RDA of Calcium

Idea of milk Equivalent

 One milk Equivalent gives Roughly about 33% of %DV of Calcium
 One milk Equivalent equals
 Cup of Milk 240 ml
 Cup of yogurt 180 gram
 Cup of Buttermilk 240 ml
 About 100 gram Cottage cheese
 About 50 gram Haloumi Cheese
 About 70 gram white cheese
 About 50 gram Yellow Cheese
 Cup of Spinach
 About 3 to 4 table spoons of Sesame seeds
 Calcium Homeostasis

Factors increasing Factors increasing

calcium absorption calcium renal excretion in
urine

Factors decreasing
Factors decreasing calcium renal excretion
calcium absorption in urine
 Factors increasing calcium absorption
 Adequate body vitamin d status
 Normal HCL secretion of stomach
 Infants, children, adolescents, and women during pregnancy and lactation exhibit
greater calcium absorption than other age groups.
 Protein intake enhances calcium absorption
 Ingesting food along with the calcium source
 The presence of lactose along with calcium
 Vitamin C
 Diets that are low in calcium (<400 mg) lead to enhanced calcium absorption

Advanced Nutrition and Human Metabolism – 7th Ed.

 Factors decreasing calcium absorption
 diminished gastric acid production (as with medications like proton pump
inhibitors for the treatment of GERD or peptic ulcers
 With aging (and with lower levels of estrogen in females), due to age-related
decreases in both gastric acid production and calcitriol production.
 Ingestion of caffeine, for example, increases the secretion of calcium into the
gut.
 Excessive phosphorus in diet
 presence of oxalic acid in same meal .
 Oxalic acid is found in a variety of vegetables (e.g., spinach, rhubarb,
Swiss chard, beets, celery, eggplant, greens, okra, squash),
 fruits (e.g., currants, strawberries, blackberries, blueberries,
gooseberries),
 nuts (pecans, peanuts),
 and beverages (tea, Ovaltine, cocoa).
 Amount phytic acid and fiber in healthy balanced diet does not affect calcium
absorption.

Advanced Nutrition and Human Metabolism – 7th Ed.

 Factors decreasing calcium absorption
 Divalent cations from supplement , especially magnesium and zinc, can
inhibit calcium absorption.
 Unabsorbed dietary fatty acids e.g. steatorrhea that occur in liver disease
(cirrhosis) and pancreatic disorders, such as pancreatitis and cystic fibrosis.

 Magnesium and calcium compete with each other for intestinal absorption
whenever an excess of either is present in the gastrointestinal tract.
Similarly, zinc diminishes calcium absorption, especially when the diet is low
in calcium and contains an excess of zinc (usually when taken in the form of
a supplement).
Advanced Nutrition and Human Metabolism – 7th Ed.
 Calcium & iron
 Calcium from dietary sources as well as from supplements (especially in
doses of 800 mg or more) can decrease non-heme iron absorption & iron
supplements absorption.
Advanced Nutrition and Human Metabolism – 7th Ed.
Factors increasing calcium renal excretion in
urine
 Urinary calcium losses are increased by dietary protein, caffeine, and
sodium.
 Protein’s stimulation of urinary calcium excretion is well documented, but it
enhance intestinal calcium absorption.
 High Phosphorus in Diet
 Sodium consumption of 500 mg per day, for example, can increase urinary
calcium excretion by about 10 mg per day
 High fructose syrup intake
 High simple and added sugar intake

Advanced Nutrition and Human Metabolism – 7th Ed.

Factors decreasing calcium renal excretion
in urine
 ( high potassium intake is associated with decreased urinary
calcium),

Advanced Nutrition and Human Metabolism – 7th Ed.

