Food first calcium.
Over half of Indians are not receiving sufficient calcium intake from food raising concerns about bone health and osteoporosis later in life. But rather than using calcium supplements, experts are now suggesting people make changes to their diet first.
The Endocrine Society of India (ESI) has issued its first consensus guidance in the Indian Journal of Endocrinology and Metabolism (IJEM) on the major dietary sources of calcium through food. The experts say supplements are only needed if the diet does not provide the recommended level and when calcium requirements are increased.
The expert panel pointed out that many people in India are not getting adequate calcium levels due to the recent trend of consuming cereal, low dietary diversity, limited consumption of dairy products and widespread vitamin D deficiency.
The guidance says that doctors should first try to determine the amount of calcium someone is getting from their diet before suggesting calcium supplements. Some of the foods high in calcium include milk, curd, cheese, ragi, sesame seeds, pulses and green leafy vegetables.
Further, the authors wrote that to maintain healthy bones and muscles it is important to get enough calcium from food. Despite making dietary changes if people do not get enough calcium from foods then they can choose an alternative option, i.e. supplements.
The consensus statement indicates that for most adults the average calcium intake should be 1,000 mg daily. But there are times when calcium requirements are higher. Teenagers between 16 and 18 usually need about 1050 mg a day and women in their first year of breastfeeding need 1200 mg per day.
The experts also suggest that supplementing will be beneficial in certain cases where the body's calcium demand is naturally elevated such as pregnancy, lactation and after menopause if the body cannot get enough calcium through diet alone or if the body's calcium requirement is greater.
Although eating a healthy diet with sufficient calcium is important for most people the panel also notes that supplements may be necessary for those who are unable to get enough calcium from their food. These include people diagnosed with osteoporosis, osteomalacia, rickets, hypoparathyroidism, lactose intolerance or any other condition that interferes with calcium absorption.
If supplementation becomes necessary the guidance recommends calcium carbonate and calcium citrate. The calcium carbonate is cheaper and is most effective when taken after a meal while calcium citrate is more suitable for people who are taking acid reducing drugs or who suffer from kidney stone disease. Other calcium salt products are not recommended by experts due to a lack of supporting evidence and higher costs.
Additionally the guidance points out that calcium won't be effective unless it is accompanied by an adequate amount of vitamin D which is essential for calcium absorption. Experts recommend maintaining a vitamin D supplementation of 1,000 to 2,000 IU daily or 60,000 IU monthly. Unless there is a medical condition that prevents absorption, it is not recommended to take vitamin D by injection.
The panel advises being careful about excessive calcium intake especially in the form of supplements without medical guidance. Food calcium doesn't seem to cause any cardiovascular damage but calcium intake of more than 2,000 mg per day could raise the likelihood of blood vessel calcium deposits in individuals with heart disease.
It also recommends that individuals with kidney stones or chronic kidney disease focus on dietary calcium intake first and only supplement as prescribed by a healthcare provider. Additionally calcium supplementation may interact with some medicines including some antibiotics and iron as well as thyroid hormone medicines. Healthcare professionals recommend following a right time interval between certain drugs and calcium supplements to prevent drug interactions.
Consensus agrees that for most people a diet with plenty of naturally rich calcium sources combined with sufficient amounts of vitamin D will provide the most effective and least dangerous approach to long term bone health, reserving calcium supplements only for those with genuine medical needs.
Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional before making changes to your diet or supplement routine
