FYI: These same nutrients also participate in regulating blood sugar levels adding to their benefits as well as importance of ratios and balance to maintain one function without jeopardizing another. 

Clarification of MEAT ON CALCIUM LOSS

Many early studies found that when people consume meat, there is more calcium eliminated in urine. The thought process behind this observation was that meat generated acid in the body and the body responded by removing calcium from bones to neutralize this meat generated acid. This would weaken bones over time. The body wants to use potassium from vegetables and fruits to neutralize acid, so the Scientists next added a potassium salt with the meat diet to attempt to save calcium. But, still calcium was found in urine. It turns out the calcium increase in the urine did not come from bone, but was from the meal with the meat. 

The next question to solve, what was neutralizing the extra meat acid if not calcium from bone, especially in people who did not consume many vegetables and fruits? It may be elements coming from muscle loss supplied the acid buffers. This changes quite a lot of past theories. One important aspect, it reveals why Americans may need higher calcium intake than in other Countries where less meat is consumed. Meat increases calcium absorption percent but also increases amount lost in urine.

This explains many controversial study results from the past. But, still shows higher vegetable and fruit intake or an alkaline diet still has value. Like maintaining muscle mass and bone integrity during the growing old process.

CRITICAL ASPECT FOR CALCIUM

Calcium does not function in a vacuum. There are some very important connections between minerals ratios that significantly influence the behavior of calcium. Magnesium is first major mineral that has a vital role to play with calcium. Magnesium opens cell doors so calcium can come in. Magnesium also needs to be present for active vitamin D generation. Vitamin D then can work with vitamin K2 to bind calcium and other mineals, phosphorus, magnesium, potassium, boron, silicon, copper and zinc into healthy bones. Generally, there is far too much calcium in the American diet compared to magnesium. ref This creates many potential adverse reactions. Studies show stronger bones with just the addition of magnesium to balance the ratio with the already present calcium. 

The ideal supplement ratio of CA/MG might be about 1.5 to 1.  300 mg calcium to 200 mg magnesium. When dietary calcium magnesium ratio is factored in, probably around 2.5 to 1 or higher, the total ratio would fall between 1.7/1 up to 2.6/1. Over 3.5/1 becomes difficult for the body to adapt and function.

Cow's milk has a ratio of 9/1. Here is a simple explanation of the importance of the CA/MG ratio.