 Types of calcium supplements
different calcium supplements are available, calcium carbonate, calcium citrate,
calcium acetate, calcium lactate, calcium gluconate, and calcium monophosphate.
The two most widely available supplements contain calcium citrate and calcium
carbonate.
Calcium carbonate contains about 40% elemental calcium by weight.
Calcium citrate contains about 21% elemental calcium by weight.
calcium lactate contains about 13% elemental calcium by weight
calcium gluconate contains about 9% elemental calcium by weight

Advanced Nutrition and Human Metabolism – 7th Ed.

 oyster shell calcium or dolomite may be contaminated with aluminum and lead and
should not be used.
 Bone meal preparations may also contain lead and should be avoided.
Advanced Nutrition and Human Metabolism – 6th Ed. Page 427
 Assessment of body calcium Nutriture

 total body weight, or between ∼1,000 and 1,400 g in the human body
 Bones and teeth contain about 99% of the body’s calcium.
 The other 1% is distributed in intra-cellular ,blood and other body fluids.
 No routine biochemical method is available to directly assess calcium
status.
 Serum Ca is only less than 1% of total body calcium so measuring serum
calcium ONLY give idea about that 1%
 Because the majority of calcium is found in bone, it is common to assess
bone mineral density, especially in those at risk for osteoporosis. Assessment
of bone is accomplished by several methods. Measurement by dual- energy
X-ray absorptiometry (abbreviated DEXA or DXA), a widely used method,
involves scanning specific sites at two different energy levels using an X-ray
tube. Radiation exposure is low, and the procedure is relatively quick.
Advanced Nutrition and Human Metabolism – 7th Ed.
 Dosing of calcium supplement
 Absorption of Ca supplements is
optimal when taken as individual
doses of 500 Mg elemental Ca or less.
 Ca carbonate

 Cheapest form

 Most common form of Ca supplements

 Gives 40 % elemental calcium of its amount.

 Should be taken with food because it needs acidic medium to be absorbed

 Better not to be used in patients with increases risk of renal stones

Advanced Nutrition and Human Metabolism – 7th Ed. 2018

 Ca citrate
 More expensive

 Gives 21 % elemental calcium of its amount.

 Indicated for any condition causing hypochlorhydria or Achlorhydria.

 Can be taken without or with food but food increases its absorption

 More suitable to patients with increases risk of renal stones

Advanced Nutrition and Human Metabolism – 7th Ed. 2018

 Recommended sun exposure
Sensible sun exposure 5–30 min, 2 times per week in between 10 a.m. and 3 p.m., is considered as
adequate
1. Vitamin D …A Clinical Casebook 2016

 Sensible sun exposure, especially between the hours of 10:00 am and 3:00 pm produces vitamin D in the
skin that may last twice as long in the blood compared with ingested vitamin D. [4] If sun exposure
produces slight pinkness, the amount of vitamin D produced in response to exposure of the full body is
equivalent to ingesting 10,000-25,000 IU.
https://emedicine.medscape.com/article/128762-treatment#d9

 Excessive exposure to sunlight degrades previtamin D3 and vitamin D3 into inactive

photoproducts
Diet, Nutrients, and Bone Health
 Vitamin d & Mg
 the hydroxylation of vitamin D in the 25-position requires magnesium.
 Mg deficiency leads to low PTH concentrations which usually low because PTH
secretion is diminished; low PTH levels typically result in hypocalcemia (low blood
calcium)

 Advanced Nutrition and Human Metabolism – 6th Ed.

The small Triangle of bone

Vitamin D

Calcium Magnesium

64
 Measuring body vitamin d level
 Serum 25-OH D concentrations are most often used to assess vitamin D status

 Normal level between 30 and 50 ng/mL

 Insufficiency 20–29 ng/mL
 Deficiency less than 20 ng/mL
 Severe deficiency less than 10 ng/mL

 Advanced Nutrition and Human Metabolism – 7th Ed. 2018

 Serum level below which no Ca is absorbed

1. serum 25(OH)D concentrations below 4.4 ng/mL have been associated with
decreased calcium absorptive efficiency
www.uptodate.com ©2018 UpToDate, Inc.
https://doi.org/10.1210/jc.2013-1195
 Maintenance dose of vit d

 Once repletion has occurred, maintenance intakes of about 800–2,000 IU daily are thought to be
needed for adults to maintain serum 25-OH D concentrations in excess of 30 ng/mL
Advanced Nutrition and Human Metabolism – 7th Ed. 2018