Supplements in practice - Calcium Flashcards
Calcium
Our naturopathic approach should be to focus on addressing individual calcium intake, absorption and utilisation before considering supplementation:
* Most people should achieve adequate levels from their diet; take with magnesium and vitamin D3 / K2 if supplementing (absorption).
* Calcium supplementation may be ineffective at preserving bone density when dietary intake is sufficient; it can cause kidney stones and soft tissue calcification, especially if low vitamin D / K.
* Calcium carbonate is commonly recommended but calcium citrate is easier to absorb. Maximum absorption of calcium is usually 500 mg at one time.
Organic forms of calcium supplements:
Organic and inorganic calcium supplements have varying degrees of bioavailability.
Organic forms of calcium supplements:
Calcium aspartate: * This new type of calcium is being marketed as having a higher absorption rate than other calcium supplements. Lacks scientific studies to support this claim, or any of the other claims made for this form of calcium.
Calcium glycinate: * It is presently regarded as the most bio-available and most soluble form of supplemental calcium.
Calcium citrate: * Easily assimilated by the body; most nutritional companies tend to use this form.
Calcium gluconate: * Low elemental level of calcium in this salt; 1 g contains only 93 mg of calcium.
Inorganic calcium forms:
Calcium carbonate* (Calcium bound with carbonic acid).: * Most cost-effective form.
* It is usually derived from coral or limestone.
* Used by pharmaceutical industry.
* Can cause adverse effects (nausea, gas, constipation), lacks bioavailability
* Requires more HCl for absorption than other forms.
Calcium ascorbate*: * Used as buffered source of vitamin C (contains Mg, K - gentle on GIT), lacks bioavailability
Calcium pantothenate*: * Is a supplemental form of pantothenic acid (vit. B5).
Calcium oxalate*: * Calcium bound to oxalic acid (oxalate).
* Never use as supplement ― may lead to formation of calcium oxalate kidney stones.
Calcium citrate malate: (new form): * Patented type of calcium used in supplements.
* Exceptional absorption; can be consumed with or without food (other forms should be taken with food). Good absorption.
*
- Not a good source
Calcium Nutrient Interactions: Magnesium:
Magnesium: * Competes for the same absorption pathway as calcium; unclear if this interaction is clinically significant.
* Separate by two hours to achieve highest serum levels.
Calcium Nutrient Interactions: Zinc and iron:
Zinc and iron: * May reduce absorption.
* Iron effects may be short term, adaption of absorption may occur; long term Ca supplementation fails to show adverse effect on status.
Calcium Nutrient Interactions: Lysine:
- Enhances intestinal absorption and reduces excretion (useful to take at same time)
Calcium Nutrient Interactions: Excess intake of phosphorus (soft drinks), caffeine and dietary fat:
- Will increase calcium excretion if supplements taken
Calcium Nutrient Interactions: Excess fibre:
- May slow absorption: Leave two hours after taking before taking fibre supplement.
Calcium Nutrient Interactions: Salt overload:
- Ca binds with excess sodium; excreted when the body’s Na levels must be lowered. Ingesting too much sodium through table salt or processed foods could result in losing calcium as the body rids itself of the surplus sodium.
Calcium Drug Interactions: Corticosteroids:
Long-term use can lead to reduced absorption, increased secretion and inhibition of osteoblasts.
Calcium Drug Interactions: Levothyroxine:
Competes for absorption; separate doses by > four hours.
Calcium Drug Interactions: Oestrogen and progesterone therapy:
Increases absorption; may be a beneficial interaction.
Calcium Drug Interactions: Quinolone:
Antibiotics bioavailability hindered by calcium supplements. Take two hours before, or four to six hours after calcium supplementation.
Calcium Drug Interactions: Tetracyclines:
Separate from supplements by at least two hrs.
